The Title V Maternal and Child Health Services Block Grant to States Program guidance defines the significance of this goal as follows:
Sleep-related infant deaths, also called Sudden Unexpected Infant Deaths (SUID), are the leading cause of infant death after the first month of life and the third leading cause of infant death overall. Sleep-related SUIDs include Sudden Infant Death Syndrome (SIDS), unknown cause, and accidental suffocation and strangulation in bed. Due to heightened risk of SIDS when infants are placed to sleep in side (lateral) or stomach (prone) sleep positions, the AAP has long recommended the back (supine) sleep position. However, in 2011, AAP expanded its recommendations to help reduce the risk of all sleep-related deaths through a safe sleep environment that includes use of the back-sleep position, on a separate firm sleep surface (room-sharing without bed sharing), and without loose bedding. Among others, additional higher-level recommendations include breastfeeding and avoiding smoke exposure during pregnancy and after birth. These expanded recommendations have formed the basis of the National Institute of Child Health and Development (NICHD) Safe to Sleep Campaign®.
NPM 5 Tools
- Evidence Brief (National Center for Education in MCH (NCEMCH) at Georgetown University).
- Environmental Scan (Women's and Children's Health Policy Center (WCHPC) at Johns Hopkins University). This environmental scan identifies compilations of strategies to advance NPM 5. Read more about environmental scans.
Summary of the Evidence
The following trends emerged from analysis of peer- reviewed evidence (Note: this review focused only on sleep position). These findings may serve as ideas to expand your ESM in the future.
- Interventions targeting caregivers only appear to be somewhat effective.
- Interventions implemented at the caregiver, health care provider, and hospital levels without quality improvement initiatives appear to be effective.
- Interventions implemented at the caregiver, health care provider, and hospital levels with quality improvement appear to be somewhat effective.
- National campaigns appear to be effective.
- Due to the limited scope of included studies, there is less clear evidence of the effectiveness for interventions focusing on health care providers or child care providers only.1
1 Lai Y, Garcia S, Strobino D, Grason H, Minkovitz C. National Performance Measure 5 Safe Sleep Evidence Review. Strengthen the Evidence Base for Maternal and Child Health Programs. Women’s and Children’s Health Policy Center, Johns Hopkins University, Baltimore, MD. 2017.
Access the published evidence.
Evidence Analysis Reports
- NPM 5 Safe Sleep: Evidence Review Brief (WCHPC). A three-page summary of report methodologies, results, key findings, and implications.
- NPM 5 Safe Sleep: Evidence Review Full Report (WCHPC). A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 5 to serve as the foundation for accountability across all states and jurisdictions. The evidence review uses a structured approach to evaluate the available empirical evidence and to draw conclusions for MCH programs based on the best available evidence. Read about the evidence analysis report methodology | You can also access the full set of Evidence Analysis Reports.
You can access strategies from AMCHP’s Innovation Station that have shown promise in advancing your NPM below. While these strategies may not completely align with your current activities, they can be used to help guide further development and measurement of your ESM.
|Practice Name||Primary Interest||State||Level of Evidence|
|Back to Sleep Nurse Training||Birth Outcomes||MO||Promising|
|Safe Sleep Sweep||Infant Health||NY||Cutting Edge|
|Women’s Health Education Birth Outcomes NY Promising Navigation (WHEN) Program for justice-involved families||Birth Outcomes||NY||Promising|
|Nurse Family Partnership||Home Visiting||National||Best|
|Sisters United: Promoting Healthy Habits, Protecting Our Babies||Birth Outcomes||AR||Emerging|
|Welcome Family||Health Promotion||MA||Promising|
|Safe Infant Sleep||Birth Outcomes||GA||Emerging|
|DOSE: Direct On Scene Education Program||Injury Prevention||FL||Cutting Edge|
|Prenatal Plus Program||Service Coordination and Integration||CO||Promising|
Domain and National Performance Measure: Percent of infants placed to sleep on their back
|Strategy [Source]||Evidence-based/-informed Strategy Measure (ESM)|
Analyze PRAMS and SUID-CDR data to identify program targets, inform interventions, and develop fact sheets [1,2]
|# of state-wide or local programs integrating PRAMS/SUID data to develop or target interventions|
|Partner with WIC, home visiting or other programs to provide safe sleep education and counseling [1,2]||#/% of WIC participants, home visiting clients, or other program participants that received safe sleep counseling|
|Enforce laws regarding mandatory training for childcare providers, medical professionals, and emergency medical technicians [1,2]||% of audited child care providers or other professionals in compliance with regulation|
|Implement train the trainer programs for the various providers engaged pre and postnatally [1,2]||% of licensed medical professionals who received CE credits on SUID prevention or safe sleep practices in the past year|
 Kogan et al. (2015). A new performance measurement system for maternal and child health in the United States. Maternal and Child Health Journal.
 Kogan, M., & Lawler, M. (2015, December 8). Development of evidence-based or informed strategy measures [Webinar].
Source: Sample Strategies and Evidence-based/informed Strategy Measures (ESMs) (WCHPC). A list of sample strategies and ESMs for each of the 15 NPMs. Sources are provided at the end of the document.
Related ESMs. Access ESMs being implemented by other states/jurisdictions that may serve as models for future work with NPM 5.
- NPM 5 Transformation Tools (MCH Navigator and National MCH Workforce Development Center). Learning resources, implementation strategies, and links to the evidence base for the competencies needed to carry out NPM 5 activities.
- Taking Action with Evidence Implementation Roadmap (Association of MCH Programs (AMCHP) and WCHPC). Archived webinars and additional learning and implementation resources.
- Historical Resources from the MCH Digital Library (NCEMCH). This bibliography is automatically generated to pull resources from MCHLine, the MCH Library's online catalog of seminal resources,*--- in support of NPM 5. Coming soon.
- National Action Partnership to Promote Safe Sleep (NAPPSS): An MCHB-funded technical assistance resource center, this project supports NPM 4 and 5 topic areas.
- Children's Safety Network: An MCHB-funded technical resource center, this project supports NPM 5: safe sleep
- Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care.