CHIP Training Plan and Slide Notes

Before you begin….

Number of participantsThe ideal number of participants for a CHIP session is 15.

Room layoutYou'll need a room big enough for 15 participants. Layout is flexible but participants need to see the screen. Ideally table space for 3 teams to sit and complete activities.

Resources (depending on the activities you choose)- Laptop with CHIP Training Presentation installed- Copy of CHIP Training Plan and Slide Notes- Projector and screen- Flipchart paper and pens- Sign-in sheet and evaluation forms- Copies of the CHIP Quiz and CHIP Quiz Answers sheet- A set of CHIP Hazards and Safety Messages Cards and a copy of CHIP Cards Answer Sheet- Copies of the CHIP Safety Slogans Game Sheet and CHIP Safety Slogans Answer Sheet- Copies of the CHIP Assessment and CHIP Assessment Guide

09:30 – Start of session

SLIDE 1 – Front slide

Welcome Introductions Format of the day (timings, breaks) Housekeeping (toilets, refreshments, fire alarms/fire escape, mobile phones) Ground rules

- Remind participants that the session will focus on injuries that cause disfigurement, disability and death to young children. Sensitivity is required as some people in the group may have been affected by this.

09:35 – Aims and objectives

SLIDE 2 – Marmot Quote

The Marmot Review into health inequalities in England identified unintentional injury (or accidents) as a leading cause of avoidable death, ill health and disability in children and young people and a major health inequality.

Hence the reason for today's course.

SLIDE 3 – Aims and objectives

The session is about building on the knowledge and expertise of participants, and to encourage them to focus more on accident prevention when working with their families.

09:45 – Quiz activity

SLIDE 4 – Quiz

Follow instructions on CHIP Quiz activity card.

10:05 – Local and national context

SLIDE 5 – Local and national context

SLIDE 6 – Public Health England quote

Quote taken from Public Health England's 'Reducing unintentional injuries in and around the home among children under five years', March 2018.

'Unintentional injury' is a health topic underpinned by a large body of evidence and research. It's a priority public health topic.

SLIDE 7 – Terms and definitions

Injury. Physical harm or damage to someone's body. In some cases leads to disability, disfigurement or death.

Accident. An incident that happens unintentionally and unexpectedly. Unplanned. Unintentional injury. The term is preferred to 'accident' as we know that a lot of injuries happen

because of predictable and preventable events. Accidental injury. Sometimes this term is used instead of 'unintentional injury'. Intentional injury. Injuries purposely inflicted either by the victims themselves (i.e. suicide and suicide

attempts) or by other persons (i.e. homicide, assault, rape, abuse). Avoidable injury. Defined by the Office for National Statistics (ONS) as injuries that are preventable in

light of effective healthcare or public health interventions. These could intentional or unintentional injuries.

SLIDE 8 – Hospital admission rates by age

Note how hospital admission rates for unintentional injury (green bars) are highest in children aged 0, 1 and 2. This coincides with children going through big developmental changes.

SLIDE 9 – Public Health indicator 2.07

National Public Health indicator 2.07 – 'Hospital admissions caused by unintentional and deliberate injuries in children (aged 0-4 years)' – allows for comparison with national and regional injury rates.

Lincolnshire's hospital admission rates for injuries in the 0-4s are similar to the England average; however, there are parts of the county with significantly higher admission rates (Lincoln).

SLIDE 10 – Hospital admission rates by deprivation

As the Marmot Report highlighted, childhood unintentional injuries are a major health inequality. In Lincolnshire, children in the 10% most deprived areas are 24% more likely to be admitted to hospital than the average child.

SLIDE 11 – Child death rates by parent social class

Results from a study looking at child death rates by their parent's social class found that children of parents who are long-term unemployed, or have never worked, are 13 times more likely to die as a result of

unintentional injury than children of parents in higher managerial or professional occupations. Those children are also:

37 times more likely to die from fire 21 times more likely to die as a pedestrian 28 times more likely to die as a cyclist.

Although published back in 2006, the study powerfully demonstrates the health inequalities of childhood unintentional injuries.

SLIDE 12 – Personal cost of injury

Behind each statistic is an individual, child, family whose lives have been affected.

SLIDE 13 – Lucy's story

Follow instructions on Lucy's Story activity card. Here's more about her experience:

Lucy was in the bath just before her first birthday. Her mum nipped out to answer the phone. Lucy knocked the hot tap and suffered third degree burns to a third of her body. She had to be sedated for about three months, but then she developed septicaemia and the doctors gave her three days to live. She had to have the tips of some of her fingers and toes amputated. Over the years she's undergone more than 50 operations and skin grafts and will need them for the rest of her life.

The slide picks out some of Lucy's comments. These are common experiences from others who have been affected by injuries.

Points for further discussion:

Where does accident prevention fit into the policies and procedures of the services attending?

10:15 – The most common, serious and preventable injuries and the key safety messages

SLIDE 15 – Higher or lower

Click through until only 'Struck by Person/Animal' is on the slide. Tell participants that you’re going to go through different causes of hospital admissions for the under 5s and they need to tell you whether it's a more common or less common (higher or lower) cause of admission than the one before.

Electric current (lower) Poisoning (higher) Smoke, fire, flames (lower) Drowning (lower) Heat/hot substances (higher) Struck by objects (higher) Choking, suffocation, strangulation (lower) Falls (higher).

Click until the slide also shows causes of death. Points to note:

There are more admissions for 'Falls' than all the other causes combined Admissions for 'Drowning' and 'Choking, suffocation, strangulation' are lower but they're a leading

cause of death. This is because they cause children to stop breathing. 'Struck by objects' are accidental bumps and knocks

Electrocution is very rare.

SLIDE 16 – Five for the under 5s

We want to focus on the most serious injuries and those where there's strong evidence that they can be prevented.

Public Health England suggest we focus on 'five for the under 5s': Falls; Burns and scalds; Poisoning; Downing; Choking, strangulation and suffocation. These five causes account for 90% of unintentional injury hospital admissions for this age group. Between them they are a significant cause of preventable death and serious long-term harm.

Follow instructions on the Five for the Under 5s (1) activity card.

SLIDE 17 – Choking, suffocation and strangulation

This is the leading cause of accidental death among the under-fives.

50% of under 5s who die from choking, suffocation and strangulation are under 1. For children under 1, the main cause is suffocation/strangulation in bed.

Prop feeding is when a bottle is propped up in baby's mouth and they're unable to push it away. There's a risk of choking, plus increased risk of ear infections, tooth decay and overfeeding.

SLIDE 18 – Falls

Falls are the main cause of injury-related admissions for under-fives.

Most admissions are from furniture falls.

Children under 1 mostly fall from beds or highchairs, or while being carried.

Falls from height can be serious – window, balcony, stairs, furniture, work surface and highchair.

SLIDE 19 – Poisoning

70% of admissions are poisonings from medicines and 20% are from household/garden chemicals.

Button batteries, especially the larger lithium coin cell batteries, can badly injure or kill a child if they are swallowed and get stuck in the food pipe. If a button battery gets stuck in the food pipe, energy from the battery reacts with saliva to make the body create caustic soda. This can burn a hole through the food pipe and can lead to catastrophic internal bleeding and death.

SLIDE 20 – Burns and scalds

Injuries can be disabling and disfiguring and are expensive to treat.

Hot drinks cause the majority of the injuries. Drinks can still burn to a child to the third degree 15 minutes after they've been made.

Kitchen is the most likely place to get burned (48% of all admissions).

Hair straighteners account for up to one in ten burns injuries to children.

SLIDE 21 – Drowning

The second leading cause of injury-related death for under-fives.

For the under-fives the main risk is the bath. Pond, paddling pool and swimming pool risks increase as

children get older and more mobile.

Follow instructions on the Five for the Under 5s (2) activity card.

SLIDE 22 – Supervision

Accident prevention guides for parents and practitioners often don't include supervision. Supervising children is the best way to prevent them from hurting themselves. Accidents are much more likely when the parent/carer's ability to supervise is compromised.

SLIDE 23 – Resources

Follow instructions on the Safety Slogans activity card.

11:00 – Break11:15 – The relationship between child development and injuries

SLIDE 25 – Accidents and child development

There's a strong link between the types of accidents children are involved in and their stage of development.

Children are at higher risk of injury if parents haven't anticipated their child's next stage of development and made necessary changes to their home or safety practices.

Children all develop at different speeds. A child might roll over for the first time at 3 months or at 10 months. But it will roll. It can be misleading to put a date on when this will happen. Consideration also needs to be given to children with disabilities who might significantly deviate from the average.

Parents like talking about what their children can do which means it's a good opportunity to discuss accident prevention and give timely messages.

The aim of prevention activities with parents should be to get them to think about safety rather than give them the answers.

SLIDE 26 – Stages of development

Follow instructions on the Child Development activity card.

SLIDE 27 – Child Milestone Cards

The milestone cards have been developed to support conversations with parents about child development and preventing accidents. They can be downloaded and printed at https://lincolnshire.fsd.org.uk/chip.

11:40 – How to engage parents in child accident prevention and assess injury risk

SLIDE 29 – CHIP Assessment

Talking to parents about what their children can do (or not do) is a really good opportunity to introduce accident prevention. The CHIP Assessment supports this by facilitating a discussion about developmental milestones and the associated risks.

National Institute for Health and Care Excellence (NICE) recommend that homes with children under 5 have a 'structured home safety assessment' to identify and address any child injury risks in the home.

The CHIP Assessment was developed with Lincolnshire practitioners and with input from the Child Accident

Prevention Trust (CAPT). It assesses environmental risks and parent/carer’s safety practices. It's based on the child's developmental milestones.

It takes a Sign of Safety approach, encouraging families to think about what's working well and what actions can be taken to make their children safer.

The CHIP Assessment Guide covers the safety messages behind each question on the assessment.

If you refer for a CHIP Visit (see below), the referral form will ask for a copy of the household's CHIP Assessment. This demonstrates the need for equipment and evidences that home safety has been discussed with the family.

Distribute the CHIP Assessment and CHIP Assessment Guide and give participants 5-10 minutes to look through and discuss.

11:55 – Identifying children who are most at risk

SLIDE 31 – Families under stress

Follow instructions on the Risk Factors activity card.

SLIDE 32 – Identifying children who are most at risk

The Keeping Children Safe research programme aims to increase the evidence base for preventing unintentional injuries in the home in the under-fives. It divides risk factors into Child and Parent factors.

Poverty is one of the biggest predictors of childhood injury. Many of these pressures are a consequence of living in poverty.

Points for discussion: What barriers do families put up when you’re working with them How do you overcome these barriers? How do you support families to change their behaviour? Research suggests that focusing one injury type and using short, simple messages is effective in

changing behaviours.

12:10 – Equipment that can reduce or increase risks

SLIDE 34

Ask participants to say whether these items of equipment are needed or not and click through the answers.

Safety gate – Yes!

There are two types of safety gate: screw-fit and pressure-fit gates. Screw-fit gates are generally safer and sturdier as they're fixed into the wall.

They are not suitable for children over 24 months old – after this age they may be too tall, heavy or smart to be restricted by the gate. Older children should be taught how to use the gate or to leave it alone.

Socket covers – No!

British 13 Amp sockets are required by law to conform to the BS 1363 standard, which means that they have built-in automatic shutters for protection – children cannot poke things into them.

Socket covers are not constructed to any electrical or other safety standard – they can cause damage to the socket and defeat the safety design.

Baby walkers – No!

Baby walkers are associated with more injuries than any other type of equipment designed for young children.

Most accidents involve falls down stairs or steps or when the baby walker tips over. Burns and scalds can be sustained due to falling or crashing into fires, heaters and other hot surfaces.

Use of a baby walker may delay normal child development by limiting the amount of time spent rolling, sitting, crawling and playing on the floor — all essential components of learning to walk.

SLIDE 35

Cot bumpers – No!

There have been a number of cases in the UK and abroad where infants have become entangled in the ties and material, or fallen from pulling themselves up on the bumpers.

Bath seat – No!

Bath seats are not safety devices but they can give parents/carers the impression that their child is safe and secure in the water. This false sense of security means that children can be left unsupervised and drown if they were to fall out of the seat.

SLIDE 36

Cupboard lock – Yes!

Compared to children without a poisoning, children who attend or are admitted to hospital because of a poisoning are significantly more likely to live in families who don’t store medicines at or above adult eye height or locked away.

Children's little fingers can overcome a latch or catch.

Fireguard – Yes!

To operate effectively fireguards need to be secured to the wall. Not just needed on open fires but also gas and electric fires and wood burners.

Sleep positioner – No!

Evidence shows that the safest way for a baby to sleep is on their back on a firm flat mattress. Some sleep positioners are designed to keep baby on their side or front.

Mattresses have to comply with specific safety standards; sleeping positioners do not have to comply with these same standards.

SLIDE 37

Blind cord winder – Yes!

Winders, or shorteners, wind up excess cord while not interfering with use of the blind. Blinds purchased after 2014 will be 'safe by design' and supplied with appropriate child safety

devices that prevent entanglement in cords. Can also use a small hook called a cleat to tie the cord around.

Window restrictor – Yes! Restrictors give a good balance between preventing falls, allowing ventilation and a means of escape

in case of emergencies.

SLIDE 38 – Summary

The equipment listed is provided as part of the Lincolnshire safety equipment scheme (CHIP Visits).

Potential to discuss other items of baby equipment that participants have come across.

12:20 – Useful partnerships and resources

SLIDE 40

The CHIP scheme aims to help Lincolnshire families keep their children safe from home accidents. Information on the scheme is at https://lincolnshire.fsd.org.uk/chip.

Home safety interventions that include a combination of home safety assessment, parent education and provision and fitting of safety equipment can be effective in preventing child accidents in the home.

The CHIP scheme provides a range of resources to staff and volunteers working with families so they can support families with accident prevention. There's also an equipment fitting service that families can be referred to if they need safety equipment (CHIP Visits).

CHIP E-learning – takes 10 minutes and is for anyone working with children and families.

CHIP Visits

CHIP Visits are provided by Lincolnshire Fire and Rescue (LFR). Upon referral, LFR will visit the household and supply/fit safety equipment as necessary. They will also undertake a home fire safety check which includes escape planning with the family and installation of smoke or CO alarms, if needed.

Referrals for CHIP Visits can only be made by Early Help Workers, Early Years Practitioners, Health Visitors, Family Health Workers and Social Workers.

The referral form will ask for a copy of the household's CHIP Assessment.

If the parent/carer is a tenant they will need to have permission from their landlord. You will be notified with details of action taken during the visit.

Safe and Well Checks – is the new name for LFR's Home Safety Check. They'll visit and install smoke alarms, carbon monoxide alarms and support the household with an escape plan.

District council housing teams – if families rent and have concerns about the state of repair of their property then contact the district council housing team.

SLIDE 41

12:25 – Finish

Reference materialQuizLocal data provided by the Avoidable injuries in children and young people aged 0-19 in Lincolnshire

2016/17, Lincolnshire Public Health.

Burns data taken from the Lincolnshire Cause of Injury Overview Report (2003-2016), International Burns Injury Database.

National data and injury costs taken from Reducing unintentional injuries in and around the home among children under five years, PHE, March 2018.Local and national contextSlide 8 taken from Avoidable injuries in children and young people aged 0-19 in Lincolnshire 2016/17, Lincolnshire Public Health.Slide 9 taken from the Public Health Outcomes Framework: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework.Slide 10 taken from Avoidable injuries in children and young people aged 0-19 in Lincolnshire 2016/17, Lincolnshire Public Health.Slide 11 full report: https://www.bmj.com/content/bmj/333/7559/119.full.pdf.The most common, serious and preventable injuries and the key safety messagesReducing unintentional injuries in and around the home among children under five years, Public Health England, June 2014Reducing unintentional injuries in and around the home among children under five years, PHE, March 2018Preventing unintentional injuries: A guide for all staff working with children under five years, PHE, 2017The relationship between child development and injuries / How to engage parents in child accident prevention and assess injury riskAccidents and child development guide, Child Accident Prevention TrustInjury Prevention Briefing. Preventing unintentional injuries to the under-fives: a guide for practitioners, Keeping Children Safe at Home programme, June 2014Identifying children who are most at riskPreventing unintentional injury in under 15s, Quality standard [QS107], National Institute for Health and Care Excellence (NICE), January 2016Identifying facilitators and barriers for home injury prevention interventions for pre-school children: a systematic review of the quantitative literature; Jenny C. Ingram et al; Health Education Research, Volume 27, Issue 2, April 2012, Pages 258–268Equipment that can reduce or increase risksHome Safety Position Statements, Royal Society for the Prevention of Accidents (RoSPA), September 2014Position on socket-outlet ‘protective’ covers/protectors, British Electrotechnical and Allied Manufacturers Association (BEAMA), June 2017Product Guide: a guide to buying safer sleep essentials, The Lullaby Trust