Baltimore City’s Crib Program
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Transcript of Baltimore City’s Crib Program
Baltimore City’s Baltimore City’s
Crib ProgramCrib Program A Baltimore City Health Department/First Candle
Partnership
Stephanie Strauss Regenold, MD, MPH
Senior Advisor, Babies Born Healthy Initiative
Bureau of Maternal & Child HealthBaltimore City Health Department
Consultant, First Candle
BaltimoreBaltimore
BaltimoreBaltimore
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 Infant Mortality Rate (IMR)(IMR)
National average: 6.86 National range: 4.89 (Asian & Pacific Islanders)--
13.63 (Non-Hispanic Blacks) Healthy People 2010 target goal: 4.5
BaltimoreBaltimore IMR 12.8 [ranks 4th highest in the nation] IMR Non-Hispanic Blacks 18.0
PostneonatalPostneonatalInfant Mortality Infant Mortality
RateRate
Death of an infant one month to one year of age
Leading cause nationwide: SIDS
Leading cause in Baltimore: SIDS
Unexpected Infant Unexpected Infant Death During Death During
SleepSleep 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 Unsafe Sleeping EnvironmentEnvironment
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
13
19 20
1217
19 20
3
01
2
2
4 0
0
5
10
15
20
25
2002 2003 2004 2005 2006 2007 2008
Nu
mbe
r of
Dea
ths
Unsafe sleep environment confirmed 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 unknown. Baltimore City Health Department analysis of data from cases reviewed by the Baltimore City Child Fatality Review.
Unsafe Sleeping Unsafe Sleeping EnvironmentEnvironment
Identified in 91% of infants dying unexpectedly during sleep:
>75% bedsharing
>75% soft bedding
>60% bedsharing and soft bedding
Triple Risk ModelTriple Risk Model
Critical
Development
Period
Vulnerable
Infant
Outside
Stressors
SIDS -prone/side sleeping-bed sharing-soft bedding-smoke exposure-overheating-infection
-first 6 months of life
possible brainstem abnormality-
(Filiano & Kinney, 1994, 2001)
The ABC’s of Safe The ABC’s of Safe Sleep InitiativeSleep 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 The ABC’s of Safe Sleep InitiativeSleep 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 Safe Sleep for InfantsInfants
Alone
On my Back
In a CribTM
Safe Sleep Safe Sleep Snap ShirtsSnap Shirts
Safe Sleep Safe Sleep Enclosure CardEnclosure Card
Crib DistributionCrib Distribution
Coordinated by the BCHD
Cribs distributed by Baltimore HealthCare Access
and Baltimore City Home Visiting Programs
Baltimore HealthCare Baltimore HealthCare AccessAccess
Maternal & Infant Health Maternal & Infant Health Improvement ProgramImprovement 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 Baltimore Home Visiting Programs for High Risk Programs for High Risk
Pregnant Women & Pregnant Women & InfantsInfants
• 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 Baltimore City Health DepartmentDepartmentSafe Sleep Safe Sleep
CoordinatorCoordinator 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 Determined by each distributing agencydistributing agency
Eligibility criteria
Timing of crib delivery (usually 36+ weeks)
Follow up
Crib DistributionCrib 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
FundingFunding
Proceeds from sale of infant safe sleep snap shirts nationwide through partnership with First Candle
Donations (local businesses, BHCA)
MCH Title V (budget modifications)
OutcomesOutcomes
>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
EvaluationEvaluation 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 %).
ChallengesChallenges
Sustainability/funding
Equitable distribution of cribs
Effectiveness of “giveaway” program
Need for effective SIDS/SUDI messages
Thank you!Thank you!
Questions??