Spreading Safe Sleep Messages Across Tennessee

Baby sleepingBetween 2013 and 2017, over 600 babies died in Tennessee from sleep-related causes. That’s more than 600 preventable infant deaths. And troublingly, sleep-related death rates are highest among families of color, with black babies in Tennessee dying at more than twice the rate of white babies. Now the Tennessee Department of Health (TDH) is implementing a multifaceted approach to teach families about safe sleep so all families can learn about safe sleep practices and more babies can sleep safely.

“Every year, approximately 20 percent of our total infant deaths are sleep-related, and these are all deaths that can be prevented,” says TDH Injury Prevention and Detection Director Rachel Heitmann, MS. “We’re trying to provide more targeted education through multiple different avenues, including in hospitals, families’ homes and their community.”

Tennessee focused on reducing sleep-related infant deaths during the Health Resources and Services Administration Maternal and Child Health Bureau’s national Infant Mortality CoIIN, a NICHQ-led initiative that sought to address systemic challenges in creating better infant health outcomes. Now, they are building off their successes and lessons learned through the Safe Sleep Infant Mortality CoIIN, which aims to improve infant safe sleep practices and reduce disparities in infant deaths.

“By leveraging a diverse range of partnerships across the health system, Tennessee is not only providing multiple touchpoints for families to learn about safe sleep, but they’re ensuring that all of these touchpoints share a uniform message,” says NICHQ Executive Project Director, Pat Heinrich, RN, MSN, CLE. “We have to remember that it is unrealistic to assume families will always receive, understand, and remember safe sleep guidelines if they are only shared in one place. Tennessee’s strategy for building partnerships has the potential to provide families with the consistent and comprehensive education needed to shift the trend in unsafe sleep deaths.”

How Tennessee is providing three touchpoints for consistent messaging


Hospitals are critical sites for modeling safe sleep practices and sharing safe sleep guidelines. Nurses and doctors can provide families with hands-on advice and families can practice caring for their babies in a safe environment. That’s why the TDH has partnered with all 60 birthing hospitals in Tennessee, encouraging them to develop policies on how to model and teach families about safe sleep, and providing safe sleep resources hospitals can share with their families.

In their efforts to reduce infant deaths, Tennessee launched the “BEST for Babies” award program in 2017, which celebrates the strides hospitals have made towards giving all babies the best start possible. Eligibility for the award depends on having high rates of breastfeeding initiation or significant improvement from one year to the next, low rates of early elective deliveries, and a demonstrated commitment to model safe sleep behavior in the hospital (view the full award criteria here). All recognized hospitals receive a banner and a framed and signed certificate from the TDH commissioner, Lisa Piercey, MD, MPA, FAAP. In the first two years of the program, 11 hospitals in Tennessee received this award.

Along with motivating hospitals to support safe sleep education, this award inspires a powerful partnership between Tennessee hospitals and the vital records department.

“Our vital records department is always trying to improve the quality of the birth and death data submitted,” explains Heitman. “And since breastfeeding is one of the criteria for getting the BEST for Babies award, vital records can now use the award to encourage hospitals to report data correctly and accurately—it’s really led to these two sectors working closely together.”

Given that breastfeeding may reduce Sudden Infant Death Syndrome (SIDS) rates by up to 70 percent, improving data collection on breastfeeding initiation supports improved infant health outcomes.


Assistance after families leave the hospital can make a big difference for new parents who are trying to remember every recommendation while balancing baby care, managing household demands and experiencing limited sleep. To develop in-home touchpoints, the TDH partners with multiple state agencies that already visit families—such as first responders, firefighters and home visiting services—and recruits and trains their employees as safe sleep spokespeople and educators. Now, when a first responder or home visitor checks in on a family, they can share and reinforce safe sleep messages and educational resources such as magnets, infographics and posters.

Testing to Improvement 
The TDH recently launched a home visiting initiative where families receive a diaper bag filled with resources, including a safe sleep children’s book and a safe sleep sack, after they learn about evidence-based safe sleep practices. In the spirit of continuous improvement, home visitors collect data to measure the success of this new approach: during follow-up visits, they check whether the infant is sleeping in a safe environment and ask the family if
they read the materials provided and whether they made any changes in the way they place their baby to sleep.

Housing authorities are another powerful home-based partner. By providing safe sleep training and resources to housing authority social workers and maintenance workers—any employees who visit families in their home—the TDH is getting safe sleep messaging to even more families.  

“We started working with housing authorities in Davidson County, and then expanded to other counties across Tennessee,” says TDH Program Manager April Kinkaid, MPH. “There was immediately so much energy for this partnership because housing authorities want to do more than provide families with housing; they want to improve their lives, and their social and economic well-being.”

Community partnerships

To ensure all families received safe sleep messages, regardless of whether state agency professionals visit them, Tennessee knew they needed to tap other partners—partners who engage with families in the communities where they live, work and play. That’s why they’re working with faith-based communities and daycare centers to help spread safe sleep messages throughout Tennessee. Churches across the state are sharing TDH flyers about safe sleep in their church bulletins and on their websites, and the TDH has provided safe sleep training and flyers to all licensed daycare centers.

“We knew that if we kept doing the same thing, we would keep seeing the same results,” says Heitman. “That’s why we’re continuing to seek out more innovative and diverse partnerships, such as connecting with tobacco cessation programs and community coalitions. We want to keep expanding our partnerships to more community sites.”

Interested in learning about more ways to spread safe sleep messaging across communities? Learn how Mississippi is leveraging a citywide campaign as a catalyst for improving safe sleep practices. Or, keep up with the Safe Sleep CoIIN’s work by signing up for NICHQ News.