In this module, we covered how to develop or update policies—like passenger restraint laws. We’ve also discussed how to partner with law enforcement to improve practices—like enforcing passenger restraint laws and promoting child passenger safety.

In this section we’d like to share examples of additional policies and practices that other Tribal communities have used with success. This will give you some advice on how you can complement any legislative, judicial, or enforcement programs.

For a community to safely transport children, communities, organizations, and businesses need to come to a common understanding. They must understand the legal and regulatory steps that all those who have a role in safely transporting children must follow. In addition communities, organizations, and businesses must maintain practices that guide the transportation safety of children.


The following are some great examples of policies and practices that can help your community transport children safely now and in the future.  

Click to expand on each idea. 


Iola's Experience (Shoshone-Bannock Tribes)
Iola HernandezThe Shoshone-Bannock Tribal Health Clinic in Idaho uses an electronic health record system that prompts a provider to ask caregivers about the normal and proper use of a child safety seat. It also directs the provider to refer the caregiver to the tribal car seat distribution program for help in getting a seat for their children. IHS in Fort Hall, Idaho, partnered with the Shoshone Bannock Native CARS Project.

At this IHS clinic, clinicians use the electronic health record to:

  • Document when a patient receives safety and injury prevention education.
  • Notate how the person responded to the safety, car seat, and seat belt education.
  • Indicate when a person has received car seats for their children.
  • Produce health reports to use during follow-up visits with the family, if needed.
  • View health reports that other health professionals have created.

See Module 10: Install Electronic Alerts to Help Health Care Professionals Provide Car Seat Education for tips on implementing this type of practice in your own tribal community.

Incorporate Child Safety Seat Education into Home Visits
Home visits are an already established method of care management in many communities. Public health nurses and community health workers can include child passenger restraint education in their home visits. During these home visits, parents and caregivers can learn about the importance of proper and consistent use of child passenger restraints.

One example of this type of platform is Oregon’s Babies First! public health nurse home visiting program. Through this program, public nurses have the opportunity to provide basic child passenger safety information for families.

For more information, visit Oregon’s Babies First! website. There are also some online guides and tools that Oregon Babies First! might use to go over child passenger restraint use:


Enact policies or practices to require child passenger restraint use in public transportation.

Tribes and states have their own set of laws regarding child passenger restraints. But sometimes child passenger restraint use is not specified for certain types of transportation, such as taxi cabs, and may be exempt from tribal or state laws. A tribal nation could enact a child passenger restraint policy either within the scope of a current child passenger restraint law or make a stand-alone policy regulating their use in taxis.


And taxicabs are not the only form of transportation you should target. Also consider applying the requirements to school buses. Currently, there are six states that have restraint laws for school buses. And a number of tribes currently use five-point child passenger restraint harnesses in tribal Head Start buses for 3- to 5-year-old students.



Update standards of care or licensure requirements for providers or organizations.
You could also work with providers or organizations to require that standards of care or licensure requirements are updated. Some ideas would be to require that these clinicians or organizations enact the following:


  • Create a written policy on the dissemination of child safety seats. For example, see Module 8.
  • Provide families with information about the risks associated with failing to properly use child safety seats.
  • Provide a list of local, community-specific child safety seat programs available.


Establish a practice of enforcing child passenger restraint use among children arriving to educational institutions or traveling in tribal transportation programs.
If you don’t have a tribal child safety seat law, or law enforcement is not able to administer a child safety seat law, you can establish a practice to enforce and promote child safety seat use by other tribal personnel who work directly with children such as assisting those families arriving in private vehicles to tribal programs, during the school day or when children return home—these could be at Head Start or preschool programs.
Other Tribal Nation Examples
  • In Wyoming, the Shoshone and Arapaho Tribes Safe Community Program (located on the Wind River Reservation) has aimed to increase seat belt use via school buses at the Shoshone Arapaho Head Start program. Each bus contains 5-point harness car seats installed into the seats as well as lap belts for adults. Learn more about the Wind River efforts at
Tracy's Experience (Grande Ronde)

Tracy is an Early Childhood Education Health and Family Partnership Specialist. At the Grand Ronde Early Childhood Education Center, when children come to the school and they are not sitting properly in their car, we have a conversation right then and there about best practices for child safety seat use. That provides a good opportunity for us to find out if they have a child safety seat. If they don’t, we can look at getting them a proper child safety seat so they are safe.

This is not a formal policy. It’s a best practice that we just do. We want our children to be safe. We also do the same thing if they are smoking in the vehicle.

All staff are responsible to say something. And if they are not comfortable for some reason, they can come and find a supervisor who can approach the driver in the vehicle.

Well, we’ve always used car seats, but since Tracy’s been working with us she’s really stressed the importance … and with her the importance of the correct car seat and the correct way to put it in your car. – Grand Ronde Community Member

It is the law and we follow the law. It against the law to not use child safety seats when transporting children. Home visitors are also required to make sure these practices are followed in their contact with the community. They are going to enforce it because they don’t want to lose their job. They will follow all laws and regulations regarding safe transportation of children. –Early Childhood Education

We’ve had a lady here that used my van one evening to get some parents to bring them over here to literacy night. And she had so many people she was transporting that lived in the village over there, she didn’t have enough room for all of them. She said she’d have to come back and make a second trip. Well, then a mom came out with a baby in the front, she was like a month old and she just got in the middle of the two bucket seats of the front of the van and just squatted there. And she goes, “I’ll just ride here. I’m fine. It’s just right over there.” And the driver—she’s one of our subs. She goes, “Oh no. I’m not going anywhere. I’m not going like this.” And she was a little upset with her. But she’s like, “No, I’ll come back for you.” And we reminded her again the next month when she wanted a transport again, the same family—it was another sub that was going to transport her, and I reminded her, this girl tried to do this last time with XXX. She may try to do this again with you and you’re just going to tell her, “We’re not leaving this area at all until you get her in your seat.” So I think certain ones will try to fight you, but for the most part you just kind of stick to your guns about it. – Grand Ronde Community Member

Create guidelines for Child Safety Seats during Hospital Discharges


Although a tribal community may not possess its own community hospital, the ability to partner with local hospitals or birthing centers allows further reach into providing that children are safely secured from the time they are born. Some hospital policies may not possess anything related to car seat checks at discharge. But a great resource is from the National Highway Traffic Safety Administration in partnership with the American Academy of Pediatrics. They published Hospital Discharge Recommendations for Safe Transportation of Children: Best Practice Recommendations Developed By an Expert Working Group Convened By the National Highway Traffic Safety Administration. (link to file in resource section)


Besides introducing a guideline for hospital discharge procedures, consider these in helping to support your hospital policies:


  • Encourage a nurse or provider to become a certified child passenger safety technician.
  • During hospital pre-registration appointments with families, introduce the opportunity to have the car seat checked for correct installation in the family vehicle.
  • Consider noting tribal health programs as child safety seat inspection stations in the patient handbook provided at the hospital.
  • Offer car seat clinics at the hospital for expectant families.


To learn about a tribal health system with a child safety seat policy and set of practices, please see the IHS Shiprock Hospital Child Safety Seat Policy document. This provides information about the set of hospital practices that IHS Shiprock Hospital uses to follow the state of New Mexico’s Department of Transportation policy.


Try other ideas
Here are some other practical ideas:
  • Provide staff training to organizations.
  • Create a child passenger safety sub-committee within an organization.
  • Incorporate and encourage providers, social workers, administrators, and volunteers to be involved when educating staff within an organization.
  • Provide in-hospital training to maternity and childbirth educators.
  • Establish a resource center for technical assistance.
  • Promote child safety seat loan programs, such as:


To learn more about working with law enforcement to enforce laws, go to the next module.