State and Local WIC-Screener, Staff, Personnel

OMB Approval No. 0584-XXXX

Approval Expires: XX/XX/20XX

Appendix LL.2

Feeding My Baby Study

Local WIC Site Key Informant Interview Guide

Thank you for taking the time for this interview. The U.S. Department of Agriculture’s Food and Nutrition Service has contracted with Westat and Altarum to conduct a study of WIC participants’ infant and toddler feeding practices, including their attitudes and behaviors. Your local site has been selected to participate in this study. Altarum Institute is conducting interviews of local site supervisors/coordinators to collect information about WIC program policies and operations at the local level. Altarum is a health and nutrition policy research and consulting institute and our work focuses on helping to improve the health and nutrition status of children, families, and adults.

The findings from this study will include not only outcomes related to the health and nutrition of infants and toddlers, but also information on how nutrition education and breastfeeding support is being implemented in WIC and how it relates to infant and toddler feeding practices. The findings from this study will inform national policy, and will be useful to FNS, the WIC community, and WIC researchers in better understanding the behaviors and attitudes of participants.

The purpose of this interview is to collect information about your local site’s policies and practices with a focus on nutrition education and breastfeeding promotion and support. In preparation for this interview, we have reviewed the State Plan to understand several policies and practices we see as important to the WIC Program’s influence on infant feeding behaviors. But as is the case with many state level policies and procedures, implementation at the local level can take many forms, and we recognize that state policies often leave several options to local programs. This interview will both help us determine how you operate your WIC program, and will also help us to understand how your local agency/site has interpreted state-level policies.

This interview will consist of a series of open and closed questions. Please answer to the best of your knowledge and ability. If you do not know an answer, or are unsure, we can discuss how best to find the correct answer and follow up later.

The information you share will be used in the study to better understand the relationship between WIC program characteristics and features and decisions WIC participants make with regard to infant and toddler feeding. All of your answers will be held in confidence, and nothing said today will be able to be identified back to you in any reports prepared for this study.

Our interview should last about 45 minutes, but no longer than 1 hour. Do you have any questions before we begin? Let’s get started.

I. Local Staff Qualifications and Training

First, I’d like to begin with a set of questions regarding your local site’s policies and practices related to staff qualifications and training. We are also conducting an interview with your state WIC agency regarding state-level policies in this area, so in your responses, please keep in mind that we would like to learn about any policies or procedures that are specific to your site.

1. I am going to read you a list of staffing categories commonly used by local WIC programs. For each category, please tell me if you use this or a similar category at this site and describe any minimum education or credential requirements for employees hired into these positions.

• Registered Dietitian:

• Nutritionist (non-RD):

• Nurse:

• Paraprofessional/Nutrition Assistant/Nutrition Aid:

• Lactation Consultant/LCE/IBCLC

• Breastfeeding Peer Counselor:

• Clerk/Support Staff:

• Other _______________________:

2. Other than continuing education requirements for RDs, RNs, and IBCLCs, are there continuing education requirements set by your local program for any of the staff who provide nutrition and breastfeeding education?

• Yes

• No

• Don’t know

1. [If yes] What are the continuing education requirements?

• Registered Dietitian:

• Nutritionist (4 year degree/non-RD):

• Nurse:

• Paraprofessional/Nutrition Assistant/Nutrition Aid:

• Lactation Consultant/IBCLC:

• Breastfeeding Peer Counselor:

• Clerk/Support Staff:

• Other _______________________:

3. Please describe how your site trains new employees?

4. Do new employees have to complete a competency-based training program before they can work independently?

• Yes

• No

• Don’t know

1. [lf yes] Which employees must complete the program?

2. [If yes] Who developed/provides the training program?

5. Which of the following staff categories provide nutrition and breastfeeding education for participants at your site?

• Registered Dietitian

• Nutritionist (4 year degree/non-RD)

• Nurse

• Paraprofessional/Nutrition Assistant/Nutrition Aid

• Lactation Consultant/LCE/IBCLC

• Breastfeeding Peer Counselor

• Clerk/Support Staff

• Other: _______________________

6. Does your local site have any special training requirements, in addition to training already described, for staff members who provide nutrition and breastfeeding education to WIC participants?

• Yes

• No

• Not sure

1. [If yes] Please describe those training requirements?

7. Over the past 12 months, has any of the staff at this site attended any training provided by the state?

• Yes, all staff

• Yes, some staff but not all

• No

8. Are there any trainings related to nutrition or breastfeeding that your agency or site provides to your staff beyond those provided by the state?

• Yes

• No

1. [If yes] What trainings are provided to all staff?

2. [If yes] What trainings are provided to the staff who provide nutrition and breastfeeding education to WIC participants?

9. Do you or does someone else in your local program or site offer mentoring support to guide staff in improving nutrition and breastfeeding services to WIC participants?

• Yes

• No

• Don’t know

1. [If yes] Please describe the mentoring approach.
   
   
   

1. Do you or does someone else in your local program or site work with staff to develop plans to improve their skills on the job?

• Yes

• No

1. [if yes] How often are the development plans reviewed or updated with staff?

11. As part of VENA implementation, have you provided trainings on learner-centered education or participant-centered services?

• Yes

• No

• [If yes] How confident do you think that your staff are in using skills learned in these training sessions? Overall, they are:

• Very Confident

• Confident

• Somewhat confident

• Not confident

12. Does your agency or site collaborate in a dietetic internship program?

• Yes

• No

• [If yes] Have any of your staff members completed an internship in the program?

• Yes

• No

13. How do you gather feedback from participants about services provided at your site?

    1. How do you use the information gathered?

II. Newborn Feeding Support

Those were all the questions I have regarding your staff. Now, I’d like to ask you some questions about your local program’s Nutrition Education Plan, and your site’s policies and procedures for nutrition and breastfeeding education.

To ask these questions, I’m going to focus on three time periods for nutrition and breastfeeding education. First, we’ll start with the late prenatal period through 6 weeks postpartum; and then we’ll talk about the period of time when the baby is between 4 to 8 months of age; and lastly, the time period beginning around the first birthday through the second birthday.

14. For the late prenatal period – the last trimester through 6 weeks postpartum - how many nutrition and breastfeeding education contacts do you plan for the mother and baby, and when do these occur?

    1. Do you monitor participant records or reports to see if planned contacts are achieved?

• Yes

• No

2. [If yes] What is your assessment of the level of achieving the planned contacts?

15. During these education contacts you’ve just described, what topics are usually covered?

16. What methods does your staff use to cover these topics?

17. If you use nutrition education materials to discuss the topics, may I have a copy of the two most frequently used pamphlet(s)?

• Pamphlet name (last trimester):

• Pamphlet name (after delivery-6 weeks postpartum):

18. Please tell me how you would rate the usefulness of the [title of most frequently used pamphlet(s)] with your WIC participants.

    1. Is [the first pamphlet name]:

• Extremely useful

• Somewhat useful

• Slightly useful

• Not at all useful

2. Is [the second pamphlet name]:

• Extremely useful

• Somewhat useful

• Slightly useful

• Not at all useful

19. I’d like to know how nutrition and breastfeeding education for high-risk participants differs from other participants during the late prenatal time period through 6 weeks postpartum. Are high risk participants during the late prenatal period through 6 weeks postpartum seen by specific staff and/or receive a different number of contacts?

20. Are there any other ways your local site provides nutrition and breastfeeding education during the late prenatal through 6 weeks postpartum time period that I haven’t asked about?

• Yes

• No

1. [If yes] Please describe:

21. Thinking of your nutrition education staff overall, how confident do you feel that your staff are in their ability to educate and motivate WIC mothers to breastfeed their infants? Overall, are they:

• Very confident

• Confident

• Somewhat confident

• Not confident

III. Infant Feeding Transition

Okay, now we will turn to the infant, and the time period of infant feeding transition education, typically between the ages of 4 months through 8 months. I’m going to ask similar questions to those we just discussed, so it may seem somewhat repetitive. But this focuses on nutrition and breastfeeding education during the middle of the baby’s first year.

22. For the period between 4 through 8 months of an infant’s age, how many nutrition and breastfeeding education contacts do you plan for the mother/caregiver, and when do these occur?

    1. Do you monitor participant records or reports to see if planned contacts are achieved?

• Yes

• No

2. [If yes] What is your assessment of the level of achieving the planned contacts?

23. During these education contacts you’ve just described, what topics are usually covered?

24. What methods does your staff use to cover these topics with mothers/caretakers of infants between 4 through 8 months of age?

25. If you use nutrition education materials to discuss the topics, may I have a copy of the two most frequently used pamphlet(s)?

• Pamphlet name:

• Pamphlet name:

26. Please tell me how you would rate the usefulness of the [title of most frequently used pamphlet(s)] with your WIC participants.

    1. Is [the first pamphlet name]:

• Extremely useful

• Somewhat useful

• Slightly useful

• Not at all useful

1. Is [the second pamphlet name]:

• Extremely useful

• Somewhat useful

• Slightly useful

• Not at all useful

27. I’d like to know how nutrition and breastfeeding education for high-risk infants differs from other infants between 4 through 8 months of age. Are high risk infants between 4 through 8 months of age seen by specific staff and/or receive a different number of contacts?

28. Are there any other ways your local site provides nutrition and breastfeeding education during the period of 4 through 8 months of age that I haven’t asked about?

• Yes

• No

1. [If yes] Please describe:

29. Thinking of your nutrition education staff, how confident do you feel that your staff are in discussing with parents introduction of solid foods and other topics of infant feeding transition generally covered during the period of 4 through 8 months of age? Overall, are they:

• Very confident

• Somewhat confident

• Confident

• Not Confident

IV. Toddler Feeding

Okay, now let’s talk about the transition from infant to toddler between the first and second birthdays. I’m going to ask similar questions to those we just discussed, but let’s now focus on the how you provide nutrition education for participants between 11 months of age and their second birthday.

30. For the period between 11 through 24 months of a toddler’s age, how many nutrition education contacts do you plan for the mother/caregiver, and when do these occur?

    1. Do you monitor participant records or reports to see if planned contacts are achieved?

• Yes

• No

2. [If yes] What is your assessment of the level of achieving the planned contacts?

31. During these education contacts you’ve just described, what topics are usually covered?

32. What methods does your staff use to cover these topics with mothers/caretakers of children between 11 months and the second birthday?

33. If you use nutrition education materials to discuss the topics above, may I have a copy of the two most frequently used pamphlet(s)?

• Pamphlet name:

• Pamphlet name:

34. Please tell me how you would rate the usefulness of the [title of most frequently used pamphlet(s)] with your WIC participants.

    1. Is [the first pamphlet name]:

• Extremely useful

• Somewhat useful

• Slightly useful

• Not at all useful

1. Is [the second pamphlet name]:

• Extremely useful

• Somewhat useful

• Slightly useful

• Not at all useful

35. I’d like to know how nutrition and breastfeeding education for high-risk children between the age of 11 months and the second birthday differs from other children in this age group. Are mothers/caretakers of high risk children between the age of 11 months and the second birthday seen by specific staff and/or receive a different number of contacts?

36. Are there any other ways your local site provides nutrition education for mothers/caretakers of children between 11 months and the second birthday that I haven’t asked about asked about?

• Yes

• No

1. [If yes] Please describe:

37. Thinking of your nutrition education staff overall, how confident do you feel that your staff are in their ability to discuss weaning from the bottle, appropriate food choices, and other topics relevant to children between 11 months and the second birthday with parents/caregivers? Are they:

• Very confident

• Somewhat confident

• Confident

• Not confident

38. Thinking about your nutrition education staff overall, how adequately trained do you feel they are to discuss healthy weight for children with parents/caregivers? Are they:

• Well-trained

• Somewhat well-trained

• Not well-trained

• Not at all trained

39. Thinking of your nutrition education staff overall, how confident do you feel that your staff are in their ability to discuss healthy weight for children with parents/caregivers? Are they:

• Very confident

• Somewhat confident

• Confident

• Not confident

V. Breastfeeding – Peer Counselors

We are more than half way through the interview now; we just have a couple more topics to cover. I would like to learn more about the breastfeeding services that your local site provides to WIC participants.

40. Does your local agency have a Breastfeeding Peer Counseling program?

• Yes

• No

1. [If yes] How long has your local site had a breastfeeding peer counseling program?

• Number of years:

• Number of months:

1. [If yes] How many breastfeeding peer counselors do you currently have on staff?

• Number full-time:

• Number part-time:

3. [If yes] Are all of your local site’s positions for breastfeeding peer counselor currently filled?

• Yes

• No (Note number vacant):

4. [If yes] Please describe the types of breastfeeding support that your peer counselors provide to WIC moms?

5. [If yes] How many contacts does the breastfeeding peer counselor have with pregnant women and when do these occur?

6. [if yes] How many contacts does the breastfeeding peer counselor have with women once they have delivered and when do these occur?

7. [If yes] Describe the supervision and training for breastfeeding peer counselors?]

41. Do you have certified lactation consultants at your local site?

• Yes

• No

1. [If yes] How many lactation consultants do you currently have on staff?

• Number full-time:

• Number part-time:

2. [If yes] Please describe the types of breastfeeding support that your lactation consultants provide to WIC moms?

3. [If yes] How many contacts does the lactation consultant have with pregnant women and when do these occur?

4. [If yes] How many contacts does the lactation consultant have with women once they have delivered and when do these occur?

42. What are your policies and practices in the following situations:

    1. When a fully breastfeeding woman says she wants to start some formula for her infant?

2. When a partially breastfeeding woman says she wants to stop breastfeeding and fully formula feed her infant?

VI. Breastfeeding – Breast Pumps

43. How do WIC moms who need breast pumps get access to them?

44. Tell me about the education provided to the WIC moms on the use of the breast pumps. What information is provided and who does it?

VII. Food Package

Now, we’ll shift gears and turn to a few questions related to the WIC food package.

45. Which staff members provide the education to participants on the authorized WIC foods and how to use WIC benefits?

46. Which staff members work with parents of infants when they want to make a change to the type of infant formula?

VIII. Linguistic Competency

Our last set of questions has to do with providing nutrition and breastfeeding education to participants who don’t speak English.

47. What methods are used in your local site for educating participants who don’t speak English?

48. If your site has bilingual staff or interpreters, is there a required proficiency test to evaluate their special language skills?

• Yes

• No

1. [If yes] Describe the type of proficiency test required.

And finally, my last question for you:

49. Are there any special initiatives related to nutrition education and breastfeeding support at your site or local program that you’d like to tell us about?

Those are all of the questions I have for you. Do you have any questions for me, or is there anything that you would like to share that I didn’t ask about during this interview?

Thank you very much for taking the time to participate in this interview.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB 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 60 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.