Healthy Start Standards and
Guidelines Chapter 7
HEALTHY START SERVICE:
NUTRITION COUNSELING
Healthy Start Services:
Core Standards For All Services
Offer to participants that need them
Based on local resources
Culture, language, education, and
access needs
Encourage and involve household
members
Begin services 30 days or sooner
The Service Provider…….
Reports back to the care coordinator 30
days after receipt of referral
Assess, plan, intervene, and follow-up
Responds to any identified additional
needs
Documents in participant record
Develops QI/QA plan with coalition
Meets qualifications for each service
Nutrition Counseling
For Healthy Start participants
-Assist in the ability to make informed
health decisions affecting nutrition status
Designed to meet unique needs
-Educational level
-Environmental limitations
-Cultural patterns
-Capabilities and lifestyle
Definition of Service
In addition to the nutrition
counseling that is provided to WIC
Program participants
Intensive therapeutic nutrition
assessment and counseling
Provided to participants at high risk
for adverse health outcomes
Provided through the use of
individual counseling sessions
Standard 7.1
Healthy Start nutrition
counseling services will be
offered to all participants who
are determined through the care
coordination process to be in
need of nutrition services
Standard 7.1…
Based on local resources
Culture, language, education, access
Significant others encouraged to
participate with participant’s approval
-Diagnostic assessment
-Plan of care
-Counseling
-Evaluation of progress
Additional Participants Most Likely
to Benefit from Nutrition Counseling
Infants with conditions that impact
growth and development where
nutrition is the underlying cause
such as:
failure to thrive
prematurity greater than 4 weeks
low birth weight
severe growth retardation
Most Likely to Benefit…
Infants with cleft lip and palate
Substance exposed infants
Infants at or below the 5th percentile
weight for length
Most Likely to Benefit…
Pregnant women or infants with cystic fibrosis,
gastrointestinal disorders, epilepsy, cerebral
palsy, NTDs
Pregnant women or infants with developmental
disabilities
Pregnant women or infants with increased
nutritional needs due to a major surgery, trauma
or burns requiring a hospital stay
Pregnant women who are underweight (pre-
pregnancy Body Mass Index (BMI 26.0)
Most Likely to Benefit…
Pregnant women with multifetal gestation
Pregnant women with extensive dental
problems such as severe tooth decay or
gum disease
Pregnant or breastfeeding women on
restrictive diets
Pregnant women who are homeless,
depressed or abusing substances
Pregnant teens (age <16 years at last
menstrual period)
Nutrition Counseling Includes the
Following Components:
Diagnostic assessment
Development of a nutrition care plan
Provision of individual and family
nutrition counseling consistent with
the plan
Monitoring and evaluation by the
nutritionist or dietitian of progress
toward the nutrition care plan goals
Nutrition Counseling Components…
Referral to appropriate prenatal,
postpartum, child/infant care and/or
social services
Participation in the family support plan
process, when appropriate
Coordination of care with other members
of the interdisciplinary team
Monitoring and evaluation by the
nutritionist or dietitian of progress toward
the nutrition care plan goals
Standard 7.2
The provider of nutrition counseling
will provide follow-up to the Healthy
Start care coordinator
Standard 7.2…
Submit documentation in 30 days:
-Receipt of referral
-Initial service date
-Nutrition assessment
-Plan of care
Standard 7.3
Providers of nutrition counseling will
offer and initiate services in a timely
manner
Standard 7.3…
Initiate service within 30 days of
referral or identified need
If immediate need, initiate ASAP
Initiate assessment and plan of care
Assessments
Anthropometric assessments using
CDC Growth Charts for Birth to 36
months for appropriate sex
Anthropometric assessment using
Body Mass Index or Pregnancy
Weight for Height Table shown on
Side 1 of Prenatal Weight Gain Grid
(DH 3086D)
Assessments…
Anthropometric assessments using
CDC Charts for Body Mass Index for
age percentiles (2-20 years) for
appropriate sex
Standard 7.4
Providers of nutrition counseling will
respond to any additional identified
needs
Standard 7.4…
Address additional needs by direct
referral or referral to care
coordinator
Communicate with care coordinator
Collaborate with interdisciplinary
team
Risk Assessment and Referrals
For participants threatened by conditions
for which medical nutrition therapy is a
critical component of management
-Metabolic disorders
-Chronic medical conditions
-Eating disorders
-Growth and development issues
-Obesity
Standard 7.5
Providers of nutrition counseling will
accurately code service information
in a timely manner for HMC data
entry
Standard 7.5…
In-house and contracted community
providers
-Comply with DOH coding
requirements
Standard 7.6
Providers of nutrition counseling will
document services in the
participant’s existing clinical/WIC
record or in a format determined by
the local coalition and provider
Standard 7.6…
Document on problem list, progress
notes, FSP, assessment forms
If another household member
receives services, document in a
separate record and reference
household member’s receipt of
services in participant’s record
Standard 7.7
Nutrition counseling providers will
develop and implement an internal
quality improvement and quality
assurance process
Standard 7.7…
Develop QI/QA process with coalition
Strengths and areas needing improvement
-Rate of participation in counseling
process
-Reduction of risk factors
-Increased nutrition knowledge and skills
-Ability to achieve and maintain nutrition
goals
-Participant satisfaction
Standard 7.8
Nutrition counseling will be provided
by qualified and trained providers
Standard 7.8…
Based on rules Chapter 468, Part X,
F.S., Chapter 64B 8-40 to 64B 8-45,
F.A.C.
Competency and up to date
knowledge related to nutrition
counseling
Provider Qualifications
Registered Dietitian (R.D.)
Licensed Dietitian/Nutritionist (L.D.,
LD/N) licensed by the State of
Florida, Department of Health
Public Health Nutritionist (a licensed
dietitian)
Additional Competencies for
Providers Include:
Knowledge of developmental stages
of the human life cycle
Knowledge of non-verbal
communication cues
Ability to utilize creative approaches
in the delivery of nutrition services