Topic 1: Connecting with Participants - Nevada...

Topic 1: Connecting with Participants

“People don’t care what you know until they know you care.”

- Anonymous

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

Contents:

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

Activities for staff…………………………………………………………… 5

Ideas for facilitated conversations with staff………………….. 7

Sample script …………………………………………………………………. 8

Observation guide …………………………………………………………. 11

Self observation guide…………………………………………………….. 12

Handouts…………………………………………………………………………. 13

References/Resources………………………………………………………. 16

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Key Messages for Champions

This section will explore how to better connect with WIC participants. Below are key messages to

help your staff develop and practice their ability to make lasting connections with their families.

Making a connection starts from the very first contact with the participant. Establishing a connection

with your participant right from the start will help them open up and explore their feelings about

adopting healthy behaviors. As participants begin to trust the connection, they will be more open to

ideas and suggestions. The ability to connect with participants is a powerful tool in helping people

change.

The Nevada C.A.R.E.S. approach is individualized rather than a one-size-fits-all approach. Each person

has unique circumstances, interests and dreams for themselves and their families. By establishing a

connection with participants early in the visit, the WIC staff is able to explore each individual’s needs

to better tailor the nutrition education provided.

The spirit of Nevada C.A.R.E.S. conversations

Is CARING:

It’s Collaborative – We’re working together with our participants.

It’s Accepting – It encourages honesty and allows differences of opinion.

It’s Respectful – It allows the individual to decide what path to take.

It’s Individualized – It helps the participant address what is important to them.

It’s Non-judgmental – It does not allow judgments to play a part in offering nutrition education.

It’s Genuine – It is always given from the heart – is empathetic and real.

Creating a partnership with participants

Every WIC interaction is a partnership. Participants are the experts on their own families and what

ideas would work for them. WIC staff have nutrition knowledge, strategies to help families talk about

the changes they want to make, and practical ideas to share. Viewing the WIC interaction as an equal

partnership takes the pressure off the WIC staff to come up with all the answers.

Four basic human needs

There are four basic needs that all participants share:

To feel welcome

To be understood

To feel important

To feel comfortable

By making a connection with the participant early in the session, we can fulfill these needs.

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Steps for beginning the WIC session – Making the connection

1. Greet the participant:

Greeting participants warmly makes them feel welcome and accepted and sets the stage

for successful counseling.

2. Introduce yourself and your role:

This helps to establish rapport and allows participants to feel more comfortable with you.

3. Set the agenda:

Tell participants how much time you expect the visit to take.

Tell them what you hope to accomplish during the visit. This shows respect and reduces

anxiety.

4. Ask permission to proceed:

Asking permission shows respect and allows the participant to feel in control, so they are

more likely to participate as a partner in the conversation.

5. Start with an open-ended question to begin the conversation:

If participants are encouraged to speak at the beginning of an appointment, they will be

more likely to talk throughout the visit.

Ideas could include:

o “What questions or concerns do you have that you would like to talk about today?

o “Tell me about how things are going for you since the last time we talked.”

Connecting with parents

Making parents feel good about themselves and their role will help them to make positive changes

for themselves and their families. Learning about what motivates parents will help WIC staff establish

the connection between the healthy behavior and the hopes and dreams parents have for their

families. All parents have internal motivators that traditional counseling does not often explore. By

finding out what motivates parents, we can have a more meaningful conversation that will be more

likely to lead to behavior change.

Some things that motivate parents:

I want to be a good parent

I want to be intelligent

I want to know that what I do makes a difference in my child’s life

I want to be in control

I want to feel secure

I want to feel successful

I want to feel good about myself when I take care of my child

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I want to believe in my power to change the course of my child’s life by the actions I take

I want to have a meaningful impact on my family

I want my children to know that they can count on me--and I will deliver

I want to keep my child safe

I want to lead my child towards a successful life

The art of listening

Listening to participants helps to build a connection, letting them know we are interested in their

lives. Listening helps people feel understood, one of the most fundamental human needs.

Listen with:

Presence and undivided attention

All of your senses, eyes, ears, and heart

Acceptance and non-judgment

Curiosity

Delight

Without interruption

Silence

Managing time in a WIC appointment

Managing time in a WIC appointment is important and helps establish trust with the current

participant and the next participant on the schedule. Participants are comfortable knowing what to

expect. At the same time, participants don’t want to feel rushed. Setting expectations at the

beginning of the appointment may alleviate some of the anxiety of participants.

These tips and suggestions may help staff manage their time effectively:

Sometimes a personal topic may be more important to the participant at that particular moment than food issues. It is ok to go off topic if it helps you get more information or to connect with participants.

When conversations get off track or are rambling, gather attention and focus with this statement: “Let me tell you what I am hearing; tell me if you agree.”

If participants have to leave, set expectations for the next visit.

With limited time, focus on one or two areas identified as priority issues for the participant during the assessment.

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Activity 1: Practice opening the conversation

Introduction:

Explain to staff that this exercise is about making a connection with participants at the start of the WIC visit.

Ask: What are some things you do at the beginning of an appointment to make participants

feel comfortable with you? Acknowledge all answers.

Review the key elements for setting the agenda in a WIC appointment. Use the handout, Making

the Connection, if appropriate.


Greeting participants warmly makes them feel welcome and accepted and sets the stage for

successful counseling.


It helps to establish rapport and allows participants to feel more comfortable with you.

3. Set the agenda:

How much time do you expect the visit to take.

What do you hope to accomplish during the visit. This shows respect and reduces anxiety.


Asking permission shows respect and allows the participant to feel in control, so they are more

likely to participate as a partner in the conversation.


If participants are encouraged to speak at the beginning of an appointment, they will be more

likely to talk throughout the visit.

Provide an example for staff: use this example or one of your own

“Hello. I’m Kathy, a nutritionist here in the WIC clinic. We have about 20 minutes to meet today and I’d like to take some measurements, go over the questionnaire with you and talk about Susie’s eating. Does that sound ok? (Pause for response) Thank you for filling out the questionnaire; it gives us an idea of how you and your family eat and what topics we might cover today. Tell me about Susie’s eating these days?”

Activity:

Ask staff to pair up and practice crafting an opening statement using the steps above.

Encourage them to use words that are comfortable and natural for them.

Next, have them practice opening the conversation with someone new to the WIC

Program. Facilitate a discussion first about how a new participant is different from a

returning participant and discuss different strategies for conversations with new

participants (e.g. asking what they have heard about WIC before offering information).

Have administrative staff practice how they would use these same steps to greet someone

as they entered the clinic.

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Activity 2: Connecting with participants through the environment

Introduction:

Ask staff questions to initiate a conversation about how the environment can influence our connection with participants. Suggestions include:

Think about a time when you felt comfortable in an environment (store, office, home). What about the environment made you feel comfortable?

What characteristics of an environment would make families feel welcome and comfortable? Activity: Looking at the clinic with fresh eyes

As a group take a walk around the clinic. Ask staff to pretend they had never been to the clinic before and to look at the environment with fresh eyes. As you walk through the clinic, write down any observations from staff or areas for improvement. Ask the following questions as you move through the clinic:

Starting outside, is the clinic well marked and easy to find. Is the signage clear?

Is the waiting room comfortable and child-friendly?

Are there toys or activities to occupy children?

Are the signs/posters/and instructions respectful and appropriate and do they reflect the culture/language of the participants served?

Does the waiting room have materials (bulletin boards, posters, referral information) that support positive nutrition behaviors?

Do the office or cubicle arrangements encourage and promote conversation? o Is the desk a barrier between the staff and the participant? o Is the computer blocking the view of the participant?

Do the staff offices have resources (toys, books) to occupy children?

Is the anthropometric room/area child-friendly? Follow-up: making a plan

Ask staff to brainstorm ideas for improvements to the clinic environment. Decide on those things you can do right away and those things that may take longer. Ask for volunteers to work on the different tasks. Some staff may be interested in working on making bulletin boards and others could work on replacing negative signage. Ensure everyone has a role.


Making offices homey with personal touches such as photos, pictures, plants

Collecting toys for offices to occupy children

Painting or stenciling on walls or doors

Rearranging desk placement to create an environment that promotes conversation

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Ideas for facilitated conversations with staff

1. Connecting through conversation

Ask staff to think about a time when they had a truly meaningful conversation with someone.

o Ask: “What about that conversation made it special?”

o Ask: “What did the person you were talking to do to make a connection with you?”

Ask staff what things make it difficult to connect with participants? Note challenges mentioned. (Responses may include: participants that are in a rush, angry or not engaged) Spend time trying to brainstorm solutions or changes you could make to address those issues.

o Ask: “How can you make a connection with the limited time you have in a WIC Clinic.” Or “What are some quick ways to make a connection with participants?”

o Ask: “What are ways to ‘turn around’ an angry participant?”

o Ask: “How can we get a ‘non-engaged’ participant interested?”

Ask staff to think about their participants. Most are parents or will soon become parents.

o Ask: “What are ways to connect on an emotional level with parents?”

o Ask: “What are ways to connect on an emotional level with pregnant women?”

o Ask: “What are some of the things that drive parents to do what they do – some of the inner motivators of parents?” (possible answers: the need to protect children, the desire to be proud of themselves and their children, hope for their child’s future, the desire for happiness for themselves and their children, etc.)

Ask staff to look over the handout Tips for Connecting with Participants and star the tips they feel are most important. Ask staff to share which tips they felt were most important and why.

Summarize key points from the discussion.

2. Customer service

Ask: When you are a customer, what are things that make great customer service for you?

Ask: “What are some things that make bad customer service?”

Ask: “What are some things participants are looking for when they come to WIC other than

the food benefits?”

Ask: “What do you think they don’t enjoy about coming to WIC?”

Ask: “What does our clinic do well?”

Ask: “What are some areas we could do better?”

Note areas staff mention and brainstorm possibilities to change those things.

o “What do we need to make this vision happen (resources, training)?”

Ask “How can we get feedback from participants about our service?”

o “How could we use that to improve services?”

Summarize the discussion and any plans to improve customer service.

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Sample Script

The following sample of a beginning of a WIC appointment is adapted from the Oregon WIC

Listens resources.

Ask staff to play the parts of the Clerk, the CPA, Jose and Mom. Give volunteers the script ahead

of time to read through to prepare.

Explain to the staff that they will be role-playing the beginning of a WIC appointment to

demonstrate some effective ways to connect with WIC participants.

Ask staff to jot down anything they hear the staff do well that helped to bond with the

participant.

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

What were things the clerk did well to connect with the participant?

What were things the certifier did well to connect with the participant?

What skills did they see being used?

Child Recertification – Sample Script Scenario: Mom with a very overweight child arrives at the WIC office for a recertification appointment and approaches the check-in window.

Clerk: Good morning (build rapport). How can I help you?

Mom: I’m here for a WIC appointment.

Clerk: Great! (affirm) Let me get you checked-in. Do you have your WIC ID card with you today?

Mom (irritably): No. My car wouldn’t start and I had to call my girlfriend to give me a ride, and I left my purse on the kitchen table.

Clerk: Sounds like you’ve had a rough morning (reflect). I’m glad you made it here! (affirm)

Mom: Yeah, it’s been frustrating.

Clerk: Who are we seeing today?

Mom: My son.

Clerk: What is your son’s name and date of birth?

Mom: Jose Ramos and his birthday is April 10, 2008.

Clerk: OK, I see him on the schedule. I’ll let the staff know you are ready. Please have a seat and they will call you and Jose in just a few minutes.

Mom: Thanks.

(Mom and Jose sit in waiting area.)

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CPA: __(Maria Ramos)___? Hi, my name is _____ and I’ll be your counselor today. It’s nice to meet you. Hi Jose! How are you doing? (build rapport)

Jose: (shyly) Fine.

CPA: That’s great! (affirm) Let’s all go on back to my room. (While walking down hall…) Today we are going to look at Jose’s health, growth and nutrition, and requalify him for WIC. (set the agenda). Does that sound ok? (seeking permission)

CPA: First, I’ll be taking Jose’s measurements today.

(addressing Jose) Hi there Jose! How are you today? We’re going to see how much you’ve grown since the last time we saw you. (build rapport)

(addressing Mom) Since Jose is over two years old, we just need his jacket and shoes off to get an accurate weight and height (set the agenda).

(mom takes off Jose’s coat and shoes) That’s great! (affirm)

(addressing Jose) Jose, can you step up here on the scale? Wow, what a good job standing still. (affirm) OK, let’s step over here, and have you put your feet together. Now we’re going to slide this “hat” down to see how tall you are today. OK, all done! (addressing Mom) Jose’s iron was great last time, so we don’t need to do a finger poke today.

CPA: Let’s go back to my office. Here we are, please have a seat. Jose, here’s some toys you can play with while I talk to your mom. (addressing to mom) So how’s it going today? (open ended question)

Mom: Oh, OK. (mom is leaning back in the chair with her arms crossed)

CPA: So, Jose’s appointment is to recertify for WIC. As you know, for these appointments we need to have proof of income, identity and where you live so we can update his information. (set the agenda) Do you have those things today?

Mom (irritably again): I just told the women out front that I forgot my purse! I don’t have any of my information with me!

CPA: Oh that’s right. (acknowledge oversight to build rapport) When do you think you might be able to bring in this information? (affirm participant’s right to choose)

Mom: I guess I could bring it on Monday. He has a doctor’s appointment that day in town.

CPA: That would be perfect! (affirm) We are open from 8.00 to 5:00 on Monday. And here’s a reminder slip where I’ve marked what you can bring as proof. What questions do you have about bringing in his proofs? (open ended question) (check for understanding)

Mom: Nothing about this. I just want to know if you are going to see him today.

CPA: Sure, we can still go ahead and see Jose today. He will receive some of his benefits now and the rest on Monday when you come in with his information. If it’s alright with you, I just have a couple more questions to ask in order to complete his update. (ask permission)

Mom: OK

CPA: What is your gross monthly income and household size?

Mom: I earn $1000 per month and it’s just Jose, me and his dad in my apartment.

CPA: Thanks. (build rapport) I see you live on 345 Main Street and your phone number is 775-555-1212. Is this still correct?

Mom: No, my phone number has changed. It’s now 775-123-4567.

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CPA: That is good to know! (build rapport) I’ll make a note of the change. And to finish up, here is a list of rights and responsibilities for WIC participation. Please feel free to review this information.

Mom: I don’t need to, I’ve seen this before.

CPA: That’s fine. What questions do you have about your rights? (open ended question) (check for understanding)

Mom: No questions.

CPA: Alright, then I’d like to ask you to please read this form. If you understand and agree with all of this information, please sign this line.

Mom: OK.

CPA: What other questions do you have before we get started with the rest of your visit? (open ended question)

Mom: I can’t think of anything else.

CPA: (looking at the computer) Hmm, I see Jose is going to turn 3 years old next month – what are you finding fun or interesting about him right now? (open ended question)

Mom: (thinking for a minute) Well, he is a really good eater. He’ll eat just about anything I put in

front of him.

Stop here and ask the discussion questions above.

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Observation Guide: Connecting with Participants

Option 1: Observe staff. Note areas where they do well connecting with participants and possible

suggestions for making a deeper connection.

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

Greeting:

Warm greeting

Introducing themselves and their role

Using participants names

Establishing rapport:

Body language

Smiling

Positive tone and appointment flow

Acknowledging participants questions or

concerns

Setting the agenda:

Set expectations about the length of the

appointment and what will be accomplished

Asking permission:

Asking permission to continue

Open-ended questions:

Open-ended questions to encourage

conversion

Encouraging conversation:

Talk time is balanced between participants

and staff

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Self Observation Guide: Connecting with Participants

Each time you make a great connection with a participant, note what you did that made it

successful. Writing down the successful strategies will help you be able to repeat them.

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

Successful connection –

give yourself a star!

Write down successful strategies or questions used to make the

connection with the participant

I asked the child what are her favorite foods and this led to a great

conversation with mom.

The question “What foods do you wish your family ate more of?”

seemed to work very well.

Ideas from my co-workers:

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A Motivation-Enhancing Interpersonal “Style” or “Spirit”

1. Understanding

Listening in an empathic, attentive, non-judgmental, warm, supportive way.

Seeking to see things from the participant’s perspective.

2. Participant-centered

Encouraging participants to be as active as possible in making decisions about health behavior change.

Drawing motivation to change from the participant instead of telling them what to do and why.

Encouraging participants to do most of the talking.

3. Collaborative

Pursuing common goals.

Sharing of agendas and responsibility.

Working together in partnership to determine the best course of action.

4. Individualized

Tailoring intervention approaches to match the participant’s personal needs and readiness to change.

Moving at the participant’s pace.

5. Emphasizing freedom of choice

Acknowledging that the decision if, when, and how to change is the participant’s.

Avoiding “restrictive” messages (e.g., “you have to,” “you must,” “you can’t,” “you should”).

6. Respectful/accepting

Conveying respect by accepting whatever decisions a participant makes about health behavior change.

Larson Sturtevant Consulting, LLC

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Tips for connecting with participants

Here are some proven tips for making a connection with participants. Give them a try!

Smile. It is a simple way to connect and make people feel important.

Greet every participant with a warm welcome as they enter the clinic.

Make eye contact.

Speak in pleasant tones.

Use participants’ names.

Acknowledge and compliment parents on their children.

Welcome children – say something positive and affirming to them.

Begin with an attitude of curiosity and a goal of trying to understand more.

Affirm things the participants are doing well.

Used a relaxed open-body language.

Be flexible to the style and personality of the other person.

Listen fully, without interrupting.

Explain why you need certain information.

Minimize distractions (shutting doors, turning off phone if possible).

Use encouragers to keep people talking – mm, hmmm, tell me more, what would be

an example of that, go on, what else.

Use simple, positive language that avoids “WIC jargon.”

Affirm the importance role of the parents in helping children form healthy habits that

will last a lifetime.

Be positive and enthusiastic. People with positive energy are seen as confident.

Focus on the person in front of you. Try to block out other distractions.

Tell parents you are confident in them.

Be likeable. Let people know you like and enjoy them.

Thank participants for coming in. Say goodbye.

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Making the Connection

Steps for Beginning the WIC Appointment


Greeting participants warmly makes them feel welcome and accepted and sets the stage

for successful counseling.


This helps to establish rapport and allows participants to feel more comfortable with you.

3. Set the agenda:

Tell participants how much time you expect the visit to take.

Tell them what you hope to accomplish during the visit. This shows respect and reduces

anxiety.


Asking permission shows respect and allows the participant to feel in control, so they are

more likely to participate as a partner in the conversation.


If participants are encouraged to speak at the beginning of an appointment, they will be

more likely to talk throughout the visit.


o “What questions or concerns do you have that you would like to talk about today?

o “Tell me about how things are going for you since the last time we talked.”

Example: “Hello. I’m Kathy, a nutritionist here in the WIC clinic. We have about 20 minutes to meet today and I’d like to take some measurements, go over the questionnaire with you and talk about Susie’s eating. Does that sound ok? (pause for response) Thank you for filling out the questionnaire; it gives us an idea of how you and your family eat and what topics we might cover today. Tell me about Susie’s eating these days?”

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References / Resources

Books

Carnegie, D. (1936). How to Win Friends and Influence People. New York, Pocket Books.

Cialdinin, R. (2001). Influence: Science and Practice. Boston, Allyn & Bacon.

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

Press.

Patterson, L (2008). Influencer: The Power to Change Anything. New York. VitalSmarts, LLC.

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

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