SafeStart Ballarat Report - Department of Health, Victoria

Report of

Ballarat SafeStart

Demonstration Project

September 2002 – April 2004

Report of

Ballarat SafeStart

Demonstration Project

September 2002 – April 2004

This report was written by Deborah Greenslade

SafeStart Project Worker for the City of Ballarat

BALLARAT SAFESTART DEMONSTRATION PROJECT

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ACKNOWLEDGEMENTS In mid 2002 a reference group was established to guide the writing of the submissions for SafeStart and Best Start. When Ballarat was successful in obtaining the SafeStart pilot funding, the SafeStart/Best Start Reference group continued to met on a monthly basis to receive progress reports and offer support and guidance to the project worker. The SafeStart project worker wishes to express sincere appreciation to the members of the reference group for their cooperation and practical support. Anne Scott Manager Child & Family Services City of Ballarat Kevin Zibell CEO Ballarat Child & Family Services David Beaver CEO Centacare Glenda Stanislaw CEO Ballarat Community Health Centre Desley Beechey Manager Women’s & Children’s Health Ballarat Health Services Andreana Harrison Regional Drug & Alcohol Coordinator Grampians Region Tom Niederle Manager Public Health Grampians Region Sue Nelson Co-ordinator Central Highlands Primary Care Partnership Judy Rosson Koori Alcohol & Drug Worker, Ballarat and District Aboriginal Co-operative Jim Bond Manager Student Wellbeing Central Highlands Wimmera Region

Department of Education & Training Keryl Thomas Manager Family & Community Support, Community Care and

Housing Department of Human Services Sharelle Knight Senior Project Officer Family & Community Support Community

Care, Department of Human Services Keryn Crebbin Employment & Learning Coordinator Wendouree West Community

Renewal Clare Scharper President Ballarat & District Kindergarten Teachers Association /

Directress Jubilee Kindergarten Anne Campbell Principal Black Hill Primary School Thanks are also due to others who contributed significantly to the project activities and/or provided support and encouragement during the project: Merran Fleming Best Start Community Facilitator Sue Van Styn Maternal & Child Health Co-ordinator, City of Ballarat Lyn Hedger Maternal & Child Health Nurse City, of Ballarat Pat Thurlbeck Maternal & Child Health Nurse, City of Ballarat Glenda Nuriden Maternal & Child Health Nurse Young Parents Program and

Enhanced Home Parenting Program, City of Ballarat Lorraine Gittings Enhanced Home Parenting Program, City of Ballarat Sue McRae Maternity Unit Manager Ambulatory Services Anne McMurray Parent Educator Ballarat Child and Family Services Phil Catterson Nurse Unit Manager Emergency Department Gwynne Brennan Brigade Support Coordinator Country Fire Authority

Midlands/Wimmera Region Louise Chapman Coordinator Wendouree Child Care Centre Dawn Lyons Parent Educator Ballarat Child & Family Services Janet McMurray Ballarat & District Pharmacy Alliance Barbara Minuzzo Community Safety Consultant Safety Centre Royal Children’s

Hospital Jenny Sherrard and Erin Cassell Monash University Accident Research Centre Lisa Gibbs Centre for Community Child Health Lynne Gallanti Hume City Council The project worker gratefully acknowledges the assistance of the residents of Wendouree West who gave generously of their time to assist with the planning, promotion and conducting of the child safety education strategies within their community. And special thanks to the Dandenong and Yarra Ranges SafeStart Project Workers, Karen Mildren and Carol Emanual, for their constant support, cooperation and sharing of ideas and resources throughout the project.


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TABLE OF CONTENTS Acknowledgements ……………………………………………………………… 1 List of Tables …. ………………………………………………………………... 3 List of Graphs …………………………………………………………………… 3 Acronyms …………………………………………………………………………. 3 List of Attachments ………………………………………………………………. 4 Executive Summary ……………………………………………………………… 5 Introduction ……………………………………………………………………… 8 Background ……………………………………………………………………… 8

Unintentional Injury and Children ………………………………………. 8 Unintentional Injuries in the Home ……………………………………… 9 Ballarat – Community Profile ……………………………………………. 12 Unintentional Childhood Injury in Ballarat …………………………….. 14

Methodology - Planning Process ..…………………………………………… 17

Data Collection and Analysis ……………………………………………. 18 Mapping of Existing Services and Gaps ……………………………….. 18 Description of Target/Intervention Group ………………………………. 20 Objectives …………………………………………………………………. 24 Project Strategies …………………………………………………………. 25

Implementation of Strategies ………………………………………………….. 26

Awareness Raising ………………………………………………………… 26 Training and Education for Parents and Carers ………………………... 31 Training and Education for Service Providers …………………………… 37 Increasing Awareness and Access to Safety products and

Promotion of Environmental Changes to Enhance Child Safety ……… 40 Changes in Policy and Procedures ……………………………………….. 46 Resource Distribution ………………………………………………………. 48 Resource Development …………………………………………………….. 49

Sustainability of Strategies ……………………………………………………….. 53 Evaluation Framework ……………………………………………………………… 55

Data Collection ……………………………………………………………….. 55 Education Sessions ………………………………………………………….. 55 Focus Group ………………………………………………………………….. 55

Key Outcomes and Learnings …………………………………………………… 56

Key Outcomes ………………………………………………………………… 56 Learnings …………………………………………………………………….. 58

Recommendations …………………………………………………………………… 60 References ……………………………………………………………………………... 62


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LIST OF TABLES Table 1 – Major Media (Television, newspaper, radio)…………………………. 20 Table 2 – Minor Print Media (Newsletters and information sheets)……………. 21 Table 3 – Displays ………………………………………………………………….. 22 Table 4 – Professional Education for Service provider …………………………. 31 Table 5 – Home Visits to Risk Families ………………...…………………………. 35 Table 6 – Sustainability of SafeStart Strategies …..……………………………... 44

LIST OF GRAPHS Graph 1 – Location of Injury (1999,2000,2001) …………………………………… 6 Graph 2 – Causes of Injury By Age Group ………………………………………… 7 Graph 3 – Ballarat Emergency Department Presentations for Injury …………… 9 Graph 4 – Ballarat Causes of ED Presentations for Injury ………………………. 10 Graph 5 – Ballarat and Victorian Hospitalisation Rates for Injury ……………….. 10 Graph 6 – Causes of Hospitalisations for Injury in Ballarat Children ……………. 11

ACCRONYMS M&CH Maternal and Child Health

CFA Country Fire Authority

DHS Department of Human Services

LGA Local Government Area

VEMD Victorian Emergency Minimum Dataset

VAED Victorian Admitted Episodes Dataset

MUARC Monash University Accident Research Centre

AIHW Australian Institute of Health and Wellbeing

SEIFA Socio Economic Indices For Areas

GEAS Generic Evaluation Assessment System

CCCH Centre for Community Child Health


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LIST OF ATTACHMENTS List of Key Informants ………………………………………… Attachment 1

Needs Assessment …………………………………………… Attachment 2

Program Plan …………………………………………………... Attachment 3

Maternal & Child Health Safety Session ……………………… Attachment 4

Safety Products Provided to M&CH Participants .……….…… Attachment 5

List of Contents of Safety Information packs ………………….. Attachment 6

Wendouree West Program Rationale & Outline ………………. Attachment 7

Evaluation of Wendouree West Program ……………………… Attachment 8

Safety Kitchens – Product Listing & Photographs …………… Attachment 9

Record of Distributed Resources ……………………………… Attachment 10

Evaluation Tool ………………………………………………….. Attachment 11

Collated Evaluations of Sessions ……………………………… Attachment 12

Directions in Wellbeing – Municipal Public Health Plan …….. Attachment 13

Best Start Action Plan – Health & Safety Group ……………… Attachment 14

Pharmacy Promotion Outline and Photographs ……………… Attachment 15


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EXECUTIVE SUMMARY In 2002/2003 the Department of Human Services allocated funding for eighteen

months for the purpose of supporting three local government demonstration sites to

develop, implement and evaluate local action to address targeted child injury issues.

The project aimed to test ways to achieve uptake and support for proven or

promising interventions in a small number of specific child injury areas. In particular,

the project aimed to test the approach of engaging local communities in the

management and implementation of proven interventions as a way to build long term

local government and community level focus and capacity to respond to unintentional

injury issues.

The priority areas were the home and play settings that encompass a range of

unintentional injury issues amongst 0-8 year olds, including unintentional poisoning,

drowning, near drowning, falls and a range of outdoor recreational injuries

encountered during play activities.

The objectives of the Child Injury Demonstration projects included:

Improve local knowledge of risks, barriers and facilitators, and

enhance local capacity to respond to injury issues

Make an impact on injury incidence and/or demonstratable risk for

each of the priority areas

Build sustainable injury prevention responses at a community, service

and local government level

Test specific interventions at local community level with focus on

disadvantaged groups

Build injury prevention into existing programs or plans as key areas for

attention eg local government public health plans or community health

plans

Unintentional injury is a major health issue in Australia and a leading cause of death

and hospitalisation in children. The City of Ballarat has a high incidence of

unintentional injury in children aged 0-8 years, with one in ten children sustaining an

injury requiring hospital treatment every year.


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The City of Ballarat valued the opportunity to secure funding from the Victorian

Department of Human Services, to be a SafeStart demonstration site and the project

has brought many benefits to the LGA, including a raised awareness of unintentional

childhood injury and enhanced capacity within the LGA to respond to the issue.

Key highlights and achievements of the project include:

Incorporation of child injury prevention into the Best Start Action Plan,

ensuring ongoing emphasis on child safety within the LGA and providing a

mechanism for the achievements of the SafeStart project to continue to

benefit the children and families of Ballarat

The development, piloting and independent evaluation of an innovative child

safety education program that was successfully able to target vulnerable and

at risk families and demonstrate lasting changes in knowledge and behaviour

An ability to respond to local community needs by facilitating the development

of an innovative child safety resource for use with the growing number of

parents within the LGA who have an intellectual disability.

Exploration of the benefits of innovative partnerships with organisations

including The Ballarat and District Pharmacy Alliance and the Office of

Housing, to trial new ways of delivering strategies to reduce childhood injury

by awareness raising, community education and environmental change

Formation of a number of partnerships which assisted to progress the work of

the project, facilitated greater awareness of child injury amongst service

providers and lead to the development of stronger working relationships

between staff from agencies within the LGA


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INTRODUCTION In early 2002, twelve Local Government Areas with significantly high rates of

unintentional injury in children aged 0-8 years, were invited to enter a submission to

the Department of Human Services Public Health Group for one of three SafeStart

pilot projects. The successful submissions were the City of Ballarat, the City of

Greater Dandenong and the Shire of Yarra Ranges.

In September 2002, the SafeStart project worker commenced in Ballarat with a

project brief to pilot innovative approaches to reducing unintentional childhood injury

in the local area. The project worker was initially employed at 0.8 EFT, with the

position becoming full time in July 2003.

BACKGROUND

Unintentional Injury and Children Unintentional injury is a major health issue in Australia. It is well documented that the

most common types of childhood injury resulting in attendance at hospital emergency

departments are falls, road traffic accidents, drowning, poisoning and burns. (Paul,

Redman & Evans, 1992). Each year approximately 300 Australian children aged 0-

14 years are killed and 60,000 hospitalised by unintentional injury. There are

significant financial costs associated with these injuries, with estimates placed at 1.5

billion dollars annually (Kidsafe 2000). Child injury can also have enormous costs to

the injured children and their families. Injuries cause pain, suffering and distress to

the injured child and their family, and many injuries require months of ongoing

treatment and cause disruption and added stresses to family life. Disfigurement and

disability caused by injury can also have lasting effects on a child’s development and

future wellbeing. (AIHW: Al-Yaman, Bryant & Sargeant 2002).


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Unintentional Injuries in the Home The majority of unintentional injuries to children occur in the home. There is reduced

frequency of home injuries as the child ages and an increased frequency of injuries in

other settings, such as playgrounds. This pattern is well documented and is related to

exposure to different hazards in different environments (Routley & Ashby 1997; &

graph1).

Graph 1 – Location of Injury (1999, 2000, 2001)

In the two-year period 1999 and 2000, there were 28 unintentional home injury

deaths in children aged 0-8 years in Victoria, or an average of 14 deaths per year.

Drowning was the most common cause of unintentional home injury deaths with 11

deaths by drowning recorded in 1999 and 2000. Fire, burns and scalds resulted in 9

deaths in children aged 0-8 years with the majority of these being caused by house

fires, (Australian Bureau of Statistics 1999 and 2000).

In the three-year period 1999, 2000 and 2001, there were 61,140 emergency

department presentations for unintentional injury in children aged 0-8 years to the 28

Victorian hospitals that record emergency department presentations due to injury.

(This data forms the Victorian Emergency Minimum Dataset - VEMD). This is an

average of 20,380 presentations a year. Approximately 12% of these presentations

were subsequently hospitalised.

Unintentional Injury by LocationUnintentional Injury in Victorian Children Aged 0-8 Years. VEMD Data 1999-2001

Emergency Department presentations

Home

School, Day Care,Public AdministrationPlace for Sport &RecreationRoad, Street, Highway Other Specified &Unspecified


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The most common causes of emergency department presentations and

hospitalisations due to home injuries are falls, being struck by or colliding with

objects/other persons, poisoning, fire, burns and scalds and cutting and piercing

injuries. Falls are by far the most common reason for injury in all age groups,

accounting for 40% of injuries.

Graph 2 – Causes of Injury By Age Group

The risk of injury is strongly associated with a number of factors including child’s age,

sex, area of residence and socioeconomic status of the family (Al-Yaman, Bryant &

Sargeant 2002). Children under the age of five years are most at risk of unintentional

injury, accounting for almost half of all child injury deaths in children 0-14 years

(Kidsafe 2000). There are also clear patterns associated with age and different types

of injury (see graph 2) and these are linked to mobility, access and developmental

stage. For example hospitalisations due to poisoning are highest in the 1-4 year

group, with rates dropping sharply in children ages 5-9 years. The injury pattern is

also strongly associated with a child’s sex. For most types of childhood injury and all

age groups after 1 year, boys are at higher risk of injury than girls (Al-Yaman, Bryant

& Sargeant 2002).

Top 5 Causes of Injury by Age groupEmergency Department presentations

Unintentional Injury in Victorian Children Aged 0-8 Years. VEMD Data 1999-2001

0100020003000400050006000700080009000

10000

Number of Injuries

0-1 years 6223 2315 868 1302 10132-4 years 9448 4379 1844 1845 6915-8 years 7075 3698 1929 161 322

Falls Struck by collision with Cutting piercing Poisoning Fire/burns/scalds


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Where a child resides also has an impact on the risk of injury. Children living in

remote areas experience the highest rates of injury, followed by children living in rural

areas, while children living in metropolitan areas have the lowest rate. This is likely to

associated with different hazard exposure (Al-Yaman, Bryant & Sargeant 2002).

Other factors strongly associated with childhood injury include poverty, single

parenthood, low maternal education, low maternal age at birth, poor housing, large

family size and parental drug or alcohol abuse. (UNICEF 2001). The link between

socioeconomic status and childhood injury has been well established (Stokes, Ashby

& Clapperton 2001/2002; Faelker, Picket & Brison 2000; Evans & Kohli 1997). It is

not difficult to understand the link between low socioeconomic status and childhood

injury as families living in poverty are unlikely to have access to newer and more

expensive products with enhanced safety features including cars, nursery furniture

and child safety products. Low income families are also more likely to be living in

poorer housing conditions, while social problems associated with poverty further

increase the risk of injury to children (Al-Yaman, Bryant & Sargeant 2002).

However, it appears that socioeconomic status may be involved in more than the risk

of injury. Stokes, Ashby and Clapperton (2001/2002) cite the findings of Girasek

(2001) who reported that socioeconomic status significantly predicted whether or not

respondents believed injuries could be prevented. Low socioeconomic status was

associated with the belief that injuries were inevitable, whereas higher

socioeconomic status was associated with beliefs that injuries were preventable.

Interventions targeting families from low socioeconomic status must address both

change in attitude and the financial barriers to environmental changes within the

home.


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BALLARAT – COMMUNITY PROFILE

GEOGRAPHY AND HISTORY

The municipal district of the City of Ballarat is part of an area of land under the

traditional custodianship of the Wathaurong people and comprises the city of

Ballarat, and the townships of Learmonth, Buninyong, Miners Rest and Cardigan

Village. In all the City of Ballarat has an area of 740 square kilometres.

The City displays a rich variety of topology and natural environment which comprises

rolling hills, granite outcrops, heavily forested areas and numerous bodies of water.

The urban settlement patterns offer a diversity of living environments, including small

villages and country towns, as well as the main cityscape of central Ballarat, which

includes heritage architecture of national significance and international interest..

Ballarat is rich in history, and commands an important place in the story of the

settlement of Australia. Historical remnants include significant indigenous sites, the

distinguished architecture from the gold rush era and the “living” history of Sovereign

Hill and the Eureka rebellion.

Ballarat’s economic base has gone through many changes since white settlement,

from gold mining and farming in its early days to value-added food processing and

manufacture of high-tech machinery components. Of increasing importance is the

service sector, including tourism and information technology services.

DEMOGRAPHICS The percentage of the population under 40 years of age is 57.2% which is similar to

the state average, and over the next 10 years, an increasing proportion of the

population will be aged between 45 and 75 years. Compared with the three other

LGA’s in the Central Highlands of the Ballarat population (Victoria 12%). Although the

number of 0-8 year olds is predicted to fall over the next 10 years, it is difficult to


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validate this given Ballarats current healthy growth rate, which includes an increase

in the number of families with young children relocating to Ballarat.

Ballarat has a higher proportion of people who identify as Aboriginal and/or Torres

Strait Islander (0.9%) compared with the rest of the State (0.3%). Recent data

indicates that approximately 25% of Indigenous people are aged between 0-8.

Although there is a lower proportion of Ballarat residents born overseas (7.6%)

compared with the rest of the State (24.8%) there are approximately 30 different

Countries of origin represented in Ballarat. The greatest numbers in order of the top

10 are United Kingdom, Netherlands, New Zealand, Italy, Germany, Croatia, India,

Greece, Poland and Ireland.

The Socio-Economic Disadvantage Index rates Ballarat at a higher disadvantage

than Victoria as a whole. For example, at the 50th percentile (below the median),

Ballarat had a score of 63% compared with 49.3% for Victoria. This index is derived

from attributes such as income, educational attainment, unemployment or jobs in

relatively unskilled occupations, and is extracted from the Census questions by the

Australian Bureau of Statistics.


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UNINTENTIONAL CHILDHOOD INJURY IN BALLARAT

In Ballarat, there has been a 10% increase in emergency department presentations

due to unintentional injury between 1999 and 2001. Hospitalisations due to injury

have remained fairly constant, averaging 101 per year over the last three years

(graph 3).

Graph 3 – Ballarat Health Services Emergency Department Presentations for

Unintentional Injury in Children aged 0-8 years (Source VEMD Data)

0100200300400500600700800900

100011001200

Year 1999 Year 2000 Year 2001

No E

mer

genc

y D

epar

tmen

t P

rese

ntat

ions

Falls were by far the leading cause of emergency department presentations in

children aged 0-8 years causing almost twice as many presentations than the

second highest cause – struck by or collision with a person or object. The third

highest cause was cuts, followed by injuries due to fire, burns and scalds and

poisoning (graph 4). The top 3 causes are consistent with the Victorian top 3 causes

of injury, but in Ballarat injuries caused by fire/burns & scalds were the 4th highest,

compared with poisoning in Victorian data.


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Graph 4 – Causes of Emergency Department Presentations for Unintentional Injury

in Children Aged 0-8 Years, 1999,2000 and 2001 in Ballarat (Source VEMD Data)

Top 7 Causes of Emergency Department presentations

1080

543

259

118

62

49

39

0 200 400 600 800 1000 1200

Falls

Struck by collision with person or object

Cutting, piercing object

Fire, burns, scalds

Poisoning

Motor vehicle/motorcycle

Pedal cyclist

Number of Presentations

Ballarat’s rate of hospitalisations due to unintentional injury is greater than the

Victorian average, with the Wendouree and Delacombe/Sebastopol postal areas

(3355 and 3356) having the highest rates. The 3350 postcode area which covers

most of the City of Ballarat has a slightly higher rate of hospitalisation for injury than

the state average (graph 5).

Graph 5 – Ballarat and Victorian Hospitalisation Rates for Unintentional Injury in

Children Aged 0-8 Years

Hospitalisations - Comparison With Victorian Rate. VAED Data July 1999 - June 2001. Average annual Rate

0

5

10

15

20

25

30

35

Balla

rat

LGA

3350

3351

3352

3355

3356

3357Ra

te P

er 1

000

Child

ren

0-8

Year

s

Rate per 1000Victoria


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Graph 6 – Causes of Hospitalisations for Unintentional Injury in Ballarat Children

Aged 0-8 Years (Source VAED July 1999 – June 2001)

The leading 3 causes of hospitalisation are falls, collisions and cuts and are the same

as the leading 3 causes of emergency department presentation and consistent with

Victorian data. Poisoning was the 5th highest cause of emergency department

presentation but the 4th highest cause of hospitalisation. This is indicative of the

severity of injuries due to poisoning and of the seriousness with which they are

viewed by hospital staff. Hospitalisations from dog bites ranked 7th and appears to be

a growing health issue (graphs 5 & 6).

Post code areas and causes of injuries focused on in the Ballarat SafeStart project

were selected to address areas of highest need and leading causes of childhood

injury, as highlighted by the data discussed in this section.

Top 7 Causes of Hospitalisation

0 20 40 60 80 100 120 140

Falls

Struck by collis ion 30with person or object

Cutting, piercing object

Poisoning

Fire, burns, scalds

Motor vehicle /motor cycle

Dog related

Number of hospitalisations


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METHODOLOGY - PLANNING PROCESS The SafeStart project worker commenced employment with the City of Ballarat in

September 2002. The first task for the project worker was the completion of a local

based needs assessment into the identified health issue of unintentional injury in

children (see attachment – 2). This component of the project involved three main

tasks which were tackled concurrently during the first four months of the project.

These were:

collation and analysis of demographic data for the LGA and the raw data on

emergency department presentations and hospital admissions

a review of the existing literature on unintentional child injury

a local mapping of existing injury prevention activities and gaps in service

provision.

Analysis of the data confirmed that the three postal code areas highlighted for

attention in the submission had elevated injury incidence and should remain the

focus of the project.

After consulting with the community and key informants it was decided to trial some

interventions with vulnerable and marginalised groups within Wendouree, Delacombe

and Sebastopol, rather than target the whole of those post code areas. These

interventions aimed to address the increased vulnerability to unintentional injury of

children from families with one or more of the following risk factors: poverty, single

parenthood, low maternal education, low maternal age at birth, poor housing, large

family size and parental drug or alcohol abuse.

Strategies for the 3350 post code area were planned to target all parents,

grandparents and carers of young children. The rationale behind this being that

although the incidence of injury is higher in children from disadvantaged

backgrounds, more children from non-disadvantaged backgrounds are actually

injured, because there are more of them.


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DATA COLLATION AND ANALYSIS Emergency department presentation and hospital admissions data from VISAR was

collated and analysed by the project worker and utilised to build a picture of the

incidence of childhood injury in Ballarat. The data revealed that the incidence of

injury per 1000 children was significantly higher for Ballarat than for Victoria (see

discussion under ‘Background’).

The two postcode areas that were identified as having the highest incidence of

childhood injury per 1000 children as compared to Victoria, were Wendouree and

Delacombe/Sebastopol. The 3350 post code area, where 58% of the population of

Ballarat resides, was also found to have a higher incidence, although not as high as

the other two postcodes.

Review of the one line descriptions completed by hospitals about each injury

presentation provided an added dimension to the data and a greater understanding

of how injuries were occurring and therefore what interventions could prevent them.

For example rather than just see that two children had been admitted for poisoning

during a certain period of time, we are told of a child who ate rat-sack he found under

the stove and of one who ate 2-3 antidepressants from her mother’s handbag.

Analysis of the data took a number of weeks but was time well spent as it provided a

solid foundation for program planning. A sound understanding of the data was also

essential when meeting with key informants and the data for Ballarat was certainly a

powerful tool for enlisting support for the SafeStart project.

MAPPING OF EXISTING SERVICES AND GAPS The project worker conducted approximately 30 interviews with the key informants

listed in Appendix-1 and focus groups with teenage parents and Maternal and Child

Health Nurses. The main aims of the interviews were to conduct a mapping of

existing injury prevention activities and gaps in service provision, identify areas of

high priority, canvas ideas from service providers for effective interventions and

identify individuals who may assist in delivery of interventions. Broadly speaking,

existing injury prevention strategies in the LGA were able to be classified into three

main categories: Intensive intervention

Part of regular work with target group

Broad based community education programs


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Intensive intervention - one on one injury prevention delivered as part of

intensive interventions with families experiencing problems is carried out by

organisations including Child & Family Services, Child Protection, Centacare,

Ballarat Health Services Domiciliary Care and some special programs run by

The City of Ballarat Maternal and Child Health program. Staff from these

services report high incidence of injury causing hazards in many of the

homes they visit, with knowledge, finance, attitude and poor literacy identified

as barriers to reduction. The ability of programs to access brokerage to

address child safety hazards in the home varies depending on the program’s

budget, with some organisations able to supply and install heater guards,

safety gates and various other small safety devices in the homes of the

clients they work with. Other projects do not always have access to

brokerage money and express frustration at not being able to address

identified hazards. One service has a comprehensive display of available

safety products in the bathroom and kitchen areas, which provide learning

opportunities for clients using the service.

Part of regular work with target group - Maternal and Child Health Nurses

and Antenatal Parent Education classes carry out injury prevention delivered

as a component of existing programs. Maternal and Child Health Nurses

reported handing out poisons information brochures and stickers and the

Kidsafe Ages & Stages sheets on a regular basis with mixed levels of

response from parents. Each year M&CH run first time mothers programs

and approximately half of the nurses reported covering safety as a

component of these programs.

Broad based community education programs - state and Australian wide

campaigns run periodically with the aim of raising awareness of particular

causes of unintentional child injury. Campaigns around water safety and road

safety are recent examples. These campaigns serve as very useful tools in

increasing community awareness and knowledge around child injury

prevention strategies. When coupled with legislation and on the ground

interventions, these campaigns have the potential to assist to change

community attitude to undesirable behaviours as evidenced in many of the

road safety campaigns.


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DESCRIPTION OF TARGET/INTERVENTION GROUP The target group for the SafeStart intervention was children aged 0-8 years residing

in Wendouree West, Delacombe/Sebastopol and the 3350 postcode area. The 2001

ABS census data recorded 4,555 families with a child/ren 0-8 years residing in the

four areas and a total of 7,625 children 0-8 years. Although some program activities

were addressed at the target group (especially children of school age), the majority of

the activities were aimed at the intervention group (parents/carers of children 0-8

years) and professionals working with them.

Wendouree West Children 0-8 years – 522 Families with children 0-8 years – 299 Wendouree West is part of the Wendouree postcode area 3355 and was chosen as a

target for project activities due to the high incidence of unintentional child injuries and

high levels of social and economic disadvantage. The area is ranked in the bottom

10% of the state in the Socio Economic Indices For Areas, Australian Bureau of

Statistics. Socio-Economic Indexes For Areas (SEIFA) is a series of indexes for

geographic areas based on data derived from the 1996 Census of Population and

Housing. The Index of Relative Socio-Economic Disadvantage is derived from

attributes such as low income, low educational attainment, high unemployment or

jobs in relatively unskilled occupations. Therefore areas with a low score occur when

there are many low income families and people with little training and in unskilled

occupations.

Wendouree West is an area with high levels of public housing (37.7%) and a high

proportion of families headed by a single parent (48%). The area also has a high

percent of young children, with children aged 0-8 years comprising 18.3% of the

population compared to 12.5% across the LGA.

Wendouree West has a centrally located community house which runs a range of

programs and residents can also use it as a drop in centre. The community house

was an excellent community resource for the SafeStart project providing a venue for

demonstrating safety products and a centrally located venue for meetings with

residents.


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Recent local and government initiatives in Wendouree West include the Wendouree

West Community Renewal Project and Strengthening Generations, Communities

That Care Program. Both programs work closely with local residents to enact long

lasting structural and social improvements in the area.

In Wendouree West, the Community Renewal was an excellent support for the

SafeStart project, providing significant support with program promotion, advice and

guidance. Involvement in the Health and Safety Sub-committee provided the project

worker with networking opportunities with workers and residents in the area and lead

to the partnership with the CFA which provided additional funding and expertise for

program activities (see discussion under Parent and Carer Education and Training).

Delacombe/Sebastopol Children 0-8 years – 1623 (Delacombe - 592, Sebastopol - 1031) Families with children 0-8 years – 955 (Delacombe – 338, Sebastopol – 617) Delacombe and Sebastopol cover most of the 3356 postcode area. The Jesuit Social

Services study, ‘Unequal in Life’ which examined the distribution of social

disadvantage in Victoria and new South Wales, ranked the 3356 postcode

(Sebastopol & Delacombe) 27 out of Victoria’s 622 postcode areas.

Delacombe - The suburb of Delacombe comprises 1135 homes with a large public

housing development of 148 residences (13%). The majority of the remaining

housing (72%) is owned or being purchased and includes a number of new housing

developments.

The area also has a high percent of young children, with children aged 0-8 years

comprising 18.4% of the population compared to 12.5% across the LGA. Twenty-six

percent of families are headed by a single parent which is comparable to the rate

across the LGA but higher than the Victorian rate. Families residing in the Public

Housing estate were the main focus of the SafeStart project due to the high

incidence of unintentional child injuries and high levels of social and economic

disadvantage.


- 22 -

A number of community picnics held in the in the public housing estate during late

2002 and early 2003 were attended by the SafeStart project worker. The picnics

were funded by the City of Ballarat Community Development team and provided

opportunities early in the project to meet local residents and workers and to trial

displays and competitions promoting child safety messages.

The Strengthening Generations, Communities That Care Program is also operating

in Delacombe and involvement in the Action Group enabled the SafeStart project

worker to build relationships with local residents and staff working with families in the

area.

One of the main challenges faced when working in the Delacombe community was

the lack of a central venue for activities. There are no local shops within the housing

estate and although a number of agencies work with the community, none have local

offices. A working group has been established under the Strengthening Generations

program to establish a Community House in the estate and this would greatly assist

future programs by providing a focus for project activity and opportunities to consult

with residents.

Sebastopol - Sebastopol is an established suburb within Ballarat, which is experiencing some new

housing developments on the outskirts. Children aged 0-8 years comprise 13% of the

population which is comparable to the 12.5% across the LGA. Thirty-seven percent

of families are headed by a sole parent, which is significantly higher than the state

and the LGA. There are 3156 homes in Sebastopol, of which 270 (8.6%) are public

housing properties.

The Ballarat Community Health Centre has a large facility in Sebastopol and there

are a number of businesses including two supermarkets in the area. However, the

central business district is spread out over a number of sites, giving a rather

disjointed feel to the community.

Project activities were limited in Sebastopol, as the project plan was overly ambitious

given the relatively short duration of the project.


- 23 -

3350 POSTCODE AREA Children 0-8 years – 5480 Families with children 0-8 years – 3301 The 3350 post code covers a large area including central Ballarat and residences to

the East and West of the city. Fifty-eight percent of Ballarat’s 80,045 residents reside

in this area and 11.8% of them are aged 0-8 years. The 3350 area is well serviced

with many community organisations and service providers located centrally.

Twenty-nine percent of families residing in this area are headed by a sole parent,

which is higher than the Victorian average 14%. Of the 17,933 homes in this area,

687 (3.8%) are public housing properties, with many of these located in estates in

Mount Pleasant and Ballarat East.

Interventions in the 3350 postcode area targeted the broad community and were

aimed at all parents, grandparents and carers of young children.


- 24 -

Objectives The following objectives were developed for the Ballarat SafeStart project. Refer to

attachments 2 and 3 for a copies of the needs assessment and program plan.

OBJECTIVE 1 - To increase parent/community injury prevention knowledge and intention to act to install safety products and reduce hazards in the home and at play.

SUB-OBJECTIVES -

To increase parent/community awareness & knowledge of childhood injury

To increase the access of parents in the target group to education sessions

about hazard identification, elimination and management.

To increase the awareness and use of child safety products & low cost

alternatives within the community.

To acquire support, including financial & labour, from service clubs to obtain

services & install safety products in the homes of economically

disadvantaged families.

To increase parent/community awareness of safety requirements associated

with new/second hand nursery furniture.

OBJECTIVE 2 - To increase the level of health promotion activity directed at the prevention of unintentional injury in children aged 0-8 years within Ballarat LGA.

SUB-OBJECTIVES - To raise awareness & knowledge amongst health professionals & other

workers about child injury & effective interventions.

To increase availability of injury prevention resources for health

professionals.

To provide access to health professionals to professional development in

childhood injury prevention strategies in Ballarat LGA.

To inform key personnel in the serious and growing issue of unintentional

injury in children and advocate for the integration of childhood injury

prevention into local programs & plans for key attention.

To formalise child injury prevention into policy & protocol of departments

within council & organisations within broader community


- 25 -

OBJECTIVE 3 - To increase access of parents with a child aged 0-8 years to paediatric first aid training.

SUB-OBJECTIVES To increase parent/community awareness of importance of applying

appropriate first aid treatment to reduce severity of child injuries. Increase parent/carer access to paediatric first aid training.

Strategies Many countries including America, Sweden and Australia have demonstrated the

significant reductions in childhood injuries are possible. The strategies which have

proven to be effective are education and publicity, safer products and surroundings,

promoting public policy, enforcement, data collection, research and evaluation and

empowerment. A combination of strategies is most effective (Victorian Department

of Human Services 2000; Hemmo-Lotem & Danon 2003). Listed below are the

range of strategies that were planned for the Ballarat SafeStart project to achieve the

stated objectives. (See attachment 3 for further details as per the program plan.)

1. Awareness raising of child safety issues

2. Parent and carer education and training 3. Professional education for service providers of family and children’s services

4. Increasing awareness/access to safety products and promotion of environmental

changes to enhance child safety

5. Changes in policy and procedures


- 26 -

IMPLEMENTATION OF STRATEGIES 1. AWARENESS RAISING OF CHILD SAFETY ISSUES A variety of media activities were used to deliver injury prevention messages to the

community. In the initial stages of the project the focus was on raising the profile of

the SafeStart project. Later media activities focused around specific project activities

such as the launch of the brochure display at Ballarat Health Services and the

childhood poisoning prevention promotion through local pharmacies.

The media was also utilised to promote key child safety messages associated with

various causes of injuries, such as water safety and falls prevention. A summary of

local media activity is provided in tables 1, 2 & 3.

Table 1 – Major Media (Television, Newspaper & Radio)

Title and type of material Target group % of target reached

Time period of distribution

Distribution

3BA Radio program – Health Matters (different from above) 1 x ten minute discussion by local GP

Parents/ carers & Grandparents children 0-8yrs

40% of target April Estimated 45,000 listeners in Ballarat & surrounding area

ABC Regional Radio 1 x 5 minute discussion about SafeStart & display launch at hospital

Health Professionals/Parents & Grandparents children 0-8yrs

10% of target May 13th 2003

Over 40,000 listeners

Ballarat Courier Article on launch of hospital display


Majority of families in Ballarat – 70%

21 may 2003

20,400

WIN Television News Footage of launch and program details?


Majority of adult population – 80%

May 13th 2003

Number of viewers across regional Victoria = 150,000 In Ballarat =50,000

My Ballarat – City of Ballarat Newsletter SafeStart – preventing childhood poisoning

Parents, grandparents & Carers of young children

100% October 2003

37000 copies produced, distributed to all Ballarat Homes (35,000), 1500 businesses & 50 schools

Ballarat Courier Medicine Campaign Targets Children


63% of Ballarat homes Friday 29/10/03

22,000 copies distributed

The Advocate Learn about poisons – and save a child


15/10/03

Ballarat News Prevent childhood poisoning – return unwanted medicines


100% 15/10/03 Free paper distributed to all Ballarat homes & businesses

ABC Regional Radio 5 minute interview on poison prevention promotion


21/10/03 Number of listeners

3BA Radio News bulletin item throughout the day on poison prevention promotion


23/10/03 Number of listeners

My Ballarat – City of Ballarat Newsletter SafeStart – water safety


100% October 2003

37000 copies produced, distributed to all Ballarat Homes (35,000), 1500 businesses & 50 schools

Ballarat Courier Article discussing child safety & SafeStart program


63% of Ballarat homes 21/4/04 20,400


- 27 -

Table 2 – Minor Print Media (Newsletters And Information Sheets)

Title and type of material Target group % of target reached

Time period of distribution

Distribution

Health Matters - Newsletter of BHS SafeStart Program overview + photo

Staff, Parents & carers of children 0-8

difficult to estimate April-May 2003

2000+ Staff from BHS

Health Matters - Newsletter of BHS Preventing scalds from hot tap water




Health Matters - Newsletter of BHS Falls & bumps inside the home




Health Matters - Newsletter of BHS Launch




Health Matters - Newsletter of BHS Launch + photo




Health Matters - Newsletter of BHS Water Safety + launch photo




City of Ballarat Guide to Family & Children’s Services - Promotion of program & parent information sessions

Health Professionals/ Parents & Grandparents children 0-8yrs

Provided to every new mother in hospital (1000 per year) & distributed to Maternal & Child health, Childcare centres, Little Clinic

1500 annually

Ballarat Healthy Community Program newsletter Photo + article on program, recent activities & contact details for information sessions

Health Professionals/ Parents & Grandparents children 0-8yrs

All households in Delacombe (50% of 3356 postcode) + 500 agencies & individuals associated with Healthy Communities Program

Autumn 2003

3000

City of Ballarat - Customer & City Services News In Brief

All staff & Councillors difficult to estimate July 2003 Distributed to 600 Council staff & Councillors

Parent Talk – M&CH Newsletter Water Safety Article

Parents & Carers Oct/Nov 2003

300 copies distributed to date via M&CH centres

Human Services News Photo & article on SafeStart

Health Professionals and other organisations funded by DHS

Nov’ 2003

Information sheet – child injury prevention tips. Distributed with Family & Children’s Services Parent Survey. (a basket of safety products was also provided as a prize to encourage families to return their surveys)

Parents & carers October 400 distributed


- 28 -

Table 3 – Displays

Activity/event Primary target group

Reach to target

Time period of activity

Associated benefits

Safety display at Wendouree West Healthy Kids Carnival

Parents and children aged 0-8

Target 299 families. Reach 90 adults -30%

13/11/2002 3 hours

65 competition entries – spot the hazard. 90 thermometers distributed to families. + 305 brochures/booklets

Safety Display – Delacombe Community Picnic


Sunday 16/2/03 – 3 hours

Staff networking

Safety Display – Delacombe Community Picnic


Sunday 6/4/03 – 3 hours

Networking with staff from other services & agencies. Awareness raising

Safety Display – Ballarat & District Aboriginal Cooperative

Parents and carers of young children

11/4/03 – one day

Awareness raising

Safety products display boards


Rotating display at sites in Ballarat (3-4 wks at each)

Locations: Paediatric Ward of BHS, Barkly Street & Cooinda M&CH, Family Day Carer induction training, SafeStart safety sessions

Safety Display – Ballarat & District Aboriginal Coop, NAIDOC week

Koori parents & grandparents

July 9th – one day

Display on prevention of poisoning & competition for a poisons cabinet. 21 competition entries, 20 brochures & stickers distributed.

Display of Safety products – Family Day Carers Induction

Family Day Care Providers

Eight new carers

30/6 & 1/7/2003 - 2 days

Safety product awareness raising

Display of Safety products – Family Day Carers Induction

Family Day Care Providers

Seven new carers

19th Sep 2003 1 day

Awareness raising of availability of safety product and installation

SafeStart/Best Start Display. Wendouree Village during Purple Clover Week


Engaged with 14 families

Sep 11th 2003 – 3 hours

A basket of safety product was awarded to the competition winner & 86 resources distributed.

Static display, Central Square shopping centre for Purple Clover Week


Five days Awareness raising & networking with staff from local agencies

SafeStart/Best Start static display. Show & Shine


Sunday 9th Nov 2003

Negligible

Combined SafeStart Display – Injury Prevention Week launch

Parents and carers of young children & those working in the field of injury prevention

19/10/03 Awareness raising and opportunities to network.

Combined SafeStart Display – VSCN

Those working in the field of injury prevention

31/10/03 Good level of interest show in the display and opportunities to network with others in injury prevention field.

18 x displays on prevention of childhood poisoning held in Ballarat and district pharmacies

Parents, grandparents and carers of young children

Injury Prevention week & the week following Oct 20th – 31st

Awareness raising and staff education


- 29 -

Outcomes - Media Previous experience by Council has demonstrated a high level of response by the

community when utilising the local media and so local media was thought to have the

potential to be an effective means of disseminating key child safety messages during

the project. Twenty-four newspaper, radio and newsletter items were published

during the project and some of these media items had the potential to reach many

1000’s of households.

Child safety was viewed favourably by most local media and generally a positive

response was received to press releases. The local free press newspaper, which is

delivered to all households, was thought to provide an excellent opportunity for

reaching low income families. However, although the project worker received ante

dotal feedback to support this assumption, it was not formally tested during the

project. The heavy reliance of the free press on paid advertising was a barrier to

having items published, with the paper giving preference to paid advertisements and

editorials. Council’s bi-monthly newsletter to all residents in the LGA, adopted a

more community focused approach to the publication in late 2003. This enabled a

number of child safety articles be published and was an excellent method of

reaching the whole population.

The largest identified barrier to utilising the media was the substantial time involved

in researching and preparing press releases and preparing for interviews. As a

consequence, opportunities to involve the media were not always able to be explored

and developed. The transient nature of most media forms also meant many

messages were short lived within the community.

Outcomes - Displays Thirty-one displays were held during the SafeStart project. Displays have the

potential to be an effective awareness raising strategy, but require careful planning to

ensure they reach the target audience and deliver simple key messages. The use of

small promotional items such as pens and thermometers and activities such as

competitions were found to be an effective strategy for engaging with parents and

carers during displays.


- 30 -

Utilising local businesses to host child safety displays was trialled in Ballarat during

Injury prevention Week in 2003, when SafeStart, in partnership with the Ballarat and

District Pharmacy Alliance, conducted displays in local pharmacies (see attachment

15 for proposal outline and photographs). The benefits demonstrated by this strategy

were in the areas of community awareness and engagement of the Pharmacists.

Eighteen local pharmacies were involved in this promotion which involved in store

and window displays promoting safe storage of medications, the return of unwanted

medications service provided by pharmacies and the poisons information line.

Colouring competitions were run by some pharmacies with local primary and pre-

schools, while other pharmacies held competitions where adults could win a poisons

medication cabinet. The project worker provided the display materials, prizes for

competitions and information packs for each pharmacy. Displays remained in stores

for up to two weeks, enabling the key messages to be delivered simultaneously

across Ballarat at a number of locations. Local media was also used to promote the

poisoning prevention messages throughout this time.

It is not usual for Pharmacists to actively promote injury prevention, but with data

demonstrating medications as the agent involved in of 70% of childhood poisoning it

is a logical strategy to seek support from these health professionals. The Ballarat

project encountered a high level of support and enthusiasm for the project from the

pharmacists and interest was expressed by the Pharmacy Alliance in continuing

their involvement by promoting the return of unwanted medications on an annual

basis.

There are few ready made displays on child injury prevention available and the time

spent sourcing and preparing of display materials reinforced the benefits that could

be conferred on local injury prevention campaigns by the provision of displays and

information at a state wide level. Arranging, setting up and staffing displays is also

very time consuming and the benefits have to be weighed against the substantial

time investment required.


- 31 -

2. PARENT AND CARER EDUCATION AND TRAINING Approximately 50 parent information sessions were conducted during the project.

Sessions ranged in length from ½ - 1½ hours depending on group requirements. All

information sessions aimed to:

Increase awareness of unintentional child injury as a serious health issue

Increase knowledge of child injury risk factors and prevention strategies

Raise awareness of the wide range child safety products available to

enhance home safety

inform parents/carers of local and metropolitan retail outlets for child safety

products

The following lists the various sessions that were undertaken:

a. First Time Parents’ Program - Maternal and Child Health At the commencement of the SafeStart project the Ballarat Maternal and Child Health

Nurses already possessed a positive attitude towards child safety, but it was just one

of many topics they addressed within their role and many of the Nurses reported a

lack of interest in child safety amongst parents. Child safety, as a component of the

First Time Parents’ Program was only covered by approximately 50% of nurses, with

those that covered safety reported devoting between 40 – 90 minutes (½ - 1 full

session) to the topic. Encouraging all M&CH nurses to conduct one full session of

child safety with all First Time Parent Groups was seen as an effective and

sustainable method of educating 400 families a year.

During 2003, the project worker conducted sixteen first time parent sessions, trialling

a number of resources and activities (some from existing kits and some new) aimed

at conveying maximum information and increasing the interest level of participants

and facilitators. With the assistance of a small working group of interested nurses, a

standard safety session was then developed (see attachment 4). From February

2004, this session has been delivered by the M&CH Nurses.

This was a successful strategy that built on an existing framework and the existing

skills and knowledge of the nurses. Presentation of local and state child injury data

helped to raise the profile of child safety within the Maternal and Child Health

Program. The project worker conducted the first time parent’s safety sessions during


- 32 -

much of 2003 and this enabled the project worker to establish a good working

relationship with many of the nurses and develop a session that was interesting to

deliver and informative to participants.

In order to further increase interest in the sessions and provide participants with

additional safety information, eight hundred items of safety product and eight

hundred safety information packs were purchased through the SafeStart program

(see attachments 5 and 6). The resources will be distributed via the first time parent

safety sessions over the next two years. Maternal and Child Health staff plan to seek

further funding at this time, to replenish stocks. During the next twelve months the

Maternal and Child Health Program will be aiming to develop policy documents

relating to orientation of new staff and content of the First Time Parents program. The

SafeStart project worker has been informed that child safety will be included in both

these documents, ensuring long term focus on child injury prevention by all M&CH

staff.

b. General Child Safety information Sessions

These were presented by the project worker to a range of community groups and

organisations including Young Mum’s Antenatal Groups, Neighbourhood Watch, The

Breast Feeding Association, Foster Care Parents, parenting groups, parenting

mentors groups and playgroups. Each session covered a range of child safety

issues and was tailored to the age of the children. It was important to maintain

flexibility when dealing with community groups and seize the opportunity when it

presented itself and adapt the session to the time the group had available, even if it

wasn’t ideal.

The project worker found the Kidsafe quiz on child injury to be an excellent

introductory activity for information sessions as it generated interest in the topic and

helped to establish that unintentional child injury is a serious health issue. This quiz

was subsequently integrated into the M&CH First Time Parents’ session. Other

activities which were well received were the video ‘Child Safety Made Easy’ and

small group activities where the participants brainstormed risks and preventative

strategies for different causes of injury. Hands on demonstrations of child safety

product were also an effective strategy, with many parents reporting that they had not

seen many of the products presented.


- 33 -

The use of giveaways and resource materials were also useful to add interest and

create a more lasting memory of the information presented. Participants were often

provided with a pack of safety information and sample products. One useful strategy

to encourage participants to take some action after the presentation was to provide a

take home task to the group such as completion of a home safety checklist, checking

the temperature of the hot tap water or conducting a medications audit. A prize (e.g.

a gift basket of safety product) was left with the group for a lucky ticket draw for all

those who completed the task.

c. First Aid Training Early in the project a two hour first aid information session was trialled in

Delacombe. The course was held at the local primary school and attended by 16

parents. The session demonstrated that there was great interest amongst parents in

gaining first aid knowledge, but that a two hour session was too brief as attempts to

try to condense a lot of information into two hours resulted in ‘information overload’

with some participants. From this it was ascertained that it would be better use of the

resources to offer level one first aid courses, even though this would reduce the

number of sessions offered. Sessions were planned to target low income families.

Provision of child care during sessions was considered essential as a lack of child

care was identified as a barrier to attendance by many parents. However, this

became a challenge for the project, as the provision of child care was expensive and

incredibly time consuming. In order to keep courses accessible to residents who had

transport issues, local venues such as schools were more appropriate. When child

care was provided in venues such as school halls the project worker had to hire staff

and transport toys and other equipment to the venue. As a consequence less places

were provided than initially planned and other options were explored towards the end

of the project.

In the last month of the project the final thirty places for level one first aid were

offered to residents in the Delacombe Housing Estate as part of the SafetStart /

Office of Housing Project. Two level one first aid training sessions were offered as a

full day session on a Saturday. The venue used was a local child care centre and

centre staff were contracted to provide the child care. The courses were promoted to

residents during the safety surveying and via a mail out to all residents. Incentives

such as first aid kits, lunch and transport were provided.


- 34 -

A total of twenty parents, grandparents and carers of young children participated in

the training, however only fifteen came from the Delacombe Estate. Although those

that participated were very happy with the course and delighted to be able to access

level one first aid for only $10.00, it was disappointing that not all places were filled. It

is the belief of the project worker that the response from the community would have

been better if the community had been more involved in the planning of the first aid

courses and if the venue was within the local community.

d. Wendouree West Community Education Strategies These programs, ‘Safety It’s Child’s Play’ and ‘Shed & Tool Safety Know How’, which

were piloted in Wendouree West, were developed in partnership with the Country

Fire Authority (CFA) and with support from the Wendouree West Community

Renewal. Funding was provided by the CFA from a grant received from the

Department of Justice to be expended in Wendouree West. The funding source

dictated why these programs were trialled in Wendouree West. While the

demographics of the community determined the content of the programs developed.

Both programs were very successful and much of this was due to the excellent links

the project was able to make with the community and existing projects, in particular

the Wendouree West Community renewal.

i. Safety It’s Child’s Play This program consisted of four, two hour sessions that addressed causes and

prevention strategies for common childhood injuries (see attachments 7 and 8 for

copies of the program rational and outline and evaluation). Programs were held in

August 2003 and March 2004 and were attended by 30 parents and carers of

children under five years. A working party comprising local residents and

representatives from the CFA and the SafeStart project worker met on a regular

basis to plan the content and promotion of the program. A number of incentives

were offered to participants including free child care, free lunch each week, a

celebratory meal at the conclusion of the program. Free safety product valued at

$70.00 for each participant attending at least three sessions was also provided as

the cost of devices for preventing childhood injuries is a barrier to reducing

hazards within the home (Paul, Redman & Evans 1992).


- 35 -

Developed resources used in the delivery of the program are listed below. A more

detailed discussion regarding each resource is included on page 34.

Home Safety Kits

Safety Product Resource Kit

Safety Product Display Boards

Set of Safety Lock Demonstration Cabinets

Written evaluations revealed a high level of satisfaction with the program and

attendance was excellent with only one participant missing one of the four

sessions during the first program and three participants missing a session during

the second program. Anecdotal feedback from community members and staff

working with some of the participants gave examples of changes in knowledge

and behaviour and satisfaction with the course. Follow up evaluation in the form

of a focus group was conducted with participants from the first program six month

later. (see attachment 8)

Involvement of residents was a crucial factor in the success of the program

enabling content and delivery methods to be tailored to the needs and

requirements of the local community. Those on the planning committee became

active in the recruiting of participants and those with young children also attended

themselves. Another factor judged to be important was the emphasis on the social

aspects of the program. Each session began with an informal half hour lunch and

the use of fun quizzes and group activities encouraged social interaction. A warm

relationship formed between participants and between participants and facilitators

and this also contributed to the success of the program. The content of the

program was tailored to meet the needs of all group participants, in particular,

those participants who had some level of intellectual disability and those with low

literacy.

The cost of this program was approximately $170.00 per participant (excluding

staff time) and as such is reasonably expensive when compared to single

sessions delivered to the broad community. However, many of the participants of

this program were of very high risk and the children of some families had already

experienced severe injuries due to unintentional injury and one child had died.

Therefore, although expensive, the cost of the program could be recouped by the

avoidance of just a few emergency department visits or one hospitalisation due to

unintentional injury.


- 36 -

The project worker, with the assistance of members of the Best Start Health and

Safety Working Group, is currently investigating the feasibility of this program

being taken on by another organisation. If successful this will enable ongoing

delivery of this intervention to targeted communities within the Ballarat community.

ii. Shed and Tool Safety Know-How This consisted of a single session aimed at addressing safe use of power tools,

safe chemical storage, electrical safety and correct use and storage of a fire

extinguisher. Guest speakers were sourced from Bunnings, the CFA, Sovereign

Fire protection and the local community. While initial thoughts were to market this

session as a men only event, the residents recruited to assist with planning and

promotion felt this was discriminatory and given the high percentage of

households headed by a sole female, the session should be open to all residents.

Incentives offered to participants included a free barbeque meal, a fire

extinguisher, tickets in the door prize raffle and a show bag of safety information

and small promotional products. Sessions were held in March and April 2004 and

were attended by 36 local residents. Written evaluations completed by participants

showed a high level of satisfaction with the content and presentation of the

session.

The venue for the session was the local community house and this was also

where bookings were taken. The course proved very popular and the first session

booked out quite quickly. Unfortunately this led to anger amongst a few residents,

even when a waiting list was started for a second course. Although this seems to

have been a reflection of other issues within the community, rather than directly

caused by missing out on the first course, it still caused quite a bit of stress prior to

the session. We were also surprised when a few teenagers attended the first

session, as they weren’t our target group and we hadn’t expected the session

would appeal to them (but perhaps the fire extinguishers did!). As a consequence

the booking system was revised for the second session.


- 37 -

3. PROFESSIONAL EDUCATION FOR SERVICE PROVIDERS OF FAMILY AND CHILDREN’S SERVICES Working to increase knowledge of injury prevention risks and prevention strategies

amongst staff who interact with families and children was considered an important

strategy for the SafeStart project in Ballarat. This took many forms including provision

of twelve professional education sessions and presentations to groups of workers

about the issue of child hood injury (see table 4). There were also numerous one-on-

one and small group discussions around causes of injuries and prevention measures.

Table 4 – Professional Education for Service Providers Training intervention Participants Focus or purpose of training Facilitator/Date

Maternal & Child Health Nurses Local & Victorian child injury

data & using Child Safety

product Kit

Maternal & Child Health

Nurses

10 participants

To enhance & increase number

of M&CH child injury prevention

education sessions to parents. Project Worker

20/2/2003

Maternal & Child Health Nurses Child injury risk factors &

prevention strategies using

Child Safety Resource

Manual & Child Safety

Made Easy video


Nurses

13 participants

To enhance & increase number

of M&CH child injury prevention

education sessions to parents. Project Worker

17/4/2003

Kidsafe Training

Injury prevention data &

interventions & group

facilitation skills

Maternal & Child Health,

Paediatric Nurse, Enhanced

Home Parenting Worker,

Family Day Care

Coordinator, Parent

Assessment & Skills

Development program

worker, SafeStart project

worker

6 participants

To deliver child safety training

to Ballarat Service Providers

Kidsafe Staff and

consultant

12/2/2003

Child restraint train the trainers session & distribution of flip charts


Nurses

13 participants

To enable Nurses to deliver a

safety session on child

restraints

Graham Day – VIC

Roads

July 3003

First Time Parents Session


Nurses

11 participants

To enable Nurses to deliver a

uniform child safety session to

participants in first time parent

groups

Project Worker

19/2/04

1 hour

Unintentional Poisonings Focus Group

Pharmacist, GP, Family Day

Care, Ambulance service,

Maternal & Child Health,

SafeStart

6 participants

Childhood poisoning Lisa Gibbs

29/4/2003

1 ½ hours


- 38 -

Training intervention Participants Focus or purpose of training Facilitator/Date

Family Services Forum

Staff working with families &

young children

12 participants

Program overview, discussion

of local child injury data

Project Worker

11/2/2003

20 minutes

Pharmacy Alliance Meeting

12 participants Pharmacists

Unintentional poisoning in

young children – local and state

data, prevention strategies and

available educational materials

Project Worker

6/5/2003

½ hour

Ballarat Early Childhood Network Meeting

Staff working with families &

young children

9 participants

Program overview, discussion

of local child injury data +

display of safety products

Project Worker

3/6/2003

45 minutes

Ballarat Child & Family Services Safety Session – 1st Mentor’s Grp

Mentor’s working with

families in need of support

5 participants

Injury prevention education

session range of issues

Project Worker

15/10/03

1 ½ hours

Staff Information Session - Daylesford Pharmacy

Pharmacists & pharmacy

staff participating in Injury

prevention Week promotion

8 participants

Poisoning causes & prevention

Project Worker

16/10/03

20 minutes

Ballarat Child & Family Services Safety Session – 2nd Mentor’s Grp

Mentor’s working with

families in need of support

6 participants

Injury prevention education

session range of issues

Project Worker

1/12/03

1 ½ hours

The demonstration project was able to provide a number of successful programs,

raising the profile of child injury amongst service providers and enabling workers with

the skills to deliver child safety sessions to their clients. During the demonstration

project the following factors were identified that functioned as barriers or facilitators to

engaging service providers:

- kits and tools to assist the delivery of education sessions were found to

be an incentive. Where there are no user friendly resources staff are less

inclined to cover childhood injury. The SafeStart project worker developed a

number of resources for use by service providers including a resource

manual, session outline and child safety cards. Development and

distribution of high quality and current resources on a state-wide or national

level is one method of encouraging more services to deliver child safety to

their clients. The importance of training as a tool to motivate and instruct

staff on the use of any resources developed cannot be underestimated.


- 39 -

- high quality speakers were found to be an incentive for workers to attend

training and had the potential to motivate staff to increase their focus on

child safety (for example the presentation to M&CH by Graham Day on car

restraints and the workshop facilitated by Rebecca Hicks on the Keep Me

Safe cards for staff working with parents with an intellectual disability).

Where communities are able to access specialised speakers at an

affordable cost, opportunities for child injury professional development are

likely to be enhanced. In the Ballarat demonstration project this proved a

barrier to providing more professional education. It was difficult to identify

appropriate speakers and when identified they were often found to be

prohibitively expensive.

- competing demands of other training appeared to be a barrier to

engagement of some services in professional education training, with a

couple of agencies expressing interest in professional development of staff,

but finding difficulty to commit staff time to additional professional education.

It is envisaged that these barriers would have been overcome if the

SafeStart project was resourced for a longer duration as it seemed to be a

matter of just chipping a way at management by periodically making the

offer to provide training and encouraging staff to lobby management for the

training.


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4. INCREASING AWARENESS / ACCESS TO SAFETY PRODUCTS AND PROMOTION OF ENVIRONMENTAL CHANGES TO ENHANCE CHILD SAFETY Safety Product Demonstration Kitchens

During the planning stages of the project it became apparent that many parents lack

awareness of the range of safety products available to address hazards within the

home. Installing safety products in the kitchens of facilities frequently used by parents

with young children was seen as one method of addressing this issue.

It was initially planned to resource three demonstration kitchens in each of the three

postcode areas with elevated levels of child injury. Two sites were readily identified

as suitable in the 3350 (Ballarat) and 3355 (Wendouree) post code areas. However,

a suitable kitchen was unable to be located in the 3356 post code area (Sebastopol

and Delacombe). Factors considered in determining sites for the demonstration

kitchens were location of existing infrastructure and current utilisation of sites by

parents/community groups. Sites chosen were the Eureka Family Resource Centre

and the Wendouree West Community House. The Eureka Family Resource Centre

is a Council owned building which is currently used by seventeen different parent

groups a month, many of these use the centre on a weekly basis.

Products installed included a poisons cabinet, oven and stove guards, heater guards,

finger safe guards on door jams and various appliance and cabinet safety locks.

Signage conveying simple safety messages and explaining the products was also

provided. (For a complete listing of products and photographs see attachment 9).

The kitchens have been a successful strategy and the project worker has received

numerous enquiries and comments from parents and staff regarding the products

displayed. They have been especially useful in raising awareness of products not

widely available or not stocked locally, such as stove and oven guards, and finger

safe guards . The kitchens have also proved an excellent testing ground for the

durability of safety products, with some products breaking within days of installation

and others still functioning well after over twelve months of use.

Sponsorship and Additional Funding Sponsorship and the securing of additional funding for the project enabled the

Ballarat SafeStart project to resource additional programs and increase access to


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child safety products to both the general community and targeted families from

socioeconomically disadvantaged areas.

Funding of $7500 was provided to the project by the CFA from a grant received from

the Department of Justice. This money was used to develop and trial the education

strategies in Wendouree West which reached 66 residents (see Training and

education of parents and Carers). Thirty-six fire extinguishers, thirty-fire blankets and

child safety product to the value of $1500 was distributed as part of the strategy.

Two companies who manufacture child safety products, Safety 1st and Tee-Zed

(brand name Dream Baby) both supported the project by donating products. Tee-Zed

donated two large display boards of safety product and Safety 1st donated a range of

products including kitchen and bathroom safety kits and different safety latches. Both

companies also sold product to the project at cost price, which enabled the project to

purchase large numbers of small safety items for distribution to group participants.

The project worker was able to alert other Ballarat services to the opportunity to

purchase safety product at cost price.

The Ballarat Apex Club donated $1000 towards the purchasing of safety product for

families living in the Delacombe Public Housing Estate. The donation was used to

purchase twenty poisons cabinets which will be installed by the Office of Housing in

the homes of families with young children. It is planned to write to families during

August inviting them to indicate if they would like one of the cabinets.

Home visits to high risk families The project worker carried out a small number of home visits during the course of the

project. Provision of these visits could have easily consumed a large proportion of the

project resources, both financial and project worker hours, so the strategy was limited

and only provided in special circumstances, see table 5. However, these visits were a

very effective means of providing information and assisting parents to identify and

address child safety hazards within their home. They also enabled the project worker

to further explore the issue of child safety and to build relationships with staff from

other services. Safety product such as door barriers, fire blankets and safety locks

was provided to the families (see table 5), especially in earlier visits.


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Table 5 – Home visits to high risk families

Type Description Date Provision of safety products to

low income families

The project worker & Council’s Respite Care Coordinator visited

the home & discussed safety issues after the children were

identified by Respite Child Care workers as being at high risk of

unintentional injury due to aspects of the housing and the four

year old child’s behavioural problems. A number of changes

were recommended including removal of CD player and large

vase from a bench above a portable cot, removal of a thick

mattress which was smaller than base from portable cot, locking

away of electrical appliances. The family was provided with the

following safety products – a safety gate, poisons latch, power

point covers, cupboard & drawer child resistant latches. A home

safety checklist and a number of printed resources were also

provided. Latches were installed by Public Housing maintenance

staff. A Follow up letter was sent to cover legal issues.

Feb 2003

Provision of safety products to

low income families

The Project worker & the Respite Care Coordinator visited a

home & discussed safety issues after the children were identified

by workers as being at high risk of unintentional injury due to

poor quality housing. A child safety checklist was discussed as

we walked through the home. The family was provided with the

following safety products – a safety gate, poisons latch,

cupboard & drawer child resistant latches, power point covers,

door knob covers, along with a home safety checklist and a

number of printed resources. The latches & gate were installed

by the Office of Public Housing. A follow up letter was sent to

cover legal issues. The parent participated in the 4 week safety

program.

March 2003

Provision of safety products to

low income families

The project worker & a case worker visited a home & discussed

safety issues. A number of changes were recommended

including removing a timber barricade from hallway, emptying

nappy bucket of water, safer storage of poisons & removal of

vaporiser from the floor. The family was provided with following

safety products – a fire blanket, stove guard, door knob covers &

a number of adhesive latches along with a safety checklist and a

number of printed resources. A Follow up letter was sent to

cover legal issues.

May 2003

Family living in emergency

accommodation

Visited a family living in emergency accommodation at request of

Enhanced Home Parenting worker to discuss safety concerns.

Agency provided a number of latches as an interim measure.

April 2003

Family with a child diagnosed as

having autism

Visited a family living in their own home at the request of the

Enhanced Home Parenting worker to discuss safety concerns. A

safety information pack was provided and using the Safety

Centre checklist as a guide, strategies to reduce risks discussed.

October

2003


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Type Description Date Family living in rental

accommodation

Visited a family living in rental accommodation at request of

Enhanced Home Parenting worker to discuss safety concerns. A

safety information pack was provided along with some child

safety latches & power point plugs.

Dec 2003

Family of children burned late in

2003. Family has 6 children

under 6. Two of the children

were burned when petrol they

were playing with in the lounge

room was ignited by a heater

Visited a family living in rental accommodation at request of their

case workers & Enhanced Home Parenting worker to assist

parents to complete a home safety checklist. Met with case

worker to discuss possible items that could be purchased for the

family and safety issues that the landlord could be asked to

address. Showed case worker safety products displayed in the

Eureka Family Resource centre and discussed options for more

safety education with other case workers. Invited parents to

attend a 4 week safety program in March. A safety information

pack and power point plugs were provided. Parents attended the

4 week program.

Jan 2004

Mother with a 2 year old living in

public housing

Visited the mother with her parenting worker. There were a

number of concerns raised by the mother who is hearing

impaired and concerned that her child will slip out of the house

unnoticed. Also issues with cupboards, stove etc. Provided

worker with some sample safety products and a home safety

checklist to be used on a follow-up visit

Jan 2004

Encouraging Enhancement of Child Safety in Emergency Accommodation

Staff working with families reported that they had observed a number of safety

hazards in the homes of their clients living in emergency accommodation. These

mothers and their children were often escaping domestic violence and emotionally

traumatised. Understandably, this at times resulted in behavioural issues with the

children and reduced levels of parental supervision. It was felt that these women had

enough to worry about in their lives without the added worry of child safety, so it was

important to minimise all child safety hazards within these homes. The use of child

safety products within emergency accommodation was also an excellent awareness

raising strategy providing parents with information about various products that they

may then choose to purchase when they moved into their own home.

The project worker held meetings with staff from three services that provide

emergency accommodation to women and children and briefed staff on key child

safety issues. Safety check lists and other safety information was also provided and


- 44 -

the project worker assisted two agencies to complete safety checks on some of their

premises. Written reports containing recommendations were then provided to each

agency.

WRISC Domestic Violence Support Service reported that they had forwarded the

report to the body that maintains their property and were awaiting notification of

which areas they would be prepared to address. The Salvation Army reported that

they had made some changes to the seven units, including installing mag-locks,

power point plugs and other safety latches.

Oleander Trees The project worker approached one of the City of Ballarat Horticulturalists to conduct

an information session for Family Day Care Providers on poisonous plants. In

preparation for the session the horticulturalist was collecting samples from Ballarat

gardens when he discovered 76 Oleander trees in nature strip plantings. Council is

planning to remove the trees and replace them with non-poisonous varieties.

Delacombe Public Housing Estate Project

Research suggests that there is a need for targeted injury prevention efforts among

children from socioeconomically disadvantaged populations (Faelker, Pickett &

Brison 2000) and the most successful programs to reduce unintentional injuries are

those that use a combination of approaches including education and environmental

modification (Evans & Kohli 1997). With this in mind, SafeStart formed a partnership

with the Office of Housing with the view to enhancing the safety of homes in the

public housing estates and increase residents’ skills and knowledge around child

safety.

Initially, the two housing estates considered for this project were Delacombe and

Wendouree West. However, consultation with the Office of Housing revealed a

feeling by staff that it would be good to focus on the Delacombe housing estate as

the Wendouree West community had received significant benefits through the

Renewal project including housing upgrades, training opportunities etc. Examination

of the data revealed there to be 138 Office of Housing properties in Delacombe and

over half of the homes were occupied by families with young children.


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The aim of the project was to undertake a survey of the homes to establish and

prioritise the safety requirements of each property. Identified safety issues could then

be addressed, subject to budget feasibility, by the Office of Housing. In addition,

financial support provided by the Ballarat Apex Club was able to finance additional

safety products to address identified priorities. A show bag containing safety

information, small safety products and other promotional items was provided to each

household at the time of surveying and 30 training places for level one first aid, with a

child safety component, were offered to residents at a nominal cost of $10.00.

This project was initiated in mid 2003 and was due to be completed by early 2004.

Although initial progress was delayed, the project worker was keen to pursue this

strategy and the Office of Housing agreed to commence the project in April 2004.

The City of Ballarat agreed to provide funds to enable the project worker to stay on to

complete the project and the Office of Housing provided resources to employ staff to

assist with compiling of the show bags and collation of the surveys. Surveying of the

properties was undertaken by the SafeStart project worker and the Family Day Care

Coordinators from the City of Ballarat.

The surveying was completed in late June, and 50% of properties were surveyed.

The data is currently being collated by the Office of Housing and arrangements have

been made for the data to be presented to staff involved in the surveying and for

recommendations to be made to the Office of Housing regarding priority issues

identified during the surveying. In addition, twenty poisons cabinets have been

purchased with the funds donated by the Ballarat Apex Club and two level one first

aid courses were offered to residents. The project has also been incorporated into

the Best Start Action Plan and ongoing coordination will be through the Best Start

Health and Safety working group.

The level of community involvement in the project activities in Delacombe was

limited. This was primarily due to a reluctance on the part of the project worker to

engage with the local community and raise expectations when it was uncertain if the

project would proceed. When the project was confirmed there were very tight time

lines which restricted the ability of the project to involve and work with the local

community. This impacted on project outcomes with fewer residences electing to

attend provided training opportunities. The lack of an appropriate training venue

within the local community was also a barrier to attendance as bookings and training

were provided at an unfamiliar location outside of the community.


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5. CHANGES IN POLICY AND PROCEDURES Best Start Action Plan

Strong links between SafeStart and Best Start were established from the very

beginning in Ballarat when a joint SafeStart/Best Start Reference group was

established with representatives from Council, key agencies, the Department of

Human Services and the Department of Education and Training. The reference

group oversaw the development of the submission/expression of interest for the two

projects and once successful was responsible for providing ongoing direction and

guidance to each project.

It was always acknowledged by Council and the Reference Group members that

there was a direct link between SafeStart and Best Start and that the projects would

work in parallel to one another. As a consequence, SafeStart was able to strongly

influence the Best Start Action Plan and Best Start has been able to adopt learnings

from SafeStart and build on the project’s successful strategies.

Child injury prevention has been incorporated into the Best Start Action Plan with

three of the four projects listed for the Health and Safety working group aiming to

continue the work of the SafeStart project or intending to include child safety as a

focus (see attachment 14). These are:

- Enhance the safety of the children within the Delacombe Public

Housing Estate

- Develop strategies to sustain the successes of the SafeStart project

- Organise a Family Play Day

Currently the Health and Safety working group is supporting the Delacombe Housing

project and considering education interventions which could build on the initial

project. The group is also examining the option of Ballarat Community Health Centre

incorporating the delivery of the child safety program developed and trialled in

Wendouree West into its health promotion program for the coming financial year.

Other Best Start projects, including the current development of an antenatal

information kit for parents, have also been influenced by the SafeStart project with

the incorporation of a child safety component. The forthcoming employment of the

SafeStart project worker on a short term contract to work on an Children’s and Family

Services Directory will further cement the relationship between the two projects and it

is planned to include child injury prevention tips in the directory.


- 47 -

Municipal Public Health Plan The issue of child safety has been integrated into Directions in Well-being, the City

of Ballarat’s Municipal Public Health Plan. The issue of unintentional injury to children

is discussed in detail in two main sections of the plan, ‘Basic Needs’ and ‘Safety and

Security’. See attachment 13. There was no specific focus on child injury prevention

in the previous Municipal Public Health Plan and inclusion of it in the current plan

demonstrates a commitment to child injury prevention by Council.

Maternal and Child Health First Time Parents Program A working group was established to develop a child safety session for delivery to all

first time parent groups. The program was trialled by the project worker during 2003

and has been delivered by the M&CH Nurses since February 2004. Prior to the

SafeStart project, delivery of child injury prevention sessions by M&CH was

inconsistent. Child safety has now been adopted as a consistent, ongoing part of the

First Time Parents Program.

Early Years Plan Staff in Family and Children’s Services are currently developing the Municipal Early

Years Plan. This is a new document and the work of the SafeStart project has

contributed to the awareness of the health issue of child safety and ensured it will be

incorporated into the document.


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RESOURCES DISTRIBUTED AS A RESULT OF

THE STRATEGIES During the Ballarat SafeStart project just under 40,000 child safety brochures,

booklets and flyers were distributed (see attachment 10 for a complete listing of

resources distributed). Management and collation of these resources was a large

part of the project worker’s role. Large scale resource distribution requires significant

investments of time to locate, order and collate resources, significant storage space

and an ability to transport numbers of often quite heavy boxes.

The large number of excellent child safety brochures and information sheets

available on various aspects of child injury prevention have the potential to provide

invaluable information to parents, carers and service providers. However, there is

often no way of knowing if resources distributed to service providers are distributed to

parents and carers or if distributed resources are actually read by parents and carers.

Current child safety resources do not always cater well for minority groups within our

community, with the information in many brochures excluding parents with low

literacy, intellectual disability or parents from a non English speaking background.

This issue is further discussed within the resources developed section.

One strategy utilised to encourage parents/carers to retain distributed resources was

to compile information into child safety information packs (see also discussion under

Resources Developed). Durable plastic envelopes were used for these packs. The

packs were large enough to hold up to twenty brochures as well as samples of safety

product and other small promotional items such as pens, magnets and

thermometers.

The packs were easy to transport and distribute and were well received by parents

and carers, especially when additional items such as a pen or thermometer were also

included. When compiling packs it was important to ensure, where possible, that the

information was appropriate to the age/developmental stage of the child. However,

this had to be balanced with fact that the parents may receive little additional safety

information from other sources in the months and years following the presentation.

So it was also important to also provide information in the packs related to later

developmental stages over the next couple of years.


- 49 -

RESOURCES DEVELOPED AS A RESULT OF

THE STRATEGIES Careful consideration should be given to embarking on any resource development

as it can be more complex and time consuming than first anticipated. However, the

rewards can be significant and the ability to develop resources in response to

identified local needs can be an excellent strategy to engagement of the community

and service providers. Other benefits are the bringing together of workers from

different sectors with a common purpose during the development process and the

ability of a well developed resource to focus and guide workers into consistently

addressing child safety with their clients.

In the Ballarat demonstration project consultation with service providers and parents

identified the need for a number of resources. As a consequence of this consultation,

the following resources were developed:

a. Resource Manuals Whilst there is a wide range of child safety resources available, a lack of awareness

of these resources amongst service providers was identified as an issue. In an effort

to address this barrier, a comprehensive resource folder was developed, based on

one developed by Hume City Council. The contents of the manual included:

- A copy of all current child safety brochures

- Statistics on injury incidence

- Key points on injury causes and prevention strategies

The manuals were produced by the project worker and distributed to staff working

with children and families.

b. Home Safety Kit This resource was developed for parents and carers of children aged 0-5 years who

participated in the Wendouree West Child Safety program, and aimed to provide a

lasting resource on child safety for the members of the program. At the first session

each participant was provided with a folder to which was added a plastic envelope of

resources each week relating to the topics covered that day. The kits proved very

popular with participants and were brought back to the sessions each week .


- 50 -

c. Safety Product Resource Kit A kit of child safety products was developed for use by the project worker and other

service providers when facilitating groups and holding displays. The kit proved to an

excellent resource assisting to raise awareness of the range of safety products

available and adding a visual interest to group presentations. It was considered

important to have products priced and to provide information regarding the use of

each product to enable those less familiar with the kit to still use it effectively.

d. Safety Product Display Boards Two display board featuring a range of safety products were donated by Tee-Zed

who manufacture Dream Baby safety products. The boards were used for displays

and during presentations to raise awareness of available safety products.

e. SafeStart Logo, Tee-shirts and Pens

A small amount of the budget was used to resource the development of a SafeStart

logo which was then printed onto tee-shirts and pens. These promotional products

proved popular with the public at displays and group presentations and assisted to

raise awareness of the project.

f. Safety Information Packs Information packs were developed for distribution to parents attending safety

sessions. Each pack contained sixteen child safety resources including a home

safety checklist, a thermometer and a pen (see attachment 6 for a listing of contents).

Although time consuming to compile, the kits were relatively inexpensive to put

together as most of the materials were donated. The packs proved popular with

parents, generated interest during presentations and provided a handy and lasting

reference to most child safety issues. An additional eight hundred safety information

packs were produced to provide the Maternal and Child Health Program with a two

year supply for distribution to participants in the First Time Parents Groups. The

compiling of these kits was contracted out at a small additional cost to each kit.

g. Set of Safety Lock Demonstration Cabinets A small Perspex fronted cabinet containing 9 drawers/cupboards & fitted with a range

of child safety locks was developed to promote appropriate use of safety latches

amongst parents & staff working with children. The cabinet enabled the project

worker to clearly demonstrate the variety of safety latches available and the varying

level of resistance provided by each style of latch. A clear Perspex front on the


- 51 -

cabinet enabled parents and service providers to see how latches were installed and

was particularly useful to demonstrate how latches can be installed on frameless

drawers. Although well received by parents and workers, the cabinets developed

were quite heavy and this restricted their usefulness.

h. Staff Information Pack - Prevention of Childhood Poisoning Promotion An information pack was developed for the staff of pharmacies participating in the

Poisoning Awareness project held during Injury Prevention Week. The pack was

developed to provide information to staff prior to the promotion, particularly those not

participating in a staff information session. Contents of the pack included:

Answers to frequently asked questions

brochures on poisoning prevention

a project outline

an evaluation questionnaire

i. Pictorial Child Safety Resource Consultation with service providers identified the need for a pictorial based child

safety resource for use with parents with an intellectual disability. Staff working with

these parents identified child safety as a major health issue and as their client

numbers have increased substantially in recent years, so it was felt the relatively

expensive cost of developing the resource was justified.

A working group was formed comprising the SafeStart project worker, staff from

Ballarat Health Services Domiciliary program , Maternal and Child Health Enhanced

Home Visiting program and Child and Family Services’ Parenting Assessment and

Skills Development program. The group met regularly from mid 2003 and after

discussion and research decided to develop and a set of 40 cards depicting

photographs of child injury prevention strategies and simple text supported by

symbols and colour to enhance understanding by non-literate parents.

Development of the resource proved to be a more time consuming and complex task

than was initially identified. It was a great benefit having staff who would use the

resource actively involved in the process of development as they were able to

provide ongoing feedback and this enabled the resource to be tailored to the needs

of their client group. However, development of the captions for each photograph

proved very difficult and the decision was taken to hire a consultant to assist with this

stage of the development. Purchasing assistance to develop the captions and assist


- 52 -

with training and development of the training notes proved to be an excellent use of

resources, enhancing the quality of the resource and training package. In late June,

seventeen service providers attended a half day training workshop to introduce them

to using the cards with their clients. Evaluations showed a high level of satisfaction

with both the training and the resource.

Other positive outcomes were that the resource development brought staff from

different agencies together to discuss how they currently deliver safety education to

their clients and as a flow on from this gaps and inconsistencies were identified.

Options for facilitating broader distribution of this resource are currently being

explored and St Luke’s Innovative Resources have expressed interest in publishing

the cards in the future as has a local service provider. A prior necessity to any

republishing would be an evaluation of the resource with the staff and clients

currently using it. The importance of training to assist staff to utilise the resource

effectively was also identified during the development of the Keep Me Safe Cards.


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SUSTAINABILITY OF SAFESTART STRATEGIES Some of the piloted strategies will have medium to long term sustainability, while

other components of the project will not be sustainable without the provision of at

least a minimum of resources to provide for the ongoing coordination of project

activities. In particular, the targeting of high risk families was found to be resource

intensive, but if we want to minimise injuries in this target group it must be

acknowledged that ongoing funding is necessary.

Table 6 below describes the strategies which will have ongoing impact in the medium

(M) term (1 – 2 years) and long (L) term (3 – 5 years) within the community, and

those where the impact is considered by the project worker to be short (S) term.

Table 6 – Sustainability of SafeStart Strategies Which Will Continue After the Project

Strategy

S

M

L

Comment

Maternal & Child Health First Time

Parents Safety Session

Strong support for intervention amongst staff

including program coordinator. All current staff in

serviced in session delivery. New staff have

laminated training cards & current staff as a

resource. Policies to be developed will further

reinforce child safety.

Safety It’s Child’s Play Program

Options currently being explored for another

organisation (Community Health) to coordinate

this program and seek funding to deliver twice

annually.

Focus group evaluation has shown participants of

program retain knowledge and share with family

& friends

Safety Product Demonstration

Kitchens Long term benefits to community as both sites

will be maintained by managing bodies

Enhancement of Child Safety in

Emergency Accommodation

Changes to buildings have potential to provide

long term safety benefits. Effects of education

remain with staff for 1-2 years.

Delacombe public housing Estate Involvement of Best Start Health & Safety

Working Group in project will provide ongoing

involvement with this community

Resource manuals

Resource manuals will remain current for a

minimum of two years. Possibility of an update

being provided in the future as a task for a

student on placement

Home Safety Products Kit Two yearly review and updating of kit contents to

be carried out by M&CH program staff


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Safety information packs

Current supplies sufficient to resource First Time

Parents Program for two years. All information

required to assemble additional stocks recorded

and transferred to M&CH Admin Officer. Ability to

secure additional funding will determine long term

sustainability.

Pictorial Child Safety Resource

Resource has potential to be sustainable in the

long term. Sufficient produced to allow for wear

and tear, training will be provided in a train-the-

trainer style to enable agencies to provide their

own ongoing training to staff. Options of

republishing rights being provided to a resource

publishing company.

Community & Professional

Education

Effects of educations sessions delivered by

project worker will remain within community for 1-

2 years. Evaluation of Wendouree group 7

months post intervention showed retention of

knowledge and ongoing education of friends &

family by participants


- 55 -

EVALUATION FRAMEWORK External evaluation - the contract for the evaluation and support of the three

projects was awarded by DHS to a partnership between Monash University Accident

Research Centre (MUARC) and the Centre for Community Child Health at the Royal

Children’s Hospital (CCCH). Each project was required to provide regular data input

about its planning, strategies and activities using the Generic Evaluation

Assessment System (GEAS). Staff from MUARC and CCCH conducted pre and post

project interviews with the project workers, managers and key informants in each

Local Government Area and held focus groups with program participants and key

informants at the conclusion of the project. A report of the process and impact

evaluation of the SafeStart projects are due to be submitted to DHS at the end of

June 2004.

Data Collection Generic Evaluation Assessment System – initially developed by MUARC for the

evaluation of the Foothold on Safety projects, the GEAS was modified to suit the data

collection requirements of the SafeStart projects. The GEAS required SafeStart

project workers to complete comprehensive six-monthly reports and provide

supporting data for all project activities. Project activities recorded by the GEAS

included media, resource distribution, education sessions, partnerships, awareness

raising and changes to policy and environments. Project data from the GEAS and

other local based evaluation was used in preparing this report.

Education Sessions – 90% of participants attending sessions delivered during the

Ballarat SafeStart project were asked to complete a written evaluation (see

attachment 11). The evaluation tool was developed by MUARC and CCCH and

focused on process evaluation and intention to act to reduce household hazards after

the session. A summary of some of the evaluations completed is contained in

attachment 12.

Focus Group – the Centre for Community Child Health was commissioned by the

Ballarat SafeStart project to conduct a focus group with the first participants from the

four-week child safety program developed and trialled in Wendouree West. The

evaluation was carried out by staff not involved in the overall SafeStart evaluation.

The aim of the evaluation was to gauge the impact of the program in relation to

behaviour change amongst participants and to explore further why the program was

so popular with participants. A copy of the report is provided in attachment 8).


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KEY OUTCOMES The SafeStart project strategies and activities provided considerable outcomes to the

Ballarat community, including the target population and service providers.

Increased awareness of child safety issues and injury prevention strategies

amongst parents and carers on children 0-8 years as measured by the

evaluations from the education sessions (see attachment 12)

Increased awareness of child safety issues and injury prevention strategies

amongst service providers working with families and children

The development of resources in response to identified local needs.

Resources developed include the Keep Me Safe Cards (a set of 41 cards for

teaching child safety concepts to parents with an intellectual disability/low

literacy), a child safety resource manual for service providers, a kit of safety

products for group education and a cabinet for displaying the various uses of

child safety locks

Establishment of two safety product demonstration kitchens to assist to raise

community awareness of the wide variety of safety products available for

reduction of hazards in the home. The kitchens are located within a well

utilised community house and a Council venue utilised for before school care,

playgroups and training of Family Day Care providers

Development, trialling and evaluation of a four-session education package

targeting high risk families and development and trialling of a single session

child safety information session for use by M&CH with First Time Parents

groups

Collaborative partnerships developed between SafeStart and a number of key

service providers including Maternal and Child Health, Best Start, Child and

Family Services, Ballarat Health Services, the Office of Housing and The

Country Fire Authority

Implementation and evaluation of child safety information sessions for parents,

grandparents and carers of children 0-8 years


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Inclusion of child safety in the Municipal Public Health Plan for the first time

Provided increased awareness and hazard reduction in some properties used

for emergency accommodation, child care centres and the homes of some

socioeconomicly disadvantaged families

Collation of 800 child safety information packs to be distributed to first time

parents via Maternal and Child Health, including child safety information,

sample safety product, a home safety checklist and a hot water thermometer

Surveying of 50% of public housing properties in the Delacombe Housing

Estate to identify priorities for enhancing the safety of the homes for young

children, provision of poisons cabinets to 20 households

Improved focus on injury prevention in general and within Council


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LEARNINGS Relationships – the Ballarat project worker found that good outcomes in the

demonstration project were linked to positive relationships with the community and

workers. Development of these relationships can take time, especially if the

workers/community do not initially see child injury as a pressing health issue or part

of their core business. The longer a project can be resourced, the greater the

opportunities for relationship building and achieving of project objectives. However, in

situations where time is limited, it is recommended that only the most receptive

communities and workers be engaged in order to maximise returns from available

project time

Community Infrastructure and Support Systems - The level of community

involvement in the project activities was found to have significant impacted on project

outcomes. Evaluations revealed greater community consultation and involvement in

planning and implementing of SafeStart strategies resulted in greater involvement in

project activities by community members. The SafeStart activities in Delacombe area

can be contrasted with the Wendouree community where time, existing community

infrastructure and the presence of other projects enabled more community

consultation and engagement prior to commencing project activities. The community

education programs in Wendouree were very well attended while those targeting the

Delacombe community had a poorer response.

Sustainability of Project Activities – In general, short term approaches tend to

have short term outcomes, and the longer a project is able to be resourced the

greater the likelihood of strategies becoming part of the regular and ongoing work of

services. The project worker found achieving sustainability of project activities to be

a complex issue which required consideration during the planning stages. However, it

was also discovered that sometimes sustainability can only be achieved after a

strategy has been developed and tested and shown to be of worth. The four session

program developed to target at risk families and the Keep Me Safe cards are two

examples of this. When they were just a concept there was limited interest from other

agencies in taking on these projects, but with a tangible product, interest has

increased significantly.


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Targeted Interventions – child injury is a very broad area with numerous causes

and risk factors for each age group. When planning a program it is important to

prioritise interventions based on community/worker receptiveness, community risk

profile and availability of time and other resources. Selecting fewer, more targeted

interventions is likely to be more effective.

Displays – holding displays can be a useful promotional strategy, but given the time

involved in development and staffing it may be more effective to prioritise other

strategies. If display materials were able to be provided/loaned via a clearing house,

it would significantly enhance opportunities for other workers to conduct displays

Media – some components of media promotion were found to be very time

consuming and resource intensive, but despite this the media was found to be a

useful strategy for raising community and worker awareness. Although not trialled in

Ballarat, the formation of a promotions working party may have assisted to spread

the work load of promoting child injury in the LGA. Provision of media releases on

various causes of injury, with accompanying photographs, via a centralised clearing

house or website would be a useful support for workers conducting injury prevention

strategies and may lead to more media coverage of the issue of unintentional child

injury

User Friendly Resources – where there are current, user friendly resources readily

available (eg teaching kits, giveaways, information packs, displays and other

promotional items) workers are more inclines to address child injury. Where there are

competing health issues demanding of a worker’s time it is often the

sessions/strategies that are easiest to implement and most enjoyable that will be

taken up. As most workers do not have the time or motivation to spend hours

searching for resources it appears necessary to make this process as straightforward

as possible in order for unintentional child injury to be taken up.


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RECOMMENDATIONS The following recommendations are made by the Ballarat SafeStart Project:

1. That any future child safety projects funded by the Department receive longer

period financial support to enhance sustainability of project interventions

2. That a centralised clearing house be established to distribute child safety

information resources throughout the State. This could be readily achieved by

increasing resources to existing services. This would assist to address the

issue of service providers lacking awareness of available resources and

where to access them. The majority of service providers who address child

safety issues do so as one small part of their work load and rarely have the

motivation or luxury of time to track down resources. If we want service

providers to discover and distribute resources we need to make obtaining

them a simple, one stop shop approach

3. That the Department of Human Services Public Health Group investigate the

feasibility of forming partnerships with businesses to promote and sell child

safety products in outer metropolitan, rural and remote areas

4. That the Department of Human Services Public Health Group investigate the

feasibility of providing age appropriate child safety information packs to all new

parents via the Maternal and Child Health Service or hospital system. This

could be undertaken in partnership with manufacturers of child safety product

and sponsorship could be sought to support the proposal

5. Consideration be given to the development of an ongoing media campaign to

raise the profile of child injury within the general community and service

providers and address the attitudes that ‘accidents’ are a normal part of

growing up and either unavoidable or not an issue for their children

6. Examine the option of establishing links with organisations such as Workcover

and Trade Unions to extend the key Occupational Health and Safety

messages into the home environment and apply them to child safety


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7. Development of bright, ready made, lightweight displays that can be easily

accessed to community groups and service providers for information days,

community events and festivals. (make it as easy as possible for people to

conduct health promotion in the area of child safety)

8. Establishment of links with other Departments on a State-wide level e.g. Office

of Housing and Family and Community Support Community Care to promote

child safety to staff, clients and funded organisations

9. Develop targeted child safety programs for low income families. This could

include a training manual with suggestions for arranging and promoting the

course, ideas for guest speakers, session content etc. All participant could be

provided with a centrally developed kit of child safety products

10. Explore possibilities to roll out child safety training and resources to service

providers across the State. The Ballarat SafeStart project piloted a number of

resources which showed potential and subject to further evaluation and

development could be suitable. These include the Keep me Safe Cards, a four

session program targeting low income and high risk families and a session for

first time parents to be delivered by Maternal and Child Health


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REFERENCES

1. Al-Yaman, F., Bryant, M., & Sargeant, H. (2002). Australia’s

Children: their health and wellbeing 2002. Australian Institute of

Health and Welfare. ACT.

2. Deal, L., Gomby, D., Zippiroli, L., & Behrman, R. (2000).

Unintentional Injuries in Childhood: Analysis and

Recommendations. The Future of Children, 10 (1), 4 – 22

3. Department of Human Services. Evidenced-Based Health

Promotion: No. 4 Child Injury Prevention. (2001). Public Health,

Victorian Government Melbourne, Victoria, Australia.

4. Evans, SA., & Kohli, HS. (1997). Socioeconomic Status and the

Prevention of Child Home Injuries: a survey of parents of preschool

children. 3 (1), March, 5 – 8.

5. Faelker, T., Pickett, W., & Brison, RJ. (2000). Socioeconomic

Differences in Childhood Injury: a population based epidemiologic

study in Ontario, Canada. Injury Prevention. 6 (3), September, 203

– 208.

6. Hawe, P., Degeling, D., & Hall,J. (1990). Evaluating Health

Promotion. A Health Worker’s Guide. Australia, MacLennan & Petty.

7. Hemmo-Lotem, M., & Danon, Y. (2003). Childhood Injuries in Israel:

status and prevention strategies. Harefuah, 142 (8-9), 609-611, 645,

646.

8. Kidsafe Child Accident prevention Foundation. (2000). Kidsafe Child

Safety Resource Manual. Victoria.

9. Paul, C., Redman, S., & Evans, D. (1992). The Cost and Availability

of Devices for Preventing Childhood Injuries. Journal of Paediatric

Child Health. 28, 22 – 26.


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10. Routley, V., Ashby, K. (1997). Safe Home Design. Hazard. 32,

September, 1 – 13.

11. Shenassa, ED., Stubbendick, A., & Brown, MJ. (2004). Social

Disparities in Housing and Related Paediatric Injury: a multi level

study. American Journal of Public Health. 94 (4), 633 – 639.

12. Stokes, M., Ashby, K., & Clapperton, A. (2001/2002). The Effect of

Socio-economic Status on Injury Among Victorians. Hazard. 49,

Summer, 2 – 17.

13. UNICEF. (2001). A League Table of Child Deaths by Injury in Rich

Nations, Innocenti Report Card No 2. February. UNICEF Innocenti

Research Centre, Florence.


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SafeStart Ballarat Report - Department of Health, Victoria

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Transcript of SafeStart Ballarat Report - Department of Health, Victoria