MCHB Conference Webcasts
2005 EMSC Annual Grantee Meeting
April 12-13, 2005
EILEEN BLAKE: Thank you. Before -- as I begin, I just want to acknowledge some of the project members for the model online training for the safe transportation of children with special healthcare needs or as I'll refer to it, the training.
The project is basic Connecticut Children's Medical Center where I am in the injury prevention center. I've worked very closely with our rehabilitation therapist to develop the course, our web master to host it. The Center for Children with Special Healthcare Needs and our education development program.
Also, this wouldn't have been possible without the adaptation of a program that is a two-day hands-on course developed by Riley Hospital for Children's Automotive Safety Program called Safe Travel for All Children. And we were able to have a collaboration with our University of Connecticut video Communications Department to host the program for us on their server, which was a significant cost savings and development issue that we were able to overcome.
The project addresses a problem of a lack of resources and knowledge as a general rule regarding the safe transportation of children with special healthcare needs. While there's very consistent guidelines for children and how they graduate from infant, toddler seats, booster seats to safety belts, that same kind of guidelines really isn't applicable to children with special healthcare needs, children with disabilities and can be challenging and really a grey area as to what is the best way to protect them in motor vehicles. It's a challenge for parents and caregivers of these children, it's a challenge for healthcare providers including EMS and how to transport these children in ambulances, and it's a challenge on a daily basis for school transportation providers.
We did, based on my own ongoing in-service as well, our rehabilitation therapies department realized that they were the ones who were -- parents were often turning to to find out what kind of car seat the child needed or occupant protection system. So we identified that maybe this was a need of rehabilitation therapists, occupational and physical therapists throughout the country. And after a needs assessment of rehabilitation therapy programs, we decided that a web-based format that could meet the time constraints that therapists have of really not being able to go out and get this information in a hands-on course, this might be a way to get them basic selection information.
So the overall goal of the program was pretty lofty. Of course, to provide increased occupant protection to children with special healthcare needs in motor vehicles. And we were doing this through the adaptation of what was a 16-hour Safe Travel for All Children Course which is hands on and is designed for certified child passenger safety technicians. The NTHSA certification for child passenger safety technicians is a 32-hour course, and the 16-hour course is additional for those technicians if they choose to take it. Our goal was to recruit at least 200 rehabilitation therapists to enroll in the training, and then assess the success of the course and the web-based format by looking at the gained knowledge of the participants.
The first thing we did was we conducted a survey of parents to find out who they were getting their information from currently about transporting their children, and how they access rehabilitation therapists or was it somebody else, just make sure we had picked the right target population. And overwhelmingly, parents identified rehabilitation therapists as the ones they went to for their equipment needs and questions, so they were the ones they were getting this information from. I should say they were the ones they desired to get this information from. They weren't able to get it at the time before the course, so again that was going to meet our goal.
We needed to develop and manage the online training, quite a challenge to take a 16-hour course that was a follow-up to a 32-hour course, and make it into a web-based curriculum. We needed to recruit the rehabilitation therapists, gather information about their baseline knowledge which I'll talk about, and then do some pre and post testing to assess their gained knowledge. And then we did an end of course evaluation and a follow-up evaluation.
The courses consisted of 11 modules that covered injury prevention, crash dynamics, traditional occupant protection restraints, specialized restraints, wheelchair transportation, school bus transportation, and ambulance transport. The modules could be completed any time in a period of what was initially three months, we extended it to our months. Most people completed it in about two weeks, and it was four hours in total and the lessons ranged from four minutes to the longest lesson was about 16 minutes. So most people did one or two lessons at a time on one end of the spectrum, others went through and did the entire course at once.
So 6,000 members of professional organizations like the American Occupational Therapy Association and the Physical Therapy Association were sent letters regarding the course, and we had over a thousand people complete an online preregistration process. After about 250 people had signed up, I said to our advisory committee, I think we should cut off the participation. And they kept saying, No, more is better. More is always better. When you're doing an online course, more is not necessarily better because those are all your students. So imagine sitting in a room with a thousand students and trying to manage that on top of technology issues. So we learned an important lesson in the end about that.
We did have institutional review, board approval, and we had to have the -- after they did their pre-registration process which included some baseline survey questions, they had to participate in a consent process to receive their ID to log on to the course. And 80 percent of the participants consented to participate. So our real number, real baseline number was 852. Of those 852, over 58 percent completed all aspects of the course. And completion of the course included that you had to complete all the modules and the follow-up evaluation in order to receive a certificate of completion.
We had an experimental design to assess the gained knowledge of the course. We had a randomly assigned control and intervention groups. The control group received a pre-course test and then the course and a post-proficiency test. The intervention group received the course and the post proficiency test only. The reason for this design, and we worked with NEDARC to come up with this, was to really overcome the idea that sometimes when people take pre tests, they actually learn concepts from the pre tests themselves. The pre and post tests consisted of the same ten multiple choice case scenario questions. For example, how an occupational physical therapist might be presented with a child in a hip spica cast, and they would choose what would be the appropriate restraint to use for that child.
So over the course of the four months, 58 percent of the consented participants completed all the 11 lessons and the post test and evaluation. Only 10 percent of those 800 plus original participants never even accessed one lesson. So most people accessed at least one lesson. And they could have gone on, and just done whatever lesson was of interest to them if they didn't care about receiving the course certificate and 32 percent accessed at least one or more lessons but didn't complete the course.
At the pre-registration level, what we were trying to find out was about the knowledge, training and experience that the therapists had in the safe transport of children with disabilities, so we asked them to rate their knowledge, and most rated their knowledge in the area as a little to some. Their training, really the majority said that they had had no formal training in the area, which wasn't surprising to us because prior to this course, it didn't exist. And in terms of experience -- and I shouldn't say it didn't exist. It didn't exist unless you were a certified child passenger safety technician which some people may have chose to do that. In terms of experience, most said they had a little to some experience in the safe transportation.
The other interesting element of this is we asked them how many parents children and families they were providing counseling regarding proper selection of restraints to. And most had said in the course of their career they had only provided this information to 1 to 15 families which was in sharp contrast to what parents were asking for. So there was an obvious need for this information.
So the pre-registration certainly far exceeded our expectations. We found they had little formal training or experience in occupant protection and weren't really providing counseling for safe transportation of families. So we really hoped that the course would increase all of this. In fact, and I'm sorry, I see it's little difficult to read, but our initial analysis of the gained knowledge of the participants show that the course in fact did have an impact on their knowledge regarding the safe transport and the proper selection of occupant restraints.
Of the 232 participant in the intervention group, the ones who received the course, their post course score was 8.31 versus the control group before they had the course, their score of 6.83, and that was for all occupations. There wasn't very much difference between physical therapists and occupational therapists. Really, the majority of the participants were physical therapist. We did have some other occupations that participated as well, vendors and professors in the area of rehabilitation therapy. The course evaluation which was required showed us that two percent of the people who participated had received additional training in safe transport aside from the course since they pre-registered.
The vast majority, almost everybody said that their knowledge as a result of the course increased significantly or increased, and most again said that because of the course, they would be more willing to provide counseling to the families that they served and that they would be more confident that the information they were providing was correct, which anybody can provide advice, but the important thing is that it be the correct advice. Additionally, they felt their ability to serve as a resource to their colleagues had significantly improved. We found in many cases, a director of the program would register for the course and then share that information in in-service or even share the course by having everybody come and go through the computer modules with them. The reason we found that out is there was a high demand by those directors for us to provide the information to them in written format to distribute to their colleagues.
The anticipated number of times they felt the counseling would increase, would increase somewhat as a result of the course, and 90 percent of the people would recommend the course to a colleague. And overall, the majority rated the course as either excellent or good. And given the fact that this all was also based on the ability to use the technology to actually participate in the course, we felt that was very good.
We just recently completed a three month follow-up evaluation of the participants, and 31 percent of the 495 participants completed that e-mail evaluation and most still said that they had significantly changed their knowledge regarding the topic since the course, and that they were still very confident in providing the knowledge to the children and families that they served. Again, most -- still three months out since the end of the course rated the course as excellent or good and only one percent said the course was poor. And overall that person was really having a bad day, I think, because everything they said was very negative. And 100 percent of those people were going to recommend the course to a colleague.
So our next steps is we did have people who were really having difficulty because of firewalls at their organizations or just their own ability to access technology of doing an online course. That was one of the challenges of managing over 800 people taking a course. So we have now produced the training on a CD ROM version for those people. I'm in the process of sending it out to them. We'll also have it available through the resource center here.
We are continuing to analyze all the data we have. We have so much data because of all the participants, and it's very interesting, and submitting the outcome to peer review journals. We continue to serve as a resource. Not a day goes by that a participant doesn't contact me with a follow-up question or a certain case they are dealing with. We also serve as a resource to the community. And right now we are hoping to expand our general mission beyond the safe transportation of children with disabilities to injuries experienced by children with disabilities in general, because there's really a lack of knowledge in that area.
So I thank you for the opportunity to share our outcomes. We felt it was a really beneficial project.