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us-ct/policy/wic-state-plan/fy2026 · Axiom

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caseload immediately and attended Fall Level 1 and 2 WIC Breastfeeding Curriculum training to reinforce key skills.

New Haven’s breastfeeding peer counseling program continues to thrive. Two peer counselors have recently passed the International Board-Certified Lactation Consultant (IBCLC) exam, becoming IBCLCs—a tremendous accomplishment. One has also attained her RN license, and the other is expected to complete nursing school by the end of the year. A third peer counselor is currently enrolled in nursing school, reflecting a strong pipeline of peer leaders transitioning into professional clinical roles from this agency. The IBCLC is working on identifying potential peer counseling candidates from the participant pool to recruit when the current peers move onto their next positions.

The TVCCA peer counselor has taken on a dual role, now working part-time as a Nutrition Assistant (NA). The combined peer and NA responsibilities allow for better integration of breastfeeding support into participant interactions, from calls to application processing. The expanded role is an appropriate use of available funding streams and helps ensure breastfeeding support is woven throughout participant services.

Since the Bristol Hospital WIC program merged with the Meriden WIC Program, staffing has shifted. The part-time Bristol IBCLC provides oversight across both sites. Both peer counselors collaborate effectively with their Designated Breastfeeding Experts (DBE) and if necessary, yield to the IBCLC. Joint meetings and aligned communication have resulted in a smooth integration of the two peer counseling programs into one.

Hartford’s peer counselor, hired in the fourth quarter fiscal year 2024, continues to thrive. She completed a refresher of the WIC Breastfeeding Curriculum, in Spring 2025. This boost strengthened her knowledge and confidence in participant counseling. The senior peer counselor provided mentoring and support, including co-counseling and modeling effective use of CT-WIC. Weekly coordination between the State Breastfeeding Peer Counseling Coordinator, local program coordinator, breastfeeding coordinator, and consulting IBCLC ensures consistent breastfeeding support across staff.

East Hartford continues to have a stable program, with no staffing changes. The program has two, part-time peer counselors (one Spanish-bi-cultural/bilingual peer, one African American), an IBCLC, and a Breastfeeding Coordinator with CLC.

The State BFPC Coordinator assists in training as in-kind services the USDA Breastfeeding Curriculum during biannual regional trainings or on an individual, mini training schedule as necessary based on hiring dates.

The State WIC BFPC Coordinator continued to facilitate monthly virtual peer counseling conference calls using the Teams platform.

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Most peers continue to have the opportunity to telework and have proven to be critical supports to our breastfeeding families. Virtual platforms and calls can incorporate the DBE/IBCLC easily to co-counsel and yield when outside a peer’s scope. It provides valuable assessment of the dyad, their environment and allows for comprehensive cost-effective care. Many participants prefer and respond to text messages. Using the CT WIC Resources webpage, USDA BF Support website and other links allows for evidenced based resources to be customized to participants’ needs. Information can also be forwarded from the participant to a support network as appropriate to help ensure feeding goals are met.

The Breastfeeding Peer Counseling Coordinator joined the State Monitoring Team to conduct a peer counseling review of the Bristol Hospital WIC Program’s Breastfeeding Peer Counseling Program. Connecticut’s State Breastfeeding Unit remains deeply engaged with the Regional Breastfeeding Curriculum Training Team. In fiscal year 2025, the team delivered Fall Level 1 and 2 training and Spring Levels 1 through 4. The Fall 2026 training begins in September and will include Levels 1-2.

Peer counselors and consulting IBCLCs attended the April 24, 2025, Virtual Seminar for Health Care Providers, hosted by La Leche League of Connecticut—fostering ongoing professional growth.

This year brought a renewed focus on peer counseling reporting. Breastfeeding Peer Counseling Biannual reports were received by the State Breastfeeding Unit in March 2025. Local agencies are required to include updates with the annual local agency plan (LAP) submission in September.

Both the WIC hybrid-hospital based, and WIC-clinic based peer counseling programs operate using USDA’s WIC Breastfeeding Curriculum. A regional training collaborative (CT, ME, NH, VI, VT, USVI) was formed in 2022 and launched regional trainings of the WIC Breastfeeding Curriculum on a bi-annual basis in Spring/Fall.

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History and Evolution of Peer Counseling in Connecticut WIC The following is a brief history and evolution of Connecticut’s peer counseling program as it responds to new research and fluctuations in available resources.

The State WIC Breastfeeding Peer Counseling Coordinator has been part of the WIC Breastfeeding Unit since 2016. The State WIC Breastfeeding Peer Counseling Coordinator has a Master of Science in Nutrition is IBCLC, RD and brought her experience, managing a WIC- clinic and peer counseling program at the Fair Haven WIC office, to the State agency.

BREASTFEEDING HERITAGE AND PRIDE: HISPANIC HEALTH COUNCIL, HARTFORD HOSPITAL PROGRAM SERVING THE HARTFORD WIC (AND A FEW NEIGHBORING LOCATIONS)

The Breastfeeding, Heritage, and Pride (BHP) breastfeeding peer counseling program was initially funded through a grant received by the Connecticut Department of Public Health (CT DPH) in 1993. It continues to be jointly operated by the Hispanic Health Council (HHC) and Hartford Hospital (HH). In 2005, using USDA WIC Breastfeeding Peer Counseling funds, CT DPH WIC Program, entered a contract with the HHC to expand the BHP program to include two additional full-time peer counselors and administrative support. A 2004, CDC-funded, randomized, controlled trial of the BHP (Arch Pediatr Adolesc Med 2004; 158:897-902) concluded that peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1- and 3-months post-partum. At the conclusion of FY 2020 USDA FNS WIC funds were redirected from HHC to the City of Hartford of clinic- based peer counseling services.

NEW HAVEN WIC BREASTFEEDING PEER COUNSELING PROGRAM FORMALLY: BREASTFEEDING HERITAGE AND PRIDE:

In 2009, the BHP model of peer counseling was expanded to Yale New Haven Hospital (YNHH). The program was originally established using WIC Nutrition Services and Administration funding and was planned to staff one full-time Lactation Consultant, Peer Counseling Coordinator and 2 full-time peer counselors. The program is primarily funded with Connecticut’s USDA WIC Breastfeeding Peer Counseling grant and some resources from YNHH. The program now has one IBCLC and 4 peer counselors.

WIC BREASTFEEDING PEER COUNSELING: LEARN TOGETHER, GROW TOGETHER In 2011, the Connecticut WIC Program established a pilot breastfeeding peer counseling program in three (3) WIC local agencies with existing IBCLC’s on staff (New Haven-Fair Haven site, TVCCA and Access (DKH site). Planning meetings occurred between October 2010 and January 2011 and the BHP protocol and documentation forms were modified to accommodate the more traditional WIC peer counseling model embedded in a WIC clinic.

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Connecticut’s pilot program, WIC Peer Counseling: Providing Loving Support for Breastfeeding Success has been up and running since March 2011. An IBCLC consultant was hired to provide technical assistance to both the State and local agencies and to provide training to WIC peer counselors. Since 2011 peer counseling was expanded to other local agencies: Optimus (Bridgeport 2016), East Hartford (2019), Waterbury (non-WIC funded peers-now part of Bridgeport since 2020), DKH (restored funding in 2021), Meriden (2021) Hartford (2021), Bristol New Britain/Torrington (2023). Connecticut provides peer counseling funds to seven (7) WIC programs (Bristol/Meriden merged 2024)

LATCH Study: Research partners have applied for NIH funding to expand the LATCH study to LATCH 2.0.

The YNHH (currently New Haven WIC Breastfeeding Peer Counseling Program) and HHC BHP programs and the two WIC clinic-based Breastfeeding Peer Counseling programs (Fair Haven and TVCCA) participated in the expanded LATCH (LATCH Lactation Advice thru Texting Can Help) study that concluded in FY 2016. This study was funded through the USDA Center for Collaborative Research on WIC Nutrition Education Innovations at the USDA/ARS Children’s Nutrition Research Center at Baylor College of Medicine (CNRC WIC Center). It builds on the LATCH pilot project and will examine the effectiveness of using texting to provide enhanced support through peer counselors. We’ve included a listing of published research.

In 2019, the Journal of Nutrition Education and Behavior selected Impact of the Lactation Advice through Texting Can Help (LATCH) Trial on Time-to-First-Contact and Exclusive Breastfeeding among WIC Participants by the journal’s readership as one of the top three publications of the year.

LATCH results showed 50% of moms exclusively breastfeeding at 2 weeks in the intervention arm versus 31.8% in the control arm. The study was underpowered to determine if this was statistically significant. Participants had high satisfaction with the texting they received. The study showed shortened first time contact with a Peer Counselor after delivery. Timely notification is critical for WIC participants to receive personalized breastfeeding support and education from a Breastfeeding Peer Counselor.

Published in FY 2018, Martinez, J.L., Harari, N., Segura-Pérez-S., Goeschel, L., Bozzi, V., Pérez-Escamilla, R. (2017). Impact of the Lactation Advice through Texting Can Help (LATCH) Trial on Time-to-First-Contact and Exclusive Breastfeeding among WIC Participants. Journal of Nutrition Education and Behavior. Vol 50: 33-42

Feasibility and Acceptability of a Text Message Intervention Used as an Adjunct Tool by WIC Breastfeeding Peer Counselors: the LATCH pilot to Maternal & Child Nutrition.

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GENERAL PROGRAM DESCRIPTION

A description of the Connecticut WIC Program’s model, which incorporates the FNS Model for a Successful Peer Counseling Program, follows.

1. Appropriate Definition of Peer Counselor The Connecticut WIC Program’s definition of a breastfeeding peer counselor is as follows: • Paraprofessional (i.e., no academic training in breastfeeding) • Recruited and hired from target population (ideally, a current or past WIC participant) • Available to WIC families outside usual clinic hours and outside the WIC clinic environment • Breastfeeding experience (ideally, a minimum of 6 months)

2. Designated breastfeeding peer counseling program managers/coordinators at State and/or local level State Breastfeeding Peer Counseling Coordinator, Lori Goeschel, responsible for contract management and administrative oversight of the 8 peer programs in the state. As outlined above Lori has spent time since FY 2016 on site targeted peer training, technical assistance and CT-WIC use and troubleshooting. She has also worked extensively with the New Haven WIC Program on implementing the city-wide peer services within 4 permanent sites. (Yale New Haven Hospital, Sargent Drive and West Haven, the Cornel Scott Hill Health Center (CSHHC) and the Fair Haven Community Health Center (FHCHC)). She is responsible for ensuring that the USDA WIC Breastfeeding Peer Counseling funds are used to expand WIC breastfeeding support services through peer counseling.

The State Breastfeeding Peer Counseling Coordinator maintains contact with subcontractors that hold BFPC programs regarding the status of the program and biannual reports are required to document progress (beginning FY 2025). Due to the design of CT-WIC, reports currently include more qualitative data to reflect program progress.

3. Defined job parameters and job descriptions for peer counselors • The breastfeeding peer counselors are individuals from the community reflective of the WIC participant population, who have experience in successfully breast/chest feeding a child for a minimum of six months. They are committed to encouraging women to initiate and continue breastfeeding, and supporting those who decide to do so, so that they may have the best chance of success and a positive experience. They are responsible for positive role modeling, providing information,

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encouragement, and knowledgeable support and in person assistance to pregnant and breastfeeding participants. • Peer counselors provide services through a combination of telephone (texting) contacts and home and hospital visits, according to program protocols (see item 6, below). • Peer counselors also participate in promotional and advocacy activities. Peer counselors receive ongoing training and continuing education as described in item 10.

4. Adequate compensation and reimbursement of peer counselors Most peer counselors working in the hybrid hospital/clinic based peer counseling program (New Haven) currently receive approximately $17.00 per hour at a minimum. The hiring of full-time peers who receive a benefit package and adequate compensation has resulted in the best retention rates and, ultimately, the operation of an efficient and effective program. The WIC-clinic based peers receive $15.00 per hour at a minimum and are required to work a minimum of 10 hours per week.

5. Training of appropriate WIC State/local peer counseling management and clinic staff • Some WIC clinic-based peers attended the La Leche League of Connecticut (CT- LLL) annual Healthcare Provider Seminar in April 2024. • The State agency met as needed with WIC funded peer programs in 2024. • Peer counselors provided input and feedback on the use of CT-WIC peer module including identification of bugs and development of solutions. • Peer counselors were invited to attend WIC Statewide Meetings. • Peer counseling staff attending statewide WIC new staff orientations as appropriate.

6. Establishment of standardized breastfeeding peer counseling program policies and procedures at the State and local level as part of Agency nutrition education plan. • Compensation and reimbursement of peer counselors: Peer counselors will be compensated at a rate that will promote retention. • Training: Peer counselors will be trained using the USDA/FNS WIC Breastfeeding Curriculum Levels 1 and 2. • Documentation of client contacts: All participant contacts, including unsuccessful attempts, will be documented in CT-WIC. • Referral protocols: Peer Counseling Programs continue to use CT-WIC to make referrals. Ongoing training on the referral process is provided. See specific protocols for referral procedures.

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• Confidentiality: Participant Consent will be verbally given when the referring staff member makes a referral to the program. Both hospital and WIC-clinic based programs follow WIC confidentiality regulations.

7. Adequate supervision and monitoring of peer counselors On-site Breastfeeding Coordinators or Lactation Consultants • Initial and continued training of peer counselors • Assignment of referrals • Regular guidance of patient/participant care; provision of direct care for complex cases based on program protocols. • Consult as necessary to Program Directors and report regularly to Program Coordinators. • Providing first-line problem solving for peer counselors and triaging when necessary to program directors and/or medical consultants. • Provision of public education sessions to promote and inform community members about breastfeeding and • Shared review of program participant charts for accuracy and thoroughness.

8. Establishment of community partnerships to enhance the effectiveness of a WIC peer counseling program. The Connecticut WIC program has developed many community partnerships to enhance breastfeeding outcomes and the effectiveness of its peer counseling program. In the WIC clinic-based programs, peer counselors have relationships with area birthing facilities and have also worked closely with hospitals involved in the Connecticut Ten Step Collaborative, the continuation of the successful, Connecticut Breastfeeding Initiative (CBI), a 2009 CPPW project funded by CDC to assist 10 maternity facilities in Connecticut in Baby-Friendly designation. Currently, there are 9 Baby-Friendly Designated Hospitals in the State.

The Connecticut Department of Public Health administered a CDC SPAN 1807 cooperative agreement (2018-2023), to implement statewide breastfeeding strategies in collaboration with the Connecticut Breastfeeding Coalition (CBC), Hartford and New Haven REACH grantees and their contractors. These strategies focused on increasing community support for lactation, specifically providing pathways to diverse lactation professionals.

State and local agencies maintain communication with the Mothers’ Milk Bank of Northeast (MMBNE) to educate and promote the use of donor milk. The State WIC Breastfeeding Coordinator participates in several interagency workgroups including the Substance Exposed Pregnancy Initiative (SEPI-CT), Preventing Maternal Mortality due to IPV Advisory Board, CT Food Policy Council and has ongoing communication with the Office of Early Childhood (OEC) Home Visiting Program (MICHV). These

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collaborations allow for targeted local interventions and raise awareness of the WIC Program, WIC Breastfeeding Support and the WIC Breastfeeding Peer Counseling Program.

While DPH ended its contract with the Hispanic Health Council Breastfeeding Heritage and Pride (BHP) program for peer services in Hartford, local agencies in the service areas have worked to maintain Memorandums of Understanding (MOU) with HHC-BHP to ensure continuity of care for shared families.

9. Provision of the following to peer counselors: Timely access to breastfeeding coordinators and other lactation experts for assistance with problems outside of peer counselor scope of practice Infrastructure at local agencies allows for access to DBE and IBCLC’s.

Peers are mentored by staff IBCLC’s employed by WIC local agencies. Four are also Nutritionists. The WIC IBCLC/DBE are partially funded by the peer counseling grant. WIC IBCLC/DBE have access to medical support as needed through their host agencies.

Peer Counseling staff Performance Plan addresses: • Regular, systematic contact with supervisor/DBE/IBCLC. • Participation in WIC clinic staff meetings and breastfeeding in-services as part of the WIC team • Opportunities to meet regularly with other peer counselors.

WIC clinic-based Peer Counselor Performance Plan Goals: Successfully complete peer counselor training process. (Levels 1-2 of WIC Breastfeeding Curriculum and applicable post-tests). Demonstrate competencies based on supervisor observation. Follow-up on all prenatal referrals within 1 week of assignment; postpartum within one day. Content of all visits according to training and protocols is provided based on program Forms. Thorough and accurate documentation of all contacts and attempted contacts. Participation in required (weekly) meetings with WIC IBCLC and supervisor as needed. maintain regular communication with IBCLC and other WIC staff according to protocol and as needed Participation in monthly peer counseling virtual team meetings for training and coordination activities with peer programs throughout Connecticut and State WIC staff. After the call IBCLC’s and State staff have specific time for peer management teams. This is utilized as needed. Engage in community outreach per instructed by WIC IBCLC mentor or clinic supervisor to foster continuity of care for peer counseling participants.

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10. Provision of training and continuing education of peer counselors. ▪ Peer counselors receive standardized training using “WIC Breastfeeding Curriculum, Learn Together, Grow Together”.

Peer counselors participated in monthly, virtual breastfeeding peer counseling meetings. All peer counselors are expected to participate in any staff meetings, training activities sponsored by their local WIC Program when deemed appropriate from the DBE/IBCLC, peer counseling management staff and WIC State and Local management staff.

2025 Trainings ▪ Peer Counseling teams celebrate 50 years of WIC. August 12, 2024, WICnic ▪ 11 Monthly Conference calls Monthly calls are led by the State BF PC Coordinator with BF PC team members (DBE/IBCLC) only attending quarterly (October, January, April, and July). Only peers attend the other months because peers expressed benefits from time together to discuss case studies, workflow and getting to know fellow peers.

▪ 10/24 Social media ▪ 11/24 No meeting ▪ 12/24 C-sections and breastfeeding, how to talk to participants to preserve breastfeeding if they have a C-section. ▪ 1/25 Reviewed/discussed USDA/FNS updated donor milk memo. General discussion on donor milk ▪ 2/25 University of Albany December 2025 Breastfeeding Grand Rounds debrief (recording: https://www.albany.edu/impact-social-media-breastfeedingchestfeeding). Discussed optimizing WIC documentation. ▪ 3/25 Tandem nursing ▪ 4/25 debrief (Seminar 4-24-25) ▪ 5/25 Discussion regarding wearable pump use. Peer checks in-space to ask questions and support one another. La Leche League of CT Healthcare Seminar ▪ 6/25 Use of speech messages sent via text message. Discussion/feedback on the ease of communicating with participants during the summer months. ▪ 7/25 Pacify Platform-training updates ▪ 8/25 WBW updates ▪ 9/25 Annual Civil Rights training

2026 Trainings (tentative) ▪ Food Package Changes ▪ Pacify follow-up ▪ Technical Assistance calls and meeting for program operations assistance and CT-WIC. ▪ Annual Civil Right training

(bf-peer-counseling-program-update)Connecticut WIC State Plan: Breastfeeding Peer Counseling Program Update to Implementation Plan FY 2026#

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(bf-peer-counseling-program-update)Connecticut WIC State Plan: Breastfeeding Peer Counseling Program Update to Implementation Plan FY 2026#

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