PreventingShaken Baby Syndrome

The SKIPPER InitiativeShaking Kills:

Instead Parents PleaseEducate and Remember

1011 Dutchess Turnpike

Poughkeepsie, NY 12603

845-418-6960

Mission

To increase general public awareness about the danger of shaking babies and young childrenTo educate parents and caregivers about ways that they can help protect children in their care from shaking injuries

Faces Dutchess County, NY

D.J. AndersonSept. 10, 1999Feb. 9, 2001

George ‘Skipper’ Lithco IIIDec. 24, 1999Dec. 3, 2000

Bridget WalkerSBS Survivor

The SKIPPER Principles

Shaking injuries CAN be prevented.EVERY caregiver will experience frustration and anger.

WE are all vulnerable to the impulses that result in shaking, so WE all need to be prepared to cope with the inevitable moments of frustration and anger.

Parents and caregivers should agree that it is not only OK to ask for help, but that it is the hallmark of a responsible caregiver.

Effective EducationLessons learned from Stop & Shop:

Hear. Getting attention.Listen. Getting the message.Understand. Accepting the message.Act. Getting results.

Hearing the MessagePositive focus – injury prevention .Enabling parents to keep their child safe .Reframing the Message: you can help protect your child from harm.It’s not YOU: every caregiver needs to know this.Avoid “you should never shake your baby” - “child abuse” – cognitive bias.Redirect focus: educate other caregivers.

Hearing the MessageBirth is a “teachable moment.”Challenge: overcome cognitive barriers – for parents AND educators.Cognitive biases – bad things happen to bad people.SBS is a bridge between worlds - and words - of “child abuse” and “injury prevention.”

Understanding the Message

It’s not about Good and Bad: all caregivers are tired, and everyone gets frustrated and angryBecoming a parent means surrendering much of your control over lifeNo one gets up in the morning….56% of parents report THEY have at least one “tantrum” a day.

Understanding the Message

It’s not about “those kind of people”: it’s about “US”.The value of video – fidelity of message, and, in a video culture, seeing that SBS can happen to people like US.Education programs MUST be try to be universal to be normal to be effective

Getting ResultsEmphasize the importance of educating all other caregivers.Emphasize how to educate others in a positive, non-accusatory way.Zero to Three: 47% of babies under 6 months of age have at least one other caregiver

Getting ResultsWe learn 5% of what we hear, 10% of what we read and 90% of what we teach.

Getting Results: WhoAgencies Should Talk ToFoster and adoptive parentsParents in aggression managementParents in the criminal justice systemTeen parenting programsGrandparents/Relatives as ParentsMiddle School and High School parenting/babysitting classes

Getting Results: WhyTalk About SBS

Enable parents to take action that will protect their child from injuryUpstate NY SBS Prevention Project reports sustained 47% reduction in inflicted head trauma- Pediatrics 4/2005Coping skills to prevent shaking injuries will also reduce other consequences of frustration and anger directed at children

Getting Results: WhySupport SBS Efforts?

Reduce the cost of the consequences to taxpayers: $1.00 spent on prevention saves $1.73 spent on the consequences of SBS.

Medical treatment.Rehabilitation.Criminal justice cost.Learning disabilities.Social costs.

Medical costsNon-survivors. $5—15,000Survivors with critical care. $75,000 - $125,000Survivors without critical care: $2,500

Rehabilitation costs.$105,000 annual cost for child in nursing homeHome care costs

Dutchess County 2000-2003

8 months to 2-3/4 years old7 women2 grandmothers3 child care providers1 child of a foster parent1 wife of a pediatrician

Lesson: there may be higher risk parents, but there are no no risk parents

Normal?

Not So Normal

- For Better or For Worse, Lynn Johnston

NormalPercent of parents self-reporting shaking of a child under age 2Courtesy Dr. Desmond Runyan, UNC

Coping

Develop a coping planShare the plan

Normalize the planBe proactive

Be organized and availableBe aware

How to talk to caregivers…

Make it NORMAL: part of your list of things to go over with everyone.

Talk about a narrative: an article you read.

Share a brochure, or let your baby do it…

Onesie way to break the ice with caregivers…

Legislative ActionHospital Education Legislation

Video: NY, MO, IL, MN, PA, WI MA, OH, SC, NE, IA (2010: KY)Brochure: WA, TX, VA,TN, IN, CA (2010: NJ)Campaign: WA, NJ

Child Care EducationTX, NY, AL, NJ, FL, WI, MN, MA, OH, NE, SC

School EducationNY, WI (2010: KY)

Legislative ActionIn 2010, nearly 2/3 of US births will take place in a state with some form of education requirement.A law requiring education for ALL new parents makes it easier for educators.Reframing education as safety and injury protection makes it easier for educators and institutions.JACHO: compliance for accreditation

Governor Pataki, at signing of hospital education legislation, 2004

Legislative ActionShaken Baby Prevention Act 2010

S. 3003, HE 4642Fund national prevention education for new parents, caregivers, support services for providers

Education Begins at Home ActHome visiting programs ($440 m. stimulus)- Parents As Teachers, Nurse-Family Partnership, etc.- RAND study: effective

Awareness CampaignNational Awareness Week 2010

- US Senate Resolution, States, CountiesPosters and Brochures: Pediatric Offices, Hospitals, Child Care CentersPartners

Child Care CommunitySchools (babysitter safety)Children’s Trust FundsMedicaid and Health InsurersParenting Organizations

Statistical Sampler1400-1600 cases brought to medical attention300 deaths, 600-900 disabilitiesNY: 41% Medicaid births2.6% mothers self report shaking (NC) -

More Statistics

100% think PoP is worthwhile86% report talking to others15-20% colic

More StatisticsParent is a transitional position. It has the highest turnover rate in the world: every day, there are 10,000 more babies whose parents need education. Parenting education is optional.Nearly 60% of new parents don’t feel ready.Back to Sleep – After 10 years of the Back to Sleep campaign, CA reports 65% of new parents know about it at birth (2004) – which means 35% don’t!

OpportunitiesAwareness campaignSupport hospital education programs Develop ped office protocols

ask parents to identify a support personteething, colic, vax

Support reframing educationSupport early childhood Partnerships- child care, schoolsNormalize frustration

Going To ScaleIdentify existing resources – collaborate and shareLook for ladders to climb – use existing organizations to develop partnerships – hospital associations, child care and social service agencies, children’s trust fundsFocus on Reframing - enable parents and educatorsChange the info dynamic, so parents pull informationUse social media judiciously – quicker, easier, cheaperUse Internet tools to repurpose information, act at a distance AND multiply effort: YouTube, Twitter, BlogsUse Internet tools to adapt models, maintain fidelity Identify and develop staff who can act as agent/coach: positive, supportive, knowledgeable and persistent.

Going To Scale - Caution

Understand the nuances of turf: whose program is it?Collaboration peril: the narcissism of small differences - it’s easiest to argue when you almost agree (the devil is in the details)Reframing - enable parents and educators

Going To Scale - Opportunities

Understand the non-monetary reward for a legislator – public recognition of their effortsWork with state and local legislators to implement an action plan for legislative awareness of costs and opportunities, recognition of prevention efforts Understand the role of legislative staff and build relationships – often (turnover).Understand the importance of awareness actions that don’t require funding, bridge partisan chasms, and build collaborations.