Change Package Your Team Name: Clark County Combined Health District Topic Area: Breastfeeding Name of the Intervention: Breastfeeding Checklist to be completed with prenatal and breastfeeding mothers. Primary Driver: Reliable and effective policies and practices supporting families through critical windows for breastfeeding decisions.

Definition of the Intervention A breastfeeding checklist was assembled to include breastfeeding resources. The list was designed by topic and listed all resources (pamplets, booklets, etc…) available to the visitor, including an activity for each topic section. The checklist was designed to be used regardless of when the family was enrolled during their pregnancy.

Description of the Intervention-BF Checklist Breastfeeding checklist EDD: Parent Name:   Prenatal Date completed Session 1 Suggested Activity- Topic Areas Breastfeeding Box Benefits of Breastfeeding (mom and baby) Basics around breastfeeding Suggested Handout- **Benefits of Breastfeeding Provide-Breastfeeding Class List Why Breastfeed? Breastfeeding- Your guide to a healthy, happy baby Breastfeeding- Information for new and expectant parents Breastfeeding- A how to guide Hugs and Health- Breastfeeding Breastfeeding Tips Tips on Breastfeeding Breastfeeding Basics Your Guide to Breastfeeding Success with Breastfeeding **10 Ways to get Breastfeeding off to a good start Babies Were Born to Be Breastfed Breastfeeding for Good Health Session 2 Feeding Plan Family support Barriers Dad and Baby Skin to Skin Dads and Breastfeeding How Fathers Can Support Breastfeeding Babies First: Families Support for Breastfeeding Mother Ten Tips to Help Overcome Breastfeeding Hurdles

Session 3   Suggested Activity: Topic Areas Breastfeeding spin game (questions) Milk Supply Positions Suggested Handout Myths How Breastfeeding works Skin to Skin Positions for Breastfeeding Common Breastfeeding Myths Myths and Facts around Breastfeeding **Establishing Milk Supply Keeping up your Milk Supply Kangaroo Care Session 4 Suggested Activity- Baby cue cards Cues for hunger and satiation Breastmilk Composition and Colostrum spoon Breastmilk composition Suggested Handouts- **How to tell when your baby is hungry Breastmilk Composition Session 5 Latch, preparing for breastfeeding, Babies bellies display or pocket model Positions during feeding Video on breastfeeding Baby Bellies Diapers and Breastfed babies Establishing Milk Supply Getting Ready to Breastfeed **Baby Bellies Provide resources if supports needed Is Baby getting Enough? **Latching On Diapers of the Breastfed Baby Infant Feeding and Diaper Log

Postnatal Session 6 Suggested Activity- Topic Areas   Session 6 Suggested Activity- Topic Areas Ready, Set, Go Cards Nutrition while Breastfeeding Pump Activity Is baby getting enough Keeping up milk supply Suggested Handouts Pump and storage Ten Healthy Habits while you are Breastfeeding Nutrition and Breastfeeding For Breastfeeding Moms Breastfeeding When You Are Away Breastfeeding and the Working Mom Breastfeeding when you can’t be with your baby A Guide to Pumping Your Milk Babies First: Breastfeeding and Work or School Storing Breastmilk Safely Storing Human Milk Session 7 Weaning Introducing a bottle to your full term breastfed baby How Long Will I Breastfeed? How Long Should I Breastfeed My Baby? Continued Breastfeeding and Starting Solids Weaning Your Baby Weaning from Breastfeeding Session 8 (optional) Troubleshooting Ten Tips on Managing Breast Engorgement while Nursing Are your Nipples Sore? What is Reflux?

How is the intervention carried out? 1) Compile all available resources 2) Review all materials to determine that the information is consistent and accurate. 3) Compile checklist based on topic and include recommended activities that would support breastfeeding. 4) Organize the resources so staff can easily access the materials from the checklist.

Evidence that the intervention is effective In total, 10 home visitors (all trained in Breastfeeding practices) were asked to use the checklist with families on their caseload where mom was breastfeeding or pregnant. Initially, only 2 home visitors were asked to use it. More home visitors were asked on the additional PDSAs. Also, several modifications were made on the form and more activities were developed. Home Visitor and family input was sought over the 5 cycles. Home visitors completed the checklist with 18 families. Home visitors all indicated that the list of materials and the way it was organized encouraged them to consistently talk about breastfeeding with families. Activities developed were also well liked by home visitors and families.

Pre-requisites for the intervention -Educational Resources pertaining to a variety of Breastfeeding topics -Staff were confident/skilled after completing the online WIC peer helper training and a day long training through the hospital. -Staff commitment to use the checklist.

Advice Barriers / Challenges Key advice to overcome barriers Time Consuming Process Format took some time/thought to develop. Once developed, it was a matter of organizing and putting materials into a file for staff access and completing the checklist. Staff using it consistently We are attempting to monitor use is supervision. The checklist is in the file when a family is assigned as a reminder.

Adaptations (if applicable) This was an organic checklist based on the concept of the Boston Toolkit. The toolkit was very specific and we wanted something more general to use with our families. This checklist could easily be adapted for use specific to the needs of the program.

References/ Inspiration (if applicable) Boston Toolkit