Breastfeeding Support for the Community

Introductions ISDH-Indiana WIC Director Sara Renner, MPH, MBA ISDH-Indiana WIC Breastfeeding Coordinator Crystal Fowler, RN, BSN, IBCLC

Background on WIC Started over 40 years ago Funded & guided by USDA Indiana has 41 agencies, 138 clinic sites 50% clients are children Others include Infants, pregnant, breastfeeding, postpartum Nutritious Foods & Education Referrals to other community resources Breastfeeding Information and Support

Internal Improvements Business/outreach training Communication skills, outreach plans Assessing needs of community partners Will see increase in WIC outreach after February 2016

Why Does WIC look different within Indiana? Managed by a Sponsoring Agency Agencies are typically a Health Dept., Hospital System, or a Community Action Program Rules/policies established by agency Ex: PC and home visits Still follow USDA & State guidelines Staffing issued by state based on caseload More clients in that area then more staff Clinic in every county Could have several counties managed by the same sponsor Clients do not have to see WIC in the county she resides Do not want clients to clinic hop

Limitations Funding designated by USDA Agency rules differ throughout state Staff hours/availability based on caseload One clinic may have many more PC hours if much higher caseload Similar to hospital staffing: One RN/LC to x # of patients Can only help the moms that come and get and certified If we don’t see them, we can’t help them

Visits to Clinic Initial certification F/u 1 month visit if breastfeeding or as needed Typically 3 months for check pick ups Mid-Cert Recertification After delivery (prenatal to PP)

What does a WIC visit look like? Certification process Intake with Clerk Mom provides necessary paperwork Gives demographic information Certification with CPA Gives a brief general health history Gets nutrition assessment Lactation assessment as appropriate Referral to PC Food package determination Based on: Prenatal, PP, Breastfeeding, Infant (formula or BF), Child Educated on how to use vouchers and buy foods at stores Other referrals as needed Returns to clinic in 3 months or as needed

Breastfeeding Support Eligible clients receive the following lactation support Infant feeding classes Breastfeeding and nutrition education Peer counselor Cheerleader, liaison Private lactation consultation where available Weight checks, lactation management, etc Breast pump based on client’s need Manual, single user, hospital-grade NICU, back to work/school, increase supply, occasional need

WIC & Hospital Collaboration May look very different throughout the state Monthly meetings: LC, social worker, etc Baby Friendly Task Force Meetings Hospital Certifications Peer Counselor visits Weekly referral form pick ups Nurse Navigator WIC assisting with a hospital breastfeeding class/support group We can be creative!

Benefits to Collaboration Improve mPINC score relating to discharge planning Improve continuity of care from hospital to WIC clinic Improve exclusivity-JACHO measure Increase WIC exclusivity @ 3 months Help clients meet lactation goals with lactation services Referral resource to meet other needs Healthy families Nurse Family Partnership Smoking cessation

WIC Hospital Staff Competent Professional Authority (CPA) RD, RN, or Nutritionist Would be the person doing certification in hospital Going through outreach training now Has attended a 5 day lactation course Peer Counselor (PC) Typically a former/current WIC mom Breastfed a child Has gone through USDA Loving Support training

IU Monroe WIC & Bloomington Hospital Hospital Peer Counselor Robin Lemieux, RD, IBCLC Breastfeeding Coordinator IU Health Bloomington WIC Heidi Daugherty, RN, IBCLC Bloomington Hospital Initial concerns & fears Benefits & Outcomes

Neighborhood Health & Parkview-Hospital Certifications Breanne Yoder Nutrition Coordinator Neighborhood Health Clinics Angela Russ, MSN, RNC-MNN, IBCLC-pending Prenatal Supervisor/Birth Planner Parkview Women’s & Children’s Hospital/Parkview Regional Medical Center PC in hospital CPA doing certifications WIC spent some time teaching Birth Planner about services and process

Questions? Crystal Fowler- CrFowler@isdh.in.gov