TSCNewsletter:Child Passenger Initiative

Making Child Safety Seats Part of a Prescription for Good Health
A new initiative brings awareness of their correct use to hospitals and clinics.

The Child Passenger Safety Initiative is a pioneering program launched in summer 2001 that incorporates training and information about child passenger restraints into pediatric, pre/postnatal, and emergency services at seven California public hospitals' and health systems. These public hospitals and health systems serve a patient population that is predominantly low-income and minority. The two-year, $1.5 million effort is currently the subject of an evaluation by the University of California Berkeley Traffic Safety Center.

The Traffic Safety Center is working with UC Davis and The California Health Care Safety Net Institute to provide a "before" and "after" picture of the awareness and use of child safety restraints by the adult caregivers (including foster parents) who bring children to the participating hospitals and health systems.

The Safety Net Institute, an affiliate of the California Association of Public Hospitals and Health Systems, is implementing the program in collaboration with the University of California Davis Medical Center on the initiative funded by the California Office of Traffic Safety through the state’s Business, Transportation and Housing Agency. Institute director Wendy Jameson praised its unique approach.

“It’s the first large-scale effort in California that aims to integrate child passenger safety into health care services, particularly those health care services utilized by low-income, culturally diverse populations that have typically been left behind the injury prevention movement," she said.

86% of California's child passengers use safety restraints, which is a very high rate. However, this means that 16% are not riding safely. Moreover, it is far from certain that the safety restraints for those 86% are properly installed and appropriate for the child's size. In fact, early indications suggest a high rate of incorrect use, as detailed later in this story. Restraints are so effective in reducing deaths and injuries for children—reductions of 69% among infants and 47% among toddlers—that any incremental increase in use among the 14% that do not use them would have a large impact. And finally, there is a need to educate caregivers about California's new booster seat law that went into effect in July 2002 that requires children up to 6 years of age or 60 lbs. to use child safety restraints, including appropriately sized booster seats. Nationwide, the National Highway Traffic Safety Administration estimates that only 6% of children who would benefit from them ride in booster seats. (To read the article on booster seats, click here)

The goals and objectives of the two-year, $1.5 million initiative are to:

increase child safety-seat use among families using services at participating public hospitals and health systems;

decrease the rate of child safety-seat "misuse" among these families; and
increase awareness of the new child passenger safety law, SB 567, the “booster seat” law that requires child safety restraints for children up to age 6 or 60 pounds.

California's public hospitals and health systems treat a largely minority and low-income patient population. Seventy-six percent are minorities and nearly the same share, 70%, are low-income or uninsured. In 1999, public hostpitals treated some 3,000 children who had been injured in motor vehicle collisions.

Activities funded by the initiative include

· Training staff at each site to be certified by the National Highway Traffic Safety Administration as seatbelt technicians,

· Educating parents and caregivers about good child passenger safety practices,

· Distributing free and low-cost car seats,

· Offering child safety seat inspections, and

· Training physicians and nurses to teach patients about proper car seat use.

The grant also provides for a CPS coordinator at each site in order to thoroughly integrate child safety into hospital activities.

These efforts will result in hundreds of medical and social services staff, and thousands of caregivers, receiving education on the importance of child safety restraints and how to use them properly. In addition, hundreds of children will receive child safety seats and be properly fitted. The initiative will also develop protocols for child safety interventions that can be used to frame future programs. Another part of the program targets foster parents and child welfare employees about the legal requirements and safety needs of child passengers.

Child Passenger Safety: Part of Routine Health

“According to California law, hospitals are required to discuss child passenger safety with parents of children up to 6 years old or 60 lbs.,” Jameson reported. “Beyond the law, however, there is much that hospitals and health systems can do for patients and their families who may not have other opportunities to learn about child passenger safety. Integrating child passenger safety into the variety of contacts that families have with the health care system maximizes the opportunities for education. This requires staff training, making available to patients and their families the most up-to-date and appropriate child passenger safety educational materials, and establishing policies and procedures.”

The idea is to make child passenger safety advice and questions part of the routine health care experience. Jameson gives some examples: “Nursing assistants could ask what type of safety seat the child uses when they take the child’s weight and height. Pediatricians could emphasize the importance of using safety seats with their patients’ parents and refer the parents to watch a video on child passenger safety. Hospitals and clinics can provide parents with free or low-cost car seats or a referral to a county car seat program. Health educators could refer parents to car seat fitting stations where they can get their car seat checked for fit with the child and the car. Upon a newborn’s discharge from the hospital, staff who have been NHTSA-certified as child passenger safety technicians can help parents fit the newborn properly into the car seat and properly secure the car seat into the car.”

“Once the Office of Traffic Safety grant ends in June 2003, most of the seven participating hospitals will not have funding to maintain their child passenger safety coordinator position,” Jameson said. “However, by training staff, putting protocols and policies into place, obtaining good quality patient education materials, and establishing relationships with other organizations, the participating hospital systems will hopefully be able to continue integrating child passenger safety into their regular health care services.”

The California Health Care Safety Net Institute and the University of California Davis Medical Center have contracted with the Traffic Safety Center to evaluate the project's effect on parents' knowledge about restraint requirements for their children and how well they comply with them. The results will be used to develop a better understanding of which actions best promote proper use of child passenger restraints among underserved populations.

Some Striking Early Findings

A key component of the evaluation is a survey and data collection plan developed by the Traffic Safety Center in consultation with staff at each site, as well as SNI and UC Davis. Results from the initial survey will comprise the baseline data, which will be compared to results from a second survey of participants who have experienced the program.

The baseline study found the following:

· 81% of adults reported in interviews that they always use a child safety seat with their infants or toddlers (aged 0-4),

· 67% of children were observed using the restraint system appropriate for their age and weight,

· there was a high level of observed misuse of child safety seats due to improper securing of the child and the safety seat, including: safety seat not secured tightly enough to vehicle (69%), harness clip not at armpit level (62%) and harness strap not fitting tightly enough on the child (60%), and

· while knowledge of a new booster seat law was high (84%), parents' self-reported use of booster seats for children for whom they were appropriate was substantially lower (53.8%).

These early findings among California public hospital clients reinforce what the National Highway Traffic Safety Administration has observed nationwide among the general adult population: that there is a very high level of child safety seat misuse. They suggest an urgent need for programs to increase the number of caregivers who are using their children's restraint systems properly.

“It is hoped that the evaluation, lessons learned and the models developed in each of the seven health care systems will inspire other hospitals and health care systems to undertake child passenger safety education as well," Jameson said. “In addition, government agencies and other funders will be able to use the information gained from this effort in designing future initiatives. Finally, it is hoped that this initiative will produce valuable information for researchers and practitioners about unique approaches to addressing child passenger safety among low-income, culturally diverse populations.”

October 1, 2001 Press Release announcing the Child Passenger Safety Initiative (Word Doc.)

UC Berkeley Press Release on Pre-Intervention findings

http://www.carseat.org – SafetyBeltSafe USA provides a full range of child safety seat information, as well as information on federal motor vehicle safety standards and California legislation (in the ‘Laws & Regs’ section).

http://www.iihs.org/safety_facts/state_laws/restrain.htm – Insurance Institute for Highway Safety regularly updates this summary of states’ seatbelt and child restraint laws.

http://www.saferoads.org/issues/fs-child.htm – Advocates for Highway and Auto Safety’s section on child passenger safety contains good information on current booster seat laws and child passenger protection bills.

http://www.aap.org/family/carseatguide.htm – American Academy of Pediatrics’ child safety seat guide includes comparisons and specifications of seats.


Online newsletter Volume 1, Number 2: December 2002
Related Links: Checkups for Kids—and Their Car Seats A Contra Costa County prevention specialist talks about the Child Passenger Safety Initiative Pre-Intervention Assessment of the Initiative UC Berkeley Press Release on Pre-Intervention findings NHTSA's Child Safety Seat Inspection Station Locator Other stories this issue: Getting America to Buckle Up Seatbelts are still the best way to save lives Measuring Safety Measures A new toolkit for local agencies to evaluate their interventions The "Forgotten Child" Is Getting Some Attention at Last Booster seats now the law in some states An Interview with David Manning Administrator of NHTSA's Region 9 talks about improving occupant safety in California Theresa Becher on Traffic Safety in California An interview with the Interim Director of the Office of Traffic Safety Printable PDF version of this article Printable PDF of newsletter (789 KB) Send us your comments or email a letter to the editor Traffic Safety Center Home *Other issues of the TSC newsletter* Top of page	Making Child Safety Seats Part of a Prescription for Good Health A new initiative brings awareness of their correct use to hospitals and clinics. The Child Passenger Safety Initiative is a pioneering program launched in summer 2001 that incorporates training and information about child passenger restraints into pediatric, pre/postnatal, and emergency services at seven California public hospitals' and health systems. These public hospitals and health systems serve a patient population that is predominantly low-income and minority. The two-year, $1.5 million effort is currently the subject of an evaluation by the University of California Berkeley Traffic Safety Center. The Traffic Safety Center is working with UC Davis and The California Health Care Safety Net Institute to provide a "before" and "after" picture of the awareness and use of child safety restraints by the adult caregivers (including foster parents) who bring children to the participating hospitals and health systems. The Safety Net Institute, an affiliate of the California Association of Public Hospitals and Health Systems, is implementing the program in collaboration with the University of California Davis Medical Center on the initiative funded by the California Office of Traffic Safety through the state’s Business, Transportation and Housing Agency. Institute director Wendy Jameson praised its unique approach. “It’s the first large-scale effort in California that aims to integrate child passenger safety into health care services, particularly those health care services utilized by low-income, culturally diverse populations that have typically been left behind the injury prevention movement," she said. 86% of California's child passengers use safety restraints, which is a very high rate. However, this means that 16% are not riding safely. Moreover, it is far from certain that the safety restraints for those 86% are properly installed and appropriate for the child's size. In fact, early indications suggest a high rate of incorrect use, as detailed later in this story. Restraints are so effective in reducing deaths and injuries for children—reductions of 69% among infants and 47% among toddlers—that any incremental increase in use among the 14% that do not use them would have a large impact. And finally, there is a need to educate caregivers about California's new booster seat law that went into effect in July 2002 that requires children up to 6 years of age or 60 lbs. to use child safety restraints, including appropriately sized booster seats. Nationwide, the National Highway Traffic Safety Administration estimates that only 6% of children who would benefit from them ride in booster seats. (To read the article on booster seats, click here) The goals and objectives of the two-year, $1.5 million initiative are to: increase child safety-seat use among families using services at participating public hospitals and health systems; decrease the rate of child safety-seat "misuse" among these families; and increase awareness of the new child passenger safety law, SB 567, the “booster seat” law that requires child safety restraints for children up to age 6 or 60 pounds. California's public hospitals and health systems treat a largely minority and low-income patient population. Seventy-six percent are minorities and nearly the same share, 70%, are low-income or uninsured. In 1999, public hostpitals treated some 3,000 children who had been injured in motor vehicle collisions. Activities funded by the initiative include · Training staff at each site to be certified by the National Highway Traffic Safety Administration as seatbelt technicians, · Educating parents and caregivers about good child passenger safety practices, · Distributing free and low-cost car seats, · Offering child safety seat inspections, and · Training physicians and nurses to teach patients about proper car seat use. The grant also provides for a CPS coordinator at each site in order to thoroughly integrate child safety into hospital activities. These efforts will result in hundreds of medical and social services staff, and thousands of caregivers, receiving education on the importance of child safety restraints and how to use them properly. In addition, hundreds of children will receive child safety seats and be properly fitted. The initiative will also develop protocols for child safety interventions that can be used to frame future programs. Another part of the program targets foster parents and child welfare employees about the legal requirements and safety needs of child passengers. Child Passenger Safety: Part of Routine Health “According to California law, hospitals are required to discuss child passenger safety with parents of children up to 6 years old or 60 lbs.,” Jameson reported. “Beyond the law, however, there is much that hospitals and health systems can do for patients and their families who may not have other opportunities to learn about child passenger safety. Integrating child passenger safety into the variety of contacts that families have with the health care system maximizes the opportunities for education. This requires staff training, making available to patients and their families the most up-to-date and appropriate child passenger safety educational materials, and establishing policies and procedures.” The idea is to make child passenger safety advice and questions part of the routine health care experience. Jameson gives some examples: “Nursing assistants could ask what type of safety seat the child uses when they take the child’s weight and height. Pediatricians could emphasize the importance of using safety seats with their patients’ parents and refer the parents to watch a video on child passenger safety. Hospitals and clinics can provide parents with free or low-cost car seats or a referral to a county car seat program. Health educators could refer parents to car seat fitting stations where they can get their car seat checked for fit with the child and the car. Upon a newborn’s discharge from the hospital, staff who have been NHTSA-certified as child passenger safety technicians can help parents fit the newborn properly into the car seat and properly secure the car seat into the car.” “Once the Office of Traffic Safety grant ends in June 2003, most of the seven participating hospitals will not have funding to maintain their child passenger safety coordinator position,” Jameson said. “However, by training staff, putting protocols and policies into place, obtaining good quality patient education materials, and establishing relationships with other organizations, the participating hospital systems will hopefully be able to continue integrating child passenger safety into their regular health care services.” The California Health Care Safety Net Institute and the University of California Davis Medical Center have contracted with the Traffic Safety Center to evaluate the project's effect on parents' knowledge about restraint requirements for their children and how well they comply with them. The results will be used to develop a better understanding of which actions best promote proper use of child passenger restraints among underserved populations. Some Striking Early Findings A key component of the evaluation is a survey and data collection plan developed by the Traffic Safety Center in consultation with staff at each site, as well as SNI and UC Davis. Results from the initial survey will comprise the baseline data, which will be compared to results from a second survey of participants who have experienced the program. The baseline study found the following: · 81% of adults reported in interviews that they always use a child safety seat with their infants or toddlers (aged 0-4), · 67% of children were observed using the restraint system appropriate for their age and weight, · there was a high level of observed misuse of child safety seats due to improper securing of the child and the safety seat, including: safety seat not secured tightly enough to vehicle (69%), harness clip not at armpit level (62%) and harness strap not fitting tightly enough on the child (60%), and · while knowledge of a new booster seat law was high (84%), parents' self-reported use of booster seats for children for whom they were appropriate was substantially lower (53.8%). These early findings among California public hospital clients reinforce what the National Highway Traffic Safety Administration has observed nationwide among the general adult population: that there is a very high level of child safety seat misuse. They suggest an urgent need for programs to increase the number of caregivers who are using their children's restraint systems properly. “It is hoped that the evaluation, lessons learned and the models developed in each of the seven health care systems will inspire other hospitals and health care systems to undertake child passenger safety education as well," Jameson said. “In addition, government agencies and other funders will be able to use the information gained from this effort in designing future initiatives. Finally, it is hoped that this initiative will produce valuable information for researchers and practitioners about unique approaches to addressing child passenger safety among low-income, culturally diverse populations.” Related Links: Pre-Intervention Assessment of the Initiative October 1, 2001 Press Release announcing the Child Passenger Safety Initiative (Word Doc.) UC Berkeley Press Release on Pre-Intervention findings http://www.carseat.org – SafetyBeltSafe USA provides a full range of child safety seat information, as well as information on federal motor vehicle safety standards and California legislation (in the ‘Laws & Regs’ section). http://www.iihs.org/safety_facts/state_laws/restrain.htm – Insurance Institute for Highway Safety regularly updates this summary of states’ seatbelt and child restraint laws. http://www.saferoads.org/issues/fs-child.htm – Advocates for Highway and Auto Safety’s section on child passenger safety contains good information on current booster seat laws and child passenger protection bills. http://www.aap.org/family/carseatguide.htm – American Academy of Pediatrics’ child safety seat guide includes comparisons and specifications of seats. 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