11/10/2014. Anne McGrorty DNP, RN, CPNP Alison McGrorty, MD. Welcome to the COPE Webinar Series for Health Professionals!

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Foundation of a Social Media Intervention Time: 12 noon 1 PM EST

Center for Obesity Prevention & Education Handouts of the slides are

edu/cope MacDonald Center for Obesity Prevention and Education (COPE)

Participate in Research Enhance Education A Pediatric Evidence Based

DNP, RN, CPNP Alison McGrorty, MD Objectives: The learner will be able to:

3. Evaluate the impact of creative teaching strategies on behavior change

Credits: Notice: This webinar provides 1 contact hour for nurses and1 CPEU

Villanova University College of Nursing Continuing Education is an

1 Welcome to the COPE Webinar Series for Health Professionals! November 12 th 2014 webinar: A Pediatric Evidence Based Teaching Plan: Foundation of a Social Media Intervention Time: 12 noon 1 PM EST Moderator: Rebecca Shenkman, MPH, RDN, LDN Program Manager MacDonald Center for Obesity Prevention & Education Handouts of the slides are posted at: MacDonald Center for Obesity Prevention and Education (COPE) Goals Provide Continuing Education Partner with agencies and organizations Participate in Research Enhance Education A Pediatric Evidence Based Teaching Plan: Foundation of a Social Media Intervention Anne McGrorty DNP, RN, CPNP Alison McGrorty, MD Objectives: The learner will be able to: 1. Recognize the need for evidence-based strategies in the primary care environment. 2. Identify the physical, developmental, and learning needs of obese children. 3. Evaluate the impact of creative teaching strategies on behavior change for obese children. Credits: Notice: This webinar provides 1 contact hour for nurses and1 CPEU for dietitians. Suggested CDR Learning Need Code: 5070, 5370,9060; Level 2. Villanova University College of Nursing Continuing Education is an accredited provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation. Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration. 1

2 DISCLOSURE Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products displayed in conjunction with an activity. Foundations for a Social Media Intervention for Obese Children: A Pediatric Evidence Based Teaching Plan Anne McGrorty DNP, RN, CPNP Alison McGrorty, MD Themes Evidence based Teaching Plan Social Networks Obese Children 2

Evaluate the impact of creative teaching strategies on behavior change for obese children.

3 Objectives Learning Objectives: 1. Recognize the need for evidence based strategies in the primary care environment. 2. Identify the needs of obese children physical, developmental, and learning 3. Evaluate the impact of creative teaching strategies on behavior change for obese children. Team Remember collaboration is the key to success: Save $ Utilize your available resources Too much spending too much information Lack of integration Know your available resources Stop Spending! Start Integrating! Use available resources and the gifts available! 3

Cost America spends trillions on health care yearly Approximately 18% of the economy is driven in health care

Increasing size = decreasing productivity, increasing disability!

primary care office is 10 20 minutes During a well visit providers track growth and development, nutrition,

4 Cost America spends trillions on health care yearly Approximately 18% of the economy is driven in health care costs. What impact will our size have on our economy? Increasing size = decreasing productivity, increasing disability! Commonwealth Fund, 2011 Cost to the Child The average amount of time allotted for a well child visit in a primary care office is minutes During a well visit providers track growth and development, nutrition, activity, anticipatory guidance, and address parental/child concerns Halfon, et al,2011 Insufficient Time During a routine physical, one minute is the average amount of time devoted for disease prevention. Strange et al,

Where to start? Remember You Have 10 20 Minutes! PMHx? Any Concerns? Family History?

Safety: Seat Belts, Sunscreen, Good Touch Bad Touch, Drugs, ETOH, Choking Hazards,

And then you start the discussion My patient is a 10 year old male at the office for

5 Where to start? Remember You Have Minutes! PMHx? Any Concerns? Family History? Diet? Calcium? Exercise? Sleep? School Behavior? Social Skills? Immunizations? Safety: Seat Belts, Sunscreen, Good Touch Bad Touch, Drugs, ETOH, Choking Hazards, Stranger Danger, Burns, Smoke Detectors, Family Code Words, Bullying, Cyber Bullying And then you start the discussion My patient is a 10 year old male at the office for his yearly exam. He is a new patient to the practice. His weight is 277 pounds. His BMI is

You have 10 20 minutes The clock is Ticking! What to do? Is it genetic? Is it depression? Does he exercise?

I see a child trapped in the body of an obese adult. It is difficult!

6 You have minutes The clock is Ticking! What to do? Is it genetic? Is it depression? Does he exercise? Does he eat appropriate portions? Should I report this? Is it abuse? Where do I start??? I see an adult, but I hear a child. I see a child trapped in the body of an obese adult. It is difficult! Outcomes He suffers from: Morbid Obesity Asthma Ankle Pain Penile bridging, incontinence Temper Tantrums Acanthosis nigricans Snores with pausing; sleep apnea Blood in stool; anal fissures Peri anal strep Eczema 6

Referrals ENT Orthopedics Dermatology Urology Psychology Labs to r/o Type II Diabetes

Vaccine SCHC Farm to Families/Food Trust Additional Information Mom is sole support Dad

7 Referrals ENT Orthopedics Dermatology Urology Psychology Labs to r/o Type II Diabetes EKG with Rhythm Strip Weight Management YMCA Stool for blood Asthma Allergy Hepatitis A Vaccine SCHC Farm to Families/Food Trust Additional Information Mom is sole support Dad is unemployed Lives with parents and sibling Both parents are overweight Insured no co pay for well check However, co pay $30.00 for sick or follow up care Follow up Phone follow up 1 week Office follow up 1 month Positive outcomes start Visits monthly for 3 months 7

Starting to Change Behaviors: Mother took child to every specialist T&A is completed and CPAP is ordered Asthma is well controlled EKG is normal Mom tried to get public

Mom unable to afford visits Mom unable to afford food Family reported to DHS by specialist! Stops Coming! One year later gained 15 pounds!

8 Starting to Change Behaviors: Mother took child to every specialist T&A is completed and CPAP is ordered Asthma is well controlled EKG is normal Mom tried to get public assistance for food stamps and was denied Farm to Families is recommended Mom starts to exercise with her son Gaps! Mom unable to afford visits Mom unable to afford food Family reported to DHS by specialist! Stops Coming! One year later gained 15 pounds! Looking from a New Perspective Patients not returning: increased unemployment, increase in uninsured Both parents working Time Cost Lack of resources Developmental and learning needs Little people in adult bodies Parental/child distress Provider distress guilt! 8

moves along these networks infecting friends and families In addition, food

9 Networks Christakis & Fowler (2007) Defined obesity along networks or social ties Social ties are defined as family, friends and work associates Obesity moves along these networks infecting friends and families In addition, food choices move along these networks Christakis and Fowler Network Model An Internet Map 9

Barriers in Primary Care Barriers Cost, time, educational resources

message Spivack, et al, 2010 Integrating the Messages Volume of

message address the developmental and learning needs of the child

10 Barriers in Primary Care Barriers Cost, time, educational resources Compliance of the child and family Consistency in the primary care message Spivack, et al, 2010 Integrating the Messages Volume of information Confusing for families Confusing for providers Does the message address the developmental and learning needs of the child and their family? Internet Use the network to infuse positive health messages 10

Bringing It Together Integrating the Evidence AAP Barlow 2007

Department of Health and Human Services Healthy People 2020 The

United States Department of Agriculture Let s Move Health

Integrate the Evidence Address the developmental needs of 10 14

development of a social media communication intervention

11 Bringing It Together Integrating the Evidence AAP Barlow 2007 Bloom CDC Christakis & Fowler Erikson Gardner NAPNAP Pender The Department of Health and Human Services Healthy People 2020 The United States Department of Agriculture Choose My Plate The United States Department of Agriculture Let s Move Health Promotion and Disease Prevention Using the Internet Goal: Integrate the Evidence Address the developmental needs of year old children Create a teaching plan supporting the development of a social media communication intervention strategy Outcomes Decreased weight Increased knowledge of nutrition Increased activity 11

pages long and is easy to use during a primary care visit.

12 A Social Media Communication Intervention to fill the Gaps in Primary Care Need for Evidence Based Strategies in the Primary Care Environment Start with an organized plan A teaching plan addressing key areas Nutrition Exercise Health Promotion My teaching plan is ten pages long and is easy to use during a primary care visit. Developmental Needs of Children Erikson Six to Twelve Years Industry vs Inferiority Pride in accomplishments and abilities Twelve to Eighteen Years Identity vs Role Confusion Develop a sense of self and personal Identity 12

Howard Gardner Theory of Multiple Intelligences

styles The Teaching Plan Coaching on a Continuum You

You now know: Patient s activity choices What resources

13 Howard Gardner Theory of Multiple Intelligences Educational Theory different kinds of minds and learning styles The Teaching Plan Coaching on a Continuum You have interviewed the child in the primary care office. You now know: Patient s activity choices What resources they have What the family s interest is What the child s schedule is 13

How to Use the Teaching Plan You document what you achieved during the visit Five minute target and build upon the target each time Document what was achieved Set goals during the visit Decide on

14 How to Use the Teaching Plan You document what you achieved during the visit Five minute target and build upon the target each time Document what was achieved Set goals during the visit Decide on follow up This provides the next provider an opportunity to start where you finished Developmental and Learning Needs Case Study Developmentally the child is twelve years old Industry vs Inferiority The child is a spatial learner You must develop a teaching strategy around their needs. You have 5 minutes. Pictures they want to feel accomplished Instagram???? How to Start 14

Social Networks refers to people that have something in common; friends, shared beliefs, or cause.

15 What is Social Media Social Media refers to the means of interactions among people in which they create, share, and/or exchange information and ideas. Social Networks refers to people that have something in common; friends, shared beliefs, or cause. Tuft s, 2013 Facebook Twitter MySpace YouTube Instagram Linkedin Tumblr Social Media Choices MySpace Established 2003 Music based Decline in visitors to the site Purchased in 2011 by Specific Music Group and Justin Timberlake 15

YouTube Established since 2005 Video sharing

Blogging Limit to 140 characters Send and receive

can read only Established 2010 Instagram Photo and

16 YouTube Established since 2005 Video sharing website Google owned Established in 2006 Twitter Blogging Limit to 140 characters Send and receive tweets Registered can read and post Unregistered can read only Established 2010 Instagram Photo and video sharing social network Service acquired by Facebook in

university social network Mark Zuckerburg and his roommates at Harvard Must be thirteen years

17 Linkedin Founded 2002 Professional networking Tumblr Established 2007 Micro blogging and social networking platform Purchased by Yahoo in 2013 Facebook Established in 2004 as a university social network Mark Zuckerburg and his roommates at Harvard Must be thirteen years of age to register Pictures, messages, notifications, and profiles Categorized in common interest groups 17

Facebook In 2012, there were 1 billion members on Facebook Nearly 10% were fake users! Consider safety! Facebook: Do they own my content? Can they share?

18 Facebook In 2012, there were 1 billion members on Facebook Nearly 10% were fake users! Consider safety! Facebook: Do they own my content? Can they share? Sharing Your Content and Information You own all of the content and information you post on Facebook, and you can control how it is shared through your privacy and application settings. In addition: For content that is covered by intellectual property rights, like photos and videos (IP content), you specifically give us the following permission, subject to your privacy and application settings: you grant us a non exclusive, transferable, sub licensable, royaltyfree, worldwide license to use any IP content that you post on or in connection with Facebook (IP License). This IP License ends when you delete your IP content or your account unless your content has been shared with others, and they have not deleted it. When you delete IP content, it is deleted in a manner similar to emptying the recycle bin on a computer. However, you understand that removed content may persist in backup copies for a reasonable period of time (but will not be available to others). When you use an application, the application may ask for your permission to access your content and information as well as content and information that others have shared with you. We require applications to respect your privacy, and your agreement with that application will control how the application can use, store, and transfer that content and information. (To learn more about Platform, including how you can control what information other people may share with applications, read our Data Use Policy andplatform Page.) When you publish content or information using the Public setting, it means that you are allowing everyone, including people off of Facebook, to access and use that information, and to associate it with you (i.e., your name and profile picture). We always appreciate your feedback or other suggestions about Facebook, but you understand that we may use them without any obligation to compensate you for them (just as you have no obligation to offer them). Dilemma How can I reach my population? How can I deliver my message safely? How can I achieve the outcomes that are necessary to make change? How many children will I permit to participate? Who will manage the site? Do we know it works? 18

Considering Social Media Who is the target? My patients are 10 14 years What media best fits my population?

Start the teaching plan in the primary care office, phone participants, text follow up and an Instagram diary Parent permission signed Parents must be included in the Instagram discussion Facebook

19 Considering Social Media Who is the target? My patients are years What media best fits my population? If I work with year old children, Instagram may be the safest and easiest Social Media. Picture logs of meal choices, with brief messages to the child and received by the provider. Start the teaching plan in the primary care office, phone participants, text follow up and an Instagram diary Parent permission signed Parents must be included in the Instagram discussion Facebook Once age 13: Discussion with parent and child Format decided based upon the learning needs of child Automatic feeds from Let s Move, Tracker, USDA, Motivational Quotes Evaluate the Impact of Creative Teaching Strategies on Behavior Create the Plan Identify the learning needs of each child Set up the media Include the parents Evaluate Count the likes Look for the comments Watch the pictures, the recipes, and the posting Plan for a phone follow up 19

Medical Home Link to the Medical Home Model for tracking and improved care Improving coordination of care Improving outcomes Improving reimbursement Closing Thoughts References Barlow, S. (2007).

2007 2329C Bastable, S. B. (2008). Nurse as educator, principles of teaching and learning for nursing practice (3rd ed.). Boston, MA: Jones and Bartlett. Berge, J. M., & Everts, J. C. (2011).

20 Medical Home Link to the Medical Home Model for tracking and improved care Improving coordination of care Improving outcomes Improving reimbursement Closing Thoughts References Barlow, S. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics, 120, doi: /peds C Bastable, S. B. (2008). Nurse as educator, principles of teaching and learning for nursing practice (3rd ed.). Boston, MA: Jones and Bartlett. Berge, J. M., & Everts, J. C. (2011). Family based interventions targeting childhood obesity: a metaanalysis. Childhood Obesity, 7, Bindler, R., & Bruya, M. (2006). Evidence for identifying children at risk for being overweight, cardiovascular disease, and type 2 diabetes in primary care. Journal of Pediatric Health Care, 20, Bloom, B. (1985). Developing talent in young people. New York: Ballantine Books. Boushey, C., Kerr, D., Wright, J., Ebert, D. & Delp, E. (2009). Use of technology in children s dietary assessment. European Journal of Clinical Nutrition, 63, doi: /Ejcn Centers for Disease Control and Prevention (2011). Characteristics of an effective health education curriculum. Retrieved from characteristics/index.htm. Centers for Disease Control and Prevention (2011). National health education standards. Retrieved from Chistakis, N., A., & Fowler, J. (2007). The spread of obesity in a large social network over 32 years. New England Journal of Medicine, 357,

21 References Cullen, K., & Thompson, D. (2008). Feasibility of an 8 week african american web based pilot program promoting healthy eating behaviors: family eats. American Journal of Health Behaviors, 32(1), Falvo, D. R. (2004). Effective patient education, a guide to increased compliance (3rd ed.). Boston, MA: Jones and Bartlett Publishers. Frenn, M., Malin, S., Brown, R., Greer, Y., Fox, J., Greer, J., & Smyczek, S. (2005). Changing the tide: an internet/video exercise and low fat diet intervention with middle school students. Applied Nursing Research, 18, doi: /j.apnr Gardner, H. (1993). Multiple intelligences: Theory in practice, Boston, MA: Persus Books Groups. Glasgow, R., Bull, S., Poette, J., & Steiner, J. (2004). Interactive behavior change technology a partial solution to the competing demands of primary care. American Journal of Preventive Medicine, 27(2s), Guo, S., Roche, A., Chumlea, W., Gardner, J., & Siervogel, R. (1994). The predictive value of childhood body mass index values for overweight at age 35 y. American Journal of Clinical Nutrition, 59, Jacobson, D., & Melnyk, B. M. (2012). A primary care healthy choices intervention program for overweight and obese school aged children and their parents. Journal of Pediatric Health Care, 26(1), Melnyk, B., & Fineout Overholt, E. (2011). Evidence based practice in nursing & healthcare, a guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer, Lippincott Williams & Wilkins. References National Association of Pediatric Nurses and Practitioners (2006). Healthy eating and activity together. Retrieved from and initiatives/childhood obesity/heat ClinicalPracticeGuideline.aspx. Nguyen, B., Kornman, K. P., & Baur, L. A. (2010). A review of electronic interventions for prevention and treatment of overweight and obesity in young people. International Association for the Study of Obesity, 12, doi: /j x x Pachucki, M. A., Jacques, P. F., & Christakis, N. A. (2011). Social networks concordance in food choice among spouses, friends, and siblings. American Journal of Public Health, 101, Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Boston, MA: Pearson. Redman, B. K. (2001). The practice of patient education (9th ed.). Philadelphia, PA: Mosby. Robbins, L. B., Gretebeck, K. A., Kazanis, A. S., & Pender, N. J. (2006). Girls on the move program to increase physical activity. Nursing Research, 55, Strange, K., Woolf, S., & Gjeltema, K. (2002). One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling. American Journal of Preventive Medicine, 22, The United States Department of Agriculture (2011). Choose my plate. Retrieved from materials ordering/dietary guidelines.html. The United States Department of Agriculture (2011). Let s move. Retrieved from smove.gov/. The United States Department of Health and Human Services (2012). Healthy people Retrieved from Wen ying, C., Hunt, Y., Beckjord, E., Moser, R., & Hesse, B. W. (2009). Social media use in the united states implications for health. Journal of Medical Internet Research, 11. doi: /jmir Evaluations and CE Certificates Everyone who has completed the webinar will be ed a link to the evaluation. The will be sent to the address that you used to register for the webinar. Please complete the evaluation soon after you receive the . The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate. Once the evaluation is completed, the CE certificate will be ed separately within 2 business days. 21

COPE s December Professional Webinar Ellen Wartella, PhD Food Marketing and the Childhood Obesity Crisis Date: Time: CE Credit: Tuesday December 9 th 12:00PM - 1:00PM EST 1.0 contact hour, 1.

22 COPE s December Professional Webinar Ellen Wartella, PhD Food Marketing and the Childhood Obesity Crisis Date: Time: CE Credit: Tuesday December 9 th 12:00PM - 1:00PM EST 1.0 contact hour, 1.0 CPEU To register, go to villanova.edu/cope and click on Webinar Series Questions and Answers! Moderator: Rebecca Shenkman, MPH, RDN, LDN cope@villanova.edu Web site: villanova.edu/cope To receive monthly s on upcoming COPE events, please join COPE s Contacts on our website. Thank you for your time and interest. 22

3/2/2015. Welcome to the COPE Webinar Series for Health Professionals! Motivational Interviewing: Overcoming Client Resistance to Change

3/2/2015. Welcome to the COPE Webinar Series for Health Professionals! Motivational Interviewing: Overcoming Client Resistance to Change Welcome to the COPE Webinar Series for Health Professionals! March 11 2015 webinar Motivational Interviewing: Overcoming Client Resistance to Change Time: Moderator: 12 noon 1 PM EST Rebecca Shenkman,