This announcement solicits applications for the Safe Infant Sleep Systems Integration (SISSI) Program. SISSI aims to increase the adoption of safe infant sleep behavior among infant caregivers by activating champions of these protective behaviors within systems that intersect with families at risk. An infant caregiver is defined as the individual who puts a baby down for sleep and could be a parent, grandparent, other family members, child care provider or other guardian. Examples of systems that serve infant caregivers include, but are not limited to, home visiting programs, food and nutrition programs, community-based organizations such as Healthy Start, housing assistance authorities, child care, hospitals, community health clinics, as well as health care provider networks such as pediatricians, family physicians and obstetricians.
The death of a baby before his or her first birthday is called infant mortality. Sleep-related deaths are the leading cause of death for infants between one month and one year of age, often referred to as sudden unexpected infant death (SUID). These SUID deaths can be attributed to Sudden Infant Death Syndrome (SIDS), accidental suffocation, or unknown cause of death. While all populations are impacted, African-American and American Indian/Alaskan Native families have a significantly higher risk to suffer the loss of an infant due to sleep-related circumstances. The American Academy of Pediatrics (AAP) has summarized the state of scientific evidence surrounding these behaviors and identified the following description of a safe sleep environment: placing the infant to sleep on the back, in the infant’s own crib without blankets or soft items or bed-sharing, and breastfeeding. In this funding opportunity announcement, this cohort of behaviors is referred to as “safe infant sleep behavior.” Infant caregivers face barriers to implementing safe infant sleep behavior, which can conflict with cultural and familial norms about sleep habits, or even compete with caregiver needs related to sleep deprivation.
Providers who serve at-risk families in the delivery of health care, public health and social services have an opportunity to educate and empower infant caregivers to adopt safe infant sleep behavior. However, promoting the latest evidence-based recommendations is more complex than the original “Back to Sleep” campaign message, which focused solely on infant sleep position. To be successful, providers must be supported by organizational policies, practices and resources to enhance their efforts to translate the modern safe infant sleep message to action among infant caregivers.
Some resources do exist to support these provider networks. The expanded “Safe to Sleep” campaign led by the National Institutes for Child Health and Human Development (NICHD) was launched in October, 2012, and provides communication materials that define and depict safe sleep behavior based on the 2011 AAP Policy Statement. In addition, organizations at the state and local level have developed interventions to translate the safe infant sleep recommendations to action among families at risk. However, no national, coordinated strategy to achieve measurable impact in reducing sleep-related infant death currently exists. Implementing individual behavior change on a national scale requires a multi-faceted approach that ensures common messaging through engagement of multiple stakeholders, and support of organizations within service delivery systems that intersect with infant caregivers.
Over the next three years, the cooperative agreement recipient will provide leadership by establishing, facilitating, and coordinating a national safe infant sleep coalition with the purpose of integrating safe sleep promotion throughout systems that serve families, with a particular emphasis on reaching communities at higher risk for SUID. Activities of the project should be organized into two categories:
Identifying and convening multi-disciplinary stakeholders to form a national coalition, ensuring representation from the following four domains:
safe sleep promotion experts, including researchers and public health professionals with experience designing and implementing safe sleep educational interventions,
leadership of key systems serving families, as described in Section I.1: “Examples of systems that serve infant caregivers include, but are not limited to, home visiting programs, food and nutrition programs, community based organizations such as Healthy Start, housing assistance authorities, child care, children’s hospitals, community health clinics, as well as health care provider networks primary care providers such as pediatricians, family physicians and obstetricians.”, and
advocacy groups representing communities at increased risk for SUID, such as African-American and American Indian/Alaskan Native families.
Each of these four domains brings a crucial perspective that can provide insight to existing barriers to achieving a unified movement in safe sleep promotion. For example, breastfeeding promotion professionals might clarify in which ways the recommendation to avoid bed-sharing may be perceived as disruptive to increasing breastfeeding rates among mothers. Leadership from key systems that serve families can provide insight to realistic boundaries for policy and practice levers that can be activated to further enhance the safe sleep message. And representatives from the communities at increased risk for SUID can heighten the success of the program by providing feedback about the reality of barriers that infant caregivers face when considering safe sleep as a practice.
Facilitating the coalition’s development of a strategic plan to unify and augment the safe sleep message across systems that reach infant caregivers based on evidence based recommendations.
Identifying key resources available and gaps preventing the successful implementation of safe sleep promotion priorities identified in the strategic plan.
Advancement of Systems Changes
Leveraging partnerships to advance the recommended organizational policies and practices outlined in the strategic plan, including the tracking of systems changes at the national, state and local levels.
Coordinating the development of resources such as training modules, model policy templates or health promotion materials, to facilitate the attainment of goals related to safe infant sleep promotion at the national and local levels
The strategic plan produced through this program will serve as a foundational framework to inform national, state and local infant mortality reduction efforts, as well as guide policy and practice changes among systems that serve families. Recommendations within the strategic plan should address a variety of domains, including the following four MCHB-funded initiatives that intersect with safe infant sleep promotion:
MCHB’s Collaborative Innovation and Improvement Networks (CoIINs) to Reduce Infant Mortality: the first 18 states to participate in CoIIN identified SUID/SIDS as a priority area of focus for the project, and additional states have the opportunity to do the same as the initiative is launched across the country.
the Maternal and Child Health Block Grant Program: this program has a longstanding charter to address infant mortality, including SUID/SIDS, most specifically cited within Outcome Measure #5- the post-neonatal mortality rate per 1,000 live births.
Healthy Start programs: one benchmark for these community-based programs aims to increase the proportion of Healthy Start participants who engage in safe sleep behaviors to 80%.
Maternal, Infant and Early Childhood Home Visiting programs: several of the approved home visiting models, such as the Nurse Family Partnership, include safe sleep promotion as a standard of practice within home visits.
During the project, the awardee will be expected to work collaboratively with organizations providing technical assistance to these programs, currently organizations such as the Children’s Safety Network National Resource Center and the National Center for the Review and Prevention of Child Death.
This funding opportunity directly contributes to the achievement of two Healthy People 2020 Objectives: MICH-1.9 Reduce the rate of infant deaths from sudden unexpected infant deaths, and MICH-20 Increase the proportion of infants who are put to sleep on their backs. It also is responsive to the January 2013 recommendations of the Health and Human Services Secretary’s Advisory Committee on Infant Mortality (SACIM); this Committee recommended to Secretary Sebelius the redeployment and modernization of key evidence-based, highly effective preventive interventions, specifying safe sleep as a priority. The program also advances HRSA’s strategic goals to build healthy communities and to improve health equity by addressing a public health problem that contributes to health disparities in infant mortality.
Success for this program can be estimated through changes in the prevalence of safe infant sleep behavior, estimated through the Pregnancy Risk Assessment Monitoring System (PRAMS), as well as through metrics describing the efficacy of the coalition in achieving the adoption of policy and programmatic goals set forth in the strategic plan. Of particular emphasis are measurable systems changes which empower families to embrace the safe sleep message, attain the skills and self-efficacy to implement the behavior, and further drive social norms toward practices that keep babies safe and healthy. These measures should include national, state, or local documentation of procedures or policies for delivery systems to support safe sleep. Examples of appropriate process measures are: the proportion of target service delivery systems with performance measures incentivizing the integration of safe sleep promotion into standardized practice, the proportion of MCH block grant programs that report successful integration of safe sleep promotion into their state’s WIC program, the number of hospitals that adopt safe sleep policies, the proportion of community health centers that have provided safe sleep training to their staff, the proportion of child death review prevention recommendations that align with the latest science on SUID risk factors, the number of new stakeholder organizations which publicly endorse safe sleep practices, etc.