Stay One Step Ahead – Working with Small Steps Big Changes to develop an innovative home safety programme

Dr Mike Hayes, Consultant, Child Accident Prevention Trust and Denise Kendrick, Professor of Primary Care Research, University of Nottingham, discuss the development and impact of the home safety programme ‘Stay One Step Ahead’ (SOSA.)

The need for action

Children should be safe in their homes. Yet, every year in England, around 370,000 children under five have an injury that requires a visit to a hospital. Roughly 40,000 will be admitted to hospital because of their injury, and sadly around 35 may die. It is even more distressing that injuries are more likely to occur in families living in the most disadvantaged areas.

Prevention works

Injuries in the home can be prevented. Research has shown that providing families with safety advice from healthcare professionals and fitting home safety equipment, such as safety gates, smoke alarms and cupboard locks can reduce injuries and improve parent home safety practices. The National Institute of Health and Care Excellence (NICE) recommends that this type of prevention activity is made available across England.

The Stay One Step Ahead (SOSA) project

Working with parents and practitioners involved in the Small Steps Big Changes (SSBC) programme in Nottingham, alongside the Child Accident Prevention Trust, our team based at The University of Nottingham developed an evidence-based standardised approach to home safety for families with children under three.

The SOSA project comprised two elements: the development and delivery of evidence-based resources for parents along with research to examine the effectiveness of the project.

Innovative aspects of the project included the involvement of parents, service providers and the research team, especially in resource development, and the involvement of SSBC Family Mentors in programme delivery.

The resources, which focused on preventing the most common types of injuries, consisted of four components:

• Monthly information on home safety.
• Home safety checklists completed by health visiting teams at nine to twelve months, and two to two-and-a-half-year child health reviews.
• A structured programme of home safety activities for families to undertake with guidance from Family Mentors.
• Four ‘safety week’ activity sessions per year held at children’s centres, covering reducing the risk of injuries due to fires, scalds, falls, and poisoning.

The programme was delivered over a two-year period in Nottingham to families of children aged up to three years in the four SSBC wards of Aspley, Bulwell, Hyson Green and Arboretum and St Ann’s. Delivery was carried out by the Children’s Public Health 0-19 Nursing Service (health visiting teams), children’s centre staff and Family Mentors working in combination. These service providers received specialised training to deliver SOSA.

Using multiple research approaches, we assessed how SOSA helped to make homes safer in areas where it was delivered compared to homes in five other areas that were not part of the SSBC initiative. We also looked at parents’ and practitioners’ views of the programme, how confident parents felt about their ability to make their homes safer and if the programme saved the NHS money by preventing GP attendances and hospital visits/ admissions.

The impact of SOSA

Families who received SOSA were 81% more likely to store poisons safely, 81% more likely to have a fire escape plan and three times more likely to have a fireguard or not have a fire than non-SSBC families. In addition, families receiving SOSA undertook a higher number of key safety practices – 25% said they implemented nine such practices versus 14% in the non-SSBC families. Full results have been published.

Understanding whether the programme was delivered as intended (its fidelity) allowed us to understand what might need to be changed in future to improve effectiveness. What we found through interviews was that some elements were adapted by the service providers over time, but the SSBC Family Mentor home safety activities were most likely to be delivered as intended.

Unsurprisingly, the pandemic had a big impact on SOSA’s delivery as home visits had to be curtailed.

Interviews with parents demonstrated that they liked the programme, especially valuing the time spent on injury prevention with Family Mentors. The practitioners delivering the programme also valued having a structured approach to home safety, though it was difficult for some to fit it into the limited time they could spend with families.

We showed that SOSA was cost-effective, reducing healthcare expenditure with a return of investment of £1.39 in savings for every £1 spent.

Where do we go from here?

We want the programme to be rolled out beyond Nottingham. To do this, we have developed a comprehensive Implementation Toolkit for commissioners, elected members and service providers. It also includes the resources for use with parents, guidance on monitoring, evaluation and quality control, training materials for health visiting teams, children’s centres and family mentors, and videos to present the programme for commissioners, practitioners and parents.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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Visit the A Better Start website to find out more.