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Implementation of Business Case for Breastfeeding in Hampton Roads Amy Paulson, MPH, AE-C CINCH Director/Instructor EVMS Department of Pediatrics Creating.

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Presentation on theme: "Implementation of Business Case for Breastfeeding in Hampton Roads Amy Paulson, MPH, AE-C CINCH Director/Instructor EVMS Department of Pediatrics Creating."— Presentation transcript:

1 Implementation of Business Case for Breastfeeding in Hampton Roads Amy Paulson, MPH, AE-C CINCH Director/Instructor EVMS Department of Pediatrics Creating Mom-Friendly Worksites Weight of the State Conference, April 12, 2013

2 Consortium for Infant and Child Health (CINCH)  Child health coalition with 200+ members serving Hampton Roads, VA  EVMS is CINCH’s lead agency  Mission: Engaging the community to improve children’s health in Hampton Roads  Focus: Obesity, Respiratory Health, Access to Care, Healthy Communities  Approach: Policy, Systems, Environmental Change

3 Learning Objectives 1. Identify four components of comprehensive worksite lactation support programs 2. Identify three approaches to employers regarding establishing lactation support programs for employees. 3. List at least three factors businesses must consider in establishing lactation support programs for employees 4. Introduce a mechanism to evaluate a community level BC4BF project

4  Primary Goal: Implement worksite lactation support programs with at least 10 employers in South Hampton Roads, Virginia (VDH funding for one year)  Evaluate organizational changes  Coalition building for breastfeeding promotion  Community Dialogues on breastfeeding & working  Use Business Case for Breastfeeding Toolkit  Components: Private Space, Flexible Breaks, Education and Support  September 2010 - October 2011 & July 2012 - present Business Case for Breastfeeding Project

5 Worksite Lactation Support Program Components  Private Space  Flexible Breaks  Education  Support

6 Outreach Approaches 1. Target mid-size to large employers of women of childbearing age 2. Recruit participation of ‘partner’ organizations first (i.e., “low hanging fruit”) 3. Direct contact by phone, email, in person 4. Healthcare Reform seminars, Workplace Wellness conference

7 Implementation Approaches 1. In-person consultation & site visit at workplace to introduce BC4BF toolkit & Project 2. Lactation Assessment Form 3. Free technical assistance 4. Eligibility criteria for limited-time Incentives

8 1. Lactation Program Assessment 2. Lactation Support Policy 3. Designated Lactation Area 4. Procedures 5. Company-wide Promotion 6. Employer Spotlight Eligibility Criteria for Incentives

9 The “Sell” - Benefits to Business  Compliance with FLSA  Wellness Initiative  increased productivity  decreased absenteeism  improved staff morale  cost savings  Competitive Employee Benefit  Community Role Model

10 Human Resources Considerations  Accommodating flexible breaks and addressing ‘extra’ time needed in policies  Identifying private spaces & access options  Options for room furnishings and equipment maintenance  Promoting the Lactation Support Program with new and existing employees  Long-term sustainability

11 Policy Example: REST PERIODS, MEAL PERIODS AND BREAKS FOR NURSING MOTHERS C. Break Time for Nursing Mothers. 1. In accordance with the Fair Labor Standards Act (FLSA), EVMS provides employees who have need to express breast milk with the following: a. Two 15 minute paid breaks for every four hours of working time, which would replace any other paid break time normally granted during the employee’s shift. For those employees scheduled to work a shift in excess of 8 hours, one additional paid 15 minute break may be provided; b. Any additional unpaid breaks as needed to express breast milk (employees must clock out when using unpaid time); and

12 c. A private location, other than a bathroom, to express breast milk upon written request to Human Resources. Please contact Human Resources for the location of your Department’s lactation space or more information. 2. Employees intending to express breast milk at work must notify their immediate supervisor, each shift, and schedule breaks to express milk to best accommodate the employee and the Department workflow. 3. Breaks for nursing mothers will be provided for up to one year after the birth of a child. 4. Expressed breast milk must be stored in personal coolers. Policy Example, cont.

13 Lactation Rooms and Signage: Educational Institution Setting


15 Lactation Room: Hospital Setting BeforeAfter

16 Lactation Room – Military Setting BeforeAfter

17 Implementation support useful for large and small employers Interest from an external catalyst can accelerate internal compliance & advance comprehensiveness of LSP Employers gain LSP expertise quickly with BC4BF Toolkit resources Importance of flexibility and adaptation as no two situations are identical, even within a large parent organization (e.g. hospital system) Emphasize WIN-WIN-WIN: Healthier babies, employees, business bottom line Implications for Implementing Health Reform

18 Challenges  Competing demands – low priority  Contentment with status quo  Eligibility Criteria too demanding?  Brief project timeframe  Identifying an effective champion  Additional policy/protocol needed for room & pump management (i.e., cleaning, storage, maintenance)

19 Successes 17 businesses were at least minimally engaged 16 participated in face-to-face consultations 15 completed baseline Lactation Assessment Form 14 made implementation progress during project timeframe 13 affected by 8 drafted/adopted policies 14 created/upgraded 17 lactation rooms Over 6,200 women impacted across worksites

20 Evaluation Challenges Short term project Not research Scientific rigor limited IRB – Determination of non-research Use of incentives helped motivate protocol compliance Lactation Assessment Form set-up and completion Piloting – was useful for e-format Timeliness – not all completed at most optimal start time No formal post-test

21 Lactation Assessment Form (LAF)  General information about business/worksite  e.g. type, size, role of respondent  Human Resources  e.g. # women of childbearing age, pregnancy and breastfeeding rates, absenteeism, etc.  Company Policies  e.g. general lactation support, leave, return to work, insurance coverage  Lactation Program Components  e.g. Infrastructure, breastfeeding options, funding, resources, etc.

22 The Businesses/Employers Lactation Program Assessment Descriptive Results Business Sizen = 15% Small (1-99 employees)320% Mid-sized (100-499 employees)427% Large (500 or more employees)853% Estimated Potential ImpactCountRange Female Employees, age 16-44>4,61915 to 842 Male Employees age 16-441,3533 to 233 New Babies - Annual Estimate2131 to 50

23 The Businesses/Employers Lactation Program Assessment Descriptive Results Policy and Insurance ItemsCountPercent Lactation Policy Status No Previously Existing Policy853% Previously Existing Policy747% Unwritten and/or Unofficial1173% Maternity Leave Policy FMLA1387% Disability Insurance213%

24 The Businesses/Employers Breast Pump Equipment Employees Receive Count % None, employees use their own960% Purchased hospital-grade electric pump17% Rented hospital-grade electric pump17% Portable pumps00% Other320% Unknown17% Breast Milk Storage Employee provided cooler1173% Company provided cooler00% Small designated refrigerator320% Public shared refrigerator747% Other213%

25 Evaluation Measures – Likert-Type Scales 1. Level of Engagement with the Project 2. Stage of Change – TransTheoretical Model of Behavior Change adapted for organizations 3. Comprehensiveness of Lactation Support Program Components 4. Level of Policy Development 5. Changes in Physical Environment 6. Changes in Social Environment

26 BC4BF Evaluation Ratings  Engagement (E) of businesses/employers with BC4BF Project  Minimal = 1: intention, support letter, BC4BF training  Engagement = 2: onsite consult, lactation area analysis  Moderate = 3: commitment to enhance LSP, LAF completed  High = 4: written policy, equipped lactation area, procedures, promotion

27 BC4BF Evaluation Ratings  Stage of Organizational Change (TTM)  Precontemplation = 1: non-issue  Contemplation = 2: awareness, FLSA compliance, value as family support, considering feasibility  Preparation = 3: exploring issue, timeline, info gathering  Action = 4: facilities, policy, champions, signage, promo  Maintenance = 5: ongoing champion, eval & monitoring, integration into way of doing business

28 BC4BF Evaluation Ratings  Implementation/Level of Comprehensiveness of Lactation Support Program (Comp)  Unsatisfactory: No Lactation Support = 1  Satisfactory: Basic Model (2 required items) = 2: breaks and non-restroom space; plus privacy, locks, chair, pump, table; and flexible break scheduling  Superior: Basic Model plus (3 or more items) = 3: written policy, education, peer support, enhanced (baby onsite, paid breaks, footstool, recliner, fridge, etc.)

29 BC4BF Evaluation Ratings  Policy (P): CHANGE Rating  Not Identified as a problem = 1  Problem identification gaining agenda status = 2  Policy formulation and adoption = 3  Written policy and implementation = 4  Policy evaluation and enforcement = 5

30 BC4BF Evaluation Ratings  Physical Environment (PE): CHANGE Rating  No elements in place = 1  Few elements in place = 2  Some elements in place = 3  Most elements in place = 4  All elements in place = 5

31 BC4BF Evaluation Ratings  Social Environment (SE): CHANGE Rating  No support or negative support in place = 1  Neutral or some support emerging = 2  Positive support, some encouragement for using BF facilities = 3  Active support, absence of criticism = 4  Enthusiastic support communicated = 5


33 Case Example: EVMS  Large Employer - > 500  580 women aged 16 – 44, 233 males  Estimated 50 annual pregnancies  Breastfeeding rates unknown  No lactation support policy at baseline, new policy needed  Provides FMLA and disability  Health insurance provides “Expectant Mother” programs  Employee health unit domain  Personal office available  $500 start up available  Employees’ own pump/cooler pack  Newsletter and website


35 Case Example: EVMS  Established 5 lactation rooms  Plans to establish more rooms in all buildings on campus

36 Next Steps  Seek financial support to continue promotion, coordination and technical assistance  Outreach to more businesses  Expand coalition component  Expand support for parents  Promote breastfeeding-friendly community  Monitor health impacts  Publicity and BIB awards (Business Investment in Babies)

37 Acknowledgments Elise Wallace, MPH – Project Manager Cheza Garvin, PhD – Evaluation Director Natasha Sriraman, MD, MPH, IBCLC – Medical Director Liz Flight, RN, IBCLC – Informal Consultant Liz Marshall, MPH – Volunteer Business Partners Employer Champions Professional groups and coalitions Other Volunteers & Staff support

38 Support Virginia Department of Health’s CHAMPION Program (Commonwealth’s Healthy Approach and Mobilization Plan for Inactivity, Obesity and Nutrition) American Recovery & Reinvestment Act (ARRA) Communities Putting Prevention to Work Eastern Virginia Medical School National Association of Chronic Disease Directors/CDC Action Communities for Health, Innovation and Environmental Change Grant (ACHIEVE)

39 Resources Business Case for Breastfeeding: in-action/business-case-for-breastfeeding/ in-action/business-case-for-breastfeeding/ Fact Sheet #73: Break Time for Nursing Mothers under the FLSA : AIA Lactation Room Design form: df/aiap037226.pdf df/aiap037226.pdf Sample policy development guide: s/MO-BF-WorkPolicy.pdf s/MO-BF-WorkPolicy.pdf

40 Questions? Amy Paulson, MPH, AE-C 757-668-6426 Twitter @CINCHCoalition Thank you

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