Breastfeeding: Heritage and Pride™ (BHP)

5

Manuscripts

Released in 2003 through 2023

2

Manuscripts

Impact studies rated high or moderate quality

Services intended at ages
Prenatal
0-6 months
07-11 months
Favorable results from well-defined research
Child health
Linkages and referrals
Maternal health

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Effectiveness

Does not meet criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

5

Manuscripts

Released in 2003 through 2023

2

Manuscripts

Eligible for review

2

Manuscripts

Impact studies rated high or moderate quality

Note: When an individual manuscript reports findings from multiple studies, HomVEE reviews each study as a distinct manuscript. In these rare instances, HomVEE counts that manuscript multiple times in this table, once for each study identified, screened, and reviewed by HomVEE.

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Outcomes Manuscripts Favorable Findings No Effects Findings Unfavorable Findings
Child development and school readiness Not measured - - -
Child health View 2 Manuscripts 12 6 0
Family economic self-sufficiency Not measured - - -
Linkages and referrals Not measured - - -
Maternal health View 1 Manuscript 0 0 1
Positive parenting practices Not measured - - -
Reductions in child maltreatment Not measured - - -
Reductions in juvenile delinquency, family violence, and crime Not measured - - -

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics:

Race/Ethnicity

Black or African American
13.05%
Hispanic or Latino
76.40%
White
5.35%
Some other race
5.75%

Maternal Education

Less than a high school diploma
35.00%
High school diploma or GED
33.00%
Unknown
32.00%

Well-designed impact studies about this model were conducted in the following locations:

  • Northeast
  • Connecticut
Enrollment in means-tested programs
80.16%

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

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Support Availability

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Service Delivery

Model services, adaptions and enhancements, model intensity and length.

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Requirements

Staffing and organizational requirements.

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Overview

Theoretical approach

Breastfeeding: Heritage and PrideTM (BHP) is a person-centered, peer-support counseling program that primarily serves nonwhite families with low incomes. Peer counselors are people who have successfully breastfed and been trained to support others in their communities to breastfeed.

The BHP offers breastfeeding support during the prenatal, perinatal, and postpartum periods. Peer counselors provide breastfeeding education and support with breastfeeding in clinics, hospitals, and families’ homes as well as through video calls, phone calls, and text messages. The same peer counselor works with the same family throughout the program, allowing them to develop a trusting relationship with their counselor and ensuring continuity of services across settings.

The Hispanic Health Council, a statewide community-based organization in Connecticut, established the BHP in 1993 because breastfeeding support was lacking in the Latinx community at that time. Professional support from International Board-Certified Lactation Consultants (IBCLCs) was available but often unaffordable for populations with low incomes.

The Hispanic Health Council initially developed BHP to address the cultural-contextual influences on breastfeeding among the Latinx community. However, these influences are relevant to other nonwhite and socially disadvantaged populations; thus, today the BHP serves families across racial and ethnic groups.

Intended population

The BHP serves people giving birth at partnering health care organizations in urban and suburban areas in Connecticut and Massachusetts. These partner organizations predominately serve nonwhite families with low incomes.

Targeted outcomes

The BHP aims to increase breastfeeding initiation, duration, and exclusivity.

Highlights

Populations Intended
Families with low-income
Services intended at ages
Prenatal
0-6 months
07-11 months

Support Availability

Implementation support availability

The BHP is a collaborative effort between the Hispanic Health Council, Trinity Health of New England Hospitals, Hartford Hospital, and the University of Connecticut’s Family Nutrition Program. 

An integral component of the model is the monitoring and evaluation system, which facilitates continuous improvement of services. The BHP collaborative holds biannual quality improvement conferences with BHP program leaders and managers, BHP IBCLCs, peer counselors, and health care staff and providers from Trinity Health of New England hospitals. The collaborative conducts analyses on program impacts and uses the results to guide discussions about how the BHP is being implemented, to detect bottlenecks, and to identify ways to improve program delivery to ensure high-quality breastfeeding support for all families. 

Please contact the model developer for information about ongoing technical assistance.

Highlights

Locations where model has been implemented
Within the U.S.

Service Delivery

Model services

The BHP offers the following services to promote and support breastfeeding: 

  • In-person prenatal education, including information on what to expect and strategies to help prevent challenges to families’ breastfeeding goals 
  • In-person perinatal hospital visit 
  • In-person postpartum home visits to provide support for resolving breastfeeding challenges
  • Support to families via video and phone calls, emails, and text messages
  • Hospital-grade pump rental program for special needs babies and medically critical mothers 
  • Assistance to obtain a breast pump through health insurance or other available resources 

The BHP provides services based on families’ needs and preferences. Some families opt to not receive all postpartum home visits—for example, if they are breastfeeding successfully and do not need further support. Some families also choose to stop breastfeeding and discontinue the visits. Families that need extra support with breastfeeding receive additional in-person visits and phone calls, as needed. 

The BHP Peer Counselor/IBCLC Role Delineation tool outlines the distinction between peer counselor and IBCLC scopes of services and provides a protocol for peer counselors on when to consult with or refer a family to a BHP IBCLC. If an issue arises that is outside of a peer counselor’s scope of service, they will refer the family to the BHP IBCLC for support. 

The BHP uses a protocol that specifies important topics to cover during each visit as well as the number and timing of visits. The protocol also covers how to connect families with other social and health services to address social determinants of health that may impede breastfeeding or negatively impact families’ health and well-being.

Model intensity and length

Breastfeeding peer counseling begins during pregnancy and continues in the postpartum period for up to one year. Visits last approximately 30 to 60 minutes. Families are offered at least three prenatal visits, one of which must be an in-person home visit; one perinatal visit in the hospital immediately after childbirth; and five in-person postpartum home visits that are supplemented by seven video or phone calls.

Adaptations and enhancements

Please contact the model developer for information about adaptations and enhancements made to the model.

Highlights

Language that the program is available in
Spanish
Maximum program duration
More than six months up to one year
Visit frequency
Visit frequency varies
Delivery Method Supported
Supports hybrid in-person and virtual service delivery

Requirements

Staffing requirements

Peer counselors provide BHP services under the guidance of BHP IBCLCs.

The Hispanic Health Council hires and trains peer counselors from the communities that the BHP serves. Peer counselors have previously breastfed successfully for at least six months. They are not required to have a formal education or past work experience but are screened to confirm they can meet the requirements of the job, use a data management system for monitoring and evaluation, and learn and share information with families using a strengths-based approach and a posture of cultural humility. Please contact the model developer for information about the minimum experience and education requirements for IBCLC supervisors.

BHP IBCLC supervisors provide peer counselors with ongoing clinical guidance in delivering high-quality breastfeeding counseling to families. Please contact the model developer for information about the supervision and support that is offered to supervisors.

Peer counselors participate in 40 hours of classroom training on the evidence-informed training manual developed by the Hispanic Health Council. The training is designed to equip the peer counselors with lactation management and communication skills and the ability to work effectively as part of a clinical team within health care facilities. New peer counselors also shadow experienced peer counselors and the program’s IBCLC supervisor to gain practice-based experience providing breastfeeding education and support as well as exposure to all BHP services. Please contact the model developer for additional information about the pre-service training requirement for peer counselors. 

The IBCLC supervisors conduct monthly training sessions for all peer counselors. Peer counselors also attend conferences and other relevant meetings as part of continuing education efforts. In addition, the Hispanic Health Council provides peer counselors the opportunity to earn a Certified Lactation Counselor certification and an IBCLC certification. Please contact the model developer for additional information about ongoing professional development requirements for peer counselors.

Please contact the model developer for information about pre-service and ongoing professional development requirements for IBCLC supervisors.

Organizational requirements

Prenatal clinics and hospitals operated by or affiliated with the partnering health care organizations implement the BHP. Peer counselors are integrated into these facilities to provide families with the continuity of having the same peer counselor across time (prenatal to postpartum periods) and setting (clinic or hospital and home). This integration also facilitates enrollment of BHP families during the prenatal period. 

Please contact the model developer for information about ongoing fidelity guidelines.

Highlights

Minimum education requirement
High school diploma or GED

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.