Premiere and Elite Application - Preview

This application preview should not be used to apply for an award. To complete an application please return to WIC Breastfeeding Award of Excellence.

All questions require a yes or no response.  Additional instructions are noted where appropriate.

Peer Counseling

QUESTION 1

Do you have established guidelines for how many hours of observation/ shadowing is required as part of peer counseling training/continuing education?

QUESTION 2

Do you have a WIC Designated Breastfeeding Expert or do you contract with an International Board of Lactation Consultant Examiners (IBCLC) to serve as a referral source for peer counselors?

QUESTION 3

Do you have a referral process in place between hospitals and the WIC Program to facilitate peer counselor follow-up care for newly-delivered WIC mothers after discharge?

QUESTION 4

Do you have a system that electronically documents and tracks peer counseling referrals and contacts?

QUESTION 5

Do you have policies and procedures for home visits or video conferencing as part of your peer counseling program?

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers the question can be found.

Instructions

The supportive documentation must include a process for making home visits, either in person or by video conferencing, and procedures which address travel, and/or virtual support, safety and confidentiality.

Examples of acceptable supportive documentation: Policy and procedures, Staff training materials Check the appropriate box (Yes/No) in response to the question.

Attach the supportive documentation; fill in the document title and indicate the page numbers where the information that answers this question can be found.

QUESTION 6

Do you have policies and procedures for hospital visits as part of your peer counseling program?

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

Instructions

The supportive documentation must include:

• a process for making hospital visits,

• describe the relationship with hospital,

• address confidentiality, supervision, liability, and

• clarify the scope of practice and the role of the peer counselor.

Examples of acceptable supportive documentation: Policy and procedures, Staff training materials, Written agreements/contracts with hospitals

Check the appropriate box (Yes/No) in response to the question. Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

QUESTION 7

Do you have a recognition program in place to acknowledge peer counselor accomplishments?

QUESTION 8

Do you include career path structures for upward mobility of peer counselors?

QUESTION 9

Do you have policies and procedures for peer counselors to communicate via social media or innovative technologies, e.g., Facebook, text messaging, Twitter, Skype or PalTalk?

Attach narrative and supportive documentation that indicate existing policies and procedures for peer counselors to communicate via social media technologies. Fill in both document titles and indicate the page numbers(s) that corresponds to each document.

Instructions

Social media is the use of web-based and mobile technologies to turn communication into interactive dialogue and build a sense of community among users. Research shows that WIC’s target population use social media extensively as a means to communicate.

The narrative and the supportive documentation should indicate how the local agency is using social media technologies with peer counselors. It should indicate how they allow peer counselors to use social media and/or electronic communication for at least one of the following reasons: communicating with mothers, communicating with supervisors, communicating with other peer counselors, communicating with referral sources.

Documentation must include information on at least one of the following that allows peer counselors opportunities to communicate via social media technologies or other electronic media: Facebook, text messaging, Zoom, other electronic media. Policies and procedures must address confidentiality and privacy, proper etiquette, and follows local agency, health department or State policies for use of social media. It also must indicate supervisory monitoring or documentation of communication.

Examples of acceptable supportive documentation: Policies and procedures, Screen shots, Peer counselor documentation log.

Please describe in a narrative how your peer counseling program is implementing social media technologies.

Check the appropriate box (Yes/No) in response to the question.

Attach narrative and supportive documentation that indicate existing policies and procedures for peer counselors to communicate via social media technologies.

Fill in all document titles for both the narrative and supportive documentation and indicate the page number(s) that corresponds to each document.

Partnership

Although the WIC Program can provide many of the services breastfeeding women in the community need, WIC cannot do it alone. Various community entities such as public health programs, coalitions, schools and employers, impact a mother’s ability to initiate and continue breastfeeding. Establishing meaningful partnerships among these relevant community organization/resources is critical to a mother’s breastfeeding success.

A partnership is defined as a sustainable ongoing voluntary collaborative agreement between two or more parties based on mutually agreed objectives and a shared vision, generally within a formal structure. The partners agree to work together to achieve a common goal, undertake specific tasks, and share risks, responsibilities, resources, competencies and benefits in order to provide breastfeeding support throughout the continuum of care.

QUESTION 10

Does the partnership have a written agreement or a Memorandum of Understanding?

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

Instructions

Examples of acceptable supportive documentation: Memorandum of Understanding, Written agreement

Documentation attached includes all of the following:

• Description of the role of each partner

• Description of the goals and outcomes.

• Description of the types of activities planned.

Check the appropriate box (Yes/No) in response to the question.

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

QUESTION 11

Have new policies or procedures been developed because of the partnership?

Attach a narrative or supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

Instructions

Describe the new procedures developed as a result of the partnership in a brief narrative or attach supportive documentation that indicates policies or procedures have been developed as a result of the partnership. Narrative not to exceed 500 words.

Acceptable documentation: Narrative or Supportive Documentation. Examples of acceptable supportive documentation: Policy and procedures

Check the appropriate box (Yes/No) in response to the question.

Attach narrative or supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found if using supportive documentation.

QUESTION 12

Does the partnership have a plan for sustainability?

QUESTION 13

Do you partner with stakeholders such as the American Hospital Association to support the Baby-Friendly Hospital Initiative in your community?

Other Criteria

SUPPORT OF EXCLUSIVE BREASTFEEDING

The American Academy of Pediatrics encourages exclusive breastfeeding for the first 6 months. WIC staff has an important role in educating mothers about exclusive breastfeeding, what to expect with breastfeeding, and providing the support necessary for them to feel confident in their ability to do so. The local agency must have policies and procedures in place that ensure benefits and services (support, education, and counseling) are provided to promote exclusive breastfeeding.

Staff provides realistic strategies to mothers on how to feed their baby only breast milk and provide appropriate support and/or referrals as needed.

QUESTION 14

Do you have a supportive clinic environment that implements breastfeeding-friendly workplace polices for WIC staff?

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found

Instructions

The supportive documentation should indicate workplace polices that are breastfeeding-friendly for WIC staff and should include adequate time and an appropriate place to express milk and a program such as a “Bring your baby to work” program for staff who are breastfeeding.

Examples of acceptable supportive documentation: Policies and procedures

Check the appropriate box (Yes/No) in response to the question.

Attach the supportive documentation; fill in the document title and indicate the page number(s) where the information that answers this question can be found.

QUESTION 15

Do you ensure that peer counselors are solely dedicated to peer counselor support for breastfeeding, or, if you allow peer counselors to work in dual-role positions, do you ensure that those positions do not compromise the intent and purpose of the Breastfeeding Peer Counselor (BFPC) program?

Instructions

It is vital that a WIC mother views her peer counselor as a peer—someone who is dedicated to building a trusting relationship with her inside and outside of the clinic. Peer counseling programs function best when peer counselors are allowed to solely dedicate their time to peer counselor support for breastfeeding. State agencies that allow peer counselors to work in dual-role positions must have State agency policies for dual-role peer counseling staff approved by the FNS Regional Office to ensure such positions meet the definition of a peer counselor.

Verify the applicant response. Check the appropriate box (Yes/No) in response to the question.

QUESTION 16

Do you provide around the clock assistance to assist mothers working through their breastfeeding problems?

Attach narrative. Fill in narrative title and indicate the page number(s) where the information that answers this question can be found.

Instructions

Please describe in a narrative how you provide assistance to breastfeeding mothers around the clock. Narrative not to exceed 500 words.

Check the appropriate box (Yes/No) in response to the question.

Attach the narrative. Fill in the narrative title

Performance Criteria

Verify that you have met the performance data criteria.

 

OMB 0584-0591 EXP Date: 11/30/2023