SIDS 5-Year Action Plan Sample



Deliverable Form D – 5-Year Action PlansSudden Infant Death Syndrome (SIDS) (For further instructions see separate document titled “Action Plan Guidelines”)MCAH SOW Goal X: Problem Category(ies)From Deliverable Form B of your Title V Needs Assessment.Problem Statement(s)From Deliverable Form B of your Title V Needs Assessment.Five Year Local Goal(s)Develop one or more five year local goal(s) that state the desired results of your interventions. Example: Reduce the number of presumed unexpected infant deaths by promoting infant safe sleep and Sudden Infant Death Syndrome (SIDS) risk reduction education activities.Risk/Contributing FactorsList LHJ-specific contributing factors using a problem analysis. Examples: Lack of regular prenatal care, lack of immunization or regular well-child checks, unsafe infant sleep environments, prone/side sleep positioning, exposure to cigarette smoke and/or alcohol in utero or early infancy, lack of knowledge of SIDS, lack of regular prenatal care, prematurity, and low birth weight.Best Practice Strategies/ InterventionsList best practice strategies and/or interventions to address your problems. Examples: In 2011, the American Academy of Pediatrics (AAP) released the policy statement, SIDS and Other Sleep-related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment, and an accompanying technical report. The Safe to Sleep campaign—formerly known as the Back to Sleep campaign—aims to educate parents, caregivers, and health care providers about ways to reduce the risk for SIDS and other sleep-related causes of infant death. The safe sleep strategies outlined in Safe to Sleep materials and publications are based on recommendations defined by the 2011 AAP recommendations: outreach to MCAH population and other public health programs and providers. Increase knowledge of parents of newborns and childcare providers, and birth hospitals/midwife.Intervention Population(s)List the populations you will be focusing on for the next five years. Examples: MCAH and other public health programs and providers, childcare providers and parents of newborns.Short and/or Intermediate Objective(s)1Inputs, including Community Partner InvolvementIntervention Activities to Meet ObjectivesPerformance MeasuresShort and/or IntermediateProcess Description and Measure(s) including Data SourceOutcome Measure(s) including Data SourceFiscal Year 1By June 30, 20XX, (X/X) parents of newborns will demonstrate increased knowledge and intention to follow infant safe sleep practices and SIDS risk reduction in (number) birth hospitals(This objective could be used for multiple years depending on the number of providers you are trying to reach and your capacity)Birth hospital staffPediatric, obstetric (OB) and family practice providersWIC pregnant clientsMCAH and public health department staffPublic health nurses(Insert LHJ specific partners and resources, such as funding)SIDS coordinator/public health professional outreaches to parents of newborns to provide infant safe sleep education and SIDS risk reduction in birth hospitalsDevelop and administer evaluation tools to measure knowledge changes after education and intention to follow infant safe sleep practices and SIDS risk reduction Develop SIDS evaluation tool: Family Health Outcomes Project (FHOP): SIDS Awareness and Risk Reduction Outcome Measurement Tools”: the California SIDS Program and SIDS educational materials: and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA) process to monitor implementation of policies/processes, a regular feedback mechanism to continually improve the process and evaluate the impactProvide technical assistance (TA) as neededNumber of new parents outreached about the infant safe sleep practices and SIDS risk reductionNumber of new parents receiving education about the infant safe sleep practices and SIDS risk reductionBriefly describe evaluation tool developedBriefly describe barriers, challenges, and opportunities to improve infant safe sleep Briefly describe the CQI/QA process developedBrief description of TA provided(Number) of new parents demonstrating increased knowledge and intention to follow infant safe sleep practices and SIDS risk reduction/ the total number of new parents educated (X)Briefly describe the results of evaluationDescribe the outcomes of the CQI/QA process including methods of measurements and resultsFiscal Year 2By June 30, 20XX, (X/X) childcare providers will demonstrate increased knowledge and adopt infant safe sleep practice and SIDS risk reduction in the childcare center(This objective could be used for multiple years depending on the number of providers you are trying to reach and your capacity)Childcare providers Local social service department for licensing childcare providersMCAH and public health department (PHD) staffPublic health nurses(Insert LHJ specific partners and resources, such as funding)SIDS coordinator/public health professional provides infant safe sleep education and SIDS risk reduction to childcare providers SIDS coordinator/public health professional observes infant safe sleep practices and SIDS risk reduction in childcare centerPublic health professional works with childcare providers to promote activities on infant safe sleep education and SIDS risk reductionEncourage childcare providers to share the educational materials with parents to promote the infant safe sleep education and SIDS risk reduction Develop and administer evaluation tool to measure implementation of safe sleep and SIDS risk reduction practice in child care providersDevelop SIDS evaluation tool: FHOP: SIDS Awareness and Risk Reduction Outcome Measurement Tools”: Utilize the California SIDS Program and SIDS educational materials: Develop and implement a CQI/QA process to monitor implementation of policies/processes, a regular feedback mechanism to continually improve the process and evaluate the impactProvide TA to childcare providers as neededNumber of presentations given to childcare providersBriefly describe what was observedBriefly describe evaluation tool developedBriefly describe key infant safe sleep education and SIDS risk reduction accomplishments and barriersNumber of parents receiving infant safe sleep and SIDS risk reduction information from the childcare providersBriefly describe the CQI/QA process developedList TA provided(Number) of childcare providers demonstrating increased knowledge about the infant safe sleep practices and SIDS risk reduction/ the total number of childcare providers educated (X)Number of childcare providers who adopt infant safe sleep practices and SIDS risk reduction/the total number of childcare providers educated (X)Briefly describe the results of the evaluationDescribe the outcomes of the CQI/QA process including methods of measurements and resultsFiscal Year 3By June 30, 20XX, (X/X) birth hospitals will adopt infant safe sleep and SIDS risk reduction information in their current practices(This objective could be used for multiple years depending on the number of providers you are trying to reach and your capacity)Birth hospital administrator and staffPediatric, OB and family practice providersMCAH and PHD staffPublic health nurses(Insert LHJ specific partners and resources, such as funding)SIDS Coordinators/Public Health Professional outreach and develop a relationship with the birth hospitalsSIDS Coordinators/Public Health Professional assess the birth hospitals infant safe sleep policies and practiceSIDS coordinator/public health professional observes infant safe sleep practices in the birth hospitalsSIDS coordinator/public health professional outreaches to birthing hospital administrative staff to assist them to develop and implement policies to promote infant safe sleep and SIDS risk reduction information in their current practiceSIDS coordinator/public health professional provides infant safe sleep education and SIDS risk reduction to birth hospitals and ongoing technical assistance if neededDevelop SIDS evaluation tool: FHOP: SIDS Awareness and Risk Reduction Outcome Measurement Tools”: the California SIDS Program and SIDS educational materials: Develop and implement a CQI/QA process to monitor implementation of policies/processes, a regular feedback mechanism to continually improve the process and evaluate the impactProvide TA to as neededDescribe the frequency and content of communication with birthing hospitals Describe the elements of the technical assistance provided to birthing hospitalsBriefly describe the results of observation and assessment of infant safe sleep of the birth hospital policies and practicesBriefly describe evaluation tool developedBriefly describe the process to implement infant safe sleep and SIDS risk reduction practices in the birth hospitalsBriefly describe the CQI/QA process developedList TA provided(Number) of birth hospitals who adopt safe sleep practices / total number of birth hospitals informed about infant safe sleep and SIDS risk reduction practice (X)Briefly describe policies adopted in the birth hospitalBriefly describe the results of evaluation toolDescribe the outcomes of the CQI/QA process including methods of measurements and resultsFiscal Year 4By June 30, 20XX, (X/X) (specify targeted organization) will demonstrate increased knowledge and adopt infant safe sleep and SIDS risk reduction practices into (specify targeted organization such as WIC, homeless shelter, shelter for battered women, child birth class, faith-based organizations)(This objective could be used for multiple years depending on the number of providers you are trying to reach and your capacity)Targeted populationssuch as WIC, homeless shelter, shelter for battered women, child birth class, faith-based organizationsMCAH and PHD staffPublic health nurses(Insert LHJ specific partners and resources, such as funding)SIDS Coordinators/Public Health Professional outreach and develop a relationship with targeted organizationSIDS coordinator/public health professional provides infant safe sleep education and SIDS risk reduction to targeted organization and ongoing technical assistance as neededSIDS coordinator/public health professional observes safe sleep practices in targeted organizationPublic health professional works with targeted organization to develop and implement policies to promote infant safe sleep and SIDS risk reduction practiceDevelop SIDS evaluation tool: FHOP: SIDS Awareness and Risk Reduction Outcome Measurement Tools”: Administer evaluation tool to measure implementation of safe sleep and SIDS risk reduction practice in targeted organizationUtilize the California SIDS Program and SIDS educational materials: Develop and implement a CQI/QA process to monitor implementation of policies/processes, a regular feedback mechanism to continually improve the process and evaluate the impact?Provide TA to as neededNumber of presentations given to targeted organizationBriefly describe what was observedBriefly describe evaluation tool developedBriefly describe the process to implement infant safe sleep and SIDS risk reduction practices in targeted organization Briefly describe the CQI/QA process developed.List TA provided(Number) of (specify targetedorganization) demonstrating increased knowledge of safe sleep practices and SIDS risk reduction /total number of targeted organization (s) informed about infant safe sleep and SIDS risk reduction practice (X)Number of (specify targetedorganization) adopting infant safe sleep practices and SIDS risk reduction/ total number of targeted organization (s) informed about infant safe sleep and SIDS risk reduction practice (X)Briefly describe the results of evaluationDescribe the outcomes of the CQI/QA process including methods of measurements and resultsFiscal Year 5By June 30, 20XX, (X/X) CPSP providers will provide correct infant safe sleep and SIDS risk reduction information to all their pregnant and postpartum women(This objective could be used for multiple years depending on the number of providers you are trying to reach and your capacity)CPSP providers staffOB and family practice providersMCAH and PHD staffPublic health nurses(Insert LHJ specific partners and resources, such as funding)SIDS coordinator/public health professional provides infant safe sleep and SIDS risk reduction information to CPSP providers SIDS coordinator/public health professional provides infant safe sleep education and SIDS risk reduction to CPSP providers staff Public health professional works with CPSP providers to promote activities on infant safe sleep education and SIDS risk reductionEncourage CPSP providers to develop and implement policies/protocols to provide infant safe sleep and SIDS risk reduction information to their pregnant and postpartum women?Develop SIDS evaluation tool: FHOP: SIDS Awareness and Risk Reduction Outcome Measurement Tools”: Utilize the California SIDS Program and SIDS educational materials: Develop and implement a CQI/QA process to monitor implementation of policies/processes, a regular feedback mechanism to continually improve the process and evaluate the impactProvide TA as neededNumber of presentations given to CPSP providers staff Number of CPSP providers staff demonstrating correct knowledge on the infant safe sleep practices and SIDS risk reductionBriefly describe the results of evaluationBriefly describe increasing community partnership and linkagesBriefly describe evaluation tool developedBriefly describe the process to implement infant safe sleep and SIDS risk reduction practices in CPSP providersBriefly describe the CQI/QA process developedBrief description of TA provided(Number) of CPSP providers who provide correct infant safe sleep and SIDS risk reduction information to all their pregnant and postpartum women/(X)Briefly describe policies/protocols adopted by CPSP providersDescribe the outcomes of the CQI/QA process including methods of measurements and 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