Texas Ten Step Program FAQ

We have answers every step of the way.

General Questions

If my facility is not current with their Texas Ten Step (TTS) application but was designated in the past, do I submit a new application or re-designation application?
Any facility that has not been designated as a TTS facility for more than 2 years is considered a new applicant. Please visit the How to Apply page for information on re-applying.

What are the differences between the Texas Ten Step program and the Baby-Friendly designation.
Overseen by Baby-Friendly USA, the Baby-Friendly Hospital Initiative (BFHI), helps facilities to fully implement the Ten Steps and offers technical assistance and resources to prepare for designation. To learn more about this global recognition and differences between BFHI and TTS, visit the Baby-Friendly Hospital Initiative page.

Can there be more than one contact listed for the application and to receive email notifications?
To best streamline our processes, we request that one person in your organization is listed as the primary contact for the entire application. This helps to streamline who receives program updates and other important information; however, anyone listed as the contact is free to share any of the resources or information with your facility’s task force and team members as needed. 

Does our facility have to be designated as a Texas Mother Friendly Worksite first?
Yes. TTS designation is not awarded until confirmation of designation through the Texas Mother Friendly Worksite (MFW) program is received by the Texas Ten Step Program. 

You may submit both applications at the same time. It’s a good idea to build in time to complete the requirements for MFW such as having a dedicated space and development and implementation of policy. To learn more about becoming designated, visit the Texas Mother Friendly Worksite page.

What time frame do my breastfeeding rates need to include? 
TTS strongly encourages your facility to collect annual breastfeeding rates but does not currently define the criteria or definition for how to do so. Many TTS facilities use the Joint Commission definition found in the current version of the specification manual. 

Facilities must report the following rates for the previous calendar year in which they are applying:

  • Initiation
  • Exclusive Breastfeeding (only breastmilk)
  • Breastmilk +formula, water, glucose drops
  •  Exclusive Formula (no breastfeeding)

Initial applicants should have at least one year of rates collected before your application is submitted. 

What if I don’t know what my facility’s Maternity Practices in Infant Nutrition and Care (mPINC) survey results are? Where do I get them?
The Centers for Disease Control and Prevention (CDC) administers the mPINC survey. If you do not have your facility’s results, please indicate this on your application. If you would like to request a copy of your facility’s results, contact mpinc@cdc.gov

What is the Scorecard Evaluation Tool? Does my facility need to complete it as part of the application?
The Scorecard Evaluation Tool is often used by facilities as a guide to prepare the application, but it is not required to submit as part of the application. To meet designation, facilities must score an 85 percent. For more information, visit the Scoring Assessment page.

Does my facility have to re-designate with TTS and if so, when?
Re-designation every two years is required to keep facilities engaged in the program and working on continuous quality improvement.

BFHI certification through the 4D Pathway offers optimal oversight and data reporting. TTS facilities that are jointly designated through BFHI will re-designate in the same month and year their BFHI certification is due, which is every five years.

If you are unsure of your facility’s re-designation deadline, please contact TexasTenStep@hhs.texas.gov

Questions About Staff Education documentation

What documentation do I submit for the staff education content?

WIC offers both online and live training that help meet the didactic content for Step 2 training. If your facility does not use the WIC trainings offered, complete the application demonstrating the content listed within is covered. 

Submit the following:

  • Education Content portion of the application
  • Course content for review of all non-WIC trainings
  • Blank skills-checkoff sheet 

Didactic education:

Training Option 1: Online Courses found on the WIC Partner Training site cover the core training objectives listed on the TTS application.  

  • If your facility is using this training to meet these core objectives, you are not required to send a content outline for review. 

Training Option 2: Facility designed or outsourced training

  • Submit the full content or content outlines for any training you have submitted with the application.
  • Training submitted must demonstrate the core objectives listed on the TTS application.

All training must:

  • Include didactic and skills-based components.
  • Demonstrate >50% of total maternal-infant and NICU front-line nursing staff completion. 
    • Do not include didactic or skills training for which <50% staff have attended.
    • Do not include didactic or skills training specific for lactation staff only.
  • Include dates from previous two years only.

Training formats to submit may include: 

  • PowerPoint presentations
  • Research articles with post-tests 
  • Training provided during staff meetings
  • Poster board presentations
  • Outsourced or purchased training

Skills training: It is recommended that the Required Skills-Based Training evaluation and review include shadowing by an IBCLC, CLC or other staff with additional breastfeeding education beyond basics.

All skills training must:

  • Cover the required skills listed on the TTS application. 
  • Include a blank skills checkoff list for review. 

If you have any questions regarding Step 2 training or what to send, email: TexasTenStep@hhs.texas.gov