Written information on a referral program is Inconsistently provides written information Clients are provided necessary written not provided on program referred to information to contact the referred program Additional referrals, outside of mandatory Referrals are documented appropriately in STARS ones, are not made or documented Comments: Score: _____ Follow-up on referrals Follow-up made at previous visits in not Inconsistently follows up on previous referrals The status of documented referrals are inquired from previous visits done Inconsistently documents the status of about at follow-up appointments Additional referrals are not identified or referrals Additional referrals are made when appropriate provided The status of referrals are documented in STARS Status of referrals are not documented in STARS Comments: Score: _____ Competence Needs Improvement Demonstrates Competence Program Education 0 1 2 Demonstrates Rights and Responsibility Form is not read by Rights and Responsibility Form is not Uses knowledge of program rules to explain the appropriate program the client or explained to the client consistently read by the client or explained to Rights and Responsibilities education skills Programs with whom WIC shares client the client Clients are made aware of programs share information with are not shared with clients Programs with whom WIC shares client information with Substance abuse is not provided when information with are not consistently shared Provides accurate and appropriate education to appropriate with clients clients on substance education at new ID folder is not explained to clients Substance abuse is not consistently provided certifications (includes certification of all pregnant to all clients when appropriate women) ID folder is not consistently explained to Explains the Identification Folder to new clients clients Comments: Score: _____ Demonstrates Food list is not provided and/or explained Food list is provided, but not consistently Explains in detail authorized foods and provides appropriate food delivery Check education is limited or does not explained in detail food list education skills typically occur Parts of check education is explained, but Explains in detail how to redeem checks to new Individual food packages are not explained some parts are missed clients Vendor list is not provided and/or explained Inconsistently explains the clients individual food package
Written information on a referral program is not provided Additional referrals, outside of mandatory ones, are not made or documented Inconsistently provides written information on program referred to Clients are provided necessary written information to contact the referred program Referrals are documented appropriately in STARS Score: _____ Comments: Follow-up on referrals from previous visits Follow-up made at previous visits in not done Additional referrals are not identified or provided Status of referrals are not documented in STARS Inconsistently follows up on previous referrals Inconsistently documents the status of referrals The status of documented referrals are inquired about at follow-up appointments Additional referrals are made when appropriate The status of referrals are documented in STARS Score: _____ Comments: Program Education Competence 0 Needs Improvement 1 Demonstrates Competence 2 Demonstrates appropriate program education skills Rights and Responsibility Form is not read by the client or explained to the client Programs with whom WIC shares client information with are not shared with clients Substance abuse is not provided when appropriate ID folder is not explained to clients Rights and Responsibility Form is not consistently read by the client or explained to the client Programs with whom WIC shares client information with are not consistently shared with clients Substance abuse is not consistently provided to all clients when appropriate ID folder is not consistently explained to clients Uses knowledge of program rules to explain the Rights and Responsibilities Clients are made aware of programs share information with Provides accurate and appropriate education to clients on substance education at new certifications (includes certification of all pregnant women) Explains the Identification Folder to new clients Score: _____ Comments: Demonstrates appropriate food delivery education skills Food list is not provided and/or explained Check education is limited or does not typically occur Individual food packages are not explained Vendor list is not provided and/or explained Food list is provided, but not consistently explained in detail Parts of check education is explained, but some parts are missed Inconsistently explains the clients individual food package Explains in detail authorized foods and provides food list Explains in detail how to redeem checks to new clients
ITCA_2015Jan_Chp13.AttC_.WIC-Staff-Competency-Evaluation-Scoring-Sheet.fillable.docx