Saturday, May 24, 2008

There have been four or five shaking cases (at least that I've read about) where a person who shook a child was reported to have seen an educational video in the hospital.

In response to a question about a recent case in Albany (where it is unknown whether the father had seen the video), I had some thoughts on video education programs...

- first, it's important to recognize that the law in New York and other states usually doesn't require that parents watch the video: it requires that hospitals offer all new parents the opportunity to do so.

The effectiveness of the program is a function of several things, including whether the hospital sets up an effective and efficient way to make that opportunity available, how it is managed by the staff, and how the educational opportunity is presented to the parents.

"Do you want to watch a video about shaken baby syndrome?" is a very different question than "We'd like to show you a video that will help you learn how you can help keep your child safe from shaking injuries. Is that OK?"

As I recall, the stats last year indicated that the "watch" rate varies in the hospitals supported by the regional program here varies between 45% to 75%.

Some of the hospitals close to the NYC metro area have problems because they rely on a signfiant number of per diem nurses to provide care, and those nurses don't necessarily get training on the program.

That's still better than the participation was at Albany Medical Center a couple of years ago, when I was told that about 25% of the parents watched the video. They were not involved with either of the regional prevention support programs and I was told by one parent that the nurses basically asked the first question: "do you want to watch a video about SBS?"

On the other hand, when I was at a baby safety fair in the Albany area a couple of years ago, I informally sampled parents with infants and it seemed that St. Peter's Hospital was doing the best job of the 5 maternity hospitals in the Albany area.

- second, while all of the hospitals make an effort to show the video to both parents, I believe they usually manage to get only about 60% of the fathers.

- third, and in some respects most critically, there are individuals who see the video and either don't get the information or don't acknowledge and act upon it.

I don't think there are any simple explanations that fits all cases.

For many fathers, the birth experience is not only the opening of a door into a strange, new world with new and enormous responsibilities, but it is a time of disruption, confusion and chaos. It's frequently the beginning of a long period of intermittent exhaustion, coupled with anxiety and apprehension.

In those circumstances, even when the father is present, getting him to stop, participate and focus on the video, and not just to watch it, but to understand and apply it to themselves, is a challenge. I suspect the an appeal to fathers to learn how "you can protect your baby" theme is most likely to be effective, but this is an area that requires some real psychologically based outcomes research.

- Fourth, some of those fathers (and the relatively few articles reporting on a shaking event by a parent who has seen the video all involved males) are going to watch that video and refuse to accept that it has any lessons which apply to them.

In particular, I think individuals with control issues are not disposed to learn the lessons being offered.

Video education is, I think, a very effective way to prevent shaking from ignorance - and while it didn't assess specific knowledge about the danger of shaking, the recent study which found 1/3 of parents are ignorant about important aspects of child development suggests there is significant ignorance about the nature of that danger too - and probably works to prevent many instances where parents are generally indifferent to the welfare of their child.

I think one thing that is needed is education for mothers that models ways to effectively engage their spouse in the routines of child care and child safety, especially in contexts where domestic violence is a concern.

One reason that education in the hospital is important is that research suggests education following birth takes advantage of a "teachable moment" - at least for mothers - when parents are usually receptive to education about how their behavior can affect children. It has been shown to increased the effectiveness of smoking prevention programs targeted at mothers.

In the Buffalo study area, there has been a sustained reduction in inflicted head injuries of 50%.

I believe that while some parents are involved in the cases that are still happening, the precentage is lower than the nationally reported statistics and many of those parents didn't actually see the video (I suspect partially because of the reasons noted above, and partially because some parents didn't want to watch a video about "child abuse" - another area where research needs to replace speculation).

Considering that a typical prevention program is touted as a success when there is a 10%-15% change in the targeted behavior, this is extraordinary success (as recognized by the Joint Commission on Accreditation of Healthcare Organizations).

That said, we all recognize that it won't be successful enough until there is a 100% change.

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