Child Safety Index and Toolkit
One of the ways to encourage uptake, implementation and enforcement of evidence-based practices in child injury prevention in a country is to monitor and benchmark progress. Key measurements are the evidence-based actions themselves and the desired results of those actions - children's exposures to hazards or protective measures and injury outcomes (injury mortality and morbidity). The success of previous approaches used by the European Child Safety Alliance (see Child Safety Action Plans and Child Safety Report Cards) is that they have focused on key responsibilities and actions at national level, linked to policies and to national statistical data. But this strength has limitations, too. Whilst national government is important in setting a framework, many policies and actions to enhance children's safety happen at a more local level – within devolved regional governments, counties, and municipalities. These are the levels where services are designed and delivered, and where priorities are often established. At the same time, national statistics conceal major variations and inequities – for instance, between localities or population groups.
Because safety is assured only by policies and interventions that actually change children's exposure to hazards or to living in environments that promote health and well-being, the enormous information gap on the distribution and determinants of such exposures is a major challenge to current efforts to reduce child injuries. Even where such data exist they are rarely standardised, making comparison impossible. The Child Safety Index and Toolkit work package of TACTICs is a step in taking the work and successes of the Child Safety Report Card approach to measuring national level safety policies and seeking to apply these at a more local level.
Initially, the potential to develop a top down Child Safety Index was explored, building on a number of initiatives including the Child Safety Report Cards indicators, the CHILD indicators project, the Environment Health Information System (ENHIS) and the evidence base of effective interventions, and looking at whether existing indicators could be applied at the local level. The findings of this feasibility work showed that there were insufficient data on child safety specific topics at a regional or local level to allow their use. Thus use of these indicators would require major changes to routinely collected data in existing systems.
The next step, given top down was not feasible, was to explore possible bottom up approaches. The first approach being explored is examining a method of measuring perceived and actual exposure to hazards and protective interventions. Individual level data will be collected from children using websites and short questionnaires operated by municipalities and schools. The web-based tools are being designed and tested by the Collaboration for Accident Prevention and Injury Control at Swansea University (www.capic.org.uk) with input from childhood charities such as Children in Wales and Play Wales, and project partners in TACTICS.