Increasing Breastfeeding Duration Rates in WIC clients through Hospital Peer Counselor Suppport

State: FL Type: Promising Practice Year: 2016

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The American Public Health Association (APHA) has long recognized that scientific evidence shows that human milk is the most appropriate food for almost all human infants and has recognized that there are barriers to breastfeeding. Research has shown that there is no better food than breast milk for a baby’s first year of life.  Breastfeeding provides health, nutritional, economical and emotional benefits to mother and baby.  Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself.  This pilot project enabled DOH-Broward WIC to identify gaps in WIC breastfeeding support after discharge.   The hospital breastfeeding peer counselors play a vital role in closing the gaps and are a valuable part of the healthcare team.

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Broward County Health Department
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Increasing Breastfeeding Duration Rates in WIC clients through Hospital Peer Counselor Suppport
Brief description of LHD- location, demographics of population served in your community:  Broward County is located in the southeastern portion of the State of Florida with a 2014 population estimate of 1,869,235 that represents 9% of the State’s population (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.5% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races .5%, for a total of 60.3% and White 39.7%).  The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”.  DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system.  DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county. Describe public health issue – In 2011, the US Surgeon General announced her “Call to Action to Support Breastfeeding”.  Although most new mothers plan to breastfeed and are aware that breastfeeding protects health of their babies and themselves, there are multiple barriers that discourage a mother from actually breastfeeding successfully and providing breast milk to her newborn for the first year of the newborns life. Goals and objectives of proposed practice – The objective of this practice was to increase breastfeeding duration for 6 months from 35% to 40% in the targeted WIC clinic. How was practice implemented / activities/ Results/ Outcomes (list process milestones and intended/actual outcomes and impacts: ACTIVITIES The DOH-Broward WIC Program implemented the “Loving Support through Peer Counseling” program in 2005.  Mother-to-mother support has proven to be one of the most successful approaches to encourage mothers to breast feed their babies. In 2011, the US Surgeon General, put out a call to action to support breastfeeding and suggested that WIC programs could expand the support that women receive in the hospital and extend the duration of breastfeeding.  The Surgeon General called for systems to guarantee continuity of support for breastfeeding between hospitals and community.  The DOH-Broward WIC program identified a need to expand the WIC breastfeeding Peer Counseling program into birthing hospitals in Broward County which was presented to maternity hospitals. Memorial Healthcare Systems expressed interest and a Memorandum of Agreement (MOA) was implemented to provide support to WIC mothers after delivery by Peer Counselors. Results/ Outcomes: Memorial Healthcare Systems was provided with the services of Peer Counselors.  A job description, scope of practice and training curriculum was developed and three Peer Counselors were trained using the Peer Counselor hospital curriculum.  The Peer Counselors participated in the hospital orientation.  The scope of work for the WIC Breastfeeding Peer Counselor in the hospital included providing encouragement, support, and basic breastfeeding education. The WIC Peer Counselors were provided with laptops to access the WIC data system and document the breastfeeding support provided at bedside.  If breastfeeding support was needed beyond the peer counselor’s scope of practice, a referral was sent to the WIC Program staff International Board Certified Lactation Consultants. Peer Counselors assisted mothers in establishing breastfeeding in the hospital; developed feeding plans and arranged discharge follow up as needed. Breast pumps were provided for mothers with babies in the NICU at no charge to the mother. The hospital peer counselor continued breastfeeding support after discharge by using the WIC data system and entering a follow up date for the day of discharge and offering continual support until breastfeeding was well established.  All objectives were met. In the targeted WIC clinic, breastfeeding duration increased from 35% to 43.5% as of September 2015. What specific factors led to the success of this practice? The specific factor that led to the success of this practice was introducing breastfeeding Peer Counselors into the hospital setting and providing ongoing breastfeeding support after discharge.    The Public Health impact of this practice is to improve the health and well-being of mothers and children,  by increasing the duration of breastfeeding.  Research has shown that there is no better food than breast milk for a baby’s first year of life.  Breastfeeding provides numerous health, nutritional, economical and emotional benefits to mother and baby.  Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself.   Web Address (if applicable) www.broward.floridahealth.gov  
Statement of the problem/public health issue: The American Public Health Association (APHA) has long recognized that scientific evidence shows that human milk is the most appropriate food for almost all human infants and has recognized that there are barriers to breastfeeding. Research has shown that there is no better food than breast milk for a baby’s first year of life.  Breastfeeding provides health, nutritional, economical and emotional benefits to mother and baby.  Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself. In 2011, the US Surgeon General announced her “Call to Action to Support Breastfeeding”.  Although most new mothers plan to breastfeed and are aware that breastfeeding protects health of their babies and themselves, there are multiple barriers that discourage a mother from actually breastfeeding successfully and providing breast milk to her newborn for the first year of the newborns life.  The Surgeon General called on the Public Health Community to establish a community based peer counseling program.  The Surgeon General suggested that the U.S. Department of Agriculture’s WIC program could expand the support that women receive into the hospital and help extend the duration of breastfeeding.  The Surgeon General called for systems to guarantee continuity of support for breastfeeding between hospitals and the community.  What target population is affected by problem? The Healthy People 2020 goal for percent of infants’ breastfed is 60.6%.  As of 2011, 49.9% of infants were breastfed. The DOH-Broward WIC program serves approximately 50% of the infants born in Broward County or 11,612 infants.  Although 84.6% of WIC clients initiate breastfeeding, the breastfeeding duration rate for infants 6 months of age drops to 33%.   The goal of this initiative was to increase the duration of breastfeeding in WIC clients by increasing breastfeeding support after birth. 92.76% was the percentage reached. From January 2014 through December 2014, of the 1,782 infants enrolled in the targeted site; 1653 received bedside breastfeeding support and discharge follow up.   The current breastfeeding duration rate in the WIC site targeted is 43.5%.  What has been done in the past to address the problem?  Two weeks after the birth of the infant, the DOH-Broward WIC program provided breastfeeding support to the client when they came to their WIC appointment. Why is current/proposed practice better? DOH-Broward created partnerships with labor and delivery hospitals in Broward County to provide peer counselors to post partum mothers. WIC Hospital Breastfeeding Peer Counselors at the targeted hospital offer support, education and discharge follow up after delivery and before discharge.  Peer counselors are mothers who have personal experience with breastfeeding and are trained to provide basic breastfeeding information and support to other mothers with whom they share various characteristics, such as language, race/ethnicity, and socioeconomic status. DOH-Broward WIC Peer Counselors assist mothers in establishing breastfeeding in the hospital so the mother and baby have the support to establish a successful breastfeeding bond. DOH-Broward Peer Counselors are able to develop feeding plans and arrange discharge follow up as needed in the event of difficulties or special considerations and Breast Pumps are available at no charge to meet clients’ needs. Is current practice innovative?  How so/explain? New to the field of public health OR Creative use of existing tool or practice? What tool or practice did you use in an original way to create your practice? The “Loving Support through Peer Counseling” curriculum was creatively used to introduce breast feeding peer counseling in the Broward County hospital system.  The Florida WIC data system was used to enhance the support given to post-partum clients in the hospital.  DOH-Broward peer counselors accessed the Florida Data system while making hospital rounds and offered breastfeeding services to WIC clients. The peer counselors were also able to identify potential WIC clients that were not aware of the WIC program services. The peer counselors can enter care plans and schedule follow up appointments in real time using their laptops.  Having access to the Florida Data System while in the hospital enables the peer counselors to loan and track inventory of breast pumps by entering client information into the system. Is current practice evidence-based?   The practice is evidence based. In 2004, the USDA Food and Nutrition Service (FNS) developed “Using Loving Support to Implement Best Prat ices in Peer Counseling”. In 2009, FNS modified the practice and developed the USDA “Loving Support through Peer Counseling: A Journey Together” training program based on research. In 2011, the US Surgeon General enacted a “Call to Action to Support Breastfeeding” and called for strengthening programs that include peer counseling as an evidence-based strategy.   
Nutrition, Physical Activity, and Obesity
Goal(s) and objectives of practice? What did you do to achieve the goals and objectives? The goal was to increase the breastfeeding duration rate for 6 months among WIC participants. The steps taken to implement this program include:  The DOH-Broward WIC Program presented the “Loving Support through Peer Counseling Hospital Program” to physicians,  nursing,  and hospital administrative staff in numerous community hospitals in Broward County. The Nursing Director of Broward County's three largest labor and delivery community hospitals, Memorial Healthcare Systems, contacted the DOH-Broward WIC Program Breastfeeding Coordinator to express interest in peer counselors providing breastfeeding support in this hospital for post partum mothers and their babies.  After communication with Memorial Healthcare Systems, a Memorandum of Agreement (MOA) was implemented to provide support in the hospital to WIC mothers after delivery by Peer Counselors. Establishment of this collaborative community partnership with Broward County's largest birthing hospitals was fundamental towards this projects success.  For the period from January 2014-December 2014, live births for the following three hospitals were, Memorial Hospital Miramar 3,142, Memorial Hospital West 4,137, Memorial Regional Hospital 4,927. These three hospitals accounted for 72.33% or 12,206 live births in Broward County.  The average length of stay was two days. A job description, scope of practice and training curriculum was developed. The WIC program’s Breastfeeding Coordinator trained three Peer Counselors in the “Loving Support through Peer Counselor” hospital curriculum.  The Peer Counselors participated in the hospital and maternity department orientation.  The scope of work for the WIC Breastfeeding Peer Counselor in the hospital included providing encouragement, support, and basic breastfeeding education on reasons to breastfeed, overcoming barriers to breastfeed, positioning and latch-on, skin to skin and benefits, maintaining adequate breast milk production, preventing common problems, anticipatory guidance to prepare for post-discharge needs, and resources for breastfeeding. The WIC Peer Counselors were provided with laptops in order to access the WIC data system and document the breastfeeding support provided at bedside and care plan for breastfeeding support after discharge.  If breastfeeding support was needed beyond the peer counselor’s scope of practice, a referral was sent to the WIC Program staff International Board Certified Lactation Consultants for continued support.  DOH-Broward WIC Hospital Breastfeeding Peer Counselors offered support, education and discharge follow up. WIC Peer Counselors assisted mothers in establishing breastfeeding in the hospital. Peer Counselors to developed feeding plans and arranged discharge follow up as needed in the event of difficulties or special considerations. Historically, babies born that entered neonatal intensive-care unit (NICU) had very low rates of breastfeeding. Through this program, breast pumps were provided to mothers of infants in NICU.  The hospital peer counselor continued breastfeeding support after discharge by using the WIC data system and entering a follow up appointment date. An additional community partnership was established with the Urban League of Broward County for peer counselors to provide breastfeeding support when DOH-Broward peer counselors were unavailable which provided support to new mothers 24 hours per day, 365 days per year.  Any criteria for who was selected to receive the practice (if applicable)? All Broward County WIC clients and hospital patients eligible for the WIC program received breastfeeding support. What was the timeframe for the practice - The timeframe for implementing this practice was March 2013 to September 2013.   The practice is still being utilized effectively.  DOH-Broward will continue to partner with Memorial Healthcare Systems. Due to the program’s success, steps are currently being taken to expand the program into other maternity hospitals including Broward Health Systems. For the period from January 2014-December 2014, live births for Broward Health Systems were 3,468 which will further expand the reach of this project due to its success with Memorial Hospital Systems.  Were other stakeholders involved? What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s)? The DOH-Broward WIC program leads the process by heading the Broward Breastfeeding Coalition.  Community partners from hospitals, Healthy Start, Healthy Families, Healthy Mothers Healthy Babies, Urban League, Nurse Family partnerships, La Leche League, etc., meet monthly at the DOH-Broward to collaborate and strategize to increase breastfeeding rates in our community.    Any start up or in-kind costs and funding services associated with this practice?   The main cost is the salary of the hospital peer counselors which is $13.66 per hour plus benefits. The laptop was approximately $1,000 and the aircard is $48/month.    
What did you find out?  To what extent were your objectives achieved?  Please re-state your objectives from the methodology section. To improve breastfeeding duration rates the DOH-Broward WIC Program introduced Breastfeeding Peer Counselors in a local hospital system.  The role of the peer counselor was to provide bedside education, guidance and support.  The Peer Counselor was responsible for entering a breastfeeding care plan into the Florida WIC Data system and ensuring continuity of care.  Before the breastfeeding peer counselors were introduced to Memorial Hospital system in August 2012, the targeted WIC site the breastfeeding duration rate was 39%.  As of September 2015, the site has a breastfeeding duration rate of 43.5% which is the highest rate of all sites in DOH-Broward WIC. Did you evaluate your practice? o   List any primary data sources, who collected the data, and how? Yes, data was collected through the Florida WIC Data System for evaluation and tracking of the success of the program. List any secondary data sources used (if applicable)N/A List performance measures used. Include process and outcome measures as appropriate. Performance measures include: Numerator:  1.  Infants at least 6 months old who were ever breastfed, and2.  Site as of the last day of the reporting period, and3.  Are active WIC participants as defined by having received a WIC service in the last 3 months, and4.  Are either currently being breastfed or are no longer being breastfed but had been breastfed for at least 26 weeks.  Denominator1.  Infants at least 6 months old who were ever breastfed, and2.  Site as of the last day of the reporting period, and3.  Are active WIC participants as defined by having received a WIC service in the last 3 months, and Percentage 1. Numerator divided by Denominator      
Lessons learned in relation to practice? Lessons learned in relation to partner collaboration? Did you do a cost/benefit analysis? If so, describe. Is there sufficient stakeholder commitment to sustain the practice? Describe sustainability plans This successful project enabled DOH-Broward WIC to identify gaps in WIC breastfeeding support after discharge.   The hospital breastfeeding peer counselors play a vital role in closing the gaps and are a valuable part of the healthcare team.  Hospital Peer Counselors close the gap between discharge and the next WIC clinic appointment by providing mother to mother support during this critical period of time as evidenced by the high initiation rates and low duration rates. The collaboration between DOH-Broward WIC and Memorial Healthcare Systems has led to the successful creation of a partnership for the “Baby Steps to Baby Friendly Hospital Initiative” to encourage an optimal level of care for infant feeding and mother/baby bonding.  DOH-Broward WIC is now a key stakeholder on the Memorial Healthcare Systems quarterly Breastfeeding Task Force.  This program has proven to be a successful as evidenced by Memorial Healthcare Systems request for additional peer counselor coverage and requests from other community hospital systems.   The DOH-Broward WIC Program has received federal funding for the “Loving Support through Peer Counselor Program” since 2005.  Funding will continue to be used to support this project and if additional funding is available the program can be expanded to other community hospitals.  
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