States in Action

Suicide
Wisconsin’s Plan to Reduce Suicide
Suicide in Wisconsin: Impact and Response

Suicide is a significant public health issue in Wisconsin. The suicide rate in Wisconsinexternal icon increased by 40% from 2000-2017. In September 2020, Wisconsin (WI) released Suicide in Wisconsin: Impact and Response pdf icon[PDF – 96 pages]external icon. The two-part report includes state data and the state’s prevention plan. The data provide insight about the people and populations in WI who experience self-harm injuries, as well as suicidal thoughts, behaviors, deaths, and associated risk factors. The report then presents a comprehensive approach to reduce suicide attempts and deaths in WI. i

The plan consists of four strategies:

  1. Increase and enhance protective factors
  2. Increase access to care for at-risk populations
  3. Implement best practices for prevention in health care
  4. Improve surveillance of suicide and evaluation of prevention programs.

WI’s Core State Violence and Injury Prevention Program (SVIPP)external icon anticipates this report will be used by local health departments and partners from multiple sectors to inform suicide prevention grants and program and policy development.  

WI Core SVIPP and Partners Join Together to Address Suicide Prevention Statewide

WI Core SVIPP led a planning group with the WI Division of Public Health, Division of Care and Treatment Services; other sister state agencies, an academic injury research center, other state partners and advocates to develop a joint surveillance and prevention report. The report included data and guidance for suicide prevention for people of all ages, with specific recommendations to prevent adolescent suicide and self-harm The SVIPP epidemiologist and the WI Violent Death Reporting System coordinator collaborated with the Medical College of Wisconsin/Comprehensive Injury Centerexternal icon for the report’s surveillance data.

This was the first time WI’s Core SVIPP led partners with topical expertise in risk and protective factors all working together towards a combined report highlighting both the burden and prevention resources. The effort involved approximately 20 months of meetings, data review, prevention research review, and consensus-building among the planning group. The group gathered input from professional colleagues and advocates during the report development.

i Prevent Suicide Wisconsin. Suicide in Wisconsin: Impact and Response. September, 2020.

Adverse Childhood Experiences and TBI

New York Creates Momentum for Change with Adverse Childhood Experiences Data

Adverse Childhood Experiences (ACEs) Are a Public Health Concern

ACEs are potentially traumatic events experienced by children under 18 years old. These events can have negative and lasting effects on health and well-being. They are linked to chronic health problems, mental illness, and substance misuse.

New York (NY) state had limited information on the burden of ACEs among its population and relied on national information and studies to drive its work. NY added questions regarding ACEs to its annual population health survey, the Behavioral Risk Factor Surveillance System (BRFSS) pdf icon[PDF – 26 pages]external icon. NY State Department of Health (DOH) surveyed more than 9,000 people over age 18. In NY, 6 out of 10 survey respondents (59%) reported experiencing at least one ACE, and 22% reported 3 or more ACEs. According to NY BRFSS, the higher the number of ACEs experienced, the higher the risk for unintentional and intentional injuries, negative health risk behaviors, and health conditions such as obesity, depression, suicide, and chronic obstructive pulmonary disease.

Core Program Data Expertise Critical to the State

The NY Core State Violence and Injury Prevention Program (SVIPP), housed within the DOH, analyzed and presented the survey data. During the analysis, NY Core SVIPP partnered with other programs within the DOH and other state agencies to create the BRFSS ACEs workgroup. NY Core SVIPP staff members provided subject matter expertise to interpret the data in meaningful ways, and they recommended ACEs-related interventions for use throughout the state.

Five action steps are recommended: pdf icon[PDF – 26 pages]external icon

  1. Facilitate cross-sectoral engagement in developing, implementing, and evaluating the action plan
  2. Offer technical support on best practices to prevent, reduce, and respond to ACEs
  3. Support alignment of actions to address ACEs
  4. Strengthen capacity for training and communications
  5. Collect data and information on ACEs and resilience periodically

Key Findings from State ACEs Report

For the first time, NY had state-based ACEs data to inform local action. The state’s ACEs report, Understanding and Responding to Adverse Childhood Experiences in New York State pdf icon[PDF – 26 pages]external icon, was published online in June of 2018. Key findings were that experiencing three or more ACEs was higher among those who identified as lesbian, gay, bisexual, or transgender, those who had not graduated from college or technical school, and those with annual household incomes lower than $15,000. ACEs scores were lowest among adults 65 and older. ACEs were lower among men than women.

Participants who reported three or more ACEs were:

  • Six times more likely to report being depressed
  • Four times more likely to report HIV risk behaviors, including drug use
  • Three times more likely to have arthritis or be current smokers
  • Two times more likely to be obese, have asthma, or report binge drinking

These findings were reported in more than 14 presentations at local, regional, and national conferences. This report increased internal collaboration between the DOH Office of Public Health Practice and Opioid Overdose Prevention Program. The latter program hosted a conference called, “Integrating Adverse Childhood Experiences Science to Address Substance Use Disorders.” The conference brought together more than 120 people from state agencies, local health departments, and local offices for mental health. Attendees learned about the role ACEs can play in substance use disorder treatment and prevention.   In addition, state agencies and non-profits used the data to apply for grants to conduct trauma-informed care and resiliency training.

NY Core SVIPP is working with partners through its Injury Community Implementation Group to support the efforts of local health departments and advocacy groups in using the report findings to prevent and address ACEs. Currently, NY Core SVIPP is collaborating with Prevent Child Abuse New York to develop a three-part training curriculum to change the service delivery of prevention services for child abuse and neglect. The curriculum will build and strengthen leaders at the community level.

Preventing ACEs and strengthening resilience are among the new statewide goals in the 2019-2024 Prevention Agenda,external icon the state health improvement plan.  As required by public health law, local health departments and non-profit hospitals in the state, in collaboration with community partners, must submit community health improvement plans that are aligned with the Prevention Agenda goals. The 2019-2021 local plans were submitted in December 2019.

Minnesota Evaluates Abusive Head Injury Education in Hospitals

Abusive Head Injuries Are a Leading Cause of Child Abuse Deaths in the United States.

Abusive head trauma (AHT), also known as shaken baby syndrome, is caused by violent shaking and/or with blunt impact. This causes damage to the brain and blood vessels as the brain repeatedly hits the skull. Nearly all victims of AHT suffer serious, long-term health consequences, such as vision problems, developmental delays, physical disabilities, and hearing loss. At least one of every four babies who experience AHT dies from this form of child abuse.

Core Program Implements Evidence-Base Approach to Address AHT

Dr. Mark S. Dias, a pediatric neurosurgeon, founded The New York Shaken Baby Prevention Project in 1998. The project educated parents of infants born in hospitals in Western New York about the dangers of violent infant shaking. Parents were taught about AHT in the hospital before being released to go home. This initiative reduced AHT injuries by 47% in Western New York. This became the foundation for implementing and evaluating this approach in Minnesota.

The Minnesota Core State Violence and Injury Prevention Program (Core SVIPP) partnered with the Brain Injury Interagency Leadership Council who developed a survey about AHT education. Hospital administrators at all birthing centers in the state completed the electronic survey, which asked if the hospital provided AHT education. The survey also asked if a signed statement was involved after the education was provided and if not, whether the hospital would be willing to incorporate one into its routine. The signed statement ensures parents viewed the video and understood the content. In addition, a sample of mothers who had recently delivered a baby at one of Minnesota’s birthing hospitals was asked about their experiences in receiving AHT education through a survey. Parents completed the parent survey at home.

Survey Highlights Gaps in AHT Education

The survey results provided interesting insight into implementation of the statuteexternal icon:

  • 95% of hospitals in Minnesota reported having a video or program about AHT available for viewing by parents of newborns.
  • 67% of mothers reported education about AHT had been offered while in the hospital.
  • 57% reported a video being available and 40% reported viewing the video.

Minnesota hospitals may have the video available, but it may not always be offered. From the parent survey, most mothers responded that education about this topic is important, but 48% felt the hospital was not the right place to view the video/program. The survey showed mothers feel the video/program should be offered multiple times, including while they are pregnant and after their babies are born. To address the survey results, Minnesota Core staff are working with hospitals to encourage all parents of newborns to view the video or attend a program. They are also working with healthcare providers who care for pregnant women to address this topic at prenatal visits. Minnesota hospitals that reported not having a video or program available were contacted, informed of the statute, and provided references to available resources.

Mapping Problem Hot Spots Makes Colorado Schools Safer

What is the problem?

One in five Colorado high school students report being bullied at school, and almost one in 10 have been physically hurt by a dating partner according to Colorado’s Youth Risk Behavioral Surveillance System. Five percent of high school students report that they have missed school because they felt unsafe at school or on the way to school. Colorado youth who identify as female, gay, bisexual, questioning, or transgender experience more violence than their peers. Bullying, youth substance abuse, mental health, sexual harassment, and violence have been shown to have potentially far-reaching impacts in young people’s lives. School climate – including social norms as well as the environment and school building — has been shown to influence these health outcomes.

What did the Colorado Core SVIPP do?

Colorado high school students and community members collaborated with Colorado’s Core State Violence and Injury Prevention Program (Core SVIPP) program, and the eight community Rape Prevention and Education (RPE) programs to implement the Shifting Boundaries – Building Component in schools and communities across Colorado to create safer spaces and build connections. Together, the collaborators identified safe and unsafe spaces in eight high school buildings, mapped the unsafe areas, and recommended community-level strategies to improve safety in the defined environments. The youth representatives presented their recommended strategies to the key stakeholders responsible for implementing community-level strategies to improve safety.

Colorado’s Core SVIPP funding supported infrastructure, training, and technical assistance to RPE-funded grantees to implement hot spot mapping. In addition, Core SVIPP funding supported evaluation of the hot spot mapping strategy by assessing the impact of both the process of engaging youth to identify problem areas, and assessing impact of the selected strategy on a variety of violence outcomes.

What was the outcome?

The collaborators engaged other local partners to fix problem areas such as installing permanent privacy walls in locker rooms for students, moving the girls’ locker rooms to ensure greater privacy among students, and increasing adult presence in shared spaces such as hallways.

Because of the Shifting Boundaries-Building Component collaboration, RPE-funded programs have strengthened partnerships with young people, school administrators, and community members. They have successfully integrated this strategy into existing school programming (i.e. healthy relationship curricula and social norms campaigns) and community initiatives, such as Communities That Care.  Communities That Care is a program that promotes health youth development, improves youth outcomes and reduces problem behaviors.

Colorado’s Core SVIPP is collecting outcome data to evaluate their mapping and follow up strategies. Outcomes of interest include decreased cultural norms that support aggression as measured by the percentage of students reporting they carry a weapon to school; increased connection and commitment to school; and number of grantees reporting increased number of connections with community partners  participating in the process (for increased community support and connectedness).

Colorado’s Core SVIPP  are tracking and measuring long term outcomes on teen dating violence including: decreased percentage of adolescents reporting someone they were dating physically hurt them on purpose in the last 12 months and decreased percentage of adolescents reporting they have ever been forced to have sexual intercourse.

Enhancing Child Safety Seat Education through Ohio Buckles Buckeyes (OBB) Program

What is the problem?

Motor vehicle injury is a leading cause of death for children across the nation. From 2012 to 2015, motor vehicle crashes remained the leading cause of injury deaths for Ohio children ages 5 to 9 and third-leading cause for ages 1 to 4. From 2012-2016, 44 Ohio children under eight were killed as occupants in motor vehicle traffic crashes.

What did Ohio Core SVIPP do?

The Ohio Core SVIPP recognized the need for child safety seat distribution and installation education.  They supported the creation of the Ohio Buckles Buckeye (OBB) program and established local child safety seat distribution and education sites for low income families in every Ohio county.  Regional coordinators held car seat safety events and over 3,546 car seats were checked.  Ohio is collecting data about the number of car seats that were installed correctly and incorrectly from program sites and data will be available in 2019.

What was the outcome?

In six months, Ohio provided low-income families in 88 counties access to 2,640 car seats along with education on proper installation and usage. The state trained 92 new car safety seat technicians and leveraged funds from partners to increase sustainability of the program. For example, because of the OBB accomplishments, the Ohio Department of Health received $227,891 from the Ohio Highway Safety Fund to purchase car seats from July 2017 through January 2018, and will continue this program.  The National Highway Transportation Safety Administration (NHTSA) provided funding from The Child Highway Safety Fund to purchase child safety seats for the state’s 88 OBB Programs for low-income families.

Oklahoma Fighting Infant Mortality

What is the problem?

Oklahoma has one of the highest infant mortality rates in the country. Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of a child. AHT is most common in children under age five, with children under one year of age at most risk. Many people are unaware of the increased period of crying in early infancy (the Period of PURPLE Cryingexternal icon) leaving uninformed caregivers stressed, overwhelmed, and unprepared to cope.

What did the Oklahoma Core SVIPP do?

The Oklahoma State Health Department used the news media to connect with individuals to solve a real problem in their state: infant mortality. They released a statewide news release describing The Period of PURPLE Crying and CLICK for Babiesexternal icon. The Period of PURPLE Crying is an evidence-based educational program designed to help parents understand their baby’s crying and that their child is normal and healthy despite potentially crying for hours. This program is delivered in birthing hospitals in Oklahoma and includes two videos, a booklet, and bedside education on normal crying patterns, how to cope with relentless crying, and the importance of never shaking a baby.

Click for Babies is a public education campaign collecting handmade purple baby caps to give new parents along with educational materials. CLICK for Babies supports implementation of The Period of PURPLE Crying by raising funds and awareness not just in the state, but the Injury Prevention community at large on the topic of abusive head trauma prevention.  The caps are given to newborns in local hospitals to increase awareness and educate families about the Period of Purple Crying to prevent shaken and abusive head trauma of infants. The news release included a call to individuals who knit or crochet to donate purple baby caps. The new release was picked up in national and international news and social media.

What was the outcome?

The news release’s call to action was met with an overwhelming response and the topic of abusive head trauma prevention went viral in traditional news media sources and social media. The Oklahoma Health Department received an unprecedented number of donations. In total, 69,914 purple baby caps were received from 2,876 donors.  Donations came from 41 states and territories including the District of Columbia Puerto Rico and other Caribbean islands, and multiple countries across Central America, South America, Africa, Asia, Europe, and Australia. The program received enough caps to meet their original goal sixteen times over and supplied 82% of the states’ birthing hospitals. Oklahoma’s The Period of PURPLE Crying tapped into a sizable community of knitters internationally to help prevent abusive head trauma in infants. The work done by the state captured the hearts of a global community, encouraged life-saving conversations, and likely helped provide safer homes to babies born in Oklahoma.

Wisconsin Uses Triple P Program to Prevent Child Abuse

What is the problem?

In 2010 it was estimated that there were 2.7 million minor children with an incarcerated parentpdf iconexternal icon in the United States and that at least 10 million children have experienced parental incarcerationpdf iconexternal icon.  When released from incarceration, women are at higher risk of returning to jail if they lose custody of their children. Adverse childhood experiences are potentially traumatic experiences or events that can have negative, lasting effects on health and well-being.  Having a parent who is in jail is an adverse childhood experience that places children at higher risk for a broad range of poor social, emotional, and physical health outcomes including injury and violence.

What did the Wisconsin Core SVIPP do?

The state of Wisconsin partnered with their state Child Abuse and Neglect Prevention Board to address child abuse and neglect and reducing returns to jail among formerly incarcerated mothers.  They pilot tested parenting skills classes for women in a re-entry facility (The Benedict Center in Milwaukee) who plan to return to their families and regain custody of their children when they are released from re-entry program. The Triple P Positive Parenting Program provides classes to build positive parenting skills and increase family support and connectedness. These are shared protective factors that increase families’ resilience to multiple forms of violence, including child abuse and neglect and suicidal behavior, and decrease rates of parents losing custodial rights of their children.

What was the outcome?

This pilot intervention focused on strengthening parenting skills among women in the process of being released from incarceration in order to reduce child abuse and neglect and loss of custody of their children. In the longer term, this program will potentially reduce Adverse Childhood Experiences by decreasing not only child abuse and neglect, but also recidivism and re-incarceration among these mothers. Triple P parenting education is not typically delivered in incarcerated settings. The short-term outcome of the pilot project was the establishment of a relationship between the service provider, the re-entry facility, and the department of corrections – where no relationship existed prior.  Incarcerated and soon-to-be released women have an interest in parenting education and support classes, and several departments of correction and county detention facilities have been willing to allow service providers access to female inmates to provide the Triple P parenting classes.  There are multiple locations supporting the delivery of Triple P classes in incarcerated settings in Wisconsin. Triple P International and regional staff are interested in the model and are working with providers to adjust the training guidelines. Triple P International is also interested in chairing a national work group to pursue the revision/adaptation of the Triple P parenting classes.

Motor Vehicle Safety

Arizona Increases Access to Child Passenger Safety Technicians in Tribal Communities

What is the problem?

American Indian and Alaska Native (AI/AN) children 0 to 12 years old have the highest traffic death rate of all racial/ethnic groups in the United States.  Though AI/AN child safety and booster seat use rates vary greatly, AI/AN use rates are much lower than that of other racial groups. In a study of six Northwest tribes, proper restraint use among AI/AN children aged 7 years and younger ranged from 23% to 79%. In 2015, proper restraint use among children aged 0 to 7 years ranged from 63% to 87%.  Using age and size appropriate car seats, booster seats, and seat belts significantly reduce the risk of injury and death among children in a crash.

What did the Arizona Core SVIPP do?

The Arizona Core State Violence and Injury Prevention Program (Core SVIPP) program provided a car seat technician training at the Salt River Pima-Maricopa Indian Community. They trained 20 new car seat technicians to administer the Children are Priceless Passengers (CAPP) class and conduct car seat inspections. This program educates the public on the effectiveness of proper use of child safety seats to reduce infant and toddler deaths and injuries. Nationally certified child safety seat technicians must teach each class. Core SVIPP staff coordinated the training and fostered a strong partnership with the Indian Health Service (IHS) to ensure community engagement. The lead instructor for the course was from IHS and trained previously through Core SVIPP.  Arizona’s Core SVIPP also leveraged funds to purchase car seats and stepped in when funding was cut to the IHS Tribal Injury Prevention Cooperative Agreement Program grants to continue funding the passenger safety outreach.

 What was the outcome?

Since becoming certified Child Passenger Safety (CPS) certified, instructors have held seven car seat compliance checkpoints trainings.  There have been 20 curbside checkpoints where 247 car seats were inspected for their tribal communities.  Currently, the CAPP Program has expanded to nine locations throughout the state.  The CAPP Program has been recognized both nationally and statewide as a model community partnership program.

Kentucky Targets Motor Vehicle Crash Hot Spots for Education and Enforcement

What is the problem?

Kentucky’s seat belt rate is lower than the national average.  In 2016, over half of those who died in motor vehicle crashes on Kentucky roads were not wearing their seatbelts at the time of death. Motor vehicle crashes affect crash victims, their families, friends, communities, first responders, medical personnel, and taxpayers.  Enforcing existing laws can increase seatbelt use. Seat belt use can prevent motor vehicle crash injuries, minimize injury trauma, save lives, and decrease emergency and medical costs.

What did the Kentucky Core SVIPP do?

The Kentucky Office of Highway Safety (KOHS) and the Kentucky Violence and Injury Prevention Program (KVIPP) created a motor vehicle risk index hot spot map. It mapped motor vehicle collisions, human factors, fatalities, emergency department visits, and hospitalizations by county of residence. They identified ten counties with poor motor vehicle safety outcomes to target seat belt education and enforcement efforts.

Together with the Kentucky Safety and Prevention Alignment Network (KSPAN), KOHS and KVIPP implemented the Local Heroes campaign in the targeted high-risk rural counties. It ran during the national Click It Or Ticket campaign, a highly visible enforcement seatbelt campaign. The Local Heroes campaign spotlights well-known law enforcement in a local, community setting as the face of the campaign to encourage seatbelt use and increase connection between officers and their communities. Local officers participated in video, digital, and print public service announcements. The KOHS also used the hot spots map to target seat belt enforcement projects in the high-risk areas.

 What was the outcome?

After the first year of the Local Heroes campaign, more drivers in the high-risk rural counties were observed wearing seat belts, and more citations were written by law enforcement.

The partnership between KOHS and KVIPP increased the number of pickup truck drivers wearing seat belts in high-risk counties in Kentucky by 0.6%. In addition, Kentucky’s overall seatbelt use percentage increased 0.3%. The collaboration between transportation and public health enables Kentucky to refine their education and enforcement efforts, and prioritize their efforts in high-risk counties.

Massachusetts: Infusing Injury into the State Highway Strategic Plan

What is the problem?

Motor vehicle crashes are a leading cause of death and disability across the life span in Massachusetts. They are also a leading cause of traumatic brain injury and share common risk and protective factors, such as substance use and misuse, with other injury and violence outcomes.

What did the Massachusetts Core SVIPP do?

The Massachusetts Department of Public Health was renewing the state highway strategic plan. This plan typically focuses on roadway design and engineering, and less on public health or behavior. The Injury Prevention and Control Director assessed the agenda and assigned a member from the Division of Violence and Injury Prevention to each emphasis area based on known overlap between programs and risk and protective factors linked to motor vehicle crashes.

Additionally, Core SVIPP staff took on the role of coordinating two emphasis areas: Young Drivers and Impaired Driving.. Core SVIPP staff worked to assure the public health voice was well represented and continues to be heard during the state highway strategic plan process. They identified areas that needed their involvement by using an overarching risk and protective factor approach for motor vehicle.  The staff attended meetings, provided data, reviewed behavior and behavior change strategies, and provided context to additional programs, services, and gaps in the Commonwealth that would have otherwise been missed.

What was the outcome?

The State Highway Strategic Plan was launched on October 30, 2018.  Core SVIPP staff members, and other injury and violence prevention practitioners within the Department of Public Health have identified new partners, learned about existing programs, and identified gaps. Further, the public health approach and data available about motor vehicle crashes are now better understood among state agencies involved in this process.

Nebraska: Graduated Drivers Licensing (GDL) Educational Card for Teens

What is the problem?

Motor vehicle crashes are the leading cause of death for Nebraska teens. Graduated Drivers Licensing (GDL) was first implemented in Nebraska in 1998 with additional changes to strengthen the law in 2008. Nebraska’s GDL provisions work to reduce a teen’s exposure to high risk situations in order to reduce their involvement in a crash.  Nebraska’s GDL allows new drivers time to develop critical driving skills under low risk conditions while reducing those things that cause greater risk. Nebraska teen crashes have been reduced by at least 60% since the implementation of the GDL law in 1998.

What did the Nebraska Core SVIPP do?

The Nebraska Department of Health and Human Services Injury Prevention program created, tested, and distributed a Graduated Driver Licensing (GDL) education card for parents and teens. The card contains information about important elements of the GDL law. It highlights laws against teen drivers using cell phones, driving under the influence of alcohol, and engaging in nighttime driving from midnight to 6 am unless the teen driver is going to or from school activities or work. The card also explains limitations on the number and age of passengers that teen drivers are allowed to transport and a requirement that all occupants riding with a GDL permit holder must wear a seat belt.  The GDL card has shown to increase parent and teen knowledge about GDL driving restrictions, leading to better enforcement of the law by parents and better compliance by teens.

What was the outcome?

Nebraska Core SVIPP conducted an evaluation of a pilot program that distributed education cards to schools. Responses demonstrated the card increased both parent and teen knowledge of GDL, with over 70% of parents and 80% of teens responding “agree” or “strongly agree” to their willingness to use a parent-teen driving agreement.  The GDL card encourages parent-teen driving agreements. For parents and teens not using a parent-teen driving agreement, 79% indicated willingness to use one after receiving the GDL card.  The educational card was disseminated throughout the state in 2018.