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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 5: Safe Sleep

MCH Best Logo infant in a crib looking up at the camera

Strategy. Multicomponent Strategy: Caregiver Education + Health Care Provider Education + Hospital Safe Sleep Policy

Approach. Implement a multicomponent strategy that targets caregivers, child care providers, health care providers, and hospital systems (not including quality improvement components).

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Overview. Implementation of site-specific interventions including education for caregivers, child care providers, and health care providers as well as hospital-level policies seem to improve overall safe sleep practices.1

Evidence. Moderate Evidence. Multicomponent interventions implemented at the caregiver, health care provider, and hospital levels without quality improvement initiatives appear to be effective and have more impact than implementing single-strategy interventions focused on one group. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Multiple (caregiver + child care provider + health care provider + hospital systems).

Outcome. Infants placed to sleep on their backs. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently 14 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Implement a multicomponent strategy that targets caregivers, child care providers, health care providers, and hospital systems,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of hospitals with protocols that align with the American Academy of Pediatrics' Recommendations for Safe Sleep Infant Environment.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of hospitals with protocols that align with the American Academy of Pediatrics' Recommendations for Safe Sleep Infant Environment.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of women who give birth at hospitals with protocols that align with the American Academy of Pediatrics' Recommendations for Safe Sleep Infant Environment that report confidence in applying infant safe sleep practices.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of women who give birth at hospitals with protocols that align with the American Academy of Pediatrics' Recommendations for Safe Sleep Infant Environment that report confidence in applying infant safe sleep practices.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Kuhlmann, S., Ahlers-Schmidt, C. R., Lukasiewicz, G., & Truong, T. M. (2016). Interventions to improve safe sleep among hospitalized infants at eight children’s hospitals. Hospital Pediatrics, 6(2), 88-94.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.