Breastfeeding: Heritage and Pride™ (BHP)

Breastfeeding: Heritage and Pride™ (BHP) provides peer counseling to support breastfeeding among pregnant and postpartum nonwhite families with low incomes. The model begins during the prenatal period and continues for up to one year during the postpartum period. The BHP aims to increase breastfeeding initiation, duration, and exclusivity. Peer counselors provide breastfeeding education and in-person support through home- and clinic-based visits that last about 30 to 60 minutes. Families are offered at least three prenatal visits, one of which is an in-person home visit; one in-hospital visit; and five postpartum in-person home visits that are supplemented with seven video or phone calls. During visits, peer counselors answer families’ questions, help resolve their breastfeeding challenges, and connect them with social and health services as needed.

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Breastfeeding: Heritage and Pride^TM (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.

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.

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.

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

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.

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.

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

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.

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.

Hispanic Health Council  
Phone: (860) 527-0856  
Email: info@hispanichealthcouncil.org  
Website: https://hispanichealthcouncil.org/programs-services/maternal-and-child-health-center/