Preventing Injury and Keeping Kids Safe with Chris Vitale, RN, MSN

Injury Prevention for Children and Families | CHP.edu

Safe Kids Allegheny County

Injury Free Coalition for Kids

The Injury Prevention Home Safety Van | CHP.edu

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Voiceover: This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgements when advising their patients. Patients in need of medical care should consult their personal care provider. Welcome to "That's Pediatrics", where we sit down with physicians, scientists, and experts to discuss the latest discoveries and innovations in pediatric healthcare.

Amanda Poholek, PhD: From UPMC Children's Hospital of Pittsburgh, welcome to That's Pediatrics. I'm your co-host Amanda Poholek, assistant professor of pediatrics.

Arvind Srinath, MD, MS: And I'm your co-host Arvind Srinath, associate professor of pediatrics.

Dr. Poholek: Today our guest is Chris Vitale, RN, an injury prevention manager at UPMC Children's Hospital. Chris Vitale received her bachelor's degree in nursing from Carlow College and her master's degree in Nursing Education from Duquesne University, where her focus was on community education and outreach. She has extensive experience in healthcare, including clinical, education, and administrative positions, all in the field of trauma.

Prior to joining Children's Hospital and the Injury-Free Coalition for Kids Partnership, Ms. Vitale was a prevention specialist working with children and families in local schools and communities. She coordinated and implemented school programs for grades K through 12 focusing on drug and alcohol prevention and intervention, violence prevention, families in transition, coping skills, and grief and loss. She also coordinated and participated in prevention education for families, communities, faculty and staff. Her area of expertise is grief and loss, and she's also a bereavement facilitator for children at the Caring Place, a community bereavement center for children and families. Welcome, thank you so much for joining us today.

Chris Vitale, RN, MSN: Hi. Thank you. I'm so excited to be here.

Dr. Poholek: So maybe you can start by just sharing your path to getting involved in injury prevention and your role here as prevention manager at UPMC Children's.

Ms. Vitale: Sure. So I came to UPMC Children's right after graduation and have been here my entire career, have sidestepped a couple of times to do some different things in the community but have consistently come back to Children's and have always worked in trauma. So being on the inside and seeing what kids can do to themselves kind of made me start to think about what can we do to prevent them from coming into the hospital. So that really kind of drove my passion from inside trauma to outside prevention.

Dr. Poholek: Okay. And so part of your role is participating in something called the Safety Center, right?

Ms. Vitale: Yes, yes.

Dr. Poholek: So can you tell us a little bit about what the Safety Center is and what its goals are?

Ms. Vitale: Sure. So the Safety Center is here at the hospital. We actually opened up nine months after we moved into this hospital.

Dr. Poholek: And what year was that?

Ms. Vitale: It was 2010, I believe, yeah, 2010. We had been working on the project for about eight years prior at the old hospital. One thing that led to another was kind of like, where's the funding? Where's this going to be? And then we started building the new hospital. So that's how we ended up putting it on hold till we got here. It's located on the sixth floor in the Family Resource Center, and it's modeled after a lot of the national sites, other hospitals that have safety stores where families can go and purchase safety items.

The nice thing was our administration didn't want money crossing hands. They thought that we should be able to provide everything to families for free. So the Safety Center is completely funded by philanthropy. We are opened Monday through Friday from noon until four, and we are staffed by community educators. And what we do there is home safety for families. So families can come into the Safety Center, they do a home safety assessment. We talk to them about who lives in their house, how old their kids are, and we kind of ask some questions about what their kids are like behaviorally. So if you have children you know some kids put everything in their mouth, some kids climb on everything. So that kind of drives the assessment as well. And then we take the families through a curriculum of home safety. So anyone who has a child under the age of eight, hears about child passenger safety. Anyone who has a child under the age of one hears about safe sleep. Everyone gets kitchen safety, bathroom safety, fall safety, firearm safety.

So the whole visit only takes about 20 minutes, and it's kind of a full curriculum, but mostly bullet point information. They do a little pre-test and a post-test of the things that we absolutely want to make sure they're taking home with them. And then we give them free items. We usually give them three to four items to take home. We tell them they can come back as often as they need to. They can come when their kids change developmental stages. So we may not give a baby gate to someone who has an infant but at six months where you can come back. And then we go through all of that, answer their questions, and give them time to do the hands-on practicing of using the resources that we give.

Dr. Srinath: That's a huge wealth of resources you have available and infrastructure, too. I'm really interested. Can you describe the training that you went through to really be specialized in injury prevention?

Ms. Vitale: Sure. So my specialty in my master's program was community outreach, and I had done a lot of patient education and I also taught at one of the schools of nursing. So purely on a fluke, I thought, well, let's try community and then just absolutely fell in love with it. So that's pretty much how I got involved. Then our educators usually have a background in public health, and then we put them through a rigorous training of what's happening in injury prevention.

We also have Safe Kids. We are the lead agency for Safe Kids of Allegheny County, so we have access to all of their resources. The hospital is a member of Injury Free Coalition for Kids, which is a national organization focused on injury prevention. So it's 45 hospitals that are trauma centers, pediatric specialty centers, and we share resources. We do cross-site research. We have an annual meeting, so we do a lot of presenting of what worked, what didn't work, so we're not reinventing the wheel and also not using funds for things that didn't work.

Dr. Srinath: Nice. Now for listeners out there, our families, pediatricians, how does one get referred to your center? How do they go about getting involved or getting involved with the resources of your center?

Ms. Vitale: Sure, so we do have a website. So our website is chp.edu/besafe. There's 350 pages of information. Everything is printable. So we have things in parent language as well as in kid language. So that's one way. We list all of our events on our event page so people know where they can find us and what we're up to.

The other thing that we do with the Safety Center is we have prescription pads that actually look very much like a prescription pad, and they are on all of the units. They have been given out to CYF, they've been given out to law enforcement, the CCPs, the ExpressCares, anyone can refer a family to the Safety Center. They don't need the prescription, but it's kind of nice if you have something specific you want us to focus on.

Dr. Srinath: That's fantastic.

Dr. Poholek: Yeah, so I wanted to ask a little bit more about the target audience or actually who is coming? Who are the people that you tend to see in the Safety Center? How has that maybe changed pre COVID and post COVID? And have there been some challenges in sort of getting back up to the numbers that you had prior to COVID and what have been some strategies to try and deal with that?

Ms. Vitale: Okay, so we actually mostly target kids under the age of six because it's childproofing the home. But that being said, we also do bike helmets. So we do bike helmet fittings, and then we can do that for any age level. As far as home safety, we also have carbon monoxide monitors and smoke detectors. So families have older kids, but that's an issue. They can come to the Safety Center.

Prior to the pandemic, our average monthly visit was 60 to 70 families. Then after the pandemic hit, we had to close for a short period of time. When we reopened, we reopened only to families who actually had to be in the hospital for some other reason. And about six months after that, we were again able to open the Safety Center to the general public. So families on the outside can come in, they just sign in at the welcome desk and they will head them right upstairs. But what has happened is that we kind of dropped off pre pandemic, and right now we're between 35 and maybe 40, so we're almost half of what we used to be seeing, a lot less traffic from the outside.

So we've been hitting up with our community partners again, reinforcing what we're doing. We've started to do some with some presentations virtually with Head Start and Hello Baby. So all of the things that we do in the community, we have been able to focus a lot on the Safety Center. Staff have started making rounds on the floors just to tell families what we have and who we are again. So it's very slowly starting to trickle back up, but we are excited to get back up to where we were.

Dr. Poholek: So then maybe to try and further leverage interest in the Safety Center, I wonder if you have any data that it can kind of say, okay, when you have a safety center in a hospital or in a community, what data is there to actually show that it does help prevent injuries? What are the metrics that would really encourage people to ask families to come to the Safety Center?

Ms. Vitale: So about two years after opening, we actually did a formal study of the Safety Center that included focus groups as well as pre and post-evaluation immediately after the visit, two months out, six months out, one year out, just to say, because it is an expensive venture and we wanted to make sure is what we're doing, making change. We had some really significant positive responses.

Interestingly enough, at 12 months, the knowledge and behavior changes were more significant than they were earlier in the year. And we attributed that to just the fact of talking to families about safety kind of raised their awareness and they went back to their homes and started looking at it through a different lens. So what families were telling us was, besides doing all of the things that you told me or using the resources that you gave me, I also moved the furniture away from the windows so the kids couldn't climb up on the windows or I put my knives somewhere different or I bought another gate. So that was the thing that was really the most positive for us was that we knew that just having that conversation was making change.

Dr. Poholek: Great.

Dr. Srinath: You're empowering them and you're starting that propeller and getting that propeller going and getting them moving on their own. That's fantastic. Can you talk about what are the common resources that families use in your center and what resources perhaps you feel are underutilized that you would appreciate more visibility?

Ms. Vitale: Yeah, sure. So I would say probably the most often is the baby gates. Families really appreciate the gates. And second to that, we have fire extinguishers. They're not your typical fire extinguishers, they're those one-shot fire extinguishers. Families love them though, because they can have them right there in the kitchen and a lot of the things like smoke detectors and carbon monoxide.

We have medication lock bags and lock boxes. They tend to be fairly expensive. They're about $25 a piece, so we hold onto those for the kids who are actually ingestions, and those are the ones that when physicians or staff refer them to the hospital with the prescription pad and they will say medication safety. So we target those. I would love to be able to have them for everybody, because anyone who has a toddler probably could use one. But, yeah, we're working on that. I'd say those are probably the most often used. But we have a ton of stuff up there. We have latches, we have firearm locks, just lots of different things for families that they oftentimes never knew existed.

Dr. Srinath: So if I'm taking care of a patient in the hospital who is going to be discharged or even there for a while, toddler or younger, what process would I use? Would I say, hey, please go down to the Safety Center and this is what they're going to tell you. Or for example, I need you to go down to the Safety Center and learn about baby gates and how would that whole process work?

Ms. Vitale: So you can just verbally tell them. You can give them the prescription, because again, they think that that's really important. I have across from my desk taped to the wall two of the prescriptions that really meant a lot to me. One was a referral from Dr. Zitelli, which he's like a legend. So I saved that because I felt like I have arrived when Dr. Zitelli is sending someone to the Safety Center.

Dr. Srinath: That's so true.

Ms. Vitale: And the other one is just another one that a physician referred someone, but this prescription itself is so beat up. I mean, it's torn, it's taped, it's crumpled up, and the fact that the family still hung onto it and brought it there. So that's why I like to refer to the prescription pads.

Dr. Srinath: That's great.

Ms. Vitale: But as I said, you don't have to use them. You can just refer them verbally and just let them know we're on the sixth floor in the Family Resource Center. That's pretty much it. The process is pretty easy. If you have a family here who's here in the morning and going to leave, and we don't open until noon and they don't want to stay or they can't stay, if you just ask the operator to connect you to Injury Prevention, if one of us are in the hospital, we'll meet the family. And we've done that many times.

Dr. Srinath: That's really nice.

Ms. Vitale: We do not have a problem going over there and meeting families as we need to. We also have a phone that has voicemail at the Safety Center. So you could just call and say, this family's leaving, or they were here on Saturday. Can you follow up? We'll call them and tell them about the Safety Center and then set up a time for them to come anytime during the week.

Dr. Srinath: That's amazing. You do so much.

Dr. Poholek: That's really great.

Ms. Vitale: Thanks.

Dr. Poholek: I was kind of curious a little how your program may have grown or changed over the years, particularly as we're always sort of becoming newly aware of potential risks to children or as technology changes and things that people have in their home change. How do you guys stay abreast of those changes?

Ms. Vitale: So yeah, kids are always finding a way to hurt themselves, unfortunately, no matter what we do. So probably one of the things that I'm most proud of is our helmet program. So we have a helmet program called Hard Heads that's our oldest program. When we started out the admissions to the hospital for bike injuries was about 11% of the trauma patients. In the first five years of the program, we were able to drop that down to 6%, and that was also including scooters and skateboards, so not just bikes. And the head injuries were decreasing. If we could figure out a way to protect kids from the handlebar spear injuries to their bellies, then we'd really be making a dent. But at least we've got a handle on the head injuries.

So we used to do a teen driver program called RED, which stood for Reality Education for Drivers. That program was about eight years, and we partnered with the district justices. We had a waiting list initially of up to 90 people. Over time, the district justices reported to us that a lot of the kids were not getting moving violations anymore. That program just kind of sunset naturally, and we were able to move it just into the schools as opposed to kids who were getting tickets.

What we have seen a lot more, and I'm sure you're aware of it, is firearm injuries. And so we have moved more toward doing a lot of prevention for those injuries. We have cable locks that we give away not only at the Safety Center but also on our mobile safety van. And we have been able to find a funder for providing safer firearm storage events. So for the last two years, we have been doing events in Allegheny and surrounding counties, focusing on suicide prevention and unintentional injury where we partner with adolescent medicine, the Veterans Administration, behavioral health crisis centers, basically all of the people in those communities who would be working toward eradicating this problem.

And families will come to the event. They go through each station and learn everything that they need to know from that person. At the very end, they get a firearm safe, which is a biometric safe that they are taught how to use, and about firearm safety from the firearm specialist, so either someone from a gun range, local law enforcement, and even retailers. So we kind of modeled those events over some research from Harborview that taught us how to set up the event, who to include in the event, and how families want to learn about the gun safety.

Dr. Poholek: Wow, that's incredible. So maybe you can quickly touch on the mobile safety van that you just mentioned. And then as part of that maybe also chat a little bit about the plans you have for the future. Where do you see the program going? Where are the needs that still need to be addressed?

Ms. Vitale: So the safety van, actually, it came to grow out of the Safety Center. One thing we recognized early on was the challenges that families have for transportation. So if they couldn't get to the hospital, they couldn't get to the Safety Center. And what we did in the early years was we would set up a morning presentation, and the Family Care Connections or Dr. Diego would bring a group of families in, and we would do the whole Safety Center curriculum for 10 to 15 families at a time.

But we were able to get funding from the Gismondi Family Foundation for the safety van. So the van actually is parked on the seventh floor outside of the elevators. It looks like a little house, sort of a little clown car, and driving it feels like a clown car, but we can open it up and we have a little living room area, kitchen area, bathroom, stairs, and we can do everything that we do at the Safety Center. The only thing that we can't do is bring all of our stuff.

So the resources we give away are more thematic. So in the fall, we do a lot of fire safety and carbon monoxide poisoning and that kind of thing. So we set up a theme. We go to the Beverly's Birthday showers. We go to schools. We go to community events. We spend a lot of time at ExpressCare and the CCP offices, and we do home safety, and then we also do a lot of the helmet safety then.

So, yeah, I'd say moving forward we always want to just kind of keep in touch with what's happening. As I said, kids are just always coming up with a new way. We have been really blessed by the foundation and philanthropy. So we have been able to do what we need to do when we need to do it, and when we see something changing, we have been able to find funding for it. So we've been really lucky that way. I do see probably more firearm prevention as we move forward.

One of the things that we do is training with pediatric residents who are going through their child advocacy rotation.

Dr. Srinath: Fantastic.

Ms. Vitale: So they come up to the Safety Center and we talk. The last thing I say to them is, "If you see something starting up, let us know because we will get to our people at Injury Free." So I am certain that pediatricians first saw button batteries and Tide pods long before it became a national issue. So that's my dream is just to be able to start jumping on these things right as they're happening.

Dr. Poholek: Yeah. That's amazing. I mean, this has just been so informative and so helpful. Thank you so much.

Ms. Vitale: Thank you.

Dr. Srinath: Yeah, yeah. We really appreciate what you're doing for the community, the enhancements you've made, and where you want to grow. And it's just to be available at the hours that you're mentioning, even outside, is just real. It's a real, so thankful.

Ms. Vitale: Thank you so much.

Dr. Poholek: Yeah, thanks so much for being here today. We really appreciate it.

Ms. Vitale: Okay, thanks.

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