ABSTRACT
Background: Motor vehicle crashes (MVCs) remain the leading cause of death for Kentucky children above age 1. The Nest has four separate non-profit programs that provide respite child care, legal/psychological support services to survivors of intimate partner violence, parenting classes, and crisis assistance to families (toiletries/cleaning-supplies/papergoods/diapers/formula/food/rental-assistance since COVID, serving more than 400 clients per month). Community need for car seats was previously demonstrated by the 57 used seats they distributed in a year. Methods: Standard national Child Passenger Safety (CPS) checkup forms were utilized, with an Excel data base of seats provided/notes of special circumstances/problems with seats/cars. Forms from October 1, 2020 to July 1, 2021 were reviewed for quality improvement at least monthly, with immediate adjustments as necessary. All education and seat installation occurred outdoors during fall months and on all but the coldest winter days. Staff and families were masked, items used were sanitized and meticulous hand washing was done between families due to COVID. New convertible seats from grants were supplemented with individually- purchased harnessed booster seats to serve older children and with current (never-in- crash, not -recalled) donated infant seats. CPS services were conducted in 4 languages (English, French, Spanish and Arabic) with fluent staff or consenting family members as translators, and were offered both by appointment/previous consultation/referral from Family Assistance and as walk-ins requesting help or were observed to have car-seat/booster-sized children. Results: A small program that distributed seats as commodities without instruction or assessment of child/car was revised into a formal CPS fitting station, addressing difficult cars, large families, grandparents raising grandchildren, and resettled international refugees. Approximately 90% of families had annual family incomes of < $20,000/year, many below $10,000. Almost every consult for one child revealed multiple children in need of car seat education or new seats. More than 150 seats were checked in nine months. Types of misuse (in >90%) seen include: no seat, child too loose in seat, seat too loose in car, use of infant seats facing forward for too-big toddlers, premature use of no-back boosters (NBB) for small young children when family has no money for harnessed seats or at the mis-direction of a medical professional. Families that live in high crime areas with car theft are bringing in car seats at night so need lighter weight ones, as do grandparents. Conclusion: Taking CPS to the parking lot of an established non-profit has permitted us to reach more families with great need in a place they trust. Types of misuse have provided a real-world window into the potential optimal timing/messages of CPS within pediatric anticipatory guidance, and families have shown how our anticipatory CPS guidance may need to be adapted to work in the environment that people actually live in.