Promoting safe sleep practices is a public health priority. Much research has been conducted about safe sleep practices that address Sudden Infant Death Syndrome (SIDS) and suffocation risk reduction. Simple caregiving techniques can play a critical role in keeping infants safe during sleep.  Parents, family members, teachers and all adults who care for an infant for one nap or many should follow safe sleep practices every nap time and every sleep time. Sleep-related preferences may be sensitive to a family’s culture or personal preferences and beliefs.

During our 2015 MCH Needs Assessment one (1) state priority need was identified that was inclusive of the perinatal/infant population:

• Reduce infant mortality

Under the National Performance/Domain framework, 1 National Performance measure was chosen and the objectives, strategies, activities are identified within the State Action Plan framework. In addition to the National Performance measure activities there are other perinatal/infant efforts that MCH team members support to assist in addressing perinatal/infant health priority needs.  Efforts include:

• Spearfish Police Department held a Sudden Unexpected Infant Death Investigation (SUIDI) training instructed by Brett Garland, SD Division of Criminal Investigation and member of the East River Infant Death Review (IDR) team, on September 4, 2019.  There were 43 law enforcement officers from the western part of the state in attendance.
• Jill Munger, the facilitator for NPM #5 workgroup met with Carol Cressman, director of Sanford Children’s Hospital (Sioux Falls) Pediatric and Pediatric Intensive Care units to share data from IDR.  Carol dispersed the South Dakota IDR infographic to Neonatologists, Pediatricians, and nursing staff within the Sanford Medical System.
• MCH team e-mailed Neighborhood Safety Network’s notice regarding the inclined sleeper recalls to all OCFS field offices (77 total).  Staff were instructed to discuss with parents of infants and to post the recall where clients could see it when they came into the office.
• NPM #5 workgroup facilitator attended the Annual Perinatal Conference in Rapid City, September 2019:

• Networked with nurse managers and nursing staff from Labor & Delivery, Postpartum and NICUs from Avera McKennan, Sanford Sioux Falls, and Regional Health (three largest hospitals in the state) All three hospitals have agreed to start utilizing DOH’s Safe Sleep Practices Can Save Lives handout in their discharge packets.  The handout includes state specific data from the 2014-2018 IDR.
• Promoted PRAMS to all attendees and encouraged nursing staff to inform their new moms that they may be receiving the survey a few months after discharge.
• Promoted DOH’s Breastfeeding Friendly Business Initiative to support communities working together to increase breastfeeding rates as a strategy to decrease infant mortality.

• An ad was placed in SD Medicine Journal in December 2018 and January 2019 Breastfeeding – More Than Just a Lifestyle Choice to inform providers of the reasons many moms stop breastfeeding.  Data presented in the ad was from the 2016 PRAMS-like survey.  SD Medicine has approximately 2,000 subscribers.
• South Dakota State University’s E. A. Martin Program released the 2017 PRAMS data related to NPM #5 in May 2019.  The NPM #5 workgroup reviewed the data at their August meeting and discussed ways to continue to promote the safe sleep message to caregivers.

At the end of this reporting period the MCH Impact Team workgroup members assigned to each National or State performance Measure were asked to complete a data collection form.  The data collection form was a checklist of the strategies that the program was to address during the grant year. The workgroup members rated the degree to which the strategies were implemented, and the percentage of completion is included as the ESM for each measure.  In addition to this assessment for each measure, data were reported to provide a quantitative context for each strategy. This ESM process allowed us to better report progress to date on all strategies.  Data collection form can be found at the link below:  

https://doh.sd.gov/documents/MCH/NPM5_2021DetailSheet_ESM.pdf

DOH Strategic Plan Goal 2: Support life-long health for all South Dakotans

National Performance Measure 5:

 A) Percent of infants placed to sleep on their backs

 B) Percent of infants placed to sleep on a separate approved sleep surface

 C) Percent of infants placed to sleep without soft objects or loose bedding

Data Statement:

1. South Dakota did not reach the 2019 target of 89.3% and there was no significant change in the percentage of infants placed to sleep on their backs from 87.6% in 2017 to 87.0% in 2018.  In 2018, South Dakota was ranked 4th out of 30 states for the highest percent of infants being placed on their back to sleep and the 2018 U.S. rate was 80.6%. 
2. South Dakota exceeded the 2019 target of 39.2% with 41.6% of infants being placed to sleep on a separate approved sleep surface in 2018.  This was a significant increase from 38.4% in 2017.  South Dakota was ranked 1st out of 30 states and the 2018 U.S. rate was 33.8%.

3. South Dakota did not meet the 2019 target of 48.4% with 46.9% of infants being placed to sleep without soft objects or loose bedding in 2018.  There was no significant change from the 2017 rate of 48.2%.  In 2018, South Dakota was ranked 18th out of 30 states that had an overall rate of 48.1%. 

The full-length South Dakota MCH Annual Data Summary can be found here:

https://doh.sd.gov/documents/MCH/2020_SD_MCH_DataSummary.pdf

State Objective:

By June 30, 2020, increase the percent of infants from other races (not White or AI) placed to sleep on their backs from 86.2% (2016) to 89.9% (PRAMS)

State Objective Data Statement:

South Dakota reached the 2019 target of 85.1% with 85.8% of infants from other races (not non-Hispanic white or American Indian) being placed to sleep on their backs in 2018.  This was a significant increase from 82.2% in 2017. 

Strategies:

5.1. Engage and support collaboration among state agencies to promote education on the importance of safe sleep practices.

• The Family Resource Network Early Childhood Education (ECE) Center at South Dakota State University (SDSU) offered a community-based safe sleep policy class for childcare providers in the Watertown area in April 2019.  This ECE also offers free on-line trainings to providers including a module Safe Sleep Practices – Reducing the Risk of SIDS.
• Bonny Specker, Epidemiologist with SDSU E. A. Martin Program’s article Safe Sleep Behaviors Among South Dakota Mothers and the Role of the Healthcare Provider was accepted for publication in SD Medicine.  The article is based on 2016 PRAMS data and determined that the role of the healthcare provider in talking to mothers was associated with greater compliance with some, but not all safe sleep recommendations.
• A Bright Start home visiting Facebook page is being developed by the OCFS’ marketing agency.  Once it is up and running safe sleep messages can be posted for home visiting clients across the state.
• Jill Munger, DOH’s IDR Coordinator, presented 2013-2018 data from the Child Death Review Case Reporting System at the All Staff Conference in July (2019) to help turn data into action.  The All Staff Conference includes all OCFS field and office staff from across the state, approximately 225 in number.
• The MCH team continued to support a University of South Dakota (USD) medical student’s (3rd year) Pathways Scholarship project on SIDS prevention.  The student has surveyed approximately 300 parents of infants at Black Hills Pediatrics to determine what information they received regarding safe sleep practices.  His next step is to survey parents at Community Health Center of the Black Hills.
• The MCH program continues to partner with USD Nursing Program in Sioux Falls to provide safe sleep classes at the Teddy Bear Den for low income families in the Sioux Falls area.

5.2. Implement strategies to increase awareness of the importance of safe sleep practices targeted to American Indians, dads and grandparents.

• The National Institute of Health’s Dads Can Help Baby Sleep Safe posters were distributed to all field offices (77) across the state for display.
• MCH team members presented information about IDR and safe sleep at the Thiwahe Zani Okichiya Ichahwichayapi (Raising Healthy Families Together) community advisory board meeting in Pine Ridge (October 2018).  Board members include representatives from IHS medical and dental services, Pine Ridge schools, SD Extension, Catholic Social Services, Pine Ridge WIC program, CASA, Delta Dental, Oglala Lakota Head Start/Early Head Start, SD School for the Deaf, IHS Midwife Clinic, Tribal Liaison for IHS, Bureau of Indian Affairs, DSS, Birth to Three, Bright Start Home Visiting, Victim Services, Sacred Shawl Society, Circle of Smiles, FACE (parenting program), and CHOICES (pregnancy prevention program for women who are in substance use treatment).
• Partnered with AARP in SD to target safe sleep messages to grandparents on their Facebook page.  FB posts ran in January 2019 and reached 700 members.
• In November 2018 the MCH team created a client centered handout using 2013-2017 data from SD IDR.  Copies of this Safe Sleep Practices Can Save Lives handout were dispersed at the Raising Healthy Families Together Community advisory board meeting in January 2019 and to members of the West River Infant Death Review Team in March 2019.  The Neonatal CNP who coordinates the team arranged for the handout to be included in the discharge packets of new parents at Rapid City Regional Hospital.
• In July of 2019 the Safe Sleep Practices Can Save Lives handout was updated to include 2018 data.  The updated version was dispersed to OCFS field staff (100+); Bright Start home visiting staff; East and West River death review team members; Pine Ridge IHS; Avera McKennan Hospital, Sanford Hospital - Sioux Falls, and Regional Hospital to include in their discharge packets to new parents.

• A new safe sleep ABCs ad (babies should sleep Alone, on their Backs, in a safe Crib) was created and ran in Black Hills Parent magazine’s summer 2019 issue.  Black Hills Parent is a full-size quarterly magazine with a circulation of 10,000 copies each issue (Over 3,000 copies of each issue are direct mailed to local area families with the remaining 7,000 copies distributed to schools, libraries, daycares, restaurants, hospitals, medical and dental offices, gyms, retailers, and coffee shops in the Black Hills region of SD).
• Distributed approximately 20 laminated NITHA KOZA PI KIN IYOTANWICAKILAPI HENA WAKAN PI (To Love Our Grandchildren is Sacred) safe sleep posters to OB clinics, hospital postpartum units, and NICUs at the Annual Perinatal Conference in Rapid City September 2019.
• Safe Sleep posts on For Baby’s Sake Facebook page:

Challenges:

• Lack of funding to create or use messaging for radio or television like we have done in the past.

5.3. Collaborate with community partners to provide infant death review.

• A new East River Infant Death Review team was formed in November of 2018 after the dissolution of the Regional Infant Child Mortality Review Committee. (RICMRC 1997-2018)  The new team is coordinated and chaired by the SD DOH and operates with MCH funding.  The first meeting was held in December of 2018. In CY 2018, the East River team met three times and reviewed 23 post-hospitalization infant deaths.
• The West River Infant/Child Death Review team met twice in CY 2018 and reviewed a total of six post-hospitalization infant deaths.  The West River team is coordinated by a CNP from Regional Health Systems in Rapid City who has a contract with DOH to run the West River review. (MCH monies).
• A Preventive Death Review Committee was established by the DOH in 2019 to 1) enhance the work around infant mortality 2) review infant and child death review processes 3) discuss interest in Maternal Morality review and 4) develop a process for preventive death review that is effective and easy to use for partners and providers.
• An ad hoc Infant/Child Death Review Committee was formed in August of 2019 under the umbrella of the Preventive Death Review Committee to discuss adding statewide child death review.  At present, Pennington County is the only county in the state reviewing child deaths.

Challenges: 

• Obtaining data from law enforcement agencies has been the biggest challenge for the death review process.  SD does not have a state mandate for death review.

5.4. Develop Safe Sleep Process orientation for clerical staff in OCFS.

• MCH team is in the process of developing a safe sleep process orientation for clerical in OCFS field offices.  Target completion date:  December 31, 2019.

Challenges:

• There is a safe sleep process orientation already in place for nurses and nutrition staff who work in OCFS field offices.  Seasoned clerical have already been assisting with this process.  It has been difficult to designate time developing this orientation guide with so many other safe sleep efforts taking priority.

5.5. Distribute Pack ‘n Plays to families who can’t afford a safe sleep environment.

• In CY 2019 the DOH partnered with the National Cribs for Kids program to distribute 1146 Pack ‘n Plays to low income families in SD.  SD partners and the number of Pack ‘n Plays they distributed:

• OCFS field offices: 1,023
• Rosebud IHS and Tribal MCH:  20
• Cheyenne River Sioux Tribal MCH: 80
• Teddy Bear Den (Sioux Falls):  23

Challenges: 

• The price of Pack ‘n Plays from Cribs for Kids has gone up due to the tariffs placed on goods from China.  This has decreased the number of units we can purchase for SD.

ESM: The degree to which the South Dakota Title V program has implemented evidence-based or informed strategies to assure implementation of infant safe sleep practices.

80% completion of identified strategies.