July/August 2001Vol. 2, No. 4Utah Prevents Shaken Babies Through Unique Public-Private Partnership

Nothing can unnerve a new parent faster than a crying baby. Unfortunately, frazzled nerves can lead some parents to shake their babies. In an attempt to prevent this often fatal reaction, the Utah Shaken Baby Project has launched a campaign to educate new parents at the time of delivery. Staff involved in the Project presented at the 9th Annual Colloquium of the American Professional Society on the Abuse of Children (APSAC), held June 20-23, 2001, in Washington, D.C.

Shaken Baby Syndrome (SBS), which primarily affects infants and toddlers from birth to age 3, is a form of child abuse that results in a combination of brain injuries due to violent shaking with or without impact. The prognosis for a shaken baby is poor—more than two-thirds die or suffer a permanent disability.

According to Bruce Herman, M.D., Pediatric Emergency Medical Physician and Principal Investigator for the Utah Shaken Baby Prevention Project, "Shaken baby syndrome is a major public health problem and the most common cause of death in abused children." Herman was the attending physician for a 16-month-old victim who was shaken to death by his biological father. The case was turned into a documentary called "Elijah's Story," by the National Center on Shaken Baby Syndrome. The video includes testimonies by Elijah's mom, Elijah's incarcerated dad, grandparents, detective, judge, and Dr. Herman. It serves as the focal point for educating new parents about SBS in Utah hospitals participating in the project. Since most perpetrators are males, and most victims are less than one year old, prevention efforts are targeted to both parents immediately after birth in the hospital. Parents can also be advocates to disseminate information to other caregivers of their baby.

David Corwin, M.D., Medical Director of the Center for Safe & Healthy Families at Salt Lake City's Primary Children's Medical Center, spearheaded the funding strategy that focused on the cost-effectiveness of the program for prevention. Corwin's team calculated receipts from Primary Children's Medical Center from 1997-1999, and found that the average cost for each SBS case to insurance companies was $18,000. A pie chart presented to CEOs of insurance companies also showed that for the first 5 years of life, costs could rise as much as $1 million for SBS victims who survived. In addition to soliciting private sector support, Corwin pitched Medicaid, which agreed to a lump sum payment for each baby born in participating hospitals. With costs ranging about $15 per new baby for SBS prevention, Corwin was able to convince funders that participation was beneficial. "This prevention program is the equivalent of a vaccination program for Shaken Baby Syndrome," explained Corwin. "It's a very inexpensive vaccine that is very effective."

In addition to private and public funding partners, staff at the Primary Children's Medical Center partnered with the National Center on Shaken Baby Syndrome and the University of Utah's Intermountain Injury Control Research Center to administer the project. The National Center's staff started trainings in Fall 2000. Nurse educators will administer the program at every hospital in Utah that provides maternal and child health services. Nurses are currently up to full capacity educating parents of newborns in hospitals in Northern Utah, which comprises 70 percent of Utah's population. By the Fall 2001, the project plans to expand statewide. An evaluation component of the project will look at the birth hospital of the referring SBS patient to see if prevention education was received.

The program includes the following components:

Informational brochures for parents of newborns
Video about SBS
Commitment statement signed by parents that they have received information about SBS and will educate other caregivers of their baby
Refrigerator magnet with the National Center on Shaken Baby Syndrome's contact information and space to insert baby's picture.

Debra Williams, of the National Center on Shaken Baby Syndrome, explained that nurses receive a 5-minute script and an outline to use in educating parents. "The objective is to give parents some tools on how to deal with their own stress and frustration," said Williams. "The message is that it is okay to let babies cry. Too often parents think it's bad to let a baby cry." Some obstacles that Williams encountered in hospital-based education were:

Nurses felt time restriction; too much information was already required to be taught in a mother's short stay.
Nurses felt the topic was too sensitive; video was too emotional.
Program was not mandatory; no accountability.
Internal Review Boards required commitment statement to be changed many times.

Utah's initiative is based on a successful pilot program in western New York State which drastically reduced the cases of SBS. Only two cases of SBS have been reported in the 31 participating hospitals since the program's inception in late 1998. Developed by Dr. Mark Dias, Buffalo Children's Hospital Chief Neurosurgeon, the program provides information on the dangers of violently shaking infants to every parent of every newborn infant born in the Buffalo area using the video "Portrait of a Promise," available in English and Spanish. It features three parents talking about their shaken babies—two who were severely disabled, one who died—interspersed with advice from health care professionals. Similar to Utah, after viewing the video, new parents are asked to sign an "affadavit." Dr. Dias's experience as a new father unable to console his crying baby gave him the impetus to start the prevention effort.

Using Utah's example, Corwin explained that a first step for other sites who want to replicate the prevention effort is to build a public-private partnership. "The partnership is important not only to create the program but also to build a political constituency to keep it going," said Corwin. The participants contend that if they can effectively replicate and significantly reduce the incidence of SBS in Utah, its success will provide a compelling case for the rapid dissemination of this program throughout the rest of the United States.

For complete presentation materials to parents and information about the research project, contact:

Debra Williams
National Center on Shaken Baby Syndrome
2955 Harrison Blvd., Ste. 102
Ogden, UT 84403
Phone: 801-627-3399 or 888-273-0071
Fax: 801-627-3321
Email: dj-williams@mindspring.com
Website: http://www.dontshake.com

To purchase a copy of the audiotaped presentation from the 9th Annual APSAC Colloquium, "Building Public-Private Partnerships for Preventing Shaken Babies" (program #210620, session #810), contact:

Audio Archives International, Inc.
3043 Foothill Blvd., Suite 2
La Crescenta, CA 91214
Phone: 800-747-8069
Fax: 818-957-0876
Email: audioarc@flash.net

Related Items

To obtain a conference program for the First National Australian Conference on Shaken Baby Syndrome, sponsored by the National Center on Shaken Baby Syndrome (USA), The Children's Hospital at Westmead, and the Sydney Children's Hospital, to be held September 2-4, 2001, in Sydney, Australia, contact the National Center at 888-273-0071 or visit http://www.dontshake.com.

Visit the Military Family Resource Center's Child Abuse Prevention website for a new factsheet on Shaken Baby Syndrome (http://www.mfrc-dodqol.org/pdffiles/Shaken_Baby_Syndrome_fs.pdf).

A new American Academy of Pediatrics technical report, published in the July 2001 issue of Pediatrics, discusses Shaken Baby Syndrome as a clearly definable form of child abuse and recommends prevention strategies (http://www.pediatrics.org/cgi/content/full/108/1/206).