Walk By Faith Promoting Healthy Congregations (PHC) Assessment (Preview Copy)

Walk By Faith Promoting Healthy Congregations (PHC) Assessment (Preview Copy) This preview copy of the Walk by Faith Promoting Healthy Congregations Assessment is similar but not identical to the online assessment located at http://www.mihealthtools.org/faithsurvey. The preview copy can be used in the following ways: Offers a preview of the assessment for faith-based organizations that are considering completion of the online assessment. Provides a copy of the assessment for individuals or organizations that are not faithbased organizations that are interested in the assessment but are not eligible to register to complete the online PHC assessment. Allows team members to have a copy of the assessment when they are collecting information prior to entering it on the online assessment. Provides a hard copy of the assessment for team meetings when an internet connection may not be available. The online PHC assessment provides the following advantages and benefits that the print/preview copy does not have: Questions that should be skipped based on previous answers are not shown to the user. This eliminates confusion. Information about the faith-based organization provided during online registration are automatically piped into the online assessment to personalize the assessment for each organization. Information from various sections of the online assessment are automatically piped into the Summary section. No rewriting is necessary. The points and percent of possible points are automatically calculated online each time the data is saved. This prevents errors as well as making it easier for the user, especially when maximum possible scores are dependent on answers to certain questions. Incomplete and inconsistent answers are flagged automatically on the online form making it easy for the user to spot any issues that require attention or correction. In addition to the questions, the preview copy provides instructions to indicate some but not all of the automated functions of the online system. Instructions about skip patterns or notes about point calculations are provided in red font in this preview copy. Areas where information is piped in from answers provided previously are in blue font on this preview copy. Examples include type of faith-based organization, such as church, temple, mosque or synagogue. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 1

Walk By Faith Promoting Healthy Congregations Assessment (PHC) Section 1: Faith-Based Organization Infrastructure & Policies Faith-based organizations that have a dedicated infrastructure that promotes health are much more likely to be successful in assisting their congregations in making healthy choices and supporting healthy lifestyles. Along with the infrastructure, policies that promote physical activity, healthy eating, and a tobacco-free lifestyle help create an environment that supports healthy choices. 1.1 Our type of organization has an organized health ministry run by a committee, parish nurse or a qualified member(s) of the congregation that seeks to provide health and wellness services to congregation and community members? Yes (25 pts) No Answer 1.1a,b, and c only if Yes, to 1.1 1.1.a Does your health ministry support the health and wellness needs of your congregation in any of the following ways? a. Counsels and advises members of the congregation on health topics (for example, management of current health problems, importance of being physically active) b. Provides education and training on health topics (for example, offers classes, provides literature) c. Creates health policies for the type of organization, such as a no smoking policy or serving healthy food options at type of organization events d. Communicates health and wellness, policies, events, and other information related to health to the congregation e. Facilitates/coordinates type of organization -sponsored health and wellness programs f. Provides referrals to other community resources when needed g. Establishes relationships with community resources to provide health-related services to the congregation (such as working with the local YMCA or fitness clubs to offer discounts or teaming with the county health department to offer programs) Yes No h. Other, Describe Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 2

1.1b Does your health ministry have a mission statement that guides their activities? Yes No 1.1c Does your type of organization support its organized health ministry in the following ways? Yes (2 pts) No a. Allocates budget to pay for activities and/or staffing b. Offers opportunities for training on various health topics at least once per year for those who are implementing programs and activities c. Makes health ministry a part of the type of organization s governing committee(s) d. Other, Describe 1.2 Does your type of organization have the following policies related to healthy eating and physical activity? (NOTE: This question related to established policies, not practices.) Our type of organization has the following policies about: a. Offering healthy food and beverage options* in vending machines and at type of organization -sponsored events that include food b. Offering healthy food and beverage options* in Sunday school and at youth events Yes, and they are enforced (2 pts) Yes, but they are not enforced No c. Not using food as a reward for children involved in type of organization activities d. Including/encouraging physical activity at type of organization events, such as walk or stretch breaks during meeting or organized games at type of organization picnics e. Including/encouraging physical activity during Sunday school or at events for children and youth, such as walk or stretch breaks or organized games *Healthy food options include low-fat, low-sodium, and/or sugar-free foods, such as fruits (fresh, canned or dried), baked chips or pretzels, vegetables prepared without fat or cream sauces, low-fat entrees (such as grilled or baked turkey or chicken, pasta with tomato sauce and low-fat cheeses), salads with low-fat dressing, low-sodium and sugar-free options. Healthy beverage options include 100% fruit/vegetable juices, skim or 1% milk, and water. Low carb foods are not healthy food options. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 3

1.3 Does your type of organization have a non-smoking policy? Yes, our type of organization has a policy that bans smoking in type of organization facilities, on type of organization grounds or at type of organization events 24 hours a day, 7 days a week (5 pts) Yes, our type of organization has a policy that allows smoking only in designated areas No, our type of organization does not have a non-smoking policy Answer 1.3a and b only if Yes answer, to 1.3 1.3a Is the non-smoking policy enforced? The policy is enforced all of the time (5 pts) The policy is enforced some of the time The policy is not enforced 1.3b. Does the type of organization have No Smoking signs posted in key areas throughout their facilities? Yes No 1.4 Describe your type of organization s existing strengths related to infrastructure and policies for promoting health. List one to three strengths. Check here if you cannot think of any strengths. a. b. c. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 4

Section 2: Communications about Health Topics Including health topics in routine communications to parishioners promotes health in several important ways: 1) It provides valuable information and education; 2) Reminders about the importance of healthy lifestyles that come from a credible and trusted sources are more likely to be motivating; and 3) It conveys an atmosphere of ongoing support for healthy lifestyles. 2.1 In the past 6 months, how many times have sermons included and encouraged the following aspects of a healthy lifestyle: a. Physical Activity b. Healthy Eating c. Healthy Weight 6 or more times (3 pts) 3 to 5 times (2 pts) 1 or 2 times Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 5 None d. Tobacco-Free Lifestyles e. Other health-related topics (such as stress management, cholesterol and blood pressure, diabetes) 2.2 In the past 6 months, how often has your type of organization bulletin or newsletter included information about any of the following health topics: healthy eating, healthy weight, increasing physical activity, adopting or sustaining a tobacco-free lifestyle? 6 or more times (3 pts) 4 to 5 times (2 pts) 1 to 3 times Never in the past 6 months Our church does not have a bulletin or newsletter 2.3 In the past 6 months, has your type of organization communicated health information or messages to its congregation in any of the following ways: Yes No a. Posted on type of organization bulletins, walls, or other places where congregation members can easily view it b. Posted on the type of organization website (answer no if the type of organization does not have a website) c. Distributed brochures, flyers, or information about local health offerings in the nearby community (such as fitness club discounts, health screenings, health fairs, brochures from community agencies about health topics) d. Offered seminars or presentations about health topics (in addition to any sermons)

2.4 (Optional) Are there any other ways that your type of organization distributes or provides health information not mentioned above? Please describe below. 2.5 Describe your type of organization s existing strengths related to communications on health topics. List one to three strengths. Check here if you cannot think of any strengths. a. b. c. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 6

Section 3: Health Opportunities Offered Through the Type of Organization Faith-based organizations that offer or sponsor health opportunities and encourage participation help congregation members take action to achieve and sustain a healthy lifestyle. The faith community provides a supportive, comfortable and friendly environment for making and sustaining changes. Faith-based organizations can expand their offerings and further support healthy lifestyles by collaborating or partnering with resources within the community, including other faith-based organizations. These relationships are beneficial for all involved. Type of Organization -Provided Health Opportunities 3.1 In the past year, has your type of organization offered, provided or sponsored any of the following: Yes No a. Exercise/physical activity facilities in the building(s) or on type of organization grounds for use by parishioners (Examples: weight machines, free weights, exercise bikes, treadmills, basketball courts, ball fields or other facilities and services that promote physical activity) b. Sports leagues c. Exercise classes (Examples: aerobics or yoga classes) d. Healthy eating or healthy cooking classes or nutrition counseling e. Weight management classes or clubs f. Smoking cessation classes or programs or distributed quit kits Answer 3.1a and b if at least one yes answer to 3.1 3.1a Are these activities, events or programs offered to both adults and children? Most are offered to both adults and children Most are offered to either adults or children but not both (0 pt) Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 7

3.1b How often is participation in these activities, events or programs encouraged in the following ways? i. Hours and availability are publicized to the congregation through type of organization communication channels ii. Hours and availability are convenient to most of the congregation (for example, available during after-school, evening and weekend hours) iii. A buddy system, mentoring or other type of social support system has been established to encourage participation iv. These opportunities are offered for free or very low cost All or most of the time (2 pts) Sometimes Rarely or Never 3.2 Which of the following has your type of organization sponsored in the past year? Yes No a. Health fair b. Cholesterol screening c. Diabetes screening d. Blood pressure screening e. Walking challenges or similar physical activity events f. Dances g. Presentations or lectures about health topics Answer 3.2a and b if at least one Yes answer to 3.2 3.2a Were these activities, events or programs offered to both adults and children? Most are offered to both adults and children Most are offered to either adults or children but not both (0 pt) Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 8

3.2b How often is participation in these activities, events or programs encouraged in the following ways? i. Hours and availability are publicized to the congregation through type of organization communication channels ii. Hours and availability are convenient to most of the congregation (for example, available during after-school, evening and weekend hours) ii. A buddy system, mentoring or other type of social support system has been established to encourage participation iii. These opportunities are offered for free or very low cost All or most of the time (2 pts) Sometimes Rarely or never Referrals and Networking to Community Resources 3.3 In the past year, has your type of organization collaborated with any of the following community organizations to offer health programs or education about health topics? Yes No a. Local health department b. Hospitals c. Local physicians or medical clinics d. Voluntary health organizations (such as American Heart Association, American Cancer Society) e. Other faith-based organizations f. Other community organizations, Please Describe Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 9

3.4 In the past year, has your type of organization referred parishioners to any of the following community resources? a. Gyms, fitness clubs, YMCAs, other fitness facilities Yes No b. Community sport leagues c. Exercise classes (such as aerobics or yoga) d. Healthy eating or healthy cooking classes or nutrition counseling e. Weight management classes or clubs f. Smoking cessation classes or programs Answer 3.4a and b only if there is at least one Yes answer to 3.4 3.4a Have the referrals routinely included both adults and children/youth? Most are offered to both adults and children Most are offered to either adults or children but not both (0 pt) 3.4b How often is participation in these activities, events or programs encouraged using the following methods: i. Availability of these opportunities is publicized to the congregation through type of organization communication channels ii. Hours and availability are convenient to most of the congregation (for example, opportunities available close to where congregation members live or work) iii. A buddy system, mentoring or other type of social support system has been established to encourage participation iv. Discounts or other benefits were negotiated for type of organization members, such as free trials, discounted or free services or discount coupons All or most of the time (2 pts) Sometimes Rarely or Never Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 10

3.5 In the past year, has your type of organization referred its parishioners to any of the following events held in the community or region by other organizations: Yes No a. Health fairs b. Cholesterol screening c. Diabetes screening d. Blood pressure screening e. Physical activity events such as fun walks, walking challenges g. Presentations or lectures about health topics Answer 3.5a and b only if there was one or more Yes answers to 3.5 3.5a Were both adults and children included in these referrals? Most are offered to both adults and children Most are offered to either adults or children but not both (0 pt) 3.5b How often is participation in these activities, events or programs encouraged using the following methods: i. Availability of these opportunities is publicized to the congregation through type of organization communication channels ii. Hours and availability are convenient to most of the congregation (for example, opportunities available close to where congregation members live or work) iii. A buddy system, mentoring or other type of social support system has been established to encourage participation iv. Discounts or other benefits were negotiated for type of organization members, such as free trials, discounted or free services or discount coupons All or most of the time (2 pts) Sometimes Rarely or Never 3.6 In the past year, has your type of organization provided any other health opportunities directly or through collaboration and referrals to community resources that are not mentioned above? Yes, Describe No. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 11

3.7 Describe your type of organization s existing strengths related to offering opportunities for promoting health, whether the type of organization provided them directly or they work with community resources to provide them. List one to three strengths. Check here if you cannot think of any strengths. a. b. c. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 12

Section 4: Direct Support of Healthy Lifestyles and Role Modeling When faith-based organizations and faith leaders practice what they preach, they make it easier for parishioner to make healthy choices and they provide inspiration and motivation. 4.1 Does your type of organization hold events or meetings that involve serving food and/or beverages? Yes No Answer 4.1a and b only if answer to 4.1 is Yes. If answer to 4.1 is No, then 18 points are subtracted from Maximum possible points. 4.1a How often are the following healthy food/beverage options served at these events or meetings? All or most of the time (2 pts) Sometimes Rarely or never i. Fruits (canned in its own juice, fresh, frozen or dried) ii. Vegetables (prepared without added fat or cream sauces, salad bar or tossed salad; not fried) iii. Low-fat entrees (Examples: grilled or baked poultry or fish; sandwiches prepared without cheese or mayonnaise-type dressings) iv. Low-sodium foods (sodium content of 140 milligrams or less per 4-ounce serving) v. Low-fat dairy products (fat content must be 5 grams fat or less per serving. Examples: low or non fat milk or yogurt, reduced-fat cheeses, low-fat cottage cheese) vi. Low-fat desserts (fat content is 3 or less grams per serving. Example: frozen yogurt) or sugar-free desserts vii. Healthy beverage choices, such as water, tea without added sugar, 100% fruit or vegetable juices 4.1b In general, at these events, about what proportion of the foods and beverages served are healthy options? Most or all; that is, more than 75% (4 pts) Half or more of the options, but less than 75% (2 pts) Fewer than half the options served are healthy Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 13

4.2 Does your type of organization serve food and/or beverages to children or youth at youth events or Sunday school? Yes No Answer 4.2a, b, c and d only if answer to 4.2 is Yes. If answer to 4.2 is No, then 18 points are subtracted from Maximum possible points. 4.2a How often are the following healthy food/beverage options served at these events or Sunday School? All or most of the time (2 pts) Sometimes Rarely or never i. Fruits (canned in its own juice, fresh, frozen or dried) ii. Vegetables (prepared without added fat or cream sauces, salad bar or tossed salad; not fried) iii. Low-fat entrees (Examples: grilled or baked poultry or fish; sandwiches prepared without cheese or mayonnaise-type dressings) iv. Low-fat dairy products (fat content must be 5 grams fat or less per serving. Examples: low or non fat milk or yogurt, reduced-fat cheeses, low-fat cottage cheese) v. Low-fat desserts (fat content is 3 or less grams per serving. Example: frozen yogurt) or sugar-free desserts vi. Healthy beverage choices, such as water, tea without added sugar, 100% fruit or vegetable juices 4.2b In general, at these events, about what proportion of the foods and beverages served are healthy options? Most or all; that is, more than 75% (4 pts) Half or more of the options, but less than 75% (2 pts) Fewer than half the options served are healthy 4.2c Is food ever used as a reward or prize with children/youth during Sunday school or youth events? Yes No 4.2d Is food ever withheld as a punishment for children/youth during Sunday school or youth events? Yes No Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 14

4.3 Does your type of organization have food or beverage vending machines? Yes No Answer 4.3a, and b only if answer to 4.3 is Yes. If answer to 4.3 is No, then 4 points are subtracted from Maximum possible points. 4.3a How often is at least one healthy food/beverage options* offered in these vending machines? *Healthy food and beverage options in vending machines include fresh or dried fruit; fresh vegetables; lowsodium or low-fat snacks (such as low-fat cereal, low-fat yogurt or granola bars); bottled water; 100% fruit or vegetable juice; skim or 1% milk. Most or all of the time; that is, at least 75% of the time (2 pts) Half or more of the time; but less than 75% of the time Less than half the time 4.3b In these vending machines, about what proportion of the foods and beverages offered are routinely healthy options? Half or more of the options (2 pts) At least one but fewer than half the options served are health Healthy options are not routinely offered in type of organization vending machines 4.4 Does your type of organization routinely provide physical activity opportunities at type of organization -sponsored events? For example, by making games/sports available at a picnic. Yes and activities include both adults and children (5 pts) Yes, but activities are usually for either adults or children but not both (2 pts) No routine encouragement of physical activity at social events Answer 4.4a only if answer to 4.4 is a Yes answer 4.4a Is participation in these physical activities actively encouraged or promoted? For example, by type of organization leaders promoting participation, offering some friendly competition between teams, or setting a goal and encouraging participants to meet it. Encouraged most or all of the time (4 pts) Encouraged some of the time Rarely or never encouraged Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 15

4.5 In what ways, does your type of organization provide support and acknowledgement to parishioners who are trying to make/are making healthy lifestyle changes (such as quitting smoking, losing weight, eating more healthfully, being more active)? a. Personal acknowledgement and/or encouragement by a type of organization leader, parish nurse or other health ministry representative b. Peer support, such as check ins with other parishioners or organizing peer support groups to provide accountability and encouragement Yes No c. Offering structure, programs, goals or mentoring to support lifestyle changes d. Other, DESCRIBE 4.6 Do your type of organization leaders serve as good role models for healthy behavior by maintaining a healthy weight (or trying to lose weight), being physically active, not smoking (or making an effort to quit), and eating healthfully? Most or all type of organization leaders (2 pts) Some type of organization leaders Very few or no type of organization leaders a. Maintaining a healthy weight (or making an active effort to lose weight if necessary) b. Not smoking (or making an active effort to quit) c. Being physically active d. Eating healthfully/making healthy food choices 4.7 Describe your type of organization s existing strengths related to direct support for healthy lifestyles and role modeling. List one to three strengths. Check here if you cannot think of any strengths. a. b. c. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 16

Section 5: Additional Accomplishments and Summary of Next Steps This section does not receive any points, but it is required. In this section, we ask you to reflect on your organization s current strengths and accomplishments in promoting health among your congregation. These set the foundation for priorities for improvement that you plan for the future. The information you provide in this section also provides information to the Michigan Healthy Communities Collaborative and other sponsoring organizations that will better enable them to support you in your efforts to improve health. 5.1 You listed the following strengths for your type of organization related to promoting good health. Write in the strengths you listed for Sections 1 through 4 (the last question in each Section). This is done automatically without any additional writing on the online assessment. (Optional)Please list any other existing strengths or accomplishments for your type of organization related to promoting good health. a. b. c. d. e. 5.2 (Optional) In the space below, tell us about a success story something your type of organization has done/is doing that positively affected the health of type of organization leaders or one or more type of organization members. Please include the following information in your success story: How long it took to achieve the success The estimated dollar cost associated with it and the nature of the costs (for example, it might be the cost of materials/supplies, the cost of labor or it could have cost nothing at all) The factors that were key to your success A description of what you did, what made you decide to do it, and who it impacted Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 17

5.3 List three next steps or priorities for action to improve your type of organization s health that could be realistically accomplished in the next one to two years. a. b. c. 5.4 List three next steps or priorities for action to improve your type of organization s health that could be realistically accomplished in the next three to five years. a. b. c. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 18

5.5 Please provide the names, job titles and contact information of those who helped in the completion of this assessment. In addition to helping us understand how faith-based organizations complete the assessment, we may wish to acknowledge these people for their efforts. We would also like to know about individuals who might be interested the Michigan Faith-Based Health Association (MFBHA); for more on the association, go to http://www.mihealthtools.org/mfbha. Start by entering the names and titles and contact information of the people who participated in completing the assessment and check the appropriate box in the columns to the right indicating whether the person helped complete the assessment and whether they might be interested in the MFBHA by checking the box(es) in the last column. If there are others in your faith community who did not help with the assessment but might be interested in the MFBHA, please enter their names, titles and contact information next. Be sure to check off that they are interested in the MFBHA by checking the box in the last column. (NOTE: you must enter an email address for these individuals.) Name: Title: Phone: Postal Address: Email: Helped with assessment Interested in MFBHA Name: Title: Phone: Postal Address: Email: Helped with assessment Interested in MFBHA Name: Title: Phone: Postal Address: Email: Helped with assessment Interested in MFBHA Name: Title: Phone: Postal Address: Email: Helped with assessment Interested in MFBHA Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 19

5.6 (Optional) We welcome any other comments, suggestions or feedback you have about this assessment. Please use the space below to provide comments and feedback. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 20

Promoting Healthy Congregations Assessment Feedback The points that appear on your feedback sheet below are available only to your faith-based organization (to those you provide log in access) and to the website administrators. They are not shared with anyone else unless you provide permission. Please see the Privacy page for details on how we protect your privacy. The assessment and this feedback sheet are not intended as an evaluation, but rather as a way of providing information about your strengths along with feedback and ideas about where you might take action to make improvements that will make a difference to the health of your congregation. The points for each item or section are based on our current knowledge of what makes a difference in promoting health within an organization. They are not exact, but rather common sense general indicators of what can make a difference. Section Your Points Maximum Points Possible 1. Faith-based Organization Infrastructure & Policies 63 2. Communications about Health Topics 22 3. Health Opportunities Offered 68 Type of Organization -Provided Opportunities 31 Referrals & Networking to Community Resources 37 4. Direct Support of Healthy Lifestyles & Role Modeling 61* TOTAL 214* % of Possible *These represent maximum points if all Section 4 questions are included. For section 4 (and consequently for the assessment total), scoring adjustments to maximum possible points may be made depending on the answer to particular questions (as described above). These calculations and adjustments are performed automatically on the online form. Walk by Faith Promoting Healthy Congregations Assessment Preview Copy 21