Shaken Baby Syndrome: A Comparison of Two Parent Education Programs

PURPOSE: Shaken Baby Syndrome (SBS) is a severe form of child maltreatment and the leading cause of death among infants who are victims of abuse (American Academy of Pediatrics, 2001). When an infant is forcefully shaken, he/she typically sustains a unique constellation of injuries that result in high rates of morbidity and mortality. There are approximately 1,300 reported cases of SBS per year in the United States, but research suggests that the true incidence may be as much as 150 times higher than reported rates (Theodore, Chang, Runyan, Hunter, Bangdiwala, & Agans, 2005). The detection and diagnoses of SBS is often difficult, making efforts toward preventing this form of child maltreatment all the more important. Parent education programs are the most prominent type of SBS prevention activity. There are only two evidence-based SBS parent education models: the Dias model and The Period of PURPLE Crying (Dias, Smith, deGuehery, Mazur, Li, & Shaffer, 2005; Barr et al., 2009a). Both models were created and evaluated as primary prevention strategies. This study evaluated the effectiveness of the Dias model and PURPLE model as secondary prevention strategies.

METHODS: The study took place within a network of intensive home visiting programs for first time mothers who screened as at-risk for child maltreatment. Sixteen of 44 home visiting programs agreed to participate; they were randomly assigned to an intervention model. New mothers were recruited between October 2008 and October 2009. A total of 126 mothers were enrolled in the study; 96 completed both pre-test and post-test. The study used an alternative treatment experimental design. Framing theory was used as the conceptual basis for understanding the differential framing effects of the two models. The models were evaluated for effectiveness across four dependent variables: crying knowledge, SBS knowledge, behavioral responses to infant crying, and sharing information with other caregivers. The research instrument was modified from one previously created to evaluate the effectiveness of the PURPLE program and has been validated in two prior studies (Barr et al., 2009a; Barr et al., 2009b). Data analyses included t-tests, multiple regression, and descriptive statistics.

RESULTS: Outcome data suggest statistically significant improvements in crying knowledge, behavioral responses to infant crying, and sharing information with other caregivers among subjects in the PURPLE model group; subjects in the Dias model group showed no significant improvement on these variables. An unanticipated finding was that both groups showed a high baseline knowledge of SBS. Additionally, comparison of this study's PURPLE group to previous research with primary population studies reflects similar knowledge and behavioral outcomes between studies, although the demographic features of the research populations are dramatically different.

IMPLICATIONS: In this first attempt at comparing these two parent education models within a secondary risk group, findings indicate a likelihood that the PURPLE model is the more effective SBS prevention strategy for this population. Knowledge of SBS is important to social work practitioners in disability, child welfare, and protective services settings. This study provides practitioners with basic information about SBS, as well as findings about intervention effectiveness.