Category Archives: community health

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.

Instead of developing a brand-new program and realizing the value of partnership, the project aligned with Strong Beginnings, a federal Healthy Start program, and their already established Breastfeeding Café support group, known as Helping Us Grow Strong (HUGS). Women participating in the project received weekly group support from other moms, mentors and lactation consultants at HUGS. The project partners also provided a culturally attuned training, Breastfeeding from an African American Perspective curriculum, for health professionals and related organizations.


About 35% of African American women in Kent County discontinue breastfeeding within the first month after delivery. A lack of awareness of local support services and the need for peer support may be reasons why they choose to discontinue breastfeeding. Prior to this project, information being provided to new mothers by healthcare professionals and related organizations about breastfeeding was largely unknown, and speculative at best.

Through a pre-implementation gap analysis with community members, local agencies and clinical professionals, KCHD identified that the community had limited accessible breastfeeding support services for new African American mothers and lacked culturally attuned lactation support providers. Many African American mothers reported that healthcare providers did not typically refer them to lactation care or supports. Furthermore, there was not a consistent and comprehensive resource guide detailing breastfeeding support services available to African American mothers within the Greater Grand Rapids area. Healthcare providers appeared to be giving inconsistent information, missing prime breastfeeding education opportunities during prenatal visits, and not regularly referring breastfeeding mothers to existing community resources.

This project had a short timeframe of 6 months and required an engaged multisector partnership to gather information, expand support, train and sustain the engagement. While KCHD had the desire to improve community breastfeeding rates among African American mothers they recognized the need for new and existing partnerships to effectively engage with African American breastfeeding mothers. To accomplish the project’s objectives, KCHD leveraged an existing infrastructure and key existing partnerships.


Informed by the gap analysis, which included a survey of healthcare professionals and a series of focus groups with African American mothers, KCHD identified three key strategies aimed to improve African American breastfeeding rates. The project focused on training healthcare staff, expanding an existing breastfeeding support program and developing a comprehensive breastfeeding resource guide.

KCHD recognized a gap in internal organizational capacity, appropriate skill set, and the level of cultural competency needed to support breastfeeding initiation among African American mothers. To address this gap, KCHD assembled a team which included a community program health educator, an International Board-Certified Lactation Consultant (IBCLC) and a Certified Lactation Consultant and former WIC Breastfeeding Peer Counselor, all of whom were African American women. These women then identified and mentored five Peer Breastfeeding Mentors from the Greater Grand Rapids community through the HUGS breastfeeding support group. Once trained, Peer Breastfeeding Mentors provided support for other African American mothers who were interested in initiating and sustaining breastfeeding, especially in the first four weeks following birth.


Expanding upon an existing community program, HUGS, instead of building a new one allowed for rapid engagement of African American mothers. Five Peer Breastfeeding Mentors were trained during the 6-month project, and four started actively supporting mothers with in-person individual and group counseling, phone calls and text messaging support. In addition, a private virtual support group through Facebook was created for the Peer Breastfeeding Mentors as an additional form of mother-to-mother support. Each Peer Breastfeeding Mentor was equipped with a universal breastfeeding kit that was taken to all support encounters to standardize education and care. This resource kit, adopted from the Strong Beginnings program, contained a cloth breast and belly size models, visual educational materials and information on pumping and milk storage.

The Healthy Kent Breastfeeding Coalition, Mercy Health Saint Mary’s and KCHD also provided training as a component of this project. The one-day culturally attuned training, Breastfeeding from an African-American Perspective, created and developed by Bonita Agee (Strong Beginnings Education Coordinator), Latoyia Thomas (IBCLC), and Christine Stancle (former WIC Breastfeeding Peer Counselor and now Certified Lactation Counselor), all of whom are African American women, was attended by 100 participants from various healthcare and related organizations including hospital employees, community program staff, and community health workers who work primarily with women of color. The curriculum included topics such as the historical context of breastfeeding in African American communities, factors that contribute to disparities, and breastfeeding benefits and barriers. The training also identified multiple teaching opportunities for breastfeeding education during prenatal appointments and information on how to refer African American women to culturally appropriate support groups.

To enhance training and support, KCHD compiled a universal resource guide, launching it online in conjunction with the Healthy Kent Breastfeeding Coalition. It was also made available in hard copy for distribution among healthcare providers.

The extensive engagement of the Peer Breastfeeding Mentors and IBCLC expanded into the faith-based community and known community networks to increase families receiving support.

An unexpected and welcome outcome of this project is the additional financial support provided by the Healthy Kent Breastfeeding Coalition to build a sustainability plan for the activities started during the NACCHO project period. KCHD applied for a Michigan State Health Innovation grant that was awarded for one additional year of breastfeeding support through the Mothers Helping Mothers Breastfeed project.

Lessons Learned

For a 6-month grant period, the proposed work plan was ambitious. Conducting a gap analysis with African American mothers and healthcare staff was important for informing project activities and training needs. KCHD did not struggle with recruiting Peer Breastfeeding Mentors, however, did became aware of some barriers mentors face. Several of the Peer Breastfeeding Mentors faced health issues, childcare dilemmas and family difficulties similar to the women they were mentoring.

Peer Breastfeeding Mentors were often current or former clients of home visiting programs which contributed to their interest in serving in a mentor role for other women. This initiative furthered conversation and recognition that breastfeeding support services are multi-faceted, need to account for cultural considerations, should include staff that reflect the population served, and should be delivered in collaboration with existing programs and services like home visiting programs, WIC, and related services. When determining service needs and strategies for addressing those needs, it is essential to utilize an equity lens to reduce disparities in breastfeeding and improve overall health.

For more information, contact: Barb Hawkins Palmer,

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

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. Continue reading

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


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

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