Fiscal year 2020 was a challenging year for the MCH workgroup within the Perinatal/Infant Domain.  At the start of this grant cycle, workgroup members actively participated in meetings and activities related to the MCH Needs Assessment process.  March - September found workgroup members actively involved with the Department of Health’s COVID response.  Members fulfilled various roles within the COVID surge including completing COVID investigations for active cases; facilitating COVID vaccinations across the state including planning and contracting with outside entities; and re-assigning and scheduling public health staff to COVID activities.  Every member of the workgroup was assisting in one way or another either part or full-time.  Despite these challenges, the workgroup continued addressing strategies on the current state action plan.  The results of these efforts are described below.

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/DOH field staff support to assist in addressing perinatal/infant health priority needs.  Efforts included:

• A NPM #5 workgroup member shared safe sleep resources/information with nurses from Ballard OB/GYN clinic in Rapid City.  Nurses at the clinic will be starting a monthly safe sleep class for their clients.
• South Dakota State University’s E. A. Martin Program released the 2018 PRAMS data related to NPM #5 Safe Sleep in the fall of 2019. The NPM #5 workgroup reviewed the data and discussed ways to continue to promote the safe sleep message to caregivers.  A Safe Sleep data brief was also added to the DOH website for public viewing in January of 2020 (based on the 2018 PRAMS data).
• Health professionals (nurses and dietitians) from each DOH Community Health Office across the state (76 offices total) completed training from the Michigan Public Health Institute (MPHI) titled Helping Families Practice Infant Safe Sleep. The training was a strategy for their local Infant Mortality Plan.  Health professionals make contacts with local providers, attend community events, and network with local agencies to get infant mortality prevention messages into their communities.
• Bright Start home visiting nurse, Sally Kangas, provided feedback to a government-led health education campaign’s website that provides education and outreach on safe infant sleep.  Volunteers were sought through an announcement by the National Center for Fatality Review and Prevention. Sally was asked to provide input on the layout of the website including titles of pages and links.  Bright Start nurses like Sally serve at-risk mothers and their children up to age 3.  Sally is the site coordinator for home visiting on the Pine Ridge Indian Reservation where SUID rates are higher than the state and national rates.
• DOH Community Health Nurses from Madison (Lake County) were able to convince the Madison Hospital to stop giving out baby boxes to new parents as a safe place for baby to sleep.  The hospital is no longer promoting their use.
• The MCH team continued to support Levi Franz’s (University of South Dakota medical student -4th year) Pathways Scholarship project on SIDS prevention.  A member of the NPM #5 workgroup helped facilitate a survey of parents at the Community Health Center of the Black Hills. Levi will submit his research findings Spring of 2021.
• The Rapid City Community Health Office began piloting an addition to their Postpartum Tracking tool that they had been using with all postpartum moms.  They added sleep questions similar to the ones in PRAMS to assess where baby is sleeping, how often the caregiver is placing the infant to sleep on their back, how often the caregiver bed-shares with their infant, and how often the infant sleeps with soft bedding.  Answer choices included always, sometimes, or never.  The questions were added to prompt a discussion on safe sleep practices.  The office plans to continue asking the questions as a Continuous Quality Improvement project for next FY.  The Rapid City office serves approximately 1,300 postpartum clients a year.

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/2020/DetailSheet_NPM5_FY20.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.  In 2019, the percentage of South Dakota infants placed to sleep on their backs was 86.6%. This did not yet reach the SD 2020 Target of 89.1%. It was a decrease from the previous year of 87.0% of infants being placed to sleep on their backs but the change was not significant. South Dakota ranks 7th in the U.S. and has a higher rate than the U.S. rate of 79.9%

2. In 2019, the percentage of South Dakota infants placed to sleep on a separate approved sleep surface was 40.5%. This did not yet reach the SD 2020 Target of 41.8%. It was a decrease from the previous year of 41.6% of infants being placed to sleep on a separate approved sleep surface but was not a significant change. South Dakota ranks 9th in the U.S. and has a higher rate than the U.S. rate of 35.9%

3. In 2019, the percentage of South Dakota infants placed to sleep without soft objects or loose bedding was 52.0%. This surpassed the SD 2020 target of 48.4%. It was an increase from the previous year of 46.9% of infants being placed to sleep without soft objects or loose bedding but was not a significant change. South Dakota ranks 20th in the U.S. and has a higher rate than the U.S. rate of 50.9%

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

https://doh.sd.gov/documents/MCH/2022_SDMCH_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:

In 2019, 85.6% of South Dakota infants from other races (not non-Hispanic white or American Indian) were placed to sleep on their backs. This did not reach the 2020 target of 89.9%.

Strategies:

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

• NPM #5 workgroup facilitator e-mailed Neighborhood Safety Network’s notice regarding the inclined sleeper recalls for 2019 to 4 DSS divisions: Behavioral Health, Developmental Disabilities, Policy and Strategy, and Child Protection Services as well as the Department of Education’s Birth to Three program for field staff to share with their families/caregivers that take care of infants.

• Bonny Specker’s (Epidemiologist with South Dakota State University’s E. A. Martin Program) article Safe Sleep Behaviors Among South Dakota Mothers and the Role of the Healthcare Provider was published in SD Medicine in April 2020.  The article is based on 2016 PRAMS data which 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. SD Medicine has approximately 2000 subscribers.
• MCH team collaborated with DSS Child Protection Services and DSS Economic Assistance departments to disperse SD Infant Death Review’s client centered handout Safe Sleep Practices Can Save Lives. Over 3000 copies were distributed during customer contacts; with applications or renewal materials that are sent monthly to new moms and pregnant women; and were displayed in office lobbies.
• Peggy Seurer, member of the NPM #5 workgroup presented a breakout session on Safe Sleep at the Home Visiting Institute in October 2019.   The Home Visiting Institute included staff from Early Head Start, tribal home visiting programs, and Bright Start home visiting. Peggy also had a booth at the SD LEADS conference in December 2019 and disseminated various Safe Sleep handouts to the attendees.  SD LEADS conference was the first of its kind sponsored by the governor’s office to energize and motivate women to be leaders in their communities. 
• MCH Team collaborated with SD WIC to have 2 infant sleep questions added to the WIC Infant Assessment to facilitate discussion on safe sleep.  The questions were: 1) Tell me about your baby’s napping and bedtime routines. And 2) Tell me about where your baby is sleeping.
• MCH Team collaborated with the Governor’s Office to promote safe sleep to parents of newborns by including the Sleep Baby Safe and Snug book (Charlie’s Kids Foundation) in the governor’s Strong Families mailings.  These mailings go out to mom’s who recently delivered a baby in SD.  MCH funds paid for 2,460 books and 988 mailings in this fiscal year.
• NPM #5 workgroup facilitator compiled a list of on-line safe sleep resources for DOH health professionals to utilize with client’s when they are unable to meet with the client in person (during COVID). 

Challenges:

• Difficult to know what state agencies it makes sense to collaborate with.  We need to think outside the box.  Another challenge is the time and energy it takes to seek out new partners. Workgroup members had to split their time between their own job responsibilities and COVID responsibilities.

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

• A 60-second radio spot addressing the early signs of pregnancy, prenatal care, and safe sleep, with emphasis on putting babies to sleep on their backs, on a firm surface alone, and room sharing, not bed sharing ran from October 7, 2019 through February 23, 2020. The primary audience was American Indian women of childbearing age (18-34) and while the buy was essentially a statewide schedule, the placement emphasis was in and around reservations and counties with high Indigenous populations. The flights pulsed on and off for 2-3 weeks and the relatively low budget was supplemented by an earned media requirement which allowed us to run nearly 1,800 spots on 9 stations with a frequency of 10.8 and gross rating points (GRPs) totaling 915.4—surpassing CDCs recommended best practice average of 800 GRPs per broadcast flight.

• Deb Kuehn, coordinator of the West River Child Death Review team, shared the client centered handout Safe Sleep Practices Can Save Lives with Native Women’s Health and Sioux San IHS in Rapid City to utilize with their clients.
• MCH Team worked with their media agency to expand the number of culturally appropriate images (including Indigenous dads) in our image library for social media and print materials.
• Safe Sleep Facebook posts for this fiscal year (For Baby’s Sake Facebook page) were culturally diverse and included Indigenous caregivers, dads, and grandparents.  Refer to printout below.

• Revision of the Safe Sleep section of For Baby’s Sake website was put on HOLD due to MCH team being pulled into COVID response.
• Infant Death Review’s client centered handout Safe Sleep Practices Can Save Lives was dispersed to Sanford, McKennan, and Monument Hospital’s NICU, Labor and Delivery, and Newborn Nursery units to utilize in their discharge packets for newborn parents.  It was also shared with the Family Practice Residency Program, Early Childhood Connections and Youth and Family Services all of Rapid City.
• An ad was placed in the October and November (2019) issues of SD Medicine Magazine with 5 ways providers can help assure more babies reach their first birthday. 

• An ad was placed in the December 2019 Black Hills Parent magazine to promote safe infant sleep.  Black Hills Parent magazine has a circulation of 10,000 copies.

Challenges:

• Lack of funding for television ads which were an effective way to share the safe sleep message in the past.
• Lack of time to work on strategies as team members were surged into DOH’s COVID response

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

• SD has 2 regional death review teams that review all cause infant deaths post hospitalization up to age 1 year. Both teams are multidisciplinary and include members from forensic pathology, law enforcement (Police Departments, Sheriff’s Departments, Division of Criminal Investigation, Bureau of Indian Affairs, FBI), EMS, Child Protection Services, States Attorney’s offices, hospital staff from the 3 major hospitals in SD, Pine Ridge IHS,  General Pediatricians, Child Abuse Pediatricians, and MCH staff from Great Plains Tribal Leaders Health Board.

• East River Child Death Review (CDR) team met twice in CY 2020 and reviewed a total of 15 post hospitalization infant deaths that occurred in a 44-county area. Eleven of these deaths had an ICD-10 code classification as Sudden Unexpected Infant Death (SUID).
• West River Child Death Review team met twice in CY 2020 and reviewed a total of 15 post hospitalization infant deaths that occurred in a 22-county area. Seven of these deaths were classified as SUIDs.
• NPM #5 facilitator met with newly hired DOH Injury Prevention Coordinator to discuss the process of death review and how the teams make recommendations for prevention. 
• A data abstractor was hired in May of 2020 to work with the West River Child Death Review team (0.5 FTE) on data collection, abstraction, and prevention activities.
• The DOH is in the process of forming a multidisciplinary Preventable Death Committee that will review data and recommendations from CDR, NVDRS, and MMR and implement strategies to decrease mortality in our state.  Update: the committee’s first meeting was postponed due to COVID.

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.

• A Safe Sleep Kit Distribution Orientation/Training Checklist was developed and placed into the Orientation Module for Clerical on 5/18/2020.  Clerical work in Community Health offices (76 total offices) across the state and assist with the Cribs for Kids distribution process.

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

• In CY 2020 the DOH partnered with the National Cribs for Kids program to distribute 751 safe sleep kits (includes a Pack ‘n Play) through their Community Health Offices and partners. This number is about 350 kits less than what is normally distributed. 

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.
• Due to COVID, the distribution of safe sleep kits had to be altered as clients were not coming into Community Health offices for services.  Community Health staff began doing safe sleep education over the phone and providing on-line resources to families who had internet access. Clients would then drive to their local office and meet a staff person at the door to receive their safe sleep kit.  A few of the larger Community Health Offices continued to hold in-person safe sleep classes/kit distribution classes utilizing social distancing and mask wearing.  Overall, the pandemic led to less safe sleep kits being distributed.

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.

95% completion of identified strategies.