How to Combat Childhood Obesity: A Detailed Guide for Parents, Children and Health Practitioners

By Bradley University’s Online Master of Science in Nursing program. This story was originally posted on Bradly University’s website.

In the early 1970s, approximately 6.1 percent of children ages 12-19 in the United States were obese, according to the Centers for Disease Control and Prevention (CDC). By 2011-2012, that figure had more than tripled to 20.5 percent.

This is problematic, considering that not only has the number of children with obesity risen in the country, but more kids are at risk of facing bullying, lower self-esteem and chronic health problems because of their condition. Additionally, children with obesity are more likely to continue to be obese as adults, the CDC reports, making them more susceptible to serious health conditions such as heart disease, type 2 diabetes and several types of cancer.

It’s clear that the rapid growth of childhood obesity is a problem, but determining the best method of childhood obesity prevention is much more difficult. While childhood obesity can be caused by poor eating and physical behaviors, there are often other factors out of a child’s control that contribute to their health, including genetics, metabolism, sleeping habits or even their community. Additionally, easy access to cheap fast food, candy or snacks that are high in sugar and salt can make it difficult for children to achieve healthier eating options.

Still, there are steps that adults, children and health practitioners can take to combat this growing epidemic and help children live healthier lives.

Childhood Obesity Facts and Statistics

Before discussing steps that can be taken for effective childhood obesity prevention, it is important to understand the full scope of this issue.

 In 2017, New Mexico, Nebraska and Virginia all reported that 15% of their high schoolers were obese. States like Tennessee, Kentucky and Arkansas reported their percentage of high schoolers with obesity was between 20-22, among the highest in the country. Colorado was the only state whose percentage of high schoolers with obesity was less than 10. In 2003, there were no states in the country whose percentage of high schoolers with obesity was higher than 20. Most states have seen their percentage of high schoolers with obesity rise throughout 2017.

 What is important to remember is that obesity can severely impact a child’s health beyond their weight. “Childhood obesity is associated with a higher chance of premature death and disability in adulthood,” according to the WHO. Additionally, children with obesity are more likely to remain obese as adults and be at higher risk of health ailments such as diabetes and cardiovascular disease. Many of these health afflictions faced by children with obesity don’t appear until adulthood. These may include musculoskeletal disorders or breast, colon and endometrial cancers, the WHO reports.

Additionally, children with obesity often face what the WHO calls a “double burden of disease.” While eating foods that can contribute to obesity and its related ailments, children may also experience under-nutrition, i.e., a lack of eating the proper nutrients and healthier foods. This can put them at risk for even more conditions, making childhood obesity prevention that much more important.

 These actions include frequent teasing, bullying or social rejection due to their weight. Consider the findings of Dr. Julie C. Lumeng. She conducted a study of overweight children from different socioeconomic classes that were more susceptible to bullying. Ultimately, she concluded it was the child’s weight that was the primary factor in being bullied. This type of behavior has often left children with obesity suffering from such issues as depression, social isolation and low self-esteem.

This is troubling, considering that one of the ways of working toward childhood obesity prevention is to encourage children to exercise and be active. But TV or video games aren’t entirely to blame. Children with obesity may be facing a lack of outdoor recreational facilities or even physical fitness programs within their own school. Furthermore, the HHS reports that only one in five homes had a park that was accessible within a half-mile, and approximately the same percentage had any sort of gym or other health-related center within that same distance.

Across the country, only six states require some sort of physical education class for grades K-12. If a particular child’s obesity is caused by genetics, the lack of external health resources at school or in their communities may keep them from pursuing more healthy habits.

Tips for Parents When Combating Childhood Obesity

Childhood obesity is a widespread problem. For children with obesity, among the best resources they have are their own parents or trusted adults; individuals who can help encourage healthy eating, regular exercising and other healthy habits. Here are some tips to help parents combat obesity in their children.

 When pursuing childhood obesity prevention for their own children, the first natural decision a parent might make is to prevent their children from eating less nutritious foods all together. Ultimately, one fast food meal or candy bar isn’t going to stop a child from achieving healthier eating habits. It’s the repeated consumption of these types of foods that is much more problematic.

Parents should remember, when addressing childhood obesity the key is moderation when it comes to banning unhealthy foods. Utilizing foods that have a diverse array of nutrients, while letting kids have the occasional hamburger or ice cream sandwich, can be much more beneficial to children facing obesity long term.

 As children grow, their appropriate daily calorie intake will change. So even if their meals are rich in nutrients, they might be too high in calories, which may still lead to weight gain. But balancing calories doesn’t need to be as severe as researching the calorie count for every specific item a child eats throughout their day.

The CDC suggests encouraging healthy eating habits, including choosing healthier protein options such as lean meats and poultry, serving satisfying but reasonable portions and increasing water intake while decreasing beverages that are high in sugar. Parents can also find healthier options or alternatives when serving their child’s favorite meal. Additionally, families can invite their children to go grocery shopping or participate in ordering food so they can help pick and suggest healthy options.

Maintaining a healthy diet is one of the most important steps in childhood obesity prevention. Another is exercise, ensuring that a child is healthy and active for a consistent length of time throughout the day. The NDEI suggests that parents and families include everyone in physical activity so a child who is obese or overweight doesn’t feel ostracized or left out. This may include anything from a basketball game to a walk through the neighborhood.

Additionally, parents can also find ways to make exercise more fun for their children. This may involve letting their child choose how they want to exercise that day, or potentially making a game out of exercise. It is the consistent repetition of exercise as well as family inclusion that can help a child facing obesity become healthier.

Beyond encouraging and promoting healthy eating and exercise, parents can effectively contribute to childhood obesity prevention by helping their kids understand just why these habits are beneficial. If a child has low self-esteem or is feeling down because they have been making poor eating decisions, parents can show their children that healthier foods can help them feel better. If a child who is overweight or obese is feeling stressed or anxious, parents can explain that physical activity may help them relax and feel better.

Tips for Health Practitioners When Combating Childhood Obesity

Health practitioners like doctors, nurses, counselors and others can use their knowledge and position to help prevent childhood obesity. While children and parents will be the individuals who implement these daily habits, there are still specific steps that health practitioners can take to make a strong impact.

Obesity, after all, is often simply a measure of body mass index (BMI), a measure of body weight to height. Individuals who are labeled as “obese” rank in the 95th BMI percentile or higher of their respective sex and age group.

The main point that health practitioners must emphasize to children facing obesity is that they are unhealthy. It should be made clear that they are at immediate risk of experiencing health ailments now and more severe ones down the road.

A health practitioner can often be the first source of reliable information for parents or kids seeking information regarding childhood obesity prevention. Children and families might be aware that poor diet and lack of exercise are frequent causes of obesity, but that it isn’t always just these factors alone.

A health practitioner can effectively explain to children that elements such as genetics, communal environment, mental and emotional health or other health conditions can be contributing factors to their obesity. This can better help a child facing obesity to understand that it isn’t necessarily their fault or that they did something wrong, but that there are a diverse range of factors at play in their situation.

Learn How You Can Make an Impact as a Family Nurse Practitioner

One of the most important health professionals for a child and a family is a family nurse practitioner. These individuals are dedicated to compassionate care; helping both children and adults achieve healthier lives. They work tirelessly to assist with a range of health issues, including childhood obesity prevention; serving as both a source of knowledge and an inspiration for children who wish to improve their health. For those interested in this rewarding and impactful role, Bradley University offers its online Master of Science in Nursing program.

Sources

American Heart Association, “Preventing Childhood Obesity: Tips for Parents and Caretakers”

Center for Disease Control, “Childhood Obesity Facts”

Center for Disease Control, “Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963-1965 Through 2011-2012”

Center for Disease Control, “Tips for Parents – Ideas to Help Children Maintain a Healthy Weight”

Center for Disease Control, “Youth Obesity Maps”

Childhood and Family Nutrition

Health and Human Services, “Facts & Statistics: Physical Activity”

Mayo Clinic, “Childhood Obesity”

National Diabetes Education Initiative, “Preventing Childhood Obesity: Tips For Parents”

National Institute of Diabetes and Digestive and Kidney Diseases, “Helping Your Child Who is Overweight”

New York Department of Health, “Preventing Childhood Obesity: Tips for Parents”

Obesity Action Coalition, “BULLYING, Bullycide and Childhood Obesity”

World Health Organization, “Physical activity and young people”

World Health Organization, “Why does childhood overweight and obesity matter?”

Transformational Leader Dr. Rex Archer Shares Important Decisions He’s Made as Director of KCMO and Errors He’s Witnessed from Other Leaders

By George T. Roberts, Jr., MHA, FACHE, NACCHO President and Chief Executive Officer of the Northeast Texas Public Health District

Rex D. Archer, MD, MPH serves as the Director of Health for the City of Kansas City (KCHD), MO, and is also a past president of the National Association of County and City Health Officials (NACCHO). In 2017, KCHD was awarded the Samuel J. Crumbine Consumer Protection Award for Excellence in Food Protection for demonstrating unsurpassed achievement in providing outstanding food protection services to their community. Under Dr. Archer’s leadership, in 2018, KCHD earned NACCHO’s Local Health Department of the Year Award.  In the same year, Dr. Archer was awarded the Maurice “Mo” Mullet Lifetime of Service Award. KCHD has won several Model Practices Awards, showcasing their exemplary and replicable local public health programs. With the direction of Dr. Archer, KCHD became an accredited health department by the Public Health Accreditation Board and has been one of the first 13 LHD’s to be reaccredited.

Dr. Archer exemplifies the meaning of a true transformational leader. His guidance helps the department address the root causes of health inequities and diseases and promotes the health and wellbeing of his community. Below, he shares some of the ways he uses leadership to mobilize staff and stakeholders to communicate the core values of the department and discusses some of the most important decisions he’s had to make as leader of KCMO.

What are some of the most important decisions you make as leader of your department?

Recruiting and hiring the very best people for the job is very important to me. I use a book of philosophy and approach called “Hiring the Best” by Martin Yate. You’ve got to bring the best talent in. It’s comparable to being the head coach of a major sports team—half your job is recruiting, and the other half is coaching what you recruit.

Other important decisions include, building vital relationships with the community so that you can mobilize when needed. Additionally, receiving accreditation and maintaining it is just as important.

I like to use the Eisenhower Matrix, also known as the Urgent-Important Time Matrix. I believe the biggest challenge for leadership in public health is increasing your time for those things that are important but not urgent because otherwise it’s easy to get trapped doing urgent things—some of which are important, but some are not. The accreditation and reaccreditation standards help you keep and invest time in the important and not urgent areas.

In what ways do you encourage your staff to communicate the core values of your organization? How do you ensure your organization and its activities are aligned with your core values?

We have used Patrick Lencioni’s book The Advantage and many of his other books, which have guided our decision in having a playbook. Our playbook includes us answering a series of questions—the first one is, “Why do we exist?” As a health department, we exist because collective action is needed to share the conditions where our residents can be healthy. Secondly, “How do we behave?” We behave with compassion, focus on prevention, and have a deep awareness of the sufferings of others, coupled with a passion to prevent it. Through our dedication and innovation, we strive for health equity for all.

The third question is, “What do we do?” We promote, preserve, and protect the health of Kansas City residents and visitors. We strive to prevent illness and injuries, improve health services, enforce public health laws, and support policy development to build a healthier community.

The last question there is, “How will we succeed?” The answer is within our strategic plan—by strengthening the impacts of our programs and services, increasing stakeholder awareness in support of our mission and activities, and that stakeholders are, enriching and supporting community partnerships, weighing policy and advocacy development, and developing and sustaining a high-performing organization. We also believe in integrating and supporting diversity, inclusion, and equity in the work we do with the community and using data and evidence-based practices as tools to drive decision-making. That’s our general playbook.

Just like a football team has offensive, defensive, and special teams playbooks, we have different playbooks that examines the effects of social determinants of health, prevention methods from communicable diseases, environmental threats, and violence, and one that focuses on how to save money and reduce costs.

Throughout your years serving in the public health field, what is one mistake or misstep you have witnessed leaders making more often than others?

One of my favorite quotes is from the inventor of the artificial heart, Dr. Robert Jarvik, and that quote is “Leaders are visionaries with a poorly developed sense of fear and no concept of the odds against them.  They make the impossible happen.” One of the mistakes I see is health leaders not lowering their sense of fear.

A parallel example of that would be Colin Powell’s, 40/70 rule, which states leaders should make decisions when they’ve obtained between 40 and 70 percent of the information they need and if you make a decision before you’re 40 percent certain, you’ve decided too soon—but if you wait until you are 70 percent certain, you’ve waited too late.

I think most public health leaders operate under a 95/105 rule, where they’ve got to be 95 percent certain or more before they make a decision. I try to operate in a 50/80 rule, depending on how serious the decision is, how difficult will it be to correct a wrong decision, and how many people might be harmed or hurt because the decision was not made or delayed.

I like to ask myself, “What’s my track record been recently? Do I have a bit of political capital, or am I skating on its edge right now? Should I be a little more cautious?” Leaders have to be ready to lose their jobs and in doing so, it’s important not to overextend yourself financially, and be sure to have enough of a nest egg for at least six months in case you’re told your services are no longer needed. Certain individuals in the community can sense your fear, and if you’re not afraid of losing your job, it’s easier to keep it.

The last thing is understanding that what you can do the first six months of the job may be different than what you can do two years later when you’ve built more trust and a positive reputation. Sometimes, starting slower can be more beneficial. Occasionally, you can build more resistance by pushing too much too soon. I’m comfortable in knowing that if I don’t get something done this year, I’ll get it next year because by laying more groundwork. I can come back to it during the next issue or crisis, which can give me a bit more leverage, so I keep those things on the shelf and ready. Just because I didn’t get it done the first time doesn’t mean the timing won’t be right later.

How can transformational leaders influence partners and other stakeholders in their communities?

Working in that upper-right quadrant in the matrix—the important but not urgent issues—is critical when influencing partners. Having a relationship with someone and discovering what they need or what they’re interested in, may not be in your top three or even your top ten priorities, but it may be in your top 50. If you can help them get that done, then you’ve not only done something in your top 50, but you’ve also developed a relationship with them that you might be able to count on the next time when need them to consider one of your top 10 issues. Getting people to see that even if their top priority doesn’t get resolved, that working together on any shared issue will allow for their top ten priorities to move closer to resolve. That tactic moves those issues forward.

When we worked to get our Healthy Homes Rental Inspection Program launched last year, there had not been any tenants’ rights activity in our city for many  years. We started seeing many issues and started building the case, but before taking it to our city council, we worked with several community-organizing groups that we’ve partnered with in the past, educated them on the issue, and got their support so that when we went in with council for the ordinance, they were prepared. At that time, we had difficulty getting it passed by the council. But the community-organizing groups decided to do an initiative petition. They took it to the voters with an even stronger ordinance than what we were proposing.  Eventually, it was passed by 57 percent.

Now, we have about $2 million coming in each year to do rental home inspections to keep kids from going to the emergency room because of asthma, mold in their apartments, and other issues. Also, the City Council has unanimously voted to strengthen the ordinances.

Leaders should be developing relationships and working with folks to make a difference. We’ve developed a relationship with our chamber of commerce. They often support what we do. While sometimes they decide to stay neutral, it is enough to move an issue forward.

Download Leadership Slideshow.

To share your story of transformational leadership or to recommend a leader to be highlighted, please contact Taylarr Lopez, NACCHO Communications Specialist, at tlopez@naccho.org.    

A Tale of Two Cities with One Common Goal: To Improve Breastfeeding Support for Low Income Mothers in Marion County, IN

By Julie Patterson, PhD, MBA, RDN, LDN, Northern Illinois University; Lindsay Moore-Otsby, MD, HealthNet; Carrie Bonsack, DNP, CNM, HealthNet, and Kay Johnson, HealthNet 

Our story begins with an internal champion, a physician whose personal struggles with breastfeeding inspired the creation of a breastfeeding clinic at HealthNet. She engaged internal and external stakeholders to develop a breastfeeding model of care in collaboration with Northern Illinois University. This model aims to improve breastfeeding support and outcomes at HealthNet, and ultimately could serve as a model for other clinics to improve breastfeeding disparities. This project has succeeded in many ways, particularly in highlighting the need for multipronged, multidisciplinary breastfeeding support efforts not only within the clinic system itself, but also in collaboration with local support services.

Challenge Statement

Indiana ranked 43rd out of 50 states for Infant Mortality Rate (IMR) in 2018, according to the America’s Health Rankings report. Indiana’s IMR was 7.3 infant deaths per 1,000 live births compared to the national average of 5.9. Indiana State Department of Health data shows Marion County’s 2017 overall IMR was 7.5 and its African American IMR was 11.6. This can be visualized as representing 104 empty school buses per year, with most of those seats belonging to African American children. This data highlights health outcome disparities faced by HealthNet’s patient population.

Solution and Results

Breastfeeding reduces the risk of morbidity and mortality for mothers and infants, as shown in a meta-analysis published in The Lancet in 2016 by Victora et al. Centers for Disease Control and Prevention (CDC) data shows the lowest rates of breastfeeding are among African American, Hispanic, lower socio-economic status, single, and younger mothers. Developing an outpatient breastfeeding model is crucial to address maternal breastfeeding concerns during prenatal and early postnatal care. HealthNet is uniquely suited, as it cares for dyads during these key times, and therefore, could positively influence breastfeeding outcomes.

HealthNet is the largest of the Federally Qualified Health Centers in Indiana. It offers extensive healthcare services and community programs in their nine Marion County clinics. All mother-baby dyads deliver at a Baby-Friendly Hospital. The purpose of this project was to create a Breastfeeding Support Model (BSM) using a Policy, Systems and Environment (PSE) framework. Funding was granted by the National Association of County and City Health Officials and Northern Illinois University.

To begin, we conducted an organizational assessment and used a tool created by Bermejo et al. (2015) to measure healthcare professionals’ (HCP) and staff breastfeeding attitudes, beliefs, subjective norms, and behavioral intentions. Information collected during this formative period was utilized to prioritize project objectives within the PSE framework.

For the policy aim, we worked collaboratively with internal and external stakeholders to develop a breastfeeding support policy for employees, patients, and visitors. For the systems aim, a workgroup was created to revise the Electronic Health Record (EMR) to optimize breastfeeding care. Obstetric visit templates were created to measure mothers’ breastfeeding intentions, anticipated duration, perception of support, confidence, and concerns. Newborn templates were created to measure duration and intensity of breastfeeding. The templates were piloted at one center with plans to implement across the system. For the environmental aim, marketing created culturally diverse breastfeeding-friendly screen savers to display on computers in exam rooms. Marketing messages and images were reviewed and approved by the project team and have been translated in the three main languages spoken by HealthNet patients. We also worked collaboratively with the recipients of the CDC’s Racial and Ethnic Approaches to Community Health (REACH) grant at the health department to create a breastfeeding asset map to begin identifying a network of breastfeeding support services available in the county.

In the short term, a baseline assessment of breastfeeding attitudes, beliefs, social norms, and intentions was conducted. Forty medical providers, twenty-six support staff and twenty-one nurses responded. The majority reported positive attitudes and beliefs about breastfeeding, and most recognized their role in positively influencing mothers’ decision to breastfeed.

Opportunities were: (1) knowledge of a policy to support breastfeeding employees and breastfeeding mothers, (2) lack of patient facing breastfeeding images and messages, and (3) a need for breastfeeding training. Additionally, medical providers and nurses reported time limitations as a barrier to providing adequate breastfeeding support.

Outcomes

The intermediate outcome was the creation of a collaboration among members of HealthNet, Northern Illinois University, Marion County Health Department, the Indiana Department of Public Health, and the Indiana Milk Bank. We also plan to expand upon the breastfeeding asset map to better understand the impact of the breastfeeding support services offered. Additionally, creative solutions will be identified to meet breastfeeding training needs of our medical assistants, nurses, and medical providers. The challenge continues to be the time and funding needed to provide breastfeeding training while ensuring schedules are managed to maximize patient care availability. Long-term outcomes include utilizing EMR data to improve breastfeeding support and outcomes.

HealthNet and its community have many breastfeeding support resources in place. A main challenge is creating a cohesive breastfeeding support system from these somewhat fragmented efforts. Further investigation must focus on how to best integrate those services into an overarching model of care. Research must also explore the barriers and facilitators for mothers’ participation in these programs.

HCP and support personnel need proper clinical training to better integrate professional breastfeeding support into patient care. Creative solutions and buy-in from leadership are necessary to deliver adequate, cost-effective training without taking staff away from needed clinical duties.

The literature shows breastfeeding’s health benefits. Further study must explore how to support breastfeeding in the face of countless obstacles. Many patients face financial burdens and return to work or school within weeks of delivery, often with minimal workplace and caregiver lactation support. Assisting mothers with practical prenatal and postpartum guidance is critical and must utilize health literate communication strategies.

Federally Qualified Health Centers have specific processes for policy and procedural approval. Leadership buy-in is predicated on an understanding of the organizational structure and dynamics of competing priorities. This must be considered when planning a BSM with realistic project timelines and objectives.

For more information, please contact Julie Patterson at jpatterson2@niu.edu or Lindsay Moore-Otsby, MD or Lindsay.Moore-Ostby@indyhealthnet.org.      

Increasing Breastfeeding Support at Erie Family Health Centers

By Misty Romero, BA, RN, IBCLC and Hrishikesh T. Shetty, Institutional Giving Manager, Erie Family Health Centers 

Through NACCHO’s Building a Breastfeeding Support Model for Community Health Centers’ eight-month project, Erie Family Health Centers, a community health center network comprising 13 sites, was able to standardize and improve breastfeeding support throughout the organization and make services more accessible to patients. To reflect Erie’s mission and evidence-based medical practice, we updated our organization-wide breastfeeding and employee pumping policies and procedures to align with state and federal standards. We reconvened our internal workgroup; The Erie Breastfeeding Committee (EBC) and increased Erie’s organizational capacity by training our lactation specialists as trainers, who then trained more staff. Finally, we improved our clinic environment to be supportive of breastfeeding.

Problem Statement

Mothers with lower rates of breastfeeding tend to be young, low-income, African American and Hispanic, unmarried, less educated, overweight or obese before pregnancy, and more likely to report their pregnancy was unintended (Ahluwalia IB, Morrow B, and Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring

System. Pediatrics 2005; 116:1407–1412). At the same time, while breastfeeding is beneficial to almost all mothers and infants, the benefits may be significantly greater for minority women who are disproportionately affected by adverse health outcomes (Mirsa D, editor., ed. The Women’s Health Data Book: A Profile of Women’s Health in the United States, 3rd ed. Washington, DC: Jacobs Institute of Women’s Health and The Henry J. Kaiser Family Foundation, 2001).

At Erie, 73% of patients are Latino, 12% are African American, 63% have Medicaid, 29% are uninsured, and 94% are at or below 200% federal poverty level (FPL). Lack of education, language barriers, and access to resources have a negative impact on breastfeeding rates among Erie patients. The community surrounding Erie’s West Town Health Center is home to approximately 21,500 residents, with 46% of the people coming from minority populations including Hispanic (23.7%), Black (18.8%) and Asian (3.7%) (statisticalatlas.com). Given the high volume of underserved families being served at Erie, we have enormous potential to improve breastfeeding outcomes among low-income, minority Chicagoans.

Solutions and Results

To address these rates, Erie created a system-wide and comprehensive breastfeeding support structure that impacts breastfeeding awareness and adherence among patients and staff, and can serve as a critical resource in the community. The following activities helped us achieve an improved breastfeeding program for our patients and staff:

  • As a community health center network made up of 13 sites, each location had adopted its own set of breastfeeding practices and standards for staff and patients that were not uniform. With support from NACCHO, we were able to establish a standardized clinical breastfeeding policy and procedure for all Erie staff and patients.
  • Provided two of Erie’s International Board Certified Lactation Consultants (IBCLCs) with specialized training to enable them to provide enhanced breastfeeding education to the patient facing staff at all sites. Erie currently has two IBCLCs within our network, certified to provide lactation consultation. However, the two IBCLCs encounter challenges in serving the growing breastfeeding patients at Erie while having to meet the demands of all other aspects of their jobs. In response, Erie trained two staff members through the Institute for the Advancement of Breastfeeding and Lactation Education (IABLE) to become Erie’s Breastfeeding Champions. Post-training, our IBCLCs now provide regular breastfeeding support and education classes at their home sites to other Erie staff. So far, 10 staff members have attended the 16-hour Outpatient Breastfeeding Champion course.
  • Increased the number of sites within our network with the capacity to provide “on the spot” lactation assistance to patients and ongoing breastfeeding education classes. Erie currently provides lactation support at four sites and holds free prenatal breastfeeding education classes at five of our health centers.
  • Improved the clinic’s environment to make our space more actively welcoming and supportive of breastfeeding. We displayed the International Breastfeeding symbol at the entrance of all Erie clinics. In addition, in August, during World Breastfeeding Week, we reached over 17,000 people across all our social media platforms with electronic breastfeeding resource materials. A one-minute breastfeeding informational video delivered in Spanish by Dr. Caitlin Lassus, our Family Medicine provider, was a huge success and received over five hours of total play time, reaching over 3,000 online viewers.

Lessons Learned

Re-establishing a dedicated Breastfeeding Committee (EBC) was beneficial to inform activities at the beginning of our grant period. It was critical to have a collaboration of staff at all clinical and administrative levels to deliver a successful breastfeeding program. Buy-in from the nurse, case managers, doctors, women’s health promoters, medical assistants, lactation consultants, social workers, and Erie leadership was crucial in improving patient engagement and staff awareness of Erie’s breastfeeding services.

A challenge in delivering the program was the time needed by staff to deliver breastfeeding education and support services to patients; This was greater than what we had projected at the beginning of the program. Clients’ language and culture barriers increase the direct service time needed by clinic staff to provide breastfeeding education and support. However, throughout the grant period, we were able to meet client breastfeeding needs, maintain positive organizational attitudes towards breastfeeding, and sustain buy-in from key members of our leadership. Erie continues to support and promote a positive breastfeeding culture across the organization, and we are confident that we will continue these achievements in the future.

For more information, contact Misty Romero at miromero@eriefamilyhealth.org or Hrishikesh T. Shetty at hshetty@eriefamilyhealth.org .  

Leveraging Partnerships and Strengthening Connections to Support Breastfeeding Families

By Erica Peterson, MD, MPH, Internal Medicine and Pediatrics, Bluestem Health; Tami Frank, Partnership for Healthy Lincoln; and Karina Vargas, CLC, Bluestem Health

While the need to better support breastfeeding families in safety net clinics is well recognized, internal resources are often limited. Likewise, many community-based initiatives have difficulty engaging high- risk families who would benefit most from their efforts and supports. With funding from NACCHO’s initiative “Building a Breastfeeding Support Model for Community Health Centers”, the goal of the project’s cost-effective approach was to strengthen and leverage community partnerships, enhance internal systems, and provide ongoing training to all staff.

Challenge

Bluestem Health is a multidisciplinary Federally Qualified Health Center (FQHC) located in Lincoln, Nebraska that provides adult primary care, pediatrics, prenatal care, dental care, and integrated behavioral health services to a predominantly low-income and diverse population. While our county boasts high rates of breastfeeding initiation rates (83.3%), these rates drop off significantly by two months (46.6%). Many Bluestem patients face barriers in accessing services, including lack of transportation, underinsurance, and language and cultural barriers. This makes the development of an effective integrated approach to promote and support breastfeeding at Bluestem even more critical. Lincoln had several established community resources at the start of this grant—including Partnership for a Healthy Lincoln, supported by a the Centers for Disease Control and Prevention’s REACH grant; the Lincoln Community Breastfeeding Initiative, a coalition of community partners focused on breastfeeding support; the Community Breastfeeding Educators, which trained community outreach resources; and MilkWorks, a local community breastfeeding center. However, Bluestem Health had not been integrally involved in coordinating efforts with these potential partners and had not yet developed an internal process outlining their approach to breastfeeding for clients and employees. Bluestem also had not systematized distribution of breastfeeding handouts, maternal depression screenings, and referral processes. Many staff members and providers had never been specifically educated about basic breastfeeding knowledge.

Solution

We first conducted surveys and focus groups and collected information about the resources in the community within Bluestem, and identified gaps in services. Then, we set our organizational process outlining our breastfeeding goals as an organization for both employees and clients. The employee process was designed in collaboration with Workwell, a local organization that assists employers in providing workplace lactation support. All pregnant employees now meet with our pediatric nurse and complete a Return to Work plan outlining plans for breastfeeding. We developed our own process for clients and outlined an internal workflow. As part of this procedure, handouts were designed or identified to be given out at specific prenatal visits and at the well-check visits in the first year of life. These handouts include a community resource guide developed in conjunction with our community partners, listing comprehensive updated information about available Certified Lactation Counselors (CLCs) and available breastfeeding support resources. A system was also established to refer prenatal and postpartum families to one of our interpreters, who are trained as community breastfeeding educators (CBC) by Milkworks.

We now attend the scheduled LCBI meetings and participate in a city-wide effort to improve screening for maternal depression. In collaboration with Partnership for Healthy Lincoln, we worked with pediatric and obstetrician (OB) offices across town to standardize maternal postpartum depression screening at the two-week well check. We helped to develop a process for positive screens to be communicated back to OB offices and referred to mental health resources. This is also a critical period where new mothers may need breastfeeding assistance and can now be immediately referred to lactation support. In addition, because transportation was a barrier for many of our clients, we tested some walk-in breastfeeding support and pump clinics at one of our locations. In partnership with Milkworks, we trained our entire staff on the benefits and history of breastfeeding and provided additional in-depth training for our healthcare providers on assisting clients with common breastfeeding problems.

Results

While we recognize the need and opportunity to continue to grow our breastfeeding support efforts, we have already seen several positive outcomes from our initial activities over the past nine months of the grant period. We increased organizational capacity by increasing breastfeeding knowledge, with 68% of the staff reported learning something new at our general training, and we saw a 10% increase in those who believe that breastfeeding is the best source of nutrition for most infants. Likewise, our providers demonstrated a significant increase in clinical knowledge. For example, before the training, only 57% could correctly identify likely drugs responsible for low milk supply. After the training, this number rose to 91%. We have numerous stories of less quantifiable improvements since implementing our workflow and educational interventions. For example, one teen mom presented for her infant’s newborn visit complaining of breast pain. In the past, women with concerns about breastfeeding met with inconsistent, variable support and had difficulty connecting with Milkworks due to the barriers outlined above. Now with these organizational changes, this mom was educated about support services available. She was immediately referred to our CBE/CLC, who assisted with latching. Our CBE/CLC worked directly through our newly strengthened connections at Milkworks to facilitate access to a breast pump and appropriate pump flanges. The mom was also effectively referred and connected to a teen breastfeeding group.

Lessons Learned

Leveraging community resources, strengthening partnerships, and organizing systems through an internal continuity of care lens is a potentially cost-effective approach to enhancing supports for breastfeeding families in a relatively short period of time. While we could never have developed all the materials using our internal resources alone, we worked with our partners to develop a scaffold that best integrates our systems with resources in the community. Our path was filled with smaller lessons as well. An organizational “policy” proved to be cumbersome, so a breastfeeding support process served to set our compass in terms of breastfeeding goals. This resulted in our ability to find a process that best met our needs in a more expedient way. Initially, we met some internal resistance when discussing new breastfeeding supports, highlighting the need for a common process and education of all staff. While there is still significant opportunity for further improvements, these activities were achievable in a relatively short period of time and made a sustainable, real impact for our clinic and our patients.

For more information, contact Karina Vargas at kvargas@bluestemlincoln.com

Opioid Settlement Funds Must Go Where They’re Needed Most—Treatment and Prevention

By Dana Fields-Johnson, MPA, Program Manager and Sarah Mittermaier, Communications Coordinator, Prevention Institute 

As thousands of cities and counties hard-hit by the opioid crisis move closer to settlements with opioid manufacturers and distributors, it’s time to talk about how communities can use these funds to meet urgent needs for treatment and invest in what it will truly take to stop this epidemic: preventing people from becoming addicted to opioids in the first place.

As we face up to the magnitude of the opioid crisis—estimated to have cost the U.S. over $1 trillion from 2001 to 2017, with a human toll that can’t be calculated—we need to learn from what has and hasn’t worked in past public health settlements and set more stringent parameters around how opioid settlement funds will be used. Continue reading

Streamlining Breastfeeding Support and Education in a Federally Qualified Health Center in New York City

By Lindsay DuBois, MPH, CLC, Associate Director; and Melissa Olson, RD, Nutritionist, Community Healthcare Network 

In New York City, we have witnessed staggering inequities in maternal health outcomes, which is largely driven by racial discrimination.[1] This inequity extends to breastfeeding rates. Through NACCHO’s Building a Breastfeeding Support Model for Community Health Center grant, Community Healthcare Network (CHN) implemented a project to improve organizational policies and practices to help increase breastfeeding rates within our low-income, African American community. This eight-month (February to September–2019) breastfeeding initiative was a multipronged approach to address the core tenets of breastfeeding: promotion, protection, and support within our network of health centers. Continue reading