Perinatal/Infant Domain: Annual Report (October 1, 2020 – September 30, 2021)
Priority: Safe Sleep
National Performance Measure 5:
- Percent of infants placed to sleep on their backs
South Dakota exceeded the 2020 target of 86.8% with 87.8% of infants placed to sleep on their backs in 2020. South Dakota ranked 6th in the nation with a significantly higher rate than the U.S. rate of 79.8%.
- Percent of infants placed to sleep on a separate approved sleep surface
South Dakota did not exceed the 2020 target of 41% with 40.1% of infants placed to sleep on a separate approved sleep surface in 2020. The percentage dropped from 40.5% to 40.1% from 2019 to 2020. South Dakota ranked 11th in the nation with a higher rate than the U.S. rate of 36.9%.
- Percent of infants placed to sleep without soft objects or loose bedding
South Dakota exceeded the 2020 target of 52.5% with 55.8% of infants placed to sleep without soft objects or loose bedding in 2020. South Dakota ranked 16th in the nation with a higher rate than the U.S. rate of 52.5%.
Reducing infant mortality is a public health priority in SD. Although the state’s rate has been steadily declining, the post neonatal and Sudden Unexpected Infant Death (SUID) mortality rates remain high and wide disparities persist across races. Infant mortality rates of American Indian, non-Hispanic infants have historically been 2-3 times higher than that of white, non-Hispanic infants in SD.
Most infant deaths in the post-neonatal period are related to infant sleep. Of the 95 sleep related deaths that occurred post hospital discharge, nearly 80% occurred in an unsafe sleep environment (SD Child Death Review 2016-2020). SUID rates remain higher in SD than the national average. According to the National Center for Health Statistics (NCHS) 2016-2019 SUID data, SD’s SUID rate is 135/100,000 compared to the national rate of 91.
To address these issues, the SD Department of Health’s Strategic Plan Goal 2 Provide Services to Improve Public Health includes 2 strategies the MCH team/NPM #5 workgroup are responsible for:
- Collaborate with birthing hospitals in SD to become Cribs for Kids Safe Sleep Certified
- Share infant mortality prevention strategies with 3 healthcare associations
The MCH NPM #5 workgroup has a diverse membership including:
- Assistant Vice President of Inpatient Nursing Services, Avera McKennan Hospital
- Clinical Nurse Specialist, Sanford Children’s Hospital NICU
- Director, Department of Social Services (DSS) Childcare Services
- Early Childhood Field Specialist, SDSU Extension Services
- Death Review Abstractor, Child Death Review (CDR)/National Violent Death Review (NVDR)
- Family Advocate – Lach’s Legacy founder
- Executive Director, Sanford Children’s Hospital/Clinics/Community Services
- Clinical Research Manager, Avera Research Institute, Pine Ridge Reservation
- MCH team lead, Infants Domain/State CDR Coordinator
The beginning of this grant year was a challenging time for MCH as well as workgroup members. The workgroup facilitator and many partners were emersed in COVID response efforts across the state. The workgroup met on ZOOM three times and moved forward with activities on the NPM #5 state action plan at a slower pace than was anticipated. A summary of our progress follows.
Objective: Reduce the number of SUID deaths related to unsafe sleep environment from 139.8/100,000 in 2019 to 103.9/100,000 by 2025. (NVVS)
Data Statement: In 2018, South Dakota’s (SD) SUID death rate related to unsafe sleep environment was 168.2/100,000. SD met the 2019 annual target of 157.5/100,000 with a rate of 139.8/100,000. SD ranked 41st in the nation (2019) and had a higher rate than the U.S. rate of 89.8/100,000. The change from the base year (2015) to the current year is not significant.
Objective: Increase the percent of infants placed to sleep without soft objects or loose bedding from 55.8% in 2019 to 57.2% by 2025 (PRAMS)
Data Statement: In 2019, SD’s percent of infants placed to sleep without soft objects or loose bedding was 52%. SD exceeded the previous 2025 target of 54.8% with 55.8% of infants being placed to sleep without soft objects or loose bedding in 2020. SD ranked 16th in the nation (2020) with a higher percentage than the U.S. at 52.5%.
Strategy 5.1: Disseminate culturally appropriate safe sleep educational materials, resources, and messages via social media, print, and radio.
The MCH Team continued to work with Hot Pink Media group to disseminate culturally appropriate messages. Social media posts were promoted to a South Dakota specific audience consisting of parents with children under the age of two, grandparents, and childcare providers. See metric table below.
Data to Action: Based on disparities (in the 2015-2020 Vital Statistics and CDR data) regarding race, the NPM #5 Safe Sleep workgroup promoted a safe sleep message via radio in reservation communities and utilized Native families in Facebook posts (below).
Radio flights featuring safe sleep messaging were planned and placed during this grant period. A 60-second American Indian voiced spot (below) focused on safe sleep with emphasis on putting babies to sleep on their backs, on a firm surface alone, room sharing but not bed sharing, and safe cribs. This ad points listeners to the For Baby’s Sake website. For Baby's Sake | Healthier moms + Healthier babies (forbabysakesd.com)
(Lakota Phrase) “BEBELA WA IYUNKA” or “ABU… ABU.. ABU” or combine phrases
(Repeat in English): SHHHHH! BABY'S ASLEEP.
IT SEEMS SIMPLE, BUT WE KNOW THERE'S MORE TO KEEPING BABY SAFE.
BEFORE YOU LAY YOUR BABY DOWN TO SLEEP, BE SURE TO FOLLOW THESE SAFE
SLEEP GUIDELINES –
FIRST, BABIES SLEEP SAFEST ON THEIR BACKS, ON A FIRM SURFACE, WITHOUT
PILLOWS, BLANKETS, BUMPER PADS, OR TOYS.
NEXT, BABIES SHOULD ALWAYS SLEEP ALONE, NEVER SHARING ANY SLEEP
SURFACE WITH AN ADULT, ANOTHER CHILD, OR PET. ROOM SHARING IS OKAY,
BED SHARING IS NOT.
COUCHES, CHAIRS, INFANT SEATS OR SWINGS ARE NOT SAFE PLACES FOR BABY
TO SLEEP. EVERY SLEEP TIME COUNTS.
AND, FINALLY, BABIES NEED A SAFE CRIB. IF YOU HAVE QUESTIONS ABOUT
WHERE YOUR BABY SHOULD SLEEP, OR CAN'T AFFORD A SAFE CRIB - WE CAN
HELP.
(Lakota Phrase) “ENAH EEWAH CHEE CHEE YE” (Mommy I need your help)
HELP YOUR BABY SLEEP SOUNDLY AND SAFELY.
FIND OUT MORE AT FOR BABY'S SAKE S-D DOT COM.
Data to Action: SD CDR data shows increase in percentage of infant deaths occurring in an adult bed. (NCFRP Case Reporting System)
This increase (in the percent of infants sleeping in an adult bed) prompted the creation of this ad for Black Hills Parent magazine.
Strategy 5.2: Collaborate with diverse community partners to provide CDR and disseminate findings to all South Dakotans.
MCH continues to support the work of 2 Regional CDR teams (East River and West River) and a Statewide Preventable Death Committee. DOH’s goal was to have both teams utilizing the same process for reviewing cases. To accomplish this, staff from the National Center for Fatality Review and Prevention provided training, Steps to an Effective Review, for the West River team (East River team was already using the process that we wanted to emulate). All West River team members scored above an 80% on a posttest demonstrating knowledge of the new death review process. This ESM was then revised and a training on upstream root causes of infant death was added to the list of activities for the coming year.
In addition to this training, the State CDR coordinator began participating in a Health Equity Learning Collaborative through the NCFRP. Topics included:
- Equity focused tools and strategies for victim/family blaming
- Upstream cases of child death
- So many prevention recommendations, yet so few resources
Infant death review data in the form of an 8 1/2” x 11” glossy handout is used to promote safe sleep practices statewide. The handout, Safe Sleep Practices Can Save Lives, was updated in English and Spanish (to promote health equity) for continued use in discharge packets at the 3 largest birthing hospitals: Sanford Sioux Falls, Avera McKennan, and Monument Health Rapid City. It is also given to new parents at the IHS hospital in Pine Ridge. Three hundred copies were distributed to participants (added to informational packets) at Lach’s Legacy Run for Their Lives walk/run fundraisers in May and June of 2021. Lach’s Legacy hosts these events yearly in Harrisburg and Spearfish to promote SIDS awareness and educate families on safe sleep practices. The Safe Sleep Practices Can Save Lives handout is also utilized as a teaching tool by field staff within the Office of Child and Family Services (OCFS) who serve low-income families in 74 Community Health Offices across the state.
The State CDR Coordinator and one of the Pediatricians from the East River CDR team were scheduled to present CDR data at the Medical Examiner’s law enforcement/coroner’s training (Infant Death Scene Investigations) at the end of this grant year but it was canceled due to a spike in COVID cases.
An Infant Mortality Report (2016-2020) and Infant Mortality data dashboard were added to the DOH website and include data from SD CDR.
2016-2020: Full Report | 1 pager
Infant Mortality Data Dashboard
Infant Mortality - Infant Death Review (sd.gov)
Strategy 5.3 Collaborate with diverse, multi-sector organizations/agencies to promote safe sleep
The MCH Safe Sleep workgroup is made up of multi-sector organizations including birthing hospital administrators, a Neonatal Clinical Nurse Specialist, DSS Childcare Licensing, Extension Services, a family advocate who runs a non-profit in the fight against SIDS, and a tribal representative active in native safe sleep research. Together this workgroup reviews current data and determines evidence-based strategies to decrease infant mortality. The pie graph below is one of the data points that was used to pivot away from focusing on licensed daycares and redirect activities to moms and dads. The current ESM, % of daycares who respond to survey and indicate that they follow safe sleep guidelines was abandoned for this reason. Licensed daycares continue to receive safe sleep education, training, and technical assistance in developing safe sleep policies.
Data to Action: The pie graph below (SD CDR data) shows that almost 80% of infant deaths occurred when the infant was in the care of mom, dad, or mom’s partner. The Safe Sleep (NPM #5) workgroup decided to target safe sleep education to these caregivers by partnering with the National Cribs for Kids program and all SD birthing hospitals to promote safe sleep certification within their system. The certification ensures that all families hear the safe sleep message before leaving the hospital after birth.
The NPM #5 workgroup decided to partner with Cribs for Kids to promote bronze level safe sleep certification in all 21 birthing hospitals in the state. Workgroup members affiliated with hospital systems became champions within their hospital and its affiliates. By the end of this grant year, champions had been named for 8 of the 21 birthing hospitals and information on the certification process was provided. Bette Schumacher, CNS Sanford Neonatal has taken the lead for the 6 Sanford birthing hospitals and Kerri Bjornson, Neonatal CNP is leading the Monument Health Systems efforts (2 birthing hospitals).
Family Advocate: Brianne Edwards, Lach’s Legacy
The Safe Sleep workgroup added a new member this grant year who has experienced infant loss. Brianne Edwards and her husband founded Lach’s Legacy after losing their baby boy in 2008 to SIDS. Their website, www.lachslegacy.org states “Since 2008 we have been working to give comfort to families when it is needed most, education to those who can potentially reduce a child’s risk of sudden death, and hope for an answer where there currently is no explanation.” Their non-profit offers comfort to grieving families through a care package of items that can give a starting point to the long road of healing. Lach’s Legacy has partnered with law enforcement across the state to provide information about their care packages via a 3x5 informational card to hand to a parent that has just experienced the loss of their baby. Law enforcement agencies perform all death scene investigations and family interviews when a baby dies unexpectedly in SD. The cards were provided to the Division of Criminal Investigation (DCI) witness specialists, DCI agents, county sheriffs, and police chiefs across the state. Brianne is also a member of the West River CDR team where she steers discussions away from family blaming to focusing on upstream factors. Bri is currently working on a book for bereaved parents titled A Thousand Pounds about her own experience of loss and learning to live under the weight of unbearable grief.
Bright Start/Community Health Safe Sleep CQI project: The MCH Infant Domain Lead and Community Health Nurses (CHNs) from across the state collaborated with DOH’s Bright Start visiting nurse program on their 18-month safe sleep CQI project. The SMART Aim for the project: By December 2021, improve from 81% to 83% the percentage of Rapid City Bright Start and WIC infants under the age of 6 months who are always put to sleep on their backs without bed-sharing or soft bedding.
Over the course of the project, WIC, Baby Care and Bright Start staff collected data on Safe Sleep. One significant improvement was that all staff began asking the same 3 Safe Sleep questions so there was consistent data across programs for infants under the age of 6 months who are always put to sleep on their backs without bed-sharing or soft bedding. During this time, the clients who answered “Always, Never, Never” to the questions ranged from 73-88% with a median of 79%. One note on the baseline data for this project is that home visiting staff were concerned with the high percentage of “Always, Never, Never” answers at the start of the project since the visits were virtual or over-the-phone due to COVID: concern that this may have affected the validity of the answers since the nurses were not in-person with the clients.
Data collection differed among programs (Bright Start Home Visiting, WIC/Baby Care) so the first task was to standardize the safe sleep questions and begin collecting data. The team reviewed safe sleep best practices with the MCH Lead. A fishbone diagram was developed along with strategies for implementation. PDSA were completed with families and Nurse Home Visitors to gather feedback on effectiveness/relatability of safe sleep videos used for family education. Recommended safe sleep video resources were emailed to all CHNs and Bright Start nurses. Team members determined they would provide credible resources (ex. videos, safe sleep environment and baby anatomy fact sheets, culturally relevant) to nurses but leave to nurses’ discretion which resources are provided to each family. The team discussed strategies to assist families who indicate they are not practicing safe sleep guidelines. CQI Nurse Consultant provided technical assistance on the CQI tools and methods during the meetings.
At the conclusion of the project, the team shared two main strategies to continue moving forward. First, the three safe-sleep questions asked of clients enrolled in the evidence-based home visiting program were included in the Office of Child and Family Services new electronic health record (EHR) so data could be collected in the same way across all DOH programs. Second, the team identified a set of evidence-based and relevant resources and training materials to increase consistency in staff and client education on safe sleep principles.
Cribs for Kids (C4K) safe sleep kit distribution: OCFS Community Health offices across the state (74 total) continued to partner with the National C4K program to provide safe sleep kits to families in need of a safe environment for their infant to sleep. In CY 2021, 713 kits were distributed containing a Pack ‘n Play unit. The number is down from last year’s total of 751. The pandemic has made it a challenge to disperse the kits as clients were receiving telephone calls for WIC appointments instead of in-person visits. Safe sleep education was provided over the phone and the families then made arrangements to meet a staff person at the door of the clinic to pick up the kit. Pre-pandemic, Community Health Offices were issuing over 1,000 kits per year.
Strong South Dakota Families mailings: Title V continued its collaboration with the governor’s office by including the Sleep Baby Safe And Snug book (Charlie’s Kids Foundation) in the Strong Families packets that are mailed to new parents/caregivers in SD. The packets contain information and resources on a variety of topics.
Strong Families South Dakota (sd.gov) Below is the section on safe sleep from the website.
Safe Sleep
Using safe sleep practices will greatly reduce a baby’s risk of SIDS (sudden infant death syndrome) and SUID (sudden unexpected infant death). Learn guidelines for safe sleep and other ways to keep your baby safe.
Approximately 300 packets are mailed out every month.
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