Environmental Scan of Wyoming Breastfeeding Resources

Final Report

August 2015-November 2016

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Completed By: Kate Schulz RDN, LD, LMNT

Introduction:

The purpose of this project was to complete an environmental scan of available state

and local level breastfeeding support resources and provide consultation on the development

of a statewide action plan to improve breastfeeding support resources. The initial focus of this

project included six counties that were determined by Ashley Busacker, PhD Senior

Epidemiology Advisor with the Maternal and Child Health Division. The county selection was

based on high, medium, and low breastfeeding rates and whether they were urban, rural or

frontier counties. The selected counties and their designations include:

1. Laramie County - low breastfeeding rates, urban area2. Campbell County- low breastfeeding rates, rural area3. Converse County-low breastfeeding rates, frontier area4. Johnson County- medium breastfeeding rates, frontier area5. Sheridan County- high breastfeeding rates, urban area6. Teton County-high breastfeeding rates, frontier area

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Process:

Once the county selection was finalized, a Comprehensive Plan for the Environmental

Scan (See Appendix A) was completed that outlined the process and included the following

components:

1. Stakeholders to consider in above listed counties:a. Public Health Nursing Offices (PHN)b. Non-PHN Home Visiting Programsc. WIC Offices d. Hospitalse. OBGYN providersf. Pediatric providersg. Family Practice Providersh. Midwivesi. Lactation Counselors:

i. Professionalii. Peer

j. Early Intervention/Child Development Centers k. Private Practice Providersl. Community-level organizations:

i. La Leche Leagueii. Local Breastfeeding Coalitions

iii. Othersm. Consumers:

i. parents, clients of existing services, attendees of parent groups

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ii. Focus groupsn. Other target sites, groups or populations as mutually agreed upon by both Agency and Contractor

1. Methodology:a. Interviews:

i. Phoneii. In-Person

b. Site Visitsc. Surveys if applicable d. Focus Groups if applicable e. Existing Data/ Information:

i. mPINCii. Communities Putting Prevention to Work Grant

iii. Additional as available and applicablef. Internet Search

2. What do we want to know: a. Types of resources available:

i. Professional Support (Certified Lactation Counselor (CLC), International Board Certified Lactation Consultant (IBCLC), or other professional certifications)

ii. Peer Supportiii. Group Level Support/Classes (hospital breastfeeding

groups, La Leche groups, parent groups);iv. Breast pump rentalv. Breastfeeding clinics where a professional and peer

support provider are paired b. Provider knowledge about recommendations c. How are individuals/organizations that provide breastfeeding support

resources getting the word out about their programs?d. Do providers of breastfeeding resources have room to accept more clients?

i. Is there a waiting list?ii. Is the service meeting the need?

e. Cost/Availability of Resources

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i. Hours?ii. Cost of classes?

f. General awareness of available services i. How are services marketed?

g. Barriers to receiving desired supporti. Lack of transportation, inconvenient hours, no available

peer/professional support, etc. h. What is the overall climate (political, community) for supporting breastfeeding

i. Are there champions?ii. Is there an active local coalition?iii. Is there support from leaders in the community?iv. Are there supportive places of employment?

Process Narrative:

In each of the six focus counties, there was a local Public Health Office (PHN), WIC Clinic

(WIC), Hospital with a Labor/ Delivery Department and providers; these entities were

immediately identified as stakeholders. An internet search was also completed to locate any

other stakeholders that may offer breastfeeding support, including but not limited to local La

Leche League groups, local breastfeeding coalitions, lactation support counselors, doulas,

midwives, and private practice practitioners. Public Health Nursing and WIC offices were

contacted first. Their contact information and point of contact was provided by the State Public

Health Nursing and WIC offices respectively. An initial email was sent providing a personal

introduction, the purpose of the project, potential other local breastfeeding resources including

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points of contact at the hospital and provider clinics and a mutually convenient time to meet in

person. If information on additional resources was provided, they were contacted as well.

Once the initial contact was made with known stakeholders in the county; in person site

visits were conducted. Every effort was taken to ensure in person meetings, but phone

interviews and email exchanges were also conducted if scheduling did not allow otherwise. In

each county, in person interviews were held with each Public Health Nursing Office and WIC

Clinic. Meeting in person proved to be a bit more challenging due to schedules and the nature

of work for providers and nursing staff at the hospitals and clinics. The interviews that were not

completed in person were done by phone or email.

No formal process was followed for the interviews. The purpose of the project was again

explained, along with a short personal introduction. Attention was paid to ensure all

components outlined in the comprehensive plan were covered. Including but not limited to the

following:

● What types of services are provided

● Types of breastfeeding professionals available (CLC, IBCLC, etc.)

● Known challenges/barriers that affect a mom choosing to breastfeed and/or

continuing to breastfeed

● Providers support of breastfeeding and knowledge of breastfeeding 6

● Known barriers including cost of services, waitlist, etc.

● Coordination of services between community partners

● Overall climate for supporting breastfeeding, including if there were any

physician champions or supportive places of employment

Through interviews and additional research, the following were identified as available

breastfeeding support resources in each county:

L-Laramie, Ca- Campbell, Co-Converse, J-Johnson, S-Sheridan, T-Teton

1. PHN Nurses (L, Ca, Co, J, S, T)2. Local WIC Nurses (L, Ca, Co, J, S, T)3. WIC Dietitians (L, Ca, T)4. Hospital Nurses (L, Ca, Co, J, S, T)5. Private Practice IBCLC (S)6. Local mom’s support group (J)7. Local La Leche leaders (Co, L,)8. A daycare center (S)9. A UW Practice Resident (L)

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10. Physicians (L, Ca, Co, J, S, T)11. Pharmacy (Co)12. A Dentist (S)13. Community pregnancy centers (Ca, S) 14. Doulas (T)15. Midwifes (L)16. A developmental preschool (S)17. A Nurse Practitioner (Ca) 18. The State WIC office (statewide) 19. The State WIC Breastfeeding Coordinator (statewide)20. State WIC Peer Counselor Coordinator (statewide)21. Past Peer Counselor-WIC program (L)22. Current Peer Counselor- WIC program (T)23. Numerous places of employment that are supportive of breastfeeding

employees including:a. School District (L, Ca, Co, J, S, T)b. Hospitals (L, Ca, Co, J, S,T)c. VA (S)d. National Guard (L)

Please refer to the 2016 Environmental Scan of Breastfeeding Resources Guide (See Appendix

B) and the following table for more information:

Findings:

Overview of Breastfeeding Resources Available in Focus Counties

County PHN WIC Hospital/Providers Community

Laramie 3-CLCs 1-CLE, 2-CLCs

1-CLC trained, not

certified

3-IBCLCs, 4-CLCs, UW

Resident, Breastfeeding

La Leche League, Midwife, School District, National Guard

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Clinic

Campbell 8-CLCs,

2-ANCLCs

2-CLCs, 1-ANCLC,

1 Adv. CLC,

Peer Counselor

1-IBCLC, 2-ANCLCs,

12-CLC, Breastfeeding

Clinic, Nurse

Practitioner

Women’s Resource

Center, School District

Converse 2-CLCs 1-CLC, Peer

Counselor

0-CLC La Leche League, School District, Pharmacy

Johnson 1-CLC 1-IBCLC (Sheridan) 3-CLCs, 1-ANLC School District

Sheridan 3-CLCs 1-IBCLC, 1-CLC

Peer Counselor

4-CLCs Legacy Pregnancy

Center, Patty Bell

Usher, IBCLC, Day Care Center, Dentist, School District, VA, Developmental Preschool

Teton 2-CLCs, MSN

in MCH,

CLC trained

Translator, not

certified

Peer Counselor 3-IBCLCs, 3-CLCs

1-CLE, Breastfeeding

Clinic, Teton Mamas

Mountain Doulas,

Teton Mamas

* Information provided was current at time of interviews and follow up but subject to change

CLC-Certified Lactation Counselor

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IBCLC- International Board Certified Lactation Consultant

ANCLC-Advanced Nurse Certified Lactation Counselor

CLE-Certified Lactation Educator

ACLS-Advanced Certified Lactation Specialist

Quantitative Findings: (from 6 focus counties)

● 100% of counties offer breastfeeding support resources

● 100% of the Public Health Nursing offices offer professional breastfeeding

support resources*

● 83% of WIC clinics offer professional breastfeeding support resources*

● 50% of WIC clinics offer peer counselors

● 83% of hospitals/providers offer professional breastfeeding support resources*

● One hospital offers a group level support class

● 50% of hospitals offer an in house breastfeeding clinic that is free

● 33% of counties have La Leche League groups

● 100% of counties scanned have additional community resources that either

offer professional breastfeeding support resources* or are supportive

breastfeeding environments

● No counties had a known wait list for services

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● 100% of counties offer free or reduced cost services for breastfeeding support

● 100% of counties had at least one place of employment that is supportive of

breastfeeding moms returning to work

● No counties have an active local breastfeeding coalition

● 100% of counties have access to breast pump rentals in some capacity

*Professional breastfeeding resources=advanced training/certification such as CLC/

IBCLC/ANCL, etc.

Qualitative Findings/Themes

1. Overall findings show good outreach/coverage of breastfeeding support resources by PHN,WIC, hospitals and supplemental community resources

2. Multiple stakeholders expressed concern with lack of physician support/knowledge of breastfeeding

3. Multiple stakeholders expressed concern with lack of continuing education opportunities for CLCs/IBCLCs etc.

4. Multiple stakeholders expressed concern with lack of an active Wyoming Breastfeeding Coalition

5. Multiple stakeholders expressed concern with lack of consumer/ provider knowledge of services CLCs, IBCLCs etc. provide

6. Multiple stakeholders expressed concern with moms returning to work as a barrier to continuing to breastfeed

7. Multiple stakeholders expressed concern with lack of planning/preparation by expecting moms as a barrier to breastfeeding

8. Some stakeholders expressed concern with lack of referrals between WIC and PHN clinics that are not co-located.

Evidence Based Strategies/Recommendations

The following strategies are excerpted from the CDC’s Guide to Strategies to Support

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Breastfeeding Mothers and Babies http://www.cdc.gov/breastfeeding/resources/guide.htm

Recommendations are based on the quantitative and qualitative findings/ themes from the

information gathered during the environmental scan.

Strategy 1: Maternity Care Practices

The following are recommend action steps surrounding maternity care practices to

address the expressed concern with lack of physician support/knowledge of breastfeeding, lack

of continuing education opportunities for CLCs/ IBCLCs etc. and the lack of an active Wyoming

Breastfeeding Coalition:

a. Provide opportunities for hospital staff members and providers to participate in training courses in breastfeeding.

b. Create links between maternity care facilities and community breastfeeding support networks across the state.

In regards to the first recommendation, it would also be beneficial to offer these

continuing educational opportunities to PHN, WIC, supplemental community resources, CLCs,

IBCLCs and other advanced breastfeeding professionals. The second recommendation would

be beneficial for networking and possibly help to facilitate reactivating the Wyoming

Breastfeeding Coalition.

Strategy 2: Professional Education

The following are recommended action steps surrounding professional education to

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address the expressed concern with lack of physician support/knowledge of breastfeeding and

lack of continuing education opportunities for CLCs/ IBCLCs etc.

a. Make available and coordinate grand rounds or in-service presentations on breastfeeding by health care professionals with training in this area

b. Distribute clinical protocols developed by experts, such as the Academy of Breastfeeding Medicine to local doctors.

c. Expand the reach of professional development by providing training.

It is recommended that for each of the previous steps to find opportunities for

physicians to present to other physicians. A nurse presenting the information was listed as a

barrier to physician’s willingness to participate. It is also recommended to offer continuing

education credits for participants, specifically physicians and those needing hours for their

CLC/IBCLC etc. credentials.

Strategy 3: Access to Professional Support

Based on information gathered during the scan, there are no further recommended

action steps surrounding access to professional support. Findings from the environmental scan

show good outreach and coverage of breastfeeding services by PHN, WIC, hospitals and

supplemental community resources. During the scan, an ongoing action step was completed

which was to:

a. Develop and disseminate a resource directory of local lactation support services available to new moms.

The Environmental Scan of Breastfeeding Resources Guide (See Appendix B) provides local

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lactation support services and contact information, as available, in each Wyoming County.

Strategy 4: Peer Support Programs

The following is a recommended action step surrounding peer support programs:

a. Create and maintain a sustainable infrastructure for mother-to-mother support groups and peer counseling programs in hospitals and community health settings

There wasn’t much concern expressed regarding peer support programs and 50% of

WIC clinics provide peer support counselors, but one community has a noteworthy

program to highlight. During the environmental scan, one community was found to

have great success with a mother-to-mother support group facilitated by an IBCLC

through the hospital. It is recommended that other communities consider replicating

such services, as able.

Strategy 5: Support for Breastfeeding in the Workplace

The following are recommended action steps surrounding breastfeeding in the

workplace to address the expressed concern with mom’s returning to work as a barrier to

continuing to breastfeed.

a. Provide employers with resources and technical assistance to help them comply with federal and state regulations on breastfeeding support in the workplace.

b. Develop a resource to help employers find creative ways to provide 14

breastfeeding support in the workplace.Though the above listed action steps are geared towards employers, it is recommended

to develop and provide these resources to employees as well, as a way to empower them to

start a conversation with their employers. Previous work on these action steps has already been

completed through the Communities Putting Prevention to work grant and could be updated as

necessary and easily shared through PHN, WIC, hospitals and other community breastfeeding

support agencies.

Strategy 6: Support for Breastfeeding in Early Care and Education

Based on information gathered during the scan, there are no recommended action steps

at this time, geared towards support for breastfeeding in early care and education.

Strategy 7: Access to Breastfeeding Education and Information

The following are recommended action steps surrounding access to breastfeeding

education and information to address the expressed concern with lack of planning/preparation

by expecting moms as a barrier breastfeeding and concern with lack of referrals between WIC

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and PHN clinics that are not co-located.

a. Evaluate how breastfeeding education may be integrated into public health programs that serve new families

b. Partner with local community groups that support breastfeeding mothers by providing educational seminars and classes

c. Work with childbirth educators to include evidence-based breastfeeding education in their curricula

d. Promote and support breastfeeding classes that are convenient for family members to attend.

Those interviewed shared that a large number of pregnancies seemed to be unplanned;

therefore not a lot of thought or consideration had been made into the preferred feeding

practices for their babies. Any opportunity to offer support and educate expecting moms on the

benefits of breastfeeding is encouraged and recommended. Also any opportunity for PHN and

WIC services to collaborate and work together, even when not co-located is encouraged and

recommended.

Strategy 8: Social Marketing:

The following are recommended action steps surrounding social marketing to address

the expressed concern with lack of an active Statewide Breastfeeding Coalition and lack of

consumer/ provider knowledge of services CLCs, IBCLCs or other breastfeeding professionals

with advanced training provide:

a. Identify local experts (champions) who can pitch stories that promote breastfeeding to the media

b. Develop and implement a public health campaign on breastfeeding that uses social marketing

Through conducted interviews, it appeared that individuals with advanced breastfeeding 16

credentials were not utilized to their full extent. Often times when a breastfeeding problem

occurred it was reported that the physician or provider was contacted first. It is recommended

that a marketing campaign include what training and services a CLC, IBCLC, etc. provides and

the benefits of utilizing them. The Wyoming Breastfeeding Coalition, once reactivated, could

serve as another means of marketing services and champions.

Strategy 9: Addressing the Marketing of Infant Formula

Based on information gathered during the scan, there are no recommended action steps

at this time, geared towards addressing the marketing of infant formula.

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Statewide Snapshot:

After the initial six county environmental scan, a snapshot of services provided

statewide was also conducted. Public Health offices were contacted by email, each hospital

with a Labor/Delivery Department was contacted by phone, WIC office information was

provided by Lisa Caldwell, State WIC Breastfeeding Coordinator and Connie James,

Breastfeeding Peer Counselor Program Coordinator and community information was gathered

by internet search or through communication with the other stakeholders.

Findings:

Overview of Breastfeeding Resources Available Statewide Snapshot

County PHN WIC Hospital/Providers Community

Albany 3-CLCs

2-CLCs trained,

results pending

CLC trained staff available, Peer Counselor

2-IBCLCs, 7 CLCs

Mother’s Milk Bank

Baby-Friendly Hospital

Initiative

Laramie Breastfeeding Coalition

Big Horn 2-CL’s CLC trained staff available

Campbell 8-CLCs,

2-ANCLCs

2-CLCs, 1-ANCLC,

1 Adv. CLC,

Peer Counselor

1-IBCLC, 2-ANCLCs,

12-CLCs, Breastfeeding

Clinic, Nurse

Practitioner

Women’s Resource

Center, School District

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Carbon 4-CLCs CLC trained staff available,

Converse 2-CLCs 1-CLC, Peer

Counselor

0-CLCs La Leche League, School District

Crook 3-CLCs CLC trained staff, Peer Counselor

Fremont 2-CLCs CLC trained staff, Peer Counselor Position Open

1- IBCLC, 5-CLCs

Goshen 2-CLCs CLC trained staff 1-CLC La Leche League

Hot Springs 0-CLC CLC trained staff, Peer Counselor

0-CLC

Johnson 1-CLC 1-IBCLC (Sheridan) 3-CLCs, 1-ANLC School District

Laramie 3-CLCs 1-CLE, 2-CLCs

1-CLC trained, not

certified

3-IBCLCs, 4-CLCs, UW

Resident, Breastfeeding

Clinic

La Leche League, Midwife, School District, National Guard

Lincoln 2-CLCs CLC trained staff Kemmerer- 1-CLC

trained, not

certified

Afton-CLC nurses

available

Natrona 3-CLCs CLC trained staff, Peer Counselor

4-CLCs La Leche League

Niobrara 0 CLC trained staff,

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(Goshen)

Park 2-CLCs CLC trained staff,

Peer Counselor

Powell-4-CLCs, Baby Friendly Designation

Cody- 1-CLC trained, awaiting results, 1-CLC trained, not certified

Billings Clinic-IBCLC

Platte 1-IBCLC, 1-CLC CLC trained staff,

Peer Counselor

1-CLC

Sheridan 3-CLCs 1-IBCLC, 1-CLC

Peer Counselor

4-CLCs Legacy Pregnancy

Center, Patty Bell

Usher, IBCLC, Day Care Center, Dentist, School District, VA Developmental Preschool

Sublette 2-CLCs

Sweetwater 4-CLCs CLC trained staff,

Peer Counselor

7-CLCs

Teton 2-CLCs, MSN

in MCH,

CLC trained

Translator, not

certified

Peer Counselor 3-IBCLCs, 3-CLCs

1-CLE, Breastfeeding

Clinic, Teton Mamas

Mountain Doulas,

Teton Mamas

Uinta 3-CLCs CLC trained staff, Peer Counselor

5-CLCs

Washakie 1-CLC, 1-CLC trained, not

CLC trained staff, 0-CLCs La Leche League

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certified Peer Counselor

Weston 1-ACLS, 1-breastfeeding educator, not certified

CLC trained staff, Breastfeeding Peer Counselor

* Information provided was current at time of interviews and follow up but subject to change

Quantitative Findings: Statewide Snapshot

● 100% of counties offer breastfeeding support resources

● 95% of Public Health Nursing offices offer professional breastfeeding support resources*

● 95% of WIC clinics offer professional breastfeeding support resources*

● 60% of WIC clinics offer peer counselors

● 84% of hospitals/providers offer professional breastfeeding support resources*

● 21% of counties have La Leche League groups

● 48% of counties have additional community resources that either offer professional

breastfeeding support or are supportive breastfeeding environments

● One county has an active local breastfeeding coalition

● One hospital has a current Baby-Friendly Designation

*Professional breastfeeding support resources = advanced training/certification such as CLC/

IBCLC/ANCL, etc.

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Conclusion:

As previously stated and discussed through the report, the purpose of this project was to

complete an environmental scan of available state and local breastfeeding support resources

and provide consultation on the development of a statewide action place to improve

breastfeeding support resources. In conclusion, I believe the findings indicate adequate

coverage of breastfeeding support services in most counties statewide. In addition to the data

reported from the environmental scan, the International Board of Lactation Consultant

Examiners www.IBCLE.org reports that as of August 4th, 2016 there are 22 IBCLCs in Wyoming

and the Academy of Lactation Policy and Practice www.alpp.org reports that there are 170 CLCs

registered in Wyoming on their site.

Though evidence based strategies and recommendations were already outlined in the

report, my personal recommendation is to look to each stakeholder to determine which 22

strategy fits their needs best to continue to support breastfeeding and provide breastfeeding

support resources. One possibility would be to offer mini grants to stakeholders wanting to

focus on breastfeeding efforts and providing breastfeeding resources. Some ideas that

stakeholders expressed while completing the scan would be to offer breastfeeding training to

the local translation service while another stakeholder would like to sponsor more local

continuing education opportunities for breastfeeding support professionals. Though multiple

stakeholders expressed the same concerns as to barriers to breastfeeding success and

resources, each stakeholder also expressed a different solution to that concern based on their

county’s needs and resources.

Overall, the environmental scan provided an opportunity for the Maternal and Child Health

Unit (MCH) to communicate with other important stakeholders in the state. County findings

will hopefully help inform policy and decision making at the state level, and state findings may

help inform counties about ways in which their gaps in service, needs, resources and practices

compare with other counties.

Though the environmental scan process was about collecting information, it also served as

an opportunity for MCH to dialogue with stakeholders, establish and strengthen partnerships

and inform the community. All of which have led to conversations and some preliminary activity

in reactivating the Wyoming Breastfeeding Coalition.

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Appendix A

Comprehensive Plan for Environmental Scan

As outlined in the contract between The Wyoming Department of Health, Public Health Division and Kate Stratton-Schulz, an environmental scan of available state and local breastfeeding support resources is to be completed along with consultation on the development of a statewide action plan to improve breastfeeding support services with the goal of increasing breastfeeding duration rates.

Organization of the Environmental Scan-The Environmental scan will serve as the foundation for the statewide action plan. The environmental scanning process will include three steps:

a. Developing an approach to the scanning process

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b. Scanning the environmentc. Analyzing the information collected

A. Developing an Approach for the Environmental Scan The following will be included in gathering information for the environmental scan:

● Adapt, update or refer to existing environmental scanso Communities Putting Prevention to Work State Agency Breastfeeding in

the Workplace Policy Scan● Initial interviews with community stakeholders. Focus groups, surveys and travel

once initial interviews are completed● Development of template to distribute to key stakeholders ,if necessary, to

provide or confirm scan information

B. Scanning the Environment After some discussion on the scope of the environmental scan, it has been decided that rather than a statewide scan, the initial focus will include 6 counties. Ashley Busacker, PhD Senior Epidemiology Advisor with the Maternal and Child Health Division based the county selection on high, medium, and low breastfeeding rates and whether they were urban, rural or frontier counties. The selected counties and their designation include:

1. Laramie- low breastfeeding rates, urban area2. Campbell- low breastfeeding rates, rural area3. Converse-low breastfeeding rates, frontier area

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4. Johnson- medium breastfeeding rates, frontier area5. Sheridan- high breastfeeding rates, urban area6. Teton-high breastfeeding rates, frontier area

1. Stakeholders to consider in above listed counties:a. Public Health Nursing Offices b. Non-PHN Home Visiting Programsc. WIC Offices d. Hospitalse. OBGYN providersf. Pediatric providersg. Family Practice Providersh. Midwivesi. Lactation Counselors

iii. Professionaliv. Peer

j. Early Intervention/Child Development Centers k. Private Practice Providersl. Community-level organizations

iv. La Leche Leaguev. Local Breastfeeding Coalitions

vi. Othersm. Consumers

iii. parents, clients of existing services, attendees of parent groups

iv. Focus groupsn. Other target sites, groups or populations as mutually agreed upon by both

Agency and Contractor

2. Methodology:g. Interviews

i. Phoneii. In-Person

h. Site Visitsi. Surveys if applicable j. Focus Groups if applicable k. Existing Data/ Information

i. mPINC

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ii. Communities Putting Prevention to Work Grantiii. Additional as available and applicable

l. Internet Search

3. What do we want to know: a. Types of resources available:

vi. Professional Support (CLC, IBCLC, or other certification levels you’re aware of)

vii. Peer Supportviii. Group Level Support/Classes (hospital breastfeeding

groups, La Leche groups, parent groups);ix. Breast pump rentalx. Breastfeeding clinics where a professional and peer

support provider are paired b. Provider knowledge about recommendations c. How are individuals/organizations that provide breastfeeding support resources getting the word out about their programs?

a. Do providers of breastfeeding resources have room to accept more clients/attendees?

iii. Is there a waiting list?iv. Is the service meeting the need?

b. Cost/Availability of Resourcesiii. Hours?iv. Cost of classes?

c. General awareness of available services i. This would be helpful for professionals and consumers

d. Barriers to receiving desire supportv. This would be very relevant for consumers. First,

understanding what they want, and then assessing what they got, and the gap between the two.

vi. Specifics such as transportation, no available prof/peer support, services not available during off-hours, etc.

e. What is the overall climate (political, community) for supporting breastfeeding? vii. Are there champions?viii. Is there an active local coalitionix. Is there support from leaders in community?

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4. Findings: A summary of findings from the scan will include conclusions that can be drawn from the scan that will aid in defining goals, objectives and outcomes for the statewide action plan.

C. Analyzing the Scan and Drawing Conclusions-The information gathered in the environmental scan will help aid in the development of a statewide action plan to improve access to breastfeeding support resources with the goal of increasing breastfeeding duration rates.

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