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RUNNING HEAD: Empowered Moms 1

Public Health Promotion Program Plan for

Reducing the Infant Mortality Rate Disparity in the

Neighborhood of Avondale, Cincinnati, Ohio

With the Empowered Moms, Thriving Infants Program

Final Paper

Andrea Eden Shingleton

April 10, 2016

MPH 585, Programming and Evaluation in Public Health

Dr Kelly Wheeler

Empowered Moms 2

Table of ContentsIntroduction

Needs Assessment

Program Strategic Plan

Mission, Vision and Stakeholders

Logic Model

Planning Model Discussion

Outcomes – Impact

Goals and Objectives

Program Pro Forma

Budgetary Needs

Marketing Plan

Tasks, Timelines, Responsible Leads/Partners

Program Evaluation Plan

Outcome measurements and standards

Conclusion

References

Appendix A- Gantt Chart

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Introduction

Infant mortality rate (IMR) is a reflection of how well a society takes care of its most

vulnerable citizens. Compared to all other States, Ohio’s infant mortality rates ranked 38th for

white infants, 47th for all infants, and 49th for black infants (Ohio Department of Health, 2015).

Black infants in Ohio die at almost 2.5 times the rate that white infants die (Ohio Department of

Health, 2015).

Despite having some of the nation’s best hospitals, Ohio babies are dying at unacceptably

high rates and our black infant mortality rate is next to the worst in the United States. The

neighborhood of Avondale surrounds the University of Cincinnati Medical Center and Cincinnati

Children’s Hospital Medical Center. These facilities provide health care and employment

opportunities. The latest data for Avondale (zip code 45219) showed the IMR was double the

State rate in 2012, 13.93 versus 6.37 per 1,000 births (Cincinnati Health Department, 2014).

Little to no improvement is apparent in this area. In 2014, there were 10,947 babies born in

Hamilton County, and we lost 97 of them; the infant mortality rate in Hamilton County was 8.9

that year. In the City of Cincinnati, the IMR was10.9 per 1,000 births while the United States’

reported IMR was only 6.05.

Needs Assessment

The infant mortality rate (IMR) is the most sensitive indicator of the overall health and

well-being of a community. The Center for Disease Control and Prevention (2016) defines IMR

as the death of an infant before his or her first birthday. Researchers from the Ohio Infant

Mortality Reduction Initiative (OIMRI) have found that a disparate health condition affects low-

income and people of color at a higher rate and more severely (Ohio Department of Health,

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2015). As an estimate of the number of infant deaths for every 1,000 live births, the IMR is

more than twice as high in non-Hispanic black infants than in white babies, 13.93 versus 6.37 per

1,000 births in 2012 (Ohio Department of Health, 2015). Infants are one of the most vulnerable

subsets of a population; factors that have an effect on the whole society distress the most

defenseless with greater impact. The sad truth is that 23,000 infants died in the U.S. in 2014,

leaving a heavy burden on many families and communities (Center of Disease Control and

Prevention, 2016).

The University of Cincinnati Medical Center (2013) reported the top health needs of the

surrounding community were infant mortality, diabetes, obesity, hypertension, stroke, mental

health and cancer. The specific health issues related to disease management were lifestyle

choices, socioeconomic and environmental factors (University of Cincinnati Medical Center,

2013). Finding conditions related to high infant mortality, University of Cincinnati Medical

center (2013) affirmed that wellness and prevention for women, chronic diseases, nutrition,

obesity, substance abuse, lack of education, lack access to primary care, shortage of health

providers and uncoordinated care are some of the most pressing needs.

The community of Avondale is situated on ‘Pill Hill’ or uptown Cincinnati. This is a

neighborhood with two major full service medical centers and three additional specialty medical

centers. The University of Cincinnati Medical School and nursing school are located on the

Medical Centers campus. A medical office building full of specialist and the Cincinnati Public

Health department are adjacent to the medical center.

Logically, a community surrounded by the premier health system in the county would

have the best statistical findings. University of Cincinnati Medical Center (2013) is required to

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conduct a community assessment, their findings defied logic. Utilizing the Truven Health

Analytics Company, UCMC community health assessment identified health needs with the

Community Need Index. The CNI is a statistical approach to identify health needs; the CNI is

helpful for understanding and targeting communities that have the greatest health disparities

(University of Cincinnati Medical Center, 2013). Hamilton county overall score in 2013 was 3.2

CNI that equates to a grade C. In the city of Cincinnati, the needs are at the highest level, 4.0-5.0

that equates to a grade D or F. This weighted quantitative data prioritizes the criteria of top

health needs and found that infant mortality was the number one need (University of Cincinnati

Medical Center, 2013).

In order to address the disparity in the IMR, Ohio has funded a variety of programs. The

Ohio Perinatal Quality Collaborative (OPQC), Help Me Grow, Every Child Succeeds, Ohio

Infant Mortality Reduction Program (OIMRI), Ohio Healthy Start, Ohio Medicaid, Health Care

Access Now Pregnancy Pathways program, City of Cincinnati health department primary care

services and the Affordable Health Care Center are all designated to address the high need in the

Avondale area.

The Empowered Moms, Thriving Infants program is a complimentary initiative to build

on the work already being done in the community. According to the CDC (2014), breastfeeding

is a key strategy to reduce infant mortality. Exclusive breastfeeding is significantly associated

with a reduction in infant morbidity and mortality. Human milk is not just the gold standard for

infant nutrition; it is the only source of bioactive factors for young children. Components of

human milk have medicinal qualities that have a profound role in infant survival and health

(Ballard & Morrow, 2013). The CDC (2015) found that only 32 % of hospitals provided enough

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support for breastfeeding mothers when they have left the hospital. Collaborating with the Ohio

Infant Mortality Rate Initiative (OIMRI), the new breastfeeding support program will utilize

Community Health Workers (CHWs) that are culturally and linguistically appropriate and

personally connected to the community. Detailed in this paper, the program will start training all

CHWs as Certified Lactation Counselors, open an after-hours helpline, put into practice a social

media campaign and start educational sessions for community health care practitioners.

Supporting the breastfeeding mother, the Empowered Moms, Thriving Infants program

benefits the Avondale community in a variety of ways. First, the breastfeeding mother has

personal help from certified lactation counselors during home visits and after-hours via phone.

Influencing health decision-making by leveraging social dynamics and networks to encourage

participation, conversation and community support of breastfeeding, the social media campaign

will encourage and empower the breastfeeding mom to conquer the challenges associated with

breastfeeding. Finally, to develop an increased understanding of the strategies for successful

breastfeeding and the availability of community support, the Empowered Moms, Thriving

Infants program will present two-hour educational session to community health care providers.

Breastfeeding is associated with decreased risk for infant morbidity and mortality and

provides optimal infant nutrition (Ip, Chung, Chew, Magula, DeVine, et al, 2007). Healthy

People 2020 objective MICH-21 establishes breastfeeding initiation, continuation, and

exclusivity as national priorities (U.S. Dept of Health and Human Services, 2010). According to

the CDC (2014) breastfeeding is a key strategy to reduce infant mortality. Rates for Ohio

newborns that started to breastfeed are on the rise with 70.1 % in 2011. Unfortunately, only

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42.2% of infants are still breastfeeding at 6 months and only 21.6% at 12 months (Center for

Disease Control and Prevention, 2014).

Program Strategic Plan

Mission Statement

The mission of the Empowered Moms, Thriving Infants program is to improve the health

of Avondale’s newest residents by supporting mothers in their decision to successfully and

exclusively breastfeed their infants until six months of age.

Vision

The vision of the Empowered Moms, Thriving Infants program is to eliminate the

disparity in the infant mortality rate in Avondale as compared to Hamilton County.

Stakeholders and Their Role

Ohio Infant Mortality Reduction Initiative (OIMRI) is a strategic part of the Child and

Family Health Services at the Ohio Department of Health (2015) aimed at reducing infant deaths

especially among African-American babies. As a key stakeholder and partner to the Empowered

Moms, Thriving Infants program many of the key staff positions originate from this

organization. The positions include Community Leads, Community Health Workers, Social

Media Coordinator, Hotline Coordinator and the Financial Advisor. As an integral part of the

program, these individuals will be a part of the planning committee, Board of Directors and

evaluation team. Not only will they recruit participants, they will also manage the staff, educate

the community trainer and maintain the budget. Varieties of local organizations have agreed to

help plan the program, evaluate the progress and recruit participants (see list below). The City of

Cincinnati Health Department and OIMRI will have direct contact with the target population

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through community health workers. Several large healthcare providers in the neighborhood serve

in a collaborative role by helping develop breastfeeding awareness.

Stakeholder Level of Engagement Needed

Action Needed and By When

Ohio Infant Mortality Reduction Initiative Community Lead Community Health Workers Social Media Coordinator Helpline Coordinator Financial AdvisorRepresentative of Ohio Department of Health, Bureau of Child and Family Health Services

Member of planning committeeBoard of DirectorsProgram evaluationDirect client contactIndirect client contactFinancial commitment

Recruit program participantsProgram development, Program implementation, Manage staffEducate community health workersCoordinate staff for helplineBudgetary maintenanceEvaluate the programAuthorize program

Ohio Perinatal Quality Collaborative Human Milk Project Lead

Member of planning committeeProgram evaluationCollaboration

Recruit program participantsProgram developmentEvaluate the program

Help Me Grow Home-visiting Nurses Social workers


Recruit program participants Program developmentEvaluate the program

Every Child Succeeds Community Leads Home Visitors Social workers


Recruit program participants Program developmentEvaluate the program

Residents of Avondale Community Leaders Breastfeeding Advocates Program participants Religious representative

Member of planning committeeProgram evaluation


Ohio MedicaidHealthy Start, Healthy Families Community Leads School Liaisons Case workers

Member of planning committeeProgram evaluationCollaborationFinancial commitment


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Health Care Access Now Pregnancy Pathways Program Community Leads



City of Cincinnati Health Department Community LeadsFirst Steps Program Home VisitorsCenter for Reproductive Health and Wellness Physicians Nurse Practitioners Patient educatorsWIC -3 Avondale Offices Community Leads Counselors Breastfeeding Advocates

Member of planning committeeProgram evaluationCollaborationDirect client contact


Affordable Health Care Center Physicians Nurse Practitioners



Cincinnati Children’s Hospital and Medical Center Community Liaison Physicians Researchers



University of Cincinnati Medical Center Community Liaison



United Way of Cincinnati Community Liaison

Member of planning committeeProgram evaluationCollaborationFinancial commitment

Program developmentEvaluate the program

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Logic Model: Empowered Moms, Thriving InfantsImplementation Planning:

InputsOutputs Outcomes -- Impact

Activities Participation Short Medium Long

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Staff / Providers/ Partners

Direct Funding/ Money

Advisory Board

Social Media

Research

Time

Train CHWs as Certified Lactation Counselors

Implement after-hours helpline

Implement Social Media Campaign

Educate community healthcare providers

CHWs/ Providers

OIMRI

Clients

Public

Health care providers

Increase confidence and competency of CHWs

Increase advocacy for exclusive breastfeeding that represents a broad range of committed stakeholders

Increase awareness of exclusive breastfeeding support

Increase breastfeeding support with After-hours helpline

Practice change

Community change

Individual change

Increase exclusive breastfeeding rate at 1 month, 3 months and 6 months

Reduce preventable childhood deaths and illnesses

Decrease Infant Mortality Rate Disparity

Assumptions External FactorsIncreased personal support and increased awareness leads to change in behavior

Utilization of support systems, degree of satisfaction with support systems

Completing the logic model for the Empowered Moms, Thriving Infants program was

challenging. The focus on this program is to train the Community Health Workers as Certified

Lactation Counselors (CLC). It is an assumption that adding this personal support for new moms

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in Avondale will increase their likelihood to exclusively breastfeed for a longer period. In

addition to the home visits from CHWs, the Empowered Moms, Thriving Infants program also

includes the implementation of the after-hours helpline. Lactation Counselors can answer

questions from mothers about feeding their infant immediately as issues arise, even at two in the

morning. One of the external factors that could negate the success of this program is the lack of

use of the support systems.

Planning Model Discussion

The Empowered Moms, Thriving Infants program is a collaborative effort with the Ohio

Infant Mortality Reduction Initiative (OIMRI.) The OIMRI is based on the Community Care

Coordination Model (Ohio Department of Health, 2015). Utilizing the Community Care

Coordination Model, the Empowered Moms, Thriving Infants program would empower

communities to eliminate disparities in exclusive breastfeeding rates and infant mortality rates.

The Ohio Department of Health (2015) employs individuals from the community as trained

advocates who empower women to access resources. These professional community health

workers (CHWs) provide a cultural link to the community and to community resources through

family-centered services (Ohio Department of Health, 2015). Craig and Whittington (2011)

found that utilizing the Community Care Coordination Model improved the delivery of health

benefits to those with multiple needs, while improving their experience of the care system and

drove down overall health care and societal costs.

The OIMRI’s Community Care Coordination Model (CCCM) includes five core

components; planning, training, supervision, standardized care processes and data collection with

evaluation (Ohio Department of Health, 2015). During the planning phases, OIMRI use collected

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data to target neighborhoods and identify needs. The second phase is the on-going training for

Community Health Workers (CHWs). Supervision consists of nursing and/or physician

consultation. Developing a standardized care process includes defining the expected outcomes

based on the community needs. Finally, the evaluation phases measures the programs’

outcomes. Helping design the Empowered Moms, Thriving Infants program, CCCM will

produce success (with fewer infant deaths) with increased awareness and self-sufficiency.

Historically, the CCCM was first developed to address the need for improved population

health, good care coordination and a holistic approach to care. In the 1990s, the Center for

Medicare & Medicaid Services (CMS) launched a national case management methodology and

found huge reductions in cost and dramatic improvement in health outcomes. Unfortunately, the

system lacked personal connection with the clients and complains of harassment caused CMS to

revise their methods. Today, Craig and Whittington (2011) recommend the CCCM for high-cost

populations with multiple health and social needs in order to offer the greatest opportunity for

cost savings in the health care system. This framework (see Figure 1) is used to identify those

with multiple needs, then constructing coordinated services to ensure their health goals are met

(Craig & Whittington, 2011).

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Figure 1: IHI Community Care Coordination Model for People with Multiple Health and Social Needs (Craig & Whittington, 2011)

Outcomes – Impact

The elements of the IHI’s Community Care Coordination Model include the individual

and family assets, the patient identification, the care coordinator and their roles of value

proposition, service design and service delivery and the outcomes. First, recognizing the

resources, strengths and gifts of communities with multiple health and social needs, the CCCM

leverages these assets to improve the health of the community and to offer appropriate services

(Craig & Whittington, 2011). Identifying the individuals in the community with primary care

failures, for example utilization of a hospital emergency room versus a neighborhood clinic for

preventative care is the first step in predicting those who would benefit from participation in the

program (Craig & Whittington, 2011). The care coordinator in my program will be the CHW.

This individual will be an expert in self-management, patient advocacy and care planning (Craig

& Whittington, 2011). The care coordinator works directly with the client to identify needs, build

on strengths and developing a care plan that the client agrees with. The feedback loops in the

CCCM represent the monitoring process and the modifications to the care plan based on

interactions with the client (Craig & Whittington, 2011). The value proposition is the job of the

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care coordinator to present an exhaustive list of provided services, make referrals and tailor the

list to the individual’s needs and assets, creating an individualized plan of care (Craig &

Whittington, 2011). The service design is the care coordinators responsibility to explain the

chosen services to the individual and explain each party’s responsibilities. For example, the

CHW will explain the after-hours helpline for breastfeeding support to the client and then

explain that it is the client’s responsibility to call as soon as they need help. Service delivery is

role of the care coordinator to ensure that the services provided in accordance with the care plan.

For example, if the client called the after-hours helpline and did not find the information helpful,

the care coordinator would refer the client to another service provider.

CCCM is especially useful in measuring outcomes. In order to evaluate the effectiveness

of the Empowered Moms, Thriving Infants program, Craig and Whittington (2011) recommend

the IHI Triple Aim to measure the impact of the changes. The IHI Triple Aim is made up of

high-level measures specific to the health of the population, the individual’s experience of care

and the per capita cost (Craig & Whittington, 2011)

In the past, this model has been used successfully for programs wanting to reduce health

disparites. The Agency for Healthcare Research and Quality (2014) affirmed the benefits of

community health workers to the care team. In a Denver study, CHWs not only provided

culturally-competent care during home visits, they also increase the use of primarly care services

and reduced the use of emergency room visits (Whitley, Everhart & Wright, 2006). This lead to

a cost savings of $2.28 for every dollar spent on the program (Whitley, Everhart & Wright,

2006). In the Minnesota health care system, educational institutions, government agencies,

providers, professional associations, insurers and foundations partnered together to address

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health disparities through a community health worker–based strategy. With a plan to expand and

diversify the health care workforce, the Community Health Worker Project increased provider

cultural competence and help achieve a reduction in health disparity (Cleary, Eastling &

Itzkowitz, 2010).

Goals and Objectives

The goals of the Breastfeeding Support Program are five-fold. First, the new program

will reduce the number of preventable deaths of children under one year old in Avondale. Next,

community health workers in Avondale will receive a forty-hour training and certification as

lactation counselors. Establishing a support network for breastfeeding mothers in the Avondale

community, community leaders, community health care providers and community health

promotion programs will receive a two-hour informational and educational session on the

benefits of breastfeeding and available breastfeeding support resources. A community-wide

after-hours breastfeeding helpline will be started. To influence health decision-making by

leveraging social dynamics and networks, a social media campaign will be implemented; with

the objective to encourage participation, conversation and community support of breastfeeding.

Goal: Reduce number of deaths in children less than one year old from preventable causes.SMART objective 1: By July 2019, the infant mortality rate for zip code 45219 will be less than 10.SMART objective 2: By July 2018, the infant mortality rate for zip code 45219 will be less than 12.Key Component ObjectiveSpecific - What is the specific task?

To reduce the number of children who die in the first year of life from preventable illnesses.

Measurable - What are the standards, measure or parameters?

Infant mortality rate is the number of babies who die in the first year of life, per 1,000 live births. It is a standard parameter reported in the City of Cincinnati by zip code yearly.

Evaluation period of measure is Short Term Intermediate or Long

Quarterly and yearly

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TermAchievable - Is the task feasible? The infant mortality rate in 2012 for the Avondale area

was 13.93. From April 2013 to April 2014, in Hamilton county the IMR dropped from 10.1 to 8.6. Objective 1: IMR less than 10 is achievable based on community analysis.Objective 2: IMR less than 12 is achievable based on community analysis.

Realistic - Are sufficient resources available? (Inputs from logic model)

Yes, the resources are available. Funding from the Ohio Department of Health is guaranteed with a three-year grant. Significant progress has already been shown.

Time-Bound - What are the start and end dates?

Three years, from July 2016 until July 2019.

Goal: Increase the number of community health workers that are certified lactation counselors.SMART Objective 1: From July 2016 until June 2017, 50 % of all OIMRI community health workers will be certified lactation counselors.SMART Objective 2: From July 2017 until July 2018, 100 % of all OIMRI community health workers will be certified lactation counselors.Key Component ObjectiveSpecific - What is the specific task?

OIMRI community health workers (CHW) will become certified lactation counselors after attending a 40-hour class and completing a test.

Measurable - What are the standards or parameters?

Number of CHW that are certified lactation counselors.

Evaluation period of measure is Short Term Intermediate or Long Term

Quarterly and yearly

Achievable - Is the task feasible?

Yes, based on class and schedule availability of the teachers and participants.

Realistic - Are sufficient resources available?

Yes, the resources are available. Funding from the Ohio Department of Health is guaranteed with a three-year grant.


Objective 1: Year One, July 2016 to June 2017Objective 2: Year Two, July 2017 to July 2018

Goal: Develop an increased understanding of the strategies for successful breastfeeding and the availability of community support. SMART Objective 1: The first and third Thursday of each month, from July 2016 to November 2016, the two-hour educational session on strategies to assist the breastfeeding

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mother will be presented to community health care providers at no cost.SMART Objective 2: By the end of the each session, 90 % of the community health care providers that attended the two-hour educational session on strategies to assist the breastfeeding mother will describe three strategies to assist the breastfeeding mother and will be able to name three sources of help for breastfeeding mothers.Key Component ObjectiveSpecific - What is the specific task?

Objective 1: present a two-hour education session at various locations throughout Avondale.Objective 2: Test each attendee for comprehension and knowledge


Objective 1: Number of classes, number of locationsObjective 2: A written evaluation will be administered at the end of each session. Testing results, attendance record.

Evaluation period of measure is Short Term Intermediate or Long Term

Weekly and Monthly


Yes, based on the results of previous educational sessions

Realistic - Are sufficient resources available?

Yes, the resources are available. Funding from the Ohio Department of Health is guaranteed with a three-year grant. Several locations are available.


July 2016 to November 2016

Goal: Support breastfeeding moms and health care providers with a community-wide after-hours Breastfeeding helpline.SMART Objective 1: From July 2016 to July 2019, operate a community-wide after-hours Breastfeeding helpline. SMART Objective 2: July 2016 to July 2017, each month the call volume will increase by 10 %.SMART Objective 3: November 2016 to July 2019, each month conduct a survey of 10 participants to evaluate the effectiveness of the hotline; 9 out of 10 persons surveyed will report the information they received was helpful to very helpful.Key Component ObjectiveSpecific - What is the specific task?

Operate a direct telephone line that is staffed by trained lactation counselors to provide information, education and support for breastfeeding mothers and healthcare providers.

Measurable - What are the standards or

Objective 1: Number of hours the hotline is staffedObjective 2: Total number of calls each month

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parameters? Objective 3: Survey results. Evaluation period of measure

Daily, Bi-weekly, Monthly

Achievable Yes, based on previous helpline programs.Realistic Yes, the resources are available. Funding from the Ohio Department

of Health is guaranteed with a three-year grant. Space and phones for the helpline staff are located in the City of Cincinnati Public Health Building.


July 2016 to July 2019

Goal: Influence health decision making by leveraging social dynamics and networks to encourage participation, conversation and community support of breastfeeding through a social media campaign.SMART Objective 1: From July 2016 to July 2019, a key message for breastfeeding support will be posted daily on Face book and the website.SMART Objective 2: From August 2016 to July 2019, monthly evaluation of social media traffic will show a 10 % increase in activity each month.SMART Objective 3: Bi-annual surveys (January 2017, July 2017, January 2018, July 2018, January 2019, July 2019) will find that 75% of Face book followers and website visitors report that posting somewhat changed or definitely changed their decision to continue to breastfeed.Key Component ObjectiveSpecific - What is the specific task?

Social media campaign to influence health decisions with key messages on breastfeeding support posted on Face book and the website.


Number of individuals that follow the Empowered Moms: Thriving Infants on Face book and/ or visit the website. Survey results.

Evaluation period of measure is Short Term, Intermediate, or Long Term

Monthly and Bi-annual


Yes, based on previous social media campaigns.

Realistic - Are sufficient resources

Yes, the resources are available. Funding from the Ohio Department of Health is guaranteed with a three-year grant. A dedicated team

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available? with computer and marketing skills are available.Time-Bound - What are the start and end dates?

Three years- July 2016 to July 2019

Program Pro Forma Revenue and Support Amount

Contributions from sponsors 8000Grant (Ohio Department of Health, 2015) 34000Participant fee (Healthy Children, 2016) 1200Sale of curriculum material 100

Total income 43300Expenditures

Direct Cost Personnel Salary/ wages (Ohio Dept of Health, 2015)

26300

Certification test (Healthy Children, 2016)

1200

CLC class (Healthy Children, 2016) 5250 Supplies Instructional materials (Amazon, 2016) 330 Office supplies (Staples, 2016) 120 Meeting cost (Staples, 2016) 720 Equipment (Staples, 2016) 1250 Travel (Delta Airlines, 2016) 844 Postage (USPS.com, 2016) 425 Advertising (Greenbach, 2016) 4200

Total Direct costs 41285Indirect costs Rent (space provided) 0 Insurance (included) 0

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Telephone (Cincinnati Bell, 2016) 360 Utilities (included) 0

Total indirect costs

360

Total expenditures 41645Balance 1655

Budgetary Needs

The Empowered Moms, Thriving Infants program has a budget based on grants from the

state and national levels in order to fulfill the Healthy People 2020 (U.S. Dept of Health and

Human Services, 2010) goals to increase exclusive breastfeeding and to eliminate racial

disparities in infant mortality. CHWs are recognized as Medicaid providers, leading to increase

in funding potential (Agency for Healthcare Research and Quality, 2014). Community partners

are a great source of sponsorship and volunteers. The $1200 revenue from the participant fee is

to cover the cost of the certification exam; all participants will receive a refund (see direct cost)

after they pass the exam. The plan is to purchase the curriculum materials at wholesale for $330

(see supplies) and then sell them to the participants at a discounted rate ($100) to encourage

ownership.

The expenditures were adjusted during the budgeting process. Renting a space was too

expensive, so one of the partnering organization’s facilities will be used. With the space for the

CLC class donated, this eliminates cost for rent, utilities and insurance. Additionally, original

plan to offer the 24-hour hotline had to be modified due to cost. The salary and benefits cost to

maintain a 24-hour hotline was not feasible. The National Breastfeeding Helpline (U.S. Dept of

Health and Human Services, 2016) is open Monday through Friday from 8 a.m. to 5 p.m. In

order to serve the needs of the community after hours, the local community health workers

(CHW) and volunteers who are certified lactation counselors will carry a phone for the other

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hours. The CHW have agreed to be on call for $4 per hour and to be paid $15 per call. This

change significantly altered the budget, making the after-hour’s helpline an affordable option.

I utilized many resources to estimate cost. Typically, advertising budgets are based on

profit margin. Greenbach (2016) suggest that non-profits base their adverting on their revenue

and support. I conservatively estimated the advertising budget at 10 %, with the probability of

adjusting it as needed.

Marketing Strategies

In order to improve individual or community well-being, health promotion programs

build social marketing campaigns. Different from commercial marketing, social marketing

applied to public health programs is not concerned with financial outcomes (McKenzie, Neiger,

& Thackeray, 2013). The focus of social marketing in public health is behavior change. In

addition to the outcome, the other difference between commercial and social marketing is the

consumer orientation. Successful health promotion programs must make a concerted effort to

understand the target population and to maintain them as the center of all planning decisions

(McKenzie, Neiger, & Thackeray, 2013, p. 313).

In order for my community health program to be successful, the social media campaign

must be culturally appealing to my target population and use direct language concerning

behavior change. The Centers for Disease Control and Prevention (2016) suggests using research

to identify what the target audience is currently doing. Considering that knowledge, a realistic

behavior change can be developed. For example, the Empowered Moms, Thriving Infants

program is targeting African-American women of childbearing age living in an urban poor

neighborhood with limited breastfeeding support. Infant formula feeding is the social norm and

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the risks to infant health are not well known in the community. McIntyre, Hiller and Turnbull

(2001) suggest creating a social marketing campaign that focuses on the risk of infant formula.

Infants fed artificial formula experience more episodes of diarrhea, ear infections, and lower

respiratory tract infections and are at higher risk of sudden infant death syndrome, diabetes, and

obesity (Ip, Chung, Chew, Magula, DeVine, & Trikalinos, 2007). My campaign must feature

African- American women choosing to not artificial feed their children.

Tasks, Timelines, Responsible Leads/Partners

A Gantt chart is a tool to visualize the management of a program from the planning

process to the evaluation. The Empowered Moms, Thriving Infants program has four elements.

One of the pieces is a social marketing campaign. The team lead will initially hold a planning

meeting at the start of the program. Assigning tasks, the team lead will update the Gantt chart as

responsibilities are completed. The website for the Empowered Moms, Thriving Infants program

will take about 14 days to develop. Maintaining the website is an ongoing task. Additionally,

Face book posts will proclaim the risks of formula feeding. Each Face book post will link the

reader to more information. The website and Face book posts will promote the new Empowered

Moms, Thriving Infants program.

The community education phase of the program differs from the social marketing stage.

Instead of using web-based media and materials, the community education phase will include

written pamphlets, a PowerPoint presentation and face-to-face discussion with neighborhood

healthcare members. The resources necessary for the health promotion activity are staff, funding,

a facility and lunch for the participants. The timelines are presented in the Gantt chart (see

Appendix A.)

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Program Evaluation Plan

Outcome measurements and standards

In order to evaluate the effectiveness of the Empowered Moms, Thriving Infants programs

a variety of evaluation techniques are needed at different stages. According to McKenzie, Neiger

and Thackeray (2013), formative evaluation allows for modifications of the program prior to

implementation. While formulating the budget, it was necessary to make changes to the goals

and objectives of this program. Specifically, the cost of a 24-hour hotline was too expensive and

a duplication of available services. The National Breastfeeding Helpline (U.S. Dept of Health

and Human Services, 2016) is available free to the target population during regular business

hours. The Empowered Moms, Thriving Infants program was altered prior to implementation to

meet budgetary restraints and shareholder satisfaction. The formative evaluation method has

been useful to strategize a successful start. Additionally, the social media campaign is another

area that frequent on-going evaluation will be useful to understand the impact. The Center for

Disease Control and Prevention (2011) recommends using social media tools as a valuable way

to spread, credible, science-based health messages. The built-in evaluation tools of Face book

will be useful in evaluation. The available metrics help focus and improve communication

efforts. For social media, these can include traffic driven back to the program’s website,

influence and reach, as well as user interactions and engagement (Center for Disease Control and

Prevention, 2011). The plan is to monitor these metrics weekly, in order to access the impact of

the messages.

A retrospective measure of the success of recruitment, protocols and reach, the process

evaluation of the Empowered Moms, Thriving Infants program has several quantitative

Empowered Moms 25

objectives (McKenzie, Neiger, & Thackeray, 2013). Specifically, the objectives to reduce the

infant mortality rate in the target neighborhood and to increase the number of certified lactation

counselors necessitate a process evaluation design. The shareholders are investing in a holistic

program to reduce the infant mortality disparity. It is imperative to show this measure of success.

In addition to quantitative results, the Empowered Moms, Thriving Infants program will

utilize qualitative data. To facilitate the drawing of accurate conclusions, a summative evaluation

process will also be implemented (McKenzie, Neiger, & Thackeray, 2013). Understanding the

impact of the program on the target population is important to the shareholders. The Empowered

Moms, Thriving Infants program is based on behavior change, therefore impact and outcome

evaluations are essential. In particular, the objective to increase awareness among the community

health care provider will be measures with a post-test evaluation. The participants will be able to

give immediate feedback will be given to measure the effectiveness of the content. At the end of

each class, the results will be evaluated in order to make changes for a more effective learning

experience. It is the intent of the classes for the community health care providers to increase

community support for the Empowered Moms, Thriving Infants program.

Each of the objectives of the Empowered Moms, Thriving Infants program has the

potential to affect public health policy decisions. The community health workers are a direct link

to the community and training them as certified lactation counselors increases the community’s

commitment to healthy infant feeding. With growing grassroots support for breastfeeding, the

leaders of the neighborhood will also be challenged to support breastfeeding mother through the

program’s community classes. Finally, the social media campaign will engage the public,

creating the last necessary part for public health policy change. Brownson, Chriqui, and

Empowered Moms 26

Stamatakis (2009) propose that both quantitative data and qualitative information are important

evidence for policymaking. The program evaluation for Empowered Moms, Thriving Infants will

collect both types of data to provide policymakers with strategic information on reducing infant

mortality.

Elements of Comprehensive Formative Evaluation

Element How it will be assessed/evaluated in your programJustification Completion of a needs assessment and analysis of change in

breastfeeding rates, infant mortality rate and level of perceived support.

Evidence Completion of a literature review to define evidence-based strategies to increase breastfeeding rates, decrease infant mortality rates and increase perceived support.

Capacity Contract with OIMRI, implement community partnership strengthening protocol. Completion of evaluation design, budget and logic model.

Resources Completion of Pro Forma, Budget, Grant writing, staffing, volunteer coordination

Consumer-orientation Completion of needs assessment and literature review, evidence-based strategies of culturally appropriate and target population buy-in

Multiplicity Four point strategy; CHW trained as CLC, Community health partner’s awareness, helpline, social media campaign. Partnership with OIMRI

Support Helpline, media campaign leads to website, CHW visits to home

Inclusion Numerous partners involved: see stakeholder listAccountability Completion of Gantt chart to delegate roles and responsibilities,

Creation of team lead position. Community leaders on board of trustees. Partnership with established community advocates.

Adjustment Creation of evaluation design to act on feedback for each of the four point strategies. Modifications based on feedback from participants and partners.

Recruitment Partnership with established organization, OIMRI, to find clients in the priority population with desire to breastfeed.

Reach Partnership with established organization, OIMRI, to select the

Empowered Moms 27

appropriate proportion of the priority population to participateResponse Establish criteria for appropriate measurement of those

participating; see objectives.Interaction Create culturally appropriate interaction policies and procedures

for CHWs, community trainers and helpline attendants Satisfaction Survey participants about satisfaction; analyze results and

modify program. Analyze positive impact on community.Elements of Process Evaluation Element How it will be assessed/evaluated in your programFidelity Accountability of team leads to Gantt chart timelines and

logic modelDose Program delivery to 45219 zip code only; Four point strategyRecruitment Partnership with OIMRI recruitment criteria; referral processReach Partnership with OIMRI reach criteria; Analysis of social

media campaignResponse Survey of participant satisfaction and recommendation to

others in the communityContext Analysis of OIMRI partner programs’ other zip codes

ConclusionThe State of Ohio sincerely cares about its citizens and does not want anyone to die of

preventable causes. In Ohio, black infants are 2.5 times more likely to die in their first year of

life as compared to white infants (Ohio Department of Health, 2015). Due to this disparity, the

Ohio Department of Health initiated the Ohio Infant Mortality Reduction Initiative to find ways

to rectify the problem. The Centers for Disease Control and Prevention (2014) recognize

breastfeeding as a key strategy to reduce infant mortality. In fact, exclusive breastfeeding is

significantly associated with a reduction in infant morbidity and mortality (Ip etal, 2007).

Nationally, the Healthy People 2020 goals include several objectives to increase breastfeeding

(U.S. Dept of Health and Human Services, 2010). The Empowered Moms, Thriving Infant

program is a partnership project to support breastfeeding in order to reduce this disparity in the

neighborhood of Avondale. The University of Cincinnati Medical Center (2013) reported the top

Empowered Moms 28

health need of the surrounding community (Avondale) was infant mortality. The Empowered

Moms, Thriving Infants program is based on the Community Care Coordination Model. Craig

and Whittington (2011) found that utilizing the Community Care Coordination Model improved

the delivery of health benefits to those with multiple needs, while improving their experience of

the care system and drove down overall health care and societal costs. Making the most of a

four-point strategy, the new program will employ culturally-competent community health

workers, certify lactation counselors, support community health care provider and increase

public awareness. With sound resources and established community ties, the Empowered Moms,

Thriving Infants program is assured in the completion of its’ mission.

Empowered Moms 29

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Appendix A- Gantt Chart

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