Randomized trial of enhanced anticipatory guidance for injury prevention

Objective: To develop and evaluate an injury prevention anticipatory guidan ce training program for pediatric residents. Design: Thirty-one residents were randomly assigned to an intervention or c ontrol group. Both groups attended a 1-hour seminar about injury prevention and the American Academy of Pediatrics TIPP (The Injury Prevention Program ) materials. The intervention group also received 5 hours of experiential i nstruction on injury prevention content and counseling skills (SAFE Counsel ing Framework). Families with infants from birth to age 6 months were enrol led in the study (N = 196); they were followed up until the child was aged 12 to 18 months. Data were collected by means of baseline and follow-up int erviews, audiotapes of medical visits, parent exit surveys, and home observ ations. Setting: A hospital-based continuity clinic that serves families living in low-income, inner-city neighborhoods. Outcomes: Physician counseling and parent satisfaction, knowledge, beliefs, and behaviors. Results: Parents seen by physicians in the intervention group received sign ificantly more injury prevention counseling for 5 of the 6 safety practices , and they were significantly more satisfied with the help their physicians provided on safety topics. They were no less satisfied with their physicia ns' counseling on other anticipatory guidance topics. Parents' knowledge, b eliefs, and home safety behaviors did not differ between the 2 groups. Conclusions: The frequency and impact of pediatric counseling can be enhanc ed by experiential training that targets specific injury hazards. Because l ow-income families face many barriers to carrying out the recommended safet y practices, supplemental strategies are needed to ensure safer homes.