Clear Goals, Flexible Structure: Obesity Prevention in Dallas

Collective impact offers a structured approach with specific processes to achieve effective collaboration. But how can these structures be flexible to respond to new issues or ideas that arise during the collective impact process?

A group of “breastfeeding experts” in Dallas illustrates this flexibility that allowed for collective seeing, learning, and doing. This breastfeeding experts group was a part of the Charting the Course (CtC) initiative aimed at preventing and reducing childhood obesity in North Texas developing strategies in five areas: healthy eating, physical activity, early childhood, school settings, and supportive healthcare. From its first meeting, the supportive healthcare working group identified breastfeeding as an important area to address. The Surgeon General’s Call to Action and the Institute of Medicine both support breastfeeding as a preventative measure to childhood obesity. Evidence suggests that initiation, longer duration, and exclusivity of breastfeeding provide a protective effect and lower odds of becoming overweight or obese in childhood and adolescence.

The supportive healthcare working group set out to answer the question, “What do moms need in order to initiate and continue breastfeeding?” Their path to answering this question illustrates the importance of having the right people at the table to interpret data and develop strategies, and also allowing flexibility in the structures needed to achieve overall goals.  Together, we learned that:

  1. Listening to the data is the first step. Many of the working group members were healthcare professionals in hospital settings, and were convinced that more effort was needed to improve breastfeeding initiation. But the data told a different story—Texas hospital breastfeeding initiation rates are on par with the national average of 77% and close to the national goal of 82%—all as a result of the hospitals’ push to become “Baby Friendly”. However, data suggested that the real gap was moms continuing to breastfeed at six months—a rate that in Dallas stands at 51% of moms, trailing the national goal of 61%. Working group members had to let go of their preconceived notions of focusing on hospital settings, and the group agreed that the real gap was moms continuing to breastfeed at six months.
  2. Asking the experts helps understand the numbers. Since many of the working group members were familiar with hospital settings, they were perplexed at the data showing breastfeeding rates dropping at six months. To better understand the data, working group members tapped experts in the community that work daily with moms—lactation consultants, Women Infants and Children (WIC) nurses, La Leche League peer support group leaders – to ask “what barriers do moms face in continuing to breastfeed at six months and what support do they need to overcome these barriers?” The group learned that despite lots of work being done to support breastfeeding, moms and the professionals that support them often don’t know how to access this support.
  3. Tackling the coordination challenges is as important as any other strategy. Tapping experts that work with moms every day revealed that—not surprisingly—there is no silver bullet answer of how to best support moms. Moms are drowning in informational material. There are enough trained lactation consultants in the city. Doctors are trained in breastfeeding best practices. Peer support groups exist. What was missing? The connection among all of these resources. Strategies that increase coordination are some of the most powerful in collective impact. Re-aligning and connecting existing programs to maximize system efficacy is sometimes overlooked in favor of new programs, but is incredibly powerful in creating systems change. The healthcare working group members understood that coordination was an issue, but admitted that they did not have the community knowledge to draw a map of the existing resources and map disconnects—so they called in the experts who work daily with moms.
  4. Initiating a meeting of “experts” to unlock the opportunities. Working group members invited the 5-6 experts we interviewed to join a “breastfeeding experts” group to dig into the coordination challenges. And this invitation went viral. There was such a hunger in the community among those passionate about breastfeeding that a handful of invitations turned into a meeting of over 15 individuals.  The group mapped the ecosystem of support surrounding moms once they leave the hospital from pediatricians, to WIC, to churches, to peer counselors, to other every day interactions such as shopping at Target. They agreed on specific steps the group could take to close the coordination gaps among these various stakeholders.

Even more importantly, this group verified the value of such an “experts” meeting—commenting that despite their firsthand knowledge of the challenges facing moms, they rarely get asked about how to better support breastfeeding, and had never convened in such a way that they get to initiate change with peers. The breastfeeding experts group is still meeting, connected to the supportive healthcare working group. They will continue to be flexible in their approaches to reviewing data, engaging new stakeholders, and coordinating action to make breastfeeding easier for all moms.

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