A1.1 Continuum of Prevention to Treatment for Child Health_Dianne Knox

STOMP Early Years

SickKids & Toronto Public Health Early Intervention Program The continuum of prevention to treatment for child health Dianne Knox, MSW RSW Catherine S. Birken MD, MSc, FRCPC Maplelee Cardona RN Alisa Bar-Dayan, RD Allison Jeffery, PTS, CRA

STOMP Early Years CFPC Conflict of Interest Disclosure of Commercial Support Presenter Disclosure Presenter:

Dianne Knox, MSW RSW Catherine S. Birken MD, MSc, FRCPC Maplelee Cardona RN, BScN Alisa Bar-Dayan, RD Allison Jeffery, PTS, CRA

Relationships with commercial interests: • • • •

Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

STOMP Early Years

Objectives • Learn about the collaborative practices between SickKids and Toronto Public Health through review of STOMP early years program • Indentify complex factors involved in the treatment and prevention of obesity • Learn how to strengthen future partnerships in obesity prevention and treatment

STOMP Early Years

Agenda • • • • •

Ice breaker Current evidence Case Study: STOMP Early Years Discussion exercise & moving forward Questions

STOMP Early Years Ice Breaker Benefits and Barriers Exercise Buzz- What are the benefits of developing collaborative models of care in the area of childhood obesity? What are the barriers?

STOMP Early Years

What is the current evidence?

Obesity Interventions for Young Children in the Community

• Overweight or obese 3-7 year olds • 4 additional visits, 3 phone calls • Restructured primary healthcare chronic care model

Home based intervention: 2-5 year olds • Motivational coaching home visits, phone calls, text messages – Family meals, adequate sleep, limit TV time, remove TV bedroom

• 6 month outcomes: – BMI -0.4 (-0.79, 0.00; p=0.05) – TV weekend (-1.1 hr/d (-1.9, -1.15; p=0.02) – Sleep increased (0.75 hrs/day; 0.06, 1.44; p=0.03)

Intervention: 8 public health home nurse visits     

Breast is best No solids for me until 6 months I eat a variety of fruit and vegetables every day Only water in my cup I am part of an active family

Results • BMI decreased by -0.38 (-0.68, -0.08); p=0.01

• • • •

Link staff, funds data, locally and regionally Create common research and learning networks Develop the workforce Improve existing programs and create new ones with legislation • Develop a national strategy, and investment plan

STOMP Early Years

STOMP Early Years Ecological Systems Theory ( Davison & Birch, 2001)

STOMP Early Years • Partnership between SickKids and Toronto Public Health • To promote healthy families • To prevent severe obesity, heart disease and diabetes • Connecting Families

STOMP Early Years Program Overview • Program for families with children under 6 years • Promoting child mental health and wellness • Prevention of cardiometabolic disease in children identified with increased weight • Building a stronger parent child relationship

Program Goals • • • • •

Increase fun active play Encourage healthy eating behaviours Learn coping and problem solving strategies Learn to feel good about yourself Support families in using strategies at home

STOMP Early Years PHASE I: ASSESSMENT INITIAL ASSESSMENT WITH STOMP TEAM IN CLINIC FIRST HOME VISIT with TORONTO PUBLIC HEALTH NURSE

PHASE II: INTENSIVE EDUCATION (Month 1 & 2) 10 WEEKLY HEALTHY LIFESTYLES and INCREDIBLE YEARS PARENTING SESSIONS

PHASE III: GROUP SUPPORT & CLINIC VISITS (Months 3 to 18) 6 HEALTHY LIFESTYLE CHECK INS, GROUP SUPPORT & CLINIC VISITS

PHASE IV: COMMUNITY LINKS & TRANSITION (Months 18 to 24) 3 COMBINED CLINIC & GROUP SUPPORT Visits

STOMP Early Years

Case Study • 3 year old girl BMI 25 kg/m2 • history of obstructive sleep apnea, asthma • referred by sleep clinic • lives with single mom (caring, attentive) & older brother • Income from social assistance • community centre, library and pool close by

• Moms main concerns: sleep symptoms, weight and low physical activity

The STOMP Team

Tips for Raising Healthy Eaters • • • • • •

Consistent meal time schedule Choose filling foods Comfortable eating environment Limit milk and sweet drinks Caregivers decide menu items Fill the house with healthy foods

The STOMP Team The four food groups include: • Vegetables & Fruit • Grain Products • Milk & Alternatives • Meat & Alternatives The balancing act: • Balance meals with 3-4 food groups • Balance snacks with 2-3 food groups

The STOMP Team The Plate Method

Ensures Balanced Meal with 3-4 Food Groups

The STOMP Team FIVE WAYS TO BE MORE ACTIVE BOOST THE FUN FACTOR ENCOURAGE MANY DIFFERENT ACTIVITIES FOR BOTH BOYS AND GIRLS BE A ROLE MODEL MIX IT UP STAY ACTIVE IN ALL KINDS OF WEATHER

The STOMP Team

COMMUNITY CONNECTIONS

STOMP Early Years

Parenting Ignore and Consequences Limit Setting and Follow Through Household Rules and Routines Social Rewards and Incentives Academic, Emotion and Social Coaching Child directed Play

STOMP Early Years

Group Learning Methods 

Goal setting

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Values exercises

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Role Play/ Practice

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Buzzes

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Vignettes

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Homework

STOMP Home Visit

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Neema and Jay Mertelly, their mother Nila and public health nurse, Maple Cardona get active with the hokey-pokey after dinner.

(Deborah Baic /The Globe and Mail)

STOMP Early Years Home Visiting 

Home environment assessment

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Health teaching

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Incorporating IY strategies

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Linking to community supports

The STOMP Team Community Resources TPH NURSE REFERRALS Incredible Years Parenting Series (Chinese Language Series) Centre for Information and Community Services Rouge River Ontario Early Years Center Chinese speaking RD- Scarborough Center for Healthy Communities Let's Talk Series through IIF Toronto Parks and Recreation Welcome Policy Rexdale Women's Center Albion Library North Kipling Community Center Ontario Early Years Center Parkway Forest Satellite Early Years Center

SOCIAL WORK REFERRALS Support with Ontario Works worker Jennifer Ashleigh Children’s Charity Rotary Club Patient Amenities funds Big Brothers of Canada Peel CAS Healthy babies, health children & Peel Public Health OW ACSD Transhelp OSAP United Achievers SNAP and Erin Oaks Kids Ronald McDonald House Daycare (with CAS support) Point in Time Ontario Early Years Centre Archie Stouffer Elementary School Family health Team Children’s Aid Society

STOMP Early Years

Outcomes ‘STOMP is like a family to me, they help me so much’ parent quote

• • • • • • •

BMI decreased to 20 kg/m2 in 18 months Cholesterol lower Treated GERD, improved sleep symptoms Increased water, whole grains, try vegetables Stopped multivitamin and increased nutritious foods Increased active family time together Support through Investing in families, transportation

STOMP Early Years Program Outcomes (keep slide?)

BASELINE

OUTCOME

BMI

z score

BMI

z score

n

6 mos

26.2

6.0

24.9

4.9

7

12 mos

26.1

5.9

25.8

5.1

5

18 mos

28.3

7.3

27.1

5.5

3

STOMP Early Years Change in BMI Z-Score 9.00 8.00

BMI Z-Score

7.00 6.00 5.00 4.00 3.00 2.00

0

6

12

Months

18

Summary of weight-related outcomes: @ 6 mos -1.3 kg/m2, -1.1 z score (n = 7) @ 12 mos -0.3 , -0.8 z score (n = 5) @ 18 mos -1.2 , -1.8 z score (n = 3)

STOMP Early Years

Discussion • Have participants brainstorm in small groups what future collaborations between primary care and public health might look like in the area of childhood obesity • Incorporate barriers that came from the ice breaker activity, how can we work through the barriers?

STOMP Early Years

Lessons Learned

• Meet families where they are at • Access to care • Readiness to participate

• Increasing awareness • Families • Practitioners • Community

• Flexibility in program structure and content • Address individual goals • Customized learning

STOMP Early Years

Questions