This proposal is to refine and test an online previsit child safety assessment tool that creates individualized messages in a family web portal to reinforce pediatric safety education by clinicians in order to reduce childhood injuries and deaths. It builds on a system called CHADIS (Child Health and Development Interactive System) that delivers a comprehensive array of web-based pre-visit parent questionnaires and provides linked decision support to clinicians and also on materials developed from a series of prior studies of parent safety education conducted by The Johns Hopkins Center for Injury Research and Policy. The innovative parent safety education program produced will be an individualized intervention resulting from the pre-visit inventories used at all well child check-ups. The specific preventive safety measures that are needed for each child and family will be determined, introduced and reinforced in a number of unique theory based ways: 1) the action list for change will be culturally tailored and aimed at the parent's stage of motivation for preventive action as determined by previsit questions; 2) after completing the questionnaire, the parent will be directed to an individualized child/family portal to congratulate them on what they have implemented and to review recommendations in a manner based on principles of motivational interviewing; 3) In the portal, advice will be further individualized based on additional family data collected such as the type of car they have (which determines car seat recommendations); 4). Additional information relevant to safety will come from data collected by the comprehensive set of non-safety questionnaires in CHADIS such as family member alcohol overuse; 5) This concise targeted information will be provided to the doctor for review and reinforcement at the visit rather than demanding their time for collecting and synthesizing it themselves. The clinician decision support guidance appearing in CHADIS will include suggested "trigger phrases" that could be used in the discussion based on the stage of family motivation for change and safety guidance needs along with a simple method of documenting that the topic was reviewed. 6). After the check up visit the parent will be directed back to the child/family portal which becomes an updated attractive individualized "Memory Book" and "health passport" with clinical and "keepsake" information from other previsit questionnaires and optional clinician input. The keepsake information includes such things from parent input as the child's developmental milestones and the currently "best" and "most challenging" parts of parenting Such documentation of safety education intervention could be used for quality improvement programs conducted through CHADIS such as are required beginning in 2010 for Board Recertification for all pediatricians. 7) The safety section of the portal will provide intermittent reminders to the family to address gaps in safety practices as well as providing access to product safety information for times when the family is considering purchasing new products. 8) The parent portal will be a password protected secure site but other family members will be able to be invited to certain components such as the safety information. This creates a social network and "village" to help protect the child, as when grandparents, aware of the safety recommendations, are taking care of the child or encourage the family to follow up by implementing safety measures. The effectiveness of this educational process will be evaluated in comparison to control cases receiving generic messages and with those receiving usual pediatric care and education.


Funding:

Centers for Disease Control and Prevention (CDC)
SBIR Award


Collaborator:

The Johns Hopkins School of Public Health