Creating an effective prevention curriculum to reduce transport risks and injuries Dr Lisa Buckley, Rebekah Chapman, Prof Mary Sheehan

Overview and Aims Injury prevention and health promotion are complex processes and there is considerable science required for program implementation There is a need for considerable planning and formative research required before programs get to the implementation stage. To provide an example of the process of program design

Stage 1. Development of the Intervention 1.1 Problem identification – is adolescent injury a concern? - examination of hospital data, previous survey research, survey with target population 1.2 Behavioural determinants – who is injured and from which behaviour? - examination of previous research, survey with target population, qualitative research with target population 1.3 Risk and protective factors for behaviour 1.4 Selection of methods and strategies

Stage 2. Creating and Implementing the Intervention Synthesising results from stage 1 into an intervention – the writing stage & implementing the intervention Stage 3. Evaluation Studies 3.1 Process & implementation evaluation 3.2 Impact evaluation – change in underlying program risk and protective factors 3.3 Outcome evaluation – change in behaviour and injury

Stage 1. Development of the Intervention

Self-reported risk-taking behaviours & injury over 6 months 42.2% injured riding a bike 18.1% injured riding a motorbike 13.8% injured as a vehicle passenger 5.7% injured while driving 1.1 &1.2 Problem of injury and behavioural determinants n=612, 52% female, mean age = 13.3 years

Identifying the participants’ experiences enables the program design to best reflect ‘real world’ experiences (Perry, 1999) METHOD 30 high risk youth in non-mainstream schools (23 males) Semi-structured with open-ended prompts 4 focus group discussions Qualitative examination of injury-risk behaviours 1.2 Behavioural determinants

Findings –Motorbike, bicycle, skateboard, car use –Mostly minor injuries, some exceptions “they will find any excuse for drinking and if they don’t have one, they’re excuse is they wanna get drunk” “yeah, he got knocked out, it was quite funny, probably for about half an hour, he was driving up (the track) on his motorbike and he got hit by a rock, he had his open face helmet on” “a mate of mine caught fire…the (motor)bike was on flames” “she had a miscarriage” (as a passenger in a car that crashed, driver unlicenced) 1.2 Behavioural determinants

Risk and Protective Factors 1 Adolescent risk taking Protective Factors Risk Factors Individual: Sensation seeking Impulsiveness Low self esteem Family: Poor supervision Parental modelling Family conflict School: Poor academic performance School misbehaviour Truancy Peers: Peer encouragement of risk taking Peer modelling Individual: Religiosity Attachment to parents Family: Parental monitoring Parental help with school Parental disapproval of risks School: Academic achievement Perceived school connectedness School effort/interest Peers: Peer disapproval of risks Pro-social peers 1.3 Risk and protective factors 1 information obtained from previous survey research of investigators & colleagues and literature review

Key issues in intervention process design – from the literature... Socio-culturally and developmentally relevant processes and content Interactive processes Universal, selective and targeted approaches Theory driven (e.g. cognitive-behavioural strategies) Facilitator selection (teachers successfully implement) ‘Dose’ Efficacy and effectiveness evaluations (e.g. Botvin et al.; Cuijpers, 2002; Ellickson, 2000; McBride, 2003; Perry et al., 2003; Sheehan et al., 1996; Shope et al., 2000) 1.5 Methodology and practical strategies

Teacher perceptions 13 teachers/ school staff participated Individual interviews (45 minutes) regarding best implementation/ delivery methods for a high school injury prevention program & suggestions for content 1.5 Delivery methods

Intervention methods and processes Intervention needs to be engaging, interactive and non-traditional, employing a variety of stimulus Must be implemented across the board and integrated into the school curriculum. Some contents should be assessable. A Professional Development component is considered important. Program should offer teachers greater support in the classroom context. Teacher perceptions

Comments on Materials Specific aspects of delivery discussed, e.g. formatting and layout of materials, unrealistic to include audiovisual/ computing components Some examples could be added, e.g. support services within specific schools

Stage 2. Creating and Implementing the Intervention

15 How is SPIY taught? Taught by teachers trained in program delivery and connectedness Year 9 Health Education 8 x approximately 50 minute lessons (1 school term) Integrated with the curriculum Formally assessed Interactive discussions based on scenarios Practical exercises

16 Typical lesson structure Risk taking and injury scenario Brief story of friends’ risk taking and injury to contextualise learning (e.g. getting in car with underage driver) First aid Practical responses for dealing with injury (e.g. treating fractures/ bleeding; resuscitation) Prevention Skills to prevent own and friends’ risk behaviour and injury; increasing protective behaviour

17 Example lesson Risk taking and injury scenario: Lift Home Students read story: Lift Home (friends taking a lift home from a party)

18 Worksheet – Head, Neck & Spinal Injuries Use the Facts Sheet – Head injuries and Spinal injuries to answer the questions below. 1. If you’re first on the scene what’s the first thing you should check? 2. Shannon’s checked the scene for any danger and thinks it’s safe, what should Shannon check next? 3. Lee responds and is breathing, how still should Shannon keep the head and neck? 4. Should 000 or 112 (mobile) be called urgently? First aid: Head, neck & spinal injury treatment Students taken through fact sheets and complete worksheet on head, neck and spinal injury treatment Example lesson

19 Prevention: Getting help & Helping mates Discussion on importance of getting help when alcohol is involved; Helping mates worksheet I could... Worksheet – Helping mates What could you do if you were Lee that night? What’s good about that option… What’s bad about that option… How good is that decision… Example lesson

20 Student work Example student work from a lesson with an underage driving scenario

Stage 3. Evaluation

Evaluation Method n =197 intervention students, n = 137 control students Students aged years, 49% male Schools recruited from low socio- economic areas Completed survey prior to SPIY implementation and 6 months after the completion of SPIY

Trial outcome evaluation Change in injuries

Additional evaluation components implementation evaluation (see Buckley & Sheehan, 2009) next step – cluster randomised control trial (including adaptations to SPIY made from initial trial

Implications for road safety interventions school-based programs can be work – even at the pre-licensing stage considerable preparation required for program development lessons from other health promotion programs can be learned road safety strategies targeted at the individual in the school are probably best supplemented by additional strategies

Questions? Mark your Diaries! International Council on Alcohol, Drugs and Traffic Safety Conference (T2013) August 2013, Brisbane Convention and Exhibition Centre