Hi Jennifer
Would you please write this up for either JHL or Breastfeeding Review.  It
is a great case study and illuminates the relevent variable in these 'peer
counselling' studies - the quality of training.
 
Nina Berry
Australia

-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Jennifer Tow, IBCLC
Sent: Thursday, March 02, 2006 3:26 PM
To: [log in to unmask]
Subject: Re: [LACTNET] peer support

During the four years that I coordinated a hospital-based peer counseling
program, I collated data on approx 1000 women. When we began the program,
the avg age of weaning in the clinic was 2 weeks. By one year, the avg age
of weaning was 4 months. This was among the most vulnerable population in
one of the poorest cities in the US.

During the program, we looked closely at the components that had the most
positive impact. We were very fortunate to have about 70% of our clients use
the ped clinic, which was very supportive of our program. 
The head of the newborn nursery loved the peer counselors and so did the
clinic peds.The OB staff was very unsupportive as a rule, but we had some
fabulous nurses who made a lot of referrals.

The greatest improvements came from all of the things the recent study did
not do--very early referrals and extensive prenatal contact and education,
ongoing support (alll including home visits) for as long as the women
breastfed, 24-hour a day phone support (with me available to my staff 24/7),
teen groups for our teen moms (25% of the population), spanish-speaking PC's
for the moms who requetsed one, subsidized nursing bras and slings and free
rental pumps. Most importantly--we were embedded into the hospital. This
meant that we had peer counselors do rounds every single day (except
Christmas) and we saw every mother every day that she was in the hospital.
Many of the nurses came to rely on the PC.s, but the PP floor was a
love/hate relationship, to say the least. Our babies in NICU had the same
support (ezxcept that the NICU staff was less supportive of the program, but
as in all areas, we did have a few key very supportive nurses and docs).

I also trained the peer counselors as if they were going to be LCs--they had
20 hours of training, including counseling skills, then 3 months supervised
by a more experienced PC.  There was a similar program running at the same
time that had a lot more support than ours, except that it was not
hospital-based and the training was poor and the screening for staff was not
stringent (all of my staff had to be currently breastfeeding or have bf a
baby for at least one year)---the success rates were comparatively very low.

In my opinion, all of the above elements contributed greatly to our success,
but the most important is that the women all came from the community in
which they worked--had the same socio-economic status, lived in the same
neighborhoods, etc. The PCs also brought their babies to the clinic and home
visits. They only could not bring babies on rounds.

I have never seen a bridge that worked better than our model. Sadly, it was
funded very much as a PR effort and it was the OB dept, not the Ped dept
that had all the power. Empowered women tend to be much less threatening to
peds than to OBs, in my observation and the Peer Counselors became VERY
empowered, and in turn became catalysts to empower their clients. But,
that's another story.

So, my own experience and data are convincing enough for me.
Jennifer Tow, IBCLC, CT, USA

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