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From:
Niki Konchar <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 15 Nov 2006 20:36:24 EST
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As someone who has worked within the settings of WIC for nearly 7 years, 
(spending 4.5 of those years as a PC (peer counselor)), I strongly oppose the 2nd 
credential. Admittedly, I have direct experience with only two WIC clinics in 
east Texas, but my experience has been that WIC policies and protocols are 
loosely structured, perhaps purposely, and allow LA (local agency) management to 
interpret State language in ways which are detrimental to the purpose of 
promoting and supporting BF.
   FNS (Federal Nutrition Service) language, itself, needs to be 
strengthened. A case in point, The BF Intervention Design Study; Report #WIC-04-BFDSN, 
(dated 8/04 and available at 
www.fns.usda.gov/OANE/MENU/Published/WIC/BreastfeedingStudy.pdf), advocates for equating the IBCLC credential with that of CLC 
(Certified Lactation Counselor) and/or CBE (Certified Breastfeeding Educator). On 
page 28 of the study, it states: "While the provision of clinical supervision 
by IBCLCs has been recognized by some expert consultants, California's Survey 
of WIC State Offices suggests that access to IBCLCs may be fairly limited for 
many local WIC agencies. The Survey reported that, in 65% of states, less 
than 20% of WIC clinics have at least one IBCLC on staff. FNS may therefore wish 
to broaden the required credentials of PC supervisors to include other 
relevant professionals such as Certified Lactation Consultant, Certified Lactation 
Counselor, and/or Certified Breastfeeding Educator."
   If WIC, at the State level, can equate CLC, CBE, or whatever they deem 
appropriate, with IBCLC, there will not be an IBCLC on staff. In the state of 
Texas, state language says that the "LA BF Coordinator shall be trained as one of 
the following: 1)IBCLC, 2)DSHS TBE (trained BF Educator), 3)UCLA CLC, or 
4)other comparable training as approved by the State Agency BF Coordinator. What's 
notable her is that a DSHS TBE can be attained by attending a 2 day, butt in 
the seat, everyone passes workshop. In Texas, this is all that is required to 
qualify to be a BF Coordinator, who is responsible for managing and 
supervising the PC program. Does ILCA recognize that State language is equating IBCLC 
with a 16 hour course? Is this a standard that we agree with?
   If you look at the language of the 2nd credential, you will see that 
although the IBLCE does state that the "competencies and scope of practice for this 
new credential will be significantly different from that of the IBCLC 
credential, and that individuals holding this new credential will be required to work 
under the supervision of an IBCLC", they later specify that "candidates will 
be required to complete 40 hours of practice under the direct supervision of 
an IBCLC as well as 500 practice hours under the guidance of an APPROVED 
mentor." Who is going to approve this mentor? The State Agency, presumably. 
Elsewhere in the 2nd credential document, you will find the language, "the new 
credential will work under the guidance of an IBCLC. Such guidance does not 
necessarily have to take place in the presence of the designated IBCLC, but that an 
understanding/arrangement exists whereby support and guidance is provided." So 
what you end up with is 40 hours out of 540 hours, being documented by an IBCLC, 
who may not ever even see the candidate. This is a great deal like the LAs in 
my area, who contract with IBCLCs that live 300 miles from the local office, 
and are utilized perhaps once a year, for 8 hours, to train new PCs. How 
effective is this?
   How does this even approach the original requirements for practice hours 
to qualify sitting for the exam, which were set at 900 for medical 
professionals, 2,500 for those holding a 4 yr degree, 4,000 for those with a 2 yr degree, 
and 6,000 hours for those with less than 2 yrs college education? The 
requirements for the 2nd credential state that "there is no minimum level of education 
required to pursue this credential. Candidates are expected to have both 
reading and writing skills at the 12th grade level." They are not even requiring a 
high school degree! This is NOT going to bring respect to the IBCLC 
credential or make us respected members of the health care team. Really, 540 practice 
hours, 40 of which are to be documented by an IBCLC who doesn't actually have 
to be physically present? This is a WIC dream.
  It certainly seems to me that someone is attempting to sell our profession 
to the highest bidder, who appears to be USDA/FNS WIC. It is well known that 
peer counseling became a line item in the Federal FY06 budget and WIC intends 
to use PCs as a core function of WIC. This endorsement and funding commitment 
at the national level should provide megabucks for anyone willing to board the 
train. Yes, there is money to be diverted to IBLCE, but are we actually 
willing to sell our profession to an agency with a long standing history of Code 
violations and direct ties to the formula industry? Do we want to align ourselves 
with an agency that is responsible for distributing formula to about 50% of 
the American public? 

Niki Konchar, IBCLC

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