Michigan Breastfeeding-Friendly Outpatient Awards Application

Families are more successful in meeting their breastfeeding goals when they are surrounded by systems, including outpatient providers, that support breastfeeding. The Michigan Breastfeeding Network (MIBFN) wishes to recognize Michigan outpatient providers that provide support to breastfeeding families through our Michigan Breastfeeding-Friendly Outpatient Awards.

MIBFN recognizes how vital it is for families to receive clinical- culturally representative breastfeeding support in a timely fashion. The Outpatient providers are evaluated based on criteria for three levels of support: Gold, Silver, and Bronze. Outpatient providers meeting requirements of one of the three criteria levels will be recognized with a certificate and opportunities for recognition on the MIBFN website and social media pages.

Who should apply? Outpatient Awards are for anyone providing breastfeeding support in the outpatient setting. This includes and is not limited to prenatal providers, postpartum providers, pediatricians, lactation consultants, home visitors, community-based support organizations, and more.

Award Level Determination:

Bronze: 5-15 points
Silver: 16-30 points
Gold: 31+ points

If you have any questions, please contact hello@mibreastfeeding.org.

Question Title

Contact Information

Applicant's Full Name

Email Address

Phone Number

Question Title

Organization Information

Organization Point of Contact's Full Name *

Organization Name *

Address *

City/Town, Michigan *

County

ZIP/Postal Code *

Organization Website *

Organization Facebook Page *

Application Checklist:
Please check the boxes below that apply to your organization.

Question Title

(1 point each)

Benefits of breastfeeding discussed at least once during the course of the perinatal period (conception - childhood)

Provide educational resources (website links, materials, window stickers, lending library etc.)

Have a written breastfeeding-supportive policy in office

Provide families with adequate space and time for breastfeeding/expression of milk

Use of LactMed or Thomas Hale’s Medications & Mother’s Milk when prescribing

Breastfeeding-supportive atmosphere (display signs encouraging breastfeeding, culturally representative posters, artwork, photographs)

Specific recommendations for community-based supports groups

Warm line for urgent matters

Website available

Peer referral resources (in case of need to refer out)

Question Title

(2 points each)

Community resource list available and reviewed annually

Breastfeeding education included during regular visits to ensure families are adequately informed prior to birth and throughout the duration of breastfeeding

Basic breastfeeding education and awareness of community resources for all office staff

Knowledge of where to refer patients to in the community and consistent referrals to community-based lactation services

Comfortable lactation room available (not an exam room)

Lactation Professional on staff (Peer Counselor, CLC, CLS, IBCLC)

Breastfeeding addressed at first pediatric visit or within 48 hours of birth notification by phone

Postpartum follow-up calls at 24-48 hours

Traveling range 0-30 miles

Post-consult follow-up plan

Sliding scale/payment plan for to support with financial barriers

Question Title

(3 points each)

Offer breastfeeding class and/or facilitate breastfeeding support groups for patients

Lactation training completed for all clinical staff

No distribution of any products or coupons from formula companies

Office staff knowledgeable regarding correct use of breast pump acquisition, use and milk storage guidelines

Multidisciplinary approach to care for breastfeeding families through open communication between providers, lactation support, and families to always preserve continuity of care in breastfeeding

Office space and scheduling available for Lactation Professionals to see patients in-office

Breastfeeding Services scheduled with Lactation Professional in the office

Response time for visits 24-48 hours

Direct referral sources with soft hand off

Providing breastfeeding supplies at low or no cost within scope of practice (tubing, nipple shield, syringe for feedings etc.)

Traveling range 30+ miles

Question Title

(10 points)

Staffing that reflects and represents the people who are served

Question Title

What makes your organization’s breastfeeding support unique?

Question Title

I'm granting permission for MIBFN to use my answer to the previous question as a quote in MIBFN website, reporting, social media, etc.

Yes

Question Title

Please note that there is a $15 donation requested for each award, we process applications monthly, and each award is for 1 calendar year. I have submitted this amount at mibreastfeeding.org/awards under "Awards Applications Payment."

I have submitted $15 and would like to receive one award (my outpatient organization has one location OR I would like to have one overall award)

I have submitted $15 each to allow individual locations to receive one award (my outpatient organization has multiple locations and will each have the opportunity to display theirs; ie. $30 for two locations, $45 for three locations, etc.)

Thank You For Catalyzing A Race To The Top Amongst Breastfeeding-Friendly Outpatient Providers Throughout Michigan!
Additional resources and tools can be found at www.mibreastfeeding.org