Attachment B - Policy Procedure.pdf

Rev 04/2024

WIC Breastfeeding Peer Counselor Program Policy and Procedure Contract Agency: Growing Up Together

The South Dakota WIC Program implemented the Breastfeeding Peer Counseling (BFPC) program in January 2005. The program requirements are to follow the WIC Breastfeeding Model Components for Peer Counseling and the following policies and procedures.

A Peer Counselor is a paraprofessional support person who gives basic breastfeeding information and encouragement to pregnant and breastfeeding mothers enrolled in the WIC program.

A Breastfeeding Specialist holds the International Board-Certified Lactation Consultant (IBCLC) credential issued by the International Board of Lactation Consultant Examiners, which enables the IBCLC to handle more complex breastfeeding problems, provide in-service education on lactation information and encouragement to pregnant and breastfeeding WIC mothers.

Peer Counselor Responsibilities

• Follow-up on referrals within timeframe specified in section Frequency of Contacts.

• Counsel pregnant and breastfeeding participants using an approved online tracking and communication software, to communicate by text, phone, email and virtual consultation in accordance with section Frequency of Contacts. May meet in person with participants at local WIC offices if requested by the participant.

• Counsel non-English speaking participants using an interpreter, if unable to speak the language.

• Communicate participant updates with WIC staff.

• Records overview of all contacts with participants in SDWIC-IT.

• Provide basic breastfeeding information and support to new mothers, including:

o the benefits of breastfeeding o overcoming common barriers o getting a good start with breastfeeding o how to prevent and handle common breastfeeding concerns

• Refer to the WIC Breastfeeding Model Components for Peer Counseling training curriculum for guidance on counseling techniques.

• Respect each participant by keeping her information strictly confidential.

• Keep accurate records of all contacts made with participants.

• Refer mothers to:

o BFPC Program Breastfeeding Specialist o WIC Local Agency Breastfeeding Coordinator o WIC Designated Breastfeeding Expert o Lactation Consultant within their community o Participants’ physician or nurse o Public health programs in the community o Social Service agencies

• Attend and assist with breastfeeding classes and/or support groups.

• Attend staff meetings and breastfeeding conferences/workshops as requested.

• Monitor the Virtual Help Desk forum and any support messages that are received.

• Participate in annual Department of Health HIPAA and Civil Rights trainings.

• Read assigned books and materials on breastfeeding that are provided.

• May assist WIC staff in promoting breastfeeding peer counseling through special projects and duties as assigned.

• May not give out breast pumps or breastfeeding aids.

Peer Counselor Scope of Practice

• Perform in a professional manner in all aspects of the role.

o Respect the participant’s privacy, dignity, and confidentiality.

HERC10234

Text Box Attachment B o Respect and respond sensitively to cultural attitudes and practices of participants and the community.

o Work within the policies and procedures of the WIC program.

o Maintain records according to legal requirements and ethical practices.

o Recognize when assistance is needed and consult with the BFPC Breastfeeding

Specialist, WIC Local Agency Breastfeeding Coordinator, WIC Designated Breastfeeding Expert, and/or lactation specialists.

o Identify situations outside the scope of practice and refer as appropriate in a timely manner.

• Encourage and support participants to breastfeed.

o Use participant-focused communication techniques to best meet participant needs.

o Help participants identify the support available to them and educate family members.

o Help participants identify their breastfeeding concerns, barriers, and solutions.

o Teach the reasons to breastfeed and the risks of not breastfeeding.

o Teach the importance of exclusive breastfeeding in the early weeks.

o Promote breastfeeding in the community, workplace, and healthcare system.

o Support breastfeeding participants from pregnancy through growth spurts, introducing solid foods, and weaning.

• Teach basic breastfeeding to participants and help them when difficulties occur.

o Teach basic, evidence-based techniques that help ensure a successful start in breastfeeding, including milk production, skin-to-skin care, positioning and latch, and milk expression and storage.

o Identify signs of the normal course of breastfeeding, including breastfeeding frequency and duration, infant feeding cues, and normal infant weight gain and stooling patterns.

o Provide anticipatory guidance to help prevent the occurrence of problems.

o Provide guidance to mothers regarding non-evidenced based breastfeeding information they receive.

o Help participants plan for return to work or school that supports the continuation of breastfeeding.

o Provide basic and timely problem-solving and support.

Peer Counselor – When to Yield

• A peer counselor must immediately consult the BFPC Program Breastfeeding Specialist and/or WIC DBE to discuss the best plan for supporting a mother and infant with situations/concerns outside their scope of practice.

• The peer counselor will continue to provide support while the Breastfeeding Specialist and/or WIC DBE addresses a situation outside their scope of practice unless the Breastfeeding Specialist, WIC DBE, supervisor, breastfeeding peer counselor, or WIC participant determines it is best to discontinue peer support.

• The breastfeeding peer counselor will use the following guidance for when to yield:

Yield if:

Pregnancy Concerns

• Spotting or bleeding

• Excessive vomiting or nausea

• Swelling

• Contractions, suggesting premature labor

• Baby stops moving

• Other troublesome medical situations

Baby Concerns

• Baby is born preterm or low birth weight

• Baby is sick

• Baby has fewer than 6 wet diapers and 3 stools per 24 hours in the first month after the baby is 4 days old

• Baby fails to gain weight or gains weight slowly:

• Baby loses more that 7% of birth weight

• Birth weight is not regained by 2 weeks postpartum

• Weight gain is less than 4.5 ounces per week

• Baby has difficulty latching or remaining latched after several attempts

• Baby appears unhappy at the breast or refuses to breastfeed

• Baby is still hungry after feedings despite 24 hours of increased frequency and duration of breastfeeding

• Breastfeeding typically lasts more than 45 minutes

• Baby is jaundiced

• Baby has a congenital defect such as cleft lip/palate or Down Syndrome

• Baby has restricted tongue movement from a tight frenulum

Mother Concerns

• Mother has engorgement or plugged ducts that are not resolved after 24 hours

• Mother has a fever (suggesting possible mastitis)

• Mother has nipple discomfort that does not improve after 24 hours

• Mother is supplementing with formula before the baby is 1 month old and wants to increase her milk production or reduce/eliminate formula supplements

• Mother has been formula feeding the baby since birth and now wants to breastfeed

• Mother is exclusively pumping her milk and now wants to put her baby to breast

• Mother wants to breastfeed an adopted baby

• Mother is breastfeeding more than one baby

• Mother wants to breastfeed but has been advised NOT to by her Health

Care Provider

• Mother finds a lump in her breast

Mother/Baby Illness Concerns

• Mother or baby show symptoms of thrush/yeast infection

• Mother or baby are vomiting or have diarrhea

• Mother or baby are hospitalized

• Mother has symptoms of mastitis

• Mother has a physical handicap

• Mother or baby has a chronic or acute illness

• Hepatitis B or C, tuberculosis, chickenpox

• Renal, liver, intestinal, heart problems, cystic fibrosis

• Diabetes or metabolic disorders

• Mother has been diagnosed with AIDS/HIV

Other Medical Concerns

• Mother has been prescribed medications that have not been approved for breastfeeding by current established authorities such as the American Academy of Pediatrics or LactMed

• Mother has had prior breast surgery (breast implants, breast reduction, biopsy, breast cancer), chest surgery, or trauma

• Mother has had gastric bypass surgery

• Mother has a history of Polycystic Ovarian Syndrome, hypothyroidism, or other hormonal conditions that could affect breastfeeding

Nutrition Concerns

• Mother has nutrition questions

• Mother is nutritionally at risk for underweight, has bulimia or anorexia, or other eating disorder

• Mother has no food

• Mother is eating non-food items (PICA)

Social Concerns

• Mother appears depressed or admits to depression

• Physical abuse of the mother or another family member is suspected or admitted

• Unsafe living environment https://www.aap.org/en-us/Pages/Breastfeeding-and-Medication.aspx https://www.aap.org/en-us/Pages/Breastfeeding-and-Medication.aspx https://www.ncbi.nlm.nih.gov/books/NBK501922/

• Mother is abusing or suspected of abusing alcohol or street drugs (such as heroin, marijuana, meth, cocaine)

Other Concerns

• Mother or baby have any other medical problems that are outside the peer counselor scope of practice

• Mother feels there is a problem that needs referral

• Peer counselor feels there is a situation that needs to be addressed by a lactation expert

• Mother is not following suggestions given by the peer counselor

Breastfeeding Specialist Responsibilities

• Receives referrals from Peer Counselors of mothers experiencing complex maternal and infant breastfeeding problems beyond their scope of practice.

• Receives referrals and communication from WIC staff in regards to participants enrolled in the BFPC program.

o All communication between the WIC staff and Breastfeeding Specialist must include the participants Peer Counselor.

• Assesses breastfeeding situations and provides counseling to WIC participants. Provides timely follow-up services (within 24 hours) to WIC participant by providing evidence-based information.

• Uses an approved online tracking and communication software, to communicate by text, phone, email and virtual consultation. May meet in person with participants at local WIC offices, if requested by the participant.

• Counsel non-English speaking participants using an interpreter, if unable to speak the language.

• Provide expertise to assist Peer Counselors in new and challenging cases.

• Makes referrals to health professionals with medical concerns beyond the IBCLC Scope of

Practice.

• Respects each participant by keeping her information strictly confidential.

• Keeps accurate records of all contacts made with WIC participants.

• Provides initial and ongoing breastfeeding training for Peer Counselors and WIC staff.

• Mentors Peer Counselors by reviewing online communication and participating in peer reviews.

• Facilitates virtual, statewide breastfeeding classes and/or support groups. Can provide in-person classes at local WIC office.

• Attend meetings and breastfeeding conferences/workshops as appropriate.

• Participate in annual South Dakota Department of Health HIPAA and Civil Rights trainings.

• Actively participates in initial and ongoing trainings including:

o Initial Peer Counselor training using WIC Breastfeeding Model Components for Peer Counseling curriculum to better understand Peer Counselor scope of practice.

o Breastfeeding workshops, presentations, and conferences offered by the WIC program o BFPC staff monthly meetings

Breastfeeding Specialist Scope of Practice:

• Perform in a professional manner in all aspects of the role.

• Respect the participant’s privacy, dignity, and confidentiality.

• Respect and respond sensitively to cultural attitudes and practices of participants and the community.

• Work within the policies and procedures of the WIC program.

• Maintain records according to legal requirements and ethical practices.

• Follow the International Board-Certified Lactation Consultant (IBCLC) Scope of Practice, as issued by the International Board of Lactation Consultant Examiners,

• Encourage and support participants to breastfeed.

• Use participant-focused communication techniques to best meet participant needs.

• Help participants identify the support available to them and educate family members/support persons.

• Promote breastfeeding in the community, workplace, and healthcare system.

• Support participants from pregnancy through growth spurts, introducing solid foods, and weaning.

Supervision Growing Up Together is the direct supervisor for the Peer Counselor and Breastfeeding Specialist.

Growing Up Together collaborates with the Central Office WIC Breastfeeding Coordinator to ensure that any concerns are being addressed.

Working Environment

• The Peer Counselor and Breastfeeding Specialist will not make home visits.

• Contact with the WIC participants will occur primarily through online communication from home.

• Contacts with the WIC participants may include meeting face-to-face in the local WIC office, local hospital according to their policy, a public place, or through Zoom.

• The Peer Counselor must maintain confidentiality when communicating with a WIC participant.

• The Peer Counselor will be available after “normal business hours” to assist participants who are having breastfeeding problems on evenings, holidays, and weekends.

Dress Code

• Employees will dress in appropriate, professional attire when representing the BFPC program in their local WIC office, hospital, or in public.

• The following types of clothing or apparel must not be worn when meeting with a WIC participant:

o Sweat clothes, tube tops, exercise clothes or beach clothes.

o Clothing with inappropriate logos o Cut-off shorts, or other short shorts (dress or tailored shorts are allowed permitting the length is appropriate) o Jeans that are tattered or torn.

• Employees will be provided with a nametag that is to be worn when counseling WIC participants face-to-face or are in the public such as breastfeeding classes, health fairs, etc.

Orientation and Training Employees are required to successfully complete the following trainings:

• USDA WIC Breastfeeding Training Curriculum

• Department of Health HIPAA

• WIC Program Civil Rights

• Continuing education as specified

• Trainings provided at monthly meetings by the Breastfeeding Specialist

Each peer counselor may complete 1-hour of approved continued education per month and code time for no more than 2 hours per month.

Growing Up Together will provide task-appropriate orientation and training for BFPC Program staff based on the WIC Breastfeeding Model Components for Peer Counseling training. Orientation must include, but is not limited to:

• Breastfeeding peer counselor responsibilities and expectations

• Frequency of participant contacts

• Scope of practice

• Referral/yielding procedures when an issue or concern is outside the peer counselor’s scope of practice

• Documentation in SDWIC-IT

• Training on use of Zendesk, an online tracking and communication software, to communicate with participants by text, phone, email, or virtual consultation.

• Documentation for compensation including weekly activity report and monthly report

• Caseload management

• Supervision, mentoring, and monitoring of peer counselors

• Roles and responsibilities of WIC staff, Manager, and Team Lead

Employee Recognition Peer Counselors will be recognized annually for their years of service during the monthly program meeting.

Participant Confidentiality Information obtained by BFPC staff may not be shared without the participant’s consent, except as authorized or required by law, as permitted by the SD Department of Health WIC program policy or Growing Up Together.

Driver’s License It will be the responsibility of the BFPC staff to maintain a valid driver’s license.

Infants of BFPC staff

• BFPC staff may bring their breastfed infant to training sessions as needed. If the infant is over 6 months old an assistant should be brought to care for the infant between feedings.

• BFPC staff may bring their breastfed infant to the local WIC office as needed up to 6 months of age. If the infant is fussy and not feeling well, appointments should be rescheduled for another day. It is of the utmost importance for the mom to have the full attention of the BFPC staff when meeting one-on-one.

Compensation and Reimbursement

• BFPC staff are paid monthly on an hourly basis.

• BFPC staff will receive a set monthly stipend for phone expenses.

• BFPC staff will not receive any benefits.

• BFPC staff will be reimbursed for travel and per diem based on state rates.

Work Schedule

• The priority of BFPC staff is to be available to participants after normal business hours, i.e. after 5:00 pm Monday-Friday and on the weekends and holidays.

• The workweek begins on Saturday at 12:01 am and ends the following Friday at midnight.

• BFPC staff will report vacation time to Growing Up Together and WIC staff.

Documentation Required to Receive Compensation

• BFPC staff will complete a Weekly Activity Report and Monthly Report and submit to the Growing Up Together administrator.

o The Weekly Activity Report will be submitted each week by the end of the next business day (Monday).

o The Monthly Report will be submitted according to schedule distributed by Growing Up Together.

Peer Counselor Caseload:

The WIC staff will provide referrals to the Peer Counselor. When the Peer Counselors caseloads are reaching max capacity, the priority of referrals includes:

• All First Time Pregnant

• All First Time Breastfeeding

• All Participants with a History of Breastfeeding Complications

If the caseload is too large for the Peer Counselor to be able to make the required contacts, the Peer Counselor will notify Growing Up Together. Growing Up Together will work with the Central Office Breastfeeding Coordinator to adjust the caseload. Ideally, this will be completed by adding participants to another Peer Counselor’s caseload. As a last resort, the caseload will be reviewed and those that are well-established, not having complications, or have already returned to work or school will be notified that the Peer Counselor is still available to answer questions but will not be initiating contacts as she was previously.

Referrals from WIC staff to the Peer Counselor The WIC staff will work with the Peer Counselor to provide ongoing referrals of pregnant and breastfeeding women as identified through certifications and nutrition follow-up counseling appointments.

Pregnant women will be referred to the Peer Counselor as early in their pregnancy as possible to allow for as many contacts as possible prior to delivery.

WIC staff will complete the following steps when completing a Peer Counselor referral:

• Determine correct Peer Counselor based on WIC Breastfeeding Peer Counselor Coverage Map.

• Send an email to Peer Counselor at personal email address. The email should contain:

o Mother’s First Name and Initial of Last Name o Client ID Number o Any pertinent/specific information you feel the Peer Counselor needs to know

• Enter referral into SD WIC-IT.

Referrals from WIC staff to the Breastfeeding Specialist WIC staff may reach out to the Breastfeeding Specialist with breastfeeding questions and support for any WIC participant that is enrolled in the BFPC program. All communication between the WIC staff and the Breastfeeding Specialist must include the participant’s Peer Counselor and be documented in SD WIC-IT.

This will ensure all staff are informed and can function as a true support team.

Frequency of Contacts with WIC Participants The Peer Counselor shall be available for participant-initiated contacts but should not wait to be contacted by participants with concerns. Scheduled contacts should be made between the hours of 7:30 AM and 7:30 PM within the time zone of the participant.

• Schedule contacts when a Peer Counselor referral is received:

o Pregnant women in first and second trimesters are to be contacted within ONE WEEK of the referral.

o Pregnant women in last trimester are to be contacted within 48 HOURS of the referral.

o Postpartum women are to be contacted within 24 HOURS of the referral.

• Schedule of contacts after a referral:

o Early in pregnancy: When participants are in their 1-8 months of pregnancy the Peer

Counselor will contact the participant monthly to provide basic breastfeeding education and encourage participation in breastfeeding class or support groups, if available. Peer Counselor will follow the established schedule of infographics to be sent during pregnancy.

o As the due date approaches: The Peer Counselor will contact weekly, 2 weeks prior to expected delivery date.

o After delivery:

Contact every 2-3 days in the first 7-10 days postpartum.

Replies to participants within 24 hours when contacted with problems.

Daily contact to follow-up with any problems with breastfeeding.

Make referrals if the problems are not resolved.

Weekly contacts throughout the rest of the first month.

Contact the mother about 1-2 weeks before the mother plans to return to work or school.

• Make contact 1-2 days after she returns to work or school then on a weekly basis to assist the mother with the transition.

Utilize infographics, the Virtual Help Desk, or other approved materials as guidelines for topics and to answer questions.

Once breastfeeding is well established, contact monthly.

Infographic Schedule:

Infographics are sent out to participants on a set schedule designated by the Program Administrator and Central Office Breastfeeding Coordinator.

Additional infographics, not included in the regular schedule, have been created and approved by the Central Office Breastfeeding Coordinator to address specific topics that can be shared with a mom as needed.

Narrative Documentation of Contacts

• BFPC staff will document all contacts with participants in SDWIC-IT.

• When infographics are sent according to the above schedule, the Peer Counselor will record in the SD WIC-IT PC Tracking Log.

• When a Peer Counselor or the Breastfeeding Specialist has a detailed conversation with the participant to work through an issue, a Breastfeeding Note will be entered.

• Documentation will be entered into SD WIC-IT within 1 week of contact, sooner if able.

Referrals from the Peer Counselor The Peer Counselor must document any referrals made in SD WIC-IT and notify the appropriate WIC staff.

The Peer Counselor will refer participants with issues beyond their scope of practice and participants who may have questions that the Peer Counselor is unable to answer. The Peer Counselor will have a list of local resources in each community that they provide services to participants. The Breastfeeding Specialist and WIC staff will update the Peer Counselor on the participant’s status by phone, text, or email. This will assist the Peer Counselor to reinforce what information has been shared and to provide appropriate support. The Peer Counselor will also assess the Breastfeeding Notes in SD WIC-IT for additional information. Communication between the Peer Counselor, Breastfeeding Specialist, and WIC staff will continue until the participant’s needs are met.

Virtual Consultation using Zoom When setting up a Zoom meeting it is required to have the meeting set up as ‘Waiting Room Required’.

This will help ensure that nobody uninvited will be able to join the meeting.

Closing Participant File Once a participant is no longer receiving services from the Peer Counselor because they stopped breastfeeding, were terminated from the WIC program, or graduated from the BFPC program at 12 months post-partum, it will be documented in SD WIC-IT and the participant removed from the queue.

A participant file may be closed when contact cannot be made over a 3-month period, at the discretion of the Peer Counselor. When closing the participant file, the Peer Counselor will document in SD WIC-IT why the file is being closed and remove the participant from the queue. Peer Counselor will also remove all reminders set in Zendesk and archive the participant.

Promotion of the BFPC Program

• The WIC staff will promote the BFPC Program to WIC participants.

• Promote the BFPC Program with community resources such as:

o Local Hospitals o Physician clinics o Other public health programs o Programs that serve similar population groups

Partnerships

• The Peer Counselor will communicate with the participant’s Bright Start nurse related to breastfeeding problems and concerns on an as needed basis.

• The Peer Counselors will include local area Bright Start nurses when sending out their monthly communications.

• To ensure partnership sustainability, the BFPC Program and Bright Start will coordinate an annual, virtual meeting to reiterate the partnership and ensure all staff understand the purpose of each program.

Program Evaluation

The BFPC program is evaluated on an annual basis to make sure the needs of participants are being met and to indicate if changes are needed in the program.

• Participants receive a link to an electronic satisfaction survey specific to their Peer Counselor when they have stopped breastfeeding or graduated from the program at 12 months post-partum.

o A separate survey link will be sent after the participant works with the Breastfeeding Specialist.

• WIC staff receive an annual electronic survey for each Peer Counselor they refer to. All survey responses are compiled and reviewed with the Peer Counselors individually.

• Growing Up Together will review participant files monthly to ensure that contact schedules are being met and SD WIC-IT documenting is occurring within 1 week.

• Conversations between the Peer Counselors and participants will be monitored on a weekly basis by the Breastfeeding Specialist and Growing Up Together to ensure materials provided are approved and Peer Counselors are working within their scope of practice by making referrals as necessary.

• Peer reviews are conducted on a quarterly basis.

o A meeting is held between the Peer Counselors, Breastfeeding Specialist, Growing

Up Together, and the Central Office Breastfeeding Coordinator to discuss the findings of the cases reviewed.