Implementation of Business Case for Breastfeeding in Hampton

Implementation of Business Case for Breastfeeding in Hampton

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 Consortium for Infant and Child Health (CINCH) Child health coalition with 200+ members serving Hampton Roads, VA

EVMS is CINCHs lead agency Mission: Engaging the community to improve childrens health in Hampton Roads Focus: Obesity, Respiratory Health, Access to Care, Healthy Communities Approach: Policy, Systems, Environmental Change Learning Objectives 1.

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

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 Worksite Lactation Support Program

Components Private Space Flexible Breaks Education Support Outreach Approaches 1.

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

In-person consultation & site visit at workplace to introduce BC4BF toolkit & Project Lactation Assessment Form Free technical assistance Eligibility criteria for limited-time Incentives Eligibility Criteria for Incentives 1. 2. 3. 4. 5. 6. Lactation Program Assessment Lactation Support Policy Designated Lactation Area Procedures Company-wide Promotion

Employer Spotlight The Sell - Benefits to Business Compliance with FLSA Wellness Initiative increased productivity decreased absenteeism improved staff morale cost savings Healthy Baby Healthy Mom Healthy Business

Competitive Employee Benefit Community Role Model 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 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 employees 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

Policy Example, cont. 2. 3. 4. 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 Departments lactation space or more information. 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. Breaks for nursing mothers will be provided for up to one year after the birth of a child. Expressed breast milk must be stored in personal coolers.

Lactation Rooms and Signage: Educational Institution Setting Lactation Rooms and Signage: Educational Institution Setting Lactation Room: Hospital Setting Before After Lactation Room Military Setting Before After Implications for Implementing

Health Reform 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

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) 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 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 Lactation Assessment Form (LAF)

General information about business/worksite Human Resources e.g. # women of childbearing age, pregnancy and breastfeeding rates, absenteeism, etc. Company Policies e.g. type, size, role of respondent

e.g. general lactation support, leave, return to work, insurance coverage Lactation Program Components e.g. Infrastructure, breastfeeding options, funding, resources, etc. The Businesses/Employers Lactation Program Assessment Descriptive Results Business Size n = 15 Small (1-99 employees) 3 Mid-sized (100-499 employees) 4 Large (500 or more employees) 8

% 20% 27% 53% Estimated Potential Impact Count Range Female Employees, age 16-44 Male Employees age 16-44 New Babies - Annual Estimate >4,61915 to 842 1,353 3 to 233 213 1 to 50 The Businesses/Employers

Lactation Program Assessment Descriptive Results Policy and Insurance Items Count Percent Lactation Policy Status No Previously Existing Policy 8 53% Previously Existing Policy 7 47% 11

73% 13 87% 2 13% Unwritten and/or Unofficial Maternity Leave Policy FMLA Disability Insurance The Businesses/Employers Breast Pump Equipment Employees Receive Count % None, employees use their own 9 Purchased hospital-grade electric pump

1 Rented hospital-grade electric pump 1 Portable pumps 0 Other 3 Unknown 1 Breast Milk Storage Employee provided cooler 11 Company provided cooler 0 Small designated refrigerator 3 Public shared refrigerator 7 Other 2

60% 7% 7% 0% 20% 7% 73% 0% 20% 47% 13% Evaluation Measures Likert-Type Scales 1. 2. 3. 4.

5. 6. Level of Engagement with the Project Stage of Change TransTheoretical Model of Behavior Change adapted for organizations Comprehensiveness of Lactation Support Program Components Level of Policy Development Changes in Physical Environment Changes in Social Environment 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 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

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.) 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 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 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 Results: Baseline and Post Intervention Comparison of Means, p = < 0.0001 4.5 4 3.94 4 3.65

3.53 3.5 Baseline 2.88 3 2.53 2.5 2 1.76 1.71

1.59 1.5 1 3.94 1.29 1 0.5 0 (E) (TTM) (Comp) (P) (PE) (SE)

PostIntervention 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 Case Example, EVMS: Evolution Pre - Post Baseline Post Intervention 5 5 4

5 4 3 2 2 1 1 Engage SOC Comp

1 Policy 1 PhysEnv SocialEnv Case Example: EVMS Established 5 lactation rooms Plans to establish more rooms in all buildings on campus 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) 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 Support

Virginia Department of Healths CHAMPION Program (Commonwealths 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) Resources

Business Case for Breastfeeding: http://www.womenshealth.gov/breastfeeding/government-inaction/business-case-for-breastfeeding/ Fact Sheet #73: Break Time for Nursing Mothers under the FLSA : http://www.dol.gov/whd/regs/compliance/whdfs73.htm AIA Lactation Room Design form: http://www.aia.org/aiaucmp/groups/ek_public/documents/pdf /aiap037226.pdf Sample policy development guide: http://www.cdph.ca.gov/programs/breastfeeding/Documents/ MO-BF-WorkPolicy.pdf

Thank you Questions? Amy Paulson, MPH, AE-C 757-668-6426 [email protected] www.cinchcoalition.org www.facebook.com/cinchcoalition Twitter @CINCHCoalition www.facebook.com/healthyhr

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