A Safe Place to Sleep: Developing a National/Local Partnership

State: NY Type: Model Practice Year: 2016

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 “A Safe Place to Sleep: Developing a National/Local Partnership” describes the development and implementation of an injury prevention strategy to address child fatalities resulting from unsafe sleep practices. The Nassau County Department of Health (NCDOH) is the lead agency for the Nassau County Child Fatality Review Team (NCCFRT). Case reviews of the NCCFRT resulted in identification of the need for a strategy to provide safe sleep environments for babies in at-risk situations. The National Cribs for Kids organization is recognized as the leader in the development of an intervention that combines both education and delivery of a crib to families in need. 

The NCDOH has partnered with the National Cribs for Kids program in order to obtain the support and funding mechanism to develop a local program.  For $100.00, we can purchase a Crib for Kids Graco Pack n’ Play, Halo sleep sack, 1 crib sheet and a safe-sleep message, 1 soothie pacifier and safe sleep educational material and ship the items directly to the recipient.

The NCDOH, with the support of the NCCFRT, has developed all the tools necessary to support the local program, developed partnerships with community based agencies who will identify families in need and provide the educational component of the program. The NCDOH will continue to direct the delivery of the crib package ensure sustainability of the program though grants and donations. It is well recognized that providing a safe place to sleep saves babies lives.

 

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Nassau County Department of Health
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A Safe Place to Sleep: Developing a National/Local Partnership
The Nassau County Department of Health (NCDOH) was created in 1938 by the Nassau County Charter. The mission of the NCDOH is to promote and protect the health of all who live, work, and play in Nassau County. This is accomplished through direct services and community partnerships in the following areas: development and maintenance of individual and community preparedness for public health hazards and events; investigation, prevention, and control of communicable diseases; prevention of environmental health hazards through assessment, regulation, and remediation; promotion of healthy lifestyles through outreach and education; provision for evaluation and services to individuals, children, and families that have developmental delays and concerns. Nassau County, N.Y. has a population of 1.3 million making it the 27th largest county in the nation.  Nassau County consists of 76.7% White, 12.4% black/African American, 15.7% Hispanic/Latino, 8.7% Asian, 0.5% American Indian, 0.1% Pacific Islander/Hawaiian, 1.6% two or more races (U.S. Census Bureau, 2013).  The County is undergoing a rapid demographic shift; it is aging and becoming far more ethnically, racially, and economically diverse.  Although there are pockets of great prosperity in Nassau County, areas of extreme poverty abound, and subsequent health disparities are a major concern.  Infant deaths resulting from unsafe sleep environments is a preventable public health issue. According to the CDC (2014), there are 4000 deaths/year in the U.S. due to unexplained sudden infant death.  Unexplained sudden infant death can be due to suffocation or entrapment of an infant while sleeping in an adult bed, on couches, in a crib filled with blankets and pillows, or in a defective product.  These deaths are preventable through education and the access and use of safe sleep environments. The goal of the Nassau County Cribs for Kids program (consistent with goals of the National program) is to reduce the risk of SIDS and unsafe sleep deaths by providing families living in Nassau County with safe sleep education and a safe sleep environment. The objectives are twofold: A.     Create a Cribs for Kids chapter: 1.     Secure all agreements necessary to establish a local chapter. 2.     Secure and manage funding to purchase cribs. 3.     Identify and partner with local community based agencies who will identify, refer, and educate families at risk. 4.      Develop protocols and procedures 5.      Develop training curriculum for the partners 6.     Train above community based partner on safe sleep and the Cribs for kids program. B.     Evaluate program success 7.     Evaluate changes in family safe sleep practices following partner intervention.  8.     Continue to monitor county level infant deaths due to unsafe sleep.   The Nassau County, NY- Cribs for Kids chapter was established through a Trademark License Agreement between Nassau County and National Cribs for Kids.  By becoming a chapter we were able to activate a 501(c)3 account managed through the national organization at no cost. This allows us to purchase the Graco Pack n’ Plays (an integral part of the program) at discounted pricing. A Memorandum of Understanding (MOU) was drafted by the County Attorney’s office for use when partnering with community agencies. These activities allowed us to successfully meet objective 1. The second objective, to secure and manage funds to purchase cribs is, and will continue to be, an ongoing activity. We continually leverage Public Health Interns to research and submit grant opportunities. To date, we have secured: $2000 from Ronald McDonald House Charities, $4,000 from Macy’s and $300 Private/Local Business Donations. We are also planning to outreach to local businesses to request donations.  Our 3rd objective is to enter in an MOU with local community based agencies who will identify, refer, and educate families at risk. Once an MOU is in place, the agency is trained on Safe Sleep and the protocols/procedures of the chapter and crib set up, which meets our 4th and 5th objective listed above. To date we have partnered and trined the WIC and EI programs.  We are currently working to partner with the Nassau County Department of Social Services, Visiting Nurse Services of New York and hospital based home care agencies such as Winthrop University Hospital. As more agencies are identified, we will reach out to partner. To date we have successfully delivered 3 cribs to families in Nassau County. Our 7th and 8th objectives noted above, will be met as the program grows. The NCCFRT has reviewed 99 cases since 2009, 31 of which have been related to unsafe sleep. Therefore, approximately 30% of the cases we have reviewed were potentially preventable, stressing the importance of this issue in Nassau County.    
The Cribs for Kids-Nassau County, N.Y. chapter is a creative use of an existing practice.  There is no such program in Nassau County.  We have worked with the National Cribs for Kids Program, to tailor our chapter to the needs of our County. The evidence-base for this program is clear. Sudden infant death syndrome (SIDS) has been a public health concern for over 2 decades. After the implementation of the American Academy of Pediatrics (AAP) recommendation of back sleep position for infants, the number of SIDS deaths in the United States decreased by 53% between 1992 and 2001 (Kochanek, 2004). Prone sleep positioning declined from 70% in 1992 to 11.3% in 2002 and then increased slightly to 13.0% in 2004. Some studies indicate that the prevalence of prone sleep position is contributing to the continued disparity in SIDS rates between African American and Caucasian infants. (Hauck et al., 2002). The prevalence of prone sleeping position in 2001 among Caucasian infants was 11% compared with 21% among African American infants. Research conducted in California that examined data from 1997 – 2000 revealed that there was an exceptionally high incidence of SIDS for infants placed on the side and found on the stomach or for infants who were placed in the prone position who were accustomed to sleeping on their backs, reinforcing the importance of a consistent, clear, continuing message to parents about safe sleep for infants (Li, DK, et al., 2003). Clearly, sleep position and sleep environment represents a crucial modifiable risk factor in combating infant deaths. In October 2005, the AAP published “The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk”. This policy statement presents updated recommendations to reduce SIDS deaths and describes a safe sleep environment for an infant as being “separate but proximate”, that is, a baby should sleep in the same room as the parent(s) but in its own separate sleep space of a safety-approved crib, bassinet, pack and play, or cradle (American Academy of Pediatrics, 2005).  In October 2011, the AAP published “SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment”, reinforcing the above policy statement and adding some new recommendations.  New recommendations included avoiding sitting devices for sleep, avoiding co-sleepers, avoiding commercial devices marketed to reduce SIDS and avoiding the use of bumpers pads (American Academy of Pediatrics, 2011) Although SIDS and suffocation are not the same thing, the measures used to reduce the risk for each of them are the same: placing the baby on a firm surface, in a safety-approved crib, cradle, bassinet or Pack and Play, with no soft bedding in the crib or near the infant. The recommendation is to always place an infant in its own sleep environment separate but proximate to the parent(s), and to never share a sleep surface with the infant.  Research consistently shows that bed-sharing with an infant in an adult bed or nontraditional surface is hazardous to the infant due to inherent risks of entrapment, wedging of the infant’s body and head between the mattress or another object such as bed railings, possible overlaying by the parent, sibling or other adult sharing the bed, and dangerous soft bedding (Nakamura, Wind, Danello, 1999) According to the US Census Bureau (2012), Nassau County has the 13th highest income in the nation, however, there are still deep pockets of poverty and health disparity within the County.  The racial disparities in child fatality are distinct with an infant mortality rate of African American children being four times that of Caucasian children—a trend that has remained persistent (New York Department of Health, 2009-2011).  The Nassau County Child Fatality Review Team releases Independent Reports based on case reviews it conducts. Since January 2009, the Nassau County Child Fatality Review Team (NCCFRT) reviewed Thirty-one (31) infant deaths occurring since 2009, where unsafe sleeping could not be eliminated as a risk factor in the death. Of the 31 cases reviewed: 45% are Black/African American, 48% White, 1% Caribbean, 1% mixed race and 32% Hispanic/Latino.  This illustrates a significant disparity, as out of the 1.3 million residents in Nassau County only 12.4% are Black/African American, 15.7% are Hispanic/Latino and 76.7% are White. The age range of cases reviewed spanned from 9 days to 5 months and occurred during warm and cold seasons.  All 31 cases revealed at least one of the following risk factors: bed sharing, prone (belly) sleep position, side-sleep position, positional supports/sleep positioner and/or soft bedding. Some or all of these factors may have contributed to the death of the child, resulting in the team's classifications of the deaths as either "preventable" or "undetermined."  Kidscount.org estimates that in 2009, 7.6% of Nassau County children birth – 17 years live in poverty. Based on approximately 14,000 births per year in Nassau County, we anticipate there could be up to 1,000 infants in need of a safe place to sleep each year. The Cribs for Kids program began in Allegheny, Pennsylvania and has evidenced the reduction of sleep-related death rates from 17 in 1998 to 6 in 2004 in Allegheny County. Since the creation of the Cribs for Kids in 1998, all babies in Allegheny County whose parents or caregivers have received and properly used the Graco Pack n' Play portable crib from Cribs for Kids have lived to celebrate their first birthdays. Due to the success of the Cribs for Kids program it has become a National Infant Safe Sleep program in over 320 locations nationwide. Prior activities to educate families on appropriate safe sleep practices have traditionally been done by birthing hospitals and pediatricians.  Currently, there are no state guidelines that outline what a birthing hospital must do to educate newborn parents regarding safe sleep.  Therefore, the intensity of the education as well as the information relayed varies. Prior to the Cribs for Kids- Nassau County chapter there was no formal program in Nassau County with the ability to provide both education and a crib free of charge.  An ongoing activity that the NCDOH maintains, is the mailing of safe sleep information to all newborns born in Nassau County essentially reaching 100% of that target audience. The Cribs for Kids- Nassau County chapter has identified potential partners that service pregnant and/or parenting families. Currently, the WIC and Early Intervention are partners, have been trained, and are distributing cribs through our program. We are in the process of becoming partners (having a signed MOU) with the Visiting Nurse Services of New York and Winthrop University Hospital Home Care. After the MOU is executed, we will train them according to guidelines in our partnership agreements. We are exploring partner opportunities with other agencies such as the Department of Social Services and other hospital based home care agencies. The individual partners will follow a curriculum developed for the safe sleep education and distribution of cribs. For the cost of $100 we can purchase a Crib for Kids Graco Pack n' Play, Halo sleep sack, 1 crib sheets with a safe-sleep message, 1 soothie pacifier and safe sleep educational material. Each unit will be drop shipped to the recipient or the partner agency (who will then bring to the home). The home will be the site of where the education piece of the program occurs, which will afford the partner the opportunity of a visual as to what is the status of the home. Since unsafe sleep deaths disproportionately affects low income and minority families who cannot afford to purchase a crib, our chapter will target underserved communities via our community partners through a comprehensive communication plan and educational campaign that promotes healthy sleep conditions for infants. Every family deserves to receive clear, consistent, repetitive, and culturally appropriate information regarding a safe-sleep environment for their baby, as well as the tool with which to implement this safe environment: a safety-approved crib. The provision of the portable crib is a crucial educational component to the safe sleep campaign, because once the community is enlightened about infant safe sleep, the means with which to implement the safe environment must be part of the intervention. Otherwise, the message is an empty admonition that the family is unable to achieve. The provision of the crib empowers the mother to fulfill her biological nesting instinct to prepare a safe place for her infant. Funding to support the purchase of cribs is through grant writing and fundraising. The National Cribs for Kids chapter has designated an account within their 501(c)3 for use by our local chapter.  There are no overhead fees associated with the use of this account allowing all funds secured to be used to benefit families in need. Innovation was necessary when implementing the Cribs for Kids program in Nassau County in part because of the current challenges facing the Health Department in meeting the needs of the community with shrinking budgets and staff. One innovative aspect is the partnership agreement used (MOU) to secure relationships with community agencies who go into the home as the health department does not have direct home care access. Another innovative aspect is the funding strategies uses. First, we are using our academic partners (Public Health Interns) to research funding opportunities and secure the funding. Second, we are using a 501c3 account though the National Cribs for Kids program for the financial management of all program funds without any fees allowing all money to be used for the families.
The goal of the Nassau County Cribs for Kids program is to reduce the risk of SIDS and unsafe sleep deaths by providing families living in Nassau County with safe sleep education as well as a safe sleep environment. The objectives are twofold: A.      Create a Cribs for Kids chapter: (See below for further details on each step listed.) 1.     Secure all agreements necessary to establish a local chapter. 2.     Secure and manage funding to purchase cribs. 3.      Identify and partner with local community based agencies who will identify, refer, and educate families at risk. 4.      Develop protocols and procedures 5.      Develop training curriculum for the partners 6.     Train above community based partner on safe sleep and the Cribs for kids program.   B.     Evaluate program success 7.     Evaluate changes in family safe sleep practices following partner intervention.  8.     Continue to monitor county level infant deaths due to unsafe sleep.   In order to reach the goals and objectives noted above, the NCCFRT, in coordination with the NCDOH conducted the following steps: Identification of the public health issue: The identification of unsafe sleep as a public health issue was accomplished by the Nassau County Child Fatality Review Team.  The Nassau County Child Fatality Review Team (NCCFRT) is a multidisciplinary team established pursuant to NY Social Services Law (SSL) § 422-b. The NCCFRT has functioned since December 2008.   The team was created to review fatalities of Nassau County residents ages 0-17 years who die in Nassau County and whose death is otherwise unexpected or unexplained (“Child Fatalities”). Cases reviewed include, but are not limited to cases: whose care and custody or custody and guardianship has been transferred to an authorized agency. any child for who Child Protective Services (CPS) has an open case. any child for whom Social Services has an open preventive services case. any case for which a report has been made to the State Central Registry (SCR). any case for which a report has been made to the State Central Registry (SCR).   Child Fatality Review Teams were first developed in the U.S. more than 20 years ago in response to the underreporting of child abuse deaths and the lack of communication between child welfare agencies.  The multidisciplinary approach allows for collaboration among agencies and thereby enhances the ability to accurately determine the cause and circumstances of death, making it less likely for maltreatment to be missed.  As of July 2013 in NYS, there are 16 CFRTS, of which 2 function out of the local Department of Health (Broome County and Nassau County). Since January 2009, the NCCFRT has met regularly to review child fatalities.  The team approaches each case in a systematic manner allowing for a complete review of each case identified.  Cases are reviewed after completion of any investigations and completion and filing of death certificates.  Therefore, not all deaths are able to be reviewed in the same year of occurrence.  Membership in the NCCFRT is defined by SSL §422-b(3).  This statute requires the participation of certain agencies and also allows for the appointment of associate members from various fields of practice.  Statutorily required team members include Nassau County Child Protective Services, Office of Children and Family Services (OCFS), Nassau County Department of Health, Nassau County Office of the Medical Examiner, Nassau County District Attorney’s Office, Office of the Nassau County Attorney, Nassau County Police Department, Emergency Medical Services, New York State Law Enforcement and a pediatrician or comparable medical professional, preferably with expertise in child abuse. The team has added additional members with expertise relevant to child fatality prevention and/or review.  The mission of the NCCFRT is to review child fatalities to better understand the causes of these deaths and to make recommendations based on the team’s findings in order to reduce future child fatalities.  The NCCFRT meetings by statute are confidential and closed to the public.  Further, NCCFRT requires that a confidentiality statement be signed by each member, at the start of each team meeting.  The team’s protocol and procedure manual is in accordance with New York State Social Service Law §§ 20(5), 422-b, and the rules and regulations of OCFS. As discussed earlier, the NCCFRT identified unsafe sleep as a risk factor in infant deaths in the County. Based on these findings, the need for improved safe sleep efforts was identified and a decision to pursue becoming a chapter of the National Cribs for Kids program was made.   Evaluation of evidence based strategies: Based on reviews conducted by the NCCFRT, unsafe sleep was identified as an ongoing public health concerns, consistent with findings across the country. The next step was to evaluate evidences based strategies to address this issue. Based on well recognized publications, such as the American Academy of Pediatrics 2011 described earlier, “SIDS and Other Sleep-Related Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment”, it is well established that the safest place for an infant to sleep is alone in a crib, in his/her back, with nothing else in the crib. The national Cribs for Kids program is unique in its ability to not only provide education to families at risk, but also can supply the tool (a pack n’ play) to act.   Developing a partnership between a local health department and a national organization Our next step was to develop a partnership with the National Cribs for Kids program via a Trademark License Agreement. This step involved partnering a Not for Profit organization with a local municipality. Obtaining a signed Trademark License Agreement required intensive coordination between multiple agencies including the county attorney’s office, National Cribs for Kids and the Nassau County Department of Health. The partnership allows to purchase the safe sleep kits at discounted pricing and access to a 501c3 account.   Developing partnerships within and external to the county health department for crib distribution Following the implementation of the Trademark License Agreement, we identified potential partners that service pregnant and/or parenting families. Partners have been identified as either within the county or external to the county.  In partnership with the County Attorney’s office, a Memorandum of Understanding (MOU) has been developed for potential partner agencies.  At this point we have two partners distributing cribs, are working with 3 additional agencies intensely to partner and reaching out to others. Once partners are recruited, representatives from each agency will be trained.  A training curriculum has been developed which includes all necessary information and forms for the partners.   Developing ongoing strategy to support the purchase of cribs for distribution A simultaneous activity that is ongoing is the process of securing funds to support the purchase of cribs.  We have been successful in securing a $2,000 Ronald McDonalds House Charities grant and $4,000 from Macy’s in addition to $300 in private donations.  We will be continuing to apply for grants to support the program. We also plan to reach out to local community based organizations for donations to support the chapter.   Developing protocols and procedures, develop training curriculum and training community based partners As this is a completely new program in the County, we researched how other chapters across the Country function, assimilated that information and developed a protocol and procedure manual that was specific for Nassau County, based on how the County works and how agencies interact with each other and the public. Based on this manual, we developed a training curriculum for the partners to ensure that all appropriate steps are followed.  In addition, as part of this training, we have partnered with the Sudden Infant and Child Death Resource Center of New York State.  As part of the trainings, this organization teaches safe sleep to the partners to assure that the appropriate knowledge base is up to date and myths regarding safe sleep are dispelled.    Ensure ongoing evaluation of structure, process and outcomes of the Cribs for kids chapter Built into the Cribs for Kids curriculum are 3 different questionnaires to be used as part of the home visits. The first questionnaire assesses the caretaker/family knowledge regarding safe sleep and current sleep habits before any education is given.  The second questionnaire is administered 3 months after receipt of the safe sleep education and Graco Pack n’ Play with similar questions.  These first two questionnaires are administered by the partner agencies while in the home.  The third questionnaire is administered over the phone by the Health Department to assess satisfaction with the program and possible areas of improvement.    We will also look into annual trends in deaths by looking at death certificate data received by the Health Department.  The Nassau County Child Fatality Review Team will remain the advisory body to this effort. The County Attorney NCCFRT representative is a critical liaison in ensuring agreements between partners and the Health Department and between the Health Department and the National Cribs for Kids program are met.    Criteria for program participation: The Nassau County Cribs for Kids Program will target low-income families. Eligibility Requirements must meet one of the following criteria: •       They receive some type of public health benefit (such as TANF, WIC, food stamps, child care subsidy, disability, SSI, Section 8 housing) •       Nobody in the home is working •       They can demonstrate that they are otherwise unable to afford a crib •       **If you feel that a special circumstance exists that would qualify family for a crib, please indicate on the form.  The case will be reviewed on an individual basis. •        Infant should be less than 9 months of age, or mother is within 8 weeks of due date.    All recipients should: •       Be a Nassau County resident •       Not already have a safe crib or pack n’ play for the referred infant •       Either be pregnant within 8 weeks of delivery or already have an infant under 9 months of age.   The program is intended to be ongoing, supported by grants and private donations.  There is no overhead cost from National Cribs for Kids for use of their 501c3.  That means all monies received, wither by grants funding or private donations are used solely to benefit babies in Nassau County who need a safe place to sleep. As discussed elsewhere in this application, for the cost of $100 we can purchase and ship a Crib for Kids Graco Pack n' Play, Halo sleep sack, 1 crib sheets with a safe-sleep message, 1 soothie pacifier and safe sleep educational material
In developing the components necessary for this program, we have discovered that a successful public-private partnership can be achieved in order to address unsafe sleep in Nassau County. The National Cribs for Kids program has been supportive at every juncture to ensure our success. Other local health departments can benefit from the ability to obtain a 501(c)3 account within the National Cribs for Kids program. We have been successful in securing a partnership with the National Cribs for Kids program. We now have a viable partnership to obtain cribs for distribution to families in need. The benefit of this partnership cannot be quantified and is expected to assist the functioning of the local chapter. The objectives, as described earlier are twofold and include: A.     Create a Cribs for Kids chapter: 1.     Secure all agreements necessary to establish a local chapter. 2.     Secure and manage funding to purchase cribs. 3.     Identify and partner with local community based agencies who will identify, refer, and educate families at risk. 4.      Develop protocols and procedures 5.      Develop training curriculum for the partners 6.     Train above community based partner on safe sleep and the Cribs for kids program. B.     Evaluate program success 7.     Evaluate changes in family safe sleep practices following partner intervention.  8.     Continue to monitor county level infant deaths due to unsafe sleep.   Our first objective, to create local Cribs for Kids chapter has been successful as well as ongoing.  We will continue to recruit partners and secure funding to ensure the programs viability over time. To date, we have successfully delivered safe sleep kits to 3 families in the County, along with the safe sleep education. All 3 families were residents in Hempstead--which is one of the county’s select communities. In Nassau County there are 9 select communities based on health disparities. Historically these select communities have a higher burden of adverse health outcomes. These select communities represent 19% of the Nassau County population. The following communities fall into this category: Freeport, Uniondale, Hempstead, Roosevelt, Elmont, Inwood, Long Beach, Glen Cove, Westbury/New Cassel.   The clients we have served so far, have been in desperate need of a crib.  Out very first case, was a mom who fled El Salvador with a one month old and a 3 year old.  She was seen at WIC in the middle of winter with light weight clothing and flip flops. We were able to supply a crib and safe sleep education as well as referrals to other agencies to help her. Our second case, identified by WIC, had no means to buy a crib and was sleeping with her baby in her bed.  The second case completed the program and had her last follow up. She reported being fully satisfied with the program, liked that the items supplied were new (no bedbugs!) and remembered important facts regarding safe sleep. Our third client, was mom who was due to deliver within days of being seen and also had no means with which to buy a crib. All 3 of the moms were young, with an average age of 21 years. One was Hispanic and 2 were African American. For our second objective, evaluate program success, we will be using both the partners that join and the Nassau County Child Fatality Review Team as our primary data sources. Three questionnaires have been developed which will serve as our performance measures. Our partners will be administering questionnaire to the families receiving the cribs prior to education and 3 months later. All results will be reported to us. We will be able to compare knowledge and behavior regarding safe sleep before and after the intervention.  The third questionnaire will be a follow-up at one year to determine if the behaviors were sustained. Based on what the results of the questionnaires reveal, the program will be adapted. It is the routine practice of the Nassau County Child Fatality Review Team to review all death certificates to identify appropriate cases for review and release reports which will be used as necessary. As noted earlier in this application, the National Cribs for Kids has shown the reduction of sleep-related death rates from 17 in 1998 to 6 in 2004 in Allegheny County. Since the creation of the Cribs for Kids in 1998, all babies in Allegheny County whose parents or caregivers have received and properly used the Graco Pack n' Play portable crib from Cribs for Kids have lived to celebrate their first birthdays. We are looking to replicate these findings in Nassau County.  
Cribs for Kids chapters exist across the Country. Each are unique and built to suit the needs of the local community it serves. Stakeholder commitment at both the national and local level is strong. The chapter is Nassau County was built to serve and support its local partners who go into homes and see unsafe sleep situations.  The program also affords us the ability to train staff from partner agencies on safe sleep—training which they may not have received otherwise. The National Cribs for Program is committed to supporting safe sleep for babies. The Nassau County Department of Health is also committed to making this local chapter sustainable. To date we have succeeded in raising a total of $6,300 for the Cribs for kids program. Ronald McDonald House Charities donated $2,000 via grant funds.  Macy’s donated $4,000 via grant funds. An additional $300 was raised from private donations. We anticipate final approval from the County Attorney Office to distribute a donation later. We will continue to use our academic partners to identify and write grants to support the Cribs for Kids Nassau County chapter. This project has shown us the tenacity and persistence needed to coordinate multiple agencies including a national organization and county attorney office and a local health department.  We realize that these efforts will need to be continued as we partner with other agencies on this project. It is our experience that support for this program has been strong and the need for safe sleep environments is clear.  The programs sustainability will be a direct result of the department’s ability to raise funds for this project.  We expect to be successful in securing both grants and in developing a base of organizations willing to contribute.  
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