Baltimore City’s Crib Program

1. 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 HealthBaltimore City Health Department • Consultant, First Candle • stephanie.regenold@baltimorecity.gov • stephanie.regenold@firstcandle.org

2. Baltimore

3. 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

4. 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

5. Death of an infant one month to one year of age Leading cause nationwide: SIDS Leading cause in Baltimore: SIDS PostneonatalInfant Mortality Rate

6. 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)

7. 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)

9. Unsafe Sleeping Environment • Identified in 91% of infants dying unexpectedly during sleep: • >75% bedsharing • >75% soft bedding • >60% bedsharing and soft bedding

10. Triple Risk Model Critical Development Period -first 6 months of life SIDS possible brainstem abnormality- (Filiano & Kinney, 1994, 2001) -prone/side sleeping -bed sharing -soft bedding -smoke exposure -overheating -infection Outside Stressors Vulnerable Infant

11. 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

12. 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

13. Safe Sleep for Infants • Alone • On myBack • In aCribTM

14. Safe Sleep Snap Shirts

15. Safe Sleep Enclosure Card

16. Crib Distribution Coordinated by the BCHD Cribs distributed by Baltimore HealthCare Access and Baltimore City Home Visiting Programs

17. Baltimore HealthCare AccessMaternal & 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.

19. 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

20. Baltimore City Health DepartmentSafe 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

21. Determined by each distributing agency Eligibility criteria Timing of crib delivery (usually 36+ weeks) Follow up

22. 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

23. 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)

24. 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

25. 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 %).

26. Challenges Sustainability/funding Equitable distribution of cribs Effectiveness of “giveaway” program Need for effective SIDS/SUDI messages

27. Thank you! Questions??