Perinatal & Infant Health – Application Year FFY 2021

NPM 5 - Safe Sleep: 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.

The ability of the CPHDs to perform in-person safe sleep education came was severely curtailed in early 2020 due to the COVID-19 virus. The CHPHs working on infant safe sleep activities had to re-prioritize quickly to: learn about the virus; implement safeguards; apply for PPE equipment and other resources; educate community members; and, spend time on contact tracing.

Every CPHD which participates in the MCHBG implements an injury-prevention activity, in additional to their selected national or state performance measure activities.  These are part of the requirements for Fetal, Infant, Child and Maternal Mortality Review (FICMMR) teams.  For FFY20, four CPHD FICMMR teams chose infant safe sleep injury-prevention activities: Glacier, Missoula, Sanders, and Yellowstone.

Glacier County FICMMR is partnering with the local WIC clinic to provide evidence-based “Back-to-Sleep” awareness and prevention education.  The target is all prenatal and postnatal clients, with the following education: a) safe sleep sack provided and demonstrated; b) education presented regarding crib, sleep area, and infant position; and, c) safe sleep pack-n-play provided with instruction for use, as needed to those who do not have a safe crib.  This activity compliments two others specific to MCHBG NPM 5, which are highlighted later in this narrative.
 

Sanders FICMMR is partnering with local providers and the hospital to educate families on the importance of safe sleep practices. Their primary targets in this remote and sparsely populated county, home to 3,508 potential Title V recipients (2017 census), are pregnant women and parents of newborn infants. They educated 14 families on infant safe sleep practices, and delivered six Portable Pack N’ Play crib kits to other families considered at high-risk for bed sharing.

Approximately 25 community members attended an annual women’s health fair where the CPHD displayed a safe sleep exhibit featuring an infant (doll) lying face down, with a t-shirt that reads, ‘If you can read this turn me over.”  The front of the t-shirt says, “I sleep safest on my back.”  The exhibit generated good conversations and sharing of American Academy of Pediatrics infant safe sleep guidelines. The exhibit is now stationed in the WIC Office, and continues to generate conversation. Also, Clark Fork Valley Hospital presented on infant safe sleep as part of their educational series.

Missoula County FICMMR is partnering with St. Patrick’s Hospital and Community Medical Center to provide infant safe sleep education and consistent messaging community wide, via the Cribs for Kids Safe Sleep Ambassador Training Curriculum. Their focus is on reaching grandparents, youth who babysit, and agencies that work with prenatal and infant populations, such as: Early Head Start; YMCA; Missoula Aging Services; Foster parent support group; Child & Family Services; Mountain Home; Partnership Health Center; medical provider offices; hospital’s labor and delivery departments; and, prenatal classes.  These agencies will be approached with the opportunity to participate in the Cribs for Kids Safe Sleep Ambassador online training/certification program: https://cribsforkids.org/safe-sleep-ambassador

To date, 14 Missoula Home Visiting staff were certified in the Cribs for Kids Safe Sleep Ambassador Training Curriculum and they will be leading the prevention activity. Thus far, the CPHD has offered the training to the local YMCA babysitter class; and to Mountain Home, a shelter for young mothers who need a place to live and a network of support as they create safe, stable, and nurturing homes of their own.  The CPHD’s Women, Infant, and Children Program (WIC) has also expressed interest in the online training. Agencies who decline the online training this year still receive safe sleep educational materials, with more provided as needed.  Additionally, this CPHD has asked their FICMMR team members to take the online training back to their own agencies and train staff. 

Yellowstone FICMMR is establishing new partnerships with area agencies and businesses who have significant exposure to infants, such as: sleep on premises; or, under the care of.  It is delivering safe sleep and co-sleep morbidity information and training that will be shared with partner agency clients and customers. Some partners include: Young Families Early Head Start; Aware Early Head Start; and, YMCA Child Care. The training is provided by RiverStone Health staff at partner agency staff meetings or as a separate training.  This activity also compliments two others specific to MCHBG NPM 5, which are highlighted further into this narrative.
 

During Fall 2019 two of the larger CPHDs, Missoula and Yellowstone, were working to build relationships with, and offer infant safe sleep training to, a host of potential new partners. When the pandemic hit it meant cancelling in-person trainings and meetings while practical and realistic safety procedures were designed. 

Missoula and Yellowstone had generated an exciting list of potential agency partners including: Young Families Early Head Start Program, a hospital’s case management staff, Mountain Home (a shelter and resource center for young mothers), YMCA babysitter class instructors, and a foster parent support group respectively. Mountain Home shut down to all outside visitors, babysitter classes were cancelled, and support groups ceased meeting. 

As a result of COVID-19, the Missoula CPHD home visiting staff began providing their services via phone and online with a high percent of the dialogue devoted to safety precautions from the virus. Infant safe sleep was addressed as time allowed. Yellowstone CPHD has indicated they are exploring other potential avenues to deliver safe sleep education, i.e., develop their own safe sleep video or get on the agendas of new partners’ Zoom meetings to access trainees. 

As of March 2020, the state FICMMR Coordinator has sent five emails on safe sleep education to CPHDs, topics include: Interactive E-Handouts for Safe Sleep Conversations (NICHQ); Facebook Live on Infant Safe Sleep-SIDS Prevention (CDC); and, a blog article on Eliminating Infant Safe Related fatalities via a partnership between the NICHQ and the National Center for Fatality Review and Prevention, https://www.nichq.org/insight/eliminating-safe-sleep-fatalities-starts-identifying-what-causes-them.

Six CPHDs are focused on NPM 5 for their MCHBG activities in FFY20: Cascade, Gallatin, Glacier, Mineral, Roosevelt, and Yellowstone.  These counties cover a wide range in the size of their maternal and child populations, but share in seeing this as a priority.  Each county is expected to implement at least two strategies, using knowledge of the unique needs in their areas and making good use of collaborative opportunities.  These counties have a combined maternal and child population of 157,647, and MCHBG funding of $312,170.

Infant Safe Sleep education is the main category of outreach, and it takes many forms: to other programs in the county such as foster care, or Child & Family Services; to home-visiting clients; in materials and training included with the distribution of portable cribs; a billboard along a busy highway; video-loop programs shown during immunization clinics; internal staff training; and, collaboration with a local birthing hospital.  Another category is lactation services, since breastfeeding is a protective factor for safe sleep.

 As a result of the 2020 5-Year Statewide Needs Assessment, the FCHB plans to continue addressing NPM 5 during the timeframe of FFYs 2021 – 2025.  CPHDs will be afforded the opportunity to select NPM 5 as their performance measure for these FFYs.