Baltimore city s crib program
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Baltimore City’s Crib Program. A Baltimore City Health Department/First Candle Partnership Stephanie Strauss Regenold, MD, MPH Senior Advisor, Babies Born Healthy Initiative Bureau of Maternal & Child Health Baltimore City Health Department Consultant, First Candle

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Baltimore city s crib program
Baltimore City’s Crib Program

  • A Baltimore City Health Department/First Candle Partnership

  • Stephanie Strauss Regenold, MD, MPH

  • Senior Advisor,

  • Babies Born Healthy Initiative

  • Bureau of Maternal & Child HealthBaltimore City Health Department

  • Consultant, First Candle




Population 636,000 [ranks 18th in the nation]

21.5 % below poverty level

African Americans comprise 65% of the population; Latinos <3%

9,350 births/year

Infant mortality rate imr
Infant Mortality Rate (IMR)

  • National average: 6.86

  • National range: 4.89 (Asian & Pacific Islanders)-- 13.63 (Non-Hispanic Blacks)

  • Healthy People 2010 target goal: 4.5

  • Baltimore

  • IMR 12.8 [ranks 4th highest in the nation]

  • IMR Non-Hispanic Blacks 18.0

Baltimore city s crib program

Death of an infant one month to one year of age

Leading cause nationwide: SIDS

Leading cause in Baltimore: SIDS

PostneonatalInfant Mortality Rate

Unexpected infant death during sleep
Unexpected Infant Death During Sleep

Infant (<1 year of age)

Cause of Death as determined by Medical Examiner: SIDS, SUDI, or Asphyxia due to overlay

ICD-10 Code:--R95 (SIDS)

--R99 (other ill-defined and unspecified causes of mortality)

-- W75 (accidental suffocation and strangulation in bed)

Unsafe sleeping environment
Unsafe Sleeping Environment

  • Bed-sharing—infant sleeping in a bed or couch with another person; or

  • Placing infant to sleep on stomach or side; or

  • Soft bedding, toys, or soft objects under or around the infant during sleep; or,

  • No crib available or improper use of crib; or

  • Smoking in house (never sole risk factor)

Unsafe sleeping environment1
Unsafe Sleeping Environment

  • Identified in 91% of infants dying unexpectedly during sleep:

  • >75% bedsharing

  • >75% soft bedding

  • >60% bedsharing and soft bedding

Triple risk model
Triple Risk Model




-first 6 months of life


possible brainstem abnormality-

(Filiano & Kinney, 1994, 2001)

-prone/side sleeping

-bed sharing

-soft bedding

-smoke exposure







The abc s of safe sleep initiative
The ABC’s of Safe Sleep Initiative

  • In response to Baltimore City’s CFR 2004 Recommendations

  • Partnership between Baltimore City HD and First Candle

  • Developed with grant funding from the Abell Foundation, Babies Born Healthy (DHMH), the CJ Foundation for SIDS and March of Dimes, with in-kind support from First Candle

The abc s of safe sleep initiative1
The ABC’s of Safe Sleep Initiative

ABC’s of Safe Sleep logo and message developed by the BCHD and used for educational campaign

Sale of infant snap shirts through First Candle

Free crib program

Safe sleep for infants
Safe Sleep for Infants

  • Alone

  • On myBack

  • In aCribTM

Safe sleep enclosure card
Safe Sleep Enclosure Card

Crib distribution
Crib Distribution

Coordinated by the BCHD

Cribs distributed by Baltimore HealthCare Access

and Baltimore City Home Visiting Programs

Baltimore healthcare access maternal infant health improvement program
Baltimore HealthCare AccessMaternal & Infant Health Improvement Program

  • Serves as the single point of entry for Prenatal Risk Assessments and Infant Identification Forms to identify high-risk pregnant women and infants.

  • Initial outreach services are provided by Family Advocates who refer lower risk women to supportive services including community-based home visiting programs.

Baltimore home visiting programs for high risk pregnant women infants
Baltimore Home Visiting Programs for High Risk Pregnant Women & Infants

  • Baltimore City Health Department Maternal & Infant Nursing Program

  • Baltimore City Healthy Start

  • Healthy Families

  • Bon Secours

  • BCHD Healthy Homes

  • The Family Tree

  • People’s Community Health Center

Baltimore city health department safe sleep coordinator
Baltimore City Health Department Women & InfantsSafe Sleep Coordinator

Tracks number of cribs distributed, number in stock

Trains all home visiting advocates in Infant Safe Sleep with yearly updates

Develops educational materials for crib recipients

Meets monthly with home visiting programs and BHCA

Provides inservice training to hospital staff (nurses, physicians, social workers), clinics, public agencies (social services, detention centers), and other organizations

Trouble shoots

Determined by each distributing agency
Determined by each distributing agency Women & Infants

Eligibility criteria

Timing of crib delivery (usually 36+ weeks)

Follow up

Crib distribution1
Crib Distribution Women & Infants

Family referred by home visiting program, BHCA triage, or from posters

Crib delivered by BHCA Safe Sleep Liaison or by home visiting advocate

Crib set up with family member

Safe sleep education given/reinforced

Receipt of Crib (waiver) signed by receiver

Funding Women & Infants

Proceeds from sale of infant safe sleep snap shirts nationwide through partnership with First Candle

Donations (local businesses, BHCA)

MCH Title V (budget modifications)

Outcomes Women & Infants

>2,500 cribs distributed since 2006

Better identification of high risk pregnant women

Infant safe sleep message recognized in a variety of venues around the city

Unsafe sleep recognized as major and preventable cause of infant mortality

Evaluation Women & Infants

Pre & post test questionnaires at time of crib delivery


Observational survey by M&I nurses

100 M&I clients—no difference in use of crib between those received by Crib Program and those received privately

Very few infant deaths among home visiting program population (<2 %).

Challenges Women & Infants


Equitable distribution of cribs

Effectiveness of “giveaway” program

Need for effective SIDS/SUDI messages

Thank you
Thank you! Women & Infants