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Finger Lakes Breastfeeding Partnership

State: NY Type: Model Practice Year: 2017

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S2AY Public Health Network
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Finger Lakes Breastfeeding Partnership
The Finger Lakes Breastfeeding Partnership (FLBP) is a regional committee, composed of eight counties in rural upstate New York (Ontario, Wayne, Yates, Steuben, Schuyler, Seneca, Livingston, and Chemung). The Partnership was first established by the Ontario County Public Health Department and was then expanded, through the S2AY Rural Health Network, to all eight counties. Six of the eight counties are well over 50% rural in nature (Livingston, Schuyler, Seneca, Steuben, Wayne, and Yates) with the overall region being 52.21% rural (Data Source: US Census Bureau, Decennial Census: 2010. Source geography: Tract). Mothers within this region not only struggle with accessing services due to the rural nature of the area, but they also must deal with the lack of providers themselves within the region. All of the eight counties have a HPSA designation or Healthcare Professional Shortage Area. Four of the seven counties (Livingston, Ontario, Schuyler, and Wayne) have an underserved population that is more than 23% higher than the state rate (53.21%) (Data Source: US Department of Health & Human Services, Health Resources and Services Administration, Health Professional Shortage Areas: April 2014. Source geography: HPSA). Approximately 95% of the population is Caucasian, and approximately 98% is English speaking (Data Source: US Census Bureau, 2010). There are however slightly higher concentrations of Hispanics/Latinos (mostly farm workers) in the northern Finger Lakes region, African Americans in the City of Elmira (Chemung County), and Amish and Mennonites throughout most of the Network area. The highest birth rates are among the Mennonite, Amish and Latino populations, which are served through existing programs. With lengthy distances between providers and limited access to public transportation, mothers (particularly low income mothers) within this region struggle to obtain the help and support they need to continue breastfeeding if they are having difficulty. Overall, the work of the FLBP strives to address the Public Health issue of chronic disease, specifically obesity. Breastfeeding is linked to better health outcomes and reduced obesity rates in both mothers and babies. The FLBP has made significant strides in increasing support for breastfeeding mothers, reducing the stigma around breastfeeding, and encouraging local businesses and hospitals/clinics to become breastfeeding friendly throughout the Finger Lakes region. Overall objectives of the FLBP are outlined in their workplan and include increasing the proportion of Finger Lakes region infants who are fed any breastmilk in the hospital by 10% and increasing the breastfeeding rate in WIC mothers by 10%. Implemented activities include providing trainings to daycares to become New York State Department of Health (NYSDOH) Breastfeeding Friendly Certified, working with practices to become NYSDOH Breastfeeding Friendly Certified, opening six Baby Cafes throughout the region, certifying additional Certified Lactation Counselors (CLCs) throughout the region, working with worksites to implement lactation policies, and promoting breastfeeding as a social norm through various media campaigns (flyers, posters, press releases, Facebook advertising). Since the expansion of the FLBP in 2013, 43 CLCs have been trained and certified, 1 practices has become NYSDOH Breastfeeding Friendly Certified, 11 daycare centers are now NYSDOH Breastfeeding Friendly Certified, 41 daycare homes are now NYSDOH Breastfeeding Friendly Certified, 6 worksites have implemented lactation policies, and the FLBP Facebook page has solicited 830 likes” with posts reaching over 4,000. Looking at the region as a whole, infants fed any breastmilk in the hospital increased 2.1% from 2013 to 2014. Although we were not able to reach our original goal of a 10% increase, we are confident that we will see an even larger increase when more recent data is available. Our second goal was to increase breastfeeding in WIC mothers by 10%. Overall, there was an increase of 1.6% throughout the region from 2013 to 2014. Although we were not able to reach our goal of a 10% increase regionally, when looking at the individual WIC agency regions, SPCC WIC (services Ontario, Seneca, Wayne, and Yates Counties), increased 26.5% from 2013 to 2014. This is very encouraging, considering peer counselors from SPCC WIC and several providers within these counties were trained as CLCs through the FLBP during this time period. The Public Health impact of this practice is vast. The FLBP works as a multi-disciplinary, collaborative group, to make strides toward shared objectives throughout the region. Public Health is the leader of this initiative, bringing in partners from all sectors of the community (faith based, county agencies, community based organizations, community members, providers, etc.). Through this practice, breastfeeding rates have increased throughout the region, which will in part, help to increase positive health outcomes and reduce the prevalence of chronic disease in the region. The FLBP does not have a webpage itself, but is has a very active Facebook page with more than 830 likes” - https://www.facebook.com/FLBreastfeeding/.
The Public Health issue addressed by this practice is chronic disease, specifically obesity. The target population of this practice are the low income and underserved women within the eight county region of the Finger Lakes Breastfeeding Partnership (FLBP). The region includes Steuben, Seneca, Schuyler, Ontario, Wayne, Yates, Chemung, and Livingston Counties. Six of the eight counties are well over 50% rural in nature (Livingston, Schuyler, Seneca, Steuben, Wayne, and Yates), with the overall region being 52.21% rural (Data Source: US Census Bureau, Decennial Census: 2010. Source geography: Tract). With lengthy distances between providers and limited access to public transportation, low income mothers within this region struggle to obtain the help and support they need to continue breastfeeding if they are having difficulty. Mothers within this region not only struggle with accessing services due to the rural nature of the area, but they also must deal with the lack of providers themselves within the region. Seven of the eight counties have a HPSA designation or Healthcare Professional Shortage Area. Four of the seven counties have an underserved population that is more than 23% higher than the state rate (53.21%) (Data Source: US Department of Health & Human Services, Health Resources and Services Administration, Health Professional Shortage Areas: April 2014. Source geography: HPSA.). Mothers within the region also struggle with poverty. Half of the counties have over 30% of their population at or below 200% of the Federal Poverty Level, with each of these counties over 5% higher than the New York State rate (Chemung, Seneca, Steuben, and Yates) (Data Source: US Census Bureau, American Community Survey: 2008-12. Source geography: Tract.). Although a majority of the population is Caucasian, there is a significant migrant farm worker population. A representative from Finger Lakes Community Health (formerly Finger Lakes Migrant Health) is active in the Partnership and plays a vital role in connecting the Partnership with this population. More diverse populations can be seen in Chemung, Seneca, and Wayne counties. As shown through the data above, this region covered by the Partnership is grossly underserved. Mothers are struggling with long travel times, tight budgets, and limited providers to choose from. Through this practice, more peer and professional support has been brought to this area to help mothers. The FLBP was first established by the Ontario County Public Health Department and was then expanded, through the S2AY Rural Health Network, to all eight counties (Steuben, Schuyler, Seneca, Ontario, Wayne, Yates, Livingston, and Chemung). Through the Community Health Assessment process, facilitated by the S2AY Rural Health Network, it was identified that all Network counties chose to focus on preventing chronic disease, more specifically, obesity. According to the Centers for Disease Control and Prevention (CDC), more than 1/3 of the US adults are obese. Trends in childhood obesity have been dramatically increasing as well. According to the State of Obesity, a Robert Wood Johnson Foundation project, childhood obesity rates have tripled since 1980 in the 2-19 age population. With the strong correlation between breastfeeding and reduced obesity rates later in life, all of the counties included breastfeeding efforts within their Community Health Improvement Plans. The Community Health Assessment process was completed using the Mobilizing for Action through Planning and Partnerships (MAPP) Process. Through the MAPP process, obesity was identified as a priority area to be addressed, and increasing breastfeeding rates was chosen as a strategy to reduce obesity. This is a new field for Public Health, addressing obesity through increasing breastfeeding. In the past, Public Health has focused on education and promotion to impact population health. This practice uses evidence based activities to increase breastfeeding rates. One of the activities of the Partnership includes the opening of six Baby Cafes throughout the region. Baby Café is a turnkey, evidence based program. Data for 2015 through Baby Café USA can be found here, file:///C:/Users/HBAnd/Downloads/annual-report-2015.pdf. The Partnership also models their workplan from guidance provided by the NYSDOH and other national initiatives, including the Prevention Agenda (https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/), Healthy People 2020 (https://www.healthypeople.gov), and the Business Case for Breastfeeding (https://www.womenshealth.gov/breastfeeding/business-case-for-breastfeeding.html).
Nutrition, Physical Activity, and Obesity
Overall objectives of the FLBP are outlined in their workplan and include increasing the proportion of Finger Lakes region infants who are fed any breastmilk in the hospital by 10% and increasing the breastfeeding rate in WIC mothers by 10%. Implemented activities to achieve these objectives included providing trainings to daycares to become New York State Department of Health (NYSDOH) Breastfeeding Friendly Certified, working with practices to become NYSDOH Breastfeeding Friendly Certified, opening six Baby Cafes throughout the region, certifying additional Certified Lactation Counselors (CLCs) throughout the region, working with worksites to implement lactation policies, and promoting breastfeeding as a social norm through various media campaigns (flyers, posters, press releases, Facebook advertising). Additional steps taken to implement this practices include the submission of several grants through various funding sources including NACCHO, the New York State Health Foundation, the Greater Rochester Health Foundation, the NYSDOH, and several local organizations. The timeframe that we are reporting for this practice is January 1, 2013 through December 31, 2014. Other stakeholders involved in this project include local hospitals and providers, La Leche League, NYSDOH, Child & Family Resources, WIC, Federally Qualified Health Centers, Carenet Pregnancy Resource Center, community members, faith based organizations, local CLCs, local midwives and doulas, and Child and Family Resources. Do foster collaborations between community stakeholders, Public Health actively reaches out to any/all organizations that work with mothers and children. One of the most robust relationships that was created through this practice was between Public Health and Child and Family Resources. Child and Family Resources houses two of the Baby Cafes established by the Partnership. This relationship helped to establish these Baby Cafes, while bringing promotion Child and Family Resources, further helping their program and connecting mothers to much-needed services. There was no cost associated with expanding the Partnership, but some of the activities required funding. To establish each Baby Cafe was $900 ($400 licensing fee, $350 training fee, and $150 annual renewal fee) for a total of $5,400. Additionally, we trained 43 Certified Lactation Counselors (CLCs) to staff the Baby Cafes, which costs $800 per CLC (total of $34,400). All partnership members provided in-kind support to reach out to practices and daycares, to promote and share information/messaging, and the time for CLCs to staff the Baby Cafes.
Our first overall objective was to increase the number of women breastfeeding at hospital discharge by 10% and increase breastfeeding in WIC mothers by 10%. With all of the activities/outcomes listed above and ensuring that Certified Lactation Counselors in Public Health and hospitals work to increase breastfeeding initiation and longevity, we did see an increase in breastfeeding rates in the hospital. As seen in the chart below, most of the individual county rates improved from 2013 to 2014 (project period). Looking at the region as a whole, breastfeeding at hospital discharge increased 2.1%. Although we were not able to reach our original goal of a 10% increase, when more recent rates are available, we are confident that we will see an even larger increase. With all of the work we have been able to accomplish during this project period and work that will continue for years to come (through policy/practice change, ongoing Baby Cafe meetings, and increased capacity within the workforce), we expect to meet and exceed our target within a few short years. Breastfeeding Rate at Time of Hospital Discharge (any breast milk) 2013 2014 % change Chemung 71.1% 74.6% 4.9% Ontario 79.9% 82.1% 2.8% Schuyler 75.9% 78.6% 3.6% Seneca 77.5% 77.5% 0.0% Steuben 75.3% 75.5% 0.3% Wayne 81.0% 80.0% -1.2% Yates 80.3% 82.9% 3.2% Average 77.1% 78.7% 2.1% *Data Provided by NYSDOH and Local Public Health Departments. Additionally, breastfeeding rates have been increasing within the region overall, with 2014 being the highest rate in almost 10 years. Our second overall goal was to increase breastfeeding in WIC mothers by 10%. As seen in the chart below, overall, there was an increase of 1.6% throughout the region from 2013 to 2014. Although we were not able to reach our goal of a 10% increase regionally, when looking at the individual WIC agency regions, SPCC WIC (services Ontario, Seneca, Wayne, and Yates Counties), increased 26.5% from 2013 to 2014. This is very encouraging, considering peer counselors from SPCC WIC and several providers within these counties were trained as CLCs through this project. Also, as seen in the chart below, there was a significant drop in breastfeeding rates in Steuben County during this time period. At first this may seem alarming, but in a rural county such as Steuben, numbers are very low, a change in only a few mothers can look very large statistically. Overall, with our continued efforts (Baby Cafes, policy change, increased capacity), we expect these numbers to continue to increase throughout the region. Percentage of WIC Mothers Breastfeeding (any breast milk) 2013 2014 % Change SPCC WIC (Ontario, Seneca, Wayne, Yates) 16.6% 21.0% 26.5% Chemung County Dept. of Health (Chemung & Schuyler) 17.4% 18.0% 3.4% ProAction (Steuben) 21.4% 17.4% -18.7% Region Total 18.5% 18.8% 1.6% *USDA/FNS Supplemental Food Programs Division, WIC Breastfeeding Data Local Agency Reports, FY 2013 & FY 2014 The Partnership also met several times to share lessons learned regarding the Baby Cafes and efforts implemented through this project. Modifications were made to Baby Cafe practices to try to boost attendance at Cafe meetings. Some modifications including changing Cafe meeting times, changing locations, and co-locating services to where mothers are already going.
Several measures have been considered around the sustainability of this practice. Measures include Partnership meetings held monthly (opportunities/ideas continually shared and best practices identified), applications to additional funding sources are submitted on an ongoing basis (any identified possible sources are applied to), and staff for Baby Cafe sites are built into employees daily work (there are no paid staff). The largest sustainability piece for this practice was building the Baby Cafe staff into employees regular work, this has really carried the effort on after grant funding ended. Additionally, although it does not directly/monetarily support the sustainability of the Baby Cafe sites, community support for breastfeeding and environmental change play a large role in long-term sustainability. Constantly promoting breastfeeding as a social norm helps to start conversations, bring in new mothers, and change the community as a whole – to collectively support breastfeeding mothers. Lesson learned around partner collaboration include reaching out to any/all partners. The Partnership has included any/all organizations that work with mothers in our efforts and this has opened doors that were not readily available. There is sufficient stakeholder commitment to sustain this practice. Grant funding for the Baby Cafes ended almost a year ago and the Cafes are still going strong, gaining attendance steadily. The Partnership continues to bring in partners, almost monthly there are new members attending meetings. These new partners have been able to bring additional resources to Cafe sites and helped to spark new ideas for sustainability and ways to further the objectives/goals of the Partnership.
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