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How to Assess Jay's Needs and Risks:

Accurately identifying the client’s needs and risks is a critical step that helps a nutritional advisor to recommend a nutritional plan that is appropriate for the client’s lifestyle and well-being. Before you can accurately critique how well Michael Wilson assessed Jay Carter’s needs and risks, you need to make your own assessment. Using the relevant client information (e.g., interview, Diet & Exercise Journal, and completed Client Questionnaire), follow the steps below to analyze Jay’s needs and risks. Use the Client Assessment Template provided to record your work.

Remember: As you work on Task 1 with your teammates, you should allocate some time to working independently on the “On Your Own” tasks, as suggested in the schedule.

Get Organized

1. Meet with your team. Start by asking yourselves what exactly you have been asked to do. Re-read the email from Pat Niren. Review the attached Client Assessment Template which you will use to record your work for this task. You may also refer to the support materials from Pat’s previous email in Task 1.1: Critiquing the Practitioner’s Interview.
   
   
2. Identify one person to be a team leader for this task. Discuss with your team how you plan to tackle this work and make a concrete plan. You may wish to discuss what you know and need to know about each question listed in the template as a group before you divide and conquer the related research.
   
   Keep in mind that you all need to collaborate and teach each other as you go, so that everyone is on board with the final report. For additional guidance on how to work well in teams, refer to the materials related to Teamwork in the General Skills Resources in the left menu.
   
   
   

Conduct Your Assessment

1. Start a list of questions you think Michael Wilson should have asked Jay. As you conduct your assessment, if you think Michael Wilson should have asked Jay additional questions during the client interview, write them down (listing in rough bulleted format is fine) and submit your list to your mentor as a deliverable when you complete this task.
   
   If you realize that there are questions Wilson should have asked in his meeting with Jay, you may also realize you have new thoughts about your Client History Critique from Task 1.1: Critiquing the Practitioner’s Interview.  Feel free to modify that document and resubmit it for another mentor review. Revising this document may help you better understand what worked (or did not work) well in the client interview and, as a result, better prepare you to critique the practitioner's assessment and nutritional plan in your upcoming tasks.
   
   Note: creating a list of questions a practitioner should ideally ask in an evaluation interview may also help you in the task On Your Own A as you consider questions that you think should generally go into such a questionnaire.
   
   
2. Assess Jay Carter’s needs and risks. The section below walks you through all the questions you should consider as a part of filling out each section of the Client Assessment Template.
   
   
   • The steps reflect the order of the questions on the template, but you may complete the template in any order. Throughout this task, use the template to note your observations, the issues or problems that you identify, as well as the rationale for your assessment. (Remember that the Diagnosis and Treatment Process document in the General Nutrition Resources may be a good tool for providing a better understanding of where you are in the process of helping a client. Steps 2-4 may be particularly useful at this point in the process.)
     
     
   • When providing a rationale for each element of your assessment, remember that it is not sufficient to say that you think something. You have to say why you think so and defend your position with evidence. For example, if any of the client’s measurements are outside the normal range, explain concerns you have about that, what you think may be the cause, and why you are drawing that conclusion. You may use evidence from the client case and/or the resources you use as part of your research. Make an effort to use scientific evidence (being sure to cite your source) to support your explanations from a biochemical standpoint whenever possible.
     
     
   • The assumption is that you will not know how to answer the template questions without doing research using both the Overview of Eating Disorders and other recommended Resources (link above). You may also want to do some Internet research of your own.
     
     
     
     
     

     CLIENT ASSESSMENT TEMPLATE QUESTIONS

      

     1. Assess the client’s height and weight measurements and BMI to determine whether they fall within the normal range for his age. To do this, you may need to do some research to help you evaluate Jay’s height, weight and BMI measurements. You may refer to the Resources (link above) to see the FAQ on Assessing Ideal Body Weight and Weight Fluctuations.
        
        
        • Does Jay’s current height and weight fall within the normal range for his age?
          
          
        • Does his BMI fall within the normal range
          
          
     2. Assess any recent fluctuations in the client’s weight and determine whether they fall within a healthy range. Consider the information Jay provided about his high and low weight range. If you have concerns about any of these areas, what are your concerns, what might be the cause of the problem, and what would be reasonable treatments for the problem?
        
        You may want to reference the materials available in the Resources (link above), including the FAQ on Assessing Ideal Body Weight and Weight Fluctuations.
        
        
        • Do Jay’s high and low measurements in the last 12 months fall within the normal range?
          
          
        • Has Jay experienced any abnormal fluctuation in his weight in the last 12 months? Explain any issues or concerns with the range of the weight fluctuation.
          
          
        • What was the duration of the weight loss/gain period? How/why might the speed at which the weight was gained or lost be a cause for concern?
          
          
        • Describe any patterns of repeated weight fluctuation that may be unhealthy. What are specific causes of concern?
          
          
     3. Assess the context in which the client eats (where, when, etc.) and how it may affect his eating habits.
        
        
        • In what ways does Jay eat differently depending on when or where he eats (e.g. home vs. school; weekdays vs. weekends)? What challenges does he face in each of those contexts related to, for example:
          
          
          • who chooses the food
          • who prepares the food
          • the amount of food
          • meal times
          • snacking times
            
            
        • Considering these different contexts, what may cause Jay difficulty in making appropriate dietary choices? What solutions might help the client overcome the problems?
          
          
     4. Identify any additional outside influences that may affect the client’s nutritional needs and risks.
        
        
        • What peer or familial influences, if any, may be positively or negatively affecting Jay’s eating habits and overall nutritional well-being?
          
          
        • Why does Jay eat differently at different times or in different settings?
          
          
        • How might these influences present new needs or risks for Jay?
          
          
     5. Consider the client’s level and type of physical activity. Assess whether or not it falls within the range of what is normal and healthy. You may refer to the FAQ on Guidelines for Healthy Exercise in the Exercise section of the Task Resources (link above) to help you calculate the Jay’s specific exercise needs.
        
        
        • Does Jay’s amount of exercise fall within the range of the general recommendations for healthy activity?
          
          
        • Consider the type of physical activity. Is it extreme or intense in nature? Is it high-impact or low-impact? What effect does that have on the client? What effect might it have over time?
          
          
        • What is Jay’s attitude toward physical exercise? Is it healthy? Obsessive? How might his attitude lead to problems down the road?
          
          
          
     6. Assess the client’s medical condition and history, as it relates to his nutritional well-being.
        
        
        • Does Jay have any illnesses or medical conditions? If so, how are they related to his nutritional well-being? What specific nutritional needs do they create, if any?
          
          
        • Is Jay taking any medications or supplements that may combine with foods in a negative way? If so, how?
          
          
        • Does Jay have any allergies? How might they impact his nutritional needs or diet plan?
          
          
     7. Determine the client’s caloric needs, considering his level of physical activity and his personal goals (e.g. weight gain or weight loss). You may refer to the FAQ on Determining Caloric Needs in the Caloric Guidelines for Teens section of the Task Resources (link above) to help you calculate the Jay’s specific needs.
        
        
        • What are Jay’s caloric needs for maintaining his current weight?
          
          
        • What are Jay’s caloric needs given his weight change goals?
          
          
     8. Analyze the client’s current eating habits and patterns. If you determine that Jay’s diet is not well balanced, note deficiencies that may indicate potential health risks. (As you note problems or issues in any area, remember to dive into the science to provide evidence for your judgment. Is this client on target for his needs from a biochemical standpoint? Why or why not?)
        
        
        • What is Jay’s current caloric intake, based on his submitted diet history (Diet & Exercise Journal)? To determine this, you may refer to the calorie calculator in the Caloric Guidelines for Teens section of the Task Resources.
          
          
        • Does Jay’s diet reflect an appropriate balance in terms of the percentage of calories that come from protein, carbohydrates and fats? (Look at overall balance as opposed to adequate amounts of each type, which is addressed in the next bullet.) Refer to the site about Dietary Calories from Protein, Carbohydrates, and Fats in the Diet and Nutrition section of the Task Resources for guidelines regarding the percentage of calories needed from each of these nutrients.
          
          
        • Determine whether Jay is getting enough protein (as opposed to carbohydrates and fats). To do this, calculate the protein Jay consumes according to his diet history by looking up each individual food Jay listed in his diet history and determining how much protein it contains. Then determine whether the total is enough given Jay’s weight.
          
          
          • A teen needs approximately 1 gram of protein for every kilogram of body weight. If they get more, that is usually not a problem.
            
            
          • Refer to Protein Content of Common Foods in the Diet and Nutrition section of the Task Resources for help calculating Jay’s protein intake.

        (The reason you’re calculating whether Jay is getting enough protein, but not doing that for carbs and fats is that typically when a person gets enough protein, by default they do get enough carbs and fats.)

        • Does Jay’s diet history demonstrate a balanced diet? Compare Jay’s diet to the food guide pyramid and note any discrepancies.
          
          
        • Does Jay’s diet history include sufficient meals and snacks?
          
          
        • Does the diet history indicate that Jay may be eating too much or too little of any given food or type of food or drink? If you think so, what counts as too much and why?
          
          
        • If you identified any special nutritional considerations (such as medical conditions or food allergies), are they being addressed? If not, explain any discrepancies.
          
          
     9. Analyze the client’s goals and concerns (and those of his parent) related to his nutritional well-being. Keep in mind, there may be discrepancies between Mrs. Carter’s perspective and that of her son Jay, which need to be taken into account. You may want to refer to the Resources (link above) for more information about balancing client and parent perspectives during an interview.
        
        
        • Consider Jay’s goals, including weight change goals and nutritional goals. Are they safe for someone his height and age?
          
        • Is the proposed timeline for reaching the desired goal reasonable and safe?
          
          
        • Note any lifestyle considerations (e.g., athlete, busy schedule…) that Jay raises and its potential impact with regard to his diet and exercise (e.g., need for more/fewer calories, easy snacks…).
          
          
        • Is Jay exhibiting any unsafe behaviors associated with his goals?
          
          
        • Consider the concerns Mrs. Carter raised about her son Jay’s goals and general health. How are her goals or concerns different than Jay’s?
          
          
        • Are Mrs. Carter’s concerns justified? Do they reveal any additional risks Jay may be facing?
          
          
        • Did Mrs. Carter seem to present her concerns in an appropriate, rational manner or did she seem overly concerned?
          
          
        • Does Mrs. Carter seem to have a fair understanding of her son’s lifestyle?
          
          
        • Did Michael Wilson appropriately explore Mrs. Carter’s concerns during the interview with Jay?
          
          

Write Your Report

1. Write your formal assessment of Jay Carter’s needs and risks. Convene your team and discuss your research and findings. Use the notes you took in your answers to the questions above and work together to synthesize your findings into one comprehensive report in the Client Assessment Template.
   
   
2. Summarize your assessment of Jay’s needs and risks at the end of the Client Assessment Template. Use as much space as necessary to organize your ideas in a clear way and provide a thorough summary (i.e., do not limit yourself to the space on the template). The goal of your summary is to draw a coherent picture of Jay’s nutritional health, and to make some broad recommendations about any changes you believe need to take place.
   
   

Submit Your Work

1. Review your work with your teammates. When everyone has reviewed the report and signed-off on it, the group leader may submit it for review.
   
   
2. Submit the Client Assessment Template to your mentor for review. Check the Submit your work section of this task to determine how to name and send your documents.
   
   
3. (If you have any) submit your list of additional questions you think Michael Wilson should have asked and your Client History Critique Template from Task 1.1: Critiquing the Practitioner’s Interview if you chose to revise them. Make sure all team members have signed off-on your work before submitting (or resubmitting) to the mentor.
   
   

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Height and Weight

• Remember that BMI is an indicator of body mass that leaves room for additional interpretation in the case of athletes. That is, an athlete who is very muscular and fit may appear to be overweight based on the BMI standards of what is normal body mass. A practitioner should consider whether a client falls into this category and make allowances when deciding whether or not his/her BMI falls within the normal range.

Weight Fluctuation

• A nutrition advisor should be aware of any dramatic shifts in the client’s weight and look for patterns that could indicate unhealthy behaviors such as severe dieting.

Eating Context and Outside Influences

• A practitioner might overlook the way family or friends may influence the client’s eating behaviors. Rather, s/he should consider the context in which the client eats (when, where, and how much) as well as the outside influences (peers, family, etc.) who may be shaping those habits.



• Sometimes social relationships can motivate a client in positive or negative ways that can affect his/her well-being. For example, people often make choices to follow their peers (teens are especially susceptible to this). Practitioners should consider any peer or familial relationships the client spoke of and the potential impact they may have in shaping the client’s behaviors and increasing his/her health risks.

Physical Activity

• Practitioners should be aware of extreme behaviors when it comes to exercise. A client who does not exercise at all faces different challenges than a client who over-exercises, but in both cases the level of activity could have a significant effect on the client’s overall well-being.

Caloric Needs

• When determining caloric needs, nutritional advisors should not forget to factor in the client’s exercise habits. Someone who exercises a lot needs more calories to maintain his or her current weight than someone of the same weight who leads a very sedentary lifestyle.
  
  
• Determining caloric intake is not an exact science. It’s best for a practitioner to use a preferred or recommended caloric formula.  In addition, s/he should follow the client’s eating habits, see how he/she is progressing toward their nutritional plan, and adjust the level of recommended calories appropriately over time.

Current Eating Habits

• Keep in mind, if a client is skipping meals or skipping snacks, it may or may not be a problem. To evaluate the situation, review Step 8 of the Client Assessment Template Questions in the Step-by-Step Guide.



• If the client’s diet does not reflect the suggested balance and variety offered by the Food Guide Pyramid, there may or may not be a problem. To evaluate the situation, review Step 8 of the Client Assessment Template Questions in the Step-by-Step Guide.



• A nutritional advisor should ask a client to track his/her diet history for several days, as opposed to just one day. It is recommended to get at least three days of history, including at least one weekday and one weekend day. This gives the practitioner more information to use when evaluating current eating habits and helps in identifying trends.

Client’s and Parent’s Goals and Concerns

• A practitioner should consider whether the client’s own personality traits or behaviors (e.g. overachiever, recluse, etc.) may be contributing to the risks he faces.



• Keep in mind that not all goals are healthy. Teens are sometimes influenced by peers to set unhealthy goals.



• A nutritional advisor should evaluate the client’s goals and parent’s goals independently of each other, but also take time to think about how the two may be interconnected. For example, the parent may have very high standards that could be driving the child’s behavior. The practitioner should consider the potential effect on the client’s well-being.



• When looking at the data have available to assess the client’s needs and risks, a practitioner may discover that information provided by the parent conflicts with information from the child. This does not mean that one is definitely right and the other is definitely wrong. A practitioner should consider both sides and entertain the possibility that they may both be right, but simply have different (but equally valid) perspectives.
  
  

Overall:

• In assessing the client’s needs and risks, a practitioner should consider whether s/he has enough information to develop a good nutritional plan. If not, s/he should identify the details that are lacking.

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Overview of Eating Disorders - This overview gives you information on how to identify, assess, and treat eating disorders. The content provided in the overview links to useful web sites that provide additional, relevant information on clinical findings, risk factors and treatment options.

TASK RESOURCES

Height and Weight

How to Assess Ideal Body Weight and Weight Fluctuations - This FAQ outlines helpful steps for assessing a client’s height and weight. It also includes tools and information on interpreting BMI and growth charts.

What is BMI and Why is it Useful? - This site gives you a detailed understanding of Body Mass Index for children and teens.

Exercise

The Benefits of Exercise - This site offers insights into the benefits of exercise for adolescents, including how to start an exercise program, what kind of exercise is best, and how much exercise is enough.

Guidelines for Healthy Exercise - This FAQ addresses questions related to the recommended amount of daily exercise for teens and how much exercise is too much.

Diet and Nutrition

The Truth about Snacking - This FAQ addresses the misconceptions around snacking that exist in today's world.

Common Causes of Unhealthy Eating Habits - Unhealthy eating habits develop over time. This FAQ explains some of the common causes of unhealthy eating habits and talks about how a dietitian can work with a client who has unhealthy eating habits.

Why Fiber is an Important Part of a Healthy Diet - This site explains why fiber is good for you and what foods contain fiber.

Dietary Calories from Proteins, Carbohydrates, and Fats - The U.S. Department of Agriculture’s Dietary Guidelines offer specific recommendations regarding the percentage of calories needed from key nutrients. See Chapter 5 for guidelines related to protein; Chapter 6 for fats; and Chapter 7 for carbohydrates.

Protein Content of Common Foods - This FAQ provides information on the amount of protein found in various common foods.

Assessing a Client's Diet History - This FAQ explains what a practitioner looks for when evaluating a client's diet history.

How Yo-Yo Dieting Affects the Immune System - This page talks about research that shows the possible long-term negative effects of yo-yo dieting on immune function.

Herbs and Foods Interacting with Drugs - This page features information about interactions between food, medications and dietary supplements.

Questions about Sports Nutrition - This site provides answers regarding the most common fitness and sports questions from teens.

Caloric Guidelines for Teens

Ask the Expert: How do you determine which caloric formula is the best to use?

Determining Caloric Needs - Trying to calculate how many calories a person needs is not an exact science. Most of the formulas available today are estimates of caloric needs. This FAQ explains how to determine a teen's caloric needs.

General Calorie Requirements for Children and Teens
Guidelines vary somewhat as to appropriate caloric needs for children and teens. Click on the following links for caloric ranges that can serve as a general guideline. Each site has similar, equally valuable information. It’s best to use these guidelines in conjunction with the FAQ above to determine a client’s specific caloric needs.

• From Weight Loss Resources
  
  
• From Keep Kids Healthy

Scroll half-way down the page to view charts.

Calorie Calculator - A calorie calculator is a helpful tool for determining caloric consumption. Using the tool on the home page, you can plug in the foods and beverages contained in a client's diet history into the calculator and total them to arrive at an estimated number of calories per day.

Client and Parent Goals

Balancing Client and Parent Perspectives -This FAQ helps you understand the challenges of conducting an effective client interview when both a parent and child are present.

Athletes

Healthy Eating for Sports - This page provides a guide on how athletes can eat healthier to reach their peak performance level.

Young Athletes at Risk Over Weight-Control - This page talks about how young athletes are at risk of engaging in unhealthy efforts to lose or gain weight.

Making Weight for Wrestling - It is a common practice for wrestlers to restrict fluids and food to compete in weight classes below their normal weight. This page talks about the health risks involved as wrestlers try to make weight.

GENERAL NUTRITION RESOURCES

Nutrition Tools & Practices

The Diagnosis & Treatment Process Specific to Nutrition - This document describes a process that health care professionals, and dietitians and nutritionists in particular, typically use to assess what is wrong with their patients, and how they develop treatment plans to help them.

MyPlate - This site provides information on the MyPlate Program, which was designed by the U.S. Dept. of Agriculture to promote healthy nutrition in children over two years of age. It serves as a general guide to daily food choices.

Background Information

The American Dietetic Association - This is the site for the nation's largest organization of food and nutrition professionals.

The American Society for Nutrition - This is the site for The American Society for Nutrition, a premier research society dedicated to improving the quality of life through the science of nutrition.

U.S. Department of Agriculture: Food and Nutrition - Under the U.S. Department of Agriculture's web site, this page gives you general useful information on food and nutrition.

U.S. Department of Agriculture: Dietary Guidelines for Americans - Under the U.S. Department of Agriculture's web site, this page provides guidelines regarding how good dietary habits can promote health and reduce risk for major chronic diseases.

Nutritional Needs of Adolescents - This article provides a detailed account of facts and statistics regarding the nutritional needs of adolescents.

The Science of Biology, Eighth Edition, William K. Purves - This link requires a username and password. Your username is vista1, and your password is arginine. Using the menu at the top of the screen, select Chapter 50 (on nutrition) for the most relevant material.