First 5 Alameda County - Every Child Counts
2009-10 Annual Report
Highlights
Using Multiple, Integrated Strategies to Improve Children’s Health
Alameda County children have many preventable health-related risk factors that can impact school readiness. To address these, F5AC uses multiple, integrated strategies wherever possible in order to have the greatest impact and to foster long-term sustainability.
Two of F5AC’s multi-pronged efforts related to children’s health had strong results this year:
- Increasing the number of mothers who breastfeed and the duration of breastfeeding
- Preventing and managing asthma symptoms in infants and young children
Why is this important?
The American Academy of Pediatrics recommends exclusive breastfeeding until babies are 6 months old. Breastfeeding has many positive benefits for young children and their families:
- Promotes early attachment between mother and child
- Breastfed children are healthier and have better long term health outcomes. They are less likely to suffer from diarrhea, respiratory illness, ear infections, and allergic skin disorders and are less likely to become obese or develop diabetes.
- Is less costly for families than buying infant formula
In Alameda County, 29.9% to 93% of mothers (depending on the hospital) report breastfeeding exclusively when they leave the hospital after delivery. Two months later, many mothers have stopped breastfeeding. Only 36% of Alameda County new mothers exclusively breastfeed their infants for more than 8 weeks.
Parent Voice:
“[After my daughter was born], I know that I was very anxious and worried... Even though I wanted to breastfeed her…I felt like giving up.”
When children have access to appropriate health care and asthma prevention strategies, most asthma hospitalizations and ER visits can be avoided.
Alameda County has the highest asthma hospitalization rate for children aged 0 to 5 years (49.9% per 10,000 children) in California, nearly 2 to 3 times higher than rates in neighboring Bay Area counties. Hospitalizations and Emergency Room (ER) visits for Alameda County children under 5 years are highest among African American children and those living in Oakland.
Result 1
Lactation support and education for pregnant women/new mothers in F5AC programs and their medical providers
Support to new mothers prenatally, in the hours and days after delivery, and after they leave the hospital can make a crucial difference in their breastfeeding success. Prior to F5AC implementing lactation support and consultation services, there were no in-home breastfeeding services available for low-income/Medi-Cal families in Alameda County, and resources were scarce for mothers experiencing complex lactation problems.
Detail 1: Supporting Breastfeeding [more]
F5AC Lactation Specialists:
- Provided 368 brief hospital-based consultations to mothers shortly after delivery
- Offered a weekly drop-in breastfeeding support group in a pediatric clinic
- Provided 401 visits and 569 telephone consultations to 103 mothers participating in F5AC home visiting programs
- Loaned over 100 breast pumps to mothers who were separated from their infants or had difficulties breastfeeding
- Provided lactation consultation and training to midwives and pediatric providers
Detail 2: Higher Breastfeeding Rates [more]
Despite risk status, families receiving F5AC home visitation services have consistently higher breastfeeding rates compared to county rates.
2009-2010 Results
Program |
All IFS |
SS |
Teen |
YFC |
|
Up to 1 month |
69 |
22 |
37 |
10 |
|
Up to 6 months |
131 |
84 |
42 |
5 |
|
Up to 1 year |
48 |
29 |
10 |
9 |
|
> 1 year |
77 |
32 |
35 |
10 |
|
Total (N) |
325 |
167 |
124 |
34 |
% who breastfed 6 mos or longer |
38% |
37% |
36% |
56% |
Result 2
Support for culturally specific populations with historically lower rates of breastfeeding
A community grantee serving primarily Asian and Pacific Islander families in low income neighborhoods worked diligently to support breastfeeding by:
- Training staff
- Holding prenatal breastfeeding classes
- Loaning breast pumps
- Advising moms over the phone after delivery
Detail 1: Increased Capacity to Support Breastfeeding Women [more]
2 staff members became Certified Lactation Educators, increasing the capacity in the county to support this parent population
Of the mothers who reported breastfeeding soon after delivery, 54.5% continued to breastfeed for 6 months to a year
Parent Voice:
“When Ms. S gave me a breastfeeding follow up call, she…encouraged me to…[do a number of things such as] find time to rest while my baby was sleeping…[and take] time to establish a feeding schedule [with my baby] and learn from each other. After this conversation, I finally allowed my husband and in-laws to help …take care of my older son so I could pay more attention to my newborn.”
Result 3
More county-wide access to breastfeeding information and resources for parents and medical providers
Breastfeeding guides were distributed and trainings on breastfeeding were held for providers.
Detail 1: Provider Trainings on Supporting Breastfeeding [more]
Family friendly breastfeeding support guides were created in 4 languages and over 2,000 were distributed this year. 500 handy “pocket” guides with lactation information and resources were given to medical providers.
52 providers attended the "Breastfeeding: A Tool to Address Health Disparities in Alameda County" training
70 participants attended the "Ankyloglossia and Frenotomy: Early Identification and Understanding the Procedure" training
Result 4
More hospital-based support for breastfeeding mothers
Alameda County Medical Center (ACMC) has one of the lowest rates of exclusive breastfeeding (52%) of the hospitals in the county, and serves one of the most at-risk population for health outcomes.
A F5AC lactation specialist supports Alameda County Medical Center’s efforts to become a UNICEF/World Health Organization “Baby-Friendly” hospital*.
* To obtain a “Baby-Friendly” designation, hospitals must follow a set of required practices that support breastfeeding which, in the United States, includes: helping mothers begin breastfeeding within one hour of birth, encouraging breastfeeding on demand, and training all health care staff in skills needed to implement breastfeeding policy.
Detail 1: Baby-Friendly Designation for ACMC [more]
Alameda County Medical Center (ACMC) made substantial progress toward this goal:
- Received an “Intent Certificate” from Baby-Friendly USA, Inc.
- Developed an 18 hour training curriculum for nursing staff and delivered the first 4 hours of training
- Developed additional training for midwives from lactation specialists. Midwives now conduct breastfeeding rounds on the post partum unit.
There are only 100 “Baby Friendly” hospitals in the country. When Alameda County Medical Center becomes a “Baby Friendly” hospital, it will be one of only two in Alameda County.
Result 5
Asthma prevention and management support for families mean fewer asthma hospitalizations and ER visits
Asthma Start integrated care across 3 main settings: the hospital, the clinic and at home.
Detail 1: Reduced Hospitalizations for Asthma [more]
154 children hospitalized for asthma at Children’s Hospital and Research Center Oakland (CHRCO) and their families received one-on-one asthma education and an individualized asthma care plan. 109 of the children were referred for additional home-based asthma prevention services and 25 to the hospital’s outpatient asthma clinic.
115 children received services through the hospital’s asthma clinic
240 children received home-based patient education and case management services.
- 52% of the children served were Oakland residents
- 31% of the children were African-American; 42% were Latino
- 100% of the families at exit from the program had engaged in at least one asthma trigger reduction effort (e.g., covering mattresses and pillows, vacuuming weekly with a HEPA vacuum cleaner)
48 parents of children with asthma were referred to smoking cessation resources
Over the last 5 years, re-hospitalization and ER visits have remained consistently low 3-6 months after children received asthma prevention services
Provider Report:
A 2 year old with 3 prior hospitalizations for asthma was hospitalized again: “He is one of 6 children, 5 with asthma…but he is the most affected…. Follow-up was…arranged in our asthma clinic within the week after discharge, recognizing his urgent need for consistent, timely follow-up. An Asthma Start home visiting referral was generated to assist the mom, as well as [provide] other social service support. [He] has done well with no emergency room visits and no admissions since his discharge [5 months ago], quite a record for him.”
Result 6
Greater integration of asthma services; more training and support for medical providers; new screening for tobacco exposure during pediatric visits
Hospital medical residents and attending physicians received training and support about asthma education and care, and now order asthma education for families as part of their standard admission orders.
This year a new effort was launched to train physicians, pediatric residents and nurses about children’s exposure to secondhand smoking and to do regular screening for exposure to tobacco smoke during pediatric medical visits.
Detail 1: Reducing Children's Exposure to Secondhand Smoke [more]
Between October 2009 to June 2010, all 2,628 Alameda County patients under 5 years seen at CHRCO were screened for tobacco exposure
522 parents/guardians who reported that their child was exposed to tobacco smoke were counseled about tobacco cessation and ways to reduce children’s exposure in the home