Category Archives: community health

Dakota County Public Health Builds on Breastfeeding Program to Create Rapid Referral System

By Harumi Reis-Reilly, MS, LDN, CHES, IBCLC, Lead Program Analyst, NACCHO, and Katie Galloway, MBA, RD, LD, IBCLC, Dakota County WIC Program

Dakota County Public Health Department (DCPHD) in Minnesota, a 2017 NACCHO Model Practice awardee, built upon their comprehensive breastfeeding program and implemented a rapid referral system to expand access to critical lactation care to low-income families. Through the Reducing Breastfeeding Disparities through Peer and Professional Support grant, DCPHD increased participation by 68% in prenatal breastfeeding classes and more than doubled their rapid-response lactation visits.

DCPHD provides many services to the large underserved members of its community, especially pregnant women and new mothers. For example, in 2010, about 33% of babies born were to low-income women on Minnesota’s Medicaid Program. Dakota County WIC participants started breastfeeding at high rates (85%) in 2013, however only 38% of them were still breastfeeding at six months. While breastfeeding initiation among African

Americans in the Dakota County WIC program are among the highest in Minnesota, there are concerning inequities related to the exclusively breastfeeding rates. For instance, according to the WIC database, African American clients are more than four times less likely to exclusively breastfeed than white, non-Hispanic women.

One of the reasons for low exclusivity breastfeeding rates among African American moms was the limited availability of affordable lactation support services in Dakota County. Hospitals and medical providers outsource prenatal and postpartum breastfeeding classes and support services to for-profit businesses, whose fees pose a financial barrier that prevents low-income families from receiving appropriate breastfeeding education and support. Due to staffing limitations and inadequate lactation training for public health professionals, there are few affordable breastfeeding services available in the area.

Although DCPHD’s family health nursing staff regularly promoted breastfeeding, only 8% of its staff had have completed advanced breastfeeding training. While all DCPHD WIC staff was trained at the Certified Lactation Counselor (CLC) level, staff and clinic scheduling constraints made it difficult to provide adequate support.

Prior to NACCHO funding, DCPHD led the Breastfeeding-Friendly Health Department initiative, designed to improve the breastfeeding environment and increase organizational capacity to support breastfeeding. This initiative was piloted in ten local health departments (LHD) in the state. Pilot sites implemented the ten-step protocol, including supportive policies and use of champions as outlined in the Breastfeeding-Friendly Health Department Toolkit. This program has been successful and is now recognized as a Model Practice, receiving the 2017 NACCHO Award due to its contribution to the overall improvement of public health through effective evidence-based practice methods. Watch their presentation here: Link to Dakota Presentation.

In 2015, with funds from NACCHO and the Centers for Disease Control and Prevention (CDC), DCPHD enhanced its comprehensive breastfeeding program by implementing a new component: the rapid response system. This initiative provided advanced lactation support by trained public health nurses within 24 hours of referral. The program addressed critical gaps in breastfeeding support services for African American, low-income, and underserved communities in Dakota County.

DCPHD works cooperatively with the Dakota County WIC program to support prenatal breastfeeding classes, since most DCPHD clients who are pregnant women and new mothers are also WIC participants. DCPHD also worked with Dakota County’s 360 Communities, a faith-based organization, and the Community Action Program to provide breastfeeding education training to home visitors with the goal of increasing the provision of lactation education among nursing mothers.

DCPHD was able to meet the identified community needs of access to immediate, critical support through the implementation of the rapid-response to lactation referrals. DCPHD increased organizational capacity by training 60 staff members on basic and advanced lactation management. This increased number of available trained lactation support providers led to greater availability of free-of-charge breastfeeding classes throughout the community, and a 68% increase in participation in classes. In addition, the rapid referral system more than doubled the number of rapid-response lactation visits (from 2.8 to 6.9 visits/month) during the grant period.

In addition to training public health nurses who visit clients, DCPHD was also able to build on the capabilities of additional home visitors, enabling them to provide basic lactation support and make appropriate referrals to sustain breastfeeding.

Since Dakota County already had a foundation of supportive policies and systems in their Breastfeeding-Friendly Health Department before NACCHO’s grant, they were able to build upon this supportive environment and quickly implement additional components to its program. The key factors in their success were the supportive leadership within the organization, the previously built foundation of implemented policies and systems, and prior key partnerships with WIC and a home visiting agency.

For more information, contact: Katie Galloway, MBA, RD, LD, IBCLC; Dakota County WIC Program;

Responding to Youth Violence as a Public Health Problem

By Linda McGlone, MPH, STRYVE Coordinator, Monterey County Health Department, California

Looking at youth violence through a public health lens, the Monterey County Health Department contributed to violence reduction by offering their skills in data, strategic planning, and the public health approach.

In 2011, Salinas, California was a small city with a big city problem: gang violence. The violent crime rate for Salinas was 732.5 crimes per 100,000 residents – higher than Los Angeles’ rate of 522.4. For decades, gang-related shootings caused most of the city’s violent injuries. Monterey County had the highest rate of youth homicides in California in 2009, 2010, 2012, and 2013. Salinas is a city of 150,854 residents, 75% of whom are Hispanic or Latino. This is a young community, with a high percentage of families living below the federal poverty level, organizing to become a healthy and thriving community. The Monterey County Health Department (MCHD) recognized youth violence as a public health problem, and we saw that primary prevention was lacking from the community’s response. How could this perspective gain traction in a discussion led largely by law enforcement? Continue reading

Local Public Health Spreads Importance of Good Oral Health during Children’s Dental Health Month

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

The oral cavity, including the teeth and surrounding structures, are necessary for adequate nutrition, proper speech and a positive self-image.  Although tooth decay is largely preventable, it continues to be the most common chronic disease of early childhood.1  Dental health can impact school performance when a child has untreated tooth decay with resulting pain that affects their ability to concentrate, sleep at night or even attend school, “more than 51 million school hours are lost each year to dental related illness.”2 Taxpayers share approximately 11% of the $113.5 billion spent nationally on dental care expenditures, a percentage that has increased over the years as dental care utilization continues to increase among children.3  Children with cavities in their primary (baby) teeth are three times more likely to develop cavities in their permanent (adult) teeth which could contribute to broader health problems including diabetes and cardiovascular disease.4 Continue reading

Influenza Season: Resources and Information for Local Health Departments

This story originally ran in NACCHO’s Preparedness Brief.

Flu season is upon us. The Centers for Disease Control and Prevention (CDC) reports increasing and widespread flu activity across the United States. According to CDC surveillance, influenza-like illness activity is higher than it was during the peak of the 2014-2015 flu season and so far hospitalization rates are similar to that same time period. Continue reading

Cincinnati Health Department: Smoke-free Housing Implementation Success Story

By Tonia Smith, Tobacco Free Living Coordinator, Cincinnati Health Department

By engaging residents at each step in the process, Cincinnati Health Department’s (CHD’s) Creating Healthy Communities Coalition helped to implement a smoke-free multi-unit housing (SFMUH) policy for Cincinnati Metropolitan Housing Authority’s (CMHA’s) 13,000 public housing residents. Continue reading

Leveraging Existing Resources to Achieve Breastfeeding Equity

By Emily Bernard, IBCLC, NACCHO Consultant; Barb Hawkins Palmer, KCHD, Executive Director of Healthy Kent; Bonita Agee, Strong Beginnings, Education Coordinator; Teresa Branson, KCHD, Deputy Administrative Health Officer; and Chelsey Saari, KCHD, Project Director for Population Health & Accreditation Coordinator


Recognizing there was significant racial inequity in breastfeeding among African American mothers, the Kent County Health Department (KCHD), in Grand Rapids, Michigan, deemed the disparity unacceptable and convened a group of stakeholders to discuss this issue and ways to address it. Only 53% of African American mothers initiated breastfeeding, compared to 79% for white clients. Although there is a WIC program operated by KCHD and various additional maternal and infant health support services in the community, stakeholders determined that mothers would benefit more from receiving one-on-one breastfeeding-specific care. Using the well-documented success of peer mentor models, and with funds from NACCHO, KCHD formed a committee who worked in collaboration with the Healthy Kent Breastfeeding Coalition and the EMPower Hospital (Mercy Health Saint Mary’s), to create the Mothers Helping Mothers Breastfeed project, peer mentor home visiting program, in an effort to close the breastfeeding continuity of care gap for African American women. Continue reading

The Opioid Epidemic in 2018: Where Do We Go from Here?

By Ian Goldstein, Government Affairs Specialist, NACCHO

The Centers for Disease Control and Prevention (CDC) estimates that 91 people die daily due to an opioid overdose. The Trump Administration has declared curbing the opioid epidemic a major priority. In March 2017, the White House created the Commission on Combating Drug Addiction and the Opioid Epidemic, headed by New Jersey Governor Chris Christie. The President proclaimed a public health emergency in late October 2017, however, such a declaration does not allocate any additional funding towards efforts to control the epidemic. On November 1, 2017, the Commission sent a report to the President with 56 recommendations the Administration can take to combat the growing opioid crisis. Some of those recommendations include an expanded drug court system, educational requirements for prescribers, and a media blitz to spread the word about preventive services and treatment availability for substance use disorder. Moreover, the Administration’s Council of Economic Advisors now puts the cost of the epidemic at $504 billion. Continue reading