SBS Survivors: Evan Coleman, West Allis Wisconsin

WISN.com in Milwaukee has a compelling video news report on the consequences of SBS.

It's the story of Evan Coleman, who's eight years old, and the story of how his parents are working to increase awareness - even though his father is responsible for those injuries...Link

Evan's father spent seven years in prison.

His son's sentence will last much longer."He now has epilepsy. He's been hospitalized four or five times for seizures. His behavior, his social skills -- he's 8 years old and his social skills are about a 4-year-old level," Coleman said.

Coleman said a portion of Evan's brain -- the part that regulates reasoning and emotion -- is permanently damaged, so Evan goes into rages and tantrums.

The news video includes an interview with his father, who admitted that he lost was responsible for those injuries.

Evan's father, who 12 News is not identifying, was caring for him one day in 2001 when he said Evan's constant crying pushed him over the edge.

"I lost it, and I picked him up, and I shook him. I think two or three times, and I kind of tossed him into his crib, and that's when I think he hit his head on the railing of the crib," Evan's father said. "As soon as I did it, I couldn't believe what had happened, what I had done.

"He drove his son to Children's Hospital. Evan's mother -- who had been at work -- rushed to be with them.

"I remember walking into the room, and Evan was laying there in a little bed, and his eyes were black and blue, and he had cuts all over his face. He had tubes in his head. He looked like the life was pretty much sucked out of him," Jenny Coleman said. "I said, 'I will find who did this to you and they will pay.'"

She didn't have to look far.

"I was so ashamed of myself. I couldn't bring myself to say it," Evan's father said.

Within hours, Evan's father confessed.

Action: Wisconsin Awareness PSA, Radio Blocks

TMJ4 reports the folks in Milwaukee have done a radio block - an amazing awareness event that enlists all radio stations in the listening area to broadcast the sound of a crying baby - followed by a short SBS awareness message - for one minute. Link to video news report

Kudos to Gary Mueller, the prevention advocates in Milwaukee, and participating radio stations.

Resource: Story of the first Milwaukee radio block Link (from Free Range Thinking: also a good resource - published by A Goodman - Good Ideas for Good Causes)

Unfortunately, increased awareness does seem to be a very necessary thing in Milwaukee these days...

Shaken Baby Announcement you Can't Escape
Diane Pathieu

MILWAUKEE - A crying, screaming baby, on your radio, for 60 seconds.

60 long, ear-popping seconds. It's on every radio station you turn to. And that is the point.

Gary Mueller is behind creating this public service announcement designed to teach people not to shake a baby, and end the climbing number of baby deaths in our area. "It was a message of crying that you cannot escape and I think it's an unforgettable one."

Gary is right. He's tried that before, and the numbers have dropped.

"The shaking's stopped," Mueller says.

In order to target men, Gary even created stickers placed on products that men often buy, like WD-40, spray paint, and even garden products in 3 local ACE Hardware stores.

"75% of the perpetrators of shaken baby cases are men, and they are very difficult to reach so we thought let's catch them by surprise," says Mueller.

With four kids of his own, Gary says this campaign is very close to his heart, and hopes it works for good.

8 Year Old Boy - SBS Alleged

From WSMV.Com in Nashville comes a report of an eight year old boy in Cookeville, Tennessee with symptoms of SBS....Link

Perspective: More Unmarried Mothers

Underscoring the need for techniques that help mothers educate males in their household about SBS prevention, the Washington Post reports on a dramatic increase in the number of unmarried mothers...Link

The mothers are part of a far-reaching social trend unfolding across the United States: the number of children being born out of wedlock has risen sharply in recent years, driven primarily by women in their 20s and 30s opting to have children without getting married. Nearly four out of every 10 births are now to unmarried women.

"It's been a huge increase - a dramatic increase," said Stephanie J. Ventura of the National Center for Health Statistics, which documented the shift . . . based on an analysis of birth certificates nationwide. "It's quite striking."

Of course, "unmarried" doesn't necessarily mean "single"...

About 1.7 million babies were born to unmarried women in 2007, a 26 percent rise from 1.4 million in 2002 and more than double the number in 1980, according to the new report. Unmarried women accounted for 39.7 percent of all U.S. births in 2007 -- up from 34 percent in 2002 and more than double the percentage in 1980.

"If you see 10 babies in the room, four them were born to women who were not married," Ventura said.

Although experts have been concerned about a recent uptick in births to older teenagers after years of decline, that is not the driving force in the overall trend but more likely a reflection of it, Ventura said. Instead, much of the rise is due to significant increases in births among unmarried women in their 20s and 30s. Between 2002 and 2006, the rate at which unmarried women in that age group were having babies increased between 13 percent and 34 percent, the report found.

The rates increased for all races, but they remained highest and rose fastest for Hispanics and blacks. There were 106 births to every 1,000 unmarried Hispanic women in 2006, 72 per 1,000 blacks, 32 per 1,000 whites and 26 per 1,000 Asians, the report showed.

...Previous research indicates that about 40 percent of births to unmarried women occur in households where couples are cohabitating.

Wisconsin SBS Awareness Video News: Men, SBS Awareness, and a Hardware Store

WITI-TV in Milwaukee, Wisconsin, the local Fox affiliate, reports on an innovative and inexpensive SBS awareness initiative. It's a story involving a hardware store, an awareness message and, needless to say, guys. Link to story, news video

It's a couple of minutes long, and well worth watching...

The folks in Wisconsin who put this campaign together deserve compliments.

Two things I noticed:

- one of the student volunteers mentioned he learned about SBS in seventh grade, showing school-based SBS education does make a difference;

- the reporter mentioned a dramatic rise in SBS cases being treated this year at the Children's Hospital, emphasizing the impact of economic stresses on families and communities.

To help prevention efforts, the Milwaukee Journal Sentinel reports that the Shaken Baby Association is planning another radio PSA campaign. Link to article, PSA

By the way, Benjamin Moore might be a good sponsor if you want to replicate this locally...

Resource: Radio PSAs, Radio Block - Link

Rear View Mirror: Child Abuse Prevention Month Proclamation

April 1, 2009

NATIONAL CHILD ABUSE PREVENTION MONTH, 2009- - - - - - -

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION When the child next door is maltreated, we all suffer. Every American has a stake in the well-being of our Nation's children. They are members of our communities, and they are our future.

National Child Abuse Prevention Month provides the opportunity to underscore our commitment to preventing and responding appropriately to child abuse. This month, we emphasize the importance of understanding child abuse and the need for all Americans to help families overcome this devastating problem.

The tragedy of child abuse may afflict American children in different ways. Abuse may occur physically, sexually, and emotionally. Child neglect, another form of child maltreatment, may occur physically and emotionally.

Understanding the forms of child abuse is critical to preventing and responding to maltreatment.A well-informed and strong family is the surest defense against child abuse.

To help educate and strengthen families, community members can offer their time and counsel to parents and children who may need assistance.

For example, parent support groups provide an organized forum for assistance. More informally, community members may simply offer a helping hand to families under stress.

More information about what families and communities can do is available at www.childwelfare.gov/preventing.

Civic organizations and government also have an important role to play. Civic groups offer essential support through education, assistance to those at risk, and treatment for victims.

Government at the local, State, and Federal level must provide funding for services, conduct public education projects, and enforce child abuse laws.

As we recognize that we all suffer when our children are abused, that we all benefit from mutual concern and care, and that we all have a responsibility to help, more American children will grow up healthy, happy, and with unlimited potential for success.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and laws of the United States, do more hereby proclaim April 2009, as National Child Abuse Prevention Month.

I encourage all citizens to help prevent and respond to child abuse by strengthening families and contributing to all children's physical, emotional, and developmental needs.

This is the Proclamation, transliterated by the cool tool at Wordle.net

And this is the Proclamation, circa 2001
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Persistent Effects of Pediatric TBI

Science Daily reports on two studies that describe the persistent effects of traumatic brain injuries in children....

Traumatic Brain Injury Haunts Children For Years With Variety Of Functional Problems

ScienceDaily (May 12, 2009) — Children who suffer traumatic brain injuries can experience lasting or late-appearing neuropsychological problems, highlighting the need for careful watching over time, according to two studies published by the American Psychological Association.

In one study, a team of psychologists used a longitudinal approach to gain a better idea of what to expect after traumatic brain injury (TBI). The researchers found that severe TBI can cause many lasting problems with day-to-day functioning. Some children may recover academically but then start acting up; other children do surprisingly well for unknown reasons.

In the second study, the first systematic meta-analysis summarizing the collective results of many single studies, the researchers found that problems lasted over time and, in some cases, worsened with more serious injury. Some children with severe TBI started to fall even further behind their peers than one would normally expect, in a snowball effect that requires further study.

The Centers for Disease Control in 2000 cited traumatic brain injury as the single most common cause of death and disability in children and adolescents...

Journal references:

Fay et al. Predicting longitudinal patterns of functional deficits in children with traumatic brain injury.. Neuropsychology, 2009; 23 (3): 271 DOI: 10.1037/a0014936

Babikian et al. Neurocognitive outcomes and recovery after pediatric TBI: Meta-analytic review of the literature.. Neuropsychology, 2009; 23 (3): 283 DOI: 10.1037/a0015268

Read more...Link

As Science Daily notes, the authors of the second study draw attention to a very important consequence of TBI in very young children:

That makes severe brain injuries at younger ages a "double hazard," the authors noted. Because younger children have more development ahead of them, the same injury can affect a 4-year-old and a 12-year-old very differently. This finding highlights the importance of targeted treatment developed specifically for children with severe TBI.

Perspective: Child Abuse Detection

Perri Klass writes in today's New York Times about her experience with child abuse detection and the evolution of expertise in the pediatric profession...

The conclusion is especially important:

The child abuse experts don’t want the rest of us in the profession to stop thinking about the subject. “I think the average pediatrician can diagnose this, even though it’s becoming a specialty,” Dr. Legano said.

But it’s an emotionally difficult diagnosis for a pediatrician to contemplate, especially when it concerns a family you feel you know well. And all too often, it is a diagnosis we fail to consider in families that don’t match our mental profiles of abusers. That’s why pediatricians and parents alike need all the clinical experience and all the science we can get, deployed on the side of the children.

While "average" may be statistically accurate, this excellent article by Dr. Cindy Christian describes the minimal levels of training that medical students receive, and the resulting perception among a significant number of practicing physicians that they lack skills needed to evaluate cases.

Resource: Professional Education in Child Abuse and Neglect, Cindy W. Christian, http://www.pediatrics.org/cgi/content/full/122/Supplement_1/S13

Abstract: Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe. Pediatrics 2008;122:S13–S17

Two thoughts. First, "child abuse detection", not prevention, seems an apt term to describe this important process. Second, I wonder how medical students and practicing physicians would describe their training and skills in prevention education? There's one skill set required to know how to diagnose the consequences: the skill set to do something about preventing the consequences is likely to be much different...

News; PURPLE Prevention Program Planned for Kansas

The Topeka Capitol Journal reports on plans by the Wichita Child Abuse Fatality Community Response Team to implement the PURPLE prevention program in Wichita, KS...

WICHITA -- Amid a recent spate of child-abuse deaths, a community group has announced a campaign to teach parents how to cope with a crying baby.

The program is the first initiative of the Wichita Child Abuse Fatality Community Response Team, which formed in the fall in response to eight homicides in the city that were linked to child abuse or neglect in 2008.

Their so-called “Period of Purple Crying” initiative starts June 1.

Parents giving birth at Wichita hospitals or birthing centers will watch a brief DVD before leaving with their newborn. Parents also will get a copy of the DVD and a booklet titled “Did you know your infant would cry like this?” The materials were developed by the National Center on Shaken Baby Syndrome.

The idea is to prevent child abuse, particularly shaken-baby syndrome, by emphasizing that it is normal for babies to cry, sometimes for hours and for no apparent reason. It also assures parents it is OK to put a crying baby down and walk away for a few minutes.

The simple reminders are especially important now because incidents of child abuse and domestic violence usually increase during times of economic stress, said Vicky Roper, director of Prevent Child Abuse Kansas at the Kansas Children’s Service League.

Her group hopes parents will share the video with anyone who might care for their baby.

“To have a baby that cries and cries and cries despite all your best efforts — that’s probably the time when you feel the absolute worst as a parent,” said James Haan, a Wichita doctor with four children, including two sets of twins under the age of 3.

Haan, medical director of trauma services at Via Christi Medical Center, said he already is seeing more cases of possible abuse. Shaken-baby syndrome can cause permanent paralysis, brain damage and death.

“Things are tough and money is tight, and a baby can stress things out even more,” he said.

The Kansas Department of Social and Rehabilitation Services is funding the $35,000 campaign through a grant from the federal Child Abuse Prevention and Treatment Act.

“We want to make sure that all children in our community are safe,” said Jean Hogan, regional director for Social and Rehabilitation Services.

Apple iPhone App: Continued...

The San Franscico Chronicle has a letter to the editor today

Commendable coverage

As pediatricians and members of the San Francisco Child Abuse Prevention Center's board of directors, we commend The Chronicle's coverage of the iPhone "Baby Shaker" application and the focus on this deeply disturbing issue.

Each year in the United States, more than 1,500 children die after being shaken by their caretakers. These situations are often due to the caretaker's inability to cope with the child's persistent crying.

The action of rapidly shaking an infant may cause severe brain injury. If the infant does not die, shaking can cause lifelong injury, including cerebral palsy, mental retardation and blindness.

The five delivery hospitals in San Francisco have partnered with the Department of Public Health and the center to create the San Francisco Shaken Baby Project. This project educates nurses who then educate every new parent about the danger of shaking. The project provides community resources, including a 24-hour talk line - (415) 441-KIDS - to help caretakers cope with the stress of parenting.

We urge Apple to join the effort to educate the public on the dangers of shaking a baby. Perhaps they could create "an app for that," too.

CHRIS STEWART, M.D., SHANNON THYNE, M.D., San Francisco

Making Amends: making the iPhone educational

This editorial from the Times-Call in Longmont, Colorado includes an inspired suggestion for an iPhone app that will allow Apple to atone for the atrocious "Baby Shaker."

We presume Jenn Ooton, the Editorial Page Editor, deserves kudos for the suggestion.

PS. If you agree, why not let Dean G. Lehman, the Editor and President, and John Vahlenkamp, the Managing Editor, know: jvahlenkamp@times-call.com, dlehman@times-call.com opinion@times-call.com 

Times-Call Editorial
Publish Date: 5/6/2009
Create application to make amends for 'Baby Shaker'

Apple did the right thing when it pulled an application for the iPhone off the market after people complained that it was insensitive and inappropriate.

The “Baby Shaker” application caused the phone to cry like a baby until the user shook it.

As they vie for the attention of iPhone users, software developers have raced to create new and unusual applications for the “smart phones.” Developers have come up with virtual sheets of bubble wrap, fishing rods and applications to monitor the stock market, the weather, blood pressure, blood sugar and even the H1N1 flu virus.

The applications are downloaded for an average of 99 cents each. At up to 10,000 downloads a day, the money can add up for popular applications.

Though some of the applications might sound a bit inane, they’re typically harmless fun.

Not so in the case of the Baby Shaker.

Shaken baby syndrome is a serious problem and shouldn’t have been made a joke to profit this huge company and the small software developer that created the application.

Shaking can cause a baby or small child’s brain to bounce back and forth within the skull, causing brain damage, according to the National Institute of Neurological Disorders and Stroke. An estimated 1,200 to 1,600 babies suffer from shaking abuse each year, with one in four dying at the hands of their abusers. The others suffer long-term medical problems that can range from serious brain injuries and mental retardation, to paralysis, blindness, broken bones, seizures, learning difficulties and delayed development.

Shaking babies is no joke.

If Apple really wants to atone for releasing the Baby Shaker, perhaps it should develop a new application that would cry like a baby until the phone user figured out what the phone-baby needs — a diaper change, a feeding, a burping or other comfort. And if the user shook the phone, the phone might die, never to come back to life, or it might be so damaged that it could never again function as it should.

That could teach the people who played this mean-spirited game a little something about the real world.

I left a comment in response:

As the father of a shaken baby who has spent much of the last nine years advocating for education and awareness, I'd like to extend my compliments to the Times-Call and the author for an excellent editorial.

It not only makes the simple and straightforward case for what was wrong with Apple and its app, but has a wonderful suggestion for how Apple can atone.

As with parenting education, it's necessary to educate Apple on what not to do (the "don'ts", but it's not sufficient. They need to know about positive and constructive actions they can take to help parents and caregivers keep children safe ("the do's").

Survivors: Matthew Washburn, Colorado

KKTV.com in southern Colorado reports on the story of Matthew Washburn. The article includes a video report.   Link to story and video.

Every parent has had to comfort a crying baby.   But inconsolable crying can lead to danger. According to CASA, Court Appointed Special Advocates, this is the #1 cause of shaken baby syndrome.   What you do in that moment literally can mean life or death for the child.

But even if the baby is shaken… and lives... what will his life be like?

"Matthew is deaf and blind and in a wheelchair and in diapers and nonverbal” said Jackie Washburn. “What kind of life is that?"

She’s talking about her adopted son Matthew. He was shaken when he was just 31 days old. Jackie adopted Matthew when he was two.   Back then, she was hopeful.   But today...

“Matthew is 13 years old and functions like a 2-month-old,” said Jackie.

Dr. Paul Grabb is a pediatric neurosurgeon in Colorado Springs.   He says it doesn't take much shaking to cause injuries like Matthew's.   “It's only a moment necessary to cause irreversible and at times fatal brain injuries,” said Dr. Grabb.

What's even more disturbing is that it's happening more and more in our community.

“We have seen … a dramatic increase in shaken baby especially from January to March of this year,” said Trudy Strewler with CASA.   In that time, at Memorial Hospital alone, there were 12 suspicious cases. That's almost half of the number of cases seen there all of last year. 

These may just be numbers.   But they could represent kids just like Matthew.   He'll never ride a bike, or smile for his school picture.   And because of his feeding tube, he'll never even have birthday cake.   It's a difficult existence for his mother to watch.

"Sometimes I just think if he got pneumonia and would just pass and go to heaven and he would have wings and he'd run and he'd jump and splash and run with kids and feel the wind in his hair, said Jackie.   “Then think I must be a terrible person to think that.   But your heart breaks to see the life that he has.   I wouldn't want to live like that."

Despite her agony over the hardships Matthew faces, Jackie knows his life is not in vain.   "His purpose was to make life better for people.   And if it’s to suffer the way he does to give a lesson to someone, Matthew's life has purpose."

Resources: Abstracts on SBS cases in NYC, AAP and AHT

Just got an email with links to three article abstracts that sound interesting...

JR Gill, LB Goldfeder, V Armbrustmacher, A Coleman, H Mena, and CS Hirsch; Fatal head injury in children younger than 2 years in New York City and an overview of the shaken baby syndrome; Arch Pathol Lab Med 1 Apr 2009 133(4): p. 619.
http://highwire.stanford.edu/cgi/medline/pmid;19391663

CW Christian, R Block, and and the Committee on Child Abuse and Neglect; Abusive head trauma in infants and children; Pediatrics 1 May 2009 123(5): p. 1409.
http://highwire.stanford.edu/cgi/medline/pmid;19403508

Section on Radiology; Diagnostic imaging of child abuse; Pediatrics 1 May 2009 123(5): p. 1430.
http://highwire.stanford.edu/cgi/medline/pmid;19403511

Perspective: SBS Education in Prenatal Classes

If you've been wondering why pre-natal classes aren't a better place for SBS education than hospitals, this reflective post by CatandMuse deserves your attention (caution - well-placed, functional expletives were used in the making of this post...). Link to blog post (Thanks, Pam!)

During our birthing class, my husband and I learned and saw a lot of things we didn’t already know about the birthing process and newborn care. What neither of us expected was to continually hear the sentence, “NEVER, ever shake a baby” . It was almost annoying to hear that sentence repeated so casually and so frequently, I mean isn’t that OBVIOUS?

It was such an annoyance that Cybr and I spoke of it one night on our way home, agreeing that it was ridiculous that it need be repeated so much. Everyone knows that and surely it is few and far between that need be reminded.

This was our thinking before our baby was born.

After we had been home with Kira for a few weeks, that is when it became clear as to exactly why it is repeated so frequently. Bringing home a newborn is stressful, exhausting and frightening. It pushes you to limits mentally, physically and emotionally that you have never before been. This happens while mothers are simultaneously having EXTREME hormone fluxuation, sleep deprivation and more than likely self-doubt. I can also add burning a high fever and being in severe pain to that list, which I am certain others have experienced as well....

Baby Blues: The Night Shift

Looking at the website for the Baby Blues comic, I noticed this cover on their comic "scrapbook" called "The Night Shift": it encapsulates an important part of daddy parenting in the first year...

Ohio: Evaluating the Effectiveness of Hospital Based SBS Education

I read again the abstract of an evaluation of "Love Me, Never Shake Me", an Ohio SBS education progam sponsored by Prevent Child Abuse Ohio. Link to program; Link to abstract

On second blush, some interesting points to keep in mind:

- even though awareness of SBS is high, parents still say the education is important;
- hospital-based education is still likely to be the only opportunity to educate a new parent;
- a significant percentage of mothers don't appear to live with the father, emphasizing the importance of helping single mothers discuss SBS with unrelated males in the household.

Secondary Analysis of the "Love Me...Never Shake Me" SBS Education Program, Deyo, Grace; Skybo, Theresa; Carroll, Alisa, Child Abuse & Neglect: The International Journal, v32 n11
p1017-1025 Nov 2008

Objective: Shaken baby syndrome (SBS) is preventable; however, an estimated 21-74 per 100,000 children worldwide are victims annually. This study examined the effectiveness of an SBS prevention program in the US.

Methods: A descriptive, secondary analysis of the Prevent Child Abuse Ohio (PCAO) "Love Me...Never Shake Me" SBS education program database included 7,051 women who completed a commitment statement, pre- and post-test, and follow-up survey.

Results: Participants were mostly White (76%), had at least some college education (62%), were privately insured (62%), and lived with the father and infant (63%). Mothers knew of the dangers of shaking (96%) and recommended SBS education for all parents (98%) because they found it
helpful (97%). Scores on the pre- and post-tests were significantly different, but there was no difference based on education site or demographics. There was a significant increase in a pre/post-test item pertaining to infant crying.

At follow-up, participants remembered postpartum SBS education (98%), but post-discharge did not receive SBS education from their primary care provider (62%). Most mothers practiced infant soothing techniques (79%) provided in the education; however, few women practiced self-coping techniques (36%) and accessed community support services (9%).

Conclusions: Postpartum SBS prevention education should continue. Development of SBS programs should result from these study findings focusing on education content and program evaluation.

Practice implications: Mothers report that shaken baby syndrome education is important for all parents and memorable at follow-up.

Postpartum SBS education should continue because the hospital is the primary place they receive education. Mothers' report they less frequently receive education from healthcare sources post-discharge.  Diligence of primary care providers to incorporate SBS prevention education in well child visits will increase parental exposure to this information.

Education may need to place greater emphasis on infant crying and soothing, as well as parent support and self-coping techniques versus the dangers of shaking.

Other resources:

Quebec hospital education program - Goulet et al. (2009) - Link to abstract

Vancouver PURPLE evaluation - Barr et al. (2009) - Link to abstract

PURPLE evaluation - Barr et al. (2009) - Link to abstract

Evaluation of SBS education techniques - Russell et al. (2008) - Link to abstract

Upstate New York SBS Prevention Project - Dias et al. (2005) - Link to abstract

Perspective: On Creating a Foundation for Seeing What Works

In 2007, students at the University of Maryland School of Social Work engaged in an interesting project:

Students in the School’s Child Welfare Research class have each conducted reviews of evidence about interventions that may increase child safety for children.

These reports range in focus from primary prevention programs (like education to prevent incidents of shaken baby to interventions that might address the consequences of child maltreatment and prevent the recurrence of child maltreatment, to interventions that focus on helping adolescents in foster care prevent future maltreatment of their children).

They post[ed] a brief version of their reports by replying to this post. I hope you join in the discussion about what “might” work to decrease the risk of child abuse and neglect and increase safety for children. [Link to the blog post]

The blog provides an interesting overview of prevention programs. While it appears to remain one of the more popular posts on the UMB, it doesn't seem that the online community took up the challenge to discuss prevention programs that work.

It's also unfortunate that this work remains a snapshot taken at one point in time. I visited the Acropolis in 1972: the perspective of viewing the world from a place that has been part of human experience for thousands of years and at least a hundred generations was profound.

So, this is the comment I left:

It would be a real service if this overview could be provided each year: so many survey articles capture a moment in time, without providing any sense of development over time.

For example, the SBS prevention program mentioned above has expanded to several other states. Ohio and Hawaii are conducting evaluations of its effectiveness in preventing SBS incidents, and the Ontario Neurotrauma Foundation has just published a guide to implementing the program at new sites.

http://skippervigil.blogspot.com/2009/04/resources-ontarios-cookbook-for.html

It would be really helpful if an academic program would look at the results of those evaluations (which are likely to vary themselves in effectiveness) and elict lessons learned in implementing the program in different contexts.

It would also give the students a unique perspective on prevention, based on a common foundation, and a sense of the challenges in implementing evidence based practices.

The literature is full of palliative interventions that are responsive to the consequences of the child welfare system. They are resource intense and focused on prevention of recurrences.

Let’s encourage prevention efforts that work to build strengths and to actually prevent those consequences.

The Paris Index Climbs to Record High

At the close of Child Abuse Prevention Month, the Paris Index (the ratio of news stories mentioning "Child Abuse Prevention" (1085 hits)  to stories mentioning Paris Hilton (2028 hits)) reached a record high in 2009: 53%...

All is not lost: Paris has launched a line of children's clothing and visited a children's hospital.