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NEW YORK STATE BACK TO BASICS: OVERVIEW OF THE

TEN STEPS TO A BREASTFEEDING FRIENDLY PRACTICE

VIRTUAL LEARNING NETWORK

NYS Prevention Agenda Webinar Series

June 26, 2014

12:00 PM to 1:00 PM

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Webinar Guidelines

• Please designate one person at the computer

• Adobe Features you will use today:• Chat Box

• Polls

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Welcome!

• Today you will hear a presentation and have the opportunity to ask questions via the chat box.

• Find resources and materials at

nyspreventschronicdisease.com

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Evaluations

Nursing Contact Hours, CME, LCERP

and CHES credits are available

Please visit nyspreventschronicdisease.com

to fill out your

evaluation and complete the post-test.

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Partners and Sponsors

• New York State Department of Health

• University at Albany, School of Public Health, Center for Public Health Continuing Education

The planners, moderators, and presenters do not have any financial arrangements or affiliations with any

commercial entities whose products, research or services may be discussed in this activity.

No commercial funding has been accepted for this activity.

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Today’s Objectives

• Illustrate the connection between being designated as a Breastfeeding Friendly Practice and the Prevention Agenda.

• Identify at least 4 of the 10 Steps to create, encourage or support a Breastfeeding Friendly Practice.

• Name three resources available to support a Breastfeeding Friendly Practice

• Describe early adopters of Breastfeeding Friendly Practices in New York state.

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Today’s Speakers

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Deborah Gregg, MPH, RDN, CDN, CLCPublic Health Nutritionist

Division of Chronic Disease PreventionNew York State Department of Health

Megan Prokorym, MPHHealth Program Administrator

Bureau of Community Chronic Disease Prevention

AgendaTopic Presenter

Prevention Agenda Framework Deborah Gregg, MPH, RDN, CDN, CLC

NYS Ten Steps to a Breastfeeding Friendly Practice: RequiredImplementation Activities

Megan Prokorym, MPH & Deborah Gregg, MPH, RDN, CDN, CLC

Question and Answers Megan Prokorym, MPH & Deborah Gregg, MPH, RDN, CDN, CLC

Recognition of Designated Practices

Megan Prokorym, MPH

Next Steps Megan Prokorym, MPH

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BREASTFEEDING PROMOTION IN THE FRAMEWORK OF THE 2013-2017 PREVENTION AGENDADeborah Gregg, MPH, RDN, CDN, CLC

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Prevention Agenda 2013-2017

• New York State’s Health Improvement Plan

• Blueprint for state and local action to improve the health of New Yorkers in five Priority Areas and reduce health disparities for racial, ethnic, disability, and other groups who experience them.

• https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/

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CHAs & CSPs

• Local (County) Health Department Community Health Assessment (CHA) & Community Health Improvement Plan– Submitted November 15, 2013; covers years 2014-

2017

• Hospital Community Service Plans (CSPs) – Submitted November 15, 2013, covers years 2013-15

• Plans chose two Prevention Agenda priorities; at least one needed to address a disparity

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Five Prevention Agenda Priorities

1) Prevent chronic diseases

2) Promote a healthy and safe environment

3) Promote healthy women, infants and children

4) Promote mental health and prevent substance abuse

5) Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcare-associated infections

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Selection of Chronic Disease Focus Areas

• Focus Area 1: Reduce obesity in children and adults.

• Focus Area 2: Reduce illness, disability and death related to tobacco use and secondhand smoke exposure.

• Focus Area 3: Increase access to high-quality chronic disease preventive care and management in clinical and community settings.

13Preventing Chronic Diseases

Reduce Obesity in Children and Adults: Priority Strategies

1) Increasing adoption and use of food standards

2) Implementation of Complete Streets policies, plans, and practices

3) Promotion of policies and practices in support of breastfeeding

4) Increasing the availability, accessibility and use of evidence-based interventions (chronic disease self-management program, diabetes self-management program, diabetes self-management education, diabetes prevention program)

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Breastfeeding Support and the Prevention Agenda

• Save infants’ and mothers’ lives, and reduce acute and chronic diseases among infants, children and mothers by increasing exclusive breast milk feeding.

• Specifically, increase the proportion of infants (in your county) who exclusively breastfeed for the first 6 months of life, and continue breastfeeding for 12 months----and beyond.

• Promote and sustain breastfeeding by increasing the number of hospitals, primary care settings and employers that adopt supportive policies/practices.

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Obesity Prevention Priority Strategies:Increasing Breastfeeding Fact Sheet

• Aim: What are you trying to accomplish?

• Actions: What changes will you make to achieve your Aim?• Recommended Steps• Focus on disparities• Stakeholders to engage

• Achievement: How will you know that the changes you are making will result in achieving the Aim?

• Selected Resources

http://whttp://www.albany.edu/sph/cphce/prevention_agenda/breastfeeding_fact_sheet_nysdoh_final.pdfww.albany.edu/sph/cphce/prevention_agenda/breastfeeding_fact_sheet_nysdoh_final.pdf

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Site Specific Actions

• Hospitals• Improve maternity care practices

• Primary Care• Implement supportive policies and practices

in prenatal, post-partum and pediatric care settings

• Employers• Implement lactation support programs

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Resources:

Hospitals:

• Great Beginnings NYhttp://www.health.ny.gov/community/pregnancy/breastfeeding/great_beginnings/

• Latch On NYC*

• NYS Breastfeeding Quality Improvement in Hospitals*

• NYC Breastfeeding Hospital Collaborative

*Referenced on DASH NY Breastfeeding Fact Sheet

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Resources – cont’dWorksites:

• Business Case for Breastfeeding*

• Making It Work: Returning to Work Toolkit*

Primary Care:

• NYS Breastfeeding Friendly Practice Designation

*Referenced on DASH NY Breastfeeding Fact Sheet

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NYS TEN STEPS TO A BREASTFEEDING FRIENDLY PRACTICE: REQUIRED IMPLEMENTATION ACTIVITIES & RESOURCESMegan Prokorym, MPH

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Breastfeeding Friendly Provider Practice Designation

To be designated as a NYS Breastfeeding Friendly Practice, the Ten Steps must be implemented through specific strategies by each step.

Required strategies are included in the pre- and post-assessment survey and in the office policy.

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Breastfeeding Friendly Practice Designation Process• Checklist:

Complete pre-assessment

Implement system changes needed to support breastfeeding mothers

Develop breastfeeding friendly office policy

Complete post-assessment

Submit all documentation to: promotebreastfeeding@health.state.ny.us

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Ten Steps to a Breastfeeding Friendly PracticeCreate a Breastfeeding Friendly Office

1. Develop and maintain a written breastfeeding friendly office policy.2. Train all staff to be breastfeeding friendly by promoting, supporting and

protecting breastfeeding and breastfeeding moms.3. Eliminate infant formula and formula company materials from your office.4. Create a breastfeeding friendly office environment.

Encourage Breastfeeding5. During the prenatal period, discuss breastfeeding benefits, especially

exclusive breastfeeding, and the basics of breastfeeding management with women and their families.

6. During the postpartum period, discuss breastfeeding benefits, especially exclusive breastfeeding and the basics of breastfeeding management with women and their families.

7. Encourage breastfeeding mothers to feed newborns breast milk only.8. Teach mothers about maintaining lactation when separated from their

infants.Support Mothers

9. Identify the local breastfeeding support network and foster collaborative working relationships and referral systems.

10. Provide comprehensive breastfeeding support to new mothers.

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1. Develop and maintain a writtenbreastfeeding friendly office policy.

• Establish and implement a breastfeeding-friendly office policy. • Sample policies available upon request:

• Email megan.prokorym@health.ny.gov

• Designate a breastfeeding champion in your office.

• Name in your written policy

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2. Train all staff to be breastfeeding friendly by promoting, supporting and protecting breastfeeding and breastfeeding moms.

• Train all staff on an ongoing basis in skills necessary to implement and maintain a breastfeeding-friendly office policy.

• Educate all office staff on all aspects of providing breastfeeding support upon hire and at least annually.

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Training Resources:

• American Academy of Pediatrics (AAP) Curriculum Tools• http://www2.aap.org/breastfeeding/curriculum/tools.html#preparedPresentations

• Expanding Pediatricians’ Roles in Breastfeeding Support Online Tutorial (CNE/CME) Northeastern University• http://www.northeastern.edu/breastfeedingcme/

• Supporting and Promoting Breastfeeding in Health Care Settings, SUNY Albany School of Public Health/NYSDOH• http://www.albany.edu/sph/cphce/preventionagenda_breastfeeding.shtml

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3. Eliminate infant formula and formula company materials from your office.

• Stop accepting gifts and samples from companies manufacturing infant formula, feeding bottles or pacifiers.

• Stop distributing formula samples, coupons or baby items from formula companies to pregnant women or new mothers.

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NYCDOHMH / NYSDOH Breastfeeding Publications

Breastfeeding Your Baby ‐Simply the Best Brochure, English: #2961

Breastfeeding Your Baby ‐Simply the Best Brochure, Spanish: #2962

Breastfeeding ‐ Simply the Best, Pocket Guide for Health Care Providers: #2963

Mail, E-mail or Fax Orders (limit 200) to:

NYSDOH Distribution Center 21 Simmons Lane Albany, NY 12204

E-mail: b0019w@health.state.ny.usFax: 518-465-0432 Order Form:

http://www.health.ny.gov/publications/4208/pdf/4208_order_form.pdf

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Additional Breastfeeding Resources from NYSDOHTitle Item Type Pub. # Language

A Mother’s Right to Breastfeed

Palm Card 4311 English

4312 Spanish

4313 Chinese

Breast is Best Poster 2901 English

Breast is Best – Unless You Have HIV

Poster 9246 English

9247 Spanish

NYS Laws Support Your Decision to Breastfeed

Brochure 4346 English

4349 Spanish

4350 Chinese

4351 Russian

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4. Create a breastfeeding friendly office environment.

• Display posters and pamphlets in the waiting room and patient areas with images of women breastfeeding their infants.• Do not display images of infants bottle feeding.

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• Help pregnant women create a birth plan that includes breastfeeding, skin-to-skin contact and rooming-in preferences to share with hospital staff at admission.

5. During the prenatal period, discuss breastfeeding benefits, especially exclusive breastfeeding, and the basics of breastfeeding management with women and their families.

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6. During the postpartum period, discuss breastfeeding benefits, especially exclusive breastfeeding, and the basics of breastfeeding management with women

and their families.

• Schedule a first follow-up visit 48-72 hours after hospital discharge to assess breastfeeding status and current infant feeding plan.

• Have a system in place to automatically prescribe

Vitamin D to infants per the AAP protocol.

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7. Encourage breastfeeding mothers to feed newborns breast milk only.

• Encourage exclusive breastfeeding for the first 6 months of life, with continued breastfeeding as long as mutually desired by the mother and baby.

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8. Teach mothers about maintaining lactation when separated from their infants.

• Be knowledgeable about the use of breast pumps and when to prescribe, and/or when refer to an International Board Certified Lactation Consultant (IBCLC).

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New York Medicaid Benefit Breastfeeding Education / Lactation Counseling

Effective April 1, 2013, Medicaid Fee-for-Service

Effective May 1, 2013, Managed Care and Family Health Plus Plans

Covers pregnant or postpartum woman

IBCLCs who are licensed and currently registered in New York as a: physician, physician assistant, nurse midwife, nurse practitioner, or nurse can provide services and be reimbursed by Medicaid.

Services can be provided at an Article 28 clinic, private practice, free-standing clinic, or Federally-Qualified Health Center (FQHC).

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New York MedicaidImproved Quality & Reimbursement of Breast Pumps

NYS Medicaid covers the purchase of manual and personal use electric breast pumps.• Effective April 1, 2013: Minimum pump specifications were

developed. www.health.ny.gov/community/pregnancy/breastfeeding/

• New reimbursement rates calculated by Medicaid increase the maximum reimbursement amount for both manual and personal electric pumps.

NYS Medicaid covers rental of hospital-grade electric pumps for preterm infants or infants with special needs.

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9. Identify the local breastfeeding support network and foster collaborative working relationships and referral systems.

• Acquire or maintain a list of community resources for breastfeeding mothers including WIC, La Leche League, local breastfeeding support groups, and baby cafes/drop-in centers.

• Develop working relationships with lactation specialists in your community and make referrals as needed.

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10. Provide comprehensive breastfeeding support to new mothers.

• Develop and implement an office protocol to promptly address breastfeeding problems and concerns to assist mothers at home. Examples include: a triage system to prioritize breastfeeding problems or referral to professional lactation counseling.

• http://www.jblearning.com/catalog/Details.aspx?isbn13=9781449687762

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Breastfeeding Friendly Practice Designation Process• Checklist:

Complete pre-assessment

Implement system changes needed to support breastfeeding mothers

Develop breastfeeding friendly office policy

Complete post-assessment

Submit all documentation to: promotebreastfeeding@health.state.ny.us

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Ten Steps to a Breastfeeding Friendly Practice

Create a Breastfeeding Friendly Office1. Develop and maintain a written breastfeeding friendly office policy.2. Train all staff to be breastfeeding friendly by promoting, supporting and protecting

breastfeeding and breastfeeding moms.3. Eliminate infant formula and formula company materials from your office.4. Create a breastfeeding friendly office environment.

Encourage Breastfeeding5. During the prenatal period, discuss breastfeeding benefits, especially exclusive

breastfeeding, and the basics of breastfeeding management with women and their families.

6. During the postpartum period, discuss breastfeeding benefits, especially exclusive breastfeeding and the basics of breastfeeding management with women and their families.

7. Encourage breastfeeding mothers to feed newborns breast milk only.8. Teach mothers about maintaining lactation when separated from their infants.

Support Mothers9. Identify the local breastfeeding support network and foster collaborative working

relationships and referral systems.10. Provide comprehensive breastfeeding support to new mothers.

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First NYS Practices Designated as Breastfeeding Friendly

• The Birthing Center of Buffalo• Century-Airport Pediatrics • Delaware Pediatric Associates • Integrity Health Group/Tonawanda Pediatrics• Kaleida Health OB/GYN Health Centers • Kids Alliance Pediatrics • Lancaster-Depew Pediatrics • Mercy Comprehensive Care Center • Mercy OB/GYN Center • Neighborhood Health Center • OB/GYN Associates of Western New York • Orchard Park Pediatrics• Western New York Pediatrics• Wheatfield Pediatrics• Williamsville Pediatric Center

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Next Steps

• Ten Step Materials posted to NYSDOH website:

https://www.health.ny.gov/community/pregnancy/breastfeeding/

• Next Virtual Learning Network Webinar:• Wednesday, August 13, 2014

• Plan Recognition Event

• Submit assessment and policies to:• promotebreastfeeding@health.state.ny.us

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QUESTIONS?

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Wrapping Up

More Webinars in the NYS Prevention Agenda Series to Come!

Please visit nyspreventschronicdisease.com

Remember to take your evaluation and post test

Nursing Contact Hours, CME, LCERP

and CHES credits are available

Thank You!!!

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