The 3 Inoculation Strategy
The First Inoculation - Core Elements of the In-Hospital SBS Prevention Program
The In-Hospital Prevention Education Program consists of a standardized training for nurses as well as a standardized parent education protocol:
Standardized Nurses' Training Curriculum
Using the Dias approach demonstrated in Western New York State as the foundation, a more standardized and thus a more replicable in-hospital program evolved over a multi-year pilot in Central Massachusetts. It included the development of a comprehensive one-hour nurses' training curriculum by MCC. The curriculum includes comprehensive medical information about SBS, the history of the Syndrome, and why SBS is under-detected, under-reported and often misdiagnosed. It identifies precipitating adult and infant factors that can lead to shaking and the types of caregivers who are most frequently represented in such cases. In addition, it includes key prevention messages nurses can share with their patients about infant crying, a range of infant soothing strategies, ways to respond when soothing doesn't work, and how to ensure the safety of infants when left in the care of others. The curriculum has been approved for 1.2 contact hours by the Massachusetts Association of Registered Nurses (MARN). MCC has three MARN-approved presenters who are available to deliver the nurses' training.
MCC has developed a narrated version of the one-hour nurses' training to be used by the trained Nurse Manager at each of the hospitals to manage their ongoing training needs for nurses. The two-CD set includes all the references, forms, and materials needed to support implementation of the program.
Parent Education Program
The In-Hospital SBS Prevention Education Program for parents of newborns includes the following components:
- one-to-one instruction of parents by a nurse who has completed the one-hour nurses training;
- viewing of a video by parents stressing the dangers of shaking;
- distribution of MCC's comprehensive brochure on SBS, that includes information about infant crying, infant soothing and key prevention messages that parents take home with them;
- signing an Acknowledgement Form by each parent/caregiver educated to document they have received each component of the education program and that they will share the information learned with all of their child's caregivers.
Using all of the above methods of education provides an opportunity to reinforce key messages, as well as allows for varying adult learning styles.
Data Analysis and Evaluation
Through funding from The Health Foundation of Central Massachusetts and the support of a Worcester-based child abuse prevention collaborative, formal evaluation of both the nurses training curriculum and the parent education program were conducted. The following is a summary of the evaluation protocol and data analysis:
The Acknowledgement Form serves as a quality control tool to document that parents have received all components of the education. Parents indicate whether s/he received one-on-one instruction from their nurse, were given the brochure and materials, and viewed the video. In the Central Massachusetts program, parents could also indicate on the Form if they wished to participate in a follow-up telephone survey to express their views of the training. One copy of the triplicated Acknowledgement Form is kept by the hospital and placed in the patient's medical record or other file. Patients receive one copy and the third is sent to MCC for review and data entry.
The hospital provides MCC with the total number of births each month. By comparing total births to the total number of infants' whose parents/caregivers received SBS prevention education, MCC is able to document the percentage of parents each hospital is reaching.
Parents who indicated their willingness to participate in the telephone survey were contacted by MCC staff three to four months after the birth of their child. A series of questions were asked in an effort to measure what they remember, whether or not they utilized the information learned and whether or not they found the training helpful in caring for their child. See data reported below.
Demonstrated Program Effectiveness
Nurses' Training
The effectiveness of the nurses' training curriculum has been established. Two analyses were conducted. The first was to measure the knowledge gained by nurses once trained by the Nurse Educator/Trainer. A pre- and post-survey was administered to the nurses. Based on a sample of 150 nurses who completed both the pre- and post- test who were trained at St. Vincent Hospital and UMass Memorial Medical Center, the average score from pre- to post-test rose from 66.9% (± 14.6%) correct to 82.1% (± 14.7%) correct. This is a statistically significant increase in their knowledge scores (t(144) = 13.79, p < .0005). Given their increase in knowledge, nurses are effectively trained and fully prepared to successfully educate parents.
Second, nurses must also complete an evaluation of the training curriculum and of the trainer. On a 5 point scale where 5 is excellent, the average training curriculum and trainer evaluation score has been consistently high between 4.7 and 4.8. Nurses are required to complete the evaluation in order to receive their contact hours.
Parent Education
Approximately one-half of parents educated in the program indicated their willingness to receive a call-back. A sample of 217 parents contacted from July, 2006 - May, 2007 provided the basis for the following data.
| n |
Proportions
|
||
|
Total Called
(217)
|
Specific to Questions | ||
| Recalled Nurse Discussing Calming and Dangers of Shaking a Baby |
208 | 95.90% | |
| Remembered Viewing Video | 193 | 88.90% | 193 Related to the Video |
| Found Video of Interest Some or A Lot | 191 | 88.00% | 99.00% |
| Remembered Receiving the Brochure | 201 | 92.60% | 201 Remembered Brochure |
| Read the Brochure | 179 | 82.50% | 89.00% |
| 179 Read Brochure | |||
| Found the Brochure Somewhat or Very Useful |
175 | 80.60% | 97.80% |
| Shared Brochure Information with Others |
162 | 74.60% | 90.50% |
| How Helpful Was the SBS Information for Caring for Your Baby? |
213 Answered This Question | ||
| Very Helpful | 146 | 67.30% | 68.50% |
| Somewhat Helpful | 66 | 30.40% | 31.00% |
| Not At All Helpful | 1 | 0.50% | 0.50% |
| SBS Information was Somewhat or Very Helpful |
212 | 97.70% | |
Participating Hospitals:
Beth Israel Hospital- Boston
Baystate Children's Hospital- Springfield
Emerson Hospital- Concord
Harrington Hospital- Southbridge
Heywood Hospital- Gardner
Holyoke Medical Center – Holyoke
Lowell General – Lowell
Mary Lane Hospital – Ware
Melrose-Wakefield – Melrose
Mercy Medical Center – Springfield
Milford Regional Medical Center- Milford
St. Vincent Hospital – Worcester
UMass Memorial Medical Center – Worcester
UMass Health Alliance – Leominster
Winchester Hospital – Winchester
"Through the comprehensive, high-quality training provided to Heywood Hospital nurses by the MA SBS Prevention Center, we have been providing this life- saving information to the parents of newborns since 2003. We value the Center's expertise and enthusiastically recommend its services to other Massachusetts hospitals."
Daniel Moen, Immediate Past Chair, MassachusettsHospital Association
President and CEO, HeywoodHospital, Gardner, MA
“Massachusetts Shaken Baby Syndrome Prevention Center has developed a professional teaching tool for nurse, as well as an easy-to-follow parent education program that has assisted our hospital in maintaining its commitment to shaken baby syndrome prevention education. The expert instruction and materials provided makes it very easy for any hospital to initiate a program.”
Deborah Chouinard, RNC, MSN, Clinical Nurse Specialist
Center for Women and Infants, Saint VincentHospital, Worcester, MA
“You should give this (training) to all new parents”………. “My baby’s a high-pitched screamer, but now I know how to handle it. The tips and video really helped”……. “Great guide for family and first-time parents”…..“I use the brochure tips; they all really work!”
Comments taken from surveys of parents conducted 3 to 4 months post partum
The Second Inoculation - Reinforcing Prevention Messages in Post Partum Settings
The project has clearly documented that in-hospital education of parents about SBS and its prevention is viewed positively by those educated. Preliminary data from Dias and other researchers are indicating that parents can benefit further when key messages about SBS prevention are reinforced during the postpartum period when infant crying begins to increase and peak.
MCC secured private funds and developed a training tool to more effectively and more cost-efficiently reach thousands of parents and caregivers in the community. It has produced a narrated two-DVD set which includes: a 25-minute training for family-serving professionals or paraprofessionals working in community-based settings with parents/caregivers of infants and small children; and a 20- minute version for parents and a range of other caregivers.
These tools contain information about the dangers of SBS, the latest research information about infant crying as well as infant soothing information about traditional Western strategies, documented effective strategies from other cultures, and soothing techniques promoted by pediatrician Dr. Harvey Karp. It includes specific information about what parents and caregivers can do when soothing doesn't work and the crying is making them frustrated or angry. Finally, it helps parents understand how they can better protect their children when left in the care of others.
The narrated products are intended for a wide range of community organizations that can use the tool directly with their parent clients without having to invest in or securing and scheduling a trainer/presenter. By having an easily accessible and high quality tool, agencies will be supported in routinely educating the many parents and caregivers they serve, both individually and in group settings. While the stand-alone tool is intended to convey all the key prevention messages on its own, post-viewing discussions facilitated by agency professionals is encouraged so that after viewing, parents and caregivers can share their experiences and receive support.
The Hampden County SBS Prevention Task Force is working with MCC to distribute these tools through a variety of post partum community settings. Both the Central MA SBS Prevention Campaign and the Middlesex County SBS Prevention Task Force are also moving ahead to expand their education efforts beyond the hospitals and into the broader community.
By providing this continuum of support, we hope to increase the likelihood that parents and caregivers will be better supported to cope with their infant's crying or fussiness and thus less likely to jeopardize their child's safety by shaking.
The Third Inoculation - Public Education Activities
Reinforcing key prevention messages in the general community has been accomplished through a variety of strategies including: newspaper feature articles on SBS prevention, Op Editorials, regional television programs, local community cable TV programs, radio PSAs, press conferences, hospital program launching press events, and community fairs.
MCC has presented its work at several National North American Conferences on Shaken Baby Syndrome, National Prevent Child Abuse America Conferences on Child Abuse Prevention, at the Rhode Island Summit on Shaken Baby Syndrome, as well as other local conferences co-sponsored by MCC and District Attorney Offices. It sponsors with Kohl's and The Boston Parents' Paper the "Annual Stroll for Shaken Baby Prevention" which raises funds to support the organization's SBS prevention activities.