To develop a parenting programme to prevent recurrent unintentional home injuries in preschool children, together with the resources required to test the feasibility of evaluating the intervention.
Methods
Commissioning of Parenting UK to develop the programme
Parenting UK was commissioned to develop a group-based parenting programme. The commissioning brief specified that the programme should include:
l parenting skills that have the potential to prevent injuries including, but not limited to:
¢ relationship building
¢ setting and maintaining boundaries
¢ behaviour management
¢ appropriate levels of supervision for the age and development of the child
l first aid response to common injury scenarios occurring to children under the age of 5 years in the home, including but not limited to:
¢ falls
¢ burns and scalds
¢ ingestions and poisonings
¢ foreign bodies and choking
¢ unconsciousness/recovery position
¢ life-saving skills/cardiopulmonary resuscitation
¢ cuts and wounds
¢ broken bones
l safety practices and equipment that, when used in an age-appropriate and/or development- appropriate way, can prevent injuries from occurring.
In addition, Parenting UK was requested to provide the materials, equipment and documentation to support the delivery of the programme during the testing of the intervention. This included the development of a programme manual for those delivering the programme to use as a reference aid. Six sets of materials were required to be produced for subsequent testing in a feasibility study.
Governance of the programme development
A programme development subgroup (PDS) was convened to oversee the development of the programme. Membership included three co-applicants: the chief investigator (JM), an academic with expertise in evaluating parenting programmes (S-SB) and a practising health visitor (BP), together with the Director of the Whoops! Child Safety Project, which providesfirst aid training for parents. This team communicated with the chief executive of Parenting UK and the manager employed by Parenting UK to carry out the
held every 3 weeks between February 2011 and July 2011. The emergingfindings of the two systematic reviews conducted during the theoretical phase of this study were passed to the staff at Parenting UK to help inform development of the programme.
The Parenting UK manager was asked to keep a log to record the decisions and rationale for choices made during the development of the programme, to provide an interim report after 3 months, and to provide a final report. The manager from Parenting UK made a presentation to the research team at the end of 6 months (July 2011) to describe the course that had been produced, and seekfinal sign-off prior to production of the materials.
User involvement
The PAG was consulted prior to Parenting UK commencing work on the programme. During the PAG’s second meeting we asked the mothers what they had liked and disliked about any parent support courses that they had attended and what had been good or not so good about anyfirst aid training or courses that they had attended. We then discussed the possible content and format of a course onfirst aid and home safety including resources and things they could do at home. They made some very helpful suggestions, which were passed onto the staff at Parenting UK.
At the next meeting of the PAG some of the resources developed by Parenting UK for use in the course were discussed. The outline of the course was described and members discussed some of the proposed activities. They were very positive about the content and resources, and this was fed back to the staff at Parenting UK.
Results
An 8-week programme, designed to be delivered in an acceptable, participant-friendly, incrementally progressive style, was produced and is summarised inTable 1, and described in more detail inAppendix 2. The content of each session, designed to be delivered over 90 minutes, was acknowledged to be
challenging, particularly for a less skilled/experienced trainer. While acknowledging that some parenting programmes include sessions of 2 hours’duration, the length of the sessions was chosen to be 90 minutes as a result of concerns that a longer session may reduce the likelihood of parents engaging with the programme owing to the perception of it being an onerous commitment. Each week started with a reflection on the previous week’s content and exploration of the application of knowledge or skills at home since the group last met. Each week ended with an opportunity to discuss and clarify details discussed that week together with suggestions of activities parents might wish to try at home.
The programme and trainer manual were developed through an iterative process informed through written comments on each draft version and three weekly teleconference discussions with the PDS. Some
materials were identified from other programmes and resources and, where included, written permission was provided. The artwork was directly commissioned by Parenting UK for this programme. The decision log is summarised inAppendix 3.
The following outputs were delivered:
l Twelve A4 trainer manuals–white polyvinyl chloride (PVC) ring binders, with a 4 × D-ring mechanism, clear pockets on the front cover and spine for colour inserts, and the contents divided into three sections: (1) general introduction to the programme and advice on running groups, (2) the contents of each of the 8 weeks of the programme, broken down into timed components and activities and (3) resources and materials used in each session.
l Fifty A5 parent handbooks–white PVC ring binders with a 4 × D-ring mechanism and clear pockets on the front cover and spine for colour inserts–for the participants to store handouts provided during the weekly course sessions together with any notes that they chose to make.
l Two resource kits (one for each study centre) were provided by the Whoops! Child Safety Project. Kits contained two burns dolls, doll for demonstration of resuscitation and choking response, choking tube, heat change colour mug,fire safety DVD, leaflets and an A3 poster tube with laminated drawings.
l A‘train the trainer’package, designed as a 2-day course for delivery teams and described in detail
inAppendix 4.
Support for those delivering the programme
The manager from Parenting UK made a number of recommendations regarding support for those
TABLE 1 Summary of 8-week First-aid Advice and Safety Training (FAST) parent programme
Week Content
1 Introduction to the course
l Information about the course and icebreaking activities l Exploring experiences of injuries in ourselves and others
Discussion about the challenges parents face in keeping their children safe
2 Child development and injury risk. Illustrate with head injury scenarios and advice
l How children develop physically and socially and how development links to injury risk l ‘Hunt the hazards’picture activity
Discussion of how home hazards link to injury and development
3 Communication between parents and children. Illustrate with choking risk scenarios and advice
l How we communicate/effective communication/communicating with your child l When communication fails/managing behaviour
Responding when your child is choking, preventing choking
4 Managing attention-seeking behaviour, using praise. Illustrate with burn and scald scenarios
l Why use praise/linking to communication and behaviour
l Recognising burn and scald risk situations/first response for a burn or scald Providing appropriate supervision for your child
5 Setting and maintaining boundaries. Illustrate with ingestion and poisoning scenarios and advice
l How children’s behaviour reflects adult behaviour/setting boundaries
l Three Cs: choices, consequences and consistency/links to praise and communication Keeping children safe from poisons and ingestions/first response
6 Appropriate expectations of children. Illustrate with safe play scenarios
l Having realistic expectations of children’s abilities and activities l Link appropriate activities with developmental stage/play Safe toys and games at different ages
7 Attachment/how we react when upset or angry. Illustrate with unconscious child scenarios
l Development of the baby’s brain/attachment/communication
l How adults and children act when angry or upset/managing stressful situations What to do if your child were unconscious/recovery position and resuscitation 8 Drawing the course together
l What makes a good parent/having confidence in own ability/communication l How safe is my home/reflections on what has been learnt
environment would enable shared learning and avoided duplication of information exchange. However, it was recognised that the courses were unlikely to be delivered concurrently across the study centres, resulting in deliverers having different support needs at different times. In addition, not all of the course deliverers would be available at the same time. Therefore, the manager at Parenting UK offered to be available to provide weekly telephone and e-mail support as required for those delivering the four courses planned during the feasibility study. The option of video conference contact was considered but rejected owing to the limited electronic access available to course deliverers in their usual work locations.