Reducing Infant Mortality in Hawaii through Safe Sleep Education
Hawaii Cribs for Kids equips parents and caregivers with safe sleep education and a free crib to reduce the risk of infant mortality.
Hawaii Cribs for Kids is located at 13 sites on the six main Hawaiian islands, and is built with a sustainable business model to ensure longevity and replicability.
At each one-hour class, parents take a pre- and post-test to measure their change in knowledge, and practice setting up a safe sleep environment. Parents also receive information on emotional self-regulation during periods of stressful newborn crying, and how to identify their baby's needs.
Classes primarily serve low-income, high-risk families and teach parents about hazardous risks for sleep-related infant deaths, and how to help their baby sleep more safely.
Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)
How is this applicable for new submission?
Name or Organization
Healthy Mothers Healthy Babies Coalition of Hawaii
The Hawaii Cribs for Kids program is located on the six main Hawaiian islands: Oahu, Maui, Kauai, Big Island, Molokai and Lanai. We have created a replicable model that can be launched and expanded in any geographic region.
What is your stage of development?
Advanced Innovator with 3 to 10+ years of experience in ECD
What is the stage of your proposal?
Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.
Describe your submission in one clear sentence
The Hawaii Cribs for Kids program aims to reduce the number of sleep-related deaths in Hawaii by providing a one-hour comprehensive safe sleep education class to low-income, high risk families, and a safe place for baby to sleep: a free Graco Pack N Play portable crib. The key is framing the messaging appropriately, as a positive message of "What YOU can do to PROTECT your baby" instead of "What NOT to do," and ensuring that cultural competence is relevant in all materials.
Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)
According to the Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) data, Sudden Infant Death Syndrome (SIDS) accounts for 41% of all post-neonatal deaths in Hawaii. Educating caregivers in a culturally appropriate and family-oriented approach is a vital preventive component, as many families are unaware of the simple protective steps they can take to keep their baby safe. By framing all of the education as protective factors, and staying mindful of the "real life" challenges parents face, we successfully bridge many factors that complicate safe sleep education.
Select an Innovation Target
Service: A new or enhanced service that creates value for end beneficiaries.
Tell us more about your innovation (1500 characters)
Hawaii Cribs for Kids aims to reduce the stubborn rate of infant mortality in Hawaii by addressing the most common accidental, sleep-related cause. The difference between our program and other public outreach campaigns is how the messaging is framed, along with the hands-on, face-to-face educational component and free crib.
Maintaining both a safe sleep position and environment can reduce the risk, and education is a vital preventive component to ensure caregivers know how to reduce risk factors, but many providers don't know how to sensitively discuss it with their patients. Likewise, many parents have no idea about the American Academy of Pediatrics (AAP) safe sleep recommendations to help keep their baby safe, as only 35.4% of babies in Hawaii are regularly placed in a sleeping environment that meet all of the recommendations. This program is designed to impart information in a culturally sensitive format that takes families' needs into consideration, while also providing a safe crib for the child to sleep.
We invite all caregiving family members to the class so that everyone is clear about the recommendations and "on the same page" about infant sleep safety. The education incorporates real-life stories, while empowering parents with knowledge. Instead of challenging parents to abandon cultural practices on co-sleeping, or simply discouraging unsafe behaviors, we re-frame the scenario to encourage parents to apply their knowledge firsthand, from a protective lens.
What problem are you aiming to solve? (3 sentences)
Sudden Infant Death Syndrome (SIDS) is the leading cause of accidental death among infants and the third leading cause of infant mortality overall in the United States. In Hawaii, SIDS accounts for 41% of all post-neonatal deaths in the State. This program's goal is to reduce the incidence of sleep-related deaths, by providing parents with life-saving information in an empowering, culturally-appropriate manner, along with a free Pack ‘n Play crib so each baby has a safe place to sleep.
Explain your idea (5000 characters)
Families benefit from the critical knowledge, along with a crib, to create a safe sleep environment and prevent the occurrence of sleep-related deaths. Receiving a free crib is a strong incentive to attend the class, and one of the keys to ensuring family participation. We measure incoming knowledge with a pre-test, and follow up with a post-test at the conclusion. Families typically demonstrate a 30% increase in knowledge when the class is over, and our staff continues to contact participants to check on the health of the baby, and to ask participants if they are still following safe sleep procedures at three months and 9-12 months postpartum. All data is tracked and participants are provided with other services and referrals to resources during each call. This provides an excellent strategy to ensure that families continue receiving the support they need throughout their baby's first year, along with building a trusted relationship with HMHB for their perinatal health needs.
During the class, we also provide a variety of other prenatal and infant safety information to help the mother experience a healthy pregnancy with the best possible birth outcomes. We discuss the importance of breastfeeding, immunizations, smoking and substance abuse cessation and attending prenatal appointments, in addition to other protective factors.
Participants receive comprehensive educational materials to have a healthy pregnancy and birth and are encouraged to sign up for HMHB's Text4baby program to continue receiving proactive health information throughout pregnancy and baby's first year. Parents are also alerted to information available through HMHB, such as our confidential MothersCare Line, and online Resource Directory. This support helps ensure that high-risk parents have adequate access to the best possible information available, during a critical time in their reproductive lives.
The class format also incorporates education on "The Period of PURPLE Crying," which is a national program to reduce the incidence of Shaken Baby Syndrome (SBS). In the context of discussing infant sleep, prolonged newborn crying is a highly relevant topic, and many parents are extremely frustrated by "colicky" babies who cry inconsolably. We attempt to normalize the behavior, while providing parents with a checklist so that they can identify solutions and address their baby's needs better, and emotional self-regulation techniques to help keep themselves calm and in control. By helping to prevent SBS, we can also impact the risk of a child's death due to abuse and neglect, which is another leading cause of infant death.
Parents also receive time during the class to practice setting up and disassembling the crib, so that they will continue to use it at home. Once again, the concept of empowerment through education is the key, and we discuss how they intend to use the crib as a protective tool when they go home with their newborn.
Finally, the follow-up calls present a natural way to support a family throughout its trajectory in the first year. Parents appreciate the calls, as they have developed a trusting relationship with HMHB. The education they received was all geared towards parental empowerment through education, so they are able to feel confident in making their own decisions about safety, and understand why the recommendations were made.
Currently, HMHB is promoting this program with partners statewide, with specific attention on how best to communicate these messages with parents. We train partners at each site to facilitate the classes, and HMHB remains responsible for program administration, oversight, compliance, budgeting and outreach calls to follow up with parents. This enables partners (such as health centers) to present Hawaii Cribs for Kids as an "added value" of being their patient, without adding to their own bottom line, and provides one more "touch point" for high-risk patients and their health provider.
HMHB trains partners by demonstrating a minimum of two live classes onsite, and conducts ongoing follow-up to address any additional needs as they arise. This effort has helped expand the program to multiple sites on all main islands, and has enabled HMHB to continue providing the program for a five-year duration, with hopes of many more years to come.
Who benefits? (1500 characters)
Our beneficiaries are categorized as low-income, high-risk families, including ethnicities such as Native Hawaiian/Part Hawaiian (45.77%), Samoan (9.62%), Black (3.29%) and Other Pacific Islander populations, all of whom show increased risk factors for Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS). They benefit from the program by receiving valuable and applicable safe sleep education in addition to a free safe sleep environment for baby.
Participants take a test before and after the class on their knowledge of safe sleep, including direct factors (e.g. – use of blankets and pillows in the crib; placing baby to sleep on her stomach; placing toys in the crib) and indirect health risks (e.g. – formula feeding instead of breastfeeding; smoking in the same home as an infant; timely immunizations). Our participants have averaged a 30% increase after taking the class, and continue to stay connected with HMHB.
The Hawaii Cribs for Kids program has many community stakeholders who are strongly supportive of the program. Over the past 25 years, HMHB has built strong partnerships with maternal and child health organizations, community leaders and stakeholders throughout the state. HMHB actively collaborates to convene the Perinatal Advocacy Network and the Hawaii Maternal & Infant Health Collaborative; advocating for women’s and reproductive health, and leading outreach for family-friendly health policies and programs, including Cribs for Kids.
What kind of impact will your idea have? (1500 characters)
Currently, our goal is to impact sleep-related infant mortality rates. To date, none of our participants have suffered a sleep-related or SIDS death, and we expect a "trickle-down" effect of the information throughout the community.
The best way to more rapidly facilitate the spread of the information would be to reach more families throughout the state. Currently, we only have the capacity to serve up to 300 families per year, and our hope is to double this amount within the next two years.
How does or how could your idea impact low-income children? (1500 characters)
Babies from disparate, low-income populations at highest risk for SUID/SIDS and Shaken Baby Syndrome (SBS) are primarily served by this program. HMHB partners with numerous agencies on all islands that serve the target populations with the highest risk factors, including: low-income (all applicants qualify for WIC or Medicaid), low education level (64% of applicants have a high school diploma or less), substance abuse during pregnancy, and races/ethnicities with higher infant mortality rates (including Hawaiian, Black, and other Pacific Islanders (45.7% of referrals are Hawaiian/Part Hawaiian) or otherwise identified infant health concerns.
By providing low-income families with education that extends beyond direct factors (such as the importance of breastfeeding and immunizations), we can make a considerable impact on many health factors in their lives.
Innovation: What makes your concept innovative? (1500 characters)
Hawaii Cribs for Kids is the first and only of its kind in Hawaii and has been extremely well-received by partner health organizations and participants. This program is the first to offer both a safe sleeping environment (crib) in addition to culturally-appropriate, family-oriented safe sleep education, support and follow-up to high risk, low-income families on every island throughout the entire state.
In addition to receiving safe sleep education, parents also receive information on HMHB’s wrap-around services during each class. These programs include: Text4baby, a free mobile text messaging service with customized health information throughout pregnancy and infancy; HMHB’s online Resource Directory; and our MothersCare Line to help families find information and resources for a healthy pregnancy, birth and baby.
Additionally, parents receive information on “The Period of PURPLE Crying,” an evidence-based program to reduce the incidence of Shaken Baby Syndrome. As parents are learning about safe sleep for their baby in the context of the class, this lesson is integrated to provide parents with a checklist of information to comfort their crying baby, as well as supportive self-soothing techniques for themselves.
All of this education is typically very difficult to administer during prenatal and/or pediatric visits. By providing a setting with a strong incentive to attend (a free crib), we have an innovative strategy for reaching parents who most need it.
Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)
The Hawaii Cribs for Kids program has been supported and sustained since 2013 through a combination of government grants and private foundations that have been impressed by the value of the program. As a one-of-a-kind and uniquely invaluable program for pregnant women and families in Hawaii, HMHB will continue to seek grant funding to share, promote, and administer Hawaii Cribs for Kids statewide.
As a member of the Hawaii Maternal Infant Health Collaborative (HMIHC), HMHB collaborates with partner agencies to meet objectives to decrease maternal and infant mortality and will continue to increase awareness through supportive channels. As the objectives of the HMIHC include increasing infant safe sleep practices to reduce sleep-related deaths; decreasing smoking during pregnancy; decreasing the proportion of low birth weight infants; and increasing the duration and exclusivity of breastfeeding rates, this program is highly complementary to community efforts.
Additionally, HMHB is actively promoting results of the program to gain community support. A Public Service Announcement was created and aired statewide to increase awareness of safe sleep factors, and to encourage parents to contact HMHB for information. This, along with custom-designed safe sleep posters that hang in our partners' health clinics, direct families to learn more information, along with a valuable community program to support them.
Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)
Hawaii Cribs for Kids is a reputable statewide program with multiple partner agencies on all islands. Prenatal case managers and social workers from the following 20 partner agencies have been trained on how to screen for participants, and submit applications to HMHB for potential participants.
• Oahu: Waianae Coast Comprehensive Health Center, INPEACE, Queens Medical Center, Kapiolani Medical Center, PACT, Catholic Charities Hawaii, Waimanalo Health Center, Marine Corps New Parent Support Program and WIC
• Maui: Maui Family Support Services, Maui High School and Hana Health
• Kauai: WIC, West Kauai Medical Center, Hua Moon Women’s Health and Wilcox Medical Center
• Big Island: West Hawaii Health Center and Bay Clinic
• Molokai: Molokai General Hospital
• Lanai: Lanai Community Health Center
The framework for the program is well-documented and highly successful in impacting the participants' knowledge, but there is a much larger need for the program. To date, 504 families have received the safe sleep education at a total of 109 classes. We hope to double the number of participants as support for the program continues to generate new funding.
We are also focused on continuing to train partners to administer classes in a culturally-appropriate way, so that the education can continue to disseminate widely.
Business Viability: How viable is your business model? (1500 characters)
Realistically, the biggest barrier is accessibility to sustainable funding sources. As a business model, we are entirely dependent on funders who recognize and value the contribution of the program and contribute charitably. We work diligently to report data and results, as well as promote the program via marketing channels.
Referrals are constantly increasing, and our desire to serve all eligible clients necessitates the need to increase the number of funders that support our program.
HCD: How have you used human centered design to build or refine your concept? (1500 characters)
There are three parts to evaluating the quality of program results and outcomes:
o Knowledge: participants are given a 20-question quiz on safe sleep practices prior to, and immediately following, completion of the educational class. Questions pertain to general awareness and preventative measures to create a safe sleep environment and how to identify unsafe or hazardous items in a sample crib. This test measures participants’ change in knowledge regarding safe sleep practices and the effectiveness of the class in increasing knowledge of safe sleep practices.
o Retention and behavior change: participants are asked to share information on their baby’s health status and the daily safe sleep practices at three-month and one-year follow up calls. This measures the participants’ knowledge retention and how successfully the class created behavior changes (if parents continue following safe sleep practices). This also provides the opportunity to reinforce information and provide referrals.
o SUID/SIDS rates: at three months and one year, the health status of the baby is monitored to track the SUID/SIDS rates among participants to measure the effectiveness of the program.
Participants are asked the same questions (as in the pre/post-test) regarding safe sleeping practices at their three-month and one-year follow up to measure knowledge retention, and are also asked about their safe sleep practices in order to identify whether the class successfully created behavior changes.
Tell us more about you (3000 characters)
HMHB's staff is ecstatic about the opportunity to impact the life of a mother, and we care about our mission and the people that we serve. The inspiration for the program originated after many years of discussions about how to impact our stagnant infant mortality rate. As SIDS was the leading cause of accidental death, HMHB jumped into action alongside partners to develop a custom program.
HMHB currently has three full time and three part-time staff members with ample maternal and child health experience and the leadership skills necessary to successfully carry out the requirements of the proposed project. This program has been operating with increasing capacity and service area since the launch in January 2013; demonstrating both the commitment of the staff and organization, as well as the longevity of the program and its community investment. Staff and partners are familiar with the messaging necessary to successfully classes, and outcomes have successfully demonstrated an increased awareness of risk factors for SIDS among participating high-risk low-income pregnant women and their families.
We are excited to be a contributing voice to improving MCH, and HMHB has expertise providing numerous community services in collaboration with community partners, including:
• A free MothersCare phone line designed to help pregnant women, new mothers and their families find the information and resources necessary to have a healthy pregnancy, birth and baby.
• Quarterly trainings for perinatal support service providers at community health clinics statewide on topics directly relating to improving the health of pregnant women, new mothers and infants.
• Coordination of quarterly Perinatal Advocacy Network to increase awareness of perinatal issues in Hawaii, expand advocacy efforts for perinatal health issues and legislative actions, and increase networking and collaborative partnerships among state perinatal health providers.
• Creation and distribution of culturally-appropriate educational materials for Hawaii’s pregnant women, mothers and their families (including topics such as safe sleep/SIDS prevention, Fetal Alcohol Spectrum Disorders (FASD), Postpartum Depression (PPD), breastfeeding, and nutrition, as well as a “Healthy & Hapai” educational pregnancy calendar to help women keep track of their prenatal appointments and to find resources for a healthy pregnancy).
• Maintaining a dynamic online perinatal resource directory searchable by service and location.
• Updating families and providers on current recalls, maternal and child health news, and local resources/events in the maternal and child health community through social media.
• Promotion of the Text4baby program, providing free text messages to alert expectant and new parents of health information throughout their pregnancy and their baby’s first year.
• Administer the Piko Pals New Parent Support Program, 12 weeks of social and emotional support for parents of newborns.
Do you have the people and partners you need to do what you’ve described? (500 characters)
We have multiple partner agencies on all islands who have already been trained and are currently conducting Hawaii Cribs for Kids classes. In addition, HMHB has staff who are in charge of the continued monitoring and success of the program.
We would like to explore a partnership with GRACO or a shipping company to reduce the cost of our cribs and the distribution.
As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)
Collaborators currently include the 30 partners statewide who identify clients and submit them to HMHB. We would like to see this program increase in its capacity statewide, as well as expand beyond our state. We would be very grateful to receive input on finding partners to support our efforts, along with initiatives to develop programs in new locations.
Would you like mentoring support? [Relevant only for Early Submission Deadline]
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Yes, share my contact information
[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).
Lisa Kimura, MBA, is the mother of three and executive director of HMHB, a statewide nonprofit devoted to improving maternal, infant and reproductive health. She has a background in communications, advocacy and early childhood development, chairs a statewide public-private maternal and infant health collaborative work group focused on
improving infant health and safety ,and is a member of numerous statewide and national committees for MCH.
[Optional] Attachments: Please upload relevant attachments or graphics or show us how you prototyped.
The participants in our program represent diverse ethnic backgrounds, with the majority representing populations with the highest rates of infant mortality in Hawaii.