State, Local and/or Tribal Agencies

WIC Breastfeeding Peer Counseling Study Phase 2

Appx E1 LWA Staff Interview Guide 1-jn

State, Local and/or Tribal Agencies

OMB: 0584-0548

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Appendix E1: LWA Staff Interview Guide 1: Demonstration Period



WIC Peer Counseling Study

Interview Guide 1: LWA Staff Interviews (Demonstration Period)

INTERVIEWER NAME

DATE

LOCATION




NAME OF LWA

SITE ID

Time start

Time end






OMB Clearance Number: 0584-0548

Expiration Date: mm/dd/20xx

Estimates of Burden for the Collection of Information.
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 control number. The valid OMB control number for this collection is 0584-0548. The time required to complete this information collection is estimated to average 3.5 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collected.



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 at your agency. There are two purposes of this phase of our study. First, we want to describe the Loving Support Peer Counseling Program at your agency before you began the Demonstration Period of the intervention. Next, we’d like to learn how you have begun testing two additional components: contacting new mothers when they are in the hospital for delivery and conducting in-person meetings with new mothers during the first week to ten days post-partum.


You and 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 during the interview will be released in a form that identifies you or any other staff member by name, except as required by law. Although we may report direct quotations from the interview, you and your agency will be given pseudonyms. Because of the small number of individuals selected to participate in this interview, it is possible that you may be identifiable to other people on the basis of what you have said. Please note that this study is not part of an audit or management review of WIC. Your participation in the interview is completely voluntary, although someone from your agency must complete the interview if your agency is going to participate in the impact study. Do you have any questions before we begin?





Module A: Respondent Information

Interviewer: In some agencies the Breastfeeding Coordinator and the Peer Counseling Coordinator may be the same individual, or the two roles may not be separate. If the LWA does have both a Breastfeeding Coordinator and a separate Peer Counseling Coordinator, you may interview both. You also may interview the LWA Director.


I’m going to ask you some questions about the Loving Support Peer Counseling program at your agency. First I’ll ask about your Peer Counseling program activities and procedures before you began the Demonstration Period of the enhancements, and then I’ll ask you about what your agency has done to implement the two new components to the program: having peer counselors contact women when they are in the hospital and meet in-person with new mothers during the first week to 10 days post-partum.



A1. Please enter the name and title of each person answering this survey.


Respondent

Title Use the titles below, if applicable








Title: Write the title or position, if any, each respondent holds. Examples of possible respondents:

  • Breastfeeding Coordinator

  • Budget director

  • Loving Support peer counselor

  • Loving Support peer counselor coordinator or supervisor

  • WIC Agency director

  • Respondent has other duties ( If other duties, Please specify)


A2. Who else works on the Loving Support peer counseling program? (name, position)





Module B: Agency Activities to Promote Breastfeeding

Intro: We would like to learn about your agency’s efforts to support and promote breastfeeding, including Loving Support peer counseling.


B1. How long has your agency received funding from your State WIC agency for Loving Support Peer Counseling? (probes: year and month of first funding; ensure funding referenced was for Loving Support Peer Counseling not other breastfeeding promotion or other counseling. source(s) of funding)


First received funding specifically to implement the Loving Support model:


(month): __ (year): ______



B2. Have there been any other sources of funding for your Loving Support Peer Counseling program?



B3. In addition to offering Loving Support Breastfeeding Peer Counseling, what breastfeeding promotion activities have been available to WIC participants in your agency? Again, I’m asking about activities that were available before you began implementing the enhanced Loving Support Peer Counseling services.



If they occur

Collaborating Organization(s)

(if any)

Description

Media campaigns about breastfeeding and/or posting promotional materials WIC clinics, hospitals, or other public places




certified lactation consultants and other trained specialists available to WIC participants




breastfeeding support groups or classes for WIC participants




breastpumps, breastfeeding pillows, or other equipment that supports breastfeeding




Peer Counseling or other counseling to WIC participants that is different from the Loving Support Peer Counseling program




special training on breastfeeding to nutritionists and other WIC staff




a 24-hour breastfeeding hotline or access to designated staff with cell phones or pagers who are on-call after clinic hours? (if yes, ask how the hotline is staffed or which staff carry these cell phones)




any other activities to promote breastfeeding or support breastfeeding mothers? (specify)







B4. Do you have a lactation consultant on staff?

  • Yes

  • No

  • Don’t know

If yes, confirm: Was this lactation consultant on staff before the Demonstration Period began?



If no, Is there a lactation consultant from a local hospital or other organization that you work closely with? Do peer counselors have opportunities to meet with this lactation consultant? When do such opportunities occur?


B4a. Did peer counselors have opportunities to meet with this lactation consultant? When did such opportunities occur?



B5. Did your agency have a breastfeeding Peer Counseling program prior to implementing the Loving Support Peer Counseling Program?


  • Yes Describe this prior program:

  • No

  • Don’t know









Module C: WIC 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.


Peer Counseling Coordinator

C1. Is the Loving Support Peer Counseling Coordinator/supervisor a separate position from the breastfeeding coordinator?

  • Yes

  • No

  • Don’t know


C1a. If yes, Did the Peer Counseling Coordinator position exist before the Demonstration Period began?


  • Yes

  • No

  • Don’t know


C1b. If yes, How long has this person been the Peer Counseling Coordinator?


C1c. If yes, Please describe breastfeeding coordinator’s duties and how they relate to the Loving Support peer counseling coordinator. For each duty listed below, indicate whether it performed by the Breastfeeding Coordinator, the Peer Counseling Coordinator, or both (the duty is shared).


Breastfeeding Coordinator

Peer Counseling Coordinator

Duties

Supervise and monitor work performance of Loving Support peer counselors

Develop basic policies and procedures for local Loving Support peer counseling program

Conduct needs assessment to target the WIC Loving Support peer counseling services

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

Initiate or serve as point of contact for community organizations that collaborate on Loving Support peer counseling activities

Develop and implement outreach strategies for Loving Support peer counseling

Design and/or participate in evaluation of local WIC peer counseling services

Conduct program promotion with local organizations in the community

Provide information to WIC clients about the peer counseling program

Monitor Loving Support peer counseling implementation (i.e., peer counseling caseloads, number of women served, etc.)

Report on the Loving Support program operations to State WIC administrative staff


C2. Does the Peer Counseling Coordinator have other duties besides those listed above? If yes, describe:


C3. Please describe your agency’s guidelines for qualifications of Peer Counseling Coordinator and which of these are required qualifications as opposed to preferred qualifications


Peer Counseling Coordinator’s

Agency Hiring Guidelines (if any)

Req’d/Pref’d?

Educational background


Required Preferred

Professional training or certifications


Required Preferred

Similarity to WIC participants


Required Preferred

Personal qualities


Required Preferred

Practical or logistical capacity to fulfill peer counseling coordinator duties (e.g., transportation, schedule flexibility)


Required Preferred

Other qualifications


Required Preferred



C4. Please tell me the number and positions of all non-peer counseling staff in your agency, and whether or not the person in this position worked with the Loving Support Peer Counseling Program. I’m referring to how the person in each position worked with the Loving Support Peer Counseling Program before you started the Demonstration Period. (titles of positions will vary by agency and may or may not include: nutritionists; certification specialists; agency director; assistant director; breastfeeding coordinator; peer counseling coordinator; lactation consultant; budget director; other staff.)


Title or Position

# at the agency (all service delivery sites)

Before Demonstration Period, worked with Loving Support?

Describe role in Loving Support

Example: nutritionists

10

YES NO



YES NO




YES NO




YES NO




YES NO




YES NO





Now, I’d like to learn more about each agency staff person’s involvement in the Loving Support Peer Counseling Program, including their name, who they report to, if any of their salary paid by the Loving Support grant, and the approximate amount of time they spend on Loving Support Peer Counseling Program. [ELECTRONICALLY PREFILLED FROM EARLIER ITEM]

Name

Title or Position [Prefilled]

Reports to whom?

Any salary supported by Loving Support grant from FNS/ State WIC agency?

Estimated amount of time on Loving Support program. You can tell us average hours per week, or per month, or average percent of time.


WIC agency director


Fully

Partially

None

Don’t Know



  • Hrs/week

  • Hrs/month

  • % of time


Assistant director


Fully

Partially

None

Don’t Know


  • Hrs/week

  • Hrs/month

  • % of time


Breastfeeding Coordinator


Fully

Partially

None

Don’t Know


  • Hrs/week

  • Hrs/month

  • % of time


Peer Counseling Coordinator


Fully

Partially

None

Don’t Know


  • Hrs/week

  • Hrs/month

  • % of time




Fully

Partially

None

Don’t Know


  • Hrs/week

  • Hrs/month

  • % of time




Fully

Partially

None

Don’t Know


  • Hrs/week

  • Hrs/month

  • % of time

Module D: Loving Support Peer Counselors

D1. How many Loving Support peer counselors worked for your agency before the Demonstration Period began? Please include everyone who worked at local service delivery sites/clinics.


D2. How many, if any, of these were considered “senior peer counselors”?



D3. Before the Demonstration Period began, did you have career paths for peer counselors?

  • Yes If yes, Please describe.

  • No

  • Don’t know


D4. Are you currently trying to hire additional peer counselors, or did you hire additional peer counselors to help with the Demonstration Period?

  • Yes, currently trying If yes, How many?

  • Yes, hired additional for the Demonstration Period If yes, How many?

  • No

  • Don’t know


D5. Please list the first names of each of your peer counselors, and indicate the average number of hours per week that each peer counselor worked (or hours worked during the last reported month) before the start of the Demonstration Period and the percentage of her pay supported by the FNS peer counseling grant. If you had more than 8 peer counselors working for your agency then, please continue this list by adding lines as necessary.


Table below pre-filled by agency in advance of site visit:


First Name(s)

Ave. Weekly Hours Worked

# of months or years as a Peer Counselor

Supported by FNS peer counseling grant?

IF YES, % of pay supported

by grant

Peer Counselor #1




Yes No

%

Peer Counselor #2




Yes No

%

Peer Counselor #3




Yes No

%

Peer Counselor #4




Yes No

%

Peer Counselor #5




Yes No

%

Peer Counselor #6




Yes No

%

Peer Counselor #7




Yes No

%

Peer Counselor #8




Yes No

%





Completed AFTER the interview and filled TABLE at end of MODULE F

D5a


D5b

D5c

Total # of Peer Counselors

Sum of Hours/Week

X 4.3 wks/mo

Total # of Peer Counseling Hours/Month







If job description for peer counselors not yet received:

D6. Do you have a written job description for Loving Support peer counselors?

  • Yes

  • No


D6a. If yes, please provide us with a copy of the job description. Is this the job description you were using before the Demonstration Period began?

  • Yes

  • No

If no, ask for a copy of the job description used prior to the Demonstration Period.


Using job description, probe to fill in table below on Peer Counselor qualifications. Note that in some agencies the official job description posted externally may be more generic or vague than we need for Item D7. Probe to find out what specific qualifications were sought.

D7. Before starting the Demonstration Period, what qualifications did you look for in your Peer Counselors? Specifically what were you looking for in terms of:

Characteristics

Peer Counselor Qualifications

Req’d/Pref’d?

Educational background


Required Preferred

Professional training or certifications


Required Preferred

Similarity to WIC participants:

  • Prior breastfeeding experience?

  • Prior WIC participation?



Required Preferred

Languages spoken


Required Preferred

Peer Counselor had own transportation


Required Preferred

Peer Counselor’s availability

  • Minimum hours per week

  • Is availability evenings/weekends required or preferred?


Required Preferred

Other qualifications?



Required Preferred



D8. We will ask about peer counselor's roles in further detail later on, but right now I'd like to ask, in addition to providing peer counseling, before the Demonstration Period began, what were Loving Support peer counselors’ other job activities? These can include staff training, teaching classes, leading support groups, community outreach, making referrals, service documentation and program administrative tasks. For each of these activities, could you please tell us about their responsibilities? What percentage of their time generally went to these activities?


D9. Did all your peer counselors get paid?

  • Yes

  • No

  • Don’t know

If yes, What is the pay range for your Loving Support peer counselors?

From $ ____ to $____ per (hour, week, 2-weeks, bi-monthly, monthly, annually, other) (select one)

(If other format, please specify.)


D10. How does this wage compare to WIC entry-level support staff in your agency?

  • Lower

  • Roughly equivalent

  • Higher

  • Don’t know

  • Other


D11. Did you provide non-wage compensation (e.g., travel reimbursement, paid leave) for peer counselors?

  • Yes

  • No

  • Don’t know

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

If other, Please specify.




Module E: Local Sites Offering Loving Support Peer Counseling

E1. Your agency’s application to participate in the study indicated that your agency has [number] WIC centers/local service delivery sites —is that accurate? By local service delivery site, we mean any location where WIC participants come for services. If your agency has added any new service delivery sites to accommodate the Demonstration Period, please do not include these.


# of Sites


E2. Before you began the Demonstration Period, how many of these sites were offering Loving Support peer counseling services to WIC participants?


# of Sites that offered Loving Support peer counseling services.



E3. For the last full month before you began the Demonstration Period, please tell us the following information for each of the sites where Loving Support peer counseling is offered: the monthly average number of: (1) WIC participants (2) Loving Support peer counseling participants (if available), (3) and Loving Support peer counseling participants initiating breastfeeding (if available) (If information is not available, write N/A.)


If your agency has more than 6 service delivery sites, please provide details for the 6 largest sites and summarize the information for the remaining sites.

Site #

Site Name Where Loving Support Peer Counseling is offered

Average Monthly # of WIC Participants Eligible for Peer Counseling (i.e., pregnant, post-partum, or breastfeeding)

Ave. Monthly # of Loving Support Peer Counseling Participants1

1

 

 



2

 

 

 


3

 

 

 


4

 

 

 


5

 

 

 


6





All others Combined





1 LWAs may not be able to breakdown the number of peer counseling participants by delivery site; if so, ask for the average monthly number of participants across all sites combined



Allocation of Peer Counselors Across Sites

E4. Please describe how the time of Loving Support peer counselors was allocated, before the Demonstration Period began, among your local clinics/service delivery sites offering Loving Support Peer Counseling. If you have more than six sites, please show this time for your six biggest sites. If you have more than 8 Peer Counselors please add lines to this tables as needed.


Peer Counselor Time Allocation Chart

Peer Counselor

Site. #1

Site #2

Site #3

Site #4

Site #5

Site #6

Name:

Site name

Site name

Site name

Site name

Site name

Site name

1







2







3







4







5







6







7







8









Module F: Loving Support Peer Counseling Service Delivery

Selecting WIC Participants to Receive Loving Support Peer Counseling

F1. Your application to participate in the study indicated that the following were eligibility requirements for pregnant or post-partum women to enroll in your Loving Support Peer Counseling Program. [review eligibility requirements from LWA’s response to the FOA]

Is this correct?

  • Yes

  • No If no, Please describe eligibility requirements:

  • Don’t know


If respondent confirms that the Loving Support Peer Counseling Program is offered to all WIC participants, skip to F3. Otherwise, ask F2.


F2. Also, the application indicated that you decide who will receive Loving Support peer counseling services based on [describe decision criteria or process]. Is this correct? If no, describe:



F3. During the last reported month before the start of the Demonstration Period, how many women total were in the Loving Support Peer Counseling Program – that is, across all peer counselors, how large was the total peer counseling caseload? (This answer is needed for calculating caseload and intensity – see TABLE at end of MODULE F)



F4. What percentage of WIC participants first enrolled in Loving Support Peer Counseling Program:


  • During their first trimester of pregnancy

  • During their second trimester of pregnancy

  • During their third trimester

  • Within the first month after they had given birth

  • More than one month post-partum



Assignment of WIC Participants to Peer Counselors

F5. Based on your agency’s application to participate in the study, the process your agency follows for assigning WIC participants to peer counselors is [review description from response to FOA, including who makes assignments and when; what matching criteria (language, age, cultural or racial/ethnic similarity, geographic proximity to WIC participant’s hospital/home/preferred LWA service delivery site, similar temperament, other) are used]. Is this accurate? If no, describe how you match WIC participants and peer counselors.



F6. Also, we want to confirm the procedures you use when Loving Support peer counseling participants are reassigned, if a peer counselor leaves the agency. [review description of process from response to FOA]. Is this accurate? If no, describe what happens.

F7. Before the Demonstration Period began, what percent of women targeted for the Loving Support Peer Counseling Program actually took up the services (that is, they participated in an in-person or telephone contact with a Loving Support peer counselor)?


F7a. What do you think their main reasons are for not doing so?


F7b. Do you keep records of why women do not take up services?

    • Yes

    • No

    • Don’t know


F8. In the last few years, how many peer counselors have left?

If any counselors have left: What do you think are the reasons for peer counselor turnover? For those that have left for other jobs, what have those other jobs been?




Estimated Average Caseload and Average Peer Counseling Intensity

Completed AFTER the conclusion of the interview (or programmed for automatic calculation)


During last reported month before Demonstration Period


# of WIC participants enrolled in peer counseling

(F4)

Total # of Peer Counselors

(D5a)

Total # of Peer Counseling Hours

(D5c)



Caseload: Average # of WIC participants per Peer Counselor

(F4)/(D5a)

Intensity: Average # of Peer Counseling Hours per WIC participant

(D5c)/(F4)


Contacts with WIC Participants and Documentation of Contacts

F9. Before the Demonstration Period began, what was the average number of monthly contacts made with WIC participants for all peer counselors combined?


Average # of contacts per month

(all peer counselors combined)





F10. How did these contacts breakdown according to those that occur in the WIC offices, in the hospital, over the telephone, or by other means? In the last reported month before the start of the Demonstration Period, what was the number of contacts that occurred:


Mode

#


In the WIC office(s)



In the hospital



Over the telephone


Does this include messages left on voice mail?

  • Yes

  • No

Using text messages


Does this include messages sent, received, or both?

  • Sent by peer counselors

  • Received from clients

  • Both

By mail


Does this include mailings sent out, received, or both?

By email


Does this include email sent, received, or both?

  • Sent by peer counselors

  • Received from clients

  • Both

Postings on social media sites or services such as Facebook, Twitter


Does this include postings made by peer counselors, by clients, or both

  • Posted by Peer Counselors

  • Posted by clients

  • Both

Other (specify):









F11. Before the Demonstration Period, did the agency have formal policies about the frequency of contact during each of the following time periods? (See the table below. Please check boxes to indicate that you have guidelines or policies about the frequency of contact during each period specified.)


In actual practice, how frequently did peer counselors successfully contact participants during these times? We are referring here to contacts in-person or by phone, where the peer counselor has an exchange with a WIC participant. Don’t include unsuccessful attempts to reach participants.






Guidelines require contact:

Actual contact is typically made:




Are there guidelines for frequency of contact?

Other time period (Specify # of contacts per time period)

Other time period (Specify # of contacts per time period)


During pregnancy






1st trimester

Yes No

___ contacts per ____

___ contacts per ____

2nd trimester

Yes No

___ contacts per ____

___ contacts per ____

3rd trimester

Yes No

___ contacts per ____

___ contacts per ____

After Delivery






Week 1 (after hospital stay)

Yes No

___ contacts per ____

___ contacts per ____

Weeks 2 – 4

Yes No

___ contacts per ____

___ contacts per ____

Months 2 – 4

Yes No

___ contacts per ____

___ contacts per ____

Months 4 – 6

Yes No

___ contacts per ____

___ contacts per ____

After 6 Months

Yes No

___ contacts per ____

___ contacts per ____



Intro: We just reviewed your agency policies about contact and outreach to participants. Now I'll ask you about WIC participants initiating contact with counselors.


F12. Before the start of the Demonstration Period, how frequently did WIC participants who were enrolled in the Loving Support Peer Counseling Program request assistance from peer counselors? What were the reasons for contact? When did contact usually occur (e.g. at hospital discharge, when considering stopping exclusively breastfeeding)? About what percent of contacts were initiated by WIC participants themselves?



F13. How soon did a WIC participant generally get contacted by a peer counselor after she requested breastfeeding assistance?


Are these your formal guidelines?

    • Yes

    • No

    • Don’t know



F14. Before the start of the Demonstration Period, were peer counselors available to WIC participants outside of standard work hours (Monday-Friday, 9am-5pm)?


F15. How did Peer Counselors typically find out when a woman delivered a baby?



F16. Were Loving Support peer counseling services ever delivered to WIC participants in group sessions?

  • Yes If yes, Please describe.

  • No

  • Don’t know


Content of Peer Counseling Sessions

F17. What topics were discussed and techniques demonstrated by peer counselors to Loving Support peer counseling participants at the following times:

  • During pregnancy?

  • First weeks post-partum?

  • When infant is 2-6 months?

  • General


F18. Was the content of the sessions standardized?

  • Yes If yes, Please describe how.

  • No

  • Don’t know


Documentation

F19. What did 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

  • Unsuccessful contacts

  • Materials sent

  • Demographic information about mother and baby

  • Referrals made

  • Status of WIC participant in terms of initiation, duration, exclusivity of breastfeeding

  • Other (Specify:)


F20. How was this information recorded?

  • On paper records

  • In local centralized data base

  • In state centralized data base

  • Other method (Specify)________________


F21. How often was this information recorded?

  • At each client contact

  • Once a week

  • Once every two weeks

  • Once a month

  • Other (Specify)___________________________________________________________



Module G: Recruiting, Training and Supporting Peer Counselors

Loving Support Training

G1. Below is a list of training sessions related to the Loving Support peer counseling that may be offered in your state as well as more generic training sessions. Please indicate whether any of your staff and/or the peer counseling staff have received such training during the most recent 12 months before the start of the Demonstration Period or if they received such training more than 1 year ago.


Loving Support Training Chart

WIC Staff

Peer Counseling Staff

Received in the 12 months before Demonstration Period

Received more than 1 year ago

Received in the 12 months before Demonstration Period

Received more than 1 year ago

  1. Using Loving Support to Manage Peer Counseling Programs” training

  1. Other locally and/or State-offered training on breastfeeding and/or role of peer counselors

  1. Lactation management training approved through IBCLSC Continuing Education Recognition Points (CERPs)

  1. Other lactation courses that award certificates


G2. Before the start of the Demonstration Period, what was your process for recruiting peer counselors?





G3. In addition to ongoing training, what are the ways in which you supported and monitored peer counselors prior to the start of the Demonstration Period? For instance, was there mentoring or on-the-job shadowing after peer counselors first arrive?




G4. Did peer counselors participate in WIC agency staff meetings or other activities?


  • Yes

  • No

  • Don’t know


G4a. If yes, please describe which types of meetings/activities:





Module H: Loving Support Peer Counseling Expenditures

(Prefilled from response to FOA)

What is the time period for your organization’s fiscal year?


January 1 – December 31

July 1 – June 30

October 1 – September 30

Other (specify: __________________________________________)


Please list the total labor and non-labor expenditures for your WIC agency for your last completed fiscal year (2010):


Labor costs (Including salaries and fringe benefits) $ _______________


Non-labor costs (Including rent/mortgage/fee for the

Space, utilities, professional fees, repair and maintenance,

Office supplies and equipment, etc.) $ _______________



Now we would like to know how your agency spent its FNS Loving Support peer counseling grant funding during your fiscal year 2010. Please fill in all the lines in bold. If possible, please also fill out any other lines if you have this information. If you do not have it, please indicate so with an “N/A”.



FNS Loving Support Peer Counseling Grant Expenditures

Salaries & benefits


Salaries


Fringe Benefits


Non-labor direct expenditures


Travel


Contract/ Purchased services


Capital equipment


Non-capital equipment and supplies


Indirect cost and occupancy expenditures (rent, utilities, etc.)


Total Expenditures for Loving Support peer counseling




Overall, how much funding did your agency commit in your last fiscal year to breastfeeding promotion services other than FNS Loving Support peer counseling grant funds? These funds are in addition to those you specify in the chart above.


$____________ for breastfeeding promotion in the last fiscal year.

Don’t know

Module I: Relationships with Hospital and Other Community Partnerships

I1. Please answer the following questions for the local hospitals where WIC participants served by your agency most frequently deliver their infants.




ALL

MOST

SOME

FEW/ NONE

a.

What proportion of these hospitals have been designated a Baby-Friendly Hospital, as outlined by UNICEF and the World Health Organization?

b.

What proportion of these hospitals have rooming in for newborns?

c.

In what proportion of these hospitals are mothers encouraged to breastfeed within the first hour after birth?

d.

In what proportion of these hospitals are breastfeeding infants routinely given any supplementation, including water?

e.

What proportion of these hospitals provide formula discharge packs?

f.

What proportion of these hospitals have lactation consultants on staff?

g.

What proportion of the hospitals have staff that received training in lactation management in the last 3 years?

h.

What proportion of these hospitals have any discharge lactating support programs?

i.

What proportion of these hospitals refer pregnant or newly delivered women to your agency?

j.

In what proportion of these hospitals do WIC staff provide education to newly delivered women in the hospital?

k.

In what proportion of these hospitals are WIC certifications of newly delivered women and their infants done while in the hospital?

l.

In what proportion of these hospitals does your agency have a local clinic or service delivery site?

m.

In what proportion of these hospitals are peer counselors allowed access to WIC participants in this hospital? If most, some, or few/none, report why peer counselors are not permitted in other hospitals.





I2. Before the start of the Demonstration Period, did your agency collaborate with other organizations (that is, besides hospitals) to implement the Loving Support Peer Counseling Program? Examples may include La Leche League, the Nurse-Family Partnership, Healthy Start, public health or maternal and child health agencies, or any other organizations –the ones I named were just a few of the ones possible.


I3. What organizations has your agency collaborated with to deliver peer counseling services? What were the objectives of the collaboration? How was the collaboration formed, and when? What have been the major achievements or benefits of the collaboration? What have been the major challenges?



Organization 1 Name:


Organization 2 Name:


Organization 3 Name:


Objectives




How was the collaboration established?




When did the collaboration begin?




Major achievements or benefits?




Major challenges?







I4. Before the start of the Demonstration Period, did your staff or peer counselors encourage pregnant WIC participants or new mothers to participate in the “Text4Baby” program?







Module J: Adapting the Loving Support Peer Counseling Program

Now that you’ve given me a good description of your agency’s administration of the Loving Support Peer Counseling Program before you began the Demonstration Period, I’d like to talk next about how the Demonstration Period has been going and any changes you have made to the peer counseling program since the Demonstration Period began on [DATE LWA BEGAN DEMONSTRATION PERIOD -- prefilled --].


Breastfeeding Promotion (Other Than Peer Counseling)

J1. First, I’d like to talk about your agency’s activities to promote breastfeeding other than peer counseling. Have there been any changes in the non-peer-counseling activities available to WIC participants in your agency? [Review the activities from Item B3 for any changes]



Description of Any Changes

Unchanged

Media campaigns about breastfeeding and/or posting promotional materials WIC clinics, hospitals, or other public places


Certified lactation consultants and other trained specialists available to WIC participants


Breastfeeding support groups or classes for WIC participants


Breastpumps, breastfeeding pillows, or other equipment that supports breastfeeding


Peer Counseling or other counseling to WIC participants that is different from the Loving Support Peer Counseling program


Special training on breastfeeding to nutritionists and other WIC staff


A 24-hour breastfeeding hotline or access to designated staff with cell phones or pagers who are on-call after clinic hours? (if yes, ask how the hotline is staffed or which staff carry these cell phones)


Any other activities to promote breastfeeding or support breastfeeding mothers? (specify)




J2. Since the Demonstration Period began, are you aware of any new breastfeeding awareness campaigns or changes in existing campaigns conducted by organizations other than WIC in the communities served by your agency?

  • Yes

  • No

  • Don’t know

If yes, describe:





Agency Staffing

J3. Since the start of the Demonstration Period, have you hired any new agency staff other than peer counselors? If yes, were any of these new positions that did not exist before? Have the qualifications or hiring criteria for this position changed? (In particular, review Peer Counseling Coordinator and/or Breastfeeding Coordinator qualifications .)


Agency Positions

(Examples)

# new hires

since Demonstration Period

New position?

Changes in qualifications

Peer counseling coordinator(s)



Breastfeeding coordinator(s)



Lactation consultant(s)



Assistant agency director



Clinic or service site leader(s)



Data/information processing staff



Other? Specify



Other? Specify



Other? Specify





J4. Have the responsibilities of any of existing agency staff changed since the start of the Demonstration Period? If yes, For which staff, and how? (In particular, review Peer Counseling Coordinator and/or Breastfeeding Coordinator responsibilities.) See table below.


J5. Have there been any changes in the average amount of time these staff spend working on the Loving Support Peer Counseling Program? About how much time total have these staff persons spent on the program since the Demonstration Period began? See table below.


Agency Positions (Examples)

Changes in responsibilities

Total time on

Loving Support

since Demonstration Period began

Peer counseling coordinator(s)


__ avg. hours per week

__ total hours

Breastfeeding coordinator(s)


__ avg. hours per week

__ total hours

Lactation consultant(s)


__ avg. hours per week

__ total hours

Assistant agency director


__ avg. hours per week

__ total hours

Clinic or service site leader(s)


__ avg. hours per week

__ total hours

Data/information processing staff


__ avg. hours per week

__ total hours

Other? Specify


__ avg. hours per week

__ total hours


Peer Counselors

J6. Since the start of the Demonstration Period, have the qualifications or hiring criteria for peer counselors changed? (review criteria in item D3)



J7. Since the start of the Demonstration Period, have the responsibilities of peer counselors changed?



J8. Have there been any changes in the average amount of time current peer counselors work? (Review the average hours worked for each peer counselor in D4.)


First Name(s)

Ave. Weekly Hours Worked before Demonstration Period (from D4.)

Current hours worked per week

Peer Counselor #1

Prefilled from D4

Prefilled


Peer Counselor #2

Prefilled from D4

Prefilled


Peer Counselor #3

Prefilled from D4

Prefilled


Peer Counselor #4

Prefilled from D4

Prefilled


Peer Counselor #5

Prefilled from D4

Prefilled


Peer Counselor #6

Prefilled from D4

Prefilled


Peer Counselor #7

Prefilled from D4

Prefilled


Peer Counselor #8

Prefilled from D4

Prefilled




J9. Now that the Demonstration Period has started, have there been any changes in the pay range for your Loving Support peer counselors or any changes in non-wage compensation?




J10. Since the start of the Demonstration Period, have peer counselors received any extra resources to deliver the enhancements – that is, to make telephone or in-person contact with women in the hospital for delivery, or to make in-person contacts with women who’ve just given birth?



J11. Have there been any changes in policies or practices for making peer counselors available to WIC participants outside of regular working hours?



Local Service Delivery Sites

J12. Now that the Demonstration Period has started, have there been any changes in the number of service delivery sites that offer Loving Support peer counseling services or changes in which sites offer these services?

  • Yes

  • No

  • Don’t know

If yes, describe:



Assigning WIC Participants to Peer Counselors

J13. Have you made any changes in the criteria you use to decide which WIC participants will receive peer counseling?



J14. Have you made any changes in the way that WIC participants are assigned to peer counselors?



J15. Since the Demonstration Period began, have you had to re-assign any WIC participants because a peer counselor left, or was not available to conduct an in-person meeting or make a hospital contact? If yes, how did you make this re-assignment?



J16. Has the average caseloads of peer counselors increased, decreased, or stayed about the same since the Demonstration Period began?

  • Increased Why?

  • Decreased Why?

  • About the same


Implementing the Enhancements During the Demonstration Period

J17. Now I’d like to talk about how you planned to implement the enhanced peer counseling services, and how those plans have been working. First, I’d like to review those plans with you so that you can tell me about anything you’ve done differently.


[Review the agency’s plans, including:

  1. Procedures to identify women eligible to receive the enhancements

  2. Procedures for providing peer counselor contacts (phone or in-person) during WIC participants’ post-delivery hospital stay and in-person contacts during the first 10-days post-partum

  3. Planned partnerships with hospitals or other agencies to deliver these enhancements


For (1) and (2), ask: Are these procedures the ones you’ve actually been using?

If yes, How have they been working?

If not, what procedures have you been using?

For (3), ask: Have you been able to establish these planned partnerships?

If yes, How are these partnerships working out so far? Any challenges?

If not, What have you done instead; have you made other arrangements to work with these or other agencies?



J18. What procedures have you followed to implement the enhanced peer counseling services to WIC participants – namely making contact when they are in the hospital and completing in-person meetings during the first week to ten days post-partum? How are you ensuring that these contacts occur? What are the major barriers to making these contacts?



J19. So far during the Demonstration Period, how many WIC participants have peer counselors been able to reach at the hospital – either by telephone or in-person? How many attempts were unsuccessful?


Targeted number of hospital contacts:

prefilled

Number of successful hospital contacts:


Number of unsuccessful attempted hospital contacts:





J20. What are the main challenges to completing these contacts with WIC participants in the hospital just after delivery? What practices have proven most successful?




J21. So far during the Demonstration Period, how many WIC participants have met in-person with a peer counselor during their first week (that is, up to 10 days) post-partum? How many attempts to schedule such meetings have been unsuccessful?



Targeted number of in-person post-partum contacts:

prefilled

Number of successful in-person contacts during first week post-partum


Number of unsuccessful attempted in-person post-partum contacts




J22. What are the main challenges to completing these in-person meetings during the first week post-partum? What practices have proven most successful?



J23. Where are in-person post-partum meetings taking place? How many are in the WIC participants’ homes, in the WIC clinic, etc.


Location

Number completed since start of Demonstration Period

In WIC participant homes:


In WIC clinic:


Other location (specify):


Other location (specify):




J24. Are you on target to meet the goals of the Demonstration Period?

  • Yes

  • No If not: What do you think would help?




J25. Do you know how WIC participants receiving the enhancements are reacting to them?



J26. What proportion of WIC participants targeted for an in-person meeting during her first 10 days post-partum explicitly said they didn’t want to meet with their peer counselors? What reasons have they given? What steps have you taken in response?


Documentation/Contact Logs

J27. Have the contact logs that Peer Counselors are using changed at all because of the Demonstration Period?

  • Yes If yes, ask: May I please have a copy of it?

  • No

  • Don’t know

J28. How have peer counselors reacted to changes in the contact logs? Have there been any difficulties implementing these changes?




Training and Supervision of Peer Counselors

J29. What information or training have you provided to LWA staff (other than peer counselors) about the enhanced peer counseling services or the Demonstration Period?


J30. What training and support have you provided to peer counselors to implement the enhancements, including the hospital contacts and in-person meetings during the first week post-partum?



J31. Have you made any changes in how peer counselors are supervised, or the types of mentoring they are provided?



Use of grant funds for Demonstration Period

J32. How have you used the grant funding you received to implement the Demonstration Period? I’m referring to the funds you have received from Abt Associates to help defray the costs of offering the enhanced peer counseling services. Ask as an open-ended question and code any of the below after the conclusion of the interview: Check all that apply.


  • Expand peer counseling to other service delivery sites

  • Offset salary of existing staff

  • To hire new agency staff

  • To pay new peer counselors or expand hours of existing peer counselors

  • To cover costs of hospital or in-person peer counseling meetings with WIC participants

  • To offset increased costs of tracking contacts

  • To offset costs of starting up the enhanced model of the program (e.g., time/labor spent)

  • To pay consultant(s)

  • To fund collaboration with another organizations

  • Other



J32a. Have you had any unexpected expenses?



Relationships with hospitals and other community organizations


J33. Since the Demonstration Period began, has your agency developed any new arrangements, either formal or informal, with hospitals that serve WIC participants?


J34. Since the Demonstration Period began, has your agency collaborated with any community organizations other than hospitals to deliver the enhanced peer counseling services? For example, have you worked with any agencies that have experience making home visits or providing services in hospitals?




Module K. Plans to implement the study

K1. Based on your experience so far with the Demonstration Period, what have been the major challenges to delivering the enhanced peer counseling services to WIC participants in the hospital and during the first 10 days post-partum? How do you plan to meet those challenges?




K2. What procedures have worked well to deliver these enhanced peer counseling services?





K3. Once we move from the Demonstration Period into the study itself, do you have plans for changes in any of the following areas:

  • Staffing, either LWA staff or peer counselors at the agency or site delivery level

  • Training content, frequency, or procedures for LWA staff or peer counselors

  • Which clinics/# of clinics offering peer counseling

  • Supervision and monitoring of peer counselors

  • Maintaining data or documentation on peer counseling services

  • Procedures for assigning WIC participants to peer counselors

Describe any planned changes below:




K4. Once we start implementing random assignment, what are your plans for assigning WIC participants to peer counselors? What do you think the major challenges will be? How do you plan to address those challenges?





Abt Associates Inc. LWA Staff Interview Guide 1: Demonstration Period

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