Using the Scorecard Evaluation Tool

The Texas Ten Step (TTS) scorecard (PDF) is largely based on the Baby-Friendly USA guidelines and evaluation criteria and helps to identify areas within each step for your facility to prioritize.

How Is My Facility’s Score Assessed?

The Texas Ten Step (TTS) scorecard evaluation tool (PDF) is used to score a facility’s application and any supporting documents. Once you submit your application the TTS coordinator will utilize the scorecard for assessment. Each line item on the Scorecard Evaluation Tool is worth 2 points, for a total of 100 points. Points are assigned as follows:

  • Full credit (2 points) if line item is addressed in the policy.
  • Partial credit (1 point) if line item is not addressed in policy but is demonstrated by a Texas Ten Step support document as a part of practice.
  • No credit (0 points) if line item is not addressed in policy and is not supported by Ten Step support document.
  • “For Consideration” strategies are included under each step but are not assigned a score. 

Download the Texas Ten Step Scorecard Evaluation Tool (PDF)

If your facility does not score 85% or higher on the scorecard evaluation tool, a technical assistance conference call with your task force will be offered by the TTS program coordinator. During the call, your facility will have the opportunity to review the scorecard before a final determination on score is made. 

Facilities with scores of 85% or higher and proof of Texas Mother Friendly Worksite designation are awarded the Texas Ten Step Program designation.

The Texas Ten Step program has a new Scorecard and updated requirements to achieve TTS designation. The updated criteria and revisions to the scorecard were conducted in response to the revised Ten Steps to Successful Breastfeeding from the World Health Organization (2018), the Baby Friendly USA updated Guidelines and Evaluation Criteria (6th Edition) and evaluation of our program since our last revised scorecard in 2012. 

We have highlighted the new or revised sections on the new scorecard to indicate the changes going into effect. Points will NOT be deducted for the highlighted items on applications received from now until January 31, 2024

The updated criteria will go into effect for applications received starting February 01, 2024. TTS will provide feedback and technical support as these changes go into effect. For any questions, please contact the TTS coordinator at

Improving Your Score and Building Sustainability

New Applicants

Use the scorecard evaluation tool with your Ten Step task force as a readiness assessment before submitting your application. 

  • The Texas Ten Step support document list can help ensure that you have all your documents together before you submit your application
  • You can further improve your facility’s score by using information from your scorecard evaluation tool readiness assessment to develop a quality improvement (QI) plan-do-study-act (PSDA) project to improve a step’s implementation

Current Members

Use the scorecard evaluation tool received during your previous application as a guide to highlight the changes your facility has engaged in during re-designation. To begin work toward full implementation of the Ten Steps, use the following resources and strategies:

Quality Improvement Resources: