COMMUNITY INTERVENTION WORKSHEET

Transcription

1 COMMUNITY INTERVENTION WORKSHEET Assessment: National data: The Center for Disease Control (CDC) reports show that the percentage of infants born in 2006 who were breastfed at any time is 74%, exclusively breastfed through 3 months is 33.6%, exclusively breastfed through 6 months is 33.6%, and at 1 year is 22.7%. (1) Breastfeeding rates have increased 2 percentage points in breastfeeding initiation according to data analyzing infants born in (2) HP 2020 Objective: Health People 2020 assembled an objective to increase the proportion of infants who are initially breastfed to 81.9%, exclusively through 3 months to 46.2%, and 6 months to 25.5%. State or Local data: The CDC Breastfeeding Report Cards for 2012 show that the percentage of infants born in Utah in 2009 who were breastfed at any time is 85.7%, exclusively breastfed through 3 months is 51.4%, exclusively breastfed through 6 months is 24.8%. (2) National vs. State/Local Data: Compared to 2009 data, Utah s breastfeeding initiation rate is 9.7% higher than the national data. However, compared to 2006 data, Utah s exclusively breastfed through 6 months is 9% lower than the national data Possible Root Causes : Emerging research points to these root causes for decreased breastfeeding rates: mothers perception that her milk supply is (a) insufficient and (b) fails to satisfy her baby s hunger. Adequate prenatal and postnatal education and support are needed to culminate these perceptions. The Peer Counseling Program effectively educates and supports breastfeeding women. Review of Research In 2012, research conducted among California s WIC participants, identified the major breastfeeding barrier as the mother s unrealistic expectation about breastfeeding and infant behavior. This perception was detected within focus groups where mothers described their unrealistic expectation for the amount of crying, waking, and feeding their infant demonstrated. These mothers misinterpreted their babies frequent crying or waking as a sign of hunger and felt that her milk production was low. To satisfy the babies perceived hunger, the mothers used formula. (3) In 2007, The WIC Infant Feeding Practices Study (WIC-IFPS) gathered breastfeeding attitudes among 1233 WIC clients throughout the nation. Results indicated 55% of mothers believed their

2 milk production was insufficient for her baby. This attitude is strongly related to breastfeeding initiation, breastfeeding duration, and formula supplementation, since mothers know that bottlefeeding ensures that infants receive enough to eat. (4) In 2000, the Utah Pregnancy Risk Assessment Monitoring System (PRAMS) research study identified similar causes for decreased rates of breastfeeding: (a) mother s unrealistic expectations about breastfeeding, as well as (b) inconsistent breastfeeding information among partners, family, friends, professionals, and the community. The data, gathered from 1655 mothers in Utah, showed the highest responses for stopping breastfeeding as (1) perception that she was not producing enough milk, (2) breast milk alone did not satisfy her baby, (3) went with baby to work or school, and (4) her baby had difficulty nursing. (5) The Peer Counseling Program as a solution: Peer counselors educate new mothers and promote breastfeeding. The positive impact of peer counselors is supported by research. In 2009, Maryland WIC clinics found that clients who worked with peer counselors were 14% more likely to initiate breastfeeding than clients who received standard breastfeeding education at the certification period and 6% more likely to breastfeed than clients who worked with Lactation Consultants. (6) In 2007, researchers found that mothers who worked with peer counselor prenatally were better prepared for the breastfeeding experience. Those who worked with peer counselor postnatally had mixed feelings about their preparedness for breastfeeding. Most mothers reported a close bond to peer counselors, like the relationship to an aunt or mother. (7) Another study found that mothers who worked with peer counselors were 11% more likely to exclusively breastfeed at discharge, 27% more likely to exclusively breastfeed at one month, and 26% more likely to exclusively breastfeed at two months than mothers who received conventional breastfeeding education. (8) In 2005, researchers found that low-income Latino mothers that worked with peer counselors and participated in breastfeeding support groups were 15% more likely to initiate breastfeeding and exclusively breastfeed than mothers that received conventional breastfeeding education (prenatal breastfeeding education and hands-on breastfeeding assistance by medical staff, nurses, or lactation consultant). (9) Research shows that peer counseling is more effective at increasing breastfeeding rates than the standard or conventional education. Expanding the peer counseling program by using volunteers along with more effective breastfeeding training that includes baby behavior education can positively impact the breastfeeding rate of low-income women.

3 Current Interventions and Agencies/Programs working on this issue: The Peer Counselor Program in Texas has a goal to develop the Volunteer Peer Counselor Programs. Texas encourages volunteers to attend yearly peer counselor training.(10) Volunteerpeer counselors are most likely used by other WIC clinics; however, no results were obtained using the term WIC volunteer peer counseling program in the Google Search Engine. WIC management can use WIC Talk (an electronic discussion group) as a resource to identify other volunteer programs. Can you possibly build your intervention onto what is already in place? Currently, Salt Lake County Health Department has a peer-counseling program that uses paidpeer counselors without volunteers. The Peer-Counselor Coordinator trains and manages peer counselors. Most clinics have peer counselors for at least three days a week. Each clinic has one or two peer counselors that work most days of the week during business hours. Recent budget cuts have limited peer counselors hours, decreasing the availability of counseling. The budget for 2012 is $95,463. The budget year runs from October 1, 2012 through September 30, The unavailability of peer counselors due to budget cuts adds pressure to nutritionists to provide breastfeeding support to mothers. If nutritionists are unavailable to give the amount of time needed to consult with breastfeeding mothers, then quality of service may decrease. (11) What possible organizations are willing to partner with you on this intervention? La Leche League of and Utah Breastfeeding Coalition are organizations that can be used as a way to refer volunteers interested in breastfeeding support to the new program as explained below in the Process Objectives section refer Target population description: Pregnant and/or breastfeeding women and/or children under 5 years of age with an income level below the 185% and live in the Salt Lake County area. Diagnosis: Decreased peer-counselor support among Salt Lake County WIC clinics related to decreased grant funds as evidenced by cut in peer counselor hours and immobilizing the addition of new hirers. Intervention: Modify the peer counseling program by adding volunteers to assist mothers on the days peer counselors are unavailable. Volunteers would be called assistant-peer counselors, since their job would be to support nutritionists and peer counselors by making breastfeeding phone calls that peer counseling were not able to make during her shift and provide breastfeeding support to

4 mothers on days where no peer counselors are present at clinics. Volunteers would be trained similarly to peer counselors, so that they can provide effective breastfeeding support to clients. Issues to Address Using volunteers to support paid-peer counselors solicited the following questions: (1) would volunteers have the same positive impact as paid-counselors? (2) What problems have volunteer peer-counseling programs faced in the past? (3) Would women volunteer to be peer counselors? This section addresses these questions with the most recent research available. Impact of Volunteers In 2012, researchers compared volunteer and paid-peer counselors. Paid-full and part time counselors receive more initial training and continuing education outside of their work facility. In addition, paid-full and part time employees use client-centered skills, hands-on practice, counseling mothers face-to-face, correcting poor latch, teaching mothers to use a breast pump, encouraging and making referrals to social services more often than volunteers. Continuing education positively predicted the use of these educational techniques. When continuing education was offered at the organization facility that oversaw volunteers, more volunteers would attend than paid- and part-time peer counselors who attended continuing education outside of facility. This demonstrates that if training and education is provided it is more likely for volunteers to attend than paid-peer counselors. (12) In 2002, survey results from Canada showed mothers felt that volunteer peer counselors were available during difficult breastfeeding problems, helped increase their confidence, decreased their concerns, and assisted them in reaching their breastfeeding goals. 81.5% of mothers were satisfied with their experience working with volunteers and suggested that every new mom should be offered this intervention. Similarly, all volunteers viewed their experience as positive. (13) In 1998, a two-year study in Iowa found that volunteer peer counselors can increase the duration of breastfeeding. Mothers who worked with volunteers were 51% more likely to initiate breastfeeding and 43% more likely to continue breastfeeding at 12 weeks. Volunteers improved WIC participants knowledge about breastfeeding and nutrition by a slight amount. (14) Problems with volunteers In 2004, FNS research identified high turnover rate, sustainability, and difficulty finding volunteers as concerns about volunteer peer counselor programs. Although volunteers may have a high turnover, the paid peer counselors in Salt Lake County also have a history of high turnover, with turnover being 50% in 2011, but have decreased in Carefully informing volunteers about time commitments and using surveys to evaluate volunteers experience can help decrease turnover. Sustainability is a concern because program termination is caused most frequently by the absence of the individual(s) who first spearheaded the program. Remaining staff are often uninterested and do not support the program. The last concern mostly likely arose

5 because of the 1996 welfare-to-work legislation, which mandated the decrease of cash support to low-income families to encourage employment. This regulation made it more difficult for volunteer peer counseling programs to find volunteers. (11) However, in July 2012, congress waived the work requirements for the program, which may allow more low-income women to volunteer. Target Population of Volunteers The volunteer characteristics described by Bignell et al. are mostly white/caucasian, college educated who live in small cities (10, ,000 people). Salt Lake County has similar demographics. Perhaps, target volunteers should be white, educated women. (12) Goals Provide adequate breastfeeding support for WIC mothers by using volunteer as assistant-peer counselors to support the paid-peer counselors. Process Objectives: 1. Select two WIC clinics in the Salt Lake County as pilot programs. 2. Modify peer-counselor applications for volunteers 3. Advertise volunteer assistant peer counselor openings through United Way of Salt Lake, La Leche League of Salt Lake City, and hospitals, and WIC Talk for referrals. 4. Interview and select six volunteers. 5. Assign volunteers to clinics (one volunteer per day for eight-hour shift or two volunteers per day for four-hour shifts) 6. Assign peer counselors to assistant peer counselor to train. Utilize peer counselor coordinator to provide initial and continuing training/education. 7. Design a survey instrument to assess the breastfeeding knowledge and experiences of peer and assistant peer counselors before and after six month period. 8. Design a survey instrument to assess mothers breastfeeding experience working with volunteers. Outcome Objectives: 1. By December 2013, >85% of WIC mothers with infants will initiate breastfeeding. 2. By December 2013, >40% of postpartum women will breastfeed at least six months. 3. By December 2013, >80% of volunteers and WIC mothers who work with volunteers will report a positive experience. Proposed Intervention Description: Incorporate volunteers to support the peer-counseling program. These volunteers will be called assistant peer counselors. Two WIC clinics will incorporate volunteers into their peer-counseling program for a period of five months. The modification of the program will occur within three phases: initial training, practicum, and practicing. During the first phase volunteers will attend trainings taught by the peer-counselor coordinator and other IBCLCs at WIC. Volunteers will also attend an orientation. During the second phase volunteers will practice techniques learned

6 at the initial training with paid peer counselors and peer counselor coordinator. This may require additional hours to pay paid peer counselors. During the third phase volunteers will practice breastfeeding support alone but will have the support of nutritionists to assist if needed. Throughout the practice phase, mothers who work with the volunteers will be asked to fill out surveys regarding their experience. Volunteers will receive continuing education opportunities throughout the second and third phase. Projected timeline: See Gaant Chart. How do you plan to fund your project? By use of the peer counseling program budget and minimal amounts from the state budget to cover the additional hours paid peer counselors may need to work to train the volunteers. Projected Budget: Item Description of Expense Cost Totals Peer Counselors 24 hours for training assistants $320 $320 Supplies Additional training supplies (e.g., copies) $100 $100 Overhead 10% of project cost $42 $42 TOTAL COST $462 Monitoring and Evaluation: How do you plan to monitor the success of your program? The implementation of volunteers will be monitored using Google-doc questionnaires designed to evaluate the breastfeeding knowledge and experiences of assistant peer counselors, paid peer counselors, and mothers who worked with assistant peer counselors. Questionnaires will be completed before and after the six month intervention period. Each paid and volunteer peer counselor will complete the questionnaires. Mothers who work with assistant peer counselors will be asked to fill out an evaluation after consultations or education sessions. Process Evaluations: Provide initial breastfeeding training to volunteers during the first week of August. Provide continuing educational opportunities throughout practicum and practice phase.

7 Provide hands-on training to volunteers for two weeks with peer counselors and peer counselor coordinator. Administer survey to each volunteer, peer counselor, and participant at the beginning and end of the program. Outcome Evaluations: Evaluate pre- and post-survey results. Compare number of breastfeeding women from the beginning of program to the end using Vision.

8 References 1. Healthy People. Maternal, Infant, and Child Health Objectives. Available at Accessed October 26, Center for Disease Control. Breastfeeding Report Card United States Available at Accessed October 26, DaMota K, Bañuelos J, Goldbronn J, Vera-Beccera L, Heinig M. Maternal request for inhospital supplementation of healthy breastfed infants among low-income women. J Hum Lact ;4: McCann M, Baydar N, William R. Breastfeeding attitudes and reported problems in a national sample of wic participants. J Hum Lact. 2007;23: PRAMS Perspectives Breastfeeding in Utah. Available at Accessed October 26, Gross S, Resnik A, Cross-Barnet C, Nanda J, Augustyn M, Paige D. The differential impact of WIC peer counseling programs on breastfeeding initiation across the state of Maryland. J Hum Lact. 2009;25(4): Meier E, Olson B, Benton P, Eghtedary K, Song W. A qualitative evaluation of a breastfeeding peer counselor program. J Hum Lact. 2007;23: Anderson AK, Damio G, Chapman DJ, Perez-Escamilla R. Differential response to an exclusive breastfeeding peer counseling intervention:the role of ethnicity. J Hum Lact. 2007;23: Anderson A, Damio G, Young S, Chapman D, Perez-Escamilla R. A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community..arch Pediatr Adolesc Med. 2005;159: Texas Department of state Health Services. Peer Counselor Program in Texas-Frequently Asked Questions. Available at Accessed on October 25, Using Loving Support to Implement Best Practices In Peer Counseling. Available at Accessed October 26, Bignell W, Sullivan E, Andrianos A, Anderson A. Provision of support strategies and services: results from an internet-

9 based survey of community-basedbreastfeeding counselors. J HumLact :1; Schafer E, Vogel MK, Viegas S, Hausafus C. Volunteer peer counselors increase breastfeeding duration among rural low-income women.depart of Food Sci and Hum Nutri, Iowa State University Dennis, C. Breastfeeding peer support: maternal and volunteer perceptions from a randomized controlled trial. Birth, ;

10 Gaant Chart: Assistant Peer Counselors 1 2 Assistant-Peer Counselors Task Select two WIC clinics in the Salt Lake as pilot programs Modify peer-counselor applications for volunteers 2013 MAR. APR. MAY JUN. JUL. AUG. SEPT. OCT. NOV. DEC. JAN. COMPLETED X X Advertise volunteer assistant peer counselor openings through United Way of Salt Lake, La Leche League X 3 of Salt Lake City, and WIC Talk 4 Interview and select six volunteers X X 5 Assign volunteers to clinics X 6 Write surveys X X X 7 Distribute and collect before surveys X X 8 Initiate assistant volunteer trainings X X 9 Distribute and collect post surveys X X 10 Evaluate outcomes

11 Logic Model: Assistant Peer Counselors Goal(s): Modify the peer-counseling program by adding volunteers to support peer counselors and nutritionists. Volunteers Inputs Peer counselors Peer counselor coordinator WIC team leaders/ nutritionists Money for additional trainings Time Outputs (Implementation/Process Obj.) Activities (1) Select two WIC clinics in the Salt Lake County as pilot programs. (2) Modify peer-counselor applications for volunteers (3) Advertise volunteer assistant peer counselor openings through United Way of Salt Lake, La Leche League of Salt Lake City, and hospitals, and WIC Talk for referrals. (4) Interview and select six volunteers. (5) Assign volunteers to clinics (one volunteer per day for eight-hour shift or two volunteers per day for four-hour shifts). (6) Assign peer counselors to assistant peer counselors to train. Utilize peer counselor coordinator to provide initial and continuing training/education. (7) Design a survey instrument to assess the breastfeeding knowledge and experiences of peer and assistant peer counselors before and after six month period. (8) Design a survey instrument to assess mothers breastfeeding experience working with volunteers. Short/Medium-Term Outcomes - Impact (1) By December 2013, >85% of WIC mothers with infants will initiate breastfeeding. (2) By December 2013, >40% of postpartum women will breastfeed at least six months. (3) By December 2013, >80% of volunteers and WIC mothers who work with volunteers will report a positive experience. Long-term (1) >85% of mothers, who work with the peer counseling programs and volunteers, will initiate breastfeeding, and >40% of mothers will continue to breastfeeding for at least 6 months, within the next five years. Assumptions: I anticipate that volunteers will help increase the initiate and duration of breastfeeding among WIC mothers by supporting the Peer Counseling Program, and provide a positive experience for volunteers. External Factors: Utah Breastfeeding Coalition, La Leche League, and other WIC clinics Evaluation Formative: Feedback from peer counselor coordinator, WIC team leaders, and WIC directors to review program proposal for effectiveness by ing proposal and use track changes to insert comments as well as discuss proposal at meetings. Process: Provide initial breastfeeding training to volunteers during the first week of August, provide continuing educational opportunities throughout practicum and practice phase, provide hands-on training to volunteers for two weeks with peer counselors and peer counselor coordinator, and administer survey to each volunteer, peer counselor, and participant at the beginning and end of the program. Impact: pre and post-survey results and number of breastfeeding women before and after program.

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