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 M Premiere and Elite Evaluation Instructions Instructions

This document works in coordination with the online evaluation site in PartnerWeb.

PREMIERE AWARD

Applicants do not need to respond to all 16 questions to be eligible for a Premiere award.

Each question is worth 2 or 3 points. A minimum number of points are required from each of the 3 sections:

• a minimum of 12 points from the Peer Counseling section (pscore-PC),

• a minimum of 4 points from the Partnership section (pscore-P),

• a minimum of 4 points from the Other Criteria section (pscore-OC).

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

Applicants must respond to all 16 questions to be eligible for Elite award AND have performance data that demonstrates 40% or higher of the infants are exclusively breastfed.

Start the Premiere/Elite award evaluation process at the “Prescreen for Premiere-Elite” section in the online evaluation worksheet.

PRESCREENING

In order to be eligible to apply for a Premiere or Elite award, the local agency must have applied and met the criteria for a Gold Award. Scroll down in the online evaluation worksheet to verify “Recommend Gold” is selected in the “SA-Recommendation for Gold” section. If “Recommend Gold” is selected, scroll up to the “Prescreen for Premiere-Elite” section and click “yes”.

If a Gold award is not recommended click “No” - STOP. The applicant is not eligible for a Premiere or Elite award. Complete the following sections: “State-Status”, “SA-Recommendation-Premiere-Elite” (choose “No Recommendation”), “State Evaluator Name”, and “Justification for No Recommendation”. Then click OK.

PEER COUNSELING (pscore-PC)

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?

Verify the applicant response. Check Yes or No based on applicant’s response.

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?

Verify the applicant response. Check Yes or No based on applicant’s response.

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?

Verify the applicant response. Check Yes or No based on applicant’s response.

Question 4. (2 points)

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

Verify the applicant response. Check Yes or No based on applicant’s response.

Question 5. (3 points)

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

Examples of acceptable supportive documentation: Policy and procedures, Staff training materials.

Documentation attached includes all of the following:

• Includes process for making home visits

• Procedures address travel

• Procedures address safety

• Procedures address confidentiality

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the documentation meets all of the requirements listed above.

Check Yes or No based on your documentation review.

Question 6. (3 points)

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

Examples of acceptable supportive documentation: Policy and procedures, Staff training materials.

Documentation attached must include all:

• Includes established process for making hospital visits

• Describes relationship with hospital

• Procedures address confidentiality

• Procedures address supervision

• Procedures address liability

• Clarifies the scope of practice and the role of the peer counselor

• Clarifies communication procedures and referrals

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the documentation meets all of the requirements listed above.

Check Yes or No based on your documentation review.

Question 7. (2 points)

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

Verify the applicant response. Check Yes or No based on applicant’s response.

Question 8. (2 points)

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

Verify the applicant response. Check Yes or No based on applicant’s response.

Question 9. (3 points)

Do you have policies and procedures for peer counselors to communicate via social media technologies, e.g., Facebook, text messaging, twitter, Skype, 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.

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

Narrative attached must include all of the following:

• Peer counselors communicate using at least one of the following: Facebook, text messaging, Twitter, Skype, PalTalk or other innovations.

• How peer counselors use social media for at least one of the following: taking training, communicating with mothers, communicating with supervisors, communicating with other peer counselors, or communicating with referral sources

Policies and procedures attached must include all of the following:

• Confidentiality and privacy considerations

• Proper etiquette when using social media

• Supervisory monitoring of social media used

• Follows local agency, health department or Federal/State policies for use of social media

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the narrative and the supportive documentation meets all of the requirements listed above. Check Yes or No based on your documentation review.

PARTNERSHIP (pscore-P)

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.

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the documentation meets all of the requirements listed above.

Check Yes or No based on your documentation review.

Question 11. (2 points)

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

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

Documentation attached includes all of the following:

• Description of the reason the policies or procedures were developed.

• Description of how the policies or procedures help meet the partnership goals.

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the documentation meets all of the requirements listed above.

Check Yes or No based on your documentation review.

Question 12. (2 points)

Does the partnership have a plan for sustainability?

Verify the applicant response. Check Yes or No based on applicant’s response.

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?

Verify the applicant response. Check Yes or No based on applicant’s response.

OTHER CRITERIA (pscore-OC)

Question 14. (2 points)

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

Documentation attached includes at least one of following:

• Breastfeeding staff are allotted adequate time and an appropriate place to express milk

• A “Bring your baby to work” program is established for breastfeeding staff with supportive policies.

• Other innovative method to create a breastfeeding-friendly workplace

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the documentation meets all of the requirements listed above.

Check Yes or No based on your documentation review.

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?

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.

Verify the applicant response. Check Yes or No based on applicant’s response.

Check Yes or No based on your documentation review.

Question 16. (3 points)

Do you provide around the clock assistance to mothers working through their breastfeeding problems?

Acceptable documentation: Narrative describes how assistance is provided to breastfeeding mothers around the clock.

Verify the applicant response. Check Yes or No based on applicant’s response.

Verify if the documentation meets all of the requirements listed above.

Check Yes or No based on your documentation review.

PERFORMANCE DATA

The applicant does not submit performance data. The performance data considered is the rate of exclusively breastfed infants expressed as a percentage of total infant participants in each local agency. This data is published annually on the FNS website. You can find the performance data at: http://www.fns.usda.gov/wic/breastfeeding-promotion-and-support-wic

Use the percentage found in the 8th column named “Fully Breastfed” in the spreadsheet found in the link above.

Fill in the percentage in the “Performance Data-Previous Year” and “Performance Data-Current Year” sections in the online evaluation worksheet.

Click save to go to the “Evaluations” page which reflects scores for finished evaluations.

Premiere Award Evaluation

You will evaluate for eligibility for a Premiere award prior to evaluating eligibility for an Elite award, of applicable.

You are now on a partnerweb page that displays the scores for all your applications. Look for the name of the local agency you just evaluated.

The online evaluation worksheet automatically calculates subscores for the three sections in the Premiere/Elite application: Peer Counseling (PC), Partnership (P), and Other Criteria (OC).

Verify the applicant meets the minimum points for a Premiere award:

• At least 12 points in the “pscore-PC” column

• At least 4 points in “pscore-P” column

• At least 4 points in “pscore-OC” column

If the applicant has met the minimum points for a Premiere award, the next step is to verify the performance data.

Use the back arrow to go back to the evaluation worksheet.

Verify the percentage in the “Performance Data-Current Year” section is at least 25 % OR the “Performance Data - Previous Year” section is at least 15 %, and the percentage in the “Performance Data-Current Year” section shows an increase over the previous year’s percentage.

If the points and data performance criteria have been met the applicant is eligible for a Premiere award. Complete the following sections: “State-Status”, “SA-Recommendation-Premiere-Elite” and “State Evaluator Name”. Then click “save”.

If the points and/or data performance criteria have not been met the applicant is not eligible for a Premiere award. Ensure all questions are answered and double check your evaluation responses and performance data percentages. If you have verified that your evaluation is correct and the points and data performance criteria still have been not been met, complete the following sections: “State-Status”, “SA-Recommendation for Gold” (choose “Recommend Gold”) “SA-Recommendation for Premiere-Elite” (choose “No Recommendation”), “State Evaluator Name” ” and “Justification for No Recommendation”. Then click save.

You have completed evaluating for the Premiere award.

Elite Award Evaluation

Note: If the applicant has not responded to all 16 questions on the Premiere/Elite application – STOP. No further evaluation is required.

The pscore column is the total score of all 16 questions on the Premiere/Elite application. A local agency must have a pscore of 36 to be eligible for an Elite award.

On the “Evaluations” page verify the local agency has a score of 36 in the column name “pscore”.

Use the back arrow to go back to the evaluation worksheet. Verify the “Performance Data-Current Year” section indicates a minimum of 40%.

If the pscore is 36 and the “Performance Data-Current Year” section indicates a minimum of 40%, the local agency is eligible for an Elite award.

If the points and data performance criteria have been met the applicant is eligible for an Elite award. Complete the following sections: “State-Status”, “SA-Recommendation-Premiere-Elite” and “State Evaluator Name”. Then click save.

If the pscore (score of 36) and/or the performance data (minimum of 40%) criteria is not met, the local agency is not eligible for an Elite award. Please double check your work. Ensure all questions are answered and double check your evaluation responses and performance data percentages. If you have verified that your evaluation is correct and the points and data performance criteria still have been not been met, complete the following sections: “State-Status”, “SA-Recommendation-Premiere-Elite”, “State Evaluator Name” ” and “Justification for No Recommendation”. Then click save.

Congratulations!

Thank you for completing the Premiere/Elite Award evaluation.

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 1.2 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.