The Community Health Needs Assessment (CHNA) provides valuable insights from parents, caregivers, and community leaders across our eight-county service region: Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise Counties.

More than a hundred leaders from North Texas community organizations tuned in on May 6 for the first session of the two-part summit, during which Cook Children’s explained the methodology of the survey and outlined key findings. It is important to share these results because community organizations and leaders can use this data to inform their strategies for continuing to improve children’s health in their communities.

The key focuses of part one were overall health and well-being, asthma, and healthy lifestyles. The full assessment can be found here, and offers more detailed information on each data collection method used. See more tools for result breakdowns at the interactive data dashboard.

Additional findings specific to caregiver support, injury prevention, mental health, and oral health will be shared on June 3.

Main concerns

The assessment included 6,877 parents/caregivers' responses over the last three years and 239 survey responses from community leaders such as representatives from health departments, nonprofits, schools, and faith-based groups.

The most pressing concerns for many families in our area are related to financial stressors.

As costs have risen over the last few years, 45% of community leaders flagged inflation and poverty as a serious problem in their community.

These struggles directly impact kids’ and families’ physical and mental health. One caregiver said in a survey that they worry about paying for medical visits in addition to other household expenses. Community leaders noted that they help many working families with food, clothes, and other needs.

Housing affordability, food insecurity, and childcare costs are increasing problems for our communities. More than half of community leaders said access to affordable, nutritious food was a serious problem.

Overall health and well-being

Insurance coverage came up repeatedly in interviews with caregivers and parents. While the majority of children (88%) had continuous health insurance in the last year, 5% (about 54,700), had a coverage gap, and 7% (about 81,400) are currently uninsured. Children experiencing homelessness were three times more likely to be uninsured.

Caregivers shared that the lack of coverage was mostly due to affordability, respondents said. Families who did not speak English or Spanish said the language barrier was another obstacle to insurance coverage, and they did not always know how to renew or update their insurance.

Vaccination rates have decreased in our eight-county area - 89% of parents and caregivers reported their child had received all up-to-date vaccines, which is about an 8% decrease since the 2021 CHNA.

Asthma

One in ten children in the service area has asthma, and it is one of the most common health conditions in kids. While asthma is manageable, 19% of those children did not have an asthma action plan. This shows a need for more education, training, and support for caregivers of children with asthma, including daycare providers, schools, and aftercare programs.

Healthy lifestyles

A healthy lifestyle for children includes a healthy weight, physical activity, nutritious food, and adequate sleep. Only 35% of children in our area eat fresh fruits and veggies at the recommended amount, and the majority of children (94%) are spending more than two hours on entertainment screen time every day.

While living a healthy lifestyle benefits overall health, many children and families face obstacles to doing so. Not everyone can access nutritious food in their neighborhood, and 1 in 7 children do not live in an area that has sidewalks, parks, playgrounds, or recreation centers.

In the eight-county service area, approximately 34% of children (about 390,100) live in households that cannot always afford to eat good, nutritious meals and 21% of children (about 236,400) live in a household that reported receiving food stamps or SNAP benefits in the past year.

SNAP gives families financial help to buy nutritious food, but cuts in this program have made it harder for families to get those benefits. The reduction of SNAP emergency allotments also places additional strain on local food banks and community organizations to bridge the gap left by the reduced benefits.

Reduced benefits may lead to increased food insecurity, limiting access to nutritious meals and negatively affecting the health of families and children, ultimately exacerbating social and economic inequalities.

Calls to action

Based on the findings, Cook Children’s Center for Community Health identified crucial next steps to improving children’s health in our communities. One of those tactics is to foster more partnerships focused on non-medical drivers of health, such as food security, economic stability, and housing.

Cook Children’s also plans to strengthen collaborations to create more community outreach for families, advocate for strategies that benefit our communities, and improve access to community resources for children.

More detailed strategy plans can be found on Cook Children's community outreach page.

RELATED STORY

Survey Highlights Health Concerns in the Community

Cook Children’s Center for Community Health conducted the 2024 Community Health Needs Assessment (CHNA) to identify and prioritize health needs and resources available for children in the service area. The results indicate a complex set of factors that create obstacles in caring for children and accessing health services.

Every three years, the center compiles the CHNA by surveying and interviewing parents and caregivers in Cook Children’s service area. Survey responses came from more than 7,300 parents, caregivers, and community leaders in Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise counties. That region encompasses almost 1.2 million children (0-17 years), according to U.S. Census estimates.

KEY FINDINGS

The 2024 survey showed about 390,100 children from birth to 17 years old live in households that sometimes or often couldn’t afford nutritious meals. 

Along with food insecurity, about 287,100 children have a caregiver who shared that they were unable to receive all needed health services for their child. Reasons cited include lack of insurance, high health care costs, transportation difficulty and the financial impact of parents missing work for their child’s medical appointments.

Barriers played a role in 139,600 children ages 1-17 not receiving needed dental care, and 79,900 children ages 6-17 going without needed mental health services. Immunization levels in the service area showed 89% of children up-to-date on vaccines. 

“What stands out most is how many families are dealing with overlapping challenges that all affect their children’s health and well-being,” said Mandy Wolever, Ph.D., Research/CHNA Manager at the Center for Community Health. “Caregivers shared that they’re constantly making tough choices -- between covering basic needs like food, housing and utilities——and trying to get their children the health care they need.”

Fewer caregivers reported they have a source of emotional support for raising their children. That finding aligns with the U.S. Surgeon General’s advisory in August 2024, calling attention to parental stress due to financial instability, work-life balance, lack of social support and other factors.

The struggle to put nutritious meals on the table or visit the pediatrician adds another layer of stress that impacts a child’s health and development, Wolever said.  

The top three health needs reported by caregivers were preventive health care, treatment for short-term illnesses and immunizations. Mental health care or counseling topped the list for community leaders, followed by wellness opportunities and preventive dental care.

Other takeaways from the parent/caregiver survey include:

• Eighty-four percent of children in the service area had “excellent” or 
  “Very good” health in 2024. That compares to 87% of children across Texas and 90% of children in the United States in 2022.
• In the past year, 1 in 5 children (about 217,700) in the service area experienced chronic or frequent dental problems. Children with poor or fair oral health are twice as likely to miss school due to dental problems.
• Approximately 237,000 children ages 6-17 have a diagnosed mental health condition such as anxiety, depression, or attention-deficit/hyperactivity disorder, according to their caregiver. Two out of every 5 children (about 304,100) have been bullied at school.
• Approximately 233,300 children received emergency care for an accidental injury.
• Asthma impacts 104,500 children in the service area. Asthma symptoms sent about one-fourth of those children to a hospital emergency department in the past year. 
• Almost 90% of children had continuous health insurance coverage for 12 consecutive months before completing the survey.

FROM DATA TO ACTION

These results, along with many other survey data points, give context to the center’s key priorities: children’s overall health and well-being, asthma, healthy lifestyles, caregiver support, injury prevention, mental health and oral health.

Becki Hale, AVP at the Center for Community Health, said takeaways from the survey will help the center respond to evolving needs in collaboration with more than 700 organizations across the region.

“We’re incredibly grateful to be part of such a strong, compassionate health care organization that invests and prioritizes giving back to the community and helping families thrive,” Hale said. “We also recognize that Cook Children’s is one of many partners committed to improving the health of our communities. Today’s health and social needs for families are too complex for any one entity to address alone. It takes all of us, working together.”

One example of how Cook Children’s utilizes the CHNA results in collaboration with others to implement innovative approaches that address the greatest needs: the Center for Community Health teamed up with Texas Health Resources in January 2025 to open a Good For You Healthy Hub at Fort Worth’s Eastside YMCA. The hub provides fresh fruits, vegetables and other nutritious foods for free to residents of the Eastside neighborhood.   

Chris Pedigo, senior vice president of system planning, health analytics and the Center for Community Health, pointed out that the CHNA provides insights that help Cook Children’s keep its Promise to improve the well-being of every child in our care and communities. 

“Our next steps include comparing this year’s results to those of previous years to identify areas where we’ve seen change, as well as identifying new communities that need focused programming,” Pedigo said.

Surveys were collected from a sample of households across the service area at large, not just Cook Children’s patients. Surveys were also collected from parents of special under-resourced populations, including those experiencing homelessness or living with an undocumented family member. The results are weighted to represent the actual population of children living in the service area.

The center takes steps to include a cross-section of the population through data collection and interviews. The team analyzed approximately 1.2 million data points, said Lauren Purvis, MPH, CPH, MCHES, Director of Child Health Evaluation.

“This approach can help partners feel confident using our data to inform their organization’s strategies to improve children’s health in their communities,” Purvis said.

Significant effort goes into developing and carrying out the research strategies that make the CHNA as inclusive and representative as possible.

“It’s important to us to gather a wide range of perspectives so we can thoroughly assess community needs,” Wolever said. “This approach helps us better understand how to support families and improve the well-being of children, ultimately living out our Promise.”

Regional Summits

Cook Children’s Center for Community Health is hosting two free, virtual Child Health Summits to share the survey findings with the media, community partners and other professionals.

• Part 1, May 6, 9-10:30 am: Cook Children's Child Health Summit Part 1 Registration, Tue, May 6, 2025 at 9:00 AM | Eventbrite

Focus areas: Overall Health and Well-being, Asthma and Healthy Lifestyles

• Part 2, June 3, 9-10:30 am: https://www.eventbrite.com/e/cook-childrens-child-health-summit-part-2-registration-1095338770749?aff=oddtdtcreator

Focus areas: Caregiver Support, Injury Prevention, Mental Health and Oral Health

For more survey results, please visit the data dashboard or contact CHNAFeedback@cookchildrens.org.

RELATED STORY

Parent Survey Underscores Need for Mental Health Focus

Last year, the Texas Health and Human Services Commission (HHSC) denied Cook Children’s Health Plan a renewed contract to serve its membership.

Doctors say that ending the health plan would eliminate a crucial resource for an already underserved population, potentially creating significant challenges in accessing necessary medical care.

“Our lawmakers need to look at this situation and say, do you want to work with the health plan to better serve that community,” said Taylor Louden, M.D., medical director of emergency services.

To learn more and support our efforts, please visit SaveCookChildrensHealthPlan.com.

Measles is highly contagious; one infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

 Measles symptoms typically appear seven to 14 days after infection. 

They can include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

How do we stay safe?

The most effective prevention against measles is vaccination. The size of the virus makes it more contagious. Measles can live in the air in a room where an infected patient has been for two hours after that patient leaves.

This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch the virus. 

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
•  Disinfect frequently touched surfaces

What about other illnesses?

While Cook Children’s Medical Centers in Fort Worth and Prosper are not seeing an abnormal number of cases for RSV, COVID, and Flu, these illnesses can be prevented with proper hygiene as well.

It is important to speak to your primary care physician if you have any questions or concerns about vaccines. There are now vaccines to help prevent the severity of RSV, COVID, and Flu.

Where can you get immunized?
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

"Parents may think buying costumes that are too big allow children to wear the costumes for several years, but outfits that are too big can cause falls," said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coaltion.

Use these tips as your kids are preparing for Halloween:

1. Select costumes that fit well.
2. Trick-or-treat with your children.
3. To help drivers see kids in the dark, put reflective tape at the top and bottom of costumes. This lets drivers better see your kids' height and movement.
4. Use face paint instead of masks so trick-or-treaters' vision isn't blocked.
5. Plan a familiar trick-or-treating route on safe, well-lit streets, use sidewalks and cross the street at intersections.
6. When crossing the street, use the crosswalk and make eye contact with the drivers so you know they see you and your group.
7. Use a flashlight or glow stick to light the way.

For more safety information

Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family.

Last year, 24 kids died in the U.S. and from 1998 to present, 676 children have died.

“What’s heartbreaking is that this is a serious public health issue that is totally preventable,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. “Every mom and dad out there must realize it can happen to you. Texas leads the nation in child heat-related car deaths.”

Parents may mistakenly think they can safely leave a child in a vehicle for a “quick” errand, but that’s simply not true. Temperatures inside the car can be 20 or more degrees hotter than the temperature outside, rising to dangerous levels in minutes. Unfortunately, it only takes a few minutes for tragedy to occur.

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle-related deaths for children.

“Heat is much more dangerous to children than it is to adults,” Walraven said. “When left in a hot vehicle, a young child’s core body temperature may increase 3 to 5 times faster than that of an adult. This could cause permanent injury or death.”

Heatstroke, or hyperthermia, occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

It’s difficult to think that as parents, we could “forget” our children, but it happens each year with no exception to socioeconomic or education level. Often times, a change in routine, a distraction along the way, or the event a child falls quietly asleep, unseen, in the back seat, allows for a parent/caregiver to “forget” and leave a child in the car.

Here are some important tips to help prevent unintentional injury to your child:

1. Dial 911 if you see an unattended child in a car. Sometimes, people don’t want to get involved or just assume the parents are on the way out. But as you read earlier, it doesn’t take long for a child to die in a hot car. If you see a child or children alone in a car without an adult, call 911 immediately.
2. Never leave your child alone in a vehicle, even for 1 minute. Windows left slightly open will not affect rising temperatures in the car.
3. Set safe habits: leave a cell phone, purse, briefcase, etc. in the back seat before driving, forcing you to always check the back seat and see a child is/is not back there.
4. Program your cell phone and/or computer to remind you to drop off your child each day.
5. Have a plan with your daycare provider to contact you within a few minutes of being late or absent. Let your daycare know that you want them to call you if you are late or you have not called in saying your child will not be in that day.
6. Teach children not to play in any vehicle.
7. Lock all car doors, even at home.
8. If a child goes missing, always check the cars and trunks.

Learn more by clicking here. Also, visit noheatstroke.org for the latest on heatstroke deaths of children in vehicles.

For more information

Every year children are rushed to the emergency room to be treated for car related injuries, many don't even involve traffic or another car. Some injuries occur without the car ever leaving the driveway. Click here for some of the top dangers to be aware of and the key things you can do to help make your car safer for your kids.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s, knows that guns will be a popular gift this holiday season for not only children, but for adults too.

According to the journal Injury Prevention more than one-third of American adults own a gun. Last year, Cook Children’s saw 10 total injuries related to shootings of a gun (ranging from a BB to rifle). Since 2009, Cook Children’s has seen 104 shootings and three deaths.

Dr. Warmink asks parents to explain to children that BB guns can be dangerous, with harm ranging from severe eye damage to liver and kidney injuries.

Dr. Warmink says it’s important that parents educate their children about gun safety and make sure kids know to leave the area if another child, or someone other than their parent, has a gun.

“We live in Texas and I know many kids are raised hunting and have guns in the home,” Dr. Warmink said. “But if you give your child a gun for the holidays or if the adult in the house is given a gun, it’s important to take the proper precautions. The thing we want parents to remember is to keep guns locked, unloaded and separate from ammunition”

1. Lock the gun and keep it out of reach of kids. Hiding the gun is not enough.

2. Unload your gun. Take all ammunition out of the firearm.

3. Store the keys for the gun in a cabinet or safe different from your household keys. Keep the keys out of the reach of children.

Along with guns and replica firearms, such as airsoft guns that use hydraulics to shoot pellets, Dr. Warmink lists these gifts as dangerous and even life threatening:

• Ripstik Casterboard, Skateboards, roller skates …
• Pull toys with strings over 12 inches
• Trampolines
• Backyard playground equipment
• Hard plastic swords

Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s, knows that owning a bike or scooter is part of growing up. But she encourages parents to take the proper precautions before placing wheeled gifts under the tree.

“Parents, please don’t forget a helmet for all riding toys,” Evans said. “Make sure the helmet is on properly and read the instructions.”

For younger children, Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition, warns parents to be aware of any small parts or potential choking hazards from their own toys or perhaps older siblings.

“The holidays can be an especially dangerous time for the little ones,” Walraven said. “Pick out toys and activities that will be appropriate for their age. On Christmas, designate an adult to supervise the children. It’s surprisingly easy to lose track of small children and with just a little planning we can keep choking hazards away from them. When it comes to young children, preparation is key.”

Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition, gives these 5 tips:

1. Preparation is key. Plan ahead to see how many and how old the children are that will be at Thanksgiving. Then, pick out toys/activities appropriate for several ages and keep the others out of reach.

2. Create an activity area for children to play, equipped with appropriate toys and activities.

3. Designate an adult to supervise the children. Adults can share this responsibility to reduce holiday stressors

4. Do a quick walk-thru to identify any red flags throughout the home, and in children’s reach: whether it be toys, poisons/medications, unsafe electrical outlets, doors accessing pools, etc.

5. Always ask guests to lock their car doors, so children don’t play hide and seek and get locked inside. Child heat stroke can occur even during cooler months.​

About the source

Dana Walraven is the manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition. Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family. Visit our Cook Children's Safety and Prevention Center today.

Dr. Aaron spent her morning on Thursday, July 24, doing interviews with newspaper, radio and three local TV stations.

“I’ve never been one to reach out to the media or certainly get in front of the camera,” Dr. Aaron said. “I’ve had those times where I’ve been asked to be on camera and needed to do that. This is the first time where I’ve ever picked up the phone and called our team and said, ‘Guys, we need to do something. We need to reach out because three in one week … that’s just too many.’”

The mother of a 2-year-old son, the swimming deaths hit way too close for Dr. Aaron. All three children who died were between the ages of 2 to 4 years old. The teams at Cook Children’s involved in the three drowning events met with Cameron Brown, a member of Cook Children’s Pastoral Care and a firefighter, who is specially trained to lead caregivers through a critical incident stress debriefing. To put it simply, they were heart broken.

“This is what we do. This is our profession, but it impacts us,” Dr. Aaron said. “We’ve had great sorrow. That is minimal to what we sense must be happening with these families and close friends. It’s unusual for us to have three cases in one week ... and we still have many weeks of summer left.”

What makes the deaths even more tragic is the fact that most drownings are preventable. Dana Walraven, Cook Children’s Community Health Outreach manager and Safe Kids Tarrant County coordinator, also spent the day with media to discuss drowning prevention steps. Texas has the highest incidence of swimming pool- and spa-related childhood drownings in the United States. All three children who died were pool related incidents.

Drowning is the leading cause of unintentional deaths for children 1 to 4 years of age. The common myth of children splashing, waving their arms around and yelling is simply not true.

“In many drowning situations, an adult was just a few feet away from the pool and didn’t realize anything was wrong because he or she didn’t hear any sounds of distress, such as splashing or yelling,” Walraven said. “Drowning is a silent event that can occur in the time it takes to send a text message. Should supervision fail for any reason, having multiple layers in place helps protect your child.”

Walraven offers these drowning prevention basics:

• Have your children take swim lessons.
• Have the entire family taking swim and safety lessons.
• Learn CPR.
• Provide 100 percent supervision without distractions.
• Use pool and child alarms to alert you if your child gets in the water without you.
• Isolate your pool from the rest of your backyards with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without adult supervision.

“We realize that it could happen to anyone,” Dr. Aaron said. “It happens very, very quickly. We’re not being judgmental. We feel so strongly about this and knowing how it impacts us we wanted to reach out and raise awareness to the community.”

For more information:

• Drowning prevention
• Water safety
• Vento family story
• Cookchildrens.org/safety
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning

Dr. Aaron spent her morning on Thursday, July 24, doing interviews with newspaper, radio and three local TV stations.

“I’ve never been one to reach out to the media or certainly get in front of the camera,” Dr. Aaron said. “I’ve had those times where I’ve been asked to be on camera and needed to do that. This is the first time where I’ve ever picked up the phone and called our team and said, ‘Guys, we need to do something. We need to reach out because three in one week … that’s just too many.’”

The mother of a 2-year-old son, the swimming deaths hit way too close for Dr. Aaron. All three children who died were between the ages of 2 to 4 years old. The teams at Cook Children’s involved in the three drowning events met with Cameron Brown, a member of Cook Children’s Pastoral Care and a firefighter, who is specially trained to lead caregivers through a critical incident stress debriefing. To put it simply, they were heart broken.

“This is what we do. This is our profession, but it impacts us,” Dr. Aaron said. “We’ve had great sorrow. That is minimal to what we sense must be happening with these families and close friends. It’s unusual for us to have three cases in one week ... and we still have many weeks of summer left.”

What makes the deaths even more tragic is the fact that most drownings are preventable. Dana Walraven, Cook Children’s Community Health Outreach manager and Safe Kids Tarrant County coordinator, also spent the day with media to discuss drowning prevention steps. Texas has the highest incidence of swimming pool- and spa-related childhood drownings in the United States. All three children who died were pool related incidents.

Drowning is the leading cause of unintentional deaths for children 1 to 4 years of age. The common myth of children splashing, waving their arms around and yelling is simply not true.

“In many drowning situations, an adult was just a few feet away from the pool and didn’t realize anything was wrong because he or she didn’t hear any sounds of distress, such as splashing or yelling,” Walraven said. “Drowning is a silent event that can occur in the time it takes to send a text message. Should supervision fail for any reason, having multiple layers in place helps protect your child.”

Walraven offers these drowning prevention basics:

• Have your children take swim lessons.
• Have the entire family taking swim and safety lessons.
• Learn CPR.
• Provide 100 percent supervision without distractions.
• Use pool and child alarms to alert you if your child gets in the water without you.
• Isolate your pool from the rest of your backyards with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without adult supervision.

“We realize that it could happen to anyone,” Dr. Aaron said. “It happens very, very quickly. We’re not being judgmental. We feel so strongly about this and knowing how it impacts us we wanted to reach out and raise awareness to the community.”

For more information:

• Drowning prevention
• Water safety
• Vento family story
• Cookchildrens.org/safety
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning