2006 Model Practice Application (Public)

Shaken Baby Syndrome Education and Public Awareness Program

Cuyahoga County Board of Health

It is estimated that everyday in the United States, eight children are shaken by a frustrated caregiver. This project is designed to educate professionals about shaken baby syndrome, and provide them with a curriculum they can use to teach the clients they serve (i.e.: parents, childcare providers, siblings, grandparents). The curriculum not only teaches that shaking is harmful, but provides participants with coping skills to use when they feel overwhelmed or frustrated when caring for a young child. The goals of this project are: 1) to train professionals and caregivers in Cuyahoga County about SBS who can then go on to train other professionals or clients, and to educate the general public about SBS, and 2) to raise awareness of shaken baby syndrome through public awareness activities.

The public health issue addressed by the project is Shaken Baby Syndrome (SBS), the serious injuries that result when a frustrated caregiver shakes a baby. While there are not accurate statistics, it is estimated that every day in the United States, eight babies are shaken, three of whom will die. The cost to society to care for these children is enormous, as most children suffer permanent disabilities, such as cerebral palsy, seizure disorders, paralysis, and blindness. Shaking a baby is a serious form of child abuse that can be easily prevented.

The Cuyahoga County Board of Health (CCBH) approached the St. Luke’s Foundation of Cleveland in 2001 after researching the problem of SBS in Cuyahoga County. Statistics from the Level I trauma centers in the County were gathered and showed that SBS cases had increased every year, beginning in 1998. After approaching St. Luke’s with these statistics, they agreed to fund the project. The foundation saw this as a three-year project to be carried out entirely by the CCBH, and granted CCBH with year-one funding in full.

The project initially began as a train the trainer approach to professionals in Cuyahoga County. After doing research to find out how other communities had implemented projects in the area of SBS education, staff came across a hospital-based education program out of Buffalo, NY, initiated by Dr. Mark Dias. His project involved educating new parents about SBS at the time of their new baby’s discharge from the hospital. Research showed that the time of the baby’s birth was the most critical time to teach new parents about SBS. While still in the hospital, parents filled out a ‘commitment statement” that asked them demographic information, as well as questions about their level of knowledge of SBS. Parents were also asked to voluntarily watch an 11-minute video about SBS. CCBH decided to implement the same hospital-based education program in Cuyahoga County. In addition, the program maintained the train the trainer approach to reach even more people, namely professionals, who could reach a broader target audience. Some direct service teaching was also done in local schools to students in grades 7-12.

As the LHD, the CCBH was responsible for many components of the program. The program provided the only training of the SBS curriculum. We created the curriculum, scheduled trainings, carried them out, and entered our own data. With the assistance of a CCBH epidemiologist, a pre and post test was created, as well as a database for the results of each test. On a semi-annual basis, results of the data were analyzed by the epidemiologist and a report was created. Working together, the registered nurse, who conducted the trainings, and the epidemiologist, could closely evaluate the program’s effectiveness and ability to reach its goals. The CCBH also hired a public awareness consultant on a part-time basis who was primarily responsible for the public awareness campaign (ie; bus campaign, public service announcements, press releases, etc...)

After the success of year one of our project,CCBH began to approach other funders, in addition to St. Luke’s, to assist in continuing the program. Five other local funders, and one state agency, were interested in assisting CCBH in meeting the program goals in years two and three. All community stakeholders were kept apprised of our progress, and included them in advisory board activities. Although they relied on the CCBH for expertise, they appreciated the opportunity to have input on the project and its objectives.

This project was designed to eliminate Shaken Baby Syndrome (SBS) by teaching on two levels. The first was a training component, a train-the-trainer approach geared towards anyone providing services to young children and families, parents and other caregivers. Trainees included teachers, social workers, nurses, physicians, EMS technicians, fire personnel, police officers, childcare provider instructors and group facilitators. The idea was to teach those who can then train others. Taught by a registered nurse, a training session provided methods for teaching about the crying patterns of babies, handing frustration, and recognizing the symptoms of SBS.

The program also focused on incorporating SBS education into the discharge teaching for parents of all newborns at all 12 birthing facilities in Cuyahoga County, with the potential of reaching the parents/caregivers of 18,000 infants born county-wide each year.

The public awareness component educated the general public about the dangers of shaking a baby. It featured bus signs, media coverage, radio and TV announcements, print advertising, appearances at community events, public speaking, participation in workshops, conferences, and health fairs, and promotion of the project in other venues. The program targeted those most at risk for shaking babies, such as fathers, boyfriends of mothers, and other caregivers. The campaign also reached out to the Hispanic/Latino community. The program accomplished this through cost-effective means, such as distributing brochures ands posters (including Spanish versions); sending letters and information to neighborhood newspapers; disseminating information at community health fairs and events; and presenting information to community groups.

The time-line of this project was three years, with the goal to train approximately 400 people each year. The long-term goal was to see a reduction in the number of cases of SBS in Cuyahoga County as a result of the program's efforts.

Sustainability was a primary topic of conversation when program staff met with our first funder. The best way to promote sustainability of this project was to use the train the trainer approach. After training professionals in our community one time, staff provided them with the curriculum and resources needed for them to continue SBS education to their clients. Staff then evaluated participant’s level of preparedness to continue the education, and over 82% felt they were “prepared” or “extremely prepared” to use the curriculum. For the remaining participants, staff offered ongoing assistance by phone to help them prepare themselves to train in the future.

After the project had a successful first year using this approach, other stakeholders became interested in funding the project. Cuyahoga County has a close-knit group of funding sources who often come together to fund one or more projects. By showing commitment and success in year one, the program was able to perpetuate stakeholder commitment to the project. It also helped that CCBH placed a time-limit on the project of three years. Stakeholders felt the time limit was reasonable, and still allowed us enough time to saturate the community with information and resources. At the time the project began, there was no other SBS education and public awareness program in the county like CCBH's.

Goal: To educate professionals and parents/caregivers of children birth to three about the dangers of shaking a young child, and provide resources for them so they can continue to train others in the future.

Objective: Increase knowledge of professionals and caregivers about SBS and have them feel “prepared” or “very prepared” to train others:

• Performance measures: 25% increase in knowledge of SBS and feeling “prepared” or “extremely prepared” to train others on the topic.
  
  
• Data collection: 1) demographic information, level of knowledge of SBS, comfort level to train others; 2) CCBH; and 3) Via pre and post tests.
  
  
• Outcomes: Participants' gain in knowledge of SBS and ability to train others (long-term)

Objective: Increase awareness of SBS through public awareness campaign:

• Performance measures: Increased number of inquiries about SBS and increase in requests for trainings/materials.
  
  
• Data collection: 1) diary kept of inquiries/comments/training requests based on public awareness activities; 2) CCBH; and 3) via phone, email face-to-face.
  
  
• Outcomes: Increase in public awareness on topic of SBS (long-term).

Objective: Provide trainees materials they would need to teach about SBS to others:

• Performance measures: 100% of trainees would receive materials/training packet to go on and teach others about SBS.
  
  
• Data collection: 1) class attendance; 2) CCBH; and 3) attendance sheet was signed by each participant.
  
  
• Outcomes: All participants who attended the training received a training packet and enough materials to go on and train others (long-term).