Meeting the Community Where they Are: Reaching Underserved Populations through Partnership with A Home Visiting Nurse Program

Shelby Crespi, MPH, CPST
Salvador Vargas, CPST-I
Melissa Burke, MPH

Unintentional injuries are the leading cause of death for children ages 1-19. Falls and motor vehicle crashes are among the top mechanisms of injury observed in the Lucile Packard Children’s Hospital Stanford Pediatric Emergency Department. To prevent these injuries, the Childhood Injury Prevention Program uses a partnership approach to reach underserved families throughout the Bay Area.

The Childhood Injury Prevention Program at Lucile Packard Children’s Hospital Stanford has partnered with the San Mateo County Nurse Family Partnership (NFP) Program for seven years to reach underserved families with important safety information and supplies. The NFP Program is an evidence-based, national, nurse home-visiting program. First-time expecting parents are paired with a Public Health Nurse who provides case management from pregnancy through the child’s second birthday. Families enrolled in the program are from historically underserved populations: low income, English Language Learners, racial/ethnic minorities, single parents, young or teen parents, or are experiencing substantial hardship. Safety workshops are taught by LPCHS Childhood Injury Prevention Program Staff (certified Child Passenger Safety Technicians) and cover: child passenger safety, falls prevention (furniture tip overs, stair falls, falls from furniture, trips/slips, and window falls), home safety (water safety, burns and scalds prevention, poison prevention, choking prevention). Each family takes a 2-hour safety workshop three times while enrolled in the NFP Program – while expecting, when their child is 12 months, and at 24 months before families graduate from the program. At each stage, parents are provided with safety information specific to their child’s current age and development as well as what to expect later. Families are also provided with safety supplies at no cost including an appropriate car seat, pack n plays, sleep sacks, 46-piece home safety kits, and window locks. Classes are hosted in English and Spanish by Child Passenger Safety Technicians. The class is facilitated in other languages, such as Thai, Ukrainian, and Portuguese, using translators. Knowledge change is assessed through pre and post surveys. Public Health Nurses reinforce injury prevention education while conducting in-home visits and make suggestions to modifications to child’s environment to promote safety.

In 2022, 80 families were provided with education and safety supplies. Families demonstrated increases in knowledge around confidence in installing car seats, understanding the safest place for a child to ride in a car, attitudes around bedsharing with infants, and other safety topics. Families taking safety classes three times, as well as in-home reinforcement of injury prevention knowledge by Public Health Nurses, results in program participants selecting the appropriate safety measure or behavior 90%-100% of the time by the end of the program.

Injury prevention messaging is best retained and results in positive behavior change using multiple touchpoints and education modalities. Consistent, age-appropriate injury prevention education coupled with in-home reinforcement and free safety supplies leads to families reporting prioritizing safety. Moreover, reaching families during pregnancy and in their child’s/children’s early years helps to establish a culture of safety in which parents and caregivers prioritize injury prevention and can proactively adapt to their children’s safety needs as they grow.

1. Understanding how to establish a partnership with community-based organizations and home-visit nursing programs
2. Assess impact of comprehensive, accessible injury prevention education and safety supplies in underserved communities using health equity approach
3. How to establish trust and conduct follow up to maintain attendance over several sessions