Pure Life Breastfeeding Support Services

Grant Proposal: Improving Breastfeeding Practices, Breastfeeding

Friendly Initiative

Presented by:

Janelle Bayona, B.S., MPH (c)

Doris Buezo, RD, MPH (c)

Marissa Cruz, B.S., MPH (c)

Anthony Olivar B.S., MPH (c)

Summer Zeit B.S., MPH (c)

California State University, San Bernardino

TABLE OF CONTENTS
1. Specific Aims…………………………………………………………………..……….......4
1. Needs/Problems………………………………………………………..…………...4
2. Working Hypothesis………………………………...……………….….………….4
3. Literature Review…………………………………………………….….………….5
4. General Program Plan……………………………………………….…….………..6

1. Target Populations.…………………………………………....…………….……….……....7
1. Approaches and Methods……………………………………….….……………….8
2. Project Goals and Objectives……………………………………..………….……...8
3. Activities and Timeline……………………………………………..……….…..…..9

1. Program Evaluation Plan………………………………………………………………..…...10

1. Agency Capacity and Project Management………………………………………………….12

2. Budget and Budget Justification…………………………………………………………..…15

1. Community Support…………………………………………………………………...,…….19

1. References………………………………….………………………...……………………....20

1. Appendices…………………………………………………………...…………………..…..21
 ABSTRACT

Breastfeeding is the most cost-effective way for mothers to provide nutrition to their growing
infants after birth. It allows a mother and infant to share a special bond that cannot be replicated through
infant formula. Pure Life Organization plans to demonstrate the health disparities among low-income
breastfeeding mothers in San Bernardino County. The organization also plans to raise breastfeeding
awareness, practices, and encourage positive attitudes towards breastfeeding. Many environmental
constraints are limiting low-income mothers to breastfeed despite the evidence-based practices
surrounding both mother and infant benefits of breastfeeding. To engage low-income San Bernardino
County women, Pure Life Breastfeeding Support Services plans to educate low-income women by
providing educational programs to increase knowledge and self-efficacy during breastfeeding. Pure Life
Breastfeeding Support Services-General Program Plan looks forward to working with the community by
providing educational and ethical practices to assist in eliminating breastfeeding disparities among low-
income women of San Bernardino County.
 SPECIFIC AIMS

Needs/Problems

Breast milk is the most complete form of nutrition available for infants because the compounds
found in breast milk provide protective health components that positively affect infant growth and
phsycial development. It cannot be duplicated through the manufacturing process in a laboratory as is
done with formula. The elements that make up formula do not provide the same nutrient structure that
breast milk provides. For example, breast milk contains many antibodies that help protect an infant
against bacterial and viral infections, as well as components such as DHA (docosahexaeonic acid) and
ARA (arachidonic acid) which is a crucial element in fetal brain development (The MotHERS Program,
2018). The use of formula milk can potentially hinder an infant from receiving the best possible care
during the most crucial time of neonatal development. Motivation is the key factor in the promotion of
breastfeeding among low income women, with emphasis placed on cost effectiveness and in support
groups designed to support new mothers.

Breastfeeding among low-income women requires mothers to be highly motivated to use this
most cost-effective method and mothers should feel supported in their decision to breastfeed (Chapman,
Damino, and Young, 2004). Breastfeeding is often viewed with a negative social stigma among
unsupportive family, friends, and strangers. The stigma associated with breastfeeding can often lead to
embarrassment with feeding in public and private places, often discouraging the mother to stop
breastfeeding practices altogether. Breastfeeding, specifically among low-income mothers, has specific
social and child care implications. For instance, low-income mothers at young ages are heavily reliant on
their jobs or school work, resulting in short-term breastfeeding practices (Smith, et al., 2012). Mothers
may also experience difficulty in breastfeeding due to knowledge deficit of breast pump use. Many
mothers also lack the means by which to appropriately store breast milk while at work. Various issues
arise with lactation and latching from infant to breast that can deter a mother from continuing to
breastfeed. As a result, discouraged mothers often choose a more expensive, manufactured alternative
form of nutrition for their infants.

Mothers may also be encouraged post-birth to bottle-feed their infant at the hospital, which can
discredit breast milk and bias mothers to use formula over breast milk. California state statistics reveal
that San Bernardino County is ranked 38th in the state for exclusive breastfeeding and the county average
for exclusive breastfeeding is ranked at 61.2% (California WIC Association, 2016). According to the San
Bernardino County Community Indicators report of 2015, there are only 11 baby-friendly hospitals that
promote breastfeeding over formula feeding. Victor Valley Community Hospital is one hospital among
the 15 lowest-scoring in the state for exclusive breastfeeding rates, and Arrowhead Regional Medical
Center is the highest performing hospital in the county (California WIC Association, 2016). The lack of
breastfeeding is more prevalent among hospitals that have reduced policies that undermine exclusive
breastfeeding among mothers in the labor and delivery department. The purpose of the intervention is to
elucidate the breastfeeding issue among low-income women of San Bernardino County and describe how
the Pure Life Organization is working to seek to funding through the Breastfeeding-Friendly Project to
raise breastfeeding awareness and make it easier for low-income women to breastfeed.
Working Hypothesis

To combat this issue, Pure Life Breastfeeding Support Services plans to increase additional
access to breastfeeding education and materials for low-income women living in San Bernardino County.

Literature Review

The approaches aimed are to increase breastfeeding education among low-income

women. The prioritization of advocacy for policy change will result in positive behavioral health
outcomes and will direct mothers to use breast milk as a primary source of nutrition. The World
Health Organization (WHO) defines breastfeeding as an optimal way of providing infants food
to maintain healthy growth and development. The WHO states it is vital for the mother to
breastfeed within the first hour after the birth of their infant due to the colostrum produced.
Colostrum is described as thick yellow milk, delivered at the latter end of the pregnancy cycle,
and the purest and perfect form of food for an infant. (WHO.int). To achieve the optimal growth
physically and mentally for an infant it is recommended by the WHO, infants should receive
solely breast milk from the first hour they are born to the first six months of their lives, but the
mother may breastfeed from age two and beyond if desired. (WHO.int) Breast milk meets
adequate nutritional requirements for infants until first six months of their life.

Furthermore, there are multiple benefits of breastfeeding from not only infants but the
mother as well. The benefits of increasing breastfeeding rates, for infants are less likely to
develop asthma, enteric nervous system problems, wheezing and coughing issues. (Pugh et al.,
2010). Additionally, according to the Centers for Disease Control and Prevention (CDC),
benefits for infants who are breastfed reduce the risk of developing type 2 diabetes, obesity,
asthma, ear and respiratory infections and sudden infant death syndrome (SIDS). Organically,
mothers are less likely to develop breast cancer, ovarian cancer and more likely to increase
bonding interactions with their infants (Pugh et al., 2010).

On the other hand, infants who are not breastfed (the first six of life, as WHO
recommended) face adverse health effects. Although breast milk is the purest source of nutrients
a mother can give her infant, previous studies have provided confusing and misleading
information mothers into believing the use of formula milk has more benefits for an infant than
breastfeeding. The purpose of the formula is exceptionally high among low-income women. The
study reviewed, revealed that community interventions solely based on increasing breastfeeding
among low-income women reduced the risk of developing type 2 diabetes for both mother and
child (Tenfelde et al., 2012). According to Whaley and colleagues, infants who are not breastfed
are 20-50% more likely to be obese compared to children who were fed only breast milk.

Women who qualify for WIC benefits receive formula, are more likely to opt-out of
breastfeeding their infant. Therefore, WIC has amplified the use of the formula which resulted in
an all-time low of breastfeeding rate among low-income women. This stimulated WIC recipients
at six months only 31% of them breastfed then decreased to 6% at 12 months, in comparison to
Healthy People 2020 61% still breastfed at six months and 34% breastfed at 12 months (Tenfelde
et al., 2012). Furthermore, a trending characteristic of these women was the lacked support
among their family members resulted in ending breastfeeding within the first six months
(Tenfelde et al., 2012). Among low-income women who opted out of breastfeeding, there are
trending characteristics regarding adverse health outcomes that may have long-term effects on
mothers and infants

Federal Poverty Guideline 2017 state a household size of 4 with an income of 24,600 is
100% threshold of poverty in the United States. (http://familiesusa.org/product/federal-poverty-
guidelines) According to the Public Health Foundation Enterprises (PHFE) over 300,000 WIC
recipients are from San Bernardino, Orange, and Los Angeles counties. Mothers living below
the federal poverty level enrolled in WIC benefits, succeeded by increasing breastfeeding
practices through education and support from WIC partners. A total of 45% low-income mothers
qualify in the San Bernardino County to receive benefits from Pure Life Breastfeeding Support
Services-General Program Plan (census.gov) based on federal poverty guidelines.
General Program Plan

The Breastfeeding-Friendly Project is a program designed to increase and improve breastfeeding

rates among low-income women of San Bernardino County. Through social support services, education,
and provision of breastfeeding equipment, Pure Life Breastfeeding Support Services-General Program
Plan is requesting funding to support the Breastfeeding-Friendly Project to strengthen the culture of
breastfeeding practices by informing mothers about the benefits of breastfeeding. The program will
consist of several staff members, interns, and organizational leaders that will work together to promote
breastfeeding among low-income women of San Bernardino County. Services provided focus on giving
free nutrition-related information to mothers regarding optimal breastfeeding practices, teach mothers
how to properly latch and feed, support mothers through the process with the use of group learning
sessions as well as individualized counseling sessions. If the mother is unable to produce enough milk for
her infant to latch, then counseling sessions with a lactation consultant will be provided to help the
mother succeed. Through pre and post-test surveys, mothers will answer questions that will demonstrate
the effectiveness of the program, as well as determine whether the application leads to changes in
knowledge, attitude, and self-efficacy regarding breastfeeding practices.
 TARGET POPULATION

The Pure Life Breastfeeding Support Services-General Program Plan will focus all its efforts
towards low-income women in San Bernardino County to promote healthy breastfeeding benefits such as
ethical breastfeeding practices, breastfeeding education and nutritional resources. These benefits aid both
the mother and infant in developmental, immunological, nutritional, and psychological processes. By
eliminating barriers mothers may have towards breastfeeding, the Pure Life Breastfeeding Support
Services-General Program Plan will be able to work towards equal quality of life no matter what
geographical background a child may have.

San Bernardino County consists of 50.25% of women with a poverty rate of 100% and an overall ranking
of 19.48% (CommunityCommons.org) demonstrating the needs for increased breastfeeding practices.
Figure 1 illustrates the geographical borders of San Bernardino County.

Figure 1. San Bernardino County Boundaries

Little to no prenatal care is used by expecting mothers when comparing the 20.1% women in the
county who do not receive or seek prenatal care and the 17.3% of women in the United States,
respectively (CommunityCommons.org). This statistics indicate that lack of prenatal care can also lead to
complications among mothers by increasing chances of the delivery of an infant with low birth weights
and increasing chances of infant mortality.

An article published by the Center for Disease Control and Prevention Breastfeeding Report Card
highlighted, "Breastfeeding rates continue to rise in the United States. In 2011, 79% of newborn infants
started to breastfeed. Yet breastfeeding did not continue for as long as recommended. Of infants born in
2011, 49% were breastfeeding at six months and 27% at 12 months" (CDC, 2014). There are many efforts
made in the United States by programs such as WIC to encourage effective maternity care practices, but
the women in San Bernardino County continue to struggle in receiving proper education on useful
breastfeeding practices.

Figure 2. San Bernardino County Low Birth weight

Based on the information provided in figure 2, mothers living in San Bernardino County do not
adequately maintain a nutritional diet during their pregnancy period. San Bernardino county accounts for
7.1% low birth weight compared to the 6.8% of the state (CommunityCommons.org). Quality education
is needed to administer necessary breastfeeding practices in which a mother can actively gain support
from community resources and outreach programs. The transition from hands-on instruction to home
practices can aid a mother in becoming proactive about breastfeeding and can allow mothers to learn how
to breastfeed properly in order to maintain healthy infant weight. The Pure Life Breastfeeding Support
Services-General Program Plan will reinforce positive viewpoints by establishing a culture that
encourages mothers to follow safe, ethical practices and in the process eliminate negative outlooks
regarding breastfeeding practices related to an infant's health.
APPROACHES AND METHODS

The task of nourishing infants can present many issues for newly breastfeeding mothers. There
are countless constraints mothers face when attempting to breastfeed their child properly. To name a few
there are social, economic, fundamental, time, and as mentioned previously negatives stigmas. Despite
evidence in support of breastfeeding, a barrier is still existent in women to promote breastfeeding
practices. One barrier found to be prominent among mother is the influences to formula feed rather than
breastfeed their child. The formula milk, as mentioned previously, provides very little benefit in helping
infants grow efficiently yet mother continue to prefer this method based on false information. The
principle approaches the Pure Life Breastfeeding Support Services carry is to promote breastfeeding
through the use of evidence-based practices properly.

The article, The Economic Benefits Of Breastfeeding, explains the reasons why a mother does not
want to breastfeed. Examples given in the article are, "Mothers may refrain from breastfeeding for a
number of reasons: aggressive formula product marketing; lack of support from family and friends;
insufficient knowledge among medical professionals about breastfeeding techniques and challenges;
maternity hospital practices (short maternal stays, for example); religious beliefs; cultural attitudes; and
lack of public acceptance (Weimer, 2001)". The Pure Life Breastfeeding Support Services plans to
educate low-income women who live within the county of San Bernardino by providing educational
programs that allow a mother to gain a deeper understanding as to why it is beneficial to breastfeed. The
educational material will include the following; inform mothers on how to provide their child a high level
of nutrients during lactation cycles and knowledge as to how breastfeeding can aid in healthy mother and
child relationships. Take home pamphlets will be provided to mothers in where the information will
illustrate a step-by-step analysis on how to properly breastfeed a child.

Recent studies have found, “Successfully promoting and supporting breastfeeding in the United
States may depend on persuading both mothers and society that breastfeeding is not only nutritionally
sound but economically beneficial as well. Current U.S. rates of breastfeeding are 64 percent for mothers
in-hospital and 29 percent at six months postpartum, below the recommendations of the Surgeon General.
This analysis concludes that a minimum of $3.6 billion would be saved if the prevalence of exclusive
breastfeeding increased from current rates to those recommended by the Surgeon General (Weimer,
2001)". By finding ways to successfully promote breastfeeding practices among the mothers of San
Bernardino County, many mothers will be able to receive the programs and services free of charge. Once
a mother has initially cultivated the knowledge needed to master the benefits of breastfeeding,
malnutrition in infants can be reduced substantially.

Project Goals and Objectives

Based on healthy breastfeeding practices, The Pure Life Breastfeeding Support Services will be
able to help allocate these services to the mothers through consultations with a lactation specialist to
provide a one on one experience. In addition to providing mothers with consultations, bilingual speaking
health care professionals will be made available to mothers in order to avoid a language barrier.
Counseling services are provided to both mothers and fathers who would like to partake in support groups
where fathers can help build a foundation and understand the importance of breastfeeding. This friendly
environment will give the opportunity for questions and demonstrations to help eliminate the stigmas and
gaps of lactation and breastfeeding promotion. A pre and post-test survey will be presented at the end of
the course to help confirm feedback (See Appendix, Figure 2 and Figure 3).

Most mothers are afraid to ask questions or do not know how to ask questions regarding
breastfeeding. Staff will ensure to track a mother’s improvements bi-weekly and use a growth chart to
show the progress they are making through breastfeeding practices. See Appendix, figure 7 for an
example of the growth chart. Staff members will also be able to assist the mothers and fathers by
answering questions regarding healthy breastfeeding practices by providing evidence-based data. An
article titled, “What do pregnant low-income pregnant mothers say about breastfeeding” by Alexander,
Ashley, Dowling, Donna and Furman, Lydia explain the reason why mothers may not want to breastfeed.
“When interviewees were asked, "What is the biggest reason you want to breastfeed?" responses included
maternal reasons, infant-related reasons, and advice of others. When women were asked, "What would
stop you from breastfeeding?," responses included lifestyle reasons, pain-related reasons, lactation
process issues, hypothetical medical reasons, and maternal reluctance" (Feb., 2010). These are some
responses that shed some light on how Pure Life can raise awareness and try to eliminate these stigmas
and grant insight into healthy lifestyle changes to allow breastfeeding to be simple for mothers. By
planning and promoting this practice, Pure Life's objective is to advocate breastfeeding education to
improve the overall nutritional status of infants by reducing infant mortality rates and low birth weight
infant among low-income women.

The Pure Life Breastfeeding Support Services-General Program Plan will be responsible for
administering the day-to-day fiscal and administrative oversight and accountability of the Women for
Women Organization for the Breastfeeding-Friendly Project. The first year of funding is reported as
$500,000 with on-going annual funding of $1,000,000. This is a critical component which will aim the
implementation of breastfeeding outcomes in the county of San Bernardino.

Activities and Timeline

Activities for the program evaluation plan will include breastfeeding classes aimed to create a
supportive environment for all expecting mothers. Through these classes, lactation consultants and health
educators will teach mothers the importance of choosing to breastfeed over using the formula to feed their
infants. Courses will include group activities for mothers to engage and learn how to breastfeed. These
classes will help to ensure increased breastfeeding practices by making sure to provide mothers with
qualitative information. See Figure 4 in the Appendix of the general program timeline.
 PROGRAM EVALUATION PLAN

Evaluation is the foundation of any program and is vital for implementing any future application.
Pure Life Support Services aim to address the health disparities in the community and implementing a
breastfeeding education program to promote behavior modifications. The advantage of committing to
Pure Life Support Services Free services that are designed to serve all breastfeeding women by
establishing the three components of Price free assistance to mothers, Quality of Expertise quality and
Array of Services of Lactation knowledge, nutrition counseling and breastfeeding information. We have
constructed the needs vs. wants of our population of low-income women in San Bernardino, CA. The
demands we have formulated the needs of access to breastfeeding support and education, nutrition
education, breastfeeding materials, and knowledge of breastfeeding laws and resources. Secondly, we
have put meticulous order of the wants addressed by the community of implementing our program
outcomes would correspond to healthy babies, healthy mothers, longer California Paid Family Leave
(PFL), and most importantly support and encouragement from fathers and family members, and
additional program for mothers and infants, outside of WIC, specific to San Bernardino County.

Furthermore, we generated inputs of what precisely Pure Life will need to function as well
established breastfeeding support organization. Pure Life Breastfeeding Support Services program
support includes the following: inventory, supplies, and future wish list once the program is installed.
The inventory Pure Life Breastfeeding Support Services will need to execute proper education are breast
pumps, breastfeeding brochures, exam scales, breastfeeding DVDs, breast milk storage bag, breast milk
freezing trays, breastfeeding journals for mothers to track lactation, and breast pump cleaning supplies.
Additional supplies for new mothers will include the following: Bobby prop pillows, Baby/Toddler Scale,
Nursing Pads, Nipple Shields, Breast Shells for Sore Nipples, and Sterilizing wipes for pump parts. Going
forward we will Increase the amount of Breast Pumps to donate/ rent to clients by 10, Increase the amount
of Bobby prop pillows by 10 Pure Life, and we will give 2 Regular Bras, 2 Sleep Bras, two tank tops for
lactating mothers.

Pure Life Breastfeeding Support Services evaluation plan of measuring the breastfeeding
population key factors are the demographic statistics, geographic boundaries, and the relevance of the
health disparity related to both components. Pure Life does not discriminate among any race/ ethnicity,
and all ages are welcome to equality quality breastfeeding education. Our target population is low income
pregnant and breastfeeding women, below the poverty threshold. Our chosen geographic boundary is San
Bernardino County, CA. With that being said, the demographics of age, income, and race/ethnicity play
significant roles when it comes to addressing the health disparities of low birth weights and high infant
mortality rates in San Bernardino County for lower-income women. San Bernardino County has been
reported as 41% higher than the California rate in High Infant Mortality Rates (IMR) Coupled with
21% of the population is living below the federal poverty line within this county.

Our Program Evaluation will include Implementation of Recommended Program Improvement

by conducting summative evaluations through Surveys and biweekly debriefing with staff. Surveys will
be given to participants to help evaluate the effectiveness and attitudes toward the program. Also,
communication with contractors will stay consistent on a monthly basis to assess any concerns. Most
importantly, debriefing with staff and upper management will occur monthly. Program Improvement
ideas will be taken from monthly meetings and will be implemented as needed. The Evaluation
Instruments Pure Life will conduct further assessments throughout the program to collect data and proof
of progress. We will use tools such as growth charts, surveys, support services, and through observation.
Additionally, we will need the proper office equipment for our facility, for example, office supplies,
chairs, printer, fax machine, telephones, breast pumps to rent, and expansion of private rooms for one on
counseling with mothers.

Here at Pure Life, we plan on spreading this knowledge on breastfeeding education program
planning in the public health promotion field to deepen understanding and promote health education to
the general population. It is essential we empower and advocate for health literacy among the community
through our breastfeeding program. We high believe our program will enrich and expand skills of women
in the San Bernardino Community. As a result, by shaping our approaches as a community, it will reduce
negative social determinants of health and prioritize the importance of health promotion.

Outputs- The outputs in this program will evaluate the nutritional knowledge of each mother. The
community will be able to perceive our outreach program as beneficial to combating improper feeding
habits a mother and child may have. The common goal is to reduce the stigma associated with
breastfeeding in mothers who cannot or do not choose to breastfeed by promoting positive health
achievement for mothers and infants.

Outcomes - The Pure Life Breastfeeding Support Services-General Program Plan is determined to
accomplish each goal within the given timeframe provided in the grant. The short-term outcomes are
designed to help mothers manage healthy birthing weight and provide proper cost managing skills for
baby and various supplies. Medium-term outcomes are to encourage a mother to continue breastfeeding to
promote and maintain their new-found lifestyle. The end or long-term outcome of the program is to lower
the risk of infant mortality by introducing a healthy lifestyle among mothers through concrete,
educational, and influential breastfeeding habits.

Pre-post Measures: Through the use of various charts such as a growth chart and pre/post-test, The Pure
Life Breastfeeding Support Services-General Program Plan will evaluate and monitor the effectiveness of
the program on a bi-weekly basis. See Appendix, Figures 5 and 6 for an overview of the general program
plan.
AGENCY CAPACITY

Mission Statement: Founded in 2013, Pure Life’s mission is to a contribution to the community of
underserved mothers by promoting breastfeeding the purest source of life for infants.

Agency Structure/ Organizational capacity

Pure Life Breastfeeding Support Services-General Program Plan is a non-profit community-based

agency, established in 2013 with a common goal of serving low-income mothers and their infants. This
organizational assessment is based on the target population of low-income women located in San
Bernardino County. Pure Life Breastfeeding Support Services-General Program Plan strongly believes
that by reducing social health determinants of low birth weight rates coupled with infant mortality rates in
the San Bernardino County, will improve individual and community health outcomes. Pure Life
Breastfeeding Support Services-General Program Plan is unique and stands out from other organizations
because it is free of charge, provides positive action, and nutritional counseling for optimal breastfeeding
practices. Additionally, Pure Life will provide expertise lactation knowledge, support groups, and
breastfeeding equipment to lessen the financial burden of mothers. To accelerate the education at Pure
Life Breastfeeding Support Services we will provide breast pump rentals, transportation systems, and
educational resources through support groups with other breastfeeding mothers. Our program will
coordinate counseling for fathers and family members by demonstrating lactation support to improve
knowledge and attitudes of breastfeeding among family members. Pure Life Breastfeeding Support
Services will meet the needs and wants of our target population. Once this goal has been reached, Pure
Life Breastfeeding Support Services will plan to work with other organizational leaders and public health
advocates to implement this program throughout the Southern California region.

Board of directors and staff/ organizational capacity

The demographics of the target population will reflect the diverse races/ethnicities and various
levels of the socioeconomic status of the staff. Pure Life Breastfeeding Support Services-General Program
Plan has successfully trained health coaches to implement a dual perspective of education and experience
on breastfeeding practices to tailor methods to mother's cultural beliefs. Pure Life Breastfeeding Support
Services-General Program Plan demonstrates that the key to this program success is the connection
established between the staff and the target audience. Pure Life consists of a Board of Administration
staff members that include the following: Chief Executive Officer (CEO), Chief Financial Officer (CFO),
Chief Operating Officer (COO), Post-Award Grant Manager, and Human Resources Manager. By
measuring and illustrating the impact of the needs and wants of the target population, Pure Life has expert
staff members consisting of: Clinical Staff Members (5), Staff Members (8), and Community Outreach &
Internships (maximum 8). This organization is committed to giving the community a transparent
reflection of the foundation with shared goals to improve breastfeeding education advocacy and reduce
health disparities among low-income women and infants. (See Appendix, Figure 8 for the Breastfeeding
Organizational chart).
 PROGRAM MANAGEMENT

The program management staff of Pure Life Organization will consist of a number of different full time
equivalent (FTE) managerial positions including:

1. Chief Executive Officer (CEO) - John Doe

a. Job Description: Responsible for the overall coordination and supervision of all aspects
of the Breastfeeding-Friendly Project. This will include hiring, supervising staff,
contacting provider offices, and building relationships with future businesses in order to
gain referrals and expand accessibility to all expecting mothers
b. Qualifications: B.S., M.S., M.B.A., CHES, knowledge of local San Bernardino clinics
and supplemental nutrition locations, knowledge of Health Insurance Portability and
Accountability (HIPAA) compliance and the San Bernardino County population, interest
of working with breastfeeding populations, excellent verbal and written communication
skills.
2. Chief Financial Officer (CFO) - Jane Doe
a. Job Description: Responsible for the fiscal year and quarterly expenses of all costs related
to the Breastfeeding-Friendly Project. Oversees signing off all business negotiations with
funding support agencies and departments upon which equipment is purchased
b. Qualifications: B.S., M.S., M.B.A., CHES, knowledge of local San Bernardino clinics
and supplemental nutrition locations, knowledge of Health Insurance Portability and
Accountability (HIPAA) compliance and the San Bernardino County population, interest
of working with breastfeeding populations, excellent verbal and written communication
skills.
3. Chief Operating Officer (COO) - Brian Smith
a. Job Description: Responsible for overlooking all operations related to the Breastfeeding-
Friendly Project, setting timely program evaluations, and assessing the needs and wants
related to the various San Bernardino County low-income communities.
b. Qualifications: B.S., M.P.H., CHES, knowledge of local San Bernardino clinics and
supplemental nutrition locations, knowledge of Health Insurance Portability and
Accountability (HIPAA) compliance and the San Bernardino County population, interest
of working with breastfeeding populations, excellent verbal and written communication
skills.
4. Post Award Grant Manager - Maria Diaz
a. Job Description: Oversees all aspects directly related to the grant proposed to the Women
for Women organization. Manages all aspects of grant-related research and questioning.
Oversees the grant and its effectiveness throughout the duration of the grant’s existence.
b. Qualifications: B.S., M.P.H.., CHES, knowledge of local San Bernardino clinics and
supplemental nutrition locations, knowledge of Health Insurance Portability and
Accountability (HIPAA) compliance and the San Bernardino County population, interest
of working with breastfeeding populations, excellent verbal and written communication
skills.
5. Human Resources Manager - Robert Diaz
a. Job Description: Works alongside the Director of Clinical Services to help manage and
delegate responsibilities among all other personnel. She will work to provide appropriate
schedules for employees as well as oversee the jobs and responsibilities appointed to
volunteer staff and interns.
b. Qualifications: B.S., M.B.A., CHES, knowledge of local San Bernardino clinics and
supplemental nutrition locations, knowledge of Health Insurance Portability and
 Accountability (HIPAA) compliance and the San Bernardino County population, interest
of working with breastfeeding populations, excellent verbal and written communication
skills.

Clinical Staff Management

1. Registered Dietitian Nutritionist (RDN) (2)
a. b.Job Description: Works to develop effective breastfeeding and nutrition related
education materials such as presentations, handouts, demonstrations, etc. They will
oversee the roles of the breastfeeding advocates and community health specialists to
assure that all employees are providing evidence-based nutrition facts to participants.
b. Qualifications: Registered Dietitian Nutritionist (RDN) license, Master’s Degree or 3+
years experience, at least 1 year clinical experience
2. Licensed Clinician Social Worker (1)
a. Job Description: Intervenes at appropriate times upon consult to provide community
resources regarding specific participants who are screened for receiving care under the
social worker.
b. Qualifications: Bachelor of Social Work (BSW) obtained from a school approved by the
the Council on Social Work Education (CSWE), minimum of 2 years experience in social
work
3. Director of Clinical Services (1)
a. Job Description: Oversees all aspects of clinical coordination. He or she will manage the
clinical staff members that are licensed and/or hold clinical certifications in all aspects of
lactation support and breastfeeding knowledge.
b. Qualifications: 2 years experience in clinical services

These managerial positions will work together to hire, train, and supervise supplemental staff including
the Breastfeeding Advocate (1), Positive Action Counselors (2), Social Workers (2), Activity Coordinator
(1), Community Health Specialist (2), and interns (8).
 BUDGET AND BUDGET JUSTIFICATION

Category

1. Salaries Request Leverage

Chief Executive Officer (CEO) -John Doe $110,000/year $10,000+/-

The Chief Executive Officer will be responsible for the overall management/coordination of employee
and patient safety as well as creating a financially stable organization.

Chief Financial Officer (CFO)-Jane Doe $100,000/year $10,000+/-

The Chief Financial Officer position will be responsible for all fiscal and quarterly expenses of all costs
related to the Pure Life Breastfeeding Support Services.

Chief Operating Officer (COO)-Brian Smith $80,000/year $10,000+/-

The Chief Operating Officer, under the supervision of the CEO, will be responsible for overlooking all
clinical and occupational operations related to the Pure Life Breastfeeding Support Services.

PureLife Organization Director-Maria Diaz $65,000/year $5,000+/-

Organization Director position will be responsible in coordinating all personnel meetings and
appointments with stakeholders.

Grant Manager- Brenda Smith $15,000 $5,000+/-

The Grant Manager (GM) position assist the creation of timely and concise proposals to governing
organizations, multilateral organizations and private foundations.

Human Resources Manager - Robert Diaz $45,000 $5,000+/-

The HRM will work to provide appropriate schedules for employees as well as oversee the jobs and
responsibilities appointed to volunteer staff and interns.

Director of Clinical Services $65,000/year $5,000+/-

The Director of Clinical Services will work to oversee all aspects of clinical coordination.

Registered Dietitian Nutritionist (2) $60,000-$70,000/8 months x 2 $5,000+/-

The Registered Dietitian Nutritionists (RDN) will work to develop effective breastfeeding and nutrition-
related education materials such as presentations, handouts, demonstrations, etc.

Social Worker (1) $20,000/6 months $5,000+/-

The social worker will intervene at appropriate times upon consult to provide community resources
regarding specific participants who are screened for receiving care under the social worker.

Breastfeeding Advocate $15,000/9 months $2,000+/-

The Breastfeeding Advocate will coordinate with the RDN to develop and deliver effective breastfeeding
education, as well as serve as an interventionist during the program's support groups.

Positive Action Counselors (2) $40,000/year x 2 $1,000+/-

These individuals will work directly with the support groups to help teach nursing mothers how to
breastfeed properly.

Activity Coordinator (1) $40,000/year $1,000+/-

This person will coordinate all facility meeting times and work within the community for outreach to
gather participants.

Community Health Specialist (2) $30,000/year x 2 $5,000+/-

The community health specialists will work to increase participation as well as help screen which areas of
San Bernardino County need the services.

2. Fringe Benefits

Fringe benefits are calculated at 15 - 30% of salaries, depending on job position. Benefits include: Social
Security, retirement, Medicare, Workers compensation, dental plan, vision contribution, and life
insurance. The overall fringe benefits for this budget is $195,400.

Fringe Benefits Breakdown by salary and position:

Salary

Chief Executive Officer (CEO) -John Doe $110,000/year

Fringe benefit rate: 30% $110,000 x 30% = $33,000

Chief Financial Officer (CFO)-Jane Doe $100,000/year

Fringe benefit rate: 30% $100,000 x 30% = $30,000

Chief Operating Officer (COO)-Brian Smith $80,000/year

Fringe benefit rate: 30% $80,000 x 30% = $24,000

PureLife Organization Director-Maria Diaz $65,000/year

Fringe benefit rate: 30% $65,00 x 30% = $19,500

Grant Manager- Brenda Smith $15,000

Fringe benefit rate: 15% $15,000 x 15% = $2,250

Human Resources Manager - Robert Diaz $45,000

Fringe benefit rate: 28% $45,000 x 28% = $12,600

Director of Clinical Services $65,000/year

Fringe benefit rate: 30% $65,000 x 30% = $19,500

Registered Dietitian Nutritionist (RDN) (2) $60,000-$70,000/8 months x 2

Fringe benefit rate: 28% $60,000 x 28% = $16,800

Social Worker (1) $20,000/6 months

Fringe benefit rate: 20% $20,000 x 20% = $4,000

Breastfeeding Advocate $15,000/9 months

Fringe benefit rate: 23% $15,000 x 23% = $3,450

Positive Action Counselors (2) $40,000/year x 2

Fringe benefit rate: 25% $40,000 x 25% = $10,000

Activity Coordinator (1) $40,000/year

Fringe benefit rate: 25% $40,000 x 25% = $10,000

Community Health Specialist (2) $30,000/year x 2

Fringe benefit rate: 25% $30,000 x 25% = $7,500

3. Consultant Fees $70,000 $0

Lactation Consultant is responsible for identifying and correcting lactation problems.

4. (a) Travel – Local Private Vehicle $6,200 $0

Overall travel costs are expected to be $6,200 for year one of the Breastfeeding-Friendly Project,
and this includes travel to professional conferences and all locations within San Bernardino County where
program intervention will take place.

5. Consumable Supplies and Materials Request Match

General Office Supplies $2,000 $0

Include presentation equipment, desk equipment, and data storage equipment.

6. Services $53,000 $46,500

Communications $10,000 $6,000

The types of communicators between staff will be telephones, emails, and laptops.

Printing Services $10,000 $7,000

This may include printing archival documents, educational materials, announcements, mailouts, internet,
software downloads, paper and cartridge ink.

Postage $5,000 $4,500

The conveyance of a letter sent by mail, with the usage of stamps and packages.

Facilities Cost $25,000 $23,000

The cost associated with providing/maintaining infrastructure supporting capital movements.

Staff Training $7,000 $6,000

Employee training, which helps develop employee learning and is a tool to improve performance skills in
their current roles.

Request Match
7. Other Costs

Equipment $9,000 $0

Funds are requested to purchase fifteen fully-equipped computers ($9,000) with appropriate software.
This will help to run software and storage of all aspects regarding the Breastfeeding-Friendly Project.

8. Indirect

External/Internal Administrative Costs $100,000 $0

The total estimated cost for administrative and technical departmental support is estimated at $100,000
for expenses such as managing the main facility, supporting payroll services, and handling administrative
support. These services include work provided by the Human Resources Manager and supportive staff.
The methodology used to account for indirect costs were determined by accounting for 10% of the overall
budget allocated for the Pure Life Organization.
 COMMUNITY SUPPORT

With growing interest in the community, the Pure Life Breastfeeding Support Services-General
Program Plan looks forward to working with community leaders and other charitable organizations to
provide educational services to breastfeeding mothers. Programs such as Soul Food for Your Baby, where
mothers can participate in classes and support groups which will be open to Pure Life Organization staff
and participants. The Pure Life Breastfeeding Support Services-General Program Plan also works closely
with existing organizations by creating monthly discussion tables and conduct healthy breastfeeding
workshops at local community centers, WIC and provider offices to fulfill the specific needs of the
mothers. The size of the county and geographical location will cause barriers in reaching out to every
breastfeeding mother, which is why the local community hospitals in the county have graciously provided
the Pure Life Breastfeeding Support Services-General Program Plan with a census list. By working with
existing organizations will help to establish a standard baseline where the services provided by the
organization can be used to its full potential. The Pure Life Breastfeeding Support Services-General
Program Plan looks forward to working closely with the community and partners by providing
educational and ethical practices to eliminate any breastfeeding disparity that may exist in the San
Bernardino County.
 References

Alexandra, Ashley. Dowling, Donna. Furman, Lydia. What Do Pregnant Low-income Women Say About
Breastfeeding? Retrieved February, 2010, from

https://www.liebertpub.com/doi/abs/10.1089/bfm.2009.0034

California WIC Association and UC Davis Human Lactation Center. (2015). Using Data to Drive
Change: California Continues to Increase In-hospital Exclusive Breastfeeding Rates: San Bernardino
County: 2015 Data.

Chapman, D.J., Damio, G., and Young, S. (2004). Effectiveness of Breastfeeding Peer Counseling in a
Low-Income, Predominantly Latina Population. Arch Pediatr Adolesc Med.158 (9) 897-902.
doi:10.1001/archpedi.158.9.897

Community Commons. (n.d.). Community Health Needs Assessment (CHNA) Report.

Data Access and Dissemination Systems (DADS). (2010, October 05). United States Census Fact Finder.
Retrieved March 2018, from
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF

MotHERS Program. “The Difference between breast milk and formula.” The MotHERS Program. 2018.
www.themotherspgroam.ca/after-delivery/formula-what-you-neet-to-know/breastmilk-and-formula-
differences.

Pugh, L. C., Serwint, J. R., Frick, K. D., Nanda, J. P., Sharps, P. W., Spatz, D. L., & Milligan, R. A.
(2010). A Randomized Controlled Community-Based Trial to Improve Breastfeeding Rates Among
Urban Low-Income Mothers. Academic Pediatrics,10(1), 14-20. doi:10.1016/j.acap.2009.07.005

Smith, P.H., Coley, S.L, Labbok, M.h, and Nwokah, E. (2012). Early breastfeeding experiences of
adolescent mothers: a qualitative prospective study. Int Breastfeed J. 7:13. doi:10.1186/1746-4358-7-13.

Tenfelde, S. M., Finnegan, L., Miller, A. M., & Hill, P. D. (2012). Risk of Breastfeeding Cessation
Among Low-Income Women, Infants, and Children. Nursing Research,61(2), 86-95.
doi:10.1097/nnr.0b013e3182456b0a
Weimer, John P. The Economic Benefits of Breastfeeding: A Review and Analysis. Retrieved March,
2001, from

https://permanent.access.gpo.gov/websites/www.ers.usda.gov/media/329098/fanrr13_1_.pdf

Breastfeeding. (n.d.). Retrieved March 22, 2018, from

http://www.who.int/topics/breastfeeding/en/

Whaley, S. E., Koleilat, M., Whaley, M., Gomez, J., Meehan, K., & Saluja, K. (2012). Impact of Policy
Changes on Infant Feeding Decisions Among Low-Income Women Participating in the Special
Supplemental Nutrition Program for Women, Infants, and Children. American Journal of Public
Health,102(12), 2269-2273. doi:10.2105/ajph.2012.300770
Appendix

assessment.communitycommons.org

assessment.communitycommons.org

assessment.communitycommons.org
assessment.communitycommons.org

assessment.communitycommons.org

assessment.communitycommons.org
Figure 2. Pre-test survey
Figure 3. Post-test survey
Figure 4. Pure Life Breastfeeding Support Services-General Program Timeline
Figure 5. Annual Program Evaluation SWOT Analysis

Strengths Weaknesses Opportunities Threats

· Staff · Lack of reputation ·Create a socially · Negative social

members are and presence in the acceptable stigmas that
highly qualified community since environment threaten and
and trained this is the first time where intimidate mothers,
professionals in Pure Life is breastfeeding preventing them
the field of engaging in this type practices are from wanting to
lactation and of project. welcomed and continue to
breastfeeding encouraged. breastfeed
promotion.

· Financials-
funding provides · Create a positive · Market demand
· Use of only a maximum public health for breastfeeding
innovative amount of dollars influence in San pump rentals
aspects that allocated to rentals, Bernardino county
include up-to date meaning not all and become
educational mothers will be able widespread
resources such as to qualify for throughout ·Loss of financial
presentations and breastfeeding Southern support and
videos. pumps. California regions. resources that can
be used towards
Pure Life
Organization
· Access to · Lack of behavior
county resources change of mothers
to help expecting who do not feel that
mothers engage they are learning
in other and/or benefiting
opportunities that from Pure Life’s
may aid their efforts to promote
personal life. breastfeeding
practices

· Provision of
easy
transportation to
mothers

who do not have

transportation
access.

· Free of
charge services
and rentals of
breastfeeding
equipment.
Figure 6. Program Evaluation Plan
Figure 7. Growth Chart
Figure. 8 Pure Life Breastfeeding Support Services Nonprofit Organizational Chart
Figure. 9 WHO Infographic on Breastfeeding
25 January 2018

5500 University Pkwy

San Bernardino, CA 92407

Attn: To Whom It May Concern

Re: Breastfeeding-Friendly Project Letter of Intent

Dear: Megan Smith,

The Pure Life Organization would like to express its interest in the forthcoming allocations from the
Breastfeeding-Friendly Project for the funding, education, and outreach in a breastfeeding support
program for low-income women within the county of San Bernardino. This letter is to inform the grantor
of our intention to submit the Breastfeeding-Friendly Project to the WomenforWomen Organization. The
Pure Life Organization has more than five years in providing services to the low-income residents of San
Bernardino County. Currently the Pure Life Organization administers several grant funded programs
including Soulfood for Your Baby, Loving Support, and Women, Infants, and Children.

As you are aware, the California Department of Public Health has identified San Bernardino County with
a diverse demographic and economic population comprising of Hispanics (52%) of the population,
Whites (30%), Blacks (8%), and Asians (7%), respectively. It has also identified 21% of its population to
be living below the federal poverty line. The infant mortality rate in San Bernardino County has been
reported as 41% higher than the California rate in 2012-2014. The Maternal Child and Adolescent Health
has only identified two existing programs in the County, Healthy Babies are Worth the Wait, and
Community Vital Signs, both which do not focus on breastfeeding education and support. As a nonprofit
organization, we recognized our responsibility in maintaining and improving the breastfeeding rates
among low-income women of San Bernardino County. The focus of this program is to achieve health
equity through breastfeeding, while empowering women of low-income status to breastfeed their infants
for at least six months from birth to one year of age. This program focuses on providing social support to
strengthen the culture of breastfeeding, providing equipment support for working mothers, and increasing
education regarding the nutritious benefits achieved through breastfeeding.
The Pure Life Organization will be responsible for administering the day-to-day fiscal and administrative
oversight and accountability of the WomenforWomen Organization for the Breastfeeding-Friendly
Project. The first year of funding is reported as $500,000 with an on-going annual funding of $1,000,000.
Upon submission, The Pure Life Organization will provide detailed information for review and evaluation
by the first date of submission acceptance, March 22, 2018, or within the noted time frame for
submission. We are currently interested in providing these the Breastfeeding-Friendly Project services
and would like to be kept notified of any modifications or updates related to this funding opportunity.

Respectfully,

Maria Diaz

PureLife Organization Director

PureLife Organization
March 1, 2018

Maria Diaz, CEO, Program Director

Pure Life Organization
12345 Coyote Ave
San Bernardino, CA 91739

Dear Mrs. Diaz,

I write on behalf of the San Bernardino County Women, Infants, & Children (WIC) branch in
support of the Pure Life Organization proposal to the Breastfeeding–Friendly Project to reduce
health disparities for low-income pregnant and breastfeeding women in the San Bernardino
County. We strongly support this grant application and the focus of reducing infant mortality and
lowering breastfeeding disparities among this population.

As an organization which also aims to reduce infant mortality and promote breastfeeding, we are
excited to partner with Pure Life Organization in order to reach a wider population. WIC has
many satellite locations in the San Bernardino County which will also be used to host additional
educational events from Pure Life Breastfeeding Support Services. Our health educators,
lactation consultants, and Registered Dietitian Nutritionists will be able to offer training to new
staff. Supplemental supplies and materials will be donated. We recognize our responsibilities in
helping Pure Life Organization thrive.

We look forward to working with you and with others involved in the program.

Sincerely,

Lauren Sanchez
Program Director
San Bernardino County
Women, Infants, & Children (WIC)
February 25, 2018

Maria Diaz, CEO, Program Director

Pure Life Organization
12345 Coyote Ave
San Bernardino, CA 91739

Dear Mrs. Diaz,

Soul Food for Your Baby is happy to support the Pure Life Organization proposal to the
Breastfeeding-Friendly Project in hopes of reducing health disparities for low-income pregnant
and breastfeeding women in the San Bernardino County. We strongly support this grant
application and are excited to collaborate in reducing infant mortality and increasing
breastfeeding awareness in the county.

Soul Food for Your Baby is an organization that addresses breastfeeding concerns that impact
African American families, and we recognize that this population overlaps with the target
population of the grant proposal. Our organization holds nursing meetups, sessions for dads,
home visitation, and offers classes and support groups which will be open to Pure Life
Organization staff and participants.

We look forward to collaborating with you and with the others involved in the program.

Sincerely,

Patricia Jackson
Program Director
Soul Food For Your Baby