Nottingham City Council and City Care Partnership: The Stay One Step Ahead (SOSA) programme

To reduce the injuries that young children from the most disadvantaged families suffer at home, a University of Nottingham research team worked closely with Nottingham’s Small Steps Big Changes team, funded by the National Lottery Community Fund’s A Better Start Programme, children’s public health 0-19 nursing services, children’s centre staff, family mentors (a paid peer workforce) and parents to develop, deliver and measure the impact of the innovative Stay One Step Ahead programme.  The programme was shown to make homes safer and reduce healthcare expenditure with a return of investment of £1.39 in savings for every £1 spent.

Childhood injuries and disadvantage

Children should be safe in their homes, yet every year in England around 370,000 children under five have an injury that requires a visit to a hospital.  Around 40,000 will be admitted into hospital because of this injury and sadly around 35 may die.  It is even more distressing that injuries are more likely to occur in families living in the most disadvantaged areas. 

Injuries in the home can be prevented. Research has shown that the provision of safety advice from healthcare professionals and fitting of home safety equipment, such as safety gates, smoke alarms and cupboard locks, can reduce injuries and improve parent home safety practices. The National Institute for Health and Care Excellence (NICE) recommends that this type of prevention activity is made available across England.

Working with practitioners and parents involved in the Small Steps Big Changes (SSBC) programme, a University of Nottingham research team developed an evidence-based standardised approach to home safety for families with young children. The collaborative working between multiple parties throughout the project, including parents, paid peer mentors, health visiting teams and children’s centre staff was an innovative aspect of the project. 

The Stay One Step Ahead (SOSA) project comprised two elements: the development and delivery of resources to parents; and research to examine the effectiveness of the project. 

The resources, which focused on key injury issues and used evidence-based information, consisted of four components:

• 24 unique monthly safety messages formatted as posters, leaflets and quizzes;
• home safety checklists completed by health visiting teams at 9-12 month and 2-2½  year child health reviews;
• a structured programme of home safety activities for families to undertake with guidance from family mentors;
• four ‘safety week’ activity sessions per year held at children’s centres aimed at reducing the risk of injuries due to fires, scalds, falls and poisoning. 

The programme was delivered over a two-year period in Nottingham to families of children aged up to three years in four wards with particularly high levels of health, social and educational need. 

Children’s public health 0-19 nursing services (health visiting teams), children’s centre staff and family mentors delivered the programme, working in combination.  These service providers received specialised training to deliver SOSA. 

Using multiple research approaches, the Nottingham University team assessed how SOSA helped to make homes safer in areas where it was delivered compared to homes in five other areas that were not part of the SSBC initiative. 

Parents’ and practitioners’ views of the programme, practitioner knowledge, attitudes and confidence in promoting home safety and whether the programme saved the NHS money by preventing GP attendances, hospital attendances and admissions were examined. 

SOSA made a difference.  Families that received SOSA were 81percent more likely to store poisons safely, 81per cent more likely to have a fire escape plan and three times more likely to have a fireguard or not have a fire than non-SSBC families. In addition, families receiving SOSA undertook a higher number of key safety practices – 25 per cent said they implemented nine such practices versus 14percent in the non-SSBC families.   

Interviews with parents demonstrated that they liked the programme, especially valuing the time spent on injury prevention with family mentors.  The training resulted in practitioners’ having greater knowledge, more positive attitudes towards injury prevention and greater confidence to promote home safety. Practitioners delivering the programme valued having a structured approach to home safety though it was difficult for some to fit it into the limited time they could spend with families. 

Economic evaluation showed that SOSA was cost-effective, reducing healthcare expenditure with a return of investment of £1.39 in savings for every £1 spent. 

The challenge is to roll out the programme beyond Nottingham.  To do this, the research team has developed a comprehensive Implementation Toolkit for commissioners, elected members and service providers, including the training materials used to give the service providers the knowledge and confidence to deliver the project and the resources for use with parents, plus guidance on monitoring, evaluation and quality control.  The toolkit can be downloaded from the Child Accident Prevention Trust website from 6 February 2025. The Child Accident Prevention Trust can provide training, expert advice and support to areas wanting to implement SOSA and can be contacted at [email protected]. The Local Government Association will be hosting a webinar on the Stay One Step Ahead programme on 6 February 2025. 

Understanding whether the programme was delivered as intended - its fidelity – allowed the researchers to understand what might need to be changed in future to maintain and improve effectiveness. Interviews revealed that some elements were adapted by the service providers over time, potentially compromising the effectiveness of the project. Family mentor home safety activities were most likely to be delivered as intended.  

Unsurprisingly, the pandemic had a big impact on SOSA’s delivery as home visits by health visiting teams and family mentors had to be curtailed and children’s centres were not able to run safety weeks. Despite this, SOSA helped families make their homes safer and was a cost-effective programme.