Legacy Health System - Oregon & Washington

Hospital-Based (HB) SBS Prevention Programs Profiles
"Sharing our Stories"

Hospital/Hospital System Name: Legacy Health System
Address: 4 hosps in OR, 1 in WA
Web: www.legacyhealth.org

Contact Person Name: Sandy Nipper, RN
Title: SBS Prev Program Coord
Address (include internal address/mail stop #): Emanuel Hospital 2801 N. Gantenbein Ave EH 2080 Portland, OR 97227
Office Phone: 503.413.4443
Mobile Phone:
Fax: 503.413.4443
Email: snipper@lhs.org

1. "Once Upon a Time..." - How, when, why you got started?

2002 - CARES NW (a 3-hospital collaborative child abuse and neglect response/prevention team) attended NCSBS Conf, heard about the Dias program, lobbied the concept to Legacy Directors of Women's and Children's Services for two years. CARES NW had been doing SBS prevention community outreach for years. No hospital based prev programs in state.
2004 - Tipping point: Legacy Children's Hospital SBS admissions doubled in one year, from 4 to 8. Hosp Admins approved feasibility study. Our Foundation funded a 0.2 FTE RN SBS Prev Coord position to explore costs, grant funding opps and various designs of Dias-like programs.
2005 - Concept presented by Dias MD/RN staff via teleconference with 40 Women's and Children's MDs, RN Administration/Clinical Leadership. Scope of exploratory project increased with a grant from Page 2 our Children's Trust Fund. Creation of a 14 member, multidisciplinary SBS Prev Task Force to continue R&D (comprised of MDs, NPs, RNs, LCSWs, Foundation rep, prenatal ed rep). Hospital SBS programs site visit trip to Salt Lake City, Utah and visited 4 hospital sites. Met with NCSBS SBS Prev Coord and staff, Barrs, Drs Corwin and Hermann.
2006 - Pilot design created and launched at 1 hospital. Legacy Administration approves system-wide roll out...initiated in the fall. 2 more hosps launch.
2007 - System-wide roll out continues as remaining 2 hospitals gear up.

2. Program Overview -

  • Research project? No
  • Who teaches?
    One RN from a team of all-volunteer birth center RNs teaches a daily 1-hr discharge class to a group of parents.
  • Who taught - moms, dads, g'parents? Aimed at moms and dads, but g'parents, sibs, signif others, anyone is welcome.
  • Where taught - in pt's room, classroom, prenatal class, MD office?
    Taught in a family birth center classroom. This room does double-duty as an overflow pt. room as needed. All equipment is portable and can be easily removed. Class is offered in the nursery on those days, rarely needed.
  • What taught - content?
    "Fourth Trimester Survival Skills" is the title of a one-hour class that has three 20-minute segments:
    1.) Mom Care and Dad/Partner Job Description,
    2.) (SBS Prevention) "Have a Plan for the Period of PURPLE Crying" Crying tape, discussion of reasons baby's cry and effect of crying on caregivers, esp, inconsolable crying, Portrait video viewing, PURPLE Crying presentation, Have a Plan video viewing, signing of certificate.
    3.) Baby Care (when to call MD) and Safety (car seats, safe sleep, SIDS prev)
  • How taught - timing, content, method?
    Short interactive didactic segments interspersed with flashcard activities, flipchart displays, video viewings. Close with a poem and short eval form.
  • Audiovisuals?
    1.) Classroom copies of our "Guidebooks to Pregnancy and Childbirth" binders that all expectant families receive from OB providers in early pregnancy. These contain detailed pregnancy, birth, breastfeeding, baby care/safety content that is designed to complement and reinforce classroom content.
    2.) Crying audiotape/CD
    3.) Video: Portrait of Promise 8 min version
    4.) Video: Have a Plan
    5.) Paper flipchart - outlines most impt "take aways" from class content
  • Handouts?
    1.) PURPLE Crying trifold brochure,
    2.) Crying Card,
    3.) Three Things All Dads Should Know trifold brochure,
    4.) NCSBS (Keeping My Baby Safe) glossy certificate
  • Posters? PURPLE Crying posters
  • Program Evaluation tools, measures, timing?
    Everyone signs in. Parents fill out very short written eval form at end of class. The sign-in sheet and these evals provide the program stats we track: most impt for our grant is % families that get to class. Goal: 80%.
  • Follow up - timing and method?
    Team of RNs make 15min. postpartum phone call to every family within 4-5 days of birth. Our plan, not yet implemented, is to do a phone survey at 3 months re value, recall, effectiveness of class.

3. Your Hospital/Hospital System - and where SBS prevention education included?

  • States - how many and which states? 2 states: OR, WA
  • # Hospitals - 5; 4 in OR, 1 in WA
  • # Family Birth Centers - 5
  • # Annual Births 7500 in 5 hospitals
  • # NICUs - # Annual Admissions - 2, OR NICU has 400/y. WA NICU is new...no good stats yet.
  • # ED's - 5, one in each hosp
  • # PICU's 1: 1 in OR
  • # Trauma Centers - 1 in OR
  • Prenatal Ed Program? - Yes. 12,000 classes, tours, postpartum discussion group attendees/year.
  • Lactation Program? - Yes, staff of Lactation Consultants at 5 sites avail 6 days/wk for clinic visit or phone consultation.
  • Postpartum Clinics - None. One planned for our WA site.
  • Postpartum Support Groups/Classes? -Yes, offered at 5 sites for babies/toddlers, 0-18 mos. and their parents, usually mom. Facilitated by an RN or LC.
  • RN Answer Lines - Pediatric Answer Line service avail by paid subscription for Pediatricians in Oregon and SW Washington.
  • Prenatal Family Education binder or other publication? -Yes, 100 page, 1" three ring binder covers pregnancy, childbirth, breastfeeding and baby care/safety, community resources. Given to families by OB in 1st trimester.

3a. Training/Inservicing methods, currics, frequency, numbers?

  • In-house medical staff OB, Peds, Emergency, Trauma -
    Peds Director of Newborn Nurseries/Peds Hospitalist and Director of Peds Clinics are members of task force. SBS Coord presents to Newborn Nursery and NICU Collab Practice team meetings, comprised of MD and RN clinical leadership. Upcoming: MD/RN co-presenting Neonatal Grand Rounds on SBS, informal brown bag lunch presentations to our child protection team, presenter at Pediatric Head Trauma Symposium. 2007: ED medical staff.
  • In-house nursing staff - OB, Peds, Emergency, Trauma -
    Team of volunteer RN teachers attend 4 hour trng then co-teach with expert RN teacher. Trained RN teachers then in-services their staffs. SBS Coord updates OB RN staff at staff meetings. A 15 min selflearning module re SBS prevention is scheduled to go online to become a required RN competency for all OB RN staff. 2007: In servicing of other RN areas.
  • Community/public health activity -
    SBS prevention message is integrated into prenatal ed baby care classes. Prenatal ed staff was been inserviced at one of their staff meetings. SBS Prev materials are distributed in postpartum mother-baby discussion groups.
  • Community outreach to medical networks - Not yet. 2007 Goal.

4. Complementary or competing org, local, state, national initiatives?

To leverage limited resources, we tried to find ALREADY existing org, local, state, national initiatives that might be in strategic alignment with goals and objectives of the SBS Prev project. What was already going on with hospital quality improvement, Child Abuse and Neglect (CAN) prev, child safety that might lend importance and momentum?

Org: CARES NW already very active in Portland Metro medical community doing both SBS 101 presentations and SBS prev education with youth. Org: CARES kept Women's and Children's Services Administration informed of SBS prevention initiatives, legislation nationally. Org: Pt satisfaction surveys are asking for more postpartum mom-care and baby-care information. They want to be better prepared for the "reality shock" of those first few months at home with baby.
Org: Same surveys are requesting improvements in continuity and consistency of health information being shared with families by multidisciplinary provider team.
Org: Maternity family education binder was scheduled to be completely revised.
Org: Renewed focus on the definition of and imptce of Patient/Family Centered Care.
Org: SBS rate doubled from previous year from 4 to 8. Child maltreatment admissions increasing.

State: Statewide SBS surveillance data project launched by DHS, funded by CDC.
State: Timing of Children's Trust Fund 2-year grant cycle.
State: A hospital-based prevention program on this scale didn't yet exist in our state.
State: WA is home to Harborview Period of PURPLE Crying research.
National: Increasing numbers of state are passing legislation mandating SBS prev education in the hospital.
National: Hospitals' quality and pt satisfaction survey results will be publicly reported in 2007.
National: Increasing body of evidence that shows dramatic correlation between the quality of early childhood experiences and life-long mental, emotional, physical health and well being. National: Growing problem of child abuse and neglect

5. Funding - Past, present, future?

feasibility study.
2005-6: An additional 2-year Children's Trust Fund of Oregon grant, another Legacy Foundation grant plus matching funds from Legacy's Women's and Children's Services expanded research capability, increased Coord FTEs to 0.3, and funded development and launch of a pilot at one hospital, then systemwide roll-out.
2007: Applying for additional Foundation and CTFO funding to ensure we hold the gain and to enable participation in statewide replication efforts.

6. SBS Prev Program Administration

  • Where in organization - Trauma, Peds, OB, etc?
    Joint oversight by Legacy's Women's and Children's Services.
  • Coordinator Position - who, # FTEs?
    Perinatal RN with clinical, teaching, program development/coord background. 0.3 FTEs. Currently lobbying hard for more hours!

7. Financial or Collaborative Partners Org, Local, State, National, International?

Financial: Grants from our Foundation, Children's Trust Fund of OR, matching funds from Women's and Children's Services.
Collaborative: CARES NW, our internal multidisciplinary task force, Dave Corwin, MD, NCSBS staff, Barrs, Dias' NY "Buffalo Gals", Oregon DHS, Buzzy Ito from McKay Dee Hospital in Utah, Carol Jenkins from Seattle Children's Child Protection Program.

8. In Your State/s

  • Other hospital based SBS Prev and/or CAN Prev, Injury Prev programs, initiatives in your state? We don't know of any in OR. WA: Period of PURPLE Crying research ongoing.
  • Legislation Our Governor proclaimed an SBS Awareness Week in April, 2006. No legislation.
  • Children's Trust Fund activity - www.ctfo.org OR CTF is very committed and actively supports and funds SBS prevention programs in the community and in the hospital.
  • Media coverage - So far, one feature article in The Oregonian, state newspaper, which was picked up by AP and reported in other local OR papers.

9. How would you rate the support of your hosp or hosp system's Medical, Nursing, Social Service Administrators, Managers, patient care staff?

Very high because we were fortunate enough to have had funding for a yearlong feasibility study done by a multidisciplinary task force. High, too, because of our new CEO and his new organizational strategic goals into which this new child injury prevention project fits so well.

10. SBS Surveillance Data

  • Hospital data 2004: 8, 2005: 2, 2006: 8
  • State data - Official data not yet released.

11. Greatest obstacles?

So much to do, so little time! Could use funding for more FTE's. Program momentum is straining resources.
Coming up with a program design that: RNs would buy into, parents would like, is budget-neutral, is effective, would work at all 5 hospital sites.

12. Greatest successes?

As clueless as we were in the beginning, it all came together on time, on budget and so far so good...knock on wood!
New appreciation for how each task force member fits into the whole perinatal healthcare continuum, which we each contribute something unique and valuable to the families we all serve and that multidisciplinary communication is essential.
Discovery that we have many opportunities to "inoculate" our expectant families in our system with the SBS prevention message.

13. Anything else you'd like to share about your SBS Prevention Program Story?

We learned early on that one size does not fit all, and what works magically for one hospital may not suit another. Hospitals, hospital systems and the families they serve are all so different and unique that a cookie cutter approach to program design would not ensure our success.
We didn't know how lucky we were to get a year to research the issue and study how others developed their programs. Whatever had been written about SBS and SBS prevention, we read it. We did site visits. We participated in teleconferences. We called and emailed dozens of program coordinators. We attended conferences.
Finally, from our "menu" of choices for each program element, we picked what we thought best for the staff and the families we serve. So far, so good, and we continue to learn and the program will grow and develop for as long as it's in place.
With a strong enough commitment to the well being of children and families, you almost can't go wrong! Goethe writes: "Until one is committed, there is hesitancy, the chance to draw back.
Concerning all acts of initiative and creation, there is one elementary truth the ignorance of which kills countless ideas and splendid plans: that the moment one definitely commits oneself, then Providence moves too.
All sorts of things occur to help one that would never otherwise have occurred.
A whole stream of events issues from the decision, raising in one's favor all manner of unforeseen incidents and meetings and material assistance, which no man could have dreamed would have come his way.
Whatever you can do, or dream you can do, begin it. Boldness has genius, power and magic in it. Begin it now."

14. Anything else you'd like to know about other HB programs?

Whether you're just starting out or you're a veteran, this hospital program network holds promise for us all! Legacy wouldn't have the program we have today without learning about the work of everyone who went before us. We were energized, inspired, and so encouraged by the generosity, dedication and compassion of this community of child and family advocates. Thanks to each and every one of you who was there for us!

15. Electronically accessible brochures, h/o's, materials?

Nothing's published or available online yet, but I can email sample documents if you're interested.