Karen,

We are trying a case management model for lactation too.  We have 2
lactation specialists.

One is funded through healthy start.  She sees all the women in our
clinic and provides assistance antepartally, postpartally and during
convalescence.  She will also see the same moms and infants at the
follow up visit.  The refinement of her role began earlier this year.
 She used to be the Antepartum consultant.  We are tracking
satisfaction, duration of breastfeeding in relation to planned
duration of breastfeeding, complications, discontinuance within one
month, and percentage of breastfeeding moms.

The second is funded by the institution.  She sees all other moms and
the NICU moms.  We are tracking the same outcomes here.

This is the plan as we have designed it.  It is, like most plans,
imperfectly implemented, but we find it to be an improvement over our
past geographic case assignments.

In regards to pathways.  We have had our three perinatal paths up for
about 18 months.  They are performing well.  The lactation specialist
is a part of each path.  She does not have her own path.  This is, I
am convinced, the most effective approach to paths.  However, if there
are no paths in place and you are to case manage, you are at
significant disadvantage.  I would recommend you test the waters to
see if the institution would support establishing real
transdisciplinary paths.  You would find the communication, documentation,
outcomes, evaluation and continuity of your efforts to be supported
 and more effective if your work were integrated in a
transdisciplinary path.  Moreover, you would be likely to see
positive effects from your efforts in areas you might not otherwise
measure or notice.

oops. end of sermon.  hope you find some of this helpful.

Mary
from Baltimore...the land of snow and plowed in cars