Welcome to the training on Infant Safe Sleep provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and others to recognize risk factors for sleep-related infant death, promote protective factors, and collaborate with parents and caregivers to support safe-sleep practices.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Detect risk factors for sleep-related infant death and promote protective factors to help prevent it.
- Formulate and deliver clear and consistent messages about safe-sleep practices and collaborate with parents and caregivers to support such practices.
NOTE ON TERMINOLOGY: "SUPINE" AND "PRONE"
The medical literature about infant safe sleep often refers to the supine and prone sleeping positions. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) use such terminology, as do some other public health advocacy entities. This module also uses supine and prone when referring to the sleep positioning policy and clinical guidance from such organizations.
However, the terms supine and prone can be confusing to new parents and tired caregivers, so it is best to avoid using those words when guiding families about the safest sleeping position for their infant. Say “on the back” instead of supine and “on the tummy” instead of prone.
Remember to keep it simple by saying a baby should always sleep on its back and never on its side, stomach or tummy.
Please note this module expires on 10/3/2022.
This module was released on 10/3/2019.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
American Academy of Pediatrics (AAP) Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleep Environment.
Presents the AAP’s most current guidelines for providing a safe sleep environment for infants with the goal of reducing the risk of all sleep-related infant deaths.
AAP Technical Report: SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment
Provides evidence and rationale behind the AAP’s updated recommendations for a safe infant sleep environment.
AAP's Healthy Children Website
A parent-oriented website that offers parents comprehensive information on safe sleep, addressing common parent concerns such as infant comfort, and videos and short articles about putting baby to bed safely.
Information for Parents of Newborn Children Pamphlet
A resource pamphlet from the Texas Department of State Health Services available in English and Spanish that contains the required information that health-care professionals must provide to pregnant women and to parents at delivery. It includes information about SIDS and current recommendations for infant sleeping conditions.
National Institute for Children's Health Quality's Video: How Safe Sleep Savvy Are You?
A video quiz that engages caregivers in conversations about safe sleep recommendations.
Questions and Answers for Health Care Providers: Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death
This booklet for health care providers answers common questions about SIDS and other sleep-related causes of infant death.
Safe Sleep for Babies: A Community Training
A training manual from the Texas Department of State Health Services designed to be used by service providers of all types for talking with parents, grandparents and caregivers about the best practices for safe infant sleep.
Texas Health Steps Anticipatory Guidance-A Guide for Providers
Age-appropriate anticipatory guidance topics from the Texas Department of State Health Services. For children birth through 20 years of age. Mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Record Forms.
AAP’s Policy Statement: Breastfeeding and the Use of Human Milk
Reaffirms the AAP’s recommendation for mothers to breastfeed exclusively for 6 months and advocates for facilitating breastfeeding practices in hospitals, the workplace, and communities.
Breastmilk Counts Website
Developed by the Texas Department of State Health Services to help families get off to a successful start with breastfeeding.
Ten Steps to Successful Breastfeeding
World Health Organization and UNICEF created the Ten Steps to Successful Breastfeeding to motivate all facilities providing maternity and newborn services to support breastfeeding.
Texas Ten Step Program
The Department of State Health Services (DSHS) in collaboration with the Texas Hospital Association developed the Texas Ten Step Program as a method to improve maternity care practices in birthing facilities.
Culturally Effective Health Care
Healthy Native Babies Project Workbook Packet.
This packet from U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Child Health and Human Development includes the Healthy Native Babies Project Workbook, Healthy Actions for Native Babies Handout, Toolkit disk, and Toolkit User Guide, describes ways to reduce the risk for SIDS among American Indian/Alaska Native babies.
Think Cultural Health website
Think Cultural Health offers many resources, including free, accredited online continuing education programs such as A Physician’s Practical Guide to Culturally Competent Care.
National Initiatives for Infant Safe Sleep:
Association of SIDS and Infant Mortality Programs (ASIP)
Formed with support from the Maternal and Child Health Bureau, ASIP risk reduction or bereavement support for families that have experienced an infant death.
Collaborative Improvement & Innovation Network to Reduce Infant Mortality (IM CoIIN)
A collaboration of public and private agencies, professionals and communities to reduce infant mortality.
First Candle’s mission is to reduce the rates of SIDS and SUIDs by educating caregivers and families and supporting research.
The National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN)
A coalition of more than 70 organizations committed to supporting infant safe sleep and breastfeeding.
Safe to Sleep Public Educational Campaign
Includes strategies for reducing the risk for SIDS and describes actions that parents and caregivers can take to reduce the risk for other sleep-related causes of infant death, such as suffocation.
Swaddling Resources for Parents and Caregivers:
The Benefits of Swaddling Your Baby Video
Information for new parents about how and when to correctly swaddle a baby.
How to Swaddle a Baby Video
A comprehensive online video that demonstrates correct swaddling techniques.
Swaddling: Is It Safe?
Information about swaddling from AAP’s healthychildren.org website.
Safe sleep resources for child-care providers:
AAP's Child Care Provider’s Guide to Safe Sleep
A fact sheet for child care providers that explains the AAP’s recommendations for creating a safe sleep environment.
Texas A&M Agrilife Extension’s Safe Sleep: Reducing the Risk of Sleep-Related Infant Death in Child Care
A free two-hour online training for child-care providers.
Additional Safe sleep resources to share with families:
Baby Safety 101! Video
A video about Safe Sleep for Babies developed for families and caregivers by the organization First Candle.
CDC's Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: Parents and Caregivers Web Page
The CDC’s summary of infant safe sleep recommendations for parents and caregivers.
Infant Sleep Position and SIDS: Questions and Answers for Health Care Providers
A booklet from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) designed for health-care providers to share with parents and caregivers.
Information for Parents of Newborns
Available for download in English or Spanish, page 16 of this pamphlet covers strategies to calm a baby.
Myths and Facts about SIDS and Safe Infant Sleep Web Page
A Safe to Sleep campaign web page with commonly misunderstood facts about SIDS and infant safe sleep.
A Parent’s Guide to Raising Healthy, Happy Children
This guide provides information relating to the development, health, and safety of a child from birth to five, including strategies for calming a crying baby.
A Parents' Guide to Safe Sleep—Helping you to reduce the risk of SIDS
A 2-page fact sheet safe sleep fact sheet for parents summarizing the AAP’s recommendations for infant safe sleep.
The Period of PURPLE Crying
The PURPLE program is designed to help parents of new babies understand the developmental period of infants ages 2 weeks to 3-4 months. It provides education on the normal crying curve, soothing techniques, and the dangers of shaking a baby.
Room to Breathe Website
A safe sleep campaign from the Texas Department of Family and Protective Services available in English and Spanish. The Room to Breathe website provides safe sleep videos for parents and caregivers.
Safe Sleep for Babies Fact Sheet
A fact sheet has been developed in collaboration with the Texas Department of State Health Services and the Texas Department of Family and Protective Services, to increase awareness and educate caregivers on Safe Sleep.
Safe Sleep Checklist
A printable checklist from the Texas Department of State Health Services designed to help parents assess their baby’s sleep environment for safety.
Safe Sleep for Your Baby is a general outreach brochure available for order from the NICHD. This brochure has also been adapted for African American, American Indian/Alaskan Native, and Spanish-speaking audiences and is available for download as a pdf.
Safe Sleep for Your Baby Video
An online video available in English and Spanish provided by the NICHD.
Safe Sleep for Your Grandbaby: Reduce the Risk of SIDS and Other Sleep-Related Causes of Infant Death
This booklet explains the latest safe sleep recommendations to grandparents and other trusted caregivers so they can help reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death, such as accidental suffocation. Available for order in English and Spanish.
Someday Starts Now Website
The website features tools for providers in the healthcare and community settings, Life Planning and Birth Planning Tools, videos on the importance of breastfeeding, partner involvement, and preconception health as well as information for men and women of childbearing age for before, during and between pregnancies.
Sweet Dreams: The ABC’s of Safe Sleep Web Page
A Texas Department of Family and Protective Services “Help for Parents. Hope for Kids.” web page that provides quick tips on safe sleep for parents and caregivers.
This single-page handout shows a safe sleep environment for infants and explains ways parents and caregivers can reduce the risks of SIDS and other sleep-related causes of infant death. Available for order in packets of 25.
Cribs for Kids
Provides portable cribs and education to families who provide free cribs for families who are unable to purchase a safe crib. Search for a local partner by clicking the website’s “Partners” button.
American Academy of Pediatrics. (2016). Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleep Environment. Pediatrics, 138(5) e20162938.
American Academy of Pediatrics. (2016). Technical Report: SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics, 138(5): e20162940.
American Academy of Pediatrics. (2016). American Academy of Pediatrics Announces New Safe Sleep Recommendations to Protect Against SIDS video.
American Academy of Pediatrics. (2016). Study: Parents not following safe sleep advice for infants. AAP News, Aug. 15.
American Academy of Pediatrics. (2016). Healthychildren.org, Swaddling: Is it Safe?
American Academy of Pediatrics. (2016). Study: Parents Not Following Safe Sleep Advice for Infants.
American Academy of Pediatrics. (2014). Many Infants Still Not Placed on Their Backs to Sleep.
American Academy of Pediatrics, Committee on Pediatric Workforce. (2015). Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making. Pediatrics, 132(4).
American Academy of Pediatrics. (2012). Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 129 (3) e827-e841.
American Academy of Pediatrics. (2012). A Parent’s Guide to Safe Sleep.
2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
American Academy of Pediatrics. (n.d.). Safe Sleep Resources.
Batra, E. K., Teti, D. M., Schaefer, E. W., Neumann, B. A., Meek, E. A., & Paul, I. M. (2016). Nocturnal Video Assessment of Infant Sleep Environments. Pediatrics, 138(3): e20161533.
Berlin, E. A., & Fowkes, W. C. (1983). A teaching framework for cross-cultural health care. Western Journal of Medicine, 139:934-938.
Centers for Disease Control and Prevention. (2019). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: Data and Statistics.
Centers for Disease Control and Prevention. (2018). Beyond the Data—Safe Sleep for Infants Video.
Centers for Disease Control and Prevention. (2018). Beyond the Data- Safe Sleep for Children- video #2.
Centers for Disease Control and Prevention. (2018). About SUIDS and SIDS: Understanding the Problem.
Centers for Disease Control and Prevention. (2017). Health Effects of Secondhand Smoke.
Centers for Disease Control and Prevention. (2018). Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015. Morbidity and Mortality Weekly Report (MMWR), 67(1): 39–4.
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Children’s Safety Network. (2019). Safe Sleep.
Colson, E. R., Rybin, D., Smith, L. A., Colton, T., Lister, G., & Corwin, M. J. (2009). Trends and factors associated with infant sleeping position: the national infant sleep position study, 1993-2007. Archives of pediatrics & adolescent medicine, 163(12), 1122–1128.
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Das, R. R., Sankar, M. J., Agarwal, R., & Paul, V. K. (2014). Is “Bed Sharing” Beneficial and Safe during Infancy? A Systematic Review. International Journal of Pediatrics, 2014: 468-538.
Feldman-Winter, L., Goldsmith, J.P. (2016) Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics, 138 (3) e20161889
Finer, L. B., & Zolna, M. R. (2014). Shifts in intended and unintended pregnancies in the United States, 2001-2008. American Journal of Public Health, 104(Supplement 1), S43-8.
Fu, L., Moon, R., & Hauck, F. (2010). Bed Sharing Among Black Infants and Sudden Infant Death Syndrome: Interactions With Other Known Risk Factors. Academic Pediatrics, 10(6): 376-382.
Gaydos, L. M., Blake, S. C., Gazmararian, J. A., Woodruff, W., Thompson, W. W., & Dalmida, S. G. (2015). Revisiting safe sleep recommendations for African-American infants: why current counseling is insufficient. Maternal and Child Health Journal, 19(3): 496-503.
Goldstein, R. D., Trachtenberg, F. L., Sens, M. A., Harty, B. J., & Kinney, H. C. (2016). Overall Postneonatal Mortality and Rates of SIDS. Pediatrics, 2016:137(1): e2015-2298.
Hauck, F., & Moon, R. (2016). SIDS Risk: It's More Than Just the Sleep Environment. Pediatrics, 137(1). e20153665.
Hauck, F., Thompson, J., Tanabe, K., Moon, R., & Vennemann, M. (2011). Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics, 128(1): 103-110.
Hauck, F., Signore, C., Fein, S., & Raju, T. (2008). Infant Sleeping Arrangements and Practices During the First Year of Life. Pediatrics, 122(Supplement 2): S113 -S120.
Hauck, F., Omojokun, O. O., & Siadaty, M. R. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5): e716-723.
Hays, J. T. (2017). What is thirdhand smoke, and why is it a concern? Mayo Clinic.
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Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., & U.S. Agency for Healthcare Research and Quality. (2007). Breastfeeding and maternal and infant health outcomes in developed countries: evidence report/technology assessment No. 153.
Iruka, I.U., & Carver, P.R. (2006). Initial results from the 2005 NHES Early Childhood Program Participation Survey. U.S. Department of Education, National Center for Education Statistics.
Joyner, B. L., Oden, R., Ajao, T. I., & Moon, R. Y. (2010). Where Should My Baby Sleep? A Qualitative Study of African-American Infant Sleep Location Decisions. Journal of the National Medical Association, 102(10): 881–889.
Joyner, B., Gill-Bailey C., & Moon, R. (2009). Infant Sleep Environments Depicted in Magazines Targeted to Women of Childbearing Age. Pediatrics, 124(3): e416-e422.
Kormondy, M., & Archer, N. (2017). 2017 Healthy Texas Babies Data Book. Texas Department of State Health Services, Division for Community Health Improvement.
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Mitchell, E. (2009). SIDS: Past, Present and Future. Acta Paediatrica, 98(11): 1712-1719.
Moon, R. Y., Hauck, F. R., & Colson, E. V. (2016). Safe Infant Sleep Interventions: What is the Evidence for Successful Behavior Change? Current Pediatric Reviews, 12: 67.
National Action Partnership to Promote Safe Sleep. (2016). National Action Plan to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN).
Ostfeld, B., Esposito, L., Perl, H., & Hegyi, T. (2010). Concurrent Risks in Sudden Infant Death Syndrome. Pediatrics, 12(5): 447-453.
Paruthi, S., Brooks, L. J., D’Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., . . . Wise, M. S. (2016). Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6): 785–786.s
Pease, A. S., Fleming, P. J., Hauck, F. R., Moon, R. Y., Horne, R. S.C., L’Hoir, M. P., Ponsonby, A. L., & Blair, P. S. (2016). Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics, 137(6): e20153275.
Rapaport, L. (2015). Infant sleep safety still misunderstood by many caregivers. Reuters Health, Sept. 18.
Scheers, N. J., Woodard, D. W., & Thach, B. T. (2016). Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach. The Journal of Pediatrics, 169: 93-97.
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Texas Department of State Health Services. (2018). Texas Child Fatality Data and Recommendations.
Texas Department of State Health Services. (2016). Information for Parents of Newborns.
Texas Department of State Health Services. (2015). Anticipatory Guidance-A Guide for Providers.
Texas Department of State Health Services. (2015). A Parent’s Guide for Raising Healthy, Happy Children.
Texas Department of State Health Services. (2012). Breastmilk Counts website
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The medical definitions provided in this module were adapted or obtained from the American Academy of Pediatrics and KidsHealth from Nemours.
Critical Congenital Heart Disease
Learn about state-mandated newborn screening for critical congenital heart disease, the screening process and appropriate follow-up.
Learn to provide age-appropriate nutritional assessments and counseling that promote healthy growth and development.
Building a Comprehensive and Effective Medical Home
Learn how and why to create and sustain a medical home in your primary care practice.
Preventing Unintentional Injury
Learn to identify risk factors for unintentional injury in children and adolescents, provide age-appropriate anticipatory guidance and apply state law and best practices to prevent unintentional injury and death.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.