Skip to main content
  • Original research article
  • Open access
  • Published:

Keeping our children safe: piloting a hospital-based home-visitation program in Israel



Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families’ home-safety.


The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the ‘Beterem’ checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of each visit.


352 of 773 eligible families agreed to be contacted. 135 participated, 98 completed both home visits. Significant improvement in home-safety items was observed 4 months after the first visit (14 [IQR12-16]) vs. (17 [IQR15-19]; p < 0.001), accompanied by an overall increase in home safety (Mean ± SD 71.9% ± 9.5% vs. 87.1% ± 8.6%; p < 0.001). 64% reported greater awareness of dangers, 60% affirmed home was safer, and 70% valued the equipment. No difference was found in the prevalence of injuries (14 of 98 families prior and 8 after the visit; p = 0.17). Home visitors reported benefiting from the experience of working with disadvantaged families.


The program, which included recruitment in a hospital emergency setting and use of healthcare students as home visitors, was successfully implemented and accompanied by significant improvement in home safety with a non-significant trend of child injury decrease.


Unintentional injuries are one of the leading causes of childhood morbidity, disability and mortality worldwide [1,2,3]. It is the fifth leading cause of death for children under 4 years old in the USA [4] and the third in Israel [5]. Risk factors for child home injuries have been investigated and shown to relate to family characteristics such as ethnicity [6], low socio-economic status [7], and lack of parental supervision [8]. Child characteristics include boys [1], age less than four years [8], and disorders of hyperactivity [9]. In Israel, Arabs and ultra-Orthodox Jews are at higher risk for child injuries [10].

Various educational interventions for parents have been developed over the years. One well-studied approach is home-visitation, focusing on parental education for home safety practices and the use of safety devices [11]. Examination of the literature shows conflicting findings in terms of impact. In some cases, a significant reduction in child injuries was found [12, 13], while in others it was not [14, 15]. Likewise, some studies showed a significant improvement in home safety [16, 17], while others did not [18, 19]. There have been attempts to explore why results are discrepant [20,21,22], but no clear indicators for success have emerged. Outstanding questions remain such as the relative benefit of recruiting in the community or hospital settings, the optimal number of visits, and qualifications to conduct home visits.

Given the inevitable limitation of resources, it makes sense to target families most at risk for recurrent injuries [23]. One way to do so may be to base interventions in the hospital where children with more severe injuries are more likely to be captured, yet exploration of the literature shows that most interventions are community-based, delivered through primary care clinics or children's centers [24, 25]. Only six hospital-based interventions have been described [17, 19, 26,27,28,29]. Of these, four took a focus on preventing child injury [19, 26,27,28]; two used home-visitation guidance- one, the largest, contacted families some days after arrival at the hospital for an injury [28], and one contacted families from logs of a pediatric residency continuity clinic [26]; two recruited at the time of attendance but offered guidance in the Emergency Room alone [17, 27]. Only two studies focused on home safety and/or injury prevention as well as being designed as hospital-based interventions using home visits [26, 28]. Their results were inconclusive with no significant change in child injury rate [28], and either minor changes in home safety practices [28] or no change at all [26].

We developed and implemented a home-visitation intervention for families recruited in the Emergency Department at the time of presenting with a pre-school child for a non-intentional child injury. It was delivered through Ziv Medical Center in the Galilee, Israel’s northern periphery, a region that is home to diverse populations and has amongst the highest rates of child injury in the country, particularly in the ultra-Orthodox Jewish and Arab sectors [10]. We hoped that by targeting families at risk and high need for home safety education we could create a model that would be of value elsewhere. This paper is part of a larger study that assessed the implementation process of SHABI in the hospital setting using the Consolidated Framework for Implementation Science [30]. We describe here the intervention and evaluation of its pilot year examining the impact on home safety.


The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program

SHABI aims to reduce the recurrence of child injuries by intervening with families who present to a hospital Emergency Department with a preschool child who experienced an unintentional injury at home. Home visits are conducted by trained home visitors within two weeks of the injury and again four months later. The visit involves a tour through the home with parents’ approval, and the installation of safety equipment. It includes cooking and eating areas, storage and use of detergents, pesticides and medicines, the bathroom, the electrical system, bedroom and living areas, balconies and stairs, rooftops and outdoor spaces. The safety of each area is checked, and any concerns and solutions are discussed, encouraging the parents to make suggestions for reducing hazards. A safety kit that includes a smoke detector, electric socket covers, locks for cupboards, and door stopper is provided, and help is offered to install the components. Two months later, the home visitor contacts the family by phone, offering further guidance and answering any questions. A second home visit is conducted four months after the first, and includes an additional tour of the house.

Following the outbreak of the COVID-19 pandemic in March 2020 and in accordance with Ministry of Health instructions, recruitment was suspended and the remaining second visits were conducted by telephone, rather than by a physical visit.

Training of home visitors

Eleven nursing and medical students, were trained to carry out home visits and were paid a modest stipend per visit. The training involved five sessions over eleven months, namely:

  • Two sessions on the epidemiology of child injury, unintentional injury prevention, home-visiting practice, and relationship-building skills. The sessions were taught by a coach from ‘Beterem- Safe Kids Israel’- a non-profit organization that promotes child safety [31]

  • A session on the Arab community with cultural competent guidance on how to adapt the visit, e.g. initial contact with the husband to get permission to arrange a visit with his wife. The session was led by two social workers, one the head of social services in a local Arab village

  • A session on the ultra-Orthodox Jewish community with cultural competent guidance on how to adjust the visit to their needs, e.g. incorporating child injury stories as media exposure is restricted. The session was led by a local ultra-Orthodox Rabbi

  • A session on conducting the second visit by telephone because of COVID-19 restrictions


The pilot was delivered from May 2019 until March 2020, with the recruitment of families through the pediatric Emergency Department at Ziv Medical Center, which is located in the city of Safed in Israel’s northern periphery. The hospital's catchment area includes 170,000 residents, of whom 10% are 0–4 years old, and 21% are non-Jewish [32]. Safed and surrounding towns and villages rank low in socio-economic status [32], with a high proportion of ultra-Orthodox [33] and Arab [32] residents. The hospital is characterized by higher admissions, mortality and attendance rates for unintentional child injury than elsewhere in Israel [10].

Recruitment of families

The Emergency Department nursing team recruited families during their visits to the hospital with an injured child. All ten nurses were trained at a session that included an explanation of SHABI and its inclusion criteria, namely children aged 0–5 years presenting with a home injury; residence in the hospital’s catchment area; and competence in spoken Hebrew. The intention was to recruit 100 families within a year.


The study evaluated home safety, families’ awareness of hazards, and both families’ and home visitors’ views regarding the visits’ usefulness. Outcome measures from the first and second visits were compared.

Home safety environment

The home was evaluated using a checklist developed by ‘Beterem’ [31], and based on evidence regarding injury prevention [34, 35]. It includes 30 items divided into different areas of the home (safe/unsafe), which the home visitors completed with the family during the tour. The questionnaire did not undergo a formal validation process, but has been extensively used by Beterem trained staff in various ethnic sectors as well as in disadvantaged families, and has high internal consistency (0.8 using the KR-20 exam) [36].

Awareness of child home hazards

Families' awareness of dangers in the home was assessed through an open-ended question administered by the home visitor at the start of each visit. It included an open question adapted from Kendrick and colleagues (1999) [37], regarding their perceptions of significant dangers in the home and was chosen following review of published tools assessing awareness, as well as personal contact with researchers in the field.

Reported child injuries and families' views

Families' self-report on any injuries requiring medical care (primary or secondary) for their 0–5 year old children was examined through a questionnaire developed for this study as no relevant tool was found in the literature, and administered by the home visitor. Reporting was limited to four months before the first visit (excluding the index injury) and four months after the visit. Families' views regarding SHABI were evaluated through brief telephone interviews conducted after each visit by a researcher (LS). The interview included five questions, using a Likert scale of 1 (strongly disagree) to 5 (strongly agree). The questions assessed the contribution the safety equipment and the visit made to the safety of the home, new knowledge and awareness of home safety, as well as a yes/no question regarding recommending SHABI to friends. An open-ended question after the second visit asked about any difficulties in implementing the safety recommendations. Telephone interviews were recorded and transcribed.

Home visitors' views

Home visitors' views were evaluated through a questionnaire developed for this study, regarding their views on the usefulness of the visit to the family (1—strongly disagree, 5—strongly agree), and an open-ended question about their general views of the visit.

Data analysis

Analysis of the checklist included data regarding safe and unsafe items per family, as well as relevant and irrelevant items (according to their presence in the house e.g. absence of a porch, or access to roof or items related to child age e.g. supervision during eating for children under four years, but irrelevant for a family with older children). Home safety percentage was calculated as the percentage of safe to relevant items per family. The change in home safety over 4 months was calculated by comparing home safety percentage at the second home visit with that found at the first home visit. Lastly home safety change was analyzed when data was collected through direct observation during the second home visit compared with data collected by telephone ‘visits’ due to COVID-19 restrictions.

Quantitative data was analyzed by SPSS (version 25.0). Descriptive statistics were used to describe the characteristics of the participants and the distribution of the content analysis on open-ended questions [38]. All normally distributed data were analyzed using unpaired or paired t-test. Data found to be non-normally distributed were analyzed using Mann–Whitney U test for independent subgroup, and Wilcoxon test for dependent subgroups. Comparisons of percentages between different groups were analyzed using X2. Close-ended questions using Likert scale responses were grouped as negative (1–2), neutral (3) or positive (4–5).

Qualitative analysis was conducted utilizing the theoretical and conceptual framework of CIFR (Consolidated Framework for Implementation Science [30]. The qualitative findings were categorized according to these constructs and explanatory content analysis [38].


Recruitment (Fig. 1)

From May 2019 to March 2020, a total of 773 families met the program's eligibility criteria for participation, of whom 487 (63%) were approached by nurses; 352 agreed to be contacted by the service. 135 families agreed to participate and completed the first visit, and 98 the second visit. No significant sociodemographic differences were found between families approached and not approached in the Emergency Department, nor between families agreeing and refusing to participate.

Fig. 1
figure 1

Flow chart of Emergency Department attendance for child injury and recruitment to SHABI

Sociodemographic characteristics

Table 1 summarizes the socio-demographic characteristics of families who completed one visit and those who completed both visits. Fifty percent were ultra-Orthodox Jews and 11% Arab. A high proportion had < 12 years education and a third were unemployed. 28% of families had three or more children under the age of five. Only 6% of parents lived in separate households. Significantly less Arab families completed both visits and there was a trend for the less educated and unemployed to omit the second visit. No other significant differences were found between families who completed SHABI and families who had only one visit in terms of other sociodemographic characteristics and outcome measures.

Table 1 Sociodemographic characteristics of participating families in SHABI (n = 135)

Home safety environment

Figure 2 compares home safety assessed by the checklist at the first and second visit. A significant improvement was found in both safe items and unsafe items (Z = − 7.97, p < 0.001; Z = − 8.36, p < 0.001).

Fig. 2
figure 2

Median score of safe and unsafe checklist items in families who completed both visits (n = 98)

Individual checklist items were compared between the two visits (Table 2). Families appeared to readily adopt some behavioral recommendations such as keeping detergents and hot drinks out of children's reach, although were less likely to keep medicines out of reach or use back stove burners. Families also managed to adopt some structural recommendations such as installing safety equipment, but were less likely to install window bars and stair rails.

Table 2 Families' changes to the home and barriers they reported in implementing safety guidance (n = 98)

Significant improvements in home safety were found in the category of falls, burns and scalds, poisoning, and choking/suffocation, but none for electrocution, drowning or car injury. In some, change was not possible due to high baseline safety rates. On telephone interviews, most parents saw the recommendations as necessary but found some difficult to apply due to time constraints; impracticality; requiring help from others; or cost. Other items were beyond families' control requiring landlords’ permission to make changes, or there was reluctance to invest in a house they did not own. A few recommendations were perceived as unimportant or not dangerous.

When expressed as percent safety of the household (excluding irrelevant items) there was a highly significant improvement (Mean ± SD 71.9% ± 9.5% vs. 87.1% ± 8.6%; t = -16.27, p < 0.001). No significant difference was found between home safety percentage delta improvement for families who completed the second visit via face-to-face contact (n = 55) and those who received a telephone call due to COVID-19 restrictions (n = 43) (Mean ± SD 14.9% ± 10.1% vs. 15.4% ± 8.1%; t = -0.99, p = 0.27).

Awareness of child home hazards

Parents were asked at the start of each visit about the greatest dangers that children are exposed to in homes. Of the 98 families who completed both visits, there was strong awareness of falls (91 in the first visit vs. 79 in the second visit) and burns (54, 57), with few citing animal injuries (1, 2) or heatstroke in cars (0, 1). The number of categories reported by families at baseline was significantly higher than at follow up (Mean ± SDd 2.85 ± 1.19 vs. 2.11 ± 1.57; t = 5.25, p < 0.001).

Families' views and reported injuries (Table 3)

Most parents reported high satisfaction with SHABI, its contribution to home safety and the safety equipment provided, after both visits. Only one third reported learning new knowledge at the first visit, and this reduced further at the second visit. By contrast, 64% reported raised awareness about home safety at the first visit, with a significant reduction to 44% at the second visit. After the first visit 122 (95%) of families said they would recommend SHABI to friends or family and this increased to 88 (98.9%), after the second visit.

Table 3 Families' views about the contribution of SHABI following the first and second visits (n = 135)

Families reported on child injuries requiring medical care (primary or secondary) four months before participating in SHABI and four months later. Excluding the index injury, 14 of the families who completed both visits reported an injury prior to the first visit, while only eight reported an injury following the second visit. The difference was not significant (p = 0.17).

Home visitors' views

Home visitors reported that they felt that 69% of the first visits and 74% of the second visits were useful or very useful. They also commented that the visits to ultra-Orthodox and Arab homes increased their understanding of cultural and religious groups with whom they had little familiarity.


This study describes the pilot of a hospital-based child injury intervention involving home visits and its impact on home safety. The findings indicate success in recruiting families in a hospital setting at the time of presenting with an injury, and positive results in terms of improvement in home safety and reported behavior change. Families affirmed that home safety was improved, their awareness of dangers enhanced and they appreciated the safety equipment. The study contributes to the field of injury prevention in demonstrating that recruitment of at risk families in the emergency setting is feasible, and that medical and nursing students can be trained to conduct home visits. The results suggest that improvement in home safety occurred four months following a single home visit, along with a non-significant decrease in the occurrence of child injuries.

Our hypothesis that families would be receptive to the idea of a home safety visit at the point where one of their children had incurred an injury was confirmed. Our target of 100 families, many of whom could be designated as high risk, was well exceeded. The feasibility of using a busy Emergency Department for this purpose is important as it may have relevance to other public health interventions, particularly in countries like Israel, where there is a limited interface between hospital and community [39, 40]. A literature review revealed only one hospital-based study that involved home visits following an injury, but recruitment of families occurred some days after attendance [28]. Another study recruited at the time of injury but guidance took place in the hospital and outcomes were based on families’ reports rather than observation [17].

The challenge for any public health interventions lies in achieving behavior change and not simply increasing knowledge [41]. This is evident in some child injury prevention trials, where knowledge about home safety increased but with only partial or no change in behavior [13, 16, 28, 37]. SHABI families, by contrast, reported a little gain in their knowledge levels, but more importantly did make improvements to the home which were observed four months following the first home visit.

The home visit checklist was core to the intervention. Its strengths lay in the way it created an educational guide for a visit, as well as a relatively objective way of assessing the home. Used sensitively, it provided a systematic but non-threatening structure to the visit, while allowing the collection of data. It also highlighted the difficulty of preventing child injury when living in rental accommodation, consistent with the qualitative findings by Smithson and colleagues (2010) in their systematic review [21]. The provision of safety equipment added to family participation, and was still appreciated four months after the first visit, although it is noteworthy that safety-equipment-based interventions have not been shown to help reduce injury rates [11, 42, 43].

The literature is unclear about the optimal number of visits required to improve home safety. Interventions range from two visits [28] to weekly visits over 18 months [18], with conflicting findings for home safety improvement and child injury reduction. Two trials utilizing a single visit failed to significantly improve home safety practices or recurrence of injuries [26, 28]. Indeed, although both families and home visitors felt they were of value, the added benefit of the second visit is unclear.

Our study utilized pre-clinical medical and nursing students as home visitors trained in child injury and cultural competence. Others have also employed non-professional home visitors [14, 15]. We found that the use of healthcare students had several advantages. Not only were costs kept to a minimum, but the experience exposed them to cultures they had not previously encountered in any real sense and helped change preconceptions. This may well impact on their cultural competence when working with disadvantaged populations.

There are limitations to our study. As a pilot study there were no controls, so no definitive conclusions can be made about effectiveness. Its primary outcome, home safety, was measured by observation through a checklist which also provided valuable structure to the intervention. However, it was completed by the home visitors so there was possible potential for bias. Unfortunately, sub-group analysis by ethnic group was not possible due to the small sample size for each individual group. It was reassuring that interviews conducted by an independent researcher confirmed parent's perceptions that home safety had increased. Lastly, change in injury rates, like in other studies, was calculated from family reports rather than medical records.


SHABI proved to be a promising intervention. Recruiting in an emergency setting proved feasible, and showed that the traditional gap between hospital and community care could be bridged. We found that using health-profession students was successful. A larger sample size is required to demonstrate if the occurrence of injuries is decreased significantly and sustainably by this type of program. Ultimately a randomized controlled trial is needed to ascertain the extent of SHABI’s effectiveness.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



‘Keeping our Children Safe; In Hebrew: SHomrim Al BetIchut Yeladenu


  1. Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman AF, et al. World report on child injury prevention. Geneva: Switzerland; 2008.

    Google Scholar 

  2. Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Inj Prev. 2016;22(1):3–18.

    Article  Google Scholar 

  3. Ghailan K, Almalki MJ, Jabour AM, Al-Najjar H, Khormi A, Magfori H, et al. Children domestic accidents profile in Jazan Region, a call for new policies to improve safety of home environment. Saudi J Biol Sci. 2021;28(2):1380–2.

    Article  Google Scholar 

  4. World Health Organization. Distribution of causes of death among children aged < 5 years (%). 2020. Accessed 27 Nov 2020.

  5. Goldberger N, Aburbeh M, Haklai Z. Leading causes of death in Israel 2000-2018. 2021. Accessed 1 Apr 2021.

  6. Schwebel DC, Gaines J. Pediatric unintentional injury: behavioral risk factors and implications for prevention. J Dev Behav Pediatr. 2007;28(3):245–54.

    Article  Google Scholar 

  7. Heng JS, Atkins J, Clancy O, Takata M, Dunn KW, Jones I, et al. Geographical analysis of socioeconomic factors in risk of domestic burn injury in London 2007–2013. Burns. 2015;41(3):437–45.

    Article  Google Scholar 

  8. Phelan KJ, Morrongiello BA, Khoury JC, Xu Y, Liddy S, Lanphear B. Maternal supervision of children during their first 3 years of life: the influence of maternal depression and child gender. J Pediatr Psychol. 2014;39(3):349–57.

    Article  Google Scholar 

  9. Alnababtah K, Khan S, Ashford R. Socio-demographic factors and the prevalence of burns in children: an overview of the literature. Paediatr Int Child Health. 2016;36(1):45–51.

    Article  Google Scholar 

  10. Falek A, Orr D, Kalif E. In Hebrew: child injuries in Israel: Beterem national report 2020. 2020.

  11. Kendrick D, Young B, Aj M, Ilyas N, Fa A, Nj C, et al. Home safety education and provision of safety equipment for injury prevention (review). Cochrane Database Syst Rev. 2012;9.

  12. Fergusson DM, Grant H, Horwood JL, Ridder Elizabeth M. Randomized trial of the early start program of home visitation. Pediatrics. 2005;116(6):e803–9.

    Article  Google Scholar 

  13. Johnston BD, Huebner CE, Tyll LT, Barlow WE, Thompson RS. Expanding developmental and behavioral services for newborns in primary care: effects on parental well-being, practice, and satisfaction. Am J Prev Med. 2004;26(4):356–66.

    Article  Google Scholar 

  14. Swart L, van Niekerk A, Seedat M, Jordaan E. Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial. Inj Prev. 2008;14(3):164–9.

    Article  CAS  Google Scholar 

  15. Odendaal W, Van Niekerk A, Jordaan E, Seedat M. The impact of a home visitation programme on household hazards associated with unintentional childhood injuries: a randomised controlled trial. Accid Anal Prev. 2009;41(1):183–90.

    Article  Google Scholar 

  16. Llewellyn G, McConnell D, Honey A, Mayes R, Russo D. Promoting health and home safety for children of parents with intellectual disability: a randomized controlled trial. Res Dev Disabil. 2003;24(6):405–31.

    Article  Google Scholar 

  17. Posner JC, Hawkins LA, Garcia-Espana F, Durbin DR. A randomized, clinical trial of a home safety intervention based in an Emergency Department setting. Pediatrics. 2004;113(6):1603–8.

    Article  Google Scholar 

  18. Barlow J, Davis H, McIntosh E, Jarrett P, Mockford C, Stewart-Brown S. Role of home visiting in improving parenting and health in families at-risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation. Arch Dis Child. 2007;92(3):229–33.

    Article  Google Scholar 

  19. Kemp L, Harris E, McMahon C, Matthey S, Impani GV, Anderson T, et al. Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial. Arch Dis Child. 2011;96(6):533–40.

    Article  Google Scholar 

  20. Nicks SE, Weaver NL, Recktenwald A, Jupka KA, Elkana M, Tompkins R. Translating an evidence-based injury prevention program for implementation in a home visitation setting. Health Promot Pract. 2016;17(July):578–85.

    Article  Google Scholar 

  21. Smithson J, Garside R, Pearson M. Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research. Inj Prev. 2010;17(2):119–26.

    Article  Google Scholar 

  22. Myers V, Orr D, Vered-Chen L, Baron-Epel O. Design and implementation of a multifaceted injury prevention intervention in Bedouin children in southern Israel. Inj Prev. 2021;28:1–6.

    Google Scholar 

  23. Sever A, Essa-Hadad J, Luder A, Weiss O, Agay-Shay K, Rudolf MCJ. Keeping children safe: a model for predicting families at risk for recurrent childhood injuries. Public Health. 2019;170:10–6.

    Article  CAS  Google Scholar 

  24. Bass JL, Christoffel KK, Widome M, Boyle W, Scheidt P, Stanwick R, et al. Childhood injury prevention counseling in primary care settings: a critical review of the literature. Pediatrics. 1993;92(4):544–50.

    Article  CAS  Google Scholar 

  25. Phelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP. A randomized controlled trial of home injury hazard reduction: the HOME injury study. Arch Pediatr Adolesc Med. 2011;165(4):339–45.

    Article  Google Scholar 

  26. Gielen AC, McDonald EM, Wilson MEH, Hwang WT, Serwint JR, Andrews JS, et al. Effects of improved access to safety counseling, products, and home visits on parents’ safety practices: results of a randomized trial. Arch Pediatr Adolesc Med. 2002;156(1):33–40.

    Article  Google Scholar 

  27. Woolf A, Lewander W, Filippone G, Lovejoy F. Prevention of childhood poisoning: efficacy of an educational program carried out in an Emergency Clinic. Pediatrics. 1987;80(3):359–63.

    Article  CAS  Google Scholar 

  28. King WJ, Klassen TP, LeBlanc J, Bernard-Bonnin A-C, Robitaille Y, Pham B, et al. The effectiveness of a home visit to prevent childhood injury. Pediatrics. 2001;108(2):382–8.

    Article  CAS  Google Scholar 

  29. Armstrong KL, Fraser JA, Dadds MR, Morris J. Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomized controlled trial. J Paediatr Child Health. 2000;36(6):555–62.

    Article  CAS  Google Scholar 

  30. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):1–15.

    Article  Google Scholar 

  31. Obtained by “Beterem- Safe Kids Israel”. 2021. Available from: Accessed 25 Oct 2021.

  32. Israeli Central Bureau of Statistics. In Hebrew: municipalities in Israel: Data files for processing in 2018. 2020. Accessed 27 Oct 2020.

  33. Cahaner L, Malach G. In Hebrew: the yearbook of ultra-Orthodox society in Israel 2019. Jerusalem: The Israel Democracy Institute; 2019.

    Google Scholar 

  34. Watson M, Kendrick D, Coupland C. Validation of a home safety questionnaire used in a randomised controlled trial. Inj Prev. 2003;9(2):180–3.

    Article  CAS  Google Scholar 

  35. Watson M, Kendrick D, Coupland C, Woods A, Futers D, Robinson J. Providing child safety equipment to prevent injuries: randomised controlled trial. BMJ. 2005;330(7484):178–81.

    Article  Google Scholar 

  36. Ofir Y. Based on "Beterem- Safe Kids Israel" researcher report, personal communication. 2018.

  37. Kendrick D, Marsh P, Fielding K, Miller P. General practice, preventing injuries in children: cluster randomised controlled trial in primary care. BMJ (Clin Res Ed). 1999;318(10):980–3.

    Article  CAS  Google Scholar 

  38. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405.

    Article  Google Scholar 

  39. Admi H, Muller E, Ungar L, Reis S, Kaffman M, Naveh N, et al. Hospital-community interface: a qualitative study on patients with cancer and health care providers’ experiences. Eur J Oncol Nurs. 2013;17(5):528–35.

    Article  Google Scholar 

  40. Rudolf MCJ, Bord S, Hasson R, Rubin L, Niva M, Paldi Y, et al. Between-country analysis of implementing an obesity prevention intervention using RE-AIM: HENRY in Israel and UK. Health Promot Int. 2021.

  41. Kelly MP, Barker M. Why is changing health-related behaviour so difficult? Public Health. 2016;136:109–16.

    Article  Google Scholar 

  42. Pearson M, Garside R, Moxham T, Anderson R. Preventing unintentional injuries to children in the home: a systematic review of the effectiveness of programmes supplying and/or installing home safety equipment. Health Promot Int. 2011;26(3):376–92.

    Article  Google Scholar 

  43. Hill T, Coupland C, Kendrick D, Jones M, Akbari A, Rodgers S, et al. Impact of the national home safety equipment scheme “Safe at Home” on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health. 2021;76:52–9.

    Google Scholar 

Download references


Our thanks to the Pratt Foundation, Australia, who funded this study, and Ziv Medical Center management who parented SHABI and its implementation. We also thank ‘Beterem- Safe Kids Israel’ for the guidance and valuable advice which contributed so much to our understanding child injury prevention. Special thanks to the Emergency Department nursing team, who were committed to recruitment despite their extensive responsibilities in a busy department, and to the medical and nursing students in the home visitor team- the core of SHABI, who were dedicated to helping families keep their children safe.


This work was supported by Pratt Foundation, Australia. Pratt Foundation—Israel, PO Box 37052, Jerusalem, Israel.

Author information

Authors and Affiliations



LS was involved in study planning and intervention design, collecting and analyzing data, and drafting the manuscript. AL was initiator of the study, involved in study planning and intervention design, and reviewing the manuscript. SS was involved in study planning and intervention design, and reviewing the manuscript. DK was involved in study planning and intervention design, and reviewing the manuscript. JEH was initiator of the study, involved in study planning and intervention design, and reviewing the manuscript. MR was initiator of the study, involved in study planning and intervention design, and reviewing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ligat Shalev.

Ethics declarations

Ethics approval and consent to participate

Helsinki approval was obtained through the Ziv Medical Center Ethics Committee (0029-19-ZIV; 22 October 2017). Participating parents provided their signed consent for home visits and calls from a researcher.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shalev, L., Luder, A., Spitzer, S. et al. Keeping our children safe: piloting a hospital-based home-visitation program in Israel. Isr J Health Policy Res 11, 21 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: