Unfortunately, another reminder from Florida about the need for SBS education in foster care programs. It's a sober reminder to the agencies operating foster care programs that the failure to educate foster parents increases their potential liability.

Boy In Shaken Baby Lawsuit Dies After 2 Years On Life Support

By RAY REYES - rreyes@tampatrib.com

Published: November 30, 2008

TAMPA - A child involved in a well-publicized "shaken baby" lawsuit and who had been on life support for more than two years died Friday, according to a former Pinellas County prosecutor.

State Rep. Darryl Rouson's law office represents the 3 1/2-year-old boy's mother. He said Sunday night that he will ask the state attorney's office to upgrade the charges for the child's foster caregiver, Tenesia Brown, from aggravated child abuse to murder.

Brown and her husband, Marcus, had custody of the child, Lazon, and his brother for nearly four months while their mother, Niccole Booze, completed a drug treatment program.

Brown is accused of shaking Lazon in March 2006, when he was still a toddler. Brown was charged on Nov. 1, 2006, with aggravated child abuse. She turned herself in to authorities and was released after posting $50,000 bail. Brown, a certified nurse's aide with no previous criminal record, has since been awaiting trial.

In 2006, Booze filed a civil lawsuit against the Browns and the Safe Children's Coalition, Directions for Mental Health and the Sarasota Family YMCA, the agencies responsible for caring for her children. Local agencies did "an absolutely shoddy job in vetting out foster parents," Rouson said. "She trusted her child to the system. But the baby suffered."

Today's Google News search brings a reminder from Vancouver, BC that all caregivers need education about the danger of inflicted injury and the necessity of preparing a coping plan. The circumstances aren't clear here, but some children placed in foster care will challenge the coping abilities of caregivers. Foster care programs need to incorporate training about SBS and SIDS when training foster parents who will be caring for babies, infants and toddlers.

Baby in critical condition may have been shaken: cops

10-week-old infant was in foster care; tests show brain injury

Times Colonist - Published: Saturday, November 29, 2008
A 10-week-old baby is in critical condition in hospital suffering from what police believe is shaken-baby syndrome. The child was in foster care, a ward of the province, at the time of the alleged assault, said Det. Paul Brailey of Central Saanich police yesterday.

An interesting study (Medscape may require free registration to login) on implementing culturally competent substance abuse prevention training for teachers.

It offers some important tips on training the trainers:

Training as the Teaching of Adult Learners
Teachers also responded positively to the interactive, facilitated approach to learning—both for themselves and their students.
This aspect of training emerged as key to their learning of the content, their creation of models for their students, and their classroom instructional strategies (Kealey et al. 2000). Because the Implementer Manual contained all the materials needed for every activity in every lesson, teachers embraced the notion of stressing facilitated learning and practiced it during the training sessions, prior to undertaking the exercises in the classroom with their students.
Those planning for implementer training should ensure that all materials are provided; that they are attractive; that they are clearly organized and user-friendly; and that they reflect the philosophical approach to the training as well as the program for which the training is being provided.

Worth keeping in mind not only for training teachers to deliver prevention education in schools, but nurse educators in hospital based programs.

From Culture in the Classroom: Developing Teacher Proficiency in Delivering a Culturally-grounded Prevention Curriculum, Mary L. Harthun et al. Medscape (may require FREE subscription to login) J Prim Prev. 2008;29(5):435-454. ©2008 Springer
Springer Science+Business Media

Prevent Child Abuse America has sent President-elect Obama some excellent suggestions for preventing child abuse, instead of just responding to it...

Well worth reading, and well worth acting upon PCAA's invitation to let the transition team know you support those suggestions.

Wednesday, November 26, 2008
A letter from Prevent Child Abuse America to President-elect Barack Obama's transition team.
Below please find a letter Prevent Child Abuse America has forwarded to President-elect Barack Obama's transition team. We encourage you to send similar messages to the transition team at the address included in this letter, and/or through the online form. Feel free to borrow any language from from the letter and if you have any questions please do not hesitate to contact Bridget Gavaghan our Senior Director of Public Policy at bgavaghan@preventchildabuse.org.

The Honorable Barack Obama
Office of Presidential Transitions
Washington DC, 20270

Dear President-elect Obama:

Prevent Child Abuse America and our national network of 47 state chapters and over than 400 Healthy Families America home visitation programs, congratulate you on your election to the office of President of the United States of America. Like you, our organization believes that the early years are a critical time for a developing child. Please count on this organization’s knowledge, extensive communications network and support for public policies that address the problems that arise when a child is denied healthy childhood experiences. Research is clear that there is a relationship between child abuse and neglect and often life long consequences in many other areas, including chronic health problems, academic achievement, juvenile delinquency, criminal behavior, drug abuse and mental health issues. Our organization is committed to working with your Administration to help ensure that every child has the opportunity to grow up in a nurturing, stimulating and stable environment. Below for your consideration are policy recommendations to promote healthy child development based in proven prevention strategies.

1. Develop a National Strategy for Prevention

Sustainable change cannot occur until there is a national policy and commitment to prevent child abuse and neglect. Implementing a national strategy will require the coordination of federal agencies, and the assurance that all federal funding, policies, and regulations related to child well-being are coordinated and working towards complimentary goals. Our paper, A New Way of Thinking About Prevention from the First Focus book - Big Ideas for Children: Investing in our Nation's Future, outlines specific steps that our nation must take to embrace child abuse and neglect prevention in a more effective, meaningful, and comprehensive manner.

2. Invest in Evidence-Based Early Childhood Home Visitation

Prevent Child Abuse America is grateful for your support of early childhood home visitation, and for your commitment to making a range of quality home visiting programs more widely available, as evidenced by your support as Senator of the Education Begins at Home Act (EBAH). Introduced by Senators Hillary Clinton and Chris Bond and Representatives Danny Davis and Todd Platts, EBAH enjoys broad bipartisan support and has been endorsed by over 700 national, state and local organizations. The House Committee on Education & Labor passed EBAH earlier this year by a voice vote, setting the bill up for early action in the 111th Congress. I urge you to work with Congress to ensure the immediate enactment and funding of EBAH in 2009.

Thank you for promoting the successes of the Nurse-Family Partnership home visitation model throughout your campaign. Those same successes have been achieved in other home visitation service models and I ask that you extend your support to them as well. A compelling body of research demonstrates the measurable outcomes attributable to programs that employ home visitors with a wide range of backgrounds.

For example, results from the randomized trial of a Healthy Families New York program, based on the Healthy Families America model using Family Support Workers, showed that the program had positive effects in the areas of parenting and child abuse and neglect, birth outcomes, and health care. Please see the attached fact sheets for more information on the research supporting Healthy Families America, and the attached Evidence-based Early Childhood Home Visitation Programs for information on the research supporting a number of home visitation models.

3. Increase Investments in Prevention

For far too long, prevention has been undervalued and underfunded. We urge you to support increasing investments in prevention through both discretionary and mandatory funding mechanisms.

• Fully Fund the Child Abuse Prevention and Treatment Act: CAPTA embodies the federal commitment to preventing child maltreatment, but has not been funded adequately to meet the demand for community-based prevention programs. Please support fully funding the following components of CAPTA:
o CAPTA state grants, which provide funds for states to improve child protective services. Full funding will shorten the time that post-investigative services are delivered, and increase the number of children and families who receive these services.
o CAPTA community-based grants, which help states develop and implement effective approaches to preventing child abuse and neglect. Full funding will provide communities with additional support to implement effective prevention strategies such as parenting education, home visiting programs, mutual self-help support groups for parents, and crisis nurseries.
o CAPTA discretionary research and demonstration grants. Full funding will help pay for valuable data collection, technical assistance, and grant-funded research and demonstration projects. I also ask that you support the continuation of a $10 million allocation from this funding to support evidence-based home visitation.

• Fully Fund Promoting Safe and Stable Families: PSSF grants help states pay for family support, family preservation, family reunification, and adoption support. Unfortunately, the PSSF discretionary grant is currently funded at just $63.3 million. Fully funding the PSSF discretionary grant at $200 million will promote the expansion of family support services in communities across the nation and provide more intensive help for families in crisis. Research is clear that by investing in positive outcomes for children and families, family support and family strengthening programs can also lead to fewer incidences of child abuse and neglect.

• Reform the Child Welfare Financing Structure: States may access dollars under Title IV-E, the principal source of federal child welfare funding, only after children have been removed from their home and enter foster care. Of the $7.2 billion federal funds dedicated for child welfare in 2007, approximately 90 percent supported children in foster care placements ($4.5 billion) and children adopted from foster care ($2.0 billion). States can use about 10 percent of federal funding dedicated child welfare funds flexibly for family services and supports, including prevention or reunification services. Prevent Child Abuse America urges you to support initiatives that will secure adequate, guaranteed funding for front-end, prevention services while ensuring an effective approach to child welfare that provides for a full continuum of care.

• Fully Fund the Social Services Block Grant: HHS reports that SSBG funded preventive services for 29 percent of the total child recipients of preventive services in 2005. Despite the many critical services that SSBG makes possible, funding for the block grant has been chipped away over the past decade from a high of $2.8 billion a year to its current level of $1.7 billion a year. Prevent Child Abuse America urges you to support restoring SSBG to $2.8 billion.

• Enact the Shaken Baby Syndrome Prevention Act: Introduced by Senator Chris Dodd and Representative Nita Lowey, the legislation would provide $10 million to HHS to develop and implement a public information and education campaign aimed at preventing Shaken Baby Syndrome (SBS). SBS prevention programs have demonstrated that educating parents and other caregivers about healthy strategies for coping with a crying infant, infant soothing skills, and the danger of shaking young children can bring about a significant reduction in the number of SBS cases.

• Increase resources in the work of the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control to address child maltreatment through a public health approach. This approach will compliment the other federal initiatives and efforts and can provide another inter-agency link toward a unified and integrative approach to address child abuse and neglect prevention. The CDC’s child maltreatment prevention work is designed to better understand the scope, causes, and consequences of child abuse and neglect, and to identify and disseminate effective prevention strategies. They are a critical partner in preventing child abuse and neglect from occurring in the first place.

Conclusion

Prevent Child Abuse America believes that there is no issue more important to the future of our society than how we raise our youth. Yet, a recent UNICEF report found the United Sates was ranked 20th in child well-being out of the world’s 21 wealthiest nations. The measures used by UNICEF represent educational, health and safety, material, and family and peer well being; measures that can reduce the potential for child maltreatment. The UNICEF study reinforces countless reports and government data showing that child neglect and maltreatment is a significant but preventable public health problem in our country today.

Research, such as the Adverse Childhood Experiences study, has shown that child abuse and neglect have life-long impacts, not only for child but for the nation. These studies show a strong correlation between child abuse and neglect and debilitating and chronic health consequences, delinquency, criminal behavior, mental health illness, drug dependency and lower academic performance.

Getting prevention right early is less costly to the nation, and to individuals, than trying to fix things later. Prevent Child Abuse America estimates that implementing effective policies and strategies to prevent child abuse and neglect can save taxpayers $104 billion per year. The cost of not doing so includes more than $33 billion in direct costs for foster care services, hospitalization, mental health treatment, and law enforcement. Indirect costs of over $70 billion include loss of productivity, as well as expenditures related to chronic health problems, special education, and the criminal justice system.

With your leadership, together we will finally be able to shift our federal policies from addressing the issues that arise because of child abuse and neglect towards making sure that abuse and neglect does not occur in the first place. Please consider Prevent Child Abuse America and our national network a resource to you as you consider opportunities to address this pressing issue.

Sincerely,

James M. Hmurovich President & CEO

cc: Melody Barnes, Director-designate, Domestic Policy Council
Peter Orszag, Office of Management and Budget Director-designate
Heather Higginbottom, Deputy Director-designate, Domestic Policy Council
Rob Nabors as Office of Management and Budget Deputy Director-designate

The Wall Street Journal had an interesting article [11/19/08 - requires subscription] about collaboration between Proctor & Gamble and Google.

One has enormous success selling ads and one has an enormous budget to buy ads, and together they're exploring better ways to reach consumers online.

One eye opener for those offering prevention messages - the eyeballs are spending more time on line:

Consumers ages 18 to 27 say they use the Internet nearly 13 hours a week, compared to viewing 10 hours of TV, according to market-data firm Forrester Research Inc. But currently, P&G -- so famously thorough at understanding consumers, it even tracks people's tooth-brushing strokes -- spends only a sliver of its ad budget online.

And there are significant differences between the media:

The rapid spread of high-speed Internet access "has been the biggest disruption to marketing," says Rob Norman, CEO of WPP Group's media-buying firm, GroupM Interaction Worldwide. A key factor, he argues: TV-watchers are passive viewers. But Internet-surfers are tougher to reach because they take a more active role in what they choose to view.

As the two companies started working together, the gulf between them quickly became apparent. In April, when actress Salma Hayek unveiled an ambitious promotion for P&G's Pampers brand, the Google team was stunned to learn that Pampers hadn't invited any "motherhood" bloggers -- women who run popular Web sites about child-rearing -- to attend the press conference.

"Where are the bloggers?" asked a Google staffer in disbelief, according one person present.

But the fundamental task common to both enterprises is surprisingly simple:

Google job-swappers have started adopting P&G's lingo. During a session on evaluating in-store displays, a P&G marketer described the company's standard method, known as "stop, hold, close": Product packaging first needs to "stop" a shopper, Mr. Lichtig said. "Hold" is a pause to read the label, and "close" is when a shopper puts the product in the cart.

Google's Ms. Chudy gasped. "This is just like our text ads," she said. The headline is the "stop," its description is the "hold" and the "close" is clicking through to the Web site.

"This is going to get so much easier, now that I'm learning their language," she said.

And that's the challenge for prevention marketing. Or phrased a bit differently, listen, hear and act.

We have a lot to learn about effective marketing from the likes of Google and Proctor & Gamble (whose marketing savvy includes not only the know how to market diapers, but razors too - BTW: why don't new parents leave the hospital with a baby bag that includes a disposable razor too), not to mention marketing icons like Seth Godin.

If you know of any good blogs on parenting or prevention that should be added to the Blogroll, please let me know.

Or feel free just to post a link to a good discussion on preventing inflicted injuries...

There can be connections between PPD, colic and inflicted injury. Expanding knowledge about the frequency of PPD and opportunities for treatment is an important prevention tool...

MCH LIBRARY RELEASES NEW EDITION OF KNOWLEDGE PATH ABOUT DEPRESSION DURING AND AFTER PREGNANCY Depression During and After Pregnancy: Knowledge Path is an electronic guide to recent resources about the prevalence and incidence of perinatal depression, identification and treatment, impact on the health and well-being of a new mother and her infant, and implications for service delivery. The MCH knowledge path contains information on Web sites, publications, and databases. Separate sections present resources for professionals (health professionals, policymakers, program administrators, and researchers) and for women experiencing perinatal depression and their families. The knowledge path is available at http://mchlibrary.info/KnowledgePaths/kp_postpartum.html.

An interesting letter to the editor from someone upset by lenient sentencing. For the most part, I can't agree with the prescribed remedies, but I certainly understand the frustration about sentences that are a slap on the wrist...

Upgrade punishment for shaking infants
Editor:Lebanon Daily News

Once again a parent got a slap on the wrist for abusing and shaking his baby. The courts determined that it wasn’t aggravated assault — it was only simple assault for putting his child on life support.

The justice system wants to nail people with petty crimes like a dime bag of weed,but when it comes to a 2-month-old baby on life support, all the judge and jury says is “please don’t do that again.” And the worst part about it is the parents always say, “the baby wouldn’t stop crying.” Welcome to parenthood, people! Babies cry because they are hungry, sick or just plain upset and tired. They have feelings just like the rest of us. How about if somebody shakes them for crying in the courtroom until their bones break and their eyes roll back in their heads?

Who has to suffer? The child does. He or she will never lead a normal life. Once they take that child off life support he or she won’t be alive anymore. So all the parents and baby-sitters who cause these babies shaken baby syndrome should be charged with murder or aggravated assault.

They all seem to make the most pathetic excuses of why they did it. Either they weren’t thinking, or they blacked out, or they have bipolar disorder. Give me a break.

If you know you are physically unstable, why risk it with your child? A child isn’t a person’s throw toy. Somebody may get five to 10 years in prison, but that child has a lifetime of problems physically, mentally and emotionally.

The people who do stuff like that to babies should be ordered by the courts to get spayed or neutered — they are animals. Some people might be offended, but just because someone gets upset doesn’t mean he can take it out on an infant. Go to the gym. Punch a pillow. Don’t take it out on the child.

Babies cry because they can’t talk. If they could then they wouldn’t cry. I don’t have any kids of my own, but I do have nieces and nephews, and yes, they cry. I would try to find out what is wrong. I could never look at them as an object to take frustrations out on. People want babies but they don’t want the responsibility of having a baby. I think all want-to-be parents should go to parenting classes before they decide to have a baby. We are supposed to protect our children from harm, not bring harm to them. I don’t judge because only God can do that.

The justice system should be a lot more stable and harsh for these types of crimes, because people know what shaking a baby does.

It doesn’t take much to seriously hurt an infant.

Charles Witherson
Lebanon

And finally, in Fayette County, Ohio, the Kiwanis Club is continuing its work to increase awareness of shaken baby syndrome

Cute donations carry serious message
The Kiwanis Club is providing Fayette County Memorial Hospital with bibs that are designed to make parents of newborn babies aware of the dangers of Shaken Baby Syndrome.

"It really is a wonderful donation," said Debbie McQuiniff, the nurse director at the hospital's birth center. "With the number of shaken baby incidents, we really hope that this helps convey the message of how dangerous it can be. We can also provide tips for new parents......coping mechanisms that they can use during stressful times."
Monday, November 17, 2008

Here's an interesting illustration from Coachr.org showing the differences in body proportions between a child and an adult.

And Dani Draws' website has anoher interesting sketch.

Should you prefer a more classic visual treatment, Martin Dace at www.dace.co.uk offers great illustrations and explanatory text.

Any of these illustrations help to explain how the combination of large head and weak neck muscles can contribute to injury...

Just a note - an alert came my way about three new journal articles that discuss SBS, including one by the "Buffalo Girls" (as I fondly refer to the excellent nurse-coordinators of the Upstate NY SBS Prevention Project), and one that discusses educational strategies for SBS education....

Shaken baby syndrome: diagnosis and treatment.
A Reynolds - Radiol Technol 1 Nov 2008 80(2): p. 151.
http://highwire.stanford.edu/cgi/medline/pmid;19005097

Shaken baby syndrome education program: nurses making a difference.
KM Smith and KA deGuehery - MCN Am J Matern Child Nurs 1 Nov 2008 33(6): p. 371.
http://highwire.stanford.edu/cgi/medline/pmid;18997573

Testing educational strategies for Shaken Baby Syndrome.
M Bailey, T Gress, D Bolden, and L Pfitzer - W V Med J 1 Nov 2008 104(6): p. 22.
http://highwire.stanford.edu/cgi/medline/pmid;19006900

It's time to start work on SBS Awareness Week 2009 (actually, it's a bit past time to start, but don't let that stop you - there's plenty of time left..)

Senator Dodd's 2008 resolution and the supporting organizations for that resolution follow below.

2009 would be a good year to seek a concurrent resolution in the Senate AND the House for a couple of reasons: there will be new members and new committee assignments in both chambers, and this will be a new Congress, which means pending legislation has to be reintroduced.

Hopefully, SBS Awareness Week can springboard the SBS Prevention Act. It may help that the incoming administration seems to have an interest in early childhood issues. For example, President-elect Obama has joined as a Senate cosponsor of the Education Begins At Home Act.

So, any thoughts out there on:

- how the 2009 resolution can be crafted to highlight prevention?
- how to enhance support for SBS prevention in the House?
- additional organizations that should join as sponsors?
- local or regional activities during the Week that could help improve awareness?

Organizations that sponsor the resolution will be invited to put info and links on their website and include an article in their spring newsletter.

Any other ideas for synergy?

SBS Awareness Week Resolution 2008

S. Res. 518

WHEREAS the month of April has been designated ``National Child Abuse Prevention Month'' as an annual tradition initiated in 1979 by President Jimmy Carter;

WHEREAS the National Child Abuse and Neglect Data System figures reveal that more than 900,000 children were victims of abuse and neglect in the United States in 2006, causing
unspeakable pain and suffering for our most vulnerable citizens;

WHEREAS more than 4 children die as a result of abuse or neglect in the United States each day;

WHEREAS children younger than 1 year old accounted for approximately 44 percent of all child abuse and neglect fatalities in 2006, and children younger than 3 years old accounted for approximately 78 percent of all child abuse and neglect fatalities in 2006;

WHEREAS abusive head trauma, including the trauma known as Shaken Baby Syndrome, is recognized as the leading cause of death among physically abused children;

WHEREAS Shaken Baby Syndrome can result in loss of vision, brain damage, paralysis, seizures, or death;

WHEREAS 20 States have enacted statutes related to preventing and increasing awareness of Shaken Baby Syndrome;

WHEREAS medical professionals believe that thousands of additional cases of Shaken Baby Syndrome and other forms of abusive head trauma are being misdiagnosed or are undetected;

WHEREAS Shaken Baby Syndrome often results in permanent, irreparable brain damage or death of an infant and may result in extraordinary costs for medical care in only the first few
years of the life of the child;

WHEREAS the most effective solution for preventing Shaken Baby Syndrome is to prevent the abuse, and it is clear that the minimal costs of education and prevention programs may
prevent enormous medical and disability costs and immeasurable amounts of grief for many families;

WHEREAS prevention programs have demonstrated that educating new parents about the danger of shaking young children and how to protect their children from injury can significantly reduce the number of cases of Shaken Baby Syndrome;

WHEREAS education programs raise awareness and provide critically important information about Shaken Baby Syndrome to parents, caregivers, childcare providers, child protection employees, law enforcement personnel, health care professionals, and legal representatives;

WHEREAS National Shaken Baby Syndrome Awareness Week and efforts to prevent child abuse, including Shaken Baby Syndrome, are supported by groups across the United States, including groups formed by parents and relatives of children who have been killed or injured by shaking, whose mission is to educate the general public and professionals about Shaken Baby Syndrome and to increase support for victims and the families of the victims in the health care and criminal justice systems;

WHEREAS the Senate previously designated the third week of April 2007 as ``National Shaken Baby Syndrome Awareness Week''; and

WHEREAS the Senate strongly supports efforts to protect children from abuse and neglect: Now, therefore, be it

RESOLVED, That the Senate—

(1) designates the third week of April 2008 as ``National Shaken Baby Syndrome Awareness Week'';

(2) commends hospitals, child care councils, schools, community groups, and other organizations that are—

(A) working to increase awareness of the danger of shaking young children;
(B) educating parents and caregivers on how they can help protect children from injuries caused by abusive shaking; and
(C) helping families cope effectively with the challenges of child-rearing and other stresses in their lives; and

(3) encourages the people of the United States—

(A) to remember the victims of Shaken Baby Syndrome; and
(B) to participate in educational programs to help prevent Shaken Baby Syndrome.

Association of University Centers on Disabilities
Brain Injury Association of America
Child Welfare League of America
Children's Healthcare is a Legal Duty
Children's Safety Network
Congress of Neurological Surgeons
Easter Seals
Hannah Rose Foundation
National Association of Child Care Resource & Referral Agencies
National Association of State Head Injury Administrators
National Center for Learning Disabilities
National Child Abuse Coalition
National Exchange Club Foundation
Prevent Child Abuse America
Shaken Baby Prevention, Inc.
Shaken Baby Syndrome Prevention Plus
The Arc of the United States
The Center for Child Protection and Family Support
The National Association of Children's Hospitals and Related Institutions
The National Shaken Baby Coalition
United Cerebral Palsy
Voices for America's Children
D.C. Children's Trust Fund
National Family Partnership

Uh-oh!

The Exchange Club has a wonderful SBS awareness project, and has supported some great awareness activities, including support for the Period of PURPLE Crying campaign.

So, given that SBS is described as violently shaking a child, it's a bit surprising that a regional representative of the Exchange Club was quoted in an article in the Katy Times, TX yesterday as saying

“Please keep in mind that SBS does not always occur out of anger,” said Brenda Robinson, vice president of Region 5 of the National Exchange Club.

“Sometimes it’s simply playing with your child, bouncing them on your knee or just simply setting that child on your shoulder so they can see a parade roll by and they let go and fall back.”

It's become pretty clear to me that the best way to prevent inflicted injuries is not only educate parents and caregivers about the danger of shaking young children, but to help them understand the opportunities and learn what the kinds of things they can do to help the parent-child dyad flourish.

With that in mind, it's encouraging to see significant economic actors like the World Bank providing info on early childhood development.

Forgive me for being a bit cranky, but today brought a news story from WPTZ in Vermont that once again highlights how clueless (and I mean that in a literal, not unkind way - they may be clueless, but at least they're trying) about prevention some media folks can be.

A 13 month old boy is injured as a result of being shaken by a "babysitter."

Following a shot of the hospital, Reporter interviews "experts": Nurse, who teaches a babysitting course. Reporter then interviews director of the local child care resources center. Well-meaning people all...

If you watched it, the "lessons" you learned were:

- First, hire a licensed child care provider who knows CPR (um, CPR is good, but irrelevant: does Vermont require child care providers to be trained about the causes and consequences of shaking young children? I couldn't find anything about SBS prevention on the VT DCF site for child care providers, which isn't that unusual - most states don't require it. I did find some good SBS training, but it's for child welfare specialists: unfortunately, that's cart-before-the-horse training on how to deal with the consequences, instead of prevention...).

- Second, check references and do a criminal background check (um, "has she ever shaken your child?" - while this perpetrator is the exception to the rule, having a domestic violence "charge" driving with a suspended license, and having parole violations, most SBS cases don't involve someone with a criminal background). Oh, and given that most children are shaken by a parent or relative, just how helpful is advice to "hire someone you know personally"?

Not one mention that it might be a good idea to ask someone taking care of your child whether she has learned about shaken baby syndrome (or, for that matter, if your child is not a year old yet, SIDS), and whether she has a coping plan for those inevitable moments of frustration that do come when caring for a young child.

Given the absence of that critical info, it's particularly unfortunate and misleading that the televised report is "How You Can Protect Your Children..."

More on the story from the Burlington Press

Gooznews.com comments on legislation introduced by Senator Clinton to create a federal trust for prevention health services.

It's not apparent from this (necessarily) short summary that the legislation will enable prevention efforts that "look upstream" for prevention opportunities. An obvious step would be education for new parents that enables them to influence health behaviors in early childhood.

Educating parents can have significant near-term benefits: a UCLA research project found that health literacy training for Head Start parents produced significant savings for Medicaid by helping parents learn to care for common childhood illnesses instead of bringing their children to emergency rooms and clinics for care.

October 14, 2008
Trust Wellness

New legislation dropped in the final days of a Congressional session obviously isn't going anywhere. But it does signal what that legislator thinks is important and plans to push next year. And when that legislator is Sen. Hillary Rodham Clinton and the bill involves health care, it merits close attention.

On October 1st, the junior senator from New York introduced a bill that would channel existing payments by both public and private insurers for preventive health services into a new Wellness Trust, which would then pay for all preventive services in this society. You can think of it as Medicare Part "P," except that it isn't just for the nation's elderly.

The new Wellness Trust would be run by 7-member board appointed by the president and approved by the Senate. Under S. 3674, the Wellness Trust in its first year of operation would commission and then issue reports on the best way to supplement the existing health care workforce with certified "prevention health workers"; establish new reimbursement systems that would "align incentives" with health promotion and disease prevention goals; and analyze current expenditures on prevention, which the bill estimates at 1 to 3 percent of health care costs or $20 billion to $60 billion.

A year in, with those reports in hand, the trustees would then begin collecting all payments made by Medicare, Medicaid and insurance companies for existing prevention services. The agency would then designate its own "prevention priorities." These would include community-based strategies like tobacco and alcohol counseling or diabetes prevention education, as well as the usual clinical services like the colonoscopies, mammograms and vaccinations that most people associate with preventive care.

With these priorities and money in hand, the Wellness Trust trustees would enter into contracts with certified prevention providers to deliver the services deemed the highest priorites "without regard to the insurance status of such individuals."

The legislation tracks closely to a report that Jeanne Lambrew, now at the University of Texas, wrote for the Hamilton Project at the Brookings Institution, which was created by former Secretary Treasury and Citicorp board member Robert Rubin to serve as a policy think tank for the next Democratic administration.

There's an outside chance the proposal will find a receptive ear in the next administration, whoever is elected. Prevention is included in the health care planks of both candidates. Yet neither has stressed the issue on the campaign trial.

That's not surprising. The conventional wisdom that recently emerged from the health care policy world is that strategies for preventing chronic disease -- which is responsible for 75 percent of all health care expenditures -- don't pay. They only add another layer of cost to the system and won't lower other health care expenditures for many years, if at all.

In my view, that's hogwash. Some prevention interventions lower costs, and some cost far more than they are worth -- just like health care interventions. For a critique of the new conventional wisdom on prevention, intially laid out in a New England Journal of Medicine article, see this GoozNews post.

The Clinton bill pushes back even harder. By centralizing all the money spent on prevention in a single agency, the government could deploy those limited resources in the most cost-effective manner. Moreover, it could target the populations most in need of prevention information, advice and services -- low and moderate-income people who are the most at risk of chronic disease because of poor education, low income, high stress, poor diet, and the lack of exercise that lead to unidentified or untreated pre-disease conditions like hypertension, high blood sugar, smoking, and alcohol abuse.

Right now, the prevention priorities of the nation are driven by who is best insured and a member of what University of Minnesota bioethicist Carl Elliott has called the worried well: educated consumers who know how to demand every high-end preventive service that health care providers can dream up. Have you been told yet that you ought to get a heart scan just to make sure there aren't any blockages forming in your arteries? I have, and I didn't appreciate the pressure to spend money out of my own pocket to get something I probably don't need.

I hope to start building some profiles of prevention programs to supplement the series of profiles available on the NACHRI site. This is only the conceptual framework, but the Ontario SBS Prevention Project being developed by Richard Volpe and the Ontario Neurotrauma Foundation is a good place to start.

With John Lewko, Richard has written a casebook on evidence based prevention programs. It's an excellent resource.

This chapter describes the Upstate NY SBS Prevention Project developed by Mark Dias.

NB The Upstate New York SBS Prevention Project was rated "promising" by the California Evidence Based Clearinghouse/

The Robert Woods Johnson Foundation Center at the University of New Mexico will host a discussion with Ron Barr on prevention efforts...

RWJF Offers Lecture, Workshop on Shaken Baby Syndrome
Robert Wood Johnson Foundation Center for Health Policy at UNM presents a lecture, “Where the Rubber Hits the Road: How science can be translated into policy for prevention of shaken baby syndrome,” on Thursday, Nov. 13 from 12:30 – 2 p.m. in the Barbara & Bill Richardson Pavilion room 1500. Then, from 2:30 – 4 p.m., a workshop, “Community-wide, Culturally-sensitive Prevention Programs for Shaken Baby Syndrome: Principles and Challenges for Implementation,” is set in the same location. The events are part of the RWJF Fall Lecture Series.

Photo: Ron Barr, professor of Pediatrics, Faculty of Medicine, University of British Columbia

The lecture features Ronald Barr, Canada Research Chair in Community Child Health Research at the University of British Columbia. Barr is a professor of Pediatrics on the Faculty of Medicine at UBC, and director of the Centre for Community Child Health Research at the Child and Family Research Institute of the BC Children’s Hospital. He is also director of the “Experience-based Brain and Biological Development” Programme of the Canadian Institute for Advanced Research.

Barr will describe a primary, universal, community-based prevention program for Shaken Baby Syndrome.

This presentation will:

· Delineate four convergent lines of evidence for the program,
· describe the stages of its development,
· discuss the prerequisites for a primary prevention initiative,
· describe the development (including cross cultural focus groups), testing (randomized controlled trials of knowledge and behavior) and,
· discuss strategies and challenges for jurisdiction-wide implementation in North Carolina and British Columbia

Continuing Medical and Nursing Education is available.

The workshop features Marilyn Barr, founder and executive director of the National Center on Shaken Baby Syndrome in Canada, and Ronald Barr.
In this symposium workshop, the Barrs will describe their experience of effectively implementing the Period of PURPLE Crying prevention of shaken baby syndrome program. The Barrs will illustrate their discussion using specific examples from recent implementation projects in North Carolina and British Columbia.

Topics include:
· basic principles that need to be met to justify implementation jurisdiction-wide

· importance of timing and “doses” of intervention

· challenges and processes required for effective translations of the materials into eight languages

· importance of bringing about a cultural change in order to establish long-term
sustainability

· discussion of the 10 most “frequently asked questions” that implementation raises

For more information contact the RWJF Center at 277-0130 or rwjf@unm.edu.

Media Contact: Carolyn Gonzales, (505) 277-5920; e-mail: cgonzal@unm.edu

An article from Montana that once again points out the difficulty in prosecuting many SBS cases. One interesting aspect is that the case was tried in federal court, presumably because it took place on a reservation...

Jury acquits dad in shaken-baby case
By CLAIR JOHNSON
Of The Gazette Staff

A federal jury Tuesday afternoon acquitted a Busby man accused of seriously injuring his infant son by shaking him.

The panel found Merlin Wade Littlesun Sr., 22, not guilty of assault resulting in serious bodily injury after deliberating about 2½ hours in the two-day trial.

As the clerk announced the verdict, about a dozen of Littlesun's family members and supporters jumped to their feet and applauded and cheered the verdict, prompting an angry rebuke from Chief U.S. District Judge Richard Cebull.

"Get them out of here," yelled Cebull, who stood up and pointed at the group. Courtroom security guards directed Littlesun's supporters out of the courtroom and the building. After the courtroom had been cleared, the judge dismissed the indictment against Littlesun and ordered him released from custody.

Littlesun testified Tuesday morning that he did not shake his son as alleged on May 10, 2006. Littlesun's testimony lasted barely five minutes, and he gave mostly yes-or-no answers. Littlesun said he was sleeping when he is alleged to have shaken his 4-month-old son, Merlin Wade Littlesun Jr., hard enough to cause head trauma. He drove the baby's mother, Nicole Fisher, and his son to meet the ambulance as it was coming from Lame Deer, he said. Then he returned home to get a diaper bag and baby supplies.

Under questioning by Assistant U.S. Attorney Lori Suek, Littlesun said he was aware of bruises on the baby and asked Fisher about it but did not call the police or get the bruises checked. He suspected Fisher caused the injuries because "she just looked down," he said.

Littlesun also said he told the FBI agent he took responsibility for what happened even though he didn't do it. He acknowledged that he didn't tell investigators he suspected Fisher of causing the injuries.

The prosecution's witnesses included Fisher, others who were present in Littlesun's residence at the time and doctors who treated the baby.

Dr. Richard Stevens, a pediatrician who treated the infant, said the boy is now doing "quite well" even though his injuries were life-threatening. He was flown to a Denver hospital, where pressure on his brain was relieved.

In closing arguments, Suek recalled Fisher's testimony that she saw Littlesun in their bedroom holding the baby in his arms and that his head was shaking violently. She told him to stop and left the room. She could hear her baby crying but was afraid of Littlesun, she said.

Fisher went back in a few minutes later, picked up her baby and was holding him when he began having a seizure.

Fisher initially lied to investigators and medical personnel about what happened because she was scared of Littlesun's family, Suek said. She told the truth after she moved out of the house about a year later, she said.

Defense attorney Robert Kelleher Jr. argued in closing that Fisher caused the injuries and that there were serious problems with her testimony. According to Fisher's account, it was about 20 minutes after she allegedly saw Littlesun shaking their son until they called an ambulance.

But defense witness Dr. Thomas Bennett, a forensic pathologist who has studied shaken-baby syndrome, said a baby would experience seizures almost immediately after being shaken, Kelleher said. Bennett also said it can take only a few seconds to shake a baby hard enough to injure its brain.

Fisher was a 17-year-old mother of an infant and also had a toddler at the time, Kelleher said. She was "multitasking," trying to get breakfast ready and walking around the house with the baby, he continued, and "it only takes a second for her to snap and do this to the baby."

He also discounted Fisher's fear of Littlesun and his family. Fisher was alone with the doctors at St. Vincent Healthcare, where her son had been transferred from Lame Deer, and had the opportunity to say Littlesun caused the injuries.

"She did not tell anybody. Why? Because she's the one who did it," he said.

And welcome to the Hallmark Health Systems hospitals in Melrose and Medford, Masssachusetts, who have joined an effort spurred by Middlesex County's District Attorney, Gerry Leone, to educate new parents about Shaken Baby Syndrome before they leave the hospital.