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PREVENTION INSTITUTE 221 Oak Street Oakland, CA 94607 Tel: 510.444.7738 Fax: 510.663.1280

KIDS' PLATES: THE SPECTRUM OF PREVENTION FOR CHILDHOOD AND ADOLESCENT INJURY PREVENTION The Spectrum of Prevention model was created by Larry Cohen while at Contra Costa County Health Services Department, Prevention Program. This model is based on the work of Dr. Marshall Swift in developmental disability prevention at Hahnemann College, Philadelphia, Pennsylvania. Background Everyone wants our next generation to be safe and healthy. In California, committed child advocates created a unique way for individuals to show their support of children's causes and to provide consistent funding for health and safety efforts. The Kids' Plates program was established in 1992. This program sets aside funds for the prevention of childhood unintentional injury and child abuse, and to enhance the health and safety of children in child care. By the purchase of special motor vehicle license plates, California drivers can support these vital causes. Of the funds raised, 25% are earmarked for the prevention of child and adolescent unintentional injuries, including drowning, falls, poisoning, motor vehicle related injuries, and other unintentional injuries. Beginning in July 1998, these funds win be returned to communities across the state, in the form of mini and statewide grants, to strengthen local efforts in injury prevention.

This document is provided to encourage creative and effective local projects. While every community will have its own ways of preventing injuries, projects in a community will be more successful when they fit together and support each other. The Spectrum of Prevention model is offered as a tool to help applicants in thinking about grant activities that will be successful. The examples which follow may give applicants new ideas of projects that work. They are also meant to show that that all activities, including Kids' Plates projects, will be more effective if they relate to and support other activities throughout the community. The Spectrum of Prevention is a model which describes six levels at which prevention activities can take place. It moves beyond individual services and community education to include training providers, building partnerships, changing what organizations do, and influencing policy as ways to approach prevention. Since injury problems are often complex, the best solutions are usually comprehensive. It is more likely that prevention activities will work when an issue is addressed at all six levels of the Spectrum -- as the levels fit together and build upon one another. While a project may focus on one or two levels of the Spectrum, it is important to pay attention to how the project can be a piece of broader efforts which together produce greater change. For example, when the motorcycle helmet law was passed in California, Contra Costa County's "Safe Roads -- Safe Families Coalition" set up a training for traffic reporters on how to highlight the importance of the new law in their radio and TV reports. Since so many people listen to traffic reports, this was a powerful strategy for reaching the public. So while the trainings focused on training providers (level 3), it was clear that as a result of the training, reporters would educate the community (level 2) through their reports, as well as influence policy (level 6) by supporting the implementation of this new law. The following pages offer examples of child and adolescent injury prevention projects for each of the six levels of the Spectrum. 6. Influencing Policy Legislation 5. Changing Organizational Practices 4. Fostering Coalitions and Networks 3. Educating Providers 2. Promoting Community Education 1. Strengthening Individual Knowledge and Skills 6 Levels for Change 1. Strengthening Individual Knowledge and Skills Strengthening individual knowledge and skills means assisting individuals to increase their knowledge and capacity to prevent injury. Many health providers and community agencies currently use this strategy through education, counseling, and other individual services to encourage individuals to change their behavior. The county health clinics that offer prenatal care begin a program to train expectant mothers on the correct use of car seats. The training includes hands-on practice with a model car seat in how to safely secure the baby, and. addresses what to look for in a quality car seat as well as the right size and style needed for both a newborn and as the child grows. Each expectant mother who attends the training receives a discount coupon which can be used at local stores to purchase a car seat. Members of a support group operated for and by Latino mothers want to help young parents in their community. They link with a home visiting program that uses Promotoras to educate low-income Latino families. The teens and Promotoras develop a program focusing on infant and toddler home safety including burn and poisoning prevention. During the home visits, the teens and Promotoras help the young parents identify safety problems and obtain safety devices. Because the young parents relate to the teen mothers, they are very receptive to the education they receive. 2. Promoting Community Education Promoting community education means reaching groups of people with information and resources to build support for healthier behavior and community norms. Since the media is so predominant in our society, skillful attention to the media advances community education efforts. To improve roller blade and bike safety by elementary school the local safety council holds a rap contest in which the children perform raps about wearing safety equipment and ways to bike and skate safely. Judges from a local radio station and the student council offer prizes and airplay on three local radio stations for the top winners of the competition. A comprehensive community-wide effort called "April Pool's Day" is held at local swimming pools, involving City Parks' staff, lifeguards, local businesses, schools, and celebrities to educate families and children on preventing pool drownings. Activities include: free sample swimming lessons with resources for further lessons, city staff inspecting backyard pools for correct safety equipment and fencing, and rescue training for youth and parents. Mass media and posters not only advertise the event but also give safety tips. 3. Training Providers Training providers means educating those who influence others on injury prevention, whether professionals, paraprofessionals, community activists or peers. It is critical to ensure that those who provide training, advice, or serve as role models have the information, skills, and motivation to effectively promote injury prevention with youth, parents, colleagues, and policy makers. Recognizing the function that print and media journalists play in informing the community, a local, conference is organized every year to train journalists on the importance of injury prevention and to discuss the ways it is communicated in local news events. Journalists are shown articles that take the extra step -- for example, articles about crashes mentioning whether or not the injured parties were wearing seatbelts and whether air bags deployed. Speakers include a motorcyclist who wasn't injured in a crash because he was wearing a helmet, and a mother whose child was saved from a severe fall. The child had been chasing her ball which bounced from a third story window, but was prevented from falling due to a window guard installed and used properly. Bicycle sales staff receive training on the risks of head injuries and the guidelines for properly fitting bicycle helmets in an event cosponsored by bike dealers, discount stores, and the local safety coalition. They are encouraged to provide this information to every customer at the point of sale. They are given tags saying, "This bicycle is missing a part" with a picture of a bicycle helmet and an explanation of why they are important. Local safety coalition members ensure continuation of the program by visiting all the bike stores to say hello every couple of months and by offering ongoing training for new bicycle sales staff and a new supply of tags. 4. Fostering Coalitions and Networks Fostering coalitions and networks means creating or strengthening the ability of people and organizations to join together to work on a specific problem. By strengthening the collaboration among diverse partners, coalitions and networks are useful for accomplishing a broad range of goals that reach beyond the capacity of any individual member organization. These goals range from information sharing to coordination of services, from community education to advocacy for major regulatory changes. After a risky situation at a local canal, concerned community members, including police, paramedics, relatives of drowning victims, firefighters, child safety advocates, and teen leaders, come together to reduce the drownings and near-drownings in their town. They mobilize political support to increase fencing and warning signs in the more dangerous areas and promote community awareness. A high volume of traffic and numerous streets without sidewalks has created an environment that is not pedestrian-friendly in a town which recently experienced a few serious pedestrian injuries. This issue brings together a diverse network of concerned community members, fitness advocates, school personnel, church members, safety advocates, and local businesses to discuss changes needed to create a "walkable community" and safe routes to school. 5. Changing Organizational Practices Changing organizational practices means changing internal business and agency regulations and norms. Looking at the practices of key groups, such as law enforcement, health departments, and schools has potential for affecting the health, safety, and satisfaction of the greater community. Also every organization should look at its own practices and see what could be changed or strengthened within their organization. A local community center houses both a child care program and a day program for elderly. After a meeting with concerned child care staff and parents of the children, new inhouse rules are adopted by both programs for the protection of the elders and the children, regarding storage of medicines and all cleaning supplies in locked cabinets. A school without either adult crossing guards or pedestrian safety education in the curriculum has had several serious child pedestrian injuries. With financial assistance from a community group that focuses on traffic safety, the PTA funds the startup of a crossing guard program and training for school staff. 6. Influencing Policy and Legislation Influencing policy and legislation means working to change laws or regulations at the local, state, and national levels. Sometimes the greatest improvement in injury prevention, affecting the largest number of people, can be accomplished by attention to policy issues. One city's Safe Communities Coalition asks the City Council to add speed bumps and other traffic calming measures to slow down drivers. They do this following a number of child bicycle and pedestrian injuries in residential and school areas. To bolster their point of view they pay for an independent traffic engineer to study the problem and recommend the most effective measures for the area. Based on this study and the testimony of a mother whose child was hit when on a bicycle -- but fortunately not seriously injured -- the traffic calming measures are passed by the Council. A local parents' group concerned about playground safety approaches the City Council with their concerns about unsafe surfaces that cause injuries when children fall. The group receives funding to sponsor an assessment of playground surfaces in local parks and to upgrade to safer surfaces. How the Levels Work Together Remember: the activities at each level of the Spectrum can support one another. Success at one level can encourage activities which lead to further change at other levels. For example, "media advocacy" is strategic use of the media for community education (level 2) directed at a change of policy (level 6). Effective policy discussions often lead to further individual and community education (levels 1 and 2) through media attention to an issue, and when a policy is changed, it often changes organizations' practices (level 5) and creates the need to train providers (level 3) on the implementation of new policy. Data and Evaluation Any proposed activity, at any of the six levels, should be based on data showing that the issue is important; the target population is appropriate; and the intervention is promising. And of course, strategies that seem to make sense may or may not turn out that way, so ongoing evaluation is also important at any level. While evaluation includes the technical, numerical activities necessary to measure if something is working, it is also important that it take into account the wisdom of practitioners and of the community served. Although projects will not necessarily include data gathering or outcome evaluation as part of their activities, a good evaluation will help point out ways in which a program can be continually strengthened. For more information and materials on evaluation, please contact the California Center for Childhood Injury Prevention at 619-594-3691.   Return to top of page Putting Prevention at the Center of Community Well Being preventioninstitute.org