Safe Sleep Webinar

May 17, 2017

Agenda

• FLOURISH St. Louis and Safe Sleep Background

• Parent Leader Perspective

• National Safe Sleep & Birth Equity Perspective

• Local Safe Sleep Leader Perspective

• Pack N’ Play Programs in St. Louis

• FLOURISH St. Louis Call to Action

1

Speakers

MODERATOR:

Kendra Copanas, Executive Director, Generate Health

SPEAKERS:

Rosetta Jackson & Rose Pernell, Community Leaders, Generate Health

Joia Crear-Perry, MD, President & Founder, National Birth Equity

Collaborative

David Wathen, DO, Medical Director, General Medical Units, SSM Health

Cardinal Glennon Children’s Hospital

Lori Behrens, Executive Director, SIDS Resources

Melinda Ohlemiller, CEO, Nurses for Newborns

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What is FLOURISH St. Louis?

VISION: Every baby born in St. Louis celebrates a

happy and healthy first birthday.

3

FLOURISH St. Louis – powered by Generate Health is an infant mortality reduction initiative funded and supported by Missouri Foundation for Health,

working in coordination with Generate Health. The Foundation is a resource for the region, working with communities and nonprofits to generate and

accelerate positive changes in health. As a catalyst for change, the Foundation improves the health of Missourians through a combination of

partnership, experience, knowledge and funding.

Key Areas of Concern Voiced By Listening

Session Participants:

• A disconnect between providers and parents when it comes to

understanding infant health care.

o Providers did not always take concerns seriously

o Advocates, such as home visitors, helped to empower parents

• Education and resources are needed to help parents better understand

developmental milestones and safe sleep practices.

• Outreach efforts to educate parents should be strengthened in areas of:

o Drug and alcohol use

o Nutrition and breastfeeding

o Safe sleep

• Strong support for home visiting services to improve infant health and

development and increase access to resources to promote the health of

their family.

4

FLOURISH Infant Health Action Team

First priority – reducing unsafe sleep deaths

• Reviewed data that led us to safe sleep

• Learned about SIDS Resources

• Reviewed data about what is working in other communities

• Reviewed data about baby boxes as an infant bed

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Sudden or Unexplained Infant Death

Syndrome (SUID)

• The death of an infant less than 1 year of age that occurs suddenly

and unexpectedly, and whose cause of death is not immediately

obvious before medical history review, death scene investigation,

and autopsy.

• Types of SUID:

o Sudden Infant Death Syndrome (SIDS)

o Unknown Cause

o Accidental Suffocation or Strangulation in Bed

6

2015 Child Fatality Review Program Annual

Report

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Source: http://dss.mo.gov/re/pdf/cfrar/2015-child-fatality-review-program-annual-report.pdf

St. Louis City and County SIDS Rates By Race

0.2 0.2

0.8

0.3

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

St. Louis City St. Louis County

Ra

te p

er

1,0

00

Liv

e B

irth

s

SIDS Rate, 2002-2012

White African American

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How to Reduce the Risk of SIDS

• Back to sleep

• Firm surface, fitted sheet

• No soft objects in crib

• Breastfeed

• Room share

• No smoking during pregnancy or secondhand smoke

• Pacifier during sleep

• Don’t overheat

• Prenatal care

• Vaccines and well-child care

• Tummy time while awake

9

PARENT LEADERS’ PERSPECTIVES

Rosetta Jackson

Community Leader

Making Change Happen, Generate Health

FLOURISH Infant Health Action Team

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Community Leader

Making Change Happen, Generate Health

FLOURISH Infant Health Action Team

Rose Pernell

SAFE SLEEP & BIRTH EQUITY

Joia Crear-Perry, MD

President & Founder

National Birth Equity Collaborative

Email: drjoia@birthequity.org

13

Objectives

• Describe NBEC (National Birth Equity Collaborative) mission and

programs

• Identify how birth equity and safe sleep correlate

• Observe complexities of safe sleep: Cleveland and NYC Examples

• Identify features of best practice initiative

• Evaluate equity considerations in current concepts

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National Birth Equity

Collaborative

MissionTo reduce Black maternal and infant mortality through research, family centered collaboration and advocacy.

GoalReducing black infant mortality rates by 25% in the next 5

years in cities with the highest numbers of Black infant deaths and to reduce Black IMR to at or below the national

average in these sites in the next 10 years.

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Our vision is that every Black infant will celebrate a healthy first birthday.

NBEC Programs

Safe Landing

Campaign for Black Babies

Birth Equity Solutions

Black Mamas Matter

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Safe Landing

High-Risk Home Based Intervention for NICU Babies

Safe Landing is NBEC’s home-based intervention model targeting at-

risk infants leaving the Neonatal Intensive Care Unit (NICU). Facilitators

provide culturally appropriate support to at-risk families through the

infants’ first birthdays by conducting regular home visits, connecting

families to social services.

Providing training in culturally appropriate home-visitation practices to

home visitation staff working through insurance companies and

managed Medicaid providers.

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Campaign for Black Babies

As the primary thrust of NBEC’s goal, the Campaign involves innovative

research, parent-centered collaboration, collective impact and advocacy

to effectively reduce Black infant mortality in the cities with the highest

burden of Black infant death.

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Birth Equity Solutions

NBEC works with organizations, communities and stakeholders to

develop and implement strategies to achieve birth equity goals. We

provide training and technical assistance for organizations that value

community voices and strive to improve the lives of Black families.

• Racial Equity Workshops

• Maternal Mortality (PAMR)

• Infant Mortality (FIMR)

• Reproductive Justice

• Family Health/Family Planning

• Focus Groups and Interviews

• Messaging and Social Marketing

• Community Engagement

• Organizing/Advocacy

• Health Policy

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Black Mamas Matter

Black Mamas Matter is a Black women-led cross-sectoral alliance. We

center Black mamas to advocate, drive research, build power, and shift

culture for Black maternal health, rights, and justice.

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Safe Sleep and Birth Equity

Safe sleep is an evolving set of

guidelines that inform

campaigns to educate

caretakers and reduce risk of

suffocation, SIDS/SUIDS, and

infant mortality. Safe sleep

seeks to target and mitigate the

racial and social factors that

contribute to the Black IM

disparity.

BLACK BABIES ARE 4 TIMES

MORE LIKELY TO DIE FROM SIDS

THAN WHITE BABIES IN ST. LOUIS.

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birth equity (noun):

1. The assurance of the conditions of optimal births for all people with a willingness to address racial and social inequalities in a sustained effort.

Joia Crear-Perry, MDNational Birth Equity

Collaborative

Birth Equity in Practice

Breastfeeding

• Women (of color) are disproportionally represented in low-wage

work

• Little/no paid maternity leave and limited access to on-site pumping

locations discourages new mothers

• Stigma, business supports and policies

Room Sharing

• Parents feel the need to have physical contact with the infant to

provide optimal safety, comfort and protection

• This is especially true in small urban living spaces or neighborhoods

with high crime rates

• Room sharing increases probability of bed sharing and related risks

Prenatal Care

• Limited length of patient-provider interaction

• Patient distrust of the health system/providers due to historical

trauma, experiences of racist micro-aggressions

• Education increases patient autonomy and agency

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ABCs: Rules of Safe Sleep

We all know them, not everyone uses them

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Complexities of Safe Sleep

Safe sleep was created in response to the

persistence of unsafe sleep environments and

preventable infant mortality

AND

Safe sleep must respond to the cultural,

environmental and social determinants of health

inequities that impact all disparities

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Focus Groups - Cleveland

Sisters of Charity Foundation-Funded Project

TWIST Creative

Purpose

Evaluate and rebrand safe sleep messaging in

the community. Pregnant women, expecting

fathers and influencers gathered to share

meaningful experiences and perspectives

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Focus Groups - Cleveland

Method - Focus Groups

• Community engagement and input

• Valuable input

• Real-time feedback

• New data

• Supports relationship and coalition building

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Infant Mortality Campaign Strategic Outcomes

Campaign launch by SOCF and TWIST creative branding team

“Motherhood Sisterhood 216”

Leveraging social media outlets (Facebook, Instagram) so that moms

communicate and support each other with tip sharing and resource

information

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Focus Groups - Lessons

• Need for social connectedness, limited opportunities for peers to

personally connect within their communities

• Want and willingness to share experiences, tips and information

between new moms

• Neighborhood-specific concerns (resources, policing and safety, food

availability, housing safety, and availability, quality of childcare)

• Residents are aware of best practices around safe sleep, but parents

want to be close to children due to unsafe environments and

dangerous situations

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Focus Groups - Lessons

ENVIRONMENT

Housing quality, community safety is factored into safe sleep decisions every

time a baby goes to sleep

ECONOMIC

Inability to pay for or access appropriate baby sleep spaces

EDUCATION

Even when the appropriate space is available, it may not be used because of

inadequate education/poor messaging

CULTURE

Despite adequate education and economic means, non-parent and

generational influencers have significant say in caregiving

SUPPORT

Parents or caregivers without adequate support may disregard safe sleep due

to fatigue and convenience

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Best Practice Case Study

New York City Safe Sleep

• Message testing in focus group of parents and

caregivers

• Consumers, community members, and third-

party involvement for message development

• Broadening perception of consumers to whole

people and parts of a community

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Evaluate

• Internally (staff, collaborators)

Be cognizant of personal biases

• Externally (target and non-target community

members)

Be flexible in response to the potential of

cultural incompetence

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Sherry Matthews “Signs”

NYC, 2015

• Mixed images with photographs and illustration

• Used positive language of “dreams” and “one too many”

• Used warning labels to clearly denote hazard

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Starfish “Put Them to Bed”

NYC, 2017

• Used traditional and social media marketing strategies

• Highlights life and death

• Used strong negative directive language, “Don’t…”

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Bandujo “Please make sure”

NYC, 2017

• Campaign plays on natural protective instincts of parents

• Explored impact of deliverer “Ask the Baby Doc”

• Uses factoids and scientific information to combat misconceptions

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INFANT SLEEPING DEVICES

David Wathen, DO

Assistant Professor of Pediatrics

St. Louis University School of Medicine

Medical Director, General Medical Units

SSM Health Cardinal Glennon Children’s Hospital

FLOURISH Infant Health Action Team

Email: dwathen@slu.edu

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Types of Devices

• Non-Portable Crib

• Portable Crib

• Bassinet

• Baby Box

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Non-Portable Crib

• Gold standard for sleeping devices

• New standards put in place by Consumer Product Safety

Commission in June 2011

o No dropsides

o Slats no greater than 2 3/8” apart

o Increased slat strength

• Recommend:

o Firm mattress

o Fitted sheet

o No positioners, loose blankets, pillows, soft animals,

crib bumpers, etc.

• Benefits: Durability, can use up to 2-3 years of age, allows

air circulation

• Disadvantages: Cost, not easily moved, heavy

• Cost starts at ~$100 to ~$1,000’s

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Portable Crib

• Low cost, portable version of infant crib

• New standards put in place by Consumer Product Safety

Commission in February 2013

o Sturdier side rails and corner brackets

o Sturdier mattress attachments

• Recommend:

o Firm mattress

o Fitted sheet

o No positioners, loose blankets, pillows, soft animals,

crib bumpers, etc.

• Benefits: Lower cost, more portable, mesh allows air

circulation, typically can use up to 2 years of age

• Disadvantages: Complicated to assemble/dis-assemble

• Cost starts at ~$50 up to ~$200

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Bassinet

• Small infant bed meant to be more portable than a crib and

only used during first 3-4 months of life

• New standards put in place by Consumer Product Safety

Commission in 2014

o Addresses mesh/fabric openings

o Side height

o Static load testing

• Recommend:

o Firm mattress

o Fitted sheet

o No positioners, loose blankets, pillows, soft animals, etc.

• Benefits: Lower cost, more portable

• Disadvantages: Soft/firm sides, only use up to 4 months of age

• Cost starts at ~$35 up to ~$1,000’s

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Baby Boxes

• Cardboard box with thin mattress, popularized in

Finland as part of their maternity package for all

expectant mothers

• No standard currently in place

• Not recommended by American Academy of

Pediatrics, Cribs for Kids, NIH, many other

organizations

• Benefits: More portable

• Disadvantages: Firm sides, only use up to ~4

months of age, cost, concerns regarding integrity

especially if wet or humid, many come with lids

• Cost starts at ~$50 up to ~$650; typically

dependent on “add-ons”

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Concerns Regarding Baby Boxes

• To date, there has been no research done on the safety or effectiveness of

baby boxes

• In addition to the baby box, Finland gives all expectant mothers a box filled

with products during their 1st trimester to encourage early prenatal care

o Finland also provides 1 year paid maternity leave and 54 days of paternity leave to

all parents

• The CDC is not currently funding any research into baby boxes

• Most infants will grow out of the baby box during the highest risk period for

Sudden Unexpected Infant Death (age 2-6 months)

• Use of lids, where will box be placed (pets, insects, rodents), integrity of box

when exposed to humidity/water, etc.

• The cost of providing a baby box and then providing a second infant sleeping

device is much higher than providing one portable crib

o Current baby box programs are supplying the $150 baby box to parents of infants

o If portable crib also given at 4 months of age, over $200 spent

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PACK N’ PLAY PROGRAM IN ST. LOUIS

Lori Behrens, LCSW

Executive Director

SIDS Resources, Inc.

FLOURISH Infant Health Action Team

Email: lahrens@sidsresources.org

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SIDS Resources Pack-n-Play Distribution

• Two ways a family may receive a Pack-n-Play in our St. Louis region

• Program Partner organization – parent educator or home visitor

submits application, picks up Pack-n-Play, and discusses safe sleep

with caregiver and completes follow up visit

• Caregivers come to SIDS Resources office to attend a one hour safe

sleep class, take Pack-n-Play home, and receive a follow up phone

call to discuss how it is being used.

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ProgramPartners

Direct through SR office

FLOURISH RECOMMENDATION

Melinda Ohlemiller

Chief Executive Officer

Nurses for Newborns

FLOURISH Cabinet

Infant Health Action Team Chair

Email: melinda.ohlemiller@nursesfornewborns.org

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Safe Sleep for Babies Starts with a Safe Bed

• Align resources in region around a common approach to reducing

SIDS/SUIDS due to unsafe sleep, first step is to:

o Use limited public health resources to expand existing portable crib

programs

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How to Get Involved

• Commit to align and coordinate programs around the existing

portable crib programs in St. Louis.

• Join the Infant Health Action Team (contact

skennedy@generatehealth.org).

• Share what you have done to promote Safe Sleep or what barriers

you see to safe sleep in the Comments Box.

• Follow FLOURISH on social media. @flourishstlouis

• Donate gently used portable cribs/pack n plays to Nurses for

Newborns or donate $50 to an organization to purchase a new pack

n play for a family.

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Resources Available

Attached Handouts OR Posted on Website:

http://www.flourishstlouis.org/baby-boxes-informational-webinar/

Resources:

• Webinar recording

• Safe sleep resources (national & local)

• List of portable cribs programs in St. Louis

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QUESTIONS?