Thank You To Our Sponsors - Albany
8/2/2016Breastfeeding Grand Rounds 2016Building a Continuum of Care to SupportExclusive Breastfeeding in New York StateAugust 4, 2016Thank You to Our Sponsors: University at Albany School of Public Health New York State Department of Health, SpecialSupplemental Nutrition Program for Women,Infants and Children (WIC)1
8/2/2016Evaluations & CE CreditsCME, CNE, CHES, LCERPs & general CEU credits areavailable. Other professional specialties such asregistered dieticians may request the CEU certificate &provide it to their accrediting body.Please fill out yourevaluation and post-test lConflict of Interest &Disclosure StatementsThe planners and presenters do not have any financialarrangements or affiliations with any commercialentities whose products, research or services may bediscussed in this activity.No commercial funding has been accepted for thisactivity.2
8/2/2016Featured Speakers Ruth Lawrence, MD, Professor of Pediatrics & Obstetrics &Gynecology, University of Rochester School of Medicine andDentistry Patricia Jordan, MS, RDN, CDN, Assistant Director, Bureau ofWomen, Infant and Adolescent Health, New York State Departmentof Health Deborah Gregg, MPH, RDN, CDN, CLC, Nutrition Policy Coordinator,Division of Chronic Disease Prevention, New York State Departmentof Health Kate Rose Bobseine, MPH, CLC, Obesity Prevention ProgramCoordinator, Bureau of Community Chronic Disease Prevention, NewYork State Department of HealthProgram Objectives Describe two components of the WIC Exclusive Breastfeeding(BF) Learning Community Describe three criteria for achieving the BF Friendly PracticeDesignation Describe three components of the NYS BF Quality Improvementin Hospitals Initiative List two benefits of incorporating BF support services intomedical practices Describe three ways that WIC programs, obstetric, pediatric andfamily practices can empower women to exclusively breastfeed3
8/2/2016New York StateDepartment of Health Initiatives The Special Supplemental Nutrition Program forWomen, Infants and Children (WIC) ExclusiveBreastfeeding Learning Community Breastfeeding Friendly Practice Designation Breastfeeding Quality Improvement in HospitalsComplementary Strategies OB/GYNs and Midwives – breastfeeding education andsupport during pregnancy WIC – breastfeeding education and peer counselingsupport during pregnancy and after delivery Hospitals – supportive breastfeeding practices andprotocols Pediatric and Family Practitioners – newborn follow upand lactation support for breastfeeding mothers4
8/2/2016Benefits of Breastfeeding Species Specific – human milk is for human Infants Protection against chronic diseases and certain cancers– for mothers and babies Reduced risk of diarrhea, upper respiratory infectionsand Sudden Unexplained Infant Death in babies Breastfeeding is the physiologic completion of thereproductive cycle Lactation suppresses ovulationCurrent Breastfeeding ResearchHard wiring ofinfant’s brain –exclusivebreastfeedinghas significantimpact5
8/2/2016Risks of Not BreastfeedingMotherInfant Increased risk of cancers, Permanent alteration of thechronic disease and maternalinfant microbiomepost partum depression Increased risk of obesity, Increased risk of obesityallergies, SUID, diarrhea, andupper respiratory infections Impact on hard wiring anddevelopment of the brainBarriers to Breastfeeding Support Inconsistent or incorrect Information Events in the hospital during and after birthexperience can impact breastfeeding Introducing breast milk substitutes when they are notnecessary Lack of knowledge and support from families6
8/2/2016Breastfeeding Support A woman’s intention to breastfeedcan be easily derailed withoutsupport Women need to learn about theimportance of breastfeeding duringpregnancy Mothers need to learn aboutnewborn behavior and feeding cuesand taught how to breastfeed“Just like a babyneeds to feelsafe, so does themother. Sheneeds to trust herproviders and feellike her needs arebeing heard andbeing supported ”WIC Exclusive BreastfeedingLearning Community WIC Learning Community ToPromote Exclusive Breastfeeding Exclusive breastfeeding rates arelow among NYS WIC mothers Initiation: 82.4% Exclusivity at 3 months: 13.0% WIC serves 50% of infants born inNYS7
8/2/2016New York State EBFLCNew York State Exclusive Breast Feeding LearningCommunity Opportunity for WIC local agencies to learn fromtrainers and each other, while setting agencyspecific goals to implement effective systems toreplicate a successful breastfeeding intervention Provide intensive on-going support Provide peer supportYou Can Do It / WIC Can Help A successful initiative to increase exclusivebreastfeeding in Vermont was replicated in 12 NYSWIC Local Agencies (LAs) Each LA formed an interdisciplinary performanceimprovement team (12 teams, 47 WIC staff) Teams participated in 7 learning community sessions Teams tested and implemented changes at LAs8
8/2/2016Intervention ComponentsBreastfeeding AttritionPrediction Tool (BAPT) Breastfeeding Attrition Prediction Tool (BAPT) wasused to assess knowledge, support, and confidenceabout breastfeeding 26 questions were used and scored to identifyprenatal moms strengths and those at risk forstopping breastfeeding early The BAPT identifies target areas to work on inknowledge, support and confidence189
8/2/2016Targeted CounselingCase ConferencingNutritionist, BreastfeedingCoordinator and PeerCounselor meet to holddiscussions to improvebreastfeeding outcomes2010
8/2/2016Targeted Group DiscussionsEducate and Support Mom With: Her commitment to breastfeed Hospital practices that support breastfeeding Communicating feeding plan to birth support teamand hospital birthing center Advocating for herself and baby during hospital stay Breastfeeding - first few weeks postpartum21Post-Natal ContactsPurpose of Multiple Contacts after Birth Early Breastfeeding and infant assessments Provide timely support and referrals Help mom with confidence and knowledge Prevent introduction of formula2211
8/2/2016Public Health DetailingLearning Community Peer Counselor12
8/2/2016Confident CommitmentPreliminary Outcome Data Possible impact on exclusive breastfeeding ratesamong participants Intervention may be more effective among AfricanAmerican women Possible impact may be due to differences acrosslocal agencies13
8/2/2016Local Agency Successes Improved WIC staff counseling Improved staff collaborationskills, breastfeedingthrough case conferencingknowledge and confidence Tailored counseling Exposed more staff to theencouraged participants toimportance of breastfeedingshare breastfeeding concernspromotion; fostered consistent(staff perspective)breastfeeding message Public Health Detailing Local agencies learned fromimproved relationships witheach others’ experiencesprovidersChallenges Enrolling moms in first trimester Nutrition staff and Peer Counselors don’t always worktogether Appointments were longer Keeping track of appropriate materials for each visit Finding out when moms delivered14
8/2/2016Lessons Learned Train all staff to carry outintervention Be flexible in scheduling caseconferences To identify and enroll firsttrimester prenatals:– Involve WIC clerical staff– Use community partnerreferrals Allow 30 min for targetedcounseling sessions Conduct multiple stafftrainings Hold regular interventionstaff briefings & include PCs Use creative methods tocontact momsNext Steps Process evaluation to identify characteristics of sitesand site implementation with high and low rates ofexclusive breastfeeding improvement Expand implementation in NYS WIC clinics15
8/2/2016New York State BreastfeedingFriendly Practice DesignationNew York State BreastfeedingFriendly Practice DesignationDesignation Aim: To support increased breastfeeding durationand exclusivity to advance both short and long-term healthbenefits for women and children Engages practices to create a continuum of breastfeedingcare Care is consistent and complements the WHO’s Ten Steps toSuccessful Breastfeeding in hospitals Recognizes practices that have adopted and implementedthe NYS Ten Steps to a Breastfeeding Friendly Practice16
8/2/2016Provider Roles in Practices Infant feeding decisions often made during pregnancy- obstetricians play a key role Pediatric care providers assess newborns in thehospital and at follow-up (48-72 hours of age andbeyond) – opportunities to encourage/supportexclusive breastfeeding Family physicians have relationships with families opportunities to promote breastfeeding during thepreconception period, pregnancy and postpartumRole of Obstetric ProvidersPrenatal Visits Conduct breast exam and history at the initial visit Start the breastfeeding conversation Begin breastfeeding education with all family membersinvolved with child care Encourage attendance at prenatal and breastfeedingclasses Create a birth plan together Support patient decisions for breastfeeding afterpregnancy17
8/2/2016Optimizing Support of ObstetricPractices for Breastfeeding Obstetric care providers are important resources Lactation is a two-person activity; breastfeeding problems arebest assessed by evaluating the woman and her infant, andengaging the support from the mom’s partner and family Trained medical office staff can triage common breastfeedingconcerns, and as needed, refer women to lactation professionals:International Board Certified Lactation Consultants (IBCLCs) orCertified Lactation Counselors (CLCs)ACOG Committee Opinion No. 658 February 2016The Birth HospitalizationSupport evidence-based maternity practices such as: Skin to skin and the “golden hour” Rooming-in No formula marketing or supplementation of breastfed infants,unless medically necessary Develop hospital discharge systems, i.e., warm lines, peer supportgroups, Baby Cafés , home visits, etc.Work with and encourage support by: Nurse midwives and doulas Hospital lactation consultants, nurses and managers Obstetrician and pediatrician WIC Peer Counselors18
8/2/2016Patient-Provider CommunicationPercent (%) Breastfeeding at 6 weeks70735441359Favors BreastfeedingNo PreferenceFavors Formula FeedingHealth Care Provider OpinionPrenatal PhysiciansHospital StaffRole of Pediatric Providers Establish relationship with mother and family prior to delivery Conduct infant assessments at bedside after birth - opportunityto discuss breastfeeding with mother’s support (family & friends) Make sure hand expression is taught and mother is confidentabout latch, positioning and milk transfer Schedule post-discharge appointment within 48-72 hours toevaluate infant’s health and establishment of breastfeeding Observe a breastfeeding session19
8/2/2016U.S. Preventive Services Task ForceRecommendation, 2008 and Draft 2016 Grade B recommendation: Moderate benefit ofmultifaceted/multimodal interventions that promote andsupport breastfeeding Interventions increase breastfeeding initiation, duration,and exclusivity Interventions that include both prenatal and postnatalcomponents most effective at increasing duration System-level interventions having support of seniorleadership more likely to be sustained over timeProvider-BasedIntervention Effectiveness Individual or group education:– Increased initiation - 23%, CI 12-34%– Increased duration up to 3 months - 39%, CI 27-50% Combined education & in-person or phone support:– Increased initiation - 21%, CI 7-35%– Increased duration up to 3 months - 36%,22-49%– Increased duration 4-6 months - 13%,1-25%CICICI Confidence Interval20
8/2/2016Ten Steps to a BreastfeedingFriendly Practice Supported by: Academy of Breastfeeding Medicine,American Academy of Pediatrics, American College ofObstetricians and Gynecologists, American Academy ofFamily Physicians; Centers for Disease Control andPrevention, United States Breastfeeding Committee, WIC Based on two Academy of Breastfeeding Medicine ClinicalProtocols: # 2 and #14 Designed to complement the World Health Organization’sTen Steps to Successful Breastfeeding and the BabyFriendly Hospital InitiativeTen Steps to a BreastfeedingFriendly Practice1. Develop, implement and maintain a breastfeeding-friendly officepolicy2. Train all staff to be breastfeeding-friendly by promoting,supporting, and protecting breastfeeding3. Discontinue routine distribution of breast milk substitutes andeliminate formula marketing materials and gift packs from youroffice4. Create a breastfeeding-friendly office environment5. Discuss the benefits of breastfeeding, especially exclusivebreastfeeding, and the basics of breastfeeding management withwomen and their families during the prenatal period21
8/2/2016Ten Steps to a BreastfeedingFriendly Practice6. Discuss the benefits of breastfeeding, especially exclusivebreastfeeding, and the basics of breastfeeding management withwomen and their families during the postpartum period7. Encourage breastfeeding mothers to feed newborns only breastmilk8. Teach mothers about maintaining lactation when separated fromtheir infants9. Identify your local breastfeeding support network and fostercollaborative working relationships and referral systems10. Provide comprehensive breastfeeding support to new mothersThe Designation Process Review the NYS Ten Steps to A BreastfeedingFriendlyPractice Implementation Guide Complete the NYS Breastfeeding Friendly Practice Designationpre-assessment form to assess practice status compared to theTen Steps Identify a practice champion(s) and establish a team to test,refine and implement the Ten Steps When all Ten Steps are implemented, submit the postassessment form and written breastfeeding office policy22
8/2/2016NYSDOH Web ResourcesNYS Ten Steps to a Breastfeeding Friendly Practice Introductory Letter The NYS Ten Steps Implementation Guide Designation Assessment Survey (fillable form)TakeawaysDesignated practices have reported: Meeting more of the breastfeeding needsof patients Increasing patient satisfaction Increasing the comfort of practice staff because of beingtrained on all aspects of providing breastfeeding support Increasing breastfeeding rates in their practice Creating a breastfeeding friendly office is just the rightthing to do!23
8/2/2016Next Steps for BreastfeedingFriendly Practices 35 practices and their sites designated, as of July 2016 Release of Request for Applications (RFA): “CreatingBreastfeeding Friendly Communities”– Develop/Expand Coalitions– Spread Breastfeeding Friendly Practice Designation– Spread Breastfeeding Friendly Childcare Designation– Establish Baby Cafés – Build Supportive WorksitesBreastfeeding Quality Improvementin Hospitals (BQIH)24
8/2/2016Breastfeeding MetricsHealthy People 2020 Goals vs NYS10081.980PercentHP 2020Goals86.67060.6 55.86034.1 31.340NYS Data43.446.237.125.52016.9060Formula Supplementation ofBreastfed Infants at 2 Days49.850HP 2020 GoalsPercent4028.83020NYS - Birth Certificate19.414.2U.S. - NIS10NYS - NIS05025
8/2/2016Breastfeeding Quality Improvementin Hospitals (BQIH) NYSDOH & National Institute for Children’s Health Quality(NICHQ) Partnership Purpose: Support participating hospitals to build and sustainsystems changes to achieve the Ten Steps to SuccessfulBreastfeeding, thereby increasing the exclusive breastfeedingrate among healthy newborns during birth hospitalization in NewYork– Create hospital environments that support breastfeeding– Reduce disparities in New York State breastfeeding rates,especially among low-income women who participate in WICand MedicaidBQIH Implementation Hospitals engage multi-disciplinary improvementteams to– Set hospital-specific goals– Test and implement changes– Share results– Share ideas with other BQIH hospital teams26
8/2/2016Multi-disciplinary Improvement Team Senior Hospital Administrative LeaderPhysician Champion(s): OB, Pediatrics, Family MedicineNurse ManagerSenior lactation staff memberMother PartnerManager from affiliated prenatal servicesQuality Improvement SpecialistITLocal WIC representativeData Collection for QualityImprovement (QI) Purpose of QI measurement is learning notjudgment Hospital Data Collection– Baseline data: Where are westarting?– Monthly Data: How are we doing?Are our changes making a difference? Share data back to team27
8/2/2016BQIH TimelineFebruary 2010-December2011October 2014 February 201612 Hospitals(Pilot)12 Hospitals(Cohort A)May 2016 March 201821 Hospitals(Cohort B)BQIH: Pilot & Cohort A SuccessesPilot and Cohort A - Increases in the percentage of:– Infants fed only breast milk– Breastfeeding infants rooming in– Mother/infant dyads initiating breastfeeding within 1 hour(vaginal delivery) and 2 hours (C-section delivery) of birthCohort A - Increase in the percentage of:– Mother/infant dyads feeding on cue– Mother/infant dyads who received a breastfeedingassessment28
8/2/2016BQIH Cohort B May 2016 – March 2018 in 21 NYS maternity hospitals Increased focus on WIC EngagementTakeawaysMore and more hospitals across the state and around the countrytaking this work on: 72 Hospitals across New York State– 45 hospitals outside of NYC– 27 hospitals in NYCYou can do this work, too! Start small with one step Recruit a team Find a champion Gather and share your data29
8/2/2016Importance of All Providers and WICPrograms Across the Care Continuum Maintain, update and communicate breastfeedingpolicy Train all staff regardless of the position Learn motivational interviewing techniques Tailor counseling to the needs of each mother Discontinue all marketing of breast milk substitutes Create breastfeeding-friendly environments Establish breastfeeding community support networks Create a referral and triage system for follow-upBreaking Down Barriers Incorporate public health interventions at each stageof a mother’s reproductive journey Foster collaboration at the personal, medical, andcommunity level to ensure consistent breastfeedingeducation and support Incorporate strategies that empower women to buildconfidence, make informed feeding decisions, andutilize lactation support30
8/2/2016Leadership You can do it - find champions at all points in thecontinuum of care Resources available on BFGR 2016 program webpage A breastfeeding friendly practice is the right thing todo! Leadership at all levels is important Call to Action from NYS Health Commissioner HowardA. Zucker, MD, JD Evaluations & Continuing Education: CME, CNE, CHES,LCERP and General CEU credits are available. Please visithttp://www.albany.edu/sph/cphce/bfgr16.shtml to fill outyour evaluation and complete the post-test. Conflict of Interest Disclosure Statement: The planners andpresenters do not have any financial arrangements or affiliationswith any commercial entities whose products, research orservices may be discussed in this activity. No commercial fundinghas been accepted for this activity.Thank you!31
8/2/2016Evaluations32
Supported by: Academy of Breastfeeding Medicine, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Academy of Family Physicians; Centers for Disease Control and Prevention, United States Breastfeeding Committee, WIC Based on two Academy of Breastfeeding Medicine Clinical Protocols: # 2
Lord, You’ve been so good to me Lord, I thank You You are my help, You meet my need Lord, I thank You You were my strength when I was weak Lord, I thank You Your love and mercy rescued me Lord, I thank You I thank You Lord Lord, I thank You I thank You Lord Lord, I thank You Every time I think of
Valley Ag Software US Dairy Education and Training Consortium 2015 Student Directory Endowed Sponsors: Executive Platinum Sponsors: Platinum Sponsors: Gold Sponsors: Name: Clinton Al-ag Campus Address: 2501 4th Ave City/State/Zip Code: Canyon, TX 79015 Telephone: 806-228-6279
2020 IEEE Applied Power Electronics Conference and Exposition . 4 . CONFERENCE AND EXPOSITION . APEC 2020. PARTNERS. GOLD SILVER PLATINUM. SPONSORS AND PARTNERS. Thank you to our 2020 Sponsors and Partners. SPONSORS. APEC 2020 Sponsors provide financial backing (inclu
Mail Just Sold postcards Send Thank You card to buyer with information about the town Send Thank You card to seller with (contact info is on HUD) Send Thank You card to Listing Agent Send Thank You card to Lender Send Thank You card to Closing Attorney Send Thank You card to Appraiser Send Thank
Liff, Walsh & Simmons The MacKenzie Companies Mark and Lisa Emmons MaxSent Meridian Financial Management, Inc. NUTANIX PEAKE, LLC Pusser’s Caribbean Grille TAM Financial Advisors Tony J Photography Visibiome What’s Up? Media WRNR Yorktel CAPTAIN SPONSORS ANGLER SPONSORS FIRST MATE SPONSORS DECKHAND SPONSORS The
Nov 10, 2016 · Toarmina's Pizza William D. Ford Career Technical Center/Café Marquette Thank You to Our Sponsors to Date: Platinum Sponsors - Michigan Chiropractic Specialists, PC - Dr. Amanda Apfelblat Westland Mayor William R. Wild Gold Sponsors -Ameriprise Financial/An
work/products (Beading, Candles, Carving, Food Products, Soap, Weaving, etc.) ⃝I understand that if my work contains Indigenous visual representation that it is a reflection of the Indigenous culture of my native region. ⃝To the best of my knowledge, my work/products fall within Craft Council standards and expectations with respect to
chapter twenty five - quotes to say thank you 49 chapter twenty six - thank you card poems 52 chapter twenty seven - thank you in spanish 55 chapter twenty eight - thank you wording after an interview 57 chapter twenty nine - thank you pastor 59 chapter thirty - thank you teachers 61 chapter thirty one -
