Health Plan Approaches to Child Injury Prevention

EDC & NIHCM Foundation

According to the Centers for Disease Control and Prevention (CDC), unintentional injuries remain the leading cause of death among 0-19 year olds.¹ Health plans can be important partners in the prevention of child injuries given their access to millions of Americans insured through both public and private insurance plans. Health plans can: inform health care professionals and families about the toll of injuries, encourage physicians to use Bright Futures and provide age-appropriate injury prevention guidance to families, support evidence-based prevention practices, and promote the use of and access to safety devices. Health plans can:

• inform health care professionals and families about the toll of injuries,
• encourage physicians to use Bright Futures and provide age-appropriate injury prevention guidance to families,
• support evidence-based prevention practices, and
• promote the use of and access to safety devices.

This issue brief presents the Centers for Disease Control and Prevention’s (CDC) National Action Plan for Child Injury Prevention (NAP); highlights the prevalence and cost of injuries; shares examples of current health plan child injury prevention activities; and offers opportunities for future action.

The National Action Plan for Child Injury Prevention

Injuries and associated disability and death are preventable through education, environmental modification, effective policy-making, and en-forcement of evidence-based interventions. The CDC’s National Center for Injury Prevention and Control (NCIPC) led an effort to develop the NAP to support solutions that will save lives and help children live to their fullest potential. The overall goals of the NAP are to lay out a vision to guide actions pivotal to reducing childhood injuries and provide a platform for organizing and implementing future child injury prevention activities.

The NAP seeks to:

• increase awareness about the magnitude, risk factors, and effects of child injuries,
• identify opportunities that draw attention to the preventability of child injury and unite stakeholders around a common set of goals and strategies,
• create recommendations to accelerate child injury prevention efforts through improved data and surveillance, research, communication, education and training, health systems and health care, and policy, and
• develop and mobilize actions to reduce child injuries.

Recognizing that health plans are important partners in reducing the burden of childhood injuries, the CDC funded the Education Development Center, Inc. (EDC) who subcontracted with the National Institute for Health Care Management (NIHCM) Foundation to explore the feasibility of implementing two strategies contained in the NAP. The two strategies are:

• implement child unintentional injury prevention programs through community-based prevention programs and through Bright Futures, and
• promote use of safety devices, such as child safety seats, as “durable medical equipment” so they can be prescribed and are reimbursable.

NIHCM and EDC utilized an environmental scan and two webinars with health plan and health plan foundation representatives to:

• understand current health plan injury prevention activities,
• raise awareness of the importance of child injury prevention (CIP), and
• explore opportunities and challenges to implementing CIP activities.

Through the scan and during the webinars, health plans indicated a need for data and information to make the case for investing in CIP, identified CIP-related activities that are most feasible for them to implement, and offered specific examples of activities currently underway.

The sections that follow share data and highlight current and potential ways health plans can further the goals of the NAP by developing, implementing, and evaluating evidence-informed practices to decrease the incidence and severity of injury.

Why Are Injuries A Cause for Concern?

Injuries are not “accidents,” and the majority of injuries are preventable. This section highlights data on the prevalence, causes, locations and costs of child injuries and can be used by health plans and other stakeholders to draw attention to the need for additional investments in injury prevention.

Prevalence of Child Injuries²

• In 2013 more than 8.3 million children were treated for injuries in hospital emergency departments (ED).
• More than 150,000 children were hospitalized for injuries in 2013.
• In 2012 more than 8,000 children died from injuries, which is equal to 150 school buses filled with children.

In 2008 most injury-related ED visits for children were due to injuries sustained in the home. (Figure 1). Causes and Locations of Unintentional Child Injuries³

• Youth ages 10-19 had an increasing likelihood of being injured outside of the home on the street, in sports or at school (Figure 1).
• The primary cause of home injuries for ages 1-4 was falling from beds.
• The leading products associated with injuries outside of the home for ages 10-19 were footballs, bicycles and basketballs.

Cost of Unintentional Injuries

As shown in Figure 2, the cost of ED visits and hospitalizations for child injuries totaled more than $26 billion in 2010. In addition to these costs, many children are also treated in a physician’s office at an additional cost to families, employers, health plans and the health care system.

Cost-Benefit Analysis of Injury Prevention Programs

We know a great deal about what works to prevent injuries to children. The estimated cost savings by select child injury interventions are described in Figure 3 below.

Health Plans In Action

This section highlights examples of the current ways health plans and health plan foundations are supporting child injury prevention. It includes examples of programs for: 1) members and 2) communities.

Programs for Members

Support home visitation programs: Home visitation programs connect parents and their children with trained health care providers who provide services and education during pregnancy and early childhood, including injury risk assessment and education about prevention strategies. Health plans can consider offering home visits to their members through either Medicaid managed care or private insurance. For example, Blue Cross Blue Shield of Vermont’s Better Beginnings program offers three post-delivery visits from a visiting nurse.⁴

Offer rewards or discounts for purchase of car safety seats: As discussed earlier in this brief, the proper use of car seats reduces the risk of injury and death and has been shown to achieve significant cost savings for society. According to the Department of Transportation’s National Highway Traffic Safety Administration (NHTSA), more than a third of children under age 13 who died in passenger vehicle crashes in 2011 were not in car seats or wearing seat belts.⁵ The American Academy of Pediatrics (AAP) recommends the use of car safety and booster seats for most children up to eight years of age.⁶ Many health plans offer discounts or gift cards for the purchase of child safety equipment. For example, some health plans offer members a 15 percent discount on their purchase of safety equipment with a special member discount code for safety websites such as Safe Beginnings, an online catalog of childproofing products.

"The more that we can put child injury the context of a public health issue,
the better we are positioning it [CIP] internally and externally."
-Yvonne Cook, Highmark Foundation

Communities

Incorporate child injury prevention as a focus area for foundation grantmaking and health plan corporate giving: Health plan foundations and health plan corporate giving programs are committed to improving the health of the communities in their respective markets by investing in local programs and organizations. Many health plan foundations fund community programs to improve children’s health, such as child obesity prevention programs focused on increasing levels of physical activity. There may be opportunities to incorporate a specific focus on education and training on child injury prevention, including the proper use of protective equipment, through these grantmaking programs.

"If a disease were killing our children in the proportions that injuries are, people would be outraged and demand that this killer be stopped."
-Former Surgeon General C. Everett Koop

Include child injury prevention messages in social media and other communications:

Most health plans have a social media presence and strategy to interact with their members and the broader community and share important health messages. Sharing educational messages about CIP is one way that health plans can quickly disseminate this important information to a wide audience. In addition, they can leverage existing messaging developed by the CDC, Children’s Safety Network National Injury and Violence Prevention Resource Center (CSN), Safe Kids Worldwide, and other trusted sources of information. Health plan newsletters and websites or partnerships on public service announcements are additional communication vehicles for health plans.

Additional Health Plan Opportunities and Resources

This section highlights other opportunities for health plans and health plan foundations to support child injury prevention. It includes examples of programs for: 1) health care providers and 2) employers.

"We embrace new ideas and new partnerships to propel our health and wellness education efforts." -Katie Hocking, Health Care Service Corporation

Programs for Health Care Providers

Promote the use of Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents among network providers: The mission of Bright Futures is to promote and improve the health, education and well-being of infants, children, adolescents, families and communities. Injury is discussed at all of the 31 recommended visits from birth through adolescence. Bright Futures helps providers by prioritizing injury topics by age and development and providing accurate, AAP-policy-based language providers can use to communicate information to families.

Partner with hospitals and trauma centers: Both children treated for an injury in the emergency room and their siblings are at an increased risk for a return ER visit for injury within three months.^8,9 According to the CDC’s NAP, a strategy to reduce this risk is for health plans and other stakeholders to establish partnerships with hospitals for integrated follow-up care and education after discharge. This intervention benefits not only the patient, but also any siblings who may be at risk for injury due to their home environment.

Trauma centers care for severely injured people and are required to have someone in a leadership position who has injury prevention as part of their job description. All trauma centers must have an organized and effective approach to injury prevention, prioritize efforts based on local data, and include partnerships with other community organizations.¹⁰ Health plans can explore partnerships with hospitals and trauma centers to ensure critical information on child injury prevention is conveyed to children and their families.

Incorporate child injury prevention into current health plan programs: Health plans offer prenatal or maternity programs to provide comprehensive education to expectant mothers. There are opportunities to incorporate injury prevention education and messaging during pregnancy and postpartum since these programs connect directly with members through telephonic counseling with registered nurses, educational mailings, and online materials. The AAP and CDC, among others, have developed educational resources and tools that can be adapted for use by health plans.

Share the AAP’s HealthyChildren.org Website: HealthyChildren.org is a parenting website created by the AAP. It is also available as a free app for Apple and Android smartphones and tablets. The website supports Bright Futures anticipatory guidance by providing more in-depth content on topics covered in the provider visit. Providers can interface their practice websites with the site and refer families directly to the site.

Disseminate the Family Voices Bright Futures family pocket guide: Developed in partnership with the AAP, Family Voices created this pocket guide based on Bright Futures: Guidelines for the Health Supervision of Infants, Children, and Adolescents as a resource to help parents navigate health and wellness information for their children. Similar to Bright Futures, the pocket guide includes specific content around the theme of promoting safety and injury prevention.

Programs for Employers

Provide tools to educate employees on the importance of safety devices: Employers communicate with their employees about health promotion and health care and can share information about injury prevention activities for themselves and their families.¹¹

Additonal Opportunities

Further opportunities for how health plans can prevent child injuries strategies are provided below.

• Form a safety coalition or committee and/or join an existing safety coalition. Find contact information for the Injury and Violence Prevention Director in your state at http://www.childrenssafetynetw... ways to use health plan data to guide injury prevention efforts internally or to support coalitions.
• Offer training programs around CIP for employees, members, parents, caregivers, etc.
• Use local news or events as an opportunity to share CIP messaging.
• Partner with local businesses to offer training or discounts on child passenger safety seats/booster seats, provide smoke alarms to fire departments for distribution in communities at risk, and/or provide a home safety check-list to families.
• Partner with schools to use data effectively to determine the needs for CIP. An example at a state level can be found at http://www.health.utah.gov/vip... with state or local health departments to develop and implement a state plan to reduce injuries.
• Provide opportunities for community members, including students, to learn CPR.

Conclusion

Decreasing the burden of unintentional child injuries in the U.S. requires action by all stakeholders responsible for the health and safety of children. Health plans and health plan foundations can be unique leaders in those efforts since their activities span both the clinical care and community settings and their partners include health care providers, employers, national and community organizations, and families. The information in this issue brief is intended to spark new ideas for starting and/or expanding efforts to reduce the number and severity of injuries to children and youth. Success in CIP is not only critical for the health of the nation’s children, it can also result in a significant reduction in health care costs paid by families, insurance companies, federal, state and local governments, and society.

About This Brief

This Issue Brief was produced with support from the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control Contract #200-2012-M-52690: Engaging Health Plans in Child Unintentional Injury Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

The issue brief was prepared by Kathryn L. Santoro, MA (ksantoro@nihcm.org) of the NIHCM Foundation and Ellen R. Schmidt, MS (eschmidt@edc.org) of the EDC, Inc. NIHCM and EDC thank the many reviewers for their contributions to the brief.

About NIHCM Foundation

The National Institute for Health Care Management (NIHCM) Foundation is a nonprofit, nonpartisan research and educational foundation dedicated to improving the effectiveness, efficiency and quality of the U.S. health care system.

About EDC, Inc.

EDC designs, implements, and evaluates programs to improve education, health, and economic opportunity worldwide. Collaborating with both public and private partners, we strive for a world where all people are empowered to live healthy, productive lives.