Carolina Child Care Ten Steps: Creating breastfeeding-supportive child care

Background: National guidance for child care settings includes increased support for breastfeeding in light of national initiatives, such as the Surgeon General's Call to Action to Support Breastfeeding and the First Lady's efforts to combat obesity. The Carolina Ten Step approach, including parent- and provider-friendly materials, and an innovative provider training, was developed to address this need. Methods: A quasi-experimental design was used, with baseline and follow-up data collected for intervention and control (i.e., delayed intervention) groups. Centers were assigned to early or late intervention using randomized systematic assignment. Groups were allocated to one of 8 groups by size, number of subsidized clients, and star rating for quality. Each center within each subgroup was randomly assigned to early or late intervention. The survey of providers included knowledge, attitudes and practice questions, and the survey of center directors included exploration of progress against ten practices, or Ten Steps. Data were entered on Epi-Info and downloaded to Stata for descriptive and two group comparative analyses. Findings: Preliminary findings show no significant changes in the control group. Significant improvement, however, was seen in the intervention group on 9 of 10 steps in preliminary analyses. Full dataset analyses will be presented. Conclusion: The Carolina Ten Step Approach depends on user-friendly job-aids, and overcoming negative attitudes through a stepwise process. Findings indicate that scaling up this approach is warranted.