NUTRITION EDUCATION CHAPTER 6

Transcription

1 NUTRITION EDUCATION CHAPTER 6

2 SECTION 6.1 INTRODUCTION Nutrition education is one of the three key elements of the WIC Program. The requirements for nutrition education are specified in federal regulation. This chapter describes: Required nutrition education contacts Required content of nutrition education contacts Documentation requirements for nutrition education Additional Information about Nutrition Education Nutrition Education as defined in the Child Nutrition Act of 1966: NUTRITION EDUCATION The term nutrition education means individual and group sessions and the provision of material that are designed to improve health status and achieve positive change in dietary and physical activity habits, and that emphasize the relationship between nutrition, physical activity, and health, all in keeping with the personal and cultural preferences of the individual. Nutrition education in the WIC Program is designed to meet two broad goals as stated in the federal regulations: 1. Stress the relationship between proper nutrition and good health with special emphasis on the nutritional needs of pregnant, postpartum, and breastfeeding women, infants and children under five years of age, and raise awareness about the dangers of using drugs and other harmful substances during pregnancy and while breastfeeding. 2. Assist the individual who is at nutritional risk in achieving a positive change in food habits, resulting in improved nutritional status and in the prevention of nutrition-related problems through optimal use of the supplemental foods and other nutritious foods. This is to be taught in the context of the ethnic, cultural and geographic preferences of the participants and with consideration for educational and environmental limitations experienced by the participants /06

3 SECTION 6.2 Subject: General Nutrition Education References: Policy: The local agency must make nutrition education available to WIC participants or caregivers according to federal and state requirements and to meet the nutrition education needs of families. Purpose: To ensure that WIC participants receive adequate nutrition education that strives to improve the health of nutritionally at-risk women, infants and children. Procedures: All participants must be provided with a minimum of two nutrition education contacts (must receive nutrition education on two different occasions) during each certification. o Provide education at the time of certification. See Initial Education policy, Section 6.3. o Provide education at least one more time during the certification period. See Additional Education policy, Section 6.7. o Provide education for infants at a rate equivalent to quarterly. See Additional Education policy, Section 6.7. Nutrition education is a benefit of the program and should be provided at no cost to the participant. Participants may not be denied supplemental foods for failure to attend or participate in nutrition education. Nutrition education should address the individual s nutritional risks and nutritional interests. Nutrition education should emphasize the relationship between nutrition, physical activity habits and health. The participant should easily understand the nutrition education. Nutrition education should meet the cultural and language needs of the participant. Nutrition education should be appropriate to the literacy level of the participant. Guidance: Provision of Nutrition Education: If multiple nutrition and health needs for education are identified, the CPA should prioritize those needs and focus the education on just 1 or 2 topics. Provide literature that is appropriate for the individual participant. Literature should supplement counseling, not replace it /06

4 Facilitate behavior change. Mutually explore ways to change behaviors. Counseling methods may include: goal setting, motivational interviewing, brief negotiations, and identifying barriers to change. Ask your state nutrition consultant for resources to build counseling skills. Two of the counseling resources available from the state includes: Brief Negotiations modules and Bright Ideas! for Nutrition Educators. Nutrition education should be delivered in appealing, creative and interactive ways that engage the participant, and, as appropriate, other family members. Incorporate physical activity messages (e.g., Fit WIC). Incorporate community/national nutrition messages (e.g., 5-A-Day, folic acid preconceptually). Use recognized, effective strategies, methodologies and techniques for providing nutrition education. Promote WIC as an adjunct to good health care. Staffing: Each local agency should designate a Nutrition Education Coordinator. The Nutrition Education Coordinator plans and evaluates program nutrition services. The Nutrition Education Coordinator should be a CPA who meets the qualifications of Registered Dietitian (or registration eligible), Minnesota Licensed Dietitian (LD), Minnesota Licensed Nutritionist (LN), or is an individual with a Master s or Bachelor s Degree in Nutrition. When a CPA with these qualifications is not available, a CPA who is a Registered Nurse, or who has a degree in a Health or Home Economics related field, may be used in consultation with the assigned State Nutrition Consultant. Refer to CPA policies in Chapter 4. If the Nutrition Education Coordinator is not a Registered Dietitian, Minnesota Licensed Dietitian or Minnesota Licensed Nutritionist, more oversight may be needed by the state Nutrition Consultant. The Nutrition Education Coordinator should be an individual who possesses: o Knowledge of human nutrition in health and disease. Should also have knowledge of nutrition needs of infants, children and women during the prenatal, postpartum and breastfeeding stages. o Knowledge of effective counseling and educational concepts and methods. o Ability to prepare and/or evaluate educational materials, and to prepare and deliver in-service trainings. o Ability to prepare and/or oversee nutrition education program planning and evaluation. Roles of the Nutrition Education Coordinator include: o Plan and evaluate nutrition services. o Develop the annual local nutrition education plan. o Evaluate CPA staff competencies in nutrition, and plan and coordinate training as needed. o Monitor CPA staff performance, per local agency policy and supervision schedule. o Develop and review/evaluate nutrition education materials. o Develop procedures for high-risk (INCPs) care, including methods for evaluation of high-risk care provided by CPA staff. Refer to High Risk Individual Nutrition Care Plan Policy, Section /06

5 o Provide technical assistance to and consultation with local agency staff and other health professionals regarding nutrition issues. o Provide or arrange continuing education opportunities for the local agency CPA staff. o Serve as liaison with health care providers. o Coordinate approvals of medically prescribed formulas /06

6 SECTION 6.3 Subject: Initial Education References: (e)(2) Policy: The local agency must provide nutrition education (Initial Education) at certification and recertification. Purpose: To ensure that nutrition education is made available to all participants. Procedures: Provide nutrition education to all adult participants, parents or caregivers of infant or child participants at the time of certification or recertification. See General Nutrition policy, Section 6.2. Nutrition education should be individualized to the participant s nutritional needs considering the participant s nutritional risks, anticipatory guidance needs, and the concerns of the participant/caregiver. Competent Professional Authority (CPA) staff must provide initial education. See CPA policies in Chapter 4. Provide education regarding the harmful effects of drugs and alcohol at the time of the family s first certification in WIC. See Drug and Harmful Substance Education policy, Section 6.4. Encourage all pregnant women to breastfeed unless medically contraindicated. See Breastfeeding Education for Pregnant Women policy, Section 6.5. Participants with high-risk nutrition related conditions should receive appropriate WIC service. See High Risk Individual Nutrition Care Plan policy, Section 6.6. Refer participants to other programs and services as appropriate. See Referral policy. Inform participants of the plan for additional education. For applicants determined ineligible for WIC, nutrition education and referrals must be offered and documented. Document nutrition education in the participant s record. See Nutrition Education Documentation policy, Section 6.8. Guidance: Provide a brief overview of the WIC Program to new participants. The overview should be provided as part of a positive, participant-centered assessment process. CPAs should address the topics below, as appropriate. (The Welcome to WIC handbook, which can touches on the same topics, can be given to new participants as a resource on the program.) o The purpose of the WIC Program is to provide nutritional support through nutrition education and counseling, nutritious foods, referrals, and breastfeeding promotion and support, to improve participant health /10

7 o The nutrition assessment is necessary to identify nutrition needs (e.g., medical conditions, dietary practices) and participant interests so that WIC can provide benefits that are responsive to the participant s wants and needs. o The relationship between WIC staff and the participant is a partnership with open dialogue and two-way communication working to achieve positive health outcomes. o WIC foods are supplemental. The foods satisfy some, but not all of the nutritional needs of participants. o WIC foods are for the participant. WIC foods are prescribed for each participant to promote and support their nutritional well-being. o Explain the length of the certification period. At the end of the period, eligibility will be reevaluated. o Present WIC appointments as an opportunity to ask questions and learn more about nutrition and feeding their family. o If the Minnesota WIC Program has implemented waiting lists, briefly explain that there is a priority system for participation in WIC based on nutritional needs. Advise the pregnant woman that she should know her HIV status. CPAs can inform the pregnant woman of the following: o The doctor, as a part of prenatal care, can do HIV testing. o There are medications available for HIV positive women that will reduce the chance of transmitting HIV infection to the baby during pregnancy, delivery, and postpartum. o Women who are HIV positive should not breastfeed. o See Section 6.5 for additional information about breastfeeding contraindications /10

8 SECTION 6.4 Subject: Drug and Harmful Substance Abuse Education References: (a)(3) 246.7(a) Policy: Local agency must provide information regarding the harmful effects of drugs and alcohol at the time of the family s first certification in WIC and make referrals as appropriate. Purpose: To improve the health status of WIC participants by preventing and/or reducing the use of alcohol, tobacco, or other drugs. Procedures: Discuss the potential harmful effects of drugs or other harmful substances. Give printed education materials to pregnant women and the parents/caregivers of infants and children. The materials should: o Address the harmful effects of alcohol, tobacco and street drugs. o Include a current list of local resources for drug or other harmful substance abuse counseling and treatment. Each local agency must have and maintain a listing of these resources in their community. A specific referral for treatment or counseling for drug or other substance abuse must be provided any time a participant or parent/caregiver is identified as abusing drugs or other harmful substances. Document referral, if given. Document education and materials were given. If substance use and/or abuse is suspected or identified at recertification, the information should be given again. A referral for treatment or counseling may also be appropriate. Guidance: Educational materials that address the harmful effects of alcohol, tobacco and street drugs are available on the WIC Order form. Local agencies are encouraged to include smoking cessation programs on the resource listing /06

9 SECTION 6.5 Subject: Breastfeeding Education For Pregnant Women. References: (e)(1) Policy: The Local Agency must provide all pregnant women the opportunity to discuss breastfeeding, unless breastfeeding is medically contraindicated. Purpose: To enable pregnant women to make an informed decision about feeding their infant and to overcome any perceived barriers to breastfeeding. Procedures: If the participant has not asked about breastfeeding, the CPA should begin a discussion, providing an opportunity for the participant to express her questions and concerns. If there are known reasons that breastfeeding is contraindicated, the CPA must document the reason breastfeeding was not discussed. If you are concerned that breastfeeding may be contraindicated, encourage the participant to discuss breastfeeding with her health care provider, so that the risk/benefit can be assessed. (Information on potential contraindications to breastfeeding is listed below.) Guidance: Breastfeeding counseling. There are several ways to begin a discussion about breastfeeding. CPAs are encouraged to find a method that works best for the participant and the CPA s counseling style: The three step counseling method: o Uses open ended questions, such as: What have you heard about breastfeeding? or What are your thoughts about breastfeeding? o Training on the 3-step counseling method is offered several times a year. (To request training contact the State WIC Breastfeeding Coordinator.) Brief negotiations. Brief negotiations modules can be obtained from the State WIC Office. Contact your nutrition consultant. Simply asking if the participant intends to breastfeed is not an effective counseling strategy. Breastfeeding Contraindications. There are few true contraindications to breastfeeding and very few contraindications that will be apparent during pregnancy. The information that follows is for guidance only. Knowledge about breastfeeding is rapidly changing, resulting in changes to recommendations. Use this information as a starting point to seek additional information /06

10 Maternal conditions in which breastfeeding is contraindicated: o HIV positive or has AIDS. o Human T-Cell Leukemia virus Type I (HILV-1) o Medications such as antineoplastic agents, therapeutic radiopharmaceuticals, and lithium. Other medications may be contraindicated, however there is usually an acceptable alternative to the medication. Advise participant to discuss medications with her health care provider. o Unusually heavy exposure to environmental contaminants. Contraindicated only if maternal levels are high. Maternal conditions in which breastfeeding is contraindicated until the condition resolves or is treated: o Herpes simplex virus (HSV) on the breast itself o Current use of street drugs o Other diseases when infant contact with the mother is not recommended for either breast or bottle-feeding, such as varicella herpes (chicken pox) or active untreated tuberculosis, until it is permissible for the mother to be in contact with the infant. Resources for information about potential contraindications to breastfeeding. o AAP Committee on Drugs. The Transfer of Drugs and Other Chemical Into Human Milk. Pediatrics 108;3. September o Medications and Mothers Milk, 2002 Thomas Hale. Pharmasoft Medical Publishing. Order from: Pharmasoft Medical Publishing, 21 Tascocita Circle, Amarillo, Texas 79124, Phone or o Lactation Study Center. The Lactation Study Center has a computerized database and provides free information for professionals. University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, , donations are accepted. Open 8 am to 5 pm, EST. o Dr. Hale s Breastfeeding Pharmacology Page. o Lawrence, RA. A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States. (Maternal and Child Health Technical Information Bulletin). Maternal and Child Health Bureau. October Copy available by calling , Fax , or electronic version go to and click on the Nutrition and Breastfeeding category. o Drugs in Pregnancy and Lactation fifth edition, Gerald Briggs, et al. Williams and Wilkins /06

11 SECTION 6.6 SUBJECT: High-Risk Individual Nutrition Care Plans References: Federal Regulation: (e)(5) Nutrition Service Standards: 1 E, 10 B Policy: CPA s must develop an individual nutrition care plan (INCP) for participants who meet the Minnesota WIC Program High-Risk and Medical Referral Criteria and for any participant requesting one. Purpose: To ensure that participants with high-risk nutrition related conditions receive appropriate WIC services and referrals. Related Policies: Drug and Harmful Substance Abuse Education Referrals Procedures: 1. The Local Agency must have on staff (or by contract) a qualified nutrition professional to provide nutrition services to high-risk participants (see Guidance on High-Risk CPAs). 2. At a minimum, the Local Agency must use the high-risk criteria defined in MN WIC Program High-Risk and Medical Referral Criteria (Exhibit 6-A) for determining when an INCP is required. Additionally, INCPs should be developed: when, in the CPA s professional judgment, the condition or situation warrants an INCP; and when requested by a participant. 3. INCPs must be developed and documented specifically addressing the high-risk condition(s) identified, and must include: Assessment of the individual s overall situation including nutrition status, needs, and any problems; Review of health services for the high-risk condition being provided elsewhere; Specific goals/recommendations regarding the high-risk condition; Referrals to healthcare providers and other programs and services as needed; and Plans for follow-up visits. 4. Follow-up addressing the status of the high-risk condition must be provided at least once during the certification period /06

12 Guidance: High-risk CPAs should be a registered dietitian (or registration-eligible), an individual with a bachelor s or master s degree in nutrition, or a Minnesota Licensed Nutritionist/Dietitian. o When a CPA with one of these qualifications is not available, a CPA who is a registered nurse or registered dietetic technician, or who has a degree in a health or home economics field, may be used after consultation with by the State WIC Nutrition Consultant. o High-risk CPAs should possess the following specialized skills and knowledge: Knowledge of nutrition in health and disease, and its application to public health practices, and knowledge of the nutrition needs of infants, children, and women during the prenatal, postpartum, and breastfeeding periods. Knowledge of effective counseling and educational concepts and methods. Ability to develop and carry out on-going plans for nutrition education. Participants identified as having a high-risk condition should receive an assessment and an INCP from a high-risk CPA. o Ideally this should occur at certification. o If a high-risk CPA is not available to develop the INCP at certification, a second visit should be scheduled accommodating the participant s schedule. All WIC participants are at nutritional risk, but some health conditions put participants at greater risk for poor health outcomes. Some of the goals of WIC high-risk nutrition education and follow-up are to: o Reduce fetal deaths and infant mortality. o Reduce the incidence of infants born at low birth weight. o Increase the duration of pregnancy. o Improve growth of nutritionally at-risk infants and children. o Reduce the incidence of iron-deficiency anemia. o Assure regular medical care and follow-up. High-risk is a term used in WIC to designate the need for more advanced nutrition care. When counseling WIC participants determined to have a high-risk condition, you do not need to tell them they are high-risk. Consider saying something like Because you are not gaining enough weight we would like to follow-up with you in one month to see how you are doing. or This is an important time for growth and development. I would like to see you (your child) next month to see how you are doing, and to answer questions. INCPs are intended to establish a plan for addressing the identified high-risk condition(s) and indicate strategies for correcting the nutritional problem. The nutritional assessment at certification/recertification should identify any high-risk conditions or issues that need be addressed in an INCP. The assessment should include: o Identification of most significant risk factors present; o Evaluation of anthropometric and blood-work data; /06

13 o Diet assessment; o Review of medical/nutritional support services the participant currently receives, including the frequency and extent of nutrition counseling from other sources; o Instructions or prescriptions (if any) from health care provider(s); o Participant's/caregiver's knowledge of and attitude toward the condition(s); o Any relevant concerns expressed by the participant or caregiver. The INCP should identify the strategy that will be used to alleviate or resolve the condition(s) or issues, and must be individualized to the circumstances of the participant. Criteria for INCPs and medical referrals are the same. If the participant is not receiving medical care for the identified high-risk condition, a written medical referral should be made. Referrals to other programs and services should be made as needed. See Referrals Policy, Section 5.7. Follow-up may include some, or all, of the following: o Dietary assessment. o Monitoring anthropometric measurements and discussion of growth and weight gain/loss. o Monitoring hemoglobin and discussion of blood work results. o Discussion of participant's/caregiver's nutrition or health-related concerns. o Discussion or reinforcement of instructions given by other health care providers. o Assessment of food package needs and/or revision of food package prescription. o Individualized nutrition education. o Monitoring participants with complex medical problems or serious risks to assure they are receiving adequate care from appropriate health/nutrition professionals. o Referral to other programs and services, as needed. o Follow-up on referral to other programs. o Monitoring/modifying realistic goals established with participant/caregiver. Frequency of follow-up should be based on the health condition and individual s needs. o Some participants may need to be seen monthly; others only bi- or tri-monthly. o For example, it might be prudent to plan monthly follow-up for a pregnant woman with a low rate of weight gain, until expected or desired weight gain is observed. o At a minimum, there should be at least one follow-up contact by a CPA within the certification period. For conditions beyond the scope of WIC o These conditions are identified in Exhibit 6-A by: ***If the participant is receiving appropriate care from a qualified health care provider, then the INCP should consist of adequate documentation that care is being provided elsewhere. If the participant is not receiving appropriate health care, a referral should be made to a health care provider, and follow-up of that referral should be provided /06

14 o o o If the participant is not receiving appropriate care for the high-risk condition, a referral should be made and an INCP developed. If the participant is receiving appropriate nutrition support from another health care provider with expertise in the condition, comprehensive care and follow-up may not be necessary by WIC. If this is the case, and the CPA feels the participant is receiving adequate evaluation, care, and follow-up, then the CPA may simply document the following in the participant file: The fact that the participant is receiving nutrition care elsewhere for the Condition. Name, location, and phone number of the provider if available Expertise of the provider(s), e.g., MD, RD, Certified Diabetes Educator, Occupational Therapist, Physical Therapist, etc. How often the participant is being seen by care provider(s) Time frame for the next WIC nutrition education contact Non-high-risk follow-up could therefore, be provided at the additional education contact. However, it may be beneficial to retain high-risk status for the following reasons: To follow-up on referrals. To answer questions, especially if the condition is newly diagnosed. To assure that the participant is stable and hasn t relapsed. Before discontinuing high-risk care, the CPA should be sure that the condition(s) is resolved or stable, and that further monitoring would either not be necessary or not be beneficial. o In some cases it may be beneficial to continue care to prevent relapse. o High-risk status may be discontinued if growth is stable. Documenting INCPs is essential for providing the best individualized and responsive services to participants. o Documentation must be adequately detailed and comprehensive that the condition, nutrition intervention, and planned follow-up are clear to others reviewing the record. o Documenting in a SOAP note in the WIC Information System is preferred, but another method may be used if approved in the local agency s nutrition education plan /06

15 SECTION 6.7 Subject: Additional Education References: (e)(2) Policy: Local agencies must provide additional nutrition education during the certification period. Purpose: To ensure that additional education is made available to all participants. Procedures: Procedures for all participants: Additional Education should: o Be based on the participant s nutritional needs (ie: risks, anticipatory guidance needs, concerns of the participant/caregiver). o Include interaction with an instructor. Written or audiovisual material alone is usually not sufficient. See Guidance for additional information. o Include follow-up to medical referrals and other referrals as needed. See Referral Policy, Section 5.7. o If a participant misses an additional education contact, reschedule the contact and issue vouchers for the interim period. Participants may not be denied supplemental foods for failure to attend or participate in additional education. Document additional education in the participant s record. See Nutrition Education Documentation Policy, Section 6.8. Procedures for High Risk participants: - See High Risk Individual Nutrition Care Plan Policy, Section 6.6. Procedure for Infants: Nutrition education for infants must be provided to the parent or caregiver at a rate equivalent to quarterly, generally at initial certification, midcertification and other additional education contacts as needed based on age at initial certification (see below). o Infants certified before three months of age should receive four nutrition education contacts before the first birthday. See Exhibit 6-E. For infant participants on tri-monthly issuance, a suggested schedule of contacts maybe: initial certification, 3-4 months of age, 6-7 months of age, and midcertification around 9 months of age. o Infants certified between three and six months of age should receive three nutrition education contacts. o Infants certified after six months of age require two education contacts /08

16 Individualized one-to-one education must be provided to the parent/caregiver at the time of certification and midcertification. The other infant contacts may be provided through individual or group sessions. Procedures for all other participants: Participants who do not receive additional education as a high-risk individual nutrition care plan or infant contact should be scheduled for additional education. It must occur at a time other than the initial certification visit and before the next certification. The additional education contacts can be made available through individual or group sessions. The contact should be related to the nutritional needs of the participant. (A class or display does not need to address a specific risk factor of the participant, but the content must be of some potential use to the participant.) Types of contacts: o Individual counseling or discussion session that provides information specific to that participant s risk conditions. o Individual explanation of a newsletter or educational pamphlet that involves a qualified instructor. The newsletter or pamphlet must be appropriate to the category and needs of the participant. o A group or class that is appropriate to the category and needs of the participant. o A display, appropriate to the category and needs of the participant, with a qualified instructor to explain the display, discuss important points, and answer questions. o Other methods as approved in the local agency nutrition education plan. See Guidance for specific information regarding additional education contacts for postpartum women. Guidance: Additional Education contacts by Telephone Additional education may be provided by telephone. The contact should be comprised of an interactive discussion between the CPA and the participant/parent/caregiver. Telephone calls should not be used routinely for the provision of nutrition education, but offers some flexibility in the circumstances identified below. o Examples of times when additional education may be appropriate by telephone: The participant missed their scheduled additional education contact for staff reasons (e.g., CPA staff unavailable due to illness) or participant reasons (e.g., illness, imminent childbirth, transportation difficulties, inclement weather, or unable to come in to WIC due to work schedule, appointment conflicts, or family obligations) and the additional education contact cannot be rescheduled. OR the participant initiates the call and the conversation evolves into nutrition education. o The content of the telephone contact should be based on the participant s nutritional needs identified at the last certification/recertification. Referrals should be provided as appropriate. The content of the contact should be documented per the local agency s documentation procedures. Additional Education provided by an outside entity - An outside entity may provide additional education for participants if the following criteria are met: (These items /08

17 should be discussed with the state nutrition consultant before proceeding with this option for additional education contacts.) o The additional education contact provided by the outside entity is appropriate for the individual s nutritional risks and nutritional interests, the encounter is within the current WIC certification period and the education is documented. o Services provided by staff from an outside entity must be within their scope of practice. o WIC CPA staff should be present in the area to respond to questions that are beyond the scope of knowledge/practice of the outside entity staff person. o Lesson plans written by the outside entity for the additional education contacts should be reviewed and approved by the local agency Nutrition Education Coordinator. o If an outside entity staff person is used for providing additional education, local agencies are encouraged to enter into an annual agreement with the entity which addresses the following roles/expectations: Time period the agreement covers. Responsibilities of the staff from the outside entity (e.g. day(s) of month staff will provide contacts; topic(s); length of clinic day; if staff is sick and unable to attend the WIC clinic, who will backup; and assurance that participant confidentiality will be maintained.) WIC responsibilities (e.g. providing space, setting up room, communication regarding schedule changes and materials, CPA staff present to answer participant questions.) o The contacts should be documented per the local agency documentation procedures. See Nutrition Education Documentation policy, Section 6.8. Self-guided education contacts Self-guided education includes computer-based nutrition education, viewing a videotape, or participating in a learning center. Additional education may be self-guided if the following criteria are met: (These items should be discussed with the state nutrition consultant before proceeding with this option for additional education contacts.) o The participant does not require a high-risk contact. o The contact is appropriate for the individual s needs, the encounter is within the current WIC certification period and the education is documented. o The participant is given the opportunity to interact with a CPA to discuss the content of the self-guided contact and to ask questions. Procedures for Postpartum Women (Breastfeeding and Non-Breastfeeding): o Postpartum Exit Counseling - Postpartum women who will not be eligible for the WIC Program at the end of their current certification should be provided postpartum exit counseling as their additional education contact. o This education may be offered as individual or group education and should include printed materials. o The education and/or printed information should include information on the following topics: The importance of preconceptual folic acid intake in reducing neural tube defects; Continued breastfeeding as the preferred method of infant feeding; The importance of immunizations for children; The health risks associated with the use of alcohol, tobacco, and other drugs; /08

18 The need for a well balanced diet; and, Referrals as appropriate. The participant s need for additional education and participant s preferences should be considered when determining the rate of voucher issuance (monthly, bi-monthly, or trimonthly). Tri-monthly voucher issuance is appropriate for most participants. Generally, a participant can be on tri-monthly voucher issuance unless s/he needs to return to clinic more frequently because of nutritional concerns or inappropriate use of vouchers. When determining the rate of voucher issuance, the following should be considered: o Infant contacts must be offered at a rate equal to quarterly, but not necessarily in every quarter. Contacts can and should be adjusted to meet the nutrition education and assessment needs of the infant. For the breastfed infant the early postpartum period is a time when questions and concerns related to breastfeeding may lead to cessation. The CPA should determine how frequently the breastfed family needs to be seen based on the infant s age, the mother s experience, other support systems available to the mother, and how well breastfeeding is going. It may be most appropriate to schedule breastfed infants for monthly voucher issuance and individual follow-up. Once the CPA has determined that breastfeeding is well established and the mother s questions and concerns are addressed, the family may be switched to multi-monthly voucher issuance. o If a participant is placed on monthly or bi-monthly issuance, s/he should receive meaningful education at the voucher pickups. Local agencies are discouraged from scheduling monthly weight checks unless the weight check includes an assessment of weight progress and interaction with a qualified instructor. o Participants who miss or do not attend their next scheduled additional education contact should be issued one month s vouchers and be re-scheduled in the following month for the additional education contact. Use of non-cpa WIC staff for Additional Education. WIC staff who are not CPAs may be utilized to provide nutrition education activities on a limited basis, to assist or expand the efforts of the CPA staff. Nutrition Education activities will be limited to providing additional education to parents of low-risk children who do not require an INCP. Trained and supervised peer breastfeeding counselors may provide support for breastfeeding women. See CPA policies in Chapter 4. o Qualifications of these individuals will vary depending on the resources and/or circumstances of the local agency (e.g., may include local agency health educator staff). o Any non-cpa WIC staff providing nutrition education should be: Familiar with the social and economic conditions of the specific community they are serving. Familiar with the cultural patterns and practices of the specific community they are serving. Able to complete training in the areas of nutrition for which they will be providing educational activities. Able to communicate effectively. o Roles of the non-cpa include: Complete training in basic nutrition /08

19 Present basic nutrition information prepared or approved by the Nutrition Education Coordinator. Nutrition information will be presented only under the on-site supervision of the Nutrition Education Coordinator or their designated CPA staff member. Non-CPA staff will refer all questions outside their scope of knowledge to the Nutrition Education Coordinator or designated CPA staff member /08

20 SECTION 6.8 Subject: Nutrition Education Documentation References: (e)(4) Policy: The local agency must document nutrition education in each participant s certification chart. Purpose: To help WIC staff consistently follow-up and reinforce education already provided. To ensure that appropriate education is provided for the participant. Procedures: Procedures for documenting Initial Education: Initial education contacts, which are completed at the certification or recertification appointment, must be documented in the participant s record. The required components are: o Participant name o Date the education was provided o Topics discussed o Prioritize and plan for subsequent visits o Name of CPA who provided the education (If documenting in the WIC Information System, the system will automatically record CPA user name) Initial education contacts may be documented in one of the following locations: o Nutrition Education Tab (with Notes in the WIC Information System as needed) o Notes in the WIC Information System o Forms in paper chart. Use electronic documentation unless paper documentation facilitates best services. Refer to the first and third points under Guidance. o Other options as approved in the local agency Nutrition Education Plan For high-risk participants requiring an Individual Nutrition Care Plan (INCP), See High Risk Individual Nutrition Care Plan policy, Section 6.6. Procedures for documenting Additional Education: Options for documenting additional education contacts which are provided on an individual basis: o Nutrition Education Tab (with Notes in the WIC Information System as needed) o Notes in the WIC Information System o Form in the paper chart. Electronic documentation is strongly recommended. o Other options as approved in the local agency Nutrition Education Plan Options for documenting additional education contacts that are provided in a group setting. (This includes a display board with an educator.) /06

21 o Nutrition Education Tab in the WIC Information System. (A separate record should be maintained of the class or display topics, content outline, instructor, and dates presented.) o Notes in the WIC Information System document the date and class title. (A separate record should be maintained of the class or display topics, content outline, instructor, and dates presented.) o Class attendance list for classes or displays include the topic, content outline, instructor, date of the education, participant s name and the name of the proxy or caregiver, as appropriate. o Question and Answer sheet include the participant name and date of education. Use the questions and answers for discussion with an instructor, then file the sheet in the participant s chart as documentation of attendance or document by another method as described in the local agency Nutrition Education Plan. Options for documenting additional education contacts that are self-guided (this includes computer-based nutrition education, viewing a videotape, or participating in a learning center): o Nutrition Education Tab in the WIC Information System. o o o Notes in the WIC Information System. File a Certificate of Completion in the participant s chart Form in the paper chart Documentation should also include a record of education offered and either missed or refused and the reason the participant did not attend. Guidance: Local agencies are strongly encouraged to use the Nutrition Education Tab to help minimize the time and effort needed to document nutrition education. Use of the Nutrition Education Tab enhances the local agency ability to provide consistent education. CPAs are able to follow-up on previous education without pulling a paper chart. If the agency uses the tab, all documentation of nutrition education can be completed in the WIC Information System. The tab should be used in conjunction with the Notes function. Notes maybe used for Individual Nutrition Care Plans (INCP) documentation and other lengthy narrative notes. For many low-risk participants, documentation of nutrition education in the tab should be sufficient. However, CPAs may write notes as needed to record the unique needs of a lowrisk participant and to facilitate care and follow-up. An agency may choose to use a combination of paper and the WIC Information System documentation. This may be necessary if another public health program is accessing WIC information. For example, an agency may decide to document infant and child nutrition education contacts in the WIC Information Systemand document nutrition education contacts with pregnant women on a paper form so the MCH program may access that information. (Keep data privacy requirements in mind.) If combinations of documentation methods are used, the local agency should establish specific documentation procedures and make sure that all CPAs are aware of the procedures and /06

22 using them consistently agency-wide. Such consistency will help assure sufficient documentation and facilitate good continuity of care (i.e., enabling another CPA to review the documentation and clearly understand what was covered during the nutrition contact.) Documentation is required in only one place. Local agencies are strongly discouraged from documenting the same information in multiple places /06

23 SECTION 6.9 Subject: Nutrition Education Materials References: (c)(3) Policy: Local agencies should use appropriate nutrition education materials that deliver accurate and consistent messages to participants and address the nutritional needs of participants. Purpose: To assure the use of appropriate, accurate, high-quality nutrition education materials. Procedures: All written nutrition education materials provided or suggested by the state office will be evaluated by using the Guide to Evaluating Written Nutrition Education Materials and the corresponding Written Nutrition Education Materials Review Form. Audiovisual nutrition education materials will be evaluated using the Guide to Evaluating Audiovisual Nutrition Education Programs and the corresponding Audiovisual Nutrition Education Program Review Form (see Exhibit 6-D.). Evaluations will take place as the materials are revised or updated. o State Nutrition Consultants, working with the Nutrition Education workgroup, will evaluate nutrition education materials provided or suggested by the state office. o Materials will be evaluated for content, reading level, graphic design and accuracy. Language and cultural appropriateness will also be considered. A copy of the materials and evaluation will be kept on file at the state agency as long as the resource is available from the state. Local agencies are encouraged to order and utilize materials available from the state WIC agency. Guidance: When a local WIC agency uses nutrition education materials not provided or suggested by the state office, the nutrition coordinator for the agency is encouraged to evaluate the materials using the state suggested evaluation tools or a locally developed tool. If a locally developed tool is used, it should evaluate content, reading level, graphic design and accuracy of nutrition education materials. Language and cultural appropriateness should also be evaluated.see Guide to Evaluating Written Nutrition Education Materials or Guide to Evaluating Audiovisual Nutrition Education Programs (Exhibit 6D) for information on how to use the evaluation tools. A copy of the materials and evaluation should be kept on file as long as the resource is being used /06

24 Guide to Evaluating Written Nutrition Education Materials can be used to evaluate newsletter articles, staff education materials, and materials for publication in other forms as well as participant education materials /06

25 SECTION 6.10 Subject: Local Agency Nutrition Education Plans References: (d)(2) Policy: The local agency must develop and implement a nutrition education plan for providing education relevant to participant needs. Purpose: To ensure that local agencies plan and evaluate nutrition education activities provided to program participants. Procedures: 1. The nutrition education plan is completed or updated every 2 years. 2. Each local agency will complete a nutrition education plan that is consistent with statewide nutrition education goals and objectives. 3. The state WIC agency will mail forms and instructions for submitting the nutrition education plan. The forms are for documenting the nutrition education plan. 4. Local agencies submit the completed nutrition education plan by the deadline specified in the instructions. Extensions for extenuating circumstances are available. 5. The assigned state nutrition consultant will review the local agency nutrition education plan by the date specified in the instructions. The local agency will be notified of approval or, if needed, revision requirements. If any revisions are required, the nutrition consultant will indicate the deadline for revisions in the letter of notification. 6. The local agency will implement the plan. 7. The state nutrition consultant will assure implementation of the plan /06

26 BREASTPUMP EDUCATION AND PROCEDURES SECTION 6.11 Local agencies will make breastpumps available to participants at their discretion, only when, after evaluating participant needs and other sources of breastpumps, providing a WIC breastpump is the best option for the individual participant Determining Need for a Breastpump Providing breastpumps and supportive education may facilitate longer duration of breastfeeding for some women. Providing a breastpump to a woman who does not have a need for a pump, or providing a pump not suitable to her needs, may make breastfeeding seem complicated, and could lead to shorter breastfeeding duration. Breastpumps may be provided to women who: 1) must be separated from their infants for a variety of reasons (such as returning to work/school); 2) desire to be able to leave their infant with a caregiver who can provide pumped milk; 3) have medical problems requiring separation; or 4) other situations. Issues to consider when deciding on the use of a pump include: Does the infant have special needs, such as a hospitalized infant, an infant who is not able to breastfeed, an infant with a suck too weak to obtain sufficient breastmilk? In these situations, an electric pump is recommended. The participant should check with their or their infant s medical caregiver or insurance provider/medical Assistance regarding breastpump coverage when pumping is medically indicated. What are the mother s plans? Will she be away from her infant and provide pumped milk only occasionally? Is she returning to work or school? A manual pump may be an appropriate choice for occasional or short term separations, or when returning to work for ½ days or less. For participants who are returning to work full time, a PedalPump with a double pump kit will be faster and will help provide stimulation to maintain milk supply. If a mother is returning to work with a pump provided by WIC, WIC staff should provide follow-up to see how the pump is working for her and to discuss any decrease in her milk supply. Women returning to work or school may also have coverage for a breast pump through Medical Assistance. Is manually expressing milk an option? Many women become proficient at manual expression of breastmilk and prefer it to a pump. Does the mother have a place and the time to pump milk? An electric pump may be more appropriate if a woman has limited time to pump. Is the mother sufficiently interested or motivated to make the effort to pump milk? Does she have the support and resources that are necessary to enable her to pump milk? /06

27 Education and Documentation Requirements for Breastpumps All local agency staff who are distributing pumps should be trained on breastpump assembly, use and cleaning, and on common questions related to use of the pump, by a representative of the breastpump manufacturer (or trainer approved by the state WIC office). When a pump is provided to a WIC participant, the staff person should discuss assembly, cleaning and use, and how to store breastmilk. The participant should then demonstrate correct assembly of the pump for the staff person. Written instructions on breastpump assembly should accompany the pump. Breastpump distribution and education provided should be documented in the participant s record with other nutrition education documentation, or on the pump tracking form, with a note in the client s nutrition education record that a pump was provided see tracking form for (date). If more simplified assembly instructions, or instructions in other languages are needed, contact the breastpump manufacturer. If appropriate materials are not available, contact the State Breastfeeding Coordinator Providing Follow-up on Breastpumps WIC recommends that participants who are provided with breastpumps receive a follow-up contact to determine how the pump is working for them, to assess any changes in their milk supply, and to answer any questions they might have. Sample forms, which can be used to track participants who have received pumps, are included as exhibit 6-G. These forms can be modified to meet the needs of the local program. You may find it easier to track all types of pumps on one form, or to use separate forms for each type of pump. One form includes an inventory. Another option for tracking breastpump issuance is to record pump issuance in the WIC Information System notes and set an alert for providing a follow-up contact Purchasing Breastpumps The Local Agency Breastfeeding Coordinator is responsible for determining the type and number of breastpumps to purchase. Correspondence related to selecting and purchasing breastpumps should come from the Local Agency Breastfeeding Coordinator or Coordinator. The State WIC Office determines the method that Local WIC Programs must use to obtain breastpumps if they will seek reimbursement for the breastpumps from the State WIC Office. The current method is described in Exhibit H. The State WIC Office will notify Local WIC Programs when there is a change in pump procurement methods. Specific information on ordering through our current procurement method is found in Exhibit H and Exhibit I. Manual breastpumps, double pump kits, PedalPumps, and related supplies, as listed on the Minnesota WIC Breastpump order form, may be purchased by the local WIC program on an as needed basis, unless you are informed otherwise in the future. The purchase of electric and / or personal electric breastpumps always requires prior approval from the State WIC Office. If you determine a need for an electric or personal electric breastpump contact the State Agency Breastfeeding Coordinator for purchase approval /06

28 You will not be reimbursed for any purchase of an electric or personal electric breastpump for which you do not have prior approval. If you purchase an electric breastpump refer to section 2.11 for information on inventory of WIC equipment. You will be reimbursed only for the items listed on the Minnesota WIC Pump Order Form. If you feel you need a breastpump or supply that is not listed on the form contact the State Agency Breastfeeding Coordinator Obtaining Reimbursement for the Breastpumps You Purchase When receiving the pumps: 1. Verify that number of pumps received and charges are correct. There should not be a charge for shipping. 2. Pay the vendor. 3. Complete the Claim Form for Breastpump Purchase Reimbursement, Exhibit 2H. To ensure faster payment, please use the checklist on the claim form to make sure all information necessary for payment is included. 4. Note that pump cleaning supplies are included on the order form for your convenience. We cannot reimburse you for pump cleaning supplies. 5. Submit the Claim Form for Breastpump Purchase Reimbursement with a copy of the invoice (not the statement or packing list) to the State WIC Breastfeeding Coordinator. Claim the breastpump reimbursement only on the Claim Form for Breastpump Purchase Reimbursement, and not on your normal monthly claim for reimbursement. 6. Funds will be transferred to your account. If one fiscal agent serves more than one local WIC agency it would be helpful to notify the fiscal agent to expect the funds for your agency Providing Manual Breastpumps to WIC Participants Breastpumps and/or personal pump kits may be purchased through procedures specified by the State WIC Office. These procedures include provisions which describe reimbursement methods currently in effect. Alternatively, local agencies may elect to purchase breastpumps and/or personal pump kits with their local WIC funds and provide them for free to participants or sell them to participants at or below the price paid by the agency, including shipping charges. Only breastpumps and/or personal pump kits that are purchased with WIC funds and not reimbursed by the State WIC Office may be sold to participants. Proceeds, if any, from sales of breastpumps should be deposited into the local WIC account and credited to the same category used when the pumps were purchased. Disposition of all breastpumps must be recorded so that all pumps and pump kits can be tracked back to an eligible WIC participant Reuse of PedalPumps / Manual Breastpumps The wooden component of the PedalPump may be re-used, with a new spring. Clean the pump with Envirocide or Cavicide (listed on the order form Exhibit I), or a similar product, before lending the PedalPump to another participant. Personal pump kits or personal electric pumps should be treated as a single-user item. WIC discourages re-use of single-user breastpumps or pump attachments, even when they are autoclaved /06

29 Purchase or Lease of Electric Breastpumps by Local Agencies Due to the staff time involved with leasing, tracking, and maintaining electric pumps, and liability to the local agency the Minnesota WIC program recommends that WIC agencies not lease/loan electric breastpumps. If you find a participant who has a medical need for a breastpump and the participant does not have insurance coverage or another way to obtain or rent the pump contact the state WIC Breastfeeding Coordinator to discuss the need and possible options for the participant. In rare circumstances, a local agency may be approved to purchase or lease electric breastpumps for loan to participants. The agency must: Request approval from the state WIC office before purchasing the pump; Assure that there is adequate WIC staff time to provide required WIC services in addition to maintaining pump loan and follow-up; and Demonstrate that the local agency s legal consultant has reviewed lease or loan arrangements. Such pumps must be appropriate for multiple users. Leases should not incur liability for replacement of the pump on either the state or local WIC agencies. Lease agreements should be carefully reviewed and signed by the participant, so that the participant clearly understands her responsibilities to care for and return the pump. A refundable deposit may be collected from the participant. A written agreement specifying the amount of deposit, conditions for returning the deposit, and the date, should be signed by both the local agency and the participant. A copy of the agreement must both be given to the participant and retained in the agency file Selection of Breastpumps for Purchase or Lease Many different breastpumps are available. Breastpumps should be evaluated for safety and effectiveness prior to purchase by the local agency. Contact the state WIC Breastfeeding Coordinator for guidance in evaluating and selecting breastpumps Glossary of Terms For the purposes of this policy, the following definitions have been used: Manual breastpump: a pump operated by hand (no motor) suitable for occasional pumping PedalPump: a wooden device, operated by foot, which can be attached to a pump kit for single or double pumping Personal electric pump: an electric pump that is designed to be used by only one person. Most personal electric pumps can be used with a pump kit for single or double pumping. Electric pump: a pump with a more durable motor than that on a personal electric pump, and a mechanism to prevent contamination of the motor with breastmilk; suitable for sharing between multiple users /06

30 Spring (ExpressSpring ): a device in the cylinder of the Medela manual breastpump to aid return of the pump piston. May be used with the Medela manual pump or PedalPump. Double or single personal pump kit: a personal kit that is attached to a PedalPump, personal electric pump, or electric pump, to collect breastmilk. The kit may be either single (pumps one breast at a time) or double (pumps both breasts at the same time) /06

31 SECTION 6.12 Subject: Breastfeeding Peer Support References: MWSSNP 1-2: WFM 2 /NE 4-2 Policy: Local agencies may initiate breastfeeding peer support programs to supplement existing WIC breastfeeding education and support. Purpose: To supplement the prenatal and postpartum breastfeeding support available to WIC participants, and to ensure that breastfeeding peer support staff are qualified, trained, supervised, and perform appropriate duties. Procedures: Contacts provided by peer support staff must be in addition to the two required nutrition education contacts. (See MOM section 6.2) Peer Support Manager(s) -- The local agency must designate staff to manage their peer support program. Responsibilities may be split between two or more staff if all roles are assigned and clearly defined. At least one staff person must be an IBCLC (on staff or by contract). The agency may request to fulfill the requirement for an IBCLC with a person who has been certified as an IBCLC (and can provide documentation of their previous IBCLC status) and is continuing to meet the continuing education requirements set forth by IBLCE from the date of their IBCLC certification to the present, but who has elected not to retake the IBCLC certification exam. Documentation of continuing education must be submitted with the annual end-of-year report, required of the local peer program. Responsibilities include, but are not limited to: o Policy development; o Hiring peer support staff; o Initial and ongoing training for peer support staff; o Supervision, including: At least monthly spot checks with participants being followed by peer support staff. Reviewing peer contact logs at least every other week (ideally weekly); At least weekly phone contact and monthly individual meetings with peer support staff, and Periodic meetings with all peer support staff. o Integrating WIC peer support activities into WIC operations (e.g., involvement in staff meetings; explanation of peer support to all WIC staff; identifying how WIC staff will refer participants to a peer support staff person.) o Providing back-up for peer support staff who encounter situations beyond their scope, both during and after normal clinic hours, and developing a plan for backup if a WIC peer manager, supervisor or other designated WIC staffperson is not available /10

32 o Maintaining records, in the WIC office, of all required peer / peer program documentation. Peer Support Managers must be trained using the FNS curriculum Using Loving Support to Manage Peer Counseling Programs. Peer Support Managers and all other staff providing back-up must have at least annual continuing education in breastfeeding management. WIC Peer Support Staff Peer support staff funded with FNS peer support funds must meet the minimum FNS definition of a peer counselor: o Paraprofessional; o Recruited and hired from target population; o Breastfed at least one baby (need not be breastfeeding currently); and o Available at WIC clinics and, when necessary, outside usual clinic hours and the WIC clinic environment. Peer support staff must receive the following training: o Using the FNS curriculum Loving Support through Peer Counseling ; o On appropriate scope of practice and provided written information on situations that must be referred or yielded to their supervisor and/or participant s medical provider (see Exhibit 6-J). o On confidentiality and sign a confidentiality agreement (see Exhibit 6-K). The confidentiality statement must be reviewed with, and signed by, each peer annually. Staff who work from home must be provided a locking file box for securing their records. When transported in a car the locking file box must be kept in a locked trunk. Peer staff must be trained to assure that confidential information is neither seen nor overheard by family members or guests. o Additional training at least twice a year. o Orientation to the WIC Program. o The opportunity to meet WIC staff. Peer support staff must document all contacts (and attempted contacts) with WIC participants. Documentation must include: o Participants names (mother and infant); o Date of the contact or attempted contact; o Participant s questions, concerns or comments; o Topics discussed; o Referrals; o Plan for follow-up; and o Peer contact time /10

33 Peer support staff must receive compensation for their work and reimbursement for mileage and long distance phone charges, if applicable. When a participant is no longer receiving peer services, the peer must give all documentation related to peer services for that client to their supervisor for filing in the WIC office. Other WIC Staff The local agency must have an adequate number of trained IBCLCs or CPAs trained in lactation management to supervise peer support staff and handle questions and issues beyond the scope of the peer support staff. Most peer programs will need back up staff beyond the required peer manager. All WIC staff should be trained on the role of peer staff and how to refer to peer staff, and have the opportunity to meet the staff. Claims for Reimbursement Local agencies receiving designated peer counseling funds through the Minnesota WIC Program must follow specified procedures, using the appropriate claim form, to request reimbursement for activities related to peer support program. Contact the state WIC office for the claim form for the current fiscal year. All or a portion of a WIC staffperson s salary may be billed to the peer support funds for time spent on activities directly related to the peer support program. The local agency must maintain records to document all expenses, including staff time, billed to FNS peer support funds. Time and other expenses that are billed to peer support funds must not be claimed on the local agency s monthly WIC claim for reimbursement. Expenses charged to the peer pilot grant cannot exceed the amount of the grant award. Peer-related expenses in excess of the peer grant amount, may be claimed on your monthly WIC claim for reimbursement Community Partnerships If your agency plans to work with a non-wic organization to provide WIC peer support services, you must first discuss this with the State WIC Breastfeeding Coordinator. If approved to proceed, you must submit a written plan. A WIC staffperson, designated as the peer program manager or peer program coordinator, must be, and must remain, actively involved with the peer program. If the plan is approved, and if FNS peer funds will be used to train paid staff from another entity/program as peer counselors for WIC, an MOU must be established with the other entity ensuring: o That the peer counselors will operate under the same parameters as required for WIC peer breastfeeding support programs. o Compliance with FNS requirements and Minnesota WIC peer policy and peer grant agreement /10

34 Guidance: Considerations when Hiring Peer Counselors In addition to the required qualifications of a breastfeeding peer counselor, research has shown that peer counselors may be more effective when they: o Have enthusiasm for breastfeeding o Possess good basic communication skills o Have previous breastfeeding experience (ideally > 6 months) o Are similar to WIC participants they will serve (i.e., in ethnicity, age, and language spoken) o Are currently, or have been, a WIC participant o In cases when a peer with specific language or cultural skills is needed and you are unable to identify a peer who meets all of the background requirements contact the State WIC Breastfeeding Coordinator. Peer counselors should have access to a telephone and transportation. Peer counselors should understand work expectations. Sample job descriptions are found in the FNS peer materials, available from the State WIC Office. Work Parameters In addition to their work in WIC clinics, peer counselors should expect to make home and hospital visits when needed, and make telephone contacts from home and clinic. WIC peer support staff may bring their nursing infants to work with them. Peer contact frequency More frequent contacts with pregnant and breastfeeding women increases the effectiveness of peer support. FNS recommends the following contact schedule as most effective: o Pregnant women: Monthly More frequently as due date nears. o Early weeks postpartum: Within 24 hours if there are problems; Every 2 3 days during the first week; Weekly the rest of the first month. o After the first month: The peer breastfeeding support staffperson and the breastfeeding woman can determine the contact schedule. (The peer counseling program manager can provide guidance in frequency of contacts.) FNS recommends monthly contacts during the first year, and additional contacts if needed (e.g., if returning to work or school). Compensation and reimbursement of peer support staff Many WIC programs offer peer counselor salaries similar to a clerk or community health worker. Other recommendations: /10

35 o Provide travel allowance for home/hospital visits and meetings. o Cover training expenses. o Provide benefits if possible. Peer Counselor Manager A sample job description for WIC staff that manage the peer support program is found as Exhibit 6-L. If responsibilities are split between two or more staff, the roles for each must be clearly defined and include all required roles. WIC IBCLC The IBCLC may be a WIC employee or a contracted employee. Contact the State WIC Breastfeeding Coordinator for additional information on training your WIC staff to become IBCLCs or on finding an IBCLC in the community. Training Peer counselors should receive orientation to WIC so that they are familiar with services being received by participants. WIC staff who are trained in breastfeeding support can help integrate peers into the WIC program. Materials provided for home study can supplement formal instruction for peer support staff. Opportunities for peer counselors to shadow or observe other peer counselors and lactation experts are very helpful. Some states have developed career path options for peer support staff (e.g., training/experience to become senior level peer counselors; training to become IBCLC). If peer staff attend conferences or workshops on breastfeeding, the contents of the workshop in relationship to peer s scope of practice should be discussed after the workshop. Supervision of Peer Support Staff The mentor/supervisor transition has been reported to be effective for many successful programs. These programs have the supervisor act as a mentor for the first 6 months, and then gradually change to a more traditional supervisor role. If used, this planned change should be explained to the peer support staff. Documentation of Client Contacts A sample peer documentation form is included as Exhibit 6-M. A sample Peer Weekly Activity Report is included as Exhibit 6-N. Required Peer Program Documentation Records to demonstrate that peer program implementation is consistent with the peer program requirements must be maintained in the WIC office. This documentation should include: Signed confidentiality statements, Records of spots checks, Training records, /10

36 Peer logs, Peer documentation for participant who are no longer receiving peer services, and Other records to support activities of the peer program. Community partnerships enhance the effectiveness of a WIC peer support program. Designate a WIC staffperson to establish and maintain communication with other organizations that work with pregnant and breastfeeding woman and inform them of the WIC peer support. These might include: breastfeeding coalitions; businesses and community organizations; cooperative extension program; lactation consultants; La Leche League; home visiting programs; private clinics; hospitals, and others /10