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Section 4.8: Breastfeeding Peer Program Management 1/2025 References: WIC Nutrition Services Standards; WIC Breastfeeding Policy and Guidance; WIC Breastfeeding Curriculum; WIC Breastfeeding Model Components for Peer Counseling 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 counselors must be in addition to the required nutrition education contacts (see Section 6.2: General Nutrition Education). Peer Coordinator(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: ▪ Policy development ▪ Hiring peer counselors ▪ Initial and ongoing training for peer counselors ▪ Supervision, including:

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 2 ▪ Monthly spot checks for each peer counselor during the first year of employment, quarterly spot checks thereafter. If a supervisor determines a peer counselor needs additional coaching, the number of spot checks should be increased to facilitate coaching. ▪ Reviewing peer contact logs at least monthly (ideally bi-weekly). ▪ At least weekly contact and monthly individual meetings with peer counselors. ▪ Periodic meetings with all peer counselors. ▪ 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 counselor.) ▪ Providing back-up for peer counselors who encounter situations beyond their scope, both during and after normal clinic hours, and developing a plan for backup if a WIC peer coordinator, supervisor, or other designated WIC staff person is not available. ▪ Maintaining electronic and paper records of all required peer / peer program documentation, see below for additional details. ▪ Overseeing peer program data collection in the WIC information data system as outlined in the latest version of the Breastfeeding Peer Program Data Collection Guidance and Definitions available from the State WIC Peer Coordinator. ▪ Completing and submitting to the State Office an annual budget, progress report, and work plan as specified by the State Office timeline. ▪ Peer coordinators must be trained using the WIC Breastfeeding Curriculum Staff Roles: Peer Counselor Management dashboard. ▪ Peer coordinators and all other staff providing back-up must have at least annual continuing education in breastfeeding management. Required Peer Program Documentation and Record Retention 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 ▪ Peer logs ▪ Other records to support activities of the peer program The above documentation should follow the current WIC record retention policy according to Section 1.14: Record Retention.

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 3 WIC Peer Counselors Peer counselors funded with WIC peer support funds must meet the minimum WIC definition of a peer counselor: ▪ Paraprofessional: those without extended professional training in health, nutrition, or the clinical management of breastfeeding who are selected from the group to be served and are trained and given ongoing supervision to provide a basic service or function. Paraprofessionals provide specific tasks within a defined scope of practice. They assist professionals, but are not licensed or credentialed as healthcare, nutrition, or lactation consultant professionals. ▪ Recruited and hired from WIC's target population, and, to the extent possible, representing the same racial/ethnic background as the parents they support ▪ Available to WIC participants outside usual clinic hours and outside the WIC clinic environment. ▪ Previous experience with breastfeeding, having breastfed at least one baby. ▪ A sample job description for peer counselors is found at Exhibit 4-C: Peer Breastfeeding Support Program Sample Descriptions. Work parameters ▪ Peer support staff must receive compensation for their work and reimbursement for mileage and communication device charges, if applicable. ▪ Peers hired in dual-role positions (e.g. peer and WIC clerk) must meet the definition of a peer counselor in the current WIC Breastfeeding Model Components for Peer Counseling. Peer funds used for the portion of time spent as a peer counselor may not be used for non- peer duties. ▪ Peers may not function as WIC certifiers/CPAs. ▪ Peers who take on additional administrative and/or training responsibilities may be designated Senior Peer Counselors and should be compensated accordingly. See Exhibit 4-C: Peer Breastfeeding Support Program Sample Descriptions. Training New peer counselors must receive the following training as outlined in the Required Training by Job Classification and WIC Clinic Roles: ▪ Level 1 and 2 of the WIC Breastfeeding Curriculum ▪ 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 4-E: Guidelines for Breastfeeding Peer Counselors to Yield to a Lactation Expert or Health Care Provider).

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 4 ▪ Confidentiality and sign a confidentiality agreement (see Exhibit 4-D: Breastfeeding Peer Support Confidentiality Checklist and Agreement). ▪ 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. Required annual trainings are outlined in WIC Annual Required Trainings. Peer Counselor documentation requirements Peer counselors must document all contacts (and attempted contacts) with WIC participants. Documentation must include: ▪ Participants’ names (parent and infant) ▪ Date of the contact or attempted contact ▪ Participant’s questions, concerns, or comments ▪ Topics discussed ▪ Referrals ▪ Plan for follow-up ▪ Peer contact time (e.g. weekly activity report) ▪ 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 designated breastfeeding experts (see Section 4.7: Designated Breastfeeding Expert) to handle questions and issues beyond the scope of the peer counselors. Most peer programs will need back up staff beyond the required peer coordinator. ▪ 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.

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 5 Peer program funding An overview of peer funding can be found in Module 5: Peer Program Funding and Reimbursement of WIC Financial Training Modules. 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 the peer support program. Contact the state WIC office for the claim form for the current fiscal year. Allowable costs ▪ Allowable Costs for Breastfeeding Peer Counseling Programs chart is updated annually. Key considerations in claiming peer program allowable costs include: All, or a portion of, a WIC staff person’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 WIC 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 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. Subcontracted 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 Peer Coordinator to develop a memorandum of understanding (MOU). ▪ A WIC staff person, 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 WIC 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: ▪ That the peer counselors will operate under the same parameters as required for WIC peer breastfeeding support programs. ▪ Compliance with WIC requirements and Minnesota WIC peer policy and peer grant agreement.

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 6 Guidance Considerations when hiring Peer Counselors ▪ In addition to the required qualifications of a peer counselor, research has shown that peer counselors may be more effective when they: ▪ Have enthusiasm for breastfeeding ▪ Possess good basic communication skills ▪ Have previous breastfeeding experience (ideally > 6 months) ▪ Are similar to WIC participants they will serve (i.e., in ethnicity, age, and language spoken) ▪ Are currently, or have been, a WIC participant ▪ Basic computer proficiency and current communication technology ▪ 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 peer coordinator. ▪ Peer counselors should have access to reliable transportation to and from the WIC clinic for required meetings. ▪ Peer counselors should be provided with a cell phone or cell phone stipend and a laptop computer. ▪ Peer counselors should understand work expectations (e.g. training, documentation and confidentiality requirements, contact with direct supervisor, attendance at required peer meetings, etc.). Sample job descriptions are found in Exhibit 4-C: Peer Breastfeeding Support Program Sample Job Descriptions. Work parameters ▪ Peer counselors make contacts primarily via phone, text, and/ or email. Peer contacts can include face-to face contacts in the WIC clinic. ▪ Peer counselors may make home and hospital visits as approved by their peer coordinator. ▪ WIC peer counselors may bring their nursing infants to work with them if permitted by agency policy.

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 7 Peer contact frequency ▪ More frequent contacts with pregnant and breastfeeding women increases the effectiveness of peer support. WIC recommends the following contact schedule as most effective: ▪ Pregnant women: ▪ Monthly ▪ More frequently as due date nears. ▪ 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 ▪ After the first month: ▪ The peer counselor and the WIC participant can determine the contact schedule. (The peer coordinator can provide guidance in frequency of contacts.) ▪ WIC recommends monthly contacts during the first year, and 1-2 weeks before the participant returns to work or school, and 1-2 days after the return to work or school. Compensation and reimbursement of peer counselors ▪ Many WIC programs offer peer counselor salaries similar to a clerk or community health worker. ▪ Other recommendations: ▪ Provide mileage reimbursement for home/hospital visits and outreach events. ▪ Cover training and continuing education expenses. ▪ Provide benefits if possible. Peer coordinator ▪ A sample job description for WIC staff that manage the peer support program is found as Exhibit 4-C: Peer Breastfeeding Support Program Sample Job Descriptions. ▪ If responsibilities are split between two or more staff, the roles for each must be clearly defined and include all required responsibilities.

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 8 WIC IBCLC ▪ The IBCLC may be a WIC employee or a contracted employee. Contact the State WIC Peer Coordinator for a sample contractor MOU. ▪ Contact the State WIC Peer 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. ▪ Provide opportunities for peer counselors to “shadow” or observe other peer counselors, lactation experts, and WIC staff who are trained in breastfeeding support. ▪ The WIC Breastfeeding Curriculum has guidance for 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. Community collaborations Community partnerships enhance the effectiveness of a WIC peer support program. ▪ Designate a WIC staff person 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. Reference – Complete Listing of Hyperlinks WIC Nutrition Services Standards (https://wicworks.fns.usda.gov/sites/default/files/media/document/wic-nutrition-services- standards_0.pdf) WIC Breastfeeding Policy and Guidance (https://wicworks.fns.usda.gov/resources/wic- breastfeeding-policy-and-guidance) WIC Breastfeeding Model Components for Peer Counseling (https://wicworks.fns.usda.gov/sites/default/files/media/document/WIC_Breastfeeding_Model .pdf) Section 6.2: General Nutrition Education (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch6/sct n6_2.pdf)

S E C T I O N 4 . 8 : B R E A S T F E E D I N G P E E R P R O G R A M M A N A G E M E N T 9 Section 1.14: Record Retention (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch1/sct n1_14.pdf) Exhibit 4-C: Peer Breastfeeding Support Program Sample Job Descriptions (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/exhbts/ex4/4c. pdf) Required Training by Job Classification and WIC Clinic Roles (https://www.health.state.mn.us/docs/people/wic/localagency/training/nutrition/nst/required .pdf) Exhibit 4-E: Guidelines for Breastfeeding Peer Counselors to Yield to a Lactation Expert or Health Care Provider (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/exhbts/ex4/4e. pdf) Exhibit 4-D: Breastfeeding Peer Support Confidentiality Checklist and Agreement (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/exhbts/ex4/4d. pdf) WIC Annual Required Trainings (https://www.health.state.mn.us/people/wic/localagency/training/annual.html) Section 4.7: Designated Breastfeeding Expert (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch4/sct n4_7.pdf) WIC Financial Training Modules (https://www.health.state.mn.us/people/wic/localagency/training/finance.html) Allowable Costs for Breastfeeding Peer Counseling Programs (https://www.health.state.mn.us/docs/people/wic/localagency/program/finance/peerallowabl e.pdf) Minnesota Department of Health - WIC Program 625 Robert St N, PO BOX 64975, ST PAUL MN 55164-0975; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us. To obtain this information in a different format, call: 1-800-657-3942 This institution is an equal opportunity provider.