EPIC BEST: Educating Practices in their Communities: Breastfeeding Education Support and Training Infant/Toddler Scale Grant Program The Pennsylvania Chapter of the American Academy of Pediatrics (PA-AAP) joins the Pennsylvania Department of Health to provide a grant opportunity for selected practices to receive a Tanita, BD_815U Infant/Toddler Scale.* This Program is designed to assist in the ongoing efforts to increase breastfeeding throughout the Commonwealth. Utilizing a scale in a practice can be an important tool in supporting breastfeeding mothers and infants, especially when results are taken in the context of the patient’s history, examination of the mother and infant, and first hand observation of breastfeeding. Consider the following: Accurate infant weights can reassure mothers to alleviate concerns that their breastfeeding infants are not gaining enough weight or that they are not producing enough breast milk for adequate weight gain; Pre and post breastfeeding weights assess how much milk the baby consumes to determine the need for additional breastfeeding support; Pre and post breastfeeding weights can help determine how much additional breast milk needs to be fed to preterm babies or babies with compromised feeding abilities until they are strong enough to take in enough breast milk on their own. For a preterm baby a weight check two times a week can be helpful when transitioning to full breastfeeding. Practices interested in applying to receive one of the thirty scales available should complete this form and return it to the PA-AAP by Monday, December 10, 2012. Applicants will be notified by January 31, 2013 if they were selected to receive the scale or not. Only one application per practice site will be reviewed and considered for funding. The application should be no more than one page (two sided), double spaced with a twelve (12) point font. Geographic location of the practice will be considered as we need to distribute the scales in all regions of the state. To the extent possible, fifteen (15) scales will be distributed to practices that are located in a county with a breastfeeding initiation rate below the state average initiation rate of 70%: Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Clearfield, Clinton, Columbia, Elk, Erie, Fayette, Greene, Jefferson, Lackawanna, Lawrence, Luzerne, McKean, Mercer, Mifflin, Monroe, Northumberland, Philadelphia, Pike, Schuylkill, Susquehanna, Venango, Washington, Warren, Wayne, Westmoreland, Wyoming. *The Tanita scale has a “One gram increment resolution feature up to 12 pounds then 2 grams up to 33 pounds. Tanita's technology guarantees incredible sensitivity for your smallest patients. The BD-815U baby scale is specifically designed to weigh premature infants and babies who are having difficulty gaining weight.” Application due Monday, December 10, 2012 Return this application to dschell@paaap.org or fax to 484-446-3255. If you have questions please call Dottie Schell at 888-523-6122 (PA only). Infant/Toddler Scale Grant Program Name of practice: ______________________________________________________________________ Complete address (include county): ________________________________________________________ _____________________________________________________________________________________ Phone number: _________________________________________________________ Contact Person: __________________________________________________________ Email address for Contact: __________________________________________________ Names of the doctors and PNPs (include on separate sheet):_______________________ Approximately, how many infants does your practice see in a typical year? _________ Approximately, what percent are breastfeeding at first visit? _________ Approximately, what percent are still breastfeeding at 2 months? _________ Approximately what percent of the infants you see are born at less than 37 weeks gestation? _________ Does your practice utilize a digital infant scale, accurate to 2 grams for babies under 33 pounds? Y N Does your practice accept Medical Assistance patients? Y N On a separate sheet of paper please answer the following questions: 1. Explain why your practice needs this scale. 2. What activities or procedures related to breastfeeding will be established or changed in your practice as a result of having this scale? 3. What do you anticipate will be the long-term clinical results of utilizing this scale at your practice? Applications will be reviewed and scored according the following criteria: 1. Demonstration of need 2. Soundness of approach 3. Relationship of activities/procedures to breastfeeding support 4. Sustainability of clinical change 5. Practice located in county with low breastfeeding initiation rates 5 points 5 points 5 points 5 points 1 bonus point Total: 21 points If selected to receive a scale, a practice agrees to: 1. Hold a PA-AAP EPIC BEST presentation at your practice site for all staff. EPIC-BEST is a free, onsite, 60 to 90 minute Continuing Medical Education (CME) presentation on practice-based breastfeeding support. (If you received a BEST training in the past, you do not need additional training.) 2. Describe how the scale has supported your clinical care (1 page), due six months after receiving a scale. 3. Optional: Send a photo (electronic or print) of the scale in use in your office that can be shared. Please obtain permission from anyone in the photo for use by the PA Dept of Health or the PA AAP. (We will supply the permission form.) Application due Monday, December 10, 2012 Return this application to dschell@paaap.org or fax to 484-446-3255. If you have questions please call Dottie Schell at 888-523-6122 (PA only).