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152 ALTER for home safety in brief: an adapted intervention program for a vulnerable population
  1. Amanda Cox
  1. University of Guelph, Guelph, Ontario, Canada


Purpose Unintentional injury is the leading cause of death in children 1–19 years of age, and research has identified that injury-related occurrences and mortality disproportionally impact vulnerable populations. Past research with middle-class families has demonstrated the effectiveness of a parent-directed program to increase home safety for children 1 – 5 years of age; behavioral measures showed increased supervision practices by parents, with effects persisting for at least one year post-intervention. The purpose of the current study was to determine whether an adapted version of the Supervising for Home Safety program (SHS) would serve as an appropriate intervention for vulnerable ‘high risk’ families (e.g., low income, single parent home, recent immigrant). Measures were completed by parents before (pre) and after (post) delivery of the program.

Methods A total of 40 participants completed the ALTER for Home Safety-Brief program as part of one of the Halton Public Health parenting programs. Participants typically had multiple risk factors including low SES, low level of education, mental health challenges, financial constraints, and recently immigrated, with many referred through the Children’s Aid Society.

Materials The SHS-Brief program aims to increase parent’s safety knowledge through discussion about parents’ supervision practices and challenges they might face in supervising their children. The program uses video-messaging about common types of in-home injuries and introduces parents to the mnemonic ALTER (reduce risk of injury by changing: Activity, Location, Timing, or Environment and using Resources). Parents practice ALTER by completing activity sheets to generate solutions to child safety challenges they face at home.

Results Parents’ overall level of supervision significantly increased from pre to post. They identified that the average number of minutes their children spent engaged in activities alone (e.g., playing in the bathtub) decreased from pre intervention (M=6.73 mins, SD=4.85) to post intervention (M=2.29 minutes, SD=2.41). Not only did parents supervisory attention increase (Mpre = 77.60% of time, SDpre = 25.99, Mpost = 87.45% of time, SDpost = 20.34), but so did their level of proximity to their child (Mpre= 71.83% of time proximal, SDpre = 24.40; Mpost = 87.95, SDpost = 18.32). In particular, parents identified that their typical supervision pattern at the beginning of the intervention was ‘being in another room but listening closely to their child’, and at the end of the intervention, parents identified that they were typically ‘in the same room (in view of the child) but beyond reach’. Moreover, when assessing for behavioral change on a 5 point rating scale, there was a significant increase in the ‘action’ stage of change from pre intervention (M=2.96, SD=1.16) to post intervention (M=4.10, SD=0.6853) indicating a considerable shift in parents beliefs that they have the ability to change their supervisory behavior and actively use ALTER to do this.

Conclusion The SHS-Brief Program can be successfully delivered to vulnerable caregivers in community settings and can produce desirable changes that are expected to improve caregiver’s supervision practices.

Contribution To the best of our knowledge, this is the first safety program aimed at increasing parental supervision practices for vulnerable families. Given that improved supervision is associated with a decrease in children’s injuries, identifying programs that can create readiness for change to improve vulnerable caregiver’s supervision is essential. The current findings indicate that the ALTER for Home Safety-Brief is such a program.

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