Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 01/01/2025

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Breastfeeding Peer Counseling Program Requirements

Policy: To implement and administer a Breastfeeding Peer Counseling (BFPC) Program, local WIC agencies (LA) receiving state BFPC Program grants are required to follow guidance specified in the LA’s BFPC Program contract and in the FNS WIC Breastfeeding Curriculum: Peer Counselor Management. Additionally, they are expected to provide training to BFPC staff using the WIC Breastfeeding Curriculum.

Regulations: USDA FNS WIC Breastfeeding Curriculum: Peer Counselor Management; USDA FNS WIC Breastfeeding Curriculum; USDA FNS WIC Nutrition Services Standards – Standard 9; USDA FNS WIC Breastfeeding Policy and Guidance (July 2016); USDA FNS Allowable Costs for Breastfeeding Peer Counseling Funds (January 2024).

Procedure/Additional Guidance: Program Description The BFPC Program is based on the FNS WIC Breastfeeding Model Components for Peer Counseling. The program utilizes breastfeeding peer counselors (BFPCs) to encourage and support pregnant and breastfeeding clients to breastfeed their infants via mother-to-mother support. BFPCs are paid paraprofessionals within WIC and are trained and supported by WIC breastfeeding experts. BFPCs are able to extend the Colorado WIC Program’s reach with breastfeeding promotion, education, and support by helping women initiate and continue exclusive breastfeeding through offering peer support during critical weeks after delivery outside of normal WIC clinic operating hours. Services provided by BFPCs are not counted toward nutrition education contact requirements.

Program Coordination The Colorado WIC BFPC Program is coordinated at the state and local level.

 State Level To qualify as the COWIC BFPC Program Coordinator, the individual must have experience in program management, demonstrated expertise in breastfeeding management and promotion, training in advanced lactation management, and a minimum of one-year experience counseling breastfeeding individuals.

The State BFPC Program Coordinator describes the BFPC Program in the annual state plan, develops the standards for the program and provides support to the LA implementing the program.

Standards include establishing policies and procedures that:  Define the responsibilities (job descriptions) of individuals involved with the BFPC program;  Define program standards (management, training, continuing education and evaluation); and  Describe the use and tracking of the BFPC program funds.

Support includes:  Securing funds and materials annually;  Providing training, resources and program materials (e.g., annual training, forms to document BFPC to mother contact, forms to monitor BFPC work performance);  Providing ongoing technical support; and  Incorporating an evaluation process as a part of each BFPC LA’s management review.

 Local Level LAs that receive BFPC funding must designate a BFPC Coordinator. The LA BFPC Coordinator develops, manages, and oversees the LA’s BFPC Program procedures and may directly supervise the BFPC. In most cases, the LA’s Breastfeeding Coordinator fills this role; however, the agency may select an alternate person. The individual must have experience in program management, demonstrated expertise in breastfeeding management and promotion, training in lactation management, and a minimum of one-year experience counseling breastfeeding individuals.

Supervision includes:

Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 01/01/2025

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 Weekly contacts (e.g., by phone or in person) with BFPCs during the first two months on the job (after initial orientation and training is complete); thereafter contact can be less often as determined by supervisor.  Reviewing BFPCs weekly contacts with clients. Weekly spot check calls to mothers during the BFPCs first two months and monthly thereafter for up to six months to monitor performance and to ensure BFPCs are responding appropriately to mothers’ needs.  Evaluating BFPCs performance at the completion of a three month period. Coordinators should identify strengths and give recognition, identify additional training needs and incorporate skill development into the BFPC’s work schedule, or may choose to dissolve employment.

BFPCs will be paid at least minimum wage and either an hourly rate or a salary rate depending on the preference and feasibility of each LA (evaluation of liability coverage will be done at each agency). LAs are encouraged to pay a salary commensurate with that of a WIC Educator. Compensation and reimbursement of BFPCs will be paid through LA employment systems or by contract with the LA. If the BFPC receives benefits, it will be in accordance with the LA’s policies. BFPCs will also be reimbursed for travel in situations where they are expected to make trips to the hospital or outside meeting areas from the WIC clinic. BFPC training expenses and communication resources (e.g., laptop, cell phone) specific to peer counseling will be covered by the LA.

Please refer to the Colorado WIC Policies & Procedures Manual, Local Staffing policy for BFPC Program Coordinator and BFPC job descriptions. LA must submit a BFPC job description if it differs from the job description defined in the Colorado WIC Policies & Procedures Manual prior to hiring.

Training

State and LA BFPC Program Coordinators must receive training on how to manage BFPC programs and train BFPCs through the FNS WIC Breastfeeding Curriculum: Peer Counselor Management and the WIC Breastfeeding Curriculum (Levels 1 & 2).

The LA is responsible for planning and overseeing BFPC staff training which is divided into new employee training and continuing education.  New employee training for BFPCs, includes but is not limited to the following activities:  Completes standard LA orientation and training (e.g., policies, confidentiality, work standards) and reviews COWIC breastfeeding policies.  Receives BFPC-specific training FNS WIC Breastfeeding Curriculum (Levels 1 & 2).  Completes COWIC training modules as listed on the BFPC Orientation checklist.  Shadows WIC Educators, High Risk Counselors, and BFPCs for 40 hours to observe and understand WIC Program services and expectations re: professionalism, communication, work ethics and standards.  Shadow a WIC DBE or other lactation expert assisting a WIC client with breastfeeding in the hospital or WIC clinic.  Continuing Education: The BFPC will be invited to attend all WIC breastfeeding trainings, including all sessions held at state meetings and regional workshops. As funding allows, the BFPC will be encouraged to attend other breastfeeding training opportunities held within the state. The BFPC will be encouraged to participate in regular WIC staff meetings and in-services to promote their linkages with the WIC staff.

The State and LA ensures that BFPCs receive adequate program support that includes:  Timely access to the LA BFPC Coordinator, DBE, or staff with advanced lactation training for assistance with problems outside their scope of practice.  Regular, systemic contact with, and adequate supervision and monitoring by the LA BFPC Coordinator.  Participation in clinic staff meetings and breastfeeding in-services as part of the WIC team.  Opportunities to work with more experienced BFPCs to facilitate mentoring and to meet regularly with other BFPCs.  Adequate compensation and reimbursement for expenses.  Training with a standardized curriculum.

Community Partnerships

Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 01/01/2025

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 The WIC Program encourages LAs to use the expertise of IBCLCs and other qualified lactation experts in order to serve as resources for clients who need additional lactation consultation. Colorado has an active statewide breastfeeding coalition. Several community breastfeeding coalitions exist around the state.  When BFPC and WIC High Risk Counselors are unable to respond to the lactation concerns of the client, these lactation experts can serve as a reimbursable resource. The LAs’ BFPC contract funds can be used to pay for visits with lactation consultants. Agencies are expected to identify lactation resources in their communities and establish methods to make referrals to these resources. If necessary, methods of payment will be established by each LA. LAs are encouraged to establish relationships with the mother-baby units of their local hospitals, community health centers, health care provider clinics, and La Leche League groups.

LA Policy and Procedures  Referral protocols - The referral process may be unique for each LA; however, agencies shall have a system in place for the following situations:  A system for staff to refer a pregnant woman or new mother to the BFPC individually or to a group session facilitated by the BFPC.  A system for the BFPC to refer a pregnant woman or new mother to the LA BFPC Coordinator, DBE, staff with advanced lactation training, or a community lactation expert or health care provider. Note: If referrals to the LA BFPC program need to be suspended for caseload management, the LA BFPC Coordinator should inform clinic staff. Clinic staff should then skip the BFPC support question in the Nutrition Interview.  Confidentiality - BFPCs must follow confidentiality policies of the COWIC Program and their LA. BFPCs will be expected to receive training on confidentiality and sign an agreement of understanding and compliance with WIC client confidentiality. Breach of confidentiality is grounds for discharge.  In some LAs, the BFPC will operate in the WIC clinic, and other LA may allow the BFPC to work from home. BFPC will provide peer contacts through various methods, including: prenatal/postpartum visits at the clinic (individual and group), at the hospital, in the community, in the client’s home, video conferencing, and by phone/text.  LAs that incorporate hospital visits as a method of contact for the BFPC may need to establish a written agreement with the hospital identifying permission for the BFPC to visit with the mother, where the visits can take place (e.g., bedside, other room), and codes of conduct (e.g., does the BFPC need to check in/out, is there a length of time she can visit).  LAs that incorporate home visits as a method of contact for the BFPC must have policies to address BFPC:  Process for making home visits, including, but not limited to: scheduling, verifying location, and providing phone or text reminders prior to the appointment time.  Safety within the client’s home. This must include coverage of liability insurance through the LA for home visits by BFPCs. BFPC must check in with their BFPC Coordinator/supervisor upon arrival at the client’s home and upon departure.  Travel to and from the client’s home. This should include mileage reimbursement and require that BFPCs provide proof of valid car insurance or use of LA employee vehicle.  Confidentiality of the client when in the home to maintain client privacy.  LAs that incorporate video conferencing as a method of contact for the BFPC will provide for installation and maintenance of the equipment necessary for the video call. Additionally, LA must have written procedures detailing:  How to schedule video conferences;  Video conference platform information with instructions provided to the client how to access the conference;  Where the conferencing call can occur, in an environment that promotes effective communication between the BFPC and the client and ensures that both are actively involved in the interaction; and  Client confidentiality while on the call. The video conferencing should occur on a confidential video conferencing platform and the BFPC should host the call in a private location to protect client privacy.  LA must have a process/protocol describing how the BFPC program provides breastfeeding assistance/support to clients beyond normal WIC clinic operating hours at their LA.

Contact Recommendations for Breastfeeding Peer Counselors While each LA will vary on types and frequency of contacts based on their WIC population needs, the following are recommendations for basic services provided by the COWIC Program:

Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 01/01/2025

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Contact Recommendations for Breastfeeding Peer Counselors Category Contact Time Frame Comments Prenatal Women Within 30 days of enrollment Encourage monthly contact through Support Groups and educational text messages

Contacts initiated by clients may be more frequent Once a trimester until within 2 weeks of Estimated Delivery Date (EDD) Weekly within 2 weeks of EDD Postpartum Women Weekly during the first month following delivery

Follow-up 3 days after breastfeeding problems (e.g., latch) or yield a breastfeeding complication (e.g., jaundice) Can be a phone call, text message, or in person. If problems don’t resolve within 24 hours, BFPC yields and refers to lactation management specialist, CLC or IBCLC 1-2 weeks before returning to work/school

Encourage Support Group attendance

Contacts initiated by clients may be more frequent

*Note: When BFPC caseload exceeds full-time equivalent (FTE) capacity, LAs should prioritize BFPC support for clients in their third trimester of pregnancy and the first month postpartum.

Documentation Each agency will define how the BFPC will be able to contact mothers (e.g., by text, phone, email). All contacts (two-way interactions) and attempted contacts must be documented in the Compass BFPC Documentation panel. Contacts should be entered within 5 business days but best practice to to document within 24-48 hours. Documentation for two-way interactions should be a brief summary and include:  Partipant’s questions/concerns (if applicable)  Topics/education discussed  Yields or referrals made  Next steps

The Compass BFPC Contacts Summary Report aggregates detailed information about the type and frequency of contacts made by the BFPC during a selected date range.

Compass BFPC Contact Categories  *No Answer – Phone message left or text sent without a response from the client within 24 hours.  Clinic Visit – Visit with the client in the WIC clinic.  Home Visit – Visit with the client at their home or in the community.  Hospital Visit – Visit with the client at the hospital during pregnancy or postpartum.  Telephone Support – Phone call or text during which breastfeeding concerns are addressed and education or referrals are provided.  Peer Support Group – Client attends peer support group.  *Mailing – Email or US mail sent to the client in an attempt to contact, provide educational materials, or invite to breastfeeding support groups or classes.  *Other - Social media, Facebook, Twitter, or when additional BFPC documentation is needed but no contact or attempted contact was made. *Note: No Answer, Mailings, and Other should not be used when documenting two-way interactions.