1. Presented to the 2010-11 Maternal and Child Health Interprofessional Course: Exposing Infant Mortality: High Hopes in Baby Steps University of Maryland School of Social Work January 8, 2011 Richard P. Barth, PhD, MSW Professor and Dean

2. The Conundrum of Multiply Determined Problems If there are many reasons for a problem what is the basis for picking any reason to address Effective: the determinant has been addressed elsewhere with results Convenient: Protocols and resources are available Scalable: The approach can build to something more broadly beneficial Also reduce morbidity Also assist families with older children

3. Brief Introduction To … Safe Haven Laws & Campaigns (giving parents a penalty-free chance to relinquish their children) Purple Crying (getting commitment not to shake your child) Birth Match (assuming a longer term family perspective to child safety) Alternative/Differential Response (voluntary child welfare services)

5. Safe Haven Laws II How many days do you have in Maryland to surrender your baby? What should the number be? How many places are “safe haven” safe for surrenders What other places should be? Are there limitations regarding who can surrender (must it be the mother or father)? Is that optimal? What partnerships do we need to have to improve Safe Haven implementation?

6. Period of PURPLE Crying® Peaks: Crying peaks at two to three months of age and ends at four to five months. Unexpected: Crying is often unexpected. Resists soothing: Infants may be resistant to soothing. Pain-like Face: Infants may appear to be in pain. Long-lasting: The crying is usually long-lasting. Evening: Crying occurs most frequently in the evening.

7. Purple Crying II North Carolina is committed to reaching every parent, relative, and friend of the parents with a newborn Nurses and doctors at 86 hospitals in NC are showing the DVC (about shaken baby syndrome and alternative soothing techniques) Commitment not to shake a baby Media campaign follow up at post-natal visits Is there enough evidence to justify this expense? What partnerships would we need to implement a Purple Crying campaign

8. Birth Match I New birth certificates are matched against DSS (child welfare) records indicating that parent had previously experienced “termination of parental rights” (determined by the courts based on clear and convincing evidence that the parent cannot safely care for the child.) If a child is born to a mother who has previously been shown to have a TPR within 5 years, the LDSS will visit the child in order to assess whether the child’s current situation is safe or whether a report to CWS should be made Maryland is among national leaders… should it go farther?

9. Birth Match II Should new births to parents who have children in foster care (even if they have not had a TPR) become the basis for a match and investigation? (NYC) Should new births to fathers who have had TPRs or who have had violent felonies or who are sex offenders be matched and reported for investigation? (Michigan) Should there be a presumption that the newborn would not stay in the home unless there is administrative review at a high level (NYC, MI) What partnerships are needed to generate improvements in Birth Match implementation?

10. Alternative/Differential Response Children referred to CWS are, typically, sent down one of three paths: (1) no services; (2) court ordered in –home services; (3) court ordered foster care Many states are implementing an “alternative response” which is a voluntary program of in- home services for less serious cases Maryland has tried to implement this for the last 4 years with no success (authorized by the legislature but not funded by DHR)

11. Alternative/Differential Response II Children who are referred to CWS are at elevated risk of death before age 5 Children evaluated out (i.e., they received no ongoing services) were fatally injured at 2.5 times (adjusted) the rate of unreported children One-third of all children who died from intentional injuries had prior CWS involvement Who do we need to involve to see that Maryland’s families have a chance to receive additional services? Source: Emily Putnam-Hornstein, PhD., MSW. (2010). Do “Accidents” Happen? An Examination of Injury Mortality Among Maltreated Children. Berkeley, CA: University of California, School of Social Welfare.

12. Summary Many interventions are not strongly evidence-based But prototypes for them do exist and Partnerships are needed if we are going to achieve hoped for implementation and outcomes Interprofessional education will certainly help you identify a range of options and partnerships. YOU ARE ON THE WAY TO MAKING A BIG DIFFERENCE FOR A FEW AND, POTENTIALLY, FOR MANY GOOD LUCK!