Introduction

Implementing Risk Watch®: Unintentional Injuries in your community will be extremely rewarding. You will experience the reward of knowing that fewer children are being injured because of your efforts, the reward of knowing that your community is safer because your coalition accepted a leadership role with a key health issue, and the reward of working with other dedicated individuals who believe in, and are committed to, the cause of childhood injury prevention.

The information below has been developed to help you provide leadership in your community. A Risk Watch leader is a person who is committed to reducing unintentional childhood injuries, is interested in mobilizing members of the community and wants to promote the Risk Watch program in local schools.

Note: An excellent Canadian auxiliary resource, The Safe Communities Guide Book, (published in April 2000) addresses many of the topics discussed here. Download the Guide Book.

The following tips will help make Risk Watch a success in your community:

• Familiarize yourself with the Risk Watch program and read the information on these pages before taking the first step. Before you form a coalition, it is essential that you know where you are going. You must start with the end result in mind.
• Evaluate the progress of your coalition at every step. This constant evaluation process will ensure that the proper steps are being taken and that you are on track. It is much easier to make minor corrections along the way.
• When a problem arises that you can’t solve, immediately seek help from your community or the Office of the Fire Marshal or the Office of the Fire Commissioner in your province or territory. As you will discover, there are probably other local organizations with a vested interest in preventing childhood injuries. Childhood injuries truly are a community problem: the solution must also come from the community.
• A key resource for you will be other injury prevention advocates who have already implemented Risk Watch. To get a list of those in your area already using Risk Watch, contact the Office of the Fire Marshal or the Office of the Fire Commissioner in your province or territory.
• Train all coalition members on the basic principles and philosophy of this project. Your coalition members are going to be Risk Watch advocates and champions in the community. To be effective and successful, they must understand the concepts being used.
• Ensure that all coalition members and others involved in the Risk Watch initiative clearly understand their roles and what is expected of them.
• As the leader of your coalition, you will be most effective at creating a vision for the initiative, gaining the involvement of those who have specific skills and/or resources and being the catalyst for action. The most successful coalitions are those which have a few leaders who act as “spark plugs”.

It is important to understand that success is going to require a considerable investment of time by committed “workers” in your community coalition.

Finally, know that you are not alone in your endeavour. The cause of childhood injury prevention is gaining momentum throughout North America. People such as yourself are picking up the torch and making a commitment to reduce preventable tragedies in their community. You and your coalition can and will be successful. By choosing Risk Watch, you have taken the first step toward that success. Let’s begin by learning more about childhood injuries and Risk Watch.

Why Risk Watch?

The first question that should be answered is, “Why should an educational component be used in a community childhood injury prevention initiative?” To answer this question, it is best to consider the nature of childhood injuries. Injuries are not “accidents” – they are predictable and preventable. This is a key injury prevention philosophy and is the most important reason for using an educational component.

Since childhood injuries can result from a child’s behaviour, one goal is to change the child’s behaviour so that injury can be avoided or minimized. By involving children in an educational program which focuses on injury prevention behaviours, they have the necessary information and attitudes to manage their risks by making educated choices.

Sounds simple. But for this approach to work, it is essential that the children begin this educational process at the earliest possible age and that it continues through adolescence. The education must be more than “once in a while”. Children must experience injury prevention messages repeatedly throughout the years.

It is important to emphasize that education alone is not the answer. Other solutions include changing the environment where the children live and play, like making playgrounds safer, installing hot water tempering devices at home, and mounting and maintaining smoke alarms. As well, children need good role models who can lead by example and who can bring about family and community behaviour change.

Changing the social or physical environment is a critical part of the overall childhood injury prevention formula. However, most environmental changes require human action. Many times, this includes action on the part of the child, (e.g. wearing a bike helmet or a personal flotation device). Learning to make the right choices is the result of educational efforts. While the process of preventing childhood injuries has many parts, the effective use of education is the fabric that brings it all together. Because of that, it deserves special attention from injury prevention coalitions, school teachers, school administrators, medical professionals, ministers of education, ministers of health, parents, caregivers and other community members.

Another key point about the value of educational efforts is found in the nature of the behaviour of children (and adults, for that matter). Our behaviour is guided by our attitudes and beliefs about any given issue. For example, if people’s attitude about telling the truth is very strong, they will be more likely to tell the truth in their conversations and relationships.

The same is true about injuries. A person’s behaviour is based on their attitudes (or personal values) about safety and wellness. If people value safety, they will be more likely to act in a safe manner when risky situations arise. And if children value safety, they will be more likely to wear a bike helmet and cross the street at the crosswalk.

Of course, the child must have an understanding of what safe behaviour is and how to avoid and manage risks. What does this have to do with a childhood injury prevention education program such as Risk Watch? Everything! Psychologists believe our basic attitudes and personal values are developed by the time we reach ten years old – or by the fifth or sixth grade! By engaging children in a comprehensive injury prevention education program at an early age and keeping them involved through their formative years, it is possible to help shape their attitudes and values about safety and wellness. Risk Watch can make that happen in every community in North America!

What makes a good injury prevention educational program?

• It should be a school-based program. Schools provide a unique opportunity to reach children with injury prevention messages. A majority of young children in North America attend a preschool at least part of each week. For older children, school is the one place where they are readily accessible to injury prevention educators. In addition, school provides an environment that is conducive to learning. The same cannot be said about a community centre or fire station.
• It must be easy to use. If it is cumbersome, hard to understand, or requires considerable preparation time, teachers will avoid using it on a regular basis. It must be developmentally appropriate. The instructional methods and activities in the program must be based on the developmental stage of the child. In addition, the injury prevention messages contained in the program must be appropriate for the risks faced by children at that specific time in their lives.
• It must engage the child in an active, experiential learning process. The learning process must give the child a chance to practice the injury prevention behaviours. Also, the child must be given the opportunity to be a “decision-maker” when faced with a choice of alternatives. Finally, the appropriate behaviours must be modelled in the program, in both philosophy and action.
• It must create a “link” between the classroom and the child’s home. Since children are limited in their ability to change their home environment, the child’s parents or caregivers must understand the injury problem and prevention measures.
• It must encourage the involvement of the entire community in the injury prevention educational process. Childhood injuries are more than simply the problem of the school, the parents, or injury prevention professionals – they are the problem of the entire community.
• It must overtly and deliberately foster the development of appropriate safety and wellness values. The reduction of risk-taking behaviours depends on the development of these values when children are young. If the program leaves this to chance, it will not happen.
• It must be fun for the child and the teacher. When injury prevention education is fun, the teacher is more likely to use the program and the child is more likely to internalize its messages and values.

Questions and Answers

The following “frequently asked questions” will explain the scope of the childhood injury problem in North America and why Risk Watch is a great injury prevention educational program.

Q: Are preventable childhood injuries really a problem?

A: Preventable childhood injuries in North America are worse than a problem – they are an epidemic! In Canada:

• the leading cause of death and disability for children is preventable injuries. more children die annually from injuries than from all other childhood diseases combined.
• in 2001, 286 children between the ages of 1 and 14 died as a result of unintentional injuries. This figure represents almost one third of deaths from all causes in this age range.
  Source: Statistics Canada mortality data, 2001
• injuries are also a leading cause of hospitalization – causing immeasurable pain and suffering for children and their families.
• unintentional falls are the leading cause of hospitalization due to unintentional injury among children, followed by motor vehicle collisions.
• almost 40,000 children and youth are seen in hospital emergency departments every year due to home injuries.
• the annual economic burden of unintentional injury for all ages is $8.7 billion.
  Source: Health Canada, 1997

Following are some facts about the most common childhood injury areas. Each of these injury areas is addressed in Risk Watch.

Motor Vehicle Injuries

In Canada, in the year 2001, 139 children aged 14 and under died from motor vehicle collisions and 16,830 children in this age group were injured.
Source: Transport Canada, Canadian Motor Vehicle Traffic Collision Statistics 2001

Fire and Burn Injuries

Every year in Canada, approximately 1,300 fires are started by children playing with lighters and matches. These fires result in an average of 20 deaths, 150 burn injuries and $14 million in property damage.
Source: Product Safety Bureau, Health Protection Branch, Health Canada

Each year, an estimated 9,000 children in Canada visit hospital emergency rooms for burns and almost half of these (an estimated 4,300 children) have suffered scalds from hot liquids.
Source: Safe Kids Canada, May 2001

Choking, Suffocation and Strangulation Injuries

In the year 2000, a total of 23 children between the ages of 1 and 14 died in Canada as a result of unintentional choking, suffocation and strangulation.
Source: Statistics Canada, Canadian Vital Statistics, Catalogue #84-208XIE, 2000

Poisoning Injuries

Unintentional poisoning was responsible for almost all cases of poisoning injury hospitalization among children under 10 years of age during the period April 1, 1999 to March 31, 2000 (95% of the 1,415 admissions). Of these, a peak was seen in the 1 to 4 age group (1,134 of the 1,415 hospitalizations).

Medical drugs were the typical agent of poisoning for this age group (782).

Other agents included:
petroleum products (70)
corrosives and caustics (41)
cleansing/polishing agents and paints (38)
agricultural/horticultural chemicals (38)
foodstuffs and poisonous plants (32)
alcohol (30)
Source: Canadian Institute for Health Information (CIHI), National Trauma Registry Bulletin: Poisoning Injury Hospitalizations in Canada, 1999/2000. Toronto (ON): CIHI, 2002. (These statistics do not include the countless number of children who are seen for poisoning injuries in emergency departments and doctors’ offices across the country.)

Falls and Playground Injuries

In Canada, as in other parts of the world, unintentional falls are the leading cause of injury-related hospitalization among children and youth. According to “The Economic Burden of Unintentional Injury in Canada”, these injuries cost Canadians about $630 million each year.
Source: The Economic Burden of Unintentional Injury in Canada, SMARTRISK, 1998

Injury data shows clearly that playground equipment continues to be a major cause of serious injury for children in Canada. Health Canada estimates that about 28,500 children under the age of 15 are treated in hospital emergency rooms annually, for injuries related to playground equipment. Falls, usually to the ground surface below equipment, account for approximately 75% of all playground-related injuries.
Source: Health Canada/Safe Kids Canada

Firearms Injuries

A survey of 26 middle-upper income countries by the Centers for Disease Control showed that Canada is fifth among industrialized countries in the rate of children under 14 years killed with guns, following the US, Finland, Northern Ireland and Israel.
Source: Centers for Disease Control and Prevention. “Rates of Homicide, Suicide and Firearm – Related Death Among Children – 26 industrialized countries.” MMWR, Vol. 46, No.5

Some estimates assess the frequency of non-fatal firearms injuries to be between 10 and 13 times the number of fatal injuries, with considerable variations across the country. Long guns are more often involved than handguns in unintentional injuries. Victims are frequently children and adolescents, with most cases involving children at play.
Source: Canadian Department of Justice – International Centre for Criminal Law Reform and Criminal Justice Policy, 1998

Bike and Pedestrian Injuries

Every year in Canada, over 60 children will die in bicycle incidents, most from brain injuries. Over 5000 children will be seriously injured.
Source: The Newfoundland Brain Injury Association

According to Safe Kids Canada, approximately 115 children die and close to 1800 Canadian children and youth are hospitalized each year due to pedestrian injuries. Five to 9 year olds have a higher rate of death and hospitalization than other age groups.

Water and Ice Injuries

Drowning is the second leading cause of preventable death for children under 10 years of age. For children and youth 0 to 19 years old, 27% of drownings involved 1 to 4 year-old toddlers, 22% involved 5 to 9 year-olds and 14% 10 to 14 year-olds. Toddlers tend to drown by falling into swimming pools and natural bodies of water; 5 to 9 year-olds by falling into water, swimming and wading; 10 to 14 year-olds by falling into water and swimming.

Q: Aren’t injuries simply part of growing up?

A: A few bumps and bruises are an unavoidable by-product of a healthy childhood. But most serious injuries are not inevitable. Traffic injuries, drownings, fires, scald burns, chokings, poisonings, and falls are not random “accidents” – they are predictable and preventable. With education, motivation and the support of caring adults, children can learn to be much safer. Our commitment to this goal is crucial because every time a child is injured or killed by something that could easily have been prevented, everyone suffers: the child, his or her family, classmates, friends and the entire community.

Q: Aren’t schools already teaching injury prevention to children?

A: In some schools, injury prevention is part of the overall health and safety curriculum. In other cases, some injury prevention is presented as part of other programs provided by the fire department, the Red Cross, etc. However, in many schools, injury prevention is not a planned content area addressed from preschool through Grade eight.

Q: Why is it important to teach injury prevention in so many different grade levels?

A: Injury prevention education is based on the concept that safe behaviour is a result of attitudes and values about personal safety and wellness. To effectively instill those attitudes and values in children, they must hear safety messages frequently and have opportunities to practise the behaviours. In addition, the injury risks to children change as they grow older. It is necessary to present different messages and behaviours as the children grow older.

Q: Why should I use Risk Watch?

A: It is obvious that your coalition wants to use the best educational tool available for your injury prevention initiative. Risk Watch is that program. Risk Watch is the first comprehensive injury prevention program available for use in schools. Developed originally by the National Fire Protection Association (NFPA), Risk Watch has been field-tested successfully in the United States and Canada. For more information on the various evaluations of Risk Watch, see the following website: www.nfpa.org/riskwatch/advocate_eval.html

With the input of Canadian national and regional injury prevention and education experts and advocates, the Canadian Edition incorporates Canadian information, facts, statistics and resources, and meets Canadian educational methodology and standards. It is presented in five teaching modules (PreK/Kindergarten, Grades 1-2, Grades 3-4, Grades 5-6, and Grades 7-8) with lessons that address the eight risk areas that injure or kill the greatest number of kids each year. The modules have been designed for maximum flexibility so that the program can be taught as a stand-alone unit or easily integrated into core curriculum subjects such as health, language arts, science or physical education.

Q: What is the Risk Watch program model?

A: The program provides students with an unprecedented opportunity to learn about injury prevention, to apply that knowledge in practice situations, and to develop the attitude and motivation to make the right choice in a risky situation. The goals of each module are to develop and expand each student’s safety knowledge, risk awareness, independent thinking, personal and social responsibility, prevention behaviours, and motivation to protect oneself and others.

Over time, this “safety triad” (combining knowledge, activity and commitment) helps students achieve a high degree of awareness and self-determination about their own safety decisions.

Each component of the “safety triad” works to provide students with the ability to apply Risk Watch in everyday experiences. In time, this application becomes cyclical as the students’ developmental abilities mature.

Q: Why is it important that teachers be involved in Risk Watch?

A: Teachers are role models for children. They are involved in the child’s learning experience almost every day and are in a unique position to model and influence appropriate behaviours. In addition, teachers have been trained to engage children in the learning process using developmentally appropriate instructional methods. This means the teachers can present lessons in a manner in which the children can best understand. Teachers realize the connections to curriculum and how current core activities can be used to augment Risk Watch principles. Finally, teachers are acutely aware of the specific needs and home situation of each child. They are able to ensure that an effective “link” is established between the school and the home.

Q: What’s the most effective way to use Risk Watch?

A: Risk Watch is a sequential, comprehensive program of instruction that builds on prior knowledge about injury prevention. Because this allows for an increasing level of comprehension and complexity from Pre-Kindergarten through Grade Eight, using the entire program is recommended. However, each module also can be used independently so that a school system can devise an implementation plan that makes the most sense for the community.

Q: What does Risk Watch contain?

A: Everything you and the teachers will need! Here’s a rundown!

Getting into Character – Each Risk Watch module includes a set of warm-up exercises and tips to help students step into character roles appropriate to their age group and developmental stage. Preschoolers and Kindergarteners are cast in the role of storytellers who share stories and participate in the presentation of stories in various formats. In the Grade 1-2 module, children become detectives, seeking important information in order to make educated choices and to manage their risk of injury. By the time students reach Grades 3-4, they take on the role of reporters, applying critical-thinking skills to analyze situations and to alert others to potential risks. Students in Grades 5-6 act as role models and use advanced communication skills as promoters to identify, research and promote injury prevention behaviours in the school and community. Finally, in Grades 7-8, students assume the role of coaches, becoming role models and advocates for injury prevention in the school and community.

Lesson Cards – Each module includes eight lesson cards – one for each of the eight risk areas. These cards provide a “Know the Facts” section, which presents key facts and statistics related to the risk area. They also include an “Information for Adults” section, which provides the injury prevention information necessary to present each topic. As well, each lesson card contains a “Lesson Plan” for classroom activities to allow students to extend and apply their knowledge about the different risk areas. Lessons are age-appropriate and offer cross-curricular applications with core subject areas to allow teachers maximum flexibility in implementing the lessons. Each lesson plan follows the format outlined below:

Lesson Plan Format

Expectations – specific knowledge and skills students gain from the activity.
Resources – materials for implementation of the lesson.
Reflection – discussions and/or activities that provide students with the opportunity to reflect on prior learning in order to promote sequential learning from year to year and guide students to make connections from previous years.
Procedures – step by step guidelines for the implementation of the lesson activities.
Reflect Again – follow-up discussions and/or activities to allow students to reflect on what they have learned and on their own injury prevention behaviours.
Demonstrate Learning – indicators of knowledge students will demonstrate at the end of the lesson.
Assessment – identifies two expectations that can be measured across schools and regions for larger scale evaluation purposes.
Related Activities – additional activities that can be used or as reinforcement of the lesson, in split grade classes or in alternate years, to avoid repetition of previously learned material.
Home Links – opportunities to involve caregivers and family members and to continue the Risk Watch learning process in the setting where the risk of injury is often the greatest – the home.
Community Links – opportunities to involve local injury prevention professionals, parents and caregivers and other community members in classroom activities.
Extensions – activity suggestions to extend injury prevention learning experiences beyond the classroom and into the greater community. Activities often involve students, staff, Risk Watch coalitions and other community agencies working together to provide unique informational learning experiences for community members.
Regional Issues – issues that may be relevant in one or more of Canada’s diverse regions.

Special Note for Canadian Evaluators: Assessment

When implementing any program, it is important to monitor the impact it has on its users or participants. The assessment component of the lesson plan identifies the learning that every child in Canada using Risk Watch would be expected to learn. However, one of the challenges in program evaluation is to measure similar objectives when different people may be doing different activities within the same school, at other schools or across the country. To manage this potential for diversity and to create the potential for effective evaluation, each lesson plan identifies two of the assessment items as demonstrated learning behaviours for cross-comparability. In the event that a class is part of a local, regional or national evaluation of the Canadian version of Risk Watch, the two behaviours identified in the assessment section are what students in that class should be striving to demonstrate.

Therefore, to support future evaluators of the Risk Watch program, we have outlined an evaluation procedure for cross-comparability purposes. We recommend that evaluators focus on a minimum of two of the eight injury prevention areas. Students would be asked to analyse a risk scenario related to the injury prevention area and would demonstrate their learning by being able to:

State what hazards they would look for.

Identify what they would think about.

Describe the choices they would personally make to deal with the scenario and explain their reasons.

Note: Throughout the lesson plans, there are references to “wing partners”. Wing partners are cross-age learning opportunities where older students take younger students “under their wings” and serve as role models in delivering injury prevention messages. Older students can share their knowledge through the presentation of their projects to younger classes. Younger students, in turn, can share their activities with “wing partners” for their positive reinforcement. If preferred, many of these activities can be used with peer-group partners as well.

Risk Area Icon Cards

Each of the eight risk areas covered in Risk Watch is represented by an icon that serves as a visual reminder of the key injury prevention messages. Teachers can use the colourful icon cards to create bulletin board displays, and the information presented on the back of each card (grades 3-8) can be duplicated to provide students with key injury prevention messages related to each risk area.

Risk Watch in Action: Interactive Activities

Each Risk Watch module includes one or more culminating activities designed to allow students to apply the full spectrum of their injury prevention knowledge and their critical thinking and decision-making skills. This is an essential part of the Risk Watch program, as it provides students with the opportunity to rehearse the critical decision-making and action steps that will help them to make educated choices about risk in their lives. Relevant and entertaining, the experiential design of these activities encourages student engagement and critical thinking.

Caregiver Letters

To further extend students’ learning and application of injury prevention behaviours beyond the classroom, it is important to maintain communication with parents and caregivers. Included in the Caregiver Letter section is a topic specific letter to provide parents and caregivers with information regarding the injury prevention area being studied in class. Caregiver letters provide useful tips under the headings “Extra Information For Parents and Caregivers” and “What You Can Do At Home”. As well, this section contains the Caregiver Introduction Letter and two supplemental letters: Holidays and Spring and Summer.

Evaluation Instruments

The evaluation tools include a Knowledge Test to be used as a pre-test and as a post-test of student knowledge gained, as well as a Test Score Summary Sheet to record the results. Also included is a Success Incident Reporting Form to help recognize students who put their Risk Watch training to use by preventing or minimizing a potential injury or death in an actual incident. Finally, this section includes a User Feedback Form to solicit suggestions on how Risk Watch can be improved in the future. The evaluation tools can also be found on the Risk Watch website at www.nfpa.org/riskwatch/knowledge.html.

Accessing Resources

There are many additional resources available to support injury prevention education in the classroom and in the community. Included in the Accessing Resources section is a list of related organizations and other resources specific to each injury prevention area. Also included in this section is a list of general resources, rail safety resources and farm safety resources.

Q: How much time is required to teach Risk Watch?

A: The Risk Watch lessons vary in time commitment between grade levels and risk areas. It is suggested that teachers review the lesson plans to determine how each best fits with the classroom curriculum. Some suggested formats for implementation of Risk Watch follow:

Intensive Program – This focused program requires less time to implement. In this approach, teachers would present lesson card information for one risk area per week. When all areas have been covered, they would select an activity from the Risk Watch in Action section to have students apply what they have learned.
Comprehensive Program – This year-long program involves teaching all eight lesson plans in their entirety, highlighting one risk area per month, culminating with the Risk Watch in Action activities. There is no prescribed sequence, but we suggest tying the lessons to the following months:
September: motor vehicle safety
October: fire and burn prevention
November: choking, suffocation, and strangulation prevention
December: poisoning prevention January: water and ice safety
February: firearms injury prevention
March: bike and pedestrian safety
April: falls and playground injury prevention
May: Risk Watch in Action (culminating events to apply Risk Watch skills)

Alternatively, you may choose to teach specific injury prevention areas in certain months if that area is highlighted in your region (e.g. Fire Prevention Week at the beginning of October).

A third option is for the teacher to structure the program at his or her own discretion to meet the needs of students and provincial or territorial curriculum.

Q: Can Risk Watch be customized to incorporate information on other risks found in my community?

A: Yes. While Canadian statistics clearly indicate the need to educate children about the specific risk areas covered in Risk Watch, you may want to apply the same concepts to address additional injury prevention issues of particular concern to your students (such as rail safety, farm safety or sport safety). Risk Watch may also be used in conjunction with other health and safety programs already in place. Provincial and territorial curriculum guidelines, school board mandates and regional issues can help you determine which risk areas to emphasize with your students.

Q: Does Risk Watch work?

A: Risk Watch has undergone several comprehensive field tests. Results and updates of these tests can be found at the following website: www.nfpa.org/riskwatch/advocate_eval.html. They reinforce that Risk Watch is making an impact on students’ safety knowledge and risk awareness.

Leadership Tasks

• Review all five Risk Watch modules. As a leader in the implementation process, you must thoroughly understand the structure and content of this resource. You don’t need to be an expert, but you must be able to answer questions about the program. And you will be asked questions! Your ability to answer questions will have a direct impact on your success.
• Determine the extent of injury prevention education in early childhood development programs in your area and in your local schools. Visit with school curriculum specialists, principals and teachers to get a clear picture of what injury prevention behaviours and messages are being taught in Pre-Kindergarten through Grade 8. As well, local public health practitioners can be helpful in determining this information.
• Identify which community agencies and organizations are already involved in childhood injury prevention education efforts. All of these organizations are potential partners in your coalition. Be sure to consider all eight injury areas addressed in Risk Watch.
• Conduct research on the childhood injury problem in your community. The goal is to have an understanding of the most common causes on injury for each age group. This information will help you focus on the most crucial areas and market Risk Watch to school decision-makers, funders, etc. Sources of local information may include public health departments, hospitals, fire departments, law enforcement agencies and provincial or territorial agencies.