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Keystone 10 Step Completion Application Process

Congratulations! Your birthing facility is embarking on an exciting initiative to adopt and implement evidence-based maternity care practices that support breastfeeding.  As you are well aware, promoting, supporting, and protecting breastfeeding is the single most important way to improve infant health outcomes.  Mothers, infants, families, and communities will benefit from your hard work and dedication. The Pennsylvania Department of Health (Department) is committed to supporting the work you do.
The Department has developed the Keystone 10 Initiative as a means to assist Pennsylvania’s birthing facilities in adopting and implementing evidence-based maternity care practices with the goal of improving individual facility and state level breastfeeding care and rates, and ultimately improving the health of mothers and babies.  Facilities will focus on breastfeeding initiation, exclusive breastfeeding, skin-to-skin contact, and rooming-in, among other elements.  Keystone 10 is based on similar initiatives in other states that have shown success in assisting birthing facilities in the promotion of breastfeeding.  By working together, birthing facilities can improve the initiation, duration, and exclusivity rates of breastfeeding across the Commonwealth of Pennsylvania.
As your facility works toward Keystone 10 recognition/certification, you have the opportunity to apply for completion of each of the 10 steps. Facilities should submit each step’s application when they are confident there are step-specific policies and procedures in place to meet the guidelines for completion. The Department will using a rolling application and your facility can apply for one or more steps at the same time. Steps do not have to be completed in sequential order.


The applications for step completion are found on the right side of this page.
There are two versions of each step application. One version is suitable for electronic completion and the other for printing and filling out non-electronically. Applications for completion of each of the ten steps consist of:

  • A background narrative providing:
    • a brief overview of the step;
    • highlights of helpful toolkit pages and documents; and
    • minimum requirements to qualify for step completion.

  • A form with:
    • an area for identifying the facility and the person completing the application; and
    • a questionnaire for the facility to provide evidence of having met the completion guidelines for each step (please note that any narrative responses should be concise, yet brief).   

Any birthing facility designated as Baby-Friendly® by Baby-Friendly USA® can receive recognition through the Keystone 10 initiative by completing and submitting the expedited application along with appropriate documentation.

File Submission

If facilities are electronically submitting their applications, the files should be named according to the following file naming conventions. These guidelines should be followed to ensure facilities receive credit for their progress:
Example: BestHospitalStep1123115.doc
(Note: If the facility has multiple locations with the same name, please identify the location within the filename – GreatHospitalPhilaStep1123115, GreatHospitalHbgStep5123115)
When supplemental materials are submitted, please name those files according to the application question number: 1.2c, 7.3, etc.
Example: BestHospitalStep1.2c123115

An email account has been established to receive completed applications:

If email submission is not an option for your facility, paper applications can be faxed or mailed to:
Joe Wagner
Pennsylvania Breastfeeding Awareness and Support Program
Pennsylvania Department of Health
Bureau of Family Health
Health and Welfare Building
7th Floor, East Wing
625 Forster St.
Harrisburg, PA  17120-0701
Fax: 717-772-0323

Step Completion

As each application for step completion is approved or returned for further action, the person who completed the application will be notified by the Department via the application contact information. All Keystone 10 facilities will have their step completion approvals noted on the Department’s website.​