Breastfeeding Friendly Health Departments Project

State: MN Type: Promising Practice Year: 2014

:

Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself. Despite the recognition of the many health and economic benefits of breastfeeding, national and state breastfeeding rates are suboptimal.

The goals of the Breastfeeding Friendly Health Departments (BFHD) Project were:

  1. Increase the capacity of metropolitan and rural health departments in Minnesota to promote breastfeeding in the community.
  2. Pilot the process of the Ten Steps for Breastfeeding Friendly Health Departments.
:
Dakota County Public Health Department
:
Breastfeeding Friendly Health Departments Project
Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself. Despite the recognition of the many health and economic benefits of breastfeeding, national and state breastfeeding rates are suboptimal. The goals of the Breastfeeding Friendly Health Departments (BFHD) Project were: 1. Increase the capacity of metropolitan and rural health departments in Minnesota to promote breastfeeding in the community. 2. Pilot the process of the Ten Steps for Breastfeeding Friendly Health Departments. Ten local public health departments in urban, suburban and rural counties in Minnesota were recruited to participate in the six month Breastfeeding Friendly Health Departments pilot. The lead agency for the pilot was the Dakota County Public Health Department, situated in the Minneapolis-St. Paul metropolitan area. Dakota County is the third most populous county in Minnesota, with an estimated 405,088 residents. The Breastfeeding Friendly Health Departments model initially developed by the Wisconsin Department of Health based on the World Health Organization’s Baby Friendly Hospital Initiative. This model was adapted and enhanced for the Minnesota pilot project. Each site identified an individual to serve as a “BFHD champion”. The BFHD champions received training and resources related to the Ten Steps for Breastfeeding Friendly Health Departments. The project evaluation was based on the self-appraisal process completed at the initiation and conclusion of this pilot project. The Ten Steps for Breastfeeding Friendly Health Departments model worked. All BFHD pilot sites reported that they made progress in building capacity to support and promote breastfeeding within their agency and the community. There was an increase in the mean scores from the pilot sites on all ten steps, with seven steps showing a statistically significant improvement. The pilot sites reported that identifying a BFHD champion and the training and resource materials were the most helpful components of the project. Participating sites also indicated that the project complemented other efforts to promote and support breastfeeding, including the WIC program and collaborative efforts with health care organizations. The BFHD project increased the capacity of the pilot site agencies in supporting and promoting breastfeeding in the agency and the community. There is interest and commitment from the Minnesota Department of Health and the breastfeeding community to build on the success of the pilot and adopt the Ten Steps for BFHD and to establish a process to designate a local health department as a BFHD. The BFHD Ten Steps provide a process that can assist local public health agencies to fulfill the Surgeon General’s Call to Action and provide the momentum needed to increase breastfeeding promotion and support.
Ten local public health departments in urban, suburban and rural counties in Minnesota were recruited to participate in the six month Breastfeeding Friendly Health Departments (BFHD) pilot. The agencies represent a broad geographical cross-section of Minnesota: - Urban: City of Bloomington Public Health, St. Paul - Ramsey County Public Health - Suburban: Anoka County, Dakota County Public Health - Rural: Carlton County Public Health and Human Services, Freeborn County, McLeod County Public Health, Mille-Lacs County Community Health, Sherburne County, Southwest Health and Human Services-Lyon County. Home to more than 5.3 million people, Minnesota is undergoing major shifts. More than half of Minnesota’s residents live in the 7-county Twin Cities region. It is one of the fastest growing regions in the Midwest and is predicted to continue rapid growth; increasing from 2.9 million people to more than 3.5 million by 2040. While Minnesota is still not nearly as racially diverse as the nation, the population is becoming more diverse. About 17 percent of the state’s residents are now persons of color, compared to only about 1 percent in 1960. Between 2000 and 2010, the state’s population of color grew by 55 percent. Age trends are also transforming Minnesota. By 2030, the number of Minnesotans over age 65 is expected to almost double and older adults will comprise about one-fifth of the population. The lead agency for the BFHD project, the Dakota County Public Health Department, is the local health department for Dakota County, the third most populous county in Minnesota, with an estimated 405,088 residents. Dakota County, part of the Minneapolis-St. Paul metropolitan region, is geographically largely rural; however, the county maintains an equal land use mix of urban, suburban and rural. Populations of color have grown faster than the county’s White population in the past 20 years. In 1990, people of color represented five percent of the total population. In 2010, that had grown to 15 percent. The Hispanic population grew by 485 percent during that time and the Black/African-American population grew by 431 percent. Hispanics now make up a larger portion of the population of Dakota County (six percent) than the state (five percent). According to the Centers for Disease Control and Prevention (CDC), the protection, promotion and support of breastfeeding are critical public health needs (CDC, 2010). Given the documented short and long term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice (American Academy of Pediatrics [AAP] Policy statement, 2012). Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself (Office of Surgeon General [OSG], 2011), and has been identified by the CDC as one of the ten Winnable Battles in the Nutrition, Physical Activity, and Obesity category. Breastfed babies are at a lower risk for many health problems, such as ear and respiratory infections, diarrhea, asthma and obesity and mothers who breastfeed are less likely to develop diabetes, breast or ovarian cancer (U.S. Department of Health and Human Services [DHHS], 2008). Despite the gains that have been made in increasing breastfeeding initiation, current U.S. rates are still viewed as suboptimal and results in significant excess costs and preventable deaths (Bartick and Reinhold, 2010). Exclusive breastfeeding for the first six months has been recommended by numerous health and professional medical associations based on the benefits to both the mother and children (Jones, Kogan, Singh, Dee and Grummer-Strawn, 2011). However, in the U.S. while 75 % of mothers in the U.S. start breastfeeding, only 13% of babies are exclusively breastfed at the end of six months (OSG, 2011). In Minnesota, the rates are slightly better than these national averages, with 80% of mothers initiating breastfeeding and 15% of babies are exclusively breastfed six months or more (Minnesota Department of Health [MDH], 2010). The greatest health impact is found with early initiation, exclusive breastfeeding for the first six months of life and continued breastfeeding with appropriate complementary foods for the first year of life and beyond (AAP, 2005). Results of a recent cost analysis indicated that if 90% of U.S. newborns were breastfed exclusively for their first six months then direct medical costs could be reduced by $2.2 billion per year (Batrick and Reinhold, 2010). Framed another way, the U.S. incurs $13 billion in excess costs annually and suffers 911 preventable deaths per year because our breastfeeding rates fall far below medical recommendations (Bartick and Reinhold 2010). The hospital stay is known as a critical period for establishing breastfeeding. This led the World Health Organization (WHO) to establish criteria for hospitals to become Baby Friendly (WHO, 2003). The Baby Friendly Hospital Initiative (BFHI) developed in 1991, recognizes that successful initiation of breastfeeding requires the commitment of staff to provide breastfeeding information and support in the hospital setting during this critical period of delivery and birth. Research has shown that greater exposure to Baby Friendly practices would substantially increase the new mother’s chance of breastfeeding beyond eight weeks (Tarrant, Wu, Fong, Wong, Sham, Lam and Dodgson, 2011). Although hospital practices that support breastfeeding are important, these practices alone are not sufficient for ensuring women will breastfeed (Perrine, et al., 2012). The literature reveals that along with the implementation of BFHI for health care facilities, there has been similar work in the community setting to support breastfeeding which mimics the BFHI processes. A designation as a Baby Friendly Community has been a strategy in both Canada and Italy in order to increase breastfeeding exclusivity and duration (Bettinelli, Chapin and Cattaneo, 2012; Haiek, 2012). A common thread in the literature is the importance in establishing a network that would act synergistically to protect, promote and support breastfeeding (Anton, Molina, Segura, Arguelles, Bueno, Royo, Hernandez and Alonso, 2012; Bettinelli et al., 2012) using a population based approach the promotion of exclusive breastfeeding (Jones, Koga, Singh, Dee and Grummer-Strawn, 2011). Despite the recognition of the importance of a community/population based approach, there is limited reference made in the literature regarding Breastfeeding Friendly Health Departments. The BFHD model was based on the successes of the BFHI and the need for a community focused process to be aligned with breastfeeding goals on the local, state and national levels. The ten-step BFHI process has been shown to increase the number of breastfeeding mothers and child health (WHO, 2011). The Stony Brook Hospital in New York raised the exclusive breastfeeding rates from ten to 40 percent within in one year following implementation of the BFHI process (Hutter, 2013). By providing training and financial incentives to ten Connecticut maternity facilities, the Connecticut Department of Health (CDH) reported the positive movement within the facilities towards achieving BFHI designation; staff reported increased confidence and commitment in supporting breastfeeding mothers (CDH, 2012). Although there are no published results of the Ten Steps to Breastfeeding Friendly Health Department process in Wisconsin, the Wisconsin Health department has documented that the process increased the capacity of public health staff to protect, promote and support breastfeeding in Wisconsin communities (Wisconsin DHS, 2010). There is a great opportunity for public health departments to be leaders in the area of breastfeeding by working with and through national, state and local organizations and partners. The establishment of a Breastfeeding Friendly Health Department (Wisconsin Department of Health Services [DHS], 2010) focused on a solution that increases breastfeeding initiation, duration and promotes breastfeeding exclusivity. The purpose of the Breastfeeding Friendly Health Departments project was to build on this model and increase the capacity of metro and rural health departments in Minnesota to promote breastfeeding in the community and establish the process for local public health departments to attain the designation as a Breastfeeding Friendly Health Department (BFHD). REFERENCES: American Academy of Pediatrics Section on Breastfeeding (2012). Breastfeeding and the use of human milk (policy statement). Pediatrics, 129 (3), 827-841. American Academy of Pediatrics Section on Breastfeeding (2005). Breastfeeding and the use of human milk (policy statement). Pediatrics, 115 (2), 496-506. Bartick, M. and Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics, 125 (5), 1048-1056. Bettinelli, E., Chapin, E., and Cattaneo, A. (2012). Establishing the Baby Friendly Community Initiative in Italy: Development, Strategy and Implementation. Journal of Human Lactation, 28(3), 297-303. Centers for Disease Control and Prevention. (2010). Breastfeeding report card-U.S. trends. Retrieved from http//:www.cdc.gov/breastfeeding/data/reportcard.htm. Centers for Disease Control and Prevention. (2011). Vital signs: adult obesity rises. Retrieved from http//:www.cdc.gov/vital signs/pdf. Gawande, A. (2009). The checklist manifesto: How to get things done right. (1st ed.) New York, NY: Picador. Haiek, L. (2012). Compliance with Baby-Friendly policies and practices in hospitals and community health centers in Quebec. Journal of Human Lactation, 28(3), 343-358. Hayes, A.B. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360, 491-499. Jones, J.R., Kogan, M.D., Singh, G.K., Dee, D.L., and Grummer-Strawn, L.M. (2011). Factors associated with exclusive breastfeeding in the United States. Pediatrics, 128 (6), 1117-1125. Lippit, G. (1973). Visualizing change: model building and the change process. La Jolla, CA: University Associates, Inc. Lumbiganon, P., Laopaiboon, M., Festin, M.R., Ho, J.J., and Hakimi, M. (2012). Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database of Systematic Reviews, 9. Minnesota Department of Health. (2010). Minnesota vital statistics annual summary. Retrieved from http://health.state.mn.us/divs/chs. Minnesota Department of Health. (2012). Healthy Minnesota 2020: statewide health improvement framework. Retrieved from http:// www.state.health.state.mn.us /healthymnpartnership Office of the Surgeon General. (2011). The Surgeons call to action to support breastfeeding. Retrieved from http://www.surgeongeneral.gov/topics/breastfeeding.html. Perrine, C.G., Scanlon, K.S., Li, R., Odaom, E., and Grummer-Strawn, L.M. (2012). Baby-Friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics, 130 (1), 54-61. Semenic, J., Childerhose, J.L., and Groleau, D. (2012). Barriers, facilitators and recommendations related to implementing the Baby-Friendly Initiative (BFI); an integrative review. Journal of Human Lactation, 28 (3), 317-334. Tarrant, M., Wu, K.M., Fong, D.Y., Lee, L.I., Wong, E.M., Sham, A., Lam, C. and Dodgson, J.E. (2011). Impact of baby friendly hospital practices on breastfeeding in Hong Kong. Birth, 38 (3), 238-245. United States Department of Health and Human Services. (2008). The business case for breastfeeding: steps for creating a breastfeeding friendly worksite. Retrieved from http://www.womenshealth.gov. Wisconsin Department of Health Services. (2010). Breastfeeding friendly health departments in Wisconsin. Retrieved from http://dhs.wisconsin.gov/health World Health Organization. (2003). Global strategy for infant and young feeding. Retrieved from http://www.who.int/child-adolesecent-health/New Publications/NUTRITION World Health Organization. (2011). The baby friendly hospital initiative. Retrieved from http://www.unicef.org/programme/breastfeeding/baby.htm.
Nutrition, Physical Activity, and Obesity
The goals of the Breastfeeding Friendly Health Departments (BFHD) project were to increase the capacity of metropolitan and rural health departments in Minnesota to promote breastfeeding in the community, and to pilot the process of the Ten Steps for Breastfeeding Friendly Health Departments. The BFHD Ten Steps are: ESTABLISH A DESIGNATED INDIVIDUAL OR GROUP TO MANAGE BFHD: Review and update policies, procedures, and protocols. Assure staff training. Assess community needs and initiate a community coalition. HAVE A WRITTEN BREASTFEEDING POLICY: Address all Ten Steps and identifies department and community resources. Provides support for breastfeeding employees. COORDINATE SUPPORT AND PROMOTION TO ESTABLISH BREASTFEEDING AS THE “NORM” IN THE COMMUNITY: Assure that breastfeeding mothers are referred and linked to community-based support programs. Coordinate with WIC, hospitals and clinics, and community resources. Collaborate with partners to establish protective public policies. COLLABORATE TO ASSURE ACCESS TO BREASTFEEDING CLASSES: Identify available prenatal breastfeeding resources. Work collaboratively to identify and reduce gaps and barriers. EDUCATE THE COMMUNITY ON BREASTFEEDING SUPPORT: Increase public awareness by sharing the health department policy. Provide information and increase community awareness of the importance of breastfeeding and community support. ENCOURAGE RACIALLY AND ETHNICALLY DIVERSE RESOURCES WITHIN THE COMMUNITY: Identify needs of racial and socio-economic minorities in the community and collaborate to offer diverse breastfeeding support. SUPPORT MOTHERS IN INITIATING AND MAINTAINING BREASTFEEDING FOR UP TO 12 MONTHS AND BEYOND: Educate parents and community partners about the importance of breastfeeding exclusivity. Ensure mothers have knowledge and resources to successfully breastfeed. Inform mothers and community of state and federal breastfeeding laws. ENCOURAGE LOCAL PUBLIC PLACES TO PROVIDE A BREASTFEEDING FRIENDLY ENVIRONMENT: Work with local public places to provide a private space for breastfeeding. Encourage facilities to educate staff and display signage that the location is breastfeeding friendly. SELECT BUSINESSES EACH YEAR AND PROVIDE WORKSITE LACTATION SUPPORT TRAINING: Discuss benefits of breastfeeding to workplace. Provide a sample policy and employee educational materials and specifications for a lactation room. Publicly recognize breastfeeding friendly worksites. FACILITATE ACCESS TO INFORMATION AND TRAINING FOR LOCAL CHILDCARE CENTERS TO SUPPORT A BREASTFEEDING MOTHER: Identify interest and capacity of childcare centers. Work collaboratively to offer training. Publicly recognize breastfeeding friendly childcare providers. PROJECT IMPLEMENTATION: Bonnie Brueshoff, public health director of the Dakota County Public Health Department, developed the BFHD project to fulfill a requirement for a doctorate in nursing practice degree from the School of Nursing at the University of Minnesota. Brueshoff identified process objectives and outcome objectives for the project, and received institutional review board approval for the project. Brueshoff reviewed existing literature on the topic, and designed the process for the BFHD project based on Lippitt’s phases of change approach (described below). The initial phase of the project included a needs assessment and recruitment of local health departments to participate. After the departments committed to the six-month project, each identified a BFHD Champion who completed an agency self-appraisal survey that served as a baseline for evaluation. Based on an analysis of the initial self-appraisal from the ten pilot sites, the project director designed training and resources to support implementation of the Ten Steps for Breastfeeding Friendly Health Departments. The BFHD toolkit and materials included a guide to implementing the Ten Steps, examples of policies and BFHD Tip Sheets (see attachment). The champions were also invited to participate in a webinar, and received links to relevant trainings and breastfeeding articles. Email communication and individual consultation was also provided to the champions as requested. At the conclusion of the pilot, a follow-up self-appraisal was completed to assess progress in achieving process and outcome objectives. PROCESS OBJECTIVES: 1. By October 15, 2012 develop a draft of ten steps for BFHD. 2. On October 28, 2012 conduct needs assessment for BFHD. 3. By November 16, 2012 review and document needs assessment results, using information to recruit potential pilot sites. 4. By November 16, 2012 review feedback on proposed BFHD ten steps and make revisions. 5. By November 29, 2012 distribute recruitment letter to local health departments (LHDs). 6. By December 15, 2012 complete the selection of the 10 LHDs pilot sites for BFHD. 7. By January 5, 2013 initiate self-appraisal process with pilot sites. 8. By January 30, 2013 review and analyze pilot site self-appraisal results. 9. By February 15, 2013 provide BFHD overview and policy examples to pilot sites. 10. By March 31, 2013 distribute BFHD tool kit/resources for the 10 steps based on self-appraisal results. 11. By June 1, 2013 repeat self-appraisal process with pilot sites. 12. By July 1, 2013, analyze the repeat self-appraisals and summarize results. OUTCOME OBJECTIVES: 1. By June 1, 2013 increase the capacity of local health department to establish a designated individual/group to manage the BFHD tasks including policy review, development, staff orientation and education. 2. By June 1, 2013 increase the capacity of local health department to have a written breastfeeding policy that is routinely reviewed with department staff addressing all BFHD 10 steps. 3. By June 1, 2013 increase the capacity of local health department to coordinate breastfeeding support and promotion with other programs in the health department, private and public health care systems, and community organizations to establish breastfeeding as the “norm” in the community. 4. By June 1, 2013 increase the capacity of local health department to collaborate with community partners to assure access to breastfeeding classes for prenatal women. 5. By June 1, 2013 increase the capacity of local health department to educate the community on breastfeeding support. 6. By June 1, 2013 increase the capacity of local health department to encourage racially and ethnically diverse resources within the community. 7. By June 1, 2013 increase the capacity of local health department to support mothers in initiating and maintaining breastfeeding up to 12 months and beyond. 8. By June 1, 2013 increase the capacity of local health department through community partners encourage local public places to provide a breastfeeding friendly environment for families. 9. By June 1, 2013 increase the capacity of local health department to select businesses each year and provide worksite lactation support training. 10. By June 1, 2013 increase the capacity of local health department to facilitate access to information and training for local childcare centers/providers/schools on how to support a breastfeeding mother. COMMUNITY PARTNERS: After developing a draft of the ten steps for BFHD, Brueshoff attended the annual meeting of the Minnesota Breastfeeding Coalition and surveyed 18 representatives from local public health agencies to assess need and interest for additional breastfeeding promotion and support through the proposed Breastfeeding Friendly Health Department project. This majority of respondents strongly agreed that breastfeeding is a priority issue for the health department and that the BFHD process would increase the capacity of the health department to promote breastfeeding in the community. Following approval of the institutional review board, Brueshoff recruited representatives from ten local public health departments to participate in the BFHD project. The ten participating agencies were located in urban, suburban and rural counties in Minnesota. Each site identified an individual to serve as a BFHD champion. Seven of the point persons were nurses and three were dietitians. The BFHD champions acted as the project team in addition to the Community Partner from the Minnesota Department of Health; Dakota County Public Health WIC Coordinator and Project Specialist and the project leader. Innovative leadership and a commitment to collaborate to achieve goals in order to improve population health were essential to this project. Building on the existing spirit of collaboration in the public health community and the strong partnership with state and local public health provided a good foundation for this project to be successful. The participating local health departments are members of the State Community Health Services Advisory Committee (SCHSAC), the unique partnership between local elected officials, local public health directors, community health board administrators and the Minnesota Department of Health executives and staff. The purpose of SCHSAC is to promote communications and strong working relationships among members and work collaboratively to protect and improve the health of all Minnesotans (SCHSAC, 2013). The pilot sites have demonstrated successful collaboration through programs such as the Statewide Health Improvement Program (SHIP) and/or the Metro Alliance for Healthy Families (MAHF). The WIC Program (the Special Supplemental Nutrition Program for Women, Infants, and Children) has been a critical partner in promoting and supporting breastfeeding. WIC has long recognized the importance of breastfeeding for the health of infants, children and their mothers. WIC has also led efforts to establish breastfeeding as a norm in the community, with state WIC agencies directed to identify ways to model breastfeeding support and make WIC breastfeeding services more visible in the community. WIC staff in the pilot sites were supportive and involved in the BFHD project. Another key community-based partner has been the Minnesota Breastfeeding Coalition, which was instrumental to the initiation of the project and for disseminating the findings. The BFHD results were presented at the MBC annual conference on October 13, 2013. The coalition membership has representation from the state and local health departments, the WIC Program, hospital lactation departments, La Leche League, and other organizations and individuals who support and promote breastfeeding. With the MBC mission of working collaboratively to create an environment in Minnesota where breastfeeding is recognized and supported as vital to the health and development of children and families, the Ten Steps for Breastfeeding Friendly Health Departments is now seen as a model to further the MBC mission in Minnesota. THEORY OF CHANGE: The BFHD project was based on Lippitt’s phases of change approach (1973) that focuses on seven implementation phases to establish a planned change: - PHASE ONE: DIAGNOSE THE PROBLEM. Data indicated that rates of breastfeeding, especially exclusivity, were below national and state goals. According to Lippitt, the first step towards a planned change is to examine the current practices and if desired, initiate the “felt need” for the change. The needs assessment indicated the desire and interest of local public health professionals for the BFHD project. - PHASE TWO: ASSESS MOTIVATION AND CAPACITY FOR CHANGE. The needs assessment indicated agreement in that the BFHD project would increase local public health capacity. The successful recruitment of all 10 pilot sites also indicated motivation and commitment to this project. - PHASE THREE: ASSESS CHANGE AGENT MOTIVATION AND RESOURCES. The BFHD pilot site champions committed the time to develop the project in the agency. The majority of the pilot sites had public health nurses designated as the champion. This was intentional based on information that nurses are ideal candidates to act as change agents because they possess leadership skills as well as a unique knowledge of the system necessary to implement change (Geraci, 1997). - PHASE FOUR: SELECT CHANGE OBJECTIVES. A realistic timeline was established based on the tasks and time available for the champions to work on the project. - PHASE FIVE: CHOOSE THE APPROPRIATE ROLE FOR THE CHANGE AGENTS. The champion role was outlined in the recruitment process and each champion “change agent” had a vested interest and lead role in breastfeeding work within the agency. Consultation, communication and training were provided to the champions throughout the pilot period. - PHASE SIX: MAINTAIN THE CHANGE. A key component of the project included establishing a BFHD policy in each site. In addition, the BFHD project aimed at creating a system level change that incorporated breastfeeding practices in the agency. A further project goal was to incorporate the BFHD into the Statewide Health Improvement Program (SHIP), which is funded and managed by the Minnesota Department of Health. - PHASE SEVEN: EVALUATION AND TERMINATION. The BFHD project included an evaluation plan, and the project was initiated as a pilot with a specific end point. PROJECT BUDGET: The total budget for the BFHD project was $10,738.00 per pilot site. Most of the budget consisted of staff time, estimated at 0.2 FTE during the six month period for each of the BFHD champions. The project also recognized that each site required the support of the local health department public health director to assure participation of the BFHD champion and to provide oversight for the funding source to offset the 0.2 FTE staff time. The costs of staffing were offset by Maternal and Child Health grant funds, WIC program funds, Statewide Health Improvement Program (SHIP) grant funds and/or county levy.
EVALUATION The goals of the Breastfeeding Friendly Health Departments project were to increase the capacity of metropolitan and rural health departments in Minnesota to promote breastfeeding in the community, and to pilot the process of the Ten Steps for Breastfeeding Friendly Health Departments (BFHD). Twelve process objectives and ten outcome objectives were identified. PROCESS OBJECTIVES: 1. By October 15, 2012 develop a draft of ten steps for BFHD. 2. On October 28, 2012 conduct needs assessment for BFHD. 3. By November 16, 2012 review and document needs assessment results, using information to recruit potential pilot sites. 4. By November 16, 2012 review feedback on proposed BFHD ten steps and make revisions. 5. By November 29, 2012 distribute recruitment letter to local health departments (LHDs). 6. By December 15, 2012 complete the selection of the 10 LHDs pilot sites for BFHD. 7. By January 5, 2013 initiate self-appraisal process with pilot sites. 8. By January 30, 2013 review and analyze pilot site self- appraisal results. 9. By February 15, 2013 provide BFHD overview and policy examples to pilot sites. 10. By March 31, 2013 distribute BFHD tool kit/resources for the 10 steps based on self-appraisal results. 11. By June 1, 2013 repeat self-appraisal process with pilot sites. 12. By July 1, 2013, analyze the repeat self-appraisals and summarize results. Eleven of the twelve process objectives that were identified for the project were completed by the target date. The one process objective that was not fully met focused on the development and distribution of the BFHD toolkit; this objective was partially met when most of the materials were distributed to the BFHD champions during the project. The remaining materials are being developed with assistance from staff from the Minnesota Department of Health and will be distributed in the near future. OUTCOME OBJECTIVES: 1. By June 1, 2013 increase the capacity of local health department to establish a designated individual/group to manage the BFHD tasks including policy review, development, staff orientation and education. 2. By June 1, 2013 increase the capacity of local health department to have a written breastfeeding policy that is routinely reviewed with department staff addressing all BFHD 10 steps. 3. By June 1, 2013 increase the capacity of local health department to coordinate breastfeeding support and promotion with other programs in the health department, private and public health care systems, and community organizations to establish breastfeeding as the “norm” in the community. 4. By June 1, 2013 increase the capacity of local health department to collaborate with community partners to assure access to breastfeeding classes for prenatal women. 5. By June 1, 2013 increase the capacity of local health department to educate the community on breastfeeding support. 6. By June 1, 2013 increase the capacity of local health department to encourage racially and ethnically diverse resources within the community. 7. By June 1, 2013 increase the capacity of local health department to support mothers in initiating and maintaining breastfeeding up to 12 months and beyond. 8. By June 1, 2013 increase the capacity of local health department through community partners encourage local public places to provide a breastfeeding friendly environment for families. 9. By June 1, 2013 increase the capacity of local health department to select businesses each year and provide worksite lactation support training. 10. By June 1, 2013 increase the capacity of local health department to facilitate access to information and training for local childcare centers/providers/schools on how to support a breastfeeding mother. The ten outcome objectives were based on the BFHD Ten Steps, and data for measuring achievement was based on the self-appraisal completed at the initiation and conclusion of the project. Evaluation results an increase in the mean scores from the pilot sites on all ten steps, with seven steps showing a statistically significant improvement. Comparisons of the pre and post appraisal scores were computed based on a paired t-test for correlated data. In addition, all BFHD pilot sites reported progress in building capacity to support and promote breastfeeding within the agency and the community. The sites also provided feedback on the overall BFHD process using a Likert scale rating scale of 1-5 with a rating of 5 being strongly agree and 1 being disagree. When asked if the BFHD process increased the capacity of the health department to promote breastfeeding, the average rating was 4.10. An average rating of 3.60 was noted in response to whether this process increased the capacity of the health department to engage the community in promoting breastfeeding. The average rating was 4.30 in response to being asked if this process increased the capacity of the health department to develop policy that promotes breastfeeding. Finally, participants were asked “overall have you made progress in your agency in implementing the Ten Steps?” All respondents, 100%, said yes to this question. DISCUSSION OF EVALUATION RESULTS: For the onset of this project, the BFHD champions were committed and engaged. All participants completed the pre and post self-appraisals, and as noted above, every participant reported that this project helped make progress in building capacity within their agency. The resources developed were found to be useful for the BFHD champions and appeared to provide valuable information to use in the BFHD implementation. All BFHD pilot sites are in the process or have completed the adoption of a breastfeeding policy place that addresses the ten steps for BFHD. This is important since the policy lays the foundation for the promotion and support of breastfeeding within the agency and the community. The international breastfeeding symbol was embraced by all participants and the free window clings/signs with this symbol were requested by all sites. The BFHD process can be referred to as a “checklist” that staff is to follow in order to increase the capacity of a health department to achieve the goal in becoming designated as breastfeeding friendly. The usefulness of a checklist has been found in multiple settings including the documentation of improvements in surgical procedures leading to a decrease in post-surgical complications (Hayes, 2009). Checklists have revealed striking improvements in a variety of fields from medicine to disaster recovery (Gawande, 2009). Based on the BFHD pilot there is the potential for the Ten Steps for a BFHD to serve as the “checklist”/model to improve breastfeeding promotion and support by local public health in Minnesota and beyond. Overall, evaluation results from the project support the goal of building the capacity of local public health departments to promote and support breastfeeding within their agency and the community. The resources developed were found to be useful for the BFHD champions and appeared to provide valuable information to use in the BFHD implementation. This project contributed to the gap in research in providing a process for local public health to follow that complements the existing BFHI used in the hospital setting.
The BFHD project includes a number of elements that contribute directly to maintaining and sustaining breastfeeding in health departments. The recruitment and training of BFHD champions followed a central recommendation of the phases of change identified by Lippitt. One of the Ten Steps in the BFHD process focused on establishing a BFHD policy in each site. This system level change is directed at incorporated breastfeeding practices in the agency. The partnership with staff from the Minnesota Department of Health staff has been a successful part of the project, and has laid the groundwork for sustaining the work into the future. During the 2013 session of the Minnesota Legislature, the project facilitator successfully advocated for maintaining funding for the Statewide Health Improvement Program (SHIP) from the Minnesota Department of Health that requires that local health departments develop strategies to promote and support breastfeeding in child care, worksite and healthcare settings. The overall results demonstrate that progress is being made in developing BFHDs. One factor that was identified as critical for the success was to have a designated point person within each agency. The interest and commitment from the Minnesota Department of Health and the breastfeeding community is another encouraging sign that the success of the pilot will be continued, potentially leading to an official process to designate an agency as a Breastfeeding Friendly Health Department. The pilot project found that the BFHD Ten Steps provide a process that can assist local health departments to fulfill the Surgeon General’s Call to Action that complements the work currently underway in healthcare facilities. There is momentum across our nation and throughout the world to promote and support breastfeeding. Together, breastfeeding can become the community norm and positively impact the health and well-being of mothers and babies.
I am a previous Model Practices applicant|Colleague in my LHD|E-Mail from NACCHO|NACCHO website
 
Processing...


Driving Walking/Biking Public Transit  Get Directions