School of Public Health

Oregon's Continuous Quality Improvement to Increase Safe Sleep Practice

July 2018


Oregon’s MIECHV Program is conducting a statewide Continuous Quality Improvement (CQI) project focused on its efforts to reduce rates of sudden unexpected infant death (SUID) through safe infant sleep practices.

The Goal: To increase the number of enrolled infants who never bed-share, always sleep on their backs, and always sleep without soft bedding from 18.3% to 25% by September 2018.


Continuous Quality Improvement (CQI) is an ongoing effort to collect data and use it to make decisions that will achieve measurable improvements in program processes, services, outcomes, and user experience.

Oregon’s MIECHV Program provides funding support to 20 Local Implementing Agencies with 27 home visiting services delivery sites in 13 counties. Each site has a CQI team that includes the Home Visiting Supervisor, Home Visitors, and data support specialists.


*What is the Infant Mortality CoINN?

This Collaborative Improvement & Innovation Network (CoINN) is a HRSA-supported multidisciplinary team of federal, state, and local leaders to address perinatal and infant health. Other HIRSA-supported Maternal and Child Health Bureau CoINNs address maternal and women's health, children's health, and adolescent and young adult health.

The Program’s CQI Coordinator developed a Safe Sleep Key Driver Diagram adapted from the *Infant Mortality CoIIN’s Prevention Toolkit – that identifies three primary drivers, or factors, to achieve the state’s safe sleep goal. Each CQI team selected one driver to work on based on an assessment of home visitor knowledge and possible client barriers to practicing safe sleep. The teams identified potential change ideas and tested them using Plan-Do-Study-Act Cycles.

Key Driver #1: Home Visitors actively endorse the American Academy of Pediatrics’ (AAP) evidence-based guidelines for infant safe sleep, including promoting breastfeeding in a safe sleep environment

Who: Lane County Public Health Department’s Nurse-Family Partnership home visiting program

What: Nurse Home Visitors (NHVs) used Motivational Interviewing-style questions during client-centered safe sleep discussions to generate and encourage dialogue with families. For example: “What have you heard about safe infant sleep?” and “Can we look at the space where you plan for your baby to sleep?

Impact: Viewing the place where the infant sleeps, or will sleep, elicited questions from the parents that provided more opportunities for NHVs to share safe sleep information. All existing and incoming NHV staff will be trained to integrate these questions into safe sleep discussions with families.

Key Driver #2: Infant caregivers have the knowledge, skills and self-efficacy to practice safe sleep for every sleep

Who: Klamath Basin Behavioral Health’s Healthy Families home visiting program

What: Developed a safe sleep quiz on Kahoot! (a game-based social learning platform that users access via web browser and mobile app) and invited 15 parents to participate in a group game followed by a discussion on safe sleep. Participating parents continue to receive monthly safe sleep education from home visitors to reinforce their knowledge.

Impact: Pre- and post-test questionnaires revealed that the percent of parents who answered each of the safe sleep questions correctly increased by an average of 26%.

Key Driver #3: Community champions are activated to promote safe sleep

Who: Jackson County Public Health Department’s Nurse-Family Partnership home visiting program

What: Created a county-specific, Safe Sleep Coalition to develop and deploy consistent safe sleep education strategies for pregnant women and new mothers, fathers, families, and caregivers.

Impact: 24 community partners participated in the Safe Sleep Coalition kickoff meeting in March, and chose three educational strategies: 1) hospital-based education, 2) education from medical providers (e.g. pediatricians), and 3) home visitor education. Activities are being implemented to define and finalize agency/discipline specific education for each point of contact with pregnant women or new mothers.

Questions about Oregon’s Safe Sleep activities? Contact Drewallyn Riley, MPH, Continuous Quality Improvement Coordinator at project was supported by the Health Resources and Services Administration (HRSA) Of the U.S. Department of Health and Human Services (HHS) under the Affordable Care Act - HMaternal, Infant and Early Childhood Home Visiting Program Expansion Grant;   Grant number D89MC28286. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.