Title V Transformation Tools
Recommendations to Support NPM 4 – Breastfeeding
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Significance. The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this NPM as follows:
Advantages of breastfeeding are indisputable. The American Academy of Pediatrics recommends all infants (including premature and sick newborns) exclusively breastfeed for about six months as human milk supports optimal growth and development by providing all required nutrients during that time. Breastfeeding strengthens the immune system, improves normal immune response to certain vaccines, offers possible protection from allergies, and reduces probability of SIDS. Research demonstrates breastfed children may be less likely to develop juvenile diabetes; and may have a lower risk of developing childhood obesity, and asthma; and tend to have fewer dental cavities throughout life. The bond of a nursing mother and child is stronger than any other human contact. A woman's ability to meet her childs nutritional needs improves confidence and bonding with the baby and reduces feelings of anxiety and postnatal depression. Increased release of oxytocin while breastfeeding, leads to a reduction in post-partum hemorrhage and quicker return to a normal sized uterus over time, mothers who breastfeed may be less likely to develop breast, uterine and ovarian cancer and have a reduced risk of developing osteoporosis.
Background. The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures (NPMs) for the 2015-2017 grant cycle. In order to effectively address the NPMs, MCH professionals need to think about not only the evidence and strategies to make change, but also the capacity of the workforce to carry out these activities. These lists identify online learning materials, resources, and evidence-based strategies and programs to support the knowledge sets and skills needed to advance each NPM.
Introduction. Six skill sets have been identified by the National MCH Workforce Development Center to support implementation of this NPM: (1) population health; (2) strategic planning and program design; (3) strategic alliances and effective partnerships; (4) consumer engagement and cultural and linguistic brokering; (5) policy and program implementation; and (6) communication.
In addition, two knowledge areas specific to the NPM topic area have been highlighted that are keyed to the evidence base and promising practices: (1) breastfeeding background, recommendations, and guidelines and (2) breastfeeding policies and strategies.
The MCH Navigator, in collaboration with the Center, has developed this crosswalk to guide MCH professionals to online learning opportunities and implementation resources to support these skill sets.
Please click on the Read More buttons below for additional information, learning materials, and implementation resources. You can also email us with suggestions for additions.
Six skill sets have been identified to support implementation of this NPM:
1. Population Health
A renewed focus on MCH population health is key to achieving the NPMs in the era of health transformation. These skills enable Title V professionals to analyze how program interventions and their related health outcomes are distributed among a state’s MCH population. Population health skills complement all of Title V’s work, including program design and implementation, strategic partnerships and communication.
- Ability to conduct surveillance of breastfeeding rates that allows public health practitioners to understand and respond to disparities in breastfeeding rates
- Ability to develop estimates of death rates and implications based on breastfeeding rates
- Ability to calculate quality-adjusted life years (QUALYs) to quantify impact of breastfeeding in local communities
2. Strategic Planning & Program Design
Effective strategic planning and program design requires the ability to base programs on defined goals and desired outcomes. Strategic planning should include a monitoring and evaluation system to track and monitor progress and inform program alterations as needed. Program design skills must ultimately be coupled with implementation, where program design is carried out.
- Ability to apply the socio-ecological framework to breastfeeding
3. Strategic Alliances & Effective Partnerships
The wide array of stakeholders and partners in the field of MCH, from providers and insurers to women and children, require a set of skills in strategically aligning Title V goals with those of their partners. In the Title V world, there is an increasing interest in engaging unlikely or nontraditional partners to achieve the NPMs. The skills in this category take that into account and include unique partner groups linked to this measure.
- Ability to convene public health and primary care professionals to align their breastfeeding efforts
- Ability to identify and collaborate with hospital and child care center partners, especially those that serve women least likely to initiate and continue breastfeeding
- Ability to provide public health support for implementation of breastfeeding-friendly hospitals
- Skills to collaborate with private sector partners to increase knowledge of benefits of workplace accommodations
- Skills to encourage Medicaid and managed care organizations (MCOs) to:
- Collect data on breastfeeding
- Initiate a performance improvement project that seeks to increase breastfeeding rates among employees
- Reimburse for the provision of Medical Lactation Therapy services
- Ability to align breastfeeding efforts with safe sleep initiatives
4. Consumer Engagement/Cultural & Linguistic Brokering
Consumers are arguably the most important stakeholders in MCH work, thus skills in consumer engagement and cultural and linguistic brokering are essential to moving the needle for each NPM. In some cases, consumer engagement includes negotiating with other stakeholders on behalf of MCH populations. Closely linked with this skills category are skills in communication and strategic alliances.
- Skills to promote meaningful participatory practice with families in the development and support of breastfeeding practices
- Ability to effectively engage breastfeeding mothers as peer educators
- Ability to leverage knowledge about cultural, racial, and socioeconomic differences regarding initiation and duration of breastfeeding
- Ability to help consumers understand the rights they have under the Affordable Care Act (ACA) regarding breastfeeding
5. Policy & Program Implementation
These skills ensure that MCH priorities are integrated into all aspects of policy and program implementation, as well as ensuring that policies and programs selected are well-aligned with NPMs and other MCH program goals. Implementing policies and programs with fidelity also requires skills in the implementation science drivers: technical and adaptive leadership; selection; training; coaching; systems intervention; facilitative administration; and decision support data systems.
- Ability to leverage opportunities through the ACA and other federal and state policies to support breastfeeding initiatives, particularly:
- Reimbursement for International Board Certified Lactation Consultants
- Greater access to pumps,
- Leave time for pumping at work,
- Ability to provide state public health recognition (e.g. certificates, awards, news releases) for employers, primary care clinics and birth facilities that promote breastfeeding according to the law and national recommendations
- Ability to ensure that health care providers have access to tools and best practices regarding breastfeeding and are trained to use the tools in an evidence-based manner
- Skills to ensure high-quality breastfeeding support is embedded in programs for which Title V has authority
- Ability to support or provide incentives for hospitals to become Baby Friendly or take first steps in becoming Baby Friendly through a state recognition program.
- Skills to partner with employers to implement workplace accommodations that they are required to provide by law
- Skills to educate policymakers on the value of legislation that:
- Gives women the right to breastfeed in any public or private place
- Prohibits restricting or limiting the right of a mother to breastfeed
- Ability to establish memoranda of understanding with Medicaid and other payers to promote coverage of breastfeeding services as separately reimbursable pregnancy-related services in hospitals, clinics, and other health care settings
- Ability to determine legal authority behind existing memoranda of understanding with partners
Communication skills support the creation and delivery of effective messages between MCH professionals, professional and community partners, and populations served by Title V. Effective communication ensures the delivery of appropriate messages to audiences in the way that they were intended and is key to all aspects of MCH work. These skills are linked closely with skills in strategic partnerships and cultural and linguistic brokering.
- Ability to use traditional and social media to effectively reach women of childbearing age with culturally appropriate and compelling breastfeeding messages
- Skills to train hospital staff as necessary to effectively support breastfeeding
- Skills to effectively navigate around conflicting messages between safe sleep and breastfeeding
- Skills to ensure that women of color are trained to become skilled lactation support providers
In addition to skills, each NPM requires a knowledge base that will help Title V progress effectively in the measure. Knowledge should be considered at the foundation of achieving all measures.
1. Breastfeeding Background, Recommendations & Guidelines
- Knowledge of optimal infant and young child feeding guidelines
- Knowledge of optimal birth spacing and birthing practices
- Knowledge of evidence-based interventions that increase breastfeeding initiation and duration
- Knowledge of historical & cultural context of breastfeeding practices in a given geographic area, including understanding cultural factors and personal choices that support or inhibit breastfeeding
- Knowledge of statewide and national breastfeeding initiatives
- Knowledge of breastfeeding messages that may appear contradictory to safe sleep guidelines
- Knowledge of safe sleep messages that may appear contradictory to breastfeeding guidelines
2. Breastfeeding Policies & Strategies
- Knowledge of lactation services available and reimbursable under the ACA and other state and federal policies, including exclusions
- Knowledge of state-specific lactation room guidelines as well as federal lactation room policies for both salaried and hourly employees
- Knowledge of relevant environmental policies that support or undermine breastfeeding
- Knowledge about Baby Friendly hospitals and those that provide formula upon birth of child
See other online learning resources related to health transformation, collected in the Health Transformation Learning Laboratory.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 77.