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Peer Counselor Program in Texas - Frequently Asked Questions

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Breastfeeding Peer Counselor Program in Texas web banner

Note: Some FAQs include video clips from WIC Breastfeeding Coordinators who share their expertise.  

Photo of a peer counselor holding up an Instructional Guide brochure showing a mom who's holding a baby. They're in the peer counselor office.

How do you recruit peer counselors?

Video Clips:

Look for Passion (FLV)

Breastfeeding Tea (FLV)

Breastfeeding Star Search (FLV)

Referral Process (FLV) 

We recruit and hire only WIC mothers who have successfully breastfed. Careful recruiting is the key to the success of your program. Look for mothers who have an enthusiasm for breastfeeding and are willing to share their enthusiasm with others. It’s a good idea to get everyone at the local agency involved with recruiting. If WIC staff at the site where counselors will be working recruit them, hopefully, they will recruit someone they would like to work with and will mentor their own recruits. Experienced peer counselors are also wonderful recruiters. They will choose people who will be a positive reflection on their reputation. One breastfeeding coordinator recommends having a “breastfeeding tea” as an effective recruitment technique. She invited all the breastfeeding mothers at her agency to a “breastfeeding tea” where she told them all about the Breastfeeding Peer Counselor Program and passed out applications to everyone who was interested. This gave everyone a chance to ask questions and she only had to deliver her message once. She followed up with individual interviews with the moms who turned in applications. Having a regular interview and hiring process seems to increase the number of recruits who show up for training and the length of time they stay in the job. When it seems more like a real job, they take it more seriously.

How do your peer counselors get access to clients?

Many local agencies have specific days of the week for prenatal certification. Staff who make appointments and peer counselors will work together to schedule pregnant certification days on a day when a peer counselor will be in the clinic. At most agencies, a peer counselor will talk with each pregnant woman during her certification appointment.

Many agencies also have peer counselors teaching or assisting with teaching prenatal/breastfeeding classes. Counselors may hand out breastfeeding materials and counsel pregnant and breastfeeding mothers in the waiting room. Counselors make phone calls from a computer generated list to pregnant and breastfeeding mothers. Calls are scheduled at critical intervention times, a few weeks before the due date, right after delivery, when growth spurts are expected, etc. Once clients know counselors are available they will call and ask for the peer counselor when they have breastfeeding questions.

Do peer counselors make home visits?

Some of our peer counselors do make home visits. Our priority is to get clients to come into the clinic if possible. On our 2004 Peer Counselor Surveys about twenty five percent of our counselors reported making home visits.

Do you allow peer counselors to bring their breastfeeding babies to work?

Yes, we encourage local agencies to let their peer counselors bring their nursing babies to work and role model breastfeeding in the clinic. This seems to have a tremendous impact on increasing breastfeeding rates. Generally, counselors with really young babies are working only a few hours per week. One or two half days. Some agencies allow nursing babies as long as they are not mobile (crawling away from mom) others until the baby is a year old, others as long as the child is still nursing. At this point, we have a lot of very experienced counselors who's babies are older, in our 2004 survey about 25% of our peer counselors reported that they role model breastfeeding their babies in the clinic.

Do other staff members resent peer counselors bringing their breastfeeding infants to work?

In most cases, peer counselors who are bringing their babies to work are working part time, usually only a few hours a week. Bringing a baby to work for a few hours is much different from bringing a baby 40 hours a week. Most staff members understand this. Some local agencies have also allowed other staff members to bring nursing babies to work. We leave a lot of flexibility to the local agencies.

Photo of a peer counselor an a breastfeeding mom in a hospital room.

How are hospital Peer Counselor Programs structured?

We have peer counselors working in approximately 30 hospitals in Texas. Details vary from hospital to hospital. WIC local agencies usually have agreements with the hospitals and send peer counselors to spend regular hours at the hospital.  In some areas, where hospitals have a lower rate of births, peer counselors do not keep regular hours in the hospital. Peer counselors go as a visitor when a new mom calls and requests assistance.

Peer counselors are paid by the WIC Program and integrated into the hospitals in a variety of ways. At some hospitals, they serve under the umbrella of volunteer services and go through the volunteer orientation.

At most hospitals, they are under the umbrella of the lactation services department or the maternity department and go through the regular staff orientation. Peer counselors are supervised by the local agency breastfeeding coordinator, but also have a hospital employee who serves as the peer counselor's "contact person/supervisor" - this is usually the patient educator, lactation consultant, or charge nurse on the maternity floor.

At most hospitals, peer counselors do not chart, though they do complete their own WIC counseling forms. They report to the patient's nurse and the nurse charts the peer counselor encounter with that client.

When introducing peer counselor services to hospital staff it's important to keep in mind that peer counselors are only assisting with normal breastfeeding and are not involved in any medical intervention.   While in the hospital, the mom and baby are under the care of their doctors and nurses for all medical issues. This reminder usually lessens everybody's stress over HIPAA, etc. In addition, hospitals seem to be reassured by reviewing the WIC peer counselor training materials and knowing that the peer counselors are well trained and endorsed by WIC and the Department of State Health Services.

Do you ever bring your trainees out of their hometowns for training? How do you schedule the training? How many days? What tips do you have on training logistics?

Video Clips:

Scheduling and Teamwork (FLV) 

Lunches and Breaks (FLV) 

We train peer counselors locally. The Department of State Health Services offers the Peer Counselor Trainer Workshop three to four times per year. WIC breastfeeding coordinator's, WIC directors, WIC nutritionists or nurses, lactation consultants, La Leche League leaders, hospital nurses, parent educators, or whoever is interested in developing a program and training peer counselors attends the workshop. Then they train counselors at their local agency.

We find it is difficult for peer counselors to be away from home overnight to attend training. Most of the time we are recruiting mothers with small babies. They may also have to take care of other children and/or husbands. They are often not as mobile as WIC staff who are used to scheduling travel as a part of their jobs. We try to schedule the training day so that they can drop older children off at school and be there when their children get out of school. Trainers try to offer the training in the most convenient way possible for the peer counselor. Our training is 20 hours. It is divided into 5 classes. Most trainers present it in 5 half-day sessions either during one week or spread over two weeks.

Do you need the graduation ceremony?

Photo of peer counselors standing in circle each holding a baby and a lit candle.

Video clips:

Graduation (FLV) 

Many local agency peer counselor trainers say they feel the graduation ceremony is extremely important and has an impact on how long peer counselors stay in their jobs. It can be used as a tool that educates peer counselors, the clinic staff, the health department staff, hospital staff and peer counselors” families about the importance of the peer counselor’s role. Asking a health department head to speak is a wonderful way to make that administrator aware of the importance of the program. Having to make a short congratulatory speech is a wonderful participatory education tool. He or she will have a much better idea of what your program is accomplishing than would have been learned from the most eloquent inner-office memo.

Are Peer Counselors paid or volunteers?

WIC Peer Counselors are paid, but we do encourage volunteers. The Texas Breastfeeding Initiative includes developing volunteer Peer Counselor Programs as one of the goals. The idea is to encourage volunteers or staff of other agencies to go through the Peer Counselor Training when it is offered locally so those other organizations can add breastfeeding support to their services. This may include hospital volunteers, Early Head Start workers, community clinic workers, teen parent education programs, etc. We have also had key personnel in many of these organizations come to our Peer Counselor Trainer Workshop so they can recruit and train their own peer counselors. We require that these volunteers be under the umbrella of an agency in our provider community.

Do you have a lot of attrition? Do you have any tips for retention?

Video clips:

Support Your Counselors (FLV) 

Mentoring (FLV) 

Monthly Meetings-Allow Flexible Schedules (FLV) 

We have trained 2600 peer counselors in Texas since 1991 when the program started in Texas. We have approximately 300 counselors currently employed and approximately 300 additional counselors have been hired into other positions in the WIC Program. Some counselors will stay a long time and others only a short while. In addition to training counselors to work in our clinics, we are creating a network of community support. We are identifying these mothers in their communities as breastfeeding resources for their friends, family and neighbors. Counselors who have gone on to other employment, back to school, etc., are still sharing their expertise with other mothers in the community.

Including counselors in regular staff meetings, educating staff, and making peer counselors feel they are part of the team are also crucial in retention rates. Paying adequate salaries and increasing salaries as counselors gain experience, has been identified in the FNS research as critical to the success of the program. (See FAQ How do you determine job titles and salary structure?) Many local agency peer counselor coordinators feel that holding a graduation ceremony to recognize the completion of the Peer Counselor Training helps with retention rates. (See FAQ Do you need the graduation ceremony?)

How do you determine job titles and salary structure? Do you have a career ladder for peer counselors?

The salary range will vary for all WIC staff from one part of the state to another because economic factors vary, so it is hard to compare salaries between agencies.  The SA is recommending using the salary ranges of other employees at your agency for comparison. The SA recommends peer counselors be paid in a range between the salary of a clerk and an LVN or more, because they are required to have specific experience and training. 

Many of our agencies, especially those who have had programs for a number of years have created career ladders for their peer counselors. An example: peer counselor, peer counselor coordinator, assistant breastfeeding coordinator, breastfeeding coordinator. Some agencies have a senior peer counselor level. Over the years approximately 300 peer counselors have moved into full-time jobs at WIC. Many have been hired as clerks, many as part-time PC/part-time clerk, many as full-time peer counselors. Several have been hired as breastfeeding coordinators. One has become a local agency WIC director. Many of our peer counselors have passed the IBCLC exam. Some of our IBCLC/peer counselors have been hired by hospitals. Our WIC local agencies with IBCLC/peer counselors are beginning to create another level of positions for these counselors.

How do the peer counselors handle referrals?

Peer counselors are trained to assist moms with normal breastfeeding situations and to make appropriate referrals when they encounter situations that are outside the realm of normal breastfeeding. Local agencies must have resources for peer counselors to refer clients with problems that are outside the realm of normal breastfeeding. Counselors must have good documentation, good resources and good referral sources. Many local agencies have IBCLCs on staff and others have IBCLCs on contract on as needed basis. In a few areas, where there is no IBCLC, the local agency breastfeeding coordinator and the peer counselor may be the breastfeeding experts in those communities. They must find a breastfeeding friendly doctor or nurse to make necessary referrals, or they must find some kind of backup for situations beyond their expertise. This is key, we must have good referral sources, counselors need to feel confident that their clients will get help when they make referrals. Mom's Place Lactation Resource and Training Center (WIC funded) is staffed by a lactation consultant and peer counselors available to assist moms referred by Austin and surrounding area WIC programs. The Mom’s Place staff also answers a statewide hotline that is a tremendous help to agencies who do not have a local IBCLC.

How do other WIC staff relate to peer counselors?

Video clip:

Staff enjoys having help (FLV) 

Staff training on breastfeeding promotion and on the Peer Counselor Program concept is key to the success of your Peer Counselor Program.

Staff need breastfeeding training consistent with the training provided to peer counselors so the entire program is working in harmony, clients are receiving a consistent message and everyone knows that breastfeeding promotion is a priority. Staff need to know how peer counselors can help them with their jobs and how they can help peer counselors. Including the entire staff in the initial implementation of the program will add to its success. Encourage site supervisors, nutritionists, clerks, etc. to help with the recruiting process. Using plural pronouns is a good practice. When the breastfeeding coordinator or peer counselor coordinator says “our” peer counselors and “our” Peer Counselor Program, other staff are more apt to take ownership of the program and be more helpful with recruiting, training, and mentoring peer counselors.

What is the purpose of the Texas Peer Counselor Trainer Workshop?

The goal of the workshop is to inspire and equip those who attend to make the implementation of the Peer Counselor Program at their agency a priority. When attendees learn how peer counselors will help them and enrich their work environment, they will see how much they will gain personally by creating this program. The workshop covers everything from designing a Peer Counselor Program, writing a budget, and advocating for the program with staff throughout their agency, to recruiting, training, employing, and supervising counselors.

Trainees receive “tools to advocate for a Peer Counselor Program” with people at all levels of their agency. These tools include research, videos, activities for staff meetings, and communication skills.

Trainees meet a panel of experienced peer counselors and hear personal stories and ask questions. They meet a panel of experienced Breastfeeding/Peer Counselor Coordinators who share their experiences, answer questions, and provide insight.

A lactation consultant demonstrates how to effectively teach peer counselors to help moms with latch-on. Attendees practice key elements of training counselors. Interactive teaching techniques with different learning styles are demonstrated and discussed using examples from the peer counselor training materials. The national USDA model for Peer Counselor Programs and the Loving Support Curriculum are introduced. Trainees participate in a brainstorming session and create an individualized step-by-step plan to implement or enhance their Peer Counselor Program when they get home. The workshop is designed to insure the success of your Peer Counselor Program.

For more information please contact:

Jewell Stremler
Peer Counselor Coordinator
Nutrition Services Section MC 4554
Texas Department of State Health Services
PO Box 149347
Austin, TX 78714-9347
(512) 341-4593
(512) 341-4473 (fax)
Email: Jewell Stremler

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Last updated February 24, 2011