RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

[Guest guest]

and SENATE re evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired! From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles " <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

Thank you for your expertise - I hope you are enjoying your retirementOn 22 Feb 2012, at 19:19, Coles wrote: and SENATE re evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired! From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles" <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

Hello ,

I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail.

All v best,

Diane (DeBell)

From: Coles

Sent: Wednesday, February 22, 2012 2:19 PM

Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

and SENATE

re evidence about head injury prevention in infants

Firstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.

NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.

A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_heads

Although targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.

Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.

I could go on.......but I am retired!

From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008

raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles" <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

Fascinating do. Send any info you have. Hope you are well?LizSent using BlackBerry® from OrangeFrom: "Diane DeBell" <ddebell@...>Sender: Date: Thu, 23 Feb 2012 06:30:07 -0500< >Reply Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Hello , I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail. All v best, Diane (DeBell) From: Coles Sent: Wednesday, February 22, 2012 2:19 PM Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants and SENATEre evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired!From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles" <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

Thanks, Liz. Am fine. Will be seeing the students again tomorrow morning and will ask for more detail.

All good wishes,

Diane

From: liz.plastow@...

Sent: Thursday, February 23, 2012 7:12 AM

Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

Fascinating do. Send any info you have. Hope you are well?Liz Sent using BlackBerry® from Orange

From: "Diane DeBell" <ddebell@...>

Sender:

Date: Thu, 23 Feb 2012 06:30:07 -0500

< >

Reply

Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

Hello ,

I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail.

All v best,

Diane (DeBell)

From: Coles

Sent: Wednesday, February 22, 2012 2:19 PM

Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

and SENATE

re evidence about head injury prevention in infants

Firstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.

NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.

A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_heads

Although targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.

Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.

I could go on.......but I am retired!

From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008

raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles" <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

Hello DianeWell done to have a Visiting Chair. Yes, the programme the NSPCC are trying out in the UK is the same one. Just shows how wide spread it is in the USA for you to hear. The programme was developed by paediatric neurosurgeon Mark Dias. See for an brief overview http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html.The American website for the programmehttp://www.wchob.org/shakenbaby/A Guardian write up about the UK workhttp://www.guardian.co.uk/society/2012/feb/09/shaken-baby-injuries-nspcc-education-parents?CMP=EMCSOCEML657Some papers are: Dias, Mark S., , Kim, deGuehery, Kathy, Mazur, a, Li, Veetai and Shaffer, Michele L. (2005) Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics, 15(4): e470-e477.Coles, and , Lynne (2009) Including fathers in preventing non-accidental head injury. Community Practitioner, 82(4) April: 20-23.I can give other refs if needed.From Cardiff, Professor Alison Kemp and myself met and with Professor Mark Dias and presented at conferences UK wide, with others. The team from Cardiff School of Medicine, Cardiff University, were working for 10 years on NAHI/shaken baby syndrome. My remit as Research Fellow was the prevention of NAHI. I involved the local health visitors and PCT. It’s great that something has come of all that work.Very best to youPS we are moving from Wales this year so anyone who wants to get in touch use this e mail. From: [mailto: ] On Behalf Of Diane DeBellSent: 23 February 2012 11:30 Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Hello , I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail. All v best, Diane (DeBell) From: Coles Sent: Wednesday, February 22, 2012 2:19 PM Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants and SENATEre evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired!From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles " <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

Hello LizSee my reply to Diane for a UK update on the same programme From: [mailto: ] On Behalf Of liz.plastow@...Sent: 23 February 2012 12:12 Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Fascinating do. Send any info you have. Hope you are well?LizSent using BlackBerry® from OrangeFrom: " Diane DeBell " <ddebell@...> Sender: Date: Thu, 23 Feb 2012 06:30:07 -0500< >Reply Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Hello , I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail. All v best, Diane (DeBell) From: Coles Sent: Wednesday, February 22, 2012 2:19 PM Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants and SENATEre evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired!From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles " <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

Hello Yes, all well and I can recommend retirement! But one never quite lets go of the former life.................As mentioned to Diane I am letting people know we are leaving Wales for Oxfordshire. This e mail will still be the best contact.Very best wishes to you From: [mailto: ] On Behalf Of CowleySent: 23 February 2012 09:59 Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Thank you for your expertise - I hope you are enjoying your retirement On 22 Feb 2012, at 19:19, Coles wrote: and SENATEre evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired! From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles " <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

Thanks will look it up!LizSent using BlackBerry® from OrangeFrom: " Coles" <lisa@...>Sender: Date: Thu, 23 Feb 2012 14:31:07 -0000< >Reply Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Hello LizSee my reply to Diane for a UK update on the same programme From: [mailto: ] On Behalf Of liz.plastow@...Sent: 23 February 2012 12:12 Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Fascinating do. Send any info you have. Hope you are well?LizSent using BlackBerry® from OrangeFrom: " Diane DeBell " <ddebell@...> Sender: Date: Thu, 23 Feb 2012 06:30:07 -0500< >Reply Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants Hello , I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail. All v best, Diane (DeBell) From: Coles Sent: Wednesday, February 22, 2012 2:19 PM Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants and SENATEre evidence about head injury prevention in infantsFirstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_headsAlthough targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.I could go on.......but I am retired!From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008 raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles " <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with

[Guest guest]

,

This is v helpful indeed. I'll follow this up and see if I can add to it at all.

More tomorrow late............I'm 5 hours behind you.

Thanks so much,

Diane

From: Coles

Sent: Thursday, February 23, 2012 9:29 AM

Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

Hello Diane

Well done to have a Visiting Chair. Yes, the programme the NSPCC are trying out in the UK is the same one. Just shows how wide spread it is in the USA for you to hear. The programme was developed by paediatric neurosurgeon Mark Dias. See for an brief overview http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html.

The American website for the programme

http://www.wchob.org/shakenbaby/

A Guardian write up about the UK work

http://www.guardian.co.uk/society/2012/feb/09/shaken-baby-injuries-nspcc-education-parents?CMP=EMCSOCEML657

Some papers are:

Dias, Mark S., , Kim, deGuehery, Kathy, Mazur, a, Li, Veetai and Shaffer, Michele L. (2005) Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics, 15(4): e470-e477.

Coles, and , Lynne (2009) Including fathers in preventing non-accidental head injury. Community Practitioner, 82(4) April: 20-23.

I can give other refs if needed.From Cardiff, Professor Alison Kemp and myself met and with Professor Mark Dias and presented at conferences UK wide, with others. The team from Cardiff School of Medicine, Cardiff University, were working for 10 years on NAHI/shaken baby syndrome. My remit as Research Fellow was the prevention of NAHI. I involved the local health visitors and PCT. It’s great that something has come of all that work.

Very best to you

PS we are moving from Wales this year so anyone who wants to get in touch use this e mail.

From: [mailto: ] On Behalf Of Diane DeBellSent: 23 February 2012 11:30 Subject: Re: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

Hello ,

I am in the United States (a Visiting Chair at an American university for the spring) and this very subject came up in a class yesterday. One of my students reported that (in one state) the parents of every child admitted to hospital with an injury are required to view a video of the dangers/possible consequences of shaking a baby -- before they are allowed to leave hospital. Very interesting health promotion intervention. Let me know if you want more detail.

All v best,

Diane (DeBell)

From: Coles

Sent: Wednesday, February 22, 2012 2:19 PM

Subject: RE: changes in rates of violent deaths 1974-2008 evidence about head injury prevention in infants

and SENATE

re evidence about head injury prevention in infants

Firstly, the NSPCC now has a focus more on research and policy changes rather than primarily interventions. The programme they are piloting to prevent NAHI (non-accidental head injury, or older term of shaken baby syndrome) in 12 hospitals across the UK is one that has been tried and tested in parts of the USA. There are papers documenting the intervention and evaluations over years. I can give references if wanted. The programme is now mandatory in some states and claims nearly 50% reduction in cases of NAHI (called abusive head trauma in the US). So, yes, the evidence about preventing NAHI is good in parts of the USA using one particular intervention at the time the studies were done. The intervention is hospital based health promotion to all mothers and fathers about the dangers of shaking a baby and how to manage precipitating situations like persistent crying. However this intervention is untried within the UK NHS system and the US has a head start in public health about preventing shaken babies with much wider general publicity. There is much more to learn about the concept of prevention as intervention before we have good evidence.

NSPCC working parties I was involved with a few years back covered a lot of ground before getting funding to start the programme here. I have some reservations about a blanket transfer of an intervention from one country to another but sensibly, this a pilot scheme and presumably will iron out any difficulties.

A broader approach is in the Teaching Toolbox book with leaflets produced by the CPHVA, with support from the NSPCC called Protecting babies’ heads: Preventing shaking and head injuries in babies. It covers from the available evidence at the time of writing various strategies for preventing NAHI and the risk groups http://www.cairnsbookshop.co.uk/product/1000/protecting_babies_heads

Although targeting risk groups is in vogue, a universal approach is more acceptable to parents, any of whom can be prey to the triggers for shaking which research shows commonly relate to feeling out of control over issues such as the baby having persistent crying, refusing to feed or won’t stop fretting. Strategies to cope with these events won’t prevent more complex cases for which one may never be prepared. But having a focus within a universal programme from evidence based negative factors (risks) associated with cases helps engage those at more risk than others. For example, the parent leaflet in the Teaching Toolbox was designed with Mencap in Easy Read style to engage those with poor literacy skills. I don’t know if the NSPCC material follows this approach. Also the focus was as much on fathers needs as mothers since fathers are the main perpetrators. A universal prevention programme is totally justified when research shows that in one third of NAHI cases there were no known associated negative factors.

Case studies also show that NAHI is a process rather than a one off event –a pattern of parenting responses to an infant that include shaking or impact injuries from the very earliest days with a spectrum of degrees of shaking and of damage to the head with unknown outcomes for minor incidents which do not come to the attention of health services. Again a universal prevention programme is justified from the first days of parenting as well as on many subsequent opportunities since prevention also includes building resilience factors and strengthening protective ties through professional relationships and mentoring.

I could go on.......but I am retired!

From: [mailto: ] On Behalf Of hwood@...Sent: 21 February 2012 23:47 Subject: RE: changes in rates of violent deaths 1974-2008

raises important points about thresholds. Since they may be service provision dependent, rather than an expression of evidence based professional priorities, they may vary for more than one reason.This NSPCC programme is an interesting initiative, given the frequency that child traumatic head injury and brain injury consistent with shaking are reported in SCRs. Such events may be rare in public health terms, but they're catastrophic for the child. NSPCC has the ability & funding to produce some useful materials and information for parents, but as a charity, it's limited in its reach and can only extend to some areas, not all.Varying thresholds, varying access to guidance and parent education, varying HV workforces. Doesn't this all feel a bit like nailing jelly to the wall? Standardisation would be a refreshing change, provided it's not to the lowest common level of practice all round. , what does the evidence tell us about head injury prevention in infants, please?< > From: " Coles" <lisa@...> Date sent: Tue, 21 Feb 2012 10:11:47 -0000 Subject: RE: changes in rates of violent deaths 1974-2008 Send reply to: Hello and SENATEMy view is that the issue of threshold in reporting child abuse exists and is likely to continue to in response to policy, economic and knowledge variance over time. This means standardisation of reporting, intervening and preventing child abuse is hard to achieve. I feel the answer is to have dedicated pathways within all children´s services for continual learning and updating about child protection (sorry -never was happy with rather non specific `safeguarding´). Of use may be the NSPCC Educare leaning modules. The New in the Library -alert 17 February 2012 from NSPCC Library [inform@...] gives details of some book modules which I have pasted below. To register for alerts go to NSPCC Inform Also many may be aware the NSPCC are piloting a preventing non-accidental head injury NAHI (shaken baby) programme for new parents in some hospitals across the UK http://www.nspcc.org.uk/inform/resourcesforprofessionals/underones/preventing_nahi_wda85611.html. If this is successful and becomes standardised practice it will be another example of how to overcome the effects of a threshold limitation, in preventing child abuse in this case. I realise standardising practice has particular pitfalls which will probably only increase with