TODAY’S WEBINAR: Connecticut Breastfeeding 

Initiative (CBI)

NEXT WEBINAR on June 25th, 2013: Health Bucks 

(NYC farmers’ markets)

Connecticut Breastfeeding Initiative (CBI)

Abby LoweCenter TRT, UNC ‐ Chapel Hill

and

Jennifer Matranga, BSN, RN, CCE, IBCLCConnecticut Breastfeeding Coalition (CBC) and 

Consultant for the CBICaroline Smith Cooke, RD

Connecticut Department of Public Health

What We Will Cover ….

• Housekeeping• Overview of Center TRT• Overview of CBI• Public Health Impact of the

Connecticut Breastfeeding Initiative

• How the CBI works• Q and A

Housekeeping…

• If you are calling in on a phone line – turn your computer volume all the way down.

• Audio comes through more clearly through telephone line.

• Type questions into the chat window –we’ll respond during the Q & A portion

• All participant lines are muted• Technical difficulties – please use the chat

box

Center for Training and Research Translation

Center TRT – Web-Based Training

• Nutrition and Health Module – Nutrition 101– Policy and Environmental Supports for Healthy Eating

• Physical Activity and Health Module

• Intervention Specific Modules– Nutrition and Physical Activity Self Assessment in Child Care

(NAP SACC)– A New Leaf… Choices for Healthy Living

• RE-AIM (program planning and evaluation framework) – revised training coming late 2013

Center TRT – Intervention Translation

Connecticut Breastfeeding InitiativeAim of the CT Breastfeeding Initiative is to get multiple hospitals closer to designation via training, technical assistance and financial assistance. 

• Training: In person training was offered (alternative options were also shared) to hospital maternity staff about the Baby Friendly principles

• Technical Assistance: Technical assistance hours with the consultant were allotted to each participating hospital.  

• Financial Assistance: Each hospital received $4000 for designation costs and $750 for dissemination of educational materials to staff and patients/families 

CBI Core Elements• Engage a Baby‐Friendly Hospitals expert.• Conduct info session to explain the initiative to hospitals.• Develop and implement a selection process to ensure that 

enrolled facilities meet baseline criteria.• Provide the Baby‐Friendly USA Self‐Appraisal Tool to all 

participating facilities for completion. • Deliver or support the delivery of the 15 lessons (Step 2). • Provide technical assistance, consulting time, and peer learning 

opportunities to participating hospitals. • Provide financial assistance to participating hospitals. • Conduct a mock survey at the end of the TA/training period to 

assess practice changes adopted and implemented and to inform the individual hospital of its readiness for review by Baby‐Friendly USA. 

Potential for Public Health Impact• Reach –maternity staff & to babies/moms

• Effectiveness ‐moving hospitals towards 

designation; changing  maternity staff’s attitudes, 

practices, and confidence 

• Adoption of/participation in the program

• Implementation of the Ten Steps

• Maintenance of practices and Baby Friendly status

URL: http://www.centertrt.org/?p=intervention&id=1006

Connecticut Breastfeeding Initiative:From Start to Finish, Sustainability and Beyond!

A joint project of the Connecticut Department of Public Health (DPH) and the Connecticut Breastfeeding Coalition funded through American Recovery and Reinvestment Act (ARRA), Communities Putting Prevention to Work from

the Centers for Disease Control and Prevention (CDC).

Jennifer Matranga, BSN, RN, CCE, IBCLC, CBI ConsultantCaroline Smith Cooke, RD, CLC, CT DPH

Jennifer Matranga, BSN, RN, CCE, IBCLC

Connecticut Breastfeeding Initiative Consultant

CBC Board Member, former Chairperson

Be Ready! Project Background Program “written” prior to funding opportunity

Communities Putting Prevention to Work Funds $163,181 (ARRA funding)

Baby-Friendly Hospital Initiative United States: About 5% of births occur in maternity hospitals

designated Baby-Friendly At project’s start, Connecticut had 3 of 29 maternity hospitals

designated Baby-Friendly

National Baby-Friendly momentum

Leveraged existing partnerships

Connecticut Breastfeeding Coalition

Non-profit Organization

Incorporated in 2001

Convened by DPH

Mission: To improve Connecticut’s health by working collaboratively to promote, support and protect breastfeeding

Connecticut Breastfeeding CoalitionHighlights:

The Connecticut Breastfeeding Initiative

Connecticut’s 10 Step Collaborative

2012 PA 12-51 An Act Concerning Jury Duty for BF Mothers

The 2012 Hourly Employer Grant

Guide to CT’s Breastfeeding Non Discrimination and Workplace Accommodation Laws

Safe Sleep Committee

Statewide Conference Fall 2012

Connecticut Breastfeeding CoalitionProject Team

Michele Griswold, MPH, RN, IBCLC Chair CBC Co-director of CBI for CBC

Susan Jackman, MS, RD, CLC Board Member, former state breastfeeding coordinator Co-director of CBI for CBC

Jennifer Matranga, BSN, RN, CCE, IBCLC Board Member CBC Consultant to CBI hospitals

Chris Bracken, MSN, RN, IBCLC Board Member CBC Administrative Assistant for CBI

Be Collaborative

Create partnerships as a priority

Long-standing relationship with the Connecticut Department of Public Health

Long-standing relationships with “key” people in Connecticut’s maternity hospitals

Board of Directors with skills to oversee program

Project Activities Deliver 20-hours of training to maternity staff Achieves Baby-Friendly Step #2

Provide 40-hours of individualized maternity hospital consultation with Baby-Friendly expert

Foster collaboration and support between the ten maternity hospitals

Disseminate patient and staff education materials $750 per maternity hospital

Offer financial support for Baby-Friendly USA maternity hospital fees

Assist Hospitals towards Baby-Friendly Success

Tools, Policy → Tool kit

Training for Step 2

Showing the Ropes → Consultant

Committee and Hospital Buy-in

Be Resourceful:Don’t Reinvent the Wheel

Be Resourceful:Don’t Reinvent the Wheel

Help through the 4 D Pathway

Supplies

Venting of Challenges in Gatherings

Mock Survey

Sustainability possibilities for new collaborations?

March 2010 CBI Work Begins April 1, 2010 Transition to “4-D Pathway to Baby-Friendly

Designation”

With Great BFUSA Relationships We Were Ready to Help the Hospitals with the New “4-D Pathway”

Leading 10 Towards Designation

Be Realistic:Anticipate Challenges

Myths

Economic Barriers

System Change in Hospitals

Shifting Work

Power of Drug Companies

Time Management Critical Care Settings

Multidisciplinary Committee

Understanding WHO Code/Corporate Compliance

Evidence-Based Practice

Merging Hospitals

Be Well-Informed About Barriers: Both Real and Perceived

EducationSkin to Skin, Nurse First HourRoom-in → Feed Infant Frequently and

Exclusively by Infant Cue, Not the ClockEducate and Assist with Evidence-based Best

PracticeSupplement for Medical Indication OnlyCorporate CompliancePostpartum Resources

Baby-Friendly Elevator Speech

Why Is Baby Friendly So Hard?Our Maternal Child Healthcare People

Live in Our American Culture

Change is good you go first

Step 10 Foster Support Groups!!!

Steps Can Be Fun!

Data CollectionPower in NumbersmPincNational Immunization SurveyPatient Satisfaction SurveysChart AuditMock SurveyMom’s Survey: Every Step Counts

Be Data Driven:Use Data to Power Change

We’ll have no formula Truth: Follows corporate compliance and not take freebies from

pharmaceutical companies

All mothers must breastfeed Education is offered on benefits and it is encouraged but honors

mothers choice and offer safe formula prep education

It is too hard a goal to achieve By making a timeline to success it is a very achievable goal

No pacifiers allowed Education provided to avoid pacifiers until breastfeeding

established and pacifiers are utilized for painful procedures

Myths about Baby-Friendly

From This…

To This…

Ahhaa Moments!!!!!!!!!!

Over, Under or Around: Working Together Baby-Friendly is a Very

Achievable Goal!

DPH Project Team Division of Nutrition, Physical Activity and Obesity

• Stephanie Rendulic

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC)• Marilyn Lonczak• Caroline Smith Cooke

Be Open to Opportunity

Be Invested- DPH’s role CT NPAO In-kind Project Management and Oversight Provided education materials ($750) per hospital Paid Baby-Friendly USA maternity hospital fees

State WIC Program In-kind Project Support

Local WIC Programs WIC staff participated in hospital lactation committees Peer counseling programs

Other Resources

Contracting organization project oversight (CBC)

Baby-Friendly expert consultant

Baby-Friendly trainer

Administrative Assistant

Training Curriculum

Training equipment and materials

Educational materials

Baby-Friendly USA Fees

1- Have a written breastfeeding policy that is routinely communicated to all health care staff.

2 - Train all health care staff in skills necessary to implement this policy.

4 - Help mothers initiate breastfeeding within one hour of birth.

7 - Practice “rooming in” –allow mothers and infants to remain together 24 hours a day.

10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Goal: Assist ten Connecticut hospitals to achieve five Baby-Friendly steps

Be AnalyticalQuantitative

How many staff were trained?

Were any CBI hospitals designated?

Were the targeted Steps achieved?

Qualitative Phone interviews conducted

with the Breastfeeding Committee at each maternity hospital

Maternity staff on-line survey

Changes in Practice

Not addressed

Some Progress Made

Step achieved

Be Flexible

Moving in the Right Direction

Be Broad Thinking

Be Reflective to Move Forward

Lessons Learned Teleconference and Document

Sustainability Conference

Be Supportive

Ongoing Support isCritical toSustainability.

Be Connected! Contact Us!

Jennifer Matrangajmatranga@breastfeedingct.org

Caroline Smith Cooke

caroline.cooke@ct.gov