MCHbest. NPM 5: Safe Sleep
Strategy. Building on Campaigns with Conversations
Approach. Provide training to professionals who interact with expecting and new mothers and families that emphasize a nuanced approach to take family needs, beliefs, and context into account when talking about safe sleep, breastfeeding, and smoking.
Overview. This is a new approach to supporting caregivers to help overcome barriers to safe sleep and breastfeeding. It is part of a greater trend in public health promotion—utilizing an individualized approach that takes into account each family’s needs, beliefs, and the context of their lives.
This training on the Conversations Approach is based on Ajzen’s Theory of Planned Behavior and follows current recommendations from the American Academy for Pediatrics (AAP) for safe sleep and optimal breastfeeding for healthy infants.1
Evidence. Expert Review and Consensus. The NAPPSS coalition developed the conversations approach with input and review from over 70 national organizations who represent service systems, providers, programs, and community support networks. Initial articles have included the conversations approach in the group of “provider training modules that integrate effective behavior change methods, such as motivational interviewing” that “show promise to improve safe sleep practices.”2
The modules have also been identified as resources that “acknowledge nuance and encourage conversation.”3 The approach has been shared by the AAP, the United States Breastfeeding Committee, University of Washington, Healthy Start EPIC Center, the Safe to Sleep Campaign, NICHQ NAPPSS project and the Oregon Health Authority.
(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. Wisconsin has developed a guide to implement a conversations approach with families. West Virginia developed an on-line continuing education module for home visitors on how to implement the conversations approach (through their Abused Children’s efforts, which is where safe sleep sits organizationally).
In addition, NICHQ through its MCHB funded National Action Partnership to Promote Safe Sleep (NAPPSS) activities is working at sites in five states to utilize quality improvement methods to integrate safe sleep and breastfeeding promotion within hospitals, with prenatal health care providers and with community partners.
The Role of Title V. Title V Agencies can support a conversations approach/motivational interviewing by:
- Encouraging professionals to take the course directly.
- Conducting a train-the-trainer session to deputize professionals on how to promote the conversations approach.
- Engaging with NICHQ (NAPPSS-IIN project) to use the modules across the state in multiple sectors and across different professional groups (e.g., AL, FL, GA, IL, OH, MA, NY, TX).
For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.
Sample ESMs. Using the approach “Provide training to professionals who interact with expecting and new mothers and families that emphasize a nuanced approach to take family needs, beliefs, and context into account when talking about safe sleep, breastfeeding, and smoking,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:
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).
2 Hirai AH, Kortsmit K, Kaplan L, et al. Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics. 2019;144(5):e20191286
3 Main M. The Perplexing State of Sleep-Related Infant Death – Emerging Data, New Trends, and Current Approaches. Northwest Bulletin. 2018.