Forest County Potawatomi Car Seat Safety Program

Summary

Impact Statement:

The tribal health department used QI to increase the number of parents using car child seats correctly from 30 to 65% using new dramatic visual presentations and enhanced car safety seat installation demonstrations. This will save children’s lives and reduce auto related injuries.

Summary:

The Forest County Potawatomi (FCP) Community Health Department has offered a Car Seat Safety Program in alignment with the Child Safety Restraints, Booster Seats, and Safety Belt Requirement, 2005 Wisconsin Act 106 since its enactment in June 2006. This law requires parents to use a progression of three car safety seats (rear-facing, forward-facing, and booster) for children who are 8 years or younger, 40 to 80 pounds, and no taller than 4’9”.

The program offers free car safety seats to FCP tribal members and offers personalized education through videos, hands-on demonstrations, and consultations. The program has experienced high participation rates over the years; however, informal data have suggested that tribal parents are not using distributed car safety seats properly, despite receiving education when meeting with FCP child passenger safety technicians.

Recent data have identified high rates of unintentional injuries, specifically traffic-related incidents, among the FCP tribe. Car seat safety is a critical component of protecting children on the roadways; therefore, the FCP Community Health Department thought it was necessary to examine the current Car Seat Safety Program to determine effectiveness and areas of improvement.

Organization that conducted the QI initiative:

FCP Health & Wellness Center Community Health Department

Citation:

Kuber, K. Public Health Quality Improvement Exchange. Forest County Potawatomi Car Seat Safety Program. Wed, 10/09/2013 - 13:39. Available at https://www.phqix.org/content/forest-county-potawatomi-car-seat-safety-program. Accessed September 14, 2024.

Background and Aim

Aim statement:

The FCP Community Health Department Car Seat Safety Program will increase the percentage of tribal members who properly use distributed child passenger safety seats by 10%.

Need For The QI Initiative:

When collecting data for the FCP community health assessment, the FCP Community Health Department noted that motor vehicle-related injuries were the third most common injury among tribal members. The health department reviewed the current programs available in the FCP community that address motor vehicle safety. The health department identified the Car Seat Safety Program as being the main program that addresses this issue. Although this program is one of the most popular programs and is considered to be one of the most successful, FCP Community Health Department realized that it never took the time to study the program's actual effectiveness. The health department has always tracked car safety seat distribution rates but has never followed up with families to ensure that they are still using their car safety seats properly, months or even years later. The health department's child passenger safety technicians also noticed an increase in the number of families not using car seats or using them improperly. With the lack of data and recent observations, the health department staff thought it was important to study whether the education that it is providing is effective and whether it has staying power with program participants.

Area for Improvement:

According to the Centers for Disease Control and Prevention (CDC), motor vehicle injuries are the leading cause of death among children in the United States; however, many of these deaths can be prevented. Placing children in age- and size-appropriate car safety seats and booster seats reduces serious and fatal injuries by more than half. In 2009, 1,314 children aged 14 years or younger died as occupants in motor vehicle crashes, and approximately 179,000 children were injured in the United States. One study conducted by CDC found that, in 1 year, more than 618,000 children aged 12 years or younger rode in vehicles without the use of a car safety seat, booster seat, or seat belt at least some of the time. Other than obtaining basic injury surveillance data for the FCP community, the FCP Community Health Department has never collected tribal-specific data related to car safety seat use. Motor vehicle injuries are the third most common injury in the FCP community. The FCP Community Health Department thought it was important to study car safety seat usage in the community and to determine ways that it can improve the current program. Please see the attached FCP Tribal Member Injury Surveillance bar graph.

Root Cause:

The most common reason for not using a car safety seat or using one improperly was “personal choice.” This reason indicated that FCP Community Health Department needed to provide education in a more effective way, so a greater number of tribal members see the value and importance of car safety seats.

Planning and Execution Details

QI Implementation:

FCP Community Health Department used a check sheet to track car safety seat use in the community. The check sheet included information about the following topics: • improper and proper car safety seat use, • reasons for not properly restraining the child, and • what was wrong with the installation of the car safety seat. After collecting baseline data, the health department staff realized how few tribal members were actually using car safety seats, and if they were using them, how few were using them correctly. Out of the 23 observations that were conducted, only 30% (7) of the children were properly restrained in a car safety seat. The most common reason provided for not using car safety seats properly was "personal choice." The health department determined that it needs to provide education more directly and effectively, so people value car safety seats and see their importance. FCP Community Health Department identified crash test dummy videos as an option to enhance the message of the importance of car safety seats. Using a visualization of what can happen to children when they are not in a car safety seat or not properly restrained can be eye-opening for viewers. The health department tested various crash test dummy videos that were shown at the Car Seat and Bike Safety Event on May 21, 2013. Along with showing videos, the health department also provided car safety seat installation demonstrations, a car seat height bar, and mock accident demonstrations with car safety seats and infant mannequins. These education strategies appeared to be successful. The visual and hands-on components appeared to be effective in getting the message across. The videos also caused more of a reaction from participants; many did not realize that older children still need to be in a car safety seat. Other participants were also surprised by how violent accidents can be if a child is not properly restrained. Constructive conversations occurred between parents and children during the videos and mock accident demonstrations. Because this trial was successful, the health department decided to incorporate crash test dummy videos in its current Car Seat Safety Program and to plan on incorporating mock accident demonstrations in the future. Crash test dummy videos have been added to the current Car Seat Safety Program curriculum. Every time clients pick up a car safety seat, they are shown crash test dummy videos and a basic car safety seat installation instructional video that pertains to the car safety seat that is appropriate for their child’s age, height, and weight. This change was implemented after the event on May 21, 2013. The results of the initiative were as follows: • At the Car Seat and Bike Safety Event on May 21, 2013, 33 participants were exposed to the quality improvement (QI) initiative. • Since the implemented change to the Car Seat Safety Program, 16 car safety seats have been given out.

Focus activities

Data collection, Epidemiology and Surveillance:

Injury

Population-based Primary Prevention :

Injury

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

QI Tool Documentation:

FCP Car Safety Seat Flow Chart 2013.xlsx

FCP Observational Survey Template.docx

PDSA Car Seat Safety 8.27.13.docx

Initiative Dates:

2/1/13

Initiative Duration:

Between 6-12 months

Methods of evaluation:

FCP Community Health Department conducted a second round of observational surveys using the check sheet tool and analyzed data to identify improvements in proper car safety seat use.

Supplemental Materials:

Sample of materials produced

Report

Supplemental Files:

Attachment	Size
NNPHI COPPHI Car Seat Grant Data 2012-2013.xlsx	134.88 KB
NNPHI COPPHI Car Seat Workgroup Min 3.21.13.doc	1.12 MB

Results

Measurable QI Outcomes:

Aim statement: The FCP Community Health Department Car Seat Safety Program will increase the percentage of tribal members who properly use distributed child passenger safety seats by 10%. After the first round of observational surveys (baseline data), the health department found that only 30% of the clients surveyed were using the car safety seats correctly. The common reason for using a car safety seat improperly or not using a car safety seat at all was “personal choice.” The health department used a Pareto chart to illustrate the significance of addressing this reason. The health department used brainstorming techniques to identify educational methods that would affect clients' decision making and increase the likelihood that they would use a car safety seat correctly. The health department identified crash test dummy videos as a possible option because of their extreme graphics and realistic consequences. This change was tested at the Car Seat and Bike Safety Event and appeared to be effective with the participants. The health department adopted this change and decided to implement it throughout the Car Seat Safety Program. A second round of observational surveys was completed with the same individuals from the first series of observations. The number of clients who used a car safety seat correctly increased by 65%, which indicated that the change that was tested was effective.

Other QI Outcomes:

After FCP Community Health Department collected baseline data, it made changes to the structure of the educational portion of the program. It updated the program policy by requiring clients who are receiving a car safety seat to view the appropriate segment of the car safety seat video and crash test dummy video clips.

Lessons Learned, Observations and Insights:

During the grant period, FCP Community Health Department learned the importance of having staff buy-in from the ground up and including staff who are involved in the program during the initial planning stages. The health department realized the importance of comparing and analyzing similar data. The health department was also made aware of the importance of ensuring consistency with how data are collected to decrease variations in the data collection process. The health department experienced challenges with the sample size for the second round of observational studies. Some factors that may have added to the improved outcomes may have been that clients were made aware that the health department was scheduling car safety seat surveys and was monitoring whether car safety seats were used correctly.

Future Plans:

Child passenger safety technicians will continue to conduct quarterly observational surveys to ensure that the education that they are providing to clients is maintaining its effectiveness. If proper use rate decreases, additional QI studies will be implemented. FCP Community Health Department will complete at least one QI study annually. It will also be developing a tailored QI plan and performance management plan.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Submission Status:

Completed

Comments

Good QI measure. We will take

Good QI measure. We will take lessons learned and improve our own program.

Using data collected from the

Using data collected from the Community Health Assessment provided an opportunity to study one of the more popular and successful programs offered by the Tribal Health Department. Which in turn led to an improvement in the proper installation and use of car seats. Good example of pre and post improvement data collection and analysis to confirm the change made resulted in an improvement.

Very compelling interventions

Very compelling interventions were applied to increase the proper use of child safety seat -- thanks for sharing your successful solutions!

Forest County Potawatomi Car Seat Safety Program

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

Good QI measure. We will take

Using data collected from the

Very compelling interventions

QI Spotlight

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Forest County Potawatomi Car Seat Safety Program

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

QI Spotlight