Minnesota WIC Breastfeeding Peer Support
Program:
Background, Instructions, Guidance, Timeline, and
other resource materials.
Intent to apply Due Monday, April 24, 2006
(The intent to apply is a very brief form included with the application.
Submitting this form does not obligate you to complete the application.)
Proposals Due Wednesday, June 21, 2006
Minnesota Department of Health
Minnesota WIC Program
April 2006
Contents
Background, Instructions, Guidance, Timeline, and other resource materials.
Background .................................................................................................................. 1
Websites for additional information .............................................................................. 2
Timeline ....................................................................................................................... 3
Criteria for scoring........................................................................................................ 4
Instructions and Guidance ........................................................................................... 5
Instructions for completing application and obtaining guidance .............................. 5
Instructions for Completing Cover Page ................................................................. 6
Instructions for Completing Face Sheet .................................................................. 6
Instructions for Completing Project Information Sheet ............................................ 7
Instructions for completing other parts of the grant application .............................. 8
Need for peer breastfeeding support /plan for addressing highest priority needs
Need for peer support staff .......................................................................... 8
Plan for addressing highest priority needs ................................................... 8
Days, times, locations peer services will be available .................................. 8
Staffing
Number of peer staff .................................................................................... 9
Guidance from FNS on planning number of peers ................................. 9
Other tips from FNS on planning for peer support .................................. 10
Tips from MN pilot programs .................................................................. 10
International Board Certified Lactation Consultant (IBCLC) involvement ..... 11
IBCLC who is not currently employed by WIC ........................................ 11
IBCLC and Other Staff if any involved in training, backup & supervision 11
Essential functions ............................................................................................ 12
Essential functions grid ................................................................................ 12
Letters from collaborating organizations if provide essential functions ........ 12
Training / Integrating Peer Program with other WIC services............................ 12
Plan for participation in required meetings and training ............................... 12
Plan for training of WIC Peer support staff and other WIC staff ................... 13
Providing the initial peer support staff training ........................................ 13
Providing ongoing training for existing peer support staff ....................... 13
Plan for orienting current WIC staff to peer support functions / referral .. 13
Plan for training WIC CPAs in lactation for back-up, if needed............... 13
Plan for providing ongoing training in lactation management ................. 13
Plans for integrating all peer staff into the WIC program.............................. 14
Outreach / Coordination .................................................................................... 14
Plan for collaboration and coordination with others ..................................... 14
Planned new activities for disseminating information about peer support .... 14
Evaluation & Agency Capacity .......................................................................... 14
Evaluation and progress report .................................................................... 14
Agency capacity ........................................................................................... 15
Contact information for phone call about application ......................................... 15
Budget ............................................................................................................... 15
Outside funding, if any ................................................................................. 15
Budget form ................................................................................................. 15
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Narrative budget description ........................................................................ 16
Attachment A. Letters from collaborating organizations providing essential peer
functions, if any .............................................................................. 18
Attachment B List of abbreviations used in application, if any ......................... 18
Submitting your application .................................................................................... 19
Definitions from FNS .............................................................................................. 20
Appropriate Definition of Peer Counselor ............................................... 20
Paraprofessional..................................................................................... 20
Abbreviations used within the MN WIC PBSP application and guidance materials 20
Questions and answers from FNS .......................................................................... 20
Additional resources for training ............................................................................. 21
Community Health Worker Training........................................................ 21
Lactation management courses ............................................................. 21
Attachment A Sample Job Description for WIC Breastfeeding Peer Counselor ..... 22
Attachment B– Sample record of breastfeeding initiation & duration rates ............. 24
Attachment C – MN Policy on Peer Support ........................................................... 26
Guidelines for peers to yield
Confidentiality checklist and agreement
Sample job description for peer manager or coordinator
Sample peer documentation form
Sample peer counselor weekly activity report
Intent to Apply and Application (separate document)
Intent to Apply ............................................................................................................. i
Application
Application cover page ........................................................................................... 1
MDH Grant Application Face Sheet........................................................................ 2
MDH Information Sheet for Minnesota WIC Program PBSP Grant Applications .... 3
Need for peer breastfeeding support /plan for addressing highest priority needs ... 4
Need for peer support staff (1) ..................................................................... 4
Plan for addressing needs (2) ...................................................................... 4
Days, times, locations peer services will be available (3) ............................ 4
Staffing ................................................................................................................... 5
How many peer support staff do you plan to use (4) ................................... 5
International Board Certified Lactation Consultant (IBCLC) involvement (5) 6
Plan to obtain services from IBCLC not currently employed by WIC(6) ....... 6
IBCLC / Other Staff, if any, involved in training, backup & supervision (7) .. 7
IBCLC (A) .................................................................................................... 7
Other Staff (B) ............................................................................................. 7
Essential Peer Breastfeeding Support Functions Plan ........................................... 7
Essential functions grid. (8 A -Grid on page 8) ............................................ 7
Instructions for letters from collaborating organizations that will provide
essential PBSP functions (8B) ..................................................................... 7
Training / Integrating Peer Program with other WIC services ................................. 9
Plan for participation in required meetings and training. (9) ........................ 9
Plan for training of WIC Peer support staff and other WIC staff (10) ........... 9
Plan for initial training of new peer support staff(A) ............................. 9
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Plan for ongoing training for peer support staff. (B) ............................. 9
Plan for orienting WIC staff to peer support functions & referrals (C) .. 10
Plan for training WIC CPAs to help provide back-up (if needed) D ...... 10
Plan for providing ongoing training in lactation management for staff who
provide supervision and back-up (E) ................................................... 10
Plans for integrating all peer staff into the WIC program (11) ...................... 10
Collaboration / Outreach ......................................................................................... 11
Plan for collaboration with others (if any) to deliver peer services (12) ........ 11
Plan for outreach / coordination to inform of PBSP/address barriers (13) ... 12
Evaluation / Agency Capacity ................................................................................. 12
Evaluation and progress report (14) ............................................................ 12
Agency Capacity (15)................................................................................... 13
Contact information for phone call about application (16) ....................................... 13
Budget .................................................................................................................... 13
Other funding sources, if any (17) ................................................................ 13
Budget (18A)............................................................................................... 14
Budget narrative (18B) ................................................................................. 15
Attachment A. Letters from collaborating organizations providing essential peer
functions. (If any.) .................................................................................................. 16
Attachment B. Abbreviations used in application, if any ......................................... 17
Submitting your application .................................................................................... 18
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Background
The Minnesota WIC Program is seeking a current Minnesota local WIC agency or
agencies interested in developing or continuing a peer breastfeeding support program
(PBSP) for WIC participants. The programs will be funded with earmarked Federal Food
and Nutrition Services (FNS) funds and must be based on the FNS peer support model.
We anticipate funding two to five WIC agencies or WIC agency collaborations, as funds
permit. FNS has indicated that they wish states to continue to build upon and expand peer
activities. With this in mind the available FFY07 funds are allocated as follows: 70%
($127,400) for priority for current grantees, and 30% ($54,600) to be allocated to either
new or existing peer grantees. If no applications are received in a category or if the review
committee feels that the applicant agencies within a category do not have sufficient
capacity to provide quality peer breastfeeding support services we reserve the right to not
provide funding in a category and to award the funds in another category.
Local MN WIC grantees may apply independently or may collaborate with other WIC
grantees in developing or implementing their program. (For example, shared training
and/or supervision or a shared International Board Certified Lactation Consultant (IBCLC)).
Alternatively, a WIC Grantee may choose to work with an outside organization (e.g., to
provide peer support staff) as long as all requirements for the FNS model are met and a
letter outlining responsibilities of the partner organization is included with this application,
with a Memorandum of Understanding (MOU) or similar agreement between the agencies
signed when the grant is awarded. Applications from collaborations should be submitted by
the lead agency (which must be a current Minnesota WIC grantee), with letters from
collaborating WIC programs or other agencies that will provide essential PSBP functions, if
any. The application must come from a current Minnesota WIC grantee or a collaboration
between two or more local WIC Programs to serve participants within their designated WIC
service area.
Peer breastfeeding support programs are initiated to supplement the prenatal and
postpartum breastfeeding support available to WIC participants, leading to a more positive
breastfeeding experience of longer duration. Peers are women similar to WIC participants
they will work with, and are hired and trained to provide breastfeeding information and
support to supplement other information provided by WIC. When a peer works with a
participant during pregnancy and is known to the participant she is more likely to be trusted
to provide breastfeeding encouragement and support during the postpartum period.
The PBSP(s) will be funded to provide additional support for pregnant and breastfeeding
WIC participants with the goal of increasing breastfeeding initiation, exclusivity and
duration. The programs will also help evaluate the benefits and challenges related to
providing peer support to WIC participants, and help in identifying and sharing effective
models and practices related to peer breastfeeding support.
These funds are earmarked by FNS for breastfeeding peer support programs and may
only be used to develop and implement activities necessary to sustain a successful peer
support program.
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Allowable costs include:
 Compensation for designated peer counselor managers / coordinators, and for
peer counselors;
 Training costs;
 Telephone expenses for participant contacts;
 Travel for home and hospital visits;
 Recruitment of peer counseling staff;
 Purchase of demonstration materials.
(See http://www.nal.usda.gov/wicworks/Learning_Center/support_peer.html for additional
information)
Items and materials for general distribution to WIC participants (with the exception of
materials to promote the PBSP) are not allowable costs under this funding. The peer
support provided will supplement the breastfeeding education and support currently
provided by WIC. The required breastfeeding and nutrition education contacts must still be
provided. Acceptance of the grant and adding peer support to your agency’s WIC services
must not compromise existing required WIC nutrition education / breastfeeding services.
We will be entering into a five - year contract. Funds for the initial year of this project must
be used before October 1, 2007. Funding beyond September 30, 2007 is contingent
on the receipt of additional Federal funds designated for peer breastfeeding
support.
Benefits to WIC agencies participating in this peer support program include:
 Additional breastfeeding support for your participants.
 Opportunity to develop additional trained staff.
 Increased WIC visibility in the community.
 Priority for future PBSP funding, as funds are available.
For additional information:
Additional background information about peer support and the FNS model can be found at
the WICWorks site: http://www.nal.usda.gov/wicworks/Learning_Center/support_peer.html
Links to additional resources for PBS are found in this document and also available at:
http://www.health.state.mn.us/divs/fh/wic/localagency/bf/index.html
Agencies who do not have Internet access can request a copy of materials found at this
site by contacting Pamela Anderson at 651-281-9911 or
pamela.anderson@health.state.mn.us.
Other questions about the peer application and peer support should be directed to Mary B
Johnson at 651-281-9906 or mary.b.johnson@health.state.mn.us.
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Minnesota WIC Breastfeeding Peer Support
Timeline FFY07:
April 12, 2006
Peer support announcement in Wed fax and on MDH grant page.
April 24, 2006 (Mon)
“Letter of Intent” due (short form to return). Does not obligate agency to
apply.
May 2006
Phone conference on peer support if requested in letter of intent.
June 21, 2006 (Wed)
Applications due
On or before
July 31, 2006
Notify applicants of awards.
July/Aug/Sept 2006
Process grants.
Friday, Oct 13, 2006
Required meeting with local & state staff to discuss plans for peers, peer
training, etc. Please hold the date. (We will reschedule if it looks like
agreements will not be signed by the meeting time.) 9 – 3:30. St Paul.
Workplan due first quarter FFY07. Date to be specified in project agreement.
Dec. 30, 2006
Progress report for period of Oct 1 - Dec 15 due. For previously funded
peer programs the report of for FFY06 and brief update on FFY07 is due.
Jan. 20, 2007
Invoices for reporting period Oct 1 – Dec. 31, 2006 due.
March 15, 2007
Progress report for period of Dec 15, 2006 – Feb. 28, 2007 due.
Apr. 20, 2007
Invoices for reporting period Jan 1 – March 31, 2007 due.
July 14, 2007
Progress report for period of March 1 – June 30, 2007 due.
July 20, 2007
Invoices for reporting period Apr. 1 – June 30, 2007 due.
Sept 30, 2007
Last day for local agencies to use FFY’07 funds.
Oct. 15, 2007
Progress report for period of July 1 - Sept. 30, 2007 due.
Oct. 20, 2007
Invoices for reporting period July 1 – Sept.30, 2007 due.
Nov. 14, 2007
Last day for submitting claims for FFY’07 peer funds.
Dec. 30, 2007
Local agencies submit final evaluation and summary report of peer
support pilots to State, for FFY07 (March 1 – September 30, 2007.)
To be scheduled:
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*Additional meeting with lead staff from each peer pilot and State
(required meeting). Likely Spring/Summer 07
*State WIC Breastfeeding Coordinator site visits to peer support pilot
sites.
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WIC Peer Breastfeeding Support Applications will be scored as follows:
A.
Documentation of unmet breastfeeding support needs. Specific needs identified. Up to 5
points.
B.
Explanation of how the unmet needs will be / have been addressed by peer support.
Highest priority needs are addressed. Up 10 points.
C.
Peer support staff meet FNS definition (or explanation of why agency feels they are unable
to identify staff who meet the FNS definition and how they will develop peers that will meet
the definition in the future.). Up to 6 points.
D.
Plan for involvement of IBCLC is adequate to meet needs. Up to 6 points.
E.
Plan for availability of peer support staff. Available as much as possible. Appropriate plan
for back-up. Up 10 points.
F.
Appropriate staff identified for required meetings. Up to 3 points.
G.
The plan for addressing essential functions. Number of staff addressing essential
functions is manageable and appropriate. Appropriate staff for each function. WIC staff
involved with supervision. Up to 10 points.
H.
Plan for training peer staff and other WIC staff includes FNS curriculum and ongoing
training for peer support staff. Ongoing training for staff who manage peer support
programs. Lactation management training for additional back-up staff if needed. Up to 6
points
I.
The extent to which the application proposes to collaborate / coordinate peer support
services, organizations, agencies, and individual providers in the geographic area. Peers
integrated into WIC. Up to 10 points. (Up to 4 for community collaboration and up to 6 for
peer integration with WIC services.)
J.
Budget. Justification for budget items. Evidence of planning for needs. We will also review
for reasonable amounts and may request adjustments based on available funding and
budget justification. Up to 8 points.
K.
Evaluation. Identification of evaluation methods beyond what is required that will help us in
evaluating the effectiveness of the peer support program. Up to 1 point.
L.
The extent to which the application describes how the agency will assure that the basic
WIC services will continue to be met. Identification of strengths, concerns, challenges to
maintaining services, technical assistance needs. Up to 5 points.
M.
Current Performance and Capacity: We will review the Agency's most recent Management
Evaluation / Field reports to assess current performance. We will confer with their Program
and Nutrition Consultants for their perception of the agency's capacity to continue providing
basic WIC services and implement the PBSP. For current MN peer programs we will also
review peer progress reports. Up to 10 points
N.
Other. Overall impression, innovation, phone responses. Up to 12 points
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Instructions and Guidance
WIC Peer Breastfeeding Support Application
Instructions for completing application and obtaining guidance:

You can contact the State WIC Breastfeeding Coordinator with questions about this
application, ideas for how you might implement peer support, help with using your
summary statistics to identify needs or other related questions. Contact Mary B.
Johnson at 651-281-9906 or mary.b.johnson@health.state.mn.us. Please include
”Peer Application Question” in the memo line.

Additional background information about the FNS model for peer breastfeeding
support can be found at the WIC Works site:
http://www.nal.usda.gov/wicworks/Learning_Center/support_peer.html

Agencies who do not have Internet access can request a copy of materials found at
this site by contacting Pamela Anderson at 651-281-9911 or
pamela.anderson@health.state.mn.us

The Minnesota WIC Program Policy on Peer Breastfeeding Support is attached.

Sample peer counselor training manuals from several states can be borrowed from
the MDH library. http://www.health.state.mn.us/library/index.html

If there is interest expressed in the letter of intent, we will host a conference call to
answer questions about peer breastfeeding support and this application. We will
notify those who have expressed interest via an email to those indicated on the
Intent to Apply.

Instructions and guidance for completing this application and planning your program
follow. We realize that additional details for your peer support program will be
developed if you are awarded a grant. In this application we would like brief, but
sufficient, information to help us determine areas most in need of peer support and
agencies with the capacity to implement or continue implementation consistent with
FNS requirements and best practices, without compromising current WIC services,
and to provide feedback to help define elements of successful peer programs. We
hope the application will also guide you in considering how peer support can be
integrated into your WIC services.

Please remember that for most items your score will depend on how clearly and
completely your written answers address the questions outlined. Existing programs
should outline their current program and planned changes, if any. Please do not
assume we are already familiar with your program.

Abbreviations. Please keep abbreviations to a minimum. If you use abbreviations
spell the term the first time and also attach a list of abbreviations as Attachment B.
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Instructions for Cover Page.



Please indicate the name of the lead organization on the cover page.
Confirm that the lead organization is a current MN WIC grantee.
Indicate if your agency is a current MN WIC Peer Breastfeeding Support Pilot
Program or a new PBSP applicant.
Instructions for Completing Face Sheet
Please type or print all items on the Grant Application Form Face Sheet.
Applicants please note:
The application form has been designed to be used on all Special Project grants
administered by the Minnesota Department of Health. If you have questions, or need
assistance in completing the application form, please contact the program Manager or
Consultant identified as responsible for the grant.
1. Applicant Agency
Legal name of the agency authorized to enter into a grant contract with the Minnesota
Department of Health.
2. Director of the Applicant Agency
Person responsible for directing the applicant agency.
3. Fiscal Management Officer of Applicant Agency
The chief fiscal officer for the recipient of funds who has primary responsibility for grant
and subsidy funds expenditure and reporting.
4. Operating Agency
Complete only if other than the applicant agency listed in number 1 above.
5. Contact Person for Operating Agency
Person who may be contacted concerning questions about implementation of this
project.
6. Contact Person for Further Information
Person who may be contacted for detailed information concerning the application or the
project if different from number 5 above.
7. Signature of Director of Applicant Agency
Provide original signature and date. If an application is sent by email the pages with
original signatures must be mailed.
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Instructions for Completing Project Information Sheet for the
Minnesota WIC Program Peer Support Proposals.
Please type or print all items on the Project Information Sheet for the Minnesota WIC
Program Peer Support Proposals.
1. Applicant Information
Provide name of applicant agency, Minnesota Tax I.D. Number and/ or Federal I.D.
Number. Check the appropriate answer for 501.C3 status. Nonprofit agencies are
required to provide a copy of their 501.C3 form with this form as evidence the agency is
a non-profit institution, corporation or organization.
2. Proposal Information
The total amount requested (see budget pages 13 – 15 in application) and the
proposed geographic area. You can indicate that the area you are proposing to serve
is the same as your current WIC service area. Please briefly describe this area.
(Specify county or counties, etc.) The funding category is Minnesota WIC Program
Peer Breastfeeding Support Program.
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Instructions for completing other parts of the grant application:
Need for peer breastfeeding support /plan for addressing highest
priority needs.
1. Need for peer support staff.
Describe any breastfeeding education and support needs you and the other WIC staff
have identified in your WIC population that could be at least partially addressed through
peer support.
Needs might include language, culture, age, isolation / lack of support, characteristics of
your community or service area that create challenges to breastfeeding support, length of
breastfeeding duration, support for first time mothers or first time breastfeeders, etc.
Please be as specific as possible. Brief statements are sufficient.
To assess numbers of breastfeeding participants and breastfeeding initiation and duration
rates the summary statistics may be helpful.
Please include the numbers of pregnant and breastfeeding women in each of your
proposed peer services areas. Use the Summary Statistics Report – Participation for the
report month of February and the combined total for pregnant (PG) and postpartum
breastfeeding (PP BF) women from the first section, Total Participants by Race.
2. Plan for addressing needs.
Describe how peer counselors will be used to address the highest priority needs identified
above.
If you plan to use peer support to address several of the highest priority needs or all of the
needs identified above, identify and briefly describe all areas you plan to focus on.
If you plan to have peers available for all of your WIC clients please describe your plan and
how you will assign peers to the highest priority needs if there is not enough peer time
available to serve all of your participants.
3. Days, times, locations peer services will be available.
Complete the grid showing days and hours peers are or will be available and the plan for
back-up during those times. If needed you can insert additional rows or copy the grid to
show differences between different peer sites.
If you plan to have peer staff and WIC peer back-up available for calls 24 hours a day, 7
days a week, note “24/7” in the first box and draw an arrow across the entire table for
hours available. If you anticipate that peers will be available only certain times of the day
and certain days of the week please note that in the table.
Add any brief comments that will help us understand your plan.
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For initial implementation large WIC programs might want to focus on a few of their WIC
clinics, for example clinics with larger numbers of participants with special need, then
expand their programs to other clinic sites. This can help to focus staff supervision,
orientation, and training time more efficiently initially and work out any issues that arise
before expanding to other sites. Smaller WIC programs may want to have peer counselors
potentially available for any WIC participant or they may choose to focus on a segment of
their population with special needs.
Identify areas where peer services will be available. (Geographic areas, specific clinics,
entire WIC grantee service area, etc.)
Identify work areas where peers will work. (Clinic, own home (phone), hospital, home
visits, etc.)
Staffing
4. Number of peer staff.
 Identify the arrangement you will have for obtaining peer support staff (hired,
contracted by WIC, contracted through another program.)
 If you plan to use staff who are contracted through another program explain your
plans and how you will assure that the FNS requirements are met.
 Identify the number of peer support staff you plan to use and how many hours a
week you anticipate they will work providing peer support. (A range of hours is fine.
Some may work more hours than others)
For initial planning of peer counselor caseloads, information shared by FNS will be helpful.
Current MN WIC PBSP grantees are also resources to learn about caseload.
Guidance from FNS on planning number of peers.
Factors in determining the number of peer support staff needed include:
•Number of clinic sites
•Caseload at each clinic site
•Demographics of the area
•Responsibilities required of the peer counselors
•Hours per week each peer counselor can work
•Frequency that sites schedule certifications of pregnant and breastfeeding women
•Varied caseload mix of peer counselors
Estimating time for various types of peer contacts:
Type of Contacts
Telephone Calls
Home Visits
Hospital Visits
Clinic Counseling
Classes and Support
Groups
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Calculating Time Charged
4-6 calls per hour, including documentation time
Around 2 hours per visit, including travel time and documentation
(will vary depending on assistance provided, and distance to
mother’s home)
Varies depending on purpose (general 1st introduction rounds vs.
problem-solving)
Around 30 minutes per visit, including time to document the
counseling
Around 2 hours (1 hour class, plus preparation and class set-up)
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Other tips from FNS on planning for peer support:
“The number (of peer counselors) needed is extremely variable, depending upon a
number of factors unique to the area, including the overall caseload of WIC clients and
demographics of the community. For instance, if the community is rural and spread
out, you might want to consider hiring a peer counselor who can cover 2 or 3 counties.
You may want to hire a different peer counselor for each telephone district to minimize
long-distance calls needed. If transportation issues are apparent, it might be better to
have a separate peer counselor in each small area. If you live in an urban area with a
large pool of potential peer counselors, you might want to hire several peer counselors
in key service areas or from various ethnic backgrounds. You may want to hire peer
counselors who can provide services to fulfill various client needs, such as a peer
counselor who breastfed multiples to provide help to other mothers of multiples.
Consider also how they will be used. For instance, if they will primarily make home
visits with all new breastfeeding mothers, you will need more peer counselor hours than
if their primary role will be making telephone calls from home.
Typically, a peer counselor who primarily works from home making telephone calls to
pregnant and new mothers and is available to work around 10 hours per week should
be given no more than 50 clients or so to begin with. As she grows in her knowledge
and skills, both the supervisor and peer counselor can assess whether she can handle
more.
Some programs recommend providing peer counselors with a mix of mothers within
their caseload so they are not solely following pregnant women or solely following
brand new breastfeeding mothers. This helps them to space out mothers who need
intense follow-up.
Tips from MN pilot programs
Have CPAs start making referrals while you are training peers, so peers can get started
as soon as they are trained.
Start peers with a smaller caseload and work up to a larger caseload.
Plan for travel time and parking for hospital visits.
Involve your HR person early.
Try to get a good estimate from a similar size WIC program to estimate the number of
peers needed.
Plan for peer turnover. Consider training back-up peers at your initial peer training.
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5. International Board Certified Lactation Consultant (IBCLC1) involvement.
An IBCLC must be available on staff or by contract.
Describe if and how the IBCLC will be available at all peer service locations (clinic
locations) in the rare circumstance that the scope of the lactation concern is beyond the
skills and abilities of WIC staff and peer at that site and phone consultation is not
sufficient.
The IBCLC may have responsibilities related to training, supervision and providing
back-up for breastfeeding problems beyond the scope of the peer counselors, as well
as other responsibilities.
The IBCLC may be a WIC staff member, a shared staffmember (such as an IBCLC
currently working within the agency but not within WIC or who is employed by another
WIC program) or a contracted IBCLC.
CLC, CLE, LE and similar designations indicate someone has taken one specific
lactation course, but are not the equivalent of an IBCLC. CPAs who have completed
this coursework will also be valuable to your peer support program.
6. IBCLC who is not currently employed by WIC.
Please check the box that best describes how you will obtain the services of an IBCLC
or indicate not applicable, as you have an IBCLC on staff.
IBCLC Time available. Please include an estimate for the amount of time you will use
the IBCLC and other staff to provide peer program management, training, supervision
and other peer program functions. (Completing the essential services table found on
page 8 can also help you in identifying the amount of time that will be needed.)
7. IBCLC and Other Staff if any involved in training, backup & supervision
A. IBCLC
Describe the involvement of the IBCLC(s).
FTE of IBCLC time.
Briefly describe why you feel this amount of time will meet the needs for the program
responsibilities she is assigned.
B. Other Staff
Identify any other staff who will be involved in training, back-up, and supervision of peer
support staff and their credentials, as well as lactation training completed (name and
1
1IBCLC stands for International Board Certified Lactation Consultant. This means that the person has
obtained the specified amount of training and experience and passed the examination offered by the
International Board of Lactation Consultant Examiners. For more information see: http://www.ilca.org/. This
site has a search feature that may help in finding an IBCLC in your area. Not all IBCLCs are listed at this
site. If you need assistance in identifying an IBCLC in your community contact the State WIC Breastfeeding
Coordinator.
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date of training program) or plans to send any of these staff to a breastfeeding
management course or other training, if needed.
Information about lactation education programs, as well as information on requirements
for becoming an IBCLC, can be found at:
http://www.health.state.mn.us/divs/fh/wic/localagency/bf/index.html
8. Essential functions.
FNS has identified functions that they consider essential to the success of a peer
support program. They are requiring these components in programs they fund. Please
complete the grid and check off the staff member who will be responsible for providing
this function. If for some reason you feel that you will provide an “essential function” in
a different way, please describe your plan in “comments”. In some cases staff may
share a role, such as initial training. In this case check all the columns for staff who will
be involved and identify the lead staff person in comments
If using current staff identify the person’s first name and last initial and position title,
otherwise use just the position title.
WIC agencies that will provide some essential functions through arrangements with
another organization or organizations must include a signed letter from the
organization(s) outlining:

roles,

defining who has decision-making authority for the peer functions in the
organization, and

agreeing to fulfill the designated required functions if the grant is awarded.
Include as Attachment A
Training / Integrating Peer Program with other WIC services
9. Plan for participation in required meetings and training.
Identify how staff involved in the peer program have been / will be trained on the FNS Peer
Management and Peer Training Curriculum.
Please briefly describe how you will provide training for replacements of key staff, if
needed.
Indicate the number of staff, and either name and position or just position of the staff who
will attend:
o The two required meetings with the state and other staff from peer programs.
(See timeline for approximate dates.)
o We recommend that at least two attend.
o The staff must be an IBCLC or CPA who will be involved in implementing the
peer program and planning training.
If needed, add any comments that will help us understand your plans.
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10. Plan for training of WIC Peer support staff and other WIC staff.
A. Please let us know your preferences for providing the initial training for new peer
staff. We know that some agencies prefer to train their own staff and others may be
interested in planning a joint training. If agencies are interested in coordinating the
training with other PBSP sites we will plan time at the meetings with other PBSP
managers to discuss possible coordination (dependent on the interest of other peer
programs in a joint training).
 If needed, add any comments that will help us understand your preferences.
B. Our plan for providing ongoing training for existing peer support staff:
 Ongoing training is important for reinforcing information provided at the initial
training, addressing issues that arise in discussion with peers or review of peer
documentation that would be of benefit to the group of peers, and further developing
your program. The training can be provided in a number of ways, and using several
methods can help accommodate various learning needs and styles. Please identify
how you will provide ongoing training for your peer support staff.
C. Our plan for orienting current WIC staff to peer support functions and how CPAs will
refer a participant for peer support.
 It is important for current WIC staff to understand the role of the peer support staff
and why their hours and work locations may vary. CPAs also need to know how
they will refer clients for peer support. Please briefly describe how you will orient
current WIC staff to peer support. You may want to have CPAs attend all or a
portion of the peer training, or provide information at a staff meeting. It is also
important for existing WIC staff and peer support staff to meet, perhaps through
assigning someone to greet the peer and make introductions on their first day of
work.
 A brief PowerPoint presentation is available for your use to introduce peer
breastfeeding support to your WIC staff. You can adapt the presentation to
describe your local program. Contact the State WIC Breastfeeding Coordinator to
request a copy.
D. Our plan for training WIC CPAs more extensively in lactation to help provide backup for peer support staff, if needed.
 You may determine that the existing staff are adequately trained in lactation
management or that you need to train one or more staff to help provide back-up /
follow-up on issues identified by the peers. Indicate if you feel you have sufficient
numbers of trained staff or if you plan to train additional CPAs. Also identify the
method you will use for training
E. Our plan for providing ongoing training in lactation management for staff who
provide supervision and back-up.
 Describe how you will provide ongoing continuing education opportunities for staff
who provide supervision, back-up and training for the peer breastfeeding support
program.
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11. Plans for integrating all peer staff into the WIC program to help them feel a part
of the program.
 Briefly describe how you will provide information about WIC and the peer role in
WIC, how you will introduce peers to other WIC staff, and how you will involve peers
in meetings or other ongoing activities to help them feel a part of the WIC program.
12. Plan for collaboration and coordination with others:
 Working with another WIC program or programs may help each program most
effectively use their time and resources.
 It may be most efficient for training peer counselors and implementing the peer
support program if several WIC agencies work together. If no agency has an
IBCLC on staff consider sharing services of a contracted IBCLC who could train,
provide training updates and serve as a back-up. If several larger agencies have
access to IBCLCs or other staff trained in breastfeeding management they could
take turns being available to be reached after hours via a beeper, if a peer support
person encounters a situation that is beyond her scope. If an agency has a
neighboring WIC program with an IBCLC consider contracting with that IBCLC to
help train and supervise breastfeeding peer support staff in two or more agencies.
 If you plan to collaborate with another WIC program or programs briefly describe
your plans. Include any specific activities such as contracting with an IBCLC
employed by another program, coordinating training, coordinating after hours backup for peer support staff, etc. (Note that a MOU will be required after the grant is
awarded.)
 Include a letter of support from the agency/ies with which you will be collaborating
to provide essential peer services.
13. Plan for outreach / coordination.
 Identify existing networks you will use for informing others in your community about
planned peer support activities, encouraging other programs to develop peer
support, or helping to make peer counselors welcome at other locations, such as a
community hospital. Please describe any existing breastfeeding coalitions, task
forces, or other established methods of communicating about breastfeeding and
how you will use these existing relationships to disseminate information about peer
support and build a supportive breastfeeding environment.
 Describe your plans for any new activities to inform and involve others in your
community, such as meeting with representatives from area hospitals, clinics and
other organizations to introduce peer management staff and eventually the peer
support staff.
Evaluation / Agency Capacity
14. Evaluation and progress report.
 Please describe any evaluation methods you plan to use in addition to the
requirements outlined in this section (see information below).

Required minimum components of progress reports and evaluation include progress
to date on your PBSP initiation (staff hired or trained, policies developed, etc). Later
reports will include information on the number of peer support staff, numbers and
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types of contacts provided, and any comments from CPAs, peers or participants
that would help identify successes or challenges of the program and provide
feedback to encourage continued funding and to assist others who are developing
peer support programs. We will also ask you to report your breastfeeding rates in
the 3rd month of life and numbers of participants in the month for your WIC program
and if applicable for the specific clinics in which you are initiating the PBSP (see
attached report form.). We may request other information needed for reporting to
FNS or to help us learn more about implementation of peer support.

See the timeline for information on when progress reports will be due.
15. Agency capacity. (Comments on how your WIC Program can successfully implement
/ has implemented the peer program meeting the goals from your initial application and
FNS and MN WIC requirements.)
 Briefly outline strengths of your agency or program that will help with
implementation. If you have concerns about factors that may impact success
(agency funding, staffing, other) or if you anticipate technical assistance needs,
describe these as well.
16. Contact for phone call with grant review team.
On June 28, 2006 the grant review team, as a part of the review process, will
initiate a call to each applicant for PSBP funding. We will have more information on
timing of the calls when we know how many applications we receive.
Include information on the name of the person we should call, anyone else who plans
to participate on the call (several using one speaker phone) and the phone number we
should call, with area code.
Budget
17. Other funding sources, if any. Other funding sources encouraged, but not
required.
In addition to the designated peer funds we will use the following funding sources to
supplement the peer program funding:
We receive the following in-kind services:
 Briefly describe source of in-kind support (and approximate amount if known).
We plan to seek outside funding from:
 Briefly describe any sources you plan to approach to provide additional funding for
PBS services, if any. If you are currently receiving additional funding indicate the
source and the approximate amount.
18. A. Complete the budget form with totals for each category.
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18 B. Include a narrative description explaining the details of your first year
budget in two pages or less. (First year is FFY2007 which runs from October 1, 2006
to September 30, 2007)
1. Salary and Fringe Benefits
Grant funds can be used for salary and fringe benefits for staff members directly
involved in your proposed activities.
For each position to be charged to the PBSP, include title of the position, name (if
known, first name, last initial), the hours or full-time equivalent, the expected rate of
pay, and the total amount you expect to pay the position for the grant period. Only
activities related to the peer support may be charged. Examples of positions
include: Peer Counselor Manager / Supervisor(s), IBCLC if not the peer counselor
manager or supervisor, peer support staff, other staff who will provide back-up if a
peer support staffperson encounters a situation beyond her scope.
“Full-time equivalent” (or FTE) is defined as the percentage of time a person will
work. To calculate the FTE, divide the hours the person will work by the standard
number of work hours, which is 40 hours per week, 174 hours per month, or 2,088
hours per year. For example, a person who works 20 hours per week is a 0.5 FTE
(20 divided by 40 equals 0.5).
Use separate lines for employees and contracted staff.
Describe your plan for compensation and reimbursement of peer support staff,
including how you will determine or determined the hourly rate of pay, opportunities
for salary increases (if known), and benefits, if any.
Starting salaries for clerks or community health workers may provide a guide for
starting pay for peer support staff.
2. Training
Include peer training costs (other than the staff listed above), costs for training
materials for home study for peer support staff (if any), lactation education for peer
manager and / or staff who will provide back-up for peer support staff. Note that no
work / training / expenses related to the grant can occur before the grant application
is signed and you are notified to begin work, so please do not schedule training for
peer managers until you know the grant has been awarded and the contract is
signed. If the grant agreement is not signed by all parties before October 1, 2006
the grant period will not begin until everything is signed and you are notified to begin
work.
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3. Travel
Include:
Peer support staff travel to hospital or home visits. (# miles anticipated per week x
mileage reimbursement rate x 52 weeks x # of peer counselors) and any related
travel by the peer manager or supervisor.
Travel for staff to required meetings and training.
You must include the cost for at least one staff member (preferably two) to attend
the two required meetings. The site for the two meetings with the state and
representatives from each local WIC peer program will be determined. For
budgeting plan that at least one of the meetings will be in the Twin Cities. The
location of the other meeting will be determined by the locations of the projects.
Plan also for staff who need to complete the FNS peer management and peer
curriculum training and your preferred plan for this.
Grant funds cannot be used for out-of-state travel without prior written approval from MDH.
Please include anticipated out-of-state travel expenses, if any, in your proposal.
Travel paid for from this grant cannot be paid at a rate higher than:
Mileage
The current IRS rate at the time of travel.
Parking fees Actual cost
Breakfast
$7.00
Lunch
$9.00
Dinner
$15.00
Hotel
Actual cost within reason
4. Supplies and small equipment
Explain your expected costs for such items as answering machines or voice mail for peer
support staff, beepers, locked file boxes for peer records when working from home or off
site, etc.
Grant funds may be not be used to purchase computers or large equipment.
5. Other costs
List other costs associated with your project. Costs might include videos or demonstration
dolls for peer support staff to use for educating participants, reference books for peer
support staff, etc. Educational materials, such as books or handouts, for participants are
not an allowed cost under this grant.
6. Indirect costs
“Indirect costs” are defined, as costs that represent the expenses of doing business that
are not easily identified with a particular grant, contract, project, function, or activity, but
are necessary for the general operation of the organization and the conduct of activities it
performs. Examples of such expenses include accounting, human resources, general
agency administration, and costs to operate and maintain facilities. Indirect costs can be
calculated as an indirect cost rate or through a cost allocation plan; however; they cannot
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be more than 12 percent of your total proposed budget. In your budget description,
explain what kinds of indirect costs you expect to have.
Attachment A. Letters from collaborating organizations for providing essential peer
functions
WIC agencies that will provide some essential functions through arrangements with
another organization must include a letter of support from that organization outlining roles,
defining who has decision-making authority for the peer functions in the organization, who
is responsible for peer financial reports, who is responsible for assuring that confidentiality
issues are addressed, and agreeing to fulfill the designated required functions.
List all collaborating agencies on the cover page for the attachments, then attach the
letters in that order.
Attachment B. Abbreviations used in your application, if any.
If you use abbreviations in your application please submit a list of the abbreviations and
what the abbreviations stand for.
See the next page for requirements for submitting your application.
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Submitting your application.
 To be considered for funding, your proposal must be mailed or delivered to:
Mailing Address
Pamela Anderson
Minnesota WIC Program
Minnesota Department of Health
Post Office Box 64882
St. Paul, Minnesota 55164-0882
Delivery Address
Pamela Anderson
Minnesota WIC Program
Minnesota Department of Health
85 East Seventh Place, Room 220
St. Paul, Minnesota 55101
pamela.anderson@health.state.mn.us
If no one is available in room 220 to accept
the application do not leave the application
- call and make sure a WIC staff person
accepts the delivery. There is a phone in
room 220 you can use. See below.
To meet the deadline, your proposal must:
 Have a legible postmark from the U.S. Post Office or a private carrier dated on
or before June 21, 2006. We will not accept a postmark from a private, in-office
metering machine as proof that you mailed your proposal on time, or
 Be hand delivered to the address listed above and date-stamped upon delivery
before 4:30 p.m. on June 21, 2006.
o If no one is in the room to accept the proposal call 651-281-9911 or 651-2819906 to have a WIC staff person accept and date-stamp the proposal.
 We will accept emailed proposals if received before 4:30 pm on June 21, 2006.
Proposals must be attached as a Microsoft Word document. It is the
responsibility of the applicant agency to verify that the emailed proposal was
received. This verification must be made before the deadline. Occasionally
email delivery systems are slow. Email with viruses or files that are too large is not
delivered. The State email system does not inform you if a document was not
delivered.
o If you submit a proposal by email you must also mail in pages that require
signatures, with an original signature.
o E-mail the proposal to pamela.anderson@health.state.mn.us with “WIC
PBSP” in the subject line. Copy mary.b.Johnson@health.state.mn.us on
the email.
 We will not accept FAXED proposals.
We will not accept or consider late proposals
If an organization plans to provide some essential peer services through
collaboration with another WIC program or organization a signed letter from that
organization must be included for the peer proposal to be considered.
Proposals will not be considered if they are not from a current MN WIC Program
Grantee
WIC is an equal opportunity provider
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Definitions and FNS Q & A on peer support
Appropriate Definition of Peer Counselor (FNS definition)
 Paraprofessional
 Recruited and hired from target population
 Available to WIC clients outside the usual clinic hours and outside the outside the
WIC clinic environment
 Has breastfed at least one baby (does not have to be currently breastfeeding).
What is the definition of "paraprofessional" in FNS' definition of breastfeeding peer
counselor? For the purposes of using these funds, peer counselors fall under the
general category of paraprofessionals – those without extended professional training who
are selected from the group to be served and are trained and given ongoing supervision to
provide a basic service or function.
MN Abbreviations used within the peer application and guidance materials:
CHW
Community Health Worker
FNS
Food and Nutrition Service
IBCLC
International Board Certified Lactation Consultant
LLL
La Leche League
MN
Minnesota
PBS
Peer Breastfeeding Support
PBSP
Peer Breastfeeding Support Program
Questions and answers from FNS:
Can we use these funds to pay for the salaries of our dual-role staff when they are
performing peer support duties? (These staff perform clerical duties part-time and
peer support duties part-time to equal a full-time job.) The peer support funds can be
used for these dual-role staff only if these staff meet the definition of peer counselor as
outlined in the FNS model. These special funds are intended to take programs beyond
current operations and improve services offered to WIC participants, e.g., making peer
support services available to WIC clients outside usual clinic hours and outside the WIC
clinic environment. When determining how you may want to use these special funds, think
not in terms of how your program is currently being operated, but how this money can be
used to fill the gaps in peer support services offered to WIC participants.
For other questions and answers see this website:
http://www.nal.usda.gov/wicworks/Learning_Center/support_peer.html
Also see: http://www.health.state.mn.us/divs/fh/wic/localagency/bf/index.html
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Additional considerations and resources for training
Community Health Worker training. Training programs for Community Health Workers
began in two community colleges in Minnesota in 2005. The community health worker
training could be considered as a way to provide initial training on responsibilities related to
work, confidentiality, and other basic training needs for paraprofessionals working in the
community. Specific content on breastfeeding is not included and will need to be provided.
Components of the FNS curriculum must still be included in training for all peer staff, and
are not included in the CHW curriculum. Scholarships to attend the Community Health
Worker training may be available. For more information on Community Health Workers
see:
http://www.health.state.mn.us/divs/idepc/refugee/metrotf/chwdefine.pdf or
http://www.health.state.mn.us/divs/idepc/refugee/immigrant/chwmodels.html or contact the
State WIC Breastfeeding Coordinator.
A number of organizations offer lactation management courses. Peer managers from
MN PBSP Pilot sites found these courses helpful in training additional CPAs to provide
back-up for peer support staff. For a list of organizations offering this type of course see:
http://www.health.state.mn.us/divs/fh/wic/localagency/bf/bfconted.html .
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Attachment A – Sample Job Description
WIC BREASTFEEDING PEER COUNSELOR
Title: WIC PEER COUNSELOR
General Description:
A WIC Breastfeeding Peer Counselor is a paraprofessional support person who
gives basic breastfeeding information and encouragement to WIC pregnant and
breastfeeding mothers.
Qualifications:
 Has breastfed at least one baby (does not have to be currently breastfeeding).
 Is enthusiastic about breastfeeding, and wants to help other mothers enjoy a
positive experience.
 Can work about 10 hours a week.
 Has a telephone, and is willing to make phone calls from home.
 Has reliable transportation.
Training
 Attends a series of breastfeeding classes (nursing babies are welcomed).
 Observes other peer counselors or lactation consultants helping
mothers breastfeed.
 Reads assigned books or materials about breastfeeding.
Supervision:
The peer counselor is supervised by the
.
Specific Duties:
The WIC Peer Counselor:
1. Attends breastfeeding training classes to become a peer counselor.
2. Counsels WIC pregnant and breastfeeding mothers by telephone, home visits, and/or
hospital visits at scheduled intervals determined by the local WIC program.
3. May counsel women in the WIC clinic.
4. Receives a caseload of WIC clients and makes routine periodic contacts with all clients
assigned.
5. Gives basic breastfeeding information and support to new mothers, including telling them
about the benefits of breastfeeding, overcoming common barriers, and getting a good start
with breastfeeding. She also helps mothers prevent and handle common breastfeeding
concerns.
6. Is available outside usual 8 to 5 working hours to new mothers who are having breastfeeding
problems.
7. Respects each client by keeping her information strictly confidential.
8. Keeps accurate records of all contacts made with WIC clients.
9. Refers mothers, according to clinic-established protocols, to the:
 WIC nutritionist or breastfeeding coordinator.
 Lactation consultant.
 The mother’s physician or nurse.
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 Public health programs in the community.
 Social service agencies.
10. Attends and assists with prenatal classes and breastfeeding support groups.
11. Attends monthly staff meetings and breastfeeding conferences/workshops
as appropriate.
12. Reads assigned books and materials on breastfeeding that are provided by
the supervisor.
13. May assist WIC staff in promoting breastfeeding peer support through
special projects and duties as assigned.
I understand the above job responsibilities, and agree to perform these duties as assigned.
WIC Breastfeeding Peer Counselor
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Attachment B – Sample Form for recording breastfeeding initiation and duration rates.
Contact State WIC Breastfeeding Coordinator for additional information on finding the data and
completing the form. This form is not required for the application but will be a required component
of evaluation for PBSP that are funded.
See next page.
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Breastfeeding Rates: ______________ WIC Program, Clinic: ____________Clinic #___
From Summary Statistics Report – Breastfeeding
.
Participants in their
3rd month of life on
report for this
month …..
…were born in this
month.
Statistics Report
Month
Birth month
Feb 2007
(Dec 2006)
Mar 2007
(Jan 2007)
Apr 2007
(Feb 2007)
May 2007
(Mar 2007)
June 2007
(Apr 2007)
July 2007
(May2007 )
Breastfed
Ever
I, 3rd mo
of life (all)
%
#
Breastfed
Ever &
Currently
breastfed
I, 3rd mo of
life (all)
%
#
(Specify if data is from your consolidated or all clinics report-if so, label as “All” or
from a specific WIC clinic.)
Notes (note date of any breastfeeding promotion and support
initiatives, month peer counselors started working with clients,
or comments on other activities or events that might affect
the breastfeeding initiation or duration rates. List these by
the birth month in which they occurred- the second columnnot the report month.)
Data from this point and below will be required for reporting on your peer program progress. If you have data for earlier months please
complete as much data as you have readily available. (For new PBSP June, July, Aug, Sept are baseline, before the start of the peer
program.)
Aug 2007
(June 2007)
Sept 2007
(July 2007)
Oct 2007
(Aug 2007)
Nov 2007
(Sept 2007)
Dec 2007
(Oct 2007)
Jan 2008
(Nov 2007)
Feb 2008
(Dec 2007)
Mar 2008
(Jan 2008)
Apr 2008
(Feb 2008)
May 2008
(Mar 2008)
June 2008
(Apr 2008)
July 2008
(May 2008)
Aug 2008
(June 2008)
Sept 2008
(July 2008)
Oct 2008
(Aug 2008)
(Interim Goal for 2008)
(Sept 2008)
Nov 2008
1st year Peer grant through Sept 30, 2007. Submit a copy of this grid completed to report month of Nov 2008 to State WIC Office by
Dec 30, 2008.
Dec 2008
(Oct 2008)
Jan 2009
(Nov 2008)
Feb 2009
(Dec 2008)
Mar 2009
(Jan 2009)
Apr 2009
(Feb 2009)
May 2009
(Mar 2009)
June 2009
(Apr 2009)
July 2009
(May 2009)
Aug 2009
(June 2009)
Sept 2009
(July 2009)
Oct 2009
(Aug 2009)
Nov 2009
Goal for 2009
Revised 2009 Goal:
Revised on
due to
(Sept 2009)
nd
If funded for 2 year of peer support , submit a copy of this grid completed to report month of November 2009 to State WIC Office by
December 30, 2009. We will provide additional grids for future years of the peer breastfeeding support program, if funds are available.
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Attachment C – MN Policy on Peer Support
See next page.
The policy is from the Minnesota WIC Program Operations Manual (MOM). Exhibit numbers and
page numbers on the policy are from the MOM manual.
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MOM SECTION 6.12
Subject: Breastfeeding Peer Support
References: MWSSNP 1-2: WFM 2 /NE 4-2
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 support staff must be in addition to the two required nutrition
education contacts. (See MOM section 6.2)
Peer Support Manager(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).
 Responsibilities include, but are not limited to:
o
Policy development;
o
Hiring peer support staff;
o
Initial and ongoing training for peer support staff;
o
Supervision, including:
 At least monthly spot checks with participants being followed by peer support
staff.
 Reviewing peer contact logs at least every other week (ideally weekly);
 At least weekly phone contact and monthly individual meetings with peer
support staff, and
 Periodic meetings with all peer support staff.
o 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 support staff person.)
o Providing back-up for peer support staff who encounter situations beyond their
scope, both during and after normal clinic hours, and developing a plan for backup if a WIC peer manager, supervisor or other designated WIC staffperson is not
available.
 Peer Support Managers must be trained using the FNS curriculum “Using Loving
Support to Manage Peer Counseling Programs”.
 Peer Support Managers and all other staff providing back-up must have at least
annual continuing education in breastfeeding management.
6.12-1
4/06
WIC Peer Support Staff
 Peer support staff funded with FNS peer support funds must meet the minimum FNS
definition of a peer counselor:
o Paraprofessional;
o Recruited and hired from target population;
o Breastfed at least one baby (need not be breastfeeding currently); and
o Available at WIC clinics and, when necessary, outside usual clinic hours and the
WIC clinic environment.

Peer support staff must receive the following training:
o Using the FNS curriculum “Loving Support through Peer Counseling”;
o On 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 6-J).
o On confidentiality and sign a confidentiality agreement (see Exhibit 6-K).
 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.
o Additional training at least twice a year.
o Orientation to the WIC Program.
o The opportunity to meet WIC staff.

Peer support staff must document all contacts (and attempted contacts) with WIC
participants. Documentation must include:
o Participants’ names (mother and infant);
o Date of the contact or attempted contact;
o Participant’s questions, concerns or comments;
o Topics discussed;
o Referrals;
o Plan for follow-up; and
o Peer contact time.

Peer support staff must receive compensation for their work and reimbursement for
mileage and long distance phone charges, if applicable.
Other WIC Staff
 The local agency must have an adequate number of trained IBCLCs or CPAs trained
in lactation management to supervise peer support staff and handle questions and
issues beyond the scope of the peer support staff. Most peer programs will need backup staff beyond the required peer manager.

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.
6.12-2
4/06
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 peer support program. Contact the state WIC office
for the claim form for the current fiscal year.
 All or a portion of a WIC staffperson’s salary may be billed to the peer support funds
for time spent on activities directly related to the peer support program.
 The agency must maintain records to document all expenses, including staff time,
billed to FNS peer support funds.
 Time and other expenses that are billed to peer support funds must not be claimed on
the Agency’s monthly claim for reimbursement.
 Expenses charged to the peer pilot 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
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 Breastfeeding Coordinator.

If approved to proceed, you must submit a written plan.

A WIC staffperson, 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 FNS peer funds will be used to train paid staff
from another entity/program as peer counselors for WIC, a MOU must be
established with the other entity ensuring:
o That the peer counselors will operate under the same parameters as
required for WIC peer breastfeeding support programs.
o Compliance with FNS requirements and Minnesota WIC peer policy and
peer grant agreement.
Guidance:
Considerations when Hiring Peer Counselors

In addition to the required qualifications of a breastfeeding peer counselor,
research has shown that peer counselors may be more effective when they:
o Have enthusiasm for breastfeeding.
o Possess good basic communication skills.
o Have previous breastfeeding experience (ideally > 6 months).
o Are similar to WIC participants they will serve (i.e., in ethnicity, age, and
language spoken).
o Are currently, or have been, a WIC participant.
o 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 Coordinator.

Peer counselors should have access to a telephone and transportation.

Peer counselors should understand work expectations.
Sample job descriptions are found in the FNS peer materials, available from
6.12-3
4/06
the State WIC Office.
Work Parameters

In addition to their work in WIC clinics, peer counselors should expect to
make home and hospital visits when needed, and make telephone contacts from home
and clinic.

WIC peer support staff may bring their nursing infants to work with them.
Peer contact frequency

More frequent contacts with pregnant and breastfeeding women increases the
effectiveness of peer support. FNS recommends the following contact schedule as
most effective:
o
Pregnant women:

Monthly.

More frequently as due date nears.
o
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.
o
After the first month:

The peer breastfeeding support staffperson and the
breastfeeding woman can determine the contact schedule. (The peer
counseling program manager can provide guidance in frequency of
contacts.)

FNS recommends monthly contacts during the first year, and
additional contacts if needed (e.g., if returning to work or school).
Compensation and reimbursement of peer support staff

Many WIC programs offer peer counselor salaries similar to a clerk or
community health worker.

Other recommendations:
o
Provide travel allowance for home/hospital visits and meetings.
o
Cover training expenses.
o
Provide benefits if possible.
Peer Counselor Manager

A sample job description for WIC staff that manage the peer support program
is found as Exhibit 6-L.

If responsibilities are split between two or more staff, the roles for each must
be clearly defined and include all required roles.
WIC IBCLC

The IBCLC may be a WIC employee or a contracted employee. Contact the
State WIC Breastfeeding Coordinator for additional information on training your
WIC staff to become IBCLCs or on finding an IBCLC in the community.
6.12-4
4/06
Training

Peer counselors should receive orientation to WIC so that they are familiar
with services being received by participants.

WIC staff who are trained in breastfeeding support can help integrate peers
into the WIC program.

Materials provided for home study can supplement formal instruction for peer
support staff.

Opportunities for peer counselors to “shadow” or observe other peer
counselors and lactation experts are very helpful.

Some states have developed 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.
Supervision of Peer Support Staff

The mentor/supervisor transition has been reported to be effective for many
successful programs. These programs have the supervisor act as a mentor for the first
6 months, and then gradually change to a more traditional supervisor role. If used,
this planned change should be explained to the peer support staff.
Documentation of Client Contacts

A sample peer documentation form is included as Exhibit 6-M.

A sample Peer Weekly Activity Report is included as Exhibit 6-N.
Community partnerships enhance the effectiveness of a WIC peer support program.
Designate a WIC staffperson 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.
6.12-5
4/06
MOM Exhibit 6-J
Guidelines for Breastfeeding Peer Counselors to Yield to a lactation expert
or health care provider
When Peer Counselors identify any of the following problems or situations, they must
immediately consult their supervisor to help decide the best plan for helping the mother and
infant and refer as needed. The Peer Counselor will continue to provide support while the
lactation expert or health care provider is addressing the issue, unless the
Coordinator/Supervisor or peer decides it is best to discontinue peer support.
Breastfeeding problems for
mother or baby:
1.
2.
Mother and/or Baby Illness
1.
Baby has jaundice.
Baby is premature, LBW or sick and mother is
unable to begin breastfeeding following delivery.
2.
Mother with chronic or acute illness or with a
physical handicap.
Baby has less than 6 wet diapers and 3-4 BMs/24
hours, any time during the first month (after the
baby is 3 or 4 days old)
3.
Chronic diseases with nutritional implications, e.g.,
renal, liver, intestinal, or heart problems.
Metabolic disorders with nutritional implications,
e.g., diabetes mellitus.
4.
3.
Failure to gain weight or slow weight gain--initial
loss of > 8% of birth weight, failure to regain birth
weight by 2 weeks, weight gain of < 4 oz/week.
4.
Mother has engorgement, unresolved in 24 hours.
5.
The mother has breast pain or redness on one or both
breasts.
6.
7.
8.
9.
5.
Diagnosis of AIDS/HIV (Breastfeeding is contra
indicated).
6.
Hospitalized mother or baby.
7.
Baby with congenital defects or neuromuscular
problems, e.g., Down Syndrome, cleft lip/palate
8.
Baby with chronic diseases, e.g., cystic fibrosis.
The mother has sore or cracked nipples.
The baby is having difficulty latching onto the breast
after several tries.
Medical History
1.
Routine use of prescribed medication by mother.
The baby is unhappy at the breast or refusing the
breast.
2.
Mother with prior breast surgery (i.e. breast
implants, breast reduction, breast cancer).
The mother is both breastfeeding and bottle-feeding
her baby before the baby is 1 month old.
3.
Mother with prior gastric bypass surgery
4.
Relactation after 3 or more days off the breast.
5.
Plans to nurse an adopted infant.
10. The mother has decided to breastfeed; but baby has
been bottle-fed since birth.
11. The mother wants to breastfeed; but has been
advised NOT to by her health care provider.
12. Baby “still hungry” after feeding, unresolved after
24 hours of increasing frequency and duration of
breastfeeding.
13. Regular/routine lengthy feedings (greater than 45
minutes duration).
Nutrition
1.
Mother is nutritionally at risk for underweight, has
bulimia or anorexia.
2.
Mother has no food.
3.
Mother or baby experiencing vomiting or diarrhea.
14. Mother or baby has suspected thrush/yeast infection.
4/06
MOM Exhibit 6-J
Social
Other
1.
Suspected physical abuse of mother or other family
member.
1.
Mother feels there is a problem that needs referral.
2.
2.
Suspected depression in mother.
Peer feels there is a situation that needs to be
addressed by the lactation expert.
3.
Any use of alcohol or street drugs (such as heroin,
marijuana, cocaine, etc.)
Breastfeeding teenager less then two years after
onset of first menstrual cycle.
3.
Mother not following suggestion given.
4.
In cases where the Peer needs to yield a breastfeeding question or concern to the Lactation
Specialist:
1. In all situations with breastfeeding problems for mother or baby, mother and/or baby illness,
or medical history:
a. Ask the mother whether the issue or concern is being monitored by her health care
provider.
b. If yes, ask the mother what the doctor or other HCP has advised her to do.
c. If there is a concern about the baby getting enough to eat, ask for:
i. How the delivery went
ii. Birth weight
iii. Lowest weight
iv. Subsequent weights
v. Supplementation – when and how much, breast milk or other
vi. Use of pacifiers or nipple shields
vii. Pumping
d. If there are medications involved, ask the mother to spell the name of the drug and to
detail dosage, including how much and how often.
e. Tell the mother you’d like to refer her to a lactation specialist and ask her permission
to have the lactation specialist call the mother and ask her to sign a release /or
document that permission was given if you are making a phone contact. Give the
mother the lactation specialist’s number so that the mother can call also.
f. Document and call the Peer Counselor Coordinator or Manager.
2. For families who need referrals for food, social services, and / or other situations:
a. Use the list of referral resources to offer information to the mother about the
appropriate social agency.
b. Document and call the Peer Counselor Coordinator or Manager.
4/06
MOM Exhibit 6-K
Breastfeeding Peer Support Confidentiality Checklist and Agreement
Handling of WIC Participant Information
Trust and confidence are needed for a successful program. This trust must be on all levels…between
supervisors and peer counselors, between peer counselors and colleagues, and between peer
counselors and clients.
Clients share personal information in order to be served as WIC participants. This includes medical,
financial, and personal information. At the same time, clients have the right to know that the
information they give will be kept confidential and used only as needed by clinic staff.
It is our responsibility to respect their privacy and not disclose client information.
In order to protect my clients’ confidentiality, I will adhere to the following policies and procedures:
 I will collect, access, maintain, use and disseminate information only if it is necessary and
needed to perform my duties as a peer counselor.
 I understand that the very identity of the client and the fact that they are a WIC participant is
confidential information.
 I will not discuss confidential information (including the client’s name or identifying details)
with anyone other than WIC staff; except when it may be needed to provide services to a
client and I have any required permission / release to share the information.
 When off-site, I will keep all client records secure in a locking file box, where they cannot be
viewed by anyone other than authorized WIC program employees. I will transport the box in
the locked trunk of the car.
 I will take care at all times not to discuss private and confidential information in person or
over the phone in any public area either at work or at home, or whenever I’m out in public.
 Clients should be aware that messages left on home answering machines are not private.
I
will make every attempt to listen to messages from clients in privacy.
AGREEMENT
I have carefully read the above Confidentiality Agreement and reviewed the checklist with the WIC
peer manager, WIC peer coordinator, or WIC supervisor signing below. I understand the
confidential nature of all client information and records. I understand that it is my job to share client
information only with staff involved in the case, and understand that I am prohibited by law from
disclosing any such confidential information to any individuals other than authorized WIC Program
employees and agencies with which the participant has given written permission to share
information. I understand that any willful and knowing disclosure of confidential information to
unauthorized persons is in violation of the law and subject to possible legal penalty.
Name (please print)
Signature
Date
4/06
MOM Exhibit 6-L
Peer Support Coordinator or Manager
Date
Sample Job Description for WIC staff who manage the peer support program
Title: WIC Peer Counselor Manager/Supervisor/Coordinator
(Note that duties may be split between two or more WIC staff.)
General Description:
The supervisor of WIC breastfeeding peer counselors manages the breastfeeding peer counseling
program on the Local agency level.
Qualifications:
 Has demonstrated experience in program management.
 Has demonstrated expertise in breastfeeding management and promotion.
 Has credentials of an International Board Certified Lactation Consult (IBCLC) (at least one
staffperson available through the local WIC agency or by contract) or has other certification
in lactation management (e.g., CLE, CLC) or State-approved training in lactation
management. (Other staff who are involved in managing and supervising and / or back-up)
 Has a minimum of one year experience counseling breastfeeding women.
Training
 Receives State-approved training in breastfeeding management.
 Participates in breastfeeding continuing education annually.
 Receives “Using Loving Support to Manage Peer Counseling Programs” training.
Supervision:
The Peer Counselor Manger (or supervisor/coordinator) is supervised by the
.
Duties:
The WIC Peer Counselor Supervisor manages the WIC peer counseling program, including:
 Assists in establishing program goals and objectives.
 Assists in establishing peer counseling program procedures, protocols and policies.
 Determines peer counselor staffing needs.
 Recruits and interviews potential peer counselors in alignment with program
policies and standards.
 Arranges for training of peer counselors.
 Mentors new peer counselors during the first six months, providing follow-up and guidance
in the early days of the job.
 Provides ongoing supervision.
 Holds monthly meetings with peer counselors.
 Collects documentation records and data as appropriate.
 Monitors the program, including conducting spot checks.
 Routinely reports on the program to supervisor and/or State Breastfeeding Coordinator.
 Works with other peer counselor supervisors (if available) to assess for ongoing
improvements to the program that may be needed.
4/06
MOM Exhibit 6-M
EXHIBIT 6-M
SAMPLE PEER
DOCUMENTATION FORM
4/06
Exhibit 6-M
1. Client Name
____________________________________
WIC ID#
___________________________________________
Date of Birth (MM/DD/YYYY)
Age______
___________________________________________
Expected date of delivery ____________________
Infant’s Birth Date_________________ Sex M / F
Infant’s Name ______________________________
Phone/Message #____________________________
Alternate phone# ____________________________
Best Time to Contact ________________________
Language___________________________________
Notes______________________________________
___________________________________________
First Contact or Referral
Directions: This form is used to refer women to
the Peer Counseling Program by completing
sections 1 and 2 (sections 3 and 4 are optional).
This form is then given to the Peer Counselor
Manager or Coordinator, who will assign the
client to a peer counselor for follow-up.
2. Referred by: _____________________________
Date:______________________________________
Issues Discussed:___________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
3. Get to know who you’re talking to.
Where did you/will you be delivering? _____________________________________________________________
Any previous breastfeeding experience? Yes No Explain ________________________________________
_________________________________________________________________________________________________
What have you heard about breastfeeding?__________________________________________________________
_________________________________________________________________________________________________
What are your plans after the baby’s birth?_______________________________________________________
_________________________________________________________________________________________________
Does the baby’s father and/or other significant person support your decision to breastfeed? Yes No
Explain _________________________________________________________________________________________
Questions/Concerns about breastfeeding? __________________________________________________________
What about breastfeeding sounds wonderful to you?
__________________________________________________
4. Identify barriers
lack of confidence
embarrassment
loss of freedom
Encouragement
concerns about dieting or health practices
influence of family/friends
work/school schedule
other (identify) ___________________________
_______________________________________
5. For Peer Counselor/Manager use only
Peer assigned:____________________________
By: ______________________________________
Peer Phone Numbers Given? Date: __________
Peer Program Info Card Given? Date: ________
Peer Contact Accepted Declined
Comments: _______________________________
__________________________________________
4/06
MOM Exhibit 6-M
PRENATAL SUPPORT AND EDUCATION CONTACTS
Participant Name: __________________________________ Peer name and initials: _____________________
1st
2nd
3rd
Contact
Date
Contact
Type
Initials
Contact Types: (T) Telephone
(NA) Not avail
(HM) Home Visit
(M) Meeting/Class
Date
Topic
Initial Contacts
4th
5th
6th
(LM) Left message
(C) Clinic Visit
7th
8th
9th
(H) Hospital Visit
Comments
________ What are your questions about breastfeeding?
_____________________________________________
________ Discuss potential barriers/family support
_____________________________________________
________ Benefits of early exclusive breastfeeding
_____________________________________________
________ Smoking/alcohol/drugs
_____________________________________________
________ Breastfeeding and childbirth classes
_____________________________________________
________ Positioning
_____________________________________________
________ Other _________________________________
_____________________________________________
________ Other _________________________________
____________________________________________
Further Pregnancy Contacts
________What are your questions about breastfeeding ?
_____________________________________________
________Have you talked with your health care provider about your plans to breastfeed? ________________________
________What to expect about /plan for breastfeeding in the hospital ________________________________________
________Social and family support and barriers
_____________________________________________
________What are your plans after the baby is born?
_____________________________________________
work / school
_____________________________________________
other
_____________________________________________
________Positioning
_____________________________________________
________Talking/Communicating with baby while breastfeeding ___________________________________________
________Answer questions about nipple sizes and shapes
_____________________________________________
________Frequency and duration of feedings
_____________________________________________
________Explain relationship between let-down and relaxation _____________________________________________
________ Reviewed “Diapers of the Breastfed Baby”/”Diaper Diaries” ______________________________________
________How to avoid engorgement
_____________________________________________
________How to avoid sore nipples
_____________________________________________
________Calling WIC after the baby is born
____________________________________________
________Waking a sleepy baby
_____________________________________________
________Supplies/resources offered through the hospital and WIC ________________________________________
________Benefits of breastfeeding
________________________________________
________Benefits of exclusive breastfeeding
_______________________________________
________Other ____________________________________
________________________________________
________Other ____________________________________
_______________________________________
4/06
WIC Breastfeeding Brochures and Handouts
The Peer can provide these handouts if they were not provided at the WIC appointment and would be helpful to the client. If
the client has received the material at WIC the peer can ask if the mother has questions. Select the most relevant topics and
discuss.
_____ Breastfed Babies Welcome - Child Care Providers
_____ Breastfed Babies Welcome - Mothers Guide
_____ Breastfeeding, Card 1 – What to Expect in First Weeks*
_____ Breastfeeding, Card 2 - How to Prevent Breast Soreness*
_____ Breastfeeding, Card 3 - Returning to Work or School*
_____ Breastfeeding, Card 4 -Breastfeeding an Older Baby *
_____ Breastfeeding, Card 5 - When You Need to Be Away*
_____ Breastfeeding: Getting Started in 5 Easy Steps*
_____ Busy Moms (BF)
_____ Embarrassment? (BF)
_____ Encouragement (BF)
_____ Helpful Hints on Breastfeeding*
_____ Infant, Card 1 - Breastfeeding Your Baby*
_____ Pregnancy, Card 1 - Benefits of Breastfeeding*
_____ Tips for Breastfeeding
_____ Ways I Can Help Mommy (BF coloring pages)
_____ Loving Support…Breastfeeding magnet with phone numbers for breastfeeding support
_____ Other: ________________________________________________________________
_____ Other: ________________________________________________________________
_____ Other: ________________________________________________________________
_____ Other: ________________________________________________________________
_____ Other: ________________________________________________________________
* Most commonly used handouts
4/06
MOM Exhibit 6-M
POSTPARTUM SUPPORT AND EDUCATION CONTACTS
Participant Name: __________________________________ Peer name and initials: _________________
1st
2nd
3rd
4th
Contact
Date
Contact
Type
Initials
Contact Types: (T) Telephone (NA) Not avail
Home Visit
(M) Meeting/Class
Baby’s date of birth:
/
5th
(LM) Left message
/
Baby’s name:
Baby’s birth wt.
Date
6th
7th
8th
(C) Clinic Visit
Cesarean Y / N
9th
10th
11th
(H) Hospital Visit
12th
(HM)
Gestational Age: __________
Birth Interventions?
Discharge wt.
Topic
Wt. at ______weeks___________________
Comments
Early Postpartum Period
________ How does mother feel that breastfeeding is going? __________________________________________
________ Ask mother: Do you have help?
___________________________________________
________ How are other family members adjusting? _________________________________________________
________ Is baby content between feedings?
_________________________________________________
________ Are you able to nap when the baby naps?
___________________________________________
________ Supplementation, if any (what/how much)
___________________________________________
________ Noticeable let-down/audible swallowing
_________________________________________________
________ Baby’s output (Diaper Diaries)
_________________________________________________
________ Basic breastfeeding technique (position/latch) ______________________________________________
________ Supply and Demand
_________________________________________________
________ Weight checks
_________________________________________________
________ Engorgement
_________________________________________________
________ Sore Nipples
_________________________________________________
________ Growth Spurts
_________________________________________________
________ Postpartum blues
_________________________________________________
________ Yielded for:
_________________________________________________
________ Other:
_________________________________________________
Later Postpartum Period
________ How is breastfeeding going?
_________________________________________________
________ Getting enough rest?
_________________________________________________
________ Family members still supportive?
_________________________________________________
________ Teething
_________________________________________________
________ Milk Supply Issues
_________________________________________________
________ Nursing schedule
_________________________________________________
________ Sore Nipples
_________________________________________________
________ Family Planning
_________________________________________________
________ Returning to work or school
_________________________________________________
________ Supplementation / weaning
_________________________________________________
________ Yielded for:
_________________________________________________
________ Other ___________________________
_________________________________________________
________ Other __________________________
_________________________________________________
4/06
MOM Exhibit 6-N
EXHIBIT 6-N
SAMPLE PEER COUNSELOR
WEEKLY ACTIVITY REPORT
Breastfeeding Peer Counselor Weekly Activity Report
Peer Counselor Name:___________________________
Week Ending: ___________ Peer Counselor signature:_________________________________________
Daily Total Hours
Other: ______________
Home Study
Clerical / Admin
Consult w Peer Mgr/Sup.
PC Promotion
Peer Meeting
Postpartum
Prenatal
# Stamps Used
Mailed information
Other contact
Class
Hospital Visit / Miles
In clinic / individual
Home Visit / Miles
Telephone contact
Date
Training / In-service
Type & Time of Contact
Other Peer Activities
Client Contacts
Totals
Page ____ of ______
Total Hours ______
Remarks
Time:
Miles:
Round time to the nearest 5 minutes.
4/06