Missoula County Breastfeeding Outreach Project

The team brainstormed all of the areas that might affect a new mother being able to access support in a timely manner. The team used a fishbone diagram to group these areas into categories: the internal process, community coordination, and client perception/knowledge of services. These areas were big enough to be further broken down. The team used a group decision-making process to prioritize the areas based on the potential impact on a new mother’s likelihood of receiving services when needed. The team proceeded to implement the following changes. Instead of all 14 MCH staff members being responsible for outreach and response, the team identified 5 staff members who were CLCs and had enthusiasm for breastfeeding support. This newly formed breastfeeding team picked up the hospital referrals for recently discharged mothers and babies daily instead of twice weekly. This same team became solely responsible for responding to hotline calls, which immediately eliminated the confusion of having too many people responsible for the task and ensured a trained and competent staff. These team members agreed to keep time open on their assigned days, not only to make outreach calls, but also to make same-day home visits if new mothers needed in-person support. When making the outreach calls, the team started using the hotline instead of the health department's landline because the health department's phone system did not allow mothers an easy way to reconnect with the person who had called. The new mother would have the hotline number in her phone's call log to enable her to call back immediately or even weeks or months later. When leaving a voicemail, staff left a standardized message that included letting the mother know that a CLC would respond to the call and that the mother would not be charged for the service. Staff let the mother know that she could call back in the future if breastfeeding concerns arose. The health department soon expanded outreach to include all discharged mothers, not just first-time mothers. The team developed a standard assessment and intervention protocol for breastfeeding visits. The health department coordinated with the hospital, which provides women with information about the hotline during registration. Hospital lactation consultants now use the hotline to let the health department know if a woman who is leaving the hospital will need additional support. The team coordinated with WIC staff, so they are promoting the health department's services to pregnant women. The team let the pediatricians know that staff are available to make in-home visits to women who identify breastfeeding concerns. The health department began promoting its services to pregnant women and has an ongoing outreach plan. The health department offers wrap-around care with its breastfeeding partners, including WIC, the hospital, health care providers, and La Leche League International. The MCH breastfeeding team eventually changed its name to the Newborn Team and added outreach to formula-feeding mothers. Now instead of only first-time breastfeeding mothers, every woman who delivers in a Missoula County hospital receives an outreach call and is offered feeding and newborn support services. Staff members enjoy being on this team and providing this service. The response from mothers and community partners has been excellent. New mothers are happy to receive this service at the exact time they need it. Mothers are now calling the hotline about subsequent concerns, such as pumping, weaning, night feeding, or adding solids.

The team kept a log of the calls that came in to the breastfeeding hotline before the project and compared that with the number of calls after implementing the project. The team used the health department's computer documentation system to determine the number of women who received services before and after project implementation. The team did a by-hand tally and assessment of how soon from the day of delivery they were able to make outreach calls. The specific interventions were piloted separately and evaluated to ensure that the team was not measuring the consequences of a previous intervention. The team used a Gantt chart to track the individual elements of the overall project.