Dear all:

I've been thinking about the implications of CBCs in terms of consequences for IBCLCs 
and how this is very typical of "downgrading" a profession so that those who have 
expertise and skills can no longer compete and no one gets adequate care.  

But then I started thinking about the stated purpose of the CBCs and it made even less 
sense to me.  

For 20 years I worked in international development.  Programs that dealt with populations 
of MILLIONS.  Community empowerment and peer-support systems were all part of many 
different programs for many different problems.  One program that was very successful 
in the pilot stage was the Triple A program in Tanzania. Village women were empowered 
to evaluate and solve problems to improve their children's growth.  It is one of the few 
successful examples of growth monitoring and PROMOTION (the latter being forgotten in 
most programs) that I have seen.  Yet, this successful program was extremely costly and 
was not able to scale up.

The claim is that the CBCs is a pilot project that will scale up.  I spent 20 years observing 
pilot projects that never made the grade to "scaling-up"

And this claim finally made the light bulb click on in my head.  La Leche League 
International is the ONE AND ONLY example I know of a peer-support program that is 
truly INTERNATIONAL.  They scaled up from a small group of women to an international 
scale. This is totally unprecedented as far as I know.  They did not do this by having a 
hierarchical model or standards of practice.  They do not have something like the IBCLE 
administered standardized tests.  Because it is volunteer, there is no competition with 
other professionals either.  No other pilot project has ever ever achieved this tremendous 
accomplishment.

Furthermore, I think there is a huge distinction between the peer-support model and the 
expert-facilitated group.  I do think that it is helpful to have the expert-facilitated group 
for clinical problems.  There are times when the in-depth knowledge is necessary and this 
cannot be acquired through a little reading, dabbling on the internet or experience with 
one type of baby.  Nevertheless, I have enough experience evaluating what does NOT 
work in a true peer-support system.  The flaws are the following:

a) setting up the peer leader as the "expert": when a peer leader becomes too much of 
an expert she is resented by the members of the group (this is from many many survey 
interviews for various different projects).  What does work is a peer leader who 
facilitates discussion and enables all members to participate
b) the "positive deviant" approach:  right now the "postive deviate" models started in 
Haiti have taken on a new life and become popular.  But I have seen serious flaws with 
this approach in that the one person who can manage in tough situations to do what 
others cannot doesn't always mean that that person can instill the same practices in 
others.  Again, resentment can ensue when others cannot manage to achieve what this 
person can achieve.  What usually happens is that you get a group where only those who 
can meet the "standards" remain in the group --- and those on the outside are viewed 
with disdain and "not good enough" 

Inclusiveness, and a true "PEER" system is what works.

Applying IBCLE tests and criteria would not work for this model.  As far as I'm concerned, 
decades and decades of research shows that the model for the CBC will not be successful 
for peer-support. As a model for professional support -- it is the equivalent of the cheap 
pumps that merely cause pain and don't remove sufficient milk to be useful. 

Sincerely, 

Susan E. Burger

Who is really appreciating the enormity of the accomplishment of the founding mothers of 
La Leche League.

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome