Shaken Baby Syndrome

[Tom Hanna <tph3@xxxxxxxxxxx>]

(apologies for any cross-posting duplications)

PUBLIC AWARENESS ON SHAKEN BABY SYNDROME (SBS)
Some of us at Cornell are looking at the public education aspects of SBS
prevention.  It would be good to have dialog on this list about what would
work, and what doesn't.  I'd appreciate private feedback on what we are
considering, especially any experience you have which confirms or dispels
the assumptions below.  Some issues we are looking at:

CEILING EFFECT?
Some studies seem to indicate that "don't shake the baby" is a message that
is already known. In at least one case, the pre-test/post-test knowledge
gains were very small (a couple of points), since the group started out
with 90% knowledge. Granted -- another way to view this is that the 10% who
don't know may include some of those in the high-risk population: parents
and caretakers of infants, especially inconsolable babies.

LIMITS OF KNOWLEDGE
It is less clear how well at-risk individuals (a) understand the dangers
(b) are capable of impulse control.  There is some doubt that knowledge
alone is adequate to assure prevention.

DECAY EFFECT
In general, in public awareness campaigns, the length of time between
hearing a message and having to act on it is important.  The longer the
delay, the greater the decay.

TARGET AUDIENCES
In general, studies indicate that the most at-risk populations are  males
(not necessarily fathers of the children) and babysitters.

INTITIAL APPROACH
We attended the Shaken Baby Syndrome National Conference last year, and had
the opportunity to hear recent research, and evaluate many of the best
known, and not-so-well known public awareness and community education
strategies.  Our  approach now is to bring together and analyse
	*all the messages we can find that are being used currently,
	*the communication channels (doctors, nurses, hospital social
workers, home visitors, etc),
	*the opportunities (pre-natal office visits, in-hospital and
post-partum contacts, well baby clinic visits and pediatric office visits,
etc) and
	*the communication media ("Baby Packets," flyers, mini-lectures by
professionals, "behavior management cards," group sessions & parenting
classes, Cooperative Extension bulletins and letter series, radio PSA's,
videos, Internet Web Sites, listservs and newsgroups, etc).

(Any references to more recent campaigns would be appreciated.)

>From the analysis, we want to develop a strategy to get the right messages
to the right people at the right time. We think this means precise
targeting and timing. Normally, this seems to suggest delivery of the
messages through professional and paraprofessional channels.

Is there also a community education role? Is there a different way of doing
a public awareness campaign on SBS that will make the well-meaning
community provide better supports to the at-risk families we are targeting?
Perhaps Dr. Chadwick's point about "caretaker isolation" is a key:  he
stated that few SBS cases occur when there is more than one caretaker
present.  Perhaps that can be crafted into a message "for public
consumption."

HYPOTHESES
1. Parents (including step fathers and paramours) who are reached all
through the high risk periods of a child's development will be less likely
to inflict severe shaking and banging
2. Parents who are trained to instruct babysitters will be more successful
at avoiding abuse of their children by caretakers than parents who rely on
others to train and/or screen babysitters.
3. Positive prescriptive approaches (clear instructions on "what to do")
that accompany proscriptions (interdictions or prohibitions) are more
likely to succeed than proscriptive approaches alone.  (As one professional
family educator said to me "don't teach me how to do don't.")

CAVEATE
Some adults in an infant's life may be psychopathic or sociopathic.  In
such circumstances interdiction (not education) is the stronger strategy.
There are analogies with certain domestic violence situations.

I hope this is of interest to some on this list.  And I hope it begins to
address some of the cautions that Dr. Chadwick raised on the topic of
public awareness.

--Tom

PS:  Dr. David Chadwick, of Children's Hospital in San Diego, has called
attention to the California campaign in which millions of dollars were
spent over three years without being able to measure an effect.  As he
implied, measuring an effect in such a wide-open campaign is difficult at
best.

Without a carefully structured study, it is unlikely that the anticipated
"small effects" could be filtered. Isn't it possible that many people *did
not* shake babies as a result of the campaign?

This is sometimes called the United Nations effect. (Perhaps some remember
that the UN ran a public awareness ad back before 1980 that said in
essence:  "maybe we can't prove that we have prevented wars, but would you
care to see what happens if we are not here?"  It may not have been the
smartest public relations stance at the time (the US cut back contributions
to the UN severely in subsequent years), but it is a classic example of the
dilemma of prevention campaigns.