Nutrition care manual vt

Nutrition services are an important part of integrating food and food access into health care. The types of services may range from education in basic kitchen skills to licensed providers working closely with patients to develop tailored plans for addressing specific health goals. This page provides links to examples of publicly available resources to help individual learn skills that support good nutrition. For a framework of how services fit together in Vermont, along with considerations related to services that move across the range from general prevention to clinically-integrated patient counseling, see the 2022 Landscape of Nutrition Services report. As an addendum to this report, this one-page handout describes reimbursement for Medical Nutrition Therapy (clinical services from Registered Dietitians) in Vermont in 2022.

The federal government supports nutrition-related activities through 21 different agencies, with 72 efforts connected to education (per a 2021 GAO report). The U.S. Department of Agriculture and Centers for Disease Control & Prevention support many activities related to education and clinical services, and provide funds to help states tailor to their local needs.

U.S. Department of Agriculture:

• The Expanded Food and Nutrition Education Program (EFNEP) serves income-eligible households with expecting parents, children, and teens. UVM Extension is home to the Vermont EFNEP Program.
• The Women, Infants and Children (WIC) program includes community activities, in-person counseling, and online learning.
• SNAP-Ed supports nutrition education, along with policy / systems / environmental change and social marketing. SNAP-Ed provides this library of materials for the Nutrition Education component. The Vermont Department of Health manages SNAP-Ed funds to support local programs.
• USDA School Food & Child Care Centers programs. The National Farm-to-School Network builds from the starting point of federally supported school food access to integrate education components (among other initiatives). Find Vermont resources at VT FEED.

Centers for Disease Control & Prevention:

• One framework for understanding the CDC data on chronic diseases and causes of death nationwide is the 3-4-50 Campaign - changing 3 behaviors (no physical activity, poor diet, tobacco use) that lead to the 4 diseases causing more than 50% of deaths in Vermont. Online materials from the Vermont Dept of Health provide ways to support behavior change and track progress.
• National Diabetes Prevention Program uses lifestyle changes to manage Type 2 Diabetes and Pre-Diabetes.
• MyHealthyVT.org provides access to evidence-based self management programs for diabetes and other health conditions.
• You First - Supports health for members who have or had breasts and a cervix, including health coaching and nutrition programs.

Find all Vermont Department of Health programs for health promotion and preventing chronic disease online.

Health Providers & Health Professionals:

Nutrition education and related services are offered by different health professionals. Some licenses and certifications focus largely on nutrition, such as Registered Dietitians (see the national Academy of Nutrition and Dietetics and the Vermont Academy of Nutrition and Dietetics - VAND), certification as a Diabetes Care and Education Specialist, and certification as a Health and Wellness Coach. Some organizations support greater inclusion of nutrition as part of basic medical training regardless of specialty. The links below highlight resources related to cross-training medical professionals to incorporate more nutrition-related elements in work with patients.

Culinary Medicine:

• Materials and Recording from 2.22.22 Webinar on Culinary Medicine and Culinary Nutrition at UVMMC
• UVM Culinary Nutrition Continuing Education course - includes an introductory video. See also this episode from Policy in Plainer English that discusses UVM’s Culinary Nutrition course for undergraduate and graduate students.
• Healthy Kitchens, Healthy Lives and the Teaching Kitchen Collaborative build national networks to connect health professionals and culinary professionals.
• Season 4 of the Policy in Plainer English podcast explored many of the themes close to culinary medicine - examining ways to apply the skills of food professionals to making dietary change for health-related reasons. Find the library here.

Lifestyle Medicine:

• Lifestyle Medicine focuses on addressing root causes of disease, including diet. The American College of Lifestyle Medicine provides resources and additional background information.
• One introduction to the type of evidence based nutrition advice and techniques used in Lifestyle Medicine is the Food, We Need to Talk podcast.
• Season 3 of Policy in Plainer English profiled Lifestyle Medicine at Springfield Medical Care Systems Part 1 and Part 2.
• Two virtual lifestyle medicine based programs for using diet to manage chronic conditions, provided through some commercial health plans, are Pivio and Omada Health. This podcast episode considers the role of virtual care more generally in addressing chronic condition management.

Examples of Community Partnerships:

Nutrition education and services are often made available through a team-based approach, either within a health care practice or in a larger partnership with community organizations. A Policy in Plainer English podcast episode from Season 4 provides examples of Building a Team that spans different programs. The resources below offer more examples.

• Accountable Communities for Health provide one framework for general education to support healthy eating. For example, the NEK Prosper! ACH builds from the nationally recognized Food Hero program for food education.
• Community Health Teams and Community Collaboratives may organize nutrition education opportunities for their regions.
• Community Health Workers (CHW) are another point of connection for nutrition education and services that bridge between health care practices and community groups, the Rural Health Information Hub offers this collection of resources and this link provides details on Vermont-based CHWs.

Retail food businesses are increasingly involved in nutrition education and services, up to and including offering RD and clinical services. Sources of information on this sector:

• Academy of Nutrition & Dietetics “Food as Medicine” Retail Framework
• National Grocers Association Technical Assistance Center
• Vermont Farm-to-Plate training resources
• D.C. Greens Produce Prescription & Giant Grocery
• NOTCH Social Grocery model
• The retail system is also an example of where environmental change can promote healthy decisions, as outlined in this SNAP-Ed toolkit.

Older Vermonters have particular nutrition needs and several programs work with people over the age of 60 to provide nutrition services, including access to registered dietitians, healthy meals, and educational resources.

• The Older Vermonters Nutrition Coalition helps navigate available services.
• The Area Agencies on Aging provide a range of nutrition programs, their statewide association is V4A.
• The episode Food As We Age from Policy in Plainer English highlights some of the Vermont services.
• The national Meals on Wheels organization highlights health care partnership opportunities.

Children are another group with unique nutrition needs and programs that link medical providers and community partners. Examples include:

• UVM Extension- Nutrition programs
• Women Infants and Children (WIC) Program
• Vermont Farm-to-School Resources
• VT Department of Education Child Nutrition - includes training materials for child care meals.
• Help Me Grow Vermont
• Dinner Together - a program of Rise VT
• Kids Eat Right

Recipe Libraries & Meal Plans:

The following links provide a round up of resources for recipes, meal plans, and healthy dietary patterns - there are many resources out there. These were selected because they have been recommended by participants in the VT Food Access & Health Care consortium. They have not been independently reviewed.

Sources of health-focused recipes used in Vermont programs:

• Farm Shares for Health 2022 Handbook - UVM Medical Center
• The Good & Cheap cookbook by Leanne Brown (includes link to a free PDF version)
• Hunger Free Vermont: Nutrition Education Resource Hub (includes Learning Kitchen curriculum)
• VT FEED (Food Education Every Day) - Farm-to-School
• Vermont Harvest of the Month
• Vermont Foodbank VT Fresh Program
• Food Fit Program – Bennington
• Food Hero - developed by Oregon State, used by NEKProsper!
• VYCC Health Care Share Newsletters – include recipes & directions that go with the food in the share.
• Salvation Farms – Vermont Fresh Fruit & Vegetable Handbook

• What’s That Food? - UVMMC Culinary Medicine Program
• NOTCH Healthy Choices Video Showcase
• Age Well – YouTube channel and Older Vermonters Nutrition Coalition
• Employee Wellness YouTube Playlist from UVM Medical Center
• Library of cooking videos from the Veterans Health Administration

Examples of curriculum- and dietary pattern-based meal plan resources:

• SNAP-Ed
• Expanded Food & Nutrition Education Program (EFNEP)
• Healthy for Life and Eat Smart from American Heart Association
• The Kitchn Beginner’s Guide to Meal Planning
• Harvard T.H. Chan School of Public Health - building a plate with less red meat
• Old Ways Traditional Diet Patterns
• NIH Sample Plan for DASH Diet
• EatingWell 30 Day DASH Plan and Mediterranean Diet
• Environmental Working Group - Good Food on a Tight Budget

Food safety education materials

• USDA Food Safety Education
• CDC Food Safety
• God’s Love We Delivery Food Safety Instructions - delivered meals
• Fight Bac

FAHC Next Steps:

In late 2022, the Vermont Department of Financial Regulation released an RFP for a consultant who could review Medical Nutrition Therapy (MNT) utilization patterns in Vermont and provide initial information on barriers to optimal utilization. The analysis would include questions such as:

• Consistency in clinical indicators used to direct MNT and other nutrition service referrals
• Provider understanding of reimbursement structures for clinical nutrition services
• Tracking and engagement with patients’ primary care providers as follow up to services by a registered dietitian
• Non-clinical barriers, such as food access or transportation constraints, that impact patients’ decisions to participated in clinically-indicated nutrition services
• Gaps in data on clinical nutrition integration that restrict analysis in a significant way, and options to resolve those gaps

Work on this analysis is expected to begin in 2023.

Bi-State Primary Care Association applied for Network Development funds for work in 2023 that would support the Vermont Association of Nutrition and Dietetics (VAND) in joining as a Food Access and Health Care consortium partner. Examples of ways FAHC hopes to partner with VAND include:

• Sharing and helping keep up to date this overview of nutrition services.
• Analysis of MNT consultant report (above) and next steps - particularly in strategies for engaging referring providers.
• Tracking implementation of the Global Malnutrition Composite Score beginning in 2024 - including how it integrates with hospital-based food insecurity screening systems and care coordination.
• Assisting in SDOH coding efforts if those rise to the top as a priority in future years (see Next Steps on SDOH coding page).
• Advising on efforts to create a closed loop between Primary Care Providers and Registered Dietitians to coordinate patient care plans, including at discharge from an inpatient hospital stay (see also GMCS above).

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.