Perinatal/Infant Health Overview

Perinatal and infant health is a central focus of the Division of Maternal and Infant Health (DMIH), which supports programs to help infants be born healthy and ready to thrive. The Women and Maternal Health Section and Perinatal and Infant Health Section within DMIH oversee many programs including the Michigan Perinatal Quality Collaborative, Maternal Infant Health Program (MIHP), Infant Safe Sleep, Breastfeeding, Fetal Infant Mortality Review, Safe Delivery of Newborns, and the Early Hearing Detection and Intervention program. Title V funding supports a variety of programs and initiatives related to perinatal and infant health, including infant safe sleep, breastfeeding, PRAMS, and infant and maternal mortality reduction. Title V funding is also used as a gap-filling funding source for Regional Perinatal Quality Collaboratives (RPQCs). DMIH provides funding, staff support, and infrastructure for the RPQC network that uses quality improvement methods to implement strategies to improve maternal and infant health. Other federal funding is used to identify and meet the needs of this population, such as WIC (USDA), Universal Newborn Hearing Screening and Intervention (HRSA), and PRAMS (CDC). Perinatal and infant health is promoted through a network of partnerships, including those with health care providers, labor and delivery hospitals, universities, the Mother Infant Health and Equity Collaborative, and the Michigan Association for Infant Mental Health.

Title V funding also supports the Local Maternal Child Health (LMCH) program which provides funding to all 45 Local Health Departments (LHDs). In FY 2022, Title V funds via the LMCH program were expended on NPM 4 (breastfeeding), NPM 5 (infant safe sleep), and Local Performance Measures (LPMs) in the perinatal/infant health domain. Nineteen LHDs implemented breastfeeding (NPM 4) activities including breastfeeding support in a variety of settings for pregnant people and women to provide infants with human milk. Other activities included staff development and lactation training; participation in virtual community breastfeeding coalition meetings, promoting breastfeeding friendly businesses; social media posts; and community outreach events. Ten LHDs addressed infant safe sleep (NPM 5) through education in a variety of creative, socially distanced ways such as prenatal/postnatal classes, home visits, social media posts, and community events. Infant safe sleep education was provided to childcare, faith-based entities, emergency management, and nursing students. Sleep sacks, pack-n-plays, and books were distributed to families with an assessed need.

Eight agencies selected an LPM based on local priorities. Activities included FIMR team processes, car seat safety, gap-filling administration of infant immunizations, Healthy Families America program support for infants, and assisting NICU families with linkage to resources. For over half of the fiscal year, COVID-19 safety precautions continued to cause disruptions in agencies’ ability to conduct in-person visits and in-person services at provider offices. A significant number of agencies reported unprecedented staff turnover which impacted the ability to provide service.

Michigan’s approach to perinatal and infant health through Title V emphasizes implementation of strategies that prevent maternal and infant morbidity and mortality, which are critical indicators of the degree to which a community takes care of its women and children. Focus areas for Title V are infant safe sleep and breastfeeding.

Breastfeeding (FY2022 Annual Report)

The American Academy of Pediatrics (AAP) recommends all infants are exclusively breastfed for six months to support optimal growth and development. Additionally, in 2022 the AAP published updated guidance supporting continued breastfeeding for two years or beyond, as long as mutually desired by mother and child. Breastfeeding has health benefits for infants and mothers, including mental health benefits for both mothers and babies. For infants, breastfeeding can reduce risk of asthma, obesity, SIDS, diabetes, ear infections, childhood leukemia, and some respiratory diseases. For mothers, breastfeeding can reduce feelings of anxiety and postnatal depression, reduce post-partum hemorrhage, lower the risk of type 2 diabetes, and may decrease the likelihood of developing breast, uterine, and ovarian cancers. Human milk remains the optimal source of nutrition for the first months of life.

The Title V needs assessment also revealed that breastfeeding is still a critical maternal and child health (MCH) issue for Michigan’s mothers and infants. Needs assessment themes showed that families want more breastfeeding support and education and that families are having difficulty accessing breastfeeding support professionals and providers that support breastfeeding. During the Title V needs assessment, stakeholders identified the priority need to “Create and enhance support systems that empower families, protect and strengthen family relationships, promote care for self and children, and connect families to their communities” as an important way to achieve breastfeeding initiation and duration. The COVID-19 pandemic has highlighted the need for emergency preparedness plans to support access to human milk especially in Black, Indigenous, and People of Color (BIPOC) communities that have been disproportionately impacted by COVID-19. MDHHS will continue to expand collaboration with BIPOC-led organizations and communities that lead in addressing this health equity work, especially in relation to dismantling barriers to breastfeeding.

According to the National Immunization Survey (NIS), in 2019 Michigan’s initiation rate was 83.1% (CI 77.3-87.7). This meets the annual objective set of 81.2%. Michigan’s breastfeeding exclusivity rate through six months was 25.1%, and Michigan’s goal is to reach 41.1% by 2025.

PRAMS data 2020 tell a more complicated story with an initiation rate of 85.9%, which is above Healthy People 2020 goals. PRAMS has shown that Michigan’s initiation rate has increased steadily from 2009 to 2014. However, from 2014 to 2020, a leveling in breastfeeding initiation occurred, with no significant change seen. Disparities in breastfeeding initiation persist among non-Hispanic white women and non-Hispanic black women. According to PRAMS, while from 2009-2014 initiation rates grew among black women at a comparable or even faster rate than white women, from 2014 to 2017, initiation rates among black women remained unchanged (77.3% to 77.2%) compared to increases among white mothers (86.3% to 90.1%). Alarmingly, initiation rates among black women were lower in 2020 (75.1%) compared to 2017 (77.2%). Initiation rates among black mothers are now about 12% lower than white mothers. This 12% gap in initiation has grown from a prior gap of 10% in 2014-2016 [86.3% NHW - 73.8% NHB]. Data from MDHHS Office of Vital Statistics also show slightly lower initiation rates among Hispanic and Native American women when compared to white women. MDHHS will continue to intentionally gather data as it relates to Native American breastfeeding rates.

Based on the disparity data, the Title V state action plan continues to focus on reducing disparities in breastfeeding rates among women of color. In alignment with the plan, MDHHS has continued to prioritize using culturally responsive, evidence-based images and messages within public health campaigns to support the normalization of breastfeeding. The plan also focuses on increasing breastfeeding knowledge among maternal and infant health professionals who work with pregnant or postpartum people by offering breastfeeding educational opportunities statewide through a webinar series and forthcoming breastfeeding training course. The evidence continues to support that babies born in Baby-Friendly designated hospitals are more likely to be breastfed; therefore, increasing the percent of Baby-Friendly hospitals in Michigan remains the Evidence-based Strategy Measure (ESM) for this NPM.

MDHHS receives and shares parent and community input on breastfeeding-related issues through several means, including collaboration with the Michigan Breastfeeding Network and their CORE Cohort workgroup members. MDHHS recruits and encourages local breastfeeding clinicians and advocates to speak at maternal child health conferences. In addition, MDHHS team members attend state and local breastfeeding conferences in order to support breastfeeding networks. 

Objective A: Increase the percent of infants who are breastfed exclusively until 6 months to 41.1% by 2025.

Since its public release in February 2021, the Michigan Breastfeeding Plan has continued to set a common agenda necessary for a collaborative approach to support breastfeeding in Michigan. A key staff positions tasked with overseeing the activities in the Michigan Breastfeeding Plan was vacant from January 2022 through September 2022. However, as of October 2022, a staff member has been hired to support breastfeeding promotion activities and programs. Despite the vacancy, MDHHS convened a course development team to create a breastfeeding training course for professionals working with families in Michigan. Content in the breastfeeding training course will cover breastfeeding disparities in Michigan, the root causes of inequities and how to address them, information to support consistent messaging about breastfeeding, and community-based, culturally responsive breastfeeding resources to support families and professionals. The breastfeeding training course is in the final stages of development and will be available to professionals across the state. In accordance with the vision of the Plan, MDHHS will promote the training course widely and continue to work toward improving the knowledge of breastfeeding support among staff working in maternal and infant health programs.

A key activity to train home visitors and other maternal and infant health staff is the Great Lakes Breastfeeding Webinar Series, a project of the Michigan Breastfeeding Network. These webinars have continued to be offered every month at no cost to participants and are available on demand for up to one year after their initial release dates. Participation in the webinars varies, but most webinars have over 1,000 attendees nationally. During FY 2022, over 400 participants from Michigan viewed the webinars, with a combined total of over 3,500 unique webinar participants during FY 2022. Statistics show that among webinar participants from Michigan, 14% are home visitors and over 50% work for a state or local health department.

Evidence shows that access to professional and peer support can increase breastfeeding duration. MDHHS directly supported this activity through mini-grants, awarded in partnership with the Michigan Breastfeeding Network, to Black and Indigenous-led breastfeeding organizations that provide breastfeeding support to families. The goal was to give local organizations the flexibility to use the funds to respond to the unique needs of their communities. The mini grants were supported with Title V funds. Projects focused on developing educational resources addressing latch, milk supply, and pain, which were identified through PRAMS data as top reasons for why Michigan mothers stop breastfeeding. As part of the project, a resource guide was created, which linked to all of the resources created by the 10 organizations. Over 30 resources were created, which included videos, infographics, and informational documents that can be used to inform and support breastfeeding families. In addition, access to local breastfeeding and peer support has been placed on the MDHHS website and distributed to local partners and families. The WIC Division also leads efforts to increase access to breastfeeding support by funding peer counselors and a warmline.

MDHHS continues to work with Michigan Birthing hospitals to encourage, support, and acknowledge hospitals achieving Baby-Friendly status. This is Michigan’s ESM for this NPM. MDHHS staff promote the implementation of breastfeeding-friendly maternity care practices through trainings and encouraging hospitals to review and complete the CDC Maternity Practices in Infant Nutrition and Care (mPINC) survey. MDHHS has also remained engaged with partners that support Baby-Friendly efforts across the state. In 2022, MDHHS submitted a support letter as part of a community partner’s Baby-Friendly grant application and has continued to identify new ways to promote these efforts. The Great Lakes Breastfeeding Webinar series is promoted with hospital staff, and it is estimated that around 10% of participants identify maternity care nurse as their primary job function. Unfortunately, one birthing unit in Michigan closed as of June 1, 2022, bringing the total number of birthing hospitals from 80 to 79. The number of Baby-Friendly Hospitals in Michigan has remained at 13, with the percent of Baby-Friendly designated birthing hospitals also staying the same at about 16%. Responding to the COVID-19 pandemic has placed incredible strain on Michigan’s hospitals in recent years and has impacted their ability to meet and/or maintain the Baby Friendly USA standards.

Objective B: To impact breastfeeding disparity, increase percent of non-Hispanic black women who initiate breastfeeding from 74.4% to 78.4% by 2025.

According to PRAMS data, breastfeeding initiation among Michigan’s non-Hispanic Black women was 75.1% in 2020. Non-Hispanic white women breastfeeding initiation rates were 87.3% in 2020, which has remained relatively consistent since 2017. When asked about 10 different possible barriers to initiating breastfeeding, fewer non-Hispanic Black women report that they had multiple reasons for not initiating breastfeeding (37.1% vs. 46.2%) compared to non-Hispanic white mothers. This reflects persistent challenges in reducing the disparity in breastfeeding and a need for MDHHS to continue intentionally gathering data related to reasons for not initiating. While PRAMS data often illustrate individual reasons for not breastfeeding, systems level reasons—including historical and present-day racism—must be examined. Still, about half of non-Hispanic Black mothers who did not initiate, stated that there was just one barrier to initiate breastfeeding. As we investigate systems-level barriers and other complex problems, we will seek to support those whose single stated barriers may be more readily addressed.

To reduce disparity gaps, MDHHS continues to partner and support the Great Lakes Breastfeeding webinar series, a project of the Michigan Breastfeeding Network, which offers breastfeeding-specific information every month at no cost to participants. Over the last year, the Michigan Breastfeeding Network has expanded the types of continuing education offered through the webinars and now provides contact hours for nurses, social workers, lactation consultants, community health workers, certified health education specialists, physicians, and dietitians. This free, easy-to-access education allows all providers the ability to receive advanced training, which diversifies and strengthens Michigan’s lactation workforce. Topics have a strong focus on health equity and supporting community-driven work in BIPOC communities. The webinars have been viewed by participants in 24 countries; in the U.S., there have been participants from all 50 states and the District of Columbia. Webinar participants report a variety of job functions including peer counselors, maternity care nurses, home visitors, other breastfeeding services, nutrition, social work, physicians, and nurse practitioners.

In August 2022, the State of Michigan issued a proclamation recognizing August 2022 as Breastfeeding Month in Michigan. Proclamations were also issued recognizing Black Breastfeeding Week and Indigenous Milk Medicine Week in the State of Michigan. The WIC Division hosted a webcast to celebrate Black Breastfeeding Week, which was viewed by 81 participants.

In FY 2022, MDHHS funded a social media campaign, which targeted the areas within Michigan that experience the largest breastfeeding disparities. The goal of the campaign was to normalize breastfeeding among young parents and promote the ways in which breastfeeding has been shown to reduce the risk of sleep-related infant deaths. Social media content was created with a goal of reaching parents and pregnant people who are 21 and under, extended family networks and friends of BIPOC parents and pregnant people of any age, and those with household incomes of $33k or less. Content from the campaign was viewed or heard over 20 million times, and nearly 50,000 clicks to the MDHHS website were generated from the campaign. MDHHS continues to identify new and innovative methods, including via social media, to promote breastfeeding within the communities most affected by breastfeeding-related disparities.

The MDHHS Communications team has continued to prioritize creating and posting breastfeeding promotional messages on the department’s social media accounts. MDHHS has over 147,000 Facebook followers, over 34,000 Twitter followers, and over 12,000 followers on Instagram. As part of breastfeeding awareness commemorations during August, MDHHS created and shared 18 posts promoting breastfeeding across all MDHHS social media pages. Social media posts were created to recognize specific groups and celebrations throughout the month of August, including Indigenous Milk Medicine providers, Asian American, Native Hawaiian and Pacific Islander Breastfeeding Week, and Black Breastfeeding Week.

Rather than facilitating community efforts in one community to impact low breastfeeding rates among women of color, a more complete approach was used by funding 10 BIPOC-led breastfeeding organizations as described above. Organizations were based throughout the state in Detroit, Grand Rapids, Saginaw, Benton Harbor, Battle Creek, Pontiac, the Upper Peninsula, and Flint. In addition, MDHHS continues to work with the Genesee County Health Department to increase breastfeeding rates within Genesee County and the City of Flint. Activities were impacted by the COVID-19 pandemic, but breastfeeding promotion progress has resumed.

Safe Sleep (FY 2022 Annual Report)

Michigan’s safe sleep strategies and activities promote three key messages to parents and caregivers: infants should sleep 1) alone, 2) on the back, and 3) in a crib, bassinet or pack and play. These behaviors are critical to the prevention of sleep-related infant death. Of the leading causes of infant death, sleep-related causes are considered the most preventable. In FY 2022, Title V federal funding was used for activities that support Michigan’s safe sleep work, including PRAMS, infant mortality communication, Fetal Infant Mortality Reviews, breastfeeding support, and funding to local health departments to support community-based safe sleep prevention efforts.

When comparing birth year 2019 to birth year 2020, there were improvements in the weighted percentage of mothers placing infant to sleep on the back, in separate approved sleep surface, and with no soft objects or loose bedding. However, none of the measures reached a statistically significant improvement. In 2020, 85.4% of Michigan mothers placed their infants to sleep on their back, compared to 84.9% in 2019. The proportion of infants sleeping with no soft objects (i.e., pillows, bumpers, blankets, toys) has increased from 63.1% in 2019 to 66.7% in 2020. Infants placed to sleep on a separate approved sleep surface increased from 40.6% in 2019 to 41.5% in 2020. Starting in 2016, this measure has been based on the combination of five different sleep risk factors, including whether infants sleep in a car seat or swing. That risk factor has an especially large impact on this measure.

While four distinct objectives for infant safe sleep were identified, the strategies to address them are combined, since the safe sleep behaviors are so closely related. All strategies and activities will promote the key messages to parents, caregivers, and providers that infants should sleep alone and without objects on the back, in a crib, bassinet or pack and play and will continue to address ways to increase those behaviors by all families, while also addressing the disparity for non-Hispanic Black families.

Objective A: Increase the percent of infants put to sleep on their backs from 84.9% in 2020 to 92.3% by 2025.

Objective B: Increase the percent of infants put to sleep on a separate approved sleep surface from 40.6% in 2020 to 53.5% by 2025.

Objective C: Increase the percent of infants placed to sleep without soft objects or loose bedding to from 63.1% in 2020 to 80.9% by 2025.

Objective D: Increase the percent of non-Hispanic Black infants put to sleep on their backs, put to sleep on a separate approved sleep surface, and put to sleep without soft objects or loose bedding.

In FY 2022, activities occurred within six strategies:

1. Support safe sleep activities of local health departments and the Inter-Tribal Council of Michigan.
2. Support providers to implement safe sleep policies/protocols/programming so that families receive infant safe sleep education and access to resources.
3. Explore legislative/regulatory change to increase the number of babies that are safely sleeping.
4. Develop and share tools with providers, families, and workers regarding having client/patient centered conversations regarding safe sleep.
5. Promote protective factors (i.e., smoking cessation, breastfeeding, immunizations) and evidence-based programs (i.e., home visiting) to enhance the overall health and well-being of moms and babies.
6. Engage hospitals in areas with a high rate of sleep-related infant deaths and disparities to explore needed policies and resources to support families of NICU infants in practicing safe sleep behaviors after discharge.

The first strategy is to support the safe sleep activities of local health departments (LHDs) and the Inter-Tribal Council of Michigan (ITC) to increase the capacity of communities to implement infant safe sleep education, awareness, and outreach activities. In FY 2022, the Detroit Health Department received $125,000 in funding, four other LHDs received $70,000 in funding, and the ITC received $45,000 in funding. These five LHDs account for 51% of sleep-related infant deaths in the state and experience significant racial disparities among the deaths. Grantees are required to participate in or coordinate a local/regional advisory team to oversee their safe sleep efforts. The teams are required to include community members. The grants allowed communities to develop programming that targeted the highest-risk areas and that were informed by the community. Activities ranged from providing safe sleep education sessions; purchasing billboards; providing group classes; conducting community awareness events; creating public service announcements; engaging families; and promoting protective factors such as breastfeeding and smoking cessation. A portion of the grant funds were used to purchase pack and plays, sheets, and/or sleep sacks.

In FY 2022, the COVID-19 pandemic continued to have an impact on grantees with many offices and related services only operating virtually. Grantees have moved to a hybrid approach to be flexible on whether events are in-person or virtual. Several LHDs planned to implement the Society for Public Health Education (SOPHE) SCRIPT® (Smoking Cessation and Reduction in Pregnancy Treatment) Program but were unable to due to only seeing families virtually. Despite challenges, grantees were able to provide infant safe sleep education to nearly 12,000 individuals (parents, caregivers, professionals, and community members) through virtual and in-person classes and community events. LHDs continued to be creative in ways to reach families, hosting virtual house parties and gender reveal parties, as well as virtual bingo. Some LHDs were exhibited at untraditional places such as farmers’ markets.

Social Determinants of Health (SDOH) are drivers in the disparity of sleep-related infant deaths. In addition to community members, the local/regional advisory teams are required to include partners that can address SDOH. This includes partners that can meet resource needs of families, as well as partners that work further upstream to address systemic policies and practices that drive disparities.

A second strategy was to support providers in implementing and updating existing safe sleep policies or protocols so that families receive infant safe sleep education and access to resources. An evidence-based or -informed strategy measure (ESM) was established to increase the number of agencies that have a safe sleep policy/protocol. Agencies faced a multitude of constraints (staff turnover, the pandemic, etc.) that limited their ability to update or implement a policy/protocol. Therefore, this ESM was updated to focus on the number of agencies that received technical assistance on updating or implementing a policy. Four agencies received technical assistance and support with implementing and/or updating a safe sleep policy. One local health department implemented the policy with their home visiting program, with plans of rolling it out to other programs. Another program already had a policy but made some updates. In addition, the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program was provided technical assistance on a policy guidance document for their funded programs. All MIECHV programs will be required to implement a safe sleep policy by the end of FY 2023.

As part of the third strategy, in FY 2021, the MDHHS Infant Safe Sleep (ISS) program met with MDHHS Legislative Affairs to discuss how to increase awareness among the legislature about maternal child health and infant safe sleep. A presentation on infant safe sleep was made to the Senate Families, Seniors, and Veterans Committee and a Lunch and Learn for Legislative staff was held in October 2021. This strategy also included identifying possible legislative or regulatory changes that would increase the number of babies safely sleeping. A scan of regulations was completed in FY 2020 and a proposed policy/regulation change document was developed. Updates were made in FY 2021. This document was shared with the Maternal Infant Health (MIH) Policy and Legislation Action Committee in late FY 2021. The committee planned to determine any actions in FY 2022, but they didn’t pursue any items because of other priorities.

A continued strategy was to develop and share tools with providers and family support workers on how to have client/patient centered conversations regarding safe sleep. This strategy included continuing to promote the Helping Families Practice Infant Safe Sleep (Safe Sleep 201) training and incorporating the core tenets of this training into other educational venues: how to have more effective conversations with families by starting where the family is at, educating on safe sleep guidelines and helping the family evaluate their current risk and explore strategies for risk reduction. A continued ESM is to increase the number of Maternal Infant Health Program (MIHP) agencies that have staff trained to use motivational interviewing with safe sleep. In FY 2022, all 72 MIHP agencies have staff trained to use the concepts of motivational interviewing with safe sleep by requiring the Safe Sleep 201 training for all staff.

To reach professionals who work with pregnant and parenting families, the MDHHS ISS Program continued to build upon connections with existing partners, such as the Women, Infants and Children (WIC) Program, home visiting programs (MIECV and MIHP), child welfare, the Regional Perinatal Quality Collaboratives, MDHHS Tobacco, and MDHHS Emergency Medical Services and Trauma (EMS). These continued collaborations led to training on the safe sleep basics, how to support families, and access to resources for a variety of professionals. In FY 2022, nearly 1,000 individuals attended a virtual or in-person safe sleep training and over half of those individuals received training on how to support families. In addition, over 10,000 individuals completed one of the three online infant safe sleep trainings, just over 140 hospital nurses and other staff took the online training Infant Safe Sleep: The Basics and Beyond, and over 275 participants attended one of four safe sleep webinars. Providers were also supported with access to free educational materials; over 215,000 educational items were distributed by MDHHS in FY 2022. By the end of FY 2022, over 5,700 professionals were subscribed to the infant safe sleep email listserv, an 80% increase over FY 2021.

As an additional tool to integrate safe sleep education into prenatal visits, the High Touch, High Tech (HT2) e-screening tool, which delivers a brief motivational intervention and helps connect families to additional supports, was expanded to include screening for safe sleep knowledge and behaviors. The safe sleep education modules were rolled out in May 2022. To date, over 600 patients participated in the prenatal safe sleep intervention.

Another strategy is to promote protective factors (i.e., smoking cessation, breastfeeding, immunizations) and evidence-based programs (i.e., home visiting) to enhance the overall health and well-being of moms and babies. As noted above, outreach to and coordination with other MDHHS programs continued. In conjunction with MDHHS Tobacco Section, the MDHHS ISS Program continued to host a quarterly call to support local health departments implementing SOPHE SCRIPT and other smoking cessation activities.

In FY 2021, University of Michigan students completed a Capstone project on how MDHHS can better address the needs of younger parents—including teen parents and those 20-24 years old—through more effective programming and messaging for these cohorts. The Capstone project helped launch several projects, supported by Title V funds, directed at youth and young parents. These included a media campaign on breastfeeding and infant safe sleep. The media campaign was developed by first having the Michigan Organization on Adolescent Sexual Health (MOASH) complete education sessions and focus groups on safe sleep and breastfeeding with a diverse group of youth ages 13-21. The themes that emerged in the focus groups were used to develop media (social media posts and audio streaming app ads) that ran in the first quarter of FY 2022. The campaign ran statewide, but targeted parents and pregnant people 21 and under, as well as the LGBTQ+ community. Through audio streaming, almost 700,000 impressions were delivered; through Facebook, over 500,000 impressions were delivered with over 7,000 post engagements; and through Instagram, over 66,000 impressions were delivered with over 2,500 post engagements.

MDHHS ISS Program continued to explore other ways to engage families directly in the work, including support of the MIH Infant Safe Sleep Action team which included two parent members. In FY 2022, the parent members were active at meetings and helped plan Infant Safe Sleep Awareness month activities for October 2022.

The final strategy is to engage hospitals in areas with a high rate of sleep-related infant death and disparities to explore needed policies and resources to support families of NICU infants in practicing safe sleep behaviors after discharge. In FY 2021, two hospitals volunteered to participate. They helped the MDHHS Infant Safe Sleep Program develop sample infant safe sleep protocols and crib audit forms for hospitals to use as a guide in creating or updating safe sleep policies. These resources are available online for any hospital that wants to utilize them to develop or update a policy.

An ESM was utilized to track the number of hospitals that have implemented or revised/updated a safe sleep policy/protocol. However, hospitals faced a multitude of constraints (staff turnover, the pandemic, etc.) that limited their ability to update or implement a policy/protocol. Therefore, this ESM was updated to focus on the number of hospitals that received technical assistance and support on updating or implementing a policy. Technical assistance was provided to one hospital and their updated policy will be rolled out in FY 2023. One hospital that worked to revise a policy in FY 2021 was going to roll it out in FY 2022 but experienced several delays. Due to limited response from the contact, it is unknown if it was rolled out in FY 2022. However, that hospital did recruit Safe Sleep Champions for their pediatric, NICU and Mother Baby Units. In that role, they conduct regular crib audits.

In FY 2022, the MDHHS Infant Safe Sleep program was connected to a hospital that felt more attention needed to be paid to social determinants of health and other factors. Several meetings were held to discuss this concern, and technical assistance was provided to help better connect their patients with services in the community.

The Infant Safe Sleep program worked with one hospital to get the online training for hospital nurses and staff, Infant Safe Sleep: The Basics and Beyond, integrated into their staff education system. In FY 2023, that hospital plans to make the training mandatory for staff.

Finally, the program continues to host quarterly meetings for hospitals. The informal meetings are intended to be an avenue for hospitals to learn what other hospitals are doing to support safe sleep, learn about MDHHS activities, serve as a venue to problem solve, and be an avenue to obtain resources and have questions answered.