Prevention Education in Vacaville, California: Simulator Doll

The Vacaville Reporter brings news of a prevention effort in California.

Recognize the motivation, but have to wonder about how likely this prevention technique would have been in preventing the case that gave rise to the initiative (although, since the article doesn't say how the person charged and the baby are related, or if they are...).

Would the target audiences have included him?  Can't tell, but one wonders how many 42 year old men would opt to be in the audience at the places they intend to offer the demonstration.

Nor can one tell whether this is The Strategy, or merely one part of a comprehensive strategy that uses hospital based education for new parents, school based parenting education for students and baby-sitters and mandatory education for child care providers to teach parents and caregivers how they can help keep children in their care safe from inflicted injuries.

Let's hope the latter.


A broad, comprehensive, non-selective, inclusive campaign that educates all parents and all caregivers about what they can do to keep children safe, using a message that minimizes pushback, is more likely to be shared, and more likely to be self-sustaining.

It would be useful to others looking for evidence-based programs if the reporter checks back in a year to see what's actually been accomplished.

Sometime between Thanksgiving and Christmas, a fairly large amount of new exercise equipment is purchased.  Sometime the following spring, spring cleaning moves a large amount of unused exercise equipment from garages and basements to yard sales and the like.

Prevention resources being scarce, no one wants to see them recycled that way...

The goal: No more Shaken Baby Syndrome cases in Solano County 

By Catherine Bowen/ CBowen@TheReporter.comPosted:   11/24/2012 01:08:26 AM PST 

A shake and the crying stopped.

On Sept. 16, a 5-month-old Fairfield baby was hospitalized with brain bleeding, said Fairfield police Sgt. Kevin Carella. The baby's head had started swelling, before arriving at the hospital and medical staff immediately recognized the symptoms.

A short time later, 42-year-old Kenneth Burroughs was arrested by Fairfield police on suspicion of child abuse causing great bodily injury, Carella said. The baby remains in the hospital.

An estimated 1,200 to 1,400 babies are treated for Shaken Baby Syndrome (SBS), a term used to describe child abuse caused by the vigorous shaking of an infant -- often in anger -- to get the child to stop crying or fussing, each year, according to the California Department of Social Services. Of that number, 25 to 30 percent die as a result of their injuries, and many others suffer lifelong complications.

Authorities suspect many more children also fall victim to SBS but do not receive treatment.

The severity of September's case rocked Fairfield authorities, and launched them into an outreach mission to educate others on just how devastating the effects of SBS can be, according to Carella, who works with both the department's Major Crimes and Family Violence units. 

To bring their demonstration home, the department purchased a RealCare shaken baby doll simulator, while a second doll was donated by the Twilight Rotary Service Club.
Each of the life-sized dolls is fitted with a see-through plastic head, Carella explained. The RealCare Shaken Baby cries inconsolably, like some real infants do and, when the doll is shaken a device inside its head measures the force on the brain area. The simulator's cries stop abruptly and red LED lights show the specific parts of the brain that suffer damage.

Carella said it is the department's hope to provide training at Solano Community College, local high schools, service clubs and other law enforcement agencies for future parents, babysitters and child care providers.
"Our hope is to demonstrate to people how little force it takes to injure a child," Carella said.
"It is our goal to reduce the number of SBS incidents in Fairfield and our surrounding communities with this valuable instruction," Carella stated. 

The training is comprised of specific instruction on topics including:
* The many reasons babies cry and helpful ways to soothe them,
* Signs and symptoms of SBS,
* Physical results of SBS-related brain injuries, and
* A pledge to never shake a baby.
For more information, or to schedule a demonstration contact Carella at 428-7354 or Debra Shibuya with the Fairfield Family Violence Unit at 428-7770.
Follow Staff Writer Catherine Bowen at Twitter.com/cbowen4.

Abusive Head Trauma (SBS) - Costs, Benefits and Prevention: New Zealand Does the Maths!

The abstract below is from the November 2012 edition of the Journal of Child Abuse and Neglect.  

The full article is behind a paywall, but the abstract indicates this study from the folks at Starship Children’s in NZ will be a solid step forward in making the economic case for prevention.  Click on this link for the abstract. 

More good work from the Starship!

PS. This seems to provide a good template for replicating the analysis on our side of the Equator, no?

----------------------------------

Primary prevention of pediatric abusive head trauma: A cost audit and cost-utility analysis.J Friedman, P Reed, P Sharplin, and P KellyChild Abuse Negl, November 8, 2012
Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Private Bag 92024,Auckland 1142, New Zealand. OBJECTIVES: To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program.
 METHODS: A 5 year cohort of infants with abusive head trauma admitted to hospital inAuckland, New Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs.
 RESULTS: There were 52 cases of abusive head trauma in the sample.
 Hospital costs totaled: $NZ 2,433,340,child protection: $NZ 1,560,123,police investigation: $NZ 1,842,237,criminal trials: $NZ 3,214,020,punishment of offenders: $NZ 4,411,852 andcommunity rehabilitation: $NZ 2,895,848. Projected education costs for disabled survivors: $NZ 2,452,148, and the cost of projected lifetime care:$NZ 33,624,297.  Total costs were $NZ 52,433,864, averaging $NZ 1,008,344 per child.[NB. current exchange rate 1.00 NZ = .81 US] Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes. CONCLUSIONS: Pediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs.If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost-benefit analysis in the field of abusive head trauma prevention.

Resource: Educating Policy Makers Influences Policy

While it should come as no surprise that educating policy makers about early childhood development results in more informed policy, it hasn't always been recognized by advocates that "telling ain't teaching."

Prevention Action (itself an interesting blog in the UK) reports on an important article in the February issue of Child Development by Jack Shonkoff and Susan Nall Bales: ‘Science does not speak for itself: Translating child development research for the public and its policy makers’ Link to PDF

It touches upon a couple of the paradoxes of sustainable advocacy: that every stage of parenthood is transient, and thus one important part of the constituency for early childhood programs (parents) are not only learning their new role as they go, but constantly going onwards to the challenges of the next stage of development, and that sustained advocacy therefore often devolves to institutional stakeholders, and those institutions require resources to sustain themselves.

Stated simply, the aim of this exercise is to communicate complex scientific principles simply but accurately, using techniques of investigation from the cognitive and social sciences in order to achieve that objective.

The lessons of this initiative so far are that child development researchers can influence the thinking and actions of the target group – comprising the professionals, policy makers, elected officials and interested parties mentioned earlier - if they focus on teaching about science and less on preaching about which policies and services should be supported. The authority of the ‘core story’ in terms of its scientific underpinning is essential for this. Second, the most effective dissemination occurs when scientists present their ideas directly to the target audiences but do so with advice and support from communication experts.

The benefit of this approach is that sound scientific knowledge is presented without being dumbed down and in a way that policy makers can understand, apply and pass on to colleagues.

The study offers some interesting lessons to those seeking to influence policy.

So what is special about this model? First, its intention is to convey a body of knowledge, in this case the theory of child brain development. Many disseminations exercise focus on one study and stop at summarising the findings and drawing out policy and practice implications. This exercise has a much wider educational brief affecting a whole way of thinking about the nature, cause and consequences of a social problem and the relevance of a whole area of child development to it.

Secondly, it seeks to present extremely complex theories and concepts in a new way without being selective or over-simplifying. The core story is a robust summary of current knowledge and not a list of findings presented as open to different interpretations.

Thirdly, the consultation and dissemination processes involve a lot of repetition as testing reveals failures, but it is ultimately cumulative as understanding grows.

Fourth, the need to link abstract ideas with policy and practice must always be in the mind of those seeking to explain.

The core story of brain development:

1. Child development is a foundation for community development and economic development, as capable children become the foundation of a prosperous and sustainable society.

2. Brain architecture is constructed through an ongoing process that begins before birth and continues into adulthood. As it emerges, the quality of that architecture establishes either a sturdy or a fragile foundation for all the capabilities and behaviour that follow.

3. Skill begets skill as brains are built in a hierarchical fashion, from the bottom up. Increasingly complex circuits and skills build on simpler circuits and skills over time.

4. The interaction of genes and experience shapes the circuitry of the developing brain. Young children serve up frequent invitations to engage with adults, who are either responsive or unresponsive to their needs. This ‘serve and return’ process (what developmental researchers call contingent reciprocity) is fundamental to the wiring of the brain, especially in the early years.

5. Cognitive, emotional and social capabilities are inextricably intertwined and learning, behaviour, and both physical and mental health are highly interrelated over the life course. You cannot address one domain without affecting the others.

6. Although manageable levels of stress are normative and growth promoting toxic stress in the early years (e.g. from severe poverty, serious parental mental health impairment, such as maternal depression, child maltreatment and/or family violence) can damage developing brain architecture and lead to problems in learning and behaviour, as well as increased susceptibility to physical and metal illness.

7. Brain plasticity and the ability to change behaviour decrease over time. Consequently, getting it right early leads to better outcomes and is less costly, to society and to individuals, than trying to fix it later. We can pay now or we will pay more later for society’s failure to promote healthy development in the earliest years of life.

8. Effectiveness factors make the difference between early childhood intervention programmes that work and those that do not work to support children’s healthy development. These factors can be measured and can inform wise investments in effective policies and programmes.

Link to Prevention Action postResource: Jack P Shonkoff and Susan Nall Bales, ‘Science does not speak for itself: Translating child development research for the public and its policy makers’, Child Development, 82:1, February 2011, pp. 17-32 Link

Resource: Shonkoff, Investment in Early Childhood Education Lays The Foundation of a Prosperous Society, Early Childhood Encyclopedia (2009) Link

Resource: Child Development Homepage Link

Resource: Society for Research in Child Development Link

The Society is a multidisciplinary, not-for-profit, professional association with a membership of approximately 5,500 researchers, practitioners, and human development professionals from over 50 countries.

The purposes of the Society are to promote multidisciplinary research in the field of human development, to foster the exchange of information among scientists and other professionals of various disciplines, and to encourage applications of research findings. Our goals are pursued through a variety of programs with the cooperation and service of our governing council, standing committees, and members.

Resource: Child Maltreatment Prevention as a Public Health Priority

Via the Doris Duke Foundation, CDC's 2009 presentation on "Child Maltreatment Prevention as a Public Health Priority" featuring Jack Shonkoff and James Mercy.

Did you know some of the worst adult health problems in the nation can be linked to the toxic stress resulting from adverse experiences in childhood?

Population health priorities, including obesity, heart disease, and diabetes are associated with harmful childhood experiences such as abuse or neglect.

The goals of this webinar are to develop a shared understanding of how the prevention of child maltreatment not only promotes optimal development but also reduces disparities in health and explore the important role public health agencies play in improving the health of children and families by preventing childhood abuse and neglect.

Powerpoint presentations from the webinar are available here, although the webinar itself is not.
Instead, please listen to this excellent thought piece, sponsored by the Cambridge Trust Company: Early Childhood Development and Public Policy: Closing the gap between what we know and what we do. downloadable .MP3 file

Jack Shonkoff, the director of the Center on the Developing Child at Harvard University talks about the impact of early experience on brain development and the policy and practice implications of new research.

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