Topic 5: Support with Follow-up

“If you don’t know where you are going, you might end up

someplace else.” - Yogi Berra

1

Nevada WIC C.A.R.E.S.

Contents:

Key messages for Champions …………………………………………. 2

Activities for staff …………………………………………………………… 6

Ideas for facilitated conversations with staff ………………….. 11

Sample script …………………………………………………………………. 12

Observation guide ………………………………………………………….. 16

Self observation guide …………………………………………………….. 17

Handouts ………………………………………………………………………… 18

References/Resources ……………………………………………………… 21

2

Nevada WIC C.A.R.E.S.

Key Messages for Champions

In a WIC counseling session, the latter parts of the conversation are just as valuable as the early parts.

After establishing rapport, assessing needs and interests, and using C.A.R.E.S. skills to bring out the

participant’s reasons for making a change, it is time to move to goal setting, summarizing and closing

the conversation. This section will explore how to support the participant through the process of goal

setting and how to summarize and close the conversation in a way that will encourage participants to

work towards their goals after leaving the WIC office. Below are key messages to help staff

understand the benefits of using these skills to help participants achieve positive health changes.

Why set goals?

People who set goals for themselves are more likely to achieve behavior change than those who do

not set goals. Goals provide a target to aim for and help establish priorities. They provide a roadmap

to take someone from where they are to where they want to be. People who achieve goals feel pride

which motivates them to achieve even more. Participants are more likely to take action when it is

their idea and when they come up with the goals and action steps themselves.

Creating clear, specific goals

Clear, specific goals help motivate participants. The clearer the participant’s goals, the more likely

they are to achieve them. WIC counselors often must help participants take broad, unspecific hopes

and mold them into more concrete and realistic goals. For example, goals such as “I want to eat

better” or “I want Angel to be healthier” are not specific enough to help drive particular behaviors.

Examples of more concrete goals are “I’ll pack fruit instead of chips with my lunch” or “Angel and I

will go for a walk after lunch three days a week.” It is also important to design achievable goals.

Achieving small goals will help build confidence and keep the participant motivated.

Questions to support goal-setting

Participants will be more committed to achieving the goals they create. Using open-ended questions

helps the participant to explore how the behavior change might look and feel like to them. Questions

help turn broad, unspecific goals into concrete, realistic steps participants can take. Examples:

“If you were going to (make the change), how would you do it?”

“What might support you to do this?”

“How will you know when you are ‘eating better’?”

“So, what do you see yourself doing next?”

“What is your next step?”

It is also helpful to ask participants to rate their confidence in achieving their goals.

For example: “On a scale of 1 to 10, what do you think your chances are of being able to do

this, with 1 being, “I can’t do it”, and 10 being “I can definitely do this?”

3

Nevada WIC C.A.R.E.S.

If a participant has a low confidence number, they may need more discussion around small

achievable steps. Using questions will help participants choose goals that they are confident they

can actually achieve.

Goal setting tips

Be concrete – goals should be specific and measurable.

Work on small achievable targets.

Set reasonable time frames.

Discuss how to monitor progress.

Ask participants what it will feel like when they achieve their goals. This will help build

importance for making the change.

Offering ideas and suggestions

Although the best ideas come directly from the participant, they often may need advice and

suggestions from you. Because the C.A.R.E.S. conversation is a partnership, sharing ideas and

resources based on the participants needs and interests may help them take action. After offering a

menu of possible options, follow-up with questions to help participants identify the alternative that

fits best for them. Suggestions include:

“What do you think about those ideas?”

“Would any of those ideas work for you?”

“How do you see yourself using this information?”

“What would work best for you?”

Brainstorming possible challenges

Making positive behavior changes often involves overcoming challenges and set-backs. Helping

participants brainstorm possible difficulties they might encounter will help them think through

solutions and prepare them for being successful in overcoming challenges. Examples:

“What could get in your way?”

“What will you tell yourself the next time this situation comes up?”

When participants are not ready to set a goal

Not every participant will be ready or committed to making a change at that moment. Forcing a

change when the participant is not ready may build resistance to change. Often just thinking about

change is a positive goal to set. Additionally, having the participant “just try” a new behavior may be

less intimidating than committing to a complete change. A constructive goal may also be to continue

a positive behavior they are currently doing. Even established behaviors need to be supported and

continually reinforced.

4

Nevada WIC C.A.R.E.S.

Summarizing – what it does

Summaries are particularly useful at the end of a WIC appointment, but can be used throughout the

appointment to periodically collect highlights and focus the conversation. Summaries allow you to tie

important concepts together and help the participant to hear their own motivations for change.

Some of the benefits of summarizing include:

Shows you are listening

Ties together what has been said

Helps ensure you ‘got’ all the concerns and have not missed something important

Allows you to reemphasize important points or change talk (reasons to change) you heard

from the participant

Helps the participant open up and share more

Provides transition to further discussion (useful when transitioning from assessment to

counseling) and can be used to help get the client back on track

Summarizing – key elements

Let the participant know this is a summary

o “Let me summarize what I’ve heard so far…”

o “OK, let’s see if I have everything…”

Lay out highlights of the conversation (or part of the conversation)

o Participant’s reasons or need for change

o Any ambivalence (feeling two ways about making the change)

“One the one hand….and on the other hand…”

o Ideas/goals/strategies discussed

Check for understanding

o “Did I get it all?”

o “Did I miss anything?”

USDA Health Outcome Statements

The USDA requires that WIC participants are informed about the reasons they are eligible for the WIC

program and the period of their eligibility. To do this, the counselor connects the eligibility to an

improved health outcome. Below are some examples of health outcome statements:

Examples:

“I will be enrolling you on WIC today until the end of your pregnancy so we can support your

commitment to having a healthy baby and a healthy weight gain.”

“We are certifying you for up to a year today to help you successfully breastfeed your baby.”

“We will continue WIC services for Samuel for the next year so we can help with his nutrition

and watch his growth and weight gain.

5

Nevada WIC C.A.R.E.S.

Closing the conversation

The end of the WIC appointment is the time to pull everything together, highlighting key issues

discussed, change talk and next steps. Although each conversation is unique, including certain

elements at the end of the conversation will help participants clarify their goals and reinforce their

motivation to change. Some things to achieve in the conversation closing include:

Summarize the conversation, goals and ‘next steps’ discussed

Assign the appropriate WIC food package

Summarize the reasons the participant is on the program (health outcome statement)

Set the next appointment

Confirm that there are no more questions or concerns

Express confidence in the participant and tell them you will follow-up on progress at the next

appointment

Thank them for coming

Example: Today we talked about making healthy choices at fast food restaurants. It is important

for you to ensure your kids eat healthy even when you have to eat out. Your said the next time

you eat out with the kids, you will try ordering the apple slices and having the kids share a small

order of fries instead of having a whole order each. You also want to order milk for them instead

of soda. Did I get that right? That sounds like a great plan. I will be certifying Camilla for six

months today so we can continue to help you with your healthy eating goals for her. We will be

loading your foods on your card for her today. Do you need any adjustments from the food

package you received last time? Your next appointment will be in three months for a nutrition

class. Here are our class options during the week. Which one will work best for you? What other

questions or concerns do you have today? I know you will be able to make some healthier

choices when you are ordering fast food and we’ll check back during the next certification and see

how it is going. Thanks for coming today!

Following up at the next appointment

Checking back in with the participant on previously set goals helps them know you care and builds

importance for the behavior change. This also gives you the chance to affirm their efforts towards the

goal, discuss any challenges, and help them to keep moving forward. Participants may also be excited

to see you at their next visit to tell you how they did!

6

Nevada WIC C.A.R.E.S.

Activity 1: Creating Summary Statements

Introduction:

Explain to staff that this exercise is about practicing using summary statements with participants.

Explain that summary statements can be used throughout the appointment and at the end of the appointment as well.

Ask: Why is it important to use summary statements with participants?

Possible answers: o Shows you are listening o Helps ensure you ‘got’ all their concerns and have not missed something

important o Allows you to reemphasize important points or change talk (reasons to change)

you heard from the participant o Helps the participant open up and share more o Ties together what has been said o Provides transition to further discussion (useful when transitioning from

assessment to counseling) and can also be used to help get the client back on track.

Review the elements to include in a summary from the Key Messages section.

Activity: Creating summary statements

Ask staff to work in groups of 2 or 3.

Hand out the following sheet that contains three statements from WIC participants.

Tell staff to take turns reading the statements to the others in the group.

For each statement, ask staff to create a summary statement that can be used with the participant.

After the groups have had a chance to finish all three summary statements, read each scenario and have staff share some of their ideas for components that should be included in the scenario.

7

Nevada WIC C.A.R.E.S. Creating Summary Statements For each participant statement below, write down a possible summary statement you could use to tie the pieces together. Your summary may vary depending on where you are in the appointment. Some of the components of the summary could include:

A statement indicating that you will be pulling together what has been said

A summary of client’s concerns including reasons or need to change

A summary of any ambivalence you heard from the participant (they feel 2 ways)

A summary of any ideas or possible strategies identified by the participant

A question to confirm you included important concepts (e.g., “Did I get it all?”)

A question about next steps (e.g., “What do you see yourself doing next?”)

1. “I have decided to eat healthier. I think I would feel better if I did that. My follow-though isn’t always as good as my intentions and I do have a sweet tooth. But I’ve tried to be smarter with my eating lately. I would like to eat more salads. I really do like salad for lunch. Breakfast and lunch, and even dinner, for that matter are generally ok. I have one problem area currently – snacking at night. I like ice cream, and that is a problem. I’m not crazy about fruit as a substitute, even though I know it would be better for me. I can manage those other areas, but this night-time stuff needs work.”

Summary Statement:

2. “I worry about my daughter. Maria is three years old now and just doesn’t want to eat many foods. I think she is too thin. She used to be nice and plump and now I can see her ribs. She will often refuse to eat but at least she drinks lots of milk, juice, and water. She doesn’t use the bottle anymore. She may go all day without eating solid foods. I don’t want to fight with her to eat but I want to make sure she is healthy.”

Summary Statement:

3. “Everyone says breastfeeding is healthy for the baby. My doctor said it was good to breastfeed and I believe you about all the benefits. I just know that lots of my friends had problems and eventually had to switch to formula. I want to do what’s best for the baby. I am really trying to be healthy and eating well. I want to try to breastfeed and I hope I can do it. I told my doctor I would try but I am still worried about possible problems.”

Summary Statement:

Activity adapted from David Rosengren

8

Nevada WIC C.A.R.E.S.

Activity 2: Creating concrete goals

Introduction:

Explain to staff that this exercise is about helping participant transform broad hopes for change and transform them into more concrete action plans.

Ask: What are some of the reasons why it is important to set clear and specific goals?

Share: Often questions can be used to help the participant further define their goals and to help define clear action steps that they could take to achieve those goals.

Ask: What are some questions you could ask to help participants in their goal setting?

Share some questions as necessary such as:

o “If you were going to (make the change), how would you do it?”

o “What might support you to do this?”

o “How will you know when you are ‘eating better’?”

o “So, what do you see yourself doing next?”

o “What is your next step?”

Activity: Defining goals and action steps: what questions could I ask?

Ask staff to get into groups of 3 or 4.

Hand out the following sheet that contains broad goals from participants.

For each goal, have the groups brainstorm 2 or 3 questions that they could ask to help the participant start to develop clear and concrete goals/action steps.

After the groups have had a chance to write their questions for each goal, read each goal and have staff share some of their questions.

Suggestion: Do one together as an example. Read the following participant statement and ask the staff to brainstorm possible questions.

o Statement: “I want to exercise more.”

Some possible questions could include:

What types of exercise do you enjoy?

What could you do?

How often could you exercise?

What does “exercise more” mean to you?

Who could support you in this?

How will you go about it?

What will be your next step?

9

Nevada WIC C.A.R.E.S.

Defining goals and action steps: what questions could I ask?

Participants will be more committed to achieving goals they themselves create. Often participants

need help taking broad hopes and turning them into behavioral goals or specific action steps they can

take. Using open-ended questions can help transition broad, unspecific goals into concrete, realistic

steps. Below are several broad goal statements that a participant might make. For each one, create 2

or 3 questions that you could ask the participant to help them create a more specific goal.

1. “I want to do everything I can to have a healthy baby.”

Possible Questions:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

2. “I want to eat better.”

Possible Questions:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

3. “I want Angel to be healthy.”

Possible Questions:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

3. “I need to lose weight.”

Possible Questions:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

10

Nevada WIC C.A.R.E.S.

Activity 3: Summarizing

Explain to staff that this exercise is about practicing summaries.

Ask the staff to work in pairs.

Explain that one person will be the listener and one person will be the talker and then they

will switch.

The first person will talk for 90 seconds about a habit, behavior or situation that they are

thinking about changing. It could be something that they want to or need to change, and

haven’t done it yet.

Explain that the talker could include things such as:

o Reasons for wanting to make the change

o The reasons why the change may be difficult or why they have not done it yet

o What they think they could do to make the change

o How they will feel when they make the change

The listener’s job is to be an interested listener without saying anything and then to give a

summary of what they have been told.

Explain that the summary could include:

o A statement letting the talker know this is a summary

“Let me summarize what I’ve heard so far…”

“OK, let’s see if I have everything…”

o Highlights of the conversation

Summarize the talker’s motivations, reasons or need for change

Capture any ambivalence (feeling two ways about making the change)

Summarize the talker’s Ideas/goals/strategies they think they could try

o A statement that checks for understanding

“Did I get it all?”

“Did I miss anything?”

Tell the pairs it is important to start at the same time, and to wait until you say ‘go’ to start

talking.

Have the first talkers take their turn and then have the listeners summarize.

Ask the groups to switch roles and then repeat the exercise.

After the exercise ask staff to share their experience.

o What were some things that made it difficult to summarize?

o How could they use these techniques with participants?

11

Nevada WIC C.A.R.E.S.

Ideas for a facilitated conversation with staff: Goal Setting

Let staff know this discussion will be about setting goals.

Read the following quote and ask staff what they think the author meant by the statement.

o “A goal without a plan is just a wish.”

Ask: What are some reasons to set goals for ourselves?

o Possible answers: They help us achieve more than we would have; they motivate us; they help us focus our energy; you feel proud after achieving the goals; people who set goals are more likely to achieve them.

Ask staff to think about a time when they set a goal for themselves and they achieved it.

o Ask: How did achieving that goal, make you feel?

Ask: What characteristics should a goal have to make it more likely to be successful?

o Possible answers: Specific, measurable, attainable, realistic, include small steps or sub-goals, include a time frame.

Ask: How can we help our participants take their broad wishes or dreams such as “I want to exercise more” and make them into more concrete goals?

o Possible answers: ask them questions to make it more specific, offer them suggestions and resources, ask them to write down their goals.

o Probe further if necessary. For example, if staff suggest asking questions, ask which questions they could ask to make the above desire into a more concrete goal.

Ask: What are some things that make it difficult to practice goal setting with participants?

o Possible answers: they may not be ready to change anything in their lives; they say that everything is fine; they are in WIC for the food benefit but not for the nutrition information.

Take one or two of the challenges and discuss them.

o Example: if a participant is not ready to set a goal for behavior change, what are some of the things we could do to help them?

Possible answers: Explore what positive behaviors they are already doing and suggest the goal of continuing the behavior; don’t force behavior change – let participants know it is up to them to decide when and if they change; suggest participants just ‘test out’ or ‘try’ a behavior one time to see how it feels.

Ask: Why is it important to discuss possible obstacles to change that participants may face?

Ask: Why is it important to follow up with participants about their goals at the next visit?

o Ask staff how they can remember to follow-up with participants about their goals at the next appointment.

Summarize the conversation.

12

Nevada WIC C.A.R.E.S.

Sample Script The following sample of a WIC appointment is adapted from the Oregon WIC Listens resources.

Ask staff to play the parts of the CPA or certifier, and the mom. Give the volunteers the script

ahead of time to read through to prepare.

Explain to staff that you will be role-playing the middle and end of a WIC appointment to

demonstrate goal setting, summarizing, and closing the conversation.

Ask staff to jot down any examples of techniques they hear the CPA using that help the

participant set goals for breastfeeding her baby.

Read the scenario and have the volunteers complete the role play.

After the role play, have staff share their feedback about the interaction:

What was the participant’s primary concern or goal?

How did the CPA help her with setting her goal?

What did the CPA do to wrap up the appointment?

What types of things did she include in her summary?

Breastfeeding Certification – Sample Script

Scenario: Participant is a postpartum mom who was on WIC during her pregnancy and is exclusively breastfeeding. Check-in and weighing and measuring have been completed and the CPA has completed several of the assessment questions when the topic of breastfeeding comes up.

CPA: Wow, I’m glad she is doing so well and that you’re breastfeeding. That is so nice! And how’s it going? Mom: It’s going, but I don’t know if I can keep it up. CPA: What makes you say that? Mom: I just feel like quitting and giving her formula, even though I know breastmilk’s best for her. CPA: I appreciate your honesty. Sounds like you’re not sure what to do and yet you recognize that breastfeeding is best for her. What’s making you think you might want to quit? Mom: Well, I think I can keep it up now, but I’m just concerned about how it’ll work once I go back to my job. CPA: So you are wondering about this transition. It’s great that you’re already thinking about what might come up. What are your thoughts about balancing breastfeeding and going back to work? Mom: Well, I do have some concerns about breastfeeding when go back to work. Like when I should start pumping to build a supply and how long my pumped milk will be good for. Things like that. CPA: Yeah, these are all details to think about. If you’d like we can spend some time working through these details together today. Would it be okay if we finished up with the rest of the questions I need to ask you and then we could spend some time talking about this? Mom: That’s fine.

13

Nevada WIC C.A.R.E.S. CPA: Sounds good. These are some of the mandatory questions I have to ask everyone, so just bear with me while we go through these. During your pregnancy, you told us you weren’t smoking or using drugs. Mom: Nothing, I don’t smoke or drink. CPA: That’s wonderful. And does anyone living in your household smoke inside your home? Mom: No, we’re really strict about that. CPA: You’re making good choices for you and your children. And how has your appetite been? Mom: I’m always hungry! CPA: What kinds of things are you craving in particular? Mom: I just eat whatever’s handy. CPA: Are there any foods that you are avoiding right now? Mom: Nope, if it’s around I’ll eat it (laughs) CPA: Ok and what beverages are you drinking? Mom: I drink lots of water and some milk and juice. But mostly water. CPA: Sounds like you’re doing a good job keeping yourself hydrated. Now I have a question that I need to ask you that we ask everyone - just to check-in with you about your safety. Has anyone pushed, hit, kicked or physically hurt you or your baby in the past 6 months since she was born? Mom: No, everything is fine. CPA: Seems like other than having some concerns about pumping when you go back to work that you’re doing really well. Mom: Yeah. CPA: And how are you feeling about how she’s eating and growing? Mom: I feel like she wants to nurse all the time and she seems a little bit smaller than some of my friends’ babies. CPA: You’re a little worried about her size… Well would you like to look at the growth grids that we have for her to see how she compares with other babies her age? Mom: Yeah, I definitely want to see how she’s doing. CPA: So today, her grid is showing that in a group of 100 girls her age, 75 would be longer than she is. And again in that same group of girls, about 50 would weigh more. When we compare her weight to her length, you can see she is coming out right about in the middle. How does that compare with what you heard at the doctor? Mom: Sounds pretty much like what he told me. I guess she’s growing well but she cries a lot and sometimes I wonder if I should give her a little formula. CPA: You’re wondering if she’s getting enough to eat. Mom: Yeah, but I guess I feel better now knowing she’s growing alright. But I feel bad when she cries and I worry that my breast milk isn’t enough for her now, let alone when I go back to work. CPA: How many times is she feeding each day? Mom: My gosh - at least every two hours and sometimes it feels like every hour! CPA: How does she let you know that she’s ready to eat or that she’s all done? Mom: She makes these smacking sounds and sucks on her fist when she is getting hungry. Sometimes she cries like crazy like she’s starving. CPA: Sounds like most of the time you can tell she’s hungry before she starts to cry. What do think might be happening when she does cry like that? Mom: Well, maybe I am just waiting too long between feedings.

14

Nevada WIC C.A.R.E.S. CPA: I have definitely heard from other mom’s that feeding more regularly can help with that. And you’ve already told me how much you enjoy that special time together. Mom: Yeah I am really going to miss our time together once I go back to work. CPA: So you’re really close to your baby and you’re going to miss that time together. Tell me a little bit about the job you’re going back to and when that might happen? Mom: I work in one of the stores at the mall. My hours and days really vary. My boss has been really supportive while I was pregnant and she’s looking forward to me coming back in another month or so. CPA: So is your boss supportive of you pumping back at work? Mom: I’m pretty sure she is. CPA: Great and what spots are available for you to pump while still having some privacy? Mom: I should be able to use the back room and there’s a little refrigerator to store the milk after I pump it, so I should be okay. CPA: It sounds like you’ve already been thinking about this and your workplace should be supportive. What other concerns do you have about making pumping work for you? Mom: I’m just not sure if I should start pumping now so that I have enough stored? And I’m afraid she won’t take the bottle. CPA: Well, if you’re interested, I have a handout that talks about pumping and storing breast milk. Would you like to take a minute to go over this together? Mom: Sure CPA: So as you’ll see, there are some tips here about how to pump, and on the other side is information about storage. Since our time is limited today, why don’t you take this info with you and read through it. There’s a class next month about pumping that will go into this in greater detail. Would you like me to sign you up for that? Mom: Yes, that would be helpful. Thanks! CPA: The other thing you mentioned was a concern about her not wanting to take the bottle. I’m wondering how you handled that with your older child? Mom: I got to stay home for almost a year the first time, so at that point she was already onto using a cup, so it wasn’t an issue. CPA: I see. If you’d like I could share a few tips that I’ve heard from some other moms? Mom: Sure CPA: Some moms find that it is easier for someone else in the family to introduce the bottle to baby at first, since the baby associates you with breastfeeding. Some others have told me that they introduce the bottle after they’ve breastfed since the baby isn’t so hungry. How does that sound to you? Mom: Those are great ideas for introducing the bottle, but now that I’m thinking about it, maybe my sister-in-law could bring her by work, so I could breastfeed there. CPA: What a great idea! Do you think that’s something she would agree to? Mom: Oh, yeah. She loves coming to the mall. CPA: So, if you could, how long would you like to keep breastfeeding her? Mom: Well, I went over a year the first time and I’d like to do that again, even with going back to work. CPA: Sounds like you have a pretty good plan here. What are some of the next steps you can take to make sure it all comes together for you before you go back to work? Mom: Well, I definitely need to talk to my sister in law and I need to get a pump from you guys.

15

Nevada WIC C.A.R.E.S. CPA: In the pumping options class next month, they’ll help you select the right pump for your needs and they go over any questions you might have including the storage options. Let me just take a moment to put that into the computer so that the next time we see you we can check in to see how that’s going. CPA: So to wrap up, we’ve talked today about how you’re both doing and although you were initially concerned with her being smaller than some of your friends babies, looking at the growth grids you’re now feeling better about how she’s growing. The main thing we talked about was how you can continue breastfeeding once you go back to work. Sounds like you’d really like to breastfeed her for a year like you did with your first one and you have a plan for making that happen: Some days your sister in law will bring you the baby to breastfeed and other days you’re going to be able to pump in the back room and store your milk in the mini fridge at work. Did I get it all? Mom: Yeah, that’s good. CPA: To help you and your baby meet your breastfeeding goal, I am certifying you both on WIC until the baby turns a year old. You’ll be able to stay on a year as long as you continue to breastfeed. And I can tell from the plan that you have made that that’s going to happen! Before we finish is there anything else I can help you with? Mom: No, I think we covered everything. CPA: Well thanks very much for coming in today. You’re such a wonderful mom for breastfeeding her and I’m sure you’ll be able to keep it going. If you do have any questions or concerns, please give us a call because we’d be happy to help. And maybe I’ll see you when you come back for the pumping options class. Mom: Great. CPA: So we will load your benefits on your card. I saw in the computer that you were already changed to the ‘fully breastfeeding’ package so you’ll be getting some extra foods as well. What questions do you have about using the WIC card at the store? Mom: I’ve pretty much got shopping down at this point! CPA: Super, have a great rest of your day. And we’ll see you next month.

Stop here and ask the discussion questions above.

16

Nevada WIC C.A.R.E.S.

Observation Guide: Summarizing, Goal Setting, and Closing the

conversation

Option 1: Observe staff. Note areas where staff did well support the participant in goal setting and

summarizing and areas for improvement.

Option 2: Have staff observe each other and use this form to note areas where they do well. Have

them share specific feedback with each other about strengths they saw. Encourage sharing

strategies.

Qualities Comments and examples

Summarizing during the appointment

Asking the participant for their input,

ideas and solutions

Helping the participant create concrete

and achievable goals and action steps

Closing summary

Following up on previously set goals

17

Nevada WIC C.A.R.E.S.

Self Observation Guide: Goal Setting Each time you use techniques to help the participant with goal setting, note the skills you

used. Collecting successful strategies will help you use them in the future with other

participants.

Save this sheet to remind you of successful strategies and share them with your co-workers.

Successful strategies –

give yourself a star!

Write down successful strategies to help the participant to set realistic

and achievable goals.

Mom said she wanted to have her son eat healthier snacks and less junk

food. I asked her what she thought she could do to make this happen.

She said that one thing she could do was to put a bowl of fruit on the

table so he would see it. I affirmed her idea and offered her a couple of

other ideas as well. She said that she would also bring along a couple of

healthy snacks when they had to be in the car so she would not be

tempted to buy junk food when he got hungry while they were out.

18

Nevada WIC C.A.R.E.S.

OARS: Summarizing

Goals

1. To reinforce what has been said. 2. To show that you have been listening. 3. To provide a mirror for the clients to see themselves (show them the “big picture”). 4. To allow the client to hear his or her “change talk.” 5. To tie together what has been said, to provide a transition link, to get the client back

on track, and/or to bring closure to a conversation.

Key Elements

1. Summarize in a brief, concise manner. 2. Preface a summary statement with an introduction (e.g., “let me see if I understand

what you’ve told me so far”). 3. If a client has expressed ambivalence, capture both sides of the ambivalence in the

summary statement (“On the one hand ...and on the other hand...) Note: use ‘and’ rather than ‘but.’ Note: Summarize cons first, and then end with pros. 4. End a summary statement with an invitation for the client to respond, such as: “How

did I do?” “What did I miss?” “Did I get it all?”

Avoid

1. A rambling summary.

Larson Sturtevant Consulting, LLC

19

Nevada WIC C.A.R.E.S.

Module 9 Next Steps

Step 1: Ask the participant about their next step

So, what do you see yourself doing next?

Where does this leave you?

What are your thoughts about what you’ll do tomorrow/next week about...?

Step 2: Take your next S.T.E.P.

S = Summarize the important points you’ve discussed.

T = Thank the participant for showing up, for being willing to talk to you, for giving you some good ideas, or other affirmation.

E = Express confidence in them, “I know you’ll succeed...”.

P = Praise any other way you can affirm them.

Tip: You can incorporate a positive health outcome as part of your program eligibility statement into your summary.

Handout:

Establishing Next Steps - Two Baby

Steps to a Healthy Future

Oregon WIC Listens

20

Nevada WIC C.A.R.E.S.

Oregon WIC Listens – Continuing Education: “Did I get it All?” – Summarizing

Staff Handout

Content:

Summaries link together and reinforce information that has been discussed. This shows you’ve been listening carefully, and prepares the participant to tell you more. It also allows the participant to hear their own change talk (reasons to change).

Why summarize?

Reinforces what the participant has said Shows you’ve been listening Allows participant to hear their thoughts about change Insures counselor “got it all” or understands the participant’s concerns Provides transition to further discussion

Key elements:

Start with an introduction - “Let me see if I understand…” Capture both sides, starting with “cons” and end with “pros” Check for understanding – “Did I get it all?” If the participant has expressed ambivalence, capture both sides – “On the one

hand… and on the other hand…”

Note: use of ‘and’ versus ‘but’

21

Nevada WIC C.A.R.E.S.

References / Resources

Books

Kellogg, M. (2006). Counseling Tips for Nutrition Therapists, Volume I & II. Philadelphia, Kg

Press.

Rollnick, S., Miller, W., Butler, C. (2008). Motivational Interviewing in Health Care. New York,

the Guilford Press.

Rosengren, D. (2009). Building Motivational Interviewing Skills: A practitioner workbook. New

York, the Guilford Press.

Presentations / Training Manuals

Nevada WIC C.A.R.E.S. Presented by Dana Sturtevant, M.S. R.D. Larson Sturtevant Consulting

LLC.

Motivational Interviewing: Resources for Trainers. Motivational Interviewing Network of

Trainers. Updated: November 11, 2008. Available from www.motivationalinterview.org.

Websites

Oregon WIC Listens

www.oregon.gov/DHS/ph/wic/docs/orwl/

Touching Hearts, Touching Minds Website, Pam McCarthy and Associates

www.touchingheartstouchingminds.com

California WIC Program

http://www.cdph.ca.gov/programs/wicworks/Pages/WIC-LocalAgencyResources.aspx

WIC Works Resource System

http://wicworks.nal.usda.gov