Category Archives: community health

Shifting Internal Policies and Systems to Create Breastfeeding Continuity of Care

By Carmen Vergara, RN, MPH (ESPERANZA HEALTH CENTERS) and Harumi Reis-Reilly, MS, CNS, CHES, IBCLC (NACCHO)  

Esperanza Health Centers, a former grantee of NACCHO’s Breastfeeding Initiative, is a Federally Qualified Health Center (FQHC) on the Southwest side of Chicago. The main population served is predominately low-income and Latino, and families in Esperanza’s service area experience significant economic, educational, and health inequities. Over 70% of area residents live 200% below the poverty level. Esperanza’s main services are adult primary care, pediatrics, prenatal care, and behavioral health. Additional public health services include programs related to children’s weight management, diabetes management, and physical activity.

Healthy Tomorrows Program (HTP)

In 2013, the HTP was launched with funds from Health Resources and Services Administration (HRSA). The program has been endorsed by the Department of Public Health in Chicago, owing to its potential to reduce inequities by providing access to high-quality culturally appropriate care. The program is designed to improve breastfeeding rates among Latinas, who typically initiate breastfeeding, but have lower rates of duration and higher rates of formula supplementation. 

Beyond providing culturally appropriate breastfeeding education and support, the HTP seeks toaddress client social service needs and remove barriers to care access by helping Latinas navigate the U.S. healthcare system, as well as insurance issues, to ensure that they receive comprehensive prenatal and postpartum care. The HTP aligns the medical specialties, including, but not limited to, OB/GYNs and pediatricians, and frontline staff within the FQHC to work together to increase breastfeeding rates. 

In 2015, with funds from the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC) and other sources, Esperanza expanded the HTP by implementing weekly breastfeeding peer support groups in a highly visible public area at one of its three clinic locations, and partnered with a local library branch to host offsite support groups within the broader community. Esperanza went beyond the provision of direct services by implementing internal policy and system changes to improve the consistency and quality of breastfeeding support services provided by staff in a way that would be sustained after the grant funding ended.

Policy System and Environmental (PSE) Changes and Partnerships

Esperanza implemented an agency-wide Breastfeeding Support and Education Work Flow system by establishing protocols to ensure that clients receive seven points of breastfeeding support contact, starting from the first prenatal medical visit to the infant’s first month of life, and at least two or more contacts until the baby’s first birthday.

Figure 1

Figure 1 illustrates the client contact points and indicates who and how breastfeeding support services are provided.

The center updated its electronic medical record (EMR) system to capture client breastfeeding intentions and status, and to document all breastfeeding education and support sessions (e.g., during client medical visits, by phone, and at the hospital post-birth) by different staff within the center.

A goal of the program was to increase broad acceptance and support of breastfeeding by training all center employees, including front-desk staff, medical assistants, and physicians, on the importance of breastfeeding and lactation support management. They tested staff knowledge and attitudes through pre- and post-training assessment. In addition, Esperanza instituted weekly breastfeeding support groups in a highly visible clinic area and at a local library branch.

To address community continuity of care and close the gap in services that often occurs between hospital delivery and the early postpartum period, Esperanza enhanced its partnership with Saint Anthony Hospital, a local facility where most FQHC clients deliver. Esperanza joined the hospital’s baby-friendly committee, and also invited hospital staff to join the center’s advisory board. A result of the partnership is the Birth Visit by Esperanza’s lactation staff or covering pediatrician at the hospital, which is one of the seven points of contact in the HTP Breastfeeding Support and Education Work Flow system. The main facilitators for this key partnership and program implementation were leadership buy-in, and the use of physician champions that were engaged and active program advocates.

By shifting internal policies and systems and integrating breastfeeding support into other existing culturally appropriate, population-based services within the clinic, Esperanza Health Center’s HTP was able to increase breastfeeding community continuity of care for the predominately low-income Latino community served by the FQHC in Southwest Chicago.

To learn more about this project, watch the recording of the webinar Breastfeeding in the Community: Closing the Care Gap No Cost Continuing Education Available here:


Tobacco Cessation for Cancer Survivors: A Resource Guide for Local Health Departments

Local health departments (LHDs) play a vital role in minimizing the impact of cancer in their communities. NACCHO supports LHDs in planning, implementing, and evaluating evidence-based cancer prevention and control strategies to improve population health. With that said, NACCHO has released of Tobacco Cessation for Cancer Survivors: A Resource Guide for Local Health Departments. This guide details the importance of tobacco cessation for cancer survivors and features recommendations on how local health departments can use existing resources to link cessation services to cancer survivors. This resource guide was created through collaboration with American Cancer Society under the Centers for Disease Control and Prevention cooperative agreement DP1315 National Support to Enhance Implementation of Comprehensive Cancer Control Activities.

Download Tobacco Cessation for Cancer Survivors: A Resource Guide for Local Health Departments from the NACCHO website today.

National Child Abuse Prevention Month: Building Community, Building Hope

By Margaret Carr, NACCHO Senior Program Assistant

The National Association of County and City Health Officials (NACCHO) encourages local health departments (LHDs) to engage their communities throughout the month of April in promoting child abuse prevention efforts. April is National Child Abuse Prevention Month and the theme this year is Building Community, Building Hope.

Child Abuse and Violence

Child abuse and neglect continues to be a major public health issue in the United States. In 2014, 702,000 victims of child abuse and neglect were reported to child protective services.[i]

Children are particularly vulnerable to the negative effects of violence. Early experiences and environments shape the architecture of children’s developing brains,[ii] which in turn influences the connections their brains make. For example, children who grow up in environments where they do not feel safe, learn to better recognize and respond to threats. As such, this can lead to an increased fight-or-flight response which can override other skills that enable non-violent conflict resolution. Exposure to child abuse and neglect as well as other traumatic stressors termed adverse childhood experiences (ACEs), lead to short- and long-term health and social problems.[iii] Violence is preventable and LHDs can work with their communities to ensure every child has the opportunity to grow up in a safe environment.

Child abuse is just one form of violence children may experience, however, the many forms of violence are related and often share root causes. Addressing the shared risk and protective factors for violence can prevent child abuse and violence across a life span.

The Role of Local Health Departments

LHDs play an essential role in preventing child abuse and creating a safe, healthy community for all of their residents. Interventions that include protective factors, which are those that reduce risk and encourage positive and healthy development, are proven to be successful.[iv] NACCHO’s resource, Local Health Department Efforts to Prevent Child Maltreatment highlights five evidenced-based parenting programs. LHDs can implement interventions such as home visiting and/or other parenting programs, which provide parents with the necessary skills to promote the health and well-being of their children. While these programs are beneficial, prevention efforts must go beyond individuals and families. LHDs can work with community partners (e.g. hospitals, schools, social services, non-profits) to change social norms and increase community connectedness for families. Reducing social isolation can reduce the risk for multiple forms of violence.[v] LHDs can help move the community to take collective responsibility for all children.

We encourage you to share child abuse prevention messages throughout the month of April!

Potential Messages to Share:








Curbing Opioid Overdose Using Programmatic and Geospatial Data

By Kate Lena, MPH, Linkages to Care Coordinator, AHOPE Needle Exchange Program, Boston Public Health Commission

This is an excerpt from the 2017 NACCHO Exchange Winter Issue on opioids.

Opioid misuse is highly stigmatized and criminalized, making people who inject opioids an especially hard-to-reach, high-risk population and hampering public health surveillance efforts to understand the timing, circumstances, and proximate causes of overdose events. Boston Public Health Commission’s needle exchange program, AHOPE, has spent more than a decade working to overcome those obstacles. Launched in 2006, AHOPE—Massachusetts’s first community Overdose Education and Naloxone Distribution (OEND) pilot program—distributes harm reduction supplies to people who inject drugs.1 Continue reading

Commemorating American Heart Month: Resources and Strategies for LHDs

Claude JacobBy Claude-Alix Jacob, MPH, NACCHO President and Chief Public Health Officer for the Cambridge Public Health Department (MA)

The burden of cardiovascular disease poses significant risk to the health and well-being of our communities. Heart disease is the leading cause of death for both men and women in the United States. According to the CDC, approximately 610,000 Americans die from heart disease—one in every four deaths. Someone dies from a heart disease-related event every minute in the United States.1 These statistics have dire consequences for the quality of life and vitality of our populations. Our nation also experiences these consequences economically: Heart disease costs the United States about $207 billion each year in healthcare services, medications, and lost productivity.1 Continue reading

A Look Back: The Best of NACCHO Preparedness


By Anastasia Sonneman, NACCHO Communications Specialist

This story originally ran on NACCHO’s Preparedness Brief.

The year 2016 brought a whole new meaning to the importance of public health emergency preparedness. From the onset of Zika virus disease to international acts of violence related to terrorism, to the worst global migrant crisis since World War II, NACCHO has worked diligently in collaboration with many of its members and partners to enhance the capacity of local health departments (LHDs) to protect and increase the resiliency of their communities. As we enter the new year, many of NACCHO’s preparedness-related projects can still serve as a valuable resource to local preparedness staff. With this in mind, the NACCHO Preparedness team compiled the following list, highlighting a selection of the year’s featured programs, events, resources, and tools. Continue reading

Health and Disability Training: The Power to Transform Public Health

meredith-williamsBy Meredith Williams, MPH, 2015–2016 NACCHO Health and Disability Fellow

This story originally ran in NACCHO’s Healthy People, Healthy Places.

This October, I had the privilege of representing the National Association of County and City Health Officials (NACCHO) Health and Disability Team at the American Public Health Association (APHA) Conference in Denver. As a former NACCHO Health and Disability Fellow, I was thrilled to see so much interest in our poster on health and disability training. My time at the conference gave me the chance to share my experiences with training, learn from national disability leaders in public health, and encourage professionals, students, and educators to join us in advancing this crucial field. Continue reading