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Good afternoon
and good morning to everyone.

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Welcome to the DNPAO Seminar Series
From Hospital to Community:

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Monitoring,
Promoting, and Supporting Breastfeeding.

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Welcome to our webinar for today.

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We have an exciting opportunity today

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and will be offering this
in English and Spanish.

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Hi, everybody.

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I'm Janelle Gunn.

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Welcome to our DNPAO Seminar Series.

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We have an excellent seminar today

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on breastfeeding and are so glad
that you have joined us to hear this

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great information and stories
from the field.

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As a reminder,
this seminar is being recorded.

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It will be offered
later on the DNPAO website.

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If you've missed some past seminars

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and are interested in them,
you can find those on our website.

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All of your lines are muted,
but we want your questions and answers.

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We'll have some time at the end for that.

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And so please go ahead and submit them
whenever they come to you and

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we will try to get to as many as we can

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during the time we have allotted today.

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We have a truly outstanding
set of speakers for you today.

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I think you're going to really enjoy
the information.

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First, we have Lieutenant Kristin Marks.

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She's with us here at CDC
in the Division of Nutrition,

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Physical Activity and Obesity.

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And she is a scientist officer for the
United States Public Health Service,

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and she's an epidemiologist
on our maternal infant and toddler

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nutrition team.

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Next, we have Daurice Grossnicklaus,

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and she's a health scientist
also with us here at CDC.

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And she works to improve maternity care
practices, supportive of breastfeeding.

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Then we'll have Harumi Reis-Reilly.

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She's a lead program
analyst at the National Association

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of County and City Health Officials,
otherwise known as NACCHO.

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She's a public health professional,

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nutritionist and international board
certified lactation consultant.

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She will be followed by Paulina Erices.

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We have a special guest from

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some doing some work in Colorado.

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And she will also be joined
by Lucy Guereca who will be sharing

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some of her experiences
and work in the Colorado area as well.

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All right.

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Our agenda for today
is to review the Maternity Practices

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and Infant Nutrition and Care survey,

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also called mPINC.

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Our work covering, supporting the U.S.

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hospitals to provide safe

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evidence based maternity care,
supportive of breastfeeding.

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Then we will hear an overview of NACCHO's
work to advance

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continuity of care in communities
across the United States.

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And then we'll hear from Cuenta Conmigo
Cooperatives successful

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efforts
to advance continuity of care in Colorado.

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So let's go ahead and get started.

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I'm going to hand it over to my colleague,
Lieutenant Marks.

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Kristin. Good afternoon.

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Thank you for the opportunity
to share our team's work

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on Maternity Practices
in Infant Nutrition and Care.

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Breastfeeding initiation rates
have increased over the past two decades.

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This considerable increase from 70 to 83%

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is due in part
to improved maternity care practices.

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In the

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United States,
nearly all infants are born in a hospital.

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Maternity care practices in hospitals
in the first hours and days after birth

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make a difference in whether
and how long infants are breastfed.

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Hospitals have an important influence on
how infants are fed, as there are several

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key supportive hospital practices
that can improve breastfeeding outcomes.

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Maternity care practices
make a difference in breastfeeding.

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So what is CDC doing to monitor
these practices?

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CDC National Survey of Maternity Practices
in Infant Nutrition and Care,

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or mPINC, assesses
maternity care practices and provides

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feedback to encourage hospitals

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to make improvements
that better support breastfeeding.

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About every two years, CDC invites
all hospitals across the country

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with at least one birth in the past year
to complete the mPINC survey.

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CDC calculates the

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total mPINC score for every participating
hospital to indicate its overall level

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of maternity care practices and policies
that support optimal infant feeding.

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Responses are scored using an algorithm
that denotes the evidence and best

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practices to promote optimal infant
feeding within the maternity care setting.

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Possible scores range from 0 to 100,

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with higher scores indicating better
maternity care practices and policies.

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Sub scores
further categorize maternity care practice

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domains and are scored
using the same approach.

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These domains are immediate postpartum

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care, rooming in, feeding
practices, feeding education and support,

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discharge support,
and institutional management.

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I've compiled data from 2018,
2020, and 2022 to show

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mPINC scores over time for the total score

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as well as the six domain scores.

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Since 2018,
the total mPINC score has increased from

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79 to 81, and we see higher
scores across most domains.

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Consistently, the

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domain with the highest national score
is feeding education and support,

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which covers items like identifying
feeding cues and breastfeeding problems,

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while the lowest domains are typically
rooming in and institutional management,

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which include items like rooming in safety
protocols,

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the assessment of staff competencies,
and written policies.

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In this map, state scores were calculated
as the average of scores

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for all participating hospitals
within that state.

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These were color coded as shown in the key
at the top, with darker

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blue indicating higher scores and lighter
teal for lower scores.

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This map shows total
mPINC scores for 2022.

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The national total score was 81,

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and the range of state scores
varied from 72 to 93.

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We collect states data on maternity
care practices for monitoring purposes.

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But we also want mPINC data
to be used for action.

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These data can be used
at a variety of levels

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from the hospital
to state and national levels.

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Every two years we released national,
regional, and state mPINC reports

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to provide an overall picture

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of maternity care
supportive of breastfeeding in the US.

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Together, these reports can be used
to provide context for jurisdictions.

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For example, our regional report
shows state participation,

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total score and domain scores by region.

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This type of report

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allow states to see how they are doing
in relation to their neighbors.

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We also provide individualized reports
to each hospital

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showing their total and domain
specific scores.

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In hospital reports,
we provide average scores

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among facilities of similar size
in the same region

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and among all participating facilities
for comparison.

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Participating hospitals
receive their mPINC report roughly

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every two years, but how did they use it?

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First, hospitals often use mPINC

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as part of quality improvement
initiatives.

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Hospitals use mPINC data to see how
they align with baby friendly standards.

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They use the mPINC questions
to determine standards of care, and

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they will based their quality initiatives
off their lowest scoring questions.

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Second,

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hospitals use their mPINC reports
for benchmarking.

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They compare their own scores, cycle
after cycle,

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to see where they can make improvements.

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And they also compare to other hospitals
across their state

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and can use that as leverage
for practice changes.

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Third, reports are used for staff
motivation.

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Hospitals
highlight key areas where they did well

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and post the report on bulletin boards
for staff to see.

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Staff
motivation also comes from those regional

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and national comparisons to validate
and celebrate the work they're doing.

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Lastly, mPINC scores are part are used
as part of staff education.

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Hospitals will use mPINC scores
as a driver to provide

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more staff education in low scoring areas.

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We also want to share
some qualitative data on how jurisdictions

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use their mPINC reports.

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First, state reports
allow partners to advocate

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for state policies based on where
hospitals fall behind clinical standards.

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Second, benchmarking.

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State and regional reports
allow states to compare their scores

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to others in their region or compare
their own scores cycle to cycle.

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Lastly, we've heard that mPINC reports

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are used
when applying for funding opportunities.

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And how is mPINC used by breastfeeding
coordinators.

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mPINC reports allow breastfeeding
coordinators to consult with hospitals

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to see where they can improve
staff education and patient education.

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mPINC reports are also great
for local outreach.

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Coordinators can share their state’s
mPINC scores with other groups

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specializing in breastfeeding,
including WIC, Head Start,

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childcare providers and coordinated care
organizations.

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I'd like to take a step back and highlight
a unique aspect of mPINC

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that you've probably gotten a sense
for as I've been speaking.

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You may know CDC for putting out
data known as surveillance.

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Surveillance
is the ongoing systematic collection

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of health related data
to inform public health practice.

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CDC uses
mPINC to get a picture of maternity care

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practices supportive of optimal infant
feeding across the country.

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But mPINC can be used for more than that
as hospitals take the mPINC survey

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and then later
when they receive their hospital report.

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mPINC raises awareness
among hospitals of best practices

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and any gaps in their maternity
care practices and policies.

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This feedback mechanism is pretty unique
among other large surveillance systems,

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which typically passively collect data

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and don't necessarily
report it back to participant.

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In contrast, mPINC provides
an opportunity to learn and take action.

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As I've said, mPINC can function
as both a surveillance tool

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and to inform interventions,
especially at the hospital level.

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I've pulled some open text responses
from hospitals who participated

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in the 2022 mPINC survey to demonstrate
how hospitals use mPINC data.

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Respondents
seem to appreciate the available

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the ability to see their scores
improve over time, saying

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things like “We've worked very hard
to improve our scores and are very proud

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of our accomplishments.” On the awareness
raising and intervention side of things,

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respondents say “It raised awareness
of what we should be doing and measuring”

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as well as “The questions provided insight
into areas we can improve upon

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as well as measure better.”
These comments suggest that hospitals use

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the mPINC survey

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as an opportunity to make improvements
to their maternity care practices.

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In summary, whether your work
is at the hospital, community,

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or governmental level, there are steps
you can take to use these data

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for action to improve the health
of infants and families.

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First,
know your hospital or state mPINC scores

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and share them with key people
in your organization.

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Use that information to identify
both areas of success

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as well as areas for improvement
to inform future work.

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Second, you can also encourage hospitals
to participate in mPINC.

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The more participants,
the more accurate a picture

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it provides of maternity care practices
across the US.

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And lastly,
look out for the mPINC 2024 survey,

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which is scheduled
to launch in early 2024.

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You can join our mPINC listserv to receive
periodic updates about the survey.

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If you would like to sign up
for our listserv, please email

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mPINC@cdc.gov
with your name and email address.

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Thank you and I am pleased to pass the mic
over to my colleague Dr.

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Daurice Grossniklaus.

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Thank you, Kristen, and hello everyone.

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I will be giving an overview
of our quality

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improvement efforts
to support hospitals to provide

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evidence based maternity care
supportive of breastfeeding,

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the optimal form of nutrition
for most infants.

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Evidence
shows that hospitals play a critical role

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in helping families
to start to practice breastfeeding

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and in connecting breastfeeding families
to community resources.

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The Surgeon
General's Call to Action to Support

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Breastfeeding was released in 2011
in a call for hospitals

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to do more to implement
the ten steps to successful breastfeeding.

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These ten steps are a set of evidence
based maternity practices

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that, when implemented together, result
in better breastfeeding outcomes.

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The ten steps form
the foundation of UNICEF and the World

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Health Organization's Baby Friendly
Hospital Initiative,

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which recognizes those hospitals
globally that implement the ten steps

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and adhere to this high
standard of maternity care.

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Baby Friendly
USA is the national authority

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and in this role confirms
the baby friendly designation to U.S.

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territorial hospitals.

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or facilities.

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Why is CDC's quality improvement work
so important?

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In 2011, when we started this work
only 5% of U.S.

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infants were born in baby
friendly designated facilities.

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The majority of infants were born
in facilities that were not practicing

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maternity care or infant feeding routines
that fully supported breastfeeding women.

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afternoon, I will describe
our collaboratives, including two aimed

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at supporting hospitals to become baby
friendly designated, two

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aimed at building maternity staff capacity
to support breastfeeding, and our newly

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funded project aimed at improving
breastfeeding supportive maternity care.

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Best Fed Beginnings was our first
collaborative focused on achieving

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designation.

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It was successful in 76 of the 90
hospitals reached our goal.

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We estimate that an additional quarter
of a million infants

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born each year received
optimal breastfeeding support.

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EMPower Breastfeeding was our second
collaborative

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focused on becoming designated.

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It was also successful in 72 of the 93
hospitals reached the goal.

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We estimate that an additional
157,000 infants

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each year received
optimal breastfeeding support.

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What did we learn?

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These projects have ambitious outcomes
to be accomplished

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in a short amount of time,
and we learned that with support,

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hospitals could achieve designation
in a three year time period.

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Support included training and tailored
technical assistance

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provided by QI
and or breastfeeding experts to coaches

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using QI methods such as planned
use study cycles and small tests of change

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to make sure that practice changes
that were being implemented

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actually resulted in improvements
in maternity care.

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We also learned the importance and value
of having well-trained maternity

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staff at the bedside
to help breastfeeding families 24 seven

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and the challenges hospitals faced
in providing this training to their staff.

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We use the lessons learned
to inform our next funding opportunities

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and focus on helping hospitals overcome
the training related barriers.

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EMPower Training was a two year
collaborative

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that focused on training maternity staff
in the 5 hours of breastfeeding skills.

00;15;20;02 - 00;15;24;16
This project was successful
in meeting the goal, and 81 of that

00;15;24;18 - 00;15;29;14
81 of the 85 participating hospitals
reached the training goal.

00;15;29;17 - 00;15;32;18
This translated to more than 3600 staff

00;15;32;18 - 00;15;36;19
receiving over 18000 hours of training.

00;15;36;22 - 00;15;39;00
EMPower Best Practices is our current
collaborative

00;15;39;00 - 00;15;43;01
that began in 2020
and runs through September of 2024.

00;15;43;03 - 00;15;47;19
The goal is to train staff
in those hands-on breastfeeding skills

00;15;47;22 - 00;15;51;16
to better address disparities
in breastfeeding rates.

00;15;51;19 - 00;15;55;09
The EMPower Team developed training
related to health equity.

00;15;55;12 - 00;15;59;19
This training is designed to help
maternity staff navigate their own

00;15;59;19 - 00;16;04;06
implicit biases and provide
culturally competent care.

00;16;04;08 - 00;16;07;25
The EMPower Training is delivered
an e-learning platform

00;16;07;27 - 00;16;11;23
and it is organized in modules
with a module for each of the ten steps

00;16;11;23 - 00;16;15;16
and a module to dedicated to communication
skills.

00;16;15;18 - 00;16;20;02
Each module includes learning objectives
and performance indicators, case

00;16;20;02 - 00;16;21;13
studies, self-reflection

00;16;21;13 - 00;16;25;20
activities, knowledge checks and relevant
resources and job aids.

00;16;25;22 - 00;16;30;24
This is an image of Lorraine, who serves
as a virtual trainer and mentor.

00;16;30;26 - 00;16;33;13
This is an example of one of the case
studies.

00;16;33;13 - 00;16;36;05
This particular case study
focuses on building

00;16;36;05 - 00;16;40;04
the skills needed to communicate
effectively across cultures.

00;16;40;07 - 00;16;44;09
There are case studies for each of the ten
steps, and each case study includes

00;16;44;12 - 00;16;48;08
brief background information
to provide some context,

00;16;48;11 - 00;16;51;18
a scenario that staff
would likely encounter in their day to day

00;16;51;18 - 00;16;57;00
work and questions to answer with the help
of Lorraine, the Virtual Trainer.

00;16;57;03 - 00;16;59;03
A unique aspect of this collaborative

00;16;59;03 - 00;17;03;26
is that an equity community of practice
grew organically from the work.

00;17;03;29 - 00;17;06;26
Staff identified a need for help

00;17;06;26 - 00;17;11;04
with how to integrate equity principles
into maternity care.

00;17;11;06 - 00;17;16;23
Activities include regular webinars
to learn from experts and peers to share

00;17;16;27 - 00;17;19;27
challenges and solutions across hospitals,

00;17;19;29 - 00;17;23;16
and to share equity related resources.

00;17;23;19 - 00;17;27;25
The E-learning platform provides
a forum for ongoing discussion.

00;17;27;27 - 00;17;30;10
I wanted to share successes
that we have seen

00;17;30;10 - 00;17;33;19
in our current collaborative EMPower
Best Practices.

00;17;33;21 - 00;17;37;27
The first is a quote from a nurse
and international board certified

00;17;37;27 - 00;17;42;19
lactation consultant at the University
of North Carolina Hospital.

00;17;42;22 - 00;17;46;05
This hospital was the first in the nation
to be successfully assessed

00;17;46;05 - 00;17;49;05
on the new Baby Friendly USA

00;17;49;09 - 00;17;51;24
training criteria.

00;17;51;24 - 00;17;55;11
Another hospital, AdventHealth
Fish Memorial,

00;17;55;14 - 00;17;59;00
was able to create a report
summarizing their participation in

00;17;59;02 - 00;18;01;28
and the impact on the families
they served.

00;18;01;28 - 00;18;03;26
They shared it with their hospital
leadership

00;18;03;26 - 00;18;07;24
and other partners
to show the value of their work.

00;18;07;26 - 00;18;11;15
These are two examples of the importance
of our quality improvement work

00;18;11;18 - 00;18;15;00
and how these efforts impact
improvements in families.

00;18;15;03 - 00;18;17;06
So what has been accomplished?

00;18;17;06 - 00;18;22;14
We've added the progress made since 2011,
which is indicated by the orange line.

00;18;22;17 - 00;18;26;02
The percent of births
occurring in designated hospital grows

00;18;26;02 - 00;18;31;11
from 5% in 2011 to almost 29% in 2021.

00;18;31;14 - 00;18;33;29
Our work with the Best
Fed Beginnings and EMPower

00;18;33;29 - 00;18;38;10
breastfeeding hospitals
contributed in part to this increase.

00;18;38;12 - 00;18;42;23
However, this graph also reflects
the contributions of other organizations

00;18;42;23 - 00;18;47;08
and facilities and the dedication and hard
work of many people.

00;18;47;10 - 00;18;51;15
For example, it reflects the Best
Fed Beginnings and EMPower hospitals

00;18;51;18 - 00;18;54;18
that have successfully maintained
their designations and/or

00;18;54;21 - 00;18;58;12
achieved re-designation
and those in our training collaboratives

00;18;58;12 - 00;19;02;13
that have gone beyond the expectations
to achieve designation.

00;19;02;15 - 00;19;06;18
We have contributed in part to more
than a million infants each year receiving

00;19;06;26 - 00;19;11;15
maternity care that supports breastfeeding
and optimal infant nutrition.

00;19;11;18 - 00;19;14;10
As a nation,
we have made remarkable progress.

00;19;14;10 - 00;19;16;28
But there's still work to be done.

00;19;16;28 - 00;19;19;26
To continue this work,
we awarded funding to the Center

00;19;19;26 - 00;19;24;06
for Health Equity, Education
and Research at Boston Medical Center.

00;19;24;09 - 00;19;27;09
They will begin work in September of 2023

00;19;27;16 - 00;19;31;18
and will enroll 100 hospitals
to take part in a collaborative.

00;19;31;20 - 00;19;35;01
The Collaborative is designed
to increase the use of culturally

00;19;35;01 - 00;19;40;05
competent approaches to improve
breastfeeding supportive maternity care.

00;19;40;08 - 00;19;44;09
CDC is committed to continuing our work
to support hospitals

00;19;44;15 - 00;19;47;25
and to ensure equitable access

00;19;47;27 - 00;19;52;21
so that all individuals and families
receive optimal breastfeeding support.

00;19;52;24 - 00;19;58;11
This work has a profound impact on
the health of families across our nation.

00;19;58;14 - 00;19;58;16
Thank you

00;19;58;16 - 00;20;01;16
for the
opportunity to share our work with you.

00;20;01;20 - 00;20;03;15
I'll now turn it over to Harumi.

00;20;03;15 - 00;20;05;22
Thank you again.

00;20;05;22 - 00;20;08;16
Hi, everyone, and thank you Daurice,

00;20;08;16 - 00;20;13;16
and thanks to DNPAO for having us here
in the last day

00;20;13;16 - 00;20;17;16
of this very important month
and very important week.

00;20;17;18 - 00;20;21;11
So we just heard from CDC
a lot of what's happening

00;20;21;11 - 00;20;26;03
with breastfeeding in the hospital
and how hospitals have improved.

00;20;26;05 - 00;20;29;28
Many of the ten steps
which then result in this great

00;20;29;28 - 00;20;33;26
increase of the breastfeeding initiation
rates, it's awesome.

00;20;33;29 - 00;20;38;29
We heard from Lieutenant Kristen
that most births happen in the hospital.

00;20;39;05 - 00;20;41;14
And as we like to say here in NACCHO,
breastfeeding

00;20;41;14 - 00;20;42;27
usually starts in the hospital,

00;20;42;27 - 00;20;47;09
but most of the breastfeeding journey
actually takes place in the community.

00;20;47;12 - 00;20;50;25
Hopefully this journey lasts
for at least the next two years

00;20;50;25 - 00;20;53;22
after the hospital discharge. Right.

00;20;53;22 - 00;20;58;04
But if the community infrastructure
does not enable breastfeeding,

00;20;58;04 - 00;21;02;10
we won't see breastfeeding duration
and exclusivity rates increase

00;21;02;10 - 00;21;05;10
so much like we saw
with the initiation rates.

00;21;05;15 - 00;21;09;00
So how do we build
the same supportive environment

00;21;09;00 - 00;21;14;05
that we have in baby friendly hospitals,
also in the community?

00;21;14;08 - 00;21;17;07
So this is mostly
what we do here at NACCHO

00;21;17;07 - 00;21;20;10
and I'll be sharing
some of the highlights of the best

00;21;20;10 - 00;21;25;04
five years of our program
that we have done with support from DNPAO.

00;21;25;07 - 00;21;29;15
It's like steps three
and ten of the ten steps and beyond,

00;21;29;17 - 00;21;33;07
way beyond the hospital
walls into the community.

00;21;33;10 - 00;21;35;23
Well, I’ll start
just talking a little bit about us.

00;21;35;23 - 00;21;39;27
NACCHO’s mission is to improve the health
of all communities.

00;21;39;29 - 00;21;44;27
We have several different public health
programs here to help advance our mission.

00;21;44;29 - 00;21;48;21
Our program is within the maternal child
and adolescent health team.

00;21;48;23 - 00;21;54;09
NACCHO is a national organization,
but with a local community reach.

00;21;54;12 - 00;21;58;13
Our team has been working with CDC
for nearly ten years,

00;21;58;16 - 00;22;01;14
but NACCHO
as an organization, has partnered

00;22;01;14 - 00;22;05;08
with CDC for the past 50 years
in different programs.

00;22;05;10 - 00;22;06;22
Current current.

00;22;06;22 - 00;22;10;29
We are in the final year of the six year
project.

00;22;11;02 - 00;22;14;20
We operate with the mission
to advance continuity of care.

00;22;14;20 - 00;22;19;03
To enable breastfeeding should be the easy
default choice in our communities,

00;22;19;05 - 00;22;21;07
especially those communities
where breastfeeding

00;22;21;07 - 00;22;24;22
is not a feasible option
for many families.

00;22;24;24 - 00;22;28;02
So you're going to see our goals
in the next slide

00;22;28;05 - 00;22;30;28
that are to increase
the operational capacity

00;22;30;28 - 00;22;35;15
of local public health systems
to advance continuity of care.

00;22;35;18 - 00;22;40;11
It is also to identify and amplify
local successes and best practices

00;22;40;11 - 00;22;45;15
to increase specifically the breastfeeding
duration and exclusivity rates,

00;22;45;17 - 00;22;49;19
and also strengthen partnerships
to advance the first thousand days

00;22;49;19 - 00;22;54;01
nutrition
So we do that through this activities.

00;22;54;04 - 00;22;55;22
We fund local organizations

00;22;55;22 - 00;22;59;27
and their partners to advance
continuity of care in their communities.

00;22;59;29 - 00;23;04;01
In this project period,
we funded about 35 communities

00;23;04;02 - 00;23;06;18
and we will be funding some more soon.

00;23;06;18 - 00;23;09;08
We also provide training
and technical assistance to communities.

00;23;09;08 - 00;23;12;08
We have provided over 400 hours

00;23;12;09 - 00;23;17;02
of technical assistance to grantees
and also the CDC REACH recipients.

00;23;17;05 - 00;23;22;14
Another activity is fostering partnerships
at the local, state and national level.

00;23;22;16 - 00;23;26;02
For example, at national level,
we convene the Breastfeeding Public Health

00;23;26;02 - 00;23;29;28
Partners in 2014,
which is a group of about ten

00;23;29;28 - 00;23;32;27
national organizations,
and we are still very active.

00;23;33;02 - 00;23;36;06
And finally, we have developed
the Continuity of Care Blueprint

00;23;36;06 - 00;23;39;06
that just turned two years old last week.

00;23;39;08 - 00;23;42;04
So the blueprint is the systems approach

00;23;42;04 - 00;23;46;10
for communities
to consistently provide this continuous,

00;23;46;12 - 00;23;50;07
high quality lactation support
and supportive environments for families.

00;23;50;09 - 00;23;54;12
It was designed to build a safety net
for families before

00;23;54;12 - 00;23;59;00
and after the hospital delivery throughout
the first thousand days of life.

00;23;59;03 - 00;24;04;02
So the centerpiece of the blueprint
are the 43 strategies to improve care,

00;24;04;02 - 00;24;08;16
coordination and communication
among providers and the establishment of

00;24;08;16 - 00;24;13;16
proactive, supportive policies, systems
and environments throughout the community.

00;24;13;18 - 00;24;17;09
So since the launch, there were over
2000 downloads

00;24;17;09 - 00;24;19;02
from every state in the country.

00;24;19;02 - 00;24;23;25
And surprisingly, we also had downloads
from other 20 different countries.

00;24;23;28 - 00;24;27;21
Also in this map, you see the red stars
representing grantee communities

00;24;27;21 - 00;24;29;11
that implemented the blueprint.

00;24;29;11 - 00;24;32;08
Grantees were a mix of local health
departments, community

00;24;32;08 - 00;24;38;12
based organizations, FQHCs, breastfeeding
coalitions and some hospital systems.

00;24;38;15 - 00;24;42;04
So here are some of the trainings
that we did for the past two years.

00;24;42;04 - 00;24;44;15
We having an accredited continuity of care
series.

00;24;44;15 - 00;24;47;21
And each webinar
showcase speakers from communities

00;24;47;21 - 00;24;50;20
that were successful
implementing the strategies.

00;24;50;21 - 00;24;54;02
We had great participation
and you can still watch

00;24;54;02 - 00;24;57;23
the recording and claim
most of this continuing education credits.

00;24;57;25 - 00;25;01;15
And on the next slide,
you're going to see a bit of history

00;25;01;15 - 00;25;04;26
of the grants that we put together
through the past five years.

00;25;04;29 - 00;25;09;01
The last three cycles, we're
related to the blueprint implementations

00;25;09;07 - 00;25;14;02
and also a note there
that from 2018 to 2023, we also worked

00;25;14;02 - 00;25;18;09
with REACH recipients implementing
continuity of care in their communities.

00;25;18;12 - 00;25;21;01
Finally,
you're going to be able to see here

00;25;21;01 - 00;25;24;17
the outcomes from the past
well the preliminary outcomes

00;25;24;17 - 00;25;27;16
from this past two years of blueprint
implementation.

00;25;27;16 - 00;25;31;14
Collectively, grantees
increase capacity and diversify

00;25;31;16 - 00;25;34;16
the lactation
workforce in their communities.

00;25;34;16 - 00;25;38;26
They have also conducted
community lactation specific assessments

00;25;38;28 - 00;25;42;08
to understand gaps in continuity of care
in their communities,

00;25;42;08 - 00;25;46;23
and then to focus efforts
where they need the most.

00;25;46;25 - 00;25;49;22
They have also improved breastfeeding
policies, systems

00;25;49;22 - 00;25;53;27
and environments in many, many, many,
many settings in the community.

00;25;53;29 - 00;25;58;08
So they increased the availability
of supportive environments

00;25;58;08 - 00;26;03;07
throughout the spaces where families
live, work, play and raise kids.

00;26;03;09 - 00;26;07;06
And finally, at the heart of our project
is to foster local partnerships,

00;26;07;06 - 00;26;08;26
because this is a must to advance

00;26;08;26 - 00;26;12;24
continuity of care,
since no one can do continued care alone.

00;26;12;27 - 00;26;16;16
So there are lots of partnerships
formed or strengthened, especially those

00;26;16;16 - 00;26;20;10
collaborations with agencies that address
social determinants of health.

00;26;20;12 - 00;26;23;11
So they provide care for the family
holistically

00;26;23;11 - 00;26;26;24
and not just solely focused on latching
baby to breast.

00;26;27;01 - 00;26;30;15
Also a great success for many grantees,
is that they improved

00;26;30;15 - 00;26;36;15
their referral systems and strengthened
their handoff policies and procedures.

00;26;36;17 - 00;26;40;23
Finally, a grant is also focused
on building authentic relationships

00;26;40;23 - 00;26;45;04
with families through family centered care
father engagement projects.

00;26;45;06 - 00;26;47;17
So there's a lot to describe in one slide.

00;26;47;17 - 00;26;51;25
I hope you'll go check out their stories
in the continuity of care website.

00;26;51;25 - 00;26;57;13
And for the next steps, you'll see that
we launched, we just launched our request

00;26;57;13 - 00;27;01;17
for application for the third cohort
to implement the blueprint.

00;27;01;19 - 00;27;04;12
And this time
we are also looking for applicants

00;27;04;12 - 00;27;08;07
who proposed strategies
to also improve child nutrition security.

00;27;08;10 - 00;27;15;06
So check out our RFA and in the same
website and the link is on the chat box.

00;27;15;08 - 00;27;19;21
And next,
thank you so much DNPAO for having NACCHO

00;27;19;21 - 00;27;23;20
and I'll turn it over to our amazing
grantees in Jefferson County.

00;27;23;22 - 00;27;27;13
Lucy and Paulina
were part of our last grant project

00;27;27;13 - 00;27;31;12
and we had the chance
to visit their community last month.

00;27;31;19 - 00;27;35;23
We're so amazed by all the work
they do to build continuity of care

00;27;35;23 - 00;27;37;12
for the Latino community.

00;27;37;12 - 00;27;40;13
And I'm sure you all
are going to be just as inspired.

00;27;40;15 - 00;27;45;02
Gracias and beinvenidos Lucy and Paulina.

00;27;45;04 - 00;27;45;25
Hello, everybody.

00;27;45;25 - 00;27;50;03
Thank you
so much for the invitation to join today.

00;27;50;05 - 00;27;53;22
We are delighted to share about
how we're knitting networks of care

00;27;53;28 - 00;27;58;00
and support for our families
after the hospital discharge in community.

00;27;58;06 - 00;28;02;05
So this is, we’re in Colorado
and this is how people think of Colorado.

00;28;02;06 - 00;28;05;24
It is gorgeous, just like our families
and our communities.

00;28;05;24 - 00;28;11;00
This is where we live where we learn,
where we grow, we play, where we pray.

00;28;11;02 - 00;28;15;12
For us doing this work that it's important
to have another perspective.

00;28;15;14 - 00;28;16;24
Because not everybody

00;28;16;24 - 00;28;21;05
gets to play in this mountains
and no matter how close they are to them.

00;28;21;07 - 00;28;24;07
And this is a map of the Child
Opportunity Index,

00;28;24;10 - 00;28;28;10
which shows disparities in opportunities
for children in the Denver metro area.

00;28;28;17 - 00;28;31;18
The lighter colors show
where our communities,

00;28;31;18 - 00;28;35;15
our children have less opportunities
and the darker colors show

00;28;35;15 - 00;28;39;09
a abundance of opportunities for them.

00;28;39;11 - 00;28;40;26
This is where we work.

00;28;40;26 - 00;28;45;17
We work in the lighter areas, the color,
the lighter blue areas.

00;28;45;23 - 00;28;50;10
This is where our immigrant communities
live and also the historical

00;28;50;12 - 00;28;53;07
geographical locations of red lining.

00;28;53;07 - 00;28;55;08
This grant has allowed us to dream.

00;28;55;08 - 00;28;58;15
To start thinking
about how we rebuilt connections

00;28;58;15 - 00;29;03;01
so those opportunities become available
for everybody in our communities.

00;29;03;03 - 00;29;06;16
We have been able to imagine
and build a community where groups

00;29;06;22 - 00;29;10;17
with different knowledge,
information and power start connecting.

00;29;10;17 - 00;29;14;16
In our study,
we did a qualitative qualitative study

00;29;14;19 - 00;29;18;16
of the experiences of families
after discharge.

00;29;18;18 - 00;29;21;27
We hear that when families
leave the hospital, even baby friendly

00;29;21;27 - 00;29;25;26
hospitals, they have no connections
of support in their communities.

00;29;26;03 - 00;29;28;18
They experience profound isolation.

00;29;28;18 - 00;29;32;27
So our job has been to create
those networks to weave neighbors

00;29;33;00 - 00;29;36;22
in neighborhoods and networks
so everybody who have someone

00;29;36;22 - 00;29;40;14
in their closest contact
that can give them information and support

00;29;40;20 - 00;29;45;18
related to lactation, breastfeeding
and nutrition, infant nutrition.

00;29;45;22 - 00;29;47;26
We have not done this on our own.

00;29;47;26 - 00;29;50;25
We're also weaving networks
between organizations.

00;29;50;25 - 00;29;53;28
JCPH supported us through
funding mechanisms

00;29;53;28 - 00;29;58;01
and helping us to align our work
with the health priorities of the county.

00;29;58;08 - 00;30;03;06
Then Edgewater Collective help us to build
our structure, organizational structure.

00;30;03;06 - 00;30;04;29
And we, Cuenta Conmigo, we

00;30;05;01 - 00;30;06;07
were able to bring local

00;30;06;07 - 00;30;10;01
knowledge
and experience to make this happen.

00;30;10;03 - 00;30;11;07
We make connections.

00;30;11;07 - 00;30;12;17
We are those touchpoints

00;30;12;17 - 00;30;16;14
between the resources, the organizations,
and our families.

00;30;16;17 - 00;30;19;23
In the next week,
we are celebrating at national level

00;30;19;29 - 00;30;24;29
the Latino Lactation Week, and we'll be
celebrating across the country.

00;30;24;29 - 00;30;28;16
In a couple of weeks,
our team will be traveling to Arkansas

00;30;28;18 - 00;30;34;00
to also share our experiences to train
on clinical lactation at community level

00;30;34;03 - 00;30;37;05
so other communities can also start
creating their own

00;30;37;05 - 00;30;40;05
networks of support at local level.

00;30;40;09 - 00;30;43;22
Thank you so much, Lucy, your turn.

00;30;47;22 - 00;30;58;27
Thank you Paulina. We increase the capacity of our community
by speaking the language of their heart.

00;30;59;18 - 00;31;02;02
We are culturally sensitive.

00;31;02;08 - 00;31;11;03
Our community feels included and that motivates them to move forward and put into practice what they have learned within their families and for their families.

00;31;11;14 - 00;31;12;10
Slide please.

00;31;15;16 - 00;31;28;23
This is possible because we provide community preparedness training, safe infant feeding in emergencies, breastfeeding clinic,

00;31;28;23 - 00;31;38;09
breastfeeding friend notifications to child care providers, and we have monthly study sessions. It is a local participants

00;31;38;09 - 00;31;45;06
with real cases where we are learning. 

00;31;47;27 - 00;31;58;26
We are increasing the presence of families with in-person and virtual groups in cafes where we listen, talk, and support their

00;31;58;26 - 00;32;05;14
needs in the areas of breastfeeding, nutrition, health, and others.

00;32;05;14 - 00;32;15;06
In alliance with other entities and with the same objective, we work and reflect on the interests of families

00;32;15;06 - 00;32;19;02
with a broad vision from our experience and connection.

00;32;23;05 - 00;32;42;10
We know that that personal contact lies in dealing with families culturally and directly. Having one-on-one visits is an effective way to build trust. By removing language barriers, we are able to actively listen in-person, virtually, or by phone. 

00;32;42;10 - 00;32;49;14
Families feel more understood when accompanied, and we create very significant bonds of trust.

00;32;49;14 - 00;33;00;06
We conduct interviews and expand our “role” knowing that the transition from the hospital to home is overwhelming and sometimes even traumatic.

00;33;00;06 - 00;33;07;10
Being a mother is a very exhausting job because we don't know what to do when we are alone with the baby.

00;33;07;10 - 00;33;10;26
There may not be anyone who can support their immediate needs.

00;33;10;26 - 00;33;20;10
We let them know that we are there to accompany them in those difficult moments from a cultural perspective, in the same

00;33;20;10 - 00;33;28;08
language, with the same sentiment, and with a deep perspective from our experience and understanding.

00;33;31;29 - 00;33;39;16
We know that it is working because we are constantly listening and reflecting on what families want.

00;33;39;16 - 00;33;49;14
We created a connection network with other entities to support the breastfeeding, nutrition, health, and well-being needs of families in our community.

00;33;49;14 - 00;34;01;27
We are navigators and respond to their interests. We support them with available resources and teach them the skills needed to learn how to do it. We are empowering families,

00;34;01;27 - 00;34;13;05
and they are developing the confidence to do it themselves. During the small moments of breastfeeding, we listen culturally.

00;34;13;05 - 00;34;20;20
We listen to their experience in the hospital, how breastfeeding is working, their health and well-being right now, and even what their future expectations are.

00;34;20;20 - 00;34;28;27
We continue to build trust, stay connected, and respond to families in the community.

00;34;31;10 - 00;34;40;09
Here is our information in case you want to contact us, and thank you very much for the opportunity. And now I pass it on to Janelle.

00;34;47;28 - 00;34;52;02
Thank you to our panelists
for our wonderful presentation today.

00;34;52;02 - 00;34;56;00
Before we move on to the questions
and answers, I want to remind folks

00;34;56;00 - 00;34;59;13
and to stay connected with us here at CDC,

00;34;59;15 - 00;35;03;16
we have both a Twitter
and Facebook account.

00;35;03;16 - 00;35;05;28
If you're not following us,
go ahead and follow us.

00;35;05;28 - 00;35;07;14
And wanted to also share.

00;35;07;14 - 00;35;10;15
We have some great resources,
including those

00;35;10;22 - 00;35;14;08
related to breastfeeding and our State
and Community Health Media Center

00;35;14;10 - 00;35;17;18
and also great data on our Data, Trends and Maps.

00;35;17;20 - 00;35;25;01
So I invite all of my panelists to turn
their cameras on and we will do some Q&A.

00;35;25;03 - 00;35;27;13
First question is for you Daurice.

00;35;27;13 - 00;35;32;22
Are the training materials being used in
the EMPower Projects publicly available?

00;35;32;24 - 00;35;37;08
Yes. The training materials that are
that were used in the first EMPower

00;35;37;08 - 00;35;41;07
training project, our collaborative, are publicly available.

00;35;41;09 - 00;35;44;23
And I believe that we drop the

00;35;44;25 - 00;35;50;15
email or the URL and the webinar chat box.

00;35;50;17 - 00;35;55;05
They're available on the UNC Chapel Hill

00;35;55;07 - 00;35;57;27
website and we are currently working

00;35;57;27 - 00;36;01;29
with our partners to make available
after the conclusion

00;36;02;04 - 00;36;06;11
of our current project EMPower Best Practices

00;36;06;13 - 00;36;09;22
the the training materials.

00;36;09;25 - 00;36;12;10
Does that answer the question? It does.

00;36;12;10 - 00;36;14;06
Thank you.

00;36;14;06 - 00;36;16;12
The next question is for Harumi.

00;36;16;12 - 00;36;19;15
Have you identified some commonalities
among grantees

00;36;19;15 - 00;36;23;14
that were very successful?

00;36;23;16 - 00;36;23;28
Thanks.

00;36;23;28 - 00;36;25;11
Thanks, Janelle.

00;36;25;11 - 00;36;28;26
Yeah, there's
we're still analyzing all that data,

00;36;28;26 - 00;36;32;06
but I think one of them that stands out

00;36;32;06 - 00;36;36;00
is the grantees like Jefferson

00;36;36;00 - 00;36;40;06
County here, that they already had
this partnerships in place.

00;36;40;06 - 00;36;46;07
So they weren't trying to build trust and
collaborate during a nine month project.

00;36;46;10 - 00;36;49;19
So the ones that were already

00;36;49;21 - 00;36;50;21
already had those

00;36;50;21 - 00;36;53;21
relationships in place were

00;36;53;27 - 00;36;54;23
more successful.

00;36;54;23 - 00;37;00;03
I think another factor that comes to mind
now is the ones that really worked

00;37;00;10 - 00;37;05;15
with the community, co-created
with the community, got community input

00;37;05;19 - 00;37;09;27
or even onboarded a community member

00;37;09;27 - 00;37;13;27
as that community expert advisor.

00;37;13;29 - 00;37;16;29
So they've really created

00;37;17;05 - 00;37;18;22
services that really fit

00;37;18;22 - 00;37;21;22
the needs of the community
they're serving.

00;37;21;27 - 00;37;24;27
I think those two that comes to mind now.

00;37;25;02 - 00;37;27;10
Thank you,

00;37;27;10 - 00;37;27;25
Kristen.

00;37;27;25 - 00;37;30;25
The next question is for you.

00;37;30;29 - 00;37;34;19
It's about mPINC data
and how can the public access

00;37;34;19 - 00;37;39;29
mPINC data and is individual
hospital data available?

00;37;40;01 - 00;37;41;02
Thanks for that question.

00;37;41;02 - 00;37;45;08
So hospitals
will receive their individual reports,

00;37;45;08 - 00;37;48;18
which are confidential
and not publicly available.

00;37;48;20 - 00;37;53;01
They'll be sent out to the hospitals
at the conclusion of our survey.

00;37;53;03 - 00;37;55;19
We do have national,
regional and state reports

00;37;55;19 - 00;37;58;04
that are publicly available
on our website.

00;37;58;04 - 00;38;03;09
And for researchers looking to use
mPINC data to answer research questions

00;38;03;09 - 00;38;06;09
or state health departments
who are looking to use

00;38;06;09 - 00;38;09;15
mPINC data for the development
of public health programs,

00;38;09;18 - 00;38;12;14
we have data available
and those folks can email

00;38;12;14 - 00;38;18;11
mPINC@CDC.gov to learn
more and receive a data request form.

00;38;18;13 - 00;38;19;06
Thank you.

00;38;19;06 - 00;38;21;06
And then Paulina and Lucy.

00;38;21;06 - 00;38;23;13
And the next question is for you.

00;38;23;13 - 00;38;26;02
How can communities support each other
in breastfeeding

00;38;26;02 - 00;38;29;20
decisions?

00;38;29;22 - 00;38;31;02
That's a beautiful question.

00;38;31;02 - 00;38;33;16
I actually would love to know as well.

00;38;33;16 - 00;38;39;12
What we what we know is that a,
people are asking for information.

00;38;39;14 - 00;38;41;24
People are asking to be able
to make decisions.

00;38;41;24 - 00;38;44;29
They want to have a trusted partner
that can give them the information

00;38;44;29 - 00;38;48;12
that they need, not just about,
oh It's so good that you're breastfeeding.

00;38;48;18 - 00;38;49;18
Just go ahead and do it.

00;38;49;18 - 00;38;54;07
But actually, what do they solve the day
to day challenges to make that happen.

00;38;54;14 - 00;38;58;00
So I think that supporting each other
with decisions has to do with

00;38;58;00 - 00;38;59;17
what are the possibilities?

00;38;59;17 - 00;39;03;16
What are the visions that people
and community are building together

00;39;03;23 - 00;39;10;15
in order to fulfill their goals
in this journey of breastfeeding?

00;39;10;18 - 00;39;12;27
And then there's a follow up.

00;39;12;27 - 00;39;18;06
Folks are interested in what meeting
you'll be at an Arkansas.

00;39;18;09 - 00;39;21;26
Teaching, one of our clinical and

00;39;21;28 - 00;39;24;02
curriculums in Arkansas,

00;39;24;02 - 00;39;27;09
in Springfield,
in the University of Arkansas.

00;39;27;09 - 00;39;30;08
It's going to be a week long

00;39;30;08 - 00;39;32;01
training with an amazing group.

00;39;32;01 - 00;39;34;03
We met them yesterday, actually.

00;39;34;03 - 00;39;38;22
A they it's all going to be in Spanish
and be very culturally based.

00;39;38;25 - 00;39;41;16
We tend to discuss those challenges

00;39;41;16 - 00;39;45;10
that are specific to our communities
as well as the celebrations that we have.

00;39;45;10 - 00;39;48;18
There's so many strengths in our community
that help us build up

00;39;48;18 - 00;39;52;25
solutions in ways
that are way easier to see and explore

00;39;52;25 - 00;39;57;08
and advance
When we're there with community.

00;39;57;10 - 00;39;58;23
Thank you for those questions.

00;39;58;23 - 00;39;59;20
Yeah, thank you.

00;39;59;20 - 00;40;02;19
And keep the questions coming in.

00;40;02;20 - 00;40;03;05
Harumi,

00;40;03;05 - 00;40;05;10
there's a question for you. In your work,

00;40;05;10 - 00;40;08;10
how do you see hospitals
as supporting community programs?

00;40;08;16 - 00;40;17;19
And do you have any stories of hospitals
implementing the blueprint?

00;40;17;22 - 00;40;20;02
Yes. Yes, we definitely have.

00;40;20;02 - 00;40;24;01
I would say about one third,
maybe of our grantees,

00;40;24;01 - 00;40;27;01
our hospital systems.

00;40;27;07 - 00;40;31;24
I can give some examples of the past year
or two years.

00;40;31;26 - 00;40;36;24
We had university of Chicago
Medical Center.

00;40;36;24 - 00;40;40;10
So I think they really provided
that consistent

00;40;40;12 - 00;40;43;06
constant care
because they're a university hospital.

00;40;43;06 - 00;40;46;28
So they actually hired
a community

00;40;47;00 - 00;40;50;18
To be in contact from pregnancy

00;40;50;24 - 00;40;53;18
through postpartum

00;40;53;18 - 00;40;57;07
with their patients
instead of them seeing different providers

00;40;57;07 - 00;41;00;09
all the time.

00;41;00;10 - 00;41;04;02
The other one  the Cincinnati Children's Hospital.

00;41;04;02 - 00;41;09;00
They are a group of so much experienced
physicians and community.

00;41;09;00 - 00;41;12;08
They the great community
clinic partnerships.

00;41;12;10 - 00;41;15;09
So they've really worked
on improving their warm

00;41;15;09 - 00;41;20;11
handoffs from the hospital
to the community and also they focused

00;41;20;11 - 00;41;23;11
on the really increasing

00;41;23;11 - 00;41;25;25
the supportive environment
in the community.

00;41;25;25 - 00;41;30;13
So I think they have a quality improvement
going on with a bunch of their

00;41;30;16 - 00;41;33;09
early care and education settings.

00;41;33;09 - 00;41;36;17
And finally, the other one that we have

00;41;36;17 - 00;41;41;00
was the MedStar Hospital,
that it was current grantee in Baltimore,

00;41;41;00 - 00;41;45;11
and they did a fascinating partnership
with City of Refugee

00;41;45;12 - 00;41;49;06
that is a resilience center
for the Baltimore community.

00;41;49;09 - 00;41;52;08
And they they provide

00;41;52;08 - 00;41;55;08
food, food, fresh foods,

00;41;55;08 - 00;41;59;10
career advancement opportunities and diaper bank.

00;41;59;10 - 00;42;05;07
So they co-located their lactation
support in this diaper bank.

00;42;05;10 - 00;42;10;13
So it's really, really rich and holistic
and the way they are providing care.

00;42;10;15 - 00;42;12;06
So I think those three come to mind.

00;42;12;06 - 00;42;16;11
But check our stories
in the Blueprint website that you're going

00;42;16;11 - 00;42;22;05
to see way more ways that hospitals have
been supporting communities.

00;42;22;08 - 00;42;23;23
Thank you.

00;42;23;23 - 00;42;26;06
Lucy, the next question is for you.

00;42;26;06 - 00;42;29;06
Do you have any lessons
from the COVID time period

00;42;29;06 - 00;42;39;02
and best connecting with communities

00;42;39;04 - 00;42;40;04
Si.

00;42;40;04 - 00;42;45;00
I think that COVID brought a great lesson to us all.

00;42;45;00 - 00;42;51;05
The community that I live in, which is the Hispanic community,

00;42;51;05 - 00;42;59;04
was very underserved and there were many resources in the community to which we did not have access.

00;42;59;04 - 00;43;09;28
COVID came to open doors so that people could realize that these programs are possible and within reach.

00;43;09;28 - 00;43;23;11
What the community needs most is direct one-on-one contact, and I think that is the lesson that COVID has brought us. Thank you.

00;43;26;04 - 00;43;28;02
Thank you,

00;43;28;02 - 00;43;29;03
Kristen,

00;43;29;03 - 00;43;30;23
the next question is for you.

00;43;30;23 - 00;43;35;26
And it's about when will the next mPINC survey take place?

00;43;35;28 - 00;43;37;13
So we are planning to launch

00;43;37;13 - 00;43;41;16
the 2024 mPINC survey starting in early January.

00;43;41;19 - 00;43;45;10
So folks can stay up to date
on the survey's progress by subscribing

00;43;45;11 - 00;43;49;04
to our listserv
and checking the blue update boxes

00;43;49;04 - 00;43;51;13
that we put on the top of our mPINC website.

00;43;51;13 - 00;43;55;03
And maybe someone can drop the link
to the mPINC website in the chat

00;43;55;05 - 00;43;58;27
as I'm speaking,
but will be periodically sending updates

00;43;58;27 - 00;44;03;06
through both our listserv
and posting those on the website.

00;44;03;08 - 00;44;05;20
And I will say
it takes a little bit of time to reach out

00;44;05;20 - 00;44;09;09
to all hospitals
across all the states and territories.

00;44;09;09 - 00;44;14;00
So hospitals in your area may
not be contacted until closer to February,

00;44;14;02 - 00;44;15;05
but if you have any questions

00;44;15;05 - 00;44;19;00
about the survey or would like to request
a previous hospital report

00;44;19;00 - 00;44;24;27
or mPINC data, like I said before,
you can reach out to mPINC@cdc.gov.

00;44;24;29 - 00;44;27;08
Thank you. Daurice,

00;44;27;08 - 00;44;31;25
If hospitals in my state are interested
in taking part in the newest initiative,

00;44;31;28 - 00;44;35;23
how would they learn more?

00;44;35;26 - 00;44;37;00
Thanks for the question.

00;44;37;00 - 00;44;40;22
I think the guidance would be to check out

00;44;40;22 - 00;44;43;22
the cheer website

00;44;43;29 - 00;44;49;06
and I think we have that in the chat chat
and also

00;44;49;08 - 00;44;53;03
you can send an email
to cheer at the gmail account,

00;44;53;03 - 00;44;57;16
which is also on there in the chat
and on their home page.

00;44;57;18 - 00;45;01;03
Their period of performance begins
at the end of September,

00;45;01;03 - 00;45;06;23
so they may not start recruiting hospitals
until little bit later than that

00;45;06;23 - 00;45;09;23
because they have some planning to do
and that sort of thing.

00;45;09;24 - 00;45;12;23
But again,
watching for updates on their website

00;45;12;23 - 00;45;15;23
around October.

00;45;15;26 - 00;45;17;02
Thanks.

00;45;17;02 - 00;45;19;01
Thanks.

00;45;19;01 - 00;45;22;14
And Paulina,
our last question will go to you.

00;45;22;14 - 00;45;25;10
What do you see
as some of the biggest opportunities

00;45;25;10 - 00;45;30;21
and challenges for organizations
like yours to promote breastfeeding?

00;45;30;24 - 00;45;31;24
The opportunities is

00;45;31;24 - 00;45;35;12
that we have communities who are

00;45;35;15 - 00;45;37;21
really accepting and caring.

00;45;37;21 - 00;45;40;21
I'm very concerned about the health
of our families and children.

00;45;40;27 - 00;45;43;16
And so I think that we have the ground

00;45;43;16 - 00;45;47;19
a very it's a very
has been cultivated, right.

00;45;47;24 - 00;45;49;12
We are there ready.

00;45;49;12 - 00;45;51;24
I I am not finding an argument.

00;45;51;24 - 00;45;54;13
I don't have to argue about how beneficial
this is.

00;45;54;13 - 00;45;55;01
Right?

00;45;55;01 - 00;45;57;17
People are ready to jump in
and start doing it.

00;45;57;17 - 00;46;01;21
There may be some cultural barriers
sometimes because there's a misalignment

00;46;01;21 - 00;46;05;21
of how we're presenting the context,
how we're presenting our values.

00;46;05;21 - 00;46;10;24
But there's so much work that we can in
we can do creating some congruent

00;46;10;28 - 00;46;14;18
congruence in like equivalent meaning.

00;46;14;20 - 00;46;18;17
I will say that we can bring together
these goals

00;46;18;19 - 00;46;21;18
and now in terms of challenges,
I think that the work,

00;46;21;18 - 00;46;23;03
some of the work that we do,

00;46;23;03 - 00;46;24;23
there's no funding for this kind of thing.

00;46;24;23 - 00;46;27;03
We are piecing together things.

00;46;27;03 - 00;46;28;24
We are like thanks to NACCHO,

00;46;28;24 - 00;46;32;01
this really help us set up
on this structure that then will

00;46;32;01 - 00;46;35;11
allow us to launch this into the next steps.

00;46;35;13 - 00;46;39;12
But we have families who work
with families actually more than Spanish.

00;46;39;12 - 00;46;42;18
We have also seen Vietnamese families
and they come to us

00;46;42;18 - 00;46;46;10
because we have an understanding
of immigration experience,

00;46;46;10 - 00;46;49;28
of refugee experience
that many other that other communities

00;46;49;28 - 00;46;53;03
or I would say
the more dominant cultures do not have.

00;46;53;06 - 00;46;57;05
So some of the challenges is
that this work is extremely important.

00;46;57;07 - 00;47;01;06
I think that we at that moment
and that link between everything

00;47;01;06 - 00;47;05;13
that our institutions are trying
to accomplish in what is a real community

00;47;05;13 - 00;47;09;10
experience where right there in the middle.
And unless we get funded,

00;47;09;14 - 00;47;13;11
unless we get a recognition
and support for our lactation counselors,

00;47;13;11 - 00;47;16;19
for navigators in the community, we do it
all right.

00;47;16;20 - 00;47;18;16
We're not just lactation counselors.

00;47;18;16 - 00;47;22;20
We have to do navigation
on housing, on food access, on education,

00;47;22;26 - 00;47;26;12
and everything comes
and we will take it and run with it,

00;47;26;12 - 00;47;28;09
because that's what our families need.

00;47;28;09 - 00;47;31;22
So a recognition
that this role is essential

00;47;31;25 - 00;47;34;28
to build this infrastructure, and needs to happen.

00;47;34;28 - 00;47;39;22
And I think that's the biggest challenge
that we're facing right now.

00;47;39;25 - 00;47;41;11
Thank you.

00;47;41;11 - 00;47;44;15
Well, if everyone can please join me
in a virtual applause

00;47;44;15 - 00;47;46;26
for our outstanding panel today.

00;47;46;26 - 00;47;49;15
We're so glad that we were able
to spend this last day

00;47;49;15 - 00;47;53;10
of breastfeeding month with you all
and really appreciate

00;47;53;10 - 00;47;57;15
all of the great content and resources
that were shared today.

00;47;57;17 - 00;47;59;20
This seminar, as with our others,

00;47;59;20 - 00;48;02;22
will be posted on the DNPAO website.

00;48;02;24 - 00;48;04;11
And thank you all for joining us.