Transcript Document

Baltimore City’s
Crib Program
A Baltimore City Health
Department/First Candle
Partnership
Stephanie Strauss Regenold, MD, MPH
Senior Advisor,
Babies Born Healthy Initiative
Bureau of Maternal & Child Health
Baltimore City Health Department
Consultant, First Candle
[email protected]
[email protected]
Baltimore
Baltimore
 Population 636,000 [ranks 18th in the nation]
 21.5 % below poverty level
 African Americans comprise 65% of the
population; Latinos <3%
 9,350 births/year
Infant Mortality Rate
(IMR)
 National average: 6.86
 National range: 4.89 (Asian & Pacific Islanders)-- 13.63
(Non-Hispanic Blacks)
 Healthy People 2010 target goal: 4.5
Baltimore
 IMR 12.8 [ranks 4th highest in the nation]
 IMR Non-Hispanic Blacks 18.0
Postneonatal
Infant Mortality Rate
 Death of an infant one month to one year of age
 Leading cause nationwide: SIDS
 Leading cause in Baltimore: SIDS
Unexpected Infant
Death During Sleep
 Infant (<1 year of age)
 Cause of Death as determined by Medical
Examiner: SIDS, SUDI, or Asphyxia due to
overlay
 ICD-10 Code:--R95 (SIDS)
--R99 (other ill-defined and
unspecified causes of mortality)
-- W75 (accidental suffocation and
strangulation in bed)
Unsafe Sleeping
Environment
 Bed-sharing—infant sleeping in a bed or couch
with another person; or
 Placing infant to sleep on stomach or side; or
 Soft bedding, toys, or soft objects under or
around the infant during sleep; or,
 No crib available or improper use of crib; or
 Smoking in house (never sole risk factor)
Unexpected Infant Deaths that Occured During Sleep:
Baltimore City, 2002-2008
Number of Deaths
25
20
15
0
0
2
3
2
10
5
4
1
19
20
13
17
19
20
2007
2008
12
0
2002
2003
2004
Unsafe sleep environment confirmed
2005
2006
Unsafe sleep environment not confirmed*
Deaths for which the evidence did not indicate an unsafe sleep environment, however, data on unsafe sleep risk factors may have been missing or
nknown. Baltimore City Health Department analysis of data from cases reviewed by the Baltimore City Child Fatality Review.
Unsafe Sleeping
Environment
Identified in 91% of infants dying
unexpectedly during sleep:
>75% bedsharing
>75% soft bedding
>60% bedsharing and soft bedding
Triple Risk Model
Critical
Development
Period
possible brainstem
abnormality(Filiano & Kinney, 1994,
2001)
-first 6 months
of life
SIDS
Vulnerable
Infant
Outside
Stressors
-prone/side sleeping
-bed sharing
-soft bedding
-smoke exposure
-overheating
-infection
The ABC’s of Safe Sleep
Initiative
 In response to Baltimore City’s CFR 2004
Recommendations
 Partnership between Baltimore City HD and First
Candle
 Developed with grant funding from the Abell
Foundation, Babies Born Healthy (DHMH), the
CJ Foundation for SIDS and March of Dimes,
with in-kind support from First Candle
The ABC’s of Safe Sleep
Initiative
 ABC’s of Safe Sleep logo and message
developed by the BCHD and used for
educational campaign
 Sale of infant snap shirts through First
Candle
 Free crib program
Safe Sleep for Infants
Alone
On my Back
In a Crib
TM
Safe Sleep
Snap Shirts
Safe Sleep
Enclosure Card
Crib Distribution
 Coordinated by the BCHD
 Cribs distributed by Baltimore HealthCare Access
and Baltimore City Home Visiting Programs
Baltimore HealthCare Access
Maternal & Infant Health
Improvement Program
• Serves as the single point of entry for Prenatal
Risk Assessments and Infant Identification
Forms to identify high-risk pregnant women and
infants.
• Initial outreach services are provided by Family
Advocates who refer lower risk women to
supportive services including community-based
home visiting programs.
Baltimore Home Visiting
Programs for High Risk
Pregnant Women & Infants
• Baltimore City Health Department Maternal & Infant
Nursing Program
• Baltimore City Healthy Start
• Healthy Families
• Bon Secours
• BCHD Healthy Homes
• The Family Tree
• People’s Community Health Center
Baltimore City Health
Department
Safe Sleep Coordinator
 Tracks number of cribs distributed, number in stock
 Trains all home visiting advocates in Infant Safe Sleep with
yearly updates
 Develops educational materials for crib recipients
 Meets monthly with home visiting programs and BHCA
 Provides inservice training to hospital staff (nurses,
physicians, social workers), clinics, public agencies (social
services, detention centers), and other organizations
 Trouble shoots
Determined by each
distributing agency
 Eligibility criteria
 Timing of crib delivery (usually 36+
weeks)
 Follow up
Crib Distribution
 Family referred by home visiting program, BHCA
triage, or from posters
 Crib delivered by BHCA Safe Sleep Liaison or by
home visiting advocate
 Crib set up with family member
 Safe sleep education given/reinforced
 Receipt of Crib (waiver) signed by receiver
Funding
 Proceeds from sale of infant safe sleep snap shirts
nationwide through partnership with First Candle
 Donations (local businesses, BHCA)
 MCH Title V (budget modifications)
Outcomes
 >2,500 cribs distributed since 2006
 Better identification of high risk pregnant women
 Infant safe sleep message recognized in a variety
of venues around the city
 Unsafe sleep recognized as major and preventable
cause of infant mortality
Evaluation
 Pre & post test questionnaires at time of crib delivery
inconsistent
 Observational survey by M&I nurses
100 M&I clients—no difference in use of crib between
those received by Crib Program and those received
privately
Very few infant deaths among home visiting
program population (<2 %).
Challenges
 Sustainability/funding
 Equitable distribution of cribs
 Effectiveness of “giveaway” program
 Need for effective SIDS/SUDI messages
Thank you!
Questions??