Section 6 Scope of Practice for Peer Counselors

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Dont Tell MEBreastfeeding Is NATURAL!Breastfee
ding Skit

• Where were the gaps in services?
• What education and support might have helped
  Cammie?
• When did she need that education and support?
• How could a peer counselor fill the gap?

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Peer CounselingGoing Beyond Usual WIC Program
Services
Peer Counselor Shawn Wickersham leads a teen
class at a Texas high school.
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Basic Education And Support

• Pregnancy
• First two weeks postpartum
• 1-3 months postpartum
• 3-6 months postpartum
• 6-12 months postpartum

What is happening during the mothers life? How
could a peer counselor help?
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How Peer Counselors HelpPregnancy

• Help mother explore and address her barriers to
  breastfeeding
• Assess issues that may complicate breastfeeding
• Identify sources of support for the mother
• Provide basic breastfeeding information to help
  prevent common problems
• Make maternity care referrals
• Encourage her to attend prenatal classes

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Recommended Contact Frequency
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Why?

• Most infant feeding decisions are made in the
  first trimester or before pregnancy
• Women who decide to breastfeed early in pregnancy
  tend to breastfeed longer
• Many women will decide to breastfeed later with
  consistent information and support throughout
  pregnancy
• Some women (such as teens) do not make infant
  feeding choices until late in pregnancy, or
  after delivery

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How Peer Counselors HelpEarly Postpartum

• Phone call or visit in the hospital
• Assistance in preventing common concerns
• Assistance in managing breastfeeding problems
• Home visit to assess positioning and latch
• Ongoing support and encouragement
• Referrals

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Recommended ContactFrequency
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Why?

• Critical weaning period is the first 7 to 10
  days!
• Next critical weaning period is 2 weeks to 2
  months
• ¼ of WIC women begin supplementing by day 5
• ½ of WIC women are using formula by day 16
• 2/3 have weaned to formula by end of first month
• Most common reasons for early weaning
• Perception of insufficient milk supply
• Breast problems or painful breasts

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Link To Services Beyond Usual Clinic Hours

• Many breastfeeding problems do not occur between
  9 a.m. and 5 p.m., Monday through Friday
• Little support and help is available from usual
  health systems outside working hours
• Mothers appreciate knowing they have a trusted
  friend when they need help the most

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Im available 24 hours a day. Sometimes, a girl
might call me in the middle of the night at home,
but I dont care. Mothers need help more than
between 9 and 5. Mothers need 24-hour support.
WIC Peer Counselor
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Help Peer Counselors ManageAvailability To
Clients

• FEW mothers actually call during inopportune
  times
• True emergencies are usually limited to the
  early postpartum period
• Teach peer counselors how to manage
  availability
• Set the limits with clients
• Carry a pager
• Take a message/return call
• Refer mothers to
• 24-hour warm line
• Hospital outpatient clinic

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How Peer Counselors HelpLater Postpartum
1-3 months, 3-6 months, 6-12 months

• Assist mother with maintaining breastfeeding
  after returning to work or school
• Assess family support
• Help her work breastfeeding into her busy life
• Counsel her about maintaining her milk supply
• Help her network with other nursing mothers
• Refer to WIC
• Answer continuing questions of breastfeeding as
  her baby grows

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RecommendedContact Frequency
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Why?

• Ongoing education and support is still needed,
  even after breastfeeding is going well
• At every critical weaning period, concerns about
  milk supply and returning to work are significant
  reasons for weaning
• Mothers often need guidance specific to their
  work or school situation

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RecommendedContact Frequency
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Limitations Of Peer Counselors

• Teach Peer Counselors
• How to support normal breastfeeding, not to
  diagnose or address potentially serious problems
• How to make appropriate referrals

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Practice SettingsFor Peer Counselors
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Settings For Peer CounselorsTelephone Calls

• Phone calls from home enable peer counselors to
  be available to new mothers at times of crisis
• Phone calls are most effective when peer
  counselors initiate the calls
• Consider
• Assigning peer counselors within calling range
  of clients
• Reimbursing for long distance charges phone
  cards, invoices, or make calls from clinic)

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What AboutAnswering Machines?
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Settings For Peer CounselorsClinic Visits

• Waiting room plants to model breastfeeding and
  counsel pregnant clients
• Counseling as part of routine WIC nutrition
  education flow
• Consider bundling prenatal and postpartum
  appointments to maximize peer counselors time in
  the clinic
• Explore charting policies

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Settings For Peer CounselorsHome Visits

• Assess breastfeeding technique
• Counsel women about breastfeeding problems
• Assess for available support
• Consider safety issues
• Accompany other home visiting staff on early
  postpartum visits
• Refer to other health professionals who make
  home visits

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Tips For Home Visits

• Accompany other home visiting staff
• Go in daylight with someone if possible
• Inform WIC staff of the home visiting plans
• Stick to safe neighborhoods
• Do not carry valuables
• Keep equipment and materials handy
• Respect pets of clients
• Leave if uncomfortable

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Settings For Peer CounselorsHospital Visits

• Assist with basic breastfeeding information and
  assistance, if allowed by the hospital
• Counsel mothers about breast pump usage
• Follow-up on referrals by the hospital
• Meet new mothers to facilitate later phone
  follow-up
• Follow hospital protocols
• Follow-up with moms for seamless care

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Documentation

• Purpose
• Record of advice given to a WIC client
• Method for making referrals
• Measure of peer counselors effectiveness
• Justification for paying peer counselor for
  services
• Types
• Client contact logs
• Notebook and/or tickler files to organize
  contacts needed

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Questions?
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