Each episode of Child Safety Source is a previously recorded interview with someone who has our children’s wellbeing in mind. For our 55th interview, Life Saver Pool Fence’s president, Eric Lupton, is speaking with Tiffaney Isaacson.
Our regular viewers and listeners love these informal chats with experts who work tirelessly to keep our children out of harm’s way. As an Injury Prevention Specialist at Phoenix Children’s Hospital, Tiffaney Isaacson definitely fits this bill. Join us for a conversation about children’s water safety and more.
Getting to Know Tiffaney Isaacson
As we mentioned, Tiffaney Isaacson is a Senior Injury Prevention Specialist with Phoenix Children’s Center for Family Health and Safety. This is a Level 1 trauma facility that serves one of the largest communities in the United States.
There, she examines data and conducts research related to water safety and drowning risks. In her interview with Eric, she explained that she grew up in a community that had a high rate of drownings. The impact of these drownings drove Tiffaney to help little ones in need.
Beyond her day-to-day, Tiffaney participates in the Arizona Child Fatality Review team. For the state of Arizona, this team helps to teach families and coordinates community-wide programs to address child drowning risk. The death of any child is a tragedy, but through education and research, Tiffaney hopes to wipe out the danger of child drownings.
Watch our full video interview here:
About the Phoenix Children’s Center for Family Health and Safety
Tiffaney Isaacson works Phoenix Children’s Center for Family Health and Safety. The goal of this center is to provide the parents with the education to keep children safe. From water safety to car seat safety, they explore a wide spectrum of potential hazards.
According to the Center’s website, more than 6,500 children under the age of 14 in the U.S. are killed by preventable injuries each year. To fight back against this terrible news, the Center offers many health and safety programs . These programs support families with resources that will help to ensure children’s safety.
If you’d like to learn more, visit the official website for Phoenix Children’s Center for Family Health and Safety.
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Below is a direct transcript of the Child Safety Source interview with Tiffaney Isaacson from January 14th, 2019:
Eric Lupton: We are live on the Internet. How’s it going?
Tiffaney Isaacson: Good. How are you?
Eric: I am fantastic. Thank you so much. And thanks again. I just said it right before we started, but really thank you for doing this. I know you had to jump through a lot of hoops to do this and I really, I really do appreciate it.
Tiffaney: Not at all. It’s a pleasure. Thank you.
Eric: And I think the people watching will appreciate it too cause I don’t think we’ve talked to anybody who does quite what you do, so it’s kind of exciting.
Tiffaney: I do have a unique job.
Eric: So, I’ve got your bio here, but for everybody else, what is your job? How would you explain it?
Tiffaney: I’m a Senior Injury Prevention Specialist at Phoenix Children’s hospital, which is a level one trauma facility in Phoenix, Arizona. Phoenix is located in Maricopa County and for those that have not been to Arizona, the bulk of our population live in Maricopa County. It’s a very urban environment with about a dozen suburbs that surround Phoenix, which is all together, one of the largest communities in the US and we’re also very known for some terrific drowning prevention programs and unfortunately a very high drowning. Right.
Eric: Yeah. I visited Arizona for the National Drowning Prevention Alliance conference a couple of years ago. I was on the Board of Directors then and I was the Vice President I think during the Arizona conference.
Tiffaney: Yes.
Eric: Yeah, I was surprised how metropolitan Phoenix is, like a desert in the middle of nowhere, but that’s not the deal at all.
Tiffaney: Yeah, it’s a very large community. It’s very spread out. I think one of the things that really appeals to families in Arizona is that the housing is pretty affordable. So an average family is usually able to buy a little place with a swimming pool. It’s either a community pool or their very own backyard pool. A lot of the houses are very new and we don’t have a whole lot of public transportation
Eric: like Florida. Right. Kind of, the light and a lot of ways, one being you have a lot of people who move there for other places, right?
Tiffaney: Yes,
Eric: I joke, I joke that I’m one of the seven items of south Florida. There’s a, there’s not that many of us, it’s spread out. Not much public transportation but also a lot of drunks.
Tiffaney: Yeah, the valley really grew, there was a surge in construction in the 1980s and we actually saw a very high increase in our child drownings that corresponded with an increased population. And around 1989, I think we have just an unbelievably high drowning rate. I think it was 26 children per 100,000 that were drowning. And today our child drowning rate among the highest risk group, one to four year olds is about six per 100,000. So it will be rapid growth came a very rapid increase in child drownings.
Eric: So, I want to talk about that. But before that, what made you decide that you wanted to be the Senior Injury Prevention Specialist for this hospital? But that’s not, you know, most little girls or boys for that matter when, they’re thinking of their dream jobs. Astronaut, Firefighter, Princess, King, Senior Injury Prevention Specialist isn’t on the list normally. So
Tiffaney: It wasn’t something that I really saw myself coming into, but we had a few years in the valley where we have very, very high drowning rates and I decided to get involved as a volunteer. And I think what has really appealed to me about water safety, is the science of it. Really taking a look at what are the variables and what are we doing here and why is this happening? And then putting into it strong public health solutions, looking at the community in the state and understanding how drownings happen and what we can do to prevent them and then measuring our programs to see if they are effective and how we can make them more effective. Additionally, Phoenix Children’s hospital is just a very, very special place. A lot of people who work here are extremely good at what they do and it really pushes me on a personal and a professional level to consistently try to improve and be the very best that I can be. And also working in a children’s hospital really gives you an appreciation of the big picture and the things that matter in life, it’s not so much about the traffic jam at 5:00 PM, it’s more about the health and safety of your children. You knew people that they love.
Eric: When you started volunteering was there a story like connected you to water safety? Did you have a personal experience? And what made you take that first step into volunteering?
Tiffaney: I lived in a community that had a high rate of drownings. I didn’t have a personal experience, but it’s interesting if you ask most families about child drownings, almost every family that I run into wants to tell me very vivid personal experience where either that person drown or someone that they know nearly drowned. And it’s actually a great conversation starter when you’re doing education with families because it puts us both on the same level playing field. Maybe we’ve both experienced something very scary and then we’re sort of opening the mind of the family to talk about ways to prevent it from happening.
Eric: Absolutely. So obviously you know, the types of injuries you prevented go beyond drownings, right? Or is that your main focus?
Tiffaney: My main focus is child drownings. We’re looking to prevent any kind of negative outcome. If a family has a child who’s brought here to Phoenix children’s and they recover completely. We’re so glad that the child has recovered completely, but it’s obviously a very traumatic experience when you have a child brought here for a submersion. So we want to prevent the submersion from happening in the first place. In my role with the hospital, I also have some other tasks. I’m a member of the Child Fatality Review Team here in Maricopa County, both the unintentional team, which looks at drownings, furniture, tip overs, poisonings, anything that’s not a suicide motor vehicle crash or safe sleep death. And I’m also a member of the team that looks at maltreatment deaths in Arizona, cases, it might be either intentional harm or neglect.
Eric: So, I’m not sure if you saw it, but I do when I’m calling the Hashtag Light Saver Challenge every day. So what it is, every day for a year, I’m telling, I posting a video where I say, and it’s about 15 seconds long, it says, “drowning is the number one cause of accidental or death for children between the ages of one and four years old, multiple layers of production or the solution”. And I’m going to repeat this every single day and come everyone knows that for the Hashtag lakes they were challenged. And I’ll probably use that, for just now for my entry for today, and I try to do it in a weird funny way every day to not get bored. And then I think people want my Facebook to the all folders with miscarriage. Now you’ll have to do it because I told you about it.
Taffaney: I’ll have to do it now
Eric: But you said, I noticed you said unintentional and I’ve had internal debate with myself and a little bit with other people, mostly with myself, whether I should say accidental death or {Inaudible} death. You have an opinion on that. Do you think it matters?
Tiffaney: I do think it matters. I think a lot of injury prevention, it’s very important to be precise. And when we take a look at child drowning deaths, what we see is a predictable pattern of events, it’s almost sad. It is sad and it’s almost a little bit scary how consistent the scenarios that occur around turnings are. These patterns are very, very clear. So if a boulder rolled off of a mountain and crushed a car and a child was killed within that boulder, we were in an area where this had never happened before. There weren’t landslides. It’s just a random act of God. I would consider that accidental, something that maybe didn’t see coming and there was nothing that we could’ve really done to prevent Tiffaney: it. When we look at child drownings, what we see is a very predictable sequence of events. We know who’s at risk. We know where it’s most likely to occur. We know the behaviors that surround the event and we know the steps that can be taken to prevent the submersion from occurring in the first place as well as the steps that can be taken if there’s a lapse in supervision to get a child to safety as soon as possible.
Eric: So that’s why you’d use the term unintentional.
Tiffaney: Yes.
Eric: Yes or {Inaudible] and it’s funny you put it that way in the early two thousands on our website, we had a part of it where it said that an accident is something that you can’t foresee coming. Drowning is predictable, therefore drowning, It’s not an accident and because it’s, you know, a foreseen consequences of, you know, not putting it in the proper lawyers of protections. we actually took a lot of flack for that at the time because, you know, people got upset that, you know, of course, you know, I didn’t drown like an on purpose. It was an accident so, you know, we ended up changing the verbiage a bit just to keep everybody copacetic. But I’ve met with that same mindset for a long time, that drownings are so prevalent and just like you said, the way they happen is so pattern driven that yeah, the word accident really doesn’t quite cover what’s actually happening.
Tiffaney: Right. And even in cases where maltreatment occurs, about one in three drownings in Arizona is classified as a maltreatment death. In most of those cases we see a situation where there was neglect, where the level of supervision or the chaos that was present in the home was so high that it became predictable that the child might have been injured. Among maltreatment deaths and mostly what we do see is neglect, not intentional homicide. There are cases where an adult intentionally harm the child by drowning them. Those are very rare. So I think it’s important if we really want to get to the heart of the problem, we have to look at things that are difficult to see. And the fact that sometimes child neglect occurs, it’s very important for us to face. We need to face it with compassion and dignity and public have proven strategies that can reduce risk. And there are research based strategies that can help us to reduce the risk of neglected in families.
Eric: And I think it’s important too to mention, cause you said that’s one out of every three, right?
Tiffaney: About one in three.
Eric: Yeah. But which means that two thirds of those were neglect, and I think that’s important for people to realize because the idea that drowning is something that only happens to bad parents is a narrative you hear repeated all the time. And you know, if we can hammer home that message that at least two thirds of these weren’t neglect, then I think people can internalize that message, realize that they might be at risk for this based upon the fact that this happens to good parents just like them all the time and not as bad parents And I’m glad that you have those numbers so that you are communicating that.
Tiffaney: Yeah. And I think it’s very important also to realize that 100% of the families that I come in contact, with love their children and want to be better parents in the context of our culture right now, there’s a tremendous amount of pressure on parents to be better and better and better at what they do with their children. But we’re not investing a whole lot of time, money in resources into helping parents to be better at that job of parenting. So for example, one of the things that we provide here at Phoenix Children’s hospital is a Triple P parenting program to help us with basic parenting. The highest risk age group for drownings at the national level as well as here in Arizona is the one to four year olds. These are a tough age to parent. They’re emotional, they have no self-control. They don’t know the difference between real and make believe, they’re clumsy.
So they may be more likely to fall into a swimming pool and they may have swim skills one moment in the next moment they may panic and completely forget what to do. They’re not intentionally being difficult children. And when we put a lot of pressure on parents to be a good parent, what we’re doing is, we’re making those parents feel that they’re being judged. And when we can all sit down together and talk about our stresses as a parent, what’s difficult about swimming with a two year old and what we can do about it, then we can actually make a difference and reduce risk.
Eric: Yeah, you’re right. It is a {Inaudible} I think you have a {Inaudible} small parent you know, a little dictator of a house.
Tiffaney: yes.
Eric: And you know, it is tough and you know, there’s so many things to manage in your life and you know, you’re thinking about are they getting enough mental stimulation and what’s going on in, you know, are we teaching them right. You know, I think safety might actually think of back seat sometimes and I think we may not appreciate the right safety things to be focused about. You know, we’re hyper-vigilant about, you know about kidnapping and don’t talk to strangers, something that almost never happens and maybe not as vigilant as we should be about literally the number one cause of unintentional death, which is in their backyard.
Tiffaney: Yeah. Correct. And we also have to remember that not every single family is coping with the same stresses. Some families have good jobs and stable home environments and they’re able to really thrive. And some families are doing the best that they can in an environment where there might be poverty or perhaps the family is coping with really high stresses such as addiction and mental illness and we have to make sure that we provide families with all of the resources that they need in all of these settings.
Eric: So what is the Triple P stand for and the Triple P your program?
Tiffaney: It’s the Positive Parenting Program.
Eric: The Positive Parenting Program. You’ll say that 12 times fast. So how long have you been the Senior Injury Preventions Specialist at the Phoenix Children’s hospital?
Tiffaney: I’ve been here for 15 years.
Eric: That’s it. Only 15.
Tiffanney: Only 15.
Eric: Only 15. So you started there when you were {Inaudible}?
Tiffaney: Yes, I did.
Eric: It’s impressive. A child prodigy.
Tiffaney: Thank you.
Eric: So what makes Arizona in particular a place where drowning happens? What are the unique risk factors in Arizona that you don’t see other places?
Tiffaney: One of the things that makes Arizona very high risk is the fact that we have a lot of children in the high risk age group. Here in Arizona, we have more than 350,000 children between the ages of one and four years old. So in other states maybe where we have lot of retirees, we wouldn’t see quite as many young children. Families are moving very quickly into Arizona and a lot of these families are new to the state, just like in Florida, we have a very high concentration of swimming pools. We have more than 320,000 swimming pools in Arizona. And in a single year, almost 4,000 swimming pools are added every year, depending on the growth that’s going on. We also have a significantly high poverty rate when we look at the things that a family needs to do to protect their children from drowning, good childcare, a removable fence around the pool, CPR for moms and dads swimming lessons for the children.
These things cost money. And when a family is struggling to put food on the table, poverty can really increase risk for them, is one of the greatest that threats to child healthy development. And in Arizona we do have a significant problem with poverty. We rank 46th in economic child wellbeing, so it’s a struggle for a lot of families and also instability is a struggle and you can measure instability if you consider aces, aces or adverse childhood experiences. And these, these are one of about 10 things that can happen to a child that, increased stress and make things very difficult for a child. Everything from poverty to physical abuse, neglect, the death of a parent, the incarceration of the parents. Here in Arizona, 31% of our children have experienced two or more aces and aces have an effect on our health. They have an effect on how we function in our lives. The national level of children who have two or more aces is about 22%. So Arizona may have a lot more going on with families to deal with, which may influence the way that we supervise our children and the decisions that we make that influenced their safety in the swimming pool area.
Eric: And do you see a correlation between children who have experienced more aces or in these homes that have more poverty and drowning?
Tiffaney: we can probably see a correlation between parents who have experienced aces.
Eric: Okay.
Tiffaney: How they parent their children and aces do tend to be generational. A family who has a high number of aces has a lot going on in there doing the very best that they can. It’s difficult to make the decisions and have the resources that you need to create a healthy, safe, stable environment for your children. And it makes it difficult for you to connect as a parent and realize what you need to do as a parent. A good example is, if a person has their first born child when they’re a teenager, we’re doing the very best that we can to raise our children. But a teenager’s brain is still growing and a person who has a child at a very young age may have to make economic sacrifices. We may not graduate from college and make quite as much money if we have our children at a very young age.
And sometimes a teenager whose brain is still growing, may not understand that a child is not a smaller version of themselves. A five year old thinks very differently than a 15 year old and a five month old thinks very differently than a five year old. So we’re doing the best that we can when we come from a high ace environments. But these families really need resources to help them to be resilient on their own. They need to connect with concrete resources. They need basic education about child development, which all families need. They also need to reduce isolation and spend time with others so that they have strong social support systems.
Eric: You know, I talk a lot about drowning prevention on our Facebook and in this podcast all the time. And you know, water safety prevention. I want to get to that with you also. But given your environment in the hospital, I thought you might be able to shed some light on what you see when the prevention fails and someone does come to the hospital for a subursion incident. What does that look like? What are things that people can do? You know, once the child is in the pool and they’ve been discovered, you know, what should they do at that point? What does that process look like? And you know, what are the different scenarios they can branch out from there?
Tiffaney: Sure. So emergency preparedness is about preparing in advance for the emergency.
Eric: Sure.
Tiffaney: Really making sure that you have current CPR skills with rescue breaths for any adults who supervising children is critically important. I probably met five really wonderful, amazing young adults whose lives were saved when they were children, when they were found in a swimming pool and given them proper CPR.
Eric: right?
Tiffaney: So proper CPR is the very most important step that a family can take. And here in Arizona, we encourage families to go to their local fire department for the most frequent and the most affordable CPR lessons. They should make sure that they take CPR with rescue breaths. Before we find ourselves doing CPR, I think it’s very important for families to recognize that if a child is missing, the swimming pool is the most important area to go to first. And if the water is cloudy from chemicals or dark green because it hasn’t been maintained properly, they need to take something that’s very long and push it down into the water and drag the bottom of the pool area. Get the child out immediately, start CPR and call 911.
Nowadays, most families are not using landlines for using cell phones, so it’s very important that you be able to tell 911, where you’re 911 and the fact that I’m here in Arizona, the firefighters and police officers will be there to help you, not to prosecute you. We don’t want families putting their child in the car and trying to find their way to the hospital themselves that really delays their care. So once….
Eric: So that happens quite a bit.
Tiffaney: it does happen sometimes and I haven’t seen scenarios where it’s happening because a family definitely is afraid of the police, but I have seen scenarios where families are just very, very free. They’re very anxious and they’re not thinking clearly and they just want to get some help. So maybe they tried to go to the local fire station or maybe they try to go to the closest hospital down the street. It comes from good intentions. It’s an incredibly intense situation if the child is found in a swimming pool area. So really advising families about what we should do before the emergency happens is very, very important.
Once the EMS providers arrived, they get child to the hospital as quickly as possible and they’re going to do everything that they can to really get the child the most important care and get them here quickly. Our teams will respond for level one trauma facility, so we have an abundance of really wonderful staff and equipment here and we’ll do everything we can to try to bring that child back to a healthy condition. Some children will wear covered completely. Quite a few children will not. We will have some children who suffer a long term neurological impairment and lifelong injury and some children pass away as a result of their injuries. And here in Arizona, that’s about 30 fatalities a year.
Eric: Oh, you may be able to speak to this or maybe not. It might not be your area but what kind of treatments are done to a child in the hospital to try and to bring them back?
Tiffaney: I think that would probably be an area of expertise for a physician.
Eric: Sure.
Tiffaney: Well, my area of expertise is really preventing injury from happening and I provide some resources to families after the incident has occurred.
Eric: So on the prevention side then, if you could wave your magic wand and make every pools as safe as possible what would those goals look like?
Tiffaney: I think I wouldn’t focus on the pool, first, I can focus on the family.
Eric: Sure.
Tiffaney: And I would try to look at that family and find out are they getting the resources that they need to thrive as parents. The American Academy of Pediatrics is actually beginning to ask families about food and security because if the family’s food insecure, it may not be a parent. We may not know what the family’s struggling with poverty. So, we’re talking to families about their ability to fence their pool. Do you have a pool at home? Does it have a fence around it? That’s very important. Second to that, I think it depends upon the family and how I come into contact with them. We have a variety of ways that we interact with families. So we have workshops and we have materials, we have awareness events and we’re doing some research studies.
If I have a casual conversation with the family and an elevator, it’s going to be very brief conversation. I think probably the one thing that I would love to share with any families is what does good supervision look like. And I have a little visual aid for you here. This is called the boss of the pool tag. This is the person who’s in charge of watching children in the water and we have everything in Spanish, English here. We have quite a significant number of families here who may not speak English. So you wear this just like so, the boss of the pool tank goes on to the adult who’s watching children in the swimming pool area and there are some qualifications for the boss of the pool. First of all, it has to be an adult, not a child. You have to be feeling your very best to supervise children in the swimming pool area.
It’s rough to supervise a one to four year old in the pool. This is a really high maintenance age so if you’re not feeling physically, well, if you’re tired that day, it’s not the data go swimming. If you’re stressed out because you just lost your job, probably you’re going to be distracted. If you have had too much to drink, you should not be the boss of the pool. The bosses of the pool should be able to swim so that they can make a rescue. And it’s important for the boss of the pool to be close enough to see the child’s face. If we’re looking back at the child head, we can’t tell if the waters below the chin or above the nose. So the boss of the pool has to be close enough to make a quick rescue for the child, able to see their face, I’ve got another little visual aid here. Here’s my cell phone. A cell phone is a huge distraction for parents, so we really encourage them to turn it off. And the boss of the pool job is very, very boring. So we recommend that families be the boss of the pool for no more than 15 minutes. And then a different adult can supervise the child. You can turn your cell phone back on again when it’s your turn to be the boss of the pool, turn your cell phone off, do the job very well for 15 minutes and onto the next person.
Eric: Yeah. These I like, I haven’t heard that terminology, but yeah, the waterwatch idea and I kind of like, I like the boss or the pool one probably as good as any of the other ones. I think it’s critical, you know, and I’ve seen a bunch of different strategies on how to do it. The lanyards are great. I saw one recently where there was a water watcher chair. It was stuck next to the pool and you know, if the chair was empty, they knew that, there was nobody watching. So the idea was to always have a butt in the chair. Right. But yeah, critically supervision during pool time needs to be, I think each parents should be responsible for watching their own child. But there should be, like you said, one water watcher whose job for 10 or 15 minutes or no, whatever, some 15 minutes, I’m allocation. You decide it should be very clear who is responsible for that time.
Tiffaney: Right. And if it’s a single parent, I tell them that, you know I wouldn’t want to swim for two hours straight with the two year old. You might just want to swim for 30 minutes with the two year old. . And it’s okay if you go out to the pool area and there’s a temper tantrum. Being flexible as a parent is one of the best ways to really roll with the punches and enjoy yourself and build quality memories with your children. So if you go out to the pool area and there’s a giant temper Tantrum at the 20 minute mark, maybe not going to swim for 30 minutes. Maybe I’ll just swim for 20.
Eric: That makes sense, so what does a drowning typically looked like?
Tiffaney: Here in Arizona, what we tend to see is in the pattern, number one, it’s the one, to four year olds who drowned most consistently. And when we look at one to four year olds, what we see is a lot of children who are found in a residential swimming pool. So either a backyard pool, their own home or a relative’s pool or an apartment complex pool. Usually these children are in the care of one or both of their parents. We see many scenarios where there’s more than one adult who is expected to be supervising a child at that time. Here in Arizona, our drownings peak with our hot weather, we begin to get warm really around May and we stay warm through September. So we do see more drownings May through September, but the three worst months for us, our June, July and August.
And we can see patterns related to the day of the week. We see more drownings happening on Friday, Saturday, and Sunday. Or with our leisure time, we see a peak in drowning, it’s around summer holidays, like the 4th of July, Mother’s Day, Father’s Day. We also see a peak in drownings around time of day and we see more drownings that are happening between say 5:00 PM and 8:00 PM or 4 and 7. And these are the Times of day that I would associate with mealtimes for children. When we look at drownings in child fatality review, we often see that a family was in a swimming pool area. They were moving into the house to go and eat their dinner or going prepare their dinner and the child made their way back out to the pool area during that transition. So when we look at our messaging per families, if we’re talking to families about summer safety around barbecues, that’s a really great way to have families understand the highest risk times and how we can prepare an advanced to prevent a drone from happening.
Eric: You talked about educating the families beyond that, what do you recommend the parents to prevent drowning?
Tiffaney: when I work with families, I think a really good example is our playing it safe workshops. So we do one hour free workshops with families with the support of our local utility SRP Salt River Project. And then in these workshops what we’ve done is we’ve taken the pillars of a program called strengthening families, which is designed to reduce maltreatment, but these are pillars that every family needs and should be looking at. And this is increasing parental resilience, understanding child development, reducing isolation, connecting families to resources. So when I talk with families, I’ll talk with them for a full hour in the workshops and we talk about what’s normal for a child in this age group and what stresses you out as a parent and what are you really good at.
As the name implies, strengthening families really looks at your strengths and helps you build up your strengths as a parent. Every parent that I know loves their child and wants to be a good parent. Most parents I know have a sense that they know their children better than anybody else. Whether you gave birth to the child, are you adopted the child when you’re with him day in and day out. The parents of a six month old knows the difference between a hungry cry, a sleepy cry and a trying to get your attention cry, right? So we built from the strength that these families were are really good at what they do and we’d like to help you be better at it. And then we infuse basic water safety into the conversation. For example, the tips that I gave you about good supervision, we bring these tips in the context of um, increasing your social support network.
So when you’re at a swimming pool party, which is very important to spend time with the people who love you and to build your social support network, how can we make sure that water’s safety’s really important? Perhaps you might like to include on white jacket for your children? we are encouraging families to use life jackets in the swimming pool area for children ages one and up to reduce drowning, rescue more, teaching them how to use like jackets, how to fit them properly. And I’m working very hard to make sure that they understand that the level of supervision with a life jacket should be the same as the level of supervision without a life jacket.
Eric: And I imagine the life jacket is only in circumstances where the file doesn’t know. What it’s weird, obviously preferably is swim lessons and swim instruction and before flotation devices had imagined.
Tiffaney: I would say that the family should use the life jacket when they’re swimming in the pool area with their child and they’re not actively working to increase their swim skills. A lot of drownings happen when families are packing your bag in the swimming pool area. They might be in the swimming pool area and aware that the child is in the swimming pool area, but perhaps they’re not in the water with the child so having a family put a life jacket on a child anytime that they have access to the water is very important and take a life jacket off when you were taking the child out of the swimming pool area and closing the gate or perhaps if you’re at a birthday party and there’s no fence around the pool area, take the life jacket off of the child when you put the child in their car seat to go home.
Erica: What other programs is the Arizona Children’s hospital doing? You mentioned the the workshop you mentioned the program just mentioned right now, what kind of other programs is the hospital is putting out this year to try and reduce the number of drownings?
Tiffaney: we have some Toyota water safety kits and I have some materials I can show to you.
Eric: Yeah.
Tiffaney: Let’s see if this will show up on camera. A Toyota water safety kit includes a towel and the towel, the adults to be the boss of the pool. Know who the boss of the pool is. Make sure that that person knows that they’re in charge and help them to understand what we can do to reduce risk for children.
Eric: Which I think, look, looks even cooler in Spanish by the way. But you know…
Tiffaney: Thank you. And then the same information on the bags be the boss of the pool so to take can protect children in the swimming pool area, the Boss of the pool, the Toyota water safety kits do also include the boss of the pool tech, which we talked about. So Toyota kits are distributed to families who have children in the high risk age group and we really concentrate that distribution in areas of high poverty or for families who are struggling with the resources that they need.
And what we also provide free infographics to folks who do water safety here in Arizona, advocates, people who are putting together community events. We also do a statewide purple {Inaudible) campaign in the month of August to raise awareness about child drownings and what we can do to prevent them. And probably our most important role here at Phoenix Children’s hospital is research. Research informs everything that we do. We always start from a strong understanding of the problem. We look at the research and we see how drownings are happening and keep up on the literature. We also have a number of studies that are looking at how we can prevent drownings from happening or we’re looking at the circumstances of drowning. So for example, we have a life jacket study that we’re doing here at the hospital. We worked with families in low acuity settings in the emergency department.
So that means a child who’s coming in with a less minor issue, perhaps they have an ear infection as opposed to a child who’s been involved in a major car crash . For a family who’s visiting for a child who has been running with fever for a few days, that family’s going to have just a little bit of downtime and her ER when there aren’t staff in the room visiting with them about the fever. So we have come into the ER and provided families with water safety education and free life jackets. I have a life jacket here to show you.
So we’re providing families with life jackets like this one. This is a life jacket for a child who’s between 30 and 50 pounds. We did pre and post evaluations and shared information with families. We did follow up phone calls and we found in our preliminary results that it is an effective way to teach families about water safety. We’re also working with A.S.U to do some research studies for staff who are completing their doctorate of nursing, looking at tailored interventions in the emergency department. When we share information with families that is specialized in built just for them, what does that look like in, is it effective? We’re also looking at a project involving anticipatory guidance in well checks, working with staff at pediatrician offices to teach them about water safety, focusing on developmental milestones.
So when a child comes in for one year old {Inaudible} the caregiver will talk to the parents that the provider will talk to the parent about one year old is your child walking? Is your child using words? These are the vaccinations that you should have. This is what your car seat should look like. We’re teaching staff to also include water safety information for the parents of that one year old. Your child is just beginning to walk and gosh, one day they can hardly stand up and walk. And the next thing you know, what they’re running. So it’s very important that you think about your pool gate and what’s your program looks like and does it self-close itself, latch properly.
Eric: And that’s great. You know Kerry Morrison was a friend of mine and she started live like Jake, which is a nonprofit beef here in Florida, but they do work throughout the country. She put out a pullout and informal, but she had, I want to say 42 responses or maybe a couple thousand people. And she found that 85% of them reported that their doctor, or pediatrician, did not ask them about pool safety if they had a pool and advise them on water safety. So the idea that only 15% of doctors are dispensing any kind of water safety advice to their patients, really took me by surprise. I thought it’d be low, but not quite that low so I’m glad it’s happening in Arizona.
Tiffaney: Yeah, I think you, Phoenix Children’s hospital is an injury free coalition for kids site. This is a national organization that works to reduce injuries for children. As the name implies and working through injury free coalition, we’re actually able to connect with physicians, pediatricians, staff who do both reactive care when a child is injured and that proactive well-check care. And what we’re seeing is that pediatricians do receive training on what they should share and pediatricians do want those well checks to be informative and they need to be using the most current information that they can possibly use. But in today’s healthcare system, the obligations and the expectations that are built into that well-check maybe have become too much for the average well checked to really include the information. But if we work with the pediatrician’s office our nurse practitioner students did lunch and learns for staff at pediatricians offices, came out, visited with them, talk them about water safety and gave them just a few tips and some resources that they could share in the wellcheck .
We’re hoping the results will show that pediatrician offices and the caregivers in those offices will be able to include more water safety. I think first you need to seek to understand then to be understood. So when we look at what’s happening in the pediatrician’s offices, we really need to connect with those professionals and find out what’s going on in that office and what can they do and what can’t they do. And that’s where public health is a very important bridge. Working with people in the healthcare system and trying to find common ground and ways that we can work together to reduce child he uses is probably the most promising focus in the future.
Eric: And beyond just measuring the number of drownings that are happening each year, how do you go about measuring the success of the programs, the drug money?
Tiffaney: That’s a great question. We work very hard to evaluate and assess all of our programs. First of all, we do monitor the child drowning rate and we’d began to look at hospitalization data. Hospitalization data is available here in Maricopa County and it looks as if our hospitalization rate maybe almost three times as high as the national average. So it’s very important to understand the fatalities and the injuries as well. A good example is our Toyota water safety kits. When we share kits with families, we ask them just a few quick questions, how many kids live in your home? Which zip code do you live in? And I asked parents, when you’re in the swimming pool area, where’s your cell phone? It can be in your hand, it can be in your bag or it can be in your house. Where do you like for your cell phone to be?
And families will look at me like, why is this strange lady asking me this question? But it’s really a conversation starters. So if a family wants to have their cell phone in their hand, why? Do they want to have their cell phone in their hand because they want to take pictures of their child? I personally have very Instagram worthy children and I would love to your pictures up on Instagram, but maybe while I’m swimming with them I can hold off on doing that. Or maybe I can have a second adult take those pictures and then I can have a conversation with the person about how important it is to have really good supervision in the swimming pool area. For playing it safe workshops, we do a pre and post assessment and we ask parents questions about their beliefs about risk and what stresses them out in the pool area.
The other thing that we work very hard to do is I have the parent walk away feeling better about themselves as a parent. We ask parents, are you a good parent and could you be a better parent if you connected with friends and family and do you have a plan for that? And what we see is from the pre to the post, the families are feeling better about themselves as parents because they do see that they’re working hard on some things. They also see a path forward that they can become a better parent. In the case of our life jacket research study, we did follow up phone calls with the parents and we asked them, did you use your life jacket? Did you go swimming? If you went swimming and you didn’t use your life jacket, what made you decide not to use it? And how do you think that this program overall has helped you to reduce child drowning risk? Or how is it not helped at all? So constantly asking the parents for feedback, constantly listening to parents about what their struggles are is very, very important. Because parenting a two year old today is not the same as it was 5 years ago, 10 years ago, 15 years ago. Everything is rapidly changing for parents. So we really need to understand their perspective and listen to them.
Eric: So the media is really good at educating the public about some threats, right? A peanut butter went bad and we all knew about it. Right? You know, Romaine {inaudible} had a scare for a minute and everyone and their cousin you about Romaine but those threats are relatively minor compared to the threat that drowning is to children. Drowning is the number one, literally the number one causes the other than feel desperate one and four, but yet it doesn’t seem to get the attention, did a lot of other things do that are at least it’s statically not nearly as big of a deal. Why do you think that is and what do you think we could do to maybe do a better job of that?
Tiffaney: Oh, here in Arizona, our local media are very keyed into the issue and when a submersion occurs and a child has to be transported to the local hospital, there’s a pretty good chance that the media will cover that. Here’s the challenge with using media as a tool to reduce injury. First of all, it’s not a research based method, When we look at programs to spend dollars on media coverage, let’s say PSA”s. When you look in the medical literature, we haven’t necessarily proven that media coverage can effectively reduce injuries. So perhaps we should look at media as a helpful resource to us, but not as an educational tool, if it’s a helpful resource to us, what can we share with families when a drowning occurs? The challenge can be a reporter’s day is incredibly packed and a reporter who’s in a vehicle driving around covering stories in a place like Maricopa County, Arizona, they’re going to cover six stories in one day and they have to package all those stories by 3:00 PM. And many of those stories, they will have come across the issue for the very first time because there’s so much happening in a city the size of Phoenix. So that reporter may not have the resources to really do an in depth analysis and talked to the viewer about what they need to know about child drowns. So if the staffing isn’t adequate for really deep, deep coverage, what you’re going to see is a piece that tells us that a two year old was taken from a swimming pool and Glendale, Arizona, she was in the care of her mother. She was taken to a little local hospital and she’s critical and then boom, we’re off to weapon if we wanted to do more effective use of the time when we’re more watching TV and when we’re putting together TV spots. Maybe we should talk about two year olds and what they’re like developmentally, a two year old girl was found in a swimming pool today.
Did you know that two year olds don’t know the difference between real and make believe? And this is an age where children, maybe they just don’t have the self-control to listen to mom and dad and staying in their room during nap time. So this very scary incident is a great lesson to all of us to make sure that when it’s nap time, the entire houses is secure. If you have a security system on your home and it’s nap time and you’re very tired, you want to take a nap yourself, turn your house alarm on so that if the two year old tries to leave the house to go to the swimming pool area, the house alarm will wake you up. And is there a doggy doing home? Did the child make their way out the doggy door? Let’s try to secure the doggy door in a way that the child cannot get through. So trying to take incidence and learn more from them and put better coverage together may help us educate the public. But media coverage is not a research proven method to reduce child injury. What we really need to do is have evidence based programs that measure and target those who are highest at risk for injury.
Eric: No, and that makes perfect sense. You know, I’m like, no, I always do that. They do a really good job of getting some information out there but it seems for whatever reason they gloss over really the biggest threat. And I feel like it’s a constant struggle to try and get a bigger spotlight on what they should be focusing on. You know? But that may be a, a battle uphill. It’s not worth having also. Yup.
Tiffaney: Well, I think that you know, local reporters here, one of the things that we don’t discuss very often in the news is the way that drownings attract reports. When reporters have to cover child drownings, it’s very difficult for them. And they understand full well that the last thing in the world that the family wants to do is talk with a reporter about what happened. But it’s their job to tell the community about newsworthy things that are happening. So that reporter needs to share what happened, that reporters on a very traumatic scene and you’re doing the very best that they can to cover the issue in an educational and informative way. We have to think about what we can do for that reporter to help them do their job efficiently and have them share information with families.
Eric: Where do you think water safety, either it is headed or needs to head in the future?
Tiffaney: when I think about the future of water safety, I think it’s very important that we commit to research as a nation. If we want to really reduce child drowning injuries we need to ask more questions and ask them in a way that we can prove the conclusions. So looking at the circumstances, drowning in the populations who are highest risk for drowning, why are they highest risk and what is happening? A good example is the swim ability rate looking at ethnicity or race and ethnicity. We are well aware in this country that African Americans may not swim at a level that is quite as good or quite as you may not find strong swim skills quite as frequently in the African American community as you do in other communities. This is well known and they’re strong work being done and should be done to address this.
But we may not have asked the same question about Hispanic families or Hispanic families at greater risk. Do they swim at a less frequent rate than their peers? so we need to do strong research and understand that we also need to look at programs that are built to prevent injury and either conduct research with those programs or demand really strong evaluation of those programs so that when money goes into injury prevention across the nation, we can prove a return on investment and spend as much time and money efficiently working to prevent drowning as we possibly can. I also think it’s very important that we target the vulnerable populations, really look at the populations who are greatest at risk. If I’m in the shopping mall on Saturday afternoon, every family should talk about water safety, but those who have a one to four year old pop to the front of the list for me.
And then you begin to look at families who have a swimming pool at home. Families who maybe are struggling with aces, working with communities who have aces and working to get prevention information into the hands of families who are struggling with high stress is very important. So some of the playing it safe workshops that I do, I may be doing an empty domestic violence facility or at a facility helping adolescent parents as they learn to parent their children. I may be working in a homeless facility. Because a lot of families who are homeless won’t be living in their car fulltime. Sometimes they’re going to crash on someone else’s couch, sometimes they’re going to wind up in an apartment complex that might have a swimming pool. So getting information into those vulnerable populations is very, very important. And finally, replication, learning what’s working and scaling it up, connecting with strong programs with strong programs so that we can scale up and continue to do more of what does work and take an honest look at what does not work and stop doing that.
Eric: That’s perfect. And I think we can kind of wrap up there. Is there one more thing that you want to let people know before we finish here?
Tiffaney: I want to thank you for talking about the subject of water safety and for giving it a longer deeper dive into it and for informing families about it. I really appreciate it.
Eric: Oh, well thank you. We try and, nope. I’ve been doing this for over 20 years now and I’m glad that it feels like we’re getting maybe a little bit more of a critical mass, especially with social media and, you know, we have the ability to reach people on our own, you know, without the media. So I have a lot of hope for the future when it comes to educating the public on water safety. And I appreciate your part in that. We have a friend in common, I think, I’m sure you know Melissa Sutton in Arizona there.
Tiffaney: Yes. Yes.
Eric: She’s fantastic. I’ve known her for years. She’s great. So thank you so much. How can folks find out more about the Arizona Children’s hospital or the Phoenix Children’s center and in the hospital there and the work you’re doing and you know, get those resources. How do they find you?
Tiffaney: go to Phoenix Childrens.com and you’ll find for water safety resources on the website and the Twitter feed for the Center for family health and safety is kids stay safe.
Eric: Perfect. Awesome. Well, thank you so much. I really, really appreciate it.
Tiffaney: Thank you.
Eric: I am going to count on you to do the Lifesaver Challenge video, which takes exactly 14 seconds if you do a selfie style. So it’s not a big deal and I look forward to that, but thank you Tiffany. I really appreciate it.
Tiffaney: Thank you.
Eric: Alright, goodbye everybody. Thank you all so much and have a great, what’s today? Monday? Yeah,
Tiffaney: Monday.
Eric: Oh, Monday.
