Wellness for Every Body

State: MN Type: Promising Practice Year: 2014

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Location and Jurisdiction of LHD Hennepin County encompasses 46 municipalities within 600 urban and suburban square miles of the greater Minneapolis Twin Cities metro area. With a staff of 300, Hennepin County Public Health is the primary provider of public health services to the county’s 1.1 million residents.Public Health Issue A 2009 chart audit demonstrated that individuals with intellectual and developmental disabilities (IDD) in Hennepin County experience disproportionately higher rates of obesity and chronic health conditions compared to the general population. The audit also revealed they engage in less leisure time activity and do not consume the recommended number of fruits and vegetables (see health disparity graphic). Risk factors linked to obesity and chronic health conditions include: lack of physical activity, unhealthy eating habits, and lack of environmental support for healthy behaviors.

Wellness for Every Body (WFEB) is a physical activity and nutrition (PAN) program offering a new approach to improving health for adults with IDD. Instead of focusing on individual client education, county public health staff provides training and technical assistance to staff in group homes and day training and habilitation (DTH) sites to create conditions establishing healthy behaviors as the norm.

The short-term goal of WFEB is to strengthen social norms around PAN within organizations supporting individuals with IDD. The long term-goal is to decrease the prevalence of obesity and secondary chronic health conditions among individuals with IDD (see Logic Model).

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Hennepin County Human Services and Public Health
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Wellness for Every Body
Location and Jurisdiction of LHD Hennepin County encompasses 46 municipalities within 600 urban and suburban square miles of the greater Minneapolis Twin Cities metro area. With a staff of 300, Hennepin County Public Health is the primary provider of public health services to the county’s 1.1 million residents.Public Health Issue A 2009 chart audit demonstrated that individuals with intellectual and developmental disabilities (IDD) in Hennepin County experience disproportionately higher rates of obesity and chronic health conditions compared to the general population. The audit also revealed they engage in less leisure time activity and do not consume the recommended number of fruits and vegetables (see health disparity graphic). Risk factors linked to obesity and chronic health conditions include: lack of physical activity, unhealthy eating habits, and lack of environmental support for healthy behaviors. Wellness for Every Body (WFEB) is a physical activity and nutrition (PAN) program offering a new approach to improving health for adults with IDD. Instead of focusing on individual client education, county public health staff provides training and technical assistance to staff in group homes and day training and habilitation (DTH) sites to create conditions establishing healthy behaviors as the norm. The short-term goal of WFEB is to strengthen social norms around PAN within organizations supporting individuals with IDD. The long term-goal is to decrease the prevalence of obesity and secondary chronic health conditions among individuals with IDD (see Logic Model). Goals and objectives of proposed practice Short-term ·Integrate PAN policies, procedures, and practices into organizations supporting individuals with IDD. ·Increase staff knowledge and skills related to PAN promotion. Long-term ·Increase percentage of individuals with IDD who meet physical activity and fruit and vegetable intake recommendations. ·Decrease prevalence of overweight/obesity among individuals with IDD. ·Improve functionality, mood, challenging behaviors, lab values, or medication usage. How was practice implemented ·Formative research identified systems gaps and informed the development of the project. Online videos and electronic learning scenarios were designed in response to training barriers (time/financial constraints, cultural differences) identified by industry staff. ·A needs assessment tool was developed to identify each organization’s PAN needs. ·Public health staff designed personalized action plans to implement PAN-promoting policies, activities, and practices. ·Baseline and follow-up health assessments were completed for each individual with IDD to measure outcomes. ·Public health staff provided ongoing technical assistance and resources to assist organization staff in action plan completion. Results/ Outcomes Were all of the objectives met? Yes: ·Thirty-six PAN policies, procedures, and practices were integrated into the organizations in the pilot project. ·Anecdotal reports indicate improvement in staff knowledge and skills as a result of WFEB trainings. No formal measurement was done with the pilot; this will be conducted in 2014. ·Individuals with IDD consuming five or more fruits and vegetables daily increased by five percent. ·Moderate physical activity guidelines were met 31 percent more frequently. ·The average BMI of the cohort decreased by 2 points. ·The majority of individuals with IDD demonstrated improved quality of life and health measures (functionality, mood, challenging behaviors, lab values, and medication usage). What specific factors led to the success of this practice? ·Collaborating with industry stakeholders to conduct thorough formative research and a literature review to identify common gaps in, and demands for, PAN promotion. ·Testing and refining process activities through focus groups and pilot testing. Partnering with Hennepin County’s Aging and Disability Services case managers to support and reinforce WFEB practices. ·Using policy, systems, and environmental (PSE) changes to ensure sustainability of healthy behaviors.Public Health Impact of Practice The aim of WFEB is to reduce the incidence of obesity and chronic disease among individuals with IDD. Historically, efforts addressing PAN for this population focused on individual behaviors. Our project takes a “whole environment” approach to health improvement rather than the individual approach (see Logic Model). This population-focused public health practice shifts the distribution of the entire population toward a healthier norm. From our formative research we learned that ours is one of only a few projects addressing the needs of this population with a PSE approach, leading us to believe other public health departments could benefit from this project. The policies and systems approach requires initial staff training time, but implementation and ongoing costs are minimal. Once organizations make changes to improve PAN environments, sustainability is inherent. WFEB can readily be expanded to other service venues and populations (e.g., brain injury, disabled elderly, persistent mental illness). Hennepin County Public Health plans to introduce WFEB to organizations serving these groups.
Brief description of LHD – location, jurisdiction size, type of population served Hennepin County encompasses 46 municipalities within 600 urban and suburban square miles of the greater Minneapolis-St. Paul Twin Cities metro area. With its staff of 300 dedicated professionals, Hennepin County Public Health is the primary provider of public health services to the county’s 1.1 million residents. Hennepin County Public Health takes a comprehensive approach to   Promote physical and mental health, Prevent illness and injury caused by chronic and infectious diseases and environmental conditions, Diagnose and treat serious mental health conditions and Reduce the impact of chronic diseases including depression, heart disease, cancer, and diabetes among all county residents. Our target populations are individuals with IDD living in group homes and those who attend day training and habilitation centers in Hennepin County.   Statement of the problem/public health issue: Across the country, local public health efforts have been slow to address the health concerns of those with IDD. These individuals can lead healthy and active lives, yet disparities in health and well-being exist due to the lack of access to appropriate services, environmental barriers, and discrimination, among other issues. Those with IDD also experience a disproportionately high rate of obesity and chronic health conditions—many of which are preventable. The high prevalence of these conditions is at least partially the result of lifestyles that include behavioral risk factors such as physical inactivity and/or unhealthy eating choices. In 2009, Hennepin County Public Health conducted a survey to assess the health status of individuals with IDD in Hennepin County. Results show:   Seventy-one percent of this population is overweight or obese. Seventy-four percent have at least one of four chronic diseases attributable to modifiable risk behaviors (including diabetes, high blood pressure, high blood cholesterol, and cardiovascular disease). Thirty-eight percent engage in no leisure time activity. Seventy-three percent do not meet minimum dietary recommendations for fruit and vegetable consumption. The data also suggest that these conditions exist because the home, work, or community environments do not consistently support healthy behaviors.   For example, Minnesota state regulations that pertain to physical activity or nutrition in county-contracted foster care facilities for adults with IDD are very broad and do not address current standards. An initial review of case management records for adults with IDD confirmed that health-promoting physical activity and nutrition goals are not high priorities. The absence of positive lifestyle behaviors not only diminishes the quality of life for individuals with IDD but ultimately contributes to the onset of chronic diseases and subsequently higher medical costs. What target population is affected by problem (please include relevant demographics) The target population for the intervention is individuals with intellectual and developmental disabilities (IDD) living in group homes and those who attend day training and habilitation (DTH) centers in Hennepin County. Demographically, the majority of the IDD population is Caucasian, with a greater percentage being male. Ages vary, from young adults to those older than age 65. What is target population size? Hennepin County Human Services and Public Health Department (HSPHD), which includes the Aging and Disability Services division (ADS), serves approximately 8,500 people with physical and or cognitive and intellectual disabilities. This includes more than 3,500 individuals with IDD living in 522 adult group homes and more than 2,500 individuals with IDD in 43 DTH centers. These contracted services are provided by more than 80 organizations. HSPHD sees the applicability of the WFEB project to other contracted service venues and populations such as people with traumatic brain injury, physically disabled elderly, and those suffering with chronic and persistent mental illness. HSPHD is in the process of introducing the WFEB project to organizations serving these populations. Adult care homes and DTH are residences and training facilities for these populations but they are also worksites. A collateral benefit of this intervention is improved employee health. By exposing staff to healthier worksite environments and education, the potential to improve employee nutrition and physical activity behavior is also within reach. This workforce is largely comprised of recent immigrants from East Africa and Latin America, populations who experience health inequities. What percentage did you reach? Hennepin County Public Health currently has recruited 28 percent of the 80 organizations licensed in Hennepin County to implement the WFEB program. However, it is our intent to introduce the program to all organizations within four years. Each organization is at different stages of the program. However, with 28 percent of the organizations on board, the reach is approximately 900 clients to date, and with a four-to-one staffing ratio, 3,600 staff and managers within the 23 organizations. What has been done in the past to address the problem? Historically, efforts addressing nutrition or physical activity for this population focus solely on individual behaviors. Most of the interventions documented in the literature focus on developing curricula and training materials for the individuals with IDD. Hennepin County has not addressed this problem prior to this project. Why is current/proposed practice better? There is a growing body of research indicating that the environment in which an individual with IDD resides significantly influences their diet and physical activity. Despite this knowledge there are currently no interventions that target environmental determinants of health for this population. Our project takes a “whole environment” approach to health improvement rather than focusing only on the unhealthy behaviors of individual residents. Rather than focusing on those individuals most at risk, this intervention seeks to move the entire population of individuals with IDD toward a healthier lifestyle. The WFEB program also improves employee health. By exposing staff to healthier worksite environments and education, improved employee nutrition and physical activity behavior takes place. The social support and modeling provided by staff provides additional encouragement for healthy behaviors among IDD residents. Through our formative research it became apparent that the standard approach to staff training (i.e., off-site training) no longer fit many organizations’ needs due to the 24/7 nature of the industry as well as time and financial constraints. The multimedia online approach of WFEB provides resources developed specifically for industry staff, to fill knowledge gaps and deliver reliable information to implement current physical activity and nutrition standards. WFEB resources are free of charge and available anytime of the day or night to meet the needs of staff. Increased availability of resources has played an integral role in improved quality of life and health for the individuals with IDD.Is current practice innovative? How so/explain? New to the field of public health Our practice is new to the field of public health. Although other interventions have developed curricula and training materials, our project is the first of its kind to take a “whole environment” approach to health improvement for individuals with IDD. The backbone of this project is systems and policy change, with the goal of improved physical activity and nutrition environments in group homes and DTH facilities and ultimately improved lifestyle behaviors and health among individuals with IDD.   Is current practice evidence-based? If yes, provide references (Examples of evidence-based guidelines include the Guide to Community Preventive Services, MMWR Recommendations and Reports, National Guideline Clearinghouses, and the USPSTF Recommendations.) The main method utilized in this initiative is a policy, systems, and environment approach (PSE), which is held as a best practice by numerous national agencies including the Centers for Disease Control and Prevention and the National Institutes of Health. The National Center on Health, Physical Activity and Disability supports the use of PSE approaches to increase the opportunities for physical activity and healthy dietary behaviors. The nutrition and physical activity practices and recommendations are supported as best practices by the Academy of Nutrition and Dietetics, USDA Dietary Guidelines for Americans, Centers for Disease Control and Prevention, and Physical Therapists Association of America.
Nutrition, Physical Activity, and Obesity
Goal(s) and objectives of practice The short-term goal of this program is to strengthen the social norms around physical activity and nutrition (PAN) within organizations that support individuals with IDD. The long term-goal of this program is to decrease the prevalence of obesity and other chronic health conditions secondary to obesity among individuals with IDD (see Logic Model). The objectives of the program are: Short-term Intergrade PAN policies, procedures, and practices in organizations that support individuals with IDD. Increase staff knowledge and skills related to PAN promotion. Long-term Increase the percentage of individuals with IDD who demonstrate an increase in physical activity or an increase in fruit and vegetable intake. Decrease prevalence of overweight/obesity among individuals with IDD. Improve functionality, mood, challenging behaviors, lab values, or dosage or number of medications required. What did you do to achieve the goals and objectives? Steps taken to implement the program Step One: Formation of an exploratory committee. In 2008, at the request of the Public Health Director, an exploratory committee was formed to discuss the prevalence of lifestyle related chronic health conditions in individuals with IDD. The committee consisted of members from Hennepin County Aging and Disability Services (ADS) as well as the ADS licensing division, advocates for people with IDD, family members, and service providers. The committee met for more than a year, defining the scope, causes, and potential solutions to the problem. Step Two: Formative Research and listening sessions with potential partners and interested parties. In 2009, Hennepin County Public Health conducted extensive formative research around PAN promotion for the population of individuals with IDD in Hennepin County. This process was conducted to obtain an understanding of the baseline health status of the IDD population as well as the frequency of health-promoting PAN practices. As part of this process a chart audit was conducted and results reported in unidentifiable aggregate format. The county public health epidemiologist designed the method to yield a valid random sample. The chart audit showed that 71 percent of the IDD population is overweight or obese. Seventy-four percent have at least one of the four chronic diseases attributable to modifiable risk behaviors (including diabetes, high blood pressure, high blood cholesterol, and cardiovascular disease). The survey also found that 38 percent engage in no leisure time activity, and 73 percent do not meet minimum dietary recommendations for fruit and vegetable consumption. The results were provided to Hennepin County Public Health staff, ADS staff, and IDD stakeholders. Additionally, the audit results indicated that health-promoting PAN practices were not viewed as a high priority by multiple stakeholders, including service providers. In addition to the chart audit, we designed a qualitative method to gather data to help PHP staff better understand the perceptions and attitudes of key gatekeepers and stakeholders as well as current practices and facilities. We contracted with the Center for Social Marketing and Behavior Change, Academy for Educational Development, in Washington D.C., to validate the formative research design as well as analyze and compile the results. We conducted in-depth individual interviews with group home staff and managers, IDD advocates and family members, State and County Aging and Disability staff, employment and day service staff and managers, and IDD health care providers. We also conducted on-site observations at several group homes and DTHs to determine actual PAN practices. We also interviewed ADS directors, managers, social workers, and licensing staff to determine and understand contextual factors, operational procedures, establish relationships, and create project buy-in. The results were disseminated to Public Health staff, ADS staff, and IDD stakeholders. Through this process we identified a lack of adequate PAN training for provider staff and a lack of focus on preventative PAN measures. Data also indicated that stakeholders believed in the interconnectedness of PAN on health, wellness, and quality of life. The results were disseminated to PHP staff, ADS staff, and IDD stakeholders. Goal: Integrate PAN policies, procedures, and practices in organizations that support individuals with IDD. Step three: Develop activities We developed activities to address the needs identified through the formative research. These activities included a series of PAN training lessons for industry staff. Additionally, in response to the fact that promoting PAN practices was not a high priority to stakeholders, Hennepin County Public Health developed an organizational assessment and action plan materials in order to better establish service providers’ policies and norms to promote PAN.Step four: Pilot test the program Throughout the process of interviewing interested parties, we were able to recruit two large and well-respected providers in the industry to participate in a pilot project. Upon developing our program activities we presented the project to each organization’s executive management to obtain buy-in. We conducted a needs assessment with each company and developed tailored action plans based on the organization’s needs and priorities. Hennepin County Public Health staff provided technical assistance and resources to support the organizations as they made PAN changes. Through this process we developed competency-based PAN training for direct support professionals in the IDD industry. Step five: Formal roll out of program and implementation The program was formally ready for launch with the completion of the WFEB Web site. Hennepin County Public Health staff recruited a first-round cohort of 23 providers to utilize the program activities and develop PAN-promoting culture within their organization. Staff and managers in the first cohort have welcomed the program and have already begun to make changes to improve PAN promotion. Based on industry demand, county public health staff is planning to work with a second-round cohort in January 2014. Goal: Increase the percentage of individuals with IDD who report an improvement in one or more specific health parameters. Step six: Implement evaluation plan to assess change in health parameters of target population. As mentioned in other sections of this document, individuals with IDD have a higher incidence of chronic disease and lag behind the general population in specific health behaviors, such as fruit and vegetable consumption and physical activity. Improving PAN not only reduces the risk of chronic disease but also improves other health parameters such as challenging behaviors, functionality, and mood. Hennepin County Public Health staff collected baseline health information for each individual participating in WFEB and then at follow-up. At follow-up all health parameters had improved, including BMI. Perhaps the most significant finding is that 84 percent of participants reported an improvement in at least one of the following: mood, functionality, challenging behaviors, or lower doses of medication. Goal: Expand county case management services to support healthy physical activity and nutrition environments. Step seven: Ensure consistent support for healthy PAN messages and environments throughout Hennepin County Aging and Disability Services by having county case managers integrate the adoption of healthy choices into clients’ care plans. Based on the formative research we identified a strong need to address PAN promotion among county professionals. We therefore met with ADS county and contracted case managers to establish positive working relationships and to obtain buy-in. Once connections were established with ADS, WFEB training sessions were provided for county and contracted case managers and supervisors as well as public health nurses. Meetings were conducted with case manager supervisors to develop the protocol of adding PAN discussions at individual client progress meetings. Any criteria for who was selected to receive the practice (if applicable)? Those selected to receive the practice are companies that operate licensed group homes or DTH facilities in Hennepin County for individuals with IDD. WFEB information can be accessed online by any organization or individual who is interested in improving their PAN environments. However, access to the onsite technical assistance can only be provided for organizations and agencies that are licensed to serve individuals with IDD in Hennepin County. What was the timeframe for the practice? Fall 2008: Exploratory committee convened. Spring 2009: PHP staff began auditing more than 500 IDD client charts to determine current health status and PAN practices. Summer–fall 2009: Formative research took place. Spring 2010–spring 2012: Materials and resources developed. Spring 2010: Pilot project was developed and implemented using formative research data. Summer 2012: Formal roll-out conducted, including online program components (see www.hennepin.us/wellnessforeverybody). •Fall 2012: County and contracted case manager PAN procedure implemented. Winter 2012–present: Program with first cohort of organizations (23 organizations total) that serve individuals with IDD in Hennepin County implemented. Winter 2014: Program with second cohort will be implemented. Were other stakeholders involved? What was their role in the planning and implementation process?As mentioned in an earlier section, to understand the current environment and barriers to health-promoting nutrition and physical activity behaviors, extensive formative research was conducted involving industry staff, corporate managers, guardians/relatives of individuals with IDD, and the individuals themselves. The information gathered from this research was specifically used to inform the development of the initiative. Additionally, our partners assisted in the development of each aspect of the initiative, becoming pilot sites, providing feedback, and assisting in program refinement. What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) We depend on our community stakeholders to provide guidance to keep the program relevant to the needs of the IDD industry and their staff. Hennepin County Public Health staff routinely meets with our community stakeholders to provide technical assistance, gather feedback, and assess progress. In fact, our partners have helped us to identify other support professional audiences who have a significant impact on the IDD population, such as personal care attendants, family caregivers/guardians, teachers, recreation service providers, and non-county case managers, who could benefit from WFEB. Our frequent contact with our stakeholders fosters strong relationships and demonstrates our mutual goals of improving the quality of life of individuals with IDD. Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Else, provide an estimate of start-up costs/ budget breakdown. Hennepin County received grant funds to support this project in the development phase. Once program materials (online videos and electronic learning, supplemental written materials, assessments, etc.) were developed, costs were reduced to: Staff time needed to promote the program to additional sites and respond to requests for technical assistance. Optional funds to cover cost of additional materials for group home and DTH sites (e.g., cookbooks for staff or physical activity DVDs) to help support healthy eating and physical activity environments. Development costs ($103,000): Community health specialist (1.0 FTE): $53,000 (plus benefits) Nutrition and physical activity videos tailored to IDD audience: $50,000 Electronic learning modules: In-kind from Hennepin County Training and Development staff Ongoing costs ($27,500): Community health specialist (0.5 FTE): $26,500 (plus benefits) Optional material cost: $1,000
What did you find out? To what extent were your objectives achieved? Please re-state your objectives from the methodology section.The objectives of the program are: Short-term: Integrate PAN policies, procedures, and practices in organizations that support individuals with IDD. Increase staff knowledge and skills related to PAN promotion Long-term: Increase the percentage of individuals with IDD who demonstrate an increase in physical activity or an increase in fruit and vegetable intake. Decrease prevalence of overweight/obesity among individuals with IDD. Improve functionality, mood, challenging behaviors, lab values, or dosage or number of medications required. Did you evaluate your practice? List any primary data sources, who collected the data, and how (if applicable) During the formative research phase of the program, Hennepin County Public Health conducted a random chart audit of 550 individuals with IDD in Hennepin County. The information was collected to identify the baseline health status of the IDD population as well as the frequency of health-promoting PAN practices. The chart audit was conducted and results reported in unidentifiable aggregate format. A county public health epidemiologist designed the method to yield a valid random sample. A qualitative method was used to gather data to help Hennepin County Public Health staff better understand the perceptions and attitudes of key gatekeepers and stakeholders as well as current practices and facilities. Hennepin County Public Health contracted with the Center for Social Marketing and Behavior Change, Academy for Educational Development, in Washington D.C., to validate the formative research design as well as analyze and compile the results. In-depth individual interviews were conducted with group home staff and managers, IDD advocates and family members, state and county aging and disability staff, employment and day service staff and managers, and IDD health care providers. Hennepin County Public Health staff facilitated and collected the data through key stakeholder interviews and focus groups. During our pilot test, Hennepin County Public Health worked directly with the participating organizations to collect baseline and follow-up health data for individuals living in group homes. The data collected included: age, length of residency, height, weight, medication usage, and level of cognitive disability, functionality, challenging behaviors, fruit and vegetable consumption, as well as the level and frequency of physical activity. Organization staff and managers received written instructions for data collection and were responsible for completing the data collection form for each individual living in group homes. County public health staff worked with Hennepin County staff responsible for quality improvement to develop the survey and process for administration and data collection. During the course of the pilot project, meetings were held with staff and managers to assess the progress on and provide technical assistance for the completion of each organization’s action plan. At these meetings qualitative data as well as anecdotes concerning staff and residents’ reactions to WFEB were documented. Most comments revolved around the cultural shift towards wellness taking place in the pilot organizations and it becoming the way they do business. Managers and staff also indicated that both support staff and clients engage in healthier food choices and physical activity because the healthier behaviors are integrated into the routine of the day. Staff sees participating in physical activity during their work day as a “real benefit” as they can achieve their physical activity goal at work. Individuals with IDD see physical activities as “fun” because they participate with the support staff. Managers and staff see it as a “win, win situation.” Clients are achieving their health goals and so is the staff.List any secondary data sources used (if applicable) No secondary data sources were used. List performance measures used. Include process and outcome measures as appropriate. Our evaluation is a combination of process measures and program outcomes based on the nature of each objective. Conduct formative research to understand the baseline health status of the IDD population and gather data to help PHP staff better understand the perceptions and attitudes of key gatekeepers and stakeholders as well as current practices and facilities. Administer organizational assessments at each level of the company (corporate, group homes, DTH) to identify strengths and gaps regarding a healthy PAN environment. Provide technical assistance to organizations to develop action plans to integrate PAN into the existing supports for adults in group home and DTH settings. Ninety percent of each identified action plan will be completed. At the end of the pilot project all action plans were complete and improved PAN practices were implemented. In total, a combination of 36 policies, standards, and practices were put into place, such as removal of empty-calorie foods from vending machines, use of standardized menus, implementation of nutrition standards and staff taking part in physical activities with individuals with IDD. Specific health parameters of individuals with IDD will demonstrate an improvement. Baseline and follow-up measures were assessed and are as follows: oDaily consumption of five or more servings of fruits and vegetables at baseline was 71 percent, at follow-up 76 percent. oMeeting moderate physical activity recommendations was 31 percent at baseline and 62 percent at follow-up. oAverage body mass index of individuals with IDD at baseline was 31, at follow-up 29. oIndividuals with IDD realized an 84 percent improvement in at least one quality of life or health criteria, such as mood, challenging behaviors, functionality, lab values, or a decrease in medication dosage. Gain the support of Hennepin County Aging and Disability Services (ADS) managers and staff to orient the entire system in a healthier PAN direction. PHP staff conducted meetings and trainings for ADS staff and managers to present the project, build relationships, and create project buy-in. ADS staff see WFEB as a method to improve the quality of life of their clients and a method to realize lower medical costs in the long term. Hennepin County ADS case managers have begun including a PAN discussion at individual client progress meetings as of July 2013. Describe how results were analyzed: The chart audit analysis was designed by a Hennepin County epidemiologist and was primarily descriptive. The preceding data analysis was a complex data process involving coding text data and data linkage. Protocols of coding strategies were developed to code two major text fields of the chart review: the diagnoses and the individual’s physical activity and nutrition (PAN) goals. The diagnosis text data was coded by staff with medical backgrounds and PAN goal text data was coded by two staff with research backgrounds. Disagreement in coding was resolved by staff discussions. The chart data was supplemented with a survey of group home supervisors to gather data on residents’ smoking behaviors, body weight, and height. The record review data was then linked with the data obtained from the chart. As mentioned in an earlier section, Hennepin County Public Health contracted with the Center for Social Marketing and Behavior Change, Academy for Educational Development, in Washington D.C., to validate the formative research design as well as analyze and compile the results. The center conducted a content analysis of interview notes and identified key themes within the qualitative data. Baseline and follow-up health data was primarily quantitative as well as descriptive. Comparison analysis was used to interpret the results.Were any modifications made to the practice as a result of the data findings? Health parameter data was measured both pre-and post-project. Data was collected via a written survey completed by group home staff for each individual residing in that home. Surveys were de-identified and results reported in aggregate for each participating organization. During the first cohort of pilot organizations the number of baseline survey results returned and completed was very low, 50 percent returned and 70 percent were complete. This necessitated numerous phone calls and visits from PHP staff to collect all of the necessary information. Using a quality improvement process, Hennepin County Public Health staff examined the reasons for the poor response rate. To improve future response rates, staff re-designed the survey tool and the process for collecting and returning data. The redesigned questions and survey administration process yielded a 100 percent return rate and a 90 percent completion rate. Another significant change was realized as we moved through the pilot study. It became clear there were many common threads of need throughout the industry, instead of needs varying by each individual organization. In response to this finding we developed a cohesive program that addressed the common needs of organizations and made it accessible online to address the 24/7 nature of the industry as well as the commonality of staff training needs.
Lessons learned in relation to practice Successful sustainable efforts need to: Involve stakeholders from the beginning. Doing so allowed PHP to gain support and build long-term relationships to ensure sustainability. It also gave us the opportunity to identify and understand the unique needs of these stakeholders, which informed the development of this well-received program. Define mutually agreed-upon action plans with each organization. PHP staff provided technical assistance and resources to help each organization complete their action plan and achieve an improved PAN environment. Setting realistic goals based on the organization’s needs, and providing technical assistance and support to achieve those goals, increases motivation and the chances of long-term sustainability. Lessons learned in relation to partner collaboration (if applicable) We depend on our community stakeholders to provide guidance to keep the program relevant to the needs of the IDD industry and their staff. Hennepin County Public Health staff routinely meets with our community stakeholders to provide technical assistance, gather feedback, and assess progress. Frequent contact with our stakeholders fosters strong relationships and demonstrates our mutual goals of improving the quality of life of individuals with IDD. We find that the staff in the industry is passionate about improving the health and wellbeing of the people they support. Because there are so few accessible resources available to them, this program has been enthusiastically welcomed by the industry. Is this practice better than what has been done before? As mentioned earlier in this document, our project takes a “whole environment” approach to health improvement rather than focusing only on the unhealthy behaviors of individual residents. Sustainability is assured when a whole system orients in a different direction. Did you do a cost/benefit analysis? If so, describe PHP has not conducted a cost/benefit analysis. However, Hennepin County spends $135 million per year for supportive living services and $17 million per year for group residential housing for adults with IDD. For just a fraction of what Hennepin County spends each year for supportive living services and group residential housing for adults with IDD, Wellness for Every Body has the potential to significantly reduce medical costs and positively impact the long-term health and quality of life for these individuals. Sustainability – is there sufficient stakeholder commitment to sustain the practice? Describe sustainability plans. This program has been met with enthusiasm and commitment by organizations in the industry since it fills a gaping hole in PAN training and resources for nearly all of these organizations. Due to funding and time constraints provider organizations experience, the ability to provide health-promoting PAN training and resources for their staff is very difficult. Our training is free, versatile, and available anytime. Agencies participating in the pilot program have already seen improvements in individuals’ behaviors, staff knowledge, and practice.
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