infant suffocation deaths in the sleep environment
Post on 07-Nov-2014
3.627 Views
Preview:
DESCRIPTION
TRANSCRIPT
Infant Suffocation Deaths in the Sl E i tSleep Environment
March 24, 2011
C SModerator: CAPT Stephanie Bryn, MPHDirector, Injury and Violence Prevention
H lth R d S i Ad i i t tiHealth Resources and Services AdministrationSpeakers:
C i K Sh i M d PhD MPHCarrie K. Shapiro-Mendoza, PhD, MPHLena Camperlengo, RN, MPH, DrPH(c)
Theresa Covington MPHTheresa Covington, MPHLindsey Myers, MPH
Michael Goodstein MD FAAPMichael Goodstein, MD, FAAPJudy Bannon
Overview
• Recent trends in infant suffocation death rates
• Circumstances of the sleep environmentCircumstances of the sleep environment and risk factors in infant suffocation
• State and local community efforts in risk• State and local community efforts in risk reduction and prevention of infant suffocationsuffocation
• Community-based safe sleep and suffocation prevention programs
Speakers• Carrie K. Shapiro-Mendoza, PhD, MPH: Team Leader and
Lead Epidemiologist, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
• Lena Camperlengo, RN, MPH, DrPH(c): EGS, Inc. Contractor, Project Coordinator, SUID Initiative, Division of Reproductive Health National Center for Chronic Disease Prevention andHealth, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
• Theresa (Teri) Covington, MPH: Director, National Center for Child Death Review
• Lindsey Myers, MPH: Injury Prevention Program Manager, Colorado Department of Public Health andManager, Colorado Department of Public Health and Environment
• Michael Goodstein, MD, FAAP: Attending Neonatologist, York Hospital; Director, York County Cribs for Kids
• Judy Bannon: Executive Director, Cribs for Kids & S.I.D.S. for Kids
Understanding SUID: Understanding SUID: Definitions Trends and the SUID CaseDefinitions Trends and the SUID CaseDefinitions, Trends and the SUID Case Definitions, Trends and the SUID Case
Registry Registry
Carrie Shapiro-Mendoza PhD, MPHandand
Lena Camperlengo RN, MPH, DrPH(c)EGS, Inc.
Infant Suffocation Deaths in the Sleep Environment Webinar
March 24, 2011National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health
OverviewOverviewOverviewOverview
Definition of SIDS and other SUID Trends in SIDS and other SUID mortality SUID surveillance and death certificates CDC’s SUID Case Registry Pilot Program
DEFINITIONS OF SIDS AND OTHER SUID
SUID DefinitionSUID DefinitionSUID DefinitionSUID Definition
SUID : Sudden, unexpected infant death, p Infant deaths that:
Occur suddenly and unexpectedly in previously healthy infants Have no obvious cause of death prior to investigation
(unexplained) Excludes deaths with an obvious cause, e.g., motor vehicle
accidents
SIDS is a type of SUID
Some Types of SUIDSome Types of SUID
SUID CategoriesSUID Categories
Unexplained* Explained
SIDSU d t i d
Long QT MCAD Undetermined cause
Suffocation MCAD Head injury Infanticide Infanticide Hyperthermia Infection Infection Overdose
*Cause of death was unexplained by autopsy or autopsy was not completed
Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)
“…sudden death of an infant under one year of age y gwhich remains unexplained after a thorough case investigation, including performance of a complete autopsy examination of the death scene and reviewautopsy, examination of the death scene, and review of the clinical history.”
Willinger M, James LS, Catz C. Pediatr Pathol 1991
Mechanisms of Accidental Suffocation and Mechanisms of Accidental Suffocation and Strangulation in Bed (ASSB)Strangulation in Bed (ASSB)Strangulation in Bed (ASSB)Strangulation in Bed (ASSB)
Suffocation by soft bedding, ill t b d ttpillow, waterbed mattress
Overlaying (rolling on top of or Overlaying (rolling on top of or against baby while sleeping)
Wedging or entrapment between mattress and wall, bed frame, etc
Strangulation (infant’s head and neck caught between crib railings)neck caught between crib railings)
*All could be designated as ICD 10 code W75
TRENDS IN SIDS AND OTHER SUID MORTALITY
Public Health Implications of SUIDPublic Health Implications of SUIDPublic Health Implications of SUIDPublic Health Implications of SUID
About 4600 per year, half are SIDS Most frequently reported causes:
SIDS• Leading cause of postneonatal mortalityLeading cause of postneonatal mortality
Unknown or undetermined cause (UNK) Accidental suffocation & strangulation in bed (ASSB)
• Leading cause of infant injury mortality• Leading cause of infant injury mortality• Potentially preventable
Less frequently reported causes: Infanticide/intentional suffocation (<5%), inborn errors of
metabolism (1%), cardiac channelopathies (5-10%), infection
Sources: Shapiro-Mendoza et al, Peds, 2009. Kinney and Thach, NEJM, 2009.
US SUIDUS SUID--specific infant mortality ratesspecific infant mortality rates19901990--20072007160 19901990 20072007
120
140
160
hs
80
100
120
0000
birt
h
40
60
80
hs p
er 1
00
0
20
40
Dea
th
01990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
SIDS UNK ASSB Combined SUID
SIDS: sudden infant death syndrome, UNK: Unknown cause, ASSB: accidental suffocation and strangulation in bed, Combined SUID: SIDS+UNK+ASSBSource: CDC WONDER, Mortality Files
Infant Supine Sleep PositionInfant Supine Sleep Position19921992 -- 201020101992 1992 20102010
90%
100%
73%
60%
70%
80%
30%
40%
50%
13%
0%
10%
20%
30%
0%
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: National Infant Sleep Position Study
Proportion of SUID Proportion of SUID Unexplained by Autopsy, or no AutopsyUnexplained by Autopsy, or no AutopsyUnexplained by Autopsy, or no AutopsyUnexplained by Autopsy, or no Autopsy
UNK14%
ASSB2%
ASSB15%
SIDS84%
SIDS58%
UNK27%
1996 2006
SIDS: Sudden infant death syndrome UNK: Unknown causeASSB: Accidental suffocation and strangulation in bedg
SUID SURVEILLANCE AND DEATH What death certificates don’t tell us about SUID
CERTIFICATES
Cause of Death Section from US Death Cause of Death Section from US Death CertificateCertificateCertificateCertificate
entn umniral events such n cardAl:: Enter only one cau5e on.a .... e. Ad::ladd:tionaJ
IMMED TE CAUSE (Final d is.ule Of ccndition -----:> 01 •• _________ -" .. "'''''''...,''''''"'''''''', ________________________ _ resul'1ilg in dea:h ) Due:o (or ~s. a c(lflS('(!ueme of):
SequEntiaUy lin cond~on5 , b.----------"'''''''''.-.o;ru''''';;;;;-,''-------------------------if any_ leadine to the ~auu- Out to (or n a COI" u-qUi'I"Ci' 01): lis.led I)ft kle a. En:e! the
UNDERLYINGC AU!E c.- ---------"'"'"''''"''''"';rn""oo""C-----------------------(dis.ease or in~ that Du~:o (or ~s. ill COIoU'qUi'rQt of): in i: ia~Ed the @'\Oents. ft s.ulting in dea:h} LAST d.
a Net pregnln: wi:h n p.a~1 rear
o Yi' s. a ? rob,l)Jy a ?r;-gn;lllt .it &Ile c( dea:h
[] No a Unknaom a Not preon:wlt. butpreonalt with ir 42 tlayS of tli'~h
a Net pregnlm. but pregnanl 43 d<l)"> 10 1 (ear betJre death
i i
o Natural OHomici:!e
o A.ccident 0 PendilltJ Invulgaton
o Suici:!e 0 Could not be delenn:ned
, , o D river{:l~ra:cr
C Pas. .. enoer
o .(es. 0 tl o
IMMEOlATE CAUSE (Fina! d is~a ~e or COI"IditlOn --> resul\hg in d~a :h )
Seq\Kn:iaHy Ir.! C()nd'!ions. if any. k!,ad ing to the ~ause tis.ted 1)11 rlne i . Enter the UNDERLYING CAU!E (diSoe,1se or in.ury lhal in~a~td th~ events. ftsUlting ndea:h) LASf
o Yes. 0 ? rob-Ollly
C No 0 Un kncwn
o Net pregm nt w':Il n pa.Sl rear
a Pp.gnant i \ UI"Ie of de,1;h
o Not preon,1llt. butcweona,t with ir 42 dol.,.. 01 deJth
flItu tlmniraJ ~vem such as. card.ac Enter only Cl'Ie Ca\l5E on a Ine. Adj add;;ionaJ
o N,1turaJ D Homici:le
o Accident 0 Pendin,} lnYl's-;gafon
o Suici:le 0 Could not be ' ".m,n,' I
o Dri~r~:lp~ra tc r
C PaSSeftOE'f
o '(t's 0 flo
Mechanism attributed to suffocation deaths,Mechanism attributed to suffocation deaths,US death certificates, 2003US death certificates, 2003--20042004US death certificates, 2003US death certificates, 2003 20042004
Shapiro-Mendoza et al , 2009
Sleep surface or place where death occurred, Sleep surface or place where death occurred, US death certificates, 2003US death certificates, 2003--20042004US death certificates, 2003US death certificates, 2003 20042004
Shapiro-Mendoza et al , 2009
Bedsharing or coBedsharing or co--sleeping reported, sleeping reported, US death certificates, 2003US death certificates, 2003--20042004US death certificates, 2003US death certificates, 2003 20042004
Shapiro-Mendoza et al , 2009
What is needed?What is needed?What is needed?What is needed?
More comprehensive data to increase knowledge about:about: Circumstances or factors that may have contributed to or caused
the SUID caseSl i t• Sleep environment
• Prior medical history Quality of the death scene investigation or if one was even done
A SUID surveillance system that builds upon child death review may be the answerdeath review may be the answer
A new surveillance system to monitor trends in SIDS and other
CDC’S SUID CASE REGISTRY A new surveillance system to monitor trends in SIDS and other SUID
PILOT PROGRAM
Justification for SUID Case RegistryJustification for SUID Case RegistryJustification for SUID Case RegistryJustification for SUID Case Registry
Currently SUID surveillance is monitored using y gdeath certificate data
Death certificate data are limited; do not describe ;circumstances and events surrounding death
Need a more comprehensive data source to increase understanding of SUID-related factors
CDC’s SUID Case Registry collects data from scene investigations, autopsies, and other sources
Main Objectives for the SUID Case RegistryMain Objectives for the SUID Case RegistryMain Objectives for the SUID Case RegistryMain Objectives for the SUID Case Registry
To create state-level surveillance systems that build yupon Child Death Review activities
To categorize SUID using standard definitions g g
To monitor the incidence of different types of SUID
To describe demographic and environmental factors To describe demographic and environmental factors for each type of SUID
To inform prevention activities and potentially save To inform prevention activities and potentially save lives
Expected Outcomes and Impacts for Expected Outcomes and Impacts for th SUID C R i tth SUID C R i tthe SUID Case Registrythe SUID Case Registry
Strengthen states’ ability to identify, review, and g y y, ,enter data for all SUID case
Improve the completeness and quality of SUID case p p q yinvestigations by promoting policy and practice changes
Inform national, state and local policymakers and program planners
Identify at-risk groups to target prevention programs
Use as a potential source of cases for case-control study
SUID Case Registry ModelSUID Case Registry ModelSUID Case Registry ModelSUID Case Registry Model
Builds upon current Child Death Review activities pand protocols Uses pre-existing variables Integrates new and/or modified SUID related variables into Integrates new and/or modified SUID-related variables into
NCCDR Case Reporting System v2.2S
Supports states in their efforts to review child death Supports states in their efforts to review child death cases per state mandates
Strengthens states’ ability to identify, review, and g y y, ,enter data for all SUID cases
Variables included in the SUID Case RegistryVariables included in the SUID Case RegistryVariables included in the SUID Case RegistryVariables included in the SUID Case Registry
Individual variables Sleep environment Maternal health, including pregnancy complications
and injury Infant health, including newborn screening
System variables Components of death scene investigationp g Tests and exams performed during autopsy
SUID Case Review Data SUID Case Review Data SourcesSourcesSourcesSources
SUIDIRFLaw Enforcement reports Medical records Death Certificate
ME/C reportEMS reports
Witness interviewsScene reenactmentScene photos
Social service records ME/C reportAutopsy report
Hospital reports
SUID case review by multidisciplinary team
SUID Multidisciplinary Review TeaSUID Multidisciplinary Review Team
Medical Examiner/Coroner
SUID Multidisciplinary Review TeaSUID Multidisciplinary Review Team
Law Enforcement Public Health E S i Emergency Services Pediatrician or other Health Care Provider Child Protective Services Child Protective Services
The SUID Case Registry is…The SUID Case Registry is…The SUID Case Registry is…The SUID Case Registry is…
A process that m st in ol e m ltidisciplinar team A process that must involve multidisciplinary team review
A qualitative and quantitative processq q p A tool for assessing and improving case
investigations A vehicle for driving data to action
The SUID Case Registry is NOT…The SUID Case Registry is NOT…The SUID Case Registry is NOT…The SUID Case Registry is NOT…
A data linkage project A fill-in-the-blank exercise An isolated process implemented without input from An isolated process implemented without input from
key partners such as child death review, medico-legal professionals and public health
Case Information Flow ChartCase Information Flow Chart
Infant dies unexpectedly with no obvious cause of death
Review team notified of death
Case information and reports gatheredCase information and reports gathered
Team reviews and discusses available data and potential prevention strategies
Data entered into web-based reporting system
State grantee reviews data for completenessState grantee reviews data for completeness
NCCDR pools state level data and sends to CDC for analysis
SUID Case Registry State Grantees SUID Case Registry State Grantees
Note:Green states: Colorado, Georgia, Michigan, New Jersey, New Mexico; funding began August 2009Orange states: Minnesota, New Hampshire; funding began August 2010
First Year ProgressFirst Year ProgressFirst Year ProgressFirst Year Progress
Improved timelinessRecei e monthl data files from Vital Statistics Receive monthly data files from Vital Statistics
Fund staff in ME/C office
Improved death scene investigation reportingp g p g Pay for completed SUIDIRFs Train investigators to conduct doll reenactment and provide dolls
Increased access to autopsy information Increased access to autopsy information Create “summary sheets” for review teams Fund staff in ME/C office
Implemented quality assurance measures Ensure SUID Case Registry staff attend all review meetings Review each case for missing/unknown fields at state level Review each case for missing/unknown fields at state level
2010 SUID Cases* as of December 31, 2010 2010 SUID Cases* as of December 31, 2010
Identified: 567Identified: 567
Reviewed : 393
QA completed: 188
*States reporting: CO, GA, MI, NJ, NM
AcknowledgementsAcknowledgementsShin Y. Kim
Terry NjorogeTerry NjorogeRebecca Ludvigsen
Cristina Rodrig e HartCristina Rodriguez-Hart
For more information:
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333
www.cdc.gov/sids1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health
What is CDR TellingWhat is CDR Telling Us about Infant
S ff ti D thSuffocation Deaths
&
What are States Doing to HelpDoing to Help Reduce Risks?
Theresa Covington, MPH
Director
National Center for Child Death Review
Child Death Review is:
Helping improve:
investigations and diagnosis
services to familiesservices to families
Helping to describe the i t i i f t lcircumstances in infant sleep related deaths.
Healthy People 2020• IVP 5: (Developmental) Increase the number of• IVP–5: (Developmental) Increase the number of States and the District of Columbia where 90 percent of sudden and unexpected deaths to p pinfants are reviewed by a child fatality review team.
• Baseline data from 2007: 4,211 SUID deaths in the US, 37 states reviewed 2,849 SUIDs or 68%.
.. III 88 .5 ~ 0000
! II !Ii! 0000
f t 1,!d~h 1000000 •
!I! ! " ! 0000
I I I I . 1.!1 ~h l 1000000 ! • •
j I I !
,
r t I!!:! ! 00000 0
! !Hlllli 00000000
t t . ! ! 1 ! • I I I;, Iq'l I I ! !lHJ1!!! • • H~ 00000000
! .f! .fl lJuJl!! lJ!!JlI 1 · I 0001
0000 0001
000 I I "i II l! I I il t
!Hl!q !HI!1 11 til !!ooo l l. !!ooo l l .• lid!
.0 000 0 00 ~ . 0000
I I
, c
, c I c
, c
GRA.Co. • :: .i
Preliminary CDR data(November 15, 2010, 28 states, 30,920 infant deaths)
Infant’s airway was fully or partially obstructed when found
CDR Team Findings Suffocation SIDSUndetermined/ Unknown Cause
TotalUnknown Cause
Total Number of cases 1613 201 459 2273
Soft bedding* was relevant to death 716 45% 152 76% 282 62% 1150Sharing a sleep
f ** lsurface** was relevant to death 719 45% 31 16% 169 37% 919
*Blanket or pillow or comforter or mattress or pillowtop mattress or waterbed or air mattress or bumperpad or stuffed toy or clothing.** With adults, other children or animals
Infant’s Sleep Place
Incident Sleep placeSuffocation SIDS
Undetermined/ Unknown
CauseTotal
Total number of Cases 1613 201 459 2273
Crib 135 55 63 253
Bassinette 65 17 34 116
Couch 259 12 63 334
~50%Adult Bed 810 90 228 1128
Other 277 27 66 370
~50%
Other 277 27 66 370
Unknown 67 0 5 72
So What are States Doing?So What are States Doing?
37 States with Safe Sleep Promotion ActivitiesWhat are these activities?
Homo Yio.U
Differences in Messaging
What AAP Message li i lDo You Explicitly
Include in Your State’s Messaging?g gN=37
It NoToys
It No Pillows
11 No Bumper Pads
K No Quiltsor Blankets
It No Stomach or Side Sleeping
Why?
A Crib • A Mattress
A TIght-Fitt ing Sheet
A Baby Placed o n his Back to Sleep
Because babies who sleep alone in a crib without bum r d blankets, loys"o r p iliowsall' LESS likely 10 d ie from SIDr pa 5,
Safe Sleep for Baby is:
.,--_ .. _-.. ....... _ ... _ ...... -........... -.-.-~-- ....... --_ ..... _-_ ..... -............... -0 _ _ ____ ...
:::..:::'-~-::..=.:: ~ ..... --.--.... -. _ ... __ 0,...-... _ ....... ,. .. -.. _ ........ ... _-- ------.ro- .... ..... .. . _ __ - -_ ... -.... _-... _-----~--. :-.::.::::. ...............
ill baby on back
- , , ......... __ ... --... -....... -. -. -----... .. -.... -'"'- .. ........ .... ;::..-:.. ........ _---. ::::: ::.::::..."':'"'..::: -~ .... -.... -, .. -..... ----
.-~--.. - ...... --_ .. -..... ...... .... _ ... _ ... -_._ .. ,..--_ ... _---...... _- ,... -_ .. _ ... " .. .... -_ ..... _--_ ..... --_. -"-"'-..... _-- .......
in a safe crib
._--... --...... .. ..... _.-_ ... --_ ... _ .. -"'-_"'''''''' _"_.11_ ... _ ::::...~- _ ...
.......... --_ .. .... .... __ ._--.. _-- .... ------_ .. ----- ..... _._ ... --_ ... --_ .... -......... _-• __ .. w_
Lots of Target Populations
Lead AgenciesLead Agencies
Other:Multi‐agency coalitiolns
Lots of PartnersLots of Partners
Delaware’s Multi‐Agency Mass Media effort
SIDS Center of New JerseySIDS Center of New JerseyInstitutionalizes Safe Sleep Messages and
Policies by Working WithPolicies by Working With:
State Child Protection Services Primary Care Centers includingPrimary Care Centers including
Federally Qualified Health Centers Nursing staff in Newborn and
Neonatal Intensive Care Unitsl d h ld l h Maternal and Child Health Consortia
Child care programs Education programs for pediatricians,
family practitioners traineesfamily practitioners, trainees
Infant Mortality Reduction Initiative • Infant Morta li ty
Hom e Page
• MN Safe and As lee p Campa ign
• Orde r Infant Slee p Safe ty Educationa l Mate ria ls
~r~~~n~~pti~n
Interconception
• Resources
Maternal & Child Health
More from MDH • Pos iti ve
Alt e rnati ves
• Pos tpartum De press ion Education Materia ls
• Shake n Baby Syndrome Prevention Materia ls
Minnesota's Safe and Asleep Campaign
Annuall y, 40 or more otherw ise hea lthy Minnesot a bab ies d ie of s leep-re lat ed un int enti ona l injuries wh il e s leep ing in unsafe conditi ons such as in an adu lt bed or on a sofa with parent s or o lder ch il dren. Bab ies become t ang led in bedd ing , get st uck under p ill ows, or t rapped bet ween a s leep ing adul t and cushions of a sofa or rec li ner. Someti mes t he ir own s leep ing parent s ro ll over on t hem unint enti ona ll y, causing deat h from suffoca ti on and chest compress ion.
Minnesot a's Safe and Asleep in a Crib of Their Own Campa ign was launched in July 2007, and conti nues as a par t nersh ip bet ween t he Mat erna l and Ch i ld Hea lth Secti on of t he Minnesot a Department of Hea lth and t he Minnesot a Sudden Infant Ueath Lenter or Lh ll dren·s HOsp ita ls and Ll ln lcs. Add it iona l partners Inc lude the Department of Human Serv ices Ch il d Mort a lity Review Panel, t he Minnesot a Assoc iati on of Coroners and Medica l Examiners, Tw in Citi es Hea lthy St ar t, t he Crad le Minnesot a Chapt er of t he American Academy of Ped iat rics and loca l pub li c hea lth de~
••• w 0<><._ .' Safe and As leep Campa ign Press Re lease. July. 2007 ( PDF: 53KB12 pagE
., ... 0<><._ .' MN Coroners and Me dica l Exam iners' letter to prov iders. Ju ly. 2007 ( PDF
The American Academy of Ped iat r ics recommends t hat a ll infant s s leep on t he ir back: approved cr ib and in a smoke-free environment t o reduce t he r isk both of Sudden Infant Death Syndrome (SI C prevent ab le injury deaths.
Educational Materials
Download or order educational materials from t he MDH Mat erna l and Chi ld Hea lth Secti on t o safe infant s leep messages for parent s and other careg ivers. Other recommend m at er ia ls can t
at ht t p ://www. njchd .njh .gov/pub li cations/ includ ing magnet s and t he genera l ou t reach door h which MDH no longer has ava il ab le.
Additional Educational Materials
T' • • I. • .. , I. • • ~
Messaging Can Be Inconsistent
THE SOLACE OF THE family bed A renowned doctor
reassures parent!> that infant night waking is normal.
And it 's safe to 5leep with your kids.
Tips IOf caregivers
Follow these recommendations to help reduce the risk 01 sudden infanl death syndrome ar.d prevent accidental deaths:
• BabOe s should s leep an their backs (not stomach Of SIdes). whether sleepong d~ Of
""", • Keep loose or ftully bedding away from the infant and hisJher sleep are a. and us. a firm. l'!jhl.fi tting matren
If Babies Could TalkCould Talk
S f Sl S ’
71
Safe Sleep: a State’s Perspective of Linking MCH
d I j P i d and Injury Prevention and SUID Case Registry
INFANT SUFFOCATION DEATHS IN THE SLEEP INFANT SUFFOCATION DEATHS IN THE SLEEP ENVIRONMENT WEBINAR
March 24, 2011March 24, 2011
Lindsey Myers, MPHColorado Department of Public Health and Environment
Colorado Child Fatality Prevention SystemPrevention System• Began in 1989
72
Began in 1989• Legislatively mandated in 2005
45 b St t T 45 member State Team Review deaths of all children under age 18
U d t d th f hild d th Understand the causes of child deaths Make recommendations for policy changes
• Currently reviewing 2008 deaths
Colorado SUID Case Registryg y
• Case Identification: Death Certificates—2010 & 73
2011deaths• Data collection Coroner Reports and Autopsies Coroner Reports and Autopsies Law Enforcement Medical Records Child Protective Services
• Case abstraction• Multidisciplinary review of circumstancesMultidisciplinary review of circumstances• Identify factors that contributed to or caused death• Identify prevention strategies
2010 SUID Cases
• 2010 cases identified to date = 51
74
2010 cases identified to date 51 • Common Risk Factors Bed-sharing Bed-sharing Soft-bedding Unsafe sleep positionUnsafe sleep position
Prevention Recommendations
• Systems
75
Systems Death Scene Investigations AutopsiesAutopsies State Agencies
• Policy and LegislationPolicy and Legislation• Community Level Education campaigns and programs Education campaigns and programs
Investigation Recommendationsg
Use the SUIDI-RF for all child deaths
76
Use e SU o a c d dea s Doll reenactment Training for lay coroners and hospital pathologists g y p p g
regarding the national recommendation for child deaths to be investigated by forensic pathologists
Training for law enforcement regarding how to look for evidence of suffocationT k th t l t t f th th th Take the actual temperature of the room, rather than make an estimated guess
Autopsy Recommendationsp y
Clarify the Nation Association of Medical Examiners
77
C a y e Na o ssoc a o o Med ca a e s “autopsy standards” to define what a “complete autopsy” means and what test should be run
Educate coroners about filling out death certificates correctly, and about the danger of using the term SUDIT i l f ll i f d h Toxicology screens for all infant deaths
Prevention Recommendations
Safe sleep statewide campaign and education—78
p p gmultilingual and multicultural
Professional education for hospital nurses and home visitation nursesvisitation nurses
Professional education for social workers during new DHS Training Academy
Safe sleep education during home assessments for child placementS C ib f Kid P Start a Cribs for Kids Program
Expand nurse home visitation programs to serve more families
L l S f Sl C iLocal Safe Sleep Campaigns79
El Paso/Teller County CFRS f Sl C iSafe Sleep Campaign
C ll b b h l l CFR T
80
Collaboration between the local CFR Team and two local hospitals
Training for health care providers and child Training for health care providers and child care providers on safe sleep
Co-messaging with abusing head trauma programtrauma program
Posters
Billboards
Radio Spots
Education programs through churches
Local Health Fairs
Mesa County CFR S f Sl C iSafe Sleep Campaign
D h SIDS i i
81
Does not use the term SIDS in campaign
Press releases
Flyers distributed to WIC, Nurse Family Partnership, and doctors offices
30 minute segment on government access channel featuring the coroner, law enforcement, and pediatricians
Letter sent to health care providers to encourage them to adopt a policy to discuss safe sleep with
ipatients
Print and Radio ads
S id S f Sl I i i iStatewide Safe Sleep Initiative82
Linking MCH, IP, and CFPSg , ,
Child Fatality
83
yPrevention
SystemDept. of
Colorado Safe Sleep
Safe Kids Colorado
Human Services
Initiative
Injury Prevention Program
Maternal and Child
HealthgProgram
Colorado Safe Sleep Initiativep
• Collaboration with Safe Kids Colorado, based out
84
Collaboration with Safe Kids Colorado, based out of The Children’s Hospital
• Interest in creating a unified statewide approachInterest in creating a unified statewide approach• Safe Sleep Summit held in January 2011 Reviewed data from CFPS Reviewed data from CFPS Learned about local safe sleep programs Round Table DiscussionsRound Table Discussions
Safe Sleep Partnersp85
Child Fatality Prevention System Review Team
State MCH program
Prenatal Plus Programs State child care licensing
programp g Home visitation programs Local health departments
(esp MCH and injury
p g Child welfare programs WIC agencies
C l d B t F di (esp. MCH and injury prevention programs)
Public health nursesH i l
Colorado Breast Feeding Coalition
Local Safe Kids coalitions Hospitals Community birthing centers Physicians
Coroners County Attorney’s Office
y
Challengesg
• Inconsistent messaging coming from the health 86
g g gdepartment
• Some lactation specialists do not agree with AAP d irecommendations
• Crib distribution controversial because of liability issues• Due to shift in diagnosis from SIDS to undetermined or • Due to shift in diagnosis from SIDS to undetermined or
ASSB, some are reluctant to use national resources that link SIDS with safe sleep
• Limited funding• Program evaluation is difficult
Round Table Discussions87
• Messaging AAP Guidelines Bed-Sharing Terminology (to use SIDS or not to use SIDS)gy ( ) Culturally specific messages
• Community Strategies Current opportunities/venues Current opportunities/venues
• Provider Strategies Child care Health care Social workers
• Policy Training curricula (nurses, social workers) Hospital policies
Safe Sleep Summit Outcomesp88
• Agreement that there is a need for a statewide Agreement that there is a need for a statewide Safe Sleep Initiative
• Agreement to use AAP GuidelinesAgreement to use AAP Guidelines• Commitment to participate• Vision Statement Draft: A coordinated • Vision Statement Draft: A coordinated,
collaborative statewide message and strategy to reduce sleep-related deaths among Colorado reduce sleep related deaths among Colorado infants.
Next Stepsp89
• Develop Statewide Safe Sleep Coalitionp p Initial Subcommittees
• Data/Evaluation• M i• Messaging• Funding
• Literature review on best practices• Pilot hospital survey• Develop consistent safe sleep messaging to be used by
all partners• Create statewide strategic plan to disseminate message
Id if f di f i l i• Identify funding sources for implementation
Opportunitiespp
• Data from SUID Case Registry Pilot will help
90
Data from SUID Case Registry Pilot will help develop stronger prevention recommendations
• Public/private partnership could be beneficial to Public/private partnership could be beneficial to fund prevention activities
• Funding through state MCH Program to help fund Funding through state MCH Program to help fund local level MCH programs work on safe sleep
• Partners around the state using the same language Partners around the state using the same language will making it easier for parents to understand safe sleep recommendations
Evaluation of a Novel SIDSEvaluation of a Novel SIDS Risk-Reduction Program at a
Community HospitalCreating a Hospital and C it B d I f tMichael Goodstein, MD, FAAP, and Theodore Bell MS
Community Based Infant Safe Sleep Education and Theodore Bell, MSAwareness Program: The York Hospital Experiencep p
Michael Goodstein, MD, FAAP
91
York PennsylvaniaYork, Pennsylvania• Population base 425,000 (city 40,500)• Inner city, suburban, and rural populations• Almost 4,500 deliveries per year , p y
92
Infant Coroner Cases York Co. 2005-2010
678
eath
s
2345
mbe
r of D
e
*
012
2005 2006 2007 2008 2009 2010
Num
2005 2006 2007 2008 2009 2010
Year
93
total deaths SUID Inappropriate sleep
Infant Sleep SafetyInfant Sleep SafetyRequires a consistent and repetitiveRequires a consistent and repetitive message in the community to prevent
accidental deathsaccidental deaths
94
Advice on Infant Sleep Safety: p yWho Do You Listen to…
• Family and Friends• Doctors Nurses Lactation CounselorsDoctors, Nurses, Lactation Counselors• Magazines, Newspapers, Internet
O h D Phil D S k D S• Oprah, Dr. Phil, Dr. Spock, Dr. Sears• Grandma!!!
95
Why Develop a Hospital-Based P ?Program?
• It is the only way to capture 100% of theIt is the only way to capture 100% of the birthing population for education
• It is the point of intersection for all the• It is the point of intersection for all the members of the health care team including obstetrician pediatrician nursing andobstetrician, pediatrician, nursing, and lactation counselor with family membersN iti l l d l• Nurses are critical role models
• It is efficient and cost-effective
96
Hospital-Based Infant Safe Sleep Program
Goal: Reduce the risk of injury or death toGoal: Reduce the risk of injury or death to infants while sleeping
P id t d i t t i f t f• Provide accurate and consistent infant safe sleep information to hospital personnel
• Enable hospitals to implement and model infant safe sleep practices throughout the facility
• Provide direction to health care professionals so parents receive consistent, repetitive safe l d ti
97
sleep education
A Model Program
• Replicate Shaken Baby Program (now called p y gabusive head trauma)
• 50% reduction in shaken baby injuries reported by Dr. Dias (Peds April 2005)
• Program Components:g p DVD presentation on infant sleep safety Face-to-face review with nursing staffg Sign voluntary acknowledgement
statement
98
Infant Safe Sleep DVDsInfant Safe Sleep DVDs
99
Parent EducationParent Education• Prior to discharge, all parents view g , p
the Safe Sleep DVD• Nurse modeling of safe sleep g p
environment • Review of the “Safe Sleep for your p y
Baby” pamphlet. • Confirm there is a safe place for the p
baby to sleep. If not, social work referral to obtain a Pack ‘N’ Play.
100
Voluntary Acknowledgment Statement
…. that I have received this information and understand that babies should sleep on the back, and that sleeping with my baby increases the risk of my baby dying from SIDS. • An acknowledgement form only• Focuses family on the importance of the informationy p• Not for legal purposes
101
Infant Safe Sleep Program: Supplemental Components
• Posters placed prominently in every labor, maternity, and pediatric room, offered to all OB, Peds, FP offices
• Sleep sacks available for purchase at p pdiscount at gift shop and lactation center
• Display nursery: Infant Sleep Safety CenterDisplay nursery: Infant Sleep Safety Center• Hospital phone service (on-hold message)
102
Safe Sleep PostersSafe Sleep Posters
103
Model Nursery/Infant Sleep Safety CCenter
104
Organizational Chart for an Infant Sleep Safety Program
Hospital Based Infant Safe Sleep Program
Program Acceptance Curriculum Development Community Support
Hospital Administration
Physicians
Initial Staff Education
Maintenance of Education
Local Health Bureaus
Safe Kids Coalition
Nursing Staff
Other Staff (RT, LC, Aides)
Family Education Cribs for Kids Programs
Child Death Review Teams
105
Presentation for AdministrationPresentation for Administration• Support from physicians already pp p y y
knowledgeable about SIDS/SUID• Scope of problem: National and localScope of problem: National and local
statistics• Logistics of program: A successful• Logistics of program: A successful
program model that has produced excellent public health resultsexcellent public health results
• Cost-effectiveness
106
Infant Mortality Statistics
SIDS - United States 1999The major cause of infant death after the first month
26.5SIDS/SUID17.2
8.1Congenital Anomalies
Accident/Adverse Effects
SIDS/SUID
3.13.03.1
Pneumonia/Influenza
Homicide/Legal Intervention
Septicemia
1.00.70 7
p
Meningitis
Respiratory Distress % of total infant deaths28-364 days old
107
0.70.6
Bronchitis
Malignant Neoplasms
28 364 days old
Staff Acceptance “Buy-In”Staff Acceptance Buy In
• Pediatric and NBN nurses with knowledgePediatric and NBN nurses with knowledge about SUID make quick allies
• Resistance to “another program” is easily• Resistance to another program is easily overcome by:
C t f t d i f t Concept of a program to reduce infant mortality locally Use of statistics Use of statistics Use of Evidence-Based Medicine
108
Allegheny County, PASt d f 88 SIDS D th 1994 2000Study of 88 SIDS Deaths, 1994-2000
11% (10 babies)Found in cribs or bassinets
89% (78 babies)Found in unsafe sleeping environments
109Source: Allegheny County Coroner’s Office, Stephen Koehler, Ph. D., Forensic Epidemiologist
Nursing Buy-Ing y• Nurse Managers: NBN, ICN, L&D,
Pediatrics, ED• Discussions at staff organizational g
levels: multidisciplinary committees (neonatal care), nursing counsels ( ), g(education, practice) Nurse leaders: Support dissemination of pp
program concept to general staff Follow-up discussions at nurse staff
110
pmeetings, reinforcement through e-mail
Healthcare Provider EducationHealthcare Provider Education
• Develop an infant sleep safety policy forDevelop an infant sleep safety policy for the hospital: Set the standard of care at the institution Set the standard of care at the institution Sample policies on the Allegheny County
Dept of Health and First Candle websitesDept of Health and First Candle websites York Hospital policy modified the Allegheny
sample and was merged with existing policysample and was merged with existing policy Finalized through newborn and pediatric
hospital committees
111
p
Hospital Nursing EducationHospital Nursing Education• In-service lectures vs. computer-basedIn service lectures vs. computer based
training• Lecture compliance may be difficult if not• Lecture compliance may be difficult if not
mandatory…non-productive hoursComputer based easier to do but teaching• Computer-based easier to do, but teaching may be less effective P id d CME di• Provided CME credits
112
Hospital Nursing EducationHospital Nursing Education• Core group of volunteers to provide lecturesCore group of volunteers to provide lectures• Developed PowerPoint presentation and
had practice sessionshad practice sessions Materials included: AAP SIDS policy statement,
NIH materials Cribs for Kids lecture materialsNIH materials, Cribs for Kids lecture materials• Supplemental poster boards in clinical areas
M d t i i f S f Sl DVD• Mandatory viewing of Safe Sleep DVD Reinforce materials, know what parents will see
113
Avoiding Potential PitfallsAvoiding Potential Pitfalls• Focus on back vs. side sleeping and fear
of aspiration• Claims made against the program:g p g Anti-bonding Anti-breastfeedingAnti breastfeeding
• Focus on evidence-based medicine Eliminate emotion Eliminate emotion
114
Maintenance of EducationMaintenance of Education
• Safe sleep toolkit at nurses’ stations (modifiedSafe sleep toolkit at nurses stations (modified
from Allegheny county)
Hospital safe sleep policy Hospital safe sleep policy Review of appropriate practices Discussion points to review with families Discussion points to review with families
• Informational flip charts (scripted prompts, stats)
• Computer-based review course with test as part of yearly competencies
115
Healthcare Provider Education: In the CommunityIn the Community
• Went into local physician offices to lecture during staff meetingsduring staff meetings Pediatric and obstetrical
• OB office visits focused on prenatal educatorsOB office visits focused on prenatal educators Provided posters and teaching materials Discussed bad information in free magazines Discussed bad information in free magazines
• Family Practice Grand RoundsEmergency Department Education• Emergency Department Education
• VNA
116• Red Cross Educators• Prenatal Class Educators
Anticipated OutcomesAnticipated Outcomes
• Back to Sleep Campaign – 50% reduction inBack to Sleep Campaign 50% reduction in SIDS (compliance 87%)
• Shaken Baby Program 50% reduction in• Shaken Baby Program- 50% reduction in abusive head trauma injuriesS SUID t ti t t 90% f• Some SUID experts estimate up to 90% of these deaths are related to suffocation
• Reasonable expectation of up to 50% reduction in SIDS/SUID events
117
$$$ Cost of Program $$$$$$ Cost of Program $$$• DVD- Safe sleep for your baby – right from
the start- $20• Voluntary commitment statement – paper y p p
supplies• Safe sleep toolkit – more paper suppliesSafe sleep toolkit more paper supplies• Safe sleep educational brochures – free
from NIHfrom NIH• Computer-based training – no charge
118• Volunteerism – to assist with in-services
Infant Safe Sleep Program ResultsInfant Safe Sleep Program Results
• 6 months baseline; 6 months intervention• 2 725 healthy deliveries 2 256 surveys• 2,725 healthy deliveries, 2,256 surveys• Excellent knowledge base about sleep
i t (94 99% i 99% ib)environment (94-99% supine, 99% crib)• Knowledge does not equal intent (15% drop)
119
Infant Safe Sleep Program ResultsInfant Safe Sleep Program Results
• Improvement after program interventionI t ti t f ll th h ith• Intention to follow through with: Supine sleep position increased from 82% to
97% ( < 01)97% (p < .01) Crib or bassinette use increased from 81% to
92% (p < 01)92% (p < .01)
120
Results of HCP EducationResults of HCP Education
• Understanding of the AAP guidelines increased from 75% to 99% (p < 0.01)
• Agreement with all of the AAP guidelines increased from 88% to 94% (p = 0.049)% % (p )
• Staff adequately trained about ISS increased from 43% to 99% (p < 0 01)increased from 43% to 99% (p < 0.01)
121
ConclusionsConclusions
• A hospital-based community-wide InfantA hospital based community wide Infant Sleep Safety program can be maintained successfully at minimal costsuccessfully at minimal cost.
• To be successful:Id tif i f t l f t h i Identify infant sleep safety champions Build consensus
Eff i d i Effort, time, and passion
122
Program Replication• York Hospital• Memorial Hospital
• Magee Women’s Hospital• Mercy HospitalMemorial Hospital
• Gettysburg Hospital• Harrisburg Hospital
y p• St. Clair Hospital• Franklin Square HospitalHarrisburg Hospital
(Pinnacle Health)• Doylestown Hospital
q p• Williamsport Hospital• *Lancaster Women andDoylestown Hospital
• Hanover Hospital• West Penn Hospital
Lancaster Women and Children’s Hospital
• *Heart of Lancaster West Penn Hospital• Forbes Hospital• Sewickley Hospital
Hospital• *Geisinger Health System
123
• Sewickley Hospital g y• *Hershey Medical Center
Achieving a Cultural Shift on ISSInconsistency of message.Lack of HCP education.
Wrong advice from
National campaign withconsistency of message.
Improved HCP educationgfamily and friends.
Unsafe sleep images.Inappropriate sleep
products
Improved HCP education.Partnership: Religious
Leaders.Safe sleep images.S i l k iproducts.
SafeSleep
Social marketing.Legislation?
Safe Sleep
p
124
References and Contacts• The American Academy of Pediatrics Task Force on Sudden Infant
Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts controversies regarding thesyndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005;116:1245-55.
• Colson et al Trends and factors associated with infant sleeping• Colson et al. Trends and factors associated with infant sleeping position: The national infant sleep position study 1993-2007. Arch Pediatr Adolesc Med 2009;163(12):1122-1128.
• Kinney and Thach Medical Progress: The sudden infant death• Kinney and Thach. Medical Progress: The sudden infant death syndrome. N Engl J Med 2009;361:785-805.
• Contact Information: Michael H Goodstein MD FAAP Michael H. Goodstein, MD, FAAP
Office of Newborn Medicine York Hospital1001 S. George St.York, PA 17405717 851 3452
125
717-851-3452717-851-2602 (fax)mgoodstein@wellspan.org
THANK YOU!!!
126
C ib f KidCribs for Kids® National Infant Safe Sleep Education and
Crib Distribution Program
Judy Bannon, Executive Director/Foundery ,www.cribsforkids.org
Cribs for Kids®
• Originated in Pittsburgh in Nov. 1998 through the combined efforts of DistrictAttorney Stephen Zappala, Mayor Bob O’C C d G Elli tt dO’Connor, Cmdr. Gwen Elliott, and Judy Bannon (SIDS of PA)
• Steering committee consisting of• Steering committee consisting of public health, political and business leaders and child death review teamswas formedwas formed
Of the 68 infant deaths between 2001-06, how many babies were in an ideal sleeping space?
( th b k i f ib i tt k ft b ddi )(on the back, in a safe crib, no cigarette smoke, no soft bedding)
Allegheny County, Pittsburgh, PA
Unsafe!
Only 2!
FACT!
The overwhelming majority of babies who die from SUID/SIDS are discovered in an unacceptable sleep position or sleep
location!
The overwhelming majority of babies whoThe overwhelming majority of babies who continue to die from SUID/SIDS are African
American babies!American babies!
Growth between 2006 and present!AK
ME
BC
Growth between 2006 and present!
NY
WA
MNWI
NYCMIOR
VNDMT
ME
NH
VE
ID
PA
OH
KY
VAIL
NCKS
MD
NYCMI
CA
DCDE
MO
NJNE WV
CONV IN
IA
UT
WY
KY NCKS
GAAL
CA
MS
MO
SCOKTN
AZ NMARHI
LAFL
To Date: 262 Partners in 48 States
TX
Cribs for Kids locations Awaiting signed agreement
262 Partners in 48 States
National Cribs for Kids® Partners
140
National Cribs for Kids® Partners
119
100
120
140
Health Departments & DPWAgencies
5960
80
100 DPW Agencies
Hospitals
SafeKids Coalitions
32
47
20
40
60
Community Based Organizations
Oth5
0
20
Number of Partners (262)
Other
( )
SIDS is NOT SuffocationSIDS is NOT Suffocation
Although SIDS is different fromAlthough SIDS is different from suffocation, all the measures we use for SIDS risk reduction also help to preventSIDS risk reduction, also help to prevent accidental deaths such as positional asphyxia overlay and entrapmentasphyxia, overlay, and entrapment.
Th d th 100%These deaths are 100% PREVENTABLE!
The Ideal Safe Sleep Environment
Used with permission from Tomorrow’s Child, Michigan SIDS
Baby sleeps in crib.
Nothing in sleep area.
Firm mattress, tight-fitting sheet.
Unsafe Sleep Environment:Soft BeddingSoft Bedding
Unsafe Sleep Environment
Unsafe Sleep Environment
j
Components of the Cribs for Kids® program
• Standardized materials
Cribs for Kids® program
Safe-sleep brochures, posters, etc. Training manuals Standardized forms Standardized forms Grant writing language Current safe-sleep literature review
P P i t t ti PowerPoint presentations• National fundraising initiatives• Crib distribution systemCrib distribution system• Networking opportunities• Ongoing supportg g pp
National Sponsors
Graco Children’s ProductsGraco Children s Products In January, 2006, Cribs for Kids was
made the exclusive commercial distributor of the Graco Pack n’ Playdistributor of the Graco Pack n Play
Pitt Ohi EPitt-Ohio Express In March, 2006 Pitt-Ohio Express
partners with us and offers free shipping p pp gto partners across the country. They also
donated a forklift to help with our shipping needs!
Cribs for Kids® Graco Pack ‘n Play
G ‘P k Pl ’Graco ‘Pack n Play®’ --$49.99
Our own C4K SKU numberCan not be returned to any retail
storeS f t dSafety approvedPortableCompactEasy to assembleEasy to assemble
Cribs for Kids® Crib Sheet with Safe Sleep Message
$5 00 each$5.00 each
Please Keep Me Safe…
For naps & at night to reduce the risk of SIDS
Back to Sleep
Now I lay me down to sleep,Alone in my crib, without a peep.On my back, in smoke-free air,
Thank you for showing me that you care.
www.cribsforkids.org1.888.721.CRIB
Portable Crib Sheet Design
Cribs for Kids® Logo Halo Sleep Sack$14 99 each
HALO™ SleepSack™ Wearable Blanket
$14.99 each
HALO SleepSack Wearable Blanket
Replaces loose blanketsReplaces loose blankets in the crib, lessening the likelihood of babies getting blankets over or around their face.
Respironic Soothie Pacifier$1.50$1.50
Soothie®
For Babies Without TeethSoothie is a premium pacifierdesigned for newborns and babies without
h h f ll b l
For Babies Without Teeth
teeth who are successfully bottle or breastfeeding. Its one-piece construction adheres to the American Academy of Pediatrics guidelines.Pediatrics guidelines.
Respironic Pacifier
“Keep Me Safe” Photo Magnet$ 75$.75
• New item added to Safe Sleep Survival Kit
• Safe Sleep Survival Kit same price still $69.99
Safe-Sleep Survival Kit $69.99
Safe Sleep Survival Kit
Please Keep Me Safe…
Now I lay me down to sleep,Alone in my crib, without a peep.On my back, in smoke-free air,
Thank you for showing me that you care.
For naps & at night to reduce the risk of SIDS
Back to Sleep
www.cribsforkids.org1.888.721.CRIB
Public Service AnnouncementInfant Safe Sleep VideoInfant Safe Sleep Video
Please Keep Me Safe…
Now I lay me down to sleep,Alone in my crib, without a peep.
For naps & at night to reduce the risk of SIDS
Back to Sleep
www.cribsforkids.org1.888.721.CRIB
On my back, in smoke-free air,Thank you for showing me that you care.
Becoming a Partner….H d I b i ?How do I begin?
Go to www.cribsforkids.org
Or
Call: 412-322-5680 Ext 3Call: 412 322 5680 Ext 3
Components of the ‘Cribs for Kids®’ Program
Application FormApplication Form
Components of the ‘Cribs for Kids®’ Program
Trademark License AgreementTrademark License Agreement
Components of the ‘Cribs for Kids®’ Program
Standardized BrochuresStandardized Brochures
www.nichd.gov/SIDS
For more educational supplies request from
g
For more educational supplies request fromwww.nichd.nih.gov/SIDS
Components of the ‘Cribs for Kids®’ Program Survey Instruments – Pre & Post TestsSurvey Instruments Pre & Post Tests
~. I-- I
-c... ... ......
T'IIfJl I12U , -_. ' ........ -,- , ~ -, - ~ -'-- • ,- ",--~,- - ""--. ==-----~~
p,.,.l .... ~:~~ . .. K lIl l ', .~. ---"-- , --'-" ..... _- ... ". ............ _ IU-.~."""t." -::c.- '.,...--- , ..,~..,. ... :r; - ..... -.- ..... ..,... .......,_.
___ G " .. , ... , ---) "'" """"-- --,.,. -----_.- La --... _ " ",,,,,, • --" . ..--.. ,..-_ .............. - , :. ...... -..- . ."",. , -_ .. ,.. ___ ....... _.-:0;. -'" -... -- .- - -~. ...". .. - ._- .- ,
"-~ - "',.. .--. -"-- , . ...... ... m -'.. ...,. ........... , :c:r.,,::"l0l , - -. -,-....... , , , , , "',..- ... _. , . ,..---- -..... --,...-' , , , , .... - .. -....
-,..~ -:: ........... -, ".,..-,.. ..... ~- , ..... ,..... ....... ....... -... _ . ,.._ • ..r , , , , .. _..., .
• _ ... _ .. '00'''"'" , , , , -.... .............. -. ---_ ... -,..~ ..... -.... ..... _J<, ... ..., --' , , , , ""- .... -... __ .. --... , , , , ---'--'~ .. ..... .-- ~. ----.".---.~ , "" ...... ........... ---_ ....... - , , • , "" ..... -......... .- -------.:::::: ........... ....... -,.....,.. , , , , -... -,..----............. _,.....,.
~-. -
Components of the ‘Cribs for Kids®’ Program
Sample Grant Materialsp
Components of the ‘Cribs for Kids®’ Program
Sample Grant MaterialsSample Grant Materials
Components of the ‘Cribs for Kids®’ Program -- Standardized Forms
Hold Harmless AgreementHold Harmless Agreement
Components of the ‘Cribs for Kids®’ Program
Safe-Sleep ChecklistSafe-Sleep Checklist
How to Order a Safe Sleep En ironmentSafe-Sleep Environment
Mandated Legislation(language and guidance)(language and guidance)
Pennsylvania Act 73 of 2010
SIDS Ed ti d P ti PSIDS Education and Prevention ProgramSigned into law on October 19, 2010 by Governor Edward
Rendell of Pennsylvania, providing for education of parents relating to SIDS and unexpected deaths in
infanc taking effect on December 16 2010infancy, taking effect on December 16, 2010.
Networking & Ongoing SupportNetworking & Ongoing Support
• Semi-Annual conferenceSemi Annual conference• 24-Hour Hotline
E i d t ff t ti l ffi• Experienced staff at national office answers questions & provides guidance
• Fundraising Advice• Easy ordering of Safe Sleep Survival Kitsy g p
FACT!
Knowing is not enough:we must apply.
Willing is not enough:Willing is not enough:we must do.
……Goethe
Questions and AnswersQuestions and Answers Thank you for attending this event. Please
complete the evaluation directly following the p y gwebcast. An archive of this events will be posted (http://www.mchcom.com) within a few days.
top related