In some of the states that have adopted prevention legislation, the legislature has included provision for monitoring the effectiveness of prevention education. Massachusetts and Ohio come readily to mind.



In addition, the CDC has funded statewide prevention programs in Pennsylvania and North Carolina. Presumably, those efforts will also include efforts to assess the effectiveness of the program being implemented.



It seems that one common result of greater awareness is an increase in the number of cases being identified and reported. Absent perspective on the difficulties in identification and diagnosis, as well as the factors that affect reporting in the absence of a coherent effort to collect reliable statistics, it may seem that prevention efforts lead to an increase in inflicted head injuries.



Another issue is developing a consensus on incidence. Some of the epidemological studies that have estimated SBS incidence did so by examining patient histories. Apart from the difficulties in identifying inflicted head injuries from charts, those studies only included certain age ranges: none reviewed charts of children over three years of age, and one only looked at infants.



It would be useful if the variety of evaluation programs getting under way would collaborate on developing a standard methodology so that fewer issues of consistency result.