Safe n' Sound Safe n' Sound


Project 1:  Baby Be Safe
Safe N’ Sound (SNS) was originally developed under the name of Baby Be Safe to examine the efficacy of tailored materials in a randomized control trial. In this pilot study (n=174), parents who randomly received tailored materials were more likely than those who received generic materials to report deciding to adopt a new safety behavior (81% vs. 64%, p<0.05) and implementing these safety practices
(65% vs. 41%, p<0.05).


SourceNansel TR, Weaver NL, Donlin M, Jacobsen H, Kreuter MW, Simons-Morton B. Baby, Be Safe: The Effect of Tailored Communications for Pediatric Injury Prevention Provided in a Primary Care Setting. Patient Education and Counseling, 46(3):175-190, 2002.


Project 2:  Safe N’ Sound
Based on the findings from Baby Be Safe, we developed Safe N’ Sound, the existing computer-based program. This program delivers tailored information to parents of children ages 0-4 about the specific injury prevention practices they are encouraged to adopt to make their home and car safer for their child.

The SNS program was designed to reduce injury risk by promoting the use of known safety measures or devices on a kiosk-based self-assessment. The program is delivered through pediatric outpatient clinics, and generates tailored feedback reports for both parents and physicians. Physicians are encouraged to discuss the report with the parent to reinforce the importance of adopting safety behaviors, and to answer questions or provide additional information as needed. Five unintentional safety areas are included: car safety, protection from burns, falls, poisoning, and obstructed airways. These topics were selected because they are associated with significant public health burdens and have known countermeasures for prevention.


The context and structure of SNS were designed to impact the determinants of parents’ injury prevention behaviors as understood from several theoretical perspectives including Social Learning Theory. By generating patient-specific information for the health care provider, the program aims to provide an environmental stimulus to increase the salience and perceived importance of the targeted injury prevention behavior(s), and create a stronger social norm for prevention behavior. Parent testimonials in the printed feedback are intended to facilitate social learning and influence both perceived social norms and self-efficacy for a specific injury prevention behavior. Specific information about the child’s risk and the benefits of adopting the recommended safety precaution are provided to increase the perceived risk and the outcome efficacy of the precaution. Also, the feedback nests injury prevention within the many responsibilities of parenthood to increase the credibility of the source. Finally, to facilitate emotional coping, increase attention, and reduce barriers to change, the report recommends only the two highest priority changes, and parents are given very concrete, simple steps to take to make those changes.

Consistent with Baby Be Safe, parents who were randomly assigned to receive the SNS intervention were significantly more likely to have implemented or adopted safety practices one month later than those receiving the control materials. While control and intervention parents were as likely to adopt simple behaviors (using outlet covers), parents receiving the intervention materials were more likely to adopt a more complicated behavior (e.g. installing car seats).  Importantly, these differences were more pronounced for parents of lower educational attainment; the effect of SNS compared to control materials was greater for parents with a high school degree or less than for parents who had attended college.


Sources:  Nansel TR, Weaver NL, Jacobsen HA, Glasheen C, Kreuter MW.  Preventing Unintentional Pediatric Injuries: A Tailored Intervention for Parents and Providers. Health Education Research, 23(4):656-669, 2008.

Vladutiu CJ, Nansel TR, Weaver NL, Jacobsen HA and Kreuter MW. Differential Strength of Association of Child Injury Prevention Attitudes and Beliefs on Practices: A Case for Audience Segmentation. Injury Prevention, 12:35-40, 2006.


Project 3:  Safe N’ Sound implementation. 
In a small implementation study, SNS was placed in a waiting room in five clinics in North Carolina serving an average of 1,800 well child visits for 0-5 year olds each month. Four sites serviced primarily private pay and Medicaid suburban and rural families and one site was a sliding fee clinic serving primarily low income and immigrant families. The sites were chosen to reflect different organizational structures of pediatric offices as well as differing patient types (i.e. family practices, rural, multi-site, high volume). The program was housed on a desktop computer; reception staff directed eligible parents to complete the program on-screen, otherwise, the computer was left largely unattended. From this study, barriers and facilitators were gathered to implementation to make program adjustments to facilitate a larger dissemination of the program.

Sources:  Weaver NL, Williams J, Jacobsen HA, Botello-Harbaum M, Glasheen C, Noelcke E, Nansel TR.  Translation and dissemination of an evidence based tailored childhood injury prevention program. Journal of Public Health Management and Practice, 14(2):177-184, 2008.

Williams J, Nansel T, Weaver NL, Schafermeyer R.  Barriers and facilitators to implementing a waiting room based injury prevention project. Society for Advancement of Violence and Injury Research (SAVIR), March 5, 2009.

Botello-Harbaum M, Weaver NL, Jacobsen H, Williams J, Nansel TR. Dissemination of a tailored injury prevention program to facilitate anticipatory guidance in pediatric health care. Abstract accepted for oral presentation, Society for Public Health Education, July 2007.

Weaver NL, Nansel T, Williams J, et al. Reach of a kiosk based pediatric injury prevention program Translational Behavioral Medicine: Practice, Policy and Research (September 2011, Available online).  

Williams J, Nansel T, Weaver NL et al. Safe N’ Sound: a tool to prioritize injury messages for pediatric healthcare. Family and Community health – in review.


On-going projects

  • Based on implementation feedback, the program has been translated into Spanish. Both the English and Spanish options are available to users when they begin the program. The Spanish materials are identical to the English materials, but have not been evaluated.
  • A pediatric health center in Milwaukee, Wisconsin has adopted SNS and is testing the utility of the program to a) increase injury prevention counseling, b) increase reimbursement for this counseling, c) increase the delivery of safety supplies provided through a connected safety corner. This project is also integrating SNS with electronic medical records for improved data collection and outcomes research.
  • A health care system in North Carolina is utilizing SNS in a pediatric emergency room and in a family resource center in a pediatric hospital to determine the feasibility in these settings.


Source:  Williams J, Weaver NL, Nansel T, Julia T. Safe N’ Sound, prioritizing and tailoring pediatric injury messaging. National Association of Children’s Hospitals Creating Connections Conference March 2012 Poster.

  • Based on implementation feedback and nationwide priorities, a version of SNS called RISE UP! has been developed that combines positive parenting feedback with unintentional injury prevention. This extension is being evaluated by the developers to examine decreases in child abuse and neglect and unintentional injury risk. This version will be considered for wide-spread dissemination pending results from this pilot testing phase.
  • Based on potential opportunities for childhood injury prevention, and national funding priorities, SNS is also being tested in nurse home visitation programs for utility in that area of outreach and potential future dissemination. 
  • Partnerships are in development with several state-based health and human service advocates for broader dissemination.

Revised November 2011

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