Perinatal/Infant Health Annual Summary (Maternal and Infant Health Bureau)
The narrative below describes the rationale for why Mississippi selected certain measures and provides detailed narrative to link the selected NPM’s, SPM’s with Mississippi’s identified state priorities.
Priority:
- Decrease Infant Mortality
NPM 5: Percent of infants placed to sleep on their backs
Program Purpose and Summary
Infant mortality is defined as the death of a baby before his or her first birthday and is considered an important indicator of the overall quality of health and healthcare of a population. Infant mortality is closely related to important social determinants of health such as poverty, education and race. Mississippi has persistently had one of the highest infant mortality rates in the nation with nearly nine infant deaths for every 1,000 that are born. In Mississippi, the infant mortality rate was 8.72 in 2017. Racial disparities in infant mortality are significant with the black infant mortality rate at 11.9 deaths per 1,000 live births compared to the white rate of 6.2 deaths per 1,000 live births. The leading causes of infant deaths are particularly related to unsafe sleeping practices (Mississippi Infant Mortality Report 2018).
In 2017, the black infant mortality rate increased from 11.4 deaths per 1,000 live births to 11.9 and the white infant mortality rate declined from 6.7 to 6.2 deaths per 1,000. In the United States, the black infant mortality rate is 11.7 deaths per 1,000 live births and the white infant mortality rate is 4.8 deaths per 1,000 live births. Racial differences in the infant mortality are strongly influenced by the differences in preterm birth rates between black and white infants, with 16% of black babies being born before 37 weeks compared to 11.3% of white infants. Multiple social and medical factors drive these differences including poverty, education, access to medical care and maternal mental and physical health (Mississippi Infant Mortality Report 2018).
Sudden Unexpected Infant Death (SUID) describes the death of an infant where the cause is not immediately apparent before investigation. These deaths often occur while an infant is sleeping or in a sleep area. Most SUID cases in Mississippi are in unsafe sleep environments causing suffocation, strangulation and overlay accidents. Sudden Infant Death Syndrome (SIDS) is a form of SUID where no cause is identified, but is impacted by how babies are put to sleep. SUID is the leading cause of death for infants between 1 and 4 months of age (Mississippi Infant Mortality Report 2018).
The Maternal and Infant Health Bureau is providing safe sleep education through multiple venues including faith-based organizations, childcare facilities, medical offices and community centers and organizations. We understand there is no single intervention or single entity that can prevent all sleep related infant deaths alone. We utilize the multi-pronged approach and inclusion of a variety of stakeholders to aid in the success of the program. To learn more about safe sleep, please visit the website www.safesleepms.org
The Maternal and Infant Health Bureau houses MCH programs that seek to help improve the health outcomes of women and infants residing in the state of Mississippi.
Programs and initiatives include:
Mississippi Perinatal Quality Collaborative (MSPQC)
The Mississippi Perinatal Quality Collaborative (MSPQC) is a statewide partnership that promotes evidence-based quality improvement initiatives at the hospital and community level to improve birth outcomes across Mississippi. MSPQC relies on collaborative data-driven projects to address specific drivers of maternal and neonatal morbidity and mortality. These projects are selected by participating members across the state, who work to develop, disseminate and successfully implement best practices in all clinical settings caring for mothers and infants. While working collaboratively, the MSPQC has three divisions: Neonatal, Obstetric and Family Public Health. The MSPQC was launched in November of 2014.
Child Death Review (Legisaltive Mandated Panel)
The goal of the Mississippi State Child Death Review Panel is to improve our understanding of risk factors and circumstances surrounding child deaths to ultimately improve child health, safety and protection through effective policy, education, and public awareness.
- Review and better understand the deaths of children less than eighteen years of age whose death occurs in Mississippi and consistently report the accurate cause and manner of death in which the death was unexpected and/or unexplained.
- Identify preventable child deaths and improve our understanding of risk factors and circumstances surrounding these deaths with an emphasis on future protection from childhood fatalities.
- Improve communication, coordination, and linkages of agencies and organizations in response to child deaths.
- Collect and translate relevant and pertinent data on Mississippi childhood fatalities in a meaningful way in the form of an annual report to the legislature with a focus on strategies for prevention.
Maternal Mortality Review (Legislative Mandated Panel)
The Mississippi Maternal Mortality Review Committee (MMRC) was established in July of 2017 following passage of House Bill 494, which required the formal review of maternal deaths in Mississippi and secured protections for the confidentiality of the process. The committee includes representation from a broad range of physicians and nurses from multiple specialties (Obstetrics & Gynecology, Cardiology, Pulmonary Medicine, Anesthesiology, Maternal-Fetal Medicine, and Public Health) along with social workers, coroners, health advocates and other allied health professionals who extensively review maternal deaths in order to identify opportunities for prevention.
Fetal Infant Mortality Review (FiMR)
The overall goal of FIMR is to enhance the health and well-being of women, infants and families by improving the community resources and service delivery systems available to them. The FIMR process brings together key members of the community to review information from individual cases of fetal and infant deaths in order to:
- Identify factors associated with those deaths
- establish if they represent system problems that require change
- develop recommendations for change
- assist in the implementation of change
- determine community effects
Safe Sleep
The Mississippi State Department of Health is participating in the National Safe Sleep CoIIN along with 3 other states: Arkansas, New York and Tennessee. Mississippi’s project, which is called ‘Safe Sleep City’, involves challenging a city and key partners within it to commit to educating the city’s families about the risks of sleep related infant deaths, ways to keep babies safe and to ensure that every infant within the city has a safe place to sleep.
Perinatal/Infant Health Annual Report (Maternal and Infant Health Bureau)
Accomplishments and Challenges
Priority Area: Decrease Infant Mortality
Strategy 1: Review infant deaths through multidisciplinary teams to enhance data collection and where possible evaluate the role level of care played in maternal and infant care.
Rationale Strategy 1: The overall goal of FIMR is to enhance the health and well-being of women, infants and families by improving the community resources and service delivery systems available to them. Child Death Review is a state based process that also aims to improve infant and child outcomes by identifying preventable drivers of child death. The regional FIMR teams meet monthly and the state CDR team meets quarterly. For each of these processes the MSDH team collects necessary data for the CDR panel and the FIMR team to review the case. As part of this process, we have reported the hospital of birth, if the infant was transferred after birth and the level of care. Providing this information and integrating it into the review process, we seek to have the CDR and FIMR teams make recommendations about neonatal levels of care when it is relevant.
Activity 1a: Provide essential documents to child death review (CDR) panel and fetal and infant mortality review (FIMR) teams to review all infant deaths and collect data on circumstances surrounding these deaths.
Report Activity 1a:
The administrative staff of the Child Death Review Panel identified 173 infant and child deaths that met criteria for review. The Child Death Review Panel reviewed 95 of the cases with the majority of cases being motor vehicle and transportation related accidents and sudden unexpected infant death cases related to unsafe sleep environments. The Child Death Review Panel is being to implement new processes to track documents for case reviews and the level of detail documentation is provided for each case. During this reporting period, the CDRP administrative staff had significant staff turnover. The CDRP was without a coordinator for a little over a year, and the CDRP stopped meeting. A new coordinator was hired in April 2018. Currently the CDRP administrative staff consists of 1.5 FTE, a full-time coordinator and a part-time Social Worker Consultant who are responsible for coordinating the meetings, identifying cases for review, and abstracting records for case review, and writing the annual report. At this time, the CDRP does not have an assigned fulltime epidemiologist/biostatistician for data support. This hinders the efficiency of how the CDRP is able to report data from the review meetings, finalize recommendations for the annual report, and submit the report in a timely manner. Due to the nature of the cases being reviewed, the administrative staff strategically plans the timeframe and workload to prevent vicarious trauma. This is both a great concern and priority of the Maternal and Infant Health Bureau Director.
Activity 1b: Facilitate cross coordination of FIMR and CDR teams.
Report Activity 1b:
Two of the three FIMR teams in Mississippi were able to attend the CDRP 2017 infant case review meetings. The two FIMR coordinators were able to provide additional information to the CDRP on their investigation with the cases. A new reporting guideline was created for the Mississippi State Department of Health funded FIMRs to better document the work of the Case Review Teams and Community Action teams work to reduce infant mortality rates in the targeted geographical areas.
Strategy 2: Implement the Direct on Scene Education (DOSE) education program to educate families about safe sleep and safe sleep environments.
Rationale Strategy 2: DOSE is an innovative attempt at eliminating sleep related infant death due to suffocation, strangulation or positional asphyxia by using First Responders to identify and remove hazards while delivering education on scene. First Responders are trained to identify and remove hazards from an infant's sleep space while on scene during emergency and non-emergency 911 calls. If personnel find an expectant mother or infant less than one year of age, they will initiate an "environmental check" and distribute a Baby Safe Sleep Kit. If any hazards are found in the home or in the baby's sleep space, they are identified, removed and the family is educated as to why they must be kept away from the baby. The verbal education is the key to behavior change in the field. First Responders are on scene to help, giving their message more of an opportunity to make a lasting impression. This program was selected in order to add an additional layer of safe sleep messaging to the communities.
Activity 2a: Conduct regional training (s) on DOSE program to expand to 5 counties.
Report Activity 2a:
(Activity on hold) The program staff decided to put the regional DOSE trainings on hold due to the lack of staff we have to support expansion of outreach and training efforts.
Strategy 3: Increase safe sleep educational awareness to providers and community partners.
Rationale Strategy 3: Sleep-related deaths remain a major public health issue in Mississippi. Multiple strategies were selected in an effort to increase the reach of awareness. Healthcare professionals are encouraged to promote safe sleep as well as provide education at all points.
Activity 3a: Participate in quarterly community events to spread awareness of safe sleep.
Report Activity 3a:
Staff participated in one community event to spread awareness of safe sleep in the first and third quarter of the reporting period.
In the first quarter, staff participated in a Trunk or Treat event held in West Jackson. A display was designed to share information about sleep related infant deaths. West Jackson is a geographical hot spot for sleep related infant deaths. This family-friendly event had over 500 attendees including mothers, fathers, and caretakers of infants. While at the event, five mothers shared their experience with infant loss due to SIDS and expressed gratitude in information being shared with the community.
In the third quarter, staff presented information during a rotary club meeting on sleep related infant deaths. A total of 15 members were present. Resources on safe sleep for infants were left at the library where the meeting was held. The staff is working to identify new partnerships to share safe sleep information and continuing to work with existing partners.
Activity 3b: Provide resources to healthcare providers on safe sleep.
Report Activity 3b:
Safe sleep resources were distributed to 13 obstetric offices and 19 pediatric offices in the Jackson Metro Area. Each office that received a resource box will also be followed-up with in regards to committing to screen for safe sleep practices during their clients’ appointments and referring them to receive a crib, if they do not have one.
Activity 3c: Distribute safe sleep board books to all birthing hospitals in Mississippi.
Report Activity 3c:
Safe sleep board books, ‘Sleep Baby Safe and Snug’ are delivered to 40 birthing hospitals in Mississippi by the program free of charge twice a year. The Sleep Baby, Safe and Snug Board Book provides the safe sleep message in the context of a beautifully written and illustrated children’s story. This board book provides safe sleep instructions and reminders right before the child is placed in their sleeping environment. Unlike the traditional brochures on safe sleep new parents receive at the hospital, people will cherish this book and read it to their child numerous times - promoting early literacy and reinforcing the safe sleep message.
Sleep Baby Safe and Snug is now being included in every safe sleep survival kit distributed by the national organization Cribs for Kids. The National Cribs for Kids® Infant Safe Sleep Initiative provides safe-sleep cribs and other safe-sleep products to at-risk families around the country.
Charlie’s Kids Book Objectives:
- To provide safe sleep education through an easy-to-read narrative
- To demonstrate a safe-sleep environment through vivid illustrations
- To portray different races, ethnicities and family structures participating in safe sleep
- To promote early literacy
Strategy 4: Coordinate and/or provide trainings to implement safe sleep practices with childcare providers, using common messaging.
Rationale Strategy 4: Sleep-related deaths remain a major public health issue in Mississippi. Infants spend majority of their day with a caregiver. Keeping infants safe is the main concern of childcare providers.
Activity 4a: Recruit childcare sites for training.
Report Activity 4a:
Through a partnership with the MSDH Asthma program, childcare centers’ staff were surveyed on their interest in receiving infant safe sleep training. The Mississippi Asthma program provides training to childcare centers on asthma. Training evaluations were used to collect the information and a list of childcare centers interested was compiled. Additionally, the Maternal and Infant Bureau has registered as a trainer for continuing education hours through the Mississippi State Department of Health Childcare Licensure Division.
Activity 4b: Conduct trainings for childcare providers.
Report Activity 4b:
A partnership with the Kappa Silhouettes and Kappa Alpha Psi fraternity was established to assist the MSDH program with providing infant safe sleep training to childcare centers and the community in Jackson, MS and surrounding counties. Safe Sleep was identified as one of their national service projects; therefore sparking a natural partnership with our program. The Silhouettes and Kappas have implemented many programs in their communities over the years and made significant contributions. The Kappas (which is a male fraternity) and the Silhouettes (made up of wives of the male fraternity) will work to ensure that the safe sleep message is promoted in the local communities and populations they serve. In May 2019, a safe sleep train-the-trainer session was held with members from both organizations. The goals of the training were to ensure that the members were properly educated on the safe sleep message as well as increasing their comfort level with presenting the information in a clear and concise manner. Three Kappa Silhouettes and two Kappa members (one being the Canton, MS Alumni chapter president) attended the training. It is very beneficial to have the chapter president buy-in for the sake of ensuring that goals for the partnership will be carried out as planned. All members stated how important this information is for the community and understood the link to infant mortality. They are all excited about the ability to be able to share the valuable information with the community.
As a result of the train-the trainer session, childcare information sessions and other community outreach events are being planned for the summer and fall of 2019 in the Jackson region with opportunities to expand to other areas of the state as staff capacity permits. Local childcare centers will be invited to attend the infant safe sleep information sessions. It is our goal to recruit other organizations to be safe sleep champions in other communities around the state.
Strategy 5: Support Quality Improvement efforts to improve perinatal outcomes.
Rationale Strategy 5: Perinatal morbidity and mortality are key indicators of a nation's health status. State-based Perinatal Quality Collaboratives (PQCs) are networks of perinatal care providers that include hospitals, clinicians, and public health professionals working together improve pregnancy outcomes for women and newborns using a rigorous quality improvement science. Members of the collaborative are healthcare facilities, mainly hospitals, which identify processes of care that require improvement and then use the best available methods to effect change and improve outcomes as quickly as possible.
Activity 5a: Facilitate the statewide perinatal quality collaborative to engage obstetrics, neonatal and pediatric stakeholders in applying quality improvement methodologies related to perinatal outcomes.
Report Activity 5a:
The Mississippi Perinatal Quality Collaborative began hosting monthly steering committee meetings and within the past year, transitioned to monthly project leadership meetings and quarterly full steering committee meetings. MSPQC hosts monthly project webinar’s that provide continuing education; MSPQC updates, and provides time for teams to share lessons learned and challenges. There are also regional in-person learning sessions, individual coaching calls, site visits to participating hospitals and training sessions. The steering committee also provides assistance with planning the annual state-wide meeting.
The Mississippi Perinatal Quality Collaborative is funded by the Centers for Disease Control and Prevention.
Obstetric Division QI Project:
Obstetric hemorrhage remains one of the most significant contributors to preventable maternal morbidity and mortality. Several investigators have demonstrated that maternal deaths from obstetric hemorrhage are often associated with modifiable provider and systems level factors including gaps in communication, delays in care and ineffective treatment strategies. Following the call of the National Partnership for Maternal Safety, the Mississippi Perinatal Quality Collaborative (MSPQC) supports the use of Patient Safety Bundles which address systematic, optimal management of severe maternal hypertension, venous thromboembolism and obstetric hemorrhage in 36 participating hospitals with database users and active entry. Patient Safety Bundles are small, straightforward sets of evidence-based practices that, when performed collectively and reliably, have been proven to improve patient outcomes. The bundles are not prescriptive; each facility is encouraged to select the tools that best suit its own needs and resources. MSPQC has been working with The Alliance for Innovation in Maternal Healthcare (AIM) to implement the Obstetric Hemorrhage Initiative (OHI) throughout Mississippi since 2016. 2016. AIM was formed to support statewide perinatal quality efforts to effectively implement improvement strategies that can help reduce maternal morbidity and mortality. There has been implementation of AIM patient safety bundles at 100% of participating facilities. Each facility receives: Education; Risk Assessment; Toolkit; Drills/Simulation: 2 per year; Quantified Blood Loss: 75% of patients; Staff and family support and Debrief/ Case reviews.
The Maternal Division also participated in the Advanced Life Support in Obstetrics (ALSO) Training Program. The first provider and instructor ALSO courses were launched during the 2018 MSPQC annual meeting. Since then, five hospitals have hosted trainings. There are plans for ongoing financing of ALSO training and instructor certification through CDCs grant. The online content, course and instructor fees are also supported. All facilities have to identify an instructor who will carry forward the training at their site.
Future Projects
• 2019 launch of pilot for support for safe vaginal delivery
• Hypertension & Heart (Severe maternal hypertension bundle; expanded focus on postpartum period; chronic and obstetric cardiac conditions.
• Maternal Opioid development (Buprenorphine prescribing waiver; education)
Neonatal Division Project QI Project:
Golden Hour- Initiated in 2015 and is in sustainment.
Neonatal Abstinence Syndrome- Kick-off July 2019
The Mississippi Perinatal Quality Collaborative has begun work on a quality improvement project addressing Neonatal Abstinence Syndrome (NAS) in our state. Our primary goal is to develop a collaborative quality improvement initiative of Mississippi hospitals that will work together using structured quality improvement methods to develop consistent treatment and follow-up plans for infants with/at risk for NAS. Overall, the goal is to decrease hospital length of stay for babies with NAS and ultimately improve outcomes for these babies and their families. Our secondary goals include developing a standardized risk assessment tool to be used on all obstetrical patients upon hospital admission, as well as develop a standardized newborn evaluation tool for drug exposure. Additionally, we aim to standardize the scoring system used for infants with NAS in an effort to improve inter-rater reliability and improve staff proficiency in caring for infants with NAS. Finally, we will engage families in the care of infants with NAS by providing standardized caregiver and family education and to increase breastfeeding rates of infants with NAS rooming in with their mother or caregiver. Data collection on the project began June 2019 month and will continue through 2020.
Primary Goal:
- To develop a collaborative quality improvement initiative of Mississippi hospitals that will work together using structured quality improvement tools to develop consistent treatment and follow-up plans for infants with or at risk for NAS.
- Overall, the goal is to decrease hospital length of stay for babies and improve outcomes for these babies and their families
- Secondary Aim: Develop a risk assessment tool for OB patients upon admission as well as a newborn evaluation tool for drug exposure
- Family Aim: To engage families in the care of these infants by providing standardized education o To increase breastfeeding rates of these infants with rooming in
Background: Neonatologist in Mississippi
- 13 Hospitals utilizing neonatologists in the state (approximately 38 Neonatologists practicing across the state).
- All 3 regions of the state covered by a neonatologist presence.
- Remaining 25 hospital nursery services are covered by pediatricians.
- Majority of hospitals utilizing Neonatologists, also utilize NNP’s.
Participating Centers:
- Anderson Memorial- Meridian
- Forrest General Hospital- Hattiesburg
- Memorial Hospital Gulfport- Gulfport
- Merit Health CMMC- Jackson
- Merit Health River Oaks -Flowood
- Merit Health Woman’s Hospital- Flowood
- Merit Health Wesley- Hattiesburg
- Mississippi Baptist Medical Center- Jackson
- North Mississippi Medical Center- Tupelo
- Rush Foundation Hospital- Meridian
- St. Dominic’s Hospital- Jackson
- University of MS Medical Center- Jackson
Activity 5b: Host annual statewide perinatal quality collaborative meeting.
Report Activity 5b:
Perinatal quality collaboratives (PQCs) are state or multi-state networks of teams working to improve the quality of care for mothers and babies. PQC members identify health care processes that need to be improved and use the best available methods to make changes as quickly as possible. For the last five years, the Mississippi Perinatal Quality Collaborative State Meeting convened stakeholders who are interested in improving the health of mothers and babies in the state of Mississippi. In November of 2018, MSPQC hosted its 5th annual statewide meeting at the Hilton hotel in Jackson, MS with more than 200 in attendance.
The agenda included a range of topics, with national experts presenting from all over the United States. Maternal mortality is a recent national focus as it relates to black women and the disparity in the United States. The agenda below provides additional details on the topics covered at the 2018 annual meeting.
Objective 1: Increase access to risk appropriate care for very low birth weight (VLBW) infants and high-risk mothers by 90% by 2018.
Strategy 6: Use the LoCATe tool to assess levels of maternity and neonatal care at birthing facilities
Rationale Strategy 6: This strategy was selected as one of the suggested approaches supported by the Centers for Disease Control and the Collaborative Improvement and innovation Network to reduce infant mortality. In Mississippi, there had never been an assessment of maternal and neonatal levels of care using a validated instrument. In order to accurately track risk appropriate care, we determined the first critical step was assessing capacity throughout the state.
Activity 6a: Distribute LoCATe tool to birthing facilities.
Report Activity 6a:
(RETIRED) Activities 6a, 6b and 6c were retired because of the lack of capacity to implement. Last year, the program lost its dedicated staff person for this activity. There was also data quality issues identified which caused the program to shift priorities.
Activity 6b: Follow up with birthing facilities on progress of survey/complete survey.
Activity 6c: Analyze results from survey.
Strategy 7: Work with providers participating in the Mississippi Perinatal Quality Collaborative to educate about levels of care and parameters for maternal and infant transfer.
Rationale Strategy 7: It is important for both obstetric and pediatric providers to understand the importance of mothers and infants being in the risk appropriate facility before delivery. During the MSPQC annual meetings, risk appropriate care statistics were shared with the audience and experts from both the AAP and ACOG were present to address risk appropriate care in their respective discussions.
Activity 7a: Hold educational conferences discussing levels of care.
Activity 7b: Provide guidance and information to hospitals about levels of care and incorporate risk appropriate care into the MSPQC quality initiatives.
Report Activity 7a and 7b:
(RETIRED) Activities 7a and 7b were retired because of the lack of capacity to implement. Last year, the program lost its dedicated staff person for this activity. There was also data quality issues identified which caused the program to shift priorities.
Strategy 8: Review infant deaths through multidisciplinary teams to enhance data collection and where possible evaluate the role level of care played in maternal and infant care.
Rationale Strategy 8: The overall goal of FIMR is to enhance the health and well-being of women, infants and families by improving the community resources and service delivery systems available to them. Child Death Review is a state based process that also aims to improve infant and child outcomes by identifying preventable drivers of child death. The regional FIMR teams meet monthly and the state CDR team meets quarterly. For each of these processes the MSDH team collects necessary data for the CDR panel and the FIMR team to review the case. As part of this process, we have reported the hospital of birth, if the infant was transferred after birth and the level of care. Providing this information and integrating it into the review process, we seek to have the CDR and FIMR teams make recommendations about neonatal levels of care when it is relevant.
Activity 8a: Provide necessary documents to child death review (CDR) panel and fetal and infant mortality review (FIMR) teams to review all infant deaths and collect data on circumstances surrounding these deaths.
Report Activity 8a:
A new process is in process of being designed in order to track the documents gathered for case reviews. Insufficient documentation has become a barrier to thoroughly review all identified cases. The new tracking mechanism accounts for: an autopsy completion, death scene investigation when available, law enforcement reports, and CPS reports. . The administrative staff of the Child Death Review Panel (CDRP) identified 173 infant and child deaths that met criteria for review. The Child Death Review Panel reviewed 95 of the cases with the majority of cases being motor vehicle and transportation related accidents and sudden unexpected infant death cases related to unsafe sleep environments. The Child Death Review Panel is being to implement new processes to track documents for case reviews and the level of detail documentation is provided for each case.
During this reporting period, the CDRP administrative staff had significant staff turnover. The CDRP was without a coordinator for a little over a year, and the CDRP had stopped meeting. A new coordinator was hired in April 2018. Currently the CDRP administrative staff consists of 1.5 FTE, a full-time coordinator and a part-time Social Worker Consultant who are responsible for coordinating the meetings, identifying cases for review, and abstracting records for case review, and writing the annual report. At this time, the CDRP does not have an assigned fulltime epidemiologist/biostatistician for data support. This hinders the efficiency of how the CDRP is able to report data from the review meetings, finalize recommendations for the annual report, and submit the report in a timely manner. Due to the nature of the cases being reviewed, the administrative staff strategically plans the timeframe and workload to prevent vicarious trauma. This is both a great concern and priority of the Maternal and Infant Health Bureau Director.
Activity 8b: Review and analyze CDR case identification processes to improve and change current process.
Report Activity 8b:
Currently, the case identification process includes death certificates and matching birth certificates provided through the Office of Vital Records based on ICD-10 codes. The death certificates and matching birth certificates are sorted by natural and unnatural causes of death. The CDRP is responsible for reviewing child deaths related to injury and violence which mainly fall into the manner of death being accident, homicide, suicide, and undetermined. The major of causes of deaths are motor vehicle and transportation related deaths, sleep-related infant deaths due to sleep environment, injury related to assault, weapon, or person’s body part, drowning, and fire. Any death certificate with pending manner and cause of death are investigated further to determine if the manner of cause of death is reviewable by the CDRP. This process is overseen by the CDRP coordinator, the social worker consultant, and a pediatric consultant.
Activity 8c: Facilitate cross coordination of FIMR, CDR and MMR teams.
Report Activity 8c:
During the reporting period, a meeting was held with FIMR coordinators and the new CDR coordinator. This meeting was held for the coordinators to know each other’s roles and how they can work together.
The CDR coordinator is housed in the same department as the MMR coordinator. The coordinators have collaborated on abstracting records and attending review meetings.
Activity 8d: Develop and disseminate the Infant Mortality Report for Mississippi.
Report Activity 8d:
The state infant mortality report is developed and disseminated yearly to legislators, policy makers, internal and external partners, and any entity or individual with interest in learning about infant mortality in Mississippi. The report also provides recommendations and strategies for improvement in the areas that affect the infant mortality rate in Mississippi. The report can be found here: https://msdh.ms.gov/msdhsite/_static/resources/8015.pdf
Objective 2: By September 2019, increase the number of community safe sleep outreach events to 2 per quarter.
Strategy 9: Partner with FIMR programs statewide to increase safe sleep awareness in their communities.
Rationale Strategy 9: Sleep-related deaths remain a major public health issue in Mississippi. Multiple strategies were selected in an effort to increase the reach of awareness. Healthcare professionals are encouraged to encourage safe sleep as well in order to provide education at all points.
Activity 9a: Host safe sleep seminars/educational sessions for the public as well as public health and social service professionals in the FIMR districts.
Report Activity 9a:
FIMR Coordinator met with Child Protective Supervisor in Harrison County to discuss in-service for CPS case workers regarding importance of infant safe sleep – 5 cases were reviewed.
Moore Community House – FIMR coordinator attended the advisory board meeting – infant safe sleep was part of the discussion on ways to connect in the community.
Pharmacy in Diamondhead and Waveland Pharmacy displays set up in local drug stores with Infant Safe Sleep brochures.
Tobacco Coalition meeting – FIMR Coordinator discussed dangers of second & third hand smoke as it relates to SIDS..
Activity 9b: Safe Sleep outreach activities in FIMR areas.
Report Activity 9b: See details above.
Objective 3: Train 100 percent of PHRM/ISS participants on safe sleep messaging by September 2019.
Strategy 10: Provide health education to PHRM/ISS participants to encourage the use of safe sleep environments.
Rationale Strategy 10: The MSDH Perinatal High Risk Management/Infant Services System (PHRM/ISS) program provides enhanced case management services to Medicaid-eligible, medically high-risk pregnant women and infants up to one year of age. Services are provided through a multidisciplinary team. The purpose of PHRM/ISS is to help reduce the infant mortality rate and to help reduce the rates of low and very low birth weight infants in Mississippi. The PHRM/ISS partners with the Infant Health program to expand its reach in proving safe sleep education and resources for Mississippi's expectant and parenting families.
Activity 10a: Distribute safe sleep flipbooks to PHRM/ISS staff and provide staff training.
Report Activity 10a:
The PHRM/ISS staff was provided safe sleep flip books and safe sleep board books in each region to be utilized as a teaching tool for the clients they serve. Safe sleep education is one focus of the overall PHRM/ISS program. PHRM/ISS team members provide evidenced-based safe sleep education primarily through face-to-face encounters with patients, both in the clinic and home settings. Education may be offered in a variety of formats, including discussion, videos, handouts produced by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), March of Dimes, MS Safety & SIDS Alliance, Partners for A Healthy Baby (PHB), and interactive safe sleep demonstrations.
Activity 10b: Gather quarterly data from PHRM/ISS staff for reports.
Report Activity 10b:
The PHRM/ISS initially provided data on the number of clients reached with the safe sleep education. However, due to the agency’s implementation of the new EHRsystem, the supervisors came to an agreement to put the data collection on hold until the staff were properly trained on the new system. The PHRM/ISS continues to provide safe sleep education to the families that they serve.
Objective 4: By spring 2018, increase the number of first responders trained on safe sleep practices to 500.
Strategy 11: Implement the Direct on Scene Education (DOSE) education program to educate families about safe sleep and safe sleep environments.
Rationale Strategy 11: DOSE is an innovative attempt at eliminating sleep related infant death due to suffocation, strangulation or positional asphyxia by using First Responders to identify and remove hazards while delivering education on scene. First Responders are trained to identify and remove hazards from an infant's sleep space while on scene during emergency and non-emergency 911 calls. If personnel find an expectant mother or infant less than one year of age, they will initiate an "environmental check" and distribute a Baby Safe Sleep Kit. If any hazards are found in the home or in the baby's sleep space, they are identified, removed and the family is educated as to why they must be kept away from the baby. The verbal education is the key to behavior change in the field. First Responders are on scene to help, giving their message more of an opportunity to make a lasting impression. This program was selected in order to add an additional layer of safe sleep messaging to the communities.
Activity 11a: Train first responders on DOSE program.
Report Activity 11a:
(Activities on hold)The activities related to DOSE were put on hold due to the limited number of staff within the program to help implement the activity. This program requires making contacts with agencies and promoting/advocating for the program, scheduling trainings (if agreed on by all parties), identifying locations for trainings, etc. Implementation and expansion of the DOSE program presented a challenge, but we will plan for implementation in the future.
Activity 11b: Educate families on safe sleep through DOSE program.
Report Activity 11b: See above
Activity 11c: Expand DOSE Program to other areas of state.
Report Activity 11c: See above.
Strategy 12: Increase availability of culturally competent safe sleep resources.
Rationale Strategy 12: The use of plain language, the quality of the translation, and the health literacy level of patients for which the translated materials will be provided are the three most important factors when using translated health education materials.
Activity 12a: Translate the safe sleep materials into one additional language and make translated materials available on the MSDH website and partner websites.
Report Activity 12a:
Retired (Resources already produced in other languages and included on NICHD’s website).
Evidenced Based Measure Reporting (Perinatal and Infant Health) Maternal and Infant Health Bureau
ESM 1: Number of technical reports produced on causes of infant death.
ESM 1 Report:
1
ESM 2: To provide the Direct on Scene Education (DOSE) program to first responders to help reduce the high rate of unsafe sleep-related deaths.
ESM 2 Report:
On hold
ESM 3: Number of safe sleep educational events provided to the community.
ESM 3 Report:
5
ESM 4: The number of childcare facilities trained on safe sleep best practices.
ESM 4 Report:
Ongoing
ESM 5: Improve maternal/newborn health by increasing the number of hospitals that participate in state’s Perinatal Quality Collaborative’s quality improvement initiatives.
ESM 5 Report:
42
ESM 6: % of birthing facilities with documented level of care consistent with AAP guidelines using the LoCATe tool.
ESM 6 Report:
ESM 7: % of birthing facilities participating in neonatal resuscitation project that includes education and parameters for appropriate neonatal transport.
ESM 7 Report:
ESM 8: % VLBW deaths to infants born outside of level III facilities.
ESM 8 Report:
ESM 9: Number of safe sleep educational books and resources distributed to families in all birthing hospitals.
ESM 9 Report:
20,000
ESM 10: Number of educational sessions.
ESM 10 Report:
5
ESM 11: Number of first responders trained on the DOSE program.
ESM 11 Report:
On hold
ESM 12: Number of educational materials translated in Spanish.
ESM 12 Report:
0
Emerging Issues Perinatal and Infant Health (Maternal and Infant Health Bureau)
The state of Mississippi is seeing increasing numbers of mothers and newborns affected by opioids. The rate of neonatal abstinence syndrome among neonates has more than tripled over the past decade and opioid overdose is one of the leading causes of maternal mortality based upon a recent evaluation. MSDH is beginning to strengthen both the surveillance and response to the opioid epidemic, including its impact on maternal and child health. The Mississippi Perinatal Quality Collaborative is leading an initiative among neonatal hospital units to standardize and improve the care of neonates exposed to opioids in-utero experiencing Neonatal Abstinence Syndrome (NAS). MSPQC has applied for supplemental funding from the Centers for Disease Control to increase the number of obstetric and mental health providers with waivers to provide medical assistance therapy to pregnant and parenting women with substance use disorders and will broaden training on non-pharmacologic treatment of neonates with NAS. The Maternal Mortality Review Committee for MSDH has established an Equity Subcommittee to review maternal deaths with a closer lens at understanding social determinants of health and community level factors and solutions to maternal death, including and especially those driven by mental health conditions.
Other Programmatic Activities Perinatal and Infant Health (Maternal and Infant Health Bureau)
The Mississippi State Department of Health is participating in the Safe Sleep CoIIN with 3 other states: Arkansas, New York and Tennessee. The project, which is called ‘Safe Sleep City’, involves challenging a city and key partners within it to commit to educating the city’s families about the risks of sleep related infant deaths, ways to keep babies safe and to ensure that every infant within the city has a safe place to sleep. Focusing at the city level brings a greater sense of ownership, responsibility and meaning to the population than a statewide effort. Our goal is to achieve a critical level of saturation of consistent safe sleep messaging throughout the city, with a shared goal of eliminating preventable SUID cases.
We utilize the partnership between the Mississippi State Department of Health, Physician Offices, the MS Chapter of AAP, Families First, Healthy Start Program and the Mayor’s Office of each city to engage key partners throughout the city to commit to educating families about safe sleep and when possible providing safe sleep spaces for infants. This project was launched in Jackson in October 2018. The Safe Sleep City Goals are listed below:
- All pediatric offices screen families on where infants sleep and provide education to families.
- All obstetric providers educate families before delivery about safe sleep by providing materials.
- Provide safe sleep board books to all delivering hospitals.
- Provide safe sleep education to churches in targeted area.
- Provide safe sleep education to childcare centers.
Once the above objectives are met, the Mayor’s Office and MSDH will designate the city a ‘Safe Sleep City’ marked with a public celebration celebrating babies first birthdays.
The Safe Sleep City Project aims to increase program efforts by strengthening community partnerships. The program hosts a safe sleep partner meeting quarterly to provide updates on Safe Sleep City project goals and to seek assistance from partners to carry out goals and objectives. This has allowed the program to increase reach with infant safe sleep education. We also have worked with the Mississippi Chapter of the American Academy of Paediatrics Office of Tobacco Control to display safe sleep billboards in the city of Jackson to help promote the Safe Sleep City Initiative. The safe sleep billboards are set to display for one month (July 15- August 14th 2019) and are strategically placed in locations around the city of Jackson that are in the targeted Safe Sleep City Initiative, which includes South and Southwest Jackson. The billboard media campaign is an additional layer of promoting infant safe sleep and the new safe sleep website.
The MSDH Program is also working alongside the Perinatal High Risk Management/Infant Services System (PHRM/ISS) to educated clients on infant safe sleep through the Expectant and Parenting Teen grant that was awarded to MSDH from the U.S. Department of Health and Human Services, Office of Adolescent Health Pregnancy Assistance Fund, in FY2015. The focus is on expectant and parenting teens in high school, GED, or alternative school programs, ages 19 and under. The grant provides MSDH an opportunity to target and emphasize case management services to a specific at-risk population. This grant targets 15 counties in Mississippi. The funding also allows the PHRM/ISS Program to develop 6 parenting stations throughout the MSDH regions, and to restock the original parenting station at Jones County Health Department. The parenting station is a room modeled similar to an infant’s nursery where the MSDH PHRM/ISS-EPT case management team interacts one-on-one with expectant and parenting participants to teach and demonstrate important parenting skills, infant care, and bonding techniques using an evidence based curriculum. One of the health education modules within each parenting station targets safe sleep education and provides hands on learning in safe sleep practices.
Safe sleep education is one focus of the overall PHRM/ISS program. PHRM/ISS team members provide evidenced-based safe sleep education primarily through face-to-face encounters with patients, both in the clinic and home settings. Education can be offered in a variety of formats, including discussion, videos, handouts produced by the March of Dimes, SIDS Alliance, and Partners for A Healthy Baby (PHB), and interactive safe sleep demonstrations.
PHRM/ISS team members are encouraged to routinely explore plans for infants' sleeping arrangements and provide safe sleep education with maternity patients throughout their pregnancies and on an ongoing basis with caregivers of high-risk infants. Referrals are made to the Mississippi SIDS and Infant Safety Alliance “Cribs for Kids” program when the need arises both before and after an infant is delivered.
Moreover, MSDH staff serving the grant catchment areas are expected to make safe sleep education and demonstration an ongoing priority with the teens. Given the age range of the teens being served, staff members have also been prepared to engage other family members, including parents, grandparents, and extended family members in this education process.
The grant staff members have committed to use these materials within MSDH county clinics and via home visits to offer education on safe sleep practices, SIDS, and risks associated with bed sharing and co-sleeping for the target population.
Social media is used as an outlet to provide information to specific populations. The Maternal and Infant Health Bureau understands the importance of branding and marketing as it relates to expanded reach for an intended audience. The program identified a marketing company to design a logo for branding of the program and for the development of a safe sleep website that will not only be used for this project, but can be utilized statewide to provide consisted safe sleep messaging. Agora marketing company was chosen to carry out the goals of the marketing campaign, which included logo development, website development as well as being responsible for social media influence to promote infant safe sleep to high-risk groups. The safe sleep website officially launched May 2019. Please visit our website at www.safesleepms.org for more information.
Success Story Perinatal and Infant Health (Maternal and Infant Health Bureau)
MSDH has been in partnership with Mississippi SIDS & Infant Safety Alliance for many years. We continue to support their efforts with their Cribs for Kids Program, grief support, safe sleep education and other efforts surrounding safe sleep.
For over a decade the Mississippi SIDS & Infant Safety Alliance along with many generous partners have distributed 1000's of pack-n-plays from our Cribs for Kids Program. Many families have received a safe sleep environment, along with education on how to reduce SIDS/SUID and all sleep related deaths, which otherwise would not have been able to afford this for their baby. We received a message that one of our mothers who had received a pack-n-play wanted to tell us Thank You. She had received the crib for her first child and wanted us to know that she was so happy to have it so that she could now use it for her second child that was due soon. These families are so appreciative to receive these cribs and this shows that they are using them for the safety of these babies. Our Cribs for Kids program works, by providing a safe sleep area along with vital safe sleep education, which will and has saved the lives of many precious babies.
The Mississippi SIDS & Infant Safety Alliance travels the state providing education on SIDS/SUID Risk Reduction and how to have a Safe Sleep Environment. We not only educate our parents but also ALL caregivers; grandparents, friends, childcare, etc. Grandparents are raising many of our infants in the state. Many of our grandparents have not received training or education on the new research on how to place babies and a safe sleep environment. We have to reeducate them, and sometimes it is hard to change grandparents mind because it is not what they did with their children. At one Baby Basics program that we were teaching, we were fortunate to have a grandmother there. She told us that she had not heard of placing babies on their backs and having nothing in the crib. That was not what she had done with her children. After class she stated that she had learned so much that she did not know and that she had done infant sleep differently. She stated that from now own she was going to put her grand-babies on their back and have nothing in the crib! That is a win!! She even let us do a video with her stating her new knowledge! We can make a difference with Safe Sleep education!
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