PCS Skill Development
On this page: Tips for Developing PCS Skills | Welcoming Participants | Make the Nutrition Assessment More Effective and "PCS" | Reflective Listening | Affirmations | Asking Permission | Summarizing: Pulling it all together | Goal Setting | Change Talk | Rolling with Resistance | Explore-Offer-Explore | PCS Mentoring
Tips for Developing PCS Skills
PCS Counseling Skills
Common skills used in providing Participant Centered Services.
A participant’s impression of WIC is often formed during their very first encounter. That first encounter is an important opportunity for beginning to develop a caring, trusting relationship. What can we do to help create a positive first impression?
Here are some great ideas from the PCS Pilot agencies on how to make WIC more welcoming:
Greetings! Warmly welcome participants to the clinic.
- Think about the words you use to greet participants. In place of “Do you have an appointment today?”, consider asking “How can I help you?” This greeting starts the interaction off on a more welcoming, helpful note.
Refresh your voice mail greeting. Voice mail may be the first contact participants have with WIC. Listen to your message with “fresh ears”, as though you were a WIC participant. Think about the following:
- Is the greeting welcoming? Does your voice sound friendly and warm, rather than monotone?
- Is the message clear - short, simple and to the point?
- Do you assure the caller you will return their call as soon as possible? If clinic is closed, let the caller know when it will reopen, and someone will return their call.
Look at the signs and posters in your clinic. Are your signs welcoming or do they make the WIC clinic seem unfriendly? How can you make your signs more “PCS”?
- For example, instead of a sign stating “Absolutely no food or drink in WIC”, say “Thank you for not bringing food or drink into WIC”.
Make the Nutrition Assessment Process More Effective and “PCS”
- Learn the risk code criteria. See WIC Risk Criteria.
- Understand the purpose behind the suggested Nutrition Assessment questions. Training Tools for Nutrition Assessment explain the purpose of each question and identify the risk code(s) being evaluated. Remember, CPAs are encouraged to make the questions his/her own and to rephrase questions as needed to assess risk most effectively, in order to assign risk codes.
- Choose the Nutrition Assessment tool that works best for you. There are 3 tools for Nutrition Assessment Questions. Each has a different level of detail: the Complete Question Format has the most detail; Brief Questions and Probes has a moderate amount of detail; and the Checklist is an abbreviated listing.
- Become familiar with the questions and risk codes for each participant category. This familiarity helps you engage with the participant and limits the amount of time you’ll need to look at the screen or at the nutrition assessment tool. We listen better when we can focus on the person rather than a computer screen or paper.
- Avoid the back-and-forth of asking questions and then documenting answers. Start the nutrition assessment with some open-ended questions or statements to encourage conversation. For example, “What makes you happy about your child’s eating habits?” OR “Tell me about mealtimes at your home”. Often you will have many of your nutrition assessment “questions” answered in the course of the conversation. After the conversation, refer to the Nutrition Assessment Tab or your paper Nutrition Assessment Tool to quickly identify any areas that need further evaluation. For example, a mom may share lots of good information about mealtimes in the home during the conversation. You glance at your tool and realize frequency of juice consumption and supplement use was not addressed. Let mom know that you have a few follow-up questions.
Have you noticed that when someone shares a problem or concern, your first inclination is to jump in and give advice? That is a common inclination for most people, especially health care professionals! But is advice-giving an effective counseling tool on its own?
A reflection is a brief response that lets the speaker know you’ve been listening and helps you check your understanding of what is being said or the emotions behind it. To reflect means to:
- Repeat or rephrase what the person says in similar words.
- Paraphrase, making a guess to the unspoken meaning.
- Paraphrase, emphasize the emotion through feeling statement.
Use Reflective Listening to:
- Prevent miscommunication. By listening carefully and reflecting to the speaker what you heard, you can assure that you understand the situation correctly.
- Show you are truly listening. To reflect on what a speaker is saying, you must listen closely and stay engaged.
- Help the speaker identify their own solutions or reasons for making a change. If someone states how they can resolve an issue or change a health behavior, they are more likely to follow through.
- Show you care! Reflective listening demonstrates that you would like to understand the situation and want to help.
Reflective listening can help improve and strengthen relationships. It is skill that takes practice. Try out reflective listening today at WIC clinic or at home!
Affirmation is an important PCS skill. It puts the participant at ease and helps them feel accepted. Affirmation builds confidence and self-respect. After affirming a participant, have you noticed how her face lights up and she becomes engaged in the conversation? Rapport is built and she becomes more willing to listen to any information you would like to share.
Make affirmations sincere and as specific as possible. Vague, general compliments are not as effective as directed affirmations. “He is so sweet” is a good conversation starter. However, a specific affirmation can be more effective for building confidence and self-efficacy. Try “Wow, you are observant! That’s great that you’re noticing the different cues he is giving when he is hungry or just fussy.”
Affirmations should focus on the participant’s successes and efforts. For example, “You have some really good ideas trying some new vegetables.” After affirming the efforts of the participant, she may be more open to information, and you may offer some recipes or additional ideas for using vegetables. Here is another example, “Congratulations on weaning her off the bottle. I know it was really challenging.” The participant may be more willing to share other concerns or challenges with you.
Suggested group activity for a WIC staff meeting:
- I am breastfeeding my baby, but she cries a lot, so I wonder if she needs some formula.
- I don’t like to exercise. I walk some when the weather is nice.
- I have gone from smoking 1 pack a day, to about a ½ pack a day.
- Vegetables are not my favorite food, but I fix them for my family anyway because I know they are healthy.
- I am trying to eat healthier now that I am pregnant. It is so hard when I am nauseous.
For each of the following statements, share an affirmation you might say to the participant. Remember, no advice or education yet. Use affirmations before education!
Learning new skills and techniques takes time and can be overwhelming! As mentioned in an earlier WIC Wednesday Update, it helps to focus on one new skill or technique at a time. This week, consider focusing on “Asking Permission”. It is a quick and easy skill to use and has significant impact on the interaction between educator and participant.
Before jumping into nutrition education, 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.
Example of a CPA asking permission: “You mentioned that you are concerned about your baby getting enough breastmilk. Would it be ok if I shared some information on how you can know whether your baby is getting enough to eat?”
Just the act of asking, rather than jumping ahead and “telling them what to do” creates an atmosphere of respect and trust. Usually the participant says “yes” when asked for permission and is more open to the information. Participants are less likely to become resistant when they feel they have some control over the discussion.
This approach can also be used for before providing written educational materials. When reviewing information on a nutrition education card, be sure to ask the participant if they would like to take the card home. If the participant states “Yes, I would like the card”, they are more committed to reading the card later
Summarizing: Pulling it all together
As you look back at the past year, reflect on major events of the year. Describe what went well. What would you do differently? What have you learned over the year? Based on what you learned this year, what goals have you set for next year? Now take a moment to summarize your reflections and future goals.
Summarizing is a useful tool in WIC appointments. Summaries are particularly useful at the end of a WIC appointment but can be used throughout the appointment to help refocus the conversation.
- Shows you’ve been listening.
- Reinforces what the participant has said.
- Helps ensure you “got it all” or understand the participant’s concerns.
- Allows participant to hear their own thoughts about change, which can be especially helpful if they are ambivalent about a change.
- Provides transition to further discussion.
Example: Summarizing ambivalence you heard (they feel 2 ways):
“Let me summarize what I’ve heard so far. On the one hand you don’t feel that your daughter is ready to give up the bottle and will cry at night without it. On the other hand, you are concerned that the bedtime bottle is bad for her teeth. Did I get it all?”
Example: Summarizing to reinforce a goal set by a participant:
“Ok, let’s see if I have everything. During this pregnancy, you’ve been craving lots of sweets especially in the evening. You like fruit so you’ll eat a piece of fruit in the evening to help with your cravings for sweets. Did I get that right?”
One tool that CPAs can use to promote behavior change is goal setting. The most effective goal is one the participant sets for themselves. Participants are more likely to take action when it is their idea, and they determine their goals and action steps. But participants are often caught off guard when you ask them what goal they would like to set for the next few months. A common response is “I don’t know. I haven’t thought about it”.
CPAs can be a “guide” in setting goals. As you actively listen to participants, you will hear change talk. Use those openings to suggest a goal or behavior change. For example, you might say:
- “You mentioned you were interested in trying some new vegetables with your family. What vegetables would you like to try in the next month?”
- “I heard you say you were considering weaning Ethan off the bottle. What steps will you take in the next few weeks to wean Ethan?”
- “You said that you would like to get more exercise. What will you do this week to be more active?”
- “It sounds like you will try taking your prenatal vitamin in the evening when the nausea has ended.”
Notice, you don’t even have to use the word “goal”!
A few final thoughts on goal setting:
- Help participants to verbalize concrete next steps rather than big, broad goals. Rather than “I will serve more vegetables”, a participant may state “I will offer my family squash and romaine lettuce this month.”
- Focus on just one area for change. We don’t have to “fix” everything in one visit!
Listening for change talk is an important PCS skill. Change talk refers to the things people say that may indicate they are considering changing a behavior. When listening to a participant, it is important to identify and encourage change talk. If the participant identifies their own reason for change and talks about those reasons, they are more likely to change!
Generally, change talk comes up when having a conversation about a participant’s health and nutrition issues. But we might hear change talk at any point during an education session. Recognizing change talk is one of the hardest PCS skills to develop since it can be very subtle. Some statements participants make are ambiguous. They may or may not be change talk, depending on how they are said and the context of the discussion.
Recognizing Change Talk
Remember “DARN” – Desires, Abilities, Reasons, Needs. If you hear any of these kinds of statements, they might be change talk.
- Desires “I wish….” “I want…” “I’d like…”
- Abilities “I could…” “I might be able to..” “I can…”
- Reasons or Fear “I’m worried…” “It would be better if..” “I’m having problems with…”
- Needs “I must…” “I need…” “I should…”
If you think you hear change talk, gently encourage the participant to talk more about it. “Tell me more!” Practice recognizing change talk.
Next Steps with Change Talk
Studies show that people are more likely to change when they identify their own reasons or motivation to change. Use the techniques of reflection and open-ended questions to respond to change talk statements and help the participant identify their own motivation for change. Be sure to focus on the participant’s reason for change, not your reasons!
Examples of responding to Change Talk:
- A mom of a 6-month-old infant tells a CPA, “I can’t lose any of the weight I gained during pregnancy.” Respond with a reflection, “Sounds like you’ve struggled to lose weight. Tell me more about that.”
- A pregnant woman states, “I think I can eat some fruit each day in my lunch.” Affirm the change and ask an open-ended question, “Lunch is a great time to have some fruit! What types of fruit will you try this month?”
- A mother of two toddlers shares, “I can’t keep up with my kids. I need more energy.” Try a reflection, “You are worn out taking care of two small children.” Or try an open-ended question, “What energizes you?”
- A mother of two preschoolers states, “I want the kids to eat healthy, but my husband is always giving them junk food snacks.” A reflection, “You are frustrated with your husband’s snack choices.” An open-ended question might be, “What are some healthy snacks that your kids will eat?”
Remember, the objective is to listen for change talk and then encourage the participant to talk about their motivations for making a behavior change. Once a participant voices their motivations, reinforce the change talk, and help them set small, achievable goals.
Rolling with Resistance
Working with participants who are resistant
Despite our best PCS efforts, resistance and disinterest is going to happen. We have all heard “how long is this going to take” or “I couldn’t make enough breastmilk with my last baby so I not even going to try breastfeeding this baby”.
Dealing with a resistant participant can be a challenge. It may feel like you are in a wrestling match! Fortunately, there are some strategies that will facilitate communicating with resistant participants. This is often called Rolling with Resistance.
- Pause and take a deep breath. It is time to change course. When we encounter resistant behavior, our human tendency is to argue or push back. The more we argue or push, the more the participant will!
- Use Reflective Listening statements to let the person know you understand how they think or feel. This may help you find out why they are resisting and let you change the direction of the discussion.
- “It sounds like you are having a busy day and are in a hurry.”
- “You have heard this before.”
- “This idea won’t work for you.”
Acknowledge them as the decision maker. Support choice and control on the part of the participant.
- “It’s up to you. You know your child best.”
- “You can take what you like from our discussion and leave the rest.”
- “Is there anything else you would like to talk about today?”
PCS involves learning skills and techniques to connect with participant and make contacts interactive. We hear from some WIC staff that they don’t have time to “do” PCS. Don’t be discouraged! As with any project, it takes time to develop and implement new skills and activities. As you get more proficient using PCS skills, you may find that you obtain information more quickly and have more meaningful, richer contacts with participants.
Focus on one new skill at a time. Here is simple technique to remember for giving advice or education. It is the Explore/Offer/Explore Sandwich Technique. Here’s how it works:
- Explore (the top layer of the sandwich): Ask the participant what she already knows; what she has heard, has already tried and/or would like to know about a topic.
- Offer (the filling of the sandwich): Ask permission to offer information and then offer the information. Be brief and give just one or two simple facts.
- Explore (the bottom layer): Find out what the participant knows or thinks about the information you offered.
Here are a few examples of Explore/Offer/Explore:
- A mother of a 4-year-old boy reports he refuses to eat vegetables. Explore: What ways have you offered vegetables to Justin? Mom responds that she typically offers cooked vegetables at supper. Offer: Some kids at this age love raw veggies. Explore: What do you think about trying raw veggies?
- A father of a 15-month-old girl says it is time to wean from the bottle but she is being stubborn. Explore: What have you tried so far with weaning? Dad shares that he has started giving her a cup at mealtime. Offer: That is a great start! Would it be ok if I share a few other suggestions? Dad says “yes”. Some parents put only water in the bottle. Other parents find it works best to just throw the bottles out and stop cold turkey. Explore: What do you think of those options?
This technique works well for offering advice and helps participants identify their own areas for change
What is PCS mentoring?
Mentoring is a process that brings results. It is about sharing knowledge, perspective, and insights, in addition to nurturing talent. Mentoring is realizing that while the theory behind a skill is frequently learned in a formal setting, like the classroom or training room, application of that skill is fostered in a mentoring environment. Mentoring is an ongoing process that is mutually beneficial and evolves from a trusting relationship, in which people can experience change, consider adopting new skills and develop their skill set.
What is the role of a mentor?
Mentoring is both something you do and something you are. A mentor helps to create an environment which empowers staff to grow and build confidence. The precise framework of each mentoring system will be dictated by the needs of the organization and its employees. In general, mentors play many roles based on the situation. For example at times mentors may guide, instruct, cheer, lead, or coach and sometimes mentors take the role of an accountability partner.
What are common duties of mentors?
- Observe and mentor staff members as they work to incorporate new skills.
- Identify resources and training needed to promote skill development.
- Provide diverse learning opportunities to accommodate different learning styles.
- Facilitate discussions to promote learning and exploring.
- Explore ways to recognize and celebrate staff achievement on an ongoing basis.
What are common actions of successful mentors?
- Mentors form successful partnerships, recognizing much more can be achieved together than individually.
- Mentors recognize that feedback is a gift and provide it accordingly, with the interest of the mentee in mind.
- Mentors “walk the talk” and practice the same skills that are asked of staff, both in participant services, and in their mentoring relationships.
- Mentors create safe learning environments for taking risks.
- Mentors recognize and celebrate successes!
How do you make it sustainable?
- Provide mentors training on how to mentor successfully.
- Determine how to incorporate mentoring duties into work schedules.
- Clarify expectations and establish accountability to ensure mentoring opportunities take place.
- Allow for networking opportunities for mentors to share strategies, resources, and continue to develop their own skills even further.
Mentor Training and Guidance
Numerous training materials and guidance materials are available. WIC Mentor Resources