It's the same all over: perspective on child abuse reporting in Malaysia

The topic of the study abstracted below was child abuse reporting in the Malaysian press, but the conclusions are relevant to media reporting in the US.

The mainstream press largely reports on the consequences of child abuse: the death and injury of a child, the tragedy that falls suddenly on a family, and, far less less frequently than one might expect, the punishment of the perpetrator.

It is the uncommnon story that examines the circumstances that precipitated the abuse.  Even less common is the story that looks at prevention programs.

The coverage of cases varies inversely with how well we can understand it.  A simple search on Google News shows that the most uncommon cases, involving horrendous cases of deliberate and persistent physical abuse, are picked up by hundreds of media outlets across the nation.  The much more common case of a parent or caregiver losing control and inflicting injury on a crying infant rarely reaches outlets outside of the community in which it happens.

Allow me to offer two possible reasons.

First, those horrendous acts of physical violence transgress some of our strongest norms and define evil for many.  The perpetrators of such acts are beyond the pale, and such acts mark foreign territory for most of us.  By allowing us to divide and define the world into good and evil, in which evil acts are done by bad people unlike us - "them" - they help define "us."   Framing child abuse properly aids understanding, and understanding aids prevention.  Good work on framing from PCAA.

Second, acts of momentary rage violate the same norms, but are far too understandable for many.  To the extent that the perpetrator is someone like ourselves, it creates cognitive dissonance, and we struggle for explanation.  Those stories are not consistent with our division of the world, as "good" people do bad things.  So, we look less deeply, and the grey areas of the story attract less media interest.

For example, Google Trends shows differential responses to "shaken baby" and "Casey Anthony."

The final point of interest: society seems to devolve blame on the mother.  The universality of that response especially obvious if you read the comments on most shaken baby news stories.  A substantial proportion blame the mother for her choice of caregiver or just for putting the child in child care.

And so we justify our choices.

Unfortunately, many comments suggest that some still feel parents are invulnerable to the circumstances that precipitate abuse.  The statistics show otherwise, and those who believe that "good" parents are not at risk of haring their child simply have acquired a false sense of security.

The ‘social tsunami’: Media coverage of child abuse in Malaysia’s English-language newspapers in 2010

Sara Niner  Monash University, Australia

Yarina Ahmad Monash University, Australia

Denise Cuthbert School of Graduate Research RMIT University, Australia

1. Sara Niner, Sociology, School of Political and Social Inquiry, Monash University, Building H Caulfield Campus (H.5.43) 900 Dandenong Road, Victoria 3145, Australia. Email: sara.niner@monash.edu

Abstract
Since the early 1990s, Malaysian society has displayed a deepening concern over steady increases in reported cases of child abuse in the country. For many Malaysians, knowledge of this issue comes from the mainstream media. This research analyses media coverage of child abuse in two mainstream English-language daily newspapers throughout 2010.

The analysis focuses on how this issue is presented and ‘framed’ in the media. Through the use of simple episodic framing and a distorted focus on extreme cases of child abuse, media coverage internationally obscures the reality of child abuse as it occurs within the context of contemporary social, cultural, religious or political systems. This hinders any genuine understanding of the problem, leading to flawed solutions. We find these international patterns largely replicated in Malaysia.

Furthermore, gendered socialization processes in Malaysia make women and mothers principally responsible for family life and there is a tendency to blame and punish mothers for child abuse even when they are not the perpetrators. Internationally, child welfare experts and academics have advised the media to focus reporting on the underlying causes of abuse so that the issue can be better understood and addressed and this advice is pertinent for Malaysia today.  

From Boston MA to Enid OK, Missing the Real Point on Keeping Babies Safe

From the Enid News & Eagle, a reminder that there is often an interesting contrast between the words said, and the headline that results..

Shaken baby syndrome often happens with first-time parentsBy Phyllis Zorn, Staff WriterEnid News & EagleENID, Okla. — Marie Holsten, district director for Oklahoma Department of Human Services, said incidents of shaken baby syndrome often happen with first-time parents, but that’s not always the scenario.
Shaking of the baby can happen when the child is in the care of anyone not prepared to deal with the crying, or when the person caring for the child already is overwhelmed and frustrated by other things, and the crying of the baby becomes the trigger that prompts their frustration to boil over, she said. 

It's actually a fairly good article, as far as it goes.  However, this is how it ends:

Holsten emphasizes parents should be mindful of who they leave in charge of their children.
“A lot of people are going back to work,” Holsten said. “Make sure you get a licensed day care provider. You need to be careful who you are leaving your child with.”

While there's nothing wrong with recommending that parents hire a licensed day care provider, there's much more than needs to be done besides checking for a license (it should be no surprise that not everyone who claims to be licensed actually is...).  My thoughts:

Good article, but hiring a licensed day care provider is not sufficient by itself:  a parent needs to take three more steps. 
 First, ask every caregiver if they know that children as old as 5 years of age are vulnerable to an inflicted head injury, and if they have participated in a safety education program that included info about shaken baby prevention.  Second, ask if they have a coping plan for the inevitable moments of frustration.  Third, give them permission to call you if there are times when they need to talk.  
If it feels awkward, ask yourself if you'd rather leave your baby with someone who doesn't know how vulnerable babies and infants are, who doesn't have a plan to cope, and who is going to be afraid to call you if they need to.
If it still feels awkward, just let the caregiver know that you only want to help her (or him) know what they need to know to help you keep the child safe.

The advice from Enid is not much different than this MD blogger who writes on the Boston.com site

Three things parents can do to keep their child safe from child abuse Comments (12) 

Posted by Dr. Claire McCarthy  January 23, 2013 11:25 AM

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The news of the Cambridge toddler that recently died from injuries has parents terrified.

While this is really understandable, I think that instead of just being terrified we should use this as a moment to really think about what we can do to keep children safe from child abuse. While nothing can prevent all abuse, there are things that parents can do. Here are three:  

Never shake a baby. Shaken Baby Syndrome (SBS), which is when children are shaken hard enough to cause brain damage, is the leading cause of child abuse death in the United States. The most common reason SBS happens? Inconsolable crying. When you mix a baby that won't stop screaming with a stressed-out, overwhelmed caregiver, bad things can and do happen.
If you've got a baby that screams a lot, check in with your doctor--but often it's just normal crying. And in those cases, you need to take care of not just your baby but yourself. Sometimes the best way to care for both of you is to put the baby in a safe place, like his crib, and take a moment to calm down. Here in Massachusetts, you can call the Parental Stress Hotline at 800-632-8188.
Make sure that everyone who cares for your child knows the dangers of shaking. To learn more about SBS and how to prevent it, visit the CDC's Heads Up: Prevent Shaken Baby Syndrome website.

Know the signs of child abuse. It's not always obvious. The Department of Health and Human Services has a fact sheet that has all sorts of information about recognizing abuse and neglect, but here are some of the signs that parents and caregivers should watch for:

• Any unexplained bruise or other injury (or an explanation for one that doesn't make sense)

• Frequent bruises or injuries, even if an explanation is given

• Changes in behavior, such as acting withdrawn, sad, angry or afraid. An occasional off day is usually normal, but if the changes are persistent or recurrent it could be a sign of a problem.

• Changes in appetite or sleep (including trouble falling asleep, nightmares, or bedwetting). Again, only worrisome if persistent--and there can be lots of other explanations.

• Behaviors or statements from children that are odd or not normal for their age (like talking about sex)

• Negative comments about the child from the parent or caregiver--and/or lack of nurturing/happy interactions with child

• The child expresses fear or dislike of the parent/caregiver

Remember--these are just a few of the signs, and could have other explanations. But if you see them, let someone know--like your doctor, or the Department of Children and Families.

Check out all your child's caregivers thoroughly. If you use a daycare center or family daycare, be sure that they are licensed--and check with your local licensing board to find out if there have ever been any concerns or complaints. If you use a nanny or babysitter, do background checks--including in other states the person has lived. Since most child abuse happens when a child is left alone with a caregiver, doing your homework is really important. Get plenty of references. Ask lots of questions--and be sure you communicate with them regularly about your child's behavior and needs. Ask friends and neighbors who might interact with the nanny or babysitter to keep an eye out and let you know if anything concerns them--and make surprise visits regularly.
It's impossible to know everything about anybody, no matter how well you do your homework--that's what so scary about this. Keeping your antennae up can help; if for any reason something about a caregiver doesn't feel quite right to you, listen to that feeling. Don't ignore it. It's always better to be safe--after all, nothing will ever be more important than your child.
For more about how all of us can help to prevent child abuse, visit the website of Prevent Child Abuse America.

This is what I said then (and I'll say it again):

geolith01/24/2013 12:03 AMWell, as advice goes, this is better than nothing, but it falls short of good.

First, given that the impetus for the advice is a child shaken by a nanny, it would be far more effective to discuss how important it is that parents educate caregivers about the vulnerability of young children to inflicted head injury, and how to do that in a constructive, non-accusatory way.   Telling someone that "you shouldn't shake a baby" is hard to do, and hard to listen to.  Telling someone that I want you to help protect our child from head injury is a lot easier for both.

Second, background checks on a child care provider are poor advice for a number of reasons.   Most people who have options trust their own judgment about who to leave their child with, so see little reason to take the time and bear the cost of having a background check done.  Plus, once you've decided, the reality is that it's more than a little awkard to bring up the background check.  And more often than not, caregivers who inflict injury have no record.

Third, all those recommendations, and not ONE mention of the most important step?  Parents need to talk TO the caregiver and find out what he or she knows about the danger of inflicted injury and how they plan to cope with the inevitable moments of frustration.  And please, give them permission to call you if they even begin to feel the frustration is taking over.
I admire and respect doctors.  

But medical school teaches them how to treat illness, not how to educate people about prevention.  If you're learning how to drive, you don't need a mechanic or a body shop operator to tell you about the consequences of motor vehicle accidents; you need an educator to help you learn how to stay out of one.

By the way, Mass Campaign for Children has been doing some excellent work educating new parents and caregivers.  Ask Jetta Brinnier to do a follow up article about the experience of learning how to give good advice to new parents...

Perspective: Train a Parent, Spare a Child

Bruce Feiler has an interesting article in the New York Times about parent and child interaction:  "Train a Parent, Spare a Child."

That title caught my eye.  

It would be an apt one for advocating new parent education to prevent acts of abuse.

While the article covers more common ground - whether should parents bribe kids in the tween ages to induce behavior - it does point up the need to educate parents about the parentchild (no space intended) interaction.

That includes educating parents about the consequences of their choices not just for the two people involved, but for the interaction between them.

The article's worthwhile reading for those of us with children who've taken the first steps across the threshold of free will.

It's also worthwhile to consider how it applies to parents in the period between birth and preschool, when children aren't able to state their intentions, let alone negotiate behaviors.

That's when training a parent to respond appropriately to frustration may indeed spare a child.

NB It will also be interesting to see how parenting styles and parent personality traits inform the comments on the article.  When articles in the Times discuss parenting styles, the commentary becomes quite the Rorschach test....

A Tool to Understand Stress: Better Golf, Better Parenting?

The Week End Wall Street Journal reports on new technology to measure stress in golfers.

Using a wristband loaded with sensors and a Bluetooth connection, an iPhone and some inferential physiology, cognitive neuroscientist Robert Goldberg developed a tool that seems able to conveniently measure stress in real time.

There are some interesting parallels to be drawn between the performance anxiety of golfers and the anxiety of new parents, and more that could be explored.

For example, when the device was tested on a couple of MIT golfers, the less experienced golfer was learning a new putting stroke; while his body indicated he had a high stress response, he said he  wasn't aware of it.  Yet, once it was identified, his coach emphasized a different technique and his stress level declined.

If the device proves to be a reliable and effective tool, there are lots of interesting questions relevant to prevention that could be explored:

- are there differences between men and women in the stress levels experienced by new parent (a question that certainly applies to golfers too...)?  [a pair of interesting studies from Sweden looked into m/f differences in reported stress levels - link1 - link2 - (interesting, fathers report less anxiety about incompetence than mothers.  Does that reflect society's lower expectations? ]
- how does learning and experience affect individual responses to stress?
- how does the learning curve of parenting correlate with stress levels?  Behavior changes is fairly rapid during early childhood.  Do parents who learn how to learn about developmental behavior fare better than those who don't?
- how do learned stress responses change during early childhood developmental stages?  In the article, one experienced golfer shows diminished stress when he follows his routine to set up a put.  That works well for the routine of golf, but what happens when parents learn a routine that comforts the needs of their three month old, then continue their behavior when it no longer is relevant to the growing child's needs?  Toddler conflict may prove to have roots in stress cycles...
- what individual factors affect the stress response?  Are there markers for adverse responses?
- do parents experience and acknowledge their actual stress levels?  What factors make it easier to acknowledge their experience?  Knowing that it's a common response?   Just knowing what is happening to them?  Given reports of people who give birth without knowing they were pregnant, perhaps prevention education needs to focus on how to normalize the experience.

Given that one common prevention, just put the baby down and walk away, is premised on the caregiver being able to recognize that their stress level is increasing, it would seem worthwhile to validate that assumption on some inexperienced caregivers.

If not, the primary caregivers may need to learn some coaching techniques.

The article mentions that the developer is exploring the possibility of marketing the device to pregnant women.  Wouldn't it be great if this start up expanded that vision to pair up with a parenting education program on a prevention research initiative?

Could lead to a marketing edge:

"We'll help you get comfortable with your new child, and your golf game."

Might just pique the interest of a few guys...

GOLF JOURNAL
November 23, 2012
Using Science to Ward Off the 'Yips' 
Brain Scientist Designs App to Measure Stress While Golfing
By SCOTT CACCIOLA
The golf course is a treacherous, unforgiving place, where even the world's best players are vulnerable to stress-induced fits of madness.
For years, PGA Tour player Kevin Na has agonized over his swing as he waggles his club in the tee box six, seven, eight times—and then waggles it some more. Robert Karlsson abruptly withdrew from the British Open in July after finding that he simply couldn't swing, so tortured was his mental state. Just this month, Charlie Beljan was hospitalized after an early-round panic attack at a PGA Tour event in Lake Buena Vista, Fla., before he somehow summoned the wherewithal to return for the final 36 holes and win the tournament.
Lest we forget, golf is as much about the mind as it is the body—ask anyone who has had the "yips." The game can be so debilitating that the help of a neuroscientist sometimes seems required. Enter Robert Goldberg, a Ph.D. in cognitive neuroscience who has spent the last two years chipping away at one of the sports world's greatest challenges: How do you prevent golfers from blowing a gasket?

The result of Goldberg's research is a wristband that measures stress in real time by shooting small electrical charges into sweat glands. That data is then relayed via Bluetooth to an iPhone app, which displays stress as a line graph, with peaks and valleys, depending on how rattled the player feels. Goldberg hopes that golfers—and their coaches—can use that information to understand what triggers stress on the course and then go about unearthing solutions.
Goldberg, who recently left his post as a visiting scientist at the Massachusetts Institute of Technology, said he first considered the intersection of sports and stress when he was 12 years old and working as a standard-bearer at the Greater Hartford Open. The playing group that he accompanied one afternoon included Ken Green, a PGA Tour professional and notorious hothead who "lost his s—," as Goldberg put it. By the end of his round, Green was so disgusted with his play that he gave young Goldberg his Ping putter. Even then, Goldberg was fascinated by the mental aspect of the game.
"It got me wondering: How do things like that hold people back from peak performance?" Goldberg said. "There are guys who have all the physical skills but don't have the right mind-set."
Goldberg said his work focuses on the adrenal system—glands near the kidneys that release hormones in response to stress. When that happens, the body attempts to cool itself by perspiring. The small electrical charges in his device essentially measure how much sweat accumulates in the skin. "We can see a response in under a half a second," Goldberg said. To isolate these fluctuations in stress, the device has a built-in "accelerometer" that accounts for the effect of motion, as well as a temperature gauge.
Goldberg recently tested his work on two MIT golfers—one of the team's top players and one of its most inexperienced. There were patterns, he said. With the top player, a sophomore named Jon Warneke, Goldberg found that Warneke's stress level remained static during his swing—an indication that Warneke felt comfortable with his mechanics. And his stress level actually decreased during the act of replacing his ball on the green before putting. "There must be something about that routine that I find very calming," said Warneke, a double major in theoretical math and physics.
Putting was a different story: His stress level skyrocketed. Though putting is a self-described weakness, Warneke said he had no idea that his body was enduring physiological changes as a result of stress. He was too focused on the task at hand to notice. But even small amounts of stress can cause shortness of breath, an increased heart rate and/or butterflies in the stomach, any of which are kryptonite for a golfer who's trying to keep his hands steady as he lines up an 8-foot par putt.
Once the problem areas are identified, however, there are solutions, Goldberg said—breathing techniques, for example, or a revamped pre-shot routine. The graph won't lie: It will show whether the new approach is effective.
"MIT kids in general don't really show stress," MIT golf coach Jesse Struebing said. "So it's neat for me to see what's going on inside their heads. You don't know exactly what they're thinking about, but you can see from the graph that there's stuff going on up there."
As for the relatively inexperienced MIT player, his stress level always spiked at the exact moment of impact—just as his club face struck the ball. Struebing said he'd been working with the player on his swing, and it was a sign to him that the player wasn't confident in what he was doing. "It told me that maybe I needed to take a new approach," Struebing said. Once he did, he found that the player's stress level at impact decreased over the course of the round and his play improved.
Golf is one subset of a larger project for Goldberg, who has formed a company called Neumitra with two colleagues, Anand Yadav and Safiyy Momen. The idea, Goldberg said, is that anyone can use the device to monitor and manage stress. Of particular interest to the group are those who have post-traumatic stress disorder, though Goldberg said the company plans to target a broad mix of consumers—students, pregnant women, tech geeks. He said he expects the device, known as "Bandu," to hit the market in 2014.

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.

Georgia: As the House Looks at Comprehensive Education for New Parents, a Few Suggestions

Anyone from Georgia? Pending legislation in Georgia calls for the creation of a Joint Study Commission on Education for Parents with Newborn Children. It suggests that the state that's home to CDC may be taking a comprehensive look at education for parents of newborns.

[um, just noticed the bill actually says "mothers" should have an oppportunity to see a video in the hospital - while there apparently isn't need to educate the bill drafters that infants usually have two parents, they may need to know that mothers aren't the only ones who benefit from the information, and there are a number of reasons why the hospital should try for both parents**]..

Hopefully, CDC staff in Atlanta who are already involved with SBS prevention education and social media, and/or who are new parents themselves, will work with the bill drafters and the state health department to ensure the proposed initiative is as effective as possible.

CDC's already got a good guide to SBS prevention for health departments.

Thinking about social media would be a good place to start.

For example, why limit "video" to a DVD hand out to watch at home when this generation of parents have grown up with YouTube, iPad and iPhones, and are probably posting video on Facebook from the hospital?

- Lo and behold, Sutter Hospital's Facebook page for announcing births.

- And while he probably had his people do it, Sweden's Crown Prince posted his daughter's birth announcement on Facebook

Imagine if the nurse or parenting educator comes in, introduces both parents to the video highlights on an iPad, then downloads an app to both parents' mobile devices that allows them to download and watch a video course from the health department, the hospital and the AAP.  

A course keyed to the developmental stages of their child (especially important with the rate of premature births).   In their choice of language.

Think new parents might need motivation? Offer coupons from local stores - Starbucks and newborn diapers if they finished the course - and links for new baby products.

Think that parents might appreciate the thoughtfulness and effort by their hospital, pediatrican and health department? That it might influence their recommendations to friends and relatives who are expecting about hospitals?  Think they might tell their Ob-Gyn it was a good experience?

Think Disney or Target might be looking for an opt-in marketing opportunity?

And who better to share the knowledge among other new parents, child care providers, etc. than a new parent?

Why not a Facebook page and YouTube Channel for the state prevention programs?

Etc...

If you're in Georgia and want to thank your legislator, the bill info and a list of sponsors follow...

2011 Bill Text GA H.B. 1159, GEORGIA 151ST GENERAL ASSEMBLY -- 2011-12 REGULAR SESSION, Introduced: February 23, 2012, A BILL TO BE ENTITLED: AN ACT To amend Article 1 of

Chapter 1 of Title 31 of the Official Code of Georgia Annotated, relating to general provisions relating to health, so as to provide for the creation of the Joint Study Commission on Education for Parents with Newborn Children; to provide for its composition and duties; to provide for the distribution of informational videos on health related topics by hospitals and other health care facilities to mothers of newborn infants; to provide for a definition; to provide that such requirement is contingent on available funding; to provide for related matters; to repeal conflicting laws; and for other purposes. ..................................

Sponsored By (1) Pruett, Jimmy 144th (2) Dobbs, Elly 53rd (3) Lindsey, Edward 54th (4) Gardner, Pat 57th (5) Harden, Buddy 147th (6) Ashe, Kathy 56th

**Well, the bill says hospitals should offer "mothers" opportunity to view in hospital, but that the "parents" will get a copy to take home and watch. Most states encourage the hospitals to encourage both parents to participate. Perhaps even more important if the the male in the household is not related to the child...

(b)(1) ... the department shall distribute informational videos in an appropriate format to each health 52 facility in order to provide the information described in Code Section 31-1-14 and in this Code section to each mother of an infant born in such health facility. To the extent feasible, each health facility shall provide an opportunity for each mother of a newborn infant to view the video while in the health facility. Each health facility shall also provide a copy of such video, as furnished by the department, to the parent or parents of a newborn at the time of discharge from the health facility.

Awareness: Educating High School Students at Broken Arrow HS, Oklahoma

The The Tulsa World reports on great work by Erin Thomas, a 17 year old student at Broken Arrow HS, to raise awareness of the danger of shaking young children. She is working with Amber and Daniel Brafford, the parents of Davis Brafford, a one year old who died when shaken by his stepmother.

17-year-old promotes Never Shake a Baby program at school

BROKEN ARROW - After their 1-year-old son died of a severe head injury at the hands of his stepmother three years ago, it was difficult for Amber and Daniel Brafford to trust anyone again to care for their other children.

Then they met Erin Thomas, a 17-year-old Broken Arrow High School senior.

Now the couple not only have a baby sitter to help out, but they have teamed up with her to promote awareness of the dangers of Shaken Baby Syndrome to other teenagers.

"I'm grateful that Erin has brought awareness to the younger crowd because people just think it's common sense not to do that," said Amber Brafford to about 120 students who piled into the choir room Thursday after school. "I still have four other children, so there are times that they don't stop crying. I would never shake my child, but I know that if I can't get them to stop I put them in their crib and I walk away."

Thomas met the Braffords by chance after searching for a trainer to help her work through a knee injury. At Gold's Gym she met Daniel Brafford, who convinced his wife that Thomas was someone she should at least meet.

Soon the Broken Arrow student, the couple and their four children got to know one another, and on the three-year anniversary of Davis Brafford's death, Thomas was told the tragic story.

For Thomas, the effort became personal when she heard the Braffords' story, and she dedicated herself to raising awareness among her peers.

"A lot of girls are becoming pregnant or they baby-sit or have younger siblings," Thomas said.

Thomas went to her teachers and principals to see if they would allow The Parent Child Center of Tulsa to bring the "Never Shake A Baby" program to the school.

Karen Harvey, program coordinator, told students that babies are much more susceptible to injury by shaking because their brains do not yet fill out the space inside their skulls.

"We're talking about violent shaking," she said. "This isn't caused by bouncing a baby on your knee."

Comparing a baby's brain to a raw egg inside a plastic bowl, Harvey showed how the egg becomes much more damaged when it is shaken as opposed to being dropped.

If the injury doesn't result in death, babies who have been violently shaken can still have lifetime disabilities including impaired cognitive skills, blindness and hearing loss.

A crying baby is the No. 1 trigger in SBS, Harvey said.

"Babies cry for lots of different reasons, but mainly it's the only way they can communicate with the world. That's how they let us know they're there, they're hungry, they're tired, their clothes are too tight, whatever it is," she said.

Crying helps a baby's lungs adjust to breathing air and is an expected period that all babies go through, Harvey stressed. It typically starts at 2 weeks, peaks at 2 months and goes away about 4 to 5 months, and some cry more than others, she said.

"This is a normal phase. It's going to be frustrating, but it's going to be OK. There is an end to it," Harvey said.

Studies show the majority of perpetrators are men, typically the biological father or mother's boyfriend, but babies have been seriously injured or killed by all types of caregivers or family members.

Stepmother Shiloh Brafford is serving a life sentence for a first-degree murder conviction related to Davis Brafford's death.

Students guessed that men injure babies more often because they lose their patience easier and are stronger. Harvey said women typically have had more experience with nurturing activities, such as playing with dolls at a young age.

"I know a lot of you guys think it's common sense - you wouldn't shake a child," Amber Brafford said. "But my son was 14 months old. We were told he fell. Two days later he died in the hospital. He was severely brain dead, and I had to bury my 1-year-old, which is probably the hardest thing I'll ever have to go through in my life.

"It's been really hard for all of my family, my parents, my older children. I think it will affect all of us the rest of our lives, and I hope that by bringing awareness to you guys, we can save other children because it should never happen."

Read more from this Tulsa World article at http://www.tulsaworld.com/news/article.aspx?subjectid=11&articleid=20111028_78_A15_CUTLIN998126

Resources: 2011 Missouri DVD on SBS, Safe Sleep

I like that these subjects are paired up so parents will know two things that they can do to help keep their baby safer.

Missouri CTF (@missouriCTF) does good work, so check out their new DVD!

PS Let's hope the observation on the CTF site that the "DVD will satisfy State Statute 191.748 RSMo that requires all delivering hospitals to offer information to new parents about the prevention of Shaken Baby Syndrome (SBS)" doesn't give rise to the notion that all that's needed is to offer the DVD to parents on their way out of the hospital.

There's a number of reasons why hospital based education, not hospital based distribution, works; not least among them is the fact that the hospital is the last organized experience many new parents will have for months.

Everything changes when they get home, and whether a brochure or a DVD is offered, there's a good chance that it will tucked away for the trip home and put aside until far in the future...

New Prevention DVD Released to Prevent Shaken Baby Syndrome and SIDS Newborn and Childbirth Programs Across Missouri to Utilize Materials

The Children's Trust Fund of Missouri (CTF) recently announced the availability of its new DVD entitled Never Shake: Preventing Shaken Baby Syndrome and Safe Sleep for your Baby.

The DVD will be distributed to all Missouri hospitals to incorporate into their newborn and childbirth programs. “This DVD addresses two major issues related to keeping babies and children safe,” said Patrice Mugg, CTF chair. “We are happy to provide this DVD and are appreciative to those who helped create it.”

The DVD includes English and Spanish versions of the videos. It was funded in part by the Missouri Department of Health and Senior Services (DHSS).

The DVD includes the most current information about the dangers of shaking and abusive head trauma. An additional chapter on safe sleep provides information to prevent the ever increasing issue of infants being injured or dying in unsafe sleep environments.

The DVD will satisfy State Statute 191.748 RSMo that requires all delivering hospitals to offer information to new parents about the prevention of Shaken Baby Syndrome (SBS).

“We must increase awareness in the state about what a safe sleep environment is” said Department of Health and Senior Services Director Margaret Donnelly. “Babies should sleep alone, on their backs, in a safe crib. We hope the DVD is a valuable resource for new parents on safe sleep practices and will have a positive impact on the health and safety of our youngest Missourians.”

The DVD will be available at no cost for Missouri hospitals, child care providers, safe crib programs, schools and other child serving agencies to use as an educational tool to share with new parents and other caregivers.

The videos will help increase awareness about how new parents and caregivers can keep children safe by gaining knowledge, reducing their stress levels and providing safe sleep areas.

“Parents truly want the best for their babies,” said Kirk Schreiber, CTF executive director. “The more knowledge they have, the better choices they can make to prevent injury.”

The Children's Trust Fund, Missouri's Foundation for Child Abuse and Neglect Prevention, provides grant distribution, education and awareness. CTF does not receive general revenue funding, but receives funding from general donations, specialty license plate sales, marriage licenses and vital records fees, state income tax check-off, a federal grant and interest on the fund.

For additional information or to inquire about obtaining a DVD visit www.ctf4kids.org.

Transatlantic calculations | Prevention Action

From the UK, by way of Prevention Action, an interesting way to help legislators understand the costs and benefits of investing in prevention. Transatlantic calculations | Prevention Action

Awareness: An Instant, and Everything Changed - Erhard Loretan

PlanetMountain.com brings word of the death of Erhard Loretan, an accomplished Swiss mountaineer.

In 2001, he shook his son, who died. Loretan received a suspended sentence of four months in prison.

Some apparently condemned him for losing control of his emotions.

The commentary below notes he made the decision to publicize his action to increase awareness of the vulnerability of young child to shaking injuries.

So, let's think well of him for that...

On 28 April Erhard Loretan, on the most successful alpinists and Himalayan mountaineers of all times, lost his life in a fall in the mountains. At the time one wrote that, on the Grünhorn horn, Loretan was "working" as a Mountain Guide: he was tied to a "client" who, after the accident, had been airlifted in serious condition to hospital. In truth the climbing partner was Xenia Minder, his partner in life. Now, for the first time, Xenia talks about the dramatic accident and above all how she is coming to terms with it in a beautiful article published in Le Temps. Hers is a profound reflection, emotional, sincere and dense with questions.

* * *

A decade ago Erhard also made headline news, once again for tragic reasons. On 23 December 2011 left alone in his chalet at Crésuz, in Gruyère, with his seven month old child, he shook him, briefly, to stop him crying. The baby died. Erhard was sentenced to four months suspended sentence for negligent manslaughter.

In the light of his son's death, Erhard confronted the loss of his son with courage and dignity. At that time Shaken baby syndrome (SBS) was largely unknown, but he decided to disclose his name to the press in the hope that other parents might avoid a similar drama.

As he explained to me on various occasions, Erhard felt relieved for having been condemned by human justice even if - according to his own words on the day of the trial - the sentence was nothing compared to his suffering right to the end of his life.

However, during and after the trial Erhard became the target for violent public attacks. How could a man who had come head-to-head with death so often during his incredible ascents so easily lose his nerves of steel with his own, innocent and defenceless flesh and blood?

His broken heart never recovered from this loss and in the light of the media hounding, Erhard changed. He had obviously already lost many close friends in the mountains.

But as I witnessed during our two years of happiness, the loss of his own son was a tragedy from which he never recovered, even if he had now begun to imagine life once again, with me, with all projects possible.

Prevention: Incentives for Inventing Sustainable Prevention Strategies...

Incentives can be important.

Lindbergh flew the Atlantic, in part, to earn the $25,000 Ortieg Prize.

Nearly eighty years later, Dick Rutan created the first private manned spacecraft to win the $10,000,000 Ansari X Prize.

Those kinds of incentives are now being used to help solve problems on earth, not just above it. Scientific American reports a device that successfully cleans up oil spills has won the $1,000,000 Wendy Schmidt X Prize.

Now, wouldn't it be great if there was an X prize to help create successful, sustainable and translatable prevention strategies?

Maybe as part of a competition that brings together teams of students from business schools and public health programs, leavened with the real world experience of marketing and public relations professionals from ad agencies and PR firms.

For example, the Pacific Northwest could put together a regional team drawn Washington University's School of Public Health and the marketing program at Foster Business School, with advisor-members from Seattle Children's Hospital, Nike's Marketing Development Program, Microsoft's Social Marketing Program, and the Washington State Institute for Public Policy.

There's a good model for it right in the neighborhood: the social entreprenership competition that is sponsored by the Foster School of Business, with support from the Bill and Melinda Gates Foundation.

Each year, GSEC brings the world to UW: semi-finalist student teams from around the globe are invited to Seattle for GSEC Week. Teams visit regional companies, receive expert coaching, present their business ideas to 400+ professionals, and compete for monetary prizes. GSEC 2012 will award at least $30,000 in prizes, including a GSEC grand, global health, and Information & Communication Technology (ICT) prize! The professional support to GSEC is unparalleled: annually more than 200 experts participate as mentors, judges, and sponsors. We welcome this invaluable support, from individuals at organizations like Costco, Gray Ghost Ventures, Microsoft, PATH, the Bill & Melinda Gates Foundation, Smith Barney, Seattle International Foundation, the Grameen Foundation, and the Washington Global Health Alliance.

To paraphrase someone with a certain amount of experience in the field of communication, "oh, the places they could go..."

What Prevention Resources Should Be On the Congressional Reading List?

In 2009, Mikert/Butchart published an interesting meta-review of the literature about child maltreatment prevention. It's good for members of Congress and their staff to know what those in the field think is most effective, efficient and useful.

I've always thought an annual recommended reading list on prevention would be useful for Congressional staff, as they frequently change positions. Not just new readings, but those of enduring value.

With that in mind, if you had the opportunity to recommend three readings on prevention to your Congressional delegation - and their staff - to help them understand the causes, costs and consequences of child maltreatment, the opportunities for prevention, and the cost/benefits of prevention, so that they could help shape federal prevention stratgies and make informed federal funding decisions, what readings would you recommend?

Please use the comment feature to leave a list, or support recommendations. Links to the source are helpful.

In particular, I'd encourage recommendations that focus on the tipping point(s) - early intervention opportunities where a little leverage goes a long way.

(I assume, of course, there are such readings...)

NB. WHO has some good online resources on prevention, including this course book

Link to WHO prevention resources page:
http://www.who.int/violence_injury_prevention/violence/activities/child_maltreatment/en/index.html
Link to course book:
http://www.who.int/violence_injury_prevention/capacitybuilding/courses/child_maltreatment/en/

Resources: 2011 SBS/AHT Conference NYC

The Queens District Attorney's Office sponsored the 2011 Conference on AHT/SBS, as it's now denominated in medical and legal circles, last month, and it was an interesting conference indeed.

There was several excellent presentations on medical and legal issues, including Mark Dias and Carole Jenney.

There was also an excellent overview and analysis of the literature cited in support of the shaken baby "controversy" by Chris Greeley, a professor of pediatrics at the University of Texas. Link

One of the best things about this presentation was that, in the best tradition of science, it actually explored the strength of the scientific literature that is cited in support of the contention that there is a "controversy" in the medical community about the scientific basis of Shaken Baby Syndrome.

Summed up, his basic teaching point is that the "evidence" of controversy is drawn from scientific papers that are paraphrased by advocates: to know whether the cited science supports the contention, and, if so, how strongly, "you got to read the paper."

Examined objectively, it seems pretty clear that the claims exceed the evidence.

The Conference materials are available at the DA's site for a limited time and can be downloaded. Link

While I applaud the organizers for setting a session to discuss the "controversy", and Drs. Squier and Uscinski for their appearance to discuss it, I felt the formality of the panel made the discussion rather tepid. It certainly was less spirited that, say, Jerry Springer.

Unfortunately, the precaution of formal rules proved to be necessary: towards the end of the panel discussion, Uscinki read a letter from a person who thanked Uscinski for the testimony at his trial that helped get him acquitted of charges, then announced that the person was in the audience and wanted to address the Conference, presumably to say that not all innocent people are lucky enough to have an expert like Dr. Uscinki. The offer was declined.

I do have to say that I was disappointed by Emily Bazelon. She is the author of the article on SBS convictions in the New York Times Sunday Magazine earlier this year. She did not explain her article very well, and confessed to a superficial knowledge of the science. At the end, I was left with the impression that she did census research: talked to a lot of people about shaken baby syndrome and tallied up how many of those people told her the science was incomplete.

It was also disappointing that she never delved into the inconsistency between 1200-1600 reported reported cases of inflicted head trauma a year and her estimate that there are only 200 prosecutions a year. Unless she was excluding cases with pleas from the count, that means only 1 of every 6 reported cases involving children with inflicted injuries is prosecuted.

That is not such a good record.

The presentations are available at: http://www.queensda.org/SBS_Conference/2011_SBS_Conf.pdf

They're all worthy reviewing, but I would recommend Mark Dias' presentation on controversies and conspiracy theories in abusive head trauma: Link
http://www.queensda.org/SBS_Conference/Controversies%20and%20conspiracy%20theories%20in%20AHT%20NY%20Sept%202011.pdf

Study: In Times of Recession, Abusive Head Trauma Increases

The impacts of a recession are profound.

In a study appearing today in Pediatrics, Dr. Rachel Berger reports on the rise in the number of cases during the recent recession, which suggests that the rising tide of economic stress is causing a rise in the number of cases of Abusive Head Trauma/Shaken Baby Syndrome. Link to article

The story is receiving a lot of media attention, so it would be a good time to contact your elected officials and let them know that there are opportunities to help parents keep their children safe.

CBS; TIME; USA Today

As the coverage points out, if the rate reported in the study applies nationwide, it's now more likely that a child will be the victim of abuse head injury than pediatric diabetes.

CBS News includes a couple of tips from Dr. Peter Sherman at Montefiore Medical Center.

Sherman noted that most children studied were publicly insured even before the recession, suggesting that their families were already struggling financially.

Still, the recession affected many lower-income families, and Sherman said the study highlights "a very important issue."

He said pediatricians could help with prevention by asking families about difficulties paying for food or shelter and referring those in need to social service agencies. Just asking parents about stress and acknowledging their struggles can sometimes help, he said.

Most parents who abuse young children aren't "ill-intentioned," he said. "Most of it is kind of just snapping...maybe being sleep-deprived and just losing it. It's something that can happen to anyone."

Legislative Alert: Congressional Action on “Child and Family Services Improvement and Innovation Act” (S. 1542/H.R. 2883)

News and Analysis from the National Conference of State Legislatures...

Legislative Action: Child Welfare Waiver Restoration/ Reauthorization of the Promoting Safe and Stable Families Act (Title IV-B) Goes to House Floor,
Legislative Summary: “Child and Family Services Improvement and Innovation Act”
Link to Senate Bill S. 1542
Link to House Bill H.R. 2883

On September 12, 2011, Senators Max Baucus (D-Mont.) and Orrin Hatch (R-Utah), and Representatives Geoff Davis (R-Ky.) and Lloyd Doggett (D-Texas) introduced S. 1542/H.R.2883, the “Child and Family Services Improvement and Innovation Act”.

This bipartisan legislation would reauthorize child and family service programs under Title IV-B of the Social Security Act and renew Title IV-E state child welfare waiver authority for the U.S. Department of Health and Human Services (HHS). The legislation has two Titles; Title I-Extension of Child and Family Service Programs and Title II-Child Welfare Demonstration Projects. PSSF and the other programs in Title IV-B parts one and two expire on September 30, 2011.

It took three years, but NCSL succeeded this week in starting the renewal process for state child welfare demonstration projects. This state-friendly legislation is a compromise between the Senate and House and dropped a Maintenance of Effort (MOE) requirement, which was included previously. The MOE would have eliminated many states from participating in a waiver demonstration project due to difficult fiscal conditions. NCSL strongly supports this legislation and sent the House Ways and Means Committee a letter letting them know our stand.

To read the letter, click here: http://www.ncsl.org/default.aspx?tabid=23576

House: On September 14, H.R. 2883 passed out of the House Ways and Means Committee by a voice vote. The bill is scheduled for the House Floor to be voted on under suspension of the rules on September 21.

Senate: S. 1542 is referred to the Senate Finance Committee. We are currently waiting for the Committee to schedule at time for a hearing/vote on S.1542. Whether it heads to markup or Senate leadership decides to take action on a House-passed H.R. 2882 is uncertain at this time.

Title I: Extension of Child and Family Service Programs

As mentioned above, the first Title of S. 1542/H.R. 2883 would renew Title IV-B of the Social Security Act. Title IV-B programs include the Promoting Safe and Stable Families (PSSF) program. Title IV-B programs are the only federal programs focused on preventing child abuse and neglect as well as providing services to families once a finding of child abuse/neglect is substantiated. This bill would require states to make several changes to their child welfare state plans, require the Secretary of HHS to standardize the data collected, and broadens the substance abuse grants by expanding beyond methamphetamine abuse.

The legislation would require states to amend their state plans to include protocols regarding the appropriate use and monitoring of psychotropic medications and how the state will address emotional trauma associated with being a child that is maltreated and removed from their home. Additionally, states would need to describe the activities undertaken to reduce the length of time children under five do not have a permanent placement. The state plan would also need to include a description of data sources used to compile information on child maltreatment deaths, and if there are data sources not included, a plan to figure out how to include missing data sources in the future. Finally, states would be required to ensure the total number of visits caseworkers make to children placed in care is not less than 90 percent during the fiscal year. States would make this calculation by dividing the total number of visits made during the fiscal year to each child in foster care by the number of visits that should have been made to visit each child for the entire fiscal year. The legislation would require states to make 95 percent of visits to children placed in care starting in 2015.

Title I: Promoting Safe and Stable Families Program Reauthorization

The legislation would level fund PSSF at $345 million and would authorize Congress to appropriate up to $200 million in discretionary spending each fiscal year. Of the $345 million, $30 million is earmarked for the Court Improvement Program. Because of this earmark, some states may see a decrease of the PSSF funding not used for court improvement.

The bills propose several policy changes to the PSSF program. PSSF would be reauthorized through 2016. As mentioned above, the legislation would broaden the use of substance abuse grants by expanding beyond methamphetamine abuse. S. 1542/H.R. 2883 would not provide funding for the Mentoring the Children of Prisoners grant program.

Title I: Additional Changes

The legislation would strengthen adoption maintenance of effort requirements set forth in the Fostering Connections Act (P.L. 110-351) by requiring states to report on all money spent on adoption services, including post-adoption services spending. Additionally, the bills clarify that educational stability be a priority for each placement in foster care. States would also be required to assist each foster youth who is 16 obtain a credit report each year they are in placement to help prevent identity theft.

HHS would be required to establish by rule standard data elements to improve data matching. In developing the standard data elements, HHS would be required to consult with the Office of Management and Budget (OMB) interagency work group and would “consider state perspectives”. The new data standards would take effect October 1, 2012.

Finally, S.1542/H.R. 2883 would require the Government Accountability Office (GAO) to conduct a study on the additional federal funding services states are using to provide services similar to those provided by Title IV-B programs as well as the availability of services to families in need. Examples of services GAO will look into include the amount of time families need to wait for substance abuse and other preventative services and supports provided to caseworkers who investigate and manage child welfare cases.

Title II: Child Welfare Demonstration Projects

These bills would allow the Secretary of HHS to authorize ten waiver demonstration projects for three fiscal years (2012-2014), for a total of 30 waivers. Initially, a state would be granted a waiver to conduct a demonstration project for five years, unless the Secretary of HHS determines that it would be best to continue the demonstration project. This bill would sunset all waiver demonstration projects in 2019, including the demonstration projects authorized prior to the introduction of this legislation. If a tribe is operating a IV-E program, it is considered a state for purposes of applying for a waiver. This bill does not apply to current waiver demonstration projects, which can continue at the discretion of the Secretary (like they have before).

To be eligible for a waiver, states must take the following steps:

Identify one or more goals that the demonstration project is designed to accomplish. These goals include: Increase permanency for all infants, children and youth in foster care, including promoting a successful transition to adulthood for older youth; increase positive outcomes for children, youth and families in their homes and communities; and/or prevent child abuse and neglect as well as the re-entry of children into foster care.

A state must demonstrate readiness through a narrative description of the state’s capacity to effectively carry-out a demonstration projects.

A state must demonstrate that it has implemented, or plans to implement within three years of the date of application submission, at least two child welfare improvement policies, which are outlined in the bill. These improvement policies range from establishing a bill of rights for infants, children, and youth in foster care to increasing the number of sibling placements with the baseline year being 2008.

After three years, HHS can terminate the waiver demonstration project if the Secretary determines the state has not made “significant progress in implementing the child welfare improvement policies proposed by the state”. Finally, the demonstration projects are not subject to random assignment for the purposes of a control group and must be evaluated by an independent contractor.
Final Words

At this time, it is unclear how the Joint Committee on Deficit Reduction (the “Super Committee”), set up by the Budget Control Act (P.L. 112-25), will address Title IV-B funding, particularly the discretionary funds. There is an urgency to passing these bills because Title IV-B programs expire September 30. If these programs are not reauthorized, it would make them more vulnerable to Super Committee cuts. The deadlines set up by P.L.112-25 are fast approaching, with Senate and House Committees required to report to the Super Committee their recommendations for cuts by October 14, 2011. The House and Senate must vote on the legislation produced by the Super Committee on or before December 23, 2011.

Action

Please call your state delegation, particularly your Senators, to pass this bipartisan, bicameral legislation to pass these bills expeditiously.

To read a draft of either S. 1542 or H.R.2883, go here: http://thomas.loc.gov/home/thomas.php

For further information, please contact either Sheri Steisel sheri.steisel@ncsl.org or Emily Wengrovius at emily.wengrovius@ncsl.org or NCSL’s Washington DC office at 202-624-5400.

Reminder: 2011 NYC AHT/SBS Conference

Reminder that the Queen's District Attorney's Office is sponsoring a conference on Abusive Head Trauma/Shaken Baby Syndrome in New York City next week. 

It's hosted at the Medical Examiner's office in Manhattan on September 22 and 23.

ADAs Marjy Fisher and Leigh Bishop put together a very interesting program on Shaken Baby Syndrome.

The Thursday program is good, especially if you want a refresher on diagnosis and treatment, but it's the morning panel on Friday that should be really interesting...it includes Emily Bazelon, who wrote the NY Times magazine cover story on SBS earlier this year, and two defense doctors who appeared in that article.

Agenda

Sleeping Babies: Who Knew It Was So Complicated?

Very interesting article by Perri Klass in the New York Times.

It asks the question every first year parent wants to know:

What makes a child nap? Most parents cherish toddlers’ naps as moments of respite and recharging, for parent and child alike; we are all familiar with the increased crankiness that comes when a nap is unduly delayed or evaded. But napping behavior has been somewhat taken for granted, even by sleep scientists, and napping problems have often been treated by pediatricians as parents’ “limit-setting” problems.

Now, researchers are learning that it is not so simple: napping in children actually is a complex behavior, a mix of individual biology, including neurologic and hormonal development, cultural expectations and family dynamics.

Hence, the popularity of books in the vein of Go the F**k to Sleep."

Treat:  link to GTFTS narrated by Samuel L. Jackson

While uncontrollable crying is cited as the principal trigger for inflicted injury, the real trigger is the caregiver's response.

A nap allows everyone involved a bit of respite.

To a sleep deprived parent, getting an infant to sleep may be as frustrating as crying. As the article notes,

But for parents and scientists alike, there are many unanswered questions: When is it too early to give up a nap? Too late to hold on to a nap? How do domestic patterns and cultural norms affect the circadian and homeostatic processes?

“I think there’s a dire need for adults in general to be in tune with individual children’s physiology,” Dr. LeBourgeois said. “What are the capabilities, and what are the limits?

For an interesting look at SBS/AHT, and the PURPLE program, seek out this work by Rebecca Sullivan at Cook's Children...link

Resources: 2011 New York City (NYC) Shaken Baby (SBS/AHT) Conference

The Queens District Attorney's Office is sponsoring a conference on Shaken Baby Syndrome on September 23-24.

It's a two day program, with a great agenda of speakers including Bob Block, Mark Dias, Mary Case, Chris Greeley and Carole Jenny.

For dessert on Friday morning, a panel discussion among Emily Bazelon, Ronald Uscinski, Patrick Barnes, Chris Greeley and Mary Case.

Register on line and send payment ($25) by September 9

Link to agenda and registration: http://preview.tinyurl.com/4ye7n8z

Prevention: US ranks 40th in newborn mortality...

Today brings news of a study on neonatal mortality by researchers at the World Health Organization.

The stats don't look good for us: the United States dropped from No. 28 to  No. 41 in the rankings of newborn death risk, and is now tied with Qatar, Croatia and United Arab Emirates.

There are some confounding trends: for instance, preterms births make up a larger proportion of US births and the mortality rate among preterm infants is higher.

While you might think such news might spark national protests, the protest focus today is an oil pipeline.

You know, the one where Darryl Hannah got arrested...

Some days, I wonder when babies stopped being part of the environment.

Link to PLoS article on neonatal mortality