MICHIGAN DEPARTMENT OF HEALTH HUMAN SERVICES Infant Safe

MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES Infant Safe Sleep MIHP Bimonthly Agency Call September 25, 2018 Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their 1 stage in life.

Infant Safe Sleep 201 Training Timeline 2016 Identified need for “next step” training Received Michigan Health Endowment Fund grant 2017 Formed work group Developed in-person training Piloted training 2018 Sent out surveys Refined training Development of on-line training 2

Infant Safe Sleep 201 Training ØAdvanced - Must have already taken “ 101” in person or online (“Infant Safe Sleep for Professionals Working with Families”) ØAcknowledges challenges parents experience in following guidelines v. What we are asking is not easy v. Multitude of factors impact how parents sleep their babies 3

What factors influence how parents/caregivers sleep their babies? 4

What factors influence how parents/caregivers sleep their babies? Family/ Cultural norms Physiology/ Baby’s temperament Parent’s need for sleep Parent’s views on bonding & attachment Parent’s emotional issues/history Ability to process risk Media Environment/ Safety/ Access 5

Infant Safe Sleep 201 Training ØUses “partnership of experts” approach ØEncourages honest & open conversation v. Promotes use of strength-based approach v. Encourages inclusion of family & support people v. Shares techniques to do this including Motivational Interviewing 6

Infant Safe Sleep 201 Training ØFamilies feel valued, not judged ØAligns with Motivational Interviewing v. Start where client is at v. Clients are at different levels of readiness to change v. Client decides what & how 7

Taking the Next Step in the Journey SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment 8

Activity Ø Adapted from one that was originally developed by the National Institute of Child Health and Human Development (NICHD), Healthy Native Babies Project Ø Purpose: v. To learn how a situation or an action increases or decreases an infant’s risk of a sleep-related infant death v. To learn subtle distinctions between increased risk and decreased risk 9

Scenario: ongoing home visitation 10

Was this a successful conversation? 11

When starting where clients are at, have I failed if… A family doesn’t follow the recommendations? A family follows some of the recommendations, but not others? 12

When starting where clients are at, have I failed if… ABSOLUTELY NOT! YOU CANNOT CONTROL WHAT PEOPLE DO. Success is: § Educating families on the AAP recommendations and the risks posed in not following them § Starting where families are at § Listening to the concerns and challenges of families § Problem solving with families § Supporting families in making their own decisions § Keeping the dialogue open with families 13

Infant Safe Sleep 201 Training Will these techniques work? Will they make a difference with families? Let’s listen to some actual quotes from real Home Visitors who have tried these techniques in their practice. 14

Infant Safe Sleep Program Resources Ø 2 Online Trainings – link on MIHP website “Infant Safe Sleep for Professionals Working with Families” “Infant Safe Sleep: Helping Families Practice Safe Sleep” (“ 201” training) ØQuarterly Infant Safe Sleep Webinars Nov. 14, 1: 00 -2: 00 p. m. Topic: ACES and the Impact on Parenting ØMotivational Interviewing and Infant Safe Sleep webinar https: //mediasite. mihealth. org/Mediasite/Play/a 1 a 93128 b 1244 99 d 9 f 1 a 205 eae 7411 f 81 d 15

Infant Safe Sleep Program Resources ØInfant Safe Sleep for Professionals Email List To sign up, enter your email address at: https: //public. govdelivery. com/accounts/MIDHHS/subscriber/new? t opic_id=MIDHHS_99 ØNew Infant Safe Sleep resource materials available on www. michigan. gov/safesleep v. Baby Eating and Sleeping: What is Normal? v. Breastfeeding & Safe Sleep v. How Do I Know If It’s Safe for Sleep? - Learn how to tell if a product is safe for sleep. 16

Infant Safe Sleep Program Resources ØWomen, Infants, and Children (WIC) webinar Unsafe Sleep: Understanding Risks and Protective Factors Independent Study – can be accessed anytime at https: //events. mphi. org/webcasts-online-learning/ under On Demand Independent Self-Study. ØMDHHS Infant Safe Sleep Program Contact for trainings, resource materials and assistance with safe sleep questions 17

Infant Safe Sleep Program Colleen Nelson, LMSW MDHHS Infant Safe Sleep Program Coordinator nelsonc 7@michigan. gov 517 -335 -1954 Patti Kelly, LMSW, MPH MDHHS Infant Safe Sleep Program Consultant kellyp 2@michigan. gov 517 -335 -5911 18

Adult Immunizations MIHP Community of Practice September 25, 2018

20 Why do we review a pregnant woman’s immunization status? • Because it matters • It affects her health • It affects baby’s health • To meet certification requirements • It is required by Medicaid policy

21 It matters • Whooping cough is serious for infants • Pertussis (whooping cough) is on the rise in the U. S. and in Michigan • Pertussis is most severe for babies; more than half of infants younger than 1 year of age who get the disease must be hospitalized • Pertussis can be deadly, especially in infants younger than 3 months www. michigan. gov/immunize

22 It matters • Infants are too young to be vaccinated • They cannot start the whooping cough vaccine series until they are 2 months old • Infants younger than 6 months aren't old enough to get the flu vaccine • The best way to protect infants is to vaccinate those around them, including parents, siblings, grandparents, day care and child care workers, and health care personnel www. michigan. gov/immunize

23 It matters • Women who become infected with the flu during pregnancy have a greater chance for serious problems for their unborn baby, including premature labor and delivery www. cdc. gov/vaccines/pregnancy

24 It matters • Flu illness is more dangerous than the common cold for children • Each year, millions of children get sick with seasonal flu • Thousands of children are hospitalized and some children die from flu • Children commonly need medical care because of flu, especially children younger than 5 years old who become sick with flu www. cdc. gov/flu/protect/ children

25 It matters • Complications among children in this age group can include: • Pneumonia: an illness where the lungs get infected and inflamed • Dehydration: when a child’s body loses too much water and salts, often because fluid losses are greater than from fluid intake • Worsening of long-term medical problems like heart disease or asthma • Brain dysfunction such as encephalopathy • Sinus problems and ear infections • In rare cases, flu complications can lead to death www. cdc. gov/flu/protect /children

26 www. michigan. gov/immunize

27 www. cdc. gov

28 Page devoted to pregnant women

29 Adult immunization schedule Adults Aged 19 Years or Older by Medical Conditions and Other Indications, United States, 2018

30 Mother’s Health

31 • Pregnant and postpartum women have been observed to be at higher risk for severe illness and complications from influenza, particularly during the second and third trimesters • ACIP and the American College of Obstetricians and Gynecologists recommend that all women who are pregnant or who might be pregnant during the influenza season receive influenza vaccine www. cdc. gov/immuni ze

32 Mother’s Health • Tdap may be administered any time during pregnancy and provides a pertussis booster for mom • If administered in the third trimester the vaccine likely provides the highest concentration of maternal antibodies to be transferred closer to birth www. cdc. gov/immuni ze

33 DTa. P vs Tdap • DTa. P is a vaccine that helps children younger than age 7 develop immunity to three deadly diseases caused by bacteria: diphtheria, tetanus, and whooping cough (pertussis) • Tdap is a booster immunization given that offers continued protection from those diseases for adolescents and adults www. cdc. gov/immun ize

34 Protection of Infant

35 Protection of Infant Centers for Disease Control and Prevention (CDC) recommends women get a pertussis and flu vaccine during each pregnancy “Did you know that your baby gets disease immunity (protection) from you during pregnancy? To avoid the risk of hospitalization and serious complications for mom and baby, it is safe and recommended that pregnant women receive the influenza and Tdap vaccines to protect against flu, tetanus, diphtheria and pertussis (whooping cough). ” www. cdc. gov/immun ize

36 “Cocooning” • Vaccination strategy • Recommended by the CDC since 2006. • Aims to protect newborn infants from becoming infected • DTa. P/Tdap booster vaccine for mothers, family members and any individuals who would come into regular contact with the newborn infant • Creates a pool of persons around the newborn who are themselves protected from getting pertussis and passing it on to the infant, thereby creating a "cocoon" of protection around the newborn • Young infants have the highest rate of pertussis; in 87 -100% of all deaths caused by pertussis, the victim is an infant of less than 6 months of age www. cdc. gov/va ccine

37 1 st step

38 Check the Michigan Care Improvement Registry (MCIR)

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41 MCIR record

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43 Immunization record or screen shot must be added to beneficiary record

44 To meet certification requirements

45 Reminder • Any pregnant woman, with a visit after 4/1/18, must have at least one MCIR review prior to discharge • MCIR printout must be in beneficiary file • If no record found—print screen shot and place in record • Discuss importance of immunizations to protect baby when born at least once during pregnancy • Do not sign printout. Signature line is intended for immunization provider

46 Which diseases are we most worried about?

47 Pertussis • Transmitted primarily from person to person through aerosolized respiratory droplets generated by coughing or sneezing www. cdc. gov/pertussis

48 Pertussis • Young infants continue to be at greatest risk for hospitalization and death due to pertussis • Strategy of preventing pertussis in newborns through the vaccination of women with Tdap during pregnancy from 27 through 36 weeks’ gestation • 80%– 91% effective for preventing pertussis in those too young to be vaccinated www. cdc. gov/pertuss is

49 Pertussis • Acute respiratory disease • Caused by the bacterium Bordetella pertussis • Three phases of illness: catarrhal, paroxysmal, and convalescent • Catarrhal—coryza (inflammation of the mucous membranes of the nasal cavities), mild occasional cough, and low-grade fever • Paroxysmal—spasmodic cough, posttussive vomiting, and inspiratory whoop • Convalescent—symptoms slowly improve, generally lasts 7– 10 days, but can last for months www. cdc. gov/pert ussis

50 Pertussis • If symptoms occur, they begin an average of 90 days (or 3 months) after exposure, but they can appear any time between 8 weeks and 5 months after exposure www. cdc. gov/pertussis

51 www. cdc. gov/ mmwr

52 Influenza • Can spread to others up to about 6 feet away • Spreads mainly by droplets made when people with flu cough, sneeze or talk • Droplets can land in mouths or noses of people who are nearby or possibly be inhaled into the lungs • Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes www. cdc. gov/flu/ about

53 Influenza • Most contagious in the first three to four days after illness begins • Healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick • Children and some people with weakened immune systems may pass the virus for longer than 7 days www. cdc. gov/flu/abou

54 Influenza • Symptoms can begin about 2 days (but can range from 1 to 4 days) after the virus enters the body • May be able to pass on the flu to someone else before sick, as well as while you are sick • Some people can be infected with the flu virus but have no symptoms. During this time, those people may still spread the virus to others www. cdc. gov/flu /about

55 Influenza • Getting the flu shot during pregnancy is safe • Getting the flu during pregnancy is not www. cdc. go v/flu

56 www. cdc. gov/m mwr

57 Lots of options • Pharmacy • Work • School • Mobile clinics • Doctors office

58 When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons at higher risk for medical complications attributable to severe influenza who do not have contraindications Women who are or will be pregnant during the influenza season; Household contacts (including children) and caregivers of children aged ≤ 59 months (i. e. , aged <5 years) and adults aged ≥ 50 years, particularly contacts of children aged <6 months; a www. cdc. gov/vacc ine

59 Remember to discuss extended family immunizations

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61 It is required by Medicaid policy As an approved Medicaid provider, each MIHP must comply with rules set in policy

62 It is required by Medicaid policy Page 14 of the MIHP Chapter

63 Questions?