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Creating Mom-Friendly Worksites

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).

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Creating Mom-Friendly Worksites

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  1. 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

  2. Consortium for Infant and Child Health(CINCH) Child health coalition with 200+ members serving Hampton Roads, VA EVMS is CINCH’s lead agency Mission: Engaging the community to improve children’s health in Hampton Roads Focus: Obesity, Respiratory Health, Access to Care, Healthy Communities Approach: Policy, Systems, Environmental Change

  3. Learning Objectives 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

  4. 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

  5. Worksite Lactation Support Program Components Private Space Flexible Breaks Education Support

  6. Outreach Approaches 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

  7. Implementation Approaches • In-person consultation & site visit at workplace to introduce BC4BF toolkit & Project • Lactation Assessment Form • Free technical assistance • Eligibility criteria for limited-time Incentives

  8. Eligibility Criteria for Incentives Lactation Program Assessment Lactation Support Policy Designated Lactation Area Procedures Company-wide Promotion Employer Spotlight

  9. The “Sell” - Benefits to Business Healthy Baby Healthy Mom Healthy Business • Compliance with FLSA • Wellness Initiative • increased productivity • decreased absenteeism • improved staff morale • cost savings • Competitive Employee Benefit • Community Role Model

  10. 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

  11. Policy Example: REST PERIODS, MEAL PERIODS AND BREAKS FOR NURSING MOTHERS C. Break Time for Nursing Mothers. 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 employee’s 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

  12. Policy Example, cont. 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 Department’s 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.

  13. Lactation Rooms and Signage: Educational Institution Setting

  14. Lactation Rooms and Signage: Educational Institution Setting

  15. Lactation Room: Hospital Setting Before After

  16. Lactation Room – Military Setting Before After

  17. 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

  18. 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)

  19. 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

  20. 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

  21. Lactation Assessment Form (LAF) • General information about business/worksite • e.g. type, size, role of respondent • Human Resources • e.g. # women of childbearing age, pregnancy and breastfeeding rates, absenteeism, etc. • Company Policies • e.g. general lactation support, leave, return to work, insurance coverage • Lactation Program Components • e.g. Infrastructure, breastfeeding options, funding, resources, etc.

  22. The Businesses/Employers

  23. The Businesses/Employers

  24. The Businesses/Employers

  25. Evaluation Measures – Likert-Type Scales 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

  26. 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

  27. 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

  28. 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.)

  29. 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

  30. 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

  31. 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

  32. 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

  33. Case Example: EVMS Established 5 lactation rooms Plans to establish more rooms in all buildings on campus

  34. 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)

  35. 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

  36. Support • Virginia Department of Health’s CHAMPION Program (Commonwealth’s 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)

  37. Resources • Business Case for Breastfeeding: http://www.womenshealth.gov/breastfeeding/government-in-action/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

  38. Thank you Questions? Amy Paulson, MPH, AE-C 757-668-6426 CINCH@evms.edu www.cinchcoalition.org www.facebook.com/cinchcoalition Twitter @CINCHCoalition www.facebook.com/healthyhr

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