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Texas Mother-Friendly Worksite Program

Implementation

As stated elsewhere, the Texas Mother-Friendly Worksite Program was established in 1995 to recognize employers that implement written and communicated worksite lactation support policies. The Mother-Friendly Worksite Policy Initiative is a capacity-building process that DSHS implemented in 2010 to transform the MFWP to have greater capacity, and wider scope and reach. Read about the implementation activities for the CPPW-funded Mother-Friendly Worksite Policy Initiative in the box below. 

Summary Description of Mother-Friendly Worksite Policy Initiative Implementation

The following activities were an essential part of the CPPW-funded capacity building effort called the MFWPI. The focus of this effort was to scale up the Texas Mother-Friendly Worksite Program to increase program capacity and scope; provide additional guidance and support for employers wishing to implement worksite lactation support policies and programs; and to increase the program’s reach through awareness and uptake of the worksite designation. The CPPW funding provided resources to:

  • Complete formative assessment to:
    • understand needs, facilitators and barriers to establishing worksite cultures supportive of breastfeeding; and
    • develop and test messaging and strategies for engaging key target audiences;
  • Conduct a pilot-test of training, technical assistance, and implementation processes, tools and materials with select employers wishing to implement comprehensive and sustainable worksite lactation support policies and programs;
  • Develop and execute a targeted professional communications/media campaign to increase awareness about and interest in the MFWP;
  • Implement enhancements, including changes to the program’s administrative policy, and development of new resources, strategies, and outreach mechanisms to extend the capacity and reach of the MFWP;
  • Develop and strengthen strategic partnerships to ensure widespread impact and sustainability of the MFWP.

While Texas was fortunate to receive CPPW funding, funds of this size are unlikely to be available again for some time. Therefore, the activities below are detailed for your information; however, Center TRT does not expect that a new adopter would do all of these things. Rather, this section gives you an understanding of how Texas arrived at the transformed Mother-Friendly Worksite Program that is now being implemented, including the communication and implementation materials.

Please click here to read a comprehensive summary of the Mother Friendly Worksite Policy Initiative.
 

State-level planning and implementation
Below we describe the implementation of the MFWPI (the pilot process) and how lessons learned from the MFWPI are being integrated into the MFWP. Note that these steps are written linearly, but may occur in a parallel or iterative process.

  1. Round up partners. Multiple partners, within and external to DSHS, were involved in supporting the formulation and implementation of the MFWPI. In particular, extensive partnerships were fostered around breastfeeding support activities in general and worksite lactation support in particular. Throughout the initiative, internal marketing communication efforts were heavily employed to keep current partners engaged and to expand the circle of partners aware of—and buying into— the initiative. In Texas, key internal partners included state office and regional staff in program areas such as maternal and child health, WIC, obesity prevention, chronic disease prevention and wellness. Texas’ state agency wellness program, Texas Ten Step hospital recognition program, regional and local health services, and WIC served not only as invaluable advisors in the initiative but also as gatekeepers to MFWPI’s targeted worksites. Key external partners included the state and local breastfeeding coalitions, the Texas Association of Local WIC Directors, and state worksite wellness advisory board. Partnerships were expanded during program implementation to include the state stroke and heart health program, local chronic disease prevention coalitions, and others. 
  2. Conduct assessment. Gather information about what is currently known about the baseline condition of worksite lactation support in your state. This could include completing a labor analysis to identify target labor markets and potential reach; reviewing literature and state and national quantitative and qualitative data about worksite barriers to breastfeeding and infant feeding outcomes; and conducting surveys and/or key informant interviews with a variety of stakeholders to identify strengths, opportunities, current level of awareness, needs, and competing demands. Local WIC agencies, state and local breastfeeding coalitions, and breastfeeding support organizations like La Leche League will likely have a pulse on problems that women encounter with worksite lactation. Human resource management, public administration, and building and facility management organizations are also invaluable informants. 
  3. Develop strategy. Strategy development includes establishing strategies to administer and sustain the initiative as well as strategies for development of the initiative’s framework. Using the social marketing process, The Mother-Friendly Worksite Policy Initiative involved strategies designed to affect systems, organizational and public health policies, and both the built- and cultural environment. The objective was to make the healthy choice (supporting employees with lactation while working) the easy choice for employers. As part of strategy development, the project team should define the problem; set project goals, objectives and indicators; and define strategic target audiences. The project team should use the social marketing process to involve key audience sectors and increase their awareness, access and buy-in for implementation of worksite lactation support while also anticipating and proactively responding to their concerns, resistance, or competing demands about being involved in this effort. See Resource Section for social marketing training.
  4. Monitor and Evaluate. Regular, ongoing process monitoring, gathering of lessons learned, and communication with partners are critical to ensure that the project is on-track and is effectively contributing to the desired outcomes. This allows for midcourse strategy/implementation adjustments, for leveraging of new opportunities and for assurance that the initiative keeps moving in the right direction. 

Worksite-level planning implementation
DSHS walked the pilot sites through a series of implementation steps. While many worksites seeking designation may start small by adopting a policy that meets the MFWP minimum criteria and some may delay or forego the following implementation steps, worksites wishing to develop comprehensive worksite lactation support programs may follow these steps. Tools to support these steps are available at TexasMotherFriendly.org.

  1. Generate buy-in within worksites. Support from all levels of the worksite is important for developing a successful lactation program. Identification of senior management champion(s) is particularly important; these champions may participate in the worksite committee directly, approve budgets, or show support by actively and visibly communicating their support to staff.
  1. Create a planning committee that will integrate diverse perspectives, increase buy-in, and ensure that details about program logistics are covered. Committee membership should include decision-makers and interested or essential parties (i.e., human resources, wellness coordinator(s), facilities representative, an employee who has or is breastfeeding, pregnant employees, etc.). Assign roles to committee members, designate a coordinator, and establish program expectations.
  2. Before designing the program for the worksite, complete a baseline assessment to understand how the organization currently supports (or doesn’t) worksite lactation. Assess current policies, environments, supports, needs, constraints and employee demographics. Assessment might include committee discussions, an organizational scan, broad employee assessment, and interaction with stakeholders and key informants through the use of focus groups, interviews, or forums. Findings will determine what type of program is most appropriate for that particular worksite.
  3. Develop a policy and apply for designation. The lactation support policy will shape worksite culture and attitudes about this issue. The policy should clearly state what the employees can expect from the organization and what the organization expects from employees. Some find it necessary to have a policy in place first and develop the rest of the program as part of a policy implementation plan, while others find that the approval of a formal policy is the end product of the implementation process. Once a policy is finalized, apply for Mother-Friendly Designation!
  4. Plan for implementation. Outline options for your Mother-Friendly Worksite employee program in a written operating plan. The operating plan provides the framework for your worksite lactation support program, guides your organization’s implementation of the proposed components, creates legitimacy for the worksite lactation support program within the organization, and provides a road map for action.
  5. Implement the program/plan. Explore options for implementation of the time, space, education and support components of your completed operating plan (developed in step 5). Part of this step is to communicate about your worksite lactation support program to managers, employees, customers, potential employee recruits, and the larger community. Also be sure to document lessons learned so that you can refine and improve the program as time goes on!
  6. Evaluate your program. The Texas Mother-Friendly website provides evaluation planning tools so that sites can consider how to gather feedback. Evaluating the program is an ongoing activity that can ensure sustainability and help identify areas for improvement. Input from stakeholders within the worksite who are affected by the program can help identify important information valued by users and supporters of the project. The MFWP recommends evaluating the program as a whole, as well as the different components. The results of the evaluations should be incorporated into future policy revisions and program updates.

Monitoring and evaluation:
From a state coordinating agency perspective, evaluate what is working/not working about the statewide Mother Friendly program. Some of the evaluation data collected by the MFWPI pilot project includes:  

  • Number of newly designated sites and an ongoing tally of total designated sites
  • Number of employees potentially reached by the designated sites
  • Number of employers implementing worksite lactation support programs (measured by existence of policies meeting or exceeding minimum designation criteria, operating plans, interviews)
  • Comprehensiveness of worksites policies (extent to which policies explicitly address provision of time, space, education and support)
  • Comprehensiveness of employer programs as measured by activities and/or activity work plans to provide education and support

As part of the MFWPI, additional questions about breastfeeding and worksite lactation have been added to statewide surveillance systems to evaluate public beliefs, perceptions and behaviors. Three state-added questions were included in the Behavioral Risk Factor Surveillance System (BRFSS) and several questions were added to the Texas WIC Infant Feeding Practices Survey (IFPS), which is completed by mothers of infants participating in the Texas WIC program.

Keys to Success

State level

  • Fostering strategic partnerships was paramount to successful state-level implementation and to increasing reach throughout the MFWPI.
  • MFWPI strategies, objectives, and evaluation planning were shaped by the assessment. Please see “Formative Evaluation” in Evidence Summary for more on this.
  • The social marketing process (see Resources section for web-based training) was the overarching framework for the initiative and ensured that the initiative’s objectives strategies, program activities, technical assistance resources, messaging and partnerships were developed strategically with target audiences in focus and end goals in mind.  

Worksite level

  • Buy-in from all levels of worksites (from leadership to procurement/purchasing staff) was particularly important for a project’s success. Obtain information about the Fair Labor Standards Act provision for Reasonable Break Time for Nursing Mothers and the benefits of breastfeeding for business, parenting employees (dads, too!) and babies; these are effective to get needed buy-in.
  • A planning committee to support implementation was critical to success in many pilot sites. Diverse planning committees bring multiple perspectives and expertise to the project and make planning and implementation more efficient and robust. Committees typically included a woman who had breastfed who could bring experienced testimonials and an insider perspective to the group. By participating on the committee, employees who were previously uninformed about the benefits of breastfeeding or a breastfeeding friendly workplace became advocates for a mother-friendly environment.
  • Most project teams used the assessment tools provided by DSHS to develop a clear picture of the needs and attitudes of employees who were expectant- or new parents, management staff, and the larger employee population. Assessment data also provided planning committees with a better understanding of what assets were available to them as well as potential barriers to program implementation. A few teams that struggled with buy-in after not conducting an assessment wished they had done so before they approached executive leadership about the project.  In hindsight, they believed they could have made a stronger case to their organizations’ leaders by demonstrating need and making the “unspoken need spoken”.  For example, one finding from the state-level formative assessment process was the disconnect between employers’ awareness and perception of the need for worksite lactation support and employees’ reported experiences of trying to maintain lactation after returning to work. Employers reported not hearing from employees about their need for worksite lactation support, which they interpreted to mean that the need was already met. On the other hand, employees reported their struggles with maintaining lactation, finding appropriate space and time for pumping, negative or overtly hostile attitudes from co-workers, and a great deal of hesitancy from fear for job security to speak to their employers about their worksite lactation experiences and needs.
  • Training managers helps ensure comprehensive support for breastfeeding mothers returning to work. Simply leaving supervisors and managers to work out the details of policy implementation with new mothers may not be as effective.

Barriers to Implementation

State level

  • The low level of awareness and unfamiliarity with the topic of worksite lactation support was a barrier to promoting the program. The lack of familiarity ranged from lack of understanding about what is required to maintain milk production when a mother is separated from her infant to the barriers women encounter when trying to work and breastfeed. Employers did not always immediately understand the meaning of “worksite lactation support” or “employee breastfeeding support” and often assumed that this would require a mother to bring her infant into the worksite to breastfeed. For these reasons, establishing the need for such a program can be a challenge. To address this barrier, it is helpful to address myths (such as those listed here: http://www.texasmotherfriendly.org/files/document_41.pdf), to raise awareness of the need (e.g. through public health data, testimonials, and a worksite assessment) and to provide basic, concise information about the cost-benefit of supporting breastfeeding. It is helpful to develop a plan for leveraging early adopters and their successes to build awareness. Project activities and timeline should allow for some level of education, myth-busting, and awareness building for all stakeholders (even early adopters).

Worksite level

  • Locating dedicated space for lactation breaks was often identified as an initial barrier to buy-in. However, once employers learn that flexible space options are allowable, resistance diffuses. To address this barrier, deemphasize the space requirements, emphasize the importance of the other components of a supportive mother-friendly policy, and include a facilities management expert on the planning committee who can help identify appropriate lactation space.
  • Within governmental worksites, unfamiliarity and restrictions with purchasing processes for lactation space furnishings can result in implementation delays. A purchasing expert on the planning committee can reduce this barrier.