Childhood falls

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					                    OHPP Sample Health Unit Plan for Childhood Falls Prevention
                            Based on Provincial Guidance Document
                                            Sept 2010

Step 1: Project Management
Worksheet 1.1: Understand the Context

    Question                                    Response
1   Why are you going through a                 The release of the new public health standards and MHPS guidance docs mean that we need to re-evaluate
    planning process at this particular         our current childhood injury prevention strategy.
    time?
2   Are you modifying an existing plan or       Modifying
    starting a new plan?
3   What if anything, has already been          We will focus on children ages 0-9, and will make the creation of supportive environments for lower SES
    decided? For example have you               populations a priority
    decided on audience(s), issue(s),
    setting(s), strategy(ies), or activities?
4   What kind of content must be                We will be using the OHPP to design our plan, which includes the development of measurable outcome and
    included in your plan? For example,         process and objectives, and identification of specific indicators.
    is there a template or form provided
    from your potential funder?
5   Are there any other circumstances or        We are expected by our health unit and provincial funders that our contributions to these objectives will be at
    expectations that may affect how you        least matched 1-1 by community partner time and/or resources.
    must carry out your planning
    process?
6   What time will be available to              We have three months to plan. Three years to implement and nine months to finish our evaluation.
    implement the program that you plan
    (including development, after
    planning ends)?
7   What financial resources (dollars) will     The health unit has allocated $50,000 per year for 4 years to this program, plus a half-time project
    be available to implement the               coordinator position.
    program that you plan?
8   Are there any other circumstances or Other health units across the province are involved in planning similar efforts. We are hoping to leverage their
    expectations that may affect your final work and expertise to make maximum use of our own resources.

Childhood Falls Prevention                                                 Sept 2010                                                              page 1 of 59
    Question                              Response
    program?

Step 1: Project Management
Worksheet 1.2: Identify Stakeholder Roles and Expectations

Stakeholder Roles
            Name                        Interest in program/process            Degree of involvement               Details of involvement
    1.      Retailers –sporting goods- They are interested in improving        Supportive (provides some form of   They will be part of the newly
            protective equipment,      their community profile                 support)                            formed childhood injury prevention
            furniture, playground                                                                                  coalition.
            equipment; baby gates
    2.      Hospitals                   The local hospital has a mandate to Involved (frequently consulted or      They will be part of the newly
                                        support childhood injury prevention part of the planning process)          formed childhood injury prevention
                                        because childhood injuries                                                 coalition.
                                        represent a large amount of the
                                        work that they do. This has financial                                      Provide input at, and between
                                        and human cost implications.                                               meetings. Help with obtaining local
                                                                                                                   statistics and other data. Help with
                                                                                                                   generating contact lists for planning
                                                                                                                   advice, promotion and
                                                                                                                   implementation assistance.
                                                                                                                   Donating meeting space.
    3.      Early Years Centres         They have a mandate to protect         Involved (frequently consulted or   They will be part of the newly
                                        children while they are involved in    part of the planning process)       formed childhood injury prevention
                                        their programs, as well as a                                               coalition.
                                        mandate to assist in any way
                                        possible, with the health and safety
                                        of children under the age of 6.
    4.      Brighter Futures Projects   They have heavy contact with           Supportive (provides some form of   They will be part of the newly
            – CAPC – Canada Action      parents in the right age and SES       support)                            formed childhood injury prevention
            Program for Children and    brackets. They may be a good                                               coalition.
            Canada Prenatal Nutrition   vehicle for message dissemination
            Program
    5.      CPNP Projects               They have heavy contact with           Supportive (provides some form of   They will be part of the newly
                                        parents in the right age and SES       support)                            formed childhood injury prevention
                                        brackets. They may be a good                                               coalition.
                                        vehicle for message dissemination

Childhood Falls Prevention                                           Sept 2010                                                            page 2 of 59
           Name                     Interest in program/process              Degree of involvement               Details of involvement
   6.      Aboriginal CAPC          They have heavy contact with             Supportive (provides some form of   They will be part of the newly
                                    parents in the right age and SES         support)                            formed childhood injury prevention
                                    brackets. They may be a good                                                 coalition.
                                    vehicle for message dissemination
   7.      Family physicians        Many physicians are interested in   Peripheral (needs to be kept             May use the tools we provide
                                    this and do other general screening informed)
                                    advice giving activity. They are
                                    recognized as a credible source to
                                    parents
   8.      Family and Children’s    They have contact with lower SES         Peripheral (needs to be kept        May use the messages and tools
           Services Home Visiting   parents and may help disseminate         informed)                           we provide.
           Program                  materials and information
   9.      Day Care providers       They have heavy contact with             Supportive (provides some form of   They will be part of the newly
                                    parents in the right age and SES         support)                            formed childhood injury prevention
                                    brackets. They may be a good                                                 coalition.
                                    vehicle for message dissemination
   10.     Municipal planners       We need their support to improve         Peripheral (needs to be kept        May use the messages and tools
           (playgrounds)            policies and enforcement of              informed)                           we provide.
                                    policies. Our educational efforts will
                                    make their jobs easier.
   11.     Boards of Education      They have a mandate to protect           Supportive (provides some form of   They will be part of the newly
                                    children while they are in school,       support)                            formed childhood injury prevention
                                    and a desire to do whatever they                                             coalition.
                                    can to help their students be as
                                    safe as possible while under the
                                    care of parents or other caregivers.
                                    The School Board has children
                                    between the ages of 3 and 9 going
                                    to their schools.
   12.     Recreation Centres       They want to be a leader in safe         Supportive (provides some form of   They will be part of the newly
                                    environments for children, in the        support)                            formed childhood injury prevention
                                    community.                                                                   coalition.
   13.     Parent groups            They have an interest in preventing      Supportive (provides some form of   They will be part of the newly
                                    injury and collective power to           support)                            formed childhood injury prevention
                                    influence policy and raise money to                                          coalition.
                                    support playground changes.


Childhood Falls Prevention                                         Sept 2010                                                           page 3 of 59
             Name                            Interest in program/process           Degree of involvement                  Details of involvement
    14.      Farm Associations               In certain parts of the region, the   Peripheral (needs to be kept           May use the messages and tools
                                             farm associations are very            informed)                              we provide.
                                             influential and interested in this
                                             topic
    15.      Researchers                     Local university researchers and      Peripheral (needs to be kept           May use the messages and tools
                                             interested in collecting baseline     informed)                              we provide.
                                             data and changes. We need that
                                             information for our evaluation.

Stakeholder's Expectations
    Question                                     Response
1   What overall expectations do                 High
    stakeholders have in terms of the
    degree of rigor and evidence that will
    be incorporated into the planning
    process?
2   What overall expectations do                 Low, a great deal of information already exists. New information should be collected provincially to help all
    stakeholders have in terms of the need       health units in an efficient way. Some moderate data collection around specific local messaging/tools may
    for new data (versus compilation of          be warranted.
    existing data) to inform decisions
    throughout the planning process?
3   What other details are there regarding       The Ministry has collected quite a bit of provincial data about childhood injury and issued a report that
    stakeholder expectations about degree        serves as the background for the project. It is expected, and we are planning to supplement that report with
    of rigor, evidence and need for new          some local data. However, the Ministry wants most of the money to go to implementation, rather than
    data to inform planning decisions?           research.

Decision-Making Process
    Question                                     Response
1   How will decisions be made within the        Coordinator-led decision-making process
    core planning group?
2   How, specifically, will the decision-        The coalition will be consulted on all major decisions. However the project coordinator reserves the right to
    making process work within the core          make the final decision. Her decisions must be approved by her health unit manager, and supported by
    planning group?                              evidence and/or other forms of justification.
3   How will decisions be made outside of        A health unit staff person will be designated as lead for every subcommittee. Subcommittees will function
    the core planning group? For example,        as discussion groups. In general, majority rules of whoever is present is the standard for decision making.

Childhood Falls Prevention                                                  Sept 2010                                                            page 4 of 59
    Question                                    Response
    are there situations when                   However, all major planning directions must be approved by the project coordinator, and her manager.
    subcommittees will make decisions or        Thus veto of subcommittee lead is possible.
    individuals will make decisions?

Step 1: Project Management
Worksheet 1.3: Assess Resources for Planning
    Question                                    Response
1   What staff is available to participate in   Two staff people and one consultant are available to participate in the planning process. One staff person
    the planning process? What is their         (lead, coordinator) has .2FTE for the 4 years. The other staff person (PHN - to assist the lead) also has .2
    approximate available time, and do they     FTE. The consultant will work approximately 1 day per week (approx .2FTE equivalent) to support research
    have any specific expertise or              and evaluation efforts related to the program. Some of the research and evaluation work will overlap with
    interests?                                  the planning process.
2   Are volunteers available to aid in the      At this time, there are no volunteers. All participants in the planning process are compensated in some
    planning process? If so, how? What is       way, by the organization they represent, to participate in this injury prevention work.
    their approximate available time, and
    do they have any specific expertise or
    interests?
3   What partners are available to              Various coalition members will provide feedback that will support planning decisions. At this point no one
    participate in the planning process?        has offered to take on any significant role in planning other than advice-giving. Each coalition member has
    What is their approximate available         agreed to attend one two-hour meeting per month plus an additional 1.5 days per year of focused planning
    time, and do they have any specific         time.
    expertise or interests?
                                                All other health units in the province who have received government money to implement similar childhood
                                                injury prevention strategies have agreed to work together on health communication efforts related to this
                                                program. This is a group experienced with health communication, but not necessarily with injury prevention.
                                                This program is a part of each of their job descriptions - at least one day a week. Some health units have
                                                designated more staff time to the program - up to one full FTE. Health units will contribute as much as they
                                                can, given staff time available, to meet the collective goals of the group.
4   What funds are available to support the     50% of the budget will go to mass media.
    planning process? Are these funds
    tagged for a specific purpose?              Approximately $10,000 is allocated to host a community forum where community stakeholders will be
                                                asked for various types of input to help us make planning decisions. This event will be coordinated by the
                                                lead health unit contact, with PHN and researcher/evaluator assistance.
5   What in-kind contributions are available    The room for the community forum was donated by the school board. After getting input from the
    to support the planning process?            community forum participants, planning work will rest with the health unit staff/consultant.
6   What kind of equipment or space is          School board and health unit meeting rooms, computer equipment.
    available to support the planning

Childhood Falls Prevention                                               Sept 2010                                                            page 5 of 59
    Question                                Response
    process?
7   When can planning begin?                immediately
8   When will planning end?                 December 2010
9   What are the reasons for these          This is the maximum time available for planning that will allow ample implementation of activities during the
    deadlines and/or other deadlines        four years of funding.
    related to this planning process?

Step 1: Project Management
Worksheet 1.4: Develop Workplan for the Planning Process
     Task              Lead              Support             Time allocated    Deadline           Budget             Other              Approval
                                                                                                                     resources          process
1    Gather data for   Project          Project              4 days            October 1, 2010    None               None               No approval
     Situational       researcher/evalu assistant,                                                                                      needed yet
     Assessment        ator             coalition, other
                                        health units
2    Analyze and       Project          Project assistant    4 days            October 31,        None               None               No approval
     Interpret data    researcher/evalu and project lead                       2010                                                     needed yet
                       ator
3    Choose how to     Project           Project assistant   .5 day            October 31,        None               None               No approval
     proceed with      coordinator                                             2010                                                     needed yet
     planning
4    Choose goals      Project           Project assistant   1 day             November 30,       None               Coalition         Project
     and audiences     coordinator                                             2010                                  meeting;          coordinator
                                                                                                                     Teleconference
                                                                                                                     with other health
                                                                                                                     units
5    Develop           Project           Project assistant 2 days              November 30,       None               None               Run by coalition
     outcome           coordinator       and Project                           2010                                                     for feedback.
     objectives                          researcher/evalu                                                                               Project
                                         ator                                                                                           Coordinator's
                                                                                                                                        Manager must
                                                                                                                                        give final 'okay'
6    Choose broad      Project           Project             1 day             November 30,       None               None               No approval
     program           coordinator       assistant,                            2010                                                     needed yet
     strategies                          coalition, other

Childhood Falls Prevention                                            Sept 2010                                                            page 6 of 59
     Task               Lead              Support             Time allocated   Deadline       Budget              Other           Approval
                                                                                                                  resources       process
                                          health units
7    Brainstorm         Project           Project             2 days           December 15,   $200 to travel to   Coalition       No approval
     activities         coordinator       assistant,                           2010           other health        meeting, with   required yet.
                                          coalition, other                                    units to discuss    food
                                          health units                                        options
8    Assess and         Project          Project              3 days           December 15,   $200 to travel to   Coalition       No approval
     analyze activity   researcher/evalu assistant,                            2010           other health        meeting, with   needed until final
     options            ator             coalition, other                                     units to discuss    food            activities chosen
                                         health units                                         options                             and resources
                                                                                                                                  allocated.
9    Make final         Project           Project             2 days           December 15,   None                None            No approval
     activity choices   coordinator       assistant,                           2010                                               needed until
                                          coalition, other                                                                        resources are
                                          health units                                                                            assigned.
10   Assign             Project           Project assistant   1                December 31,   None                None            Run by coalition
     resources to       coordinator       (PHN)                                2010                                               for feedback.
     chosen                                                                                                                       Project
     activities.                                                                                                                  Coordinator's
                                                                                                                                  Manager must
                                                                                                                                  give final 'okay'
11   Develop Process Project assistant                        1 day            December 31,   None                None            Project
     Objectives for  (PHN)                                                     2010                                               coordinator
     Activities
12   Choose             Project          Other health         2 days           December 31,   None                None            Project
     indicators of      researcher/evalu units                                 2010                                               Coordinator's
     success            ator                                                                                                      Manager
13   Review and         Project           Project assistant 2 days             December 31,   None                None            Run by coalition
     revise overall     coordinator       and Project                          2010                                               for feedback.
     plan                                 researcher/evalu                                                                        Project
                                          ator and other                                                                          Coordinator's
                                          health units                                                                            Manager must
                                                                                                                                  give final 'okay'




Childhood Falls Prevention                                             Sept 2010                                                    page 7 of 59
Step 2: Situational Assessment
Worksheet 2.1: Develop a data gathering plan

Key Questions

    1. What is the situation?
         a. What impact is the current situation having on health, quality of life and other societal costs?
         b. What groups of people are at highest risk of health and quality of life problems?
         c. What settings or situations are high risk, or pose a unique opportunity for intervention?
         d. How do local stakeholders perceive the situation? What is their capacity to act? What are their interests, mandates, current activities?
         e. What are the needs, perceptions and favoured directions of key influential community members, and the community-at-large?

    2. What influences are making the situation better and worse?
         a. What high-risk or negative health behaviours by various groups of people are affecting the situation?
         b. What underlying causes or conditions are driving these behaviours? (individual level causes, as well as conditions in the social environment,
         organizational environments or at the broader societal level)
         c. Are there protective factors that can avoid or help to alleviate the situation?
         d. What political, economic, environmental, social and technological trends are influencing the situation?(this type of exploration is called a
         PEEST analysis)
         e. What internal strengths and weaknesses are present in your organizational that may affect your course of action? What opportunities and
         threats in your environment may affect your course of action?

    3. What possible actions can you take to deal with the situation?
         a. What are other organizations doing to address this situation? What have they done in the past? Specifically, what local policies, programs and
         environmental supports are being developed or implemented within the community? What evaluation data is available on these activities?
         b. What evidence exists to support various courses of action? (Best or recommended practices)

Data Gathering Plan
     Type of     Method       Specific Sources                 Additional Details about this   Lead      Suppor    Time     Deadline Budget            Other
     data/que                                                  data collection task.                     t         allocate                            resources
     stion                                                                                                         d
1    Impact      Large        Local public health internal
                 datasets,    teams
                 literature
                 search       intelliHEALTH;

                              Canadian Institute for Health
                              Information (CIHI) Ontario
                              Trauma Registry (Minimal,
                              Comprehensive and Death
                              Data Sets) www.cihi.ca/otr


Childhood Falls Prevention                                             Sept 2010                                                           page 8 of 59
    Type of    Method        Specific Sources                   Additional Details about this   Lead   Suppor   Time     Deadline Budget   Other
    data/que                                                    data collection task.                  t        allocate                   resources
    stion                                                                                                       d
                             Ontario Ministry of
                             Transportation (Ontario Road
                             Safety Annual Report)
                             www.mto.gov.on.ca/english/
                             safety/orsar

                             Ontario Injury Prevention
                             Resource Centre Compass
                             publications
                             www.oninjuryresources.ca/
                             Publications/Compass

                             nstitute for Clinical Evaluative
                             Studies e.g. Injuries in Ontario
                             – ICES Atlas www.ices.on.ca
                             (publications)

                             Rapid Risk Factor Surveillance
                             System (RRFSS)
                             www.rrfss.on.ca

                             Office of the Chief Coroner of
                             Ontario (Ministry of Community
                             Safety and Correctional
                             Services)
                             http://www.mcscs.jus.gov.o
                             n.ca/english/office_coroner/
                             about_coroner/about_coron
                             er.html

                             Ontario Neurotrauma
                             Foundation www.onf.org

                             Lead Trauma Hospitals (local
                             injury data and trends)

                             National Trauma Registry
                             www.cihi.ca/ntr

Childhood Falls Prevention                                             Sept 2010                                                   page 9 of 59
    Type of    Method        Specific Sources                Additional Details about this   Lead   Suppor   Time     Deadline Budget   Other
    data/que                                                 data collection task.                  t        allocate                   resources
    stion                                                                                                    d


                             Canadian Community Health
                             Survey (CCHS)

                             Health Canada: Injury
                             Surveillance in Canada:
                             Current Realities and
                             Challenges Report

                             PHAC Injury Surveillance On-
                             Line http://dsol-smed.phac-
                             aspc.gc.ca/dsol-smed/is-
                             sb/index_e.html

                             PHAC Canadian Hospital
                             Injury Reporting and
                             Prevention Program (CHIRPP)
                             www.phac-
                             aspc.gc.ca/injury-
                             bles/chirpp/injrep-
                             rapbles/index-eng.php

                             Public Health Agency of
                             Canada Publications
                             www.phac-aspc.gc.ca/inj-
                             bles/index-eng.php

                             Data Sources for Falls
                             Prevention http://www.phac-
                             aspc.gc.ca/seniors-
                             aines/publications/pro/injury
                             -blessure/scan-
                             analyse/part-partie-a-
                             eng.php#parta-02

                             Smartrisk Economic Burden
                             of Injury in Canada Report
                             www.smartrisk.ca/researche
Childhood Falls Prevention                                          Sept 2010                                                  page 10 of 59
    Type of    Method        Specific Sources                  Additional Details about this   Lead   Suppor   Time     Deadline Budget   Other
    data/que                                                   data collection task.                  t        allocate                   resources
    stion                                                                                                      d

                             rs/economic_burden_studie
                             s

                             Safe Kids Canada
                             www.safekidscanada.ca
                             Child & Youth Unintentional
                             Injury: 10 Years in Review

                             CDC Injury Data and
                             Resources
                             www.cdc.gov/nchs/injury.ht
                             m

                             Best Start Resource Centre

                             Canadian Paediatric Society
                             http://www.cps.ca/ contains
                             information for parents as well
                             as position statements on
                             preventing playground injuries;
                             trampoline use in homes and
                             playgrounds
                             http://www.cps.ca/english/st
                             atements/IP/IP07-01.pdf;
                             http://www.caringforkids.cps
                             .ca/keepkidssafe/playgroun
                             dsafety.htm

                             Protect the Ones You Love:
                             Child injuries are
                             preventable 2009.
                             Comprehensive website which
                             addresses multiple childhood
                             injury issues including falls.
                             Fact sheets, pod casts etc
                             available

                             WHO 2008 World Report on

Childhood Falls Prevention                                            Sept 2010                                                  page 11 of 59
    Type of      Method       Specific Sources                  Additional Details about this    Lead   Suppor   Time     Deadline Budget   Other
    data/que                                                    data collection task.                   t        allocate                   resources
    stion                                                                                                        d
                              Child Injury Prevention
                              http://whqlibdoc.who.int/publ
                              ications/2008/97892415635
                              74_eng.pdf
2   High risk    Large        Same as above
    groups       datasets,
                 literature
                 search
3   High risk    Large        Same as above
    situations   datasets,
    or           literature
    settings     search
4   Stakehold Consultatio Retailers – (sporting goods-          Short survey done with local
    er         ns         protective equipment, furniture,      orgs to find out what they are
    perceptio             playground equipment; baby            doing, have done, interest.
    ns,                   gates                                 Some may complete at
    capacity,                                                   community forum, others may
    interests,            Hospitals                             do via telephone or email if
    mandates                                                    they do not attend.
    and                   Early Years Centres
    current
    activities            Brighter Futures Projects –
                          CAPC – Canada Action
                          Program for Children and
                          Canada Prenatal Nutrition
                          Program

                              CPNP Projects

                              Aboriginal CAPC as they
                              include local home visiting and
                              group programs targeted to
                              high risk families.

                              Family physicians

                              Family and Children’s Services

Childhood Falls Prevention                                             Sept 2010                                                   page 12 of 59
    Type of      Method      Specific Sources                Additional Details about this     Lead   Suppor   Time     Deadline Budget   Other
    data/que                                                 data collection task.                    t        allocate                   resources
    stion                                                                                                      d
                             Home Visiting Program

                             Day Care providers

                             Municipal planners
                             (playgrounds)

                             Boards of Education

                             Recreation Centres

                             Child Care Centres/preschools

                             home day cares

                             Parent groups

                             Farm Associations

                             Researchers
5   Communit Large data Rapid Risk Factor Surveillance Note, may also do focus
    y member set        System (RRFSS)                 groups in the future once
    perceptio           www.rrfss.on.ca                priorities better established.
    ns and
    favoured
    directions
6   Problemat    Large data Same as listed in row 1 above    Note, to better understand the
    ic           sets, and                                   specific behaviours and origins
    behaviour    literature                                  of behaviours, focus groups
    s            review                                      may be done with intended
    contributi                                               audiences. once priorities are
    ng to the                                                better set.
    problem
7   Causes       Large data Same as listed in row 1 above    Note, to better understand the
                 sets, and                                   specific behaviours and origins
                 literature                                  of behaviours, focus groups
                 review                                      may be done with intended

Childhood Falls Prevention                                          Sept 2010                                                    page 13 of 59
     Type of     Method       Specific Sources                  Additional Details about this     Lead   Suppor   Time     Deadline Budget   Other
     data/que                                                   data collection task.                    t        allocate                   resources
     stion                                                                                                        d
                                                                audiences. once priorities are
                                                                better set.


8    Protective Large data Same as listed in row 1 above        Note, to better understand the
     factors    sets, and                                       specific behaviours and origins
                literature                                      of behaviours, focus groups
                review                                          may be done with intended
                                                                audiences. once priorities are
                                                                better set.
9    Trends      Consultatio Idea generation with
     (PEEST)     n           stakeholders as listed in row 4,
                             Plus invite reps (to attend, or
                             input over phone/email) from:

                              Ontario Injury Prevention
                              Resource Centre
                              www.oninjuryresources.ca

                              Ontario Neurotrauma
                              Foundation www.onf.org
10   Best or     Large data Ontario Injury Prevention
     recomme     sets and   Resource Centre
     nded        literature www.oninjuryresources.ca
     practices   search
                            Ontario Neurotrauma
                            Foundation www.onf.org

                              Public Health Agency of
                              Canada Publications
                              www.phac-aspc.gc.ca/inj-
                              bles/index-eng.php

                              Safe Kids Canada
                              www.safekidscanada.ca
                              Child & Youth Unintentional
                              Injury: 10 Years in Review
                              (report link under Resource

Childhood Falls Prevention                                             Sept 2010                                                    page 14 of 59
    Type of    Method        Specific Sources                  Additional Details about this   Lead   Suppor   Time     Deadline Budget   Other
    data/que                                                   data collection task.                  t        allocate                   resources
    stion                                                                                                      d
                             Section on home page)

                             CDC Injury Data and
                             Resources
                             www.cdc.gov/nchs/injury.ht
                             m
                             http://www.cdc.gov/safechil
                             d/


                             Injury prevention strategies in
                             Manitoba (24), NWT (25),
                             Nova Scotia (26), Alberta (no
                             ref) and Ontario (27)
                             The Injury Prevention &
                             Control Task Group of the
                             Pan-Canadian Public Health
                             Network
                             Ontario Injury Prevention
                             Strategy.

                             Canadian Standards
                             Association

                             Best Start Resource Centre

                             Canadian Paediatric Society
                             http://www.cps.ca/ contains
                             information for parents as well
                             as position statements on
                             preventing playground injuries;
                             trampoline use in homes and
                             playgrounds
                             http://www.cps.ca/english/st
                             atements/IP/IP07-01.pdf;
                             http://www.caringforkids.cps
                             .ca/keepkidssafe/playgroun
                             dsafety.htm

Childhood Falls Prevention                                            Sept 2010                                                  page 15 of 59
     Type of    Method        Specific Sources                 Additional Details about this   Lead   Suppor   Time     Deadline Budget   Other
     data/que                                                  data collection task.                  t        allocate                   resources
     stion                                                                                                     d


                              Protect the Ones You Love:
                              Child injuries are
                              preventable 2009.
                              Comprehensive website which
                              addresses multiple childhood
                              injury issues including falls.
                              Fact sheets, pod casts etc
                              available

                              WHO 2008 World Report on
                              Child Injury Prevention
                              http://whqlibdoc.who.int/publ
                              ications/2008/97892415635
                              74_eng.pdf

                              Consumer Product Safety
                              http://www.hc-sc.gc.ca/cps-
                              spc/index-eng.php

                              Safer Homes for Children,
                              Safe Kids Canada, 2006
                              http://www.safekidscanada.
                              ca/SKCForPartners/custom/
                              SaferHomesforChildrenGuid
                              eEng.pdf


11   Inventory Consultatio Same as above, plus:            Short telephone or electronic
     of past    n                                          survey asking stakeholders to
     and                   Other health units              identify unpublished activities.
     current               Local stakeholders as listed in
     activities            row 4
     and
     evaluation
     s
12   SWOT       Consultatio                                    Generate at internal planning

Childhood Falls Prevention                                            Sept 2010                                                  page 16 of 59
     Type of     Method        Specific Sources                 Additional Details about this       Lead      Suppor      Time     Deadline Budget     Other
     data/que                                                   data collection task.                         t           allocate                     resources
     stion                                                                                                                d
                 n                                              meeting exercise.

Step 2: Situational Assessment
Worksheet 2.2: Summarize the situation
Question              Response
What is the
situation?


What impact is the    Falls are the primary reason children are hospitalized, accounting for 37% of childhood injury admissions
current situation
having on health,     Approximately 1,700 children 14 years and under are hospitalized every year for a fall related to chairs, beds, stairs, and steps.
quality of life and
other societal costs? Approximately 2,500 children 14 years of age and under are hospitalized annually for playground injuries of which 14% are head injuries;
                      81% are for broken bones in other parts of the body; and 5% for other injuries (e.g. dislocation, open wound, etc)

                      The 2005 rate of fall-related deaths in children 0-19 years was 0.3 deaths /100,000 persons of which 80.9% were male Injuries from falls
                      among children 0-14 years of age cost the people of Ontario nearly $311 million.

                      A 20% reduction in the incidence of fall-related injuries for those aged 0-14 years in Ontario would result in 660 fewer hospitalizations,
                      over 2,300 fewer non-hospitalize injuries, and 193 fewer injuries leading to permanent disability. The cost savings would total over $62
                      million each year (page 17, no reference, could be a continuation of ref 23, or could be 21)

                      A 20% reduction in the incidence of self-inflicted poisoning in Ontario would translate into 50 fewer deaths. 1,600 fewer hospitalizations,
                      and 198 fewer people permanently disabled, annually. The cost savings from such a strategy would amount to more than $91 million
                      annually of which $54 million would be in direct health care costs alone (21)
What groups of         The majority (68%) of children hospitalized due to falls from beds or chairs are under 5 years of age
people are at
highest risk of health 63% of falls involving stairs and steps were in children under 5 years; 23% for 5-9 years, and 14% for children aged 10-14 years
and quality of life
problems?              The 2005 rate of fall-related deaths in children 0-19 years was 0.3 deaths /100,000 persons of which 80.9% were male

                      Boys more at risk- 64.3% of fall-related hospitalizations were male in 2005/06.

                      There is a higher risk of certain types of injuries based on age & development of child:

                           o          0-5 years - falls from one level to another, fall into a hole/pit, fall from a bed or other furniture
                           o          5-9 years - falls from playground equipment

Childhood Falls Prevention                                               Sept 2010                                                            page 17 of 59
Question           Response
What is the
situation?


                        o          10-19 years - falls involving skates, skis, sport boards, roller blades and from tripping, slipping and increasing heights at
                              i
                        work ( )
                        o          Evidence that children who are minimally mobile but considered immobile by their caregiver due to disability are at
                        increased risk of falls. Children with mental disability, psychomotor or sensory disability or in a wheel chair at increased risk of falls
                        (Error! Bookmark not defined.Error: Reference source not found)

                   School-age children are most likely to suffer playground injuries (1)

                   The risk of injury is associated with the determinants of health (1)

                   The evidence strongly indicates that people of lower socio-economic status and people who live in less affluent areas die more often by
                   injury than do people who live in other areas (2)

                   Mortality rates are 38 times higher for children living in less affluent areas than among the children of the most affluent parents (3)
                   Evidence shows that low socioeconomic status increases the risk of being injured in road traffic for both fatal and non-fatal injuries, falls,
                   burns, drowning and poisoning for both mortality and morbidity and suicide (page 10, no ref)

                   A 1996 retrospective Kingston, Ontario study showed a strong connection between increasing economic disadvantage and higher risk for
                   childhood injury. These gradients were evident for home, recreation/play and fall injuries but much less so for sport injuries. (4)

                   Individuals living in poverty have fewer resources for supervised child care or for safety measures in the home. (4)

                   Impoverished neighborhoods may have fewer safe play areas and they may be closer to busy streets and industrial sites. (4)

                   Studies have demonstrated strong socioeconomic gradients for pedestrian and bicycle injuries and fatalities. (4)

                   Injury death rates among Canadian children in 1991 were 40 per cent higher in impoverished environments. The difference was most
                   significant for deaths from fires, drowning and falls. (4)

                   Economic disparities were even more evident in hospitalizations for injury among children. Hospital admissions for fire, burn and
                   poisoning injuries are twice as high among less fortunate children. Choking and suffocation injuries are almost 40 per cent higher (5).
                   A strong relationship between children’s use of bicycle helmets and socio-economic status has recently been demonstrated-even in the
                   presence of Ontario’s bike helmet legislation. Helmet use rose among all income groups observed in several Toronto locations in 1995
                   (when the legislation was passed), stayed high among the highest income groups but fell substantially among the middle and lowest
                   income groups. In 2001, 85% of children in high-income areas were observed wearing helmets, compared with 50 per cent of children in
                   middle-income areas and just 33 per cent of children in low-income areas. (6)

                   Higher child pedestrian injury rates among lower socio-economic groups can be partly accounted for by greater exposure to traffic.

Childhood Falls Prevention                                           Sept 2010                                                              page 18 of 59
Question              Response
What is the
situation?



                      Researchers discovered that children in impoverished Montreal neighbourhoods had to cross, on average, 50 percent more streets a day
                      than those children in wealthier neighbourhoods. (7)

                      A study of Canadian playgrounds found a significantly higher proportion of play structures in poorer neighborhoods were below the
                      standards of the Canadian Standards Association (CSA) than play structures in wealthier neighborhoods (8)

                      In Ontario, substantially higher injury rates are found among Aboriginal people who experience three times the injury death rate of
                      Canadians as a whole. First Nations people are also among the provinces poorest. (9)

                      Priority Populations identified in Guidance Document: Parents/caregivers of infants and young children from birth to two years;
                           Parents/caregivers of boys; Families in low socio-economic and low-income neighbourhoods with poor-quality housing
                                                                                          ii
What settings or      Among children 0-5 years, 66% of all injures occur in the home ( )
situations are high
risk, or pose a       Approximately 1,700 children 14 years and under are hospitalized every year for a fall related to chairs, beds, stairs, and steps
unique opportunity
for intervention?     Children can fall from adult chairs, high chairs, car seats, and bouncy chairs. Falls from bouncy chairs or car seats can happen when
                      they are placed on an elevated surface (e.g. kitchen counter)

                      Growth and development play a crucial role in the risk of falls in children (e.g. rolling over for the first time on a change table while diaper
                      is being changed)

                      Approximately 2,500 children 14 years of age and under are hospitalized annually for playground injuries of which: 14% are head injuries;
                      81% are for broken bones in other parts of the body; and 5% for other injuries (e.g. dislocation, open wound, etc); Playgrounds are a
                                                                                              iii
                      significant setting for injury - especially among school aged children ( )

                      A fall down the stairs in a baby walker makes it twice as likely for a child to sustain a serious head injury
                      Falls from windows are rare but can lead to serious injury or death when a child reaches an open window while climbing on furniture

                      Babies fall off beds or from cribs while playing, sleeping, or trying to get out of it. Between 1990 and 2007, there were 5,403 cases of
                      injuries associated with the use of bunk beds. The most common circumstances cited were playing, sleeping/ resting in, and getting in or
                      out of the top bunk

                      Trampoline injures are rising. Between 1990-2007 there was an average annual percent increase of 15.4% for these types of injuries. The
                                                                                                                         iv
                      majority of trampoline injuries occur on backyard trampolines from falls on the trampoline mat ( ) Injuries from ground impact are the most
                                                                                                                                  v
                      severe resulting in almost two-thirds of all fractures and one in five patients being admitted to hospital ( )

                      Height of a fall

Childhood Falls Prevention                                               Sept 2010                                                              page 19 of 59
Question              Response
What is the
situation?


                                  o The greater the height, the more severe the injury
                                  o Falls from heights less than 1.5 m do not usually cause multiple or serious injuries except if a child is dropped by a
                                  caretaker
                                                                                                                                                vi
                                  o Short height falls may have long term implications including speech problems and learning difficulties. ( )

                      Time of the Year
                                  o More likely in warmer weather months (e.g. may be due to more outdoor activities/more leisure time (Error! Bookmark
                                  not defined.Error: Reference source not found,vii)


How do local           To be determined locally.
stakeholders
perceive the
situation? What is
their capacity to act?
What are their
interests, mandates,
current activities?


What are the needs,   Injury has historically been overlooked as a health issue due, in part, to the common belief that injuries are ‘accidents’ that can be neither
perceptions and       anticipated nor prevented. (23)
favoured directions
of key influential    Despite this evidence, Canadian policy-makers and the public are largely unaware of the human and economic burden associated with
community             preventable injury, and the many effective ways it can be reduced (page 13, no ref).
members, and the
community-at-large?   To be further explored locally.


Step 2: Situational Assessment
Worksheet 2.3: Analyze influences on the situation
    Question          Response


    What risky or     Use of the following products (as indicated in guidance document)
    negative health
    behaviours by             o       Walkers
    various groups            o       Trampolines -multiple users at the same time and inadequate supervision
    of people are             o       Bunk beds -children under the age of 6 sleeping on top bunk

Childhood Falls Prevention                                              Sept 2010                                                             page 20 of 59
   Question           Response


   affecting the              o      Baby slings/carriers worn by the caregiver - has led to serious injuries, and in some cases, the death of babies in
   situation?                 Canada. Slings that use knots or rings to hold the two ends of fabric together pose a potential safety risk because knots
                              can come loose and fabric can slip through the ring (Health Canada, Consumer Product Safety
                                       http://www.hc-sc.gc.ca/cps-spc/index-eng.php

                                                                                                                                                       viiviii
   What makes        Social Determinants of Health (e.g. poverty, education) (Error! Bookmark not defined.Error: Reference source not found - )
   people behave
   in these ways?    Children may also incur injuries as a result of one or more of a range of factors relating to their caregivers e.g. poverty, ignorance,
   (individual level and lack of control over the environment, fatigue, depression and malevolence.
   causes, as well
   as conditions in
   the social
   environment,
   organizational
   environments or
   at the broader
   societal level).


   Are there          Parental Supervision: Not allowing children under 5 years on playground equipment higher than 5 feet and actively supervising
   protective         play of young children
   factors that can
   avoid or help to   Wearing the Gear - wrist/knee/elbow pads/helmet
   alleviate the
   situation?         Playground equipment meeting CSA standards (e.g. equipment height less than 1.5 m (5 feet); soft surface material)

                      Access to home safety devices

                      Home equipment (roof railings, stair gates, window guards, and securing furniture (e.g. big screen television, bookcase, etc)
   What political,    To be determined at the local level
   economic,
   environmental,
   social and
   technological
   trends are
   influencing the
   situation?(this
   type of
   exploration is

Childhood Falls Prevention                                              Sept 2010                                                            page 21 of 59
   Question          Response


   called a PEEST
   analysis)
   What internal     To be determined at the local level
   strengths and
   weakness are
   present in your
   organizational
   that may affect
   your course of
   action? What
   opportunities
   and threats in
   your
   environmental
   may affect your
   course of
   action?




Childhood Falls Prevention                                 Sept 2010   page 22 of 59
Force Field Analysis

    Factor                        Factor     Level of       Direction of   In top three   Source   Directions or conclusions
                                  short form influence      influence      priorities?
1   Lack of parental              Supervisio   Individual   Negative
    supervision in a variety of   n
    situations.
2   Not wearing the gear          Gear         Individual   Negative
3   Lack of playground            Playgroun    Organization Negative
    standard implementation       d            al
4   Lack of use of home           Devices      Individual   Negative
    safety devices
5   Low SES living conditions     Low SES      Societal     Negative
6   Dangerous product use         Products     Individual   Negative
7   General attitudes re:         Attitudes    Societal     Negative
    ‘accidents’ (not
    preventable)
8   Recent advances in            Playgroun    Societal     Positive
    strengthening provincial      d policy
    playground standards
9   Neurotrauma local             Free gear    Societal     Positive
    association efforts to
    provide helmets to low
    SES kids for
    bike/skateboard use




Childhood Falls Prevention                                             Sept 2010                                        page 23 of 59
Force Field Analysis Diagram


Factors that                Existing playground policy          Societal (Media, Political, Economic,                      Low SES                 Factors that
                                                           >                                                <
make                           Free gear available              Social, Technological Environments)                                                make
the                                                                                                                        Playground              the
                                                           >          Organizational environment            <

situation                                                       Networks, including friends and family                                             situation
                                                           >                                                <
                                                                            environment
BETTER                                                                                                               Lack of Supervision           WORSE
                                                                                                                      Lack of sport gear
                                                           >                   Individuals                  <
                                                                                                                 Lack of home safety devices
                                                                                                                   Dangerous products use

Step 2: Situational Assessment
Worksheet 2.4: List possible actions

      Possible action          Source of idea (BP        Additional details                                                Information about effectiveness
      (program,                vs. inventory)
      intervention,
      activity)
1     Supportive home          Provincial Guidance
      visiting and             Document (Error!
      provision of safety      Bookmark not
      equipment for high       defined.Error:
      risk families            Reference source not
                               found)
2     A Step Ahead             Provincial Guidance       Awareness campaign for falls in children has had a process
                               Document                  evaluation not outcome evaluation (awareness campaign). The
                               (York Region/Toronto)     campaign is targeted to caregivers of children 5-9. It includes
                                ix
                               ( )                       fact sheets, brochures, posters and mall advertisement




Childhood Falls Prevention                                                Sept 2010                                                            page 24 of 59
     Possible action       Source of idea (BP     Additional details                                                 Information about effectiveness
     (program,             vs. inventory)
     intervention,
     activity)
3    Be Aware. Be There Provincial Guidance       This includes promising/awareness campaigns, child safety
     Campaign           Document                  resources for teachers and early childhood educators and
                                        x
                        (Central West) ( )        posters that encourage parents to always know what their child
                                                  is doing and actively supervise them beginning at a young age.
                                                  Addresses child choking, poisoning, falls down stairs, and
                                                  burns and includes EB Monkey safety website with resources
                                                  for children, parents/grandparents, teachers and early
                                                  childhood educators.
4    Million Messages      Provincial Guidance    Includes best practice at professional visits, and a program to
                           Document               standardize injury prevention messages for parents of children
                                             xi
                           (Capital Health) ( )   0-5 (e.g. immunization clinics, healthy beginnings, home visits,
                                                  and follow up for healthy beginnings and prenatal classes).
5    Parenting programs    Provincial Guidance                                                                       Effective in improving home safety
     and home visits       Document                                                                                  especially when the information is
     especially to high                                                                                              targeted, age- appropriate, and
     risk families areas                                                                                             combined with the provision and
                                                                                                                     installation of safety equipment.
                                                                                                                     (Error! Bookmark not
                                                                                                                     defined.Error: Reference source
                                                                                                                     not found)
6    Nurse home visit      Provincial Guidance                                                                       Children from families who had
     programs              Document                                                                                  received the parenting education
                                                                                                                     and training programs usually from
                                                                                                                     home visiting programs had fewer
                                                                                                                     injuries than children from families
                                                                                                                     who had not received the
                                                                                                                                  xii
                                                                                                                     programs. ( )
7    Home safety           Provincial Guidance                                                                       Found a lack of evidence that
     education and         Document                                                                                  these interventions reduced
     safety equipment                                                                                                childhood injury despite strong
                                                                                                                     evidence that they increased home
                                                                                                                     safety practices and behaviours.
                                                                                                                      xiii
                                                                                                                     ( ) It may be that interventions to
                                                                                                                     improve home safety are effective
                                                                                                                     in reducing child injury only if they
                                                                                                                     also address other aspects of

Childhood Falls Prevention                                          Sept 2010                                                             page 25 of 59
     Possible action       Source of idea (BP    Additional details                                                 Information about effectiveness
     (program,             vs. inventory)
     intervention,
     activity)
                                                                                                                    parenting. (Error! Bookmark not
                                                                                                                    defined.Error: Reference source
                                                                                                                    not found) This has specific
                                                                                                                    implications and crossover with
                                                                                                                    Healthy Babies, Healthy Children.
8    Interventions after   Provincial Guidance
     an injury or in a     Document
     healthcare setting
9    Focus on a single    Provincial Guidance
     cause of injury e.g. Document (31)
     window falls or bunk
     beds
10   Use home              Provincial Guidance
     assessment tools      Document (31)
     that assess
     caregiver, child, and
     environmental
     characteristics
11   Target the caregiver Provincial Guidance    Increase caregiver knowledge about the age and stage of the
     rather than the child Document (31)         child and how this affects the risk of injury (31)
     Increasing
     Parental/Caregiver                          Increase caregiver’s beliefs that their child can be injured and
     Awareness                                   that injuries are serious (31)

                                                         Supervise children younger than five years of age
                                                         Clothing items can become trapped in equipment and
                                                          may result in strangulation so remove drawstrings and
                                                          other cords from clothing
                                                         In the winter, use a neck warmer rather than a scarf,
                                                          and use mitten clips rather than cords
                                                         Bicycle helmets should not be worn by children on
                                                          playground equipment due to the potential for
                                                          entrapment and strangulation
                                                         Children five years of age and younger should use
                                                          only playgrounds designed for preschool children

Childhood Falls Prevention                                         Sept 2010                                                           page 26 of 59
     Possible action       Source of idea (BP    Additional details                                                   Information about effectiveness
     (program,             vs. inventory)
     intervention,
     activity)

                                                           Look for adequate surfacing – deep, loose fill (see
                                                            recommended depths above). Good surface materials
                                                            include sand, pea gravel (smooth, round, pea-sized
                                                            stones), wood chips and synthetic surfaces. Grass,
                                                            dirt, asphalt and concrete are not acceptable surfaces
                                                            for underneath and around equipment
                                                           Advise local playground operator regarding concerns
                                                            about the safety of local playground
                                                           Children under 5 years should be kept off
                                                            playground equipment higher than 5 feet or 1.5
                                                            meters
12   Interventions using   Provincial Guidance                                                                        show a decrease in injury
     the WHO Safe          Document                                                                                   hospitalization rates for children
     Communities model                                                                                                (31)
13   Kids Can’t Fly        Provincial Guidance   (Window Falls Prevention Program for Urban Settings)             In New York City, the program
                           Document              For preventing falls from high rises targeting children aged 0-6 decreased window falls by 50%
                                                 years. Aim is to:                                                and deaths by 35% just two years
                                                                                                                                         xiv
                                                                                                                  after it was started. ( )
                                                        Increase awareness of the danger posed by open
                                                       windows
                                                        Expand outreach
                                                        Make available information and technical assistance
                                                       to the public
                                                        Provide a forum for discussion with industry
                                                       representatives on the design and manufacture of an
                                                       operable window guard
                                                        Expand inter-agency cooperation and involvement
                                                        Encourage property owners to voluntarily install
                                                       window guards
                                                        Identify and track voluntary installation of window
                                                       guards
                                                        Improve coordination for accurate tracking of
                                                       incidents; and,
                                                        Participate in industry discussion on product
                                                       specifications and standards.
14   Safe Kids / Healthy   Provincial Guidance             In response to the high incidence of severe injuries to
Childhood Falls Prevention                                           Sept 2010                                                             page 27 of 59
     Possible action       Source of idea (BP    Additional details                                                   Information about effectiveness
     (program,             vs. inventory)
     intervention,
     activity)
     Neighborhoods         Document                   children aged 5 to 16 years in Harlem
     Program (now                                      Leading causes of injury were falls and motor vehicle
     known as the Injury                              collisions and assaults
     Free Coalition for                                Harlem Hospital Injury Prevention Program (HIPP)
     Kids in Harlem)                                  initiated a Coalition to reduce outdoor injuries and
                                                      assaults to school-aged children
                                                       Coalition developed alliances with city and community
                                                      agencies and the private sector to: renovate playgrounds;
                                                      involve children in safe, supervised activities that would
                                                      teach them useful skills; provide injury and violence
                                                      prevention education; provide safety equipment (bicycle
                                                      helmets) at reasonable cost.
                                                       The former Safe Kids / Healthy Neighborhoods
                                                      Program (now known as the Injury Free Coalition for Kids)
                                                      has been replicated in 44 sites in 40 cities in the US. For
                                                      more information visit
                                                      http://www.oninjuryresources.ca/BestPractices/Harle
                                                      mHospitalSafeKidsHealthyNeighborhoods.htm
15   Home Safety           Provincial Guidance   Planning interventions that use home assessment tools to
     Checklist             Document              assess caregiver, child and environmental characteristics –
                                                 Home Assessment Tool The Chilliwack Safe Baby Program
16   TD ThinkFirst for     Provincial Guidance          This is a school-based curriculum program for children
     Kids                  Document                    in grades K-8
                                                        Designed as a teacher's resource
                                                        Meets the curriculum requirements in all Canadian
                                                       provinces and territories and is endorsed by Curriculum
                                                       Services Canada
                                                        Six week program was developed by a multi-
                                                       disciplinary team including teachers, curriculum experts,
                                                       doctors, and neuroscientists and teaches children how to
                                                       think first and play safely to prevent brain and spinal cord
                                                       injuries.
                                                        Developmentally appropriate classroom interactions
                                                       and homework assignments deal with violence
                                                       prevention, playground/sport/recreation as well as
                                                       bicycle, water, vehicle/pedestrian safety, and the

Childhood Falls Prevention                                         Sept 2010                                                            page 28 of 59
     Possible action     Source of idea (BP       Additional details                                                 Information about effectiveness
     (program,           vs. inventory)
     intervention,
     activity)
                                                        anatomy and function of the brain and spinal cord
                                                         For more information visit:
                                                        http://www.thinkfirst.ca/programs/tdthinkfirst.aspx
17    Risk Watch         Provincial Guidance      school-based, comprehensive injury prevention program
                         Document                 developed by the US National Fire Protection Association
                         (Canadian version        (NFPA)
                         from the Office of the
                         Chief Fire Marshal)             Adapted for use in Canada by SMARTRISK in
                                                        collaboration with public health
                                                         Program links teachers with community safety experts
                                                        and parents
                                                         Curriculum is divided into five age-appropriate
                                                        teaching modules (Pre-K/Kindergarten, Grades 1-2,
                                                        Grades 3-4, Grades 5-6, and Grades 7-8)
                                                         Each module addresses eight topics (motor vehicle,
                                                        bike/pedestrian, and water and ice safety, the prevention
                                                        of poisoning and injuries from falls/in playgrounds,
                                                        firearms, choking/strangulation/suffocation, and
                                                        fires/burns).
                                                         Ninth lesson brings together concepts in a culminating
                                                        activity
                                                         Topics cover the areas of greatest risk of unintentional
                                                        injury for children age 14 and under.
                                                         Recommended by Curriculum Services Canada to
                                                        support the Grade 3 and 4 curriculum across Canada in
                                                        addressing personal safety and injury prevention

                                                         o    http://www.curriculum.org/csc/resources/riskw
                                                              atch34.shtml
                                                         o    http://www.ofm.gov.on.ca/english/Fire%20Saf
                                                              ety%20&%20Public%20Education/Risk%20W
                                                              atch/default.asp
18   Aim to achieve     Provincial Guidance       This process includes the following
     Canadian Standards Document                   Inspection by certified experts to assess and document
     Association (CSA)                                hazards;
     compliance of all                             Prioritizing hazards for modification or correction;

Childhood Falls Prevention                                         Sept 2010                                                           page 29 of 59
     Possible action       Source of idea (BP    Additional details                                                 Information about effectiveness
     (program,             vs. inventory)
     intervention,
     activity)
     public playgrounds.                            Maintenance of playground equipment, surfacing and
                                                     grounds;
                                                    Injury reporting and follow-up to correct hazards; and
                                                    Planning of future play areas that comply with the
                                                     standards

                                                 Efforts should be directed at decreasing the risk of a fall from
                                                 playground equipment

                                                 Reducing the fall height by:
                                                     Modifying existing playgrounds to reduce the fall
                                                        height to a maximum of 1.5 m (5 ft) for preschool-aged
                                                        children and 2.3 m (7 ft) for school-aged children
                                                     Using innovative designs for new equipment with
                                                        lower heights
                                                     Using age-appropriate equipment

                                                 Decreasing the likelihood of falling from equipment by:
                                                      Using protective barriers and guardrails;
                                                      Using vertical rather than horizontal bars (discourages
                                                         climbing);
                                                      Using peaked or curved surfaces for guardrails
                                                         (discourages use as a play surface)
                                                      Ensuring that adults are actively supervising

                                                 Improving the protective surfacing under and around play
                                                 equipment by using:
                                                      Loose fill, such as coarse sand or pea gravel (smooth,
                                                         round, pea-sized stones)
                                                             o Depth recommendations for loose fill:
                                                                  minimum of 15 cm (6 inches) for preschool
                                                                  equipment; minimum of 30 cm (12 inches) for
                                                                  full-sized equipment.
                                                      Wood chips
                                                      Synthetic surfaces
19   Playground safety     Provincial Guidance   Copy of CSA standard can be found at www.csa.ca or by
     standards required    Document              calling

Childhood Falls Prevention                                         Sept 2010                                                          page 30 of 59
     Possible action      Source of idea (BP    Additional details                                                Information about effectiveness
     (program,            vs. inventory)
     intervention,
     activity)
     for day cares                                      1-800-463-6727


20   Enforcement of the   Provincial Guidance   Since 2004, baby walkers are banned in Canada. It is a
     Canadian ban on      Document              criminal offence to sell, advertise, give away or import new or
     baby walkers                               used baby walkers. Health Canada inspectors enforce law.
21   Crib law             Provincial Guidance   Cribs made before September 1986 do not meet current safety
     enforcement          Document              regulations and should not be used. It is a criminal offence to
                                                advertise, sell, or give away these cribs.
22   Trampoline           Provincial Guidance          Remain unregulated under the Hazardous Products
     warnings             Document                      Act
                                                       Trampolines - children less than 6 years should not
                                                        use a trampoline; supervise child; follow assembly
                                                        instructions; only one person at a time; ensure model
                                                        meets ASTM International Safety standard; set up on
                                                        level ground with impact absorbing surface such as
                                                        loose fill or sand.
                                                       The Canadian Paediatric Society and the Canadian
                                                        Academy of Sport Medicine made five
                                                        recommendations including that trampolines should
                                                        not be used for recreational purposes at home and
                                                        should not be part of outdoor playgrounds
23   Building Codes       Provincial Guidance          To ensure windows on second storey and higher have
                          Document                      mechanism to prevent falls. Currently bylaws are in
                                                        place in the City of Toronto and Mississauga. (Error!
                                                        Bookmark not defined.Error: Reference source not
                                                        found)
24   Warning Labels on    Provincial Guidance   Place warning labels on car seats and bouncy chairs to place
     car seats and        Document              on floor
     bouncy chairs
25   Safety Gear          Provincial Guidance   Required on ski slopes, skateboard parks
                          Document
26   By-Laws for helmet   Provincial Guidance   Nova Scotia has provincial legislation that requires mandatory    Where evidence-based measures
     use                  Document              helmet-use for cycling, skateboarding and in-line skating         have been introduced, significant

Childhood Falls Prevention                                        Sept 2010                                                          page 31 of 59
       Possible action        Source of idea (BP        Additional details                                                 Information about effectiveness
       (program,              vs. inventory)
       intervention,
       activity)

                                                            http://www.gov.ns.ca/news/details.asp?id=200701250 reductions in disability and loss of
                                                            03                                                 life have resulted. The dramatic
                                                        City of Guelph requires every person in-line skating on a          success of mandatory seatbelt and
                                                        highway shall, at all times wear a Canadian Standards              bicycle helmet laws are two such
                                                        Association (CSA) approved helmet appropriate for in-line          examples. (23)
                                                        skating, with the chin strap securely fastened.
27     Bunk Beds warnings Provincial Guidance           unregulated product under Hazardous Products Act. Top bunk
                          Document                      is not safe for children under age 6; allow only one person on
                                                        top bunk; no playing on top bunk; guard rails on all sides and
                                                        meets standards (ASTM F1427)
28     Get Health Care        Provincial Guidance
       Providers to report    Document
       playground injuries
       to your local
       playground
       operators and
       authorities.
29     Educate playground Provincial Guidance
       operators about       Document
       playground injuries
       and their prevention.

Step 2: Situational Assessment
Worksheet 2.5: Consider how to proceed
     Question                                                     Response
1    What are the gaps in data quality or quantity, relative to   We have good data about the broad provincial situation; however we need more information
     stakeholder expectations, that may restrict your ability     about local stakeholders capacity, mandates, interests, etc.
     to make evidence-based decisions about goals,
     audiences, objectives, strategies, activities and            We would like some more data about what can be done to address injury prevention with
     resources?                                                   lower income audiences.

                                                                  Some good activity ideas have been put forward, but we need more information about the
                                                                  potential effectiveness of these potential activities. In cases where we have some
                                                                  effectiveness data, we would like to have a closer look at whether they are appropriate for
                                                                  our community (For example, will stakeholders buy in? how much work would need to be

Childhood Falls Prevention                                                 Sept 2010                                                            page 32 of 59
    Question                                                 Response
                                                             done to tailor the materials?)
2   What is your current perception about your ability to    We think we can afford to do a mass media campaign, using mostly print materials if we
    have an impact on the situation with available time,     work together with other health units. This will save us money on development costs and
    financial resources and mandate?                         hopefully allow us to purchase materials and media time in bulk.

                                                             We think we have the resources to do one other activity. We just need to prioritize our
                                                             ideas. Ideally, this would be a more upstream activity, influencing core risk factors (e.g.
                                                             single parent living situations) rather than just raising awareness. However, we are not sure
                                                             we have the resources to do this.
3   What are your next steps in the planning process? Will   We need to do more research to see whether there is research that speaks to the specific
    you proceed now, or must you revisit research            situations that cause low income and single parent households to experience more injuries.
    questions, project scope or resources?
                                                             We also need to do more research into the effectiveness, appropriateness and resources
                                                             required to implement the potential activity ideas that have been raised.




Childhood Falls Prevention                                             Sept 2010                                                           page 33 of 59
Step 3: Set Goals, Audiences, and Outcome Objectives
Worksheet 3.1: Set Goals, Audiences, and Outcome Objectives

Goal
To reduce the frequency, severity and impact of preventable falls in children

Audiences
Children 4-9
Parents of children 0-9
Childcare providers
Schools of children 0-9
Health care providers
Community partners
Municipal policy-makers

Outcome Objectives

    1. 5% decrease in fall related injuries in children aged 0-9 that lead to emergency room visits by January 2015. (long-term)

    2. To increase the number of children aged 4-9 properly using CSA approved safety gear when appropriate (bike-riding, skate-boarding, skating, etc.) by
           50%, by June 2013. (medium-term)

    3. To increase the number of parents of children aged 0-9 who are properly using home safety devices to prevent falls among children (e.g., roof railings,
           stair gates, window guards, and secured furniture such as big screen television, bookcase, etc) by 50%, by June 2013. (medium-term)

    4. To increase the number of parents of children aged 0-5 who appropriately supervise their children in high fall-risk situations (e.g., playgrounds, change
           tables, etc.) by 50%, by June 2013. (medium-term)

    5. To decrease the number of parents of children 0-5 who do specific high fall-risk actions (e.g., putting bouncy chairs on counters) by 80% by June 2013.

    6. To increase the number of community partners by 5 and health care providers by 25% who assess patient/client risk related to falls among children and
           offer education and referral as appropriate by June 2013. (medium-term)

    7. To increase the number of parents of children 0-9 who have done an independent or health-care provider/community partner assisted safety/risk
           assessment of their/their children’s injury risk factors by 70%, by June 2013. (medium-term)

    8. To increase the number of community partners including health care providers who report community hazards that have been linked with an injury, to
           appropriate authorities by 20, by June 2013. (medium-term)

    9. To decrease the number of non-CSA compliant playground facilities in elementary schools, daycare settings, and municipal recreational spaces by
           50%, by June 2013. (medium-term)
Childhood Falls Prevention                                              Sept 2010                                                           page 34 of 59
   10. To increase the number of buildings in the municipality that are compliant with building codes that reduce the risk of childhood falls, by 20% by June
           2013. (medium-term)

   11. To increase, by 20%, the number of (currently non-compliant) building owners/managers who state that they are committed to making their buildings
           compliant with building codes that reduce the risk of childhood falls within the next 18 months by June 2013. (medium-term)

   12. To improve upon (laws passed) existing community building codes to further reduce the risk of falls among children in private living spaces (E.g.,
           apartment buildings), and public spaces (e.g., recreation centres, etc.) by June 2013. (medium-term)

   13. To increase the number of parents of children aged 4-9 who believe that they/their child is at risk of being injured when they do not properly use CSA
           approved gear when appropriate (bike-riding, skate-boarding, skating ,etc.) and that those injuries are preventable by 25% by June 2012 . (short-
           term).

   14. To increase the number of children aged 4-9 who believe that they are at risk of being injured when they do not properly wear CSA approved safety
           gear and know when it is appropriate to do so and that those injuries are preventable by 75% by June 2012. (short-term).

   15. To increase the number of parents of children aged 0-9 who believe that they/their child is at risk of being injured without properly used home safety
           devices such as roof railings, stair gates, window guards, secured furniture, etc. and that those injuries are preventable by 25% by June 2012.
           (short-term).

   16. To increase the number of parents of children aged 0-9 who know how to properly install/use home safety devices to prevent falls among children by
           50% by June 2012. (short-term).

   17. To increase the number of parents of children aged 4-9 who know how to properly use CSA approved safety gear and know when it is appropriate to
           do so by 50% by June 2012. (short-term).

   18. To increase the number of children aged 4-9 who know how to properly use CSA approved safety gear and know when it is appropriate to do so by
           50% by June 2012. (short-term).

   19. To decrease the number of parents of children aged 0-9 who have barriers to accessing CSA approved safety gear and home safety devices (when
           needed) by 100% by June 2012. (short-term).

   20. To increase the number of economically challenged parents of children aged 0-9 who are aware of funding programs and other support services
           available to help access CSA approved safety gear and home safety devices by 70% by June 2012. (short-term).

   21. To increase the resources provided by community partners and corporate sponsors to purchase (or subsidize), promote and disseminate CSA
           approved safety gear and home safety devices to economically challenges families with children aged 0-9 by 100% by June 2012. (short-term).

   22. To increase the resources provided by community partners and corporate sponsors to identify and fix (e.g., pay for or subsidize) unsafe living and
           recreation sites/spaces in lower SES neigbhourhoods by 100% by June 2012.

   23. To increase the number of parents of children aged 4-9 who endorse and enforce their children’s proper use of CSA approved safety gear when
           appropriate (bike-riding, skate-boarding, skating, etc.) by 50% by June 2012. (short-term).
Childhood Falls Prevention                                             Sept 2010                                                            page 35 of 59
   24. To increase the number of parents of children aged 0-5 who believe that there are certain high-risk situations that most commonly cause injuries due to
           falls (e.g., use of certain types of playgrounds, inadequate supervision on playgrounds and change tables, putting bouncy chairs on counters, etc.)
           by 50% by April 2012. (short-term).

   25. To increase the number of community partners and health care providers who are aware of the primary injury risk factors of children aged 0-9, the
           impact of those risks, proven roles and tools they can use to decrease those risks, and other community programs and services that they can refer
           patients/clients to by 100% by April 2012. (short-term).

   26. To increase awareness among schools, daycare providers, community associations and municipalities and parents re: legislation about CSA compliant
           playgrounds and supports available to help them become compliant, by 50% by April 2012. (short-term).

   27. To increase awareness among municipal building owners and managers (including public buildings such as rec centres and private buildings such as
           apartment buildings) and parents about building codes that reduce the risk of falls among children in private living spaces (E.g., apartment
           buildings), and public spaces (e.g., recreation centres, etc.) and resources available to help them become compliant by 70% by April 2012. (short-
           term).

   28. To increase the number of parents who know who to call when they become aware of non-compliant playgrounds or buildings by 20% by April 2012.
           (short-term).

   29. To increase the number of decision-makers who believe that childhood injuries are a significant issue and are largely preventable by 50 by April 2012.
           (short-term).

   30. To increase the number of decision-makers who believe that many childhood injuries can be prevented by good legislation and proper adoption and
           implementation of the legislation re: playground safety and certain building codes by 50 by April 2012. (short-term).

   31. To increase the number of decision-makers who have the information they need to change/create policy and policy implementation plans to address
           playground safety and building codes that enhance childhood safety by 50 by October 2012. (short-term).

Step 4: Choose Strategies and Activities and Assign Resources
Worksheet 4.1: Choose Strategies and Brainstorm Activities
Strategy                                        Activity
Create supportive environments                  Peer screening and training program
Build healthy public policy
Health Communication                            Campaign to raise awareness and change beliefs about the effectiveness of prevention
Self-help/mutual support
Community mobilization
Develop personal skills                         curriculum development and delivery for children aged 4-6


Childhood Falls Prevention                                            Sept 2010                                                           page 36 of 59
Strategy                                                    Activity
Education/information
Strengthening health services                               Have physicians screen patients with children 0-6, using standard injury risk checklist

Step 4: Choose Strategies and Activities and Assign Resources
Worksheet 4.2: Assess and Choose Activities
    Potential          Include in   Strategy          Information about expected                 Information about audience         Required resources                Available resources
    Activity           final                          effectiveness                              appropriateness
                       plan?

1   Peer screening     Yes          Create            We have not been able to find another      There are many                     The resources required for        Because volunteers would be
    and training                    supportive        program that has done this exact           neighbourhoods with clusters       this strategy are primarily       involved with implementing
    program                         environments      thing. But there are many examples of      of lower income families,          time. A moderate budget for       this strategy, and there are
                                                      peer programs on other topics              many with single parents. We       printing materials and            health unit staff available who
                                                      (nutrition, smoking, parenting) that       believe it would be relatively     supporting, compensating and      could take on training and
                                                      have been proven effective. We             easy to engage at least one of     rewarding peer volunteers for     monitoring of the peer
                                                      believe this is a strong indication that   these communities in a             their efforts would be the        volunteers, we think this is a
                                                      this idea could be very effective if       strategy like this.                primary expense.                  very feasible strategy.
                                                      done correctly.

2   Campaign to        Yes          Health            In general, we know that health            Campaigns should be tailored       Campaigns costs can vary          We know that we would be
    raise                           Communication     communication campaigns can                to the needs of a specific         widely depending on the cost      restricted to print and web
    awareness and                                     change awareness and attitudes and         community. We would use            of material development and       vehicles because of our
    change beliefs                                    even behaviours. We don't know of a        resources to test and tailor the   the types of vehicles chosen.     budget. We feel that we could
    about the                                         childhood injury prevention campaign       materials so that they were        We know that we would be          do a credible, effectiveness
    effectiveness of                                  that has been well evaluated, but we       appropriate for the                restricted to print and web       campaign using only those
    prevention                                        know quite a lot about evidence-based      community.                         vehicles because of our           vehicles, with creativity, and
                                                      practices in terms of planning a                                              budget.                           the support of neighbouring
                                                      campaign (audience analysis, testing                                                                            health units.
                                                      materials in advance, etc.).

3   curriculum       Yes            Develop           There is a program that has been           We have examined the               Adaptation costs should be        We can allocate part of our
    development                     personal skills   tested, evaluated, and shown to be         materials for the program that     minimal. Printing costs will be   grant money to this budget.
    and delivery for                                  effective at changing awareness and        was tested and believe that        the primary expense. Time         We think there is health unit
    children aged 4-                                  behaviours of children 4-6.                they can be adapted very           will also be required by health   staff available (in the schools
    6                                                                                            easily for our community.          unit staff to promote and         program) to lead on promotion
                                                                                                                                    disseminate the materials to      and dissemination.
                                                                                                                                    teachers and community
                                                                                                                                    members. There will also be
                                                                                                                                    mailing costs.

4   Have               No           Strengthening     We don't know of anyone who has            We think this is very              This would be a relatively low    We have a health services
    physicians                      health services   done this precise thing. But we know       appropriate for our                cost activity. The main           person at the health unit, with
    screen patients                                   that physicians are a highly credible      community. The question is         challenge will be reaching and    good physician connections,
    with children 0-                                  source to most members of the              whether we can get                 engaging physicians who are       who could take on distribution
    6, using                                          population. We suspect high success        physicians on board.               already busy with many other      of our materials to physicians.
    standard injury                                   if we can get physicians on board.                                            things.                           We will only do this activity if
    risk checklist                                                                                                                                                    we can find an existing
                                                                                                                                                                      screening tool that has been
                                                                                                                                                                      tested. We do not have the


Childhood Falls Prevention                                                               Sept 2010                                                                                page 37 of 59
   Potential         Include in   Strategy   Information about expected       Information about audience   Required resources      Available resources
   Activity          final                   effectiveness                    appropriateness
                     plan?

                                                                                                                                   resources to develop a new
                                                                                                                                   one ourselves.




Step 4: Choose Strategies and Activities and Assign Resources
Worksheet 4.3: Assign Resources and Outcome Objectives and Worksheet 4.4: Develop Process Objectives
               Activity [Strategy]                 Resources               Strategy        Outcome               Process Objectives
                                                   Allocated                               Objective #’s
    1.         Education campaign directed at                              Create          1, 8, 9, 10, 11,          1. Produce and disseminate 300
               building owners and managers,                               supportive      26, 27, 28                   educational packages about
               parents, schools, daycare                                   environment                                  legislation relating to building codes,
               providers, and community                                    s                                            helmet use, playgrounds, who to
               associations re: existing                                                                                call when an infraction/danger is
               legislation relating to building                                                                         discovered, and what supports are
               codes, helmet use, playgrounds;                                                                          available for becoming compliant.
               importance of enforcement of                                                                             Disseminate to building
               the legislation; who to call when                                                                        owners/managers, parent school
               an infraction/danger is                                                                                  councils, school administration,
               discovered; and what supports                                                                            daycare providers and community
               are available for becoming                                                                               associations by June 2011
               compliant.
    2.         Work with community partners                                Create          1, 8, 9, 10, 11,          2. Develop list of building
               to increase the number of                                   supportive      26, 27, 28                   owners/managers, parent school
               unofficial (friendly, advice-                               environment                                  councils, school administrative staff,
               providing visits), as well as                               s                                            daycare providers and community
               official (legally supported)                                                                             associations who may not be
               playground and building code                                                                             compliant with playground and
               compliance checks in schools,                                                                            building codes, by January 2011
               daycare providers, community
               associations and other private                                                                        3. Contact all individuals on the
               and public buildings in the                                                                              possibly-non-compliant list to ask
               municipality.                                                                                            whether they would like a
                                                                                                                        consultation about how to meet the
                                                                                                                        legislation, by June 2011.
                                                                                                                     4. Conduct up to 50 face to face
Childhood Falls Prevention                                                Sept 2010                                                           page 38 of 59
          Activity [Strategy]                  Resources    Strategy      Outcome             Process Objectives
                                               Allocated                  Objective #’s
                                                                                                    meetings by September 2011 with
                                                                                                    individuals on the possibly-non-
                                                                                                    compliant list to help them
                                                                                                    understand their options to become
                                                                                                    compliant.
                                                                                                 5. Contact 5 people responsible for
                                                                                                    administering/enforcing playground
                                                                                                    and building code policy to find out
                                                                                                    how to increase the number of
                                                                                                    compliance checks and follow-ups
                                                                                                    being done by January 2011.
   3.     Collaborate with and engage                       Create        1, 9, 10, 19, 21,      6. Produce and disseminate 150
          community partners including                      supportive    22                        promotional packages, by January
          corporate partners to provide or                  environment                             2011, explaining the impact of low
          subsidize home and sport safety                   s                                       SES individuals not having proper
          gear for lower SES parents of                                                             safety home/sport gear, and safe
          children 0-9 years of age and to                                                          living/rec spaces and requesting
          identify and fix (e.g., pay for or                                                        support (Financial or otherwise) to
          subsidize) unsafe living and                                                              provide those individuals with
          recreational sites/spaces in                                                              proper gear/spaces.
          lower SES neigbhourhoods.
                                                                                                 7. Conduct 150 follow-up calls to
                                                                                                    recipients of promotional packages
                                                                                                    by March 2011, and schedule face
                                                                                                    to face meetings as required.
                                                                                                 8. Create plan to educate, assess and
                                                                                                    disseminate gear/support to low
                                                                                                    SES individuals who required it by
                                                                                                    September 2011.
                                                                                                 9. Implement safety support education,
                                                                                                    assessment and dissemination plan
                                                                                                    for low SES individuals who require
                                                                                                    it by June 2012.
   4.     Education campaign directed at                    Build healthy 1, 12, 29, 30, 31      10. Produce and disseminate 200

Childhood Falls Prevention                                 Sept 2010                                                   page 39 of 59
          Activity [Strategy]                 Resources    Strategy        Outcome           Process Objectives
                                              Allocated                    Objective #’s
          decision-makers and parents                      public policy                           educational packages and 3 mass
          re: potential impact (on falls,                                                          media messages to parents and
          long-term health, costs, etc.) of                                                        decision-makers about the potential
          better legislation and                                                                   impact (on falls, long-term
          enforcement procedures around                                                            health/welfare, costs, etc.) of better
          building codes, playground                                                               legislation and enforcement
          codes and helmet laws.                                                                   procedures around building codes,
                                                                                                   playground codes and helmet laws
                                                                                                   by January 2012.
                                                                                                11. Make follow-up phone call to all
                                                                                                    decision-makers who received the
                                                                                                    educational packages to find out
                                                                                                    whether they are interested in a
                                                                                                    face to face meeting to find out
                                                                                                    more about what legislation is
                                                                                                    proven, recommended, possible, by
                                                                                                    April 2012.
                                                                                                12. Conduct up to 50 face to face
                                                                                                    meetings with decision-makers (as
                                                                                                    they request) to discuss impact,
                                                                                                    evidence, possible actions, by June
                                                                                                    2012.
   5.     Support community partners in                    Build healthy 1, 12, 29, 30, 31      13. Create and disseminate draft
          their efforts to advocate and                    public policy                            policies about building codes for
          empower parents to advocate                                                               decision-makers to review by June
          for better legislation and                                                                2012.
          enforcement of legislation re:
          building codes, helmet use,
          playgrounds, etc.
   6.     Collaborate with, educate and                    Community       1, 6, 7, 25          14. Chair and manage invitations and
          engage community partners to                     mobilization                             agendas for quarterly network
          support childhood injury                                                                  meetings, and manag mailouts and
          prevention education, skill                                                               listservs for partners, starting
          development, supportive                                                                   immediately.

Childhood Falls Prevention                                Sept 2010                                                    page 40 of 59
          Activity [Strategy]                 Resources    Strategy       Outcome         Process Objectives
                                              Allocated                   Objective #’s
          environment development and
          policy development/
          implementation efforts. Use
          quarterly network meetings,
          supplemented by mailout and
          listserv communication to
          achieve this.
   7.     Promote, among community                         Community      1, 6, 7, 25        15. Develop and promote by Janaury
          partners, including health care                  mobilization                          2011, to community partners, an
          providers, available community                                                         electronic list of resources that they
          resources that they can use or                                                         can use or refer their patients/client
          refer their patients/ clients to.                                                      to. Disseminate using face to face
          Do this using face to face                                                             network events, mailouts and
          network events, mailouts and                                                           listservs.
          listserv.
   8.     Provide skill-building                           Community      1, 6, 7, 25        16. Research, review, rank and adapt
          opportunities for community                      mobilization                          existing assessment tools for
          partners, including health care                                                        community partners and health care
          providers re: tools to assess                                                          providers by June 2011.
          and coach clients/patients re:
          childhood injury prevention. Do                                                    17. Design and implement system of
          this via one health care                                                               follow-up for people who have
          provider training per year, one                                                        participated in a risk assessment by
          community partner training per                                                         September 2011.
          year.                                                                              18. Develop, manage and implement
                                                                                                 one health care provider injury
                                                                                                 prevention lunch and learn by June
                                                                                                 2011.
                                                                                             19. Develop, manage and implement
                                                                                                 one community partner full-day
                                                                                                 forum, at which community
                                                                                                 resources, tools, follow-up
                                                                                                 procedures, and best practices are
                                                                                                 discussed by June 2011.

Childhood Falls Prevention                                Sept 2010                                                  page 41 of 59
          Activity [Strategy]                 Resources    Strategy       Outcome              Process Objectives
                                              Allocated                   Objective #’s
                                                                                                  20. Promote, disseminate and offer one
                                                                                                      on one and electronic
                                                                                                      training/support to community
                                                                                                      partners, including health care
                                                                                                      providers, about risk assessment
                                                                                                      tools and related supports for
                                                                                                      parents of children 0-9 starting
                                                                                                      September 2011.
   9.     Share best practices and                         Community      1, 6, 7, 25             21. Manage the community partner
          evidence relating to the                         mobilization                               childhood injury prevention
          prevention of falls among                                                                   partnership contact list (address,
          children. Do this using annual                                                              telephone, email, names, and
          mailout, network meetings and                                                               positions) starting immediately.
          listserv.
                                                                                                  22. Manage the local childhood injury
                                                                                                      prevention network listserv starting
                                                                                                      immediately.
   10.    Work with community partners                     Personal       1, 2, 3, 16, 17,        23. Provide PHN home visitor training
          to provide home visits,                          Skills         18                          about injury prevention screening
          community events and school                                                                 tools and brief advice-giving
          events to assess and train                                                                  techniques by June 2011.
          parents and children (0-9) re:
          appropriate use of home and                                                             24. Hold one community safety event,
          sport safety gear and educate                                                               with community partners by June
          re: identification of other                                                                 2011.
          hazards (e.g., unsafe public/rec                                                        25. Hold 10 elementary school injury
          spaces in lower SES areas).                                                                 prevention events by June 2011.
   11.    Education campaign directed at                   Education/inf 1, 4, 5, 7, 13, 14,      26. Develop and implement a 3-year
          parents to increase awareness                    ormation      15, 18, 20, 23,              health communication campaign to
          of the risks and potential impact                              24                           begin April 2011 for parents, to
          of childhood falls in general,                                                              increase awareness of the risks and
          and for them specifically (self-                                                            potential impact of childhood falls in
          audit), and increase awareness                                                              general, and for them specifically
          of the things they can                                                                      (self-audit), and the things they can
          do/services they can access to                                                              do/services they can access to

Childhood Falls Prevention                                Sept 2010                                                       page 42 of 59
          Activity [Strategy]                   Resources         Strategy         Outcome              Process Objectives
                                                Allocated                          Objective #’s
           prevent such injuries.                                                                               prevent such injuries.

    12.    Education campaign directed at                         Education/inf 1, 14, 18                   27. Develop and implement, starting
           children 4-9 to increase                               ormation                                      April 2011, a 3-year education
           awareness of safety/injury                                                                           campaign, using schools and other
           prevention in general and for                                                                        venues/vehicles, to increase
           them specifically (self-audit),                                                                      awareness of simple injury
           and the things they can                                                                              prevention skills to prevent series
           do/services they can access to                                                                       injuries.
           prevent such injuries.

Step 5: Develop Indicators
Worksheet 5.1: Develop Outcome Indicators
.
What will you measure?          Where will you get the      Outcome objective related to this indicator
                                information?
    1. Emergency room           Hospital separation data       1. 5% decrease in fall related injuries in children aged 0-9 that lead to emergency
          visits                                                  room visits by January 2015. (long-term)
    2. Children’s use of        Public park observational      2. To increase the number of children aged 4-9 properly using CSA approved safety
           safety gear          study                             gear when appropriate (bike-riding, skate-boarding, skating, etc.) by 50%, by June
                                                                  2013. (medium-term)
    3. Parents use of home      PHN home visit data            3. To increase the number of parents of children aged 0-9 who are properly using
          safety equipment                                        home safety devices to prevent falls among children (e.g., roof railings, stair gates,
                                                                  window guards, and secured furniture such as big screen television, bookcase, etc)
                                                                  by 50%, by June 2013. (medium-term)
    4. Supervision patterns     Public park observational      4. To increase the number of parents of children aged 0-5 who appropriately
                                study                             supervise their children in high fall-risk situations (e.g., playgrounds, change tables,
                                                                  etc.) by 50%, by June 2013. (medium-term)
    5. Parental reports of   PHN home visit questions to       5. To decrease the number of parents of children 0-5 who do specific high fall-risk
          doing these things parents                              actions (e.g., putting bouncy chairs on counters) by 80% by June 2013.
    6. Number of community      Self reports by community      6. To increase the number of community partners by 5 and health care providers by
          partners and          partners and physicians           25% who assess patient/client risk related to falls among children and offer
          physicians                                              education and referral as appropriate by June 2013. (medium-term)

Childhood Falls Prevention                                       Sept 2010                                                            page 43 of 59
What will you measure?         Where will you get the         Outcome objective related to this indicator
                               information?
           assessing risk
   7. Number of parents   RRFSS data                             7. To increase the number of parents of children 0-9 who have done an independent
         who have done an                                           or health-care provider/community partner assisted safety/risk assessment of
         assessment                                                 their/their children’s injury risk factors by 70%, by June 2013. (medium-term)
   8. Number of reports into Call logs                           8. To increase the number of community partners including health care providers who
         hotline                                                    report community hazards that have been linked with an injury, to appropriate
                                                                    authorities by 20, by June 2013. (medium-term
   9. Number of CSA            Observational data from           9. To decrease the number of non-CSA compliant playground facilities in elementary
         compliant             school site visits by school         schools, daycare settings, and municipal recreational spaces by 50%, by June
         playgrounds           PHN                                  2013. (medium-term)
   10. Number of compliant     Observational data                10. To increase the number of buildings in the municipality that are compliant with
          buildings                                                  building codes that reduce the risk of childhood falls, by 20% by June 2013.
                                                                     (medium-term)
   11. Building owner          Telephone survey                  11. To increase, by 20%, the number of (currently non-compliant) building
           intentions to act                                         owners/managers who state that they are committed to making their buildings
                                                                     compliant with building codes that reduce the risk of childhood falls within the next
                                                                     18 months by June 2013. (medium-term)
   12. Whether law passed      N/A                               12. To improve upon (laws passed) existing community building codes to further reduce
                                                                     the risk of falls among children in private living spaces (E.g., apartment buildings),
                                                                     and public spaces (e.g., recreation centres, etc.) by June 2013. (medium-term)
   13. Parental beliefs        RRFSS                             13. To increase the number of parents of children aged 4-9 who believe that they/their
                                                                     child is at risk of being injured when they do not properly use CSA approved gear
                                                                     when appropriate (bike-riding, skate-boarding, skating ,etc.) and that those injuries
                                                                     are preventable by 25% by June 2012 . (short-term).
   14. Children’s beliefs      Classroom polls                   14. To increase the number of children aged 4-9 who believe that they are at risk of
                                                                 being injured when they do not properly wear CSA approved safety gear and know
                                                                 when it is appropriate to do so and that those injuries are preventable by 75% by June
                                                                 2012. (short-term).
   15. Parental beliefs        RRFSS                             15. To increase the number of parents of children aged 0-9 who believe that they/their
                                                                     child is at risk of being injured without properly used home safety devices such as
                                                                     roof railings, stair gates, window guards, secured furniture, etc. and that those
                                                                     injuries are preventable by 25% by June 2012. (short-term).
   16. Parental reports of     PHN home visit questions to       16. To increase the number of parents of children aged 0-9 who know how to properly
          knowing these        parents                               install/use home safety devices to prevent falls among children by 50% by June

Childhood Falls Prevention                                         Sept 2010                                                            page 44 of 59
What will you measure?       Where will you get the        Outcome objective related to this indicator
                             information?
           things                                                 2012. (short-term).
   17. Parental reports of   PHN home visit questions to      17. To increase the number of parents of children aged 4-9 who know how to properly
          knowing these      parents                              use CSA approved safety gear and know when it is appropriate to do so by 50% by
          things                                                  June 2012. (short-term).
   18. Children’s beliefs    Classroom polls                  18. To increase the number of children aged 4-9 who know how to properly use CSA
                                                                  approved safety gear and know when it is appropriate to do so by 50% by June
                                                                  2012. (short-term).
   19. Parental reports of   PHN home visit questions to      19. To decrease the number of parents of children aged 0-9 who have barriers to
          knowing these      parents                              accessing CSA approved safety gear and home safety devices (when needed) by
          things                                                  100% by June 2012. (short-term).
   20. Parental reports of   PHN home visit questions to      20. To increase the number of economically challenged parents of children aged 0-9
          knowing these      parents                              who are aware of funding programs and other support services available to help
          things                                                  access CSA approved safety gear and home safety devices by 70% by June 2012.
                                                                  (short-term).
   21. Amount of resources   Project records                  21. To increase the resources provided by community partners and corporate sponsors
                                                                  to purchase (or subsidize), promote and disseminate CSA approved safety gear
                                                                  and home safety devices to economically challenges families with children aged 0-9
                                                                  by 100% by June 2012. (short-term).
   22. Amount of resources   Project records                  22. To increase the resources provided by community partners and corporate sponsors
                                                                  to identify and fix (e.g., pay for or subsidize) unsafe living and recreation
                                                                  sites/spaces in lower SES neigbhourhoods by 100% by June 2012.
   23. Parental reports of   PHN home visit questions to      23. To increase the number of parents of children aged 4-9 who endorse and enforce
          doing these things parents                              their children’s proper use of CSA approved safety gear when appropriate (bike-
                                                                  riding, skate-boarding, skating, etc.) by 50% by June 2012. (short-term).
   24. Parental reports of   PHN home visit questions to      24. To increase the number of parents of children aged 0-5 who believe that there are
          beliefts           parents                              certain high-risk situations that most commonly cause injuries due to falls (e.g., use
                                                                  of certain types of playgrounds, inadequate supervision on playgrounds and change
                                                                  tables, putting bouncy chairs on counters, etc.) by 50% by April 2012. (short-term).
   25. Number of community   Short survey of health care      25. To increase the number of community partners and health care providers who are
          partners and       providers and community              aware of the primary injury risk factors of children aged 0-9, the impact of those
          physicians who     partners                             risks, proven roles and tools they can use to decrease those risks, and other
          answer correctly                                        community programs and services that they can refer patients/clients to by 100% by
          questions about                                         April 2012. (short-term).
          risks and tools

Childhood Falls Prevention                                      Sept 2010                                                           page 45 of 59
What will you measure?        Where will you get the        Outcome objective related to this indicator
                              information?
    26. Knowledge             Telephone survey                 26. To increase awareness among schools, daycare providers, community associations
                                                                   and municipalities and parents re: legislation about CSA compliant playgrounds and
                                                                   supports available to help them become compliant, by 50% by April 2012. (short-
                                                                   term).
    27. Building owner        Telephone survey                 27. To increase awareness among municipal building owners and managers (including
            knowledge                                              public buildings such as rec centres and private buildings such as apartment
                                                                   buildings) and parents about building codes that reduce the risk of falls among
                                                                   children in private living spaces (E.g., apartment buildings), and public spaces (e.g.,
                                                                   recreation centres, etc.) and resources available to help them become compliant by
                                                                   70% by April 2012. (short-term).
    28. Parental reports of   PHN home visit questions to      28. To increase the number of parents who know who to call when they become aware
           knowing these      parents                              of non-compliant playgrounds or buildings by 20% by April 2012. (short-term).
           things
    29. Decision-maker        Telephone survey                 29. To increase the number of decision-makers who believe that childhood injuries are
           beliefs                                                 a significant issue and are largely preventable by 50 by April 2012. (short-term).
    30. Decision-maker        Telephone survey                 30. To increase the number of decision-makers who believe that many childhood
           beliefs                                                 injuries can be prevented by good legislation and proper adoption and
                                                                   implementation of the legislation re: playground safety and certain building codes
                                                                   by 50 by April 2012. (short-term).
    31. Decision-maker        Telephone survey                 31. To increase the number of decision-makers who have the information they need to
           knowledsge                                              change/create policy and policy implementation plans to address playground safety
                                                                   and building codes that enhance childhood safety by 50 by October 2012. (short-
                                                                   term).

Step 5: Develop Indicators
Worksheet 5.2: Develop Process Indicators

What will you measure?        Where will you get the               Process Objectives
                              information?
    1. Number of packages    Follow-up phone calls             1. Produce and disseminate 300 educational packages about legislation relating to
          that were received                                      building codes, helmet use, playgrounds, who to call when an infraction/danger is
                                                                  discovered, and what supports are available for becoming compliant. Disseminate
                                                                  to building owners/managers, parent school councils, school administration,
                                                                  daycare providers and community associations by June 2011
    2. Number of contacts on Adminstrative records             2. Develop list of building owners/managers, parent school councils, school

Childhood Falls Prevention                                       Sept 2010                                                            page 46 of 59
What will you measure?       Where will you get the              Process Objectives
                             information?
          the list                                               administrative staff, daycare providers and community associations who may not be
                                                                 compliant with playground and building codes, by January 2011
   3. Number of contacts     Administrative records          3. Contact all individuals on the possibly-non-compliant list to ask whether they would
         made                                                   like a consultation about how to meet the legislation, by June 2011.
   4. Number of face to      Project coordinator records     4. Conduct up to 50 face to face meetings by September 2011 with individuals on the
         face meetings                                          possibly-non-compliant list to help them understand their options to become
         held                                                   compliant.
   5. Number of              Project coordinator records     5. Contact 5 people responsible for administering/enforcing playground and building
         enforcement                                            code policy to find out how to increase the number of compliance checks and
         people willing to                                      follow-ups being done by January 2011.
         ramp up efforts
   6. Number of packages     Follow-up phone calls           6. Produce and disseminate 150 promotional packages, by January 2011, explaining
         received                                               the impact of low SES individuals not having proper safety home/sport gear, and
                                                                safe living/rec spaces and requesting support (Financial or otherwise) to provide
                                                                those individuals with proper gear/spaces.
   7. Number of face to      Project coordinator records     7. Conduct 150 follow-up calls to recipients of promotional packages by March 2011,
         face meetings                                          and schedule face to face meetings as required.
         scheduled
   8. When plan was          Project coordinator records     8. Create plan to educate, assess and disseminate gear/support to low SES
         created and                                            individuals who required it by September 2011.
         implemented
   9. Number of lower SES    Project coordinator estimates   9. Implement safety support education, assessment and dissemination plan for low
         individuals                                            SES individuals who require it by June 2012.
         reached
   10. Number of packages    Follow-up phone calls           10. Produce and disseminate 200 educational packages and 3 mass media messages
          received                                               to parents and decision-makers about the potential impact (on falls, long-term
                                                                 health/welfare, costs, etc.) of better legislation and enforcement procedures around
                                                                 building codes, playground codes and helmet laws by January 2012.
   11. Number of face to     Project coordinator records     11. Make follow-up phone call to all decision-makers who received the educational
          face meetings                                          packages to find out whether they are interested in a face to face meeting to find
          scheduled                                              out more about what legislation is proven, recommended, possible, by April 2012.
   12. Number of decision-   Project coordinator records     12. Conduct up to 50 face to face meetings with decision-makers (as they request) to
          makers intending                                       discuss impact, evidence, possible actions, by June 2012.
          to support

Childhood Falls Prevention                                    Sept 2010                                                           page 47 of 59
What will you measure?           Where will you get the            Process Objectives
                                 information?
           legislation efforts
   13. Number of decision-       Follow-up phone calls         13. Create and disseminate draft policies about building codes for decision-makers to
          makers who                                               review by June 2012.
          received draft
          policies

   14. Decision-maker
          opinions about the
          policies
   15. Number of partners        Project coordinator records   14. Chair and manage invitations and agendas for quarterly network meetings, and
          who attend each                                          manage mailouts and listservs for partners, starting immediately.
          meeting.
   16. Number of people who Webstatistics                      15. Develop and promote by Janaury 2011, to community partners, an electronic list of
          download the                                             resources that they can use or refer their patients/client to. Disseminate using face
          resource list                                            to face network events, mailouts and listservs.
   17. Date the tools            Project coordinator records   16. Research, review, rank and adapt existing assessment tools for community partners
          exercise is                                              and health care providers by June 2011.
          complete
   18. Date the system is        Project coordinator records   17. Design and implement system of follow-up for people who have participated in a
          implemented                                              risk assessment by September 2011.

   19. Number of people          Project coordinator records
          contacted as a
          part of the follow-
          up
   20. Number of health care Project coordinator records       18. Develop, manage and implement one health care provider injury prevention lunch
          providers who                                            and learn by June 2011.
          attend the event

   21. Participant quality and Event evaluation forms
           usefulness ratings
           about the event
   22. Number of community       Project coordinator records   19. Develop, manage and implement one community partner full-day forum, at which
          partners who                                             community resources, tools, follow-up procedures, and best practices are discussed
          attend the forum                                         by June 2011.


Childhood Falls Prevention                                      Sept 2010                                                            page 48 of 59
What will you measure?           Where will you get the            Process Objectives
                                 information?
   23. Participant quality and Event evaluation forms
           usefulness ratings
           about the event
   24. Number of contacts        Project coordinator records   20. Promote, disseminate and offer one on one and electronic training/support to
          made with                                                community partners, including health care providers, about risk assessment tools
          partners/health                                          and related supports for parents of children 0-9 starting September 2011.
          care providers to
          clarify/support
          their efforts to use
          the tools
   25. Number of partners on Project coordinator records       21. Manage the community partner childhood injury prevention partnership contact list
          the contact list                                         (address, telephone, email, names, and positions) starting immediately.
   26. Number of posts on        Webstatistics                 22. Manage the local childhood injury prevention network listserv starting immediately.
          listserv
   27. Number of PHN’s           Project coordinator records   23. Provide PHN home visitor training about injury prevention screening tools and brief
          trained                                                  advice-giving techniques by June 2011.
                                 Event evaluation forms
   28. Participant quality and
           usefulness ratings
           about the event
                                 Event evaluation forms
   29. Participant ratings of
           confidence to
           implement tools in
           the field
   30. Number of community       Project coordinator records   24. Hold one community safety event, with community partners by June 2011.
          partners that
          contribute to
          holding the event
                                 Project coordinator records
   31. Number of community
          members who
          attend the event
                                 Event evaluation forms
   32. Participant ratings of
           quality of
           usefulness of the     Media tracking company

Childhood Falls Prevention                                      Sept 2010                                                           page 49 of 59
What will you measure?          Where will you get the               Process Objectives
                                information?
           event                results

   33. Amount of press          Partner event evaluation form.
          generated around
          the event

   34. Community partner
          ratings of quality
          and usefulness of
          the event
   35. Number of community      Project coordinator records      25. Hold 10 elementary school injury prevention events by June 2011.
          partners that
          contribute to
          holding the event
                                Project coordinator records
   36. Number of community
          members who
          attend the event
                                Event evaluation forms
   37. Participant ratings of
           quality of
           usefulness of the    Media tracking company
           event                results

   38. Amount of press          Partner event evaluation form.
          generated around
          the event

   39. Community partner
          and host ratings of
          quality of
          usefulness of the
          event
   40. Parents knowledge        RRFFSS                           26. Develop and implement a 3-year health communication campaign to begin April
          and attitudes                                              2011 for parents, to increase awareness of the risks and potential impact of
                                                                     childhood falls in general, and for them specifically (self-audit), and the things they
                                                                     can do/services they can access to prevent such injuries.
   41. Children’s knowledge     Classroom polls conducted by     27. Develop and implement, starting April 2011, a 3-year education campaign, using

Childhood Falls Prevention                                        Sept 2010                                                              page 50 of 59
What will you measure?          Where will you get the                   Process Objectives
                                information?
           levels, and          PHN’s                                    schools and other venues/vehicles, to increase awareness of simple injury
           attitudes                                                     prevention skills to prevent series injuries.

Step 6: Review the Plan
Worksheet 6.1: Review your plan
     Question                                                                  Yes/No     Notes and potential actions

1    COMPLETENESS: Is there a broad goal giving direction to the               Yes
     program (worksheet 3.1)?
2    COMPLETENESS: Does it have audiences including individuals,               Yes
     networks, organizations and/or governments (worksheet 3.1)?
3    COMPLETENESS: Does it include SMART (specific, measurable,                Yes
     appropriate, realistic and time-limited) outcome and process objectives
     (worksheets 3.1 and 4.4)?
4    COMPLETENESS: Does it include a few major strategies identified to        Yes
     advance the outcome objectives and do these strategies reflect your
     overall guiding health promotion strategy (worksheet 4.1)?
5    COMPLETENESS: Does it include activities that fall within clearly         Yes
     defined strategies (worksheets 4.1 and 4.2)?
6    COMPLETENESS: Does it indicate what resources are required to             Yes
     implement each activity properly (worksheet 4.3)?
7    COMPLETENESS: Does it include indicators for both outcome and             Yes
     process objectives (worksheets 5.1 and 5.2)?
8    COMPLETENESS: Are all indicators accessible, reliable, and valid?         Yes
9    LOGIC: Will the short-term objectives contribute to your medium and       Yes
     long-term outcome objectives (worksheet 3.1)?
10   LOGIC: Will the strategies contribute to meeting the goals and            Yes
     objectives (worksheets 3.1 and 4.1)?
11   LOGIC: Are the activities the best ones to advance each strategy          Yes
     (worksheets 4.1 and 4.2)?
12   LOGIC: Are the activities appropriate for the audience(s) (worksheets     Yes
     3.1 and 4.2)?

Childhood Falls Prevention                                              Sept 2010                                                       page 51 of 59
     Question                                                                  Yes/No   Notes and potential actions

13   LOGIC: Are there adequate resources in place to properly implement        Yes
     the activities?
14   ALIGNMENT WITH SITUATIONAL ASSESSMENT: Is your plan                       Yes
     consistent with the key findings of the situational assessment? In
     particular, does your program plan take the major influences on your
     situation into account (worksheet 2.3). this check for alignment should
     also include a review of any new data that arose during the planning
     process.
15   ALIGNMENT WITH SITUATIONAL ASSESSMENT: Will stakeholders                  Yes
     be satisfied? ( worksheet 1.2)
16   PRESENTATION: Is it user-friendly and easy to follow?                     Yes
17   PRESENTATION: Is it easy to follow the arrows and/or flow of logic?       Yes
18   PRESENTATION: Is there enough white space?                                Yes
19   PRESENTATION: Is it presented in an order that is useful for you and      Yes
     your stakeholders?




Childhood Falls Prevention                                             Sept 2010                                      page 52 of 59
Logic Model

Goal
To reduce the frequency, severity and impact of preventable falls in children

Audiences
Children 4-9
Parents of children 0-9
Childcare providers
Schools of children 0-9
Health care providers
Community partners
Municipal policy-makers



Long-term            1. 5% decrease in fall related injuries in children aged 0-9 that lead to emergency room visits by January 2015. (long-term)
outcome
objectives
Medium-term          2. To increase the number of children aged 4-9 properly using CSA approved safety gear when appropriate (bike-riding, skate-boarding,
outcome                 skating, etc.) by 50%, by June 2013. (medium-term)
objectives
                     3. To increase the number of parents of children aged 0-9 who are properly using home safety devices to prevent falls among children
                        (e.g., roof railings, stair gates, window guards, and secured furniture such as big screen television, bookcase, etc) by 50%, by June
                        2013. (medium-term)

                     4. To increase the number of parents of children aged 0-5 who appropriately supervise their children in high fall-risk situations (e.g.,
                        playgrounds, change tables, etc.) by 50%, by June 2013. (medium-term)

                     5. To decrease the number of parents of children 0-5 who do specific high fall-risk actions (e.g., putting bouncy chairs on counters) by
                        80% by June 2013.

                     6. To increase the number of community partners by 5 and health care providers by 25% who assess patient/client risk related to falls
                        among children and offer education and referral as appropriate by June 2013. (medium-term)

                     7. To increase the number of parents of children 0-9 who have done an independent or health-care provider/community partner assisted
                        safety/risk assessment of their/their children’s injury risk factors by 70%, by June 2013. (medium-term)

                     8. To increase the number of community partners including health care providers who report community hazards that have been linked
                        with an injury, to appropriate authorities by 20, by June 2013. (medium-term)


Childhood Falls Prevention                                              Sept 2010                                                            page 53 of 59
                  9. To decrease the number of non-CSA compliant playground facilities in elementary schools, daycare settings, and municipal
                     recreational spaces by 50%, by June 2013. (medium-term)

                  10. To increase the number of buildings in the municipality that are compliant with building codes that reduce the risk of childhood falls,
                      by 20% by June 2013. (medium-term)

                  11. To increase, by 20%, the number of (currently non-compliant) building owners/managers who state that they are committed to making
                      their buildings compliant with building codes that reduce the risk of childhood falls within the next 18 months by June 2013. (medium-
                      term)

                  12. To improve upon (laws passed) existing community building codes to further reduce the risk of falls among children in private living
                      spaces (E.g., apartment buildings), and public spaces (e.g., recreation centres, etc.) by June 2013. (medium-term)
Short-term        13. To increase the number of parents of children aged 4-9 who believe that they/their child is at risk of being injured when they do not
(and other)           properly use CSA approved gear when appropriate (bike-riding, skate-boarding, skating ,etc.) and that those injuries are preventable
outcome               by 25% by June 2012 . (short-term).
objectives
                  14. To increase the number of children aged 4-9 who believe that they are at risk of being injured when they do not properly wear CSA
                      approved safety gear and know when it is appropriate to do so and that those injuries are preventable by 75% by June 2012. (short-
                      term).

                  15. To increase the number of parents of children aged 0-9 who believe that they/their child is at risk of being injured without properly
                      used home safety devices such as roof railings, stair gates, window guards, secured furniture, etc. and that those injuries are
                      preventable by 25% by June 2012. (short-term).

                  16. To increase the number of parents of children aged 0-9 who know how to properly install/use home safety devices to prevent falls
                      among children by 50% by June 2012. (short-term).

                  17. To increase the number of parents of children aged 4-9 who know how to properly use CSA approved safety gear and know when it is
                      appropriate to do so by 50% by June 2012. (short-term).

                  18. To increase the number of children aged 4-9 who know how to properly use CSA approved safety gear and know when it is
                      appropriate to do so by 50% by June 2012. (short-term).

                  19. To decrease the number of parents of children aged 0-9 who have barriers to accessing CSA approved safety gear and home safety
                      devices (when needed) by 100% by June 2012. (short-term).

                  20. To increase the number of economically challenged parents of children aged 0-9 who are aware of funding programs and other
                      support services available to help access CSA approved safety gear and home safety devices by 70% by June 2012. (short-term).

                  21. To increase the resources provided by community partners and corporate sponsors to purchase (or subsidize), promote and
                      disseminate CSA approved safety gear and home safety devices to economically challenges families with children aged 0-9 by 100%
                      by June 2012. (short-term).

Childhood Falls Prevention                                            Sept 2010                                                            page 54 of 59
                     22. To increase the resources provided by community partners and corporate sponsors to identify and fix (e.g., pay for or subsidize)
                         unsafe living and recreation sites/spaces in lower SES neigbhourhoods by 100% by June 2012.

                     23. To increase the number of parents of children aged 4-9 who endorse and enforce their children’s proper use of CSA approved safety
                         gear when appropriate (bike-riding, skate-boarding, skating, etc.) by 50% by June 2012. (short-term).

                     24. To increase the number of parents of children aged 0-5 who believe that there are certain high-risk situations that most commonly
                         cause injuries due to falls (e.g., use of certain types of playgrounds, inadequate supervision on playgrounds and change tables,
                         putting bouncy chairs on counters, etc.) by 50% by April 2012. (short-term).

                     25. To increase the number of community partners and health care providers who are aware of the primary injury risk factors of children
                         aged 0-9, the impact of those risks, proven roles and tools they can use to decrease those risks, and other community programs and
                         services that they can refer patients/clients to by 100% by April 2012. (short-term).

                     26. To increase awareness among schools, daycare providers, community associations and municipalities and parents re: legislation
                         about CSA compliant playgrounds and supports available to help them become compliant, by 50% by April 2012. (short-term).

                     27. To increase awareness among municipal building owners and managers (including public buildings such as rec centres and private
                         buildings such as apartment buildings) and parents about building codes that reduce the risk of falls among children in private living
                         spaces (E.g., apartment buildings), and public spaces (e.g., recreation centres, etc.) and resources available to help them become
                         compliant by 70% by April 2012. (short-term).

                     28. To increase the number of parents who know who to call when they become aware of non-compliant playgrounds or buildings by 20%
                         by April 2012. (short-term).

                     29. To increase the number of decision-makers who believe that childhood injuries are a significant issue and are largely preventable by
                         50 by April 2012. (short-term).

                     30. To increase the number of decision-makers who believe that many childhood injuries can be prevented by good legislation and proper
                         adoption and implementation of the legislation re: playground safety and certain building codes by 50 by April 2012. (short-term).

                     31. To increase the number of decision-makers who have the information they need to change/create policy and policy implementation
                         plans to address playground safety and building codes that enhance childhood safety by 50 by October 2012. (short-term).
.

    Objective    1, 8, 9, 10, 11, 19, 21, 22, 26,   1, 12, 29, 30, 31       1, 6, 7, 25             1, 2, 3, 16, 17, 18        1, 7, 13, 14, 15, 18, 20, 23, 24
    Numbers      27, 28
.
    Strategies   Create supportive                  Build healthy public    Community mobilization Develop personal skills     Education/information
                 environments                       policy

Childhood Falls Prevention                                                 Sept 2010                                                         page 55 of 59
.
    Activities    1. Education campaign            4. Education              6. Collaborate        10. Work with          11.         Education
                  directed at building owners      campaign                  with, educate and     community partners     campaign directed at
                  and managers, parents,           directed at               engage community      to provide home        parents to increase
                  schools, daycare providers,      decision-makers           partners to support   visits, community      awareness of the risks and
                  and community                    and parents re:           childhood injury      events and school      potential impact of
                  associations re: existing        potential impact          prevention            events to assess       childhood falls in general,
                  legislation relating to          (on falls, long-          education, skill      and train parents      and for them specifically
                  building codes, helmet use,      term health,              development,          and children (0-9)     (self-audit), and increase
                  playgrounds; importance of       costs, etc.) of           supportive            re: appropriate use    awareness of the things
                  enforcement of the               better legislation        environment           of home and sport      they can do/services they
                  legislation; who to call         and                       development and       safety gear and        can access to prevent such
                  when an infraction/danger        enforcement               policy                educate re:            injuries.
                  is discovered; and what          procedures                development/          identification of
                  supports are available for       around building           implementation        other hazards (e.g.,   12.        Education
                  becoming compliant.              codes,                    efforts. Use          unsafe public/rec      campaign directed at
                                                   playground                quarterly network     spaces in lower        children 4-9 to increase
                  2. Work with community           codes and                 meetings,             SES areas).            awareness of safety/injury
                  partners to increase the         helmet laws.              supplemented by                              prevention in general and
                  number of unofficial                                       mailout and                                  for them specifically (self-
                  (friendly, advice-providing       5. Support               listserv                                     audit), and the things they
                  visits), as well as official      community                communication to                             can do/services they can
                  (legally supported)               partners in              achieve this.                                access to prevent such
                  playground and building           their efforts to                                                      injuries.
                  code compliance checks in         advocate and              7. Promote,
                  schools, daycare providers,       empower                   among
                  community associations            parents to                community
                  and other private and             advocate for              partners,
                  public buildings in the           better                    including health
                  municipality.                     legislation and           care providers,
                                                    enforcement of            available
                  3. Collaborate with and           legislation re:           community
                  engage community                  building codes,           resources that
                  partners including                helmet use,               they can use or
                  corporate partners to             playgrounds,              refer their
                  provide or subsidize home         etc.                      patients/ clients
                  and sport safety gear for                                   to. Do this using
                  lower SES parents of                                        face to face
                  children 0-9 years of age                                   network events,
                  and to identify and fix (e.g.,                              mailouts and
                  pay for or subsidize)                                       listserv.
                  unsafe living and
                  recreational sites/spaces in                               8. Provide skill-

Childhood Falls Prevention                                              Sept 2010                                                 page 56 of 59
                  lower SES              building
                  neigbhourhoods.        opportunities for
                                         community
                                         partners, including
                                         health care
                                         providers re: tools
                                         to assess and
                                         coach
                                         clients/patients re:
                                         childhood injury
                                         prevention. Do this
                                         via one health care
                                         provider training
                                         per year, one
                                         community partner
                                         training per year.

                                         9. Share best
                                         practices and
                                         evidence relating
                                         to the prevention
                                         of falls among
                                         children. Do this
                                         using annual
                                         mailout, network
                                         meetings and
                                         listserv.




Childhood Falls Prevention          Sept 2010                   page 57 of 59
i
          .       Ontario Injury Prevention Resource Centre. Falls across the lifespan: evidence-based practice synthesis document. Toronto: Queen’s Printer for
          Ontario; 2008.
ii
          .       SafeKids Canada. Safer homes for children: a guide for communities [Web site]. Retrieved Aug 6, 2009 from:
          http://www.safekidscanada.ca/SKCForPartners/custom/SaferHomesforChildrenGuideEng.pdf
iii
          .       Canadian Paediatric Society. Preventing playground injuries. Paediatr Child Health 2002; 7(4): 255-6.
iv
          .       Canadian Paediatric Society. Trampoline use in homes and playgrounds. Paediatr Child Health 2007; 12(6): 501-5.
v
          .       Public Health Agency of Canada. Child and youth injury in review – 2009 edition: spotlight on consumer product safety. Ottawa: Her Majesty the
          Queen in Right of Canada; 2009.
vi
          .       Ward L. Evidence to action: preventing falls for children and youth [Powerpoint Presentation]. Retrieved Aug 27, 2009 from:
          http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/workshops/pism_skc_falls_prevention_l
          inda_ward.pdf


vii
          .        Khambalia A, Josshi P, Brussoni M, Raina P, Morrongiello B, Macarthur C. Risk factors for unintentional injuries due to falls in children aged 0–6
          years: a systematic review. Injury Prevention 2006; 12:378-81.
viii
          .       University of Guelph. Child Development Research Unit: recently completed projects [Web site]. Retrieved Aug 27, 2009 from:
          http://www.uoguelph.ca/~cdru/#_A_few_of
ix
          .       City of Toronto. Injury prevention [Web site]. Retrieved Aug 27, 2009 from: http://www.toronto.ca/health/injuryprevention/5to9/index.htm
x
          .       The Regional Municipality of Niagara. EB monkey safety house [Web site]. Retrieved Aug 27, 2009 from:
          http://www.niagararegion.ca/living/health_wellness/EBMonkey/default.aspx
xi
          .       Alberta Health Services. A million messages [Web site]. Retrieved Aug 27, 2009 from:
          http://www.capitalhealth.ca/YourHealth/Campaigns/Kidsafe/A_Million_Messages.htm
xii
          .      Kendrick D, Barlow J, Hampshire A, Polnay L, Stewart-Brown S. Parenting interventions for the prevention of unintentional injuries in childhood.
          Cochrane Database of Systematic Reviews 2007; 4.
xiii
          .       Kendrick D, Coupland C, Mulvaney M, Simpson J, Smith S, Sutton A, et al. Home safety education and provision of safety equipment for injury
          prevention. Cochrane Database of Systematic Reviews 2007; 1.



    Childhood Falls Prevention                                               Sept 2010                                                               page 58 of 59
xiv
      .         Ontario Injury Prevention Resource Centre. Children can’t fly: a New York department of health initiative – a window falls prevention program [Web
      site]. Retrieved Aug 27, 2009 from: http://www.oninjuryresources.ca/BestPractices/ChildrenWindowFalls.htm




Childhood Falls Prevention                                             Sept 2010                                                             page 59 of 59

				
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