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Pre-Application Assessment: NCBC Family Friendly Clinic Award --updated July 2023

Pre-Application Assessment Purpose

Pre-Application Assessment for the North Carolina Breastfeeding Coalition's (NCBC)  Family Friendly Clinic Award for Outpatient Healthcare Clinics


The purpose of this Pre-Application Assessment is twofold:
  • to collect baseline data (at a state and clinic/local level) of interested/potentially applying outpatient healthcare clinics in NC on their current use of evidence-based, high quality breastfeeding, chestfeeding and human milk feeding support practices for pregnant and/or postpartum people, infants, children and their families.
  • to assist clinic/local level staff who plan to eventually apply for the North Carolina Breastfeeding Coalition Family Friendly Clinic Award for Outpatient Healthcare Clinics by identifying which award criteria their clinic currently meets and more importantly identifying the criteria they don't meet so that an action plan can be developed.
The questions in this Pre-Application Assessment are taken directly from the Application Instructions and Criteria for Successful Awarding for the North Carolina Breastfeeding Coalition Family Friendly Clinic Award (which was updated in June 2023) and can be found at https://www.ncbfc.org/family-friendly-clinics.  Please note that in the past this award was titled the NCBC Mother Baby Breastfeeding Friendly Award for outpatient health care clinics.  

Data entered into this Pre-application are to be used locally by you and your organization to document baseline and process indicators and to assist with developing and implementing an action plan to address needs identified through the Award application review.
Essentially after completing this Pre-Application assessment you will know how ready (or not) your organization is to apply for the Award from NCBC and what areas (based on the award criteria) you and your clinic will need to work on before actually completing the online award.

While you are filling out this assessment, if you need to pause your progress, and finish at another time, you will have the option to request a save and continue link emailed to you.  The emailed link will allow you to pick up where you left off.
Once you click the "Submit" button on the last page of this Pre-Application Assessment, you will receive an emailed PDF confirmation of your responses from this online form.  Please use this PDF report for your own use.  You will be able to save it electronically and/or print a PDF hard-copy version of your responses.

Data entered into this Pre-Application Assessment will be used by the NC Division of Child & Family Well-Being and the NC Division of Public Health to potentially identify and address technical assistance, training and/or resource needs of interested/applying organizations. If you have questions about this Pre-Application Assessment please email Diane Beth (Diane.Beth2@dhhs.nc.gov).

For more information on the award, please contact the NCBC committee leadership listed under the "What if I need more information?" tab on the North Carolina Breastfeeding Coalition Family Friendly Clinic Award site: https://www.ncbfc.org/family-friendly-clinics  and/or send an email to ncbc.clinicaward@gmail.com.

North Carolina Breastfeeding Coalition Family Friendly Clinic Award applications can be submitted at any time and are reviewed on a rolling basis.  Applicants who do not yet qualify for the award will receive a follow-up email or phone call from NCBC to discuss needed improvements for future success.


To download a PDF worksheet to see all the questions to help you prepare your answers, please click here
Please note that only electronic submissions using this online form for this pre-assessment will be accepted.
(Mailed or faxed versions of your answers will not be accepted.)


 
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