Becoming Baby-Friendly… The Ontario Journey

Presenter: Linda Young Director, Director Maternal Newborn Child Mental Health,

Interprofessional Practice and Organizational Learning at Toronto East General Hospital And Lead for the BFI Strategy

Disclosure of Commercial Support

CFPC Conflict of Interest

Presenter Disclosure Presenter: Linda Young Relationships with commercial interests: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: None

How many of you are from…? - Public Health Unit - Community Health Centre - Aboriginal Health Access Centre - Family Health Team - NP-Led Clinic - Birthing Centre - Hospital - Other

Getting to Know You!

Who has started their BFI journey?

Getting to Know You!

∗ Global evidence-based model based on The World Health Organization Ten Steps to Successful Breastfeeding and the WHO/ UNICEF International Code of Marketing of Breastmilk Substitutes.

∗ Practice standards and policies that enhance the successful initiation and duration of breastfeeding.

∗ Protect breastfeeding by ensuring that industry marketing of breastmilk substitutes meets ethics standards.

What is the Baby-Friendly Initiative (BFI)?

Evidence proves…

∗ Value of BFI to enhancing breastfeeding support in hospital

∗ Value of ongoing health care provider support for breastfeeding success

Why Become Baby Friendly?

Steps to Becoming Baby-Friendly

Facility Multidisciplinary Breastfeeding Committee

Facility Capacity Building Visit

Pre-Assessment Document Review

Pre-Assessment Site Visit

External Assessment Site Visit

BFI client education resources on Best Start Resource Centre at Health Nexus website

Baby-Friendly Initiative Resource Guide

PCMCH Report and addition of BFI to Accreditation standards for hospitals

BFI in accountability agreements for Public Health Units

Rogers Hixon Ontario Human Donor Milk Bank

Mother-Baby dyad care initiative through PCMCH

BORN data report on BFI indicators and CQI information

CPS Baby-Friendly guidelines and RNAO BPG

Readiness for Change

∗ Providing 24 hour telephone access to expert support to breastfeeding mothers

∗ Providing hospitals and community health organizations with training, tools, guidance and resources to help achieve World Health Organization’s BFI designation and adopt best practices that meet BFI requirements

∗ Providing targeted support for mothers in population groups that have lower rates of breastfeeding

MOHLTC Commitment

Future State

• 36 Public Health Units

Current BFI Designated

∗ 3 hospitals - TEGH, SJ Hamilton, Grand River

∗ 2 Community Health Centres

∗ 15 Public Health Units

Scope

• 92 Hospitals • 55 Community Health Centres • 10 Aboriginal Health Access

Centres • 25 NP-led clinics • 185 Family Health Teams • 2 Birthing Centres

∗ Need for leadership support and commitment for changes required to become BFI designated

∗ Lack of clear path and support to navigate BFI journey

∗ Costs for staff education for 20 hour course

∗ Need for efficient and reliable data collection system for community organizations

∗ Timely access to BCC assessors

∗ Availability of trained lactation consultants to assist with achieving and maintaining the BFI

Identified Barriers/ Opportunities

Do the listed barriers/opportunities resonate with your experiences? Are there other major barriers that you would like to share?

Barriers and Opportunities

Increase the evidence-based support provided to women who wish to breastfeed by:

∗ Increasing the number of hospitals and community health organizations involved in pursuing BFI designation as measured every six months

∗ Increasing the number of hospitals and community health organizations that have achieved BFI designation or re-designation as measured every six months

∗ Implementing a continuous improvement strategy for BFI designated organizations to ensure the evolution and enhancement of breastfeeding in Ontario

Goals of the BFI Strategy

1. Establish and lead a collaborative partnership with organizations that have the knowledge, expertise and credibility to collectively support obtaining BFI designation

2. Develop and implement an effective stakeholder awareness and engagement plan throughout the BFI adoption process

3. Establish strategies to enhance the development and use of BFI focused patient education materials

4. Coordinate implementation of the recommended 20 hour training/education course for health care professionals who provide direct care and support regarding breastfeeding

5. Develop a strategy to foster/ drive uptake and adoption of BFI designation

6. Develop a strategy for monitoring the progress on adoption of BFI

Objectives

∗ Increased rate for initiation of breastfeeding ∗ Increased rate of exclusive breastfeeding at discharge from

hospital ∗ Decreased non medical supplementation in hospital ∗ Increased duration of breastfeeding ∗ Increased number of organizations with BFI designation

Expected Impact

Ultimately, a positive impact on the

health of infants and mothers in Ontario

Supports Available to You!

∗Toolkits

∗Webinars

∗Coaching

Toolkits

Implementation Toolkit

BFI 20-Hour Course Toolkit

Targeted Webinars

Topics for webinars ∗ Webinars for each of the 10 Steps ∗ Dealing with the formula dilemma ∗ Defining and managing medical supplementation ∗ Sustaining provider BFI knowledge post-education ∗ Leveraging regional networks

What topics would you suggest?

Engagement and Coaching

Coaching Support

Website

Regional visits

Newsletter Clearing House

Mobile coaching

teams

Webinars

Any other strategies you would suggest?

Q1 Q2 Q3 Q4

BFI Work Plan 2014-2015

• Strategy for regional delivery of the BFI Implementation and 20-hour course workshops

• Clearing House • Assessor

Workshop • Toolkit translation • BFI Scorecard • Initiate BORN

Report/Scorecard • Official Launch

• Coaching regional networks

• Tools to support BFI implementation

• Initiate 20 hour TTT workshops

• Targeted communications for organizations not engaged

• Funding support for LC training

• BFI data collection for community orgs

• Patient education materials for special needs patients

• Provide in-person training for 20-hour course

• Complete BORN BFI report

• Begin special topics webinar series

• BORN ON report stage II

• Continue workshops, webinars and coaching strategies

Tracking Our Progress

Growing a Baby-Friendly Ontario!

Key Performance Indicators

Development of BFI Capacity

• Number of coaching sessions held for hospitals and community health services.

• Number of hits to BFI Clearing House.

• Number of workshops delivered. • Implementation • BFI 20-Hour Course

• Number of direct care providers trained in BFI 20-hour Courses delivered through the Strategy.

Adoption of the BFI

• Number of organizations progressing through each implementation phase.

• Number of new or repeat designations achieved (Note: given starting point this will be 0 to 1or 2 for current year).

Impact on Breastfeeding Rates

• Rate of initiation of breastfeeding in hospital.

• Rate of exclusive breastfeeding at discharge from hospital.

• Rate of supplementation. • Rate of medically indicated

supplementation. • Rate of exclusive

breastfeeding with medical supplementation (“adjusted breastfeeding rate”).

• Rate of exclusive breastfeeding to about 6 months (Note: this indicators will be tracked in‘15-’16).

Survey Tool

Initial Results - Hospitals

Total Responses

No Response

Not Formally Initiated

Preliminary Work

Intermediate Work

Phase I

Intermediate Work Phase

II

Advanced Work

BFI Designation

36/92 (39%)

56 (61%)

24 (26%)

4 (~4%)

1 (1%)

4 (~4%)

0 (0%)

3 (~3%)

First Wave of Engagement (as of February 4, 2014)

Note: Number of hospitals are based on survey submissions. Some sites have discontinued OBS services, while others have merged and responded on behalf of multiple sites.

∗ Sent reminder letter to LHIN CEOs ∗ Hosted eight introductory webinars ∗ Launched project microsite ∗ Engaged BORN coordinators to encourage

participation ∗ Contacted individual hospitals one-on-one ∗ Prepared and presented displays at conferences ∗ PCMCH news article

Engagement Strategies

Initial Results - Hospitals

Total Responses

No Response

Not Formally Initiated

Preliminary Work

Intermediate Work

Phase I

Intermediate Work Phase

II

Advanced Work

BFI Designation

77/92 (84%)

15 (16%)

65 (71%)

4 (~4%)

1 (1%)

4 (~4%)

0 (0%)

3 (~3%)

Second Wave of Engagement (as of April 28, 2014)

Initial Results – Community Health Services

Total Responses

No Response

Not Formally Initiated

Preliminary Work

Intermediate Work

Phase I

Intermediate Work Phase

II

Advanced Work

BFI Designation

CHCs 22/55 (40%)

33 (60%)

17 (30%)

2 (1%)

1 (~1%)

0 (0%)

0 (0%)

2 (1%)

FHTs 4/187 (2%)

183 (98%)

4 (2%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

NPLC 6/24 (25%)

18 (75%)

6 (25%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

AHACs 1/10 (10%)

9 (90%)

1 (10%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

How can we raise awareness and ensure effective communication with community health services…

Engagement

Complete the BFI Implementation Status Report every three months.

Read and share the BFI Strategy Newsletter.

Participate in webinars and other coaching activities.

Advise on challenges you are experiencing.

Let us know if you would be interested in being an early adopter or workshop participant!

Visit our microsite at www.tegh.on.ca/bfistrategy.

Working Together

Questions? Suggestions?

Contact: Kristina Niedra Project Manager, BFI Strategy Toronto East General Hospital knied@tegh.on.ca