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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 120 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.
Introduction
Thank you for taking the time today to participate in this interview. As part of the WIC
Breastfeeding Peer Counseling Study for the U.S. Department of Agriculture, Food and Nutrition
Service (FNS), we are interviewing key people involved in the implementation of the Loving
Support peer counseling program funded by FNS Loving Support peer counseling grants. The
purpose of this phase of the study is to describe how Loving Support peer counseling is being
implemented in various States, local agencies, and selected clinics/service delivery sites across
the country.
As described in the letter we sent you earlier, your clinic’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 during the interview 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. Your participation in the interview is completely voluntary.
Failure to complete the interview will not affect your employment or your clinic’s receipt of
Federal WIC funds.
The estimated average total time to complete this interview and the clinic data collection form
we sent in advance of this visit is 150 minutes. This includes your time and any other person
you may need to bring in to respond to the questions.
Do you have any questions before we begin?
[Instructions to Interviewers: Skip any sections that were already covered in the local
WIC agency interview, unless the information is different for the clinic than for the local
WIC agency.]
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Respondent Information
1.
Name(s) and title(s) of respondent(s):
2.
Indicate which, if any, position each respondent holds and provide us with specific titles: (Select
all that apply)
Breastfeeding Coordinator (Title:)________________
Loving Support peer counselor coordinator/supervisor (Title:)_________________________
Clinic director (Title:)__________________________
Respondent has other duties (Specify)_________________(Title:)_____________________
Beginning and Adapting the Loving Support Peer Counseling
Program
3.
How long has your clinic received FNS funding for Loving Support peer counseling?
4.
Did your clinic have a breastfeeding peer counseling program prior to receiving Loving Support
peer counseling funding?
No
Yes
**If Yes, please describe the program before Loving Support Peer Counseling.
5.
When your clinic first began the Loving Support peer counseling program, what changes did you
make?
**Staffing (e.g., new hires, changes in responsibilities of existing staff)
**General operations
**Purchase of new equipment
**Engaging staff in the initiative
**Changing clinic policies to accommodate needs of peer counselors and other program staff
**Other (Please specify)
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Clinic Staff Working On Loving Support Peer Counseling
Now I am going to ask about the WIC staff other than peer counselors who work on the Loving Support
peer counseling program. Then, I will ask specific question about your peer counselors.
6.
Please tell me the number and positions of all non-peer counseling staff that work for your clinic.
7.
Now, please give me the titles of the WIC staff (other than peer counselors) that work on
breastfeeding promotion, including the Loving Support peer counseling program, in your clinic.
___number of non-peer counseling staff that work on breastfeeding promotion/education
**Please specify job titles (prompt to include clinic director and Loving Support peer
counselor coordinator)
Now, I’d like to talk about the involvement of each of the staff that you have indicated, starting with
questions about the clinic director.
Clinic Director [If there is one that is different from the local WIC agency director.]
8.
How involved is the clinic director in Loving Support peer counseling?
Informed but is not very involved in daily operations
Somewhat involved in daily operations
Very involved in daily operations
9.
Is any of his/her salary supported by the Loving Support peer counseling grant?
Yes
No
Peer Counselor Coordinator (Please provide title, if different)
10.
Is the breastfeeding coordinator a separate position from the Loving Support peer counseling
coordinator/supervisor?
Yes
No
**If yes, please describe breastfeeding coordinators duties and how they relate to the Loving
Support peer counseling coordinator.
11.
Who does the peer counseling coordinator report to?
12.
How long has this person been the peer counselor coordinator?
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13.
Please describe your agency’s guidelines for qualifications of peer counseling
coordinator/supervisor in terms of
** educational background
** professional training or certifications
** similarity to WIC participants
** personal qualities
** practical or logistical capacity to fulfill peer counselor coordinating duties (e.g.,
transportation, schedule flexibility)
** other qualifications
14.
Of the above guidelines, please indicate which of them are required qualifications as opposed to
preferred qualifications.
INSTRUCTION: Look over the Program Information Form and review “Breastfeeding or Loving
Support Peer Counselor Coordinator” (Questions A and B) and clarify any information.
Ask questions 15-19 for all other WIC staff other than the Clinic Director involved in Loving Support
peer counseling (Note: there may be no other staff, in which case you can skip this section.)
15.
What is this person’s title?
16.
Who does this person report to?
17.
What are this person’s duties as they relate to Loving Support peer counseling?
18.
Is any of his/her salary supported by the Loving Support peer counseling grant?
Fully supported
Partially supported
No, not funded by Loving Support peer counseling funding
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19.
I’d like to calculate the total amount of time WIC staff spent on Loving Support peer counseling
(besides peer counselors). For each of the staff people we discussed, please estimate the amount
of time spent working on the Loving Support peer counseling program. You can tell us average
hours per week or average percent of time, or give us time estimates in some other format. [Be
sure to document how respondent reports this – percent time, hours per week, per month, etc.]
Clinic Director (name)______________
Breastfeeding coordinator (name) ____________________
Loving Support Peer counseling coordinator or supervisor (name)____________
(List all other staff who were named earlier)______________
Loving Support Peer Counselors
Next I would like to ask you some questions about the Loving Support peer counselors.
20.
How many Loving Support peer counselors work for your clinic? Please include those who
provide services over the telephone as well as on site.
21.
Are you currently trying to hire more additional peer counselors and if so, how many?
22.
For each of the peer counselors, please indicate the number of hours per week, on average, that
they work.
23.
How many of your peer counselors are considered “senior peer counselors”?
24.
Do your minimum qualifications for peer counselors match those of your parent agency or do
they differ? If they differ, please describe how.
25.
Do you provide non-wage compensation (e.g., travel reimbursement, paid leave) for peer
counselors?
No
Yes
** If yes, please indicate below the non-wage compensation that you provide to your Loving
Support peer counselors. (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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26.
Do you have career paths for peer counselors?
No
Yes
** If yes, please describe.
INSTRUCTION. Review Peer Counselor Names and Staffing Chart from Program Information Form
(page 2). Prompt to confirm that all staff who do peer counseling appear on the form. (Sites that
received Loving Support peer counseling to enhance their previous program may omit peer counselors
from the form.)
Loving Support Peer Counseling Service Delivery
27.
Does your clinic serve all WIC participants eligible for Loving Support peer counseling or only
some of the participants?
Offered to all WIC participants (Skip to 21)
Offered to only some WIC participants
28.
How do you decide who gets Loving Support peer counseling services?
29.
How do you assign WIC participants to peer counselors?
**Are there ways in which you match the two?
**If assignments are made, who makes them?
**At what point are assignments made?
30.
Approximately what percent of women who are offered peer counselors refuse them?
**What do you think their main reasons are for doing so? Do you keep records of this
information?
31.
Do you get requests for peer counseling services from mothers who are not on WIC? How do you
handle them?
Peer Counselor Caseloads and Turnover
32.
Would you consider your peer counselors to have “caseloads”? If they do, could you tell me how
they are defined and what their size is?
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33.
In the last few years, how many peer counselors have left?
**What do think are the reasons for peer counselor turnover this year?
**For those that have left for other jobs, what have those other jobs been?
34.
How are Loving Support peer counseling participants reassigned, if they are, after a peer
counselor leaves?
INSTRUCTION: Look over “Information about Contacting WIC Participants” (Questions C-E) on the
Program Information Form and clarify any information.
Contacting WIC Participants
35.
When do peer counselors generally first contact WIC participants?
During pregnancy?
**If yes, during a specific trimester?
After delivery?
**If yes, when after delivery? __________
First contact coincides with participant’s visit for other WIC services
**If yes, please describe how the process works
36.
How frequently do peer counselors get contacted by WIC participants? What are the reasons for
contact?
37.
At what points do WIC participants tend to contact their peer counselors (e.g., at hospital
discharge, when considering stopping breastfeeding exclusively)?
38.
How soon does a WIC participant generally get contacted by a peer counselor after she requests
breastfeeding assistance?
**Are these formal guidelines?
INSTRUCTION. Review Frequency of Contact Chart (page 3) and Question F of the Program
Information Form. Make sure that you understand how the program works, perhaps by repeating your
understanding of it and making sure your knowledge is correct.
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Types of Contacts
39.
What proportion of contact would you estimate that your peer counselors have with WIC
participants that are in person as opposed to over the telephone?
40.
Why are some contacts in person rather than by phone? (Prompt for: when they come into the
clinic for routine reasons, when in the hospital, by special appointment with the peer counselor
and the general frequency these happen.)
41.
Do Loving Support peer counselors see WIC participants while they are in the hospital? Why or
why not? (Ask for the arrangements that were made with local hospitals and how patient privacy
and liability concerns were handled.)
42.
Do Loving Support peer counselors see WIC participants in their own homes? How frequently
and under what circumstances? How have liability concerns been handled?
43.
Do you require that at least some of the contact between peer counselors and WIC participants be
in person?
Yes.
**Please describe. (Probe: For all participants or for some?)
No
44.
Are Loving Support peer counseling services ever delivered to WIC participants in group
sessions?
Yes.
**Please describe.
No
Content of Peer Counseling Sessions
45.
What topics are discussed and techniques demonstrated by peer counselors to Loving Support
peer counseling participants? (Prompt for during pregnant, first weeks post partum, and when
infant is 2-6 months.)
46.
Is the content of the sessions standardized? If yes, please describe how.
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INSTRUCTION. Review “Documentation of Sessions” questions (G-I) on Program Information
Form and confirm you understand the answers.
47.
How is the peer counseling caseload tracked to ensure mothers receive timely contacts?
48.
How often is this information monitored by or submitted to peer counselors’ supervisor(s)?
49.
If the information is not in a state centralized data base, is it all shared with the state? If not,
which information is kept locally?
Other Duties of Peer Counselors
50.
In addition to providing peer counseling, what are Loving Support peer counselors’ other job
activities? Do they have duties related to staff training, making referrals, service documentation
and program administrative tasks, or other tasks?
**For each of these activities, could you please tell us more about their responsibilities?
**What percentage of peer counselors’ time generally goes to these activities?
Recruiting, Training and Supervising Peer Counselors
51.
How do you recruit peer counselors?
**Where do you find them?
**How do you find them?
**Who interviews them?
** What is the selection process?
52.
How do you train new peer counselors?
**Required training. Do newly hired peer counselors receive the same training as previous peer
counselors?
**Mentoring or on-the-job training/shadowing during first months after a peer counselor is hired
53.
How do you support and monitor peer counselors? Do you hold staff meetings? How often and
who attends?
54.
Do peer counselors participate in WIC agency staff meetings and other events and activities? If
yes, please describe.
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INSTRUCTION. Review the Loving Support Training Chart from the Program Information Form
(page 5) and make sure that you understand it.
55.
How do you help peer counselors stay informed about their work requirements and breastfeeding
and peer counseling information and approaches?
**Do you offer in-service training? What and how often?
**Continuing education provided? What and how often?
** Access to lactation consultants and other breastfeeding experts?
**Other
56.
Is there ongoing or advanced training for experienced peer counselors? If yes, please describe?
Relationships with Hospital and Other Community Partnerships
Local Hospitals
INSTRUCTION. Review the Hospital Policy Chart from the Program Data Collection Form (page 5)
and make sure that you understand it.
57.
Which, if any, hospitals does your clinic work with in the Loving Support peer counseling
program? Are there hospitals that your WIC participants go to that you do not work with?
58.
For each of the hospitals with which you work on the Loving Support peer counseling program,
please describe:
**The nature of the collaboration
**Other organizations involved in the collaboration
**Administrative coordination
**How referrals for peer counseling follow-up are handled
**The number and positions of hospital staff are involved in coordinating or administering
Loving Support peer counseling and what their duties are
59.
For hospitals you partner with, what other breastfeeding promotion and support activities do they
do?
**Please describe the timing and content of the activities
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**The hospital staff who work on the effort
**The other organizations or agencies involved
Other Collaborations
60.
In addition to collaborations with local hospitals, is your clinic involved in other community
partnerships directly related to the Loving Support peer counseling program?
Yes
No (Skip to 62.)
61.
How many separate community partnerships are you involved in that focus on the Loving Support
peer counseling program?
[Ask for each community partnership]
Objectives/purposes of the partnership
When and how it got formed
Types of organizations that collaborate
Achievements and challenges of the partnership.
Adapting the Loving Support Peer Counseling Program
62.
Since you started receiving the Loving Support grant, what types of changes (beyond what you
did to start up) have been made to your program?
Key Changes Made in Peer Counseling Program
Since Inception
Expansion or contraction of Loving Support peer
counseling services.
Staffing for the peer counseling program at the clinic
Peer counselor or WIC staff training content and/or
procedure
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Describe the change. Why was the change
made?
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Key Changes Made in Peer Counseling Program
Since Inception
Peer counselor supervision/monitoring procedures
Types of data/documentation maintained regarding
the peer counseling services
Funding (sources, amount, etc.)
Criteria for selecting peer counselors
Scope of practices for peer counselors
Other (Specify)
63.
Describe the change. Why was the change
made?
In the coming year, will any of the types of changes listed below be made in your local Loving
Support peer counseling program? If yes, please describe the change and why it will be made.
Key Changes Anticipated in Next Fiscal Year
Expansion or contraction of Loving Support peer
counseling services.
Staffing for the peer counseling program at the
clinic
Peer counselor or WIC staff training content and/or
procedure
Peer counselor supervision/monitoring procedures
Types of data/documentation maintained regarding
the peer counseling services
Funding (sources, amount, etc.)
Criteria for selecting peer counselors
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Describe change. Why is the change
planned or anticipated?
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Key Changes Anticipated in Next Fiscal Year
Scope of practices for peer counselors
Adaptations in peer counseling program because of
changes in food package choices for WIC
participants in the first month postpartum
Other (Specify.)
Describe change. Why is the change
planned or anticipated?
Clinic Perceptions of Loving Support Peer Counseling Program
64.
How do you track the program’s effects and what have you learned?
65.
Do you believe you have the tools to adequately and effectively monitor the changes in
breastfeeding outcomes (that is, in the rates of breastfeeding initiation, exclusivity, or duration)?
**Why or why not?
66.
What are the typical responses of WIC mothers to Loving Support peer counseling services they
receive overall and during various times before and after their baby’s birth?
67.
What are the reactions or attitudes of WIC staff about the Loving Support peer counseling
program? In terms of….
** importance of breastfeeding in general
** value or importance of peer counseling services to WIC mothers?
** quality of work peer counselors perform?
**how Loving Support peer counseling affects the other work of WIC staff?
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68.
What are your major achievements and major challenges of the Loving Support peer counseling
program since it began in this clinic?
1.
2.
3.
69.
What are the lessons learned in implementing the Loving Support peer counseling program that
you’d like to share with others who would like to implement a similar peer counseling program?
70.
Are there areas where you could use more guidance or technical assistance from the State or
USDA?
1.
2.
3.
71.
When you think about Loving Support peer counseling in your state or local WIC agency, is there
a person you would consider its champion—whose efforts and enthusiasm really make it work?
Yes
If yes, who is this person?
No
72.
If you were given $10,000 to enhance your program, how would you spend it?
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| File Type | application/pdf |
| File Title | Microsoft Word - WICPeerC localClinicGuide rev 6.27.08.doc |
| Author | NicholsonJ |
| File Modified | 2008-06-27 |
| File Created | 2008-06-27 |