Dallas WIC Community Collaborative Training Initiative

The Baby Friendly Hospital Initiative (BFHI) is a global birthing facility recognition program that encourages full implementation of the World Health Organization/ UNICEF’s Ten Steps to Successful Breastfeeding. 

These Ten Steps help to create supportive breastfeeding environments where a mother’s feeding choice is best supported. The program is recognized as the “gold standard” for lactation and is included as a target in Healthy People 2020. 

Project Overview

Three Dallas-area hospitals began working toward implementing the WHO/UNICEF’s Ten Steps to Successful Breastfeeding and participated in state and national breastfeeding initiatives in 2012:

• Methodist Charlton Medical Center participated in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, which paired hospital staff with local area WIC staff. 
• Methodist Dallas Medical Center and Parkland Health & Hospital System participated in the U.S. Centers for Disease Control (CDC)- funded Best Fed Beginnings Initiative. Both initiatives were overseen by the National Institute for Children’s Health Quality (NICHQ). 

All three facilities were pursuing the BFHI designation and had identified Step 2: staff training as a barrier based on the number of staff requiring training and costs affiliated with training. 

Each facility serves a racially diverse population and has a combined estimated annual birth rate over 17,000.

A strong partnership was developed with Dallas WIC, which served on hospital task forces for both initiatives. Partnerships helped to support Steps 3: prenatal education and 10, post-discharge support of the Ten Steps Program. 

Examples of the diverse hospital activities supported by Dallas WIC to date include:

• In-patient breastfeeding support with WIC Peer Counselors
• Creation of a warm chain of support through developed discharge referral system with the City of Dallas WIC Lactation Care Center.
• Clinical educational training for medical residents, physicians and nursing staff offered by the WIC Lactation Care Center in Dallas. 
• WIC staff support for hospital breastfeeding promotion committees. 
• Medical and nursing staff training on baby behavior and grand rounds.

Step 2 requires both didactic and skills-based training. Requirements include 15 hours of didactic lactation education and five hours of clinical or hands on education. Between the three hospitals, more than 1,000 nurses were identified as needing these educational hours. 

An online format was chosen for the didactic component, but the five hours of hands on education was daunting. 

The manager of the Dallas WIC Lactation Care Center, an outpatient breastfeeding clinic funded through the Texas WIC program and managed by the City of Dallas, suggested that the three hospitals collaborate to develop a supervised clinical workshop with Step 2 materials.   

Six key breastfeeding advocates were selected from the three hospitals and WIC. Six content areas were selected and each person created a module that would provide staff with an interactive educational experience on key topics:

• Safe skin to skin care
• Hand expression of breast milk
• Care and use of breast pumps
• Evaluation of an effective latch
• Safe formula preparation
• How and when to use supplemental feedings
• Positive messaging.

Members of Dallas WIC and the hospitals involved in creating the training met in a central location to share their successes and areas for improvement. This toolkit is the result of our work. 

The information is evidence-based and a compilation of the work of lactation experts from around the world. 

Background:

• The workshops began in September of 2013 and provided four trainings a month were given through June 2104. Since then workshops are held two or three times per quarter.
• Since its inception, more than 2,300 nurses have received the training and information on this workshop has been shared and adapted with other WIC agencies to implement in their community and across the nation. 
• Two hours of additional skills-based training was provided by the education departments of each participating hospital.
• No endorsement was made for any breastfeeding products, but a variety of products were used for demonstration purposes.

A CE application was completed for 3.2 hours of continuing education hours for all RNs who attended the program. The Nursing Education office at Parkland Health & Hospital Systems is a CE provider through ANCC and facilitated the process. All participants signed in and completed an electronic or written evaluation. Designated PHHS educator staff reviewed the sign in lists and the evaluations and then provided certificates for all attendees. The certificates were distributed to the individual hospitals or emailed directly to the student.

The goal of this training is to create a relaxed and intimate learning environment. To create this atmosphere, the following design concepts were implemented:

1. Provide more hands-on learning than didactic or lecture style learning. This includes having a hands-on component of each of the modules.
2. Keep the group sizes to fewer than 10 students per module at one time. This greatly limits the size of the overall class per session; however, keeping a small student to teacher ratio allows for more time for questions and better hands-on experience for students.
3. Create a relaxed (non-sterile) learning environment that is unique for most healthcare workers. This includes use of indirect lighting/lamps, music, snacks, discussions and role playing.
4. To keep the class on time it was important to create a flow sheet for the instructors. This helped the teachers stay on track and better direct the students from one module to another.
5. Additional staff roles for the training included:
   1. Prep: made sure that all supplies were available on the day of the training (e.g. snacks/drinks; copies/handouts; posters/models; etc.)
   2. Greeter: helped get students signed in at the beginning of class and directed them where to go before class started
   3. Timekeeper: provided teachers with a 3-minute warning so they would know to start wrapping up and answering questions.

Trainers responsible for development and implementation

Christine Wiseman, RN, IBCLC- Dallas WIC, Lactation Care Center
Janice Ballou, DNP, IBCLC- Parkland Health & Hospital System
Dani Cagle, MHP, IBCLC- Methodist Dallas Medical Center
Reba Godfrey, RN, IBCLC- Methodist Charlton Medical Center
Linda Jackson, MA, LCCE- Parkland Health & Hospital System
Valencia Moore, RN, IBCLC- Parkland Health & Hospital System