Abstracts from the Third National Conference of State/Territory/Tribal Breastfeeding Coalitions—Empowering Coalitions: Power Tools for Change Arlington,Virginia,January 23–25,2010

EDUCATING PHYSICIANS IN THE PROMOTION AND SUPPORT OF BREASTFEEDING: SUCCESSFUL APPROACHES BY COALITIONS AND PROFESSIONAL ORGANIZATIONS

Background: The U.S. Breastfeeding Committee (USBC) has devoted time and resources to help states form multidisciplinary breastfeeding coalitions. Coalitions are interested in working with physicians to improve breastfeeding promotion and clinical care in their local area or state, but many are unsure or have been unsuccessful in doing this. One common area of difficulty identified in this process is obtaining physician buy-in not only to participating in and collaborating with coalitions, but also in accepting education provided by these coalitions, which are often poorly attended by physicians. Reasons for this include that many physicians do not attend lectures or conferences that are not given by fellow physicians (due to time and financial restrictions; the perception that learning only occurs at a peer level). Collaboration may be stymied by something as simple as the coalition holding its meetings at a time that works well for other non-physician members (e.g., 2 hours over lunch; late afternoon) but that are impossible for a physician running a private practice or on a hospital's schedule. This session will describe some successful physician education models as well as ways for coalitions composed of both lay and professional members to successfully appeal to physicians and gain their support for breastfeeding promotion and educational efforts. During this session participants will learn several approaches to communicating with and educating physicians. This session will include the following:

Communicating with Physicians: Dr. Thomas will discuss ways to talk to physicians about breastfeeding to gain their buy-in and help!

Breastfeeding Teleconferences in Connecticut: Dr. Marinelli will discuss the process of setting up breastfeeding teleconferences that are primarily aimed at pediatricians in practice, but also for their staff and other allied healthcare professionals throughout the state, and will talk about needed collaborations to coordinate this type of education (Connecticut American Academy of Pediatrics [AAP], Department of Public Health, Breastfeeding Coalition) and evaluation.

Pennsylvania AAP Educating Physicians in Their Communities (EPIC) Breastfeeding Education Support and Training (BEST) Program: Dr. Bogen will describe the EPIC-BEST program, the collaborations needed to implement this program (Pennsylvania AAP, Department of Public Health, Breastfeeding Coalition), and the results of its evaluation.

Georgia AAP Breastfeeding EPIC Program: Ms. Toole will discuss the multiyear initiative in Georgia to educate physicians about breastfeeding using the highly successful EPIC model.

Working with the AAP to Promote Breastfeeding: Ms. Barone will give an overview of the AAP Breastfeeding Initiatives, including the AAP Breastfeeding Residency Curriculum, the Section on Breastfeeding, and the AAP Chapter Breastfeeding Coordinators.

Session Description for Program: The USBC has devoted considerable time and resources to help states form multidisciplinary breastfeeding coalitions over the last several years. One common area of difficulty identified in this process is obtaining physician buy-in not only to participating in and collaborating with coalitions, but also in accepting educational offerings provided by these coalitions. Coalitions in general are interested in working with physicians to improve breastfeeding promotion and clinical care in their local area or state, but many are unsure or have been unsuccessful in acquiring physician collaboration. Education attempts by coalitions are often poorly attended by physicians. This session will describe some successful physician education models as well as ways for coalitions composed of both lay and professional members to successfully appeal to physicians and gain their support for breastfeeding promotion and educational efforts.

PRACTICAL SUPPORT FOR RECENT WORKPLACE LEGISLATION: COLORADO BREASTFEEDING COALITION REPORTS ON YOUTUBE VIDEO AND WORKPLACE PARTNERSHIP PROGRAM

Background: As one of seven U.S. Breastfeeding Committee (USBC) mini-grant recipients, we would like to share the challenges and successes of our project aimed at better supporting Colorado's 2008 Workplace Accommodations for Nursing Mothers Act. A major barrier to workplace lactation support is the fact that mothers don't ask for the accommodations they need to pump breastmilk at work. This is largely because breastfeeding is an awkward subject to broach—and also because many mothers perceive that combining breastfeeding and work will be too difficult. As we inform mothers of their right to lactation accommodation at work, we must also give them tools to confidently ask for that support and the education and inspiration to take on the challenge and make it work.

Part 1: YouTube Videos: We produced three videos each weaving together video testimonials of real mothers telling their stories about breastfeeding after returning to work. One provides an overview of what motivates moms and helps them succeed, another incorporates an employer's perspective, and the third addresses the Colorado workplace lactation law specifically. The videos come across as authentic and relevant because the mothers speak from their hearts as they relay their own personal experiences. In our conference presentation, we will share a brief overview as to how we completed this project and the lessons we learned. We will then show the videos and allow time for comments and discussion.

Part 2: Workplace/Employer Partnership: Real-world success stories speak more than theoretical recommendations and cost justifications. We pursued partnerships with a number of Colorado employers where mothers face the greatest challenges (low flexibility, long hours, and little privacy). We succeeded in partnering with JW Swift, a large meat packing plant in Greeley, CO that employs over 1,000 women, helping them establish a workplace lactation program and designated area with a Lactina^® (Medela, McHenry, IL) pump. We notified the employees in person and also informed community health organizations that work with the employee population. In this portion of our presentation, we will describe how we completed the project with Swift, and also the challenges of “cold calling” and pursuing partnerships with a variety of other employers, including Walmart and McDonald's. We will share lessons learned and discuss the importance of providing a variety of options for both employers and employees at each worksite.

Session Description for Program: As one of seven USBC mini-grant recipients, the Colorado Breastfeeding Coalition will share the challenges and successes of our project aimed at better supporting Colorado's 2008 Workplace Accommodations for Nursing Mothers Act. The session will include: (1) A brief overview as to how the coalition produced three videos, each weaving together video testimonials of real mothers telling their stories about breastfeeding after returning to work. We will show the videos, share lessons learned, and allow time for discussion. (2) A description of our employer partnership with a large meat packing plant where we set up a lactation program and designated area with a Lactina pump. We will describe how we formed this partnership and lessons learned “cold calling” other employers, including McDonald's and Walmart, where mothers face the greatest challenges (low flexibility, long hours, and little privacy).

ENGAGING HEALTH INSURERS TO ENHANCE BREASTFEEDING PROMOTION AND INSURANCE BENEFITS

Background: Effectively partnering with health insurance companies is critical to achieving insurance objectives such as enhancing breastfeeding promotion and expanding lactation service and equipment benefits. This session describes how to successfully collaborate with insurers by engaging them in your coalition, providing expert consultation on breastfeeding issues, and maintaining strong insurer relationships. Sample insurer promotion materials and a case study illustrating the statewide expansion of breastfeeding insurance benefits will be used to highlight successes and the inevitable roadblocks. The session will also offer a model for clearly defining available breastfeeding benefits and successfully promoting those benefits to providers and consumers in your community.

Learning Objectives: (1) Identify three strategies for effectively engaging health insurers in your coalition. (2) Outline a model for clearly defining and promoting available breastfeeding benefits to providers and consumers in your community. (3) Describe at least two examples of utilizing these strategies and tools to engage health insurers in a local breastfeeding coalition.

Methods: (1) Identify three strategies for effectively engaging health insurers in your coalition: (a) invite insurers to identify a representative to attend coalition meetings, which (i) provides insurers with opportunities to respond to breastfeeding coverage concerns. (ii) exposes insurers to alternate approaches for addressing breastfeeding issues, (iii) educates insurers on breastfeeding issues, and (iv) engages insurers in opportunities for collaboration; (b) offer the expertise of the coalition to consult on breastfeeding matters through (i) promotional materials, such as insurance publications and a prenatal packet, (ii) data collection on lactation services and equipment; and (c) maintain relationships (i) through routine correspondence, (ii) to promote positive outcomes, and (iii) to identify representative replacements. (2) Outline a model for clearly defining and promoting available breastfeeding benefits to providers and consumers in your community by (a) identifying key contacts, (b) summarizing benefit details, (c) disseminating the benefit summary, (d) promoting the benefit summary, and (e) routinely updating the summary. (3) Describe at least two examples of utilizing these strategies and tools to engage health insurers in a local breastfeeding coalition with a three-part case study: (a) advocating for benefits, (b) the benefits of membership, and (c) be careful what you ask for, as in the electric pump shortage in 2006, troubleshooting in 2007, and clarifying pump parameters in 2008.

Session Description for Program: Effectively partnering with health insurance companies is critical to achieving insurance objectives such as enhancing breastfeeding promotion and expanding lactation service and equipment benefits. This session describes how to successfully collaborate with insurers by engaging them in your coalition, providing expert consultation on breastfeeding issues, and maintaining strong insurer relationships. Sample insurer promotion materials and a case study illustrating the statewide expansion of breastfeeding insurance benefits will be used to highlight successes and the inevitable roadblocks. The session will also offer a model for clearly defining available breastfeeding benefits and successfully promoting those benefits to providers and consumers in your community.

COMING INTO THE DIGITAL AGE: USING ELECTRONIC TOOLS TO STAY CONNECTED

Goal: Connect a network of breastfeeding advocates in the ever-changing, electronic-dominated age of our nation.

Background: One out of every seven babies born in the United States is born in California. We are the third largest state by geography, separated by many regions and demographic boundaries. The California Breastfeeding Coalition was formed in May 2003 and serves as an umbrella organization for our 49 local coalitions and breastfeeding collaboratives, acting as a coalition of coalitions. We serve to improve the health and well-being of Californians by working collaboratively to protect, promote, and support breastfeeding. Organizations must have easy-to-access, up-to-date information that can flow to all interested parties in our diverse world of advocacy, education, and outreach. Our breastfeeding networks exist across vast geographical areas, and others need to connect to find information about our organization, events, and contact information for both the California Breastfeeding Coalition as well as individual coalitions and collaboratives. In the 21^st century utilizing tools such as online mailing lists, newsletters, event registrations, file sharing, meeting planning, web-based meetings, and websites are important tools that can seem frightening and burdensome yet are simple and easy to use with little set-up time and coordination of efforts that then become invaluable to the success of small, medium, and large organizations. It has allowed the California Breastfeeding Coalition to grow into a powerful and structured organization that communicates education, legislative policy, event information, and outreach opportunities to all members.

Methods: (1) Learners will be able to identify two choices for simple and easy-to-use website building templates that can be volunteer-maintained through a user-friendly system by a non-technical professional and the importance of maintaining individuality of the website therefore not linking to commercial sites. (2) Learners will be able to describe the purpose of meta-tags used within each web page that are likely to be searched for, therefore maximizing “hits” from commonly used search engines allowing more interest to be generated to the organization's website. (3) Learners will be able to list at least two reasons why each coalition has the availability of a web page to list local meetings, resources, and up-to-date contact information as well as describe the purpose of having a central location and easy access to area and state listings of available education events throughout California and express how access to past presentations and events is important in coalition building, research, and advocacy work. (4) Learners will be able to identify two opportunities for online newsletters to provide professional-looking, eye-appealing, and user-friendly methods of information distribution and actions that need to be taken.

Session Description of Program: Internet-based information is the wave of the future and possible for volunteer coalitions to set up, maintain, and succeed. Organizations must have easy-to-access, up-to-date information that can flow to all interested parties in our diverse world of advocacy, education, and outreach. Our breastfeeding networks exist across vast geographical areas, and others need to connect to find information about our organization, events, and contact information for both the California Breastfeeding Coalition as well as individual coalitions and collaboratives. In the 21^st century online mailing lists, newsletters, event registrations, file sharing, meeting planning, web-based meetings, and websites are important tools that can seem frightening and burdensome yet are simple and easy to use with little set-up time and coordination of efforts that then become invaluable to the success of small, medium, and large organizations.

STAGES OF COALITION DEVELOPMENT: MOVING THROUGH, MOVING ON

Background: In 2008, this trio of speakers presented a well-attended session on coalition development that averaged evaluation scores of 3.6 (out of 4). Presenting tools and information on group development theory later illuminated by story telling from their coalitions, the speakers facilitated small group work wherein participants were asked to identify their stage of development, disclose and discuss points of struggle, and identify next steps. Tools to improve coalition communication were provided. The speakers left with more than 50 examples from participants to illustrate common concerns and the need for assistance pulling their coalitions through the “storming” phase of group development.

Methods: This session will build upon the last while being accessible to new participants. After a brief review of group development theory and related tools, the speakers will solicit stories of growth and change within coalitions since the last national conference, with the aim of illuminating commonalities in struggle and successful strategies for growth. Issues of ownership, leadership, and funding are particularly complex and will be given emphasis. Participants of this session will be able to: (1) state the stages of coalition development; (2) recognize what stage their coalition is in; (3) understand the purpose and opportunity of “storming” in group formation; (4) recognize the unique story of their coalition and the personalities in that story as part of a large and healthy emerging group dynamic; (5) get to know people in other coalitions with similar development issues, as well as knitting ties across their region; and (6) build a national community of state breastfeeding coalitions.

Session Description for Program: Building on work from a popular 2008 session on the stages of coalition development, this session offers participants the theoretical framework and practical tools to recognize difficult group dynamics as opportunities for growth. The tricky terrains of leadership, ownership, and funding are better navigated with a good topographical map. Become your coalition's cartographer as you learn the contours of group dynamics, the pitfalls of turf, and the geography of surrounding regions. Your three wilderness guides are experienced with navigating this terrain, and will lead small group work through activities and strategic storytelling. Adventurous spirit a plus; hiking boots not required.