WIC Local Agency Applications and State Agency Evaluations - SLT

U.S. Department of Agriculture, Food and Nutrition Service (FNS) OMB Control Number: 0584-0591

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Expiration date: xx/xx/20xx

Attachment L Premiere and Elite Application Instructions

WIC Breastfeeding Award of Excellence

Premiere/Elite Award Application Instructions

There are 3 Award Levels: Gold, Premiere, and Elite.

Gold Award Questions: In order to be eligible for any level of award applicants must fulfill the criteria for all the Gold Award questions.

The Gold Award application has a total of 30 questions. The Gold Award questions, worth 1 point each, are criteria identified as best practices, which demonstrate excellence in breastfeeding practices and support, and relate to practices beyond the core components of WIC Breastfeeding Model for Peer Counseling.

Premiere and Elite Award Questions: The Premiere and Elite application has 16 questions. The Premiere and Elite questions are each worth 2 or 3 points. The questions for these higher level awards are criteria identified as exemplary practices that are deserving of the highest recognition of excellence. An applicant may fill out only the Gold award application and choose not to complete the combined application for the Premiere and Elite awards.

Performance data: Applicant does not submit performance data. The performance data considered is the rate of exclusively breastfed infants reported by local WIC agencies and published annually on the FNS website. Performance data is considered for the Premiere and Elite Awards. Evaluators will use the most recent data posted on the FNS website.

GOLD AWARD

• All Gold Award application questions (30 points) must be answered “yes” to be eligible.

• Eight of the 30 questions require you to add additional documentation to support your response.

• Performance data is not considered.

PREMIERE AWARD

• Applicants must meet the criteria for the Gold Award (30 points) and

• Additional 20 points from the Premiere and Elite application questions such that additional points are awarded in each of the 3 sections:

  • a minimum of 12 points from the Peer Counseling section,

  • a minimum of 4 points from the Partnership section,

  • a minimum of 4 points from the Other Criteria section.

• -

  and Performance data of either:

the rate of exclusively breastfed infants is at least 15 % or higher in the previous year of published data, and the most recently published year of data shows an increase over the previous year OR

- the rate of exclusively breastfed infants is at least 25 % or higher in the most recently published year of data

ELITE AWARD (highest level)

• Applicants must meet the criteria for the Gold Award (30 points) and

• ALL of the Premiere and Elite application questions are answered “yes” (36 points) and

• Performance data that demonstrates 40% or higher of the infants are exclusively breastfed

Documentation

Some questions in this application require additional documents. There are two types of document requests, a narrative and/or supportive documentation.

Narrative refers to a document with explanatory statements that have been written exclusively for the purpose of this application. The narrative should describe how your agency meets the criteria of a specific question as noted in the instructions. Narratives are not to exceed 500 words.

Supportive documentation refers to documents that already exist. The preferred source of documentation are locally developed policies, procedures, MOU’s, etc.; however, State and Federal documentation is also acceptable. You may submit these documents to demonstrate your agency meets the criteria of a specific question as noted in the instructions for that question. When attaching documentation, indicate the page number(s) where the specific information can be found in response to the question.

Each document you attach to the application must have a unique name/title entered into the application. The title should reflect the content of the document. For example, supportive documentation for Question 2 can be named, "Q2.After Hours Policies."

If you submit the same document for more than one question, enter the same document title again, and indicate the page number(s) that corresponds to the specific question. Do not submit entire policy and procedure manuals.

In order to be eligible to apply for a Premiere or Elite award, you must have applied and met the criteria for a Gold Award for this application period or be a previous Gold Awardee.

PEER COUNSELING

Question 1. (2 points)

Do you have established guidelines for how many hours of observation/shadowing are required as part of peer counseling training/continuing education?

Check the appropriate box (Yes/No) in response to the question.

Question 2. (2 points)

Do you have a WIC Designated Breastfeeding Expert or contract with an International Board of Lactation Consultant Examiners (IBCLC) to serve as a referral source for peer counselors and other staff?

Check the appropriate box (Yes/No) in response to the question.

Question 3. (2 points)

Do you have a referral process in place between hospitals and the WIC Program to facilitate peer counselor follow-up for WIC mothers shortly after discharge?

Check the appropriate box (Yes/No) in response to the question.

Question 4. (2 points)

Do you have a system that electronically documents and tracks peer counseling referrals and contacts?

Check the appropriate box (Yes/No) in response to the question.

Question 5. (3 points)

Do you have policies and procedures for home visits as part of your peer counseling program?

The supportive documentation must include a process for making home visits and procedures which address travel, safety and confidentiality.

Examples of acceptable supportive documentation: Policy and procedures, Staff training materials Check the appropriate box (Yes/No) in response to the question.

Attach the supportive documentation; fill in the document title and indicate the page numbers where the information that answers this question can be found.

Question 6. (3 points)

Do you have policies and procedures for hospital visits as part of your peer counseling program?

The supportive documentation must include:

• a process for making hospital visits,

• describe the relationship with hospital,

• address confidentiality, supervision, liability, and

• clarify the scope of practice and the role of the peer counselor.

Examples of acceptable supportive documentation: Policy and procedures, Staff training materials, Written agreements/contracts with hospitals

Check the appropriate box (Yes/No) in response to the question.

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

Question 7. (2 points)

Do you have a recognition program in place to acknowledge peer counselor accomplishments?

Check the appropriate box (Yes/No) in response to the question.

Question 8. (2 points)

Do you include career path structures for upward mobility of peer counselors?

Check the appropriate box (Yes/No) in response to the question.

Question 9. (3 points)

Do you have policies and procedures for peer counselors to communicate via social media or innovative technologies, e.g., Facebook, text messaging, Twitter, Skype or PalTalk?

Social media is the use of web-based and mobile technologies to turn communication into interactive dialogue and build a sense of community among users. Research shows that WIC’s target population use social media extensively as a means to communicate.

The narrative and the supportive documentation should indicate how the local agency is using social media technologies with peer counselors. It should indicate how they allow peer counselors to use social media and/or electronic communication for at least one of the following reasons: communicating with mothers, communicating with supervisors, communicating with other peer counselors, communicating with referral sources.

Documentation must include information on at least one of the following that allows peer counselors opportunities to communicate via social media technologies or other electronic media: Facebook, text messaging, Twitter, Skype, PalTalk, other electronic media. Policies and procedures must address confidentiality and privacy, proper etiquette, and follows local agency, health department or State policies for use of social media. It also must indicate supervisory monitoring or documentation of communication.

Examples of acceptable supportive documentation: Policies and procedures, Screen shots, Peer counselor documentation log

Please describe in a narrative how your peer counseling program is implementing social media technologies. Narrative not to exceed 500 words.

Check the appropriate box (Yes/No) in response to the question.

Attach narrative and supportive documentation that indicate existing policies and procedures for peer counselors to communicate via social media technologies.

Fill in all document titles for both the narrative and supportive documentation and indicate the page number(s) that corresponds to each document.

PARTNERSHIP

Although the WIC Program can provide many of the services breastfeeding women in the community need, WIC cannot do it alone. Various community entities such as public health programs, coalitions, schools and employers, impact a mother’s ability to initiate and continue breastfeeding. Establishing meaningful partnerships among these relevant community organization/resources is critical to a mother’s breastfeeding success.

A partnership is defined as a sustainable ongoing voluntary collaborative agreement between two or more parties based on mutually agreed objectives and a shared vision, generally within a formal structure. The partners agree to work together to achieve a common goal, undertake specific tasks, and share risks, responsibilities, resources, competencies and benefits in order to provide breastfeeding support throughout the continuum of care.

Question 10. (2 points)

Does the partnership have a written agreement or a Memorandum of Understanding?

Examples of acceptable supportive documentation: Memorandum of Understanding, Written agreement

Documentation attached includes all of the following:

• Description of the role of each partner

• Description of the goals and outcomes.

• Description of the types of activities planned.

Check the appropriate box (Yes/No) in response to the question.

Attach supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found.

Question 11. (2 points)

Have new policies or procedures been developed because of the partnership?

Describe the new procedures developed as a result of the partnership in a brief narrative or attach supportive documentation that indicates policies or procedures have been developed as a result of the partnership. Narrative not to exceed 500 words.

Acceptable documentation: Narrative or Supportive Documentation. Examples of acceptable supportive documentation: Policy and procedures

Check the appropriate box (Yes/No) in response to the question.

Attach narrative or supportive documentation. Fill in the document title and indicate the page number(s) where the information that answers this question can be found if using supportive documentation.

Question 12. (2 points)

Does the partnership have a plan for sustainability?

Check the appropriate box (Yes/No) in response to the question.

Question 13. (2 points)

Do you partner with stakeholders such as the American Hospital Association to support the Baby-Friendly Hospital Initiative in your community?

OTHER CRITERIA

SUPPORT OF EXCLUSIVE BREASTFEEDING

The American Academy of Pediatrics encourages exclusive breastfeeding for the first 6 months. WIC staff has an important role in educating mothers about exclusive breastfeeding, what to expect with breastfeeding, and providing the support necessary for them to feel confident in their ability to do so. The local agency must have policies and procedures in place that ensure benefits and services (support, education, and counseling) are provided to promote exclusive breastfeeding.

Staff provides realistic strategies to mothers on how to feed their baby only breast milk and provide appropriate support and/or referrals as needed.

Question 14. (2 points)

Do you have a supportive clinic environment that implements breastfeeding-friendly workplace polices for WIC staff?

The supportive documentation should indicate workplace polices that are breastfeeding-friendly for WIC staff and should include adequate time and an appropriate place to express milk and a program such as a “Bring your baby to work” program for staff who are breastfeeding.

Examples of acceptable supportive documentation: Policies and procedures Check the appropriate box (Yes/No) in response to the question.

Attach the supportive documentation; fill in the document title and indicate the page number(s) where the information that answers this question can be found.

Question 15. (2 points)

Do you ensure that peer counselors are solely dedicated to peer counselor support for breastfeeding, or, if you allow peer counselors to work in dual-role positions, do you ensure that those positions do not compromise the intent and purpose of the Breastfeeding Peer Counselor (BFPC) program?

It is vital that a WIC mother views her peer counselor as a peer—someone who is dedicated to building a trusting relationship with her inside and outside of the clinic. Peer counseling programs function best when peer counselors are allowed to solely dedicate their time to peer counselor support for breastfeeding. State agencies that allow peer counselors to work in dual-role positions must have State agency policies for dual-role peer counseling staff approved by the FNS Regional Office to ensure such positions meet the definition of a peer counselor.

Verify the applicant response. Check the appropriate box (Yes/No) in response to the question.

PRENATAL/EARLY POSTPARTUM SUPPORT

The third trimester of pregnancy and the early postpartum period are critical times in encouraging and supporting mothers who express intention to breastfeed and those who have initiated breastfeeding. These time periods are important to helping mothers establish successful breastfeeding relationships with their babies. During the prenatal period, a mother should be educated about how to breastfeed, her ability to produce milk, and how to tell that her baby is getting enough milk from her to thrive. During the first few weeks after delivery, mothers need assurance they are successful and support should be provided if problems arise.

Question 16. (3 points)

How do you provide around the clock assistance to assist mothers working through their breastfeeding problems?

Please describe in a narrative how you provide assistance to breastfeeding mothers around the clock. Narrative not to exceed 500 words.

Check the appropriate box (Yes/No) in response to the question. Attach the narrative. Fill in the narrative title.

Thank you for applying for the WIC Breastfeeding Award of Excellence

How to upload documents and Frequently Asked Questions:

https://www.fns.usda.gov/wic/breastfeeding-priority-wic-program

Please .zip your files and submit via Hightail Secure Uploads

In accordance to Section 231 of the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) (Public Law 111-296), this information is being collected to assist the Food and Nutrition Service in implementing a program to recognize exemplary breastfeeding support practices at WIC local agencies and clinics. This is a voluntary collection, but failure to provide the requested information in full will prevent applicants from being considered for recognition. FNS will use the information to improve the delivery and tailoring of WIC services and increase satisfaction of both staff and participants. This collection requests only minimal personally identifiable information (email address) which will not be used routinely to retrieve records under the Privacy Act of 1974. 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 0584-0591. The time required to complete this information collection is estimated to average 2 hours 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th floor, Alexandria, VA 22314 ATTN: PRA (0584-0591). Do not return the completed form to this address.