Change Package Your Team Name: East Bay CAP Topic Area: Breastfeeding Name of the Intervention: Create strong community linkages to breastfeeding support systems Primary Driver: Close loop of communication for referral, access and engagement in breastfeeding supports and services

Definition of the Intervention What is the intervention? Include a short definition of the intervention (1-2 sentences) The HFA Family Visitors will have more open communication with the community CLC (WIC Peer Counselor, First Connections CLC, Team CLC). The HFA Family Visitors will ensure that Mom is getting the breastfeeding support that she needs at minimum 1 month prior to delivery, and within 2 weeks postpartum. Supervisor will meet with WIC director on an as needed basis to assist with any communication barriers that may take place.

Description of the Intervention Include photos, and instruments or tools that accompany the intervention (include tools that are for doing the intervention itself, like the Marion half-sheet for communicating results to parents, and tools that are used for collecting data on the intervention during PDSA cycles) The HFA Family Visitors will have more open communication with the community CLC (WIC Peer Counselor, First Connections CLC, Team CLC). The HFA Family Visitors will ensure that Mom is getting the breastfeeding support that she needs at minimum 1 month prior to delivery, and within 2 weeks postpartum. The Breastfeeding support can be in the form of a joint visit (either HV or at WIC office), if a joint visit is not attainable, the HFA Family Visitor will have communication with the community CLC to ensure that the same message is being communicated to Mom in regards to breastfeeding. The HFA Family Visitors will also distribute resources (i.e. pamphlets, brochures) that align with WIC\CDC; so Mom is getting the same message across settings.  Family Visitors document this conversation with the community CLC in our online software system, ETO.

Documentation of Communication With Community CLC, Recorded Into ETO

Below is the tracking form that the Supervisor (Caroleann) uses to collect data from the Family Visitors on a monthly basis. Angela   Angelia Emily Chalia Caroleann- Totals at the end of the Month # of Women who have identified a need for BF Support: ______ Total # of Women who have identified a need for BF Support: ______ # of women completed BF Support consultation: ________ Total # of women completed BF Support consultation: ________ How many (of the above) have a BF Plan? ______ (Intentions to BF) How many (of the above) have a BF Plan? ______ (Intentions to BF) (Total) How many (of the above) have a BF Plan? ______ # of Women Postpartum identified a need for BF Support: ______ Total # of Women Postpartum identified a need for BF Support: ______ # of women completed BF Support Consultation (Postpartum): Total # of women completed BF Support Consultation (Postpartum): How many (of the above) have a BF Plan? ______ (With intentions to BF) ______ (With intentions to BF) Total How many (of the above) have a BF Plan?

Tracking Form Page 2 How many (of the above) are BF? ______ Total How many (of the above) are BF? How many women BF exclusively at 3 months? _____ Total How many women BF exclusively at 3 months? _____ How many women are sometimes BF at 3 months? Total How many women are sometimes BF at 3 months? How many women BF exclusively at 6 months? Total How many women BF exclusively at 6 months? How many women are sometimes BF at 6 months? This tracking form is saved in a company file, similar to a cloud based document. Every month by the 5th all Family Visitors go in and record their data. Then Supervisor calculates the totals at the end. This helps ensure that the same data Being pulled from ETO (software system) is accurate to what the Family Visitors are Reporting.

How is the intervention carried out? Include instructions about how to do the intervention (as if you were explaining it to some one who has never done it before) Supervisor and PM met with the WIC director to discuss further collaboration of the BF Support with the WIC CLC; moving forward Supervisor, PM, and WIC Director will meet on a as need basis. Ordered materials that alligned with WIC/CDC. Distributed the materials to Families that align with WIC/ CDC At minimum one month before delivery and within two weeks postpartum the Family Visitors discuss the Mother’s feeding plan for baby. Family Visitors offer professional BF support to the Mothers, and will connect them to the appropriate BF Support (i.e. WIC, First Connections, BF Support Group etc.) Family Visitors use Growing Great Kids (GGK) curriculum, that has specific talk points and handouts in BF. Also, the Family Visitors developed talking points about BF to continue the conversation outside of using GGK. Family Visitors will ensure that the connection/ support was given by connecting with Mom and the community CLC. Ultimate goal is open communication with the community CLC, and that Mom is receiving BF support. Thus, more Moms within our program will exclusively BF.

Evidence that the intervention is effective Include run charts and summaries of PDSA cycles (PDSA ramp of several cycles ideally) Include qualitative information as well – such as testimonies from LIAs or home visitors or families who have used the intervention. In the begining the Family Visitors focused on doing joint visits with the community CLC to promote BF/ do the BF support. However, this was difficult due to scheduling and coordinating of everyone’s schedules. Also, the Family Visitors were becoming discouraged with this approach due to the deadlines they endure in their work plus trying to coordinate a joint HV with a community CLC. However, since the change of the PDSA and focusing on making sure the connection with the community CLC is evident and having open communication with the Mom and CLC, has shown to be effective. Since this change (starting in June our numbers have increased, with Mom’s accepting BF support and Moms initating BF). How many LIAs / home visitors / famlies used the intervention ? Who are the experts who can provide more information? This LIA (East Bay CAP) has been using this intervention. All of the HFA Family Visitors are participating in the PDSA/ promoting the COIIN initative.

Evidence that the intervention is effective Originally the PDSAs focused on doing joint HVs with a community CLC as the BF support that will be offered. However, this was determined not realistic for the Family Visitors. Due to scheduling, coordinating and completing the joint HV. However, discussing with the Team it was evident that the Mom’s were receiving BF support via different avenues: during WIC appointments, or during First Connections HVs. By looking at our actual clientele and who was receiving BF support, it became evident that we needed to change our PDSA to fit what was already happening and to see if making a change, made a difference. Our new PDSA is focusing on, making sure that the BF support is available, and that the Mom’s are making that linkage (either during a WIC appointment or at their First Connections HVs). Then the Family Visitor will follow up with the community CLC before/after Mom’s appointment to make sure that the same message is being communicated through various settings; and to ensure that Mom is getting the BF support needed to exclusively BF. By changing the PDSA the Family Visitors have felt that it’s more achievable and making a difference with the Moms in their BF goals. Also, by strengthening communication with the community CLCs in our catchment area is also strengthening the relationships with our community partners (WIC and First Connections).

% Women with identified need for BF Support identified this month who received BF Support

% women who initiate BF

Exclusively BF at 3 Months and 6 Months

Pre-requisites for the intervention What is needed in order to have success with this intervention? For example: Resources Experience (strategies or model materials/training, QI skills, other interventions that serve as a base for this intervention) This HFA Team has particpated in DOH sponsured Motivational Interviewing Training as well as East Bay CAP sponsored Motiviational Itnerviwing; this has been helpful in promoting BF with Moms. Using the Growing Great Kids (GGK) curriculum, BF talking points. Well Start Internation BF Training. Team members (for example, needs support of a parent/client, or an LIA director…) This HFA Team includes: Supervisor, PM, and 4 Family Visitors that all participate in the COIIN.

Breastfeeding Trainings Grow and Glow in WIC WellStart International (Above are hyperlinks, follow the link to the website)

Materials Used Lactessa Doll (Team CLC uses this to promote BF with Moms) Cloth Breast Model (Team CLC uses this to promote BF with Moms) BF Benefit Box (Each Family Visitor uses to promote BF with Moms) Baby Bellies Display (Each Family Visitor uses to promote BF with Moms)

Materials Used (Cont.) Ten Tips on Breastfeeding After a C-Section Pamphlet Ten Tips on Hand Expressing Breastmilk Pamphlet Is Breastfeeding Right for Me? Pamphlet Ten Tips on Getting Started with Breastfeeding Pamphlet Ten Tips on How Dad can Help Pamphlet Why Should I Breastfeed My Baby? Tear Pad Safe Storage Magnets

Examples of Materials Distributed: Above: Fridge magnet for BF Moms Above: Examples of brochures given.

Advice Barriers / Challenges Key advice to overcome barriers Joint HVs Don’t strictly do BF support through a joint HV. This was a barrier because due to schedules and program requirements this wasn’t always possible. Offering a joint HV to the Family with the community CLC; but if not possible collaborating with the community CLC is important to ensure that Mom/Family receiving the same message. Open communication with community CLCs Supervisor and PM of this program met directly with the WIC Director to discuss the strengths and challenges of offering BF support. By having this meeting, were better able to support one another in our programs; and to ensure that all Mom’s are getting the BF support, and the communication between Family Visitor and CLC is evident. No Team CLC This Team did not have a Team CLC until December 2014. By having a Team CLC it has been helpful in connecting Moms with BF support and for the non CLCs can use the Team CLC as a resource to promote BF. This Team is hopeful that another CLC training will come to RI to train more team members.

Adaptations (if applicable) Are there adaptations of this information? For example, have other LIAs taken the Marion half-sheet and made changes? If yes, include that information here. N/A

References/ Inspiration (if applicable) Where did this intervention come from? Include citations or links to information about the intervetnion, or more evidence that it works. This intervention came from the Learning Session in May 2015 and listening to other BF COIIN Teams. Also by listening to our Team and what has been and not working when it comes to offering BF Support and promoting BF.