MIchigan: Educating Teen Parents

WJRT in Flint, Michigan reports on a spike in SBS cases, and the efforts of a local pediatrician and hospital staff to reach out to teen fathers at local high schools and educate them not only about what not to do - but what to do - when caring for an infant. Link (video below)

FLINT (WJRT) -- (02/26/11) -- Doctors at Hurley Medical Center are reporting that Shaken Baby Syndrome is a rising problem in Flint.

After two shaken baby cases in Flint last month, a new awareness effort is underway in Mid-Michigan involving doctors reaching out to teens to put an end to the crime.

DeAngelo Henderson and Corey Yeager are the two young fathers who critically shook their month-old babies in January. Henderson's daughter died after the violent shaking. Yeager's daughter was last reported in critical condition. Both men could face more than 15 years in prison.

Preventing these cases is Dr. Faisal Mawri's passion. Mawri, a pediatrician, says he's seen one too many shaken baby cases at Hurley Medical Center. "Absolutely I care about it because shaken baby syndrome is 100 percent preventable," Mawri said.

Now, Mawri and his team are holding seminars at five Genesee County high schools to prevent the crime. The effort is part of a fellowship project funded by a $12,000 grant.

"We came in here today, handed them the baby and showed them what they shouldn't do with the baby," said Pediatric Emergency Physician Rachel Stanley. Following the seminar, the students were surveyed on the facts, tested two months later for retention, and then rewarded.

"I'm going to find all these kids again. I'm going to give them that survey and once they complete that survey, I'm going to give them a $10 gift card," said Hurley Medical Center pediatric researcher Beth Grundman. "Bringing in these babies brings a sense of reality to the whole educational department."

Arkansas: 2011 May Bring Hospital-Based Shaken Baby Education

2011 could be a good year for children in Arkansas.

State Senator Percy Malone has introduced SB 328: it would provide new parents with the opportunity to learn how they can help keep their child safe from inflicted head injury. Link to bill.

Prevention: Changing Awareness Doesn't Mean Changing Behavior

ScienceDaily brings word of an interesting study that examines the difference between awareness and action, and suggests more effective interventions.

Two things are pretty clear: people "know" exercise is important to maintain and improve health, and sedentary lifestyles and obesity rates are so high that they've become major national issues.

The parallel with child abuse is obvious. Increased awareness is necessary, but not sufficient, for prevention. This policy memo from Prevention Child Abuse America discusses the expanding gap between awareness and action, noting that the public's very high awareness of child abuse is not translating to action. So, PCAA solicited thought from Frameworks Institute on what to do. Link to Frameworks memo Link to Frameworks memo on child abuse and child development strategy

Back to the study.

The University of Missouri researchers found that healthy adults who received interventions focused on behavior-changing strategies significantly increased their physical activity levels. Conversely, interventions based on cognitive approaches, which try to change knowledge and attitudes, did not improve physical activity.

"The focus needs to shift from increasing knowledge about the benefits of exercise to discussing strategies to change behaviors and increase activity levels," said Vicki Conn, associate dean for research and Potter-Brinton professor in the MU Sinclair School of Nursing. "The common approach is to try and change people's attitudes or beliefs about exercise and why it's important, but that information isn't motivating. We can't 'think' ourselves into being more active."

Behavior strategies include feedback, goal setting, self-monitoring, exercise prescription and stimulus or cues. Self-monitoring, any method where participants record and track their activity over time, appears to significantly increase awareness and provide motivation for improvement, Conn said.

[Which reminds me of a story told in 2005...a researcher monitoring at risk parents gave them a cell phone, so she could call them and ask what their child was doing. As the study went on, she realized that the reports were changing because the parents were observing their child more closely, so they would have more interesting stories to tell. Link]

"Health care providers should ask patients about their exercise habits and help them set specific, manageable goals," Conn said. "Ask them to try different strategies, such as tracking their progress, scheduling exercise on their phones or calendars, or placing their pedometers by their clothes. Discuss rewards for accomplishing goals."

The study, featured in the American Journal of Public Health, incorporated data from 358 reports and 99,011 participants. Link to abstract

The study identified behavioral strategies that were most effective in increasing physical activity among healthy adults. Successful interventions were delivered face-to-face instead of mediated (i.e. via telephone, mail, etc.) and targeted individuals instead of communities.

[...which suggests that SBS prevention efforts that rely on brochures and community awareness initiatives may not be very effective. Conversely, what better place than face to face intervention by nurses in the hospital?]

Interventions were similarly effective regardless of gender, age, ethnicity and socioeconomic status.

[Another recent study shows awareness doesn't translate to action: calorie labels on food increased awareness of calories, but did not alter food choices by teens or adults. Link]

Silo Hopping: Doris Duke, Child Abuse Prevention, Pew Trust, Home Visiting

Let's do a bit of silo hopping today...

The Doris Duke Charitable Foundation does quite a bit of child abuse prevention funding.

For example, they helped fund the special Future of Children issue on Preventing Child Maltreatment. They also helped the Urban Institute look at ways to improve services to new parents with depression.

And they help give policy perspectives. For example, Dr. Jack Shonkoff laid out the long term public health consequences of child abuse in his presentation at the CDC webinar on Child Maltreatment Prevention as a Public Health Priority.

In concert with the Pew Trust, DDCF has began to look at the advantages brought by home visiting programs, including reductions in child abuse. For example, the U.S. Triple P System Population Trial found lower rates of substantiated abuse cases, child out-of-home placements, and reductions in hospitalizations and emergency room visits [Medicaid cost cutting, anyone?] for child injuries in nine study counties in South Carolina where parenting interventions were implemented.

The need to identify and disseminate effective home visiting programs has gained speed now that significant federal funding is available. Link to webinar on Federal Home Visiting Funding.

Resources on home visiting:

Pew Trust issue brief that overviews the issues and makes the case for home visiting.

Pew Trust Campaign for Home Visiting

Pew Trust National Summit on Home Visiting

National Summit on Quality in Home Visiting Programs, an interactive forum for home visiting researchers, program leaders, and policy makers concerned about improving home visiting system quality and family outcomes.
Feb. 16-17, 2011
Omni Shoreham Hotel, Washington, D.C

Press release about the Summit.

Pew Trust National Overview on Home Visiting in the States

The Pew Center on the States surveyed state agency leaders in all 50 states and the District of Columbia and inventoried their state home visiting programs, models, funding and polices for fiscal year 2009-2010. The following findings emerged:

State home visiting programs: 46 states and the District of Columbia have some level of investment in home visiting;
Funding strategies: states made available $1.36 billion to home visiting programs via two primary funding strategies: categorical funds for home visiting only; and broad-based prevention funds that could be used for home visiting (although most states could not verify whether or how much funding was directed for this purpose);
Sources of state support: state general funds were the largest source of support for home visiting programs; and
Investment in national home visiting models: 34 states invested $277 million in national home visiting models.

Interview: how home visiting helps reduce child abuse...

Links to Home Visiting Programs

Nurse-Family Partnership
Nurse-Family Partnership® (NFP) helps change the lives of vulnerable first-time moms and their babies through ongoing home visits from registered nurses. This evidence-based community health program has proven results including long-term family improvements in health, education and economic self-sufficiency.

Triple P-Positive Parenting Program®
The Triple P-Positive Parenting Program® is a multi-level, parenting and family support strategy. Triple P aims to prevent behavioral, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents (from the Triple-P website)