Story From the Field: Children’s Home Society of Florida

By Shannon Currie, MSL, Community School Director, Children’s Home Society of Florida and Harumi Reis-Reilly, MS, LDN, IBCLC, Lead Program Analyst, Breastfeeding Project, Safe, Healthy and Resilient Communities, NACCHO

Meeting Teen Moms Where They Are: An Innovative School-based Breastfeeding Program

Children’s Home Society and Commonsense Childbirth engaged the community of Pine Hills from community-based partnerships designed to demonstrate improvement in breastfeeding practices for registered participants in the early post-partum period, at 6 months and 12 months, as compared to 2013 statistical data collected from the Florida Department of Health. Children’s Home Society (CHS) of Florida provided Wellness Coaches to deliver peer lactation support and education through direct referral and online support through the Peer and Online Lactation Support (POLS) portal.

Adolescent African American mothers face unique challenges to breastfeeding at optimal rates in the rural, low-income area of Pine Hills, Florida. Through funds from NACCHO’s Reducing Disparities in Breastfeeding through Peer and Professional Support grant, Children’s Home Society of Florida implemented a breastfeeding support program in a local high school, bringing much-needed support services to new and expecting teen mothers.

Challenge

Pine Hills, one of the poorest areas in Florida, is a predominately African American community, with significant racial disparities in birth outcomes, Sudden Infant Death Syndrome (SIDS) rates, and breastfeeding initiation rates. Pine Hills is located within Orange County. In 2016, the overall infant mortality rate for Orange County was 7.1 per 1,000 live births, while the black infant mortality rate was 12.3 per 1,000 live births. These both represent an increase over infant mortality in 2015.1 In 2015, the Orange County birth rate among adolescent mothers aged 15-19 was 15.1 per 1,000 for white teens and 29.6 per 1,000 among black teens, higher than the Florida state adolescent birth rate of 20.3 per 1,000.2 In addition, Pine Hills’ overall unemployment rate is 14%.3

The lack of a supportive environments in the Pine Hills community makes breastfeeding an unfeasible option for families, especially for adolescent African American mothers. There are no Baby-Friendly Hospitals (BHFI) serving Pine Hills residents, and their community lacks formal workplace breastfeeding support policies and breastfeeding-friendly Early Care Education facilities. Within the community, there is only one part-time, professional lactation support provider located in the local WIC office. Transportation is usually an additional barrier to accessing services in rural areas. This barrier is heightened for adolescent mothers, as they often must rely on parents or guardians for transportation. Additionally, teens may not be empowered to make their own health decisions. Therefore, if their families do not support breastfeeding, they may not be able to access support services at all.

Children’s Home Society (CHS) of Florida is the oldest and largest statewide organization in Florida serving children and families. During their 112-year history, CHS has worked with pregnant and post-partum women to provide home visiting services including Healthy Start, Healthy Families America, and Early Head Start. With funding from NACCHO, CHS focused on engaging Pine Hills’ adolescent mothers in breastfeeding support services.

Working with minors brings unique challenges. Many lack transportation, have competing time demands of school and work, and experience the social stigma around teen pregnancy, which often results in a lack of social support. Prior to working with CHS, Evans High School (EHS) had no existing breastfeeding support for student mothers to breastfeed at school. Teen mothers and their families did not have the education and support needed to challenge common breastfeeding myths and overcome barriers.

Solution

CHS developed a breastfeeding support program at EHS to provide educational, emotional, and social support to pregnant and new teenage mothers. Teens today are digital natives and new mothers tend to spend more time online after giving birth. CHS made use of technology to engage expecting and new adolescent mothers in breastfeeding support services through their Peer Online Lactation Support (POLS) program, which provides mothers with interactive online lactation support and educational resources.

Establishing relationships with key partners including school administration, staff and students, Orange County Public Schools (OCPS), and True Health Wellness cottage was essential to the program’s success.  Cultivating relationships with community partners including WIC, Healthy Start Coalition of Orange County, and Common Sense Childbirth (CSC) helped to identify resources for mothers beyond the school setting.

In collaboration with CSC, CHS increased their organizational capacity by training culturally diverse community health workers, also known as Wellness Coaches, using the Community Outreach Perinatal Education (COPE) curriculum. This enabled the Wellness Coaches to become doulas, childbirth educators, and lactation educators. Those newly trained coaches were then matched with pregnant clients to provide breastfeeding support throughout the pregnancy and postpartum period.

Results

CHS used their partnership with OCPS and EHS to open a “No-Judgment Zone” lactation room, equipped with a hospital-grade lactation pump, within the high school building for the student mothers to pump and store breast milk privately during the school day. Participating students were issued special hall passes from school administrators who acted as student advocates to ensure that pumping breaks did not affect class attendance. Additionally, a new lunch program was introduced for pregnant and breastfeeding students to receive additional healthy foods to meet the increased nutritional needs of breastfeeding mothers.

Wellness Coaches engaged teen mothers’ families to improve support at home. Students were encouraged to invite their support system, including grandmothers and fathers, to ongoing group meetings. Wellness Coaches used these opportunities to dispel breastfeeding myths and provide educational support to every person directly involved with the mother’s parenting and breastfeeding process.

CHS addressed the transportation barrier for teens co-locating lactation support services within the school grounds meeting the teens where they were. Additionally, providing support through their online portal, http://www.ifeedmybaby.com, allowed teen mothers and fathers to ask questions and engage with Certified Perinatal Educators at any time.

Lessons Learned

CHS encountered some challenges when implementing its program. Establishing key partnerships enabled them to succeed and sustain the program. Partnering with OCPS and EHS and training breastfeeding champions within the high school allowed CHS to create a more accepting breastfeeding environment within the school setting. In addition to the school partnership, CHS worked in collaboration with the Easy Access Women’s Health Clinic to integrate CHS perinatal educators, who then provided education and resources to expecting mothers in the clinic. An additional partnership was established with the pregnancy center to provide monthly breastfeeding support groups with new and expecting mothers. CHS can also attribute their success to engaging the teens’ families, who often are the decision-makers in their children’s lives.

CHS has improved the breastfeeding landscape in Pine Hills by changing systems and strengthening partnerships to create a more breastfeeding-friendly environment. CHS support services have become a signature initiative that is well attended by pregnant and post-partum teen mothers and fathers. Currently, CHS has extended their breastfeeding services to two additional community providers who serve teen and adult mothers. They have also expanded the program to another high school within a predominately black and largely underserved community.

For more information:

Children Home Society of Florida: https://www.chsfl.org/

References

  1. Florida Department of Health. (2017). National Infant Mortality Awareness Month. Retrieved from http://orange.floridahealth.gov/newsroom/2017/09/infant-mortality.html Accessed on October 17, 2017.
  2. Florida Department of Health, Bureau of Vital Statistics. (2015). Birth by Mothers Age – Orange County. Retrieved from http://www.flhealthcharts.com/charts/
  3. U.S. Census Bureau; American Community Survey, 2011- 2015 American Community Survey 5-Year Estimates, (2015 – Employment Status, Pine Hills CDP, Florida; using American FactFinder; http://factfinder2.census.gov

2017 Maurice “Mo” Mullet Lifetime of Service Award Recipient Dr. Marty Wasserman Shares His Experience as Past NACCHO President and How He’s Navigated the Political Landscape in Public Health

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO is pleased to recognize Dr. Marty Wasserman, MD, JD, as the recipient of the 2017 Maurice “Mo” Mullet Lifetime of Service Award. This award honors current or former local health officials for noteworthy service to NACCHO that has reflected the commitment, vigor, and leadership exemplified by Mo’s distinguished career. For nearly 40 years, Dr. Marty Wasserman has proved his commitment to public health through leadership positions in service of medically underserved communities. 

During his tenure as NACCHO President from 1988 to 1992, membership and funding doubled and the organization created several “named” leadership awards to recognize deserving public health officials. In 1990, through collaboration with the Centers for Disease Control and Prevention, Dr. Wasserman helped to develop NACCHO’s first National Profile of Local Health Departments. While serving as NACCHO Board Treasurer, he helped jump start NACCHO’s work in environmental health by securing a contract with the Agency for Toxic Substances and Disease Registry. Dr. Wasserman worked with Dr. Maurice “Mo” Mullet to initiate NACCHO’s annual conference and developed resources to better align local health department nomenclature and services. Under his leadership, NACCHO’s visibility increased, which helped the organization better represent its members’ work in promoting wellness and preventing disease.

Before Dr. Wasserman was elected NACCHO President, he served as County Health Director in Arlington, VA, from 1978 to 1987. He subsequently served as local health official in Montgomery and Prince Georges Counties, Maryland until 1994 when he became Maryland Secretary of Health and Mental Hygiene. Currently, Dr. Wasserman is the Medical Director at Provider Resources, Inc., where he works on projects that aim to eliminate early elective deliveries and reduce central line infections to newborns.

NACCHO: Tell us about your career path in local public health.

I started in Arlington, VA shortly after completing my pediatric training, a tour in the Indian Health Service, and law school. I was interested in securing a leadership position outside of clinical medicine in public health and was soon offered a position as director of human resources that included the health department and social services which allowed me to merge health and social services to better serve the public. In that position I learned a lot about diversity. Early in my career as Health Director in Arlington County (VA), I was faced with addressing a tuberculosis outbreak among the Vietnamese immigrant population. Navigating the cultural and legal landscape for successfully tackling that public health issue was a valuable learning experience. During my time in Arlington County, many programs were implemented to address a number of public health issues like HIV/AIDS, domestic violence, and homelessness. In addition, we developed one of the earliest hospice programs in the country.

Eventually I took a position as Health Director in Montgomery County, MD.  When several obstetricians decided to stop delivering our county maternity patients, I worked with the hospitals in the county, other obstetricians, the county executive, the governor, and the state legislature, to create a program which allowed us to hire physicians temporarily as county employees and protect them from liability in return for serving indigent pregnant women. For this effort, we received the Ford Foundation and John F. Kennedy School Innovations Award.

After my time in Montgomery County, I transitioned to Health Director in Prince George’s County, MD which had the largest majority population of African Americans in the nation. We established a health center in that section of the county, adjacent to Washington D.C. That is when I first met George Benjamin, the current director of the American Public Health Association who, at that time, was the Commissioner of Health in Washington D.C. We both realized that this area in both of our jurisdictions struggled with the same health problems and we began a series of collaborative efforts that continued beyond both of our tenures in these two positions.

In 1994, the Governor appointed me to serve as Secretary of the Maryland Department of Health and Mental Hygiene where we developed many tobacco control programs and created Health Choice and the Children’s Health Insurance Program, our Medicaid-managed care effort. We also focused on several initiatives related to data collection, analysis, and reporting.

NACCHO: What are you most proud of accomplishing during your tenure as NACCHO President?

During my time as NACCHO President, we had a Board that consisted of several terrific people. As NACCHO expanded, we watched the membership grow, the budget increased, and a number of these board members later served as NACCHO Presidents. I was very fortunate to have been able to work with so many competent leaders in local public health. Helping to build NACCHO’s organization and creating a powerful group of local health departments is something I’m very proud of. During this time we contracted for NACCHO’s first environmental health grant from the Agency for Toxic Substances and Disease Registry which helped launch NACCHO’s efforts in environmental health matters.

NACCHO: As Secretary of the Maryland Department of Health and Mental Hygiene, you developed several initiatives related to data collection, analysis, and reporting. You were also instrumental in developing NACCHO’s definitive National Profile of Local Health Departments study. How has the availability and use of data changed over the course of your career and how can LHD leaders strategically use data to improve public health today?

I’ve always believed that knowledge and information were very powerful. Having accurate data gives us the ability to make appropriate and informed decisions. Having an analysis of gathered data and information gives us a leg up against competition. Professionals in public health know that there’s never enough money to address all the issues in this field, so having data allows one to be able to set goals and objectives, track and monitor programs, and provide continuous quality assurance. Having data grants organizations the opportunity to hold programs accountable, regroup and review the issues, and make modifications to get the preferred outcomes. The most relevant example today, I believe, is the opioid epidemic. Data has sufficiently increased over the past several years as it relates to the number of overdoses, deaths, visits to hospitals, and number of prescriptions written. This data can be used to educate healthcare professionals and the public and develop evidence-based initiatives to deal with this problem.

NACCHO: In your nomination, your colleague mentioned you tell it like it is and do not dwell on political correctness. How have you navigated the sometimes tricky political issues that health department leaders encounter?

Sometimes dealing with political issues in this field isn’t always easy. I’ve always tried to be honest and hardworking. I’m dedicated to the work that I do and the population that I serve. As a health director, I was responsible for examining the health of that community, gathering data, and determining what steps to take when addressing public health concerns. Putting assessment, policy, and assurance into everyday practice guide the actions of those of us in local public health. We then bring this information to our county councils or boards of health to gain support for present and future public health needs in the community.

When there were political issues, people were aware that I had done extensive research and always tried to adequately serve my population. I think they respected those efforts and provided a little freedom when I had to bring controversial issues before them.

NACCHO: What value have you found in being a NACCHO member?

NACCHO provides so much support for local public health. When dealing with things such as natural disasters, outbreaks, and prevention efforts, NACCHO has provided public health officials with a wide range of effective and up-to-date resources to help communities across the nation. Getting essential information out to print and broadcast media has helped communities in a tremendous way with receiving the necessary guidance for responding to and preparing for emergencies and addressing public health issues. NACCHO has and will continue to be an excellent resource for local health departments.

NACCHO: What does winning the Mo Mullet Award mean to you?

I had worked very closely with Mo for a number of years. I had the utmost respect for him. His integrity is unmatched. Although he was extremely professional and passionate about his work, Mo did like to have fun. He was a huge Ohio State supporter and established teaching programs for medical students and alumni.  But his love of Buckeye football was unsurpassed. One year, he and Phyllis invited Barbara, and me to see a big ten football game. It was very exciting! To receive an honor in his name and to be honored by your peers is something that I will treasure for the rest of my life. I thank NACCHO and its members for choosing to honor me this way and Mo for his service and accomplishments.

NACCHO: What advice would you give to young professionals just starting their careers in local public health?

Any career serving others is very rewarding but having the opportunity to help serve your community and improve lives at the same time is both exciting and challenging. I believe local public health is a calling that provides immense personal satisfaction. I’ve loved every minute serving as a local public health official and know that these words reflect the feelings of all those who have had a similar opportunity.

American Diabetes Month: Local Health Departments Work to Mitigate the Burden of Diabetes Across the Nation

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston

Today, over 30 million people in the United States live with diabetes—the seventh leading cause of death in the nation.1 Every day, local health departments (LHDs) work with community partners including schools, city planners, businesses, and restaurants to educate the public about diabetes and develop programs and policies to aid prevention, screening, and management.

November is American Diabetes Month, a time for the nation’s LHDs and other healthcare organizations to bring awareness to their efforts in preventing, screening, and managing diabetes. Continue reading

Laying the Infrastructure for Breastfeeding Partnerships in Lee County

By Emily Bernard, IBCLC, NACCHO consultant in collaboration with Carol Lawrence, PhD, MS, BSN, RNC-OB and Lori Riddle, Lori H. Riddle, RD, LD/N, CLC  Florida DOH and Lee Health

Synopsis

The Florida Department of Health in Lee County (DOH Lee) worked alongside three hospitals during NACCHO’s Reducing Breastfeeding Disparities through Peer and Professional Support project. DOH Lee’s project was designed to improve the county’s environment to support breastfeeding for black families through the establishment of a strategically developed coalition, as well as through the provision of advanced training of agency and hospital staff, other than nurses, to improve breastfeeding support within the hospital and the community. DOH Lee helped to implement the EMPower Breastfeeding Project by providing prenatal education and postpartum support to low-income, black families delivering in these enrolled hospitals. Continue reading

Meet NACCHO’s 2017–2018 Health and Disability Fellows

This story originally ran in NACCHO’s Essential Elements.

The NACCHO Health and Disability Program is thrilled to introduce the 2017-18 cohort of Health and Disability fellows. NACCHO’s Health and Disability Fellowship program is an invaluable opportunity for graduate students pursing degrees in public health to receive hands-on experience in the health and disability field. The fellowship includes providing support to local health departments (LHDs) through NACCHO’s Health and Disability Technical Assistance Program; expanding written and oral communication skills; and participating in networking opportunities with leaders in the health and disability field. This year’s fellows, Katelynd Todd, Vanessa Vassall and Whitney Thurman, come with impressive public health backgrounds. Continue reading

Understanding the Changing Public Health Landscape: Findings from the 2017 Forces of Change Survey

The National Association of County and City Health Officials (NACCHO) has released its 2017 Forces of Change report, The Changing Public Health Landscape, containing new findings on the forces that are affecting the nation’s local health departments (LHDs). LHDs face both challenges and opportunities as the public health environment evolves, and the Forces of Change survey helps to identify infrastructure gaps, as well as strategies for strengthening public health capacity. Continue reading

Convening Cross-Sector Partnerships to Implement Health in All Policies at the Local Level

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston

Local health departments (LHDs) play a critical role in ensuring that communities across the nation are healthy. We work every day to ensure the safety of the water we drink, the food we eat, and the air we breathe. Over time, many LHDs have broadened their missions and scope of services to address the root causes that influence health. It’s becoming commonly understood that factors like our socioeconomic status, education, the physical environmental, employment status, social supports, and access to care all play a part in shaping our health and quality of life. In addition to addressing infectious disease and chronic disease, we’re now focusing our efforts on the social determinants of health. With this increasingly complex view of health, it is imperative that LHDs move beyond the walls of our health departments to collaborate with the myriad other organizations that impact the social determinants of health and help them take into account how their policies and programs affect the health of communities. One promising tool for engaging in this work is the Health in All Policies (HiAP) framework. Continue reading