Good News Ohio: New SBS Prevention Materials

Last year, Ohio passed Claire’s Law, which mandated the development and distribution of education materials.

The SBS Workgroup announced today that they have created a Shaken Baby Syndrome Web page on the Ohio Department of Health Web site. Link

Currently, the page has a teaching tool and parent certificates. New resources, features and materials, including a Spanish-language version, will be added when they are available.

As the act of creation generally tends to take some time, and there are a lot of materials available already, I hope they will be borrowing and adapting things to fill those gaps - such as some of the resources linked to on this page
http://skippervigil.blogspot.com/2008/12/there-are-lot-of-brochures-out-there.html

The Ohio webpage will be used to distribute materials to new and expectant parents via hospitals and birthing centers, obstetricians’ and pediatricians’ offices, child birth educators and Help Me Grow. Licensed child care centers, type A homes and certified type B family child care homes are required to provide the materials to their staff.

The SBS Workgroup asks everyone to spread word about the Ohio Web page and prevention materials by sharing the news via listserves or e-mails to colleagues.

(Thanks to Jon Fishpaw for the update!)

Good News: Iowa SBS Bill Passes Legislature

Sometimes, things work out as they should.

The Iowa legislature passed legislation to establish a Shaken Baby education program and sent it to the Governor for signature. See a video interview with Representative Steckman.

State Representative Sharon Steckman, D-Mason City, won approval of the first bill she managed in the Iowa House today that will establish a shaken baby prevention program.

“It’s a great honor to get approval on my first bill, but I’m proud our state is taking another step to help save lives and prevent injuries by stopping shaken baby syndrome,” said Steckman.

According to Iowa’s Child Death Review Team, from 1995-2007, 49 of the 112 young child homicide victims died from being shaken or slammed. It is estimated that more than three dozen Iowa children annually suffer serious and potentially long-term injuries from shaken baby syndrome.

The bill approved by the Iowa House today, Senate File 101, will implement a statewide shaken baby syndrome prevention program through the Iowa Department of Public Health (IDPH) to educate parents and others about the dangers of shaken baby syndrome to children. The plan must describe strategies for prevention and provide education and support to parents and others.

The bill now goes to the Governor.

ONF Newsletter

Spotlight, the bimonthly newsletter of the Ontario Injury Prevention Resource Centre, is worth a look.  The current issue reports on:

- advice from Andre Picard, public health reporter for the Globe and Mail, about injecting injury prevention into the public policy arena. He noted that it's been "woefully neglected"
- a newsletter from Middlesex that helps parents to prevent early childhood injuries
- an injury prevention program in the Kingston area to increase public awareness of the opportunities for prevention

O Canada!: Ontario SBS Prevention Program Expanding

Good news from the good folks at the Ontario Neurotrauma Foundation: they're looking to expand the SBS prevention program. 

Better news: there's still time to apply on-line!...

ONF launches Shaken Baby Syndrome Request for Applications

The Ontario Neurotrauma Foundation has launched a Request for Applications aimed to expand its Shaken Baby Syndrome program by offering start-up support for health care facilities and communities interested in implementing this best practice intervention. The primary goal of the ONF is to prevent and reduce the incidence of Inflicted Infant Head Trauma (also known as Shaken Baby Syndrome) by working with a greater number of partners involved in providing information, education and training to parents and caregivers. 

The deadline for online application is March 2, 2009, at 4 p.m.

The purpose of this project is to broaden and evaluate the implementation of the Upstate New York Shaken Baby Prevention Program, described as a best practice in Volpe and Lewko (2004). The ONF notes that the major strength of this program lies in its simplicity and ease of implementation. The educational program is short and easy to introduce to parents, making it straightforward for busy neonatal nurses and educators to put into practice. Another strength of the program is its focus on both parents, with close attention paid to educating fathers and father figures.

See the Request for Applications or visit the Ontario Neurotrauma Foundation website. Click on the Prevention tab then the Funding Opportunities menu item to search for this initiative.

More information
For questions or clarifications, contact Hélène Gagné at helene@onf.org or 416-422-2228, ext. 206.

Central Illinois: Shaken Baby Cases Spike

WEEK TV reports on a spike in shaken baby cases in the Peoria area of Illinois.   Six cases in a relatively short time....Link to video report

The past two days, the Peoria Area has seen a sharp spike in the number of children who may be victims of Shaken Baby Syndrome. Area doctors believe the stress of the times could be taking a toll on caregivers and the babies.

Doctor Steven Lichtenstein has been a Pediatric Ophthalmologist for more than twenty years, and he says never in his career has he seen so many cases of Shaken Baby Syndrome, in such a short period of time. The doctor contacted News 25, concerned that this may be a growing trend.

In the past two days alone, Doctor Steven Lichtenstein says he has been asked to evaluate six cases of Shaken Baby Syndrome, and four of which he's already diagnosed.

"Yesterday I saw three babies who definitely had shaken baby syndrome, one baby who I did not see because they weren't dilated. This afternoon at lunchtime I saw one who was definitely shaken baby also" the doctor said.

And he was informed of another case shortly after this interview.
* * *
Psychotherapist Dr. Joy Miller believes one of the contributing factors to the alarming rise in seen at Children's Hospital of Illinois could be the hard economic times.

"I wonder how much stress is playing on these families. Maybe they are very close to the edge and there is a crying baby" Doctor Miller said.

An Unintended Economic Stimulus: Child Abuse

Ulster County, New York is just across the Hudson River.  It's perhaps best known for the Catskills, the Shawangunk Ridge (one of the East Coast's rock climbing meccas), Woodstock and the Mohonk Mountain House.   

It's a relatively prosperous slice of New York.  The Coen brothers live there, and Robert DeNiro keeps his barn collection in the Town of Gardiner..

Last night, County officials hosted a meeting on domestic violence.  It gives insight into the impact that economic stresses can have on the welfare of children:

Domestic violence cases on the rise in Ulster

KINGSTON – The recession may lead to more than just financial problems, it could lead to an increase in domestic violence. That realization came from Ulster County Social Services Commissioner Roberto Rodriguez.

An increase in reported cases of domestic violence is of concern to officials in Ulster County and how to educate and inspire a more progressive attitude toward the violence was the topic of a forum held Tuesday night in Kingston.

Investigator James McCoy of the New York State Police Ulster County Family Violence Unit spoke of a large increase in the number of domestic incident reports from 2007 to 2008. According to McCoy, based on the amount of reports so far this year, the increase in those reports from 2008 to 2009 will far surpass that of previous years.

A similar report from Nassau County

Nassau attributes child abuse spike partly to recession -- Newsday.com
Feb 15, 2009 ... Officials report record number of child abuse cases ... 1 reason," said Cynthia Scott, executive director of the Nassau Coalition Against Child Abuse and ... national data analysis at the Child Welfare League of America.
www.newsday.com/news/local/nassau/ny-linegl1612456141feb16,0,3773523.story

And it's not just here.  A columnist in the Binghamton Press notes...

Many people wonder, too, what's behind the recent uptick in reports of child abuse and neglect across New York. Newsday reports that, statewide, abuse and neglect reports were up 7 percent in 2008 to more than 160,000. Some officials on Long Island, which also saw a record number of reports last year, told Newsday they're convinced the recession is the leading cause.

In the Netherlands, too, job losses and money problems are being blamed for an increase in child abuse. Researchers there say stressed-out parents are venting their anger on their children. There have been similar reports in Japan.

Resources: NY1 Report (11/24/08)

Prevent Child Abuse America (dealing with 2001-02 recession, but still relevant)

SBS Training for Professionals: National Center on SBS

Jenifer at the Forensic Healthcare Online blog mentioned the intermediate training program on SBS offered by the National Center on SBS. She is looking for comment on the course content and info on whether continuing ed credits can be earned on course completion.

If you have info to share, please visit the FHO blog and post your comments...

The National Center on Shaken Baby Syndrome has an online training center for professionals and the lay public. One of the professional courses they offer is an intermediate course on Shaken Baby Syndrome and Abusive Head Trauma. It is comprised of 4 lessons, including an Overview of Shaken Baby Syndrome, Medical Perspectives, Investigation and Legal Issues, and Prevention.

Cost of the course is $60. I don’t have any information about the course format, and it is unclear whether CEs are offered upon completion. If you have this information or find out through completion of the course, please let us know in the comments.

She also links to a webinar from the U. of Pittsburgh on translating lessons learned from child fatality death review into practice (2005). Important stuff (it's a PPT presentation by Teri Covington of the National Center for Child Death Review - slide 4 is a map comparing the level of child deaths in states - very interesting)...

Child Death Reviews (or Child Fatality Reviews as they’re called in my neck of the woods) are happening in all 50 states and in countries around the world. Talking about child fatalities doesn’t always mean putting lessons learned into practice, though. The University of Pittsburgh, Department of Neurological Surgery’s Center for Injury Research and Control has an archived webinar on this topic: The Role of the Injury Professional on the Child Death Review Team: Translating CDR Findings to Injury Prevention Policy and Practice.

Good News: Iowa House Committee 21-0 For Prevention - Hospitals, Nurses, Primary Care and Psychologists Undecided

The Iowa legislature took an important step foward on prevention legislation.

The House Human Resources committee voted 21-0 in favor of House File 65, moving it to the House floor for consideration.

Of note, the Iowa legislative website reports on lobbyists who've declared a position on legislation.   It's interesting to see who supports this legislation - and who doesn't.   

There are a few mysteries in the ranks.  Polk County is undecided (who knew?).  

And it appears that the folks who represent hospitals, nurses, primary care and psychologists are undecided about whether they favor preventing inflicted injuries or not. 

A bill for an act establishing a shaken baby syndrome prevention program in the department of public health. (See Cmte. Bill HF 406)  John Pederson FEBRUARY 16, 2009 For        United Ways of IA Matt Eide FEBRUARY 16, 2009 For        United Ways of IA Melissa Peterson FEBRUARY 16, 2009 For        United Ways of IA Jennifer Harbison FEBRUARY 12, 2009 For        IA. Academy of Family Physicians Mary O'Brien FEBRUARY 12, 2009 For        Visiting Nurse Services Joe Kelly FEBRUARY 7, 2009 For        IA. Assn. of Nurse Practitioners For        IA. Nurse Practitioners Society David Adelman FEBRUARY 2, 2009 For        IA. Medical Society Betty Lord-Dinan FEBRUARY 1, 2009 Undecided  IA. Nurses Assn. Linda Goeldner FEBRUARY 1, 2009 Undecided  IA. Nurses Assn. Joe Kelly JANUARY 29, 2009 For        IA. County Attorneys Assn. Susan Cameron JANUARY 29, 2009 For        IA. County Attorneys Assn. John Pederson JANUARY 28, 2009 For        Prevent Child Abuse IA Kathy Leggett JANUARY 28, 2009 For        Blank Childrens Hospital Melissa Peterson JANUARY 28, 2009 For        Prevent Child Abuse IA Greg Boattenhamer JANUARY 27, 2009 Undecided  IA. Hospital Assn. J. Norris JANUARY 27, 2009 Undecided  IA. Hospital Assn. Shannon Strickler JANUARY 27, 2009 Undecided  IA. Hospital Assn. Kelly Davydov JANUARY 26, 2009 For        Prevent Child Abuse IA Lynh Patterson JANUARY 26, 2009 For        IA. Dept. of Public Health Michael Heller JANUARY 26, 2009 For        Coalition for Family and Children's Services for IA Paula Feltner JANUARY 26, 2009 For        Coalition for Family and Children's Services for IA Stephen Scott JANUARY 26, 2009 For        Prevent Child Abuse IA Amy Campbell JANUARY 23, 2009 Undecided  IA. Nebraska Primary Care Assn. (IA/NEPCA) Undecided  IA. Psychological Assn. Undecided  Polk County Carrie Fitzgerald JANUARY 23, 2009 For        Child and Family Policy Center Craig Patterson JANUARY 23, 2009 Undecided  IA. Nebraska Primary Care Assn. (IA/NEPCA) Undecided  IA. Psychological Assn. Karla Fultz JANUARY 23, 2009 For        IA. Medical Society Sheila Hansen JANUARY 23, 2009 For        Child and Family Policy Center

PPD and the MOTHERS Act (2009)

Susan Dowd Stone has a good blog post on the reasons to support the MOTHERS Act, which will provide federal support for education and awareness about PPD.

Also worth a visit: Postpartum Progress (Katherine Stone)

Status of S. 324 (Menendez)  (6 cosponsors)

Status of HR 20 (Rush)  (12 cosponsors)

Related Websites:

Postpartum Support International
- MOTHERS Act

Association of Women's Health, Obstetric and Neonatal Nurses
- PPD Resources and Policy Statement

Deliberate Calm

Heard an interview with Jonah Leher last week, talking about "deliberate calm."

It's part of the emergency training doctrine for pilots. In an op-ed, Leher wrote about its manifestation in the Hudson River splash-landing:

What, then, allows people like Sullenberger to make effective decisions in harrowing circumstances? How do they keep their fear from turning into panic? Scientists have found that the crucial variable is the ability to balance visceral emotions against a more rational and deliberate thought process, which is centered in the prefrontal cortex. This balancing act is known as metacognition -- a sort of thinking about thinking.

Pilots have a different name for this skill: They call it "deliberate calm," because staying calm under fraught circumstances requires both conscious effort and regular practice

I suspect those "visceral emotions" are the prelude to many inflicted injuries.

Suddenly awakening in the still of night to deal with the challenge of a crying baby isn't the same as landing an airplane in the Hudson, of course.

However, a bit of training that reminds parents of the importance of conscious effort and practice in retaining that balance when they awake couldn't hurt.

What Congress Needs: A Good Synergy Policy

A recurrent thought: members of the Child Welfare League of America and the Association of Maternal Child Health Programs are in DC for their national conferences. Each group has scheduled advocacy visits to Congress. Link to CWLA Advocacy Day; Link to AMCHP MCH Advocacy Fact Sheet

So, if you're a member of CWLA or AMCHP and in DC, it's a good time for synergy, and to express support for the legislation that will be before Congress this year with special benefits for the early childhood (and parenthood) years:

- the Education Begins At Home Act (home visiting and parent support),
- the Melanie Blocker Stokes MOTHERS Act (postpartum depression awareness, education and support) and
- the Shaken Baby Syndrome Act (SBS prevention education and support).

And, of course, the resolution calling for a White House Conference on Children.

The synergies seem obvious. The first years after birth are the "tipping point", when support and interventions can make the greatest difference for parent and child, at the lowest cost. It's a time of opportunity for parents and child.

Note: if you aren't in DC this week, the National Call In Day organized by CWLA is a good opportunity to get the message to your Congressional representatives.

Part of the 2009 CWLA National Conference, Advocacy Day (February 24) focuses on Capitol Hill and passage of legislation to authorize a White House Conference on Children and Youth (HR 618)

It starts with conference attendees hearing from two key congressional advocates, Representatives Jim McDermott (D-WA) and Danny Davis (D-IL) 

CWLA attendees will then head to Capitol Hill to talk to their Senators and Representatives.  One of their central messages will be to support legislation to reestablish the White House Conference on Children and Youth.  

Reps Chaka Fattah (D-PA) and Todd Platts (R-PA) reintroduced HR 618 to authorize the conference.  Senator Mary Landrieu (D-LA) is expected to reintroduce legislation in the Senate. 

CWLA urges all others who support the White House Conference to call Capitol Hill today.

Call the Capitol switchboard (202-224-3121)and ask to be connected with your Representative and Senators, and  urge them to support the legislation.

And blogging about it can't hurt....

PS. And given the incidence of pediatric brain injury, support for the resolution to designate March as Brain Injury Awareness Month is also a good thing.

National Call In Day: White House Conference on Children

In addition to visits to Congressional offices by those able to attend the CWLA National Conference next week, CWLA is organizing a National Call In Day on February 24 to encourage support for a White House Conference on Children.

This follows a conference call CWLA hosted on February 18 to discuss the status of the White House Conference, and provide a legislative update on the latest news regarding child welfare and health issues in Washington. Info at bottom of this page

Suggestions:
- Visit Congress.org for contact info: enter your ZIP on this page
- Use your free weekend cell minutes to call in and leave a message on your Congressional representatives voicemail
- Follow up with an email
- If they're not on the list below, ask them to join as cosponsors of the bills. If they are, thank them
- Also let them know about other legislation that they should support: the Education Begins At Home Act (home visiting), the MOTHERS Act (postpartum depression education and awareness) and the SBS Prevention Act (SBS education and awareness)

After great success last year, CWLA is thrilled to announce that the White House Conference Bill has been reintroduced into Congress! Each new Congress requires all bills to be re-introduced for the new session.

On February 24, hundreds of CWLA advocates will converge on Capitol Hill to get Congressional support for a White House Conference. Those of us who cannot be in Washington will join by phone!

Join your colleagues for a National Call-in Day! Call your members of Congress on Tuesday, February 24, and ask them to cosponsor this important bill!

Call the U.S. Capitol Switchboard to be connected to your members of Congress!
202-224-3121

MESSAGE

Tell your Representatives to cosponsor H.R. 618

Tell your Senators to call Sen. Landrieu's office in order to be a cosponsor for the Senate bill - she is expected to introduce it at any time now!

A White House conference on Children and Youth is needed to focus the attention of the nation on children. This conference is long overdue, as there hasn't been one in almost 40 years! The conference will examine the greatest needs and set the country on a path to reform.

Cosponsors of H.R. 618 (2.21.09)

Rep. Chaka Fattah (D-PA) Rep. Todd Platts (D-PA)
Rep. Neil Abercrombie (D-HA) Rep. Dennis Cardoza (D-CA)
Rep. Elijah Cummings (D-MD) Rep. Raul Grijalva (D-AZ)
Rep. Patrick Kennedy (D-RI) Rep. John Lewis (D-GA)
Rep. Donald Payne (D-NJ) Rep. Jared Polis (D-NJ)
Rep. Pete Stark (D-CA) Rep. John Yarmouth (D-KY)
Rep. Madeleine Bordallo (D-GU) Rep. Jim Cooper (D-TN)
Rep. Rosa DeLauro (D-CT) Rep. Reubin Hinojosa (D-TX)
Rep. Dennis Kucinich (D-OH) Rep. Carolyn Maloney (D-NY)
Rep. Loretta Sanchez (D-CA) Rep. Robert Wexler (D-FL)
Rep. Don Young (R-AK) Rep. Howard Berman (CA)
Rep. Danny Davis (D-IL) Rep. Keith Ellison (D-MN)
Rep. Michael Honda (D-CA) Rep. Carolyn Kilpatrick (D-MI)
Rep. Gregory Meeks (D-NY) Rep. Thomas Petri (R-WI)
Rep. Lynn Woolsey (D-CA) Rep. Tammy Baldwin (D-WI)
Rep. Russ Carnahan (D-MO) Rep. Bob Filner (D-CA)
Rep. Dutch Ruppersberger (D-MD) Rep. Janice Schakowsky (D-IL)
Rep. Jose Serrano (D-NY) Rep. Louise Slaughter (D-NY)

North Carolina: Funding SBS Awareness 2009

Good news from North Carolina. State Senator Purcell introduced an interesting bill, appropriating funding for hospitals to "co-brand" SBS prevention PSAs based on the North Carolina PURPLE campaign.

2009 Bill Text NC S.B. 244
DATE: February 19, 2009
SYNOPSIS: AN ACT TO APPROPRIATE FUNDS TO REDUCE THE OCCURRENCE OF SHAKEN BABY SYNDROME, AS RECOMMENDED BY THE CHILD FATALITY TASK FORCE.

The General Assembly of North Carolina enacts:

SECTION 1. There is appropriated from the General Fund to the Department of Administration, State Agency for Public Telecommunications, the sum of two hundred thousand dollars ($200,000) for the 2009-2010 fiscal year, and the sum of two hundred thousand dollars ($200,000) for the 2010-2011 fiscal year.

These funds shall be used to provide matching grants to nonprofit hospital and health care organizations to encourage co-branding in the delivery of radio and television messages on the prevention of Shaken Baby Syndrome. These messages shall be based on the principles of the statewide Period of PURPLE Crying Program.
SECTION 2. This act becomes effective on July 1, 2009.

SPONSOR: Purcell

El síndrome del bebé sacudido: Lost in Translation?

It's been almost six years since an inflicted head injury was reported in Dutchess County.

That string of good fortune is over.

Two weeks ago, an undocumented immigrant is alleged to have inflicted fatal head injuries on a four year old girl. He's Mexican, and the question has come up about educating the Hispanic/Latino community.

It's been on my mind before this. Last year, there was a spate of news reports of shaking or inflicted head injuries around New York City that involved people with Hispanic surnames.

In part, the question is whether the hospital-based education programs are being effectively implemented to reach new parents who are Hispanic. In part, the question is whether the education programs and materials are culturally competent.

As far as I know, all of the prevention videos are offered in Spanish. However, they're dubbed.

Anyone know if there is a prevention video that uses Spanish-speaking individuals?

If so, is it effective? Any thoughts on whether the dubbed Spanish versions of the English language videos are good enough?

UPDATE: Children's Hospital of Phoenix has done a video - and it's available on YouTube

Take a look and see what you think...

NYC: Behavioral Screening for parents and child

The New York Times reports on a mental health screening project at the Childrens Hospital at Montefiore Medical Center.

Experts say Montefiore’s new program is a rare example of mental health services for children under 5 ... [m]any pediatricians are not trained to recognize psychological problems, and surveys show that parents often complain about physicians’ lack of support for behavioral issues.

“There is really a disconnect between the genuine needs and challenges that are facing our young children and their families and what doctors are providing,” said Dr. Dina Lieser, executive director of Docs for Tots, a nonprofit group that advocates for young children.

It's not only effective, but efficient:

At the Comprehensive Family Care Center, there is a psychologist on site, and doctors — who are trained to recognize depression in parents — screen each patient for mental health concerns. Of 2,400 children screened since 2005, 1,120 have been recommended for mental health services, and 780 have participated.

The screening program currently costs the city $20,000 to $30,000 a year; therapy is generally covered by Medicaid. The Altman Foundation has covered the $150,000 yearly cost for a separate program, known as Healthy Steps, which since 2006 has screened 250 families at the family care center and provided individual and group counseling.

In Healthy Steps at Montefiore, which is part of a national program, 20 percent of the mothers are teenagers, 27 percent grew up in foster care, 37 percent have parents with mental illness, and more than 10 percent were physically or sexually abused — all risk factors for their babies’ healthy mental and social development, according to Dr. Briggs. Research shows that environmental factors like poverty, homelessness, domestic violence and drugs can lead to depression, anxiety, aggression, poor academic performance, autistic behavior and social or developmental delays.

According to doctors at Montefiore, a child enrolled in the Healthy Steps program is one-third as likely to score “at risk” for social or emotional developmental problems. Among mothers in the program, depression dropped from 30 percent at the first visit to 6 percent after two months, while 35 percent reported feeling unsupported at the first visit compared with 10 percent at two months.

Legislative Alert: MOTHERS Act - PPD Awareness

The Melanie Blocker Stokes MOTHERS Act (HR 20 - S.324) provides federal funding for education and awareness about postpartum depression. In the last Congress, it passed in the House, but ran afoul of procedural wrangling in the Senate.

So far, it has 12 sponsors in the House and 6 in the Senate (although Thomas still shows Sen. Gillibrand as a cosponsor in the House).

It would provide funding for efforts to educate new parents about postpartum depression and the impacts on the family.
 
Some reasons why that's important:

Depression in mothers (and symptoms of depression in fathers) has been linked to colic in infants. Link  Link  

And to the adoption of safe parenting practices. Link  Link  Link

For some mothers, research suggests that birth can produce physiological effects that lead to depression. Some research also suggests that PPD can be associated with post-traumatic stress syndrome. Link  Link   Perhaps not that surprising when you think about the complex nature of the birth process a bit...

And a 2007 study points out the need for increased efforts to screen mothers for PPD.

Not to mention perinatal anxiety disorders.

The causes may be different, but it's important to recognize that postpartum depression can occur in fathers. Link  Link Link to Newsweek report  Link to CNN report Link to WebMD article

Research on first time fathers suggests educating them about PPD may help positive outcomes. Link

The consequences of PPD can affect outcomes in children. Link. Link

Another bill that you can email your Congressional representatives about, and let them know that you support it. And why it is important...

Surviving SBS: Micah Radcliffe

Ledger.com provides insight into the challenges of surviving Shaken Baby Syndrome, and how one 16 year old boy and his family are meeting those challenges....

Safe Parenting: Time Travel Required

Prepping for a presentation to a group of child care providers, I realized that in many respects safe parenting (or caregiving) requires traveling ahead to the future.

In some cases, as when you look ahead of a toddler to see what lies in his path (and anticipate what he's likely do in response), it's only a second.

In other cases, it's looking ahead a few weeks or months, as when you start to think about what safety measures will be needed around the house once a baby learns how to walk or crawl.

In each case, it's moving the focus ahead of the here and now, visiting the future and coming back to act accordingly. It's not easy...

National Academy of Sciences: Preventing Disorders in Children

The National Academy of Sciences released a report that calls on federal and state legislators to make prevention of mental, emotional and behavioral disorders a high priority.

The NAS Report describes a substantial gap between what we know about preventing mental, emotional, and behavioral disorders and what we actually do to deliver effective prevention programs to the wide group of at-risk children and adolescents. (Link to the table of contents of the NAS Report)

For those at risk of a disorder, the key to prevention is using early symptoms to identify them and provide opportunities for treatment when it can be most effective.

The Report also points out that a number of programs have shown broader preventive effects in general populations of young people.  Especially promising are those programs that fit into family or educational setting and address major risk factors, while other programs improve children's mental health and behavior by enhancing parenting skills (the Positive Parenting Program is cited as an example).

The NAS report recommends that the White House create an entity to lead a broad implementation of evidence-based prevention approaches and to direct research on interventions. It also includes an analysis of the costs and benefits of prevention.

Texas: Too Much of a Good Thing?...

Psychologists speak of "object salience" in considering how much things stand out against the background or context...

Legislation has been introduced in Texas (HB 1240) to add new information to the resource pamphlet distributed to new parents in the hospital.   It's all good stuff: reading to children, the importance of a medical home, the importance of dental care.

But I wonder if it may unintentionally reduce the salience of Shaken Baby Syndrome awareness materials now being distributed.  

Link to article about the bill sponsor, Rep. Mike Virreal.

Most folks are already disposed to shy away from anything related to "child abuse."  

Add in more of the things that new parents expect they will to have to do and it's bound to be tempting to skip over the stuff about shaking babies....

Sec. 161.501. RESOURCE PAMPHLET [A> AND RESOURCE GUIDE PROVIDED TO PARENTS OF NEWBORN CHILDREN

(1) provide the woman and the father of the infant, if possible, or another adult caregiver for the infant, with a resource pamphlet that includes:

(A) a list of the names, addresses, and phone numbers of professional organizations that provide postpartum counseling and assistance to parents relating to postpartum depression and other emotional trauma associated with pregnancy and parenting;

(B) information regarding the prevention of shaken baby syndrome including:

(i) techniques for coping with anger caused by a crying baby;

(ii) different methods for preventing a person from shaking a newborn, infant, or other young child;

(iii) the dangerous effects of shaking a newborn, infant, or other young child; and

(iv) the symptoms of shaken baby syndrome and who to contact, as recommended by the American Academy of Pediatrics, if a parent suspects or knows that a baby has been shaken in order to receive prompt medical treatment;

(C) a list of diseases for which a child is required by state law to be immunized and the appropriate schedule for the administration of those immunizations; and

(D) the appropriate schedule for follow-up procedures for newborn screening;

(2) [A> PROVIDE THE WOMAN AND THE FATHER OF THE INFANT, IF POSSIBLE, OR ANOTHER ADULT CAREGIVER WITH A RESOURCE GUIDE THAT INCLUDES INFORMATION IN BOTH ENGLISH AND SPANISH RELATING TO THE DEVELOPMENT, HEALTH, AND SAFETY OF A CHILD FROM BIRTH UNTIL AGE FIVE, INCLUDING INFORMATION RELATING TO:

[A> (A) SELECTING AND INTERACTING WITH A PRIMARY HEALTH CARE PRACTITIONER AND ESTABLISHING A "MEDICAL HOME" FOR THE CHILD;

[A> (B) DENTAL CARE;

[A> (C) EFFECTIVE PARENTING;

[A> (D) CHILD SAFETY;

[A> (E) THE IMPORTANCE OF READING TO A CHILD;

[A> (F) EXPECTED DEVELOPMENTAL MILESTONES;

[A> (G) HEALTH CARE RESOURCES AVAILABLE IN THE STATE;

[A> (H) SELECTING APPROPRIATE CHILD CARE; AND

[A> (I) OTHER RESOURCES AVAILABLE IN THE STATE;

[A> (3) SUBDIVISIONS Subdivision AND (2)

[A> (4) (3)

(b) A hospital, birthing center, physician, nurse midwife, or midwife [A> :

[A> (1) SUBSECTION (A)(1); AND

[A> (2) MAY USE THE RESOURCE GUIDE PROVIDED ON THE DEPARTMENT'S WEBSITE OR AN ALTERNATIVE GUIDE THAT PROVIDES THE INFORMATION REQUIRED BY SUBSECTION (A)(2) this section

[A> (C) THE DEPARTMENT MAY MAKE AVAILABLE ONLINE AND DISTRIBUTE AN EXISTING PUBLICATION CREATED BY ANOTHER HEALTH AND HUMAN SERVICES AGENCY AS THE RESOURCE GUIDE REQUIRED BY SUBSECTION (A)(2).

2009 Bill Text TX H.B. 1240

Detecting Abusive Head Trauma: Something Fishy Here

Speaking of perspectives, there no lack of ways to ponder this interesting story from the NY Times.  Who would have thunk that salmon suffer TBI?  Or that it's been studied for years?  Or that there are available blood markers for TBI?  Link to study

Detecting Brain Injuries in Salmon From Hydroelectric Dams

By HENRY FOUNTAIN - Published: February 13, 2009

The journey of an adult salmon upstream on its way to spawn is not an easy one, but the downstream swim for the juvenile fish is no picnic, either. On rivers with flood-control and hydroelectric dams, like many in the Pacific Northwest, the young salmon are buffeted, subject to sharp pressure changes and otherwise knocked around as they pass through spillways, tunnels and power-generating turbines.

Scientists have been studying the effects of this rough treatment for years, with the goal of designing dam structures and equipment that go easier on the fish. To detect the forces at work, they have used dummy fish containing accelerometers and other devices and have even embedded sensors in live fish.

Now they have a new tool. Ann Miracle, a researcher at the Pacific Northwest National Laboratory in Richland, Wash., and colleagues have shown that it’s possible to directly detect brain injury in salmon.

Dr. Miracle said that the work grew out of a discussion with Nancy D. Denslow of the University of Florida, who told her about efforts to quickly detect traumatic brain injury in soldiers by testing for the presence of breakdown products of a protein found in cell membranes. When a cell is damaged, enzymes are released that break this protein into smaller compounds.

“It struck me that using a physical injury biomarker could be very useful,” Dr. Miracle said, but first she had to determine that the same cell-membrane protein and breakdown products occur in salmon. Once that was confirmed, she and her colleagues tested the method on brain tissue from juvenile Chinook salmon that had been through a dam on the Snake River.

They found that by comparing amounts of intact protein to amounts of breakdown products, an assessment of brain damage could be made. This assessment correlated well with sensor data on conditions that the fish encountered while traveling through the dam. Their findings are published in the online open-access journal PLoS One.

C'est Bonne: SBS Education in Quebec

The Journal of Obstetric, Gynecologic, & Neonatal Nursing reports on a prevention program implemented at Sainte-Justine University Hospital and Pierre LeGardeur Hospital Centre in Montréal, Canada (link to download)

The PSBSPP provides specific tools to educate and support parents and professionals and is enhanced by adding the dimension of anger management and a framework that centers on the development and use of parental coping strategies.

The PSBSPP intervention focuses on the three main factors that contribute to SBS: infant crying, parental anger, and lack of knowledge about SBS. Information that is provided focuses on the normalcy and progression of crying (frequency, duration, causes), the potential for crying to trigger anger and shaking, the dangers of shaking, and the importance of coping strategies when confronted by increasing anger.

It's interesting to read the details of parent and nurse evaluations.

For example, parents point out the value of interventions that go beyond just passing paper, and a significant number of nurse feel that not all nurses are well-suited to conduct parent education.

However, there was no doubt as to the relevance of the nurses' participation; the majority (94%) of parents agreed that simply receiving the information cards without the nurses' participation would have been insufficient.

I thought it was good … It wouldn't have been right to say, okay, take the cards and read them, and that's that … I found we weren't left on our own, so there was no risk that we would not read the cards.

As for the nurses, they were unanimous that the intervention was appropriate and that its continuation was very important. Almost all of them agreed that the intervention was well received by the parents (53% somewhat agree; 45% strongly agree). The nurses felt comfortable intervening with parents about SBS, but 28% believed that not all nurses could perform this type of intervention. On the other hand, very few of the nurses (n=2) felt that the intervention had failed to meet the parents' needs.

Brain Injury Awareness Month 2009

Rep. Bill Pascrell, Jr. (D-NJ) is co-chair of the Congressional Brain Injury Task Force.

The Brain Injury blog reported that he introduced H.Cons.Res. 40 in Congress on February 4, 2009 to designate March as Brain Injury Awareness Month (Brain Injury Association site for Awareness Month). Today (four weeks later), H.C.R 40 has 77 sponsors in the House.

H.CON.RES.40 Title: Expressing the need for enhanced public awareness of traumatic brain injury and support for the designation of a National Brain Injury Awareness Month. Sponsor: Rep Pascrell, Bill, Jr. [NJ-8] (introduced 2/4/2009) Cosponsors (60)

Latest Major Action: 2/4/2009 Referred to House committee. Status: Referred to the
House Committee on Energy and Commerce.

Rep Adler, John H. [NJ-3] - 2/11/2009
Rep Altmire, Jason [PA-4] - 2/4/2009
Rep Baca, Joe [CA-43] - 2/11/2009
Rep Berkley, Shelley [NV-1] - 2/4/2009
Rep Bishop, Timothy H. [NY-1] - 2/10/2009
Rep Bordallo, Madeleine Z. [GU] - 2/4/2009
Rep Boswell, Leonard L. [IA-3] - 2/4/2009
Rep Brady, Robert A. [PA-1] - 2/4/2009
Rep Braley, Bruce L. [IA-1] - 2/4/2009
Rep Brown, Henry E., Jr. [SC-1] - 2/4/2009
Rep Capuano, Michael E. [MA-8] - 2/4/2009
Rep Carney, Christopher P. [PA-10] - 2/4/2009
Rep Christensen, Donna M. [VI] - 2/4/2009
Rep Connolly, Gerald E. "Gerry" [VA-11] - 2/4/2009
Rep Conyers, John, Jr. [MI-14] - 2/13/2009
Rep Cummings, Elijah E. [MD-7] - 2/4/2009
Rep Davis, Susan A. [CA-53] - 2/4/2009
Rep Delahunt, William D. [MA-10] - 2/4/2009
Rep Driehaus, Steve [OH-1] - 2/10/2009
Rep Edwards, Donna F. [MD-4] - 2/4/2009
Rep Emerson, Jo Ann [MO-8] - 2/4/2009
Rep Giffords, Gabrielle [AZ-8] - 2/4/2009
Rep Gonzalez, Charles A. [TX-20] - 2/4/2009
Rep Grijalva, Raul M. [AZ-7] - 2/4/2009
Rep Hall, John J. [NY-19] - 2/10/2009
Rep Hare, Phil [IL-17] - 2/4/2009
Rep Herseth Sandlin, Stephanie [SD] - 2/4/2009
Rep Hinchey, Maurice D. [NY-22] - 2/4/2009
Rep Holden, Tim [PA-17] - 2/4/2009
Rep Holt, Rush D. [NJ-12] - 2/4/2009
Rep Kaptur, Marcy [OH-9] - 2/10/2009
Rep Kennedy, Patrick J. [RI-1] - 2/4/2009
Rep Lamborn, Doug [CO-5] - 2/4/2009
Rep Lance, Leonard [NJ-7] - 2/11/2009
Rep Lewis, John [GA-5] - 2/4/2009
Rep LoBiondo, Frank A. [NJ-2] - 2/4/2009
Rep Markey, Edward J. [MA-7] - 2/4/2009
Rep McCarthy, Carolyn [NY-4] - 2/4/2009
Rep McCollum, Betty [MN-4] - 2/4/2009
Rep McCotter, Thaddeus G. [MI-11] - 2/13/2009
Rep McDermott, Jim [WA-7] - 2/4/2009
Rep McGovern, James P. [MA-3] - 2/4/2009
Rep Michaud, Michael H. [ME-2] - 2/4/2009
Rep Miller, George [CA-7] - 2/4/2009
Rep Murtha, John P. [PA-12] - 2/4/2009
Rep Napolitano, Grace F. [CA-38] - 2/4/2009
Rep Nye, Glenn C., III [VA-2] - 2/4/2009
Rep Perriello, Thomas S.P. [VA-5] - 2/11/2009
Rep Peterson, Collin C. [MN-7] - 2/11/2009
Rep Platts, Todd Russell [PA-19] - 2/4/2009
Rep Rogers, Mike D. [AL-3] - 2/4/2009
Rep Rooney, Thomas J. [FL-16] - 2/11/2009
Rep Ros-Lehtinen, Ileana [FL-18] - 2/4/2009
Rep Ross, Mike [AR-4] - 2/4/2009
Rep Rothman, Steven R. [NJ-9] - 2/4/2009
Rep Rush, Bobby L. [IL-1] - 2/11/2009
Rep Ryan, Tim [OH-17] - 2/4/2009
Rep Salazar, John T. [CO-3] - 2/11/2009
Rep Sanchez, Loretta [CA-47] - 2/10/2009
Rep Sestak, Joe [PA-7] - 2/4/2009
Rep Sires, Albio [NJ-13] - 2/4/2009
Rep Smith, Adam [WA-9] - 2/10/2009
Rep Smith, Christopher H. [NJ-4] - 2/4/2009
Rep Snyder, Vic [AR-2] - 2/4/2009
Rep Spratt, John M., Jr. [SC-5] - 2/4/2009
Rep Stark, Fortney Pete [CA-13] - 2/12/2009
Rep Stearns, Cliff [FL-6] - 2/11/2009
Rep Sutton, Betty [OH-13] - 2/4/2009
Rep Taylor, Gene [MS-4] - 2/4/2009
Rep Thompson, Mike [CA-1] - 2/4/2009
Rep Van Hollen, Chris [MD-8] - 2/4/2009
Rep Walz, Timothy J. [MN-1] - 2/4/2009

What you can do: if your representative is not on this list, please call or email them (www.Congress.org) and ask them join as a co-sponsor of Rep. Pascell's bill to designate March as "Brain Injury Awareness" month.

We join the Brain Injury Blog and the Brain Injury Association of America in thanking you for helping Congress appreciate that brain injury is a critical public health epidemic!

Beat the Drum Slowly: Taylor Pinkas Rogers

Once again, Shaken Baby Syndrome has taken a life.

Thanks to the extraordinary efforts of family members, Taylor lived to age 9.

She left her mark, helping to increase awareness and keep other children safer.

Those of us who knew her will miss her.

PS. The Chicago Times and several Illinois news stations (WREX-TV, WAND-TV, WSBTG-TV) have picked up the story....

Good News (Sorta): Educating Iowa

The Des Moines Register has an article about two initiatives proposed by child advocates.

One would create a statewide education program:

PROPOSAL: State public health officials would create a statewide prevention program for shaken-baby syndrome to educate parents and others caring for a child. The state would reach out through parent education and support programs, child care referrals, schools, health care providers and birthing facilities. Participation in the program would be voluntary.

STATUS: Senate File 101 passed unanimously out of the Senate Human Resources Committee and is now eligible for debate by the full Iowa Senate.

The article notes that shaken-baby syndrome is the leading cause of young-child homicide in Iowa, with 49 deaths between 1995 and 2007, according to a report by the Iowa Child Death Review Team.

The other would license all home-based child care providers. Apparently, Iowa only regulates centers. Incorporating SBS education for these providers could have a significant impact on the potential for injury: research has found much higher injury rates in home based care than centers, especially for infants.

Link to a Powerpoint presentation by Dr. Julia Wrigley that describes her research.
www.namb.net/atf/cf/%7BCDA250E8-8866-4236-9A0C-C646DE153446%7D/childcare.ppt

It's interesting - in an unsettling sort of way - to read the comments on the merits of educating child care providers. One more venue in which the arguments for personal responsibility vs. social responsibility are being played out.

Regardless of what view of personal responsibility prevails, it is (or should be) obvious that keeping children safer in child care reduces social costs for everyone: it allows greater opportunity for parents to participate in the work force, reduces medical costs and avoid the costs of investigation, prosecution and incarceration.

Surviving SBS: Alex Roberts

The Pantagraph has a great story about Alex Roberts, a high school senior in Illinois who's not - unfortunately - your typical SBS survivor....

Everything about Alex Roberts suggests “healthy” and “productive.” On this night, she scores 10 points and continues her assault on the Pantagraph area rebounding lead.

Watch her play, and you understand how she’s caught the eye of junior college recruiters. Still, there is so much you can’t see, so much you don’t know.

It’s OK. Most people in her hometown don’t know how improbable all of this is.

They don’t realize Roberts was given last rites at 7 months old, her family fearing the worst as she laid motionless on an OSF St. Joseph Medical Center gurney.

They have no idea Roberts was a victim of Shaken Baby Syndrome at a babysitter’s house, that she beat long odds before taking her first step.....

Opportunity 9: Be Social

Set up a Google alert for blog postings that discuss Shaken Baby Syndrome.

Leave a comment asking the blog author(s) thanking them for their effort to increase awareness. Ask them to support SBS prevention efforts, such as the SBS Prevention Act, and to increase awareness of education opportunities for new parents and caregivers.

Opportunity 8: Volunteer Fire Departments

Most local volunteer fire departments and emergency services organizations have a sign board out front. They also respond to 911 calls involving children, and do what they can. Ask them to post a message on the board during SBS Awareness Week.