Research Impact

Using Data to Inform Action

Establishing Safe, Stable, and Nurturing Relationships & Environments is a CDC-funded initiative designed to create systems-level changes that will decrease child maltreatment. The results from the IPRC’s evaluations of this initiative have been used to inform practice, including the design of a social norms campaign implemented by Prevent Child Abuse NC. IPRC faculty also worked with the NC Office of the Chief Medical Examiner to create a case definition for child maltreatment deaths. This case definition was applied to ten years of medical examiner data & presented to the Intentional Death Committee of the NC Child Fatality Task Force.

OUR IMPACT ON POLICY AND PRACTICE

Translating Child Abuse and Neglect Research into Recommendations for Policy and Practice

One of the IPRC’s major achievements is Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a ground-breaking 20-year study of child maltreatment led by Dr. Des Runyan, resulting in more than 270 peer-reviewed publications. To ensure that these unique findings were translated into policy and practice, the IPRC undertook an extensive dissemination effort with funding support from the Doris Duke Charitable Foundation .

Meetings were held with key stakeholders in child maltreatment intervention and prevention, as well as policy makers at a Federal Congressional Briefing and other stakeholder groups such as the NC Child Fatality Task Force and the National Resource Center for Child Protective Services.

Enhanced Surveillance to Improve Estimates of Child Abuse and Neglect

IPRC researchers have led projects to integrate multiple data sources to provide a more accurate estimate of the incidence of child abuse and neglect in Alaska. Data sources include the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS), child protective services, police department, Child Advocacy Center, vital records, and child death review data, as well as an administrative data source to track out-of-state emigration.

In Wake County, North Carolina, child protective services, police department, and medical examiner data were linked to obtain rates of confirmed and possible child abuse and neglect. This project demonstrated to local agencies the importance of tracking both confirmed and possible cases to gain a more comprehensive understanding of the occurrence of child maltreatment in North Carolina.

A STATE-WIDE EVALUATION OF “PURPLE CRYING”

Research Informs Interventions to Prevent Abusive Head Trauma in Infants

IPRC researchers led a statewide evaluation of the Period of PURPLE Crying®, a parent education and media intervention designed to prevent abusive head trauma, or shaken baby syndrome, in infants. This study represented the largest intervention investigation of an abusive head trauma program coupled with a rigorous, comprehensive evaluation. Implementation of the Period of PURPLE Crying® in every birthing hospital in North Carolina and subsequent evaluation led to multiple publications in peer-reviewed journals and provided invaluable insights for future prevention efforts.

COLLABORATING WITH STATE AND COMMUNITY PARTNERS

Opioid Data to Action: A partnership with the North Carolina Division of Public Health

The goal of this CDC-funded partnership is to conduct surveillance and evaluation activities to inform opioid overdose prevention strategies implemented in North Carolina. The IPRC partners with the Injury and Violence Prevention Branch (IVPB) at the NC Department of Public Health (NC DPH) to identify research questions that can directly inform the ongoing development and evaluation of prevention efforts in North Carolina. Examples of this work include quantifying the risk of opioid overdose among formerly incarcerated individuals, evaluating the impact of naloxone distribution on opioid overdose deaths, and analyzing emergency medical services (EMS) data to examine EMS responses to opioid overdoses. Additionally, as state and community partners frequently consider innovative strategies to address the opioid crisis, the IPRC is well-positioned to respond to time sensitive inquiries from the IVPB regarding the utility of opioid overdose surveillance and prevention activities and provide critical analyses of the evidence regarding their effectiveness. The IPRC works closely with the IVPB to share results from this work to key stakeholders, as well as the broader NC community. The results of every surveillance, evaluation, and critical analysis project are summarized in a 2-3 page brief report that can be disseminated to individuals within NC DPH, NC Department of Health and Human Services, and the broader community. The IPRC also presents the results to individuals from state and community agencies, as well as at NC Opioid and Prescription Drug Abuse Advisory Committee meetings. Additionally, to reach an audience beyond NC, the IPRC presents results at academic and practitioner conferences, on webinars, and in academic journals. PI: Rebecca B. Naumann, PhD, MSPH  | Co-Is: Anna Austin, PhD, MPH; Shabbar Ranapurwala, PhD; Mike Fliss, PhD

EVALUATION OF NORTH CAROLINA’S MEDICAID “LOCK-IN” PROGRAM

Medicaid beneficiaries are a particularly high-risk population for prescription drug overdose, having prescription opioid overdose rates six times that of non-Medicaid beneficiaries. One strategy that nearly all states use in an attempt to reduce misuse of prescription drugs is the implementation of Medicaid “Lock-In” Programs. “Lock-in” Programs identify beneficiaries demonstrating potential overutilization of prescription opioids, as well as other controlled substances, and restrict their access to these drugs. Little research has examined the impact of these programs, leaving policymakers without comprehensive evidence to inform program design. Through a CDC-funded project, the IPRC conducted a unique linkage of NC Medicaid claims to the state’s Prescription Drug Monitoring Program to gain a more complete picture on all controlled substance prescriptions dispensed to Medicaid beneficiaries, regardless of payment source. Utilizing this innovative linked data source and advanced methods, the IPRC researchers have conducted several studies examining the impacts of the “Lock-In” program, notably finding that the program was associated with increased use of cash payment to obtain controlled substances. Results from these evaluation efforts have been shared widely with researchers and practitioners through publications and many other outreach activities via conferences and professional meetings with public health agencies. PI: Asheley Cockrell Skinner, PhD (now at Duke University)

Impact on TBI Programs and Interventions

The IPRC’s research sets the stage for educational and behavioral interventions to facilitate concussion disclosure and identification.

Drs. Register-Mihalik and Kerr are two of the first researchers to apply behavioral theory and public health models to understanding concussion disclosure and identification. Their work, published in journals ranging from Health Promotion and Practice to sports medicine journals such as the Journal of Athletic Training and the American Journal of Sports Medicine, is responsive to the 2013 Institute of Medicine Report on Youth Concussion, specifically Goal 6, which called for changing the culture concerning concussion safety in youth sport.

IMPACT ON INJURY SURVEILLANCE

Research to Action: IPRC’s research leads to improvements in Traumatic Brain Injury (TBI) surveillance in youth sports and informs future work

Through late 2010, IPRC and Department of Exercise and Sport Science researchers published an extensive set of papers addressing numerous aspects of sport-related traumatic brain injury across all levels of play — from youth to professional sports. This work was largely led by Drs. Kerr, Marshall, and Guskiewicz and included publications in JAMA Pediatrics, Pediatrics, and numerous publications in the American Journal of Sports Medicine, one of the most widely read practitioner-based journals in the field of sports medicine. In addition, this work emphasized the importance of and key strategies for collecting data among these vulnerable populations.

Research on building effective programs to protect young and vulnerable populations

The IPRC’s founding Director, Dr. Patricia F. Waller, was the original developer of the concept of graduated driver licensing systems (GDLS). In the 1970s, Dr. Waller drew on the background in three areas – psychology, highway safety, and public health – to argue that driving was a complex set of skills that needs to be learned in a structured and supervised manner. The concept of GDLS is now implemented in all 50 states and many countries. In collaboration with the UNC Highway Safety Research Center , the IPRC continues to advance the science of GDLS with research demonstrating both short- and long-term benefits of them (project leads: Scott V. Masten, PhD and Robert Foss, PhD); focusing on understanding the interplay between race and income level differences in GDLS (Project Lead: Yudan Wang, PhD and Arthur Goodwin, PhD); and supporting road safety work in Tribal communities (project lead: Carolyn Crump, PhD, MA).

USING DATA TO INFORM ACTION

Innovative Data Linkages to Advance Research on Risk Factors and Outcomes Associated with Crashes

The IPRC has supported several projects designed to fill gaps in the road injury-related evidence base through data linkages. Dr. Galica-Vladutiu conducted linkage of vital records to crash reports to further the field’s understanding of crashes and pregnancy outcomes, demonstrating considerable injury prevention benefits of belt use during pregnancy (Vladutiu et al., 2013; Vladutiu et al., 2014). Additionally, the IPRC has served as a key player in ongoing work to establish linkages between existing NC motor vehicle crash, emergency medical services, emergency department, trauma, hospital, and medical examiner data sources. Finally, as a core member of the Collaborative Sciences Center for Road Safety , a national University Transportation Center, the IPRC was actively involved in exploring data linkages that can advance understanding of major crash risk factors. Currently, IPRC leads work to support Vision Zero transportation safety efforts across NC, ensuring research is translated into action.

IPRC contact:  Rebecca B. Naumann, PhD, MSPH