2004-2008: The Period of PURPLE Crying® Implemented in Oregon
Ask Sandy Nipper, RN and SBS Prevention Program Coordinator for Legacy Emanuel Children’s Hospital, what this team’s biggest accomplishment of the year has been and she will tell you, “All five Legacy hospital birth centers are up and running with trained RN teachers, trained RN staff and regularly offered and well-attended discharge classes. The Period of PURPLE Crying® DVD/Booklet is being distributed to the parents of every newborn. There will be more than 7000 babies born here this year!”
Elements of these hospitals’ SBS prevention program are now integrated into their family-centered maternity services continuum of care. The Period of PURPLE Crying® message is being delivered and reinforced in the hospitals’ prenatal and discharge education classes, in the Guidebook for Pregnancy and Childbirth binder, in Lactation and Pediatric Clinics and in postpartum Baby and Me Groups at all five Legacy hospital sites.
What started out four years ago as the tragic tipping point of increased hospitalized SBS cases has resulted in a program that parents and nurses alike embrace as positive, pro-active, engaging, and up-to-date. The tabulation of overwhelmingly positive feedback taken from parent evaluation forms correlates with an overall increase in patient satisfaction scores when parents are asked to rate the quality of their hospital stay. Partial credit is being given to this new discharge education, sbs prevention program.
2004
By September of 2004, eight cases of shaken baby syndrome had been admitted to Legacy Emanuel Children’s Hospital (ECH), twice the number of any previous year. In response, an SBS prevention program feasibility study was undertaken by a system-wide, multidisciplinary task force of medical, nursing, social and child protection services providers and grant writing professionals.
The seeds for the work that would follow were planted years earlier by Dr. Leila Keltner and Debbie Kernan, Medical Director and Prevention Program Coordinator, respectively, of CARES NW, Child Abuse Response and Evaluation Services Northwest. Having worked in collaboration with Legacy since 1987, CARES NW’s community-based child abuse and neglect services include: Medical Evaluation of Child Maltreatment, Consultation and Training, Prevention of Child Maltreatment.
In the late 90s, after an eleven year-old babysitter became frustrated and shook an inconsolably crying infant, Dr. Keltner developed and launched an SBS prevention education program geared toward middle school and high school students.
Following the success of this program, Dr. Keltner and Debbie then broadened their education outreach to include the Directors of Legacy’s Women’s and Children’s Services. Having just returned from the 2002 Fourth National Conference on Shaken Baby Syndrome in Salt Lake City, they presented information about the pioneering hospital-based SBS prevention work of Dr. Mark Dias and about Dr. Ron Barr’s the Period of PURPLE Crying® research.
2005
Fast forward to February 2005. In response to the admission of the 8th shaken infant, CARES NW hosted a teleconference presented by Dr. Mark Dias and his RN Coordinators to a standing-room-only crowd of 40 Women’s and Children’s medical and nursing administrators and providers. They learned about the NY hospital-based model and together viewed the film “Portrait of Promise”. By the end of the program, Legacy’s clinical leadership’s support of the model was unanimous. The program promptly received generous grants from both Children’s Trust Fund of Oregon (CTFO) and Legacy Hospital Foundations to fund the research and development of a pilot.
To learn more about hospital-based programs, the Director of Women’s Services and the RN Mgr of the pilot birth center accompanied Sandy to Utah for hospital site visits and meetings with staff. They also met with the National Center on Shaken Baby Syndrome (NCSBS) staff, Executive Director Marilyn Barr, Dr. Ron Barr, Dr. David Corwin and Dr. Bruce Herman from Primary Children’s Hospital. They were shown the new Period of PURPLE Crying® DVD/Booklet which was undergoing research in randomized control trials.
The SBS prevention team credits much of the current program’s success to the research that this initial funding allowed them to do. Every aspect of the pilot was informed by what the team learned during this R&D year. Today, two and a half years into the program, the pilot design remains essentially unchanged.
2006
The birth center pilot program that launched in April was soon followed by two more hospital birth centers in June. In September, team members attended the NCSBS Conference in Park City, Utah where presentations on current research and emerging trends further supported and validated the team’s decisions about the program design. Another year of Foundation funding was awarded.
2007
Three sites were operational when in June, Oregon Representative Sara Gelser introduced SBS prevention legislation, HB3555, which would have required all hospitals (unfunded) to offer SBS prevention education to all parents of newborns. It passed unanimously in the House but timed-out in the Senate at the end of the 2007 session. Undeterred, Rep. Gelser convened a SBS Prevention Legislative Workgroup of state stakeholders to study the issue and make recommendations for the 2009 legislative session. Legacy and CARES NW MDs and RNs were invited to share their clinical expertise and program development experiences. To assess statewide interest, the Oregon Association of Hospitals and Health Systems (OAHHS) sponsored a webcast that showcased Legacy’s work, including the Period of PURPLE Crying® DVD. All its member-hospital RN Administrators were enthusiastic. Funding remained the challenge.
At Legacy, system-wide implementation finally came to fruition in the fall when three major developments paved the way for the last two hospitals to come on board: 1. The Period of PURPLE Crying® DVD/Booklet was released. 2. NCSBS agreed to exchange our 20,000 piece inventory of printed patient education materials for DVDs. 3. The annual mandatory Skills Day trainings for all 400 OB RNs included a 30 minute session on SBS and viewing of DVD/Booklet. RN support was now at an all time high! CTFO and Legacy Foundations renewed their grant support.
2008
On April Fool's Day, no joke, the team’s two most ambitious goals were reached: 1. Every family from every hospital was going home with the Period of PURPLE Crying® DVD/Booklet. 2. 80% of those families had both seen the DVD and received sbs prevention education at either a discharge class or in one to one education from an RN at the bedside! On to 90%!
The Legislative Workgroup adjourned in June when the state Department of Human Services and OAHHS agreed to lead efforts to fund, develop and pilot a voluntary hospital-based SBS prevention program. There is enthusiastic support for the statewide distribution of the Period of PURPLE Crying® DVD/Booklet. Legacy and CARES NW eagerly accepted their invitation to participate in this statewide replication effort.
It really does take a village. The Legacy team credits over one thousand individuals from local, state, national and international networks who contributed in some way between 2004 and 2008 to make this possible. Tens of thousands of Oregon babies will be safer as a result of their work.