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pdfState WIC Agency Survey
Welcome to the State WIC Agency Survey!
Thank you for your participation in the WIC Breastfeeding Peer Counseling Study, which is being
conducted by researchers at Abt Associates Inc. on behalf of the U.S. Department of Agriculture (USDA)
Food and Nutrition Service (FNS). The purpose of this survey is to better understand how the Loving
Support Peer Counselor Program is being implemented in your State or Indian Tribal Organization. Many
of the questions are focused on Loving Support peer counseling, while others address general
breastfeeding promotion and support activities in your State agency, which are helpful in understanding
the context in which the Loving Support peer counseling is implemented.
OMB Clearance Number: xxxx-xxxx
Expiration Date: xx/xx/xxxx
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0584-XXXX. The time
required to complete this information collection is estimated to average 150 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. If you
have any comments concerning the accuracy of time estimates or suggestions for improving this
form, please contact: U. S. Department of Agriculture, Food and Nutrition Service, ORNA,
Alexandria, VA 22302.
Use of Cookies
This survey makes use of session cookies and is consistent with OMB guidelines for use of cookies1 in
Federally sponsored Web sites. No persistent cookies are contained in the Web site. No end-user
browser information will be tracked, nor will the cookies remain on the end-user’s hard drive. After
completion of the surveys by all parties, the Web site will be dismantled.
Confidentiality
Your agency’s name and location will not be identified in reports prepared for this study or in data files
provided to FNS. None of your responses will be released in a form that identifies you or any other staff
member by name except as required by law. Please note that this study is not part of an audit or
management review of WIC operations. Your participation in the survey is completely voluntary. Failure to
complete the survey will not affect your employment or your agency in any way.
Technical Requirements for the Survey
In order for this survey to work properly for you, you will need the following:
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and maintaining specific information from users.
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•
Internet Explorer 5.0 or above, Netscape Navigator 7.0 or above, or Mozilla Firefox Version 1.0 or
above.
•
Your browser must be Java-enabled.
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You must have the "pop-up blocker" feature disabled in your browser (if applicable).
General Instructions
The survey is divided into the following topic areas:
•
Respondent Information
•
General Breastfeeding Promotion Programs
•
State-Level Staff for Loving Support Peer Counseling and Other Breastfeeding Promotion
Activities
•
Training for Loving Support Peer Counseling
•
State Distribution of Funds for Loving Support Peer Counseling
•
State Guidance for Local Loving Support Peer Counseling Programs
•
State Data Collection About Breastfeeding and About the Loving Support Peer Counseling
Program
We expect that multiple people at the State level will need to respond to the survey, including the
State WIC director, the State breastfeeding or peer counselor coordinator and the State WIC budget
officer. Please be sure to share the survey information with anyone who is needed to answer
information on any of the above topic areas. Anyone to whom you supply the survey access
passcode you received by email can access the survey and respond to specific questions. However,
we want the State WIC director to review the survey for completeness and accuracy and indicate
when it is complete by clicking on the submit tab at the end.
There are generally two types of questions.
1. Close-ended questions present response choices on the screen. For these questions, please
click the box or boxes (when more than one response is acceptable) next to the appropriate
response. You do this by placing the cursor on that box and left-clicking the mouse.
2. Open-ended questions allow you to create your own response. For these questions, please type
your response in the space provided.
Moving Through the Survey
You can move through the survey by using the navigation buttons at the top and bottom of each page
(each button will save any work on your current page):
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Additionally, you may move from any section of the survey to any other section of the survey by using the
"Jump To" links at the bottom of each page. This will take you directly to the section you wish to complete.
Please remember, if you "Jump To" a section of the survey using the links at the bottom of the page, any
changes made on the current page of the survey will NOT be saved, so please save your work before
"jumping" to any section of the survey.
**Do not use the "Back" and/or "Forward" buttons on the top of your browser while in the survey.
The survey will not work properly, and your work will not be saved if you do.2
Taking a Break
The average total time to complete this survey is 150 minutes combined time for all State staff preparing
information for or responding to the survey. It is designed so that you can respond at your convenience
and over multiple visits to this Web site and that others in your agency can log in as well to fill in sections
(as long as you are not logged in at the same time). If you do not have all the information on hand to
answer a specific question, you may save the answers you’ve provided and quit until you obtain the data
needed. If other staff members are more familiar with some topics, you may ask them to fill out those
sections or questions. We ask that each respondent record his or her name and title in the space
provided at the beginning of the survey.
If you need to take a break or have someone else work on the survey, make sure you save any changes
made on your current page (by clicking any of the "Save" buttons at the top and/or bottom of each page)
and close out of the survey. To re-enter the survey, you simply follow the same instructions you used to
log into the survey.
Saving Your Responses
At any time you may save your work on the survey by clicking on any of the “Save” button at the top or
bottom of each page.
CAUTION: If you are inactive for more than 30 minutes in this survey, you will be automatically logged
out and any unsaved responses on the current page will be lost. You are considered "inactive" if you do
not move from one page to another page in the survey, or if you do not click on the "Save" button on the
existing page. Typing or selecting answers on a page DOES NOT constitute being active. To avoid losing
your responses, please click on “Save” often and before you take a break of 30 minutes or longer.
Want to Print Your Survey?
If you would like to print a copy of your responses on this survey, simply print out each survey page once
you have completed and saved it. To print a page, simply click on the print icon on your Web browser, or
from the browser's top menu options, select "File," and then select "Print."
Note: You must print each page out PRIOR to finalizing your survey. Once you have finalized your
survey, you will no longer be able to access it.
Getting Help
We have provided definitions of ”key words” to assist you as you fill out the survey. Simply click on any
key word link with your mouse, and the definition will pop up. In addition, you may access a dictionary of
key words by clicking on the “All Key Term Definitions” link at the bottom of any page.
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Pictures of buttons will be provided to help users throughout these instructions for the web-based survey.
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If at any time you have questions regarding the survey, you may contact the toll-free Abt help line at 18xx-xxx-xxxx. You can also reach us by email at [email protected], and a member of
our project staff will respond either by email or telephone.
Completing the Survey
When you have completed the entire survey, please indicate at the end (when prompted) that your survey
is complete, and you wish to finalize it. This will let us know that no further answers will be forthcoming,
and we will proceed to process your responses. Once you have indicated that your survey is complete,
you will not be able to modify your responses. As mentioned earlier, we ask that the State WIC director
be the one that designates the survey as complete.
Getting Started
You are now ready to begin the survey. Please click on the “Start Survey Now” button below. Thank you
again for your participation in this important research study.
Respondent Information [formatting will allow for multiple respondents, each with their
title]
1.
Name of Respondent(s):
Title(s)
General Breastfeeding Promotion Programs
We would like to learn about the WIC breastfeeding promotion activities supported in your State that are
in addition to Loving Support peer counseling.
2.
Does your State agency provide other breastfeeding promotion services or programs (e.g., media
campaigns, educational materials) for WIC participants in addition to Loving Support peer
counseling?
Yes
No (Skip to Question 4)
3.
Please indicate the breastfeeding promotion activities undertaken at the State level that your
State agency funds for WIC participants. Please do not indicate local WIC agency activities.
(Select all that apply)
Media campaigns and educational materials (e.g., television ads, posters, brochures
Breastfeeding promotion training to staff other then Loving Support peer counselors
Make lactation consultants available to WIC participants
Sponsor certified lactation counselor training (or similar certification training)
Equipment (e.g., breast pumps)
Peer counseling or other counseling by clinic staff to WIC participants that is different than
Loving Support peer counseling
Warmline or hotline
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Classes or support group meetings for WIC participants
Other (Specify:
4.
)
Are you able to track at the State level the amount of Nutrition Services and Administration
(NSA) funds spent for the breastfeeding promotion activities that you specified in Question 3?
Yes
No (Skip to Question 7)
5.
Do you track just what the State spends on the above-indicated activities or do you also include
what local WIC agencies spend on those activities using NSA funds?
Just what the State spent
What both the State spent and what local WIC agencies spent
6.
How much NSA funding was spent on breastfeeding promotion activities described in Question 3
in FFY 2007: $___________.
This amount includes NSA funding that augmented the Loving Support peer counseling grant.
This amount excludes NSA funding that augmented the Loving Support peer counseling
grant.
7.
How has your State chosen to use the Loving Support grant funds? Check all that apply.
Use some Loving Support grant funds at the state level (e.g., for staff training, planning, etc.).
We chose to focus the grant funds on a small number of sites, rather than trying to make
funding available to all sites.
We chose to distribute the grant funds to as many sites as possible rather then concentrating
funding on relatively few sites.
We chose initially to focus the grant funds on sites that were enhancing existing peer
counseling programs.
We chose initially to focus the grant funds on sites that were beginning peer counseling
programs.
Other (Specify:___________________________)
8.
At the State level, what other major initiatives are underway that you believe have an impact on
breastfeeding rates in your State:
Major public education campaigns, sponsored by either public or private funding
Efforts to change hospital policies to limit the distribution of formula and make them more
“Baby Friendly”
Major training initiatives for health professionals to support breastfeeding
Other (Specify:___________________________)
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State-Level Staff for Loving Support Peer Counseling and Other
Breastfeeding Promotion Activities
In your State, please list all WIC State employees who work on the Loving Support peer
counseling program. Please include anyone who is involved in either policy guidance, resource
allocation, financial monitoring, and/or management information systems as they relate to Loving
Support peer counseling. Please include yourself. Please also indicate whether this person’s
salary is fully supported, partially supported, or not supported by the FNS Loving Support peer
counseling grant.
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< 1 year
1-3 years
> 3 years
< 1 year
1-3 years
3 years
< 1 year
1-3 years
> 3 years
yes
no
yes
no
yes
no
< 1 year
1-3 years
> 3 years
yes
no
< 1 year
1-3 years
> 3 years
yes
no
< 1 year
1-3 years
> 3 years
yes
no
Not Supported by FNS Peer Counseling
Grant
Partially Supported By FNS Peer Counseling
Grant
Salary is
supported by….
Other (Specify)
Training
Financial Monitoring
Is this person
the State
designated
Loving
Support peer
counseling
coordinator?
Policy Guidance
Approximately
how long has
this person
been in this
position?
Resource Allocation
Name
Management Information Systems
Person is involved in….
Fully Supported by FNS Peer Counseling
grant
9.
6
10.
Adding up all of the time of all of the State WIC staff involved in the Loving Support peer
counseling program, what is the approximate average number of hours per month paid for by the
Loving Support peer counseling program, as opposed to the supported by NSA or other funding?
____ hours per month
11.
When you think about Loving Support peer counseling in your State, is there one person you
would consider its champion – whose efforts and enthusiasm really make it work?
Yes
If yes, who is this person? ______________________
No
12.
Please indicate if anyone at the State level is involved in the Loving Support peer counseling
program undertakes the following activities: (Select all that apply)
Conduct needs assessment to identify the local program, population, geographic areas, and
potential sites to target the WIC peer counseling services
Provide technical assistance to local WIC programs to hire a breastfeeding/peer counseling
coordinator
Develop statewide program policies for Loving Support peer counseling
Provide technical assistance to local WIC programs on basic policies and procedures for a
peer counseling program
Provide training to local WIC staff (other than peer counselors) about breastfeeding and peer
counseling
Provide training to peer counselors about peer counseling duties and responsibilities
Develop informational materials about breastfeeding
Monitor the implementation of local WIC peer counseling services
Design and/or participate in evaluation or ongoing monitoring of local WIC peer counseling
services including data collection
Conduct Loving Support peer counseling program promotion with local organizations in the
community
Provide information to WIC clients about the peer counseling program
Report on the program operations to WIC administrative staff
Provide direct supervision to local peer counselors
Other (Specify:
)
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Training for Loving Support Peer Counseling
Training Received By WIC State Agency Staff
13.
Please indicate the training related to Loving Support peer counseling that State-level WIC staff
have received since your State first accepted the Loving Support peer counseling funding.
a. Loving Support peer counseling training
b. Other locally and/or State-offered training on
breastfeeding and/or role of peer counselors
c. Lactation management training approved
through IBCLC Continuing Education
Recognition Points (CERPS)
d. Other lactation courses that award certificates
e. Other (Specify:) ________________________
No training
received
Training
received 1
time
Training
received more
than 1 time
Training Offered By State Agency Staff or Sponsored by the State
14.
In the last question we asked you about training State staff received. Here we ask about training
State staff provided or sponsored. Please indicate the training related to Loving Support peer
counseling that State staff provided to local WIC agency staff since your State first accepted the
Loving Support peer counseling funding. We would like to know about training that the State
provided directly or paid for through contracts or other agreements.
a. Loving Support peer counseling training
b. Other locally and/or State-offered training on
breastfeeding and/or role of peer counselors
c. Lactation management training approved
through IBCLC Continuing Education
Recognition Points (CERPS)
d. Other lactation courses that award certificates
e. Other (Specify:) ________________________
Training
offered 1 time
Training
offered more
than 1 time
No training
offered
State Distribution of Funds for Loving Support Peer Counseling
This section focuses on how the State distributes funding for the Loving Support peer counseling
program, which may be funded by FNS Loving Support peer counseling grants exclusively or in
combination with other funding sources.
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15.
Does the WIC State Agency currently fund any local WIC agencies or regional entities (i.e., that
include more than one local WIC agency, such as a regional health district) to implement the
Loving Support peer counseling program?
Yes, funding goes directly to local WIC agencies (Go to 16)
Yes, funding goes to regional agencies (i.e., that include more than one local WIC agency)
who then distribute it to local WIC agencies (Ask 15a-b)
No (Skip to end)
15a.
How many regional entities are there?
______
15b.
How many receive FNS peer counseling grant funds?
______
16.
How many local WIC agencies are in your State?
______ Number of local agencies
17.
Of these local agencies, how many offer Loving Support peer counseling?
______ Number of local agencies that offer Loving Support peer counseling
17a.
Of these, how many had peer counseling programs in place the same as or similar to
Loving Support peer counseling prior to the FNS peer counseling grants?
______ Number of local agencies that had similar programs in place prior to the FNS
peer counseling grant, including voluntary programs.
18.
Of local agencies that offer Loving Support peer counseling, how many receive funding from
FNS peer counseling grants?
______ Number of local agencies with Loving Support peer counseling that receive FNS peer
counseling grants
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19.
In addition to providing local sites with funding from the Loving Support peer counseling grant,
did your State allocate additional funds from NSA or from other sources for the Loving Support
peer counseling program? (Check all that apply.)
Yes, we distribute to sites NSA and/or other funds to augment Loving Support peer
counseling programs
No, we do not distribute to sites any funding in addition to the Loving Support peer
counseling grant to support the Loving Support peer counseling program (skip to Question
21.)
Whether or not we explicitly allocate NSA and other funds, we allow sites to choose to spend
some it their NSA funds to augment Loving Support
20.
What are the sources of these additional funds for Loving Support peer counseling? Please check
the box to next to the source and provide the amount of funding in FFY 07 that went to local
Loving Support peer counseling programs.
Source of funds
Nutrition Services and Administration (NSA) funds
State non-WIC funds (e.g., State public health dollars)
Other funds (e.g., private philanthropic funding)
(Specify:
________________________________________ )
21.
Amount of funding
$___________
State does not collect this
information
$____________
State does not collect this
information
$___________
State does not collect this
information.
Taking into account all sources of funding for Loving Support peer counseling, what percentage
of funding to local agencies comes from the FNS Loving Support peer counseling grant? (Select
one)
100%
75 - 99%
50 - 74%
25 - 49%
Less than 25%
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We have created a list of local WIC agencies for your State below. Please review the list and update it if
agency contact information is incorrect. Next to each, please indicate the following:
• Whether the agency is operating a Loving Support peer counseling program,
• Whether, to your knowledge, it is implementing all 10 components of the FNS model for the
Loving Support peer counseling program (please press the Glossary button to review the 10
components of Loving Support peer counseling)
• Whether it is receiving the Loving Support peer counseling grant and the amount of grant it
received in FFY07;
• Whether it is receiving NSA funds to support Loving Support peer counseling; and
• Whether it is receiving other non-NSA funding for Loving Support peer counseling from the
State.
[Note: Programming will create list all agencies, for each state and ITO in left hand column.]
Agency name and contact
information
Operates
Loving
Support peer
counseling
program?
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Yes
No
Don’t Know
Yes
No
Don’t Know
Yes
No
Don’t Know
Yes
No
Don’t Know
Implementing
all 10
components of
Loving
Support?
Yes
No
Don’t Know
Yes
No
Don’t Know
Yes
No
Don’t Know
Yes
No
Don’t Know
Receiving
the FNS
peer
counseling
grant?
If yes in
previous
column,
FNS peer
counseling
grant
amount
received
Receiving NSA
funds to support
Loving Support
peer counseling?
Receiving other
non-NSA funding
for Loving Support
peer counseling
program from
state?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
11
State Written Guidance for Local Loving Support Peer Counseling
Programs
This section is about written guidance the State WIC Agency provides to local WIC agencies about major
aspects of the Loving Support peer counseling program. (If the specific guidance conforms exactly to that
provided in the Using Loving Support to Manage Peer Counseling Programs,3 please indicate below.)
22.
Does the State provide guidance to local WIC agencies about the following aspects of local
Loving Support peer counseling programs? Guidance can include either State
recommendations or State requirements. (Select all that apply)
Role, responsibilities, and qualifications of local WIC peer counseling coordinators. [If
checked, then the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 23-28 will be asked. Otherwise they will not appear.]
Qualifications of local WIC peer counselors. [If checked, then the two following boxes pop up
for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 29-30 will be asked. Otherwise they will not appear.]
Timing of peer counselor’s first contact with pregnant women or new mothers (e.g.,
during pregnancy, in hospital). [If checked, then the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, question 31 will be asked. Otherwise it will not appear.]
Frequency of peer counselor’s contact with program participants. [If checked, then the two
following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 32-34 will be asked. Otherwise they will not appear.]
3
This is the training curriculum designed for management staff of the special supplemental nutrition
program for WIC. The URL is http://www.nal.usda.gov/wicworks/Learning_Center/support_peer_training04.html
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Maximum length of time that WIC participants may receive peer counseling. [If checked,
then the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If checked,
question 35 will be asked. Otherwise it will not appear.]
Settings where peer counseling services are provided to clients. [If checked, then the two
following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 36-38 will be asked. Otherwise they will not appear.]
The types of contact (i.e., in-person, telephone) that peer counselors have with WIC
participants. [If checked, then the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling [If checked, question
39 will be asked. Otherwise it will not appear.]
Accessibility of peer counselors to clients outside WIC clinic hours. [If checked, then the
two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, question 40 will be asked. Otherwise it will not appear.]
Caseload, number of clients for each peer counselor. [If checked, then the two following boxes
pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, question 41 will be asked. Otherwise it will not appear.]
Wages or benefits and career paths for peer counselors. [If checked, then the two following
boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 42-47 will be asked. Otherwise they will not appear.]
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Nature and amount of initial and ongoing training and support that peer counselors
receive. [If checked, then the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 48-52 will be asked. Otherwise they will not appear.]
Supervision and job monitoring of peer counselors. [If checked, then the two following boxes
pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, question 53 will be asked. Otherwise it will not appear.]
Community partnerships related to the Loving Support peer counseling program that
local agencies must establish. [If checked, then the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, questions 54-55 will be asked. Otherwise they will not appear.]
Peer counselors’ job activities (e.g., duties related to staff training, making referrals,
service documentation and program administrative tasks). [If checked, then the two following
boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs
Documentation of peer counselors’ interactions with WIC participants. [If checked, then
the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs
Content of peer counseling activities with clients (e.g., topics/issues to discuss with
clients, educational activities) participants. [If checked, then the two following boxes pop up for
user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs
Procedures for referrals of Loving Support peer counseling participants to other related
services. [If checked, then the two following boxes pop up for user to check]
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Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling
Documentation of peer counselors’ interactions with WIC participants. [If checked, then
the two following boxes pop up for user to check]
Conforms exactly to recommendations found in Using Loving Support to Manage Peer
Counseling Programs.
Is different from Using Loving Support to Manage Peer Counseling Programs [If
checked, question 56 will be asked. Otherwise it will not appear.]
Local Peer Counseling Coordinators
23.
Does the State recommend or require that local WIC agencies with a Loving Support peer
counseling program designate a local peer counselor coordinator?
Yes
No (Skip to 25)
24.
Does the State recommend or require that the local Loving Support peer counseling coordinator
be a different person than the local breastfeeding promotion coordinator?
Yes
No
25.
Does the State have guidelines about the educational level or experience of local peer counseling
coordinators?
Yes
No (Skip to 27)
26.
Please indicate whether the State has guidelines for the following education, experience, and
other qualifications for local peer counseling coordinators. (Select all that apply)
Associate’s degree
Bachelor’s degree
International Board Certified Lactation Consultant or IBCLC eligible
Registered dietitian or nutritionist
Registered nurse
Experience in program management
Experience in breastfeeding promotion
Training in lactation management
Experience as health-related program supervisor
Personal experience in breastfeeding
Computer skills
Bilingual
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Experience in counseling
Experience in peer counseling
27.
Does your State have guidelines about the responsibilities of local peer counseling coordinators?
Yes
No (Skip to 29)
28.
Please indicate whether the State has guidelines about the responsibilities of peer counseling
coordinators in the following areas. (Select all that apply)
Conduct needs assessments related to Loving Support peer counseling services
Participate in local WIC program’s establishing the basic policies and procedures for the
Loving Support peer counseling program
Supervise and monitor work performance of Loving Support peer counselors
Participate in the training of local WIC agency staff about breastfeeding and peer counseling
Provide training to local Loving Support breastfeeding peer counselors
Monitor the implementation of local Loving Support peer counseling services
Design and/or participate in evaluation of local Loving Support peer counseling services
Conduct promotion activities for the Loving Support peer counseling program
Provide information to WIC clients about the Loving Support peer counseling program
Initiate or serve as point of contact for community organizations that collaborate on Loving
Support activities
Report on Loving Support program operations to State WIC administrative staff
Other (Specify:
)
Local Peer Counselor Qualifications
29.
Does the State have guidelines about the educational level or experience of local peer counselors?
Yes
No (Skip to 31)
30.
Please indicate whether the State has guidelines about the qualifications of local peer counselors
in the following areas. (Select all that apply)
Paraprofessional
Professional certification, e.g., International Board Certified Lactation Consultant or IBCLC
eligible, registered dietitian or nutritionist, lactation management
GED or high school completion
Associate’s degree
Bachelor’s degree
Master’s degree
Current or previous WIC recipient
Current or previous breastfeeding experience
Ethnic background similar to the target peer counseling program participants
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Age similar to the target peer counseling program participants
Speak the same language as the target peer counseling program participants
Live in the same community as the target peer counseling program participants
Available to clients outside the usual clinic hours
Available to clients outside the WIC clinic setting
Willing to travel to remote parts of the WIC service area
Available to conduct peer counseling services for a minimum number of required hours per
week
[If this is selected:] What is the required minimum hours/week?
_______________ hours/week
Minimum length of commitment to serve as peer counselor
[If this is selected:] What is the minimum length of commitment required?
__________ months
Good parenting model
Project positive image of WIC, present information consistent with WIC philosophy
Enthusiastic about breastfeeding
Have good interpersonal communication skills
Recognize when to make referrals to other services, specialists, and programs
Have access to reliable transportation
Must have telephone
Other (Specify:
)
Timing of First Contact
31.
When does the State recommend or require that peer counselors first contact WIC participants?
31a.
During pregnancy?
Yes
No (Skip to 32)
31b.
During a specific trimester?
Yes
No (Skip to 31d)
31c.
During which trimester?
First
Second
Third
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31d.
After delivery?
Yes
No (Skip to 32)
31e.
When after delivery?
While in hospital
Within first week at home
Other/It depends (Specify or explain:
)
Frequency of Contact
32.
Does the State have guidelines about how soon a response is required after a request for
breastfeeding assistance from a WIC participant?
Yes
No (Skip to 34)
33.
Please specify below—either in days or hours—the guideline for the maximum time that can
elapse after a request.
______ Number of days can elapse after a request
OR
______ Number of hours can elapse after a request
34.
What are the State guidelines about frequency of contact during the following time periods?
At least 1 time every…
During pregnancy
During 1st trimester
During 2nd trimester
During 3rd trimester
During last month of
pregnancy
After Delivery
Week 1 (after hospital stay)
Weeks 2 – 4
Months 2 – 4
Months 4 – 6
After 6 Months
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No
guidelines
1 week
2 weeks
1
month
2
months
3
months
Other time period (Specify #
of contacts per time period))
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
___ contacts per _____
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Maximum Length of Time
35.
Please indicate your State's guidelines about the maximum number of months after delivery that a
WIC participant may receive Loving Support peer counseling.
______ Number of months
Settings
36.
Please indicate the settings for which the State has guidelines regarding peer counselors' inperson contact with WIC participants. (Select all that apply.)
37.
Do your guidelines prohibit in-person contact between WIC participants and peer counselors in
the any of the above settings? (Select all that apply.)
38.
In the hospital
In WIC participants’ homes
In local WIC offices during office hours
In local WIC office after hours
Other (Specify:)
In the hospital
In WIC participants’ homes
In local WIC offices after hours
Other (Specify:
)
Do your guidelines address liability issues related to in-person contact between WIC participants
and peer counselors in the any of the above settings? (Select all that apply.)
In the hospital
In WIC participants’ homes
In local WIC offices during office hours
In local WIC offices after hours
Other (Specify:
)
Type of Contact
39.
Does the State recommend or require that at least some of the contact between peer counselors
and WIC participants be in-person?
Yes
No
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Accessibility
40.
What are the State's guidelines about accessibility of Loving Support peer counselors outside of
WIC program hours? (Select all that apply)
A peer counselor should be available by telephone for specific periods of time.
[Ask Questions 40.a – 40.e]
A peer counselor should be available in person for some periods of time.
[Ask Questions 40.f – 40.i]
40a.
What kind of equipment does the State recommend or require that local agencies provide
to make WIC peer counselors accessible to WIC participants?
40b.
)
What time periods does the State recommend or require that peer counselors be available
by phone for their own clients (if they are assigned a caseload) at least some of the time?
40c.
Cell phones
Answering machines
Beepers
Other (Specify:
No equipment
Evenings
Weekends
Holidays
Other (Specify:
The programs in our state do not operate this way.
)
Do the recommendations or requirements for peer counselor availability by phone depend
on the status of the WIC participant (i.e., if she is pregnant, just after delivery, etc.)?
Yes
No
40c.1
40d.
If yes, please indicate which types of clients are high priority.
Does your state have guidelines on time periods that at least one peer counselor must be
available to WIC clients by phone, whether or not these clients are in that counselor’s
caseload?
Yes
No
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40e.
Does your State recommend or require that at least one peer counselor be available by
phone to all WIC clients, or only some types of WIC clients (e.g., when pregnant, just
after delivery, etc.)?
All WIC clients
Only some WIC clients
40e.1
40f.
What time periods does your State recommend or require that peer counselors be
available in person for their own clients at least some of the time?
40g.
If only some WIC clients, please indicate which ones are high priority.
Not applicable. Peer counselors in this State do not have specific caseloads.
Evenings
Weekends
Holidays
Other (Specify:
)
What does your State recommend or require about a peer counselor’s availability in
person to all of their own clients or only some clients, depending upon their status (e.g.,
when pregnant, just after delivery)?
All their caseload
Only some of these caseload
40g.1
40h.
If only some of their caseload, please the priority groups
Does your State recommend or require that at least one peer counselor be available in
person at least some time periods for WIC participants not on their caseload?
Yes
No
40h.1
If yes, please indicate if guidelines pertain to the following time periods at least
for peer counselor availability.
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Evenings
Weekends
Holidays
Other (Specify:
)
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Caseload
41.
Please indicate the State's caseload guidelines for a full-time peer counselors. (We assume that
part-time peer counselors will have lower maximum caseloads.) Fill in only the rows for which
the State has guidelines (e.g., the State may have caseload guidelines for breastfeeding women,
but does not break it down by “exclusive” or “partial” breastfeeding).
Pregnant women
Breastfeeding women
Exclusive
Partial
All pregnant and breastfeeding women
No guidelines
Maximum caseload
_________
_________
_________
_________
_________
Wages, Benefits and Career Paths
42.
Does your State require that all peer counselors be paid?
Yes
No (Skip to 45)
43.
Does your State set a minimum amount that peer counselors must be paid?
Yes
No (Skip to 45)
44.
What is that minimum amount
$_________ per hour
45.
Does your State have any guidelines about non-wage compensation (e.g., travel reimbursement,
paid leave) for peer counselors?
Yes
No (Skip to 47)
46.
Please indicate below the non-wage compensation about which your State has guidelines. (Select
all that apply)
Paid leave (e.g., sick, holiday, vacation)
Health insurance benefits
Other benefits (e.g., life insurance, disability insurance)
Compensation for job-related expenses (e.g., mileage, telephone)
Other types of compensation (Specify:
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47.
Does the State have guidelines about career paths for peer counselors?
Yes
No
Training and Support
48.
Does the State have guidelines about the minimum types and levels of initial training that peer
counselors must receive?
Yes
No (Skip to 50)
49.
Does the State's minimum training guidelines exceed the Loving Support peer counseling model
guidelines?
Yes
No
50.
Does the State have guidelines about the amount of in-service training that peer counselors must
receive?
Yes
No
51.
Does the State have guidelines about other types of ongoing supervision and support that peer
counselors receive?
Yes
No (Skip to 53)
52.
Please specify the areas in which there are State guidelines about support to peer counselors.
(Select all that apply)
Access to breastfeeding consultants and other experts
Regular contact with local peer counseling supervisor
Participation in WIC agency or clinic staff meetings
Opportunities to meet regularly with other peer counselors
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Supervision and Job Monitoring
53.
Please indicate in which of the following areas the State provides guidance to local WIC
programs. (Select all that apply)
Frequency of contact with Loving Support peer counselor coordinator/supervisor
Review of client contact logs/activity records by coordinator/supervisor
Routine spot checks by coordinator/supervisor
Attendance of Loving Support peer counselors in supervisory meetings and/or WIC staff
meetings
Observation of Loving Support peer counseling activities by coordinator/supervisor
Formal performance evaluation/review of Loving Support peer counselors
Submission of monthly work activity reports by peer counselors
Monitoring client participation and retention rates for individual peer counselors
Review of peer counselors’ time sheets, travel vouchers, phone logs, paperwork
Other (Specify:)
Community Partnerships
54.
Does the State provide guidance about the types of agencies that should participate in community
partnerships?
Yes
No (Skip to 56)
55.
In the State guidance, what types of organizations should participate in community partnerships?
(Select all that apply)
Hospitals
Clinics
Schools
Community agencies
Other government agencies
Other (Specify:)
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Peer Counselors Documentation of Interactions with WIC Participants
56.
What is the State's guidance about the type of information peer counselors record/document about
peer counseling activities? (Select all that apply.)
Location of contact
Method of contact (e.g., home visit, phone)
Topics/issues discussed with client
Referrals made
Status of breastfeeding (e.g., initiation, exclusivity)
Unsuccessful contacts
Materials sent to participants
Demographic data about participant and her baby
Other (Specify:)
State Data Collection about Breastfeeding and the Loving Support
Peer Counseling Program
The next section addresses information on breastfeeding collected at the State level, the method used to
collect it, and the schedule for data collection. Some of the questions are designed to understand
information on breastfeeding in general, not just Loving Support peer counseling.
57.
Does your State collect data on whether WIC participants have ever breastfed?
Yes
No (Skip to Question 58.)
57.a. How does the State define ever breastfed?
Breastfed or fed breast milk to infant at least once
Other definition (Specify)__________________________________________
57.b. Please give us your average percentage of WIC participants who have ever breastfed for each April
of the last three fiscal years:
April 2007 _____________
April 2006 _____________
April 2005______________
58.
Does your State collect data on the duration of breastfeeding for WIC participants?
Yes
No (Skip to Question 59.)
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58.a. How does the State define breastfeeding duration?
Number of weeks an infant is at least partially breastfeeding
Number of months an infant is at least partially breastfeeding
Other definition (Specify)__________________________________________
58.b. Please give us your average percentage of WIC participants who have breastfeeding
duration for each April of the last three fiscal years:
April 2007 _____________
April 2006 _____________
April 2005______________
59.
Does your State collect data on breastfeeding exclusivity for WIC participants?
Yes
No (Skip to Question 60.)
59.a. How does the State define breastfeeding exclusivity?
59b.
No solids, water, or other liquids besides breastmilk
Receives WIC food package exclusive breastfeeding
Other definition (Specify)___________________________________________
Do you characterize breastfeeding exclusivity by the age of the infant (e.g., number of
infants exclusively breastfeeding at 1 month)?
Yes
No (Skip to 59.d.)
59c.
At what age(s) do you measure exclusivity? (Specify)_____________________________
59.d Please give us your average percentage of WIC participants who were breastfeeding
exclusively in each April of the last three fiscal years:
April 2007 _____________
April 2006 _____________
April 2005______________
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60.
On a scale of 1 to 5, 1 being the least accurate, please tell us a number that reflects how accurate
you think the data are for each of these items. [Each outcome measure will pop up if the user
indicates that the State collects data about it.]
61.
Breastfeeding initiation (circle one.)
1
2
3
4
5
Breastfeeding duration (circle one.)
1
2
3
4
5
Breastfeeding exclusivity (circle one.)
1
2
3
4
5
How are data on ever breastfed, breastfeeding duration, and breastfeeding exclusivity collected?
[Each outcome measure will pop up if the user indicates that the State collects data about it.]
Entered by local WIC agencies into centralized data base
Periodic paper or electronic reports produced by local WIC agencies and
sent to State office as part of program requirements
Survey sent from State to local WIC agencies for completion
Other (Specify:) ___________________________________________
Other (Specify:) ___________________________________________
Other (Specify:) ___________________________________________
62.
Breastfeeding
initiation
Indicator
Breastfeeding
duration
Breastfeeding
exclusivity
Breastfeeding
initiation
Indicator
Breastfeeding
duration
Breastfeeding
exclusivity
How are these data available at the State level?
Stored in an electronic spreadsheet or data base (e.g., Excel, ACCESS or
other data base)
Available in electronic document formats
Available in paper only
Not all data are in one format
Other (Specify:) ___________________________________________
Other (Specify:) ___________________________________________
Other (Specify:) ___________________________________________
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63.
How often are these data collected?
On an ongoing basis
More than once a year
Annually
Less often than annually
Other (Specify:) ___________________________________________
Other (Specify:) ___________________________________________
Other (Specify:) ___________________________________________
64.
Breastfeeding
initiation
Indicator
Breastfeeding
duration
Breastfeeding
exclusivity
How are these indicators used? (Select all that apply. Not all indicators may be used for all
purposes.)
Needs assessment
Federal reporting
Monitoring Loving Support peer counseling program
Evaluating Loving Support peer counseling program
Monitoring other breastfeeding promotion initiatives
Evaluating other breastfeeding promotion initiatives
Other (Specify:)
Loving Support Peer Counseling Program Data
65.
Which of these data items does the State collect? (Select all that apply)
Overall number of WIC participants in Loving Support peer counseling
Number of pregnant WIC participants receiving Loving Support peer counseling
Number of postpartum WIC participants receiving Loving Support peer counseling
Type of prenatal Loving Support peer counseling received by individual participants
Frequency of prenatal Loving Support peer counseling received by individual participants
Type of Loving Support peer counseling received by individual participants after delivery
Frequency of Loving Support peer counseling received by individual participants after
delivery
Number of weeks or months over which postpartum Loving Support peer counseling services
are received by individual participants
Demographic information about Loving Support peer counseling participants (e.g., race, age,
region)
Feedback from WIC participants about the effects of Loving Support peer counseling
Caseload, hours worked, breastfeeding rates, or other disposition information for individual
peer counselors
Other (Specify:)
None of the above (Skip to end)
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66.
How are these data used? (Select all that apply)
67.
Needs assessment
Federal reporting
Monitoring Loving Support peer counseling program
Evaluating Loving Support peer counseling program
Other (Specify:)
Are the program data that you indicated the State collects gathered through one method or by
more than one method?
One method
More than one method (Skip to 69)
68.
How are these data collected?
69.
How are these data available?
Entered by local WIC agencies into centralized data base
Periodic paper or electronic reports produced by local WIC agencies and sent to State office
as part of program requirements
Survey sent from State to local WIC agencies for completion
Other (Specify:)
70.
How often are these data collected?
On an ongoing basis
More than once a year
Annually
Less often than annually
[Questions 71-73 will be asked for each indicator SELECTED in Question 65 if respondent
indicates more than one method in Question 63]
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71.
How are these data collected?
Overall number of WIC participants
in Loving Support peer counseling
Number of pregnant WIC
participants receiving Loving
Support peer counseling
Number of postpartum WIC
participants receiving Loving
Support peer counseling
Type of prenatal Loving Support
peer counseling received by
individual participants
Frequency of prenatal Loving
Support peer counseling received by
individual participants
Type of Loving Support peer
counseling received by individual
participants after delivery
Frequency of Loving Support peer
counseling received by individual
participants after delivery
Number of weeks or months over
which postpartum Loving Support
peer counseling services are received
by individual participants
Demographic information about
Loving Support peer counseling
participants (e.g., race, age)
Other. (Specify:) _____________
Other. (Specify:) _____________
Other. (Specify:) _____________
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Entered by local
WIC agencies into
centralized data
base
Periodic paper or
electronic reports
produced by local
WIC agencies and
sent to State office
as part of
program
requirements
Survey sent from
State to local WIC
agencies for
completion
Other (Specify:)
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
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72.
How are these data available at the State level?
Overall number of WIC participants
in Loving Support peer counseling
Number of pregnant WIC
participants receiving Loving
Support peer counseling
Number of postpartum WIC
participants receiving Loving
Support peer counseling
Type of prenatal Loving Support
peer counseling received by
individual participants
Frequency of prenatal Loving
Support peer counseling received by
individual participants
Type of Loving Support peer
counseling received by individual
participants after delivery
Frequency of Loving Support peer
counseling received by individual
participants after delivery
Number of weeks or months over
which postpartum Loving Support
peer counseling services are received
by individual participants
Demographic information about
Loving Support peer counseling
participants (e.g., race, age)
Other. (Specify:) _____________
Other. (Specify:) _____________
Other. (Specify:) _____________
73.
Stored in an
electronic
spreadsheet or
data base (e.g.,
Excel, ACCESS or
other data base)
Available in
electronic
document formats
Available in paper
only
Not all data are in
one format
On an ongoing
basis
More than once a
year
Annually
Less often then
annually
How often are these data collected?
Overall number of WIC participants
in Loving Support peer counseling
Number of pregnant WIC
participants receiving Loving
Support peer counseling
Number of postpartum WIC
participants receiving Loving
Support peer counseling
Type of prenatal Loving Support
peer counseling received by
individual participants
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Frequency of prenatal Loving
Support peer counseling received by
individual participants
Type of Loving Support peer
counseling received by individual
participants after delivery
Frequency of Loving Support peer
counseling received by individual
participants after delivery
Number of weeks or months over
which postpartum Loving Support
peer counseling services are received
by individual participants
Demographic information about
Loving Support peer counseling
participants (e.g., race, age)
Other. (Specify:) _____________
Other. (Specify:) _____________
Other. (Specify:) _____________
On an ongoing
basis
More than once a
year
Annually
Less often then
annually
Conclusion
Thank you very much for responding to this survey. We may be in contact with you if we have any
further questions. If you have any question, please do not hesitate to call Patty Connor at (1-xxx-xxxxxxx.)
Please certify that the survey is complete
I certify that the survey is complete.
Enter name_____________________________________
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| File Type | application/pdf |
| File Title | Microsoft Word - WIC PeerC State Survey rev 6.27.08.doc |
| Author | NicholsonJ |
| File Modified | 2008-06-27 |
| File Created | 2008-06-27 |