Title V Transformation Tools
Recommendations to Support National Performance Measure (NPM) 5 – Safe Sleep
Jump To: Skills | Knowledge
Significance. The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
A well-woman or preconception visit provides a critical opportunity to receive recommended clinical preventive services, including screening, counseling, and immunizations, which can lead to appropriate identification, treatment, and prevention of disease to optimize the health of women before, between, and beyond potential pregnancies. For example, screening and management of chronic conditions such as diabetes, and counseling to achieve a healthy weight and smoking cessation, can be advanced within a well woman visit to promote women's health prior to and between pregnancies and improve subsequent maternal and perinatal outcomes. The annual well-woman visit has been endorsed by the American College of Obstetrics and Gynecologists (ACOG) and was also identified among the women's preventive services required by the Affordable Care Act (ACA) to be covered by private insurance plans without cost-sharing.
Background. The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures (NPMs) for the 2015-2017 grant cycle. In order to effectively address the NPMs, MCH professionals need to think about not only the evidence and strategies to make change, but also the capacity of the workforce to carry out these activities. These lists identify online learning materials, resources, and evidence-based strategies and programs to support the knowledge sets and skills needed to advance each NPM.
Introduction. Six skill sets have been identified by the National MCH Workforce Development Center to support implementation of the Title V National Performance Measure (NPM) 5: Safe Sleep: (1) population health; (2) strategic planning and program design; (3) strategic alliances and effective partnerships; (4) consumer engagement and cultural and linguistic brokering; (5) policy and program implementation; and (6) communication.
In addition, two knowledge areas specific to the NPM topic area have been highlighted that are keyed to the evidence base and promising practices: (1) safe sleep background, recommendations, and guidelines and (2) safe sleep policies and strategies.
The MCH Navigator, in collaboration with the Center, has developed this crosswalk to guide MCH professionals to online learning opportunities and implementation resources to support these skill sets.
Please click on the Read More buttons below for additional information, learning materials, and implementation resources. You can also email us with suggestions for additions.
1. Population Health
Six skill sets have been identified to support implementation of this NPM:
- Ability to conduct surveillance of safe sleep that allows public health practitioners to understand and respond to disparities in safe sleep practices
2. Strategic Planning & Program Design
Effective strategic planning and program design requires the ability to base programs on defined goals and desired outcomes. Strategic planning should include a monitoring and evaluation system to track and monitor progress and inform program alterations as needed. Program design skills must ultimately be coupled with implementation, where program design is carried out.
- Ability to apply the socio-ecological framework to safe sleep
- Ability to ensure that evidence-based safe sleep promotion messages are included in home visiting and care coordination programs for which Title V provides oversight
3. Strategic Alliances & Effective Partnerships
The wide array of stakeholders and partners in the field of MCH, from providers and insurers to women and children, require a set of skills in strategically aligning Title V goals with those of their partners. In the Title V world, there is an increasing interest in engaging unlikely or nontraditional partners to achieve the NPMs. The skills in this category take that into account and include unique partner groups linked to this measure.
- Ability to collaborate with federally qualified health centers and school-based health centers to promote policy solutions to unsafe sleep practices
- Ability to partner with Medicaid and managed care organizations (MCOs) to collect and analyze data on sudden infant death syndrome/sudden unexplained infant death (SID/SUID)
- Ability to align safe sleep efforts with breastfeeding initiatives
4. Consumer Engagement/Cultural & Linguistic Brokering
Consumers are arguably the most important stakeholders in MCH work, thus skills in consumer engagement and cultural and linguistic brokering are essential to moving the needle for each NPM. In some cases, consumer engagement includes negotiating with other stakeholders on behalf of MCH populations. Closely linked with this skills category are skills in communication and strategic alliances.
- Skills to effectively engage expectant families, new parents and intergenerational families in designing safe sleep interventions
- Skills to engage families in needs assessment for safe sleep programs and policies
- Ability to effectively engage new parents as peer educators for safe sleep initiatives
- Skills to respectfully build relationships with families and communicate the importance of safe sleep practices using cultural understanding and humility
- Ability to be sensitive to the cultural norms that impact newborn sleep practices
5. Policy & Program Implementation
These skills ensure that MCH priorities are integrated into all aspects of policy and program implementation, as well as ensuring that policies and programs selected are well-aligned with NPMs and other MCH program goals. Implementing policies and programs with fidelity also requires skills in the implementation science drivers: technical and adaptive leadership; selection; training; coaching; systems intervention; facilitative administration; and decision support data systems.
- Skills to ensure high quality safe sleep counseling is embedded in programs for which Title V has authority
- Ability to provide state public health recognition (e.g., certificates, awards, news releases) to health providers, birth facilities, and others who work to reduce SIDS/SUID or lessen its impact on families
- Ability to leverage national safe sleep resources for a public education campaign, including distribution of materials to health providers, health department clinics, childcare centers and homes, and families in birth facilities
- Ability to conduct a performance improvement project that attempts to increase rates of safe sleep among enrollees in partnership with Medicaid and/or MCOs
- Ability to effectively communicate with policymakers about the value of laws requiring emergency medical technicians, firefighters, child care providers, and law enforcement officers to receive training on how to handle SID/SUID deaths
- Ability to advocate for adoption of a law that requires post-mortem examinations or autopsies when SID/SUID death is suspected
- Ability to create/maintain a child death/fatality review process that includes SID/SUID-specific protocols and SID/SUID experts
Communication skills support the creation and delivery of effective messages between MCH professionals, professional and community partners, and populations served by Title V. Effective communication ensures the delivery of appropriate messages to audiences in the way that they were intended and is key to all aspects of MCH work. These skills are linked closely with skills in strategic partnerships and cultural and linguistic brokering.
- Ability to effectively reach women of childbearing age with culturally appropriate and compelling safe sleep messages
- Skills to train hospital staff as necessary to effectively support safe sleep practices
- Skills to effectively navigate around potentially conflicting messages between safe sleep and breastfeeding
In addition to skills, each NPM requires a knowledge base that will help Title V progress effectively in the measure. Knowledge should be considered at the foundation of achieving all measures.
1. Safe Sleep Background, Recommendations & Guidelines
- Benefits of safe sleep strategies
- Risks of unsafe sleep practices, including SIDS and SUID:
- Current guidelines and American Academy of Pediatrics (AAP) recommendations for safe sleep practices
- Historical and cultural context of safe sleep practices in a given geographic area
- Barriers to safe sleep practices reported by families
- Existing statewide and national initiatives to promote safe sleep
- Safe sleep messages that may appear contradictory to breastfeeding guidelines
- Breastfeeding messages that may appear contradictory to safe sleep guidelines
- The National Action Partnership to Promote Safe Sleep (NAPPSS) is funded by MCHB to develop and implement the National Action Plan to Increase Safe Infant Sleep and partner to support breastfeeding among infant caregivers by activating systems, supports, and services to systematically work together to make safe infant sleep and breastfeeding a national norm. Resources include safe sleep and breastfeeding materials, materials from NAPPSS leadership organizations, Safe to Sleep public education campaign materials, statistics, and Healthy People 2020 Objectives.
- The SUID/SIDS Gateway provides resources for states, communities, professionals, and families to reduce sudden unexpected infant death (SUID) and Sudden Infant Death Syndrome (SIDS), promote healthy outcomes, and cope with grief when losses occur. NCEMCH supports MCHB's ongoing commitment to reducing infant mortality by housing the federal investment of materials developed by the National Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) Consortium, including the SUID/SIDS Resource Center, the Program Support Center, Project IMPACT, and the National Center for Cultural Competence. Due to cessation in funding, the Consortium was disbanded in January 2014.
- The United States Breastfeeding Committee (USBC) is an independent nonprofit coalition of more than 50 nationally influential professional, educational, and governmental organizations that share a common mission to drive collaborative efforts for policy and practices that create a landscape of breastfeeding support.
2. Safe Sleep Policies & Strategies
- Relevant environmental policies that support or undermine safe sleep practices
- Policies (in hospitals, primary care settings, federally qualified health centers, etc.) that promote safe sleep and the relative effectiveness of these policies
- Essential components of any relevant state and federal policies that facilitate access to safe sleep programs for pregnant women
See other online learning resources related to health transformation, collected in the Health Transformation Learning Laboratory.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p.78.