It s a win-win: Hospitals and Community Fighting Obesity Together. Megan Lipton-Inga, MA CCRP Ellen Iverson, MPH Brenda Manzanares, RD

Transcription

1 It s a win-win: Hospitals and Community Fighting Obesity Together Megan Lipton-Inga, MA CCRP Ellen Iverson, MPH Brenda Manzanares, RD

2 The Diabetes & Obesity Program Children s Hospital Los Angeles Mission: To develop, implement, and promote innovative and effective strategies to combat childhood and adolescent diabetes and obesity PHOTO

3 Stopping the Cycle CAUSES Prevention Community Engagement OBESITY EMPOWER CLINIC EMPOWER T2 CLINIC KIDS N FITNESS Treatment COMPLICATIONS

4 The Diabetes & Obesity Program Children s Hospital Los Angeles EMPOWER Weight Management Clinic- Children above 85th% with co-morbidities EMPOWER T2DM- Clinic for T2DM children Kids N Fitness - Evidence-based, Family-centered healthy lifestyle program for children ages 8-16 with BMI %ile years in operation; 1800 families Kids N Fitness Jr. Ages 3-7 4

5 Hospital: Rationale for Hospital - Community Engagement Expertise in complex obesity care, research Clinics has long waitlist, high no shown rate, costly to operate; geographically far, uninviting Medicalizing weight management can be a barrier No one likes to go to the hospital Community: Expertise in their community, people & resources available Convenience; Accessibility; Familiarity Helps with retention and engagement Increases likelihood that families show up and stay.

6 Rationale for Hospital Community Engagement Integration of obesity prevention interventions into one s everyday setting increases one s ability to make and sustain healthy changes. This model connects high risk patients to specialty care and allows for everyone else to received education, care, and support in their own community.

7 South Los Angeles Over two thirds of children are Latino (68%); 27% African American South Los Angeles consistently ranks highest on nearly every parameter of economic disadvantage, income, food and housing insecurity, education, unemployment, safety 1 The obesity rate is 32.7% for adults and 29% for youth (grades 5, 7, 9) compared to 23.9% for adults and 23% for youth in the whole of LA County. Nutritious, healthy food options are scarce, a disproportionate high number of fast-food chains, liquor retail stores, and convenience markets. Los County Department of Public Health

8 CHLA Community Partnerships in South Los Angeles Faith community: New Mount Calvary Missionary Church FQHCs: St John s Well Child & Family Center Schools: Just Keep Livin Foundation Afterschool Program

9 Faith-based partnership To pilot a two-year, faith-based obesity/diabetes initiative targeting children and adolescent congregants and their families Why partner with a church? Hubs of spiritual, psychological and social support and communication Promotion of physical and mental health is a natural tie in to spiritual health Considered to be trusted source of information Access to multigenerational, consistent population Multiple opportunities to introduce and reinforce wellness messaging 9

10 Overarching goal was to work with church to create an overall culture of wellness Six month planning period- critical to establishing trust and rapport Conducted health needs assessment (n=300) Forming a Health and Wellness Advisory Board Hired and trained 7 congregation members (program coordinator, care coordinator, and peer health educators & counselors) Pastor s outspoken commitment and support to our partnership was essential. All intervention activities developed with active participation of the pastor, congregational leadership and a Health and Wellness Advisory Board. Funded by Centinela Medical Foundation

11 Successes Implemented 3 adaptations of Kids N Fitness in multiple congregational settings. 6 week program Summer camp (2 summers) KNF nuggets integrated into Children s church and Kingdom Kids Three large scale health and wellness fairs Quarterly nutrition events for the adults Faith and Fitness weekly education and exercise 4 teen wellness retreats Healthier food options served at church events 11

12 Project H.E.A.L.-- Successes 12

13 Sustaining Impact NMC leadership committed to institutionalize PROJECT HEAL Advisory Board has become an official Health and Wellness Ministry. Nurses in wellness ministry are providing ongoing training and workshops for congregation Weekly Faith & Fitness program has expanded to include more wellness programming Children s Church leaders carving out time for more PE, offering healthier snacks and emphasizing nutrition-related messages to children. CHLA/HEAL staff have created a toolkit for short nutrition lessons for use with children in faith-based settings. 13

14 St. John s Well Child & Family Health Center St. John s is a consortium of 11 community clinics in South LA with over 18,000 pediatric patients, 40% of whom are overweight or obese Began collaboration with a community provider needs assessment In-service trainings and clinical guidelines to PCPs Trained 5 St.John s promotoras and 1 coordinator to deliver KNF CHLA RD co-led four cohorts of KNF with 80 families participating Facilitated access to EMPOWER clinic for more complex patients with greatest need Sponsored by Unihealth Foundation 14

15 Mutually Beneficial relationship In the community We were able to reach more kids, focus on prevention, saving our clinical higher cost resources for more critical cases Training community educators was cost effective, resulted in classes with comparable adiposity decreases, and the same or improved retention rates. Community educators enhanced the intervention cultural synergy with the families, providing them with relevant, familiar, local community resources In the same time period CHLA enrolled 90 kids while St Johns enrolled 180.

16 Sustaining Impact Kids N Fitness program is integrated into St. John s programming Financed and staffed by St John s w/limited consulting from CHLA 8 cohorts total since completed 4+ classes St John s applied for a grant for us to partner to adapt KNF for children with autism and other developmental disabilities KNF4ALL (Kids N Fitness for All Learning Levels) began in May 2 year pilot to implement 8 6-week cohorts of Kids N Fitness for this populations

17 St. John s Frayser Clinic 17

18 Afterschool Programs with Teens Just Keep Livin (JKL) Foundation: Aligned mission: empowering high school students by providing them with the tools to lead active lives and make healthy choices for a better future. Focus group/pilot Teens N Fitness with 20 JKL youth Spring 2016 Finalize curriculum (Summer 2016) Pilot 2 sessions of TNF with JKL 65 students (academic year 16-17) Animo Charter (Inglewood) and Fremont High School 18

19 Partnership Challenges Managing competing priorities of partners Identify stakeholders/organizations with aligned missions Dedicate time in project design to build relationships, establish rapport and trust and learn organizational structure of partner Build relationships and buy in from leadership down Create program initiatives with active engagement of community partner Space Staffing changes mid collaboration Supervision challenges when training/working with local staff; Unclear chain of command Flexibility and contingency planning

20 Challenges - Sustainability Think about sustainability from the beginning Hire & train local staff, Use community resources Design programs to be integrated into existing structures

21 KNF & CAMP UCLA UniCamp Collaboration with UCLA Adapted the KNF curriculum American Diabetes Association - Camp Strong CHLA staff and volunteers conducted camp activities National partnership with ADA embedding KNF in all of their POWER UP prevention camps going forward. Training 8 ADA staff around the country to become certified KNF instructors to scale to communities in other regions 21

22 Community Engagement The Dream Team Megan Lipton-Inga, MA Director, Program Development Ellen Iverson, MPH Director, Community Outreach Valerie Ruelas, MSW Director Community Advocacy Brenda Manzanarez, RD Program Leader, Trainer Kelleen Young, BA Project Coordinator 22