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Lorraine Boyd, MD, MPH
Medical Director Bureau of Maternal, Infant & Reproductive Health
New York City Department of Health & Mental Hygiene
Eileen DiFrisco, MA, RN, IBCLC, LCCE
Coordinator, Parent Education Women's & Children's Services
NYU Langone Medical Center
Teaming Up to Shape Our Region:
A Pathway to Baby-Friendly Conference
December 1, 2011
NYC’s Pathway to Baby-Friendly
1
Presentation Outline
DOHMH History of Breastfeeding Promotion & Support
Overview of CPPW Parts A, B & C
Accomplishments, Challenges & Next Steps
NYU Langone Medical Center
Keys to Baby-Friendly Success
Questions & Discussion
2
Making Breastfeeding the Norm in NYC
3
0
10
20
30
40
50
60
70
80
90
Initiation 6 months 12 months Exclusive at 3 months
Exclusive at 6 months
% I
nfa
nts
Bre
as
tfe
d
Breastfeeding Rates in NYC, NYS, and US, 2004
NYC NYS
HP 2010 – 75%
HP 2010 -50%
HP 2010 – 17%
HP 2010 – 40%
HP 2010 – 25%
Data Source: CDC National Immunization Survey, 2004
2005 2006 2007 2008 2009 2010 2011
Surveyed BF
practices in all
NYC maternity
facilities
Funded 11 HHC
maternity facilities to
develop standard
policies and procedures
consistent with BFHI
and other experts
Sponsored CLC courses
for HHC, NFP, NBHV to
increase BF knowledge
Began efforts to work
with private hospitals by
sponsoring a breakfast
for CEOs
Launched
Public Health
Detailing
campaign to
community and
hospital-based
providers
Awarded Communities
Putting Prevention to Work
(CPPW) Obesity funding for
13 hospitals
NYC Department of Health History of Breastfeeding Promotion, Support and Protection
First NYC Hospital designated
Baby-Friendly :
Harlem Hospital Center
Second NYC
hospital
designated:
NYU Medical
Center
Received
joint
funding
from United
Hospital
Fund to
promote BF
in Staten
Island
Partnered with NYS to
remind hospitals about
state regulations on
formula distribution
Created BF toolkit for Faith
Based Organizations
Created DOHMH
workplace
lactation room and
breast pump
loaner program
Developing a community
BF campaign & policy Δ
Awarded CPPW
Mentoring Grant for
10 LHD/communities
Awarded CTG Grant
Baby-
Friendly
Hospitals
Project
with Beth
Israel
Medical
Center &
NYU
Medical
Center
4
Breastfeeding in NYC 2009
90% of NYC mothers initiate breastfeeding
(HP 2020: 81.9%)
Only 28% are exclusively breastfeeding at 8 weeks
(HP 2020 at 3 months: 46.2%)
79% of breastfeeding mothers report receiving a
gift pack with formula before hospital discharge
61% of healthy breastfed newborns receive
formula supplementation in the hospital
5 Source: NYC PRAMS, 2009
NYC CPPW Parts A, B & C Goals
• Part A: Funded Hospitals
• To create policy change to increase breastfeeding initiation, exclusivity and duration
support in hospital settings.
• To provide TA, funding and staff education to Bellevue, Beth Israel, Montefiore,
Queens & Woodhull to improve breastfeeding data collection, policies and procedures
consistent with NYS regulations and the 10 Steps to Successful Breastfeeding.
• Part B: Linkages to Breastfeeding Services
• To provide technical assistance to Bronx Lebanon, Elmhurst, Flushing, Lincoln, North
Central Bronx, Richmond, St. Barnabas and SUNY Downstate to establish formalized
linkages and referral systems between their in-patient units, WIC peer counseling
programs and home visiting services.
• Part C: Systems and Policy Levels
• To work with NYS DOH, NYS WIC, NYS Medicaid and other agencies to promote and
protect breastfeeding duration and exclusivity at state and local levels.
6
Breastfeeding Mentoring Logic Model
Inputs Activities Outputs Outcomes Impact
CPPW Part A Initiative 2 Site Coordinators 1 Data Manager Hospital Funding CPPW Part B Initiative 1 Site Coordinator Healthy Children Trainers Curriculum Resource Materials Brochures, DVDs, posters, crib cards, pocket guides, etc.
Provide 1:1 TA to 5 hospitals to improve breastfeeding data collection, policies and procedures consistent with NYS regs and 10 Steps Provide 1:1 TA to 8 hospitals to promote breastfeeding-friendly policies and procedures consistent with Steps 3 & 10 Provide 5 CLC or TTT courses to hospitals Provide tools and resources to hospitals
All 5 hospitals adopt breastfeeding-friendly polices and procedures as well as viable data collection systems All 8 hospitals form linkages between prenatal & postpartum breastfeeding support systems Number of hospital-based staff who are trained to promote and educate patients about breastfeeding New tools and resources adopted by hospitals to promote breastfeeding
All 5 hospitals in improved position to request Baby-Friendly designation All 8 hospitals in improved position to move toward Baby-Friendly designation Local capacity to provide hospital-based breastfeeding promotion and support Improved breastfeeding knowledge and practices among patients and staff
Short-term Number and scope of hospital-based breastfeeding-friendly polices and practices in NYC Intermediate Rates of exclusive breastfeeding and breastfeeding duration in NYC Long-term Number of Baby-Friendly designated hospitals in NYC
7
CPPW Accomplishments in Part A Hospitals
Activities Status
Established or enhanced multidisciplinary breastfeeding teams Updated hospital-wide breastfeeding policies and procedures Trained all MCH staff on new breastfeeding policies and procedures
Trained 555 staff in breastfeeding education (220 MDs, 265 RNs and 70 support staff)
Established functioning data collection system Trained 111 staff to become CLCs and 21 staff to become hospital-based trainers Increased rooming-in and skin-to-skin rates Decreased accessibility of formula Banned formula promotional materials on MCH units
8
CPPW Next Steps, Part A Hospitals
Continue to:
Train additional staff in breastfeeding education
In-service new staff on breastfeeding policies and procedures
Sponsor an additional CLC course in December 2011
Provide ongoing technical assistance to enhance data collection system
and improve data quality
Present data to hospital staff and form strategy to continue to improve
patient care
Increase skin-to-skin rates (especially with C-sections)
Increase rooming-in rates by decreasing procedures that separate moms
and babies
Decrease pacifier use and formula rates
Complete an evaluation of our work
Develop sustainability plans for all hospitals
9
CPPW Accomplishments & Next Steps
in Part B Hospitals
Activities Status
Identified community resources to link pre-natal and discharge support services
Conducted baseline needs assessments at all hospitals
Established work plans based on project objectives and hospitals’ priorities
Develop/update prenatal and discharge protocols In progress
Develop/update breastfeeding policies and procedures to reflect prenatal education
and discharge protocols In progress
Develop/update prenatal curriculum and other materials to assist in implementation
of prenatal education and discharge protocols In progress
In-service all relevant staff on updated breastfeeding polices and procedures In progress
Complete a final needs assessment and develop a sustainability plan In progress
10
CPPW Challenges
Convening Teams from Multiple Disciplines
• Clinical and non-clinical staff
• Different units across many disciplines
• Multiple practice locations (i.e., main hospital vs. community site)
Staff Training
• Physicians
Budget and Personnel
• Staff shortages
• Staff turn over
Data Collection
• Paper vs. EMR
• Improving data quality
• Demographic data
11
Additional Accomplishments
• 9 of our 13 CPPW hospitals are on the
4-D Pathway
• In September 2011, we received the
CDC Community Transformation Grant
(CTG) to work with 25 NYC hospitals
12
NYU Langone Medical Center
NYC’s 2nd Baby-Friendly Hospital (Designated in January 2011)
13
NYU Langone Medical Center
Magnet Hospital
879 Beds
Private, urban, academic
medical center
4600 births per year
10 LDR rooms
36 Bed Mother-Baby Unit
4 private rooms
Units separated by 5 floors
14
Journey to Implementing Baby-Friendly
The Need: •85% intended to breastfeed but only 39% were
exclusively breastfeeding In Place: •Well established family centered model of care •Breastfeeding Policy •Breastfeeding Improvement Team
•Highly motivated nursing staff
•Senior leadership support Our Challenges: •Changing our hospital culture, practices, attitudes and beliefs
•Keeping mothers and babies together
15
Eliminate All Marketing for Formula
Including Gift Bags
16
17
Keeping Mother’s and Babies Together
Mother/Baby togetherness posters
New RN role – “Admit Nurse” admits baby at the mother’s bedside
Partners staying over
NYC DOH grant
Scripting cards
Quiet hours
Newborn observation area
Pediatrician exam at bedside
18
Step 2 –Train all Staff
19
20
Key to Baby-Friendly Success
Educating the staff
Staff Involvement
Positive Reinforcement
Administrative “buy-in”
(Key physician leaders)
Standard of Care
Accountability
Celebrating Achievements
21
22
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
(%)
Breastfeeding Rates at NYU Langone
Initiated Breastfeeding Exclusive Breastfeeding
23
65
70
75
80
85
90
95
2008 2009 2010 2011
Patient Satisfaction Press Ganey Results
Time to Bond with Baby
Breastfed 1 hour after birth
Nurses Support Feeding Choice
Breastfeeding Info
Instructions given about Baby Care
Questions and Discussion
24
Contact Information
Lorraine Boyd, MD, MPH
Medical Director
Bureau of Maternal, Infant & Reproductive Health
New York City Department of Health & Mental Hygiene
(347) 396-4512
Eileen DiFrisco, MA, RN, IBCLC
Coordinator, Parent Education
Women's & Children's Services
NYU Langone Medical Center
(212) 263-3389
25
Supplemental Slides:
Lorraine Boyd
26
0%
10%
20%
30%
40%
50%
60%
70%
80%
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11
Excl BF Formula Combination
N=149 N=106 N=114 N=107 N=115 N=144 N=106 N=140 N=114
Healthy, Full-term Infant Feeding Status
Throughout Hospital Stay at a Part A Hospital
* Exclusive Breastfeeding: Neonate receives breast milk ONLY (no formula, water, or sugar water)
** Formula Only: Neonate receives formula ONLY
*** Mixed Feeding: Neonate receives BOTH breast milk and formula
* ** ***
Trends in Breastfeeding Initiation and Duration of
Any and Exclusive Breastfeeding at 8+ Weeks
28 Data Source: NYC PRAMS 2005-2009
29
0
10
20
30
40
50
60
70
80
90
100
0.5 1 2 3 4 5 6 7 8
Any Breastfeeding Exclusive Breastfeeding
Weeks Postpartum
Any and Exclusive Breastfeeding by Weeks
Postpartum, NYC 2009
Source: NYC PRAMS, 2009.
Progress to Date in Part B Hospitals
Part B
Hospital
CPPW
Mentoring
Completed
Assessment
Tool
Completed
Evaluation Tool
JULY 2010
Completed
Evaluation Tool
JULY 2011
Bronx Lebanon Elmhurst Flushing Lincoln
North Central Bronx
RUMC
St. Barnabas SUNY Downstate
Supplemental Slides:
Eileen DiFrisco
31
Offering Hospital Discharge Support
Congratulations Booklet
Resource Guide for Discharge
Breastfeeding and New Mother’s Group
Warm line:
(212) 263-BABY
www.nyubaby.org
