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Child accident prevention - everybody's business

Anne Lewis
BNurs RGN HVCert DNCert PGCert(ProfPract)
Health Visitor
Preston PCT

A child accident prevention and safety scheme (CAPS), an innovative multiagency approach to accident prevention, has been established in Preston, a city where nearly half of the electoral wards feature in the top 10% disadvantaged wards nationally.(1) The scheme aims to reduce childhood accidents by raising awareness of accident prevention using monthly safety messages disseminated by a variety of methods.
The scheme fulfils both local and national targets to reduce death and injury from preventable accidents, particularly among children.(2,3) By adopting a family- centred public health approach,(3) the scheme supports government policy drivers aimed at developing new ways of working in partnership and collaboration with others outside the primary healthcare team.(4,5)

Why accident prevention?

  • In the next 12 months over 400 children and young people will be killed in accidents.(6)
  • In 2000, there were 320,283 road accident casualties in the UK; 16,184 were child pedestrians.(7)
  • More children die each year from accidents than any childhood illness, while accidental injury is the leading cause of child death in the UK.(6)
  • Accidental injury costs the NHS £2.2 billion per year. The estimated cost to society of home ­accidents in 1996 in the UK was £25 billion.(7)

Policy context
The policy context and priorities for healthcare in support of accidental injury prevention are strong. In 1999 the government set national targets to reduce the rates of death and serious injury from accidents by 2010, and announced that a taskforce would be set up to advise on how these targets should be achieved.
A more integrated approach with effective coordination and strong leadership of specific injury prevention programmes at all levels is needed. Reducing accidental injuries will also impact on wider government programmes aimed at reducing social exclusion and other health inequalities. Priority populations for immediate action are children and young adults. Headline interventions include measures to improve home safety, road safety, cycle safety and use of cycle helmets, to reduce house fires, and to strengthen risk and safety education in schools.(7) Focusing on improving life chances for children and reducing health inequalities and preventable deaths among the most disadvantaged are echoed in other government policies.(8,9) Successful interventions involve finding mechanisms that enable organisations to work together, ensuring dialogue, contact and commitment, that empower frontline staff and that engage users and communities.(10,11)

Public health approach
A public health approach means developing services based on the needs of a population and working in partnership to address health inequalities and support community participation.(12)
All available data were considered, both local and national statistics, which enabled identification and targeting of those most in need. Information from the local accident and emergency department, the fire department and the police was collected. Local knowledge from health-visiting teams and data from the annual caseload profile were used. The CAPS programme is delivered at all levels: individuals, families, communities and schools adopting an integrated approach across all agencies. A key feature is the importance of working in partnership with other statutory and voluntary organisations and the public. Partner agencies from both voluntary and statutory sectors are involved.
CAPS recognises that a multidisciplinary approach is vital. Each agency is valued for the different skills and expertise they can contribute to the scheme. A core group of community nurses lead and drive the programme, while a multidisciplinary, interagency forum plans and monitors the the scheme to promote a collaborative approach to accident prevention.
Empowering communities and accessing and using existing community groups (eg, childsplay, parent and toddler groups, local community associations, Sure Start programmes and libraries) to raise awareness and promote action is vital to success.

Practical aspects of the scheme
As a result of our research into common childhood accidents both locally and nationally, 12 key areas where children are particularly vulnerable to accidents were identified. These areas were developed into monthly themes, the theme being matched where appropriate to the month in which the accident is most likely to occur. Safety messages and first-aid advice were then related to each theme. The scheme involves:

  • The production of an accident prevention calendar illustrated by local primary school children and distributed to a cohort of preschool children.
  • The production of posters and postcards illustrating the same themes each month, which are distributed to all partners for display in public places.
  • The collation and organisation of the publication of articles relating to the same monthly safety topic in local newspapers, community newsletters and school-distributed publications.
  • The production of teaching and assembly packs relating to the monthly theme for use in ­participating schools across Preston.
  • The coordination of regular multiagency meetings to monitor and evaluate the process and promote joint working and the sharing of ideas.
  • The planning and delivery of an annual "Safety Town" for participating primary schools, in collaboration with multiagency partners and users.
  • Delivery of messages and awareness-raising at community events in the city, such as health mela (galas organised by ethnic groups), Sure Start events and galas with local community groups.

Evaluation
An audit tool, for use at routine 2- and 3-year developmental assessments, has been developed that gives information about:

  • The number of children involved in accidents.
  • The types of accident.
  • Knowledge base of carers - around safety, ­prevention and first-aid issues associated with the scheme's safety topics.

The collation of accident data already available from the local hospital, the annual health visitor caseload profile and partner agencies will further inform the evaluation process. A qualitative method of data collection and evaluation, to focus on user feelings and the experiences and views of the schools and other partners, is in progress.

Challenges and lessons learnt

Engaging partners
A group of interested, motivated, enthusiastic and committed people is vital. It does take enormous effort so these qualities are essential. An effective team approach with a true sense of sharing and humour are necessary.

Communication and collaboration
Agreement and understanding of common vision, values and responsibilities is essential. This involves recognising and valuing the roles, skills and expertise of others, accepting role limitations and boundaries and sharing appropriately and equitably. Establishing these issues formally and explicitly at the start of the venture is recommended.

Time
Be realistic; do not underestimate the enormous time commitment involved. It should be incorporated into the project at the start.

Coordination and administration
This is vital to the smooth running of the scheme and is enormously time-consuming. Build into the plan  provision for a clearly defined coordinator/administrator from the start. It will reduce frustration, role overlap and communication difficulties, and also avoid inappropriate use of clinician time.

Funding
Funding is another hugely time-consuming aspect that requires specific skills. If it is necessary to bid for funding for your project, be sure to take expert advice or, better still, get the experts to make the applications on your behalf, advised by the relevant clinicians.

Successful bid
CAPS made a successful bid to Lancashire Children's Fund and secured a substantial sum of money to maintain and develop the scheme over a 3-year period. This created the need to develop a business plan and a service level agreement and new levels of accountability and responsibility.
The funding has enabled growth and expansion of the scheme. This includes the appointment of a project manager to coordinate and facilitate; increased media coverage; a major public health event staged in a city- centre location that involved multiagency collaboration; and a multiagency training event. 

References

  1. North West Lancashire Health Authority. Annual report on the health of the population 2000.
  2. Department of Health. The NHS plan. London: TSO; 2000.
  3. DH. Saving lives: our healthier nation. London: TSO; 1999.
  4. DH. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and health care. London: TSO; 1999.
  5. DH. The new NHS, modern and dependable. London: TSO; 1997.
  6. CAPT. Fact-sheets. Accessed at www.capt.org.uk. 12/03.
  7. DH. Preventing accidental injury ­- priorities for action. London: TSO; 2002.
  8. DH. Modernising health and social services. National priorities ­guidelines. London: TSO; 2002.
  9. DH. Tackling health ­inequalities: a programme for action. London: TSO; 2003.
  10. DH. Shifting the balance of power. London: TSO; 2001
  11. DH. Liberating the talents. Helping PCTs and nurses deliver the NHS plan. London: TSO; 2002.
  12. DH. Health visitor practice development resource pack. London: TSO; 2001.

Resources
Child safety
W:www.childsafety.co.uk
Preston CAPS
W:www.prestoncaps.co.uk
Royal Society for the Prevention of Accidents
W:www.rospa.com