**6. Parenting group intervention for injury prevention in the city of Bogotá, Colombia**

Safe Environments Module is part of a set of public social policy performed in family envi‐ ronments in the city of Bogotá, Colombia. With this set of interventions, early childhood education is addressed to parents. It teaches parents to promote positive parenting, breast‐ feeding, healthy child development, play, child participation, and the rights of all children [68]. Family scope intervention is a process of training families with young children which is aimed at strengthening family activities that foster improvements in the home to promote child development. The long-term goal of these interventions is to transform cultural patterns of child abuse, to help improve the health of young children through timely medical and nutritional care, and to promote social mobilization and development to open more opportu‐ nities for all children in the city [69].

**2.** Education, training and behavioral change: interventions in this category have the common goal of encouraging behavioral change through different teaching strategies, for example campaigns for pedestrians to use crosswalks. Such actions may extend beyond the primary caregivers, including health professionals, educators (beginning in kinder‐

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**3.** Home visits: the approach to the immediate context of children's lives, therefore the ability to impact the real context in which they are growing up. This type of actions is the most effective intervention to a wide range of preventable problems in families, thus such actions usually go beyond the prevention of accidents, even preventing child abuse and

**4.** Community actions: such actions lead us to believe in interventions with long-term incidence within specific communities. The hallmark of this type of actions is that

With this background, in Bogotá was tested the injury prevention program Safe Environments Module [70], an intervention for domestic accidental injuries prevention addressed to primary

The caregivers were trained to modify their home environment with their children in mind, improving their home safety settings and adjusting their own behaviors to prevent uninten‐ tional injuries. Intervention was implemented following a detailed protocol. The intervention

The impact assessment was divided in two studies. The aim of the first study, as a pilot study, was to determine how protocols and their procedures were applied by data collectors. Opportunities and barriers when applying intervention protocols were analyzed. The findings from this evaluation process were used to improve the protocols and therefore guarantee methodological quality of study 2 regarding intervention effects. A group of 16 volunteer primary family caregivers participated (age range 23-55 years old; *M* = 33.9, *SD* = 8.7). In study two, an intervention group was formed of 29 caregivers selected conveniently from a public kindergarten in the city of Bogotá, Colombia (27 mothers, 1 grandmother and 1 aunt) (ages ranging from 19-74 years old; *M* = 31.7, *SD* = 10.8), and a comparison group with 18 caregivers (14 mothers, 1 grandmother, 1 aunt, 1 sister and 1 stepmother) (ages ranging from 20-58 years old; *M* = 28.6, *SD* = 8.7). Each caregiver was visited twice by three observers, one focusing on

Naturalistic measures were used to assess intervention effects on the following variables: early infancy risks and home injury antecedents, the quality of social and physical immediate environment that included housing quality and adult-child social and cognitive interaction at home, and caregiver sensitivity behaviors, correspondingly: Injury Home Risk Scale [76]; Injury Home Antecedents [76]; optional modules of Multiple Indicator Cluster Surveys, MICS3

Comparing the results between groups with nonparametric statistics showed that groups were similar in social, demographics and research variables. The results displayed a significant

garten), among others.

increasing childhood immunization rates.

generally they are based on the initiative of the social group.

consists of four- two hours sessions, one per week (see Appendix A).

injury risk and home safety, and the other two on caregiving quality [75].

[77]; and Maternal Behavior Q-sort [7].

family caregivers. The study performed is described below.

The design of the Safe Environments Module intervention [70] was based on literature about the prevention of domestic accidents, theories for intervention in early childhood, Attachment Theory, and the Bioecological Theory of Human Development. The intervention was devel‐ oped by the agency responsible for the implementation of the social policy in the city (District Department of Social Integration - SDIS) in cooperation with private entities.

The broad policy framework for the Safe Environments Module intervention arose from the Convention on the Rights of the Child [3] and the Colombian Constitution of 1991 [71]. The local context for the intervention in the city of Bogotá is the Social Policy for the Quality of Life of Children and Adolescents 2004-2008, updated for the period 2008-2011 [69].

This policy excelled within the country by affirming that it is possible to build a society that is tolerant and respectful of diversity and differences, to the extent that the condi‐ tions of the places (homes and neighborhoods) where children live and grow in the city become adequate and safe. The policies in Bogotá also stress the importance of interven‐ ing in the relationships established between children, families, and other developmental aspects of the child so that interactions would be more affective and respectful. The policy states a set of intolerable situations, for example: "For a city that claims to be modern and humane, it is intolerable that children and adolescents suffer or die from preventable causes such as perinatal diseases, infections, and accidents" and "It is intolerable that children and adolescents are so alone" ([69] p11).

According to the District Diagnosis of Childhood and Adolescence [68], "the third leading cause of violent death in children and adolescents aged 0-17 years are accidents different to those caused by traffic and children in early childhood have been most affected by this type of death during the period 2002-2011 "(p111). In Bogotá, in 2007, when a report was made on the cause of accidental deaths of children in the city, it was observed that the 9099 accident cases recorded, with 3580 of those involving children under 10 years old [72]. These figures are shocking considering not only the age of the victims, but also in recognizing that all accidents were preventable [73]. However such these figures remain in Bogotá, the city still has reduced systematized information of these accidents in childhood, as occurs in the rest of the world [73,74].

According to Peden et al. [73], the preventive actions that have been found effective in the intervention against domestic accidents can be grouped into four categories:

**1.** Safety devices: there are passive interventions that seek to promote the use of safety devices. It can lead to a rapid decline in accident rates and in fact it is known that a decrease in these rates, in turn increases the confidence of the people in the use of such devices. Examples of this type of preventive actions are the use of helmets for cyclists, installing railings on stairs and windows, safety caps on drugs to secure them from children, and the installation of smoke detectors.

**2.** Education, training and behavioral change: interventions in this category have the common goal of encouraging behavioral change through different teaching strategies, for example campaigns for pedestrians to use crosswalks. Such actions may extend beyond the primary caregivers, including health professionals, educators (beginning in kinder‐ garten), among others.

nutritional care, and to promote social mobilization and development to open more opportu‐

The design of the Safe Environments Module intervention [70] was based on literature about the prevention of domestic accidents, theories for intervention in early childhood, Attachment Theory, and the Bioecological Theory of Human Development. The intervention was devel‐ oped by the agency responsible for the implementation of the social policy in the city (District

The broad policy framework for the Safe Environments Module intervention arose from the Convention on the Rights of the Child [3] and the Colombian Constitution of 1991 [71]. The local context for the intervention in the city of Bogotá is the Social Policy for the Quality of Life

This policy excelled within the country by affirming that it is possible to build a society that is tolerant and respectful of diversity and differences, to the extent that the condi‐ tions of the places (homes and neighborhoods) where children live and grow in the city become adequate and safe. The policies in Bogotá also stress the importance of interven‐ ing in the relationships established between children, families, and other developmental aspects of the child so that interactions would be more affective and respectful. The policy states a set of intolerable situations, for example: "For a city that claims to be modern and humane, it is intolerable that children and adolescents suffer or die from preventable causes such as perinatal diseases, infections, and accidents" and "It is intolerable that children and

According to the District Diagnosis of Childhood and Adolescence [68], "the third leading cause of violent death in children and adolescents aged 0-17 years are accidents different to those caused by traffic and children in early childhood have been most affected by this type of death during the period 2002-2011 "(p111). In Bogotá, in 2007, when a report was made on the cause of accidental deaths of children in the city, it was observed that the 9099 accident cases recorded, with 3580 of those involving children under 10 years old [72]. These figures are shocking considering not only the age of the victims, but also in recognizing that all accidents were preventable [73]. However such these figures remain in Bogotá, the city still has reduced systematized information of these accidents in childhood, as occurs in the rest of

According to Peden et al. [73], the preventive actions that have been found effective in the

**1.** Safety devices: there are passive interventions that seek to promote the use of safety devices. It can lead to a rapid decline in accident rates and in fact it is known that a decrease in these rates, in turn increases the confidence of the people in the use of such devices. Examples of this type of preventive actions are the use of helmets for cyclists, installing railings on stairs and windows, safety caps on drugs to secure them from children, and

intervention against domestic accidents can be grouped into four categories:

Department of Social Integration - SDIS) in cooperation with private entities.

of Children and Adolescents 2004-2008, updated for the period 2008-2011 [69].

nities for all children in the city [69].

158 Parenting in South American and African Contexts

adolescents are so alone" ([69] p11).

the installation of smoke detectors.

the world [73,74].


With this background, in Bogotá was tested the injury prevention program Safe Environments Module [70], an intervention for domestic accidental injuries prevention addressed to primary family caregivers. The study performed is described below.

The caregivers were trained to modify their home environment with their children in mind, improving their home safety settings and adjusting their own behaviors to prevent uninten‐ tional injuries. Intervention was implemented following a detailed protocol. The intervention consists of four- two hours sessions, one per week (see Appendix A).

The impact assessment was divided in two studies. The aim of the first study, as a pilot study, was to determine how protocols and their procedures were applied by data collectors. Opportunities and barriers when applying intervention protocols were analyzed. The findings from this evaluation process were used to improve the protocols and therefore guarantee methodological quality of study 2 regarding intervention effects. A group of 16 volunteer primary family caregivers participated (age range 23-55 years old; *M* = 33.9, *SD* = 8.7). In study two, an intervention group was formed of 29 caregivers selected conveniently from a public kindergarten in the city of Bogotá, Colombia (27 mothers, 1 grandmother and 1 aunt) (ages ranging from 19-74 years old; *M* = 31.7, *SD* = 10.8), and a comparison group with 18 caregivers (14 mothers, 1 grandmother, 1 aunt, 1 sister and 1 stepmother) (ages ranging from 20-58 years old; *M* = 28.6, *SD* = 8.7). Each caregiver was visited twice by three observers, one focusing on injury risk and home safety, and the other two on caregiving quality [75].

Naturalistic measures were used to assess intervention effects on the following variables: early infancy risks and home injury antecedents, the quality of social and physical immediate environment that included housing quality and adult-child social and cognitive interaction at home, and caregiver sensitivity behaviors, correspondingly: Injury Home Risk Scale [76]; Injury Home Antecedents [76]; optional modules of Multiple Indicator Cluster Surveys, MICS3 [77]; and Maternal Behavior Q-sort [7].

Comparing the results between groups with nonparametric statistics showed that groups were similar in social, demographics and research variables. The results displayed a significant positive association between age of children and caregivers' report history of home injury (*r*(47) =.33, *p* <.05); and an inverse association between level of accident risk and level of housing quality (*r*(47)= -.29, *p*<.05) (*spearman* correlations based on pre-test measurements). It was found that leaving children alone at home declined in frequency after the intervention (*Z* = -.20, *p* <. 05). Also, it was established that intervention increases the number of potential social interac‐ tions for children at home (*Z* =.22, *p* <.05) [75].

presented two models of interventions that have taken into account the main principles of both

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Even though the two presented interventions have distinct patterns, both of them aimed to enhance the infant development, considering the quality of relationship between child and mother/caregiver as a major factor. Besides, both of them conceptualize the importance of contextual variables, like the infant's home environment. That is way the first presented intervention (PIM) occurs in a home-basis or in a community center. The second one is targeted to prevention and aimed to reduce the risks of home environment in child development. It is worth stressing that the caregivers are enrolled in both interventions, because they are considered as main elements to the regulation of infant needs, promoting adjusted outcomes,

Moreover, these interventions addressed to contextual demands looking for the best socioemotional development. These aspects correspond to BTHD principles, in which the change in microsystem needs to be operated by their elements [26]. Each intervention aimed to promote changes in children environment. However, these changes involved the person included in this environment. In agreement with PPCT model [24], these interventions conceptualize the person in constant evolution affecting and affected by the context where they live. Every intervention intends to promote change in contextual background of the infant, besides seeks to promote change in the quality of their relationship, evaluating it as "the secure base" for the further outcomes. Then, it is attempted to ensure an adequate infant development, helping the caregivers to identify and correctly respond the signals and needs of the child. In doing that, a positive relationship is built, mutally satisfactory and, importantly, determining the safety of the child [43,44]. Another important factor of the presented interventions is the involvement of caregivers and their sensitivity/responsivity to the challenges of the environ‐ ment where they operate, minimizing the possible threats of it [40]. Particularly, the interven‐ tions are looking to the possible challenges presented in mother/caregiver-infant interaction in order to improve the motivation and knowledge of caregivers about child care quality, and

increase the frequency, power, and contingency of their responses [6, 7].

Considering that the main core of each intervention is the opportunity of promoting positive parenting, enhancing their skills, and attending to their particular needs and concerns, it is possible to establish that Bronfenbrenner's guidelines for interventions are useful to promote changes in the microsystem as well as in proximal processes in Latin American contexts. In general, the basis of each intervention presented was improving the ability to self-manage caregiving behavior. Therefore these kinds of interventions are relevant, considering the data revealing that children whose caregivers had more sensitive behaviors presented less devel‐ opmental injuries [14]. As sentenced by Sroufe and Waters [17] the dyad is a unit biologically based, but organized by the effect of culture, so in the Colombian and Brazilian interventions the fact that they focused on mutual adaptation between caregivers and infants, exemplify how those actions help to build an stable system of interactions that enable the children

theories.

healthy development and child´s adaptation.

potential of development in their own context.

No significant differences in domestic injury risk were found between the comparation group and the intervention group; however, the results suggested that domestic injury risk was a highly determined variable related to socioeconomic conditions, such problems with housing facilities [78,79]. These findings support an urgent need to improve housing and environment quality of low income contexts and also the idea that short interventions focusing in caregiver behavior could be effective in domestic accidental injuries prevention in early infancy.

In the case of the city of Bogotá, scientists working in the field of human development are committed with political decisions on early childhood interventions, and their main argue is that interventions themselves most to be based on evidence. It is well known that tested interventions can guarantee that public funds are well spent and produce the desired effect. Scientist in this contexts have begun to include in their academic responsibilities reflections and disclosures on the implications of this type of research, in order to help bridge the gap between academic knowledge, current quality of home care, and children' s developmental needs [79-82].
