Successes and Challenges in Implementing a Broad-based Partnership to Prevent Shaken Baby Syndrome in San Mateo County (CA) CityMatCH Annual Conference August 26, 2007 Anand Chabra, MD, MPH, MCAH Director, San Mateo County Health Department Jane Smithson, JD, Co-Chair, San Mateo County Child Abuse Prevention Council

Background Child Death Review Team reviewed 3 Shaken Baby Syndrome deaths in 2002 – 2004, creating significant concern. This appeared to be an increase over previous years. Review of the circumstances surrounding one Shaken Baby Syndrome death resulted in a changed structure where all countywide Child Welfare responsibilities were given to one executive manager. Other significant instances of non-fatal shaking injury suggested that the problem was more prevalent in the county than previously assumed, and that many of these children were involved with county programs.

New Partnership Formed - Shaken Baby Syndrome Public Education Campaign Task Force - Councils Child Abuse Prevention Council Fatherhood Collaborative County Government Health Department Human Services Agency Healthcare Providers Hospitals (especially Birthing Hospitals) San Mateo Medical Center (county hospital and clinic system) Foundations Lucile Packard Foundation for Children’s Health Community Based Organizations Family Service Agency (mental health services) Legal Aid Society (legal assistance) Child Care Coordinating Council (child care resources and referrals)

Funding Partnership Created Child Abuse Prevention Council (Lead entity, focus on child abuse prevention, receives federal & state child abuse prevention funds, $10K) Health Department (Co-lead, public health agency, prevention and service focus, $13.5K) Human Services Agency (Investigates mandated child abuse reports, conducts prevention efforts, $5K) Fatherhood Collaborative (Advocates for fathers, assures SBS messages are father-friendly, $5K) Lucile Packard Foundation for Children’s Health (Focuses on child abuse prevention and preteen mental health issues, $5K)

( More or Less) New Materials Created For 10,000 San Mateo County Births/Year Parent Education Handout – English and Spanish (back to back); attractive colors; durable; inexpensive Onesie – Attractive colors; useful; costly Refrigerator Magnet – Useful; inexpensive; daily reminder Pen On A Rope – Provider-oriented; useful; daily reminder

Quote About the Onesies “They (parents) especially love this item as they place it on the baby/babies when they must leave the baby in someone else’s care. This gives mother the opportunity to speak with the sitter and provide a number to call should the sitter become frustrated or angry.”

Refrigerator Magnet

Successes – SBS and the community Child Abuse Prevention Council prioritized SBS activities (one of 4 priorities) for FY and Handout and onesie received very positive initial feedback – thousands of handouts distributed within first few months SBS training provided to Child Abuse Prevention Council; Child Care Providers; Teen Parents; Hospital Staff; Health Dept managers; and all Family Health Services staff in Health Department (~250)

Successes – SBS and the community (cont.) SBS was the focus of Child Abuse Prevention Month (April 2006), including the Children’s Memorial Flag Raising SBS was the topic of 5-minute cable TV interview, a local KCBS television interview after a non-fatal SBS incident, and several newspaper articles

Both a Success and a Challenge – SBS education in Birthing Hospitals Hospital Consortium leadership (representing most local hospitals) supported implementing SBS education for all new parents – minimal SBS education was provided before SBS program inception Hospital leadership did not appear to communicate much about this project to other hospital managers and staff

Both a Success and a Challenge – SBS education in Birthing Hospitals (cont.) Most hospitals loved the materials for parents, but –the onesies generated some controversy –doctors and staff at one community hospital would not agree to distribution of onesies (felt they would offend parents) –nursing staff wanted more training –nurses in the county hospital and clinic system (no birthing services) wanted the physicians more involved in distributing these materials At least one hospital had not yet started distributing materials to parents of newborns 3 months after they received all materials

Process Outcomes Distribution of 10,000 Onesies, Parent Education Handouts, and Refrigerator Magnets to –5 Birthing Hospitals –County hospital and clinic system –WIC –Home Visiting Programs Distribution of an additional 5, ,000 Parent Education Handouts at community events Community education SBS training for all Family Health Services staff

Intermediate Outcome Significant increase in monthly calls to the Toll Free Parent Resource Line (clearly identified on all SBS Campaign materials): –Mean of 41 calls per month (2005) –Mean of 74 calls per month (2006) –Mean of 104 calls per month (January to June 2007)

Parent Resource Line Calls January 2005 – June 2007 Shaken Baby Syndrome Prevention Campaign Begins Birthing Hospital Distribution of SBS Materials Begins 2007

Endpoint Outcome No Shaken Baby Syndrome deaths in 2005, 2006, or the first half of 2007 (based on Child Death Review Team analysis of all child deaths)

Conclusions What we did well: Broad community support Rapid implementation with minimal funding Wide distribution of materials with positive outcomes What we could have done better: Earlier engagement of medical community given focus on birthing hospitals Marketing to hospital and clinic physicians and nurses, and their professional organizations Grant funding for long-term implementation

Public Health Implications 1. Parents are open to receiving a Shaken Baby Syndrome prevention message when presented in an attractive and non-threatening way. 2. A community partnership of county agencies, collaboratives, health care providers, community- based organizations and funders can be an effective vehicle for educating the community on Shaken Baby Syndrome prevention. 3. Early health care provider buy-in and extensive health care provider involvement and training is essential when sharing educational messages through the health care provider community.

Thank you! Questions?