Breastfeeding Initiation and Extension HV CoIIN Measures Breastfeeding Initiation and Extension This set of measures describes a complete system of home visiting services that promote breastfeeding. They are intended to help guide quality improvement efforts and to support data-driven decision-making in practice. From 2013 to 2016, the measures underwent several iterations of testing and refinement by a group of early adopters: home visitors and supervisors in local implementing agencies, MIECHV grantees and expert faculty. Several resources have been developed to facilitate their use, including: This orientation powerpoint A Cheat Sheet that lists all of the measures with their numerators and denominators An excel data reporting template, “HV CoIIN Breastfeeding Data Reporting Template 2017,” with data collection tools and automated run charts An instruction document with detailed instructions and operational definitions to help you complete the reporting template

HV CoIIN Breastfeeding SMART AIM: 30% of infants exclusively breastfed at 3 months/15% at 6 months [ % children breastfed some to 3 and 6 months ] PD 1 Reliable and effective policies and practices supporting families through critical windows for breastfeeding decision-making. % Women that intend to BF at enrollment % Women that intend to BF at 36 weeks % of women have an infant feeding plan and goals written prior to delivery % Women that initiate BF among all enrolled prenatally % of mothers with the intention to breastfeed, initiate breastfeeding PD 2 Capacity of and support for home visitors to address breastfeeding in the target population. % of home visitors are trained in BASIC competencies in lactation and breastfeeding within 3 months of date of hire. PD 3 Strong community linkages to breastfeeding support systems % women that need BF support and receive it PD 4 Family Engagement in Infant Feeding Practices The measures include outcome and process measures. The outcome measures show progress toward the SMART AIM: % of infants exclusively breastfed at 3 months % of infants exclusively breastfed at 6 months % of infants breastfed some at 3 months % of infants breastfed some at 6 months The process measures show how well each primary driver is working. The primary drivers are essential pieces of the system that need to be in place and working well in order to reach the SMART Aim. For Primary Driver 1 (Reliable and effective policies and practices supporting families through critical windows for breastfeeding decision-making): % Women that intend to BF at enrollment % Women that intend to BF at 36 weeks % of women have an infant feeding plan and goals written prior to delivery % Women that initiate BF among all enrolled prenatally % of mothers with the intention to breastfeed, initiate breastfeeding For Primary Driver 2 (Capacity of and support for home visitors to address breastfeeding in the target population): % of home visitors are trained in BASIC competencies in lactation and breastfeeding within 3 months of date of hire. For Primary Driver 3 (Strong community linkages to breastfeeding support systems) % women that need BF support and receive it For Primary Driver 5 (Data system for tracking all clients breastfeeding intention, initiation, duration and need for and access to breastfeeding support and follow-up) % of team members using CQI data in practice PD 5 Data system for tracking all clients breastfeeding intention, initiation, duration and need for and access to breastfeeding support and follow-up % of team members using CQI data in practice

Women who need BF support get it My First Template HV CoIIN Measures were selected to capture steps in the process of breastfeeding intention, initiation and duration Women who need BF support get it Support for women to BF Women intend to BF Women initiate BF Women persist BF % HV trained in BF competencies % Women that enroll prenatally % Women that initiate BF among all enrolled prenatally % women that need BF support and receive it % children BF exclusively to 3 and 6 months % Women that intend to BF at enrollment % children BF some to 3 and 6 months Another way to think about the measures is that they reflect steps in the process of breastfeeding intention, initiation and duration. This slide presents a simplified process map. Above the brown line, each box shows a step in the process along the way to exclusive breastfeeding at 3 and 6 months. The boxes below the brown line contain the measure(s) that align with each step in the process. % women who initiate, among those who intend to % Women that intend to BF at 36 weeks

Breastfeeding Initiation and Extension HV CoIIN Measures Breastfeeding Initiation and Extension My First Template When viewed on a single page, these measures provide a visual summary of how well each step in the process to initiate and extend breastfeeding is working.

Color coded by Primary Driver HV CoIIN BF Report 2015-2016 Color coded by Primary Driver When viewed on a single page, these measures provide a visual summary of the entire system of support for breastfeeding initiation and extension. The white run charts show the outcome measure over time. The colored run charts who the process measures over time.

Resources to support the use of these measures: Cheat Sheet This is a “cheat sheet” which lists all the measures, the numerator & denominators of each measure, and which columns in the data template they refer to. The measures in blue text are optional.

Resources to support the use of these measures: Instructions This document contains detailed instructions to walk you through completing the breastfeeding data reporting template. It orients you to the data template, explains what each tab in the template is for, describes in detail the data collected in each column and includes operational definitions.

Resources to support the use of these measures: Data Reporting Template Pink columns are “calculated fields” and you will not be able to edit them. Yellow columns are denominators of calculated values. Green columns are numerators for calculated values. Dark gray columns are optional measures. Open the excel template and choose the “BF_Data_Entry” tab. Notice the column heads are different colors. The pink columns are “calculated fields” and you will not be able to edit them. The yellow columns are denominators of calculated values. The green columns are numerators for calculated values. If you enter a value into one of these columns that is larger than the denominator it corresponds to, both cells will turn red, indicating an error. The dark gray columns are optional measures.  

Resources to support the use of these measures: Data Reporting Template Brown columns are “calculated fields;” you cannot edit them. Purple columns are denominators of calculated values. Green columns are numerators for calculated values. BSES_Data_Entry tab is meant to facilitate appropriate use of the BSES and reporting of data in columns Y and Z on the Data_Entry tab. Its use is not required, but may be helpful. Open the excel template and choose the “BSES_Data_Entry” tab. Brown columns are “calculated fields” and you will not be able to edit them. Purple columns are denominators of calculated values. Green columns are numerators for calculated values. This data is optional.

Data Reporting Template Demo

Next Steps Use the resources provided to complete the Data Reporting Template for February, 2017. *For help, please contact Robert O’Connor roconnor@edc.org and MaryCatherine Arbour <cataarbour@gmail.com > **If we receive many requests for coaching and / or recognize frequently asked questions, we may propose a follow-up group webinar coaching call to review common questions that arise. Would you and your teams be interested in a group webinar where you can ask questions about reporting, and listen to others’ questions and answers. If so, how soon might you be ready to participate in a group coaching call?