BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention

Transcription

1 BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention Janice D. Key, MD Director, MUSC Boeing Center for Children s Wellness

2 The MUSC Boeing Center for Children s Wellness The MUSC B oeing Center for Children s Wellness winning the 2016 Healthcare Leadership Council Wellness Frontiers Award

3 BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention What is it? How was it developed? What is working? Discussion

4 MUS C B oeing Center for Children s Wellness: P rograms and Activities S C DHEC Obesity Action P lan S CMA Childhood Obesity Taskforce Docs Adopt S chool Health Initiative; S CP ITC Bridge Walks and Wellness Committees Childhood Obesity Toolkit with patients and families CDC S ocial Ecological Approach to Obesity Prevention / obesity/ health_equity/ addressingtheissue.html

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6 BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention What is it? How was it developed? What is working? Discussion

7 Docs Adopt S chool Health Initiative HEALTHY STRATEGIES AMONG SCHOOLS AWARD WINNING SCHOOLS n=195/207(94%) N (%) Fruit & vegetable tastings 53 (27%) Water drinking campaign 93 (48%) S chool garden 114 (58%) Increase physical activity 145 (74%) Smart beverages 148 (76%) Smart snacks 121 (62%) Applied for wellness grant 125 (64%) S chool fundraiser for wellness 127 (65%) Kinesthetic Learning at Harborview Elementary Charleston County S chool District S chool garden at Manning Early Childcare, Clarendon 2 S chool District Healthy Fundraiser Spartanburg 1 School District

8 S chool Wellness Checklist Winners B amberg 1: Richard Carroll Elementary B amberg 2: District: Denmark-Olar High S chool Charleston County S chool District: Mary Ford Elementary Clarendon County S chool District 2: Manning Junior High S chool Colleton County S chool District: Colleton High S chool Greenwood County S chool Distict 50: Hodges Elementary S chool

9 S chool Wellness Checklist Winners Dorchester 2: Tied:Ashley Ridge High & Flower town High B erkeley County: Tied Westview Middle & S angree Elementary Richland 2: (With Palmetto Health Children s Hospital) B lythewood High Pottstown PA: (With Pottstown Area Health & Wellness Foundation) Cherokee County: B lacksburg High Spartanburg 1: Landrum High

10 S chool Wellness Checklist Winners Florence 1 & 2 (with McLeod Children s Hospital) Florence 1: S outhside Middle Florence 1: S avannah Grove Elementary Florence 1: Wilson High Florence 2: Hannah-Pamplico Elementary/ Middle Florence 2: Hannah-Pamplico High

11 BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention What is it? How was it developed? What is working? Discussion

12 Background: Effective obesity prevention must go beyond traditional health care and address today s obesogenic environment through policy, systemic and environmental (PSE) changes targeting improved nutrition and increased exercise. Childhood obesity prevention must be centered in schools as the heart of health Many health care organizations recommend that physicians become involved these public health efforts including the AMA, IOM, CDC, HRSA, AAP, and AAFP However implementation of school-based programs is difficult and including physicians even more so

13 GOAL 4: Expand the role of health care providers in obesity prevention Health care providers should increase the support for achieving better population health and obesity prevention. advocate for improved physical activity and diet opportunities in their patients' communities.

14 GOAL 5: Make schools a national focal point for obesity prevention 1. Require quality physical education and opportunities for physical activity 2. Ensure strong nutritional standards for all foods & beverages 3. Ensure food literacy

15 Public Health Approach for Obesity Prevention: IOM Accelerating Progress in Obesity Prevention 2012

16 Public Health Approach for Obesity Prevention: IOM Accelerating Progress in Obesity Prevention 2012

17 Community-based Program Development Charleston County Medical S ociety S chool Health Committee South Carolina Medical Association Community Health Award 2012

18 Enhancing school-based obesity prevention programs by including services for teachers NICHQ S teps Workshop #1 IDENTIFY KEY STAKEHOLDERS Superintendent Principal Food Service PTA President Parents Others Teachers School Nurse

19 #6 ESTABLISHMENT OF A WELLNESS TEAM Set date with at least1 key stakeholder to assist in SHI Decide which modules to complete Meet to review and establish next step Hold regular scheduled meetings < 1 hour Provide HEALTHY snacks Identify specific goals, activities & outcomes

20 CUMULATIVE ENROLLMENT In wellness assessment Teachers Teachers Students Family

21 STUDENTS (n=321) Mean 22 (12-53)* 138/321 (43%) Overweight/Obese* *p < % 18% Underweight Overweight 2% Healthy Obese 55% BMI 11% 21% 12% TEACHERS (n=207) Mean 30 (16-58)* 143/207 (69%) Overweight/Obese* Underweight Overweight Obese II 1% Healthy Obese I Obese II 30% 25% PAS Annual Meetings, May 2-5, 2009, Baltimore, MD Presented at the Pediatric Academic Societies 2009

22 B LOOD PRES S URE Variable Systolic Mean (range) Diastolic Mean (range) Normal # (%) S & D > 95% # (%) Students N=300 Teachers N=204 p < (63-167) 124 (94-169) 67 (40-114) 79 (52-114) < (83%) 66 (32%) < (2%) 16 (8%) PAS Annual Meetings, May 2-5, 2009, Baltimore, MD Presented at the Pediatric Academic Societies 2009

23 COMPLIANCE with % Participants >5 Fruits/Vegs / Day <2 Hours Screen Time / Day >1 Hr Phys Activity / Day 0 sugar sweetened drinks Students Teachers Presented at the Pediatric Academic Societies 2009

24 WEIGHT LOS S Teachers (% that lost weight) 3 Months 71% Overweight 60% Obese 6 Months 67% Overweight 35% Obese S tudents (% that had decrease B MI Z score) 3 Months 65% Overweight 72% Obese 6 Months 86% Overweight 67% Obese

25 Basis of Docs Adopt S chool Health Initiative S chool level wellness committees Committees should include many types of members Wellness programs / strategies should: B e evidence-based Include several areas (ie nutrition & physical activity) Include everyone at the school (teachers & staff & students & families) B e selected by the school to meet identified needs Financial award given directly to wellness committee Focus group targeted $1,000 and competition Physicians are interested in limited, nonclinical but effective role

26 (1) DOCS-ADOPT Recruit local physicians to join school wellness committees Collaborate with local medical organizations if available Train physicians & school staff in obesity prevention efforts Provide ongoing support for physicians Display signage indicating participation of the doctor (2) SCHOOL WELLNESS CHECKLIST Obtain district level support Provide password protected web access for each school Assist schools in establishment of wellness committees Encourage school needs assessment (School Health Index/ Alliance for a Healthier Generation) Provide Checklist of evidence-based PSE changes from which schools can select based on their needs assessment Make it easy and free for schools to implement some strategies Hold year end districtwide Wellness Achievement Celebration Award incentive ($1,000) directly to wellness committees for schools with > 50 points (> 30 points for first year participants) Award first prize to overall winning school ($2,000 & trophy) Monitor Checklist activities and use of incentive awards Evaluate and report results annually to districts and schools

27 School Wellness Checklist Evidence-based strategies Starts with SHI needs assessment 7 categories required Getting Started Nutrition Physical Activity Stress Management Wellness Culture Employee Connections Sustainability Online password protected site Wellness Achievement Celebration Annual awards ($1,000) Overall winner ($3,000)

28 Together these form the Docs-Adopt School Health Initiative +

29 Participating schools n= 11 CCSD

30 Participating schools n= 11 CCSD

31 Participating schools that achieved award n=23 CCSD

32 Participating schools that achieved award n=54 CCSD

33 Participating schools that achieved award n=93 (72 CCSD, 12 BCSD, 9 DD2)

34 Participating schools that achieved award n=113 (69 CCSD, 22 BCSD, 22 DD2)

35 RFP Expansion P lan for the Docs Adopt S chool Health Initiative Current Expansion P lan: Local community support for licensing fees & awards. Contact the MUSC B oeing Center for Children s Wellness for more information or to arrange a presentation to an interested community

36 : 13 Districts 275 S chools total 207 S chools par ticipated 195 S chools earned an award

37 Examples of strategies selected by participating schools Students at Belle Hall gather around their school garden Tasty Tuesday fruit cups D2SD Water-Drinking Campaign Dr. Jane C harles, adopting physician at Stall High School with Wellness Leader Danny Ilagan and school nurse, Treva Mardis. Devon Forest Healthy School Pledge drive

38 Hos ting a Health Event, 11% Walking P rograms, 18% Use of $1000 Wellness Awards Fitness Equipment, 45% Incentives, 30% Nutrition, 30% Health Ed/ Screenin g, 4 5%

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40 Docs Adopt School Health Initiative Operational Annual training Timeline of doctors and school wellness leaders

41 Docs-Adopt Physician Training 2014 Epidemiology and causes of obesity Recommendations for effective interventions History and replication Components of Docs-Adopt S chool Health Initiative Outcomes S uccesses Dr. Mike B owm an Jennie Moore Elementary 2013

42 leanteam

43 BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention What is it? How was it developed? What is working? Discussion

44 Outcome Evaluation: Focus Groups Teachers Physicians attended meetings infrequently Physician involvement very important Very satisfied with physician involvement Doctors Not able to attend many meetings Not sure if contributed significantly Very satisfied with involvem ent

45 Outcome Evaluation: Partnership with medical organizations In counties with medical organizations, the Initiative collaborated with the local medical society in implementation of the Docs-Adopt component. Outcome evaluation found more rapid implementation and more physician participation when there was collaboration with a local medical society Key J, Martin C, Kramer L, Lindstrom C. Rapid adoption of a s chool-based obesity prevention initiative that targets policy, systemic and environmental changes to improve nutrition and increase exercise. The Obesity S ociety, November 2014.

46 Dr. Bill Lomax, Alston Middle S chool- DC2S D

47 There was significantly more physician involvement in communities that had a medical organization

48 Docs-Adopt School Health Initiative Summary of Outcomes Increased score over time (p<0.022) Reduction in variance in Title 1 schools (p<0.039) Increased scores with physician adoption (p<0.05)* Increased scores associated with healthier B MI (p<0.05)** Increased student attendance (p<0.0005) Decreased office referrals (p<0.0006) More rapid implementation when supported by a local medical organization (p<0.05)*** 1/ 3 less obesity, improved behavior and attendance**** *Key et al PAS 2013; **King et al PAS 2014, ***Key et al TOS 2014 ****King et al PAS 2015

49 Conclusions: The Docs-Adopt School Health Initiative : Is a simple school-based intervention that is readily accepted by schools and physicians Leads schools to make many PSE changes targeting both healthy nutrition and increased physical activity Is unique in promoting physician involvement in school-based obesity prevention efforts Involves more physicians when there is support from a community medical organizations

50 References Key J, B ryne J, Saito A, Prendergast M, Chambers J, Spurlock D. The Docs-Adopt S chool Wellness Initiative: An innovative program to involve doctors in school-based obesity prevention efforts. Journal of the South C arolina Medical Association, Vol 110 (No3):94-97, Key J D, Oexmann MJ, and Russell AM. Community and school-based interventions to prevent obesity in children and adolescents. Journal of the South C arolina Medical Association 105:59-63, Key J, Martin C, Oexmann MJ, S purlock D, Hulsey T. The Lean Team: Enhancing school-based obesity prevention programs by including services for teachers. National Initiative for Children s Healthcare Quality Annual Forum for Improving Children s Healthcare and Childhood Obesity Conference Key J, Moore J, Martin C, King L. Docs-Adopt : P hysician participation enhances school wellness initiatives. Pediatric Academic S ocieties, April 2012 Abstract

51 BREAKING TRADITION: Engaging Physicians (Docs Adopt) in S chool-based Obesity Prevention What is it? How was it developed? What is working? Discussion

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