Assignment #4_ final no mark up

Food Safety in Children with Developmental Disabilities

Assignment # 4:Presentation

Respite Care Inc.

Claire CalhounKristin Lamb

Rachel Mostek

FSHN 451: Community Nutrition

12/11/2015

Honor Pledge: I have not given, received, or used any unauthorized assistance on this assignment.

Signature: ______________________________________

Signature: ______________________________________

Signature: ______________________________________

Food Safety Intervention Page 1 of 35

TABLE OF CONTENTS

Team & Work Distribution............................................................................................................................ 2

Team Members, Team Leader................................................................................................................. 2

Work Distribution/Plan to Accomplish Team Project................................................................................2

Community Partner...................................................................................................................................... 4

Context: Target Audience & Community Description...................................................................................4

Problem Statement, Project Purpose & Brief Description............................................................................5

Problem Statement.................................................................................................................................. 5

Project Purpose........................................................................................................................................ 5

Description of Proposed Project...............................................................................................................6

Behavior Change Theory & Research Basis...............................................................................................8

Social Cognitive Theory (SCT) Definition.................................................................................................8

SCT Constructs Selected for This Project & Rationale............................................................................8

Research Basis...................................................................................................................................... 10

Lesson Plan Table..................................................................................................................................... 14

Evaluation Table........................................................................................................................................ 16

Logic Model............................................................................................................................................... 19

Presentation.............................................................................................................................................. 20

Summary of Findings................................................................................................................................. 20

Reflection................................................................................................................................................... 21

Acknowledgments...................................................................................................................................... 22

References................................................................................................................................................ 23

Appendices................................................................................................................................................ 25

Appendix 1: To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study...................................................................26

Appendix 2: Understanding adherence to hand hygiene recommendations: the theory of planned behavior................................................................................................................................................. 28

Appendix 3: When and how to wash your hands..................................................................................30

Appendix 4: Lesson Plan for Respite Care...........................................................................................32

Appendix 5: Pre and Post Intervention Observation Sheet....................................................................33

Appendix 6: Check List for Hand Washing Intervention.........................................................................34

Appendix 7: Telephone survery for Respite...........................................................................................35


TEAM & WORK DISTRIBUTION

TEAM MEMBERS, TEAM LEADER

Claire Calhoun, Team Leader

Kristin Lamb

Rachel Mostek

WORK DISTRIBUTION/PLAN TO ACCOMPLISH TEAM PROJECT

Assignment #1:

To complete assignment #1, we were able to evenly distribute all of the tasks in order to

accomplish this portion of the team project. Claire, the team leader, acted as the main

coordinator and contact source for Respite Care Incorporated by initiating the first

contact and setting up our first meeting. She also was in charge of researching regional

statistics and data for WTL #2, as well as participated and worked on all of the WTLs

and Assignment #1. Kristin was in charge of doing researching for the national statistics

on children with developmental disabilities for WTL #2. Kristin also did the main editing

for WTL #2 and WTL #3, and assisted with the completions of WTL #1 and Assignment

#1. Rachel did the research for the state data and statistics, organized the WTLs and

Assignment #1 into Google Documents, and did the final editing of Assignment #1.

Assignment #2:

For assignment #2, our team talked through concepts for our overall submission and

then split up some of the sections for initial drafting. The Context section was drafted by

Rachel. Rachel also did all of the document assembly, final editing, and formatting as


well as AMA citations. The Problem Statement, Description of Proposed Project, and

SCT Descriptions were drafted by Claire. The Project Purpose, Lesson Plan table, and

the Logic Model Table were drafted by Kristin. As a team, we reviewed our assignment

as well as gathered research and participated in the all of the Write to Learn activities.

Each member has also suggested and organized different activities for our Respite

Care volunteer hours.

Assignment #3:

In order to complete our assignment #3 our team worked together to complete all

aspects of this section. Rachel worked on creating the outline for the Lesson Plan for

Respite Care in appendix 4, the Pre and Post Intervention Observation Checklist in

appendix 5, the Checklist for the Hand Washing Intervention in appendix 6, the

Telephone Survey in appendix 7, the appendices, and all the formatting for the project.

Claire helped with the Evaluation Table, worked on revisions to assignment #2, updated

the Research Basis table, helped edit the lesson plan table from assignment #2 and

planned the post intervention activity. Kristin helped with the Evaluation Table, typed up

the summary of findings, wrote the revisions for the lesson plans in the appendix,

helped edit the lesson plan table from assignment #2 as well as researched and

summarized an article for the Research Basis Table.

Assignment #4:

Rachel worked on completing the Summary of Findings and Kristin and Claire worked

on filling in the information for the presentation slides and creating the Presentation

Description. The whole group worked together to edit and polish our Assignment #3

submission as well as our presentation.


COMMUNITY PARTNER

Respite Care is a non-profit organization that specializes in short and long-term care for

youth with developmental disabilities. Their goal is to enhance quality of life for the

youth and to help their families feel relieved by offering 24/7 supportive care. Respite

Care believes that "a child with a disability is a child first and that his or her challenges

are secondary.”1 This philosophy helps them guide their services to encourage social

and life skills while accommodating special needs at a reasonable price. According to

the Early Childhood Council of Larimer County, the average cost of childcare is $211

per week and Respite Care can provide additional services for children with

developmental disabilities at a comparable price that is specific according to the

parent’s income.2

CONTEXT: TARGET AUDIENCE & COMMUNITY DESCRIPTIONAccording to the Centers for Disease Control and Prevention, it was reported that

13.9% of children had a developmental disability in the United States in 2008.3 The

prevalence for children who have a developmental disability in Colorado in 2007 was

12.1% of the state’s population.4 Roughly 1 in 10 children living in Larimer County in

2011 have a developmental disability.5 Respite’s focus is specified to children with

developmental disabilities living here in Larimer County, CO. According to Natalia

Perea, the program director at Respite Care Inc., the three main developmental

disabilities they help includes autism, Down syndrome, and cerebral palsy. Individuals

with a chronic condition such as autism, Down syndrome, and cerebral palsy have an


increased risk of infection due to an altered range of lymphocytes and the inability to

produce appropriate antibodies.6 Due to this decreased immune function, there is a

major concern for food safety for this population. According to the 2010 Dietary

Guidelines, “hand washing is key to preventing contamination of food with microbes

from raw animal products and from people.”7 Respite Care Inc. is relevant to addressing

the problem of proper food safety, as they are directly responsible for the safety of the

children at Respite Care.

PROBLEM STATEMENT, PROJECT PURPOSE & BRIEF DESCRIPTION

PROBLEM STATEMENT

Children with developmental disabilities have decreased immune function that causes

them to be more susceptible to infectious microbes. While lower than the national

average of 13.9%, currently 12.1% of kids in Colorado are living with a developmental

disability and that number is still rising. Teaching healthy food handling and food safety

behaviors will have a positive impact on preventing food related infections in this

population. The consequences of not addressing this problem are more doctor visits,

increased medical costs, and decreased quality of life. By supporting life skills and

behavior, Respite Care is encouraging children to develop healthy and safe food habits.

PROJECT PURPOSE

The purpose of our proposed project is to improve food safety procedures at Respite

Care by specifically working on hand washing techniques. The kids at Respite Care

specifically have a harder time recognizing social cues that would normally prompt the


need for hand washing. This can include when kids need to wash their hands before

preparing food, after coughing into their hands, after using the restroom, and before or

after touching their face. We want to focus on improving this behavior because we

believe it could truly benefit the individuals of this community, allowing them to practice

standard health safety habits that they can carry with them into the future.

Hand washing techniques are not only relevant to Respite Care, but it is also important

to all caregivers who work with people that have developmental disabilities. We believe

our program would address everyone within this community because hand washing can

prevent illness from spreading from one person to another, keeping everyone in the

community healthy. Microbes can get onto hands if someone touches an object that has

been contaminated by something that was coughed or sneezed on, and if that person

fails to wash their hands immediately, they can easily spread germs from one person to

another. This is why teaching people about hand washing helps them and their

communities stay healthy. According to the CDC, "hand washing education reduces

respiratory illnesses, like colds, in the general population by 16-21%" which proves how

much of an impact our proposed project can have on the Respite Care community in

general, including the caregivers.8

DESCRIPTION OF PROPOSED PROJECT

The project that we will use at Respite Care is an educational lesson that shows how

germs can spread through contact, and highlight the need for proper food safety and

hand washing behavior. To determine the success of our intervention, we will collect


some observational data about the children's self-initiated hand washing behavior as

well as adherence to prompted hand washing. These observations will take place at

Respite Care during volunteer hours each week leading up to and following the

intervention. The intervention will take place during a one-hour lesson at Respite Care.

The lesson will include a brief overview of germs and how they are linked to illness.

Then, to show the kids how germs are passed through a community, one child will be

picked as the "infected" person. This child will dip their hands into a plate of paint, to

represent the germs. This child will then be instructed to high-five or shake hands with

another child in the group as well as pick up an apple and pass it to another participant,

spreading the paint. This chain will continue through all the children in the group. We

will then talk about how the germs made it all the way around the table and onto the

apple. We will explain how washing their hands will keep the germs from spreading any

further. Once the children wash their hands, they will go back around the circle shaking

hands or giving high-fives to show that now none of the participants are "infected." In

the following weeks, we will plan activities for the kids that incorporate food preparation

and interaction and see if they self-initiate hand washing before the activity. If they do

not, we will also observe the adherence and attitude to prompted hand washing.


BEHAVIOR CHANGE THEORY & RESEARCH BASIS

SOCIAL COGNITIVE THEORY (SCT) DEFINITION

According to Albert Bandura, the Social Cognitive Theory involves interacting with our surrounding social environment and

forming thoughts and beliefs that form our attitudes and how we respond to stimuli.9 The theory consists of a triangle of

the environment, personal, and behavioral factors which interact with each other and influences behavior.9 These factors

are important to know and understand when attempting to change peoples behaviors as it can help us to understand what

specific factors need to be in place in order to help our group at Respite Care efficiently learn and master food safety.

SCT CONSTRUCTS SELECTED FOR THIS PROJECT & RATIONALE

The observational learning construct is defined as behavior change related to observed behavior of others.9 This is

displayed in our intervention by utilizing behavior modeling by peers and mentors at Respite Care. By seeing the

caregivers, volunteers and other Respite Care participants washing their hands before activities, it will help the children

learn successful hand washing behavior as well as the appropriate situations to wash their hands. Also, the use of a

visual representation of germs and asking the children to problem-solve a way to stop the paint spreading will help them

visualize the larger concept in a simple way. This will also encourage the kids to come to their own conclusion that hand

washing is an appropriate behavior when handling food and close interactions.


The behavioral capability construct is defined as the skills and understanding that are needed to accomplish a

specific behavior.9 This construct is displayed in our intervention by teaching the children the benefits of hand washing as

well as the steps required to effectively clean their hands. This will include a focus on using soap, scrubbing hands for the

suggested 20 seconds and rinsing. After learning the skill, they will be more likely to effectively wash their hands without

oversight.

The reciprocal determinism construct is defined as the way that people, actions and environments are interrelated.9

This construct will be displayed in our intervention by visually representing the spread of germs and how interactions with

their environment and other people can be a source of infection. This is the basis knowledge and example that

encourage the learned hand washing behavior to continue based on the children understanding its value.


RESEARCH BASIS

**Complete this table for two selected research studies that support your project design**Citation

AMA format required; include copy of article in appendices.

Setting & Participants

Intervention description

(include Social Cognitive Theory

constructs)

Evaluation strategies

(include how SCT constructs were measured)

Describe study findings relevant to

your project outcomes

Based on their results, what

can you expect from your project?

Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study. Research in Developmental Disabilities. 2014 (35); 3014-3025. doi: 10.1016/j.ridd.2014.07.016. Refer to appendix 1 for an abstract of study and reference if more information on the study is needed.

20 school aged (6-12) children with mild developmental disabilities in a special education school setting

Half of the students were part of a control group and the other half of the students were in the intervention group and received a simplified 5 step hand washing intervention demonstration for 15 minutes daily for four weeks. The students were rewarded for good hand washing by earning a star on their achievement board.

SCT Constructs:Environment - creating a physical representation of germs and demonstrating the methods for successful hand washing as well as modeling situational cues for hand washing.

The students were then shown their hand washing “success” through glow gel. The glow gel is a plastic “germ” gel that glows under UV lighting, and provided a picture of how well the participants washed their hands. The pictures were then ranked on a 0-4 scale to provide pre and post test data. The SCT Constructs were measured by how well the children washed their hands after being exposed to the intervention.

Students who were in the intervention group showed significant improvement in hand washing skills compared to the control group. This suggests that the use of multimedia support and visualization of quality results were influential for improving hand washing ability. This relates specifically to our use of physical and visual cues for prompting desired behaviors and our ability to gauge relative quality of hand washing behavior.

These results suggest that we can expect our intervention project to improve the participant's hand washing skills significantly compared to groups who do not get the intervention.


CitationAMA format required; include copy of article in appendices.




constructs)







Behavioral - capability training and skill development for hand washing.

Personal - reinforcement of desired behavior with tangible reward system and promoting self-efficacy.

Reciprocal Determinism - using physical and social cues to prompt desired behaviors that have been improved through modeling and training and reinforced with a tangible reward.

O’Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American Journal of Infection Control. 2001 (29); pp 352-360. doi:

120 Healthcare professionals in a hospital setting were used in this study

The purpose of this intervention was to determine how well healthcare professionals adhere to proper

The associations of cognitive factors with hand hygiene compliance were studied through

The observed hand washing adherence during the post-intervention period of this study was 70%. The study found that

Participants at Respite Care will only wash their hands without being prompted to do so when






constructs)







10.1067/mic.2001.18405 Refer to appendix 2 for an abstract of study and reference if more information on the study is needed.

hand washing and to study their motivation behind proper hand hygiene. The theory of planned behavior was used as a social cognitive construct model to determine whether or not the health care workers were motivated to wash their hands.

a behavioral model called the theory of planned behavior. An observational design was used to collect data from 120 nurses employed in a hospital setting. The health care professionals provided information regarding their motivational factors and intentions when it comes to hand washing. Each participant provided a self report on how often they follow guidelines when it comes to hand hygiene. Two weeks after the original data was taken, hand hygiene performance was observed in the same 120

motivation towards hand hygiene is more directed towards the need to wash hands, rather than internal motivational factors. This relates to our expected project outcome, considering participants have been washing their hands only when they feel the absolute need to and that their internal motivation for hand hygiene is low.

they feel the absolute need to. For example, the teens will wash their hands when they can see they are physically dirty, but when they do not see physical substance that needs to be washed off, they will have no internal motivation to follow proper hand hygiene.






constructs)







participants. The results were compared to the original observations.


LESSON PLAN TABLESpecific 2010 Dietary or 2008 Physical Activity Guidelines for Americans emphasized: As part of the 2010 Dietary Guidelines, it is stated

that “ a healthy eating pattern needs not only to promote health and help to decrease the risk of chronic diseases, but it also should prevent

foodborne illness. Four basic food safety principles (Clean, Separate, Cook, and Chill) work together to reduce the risk of foodborne illnesses.”7

**Complete this table for each lesson developed** Lesson Title Social Cognitive

Theory ConstructsNutrition or Activity Message(s)

Learning Objectives Learning Activities Instructional Materials

Evaluation Strategies for learning objectives

“Clean it Up!” This lesson will help the participants understand visual and social cues for prompting hand washing behaviors as well as demonstrating and practicing quality hand washing techniques.

Observational Learning - This construct is included in our lesson plan by having the participants observe group leaders and peers during hand washing activities. This includes observing positive verbal feedback when others do a good job, encouraging them to do their best.Behavioral Capability - This construct is included in our lesson by teaching and explaining the skills associated with proper hand

Hand washing is necessary for proper cleanliness and the prevention of obtaining harmful microbes.

At the end of this lesson, the majority (>50%) of the participants will be able to demonstrate proper hand washing techniques as measured by observation. We will be watching the participants wash their hands to make sure they are using soap and scrubbing their hands for at least 20 seconds. The observation on whether or not they properly washed their hands will be a simple “yes” or “no.”.

Anchor: Have the participants think of a time when their hands have gotten dirty.Add: A discussion about how not washing hands can make you sick.Apply: Activity to wash their hands and show them how to do so properly. The participants will get their hands dirty with paint and spread the paint amongst the participants, as well as have them touch various surfaces to see how microbes can spread. Away: A

The instructional materials we need for this activity are hand washing instructions, non-toxic washable paint, butcher paper, soap, paper towels and timers.

We will check for cleanliness after handwashing through visual observation to check for remaining spots and help the participants recognize residual paint. We will record how long they wash their hands with the timers. We will note whether or not they use soap without being prompted. We will observe the participants’ ability to focus on the task through its completion by observing behavioral clues. We will ask the

Hibbs-Shipp,Sarah, 05/04/15,

Instructions: Complete as part of Assignment 2. Delete the text in here as you complete the table. The text inside the table are your instructions on how to complete the table.


Lesson Title Social Cognitive Theory Constructs

Nutrition or Activity Message(s)

Learning Objectives Learning Activities Instructional Materials

Evaluation Strategies for learning objectives

washing skills and giving the participants an opportunity to practice and build confidence in their physical movements.Reciprocal Determinism - This construct is included in the fact that the social environment and activity are motivators for the participants to want to wash their hands as well as modeling successful hand washing within their peer group.

discussion about why and when to wash hands and the importance of doing so. Have the participants brainstorm when it’s a good time to wash hands.

participants about their attitudes toward washing their hands to gauge their enthusiasm on a general scale of very averse, averse, neutral, enthusiastic, and very enthusiastic.


EVALUATION TABLE

Process Evaluation (these are measures that will tie to the activities and participants you outlined in your logic model)

Impact Evaluation (these tie to the learning objectives, behavioral intent, skill demonstrations, etc., listed in your lesson plan table and short term outcomes in your logic model)

Outcome Evaluation (these tie to the medium term outcomes listed in your logic model).

Definition (include reference)

Process evaluation is a reflection of how well the intervention was administered in order to determine the areas of improvement. 13

Impact evaluation means assessing that results are direct effects of our intervention.13

Outcome evaluation measures the number of participants who were able to change behavior.13

Specific purpose of each type of evaluation for our project

The specific purpose is to make sure that our group was able to fulfill all tasks of the intervention in the way we intended and to tell us if we met our outcome expectancies of delivering a successful intervention by properly completing our checklist.

The purpose of impact evaluation is to tell us if the audience actually understood our intervention and they were able to learn the importance of hand washing and how to do so properly.

The specific purpose of our outcome evaluation is to measure the amount of people that change their habits related to hand washing as a result of our intervention, and whether that amount of people met our expected outcome

1 to 3 4-part objectives for each type of evaluation (action, population, measure of success, time frame)

1. At the end of our hand washing intervention, we will have involved each participant with a one-on-one interaction of how to wash his or her hands, as measured by our observation.2. At the end of our hand washing intervention, we will have explained how germs are spread to each of the participants, as measured by our observation.3. At the end of our hand washing

1. After going through our painting activity explained in appendix 4, each participant will have a better understanding of how germs are spread and how they can be avoided, as measured by our post-intervention observation sheet in appendix 5..

1. 6 months later, 50% of participants will be able to demonstrate proper hand washing techniques, as measured by a survey.2. 6 months later, 50% of participants will demonstrate social awareness by recognizing appropriate times to wash their hands, as measured by a survey.


Instructions: Complete as part of Assignment 3. Draft Process evaluation measures based on activities specified in lesson plan table, and participants specified in Logic Model. Draft Impact evaluation measures based on Lesson Plan Table Learning Objectives. Complete as part of Assignment 3. Please delete the example text as you complete each box with your project information.


Process Evaluation (these are measures that will tie to the activities and participants you outlined in your logic model)

Impact Evaluation (these tie to the learning objectives, behavioral intent, skill demonstrations, etc., listed in your lesson plan table and short term outcomes in your logic model)

Outcome Evaluation (these tie to the medium term outcomes listed in your logic model).

intervention, our group will have completed all components listed on the checklist in appendix 6, as measured by our observation.

2. After teaching the participants how to effectively wash their hands which is explained further in appendix 3, the majority (>50%) of participants will be able to demonstrate proper hand washing techniques, as measured by our observation.3. After going through our painting activity explained as a part of our lesson plan in Appendix 4, each participant will have an increased social awareness of when it is appropriate to wash their hands, as measured by our observation.

Method/s used to measure each objective for each type of evaluation

Observation while completing the checklist in Appendix 6.

Observation while completing the pre and post intervention checklist in Appendix 5.

Telephone survey to current staff members at Respite as seen in Appendix 7.

Summary of actual results OR expected results from each type of evaluation method described above

Our actual results showed that we were successful in completing all of our objectives by going through our checklist during the intervention and making sure that we covered everything we intended to.

The hand washing activity the teens willingly participated in gave them a better social awareness of when to wash their hands, which was a direct result of our demonstration.

The expected results will be determined by the telephone survey as seen in appendix 7. If our results come out as expected, 50% of the participants will be able to demonstrate social awareness by knowing when and how to properly wash their hands.


LOGIC MODEL


Inputs Outputs Impact -- OutcomesActivities Participation Short Medium Long

What was invested by you & others? Time from both the staff, ourselves, and the participants of respite care.

Supplies: soap, paper towels, recording material like pens and paper, washable paint, fruit, and ect.

Assistance from respite care in order to help the facilitation during the lesson and to keep them washing their hands even after we are gone.

Research from our group to make sure our program is relevant.

What did you do?Pre-intervention phase:*Observe the participants at Respite Care and their food safety skills.* hand washing habits- observe if the participants use soap and how long they scrub their hands for*proper food handling techniques- observe whether or not participants use utensils or grab food with their hands.Intervention phase: *implement an educational activity that teaches the participants about the importance of hand washing. *This will include an activity that demonstrates how easily germs spread by having the kids put paint on their hands and touching objects to show the spread of germs (germs are represented by paint in the activity). *Proper hand washing will be demonstrated by CSU nutrition students and the participants will be asked to wash their hands following the same procedures Post Intervention Phase: *Observe participants to see if they wash their hands properly before eating

Note whether or not they wash their hands without being asked to do so.

Refer to appendix 4.

Who did you reach?

*Respite Care Caregivers

*Respite Care Participants

(Process Evaluation)

What did they learn? What were their immediate

changes?*Skills - Displayed how to effectively wash their hands with soap and water for 20 seconds.*Knowledge - Learned how germs are spread and how it can be avoided*Social Awareness - Recognize social cues that prompt hand washing behavior

(Impact Evaluation)

What actions (behaviors) are

they now doing?

*Washing their hands before handling food*Washing their hands after eating or touching their mouth/face*Washing their hands after using the bathroom*Washing their hands after close interactions with others*Washing their hands when they see they are physically dirty

How will health conditions improve? *Decreased incidence of illness*Increased hygiene*Decreased days missed from school and other learning environments, like Respite Care

(Outcome Evaluation)

Assumptions (beliefs you have about your project, the people involved, and the way you think the project will work)

External Factors (environment in which your project exists, interacts with and influences the impact of your project)

We believe that the participants are capable of washing their hands properly but we believe they will almost always need some prompting to do so. We believe that the paint activity will help the participants understand the need to wash their hands without prompting.

The environment of Respite Care itself is a fun place for the participants to be, so we may be dealing with some distractions that are out of our control and highly unpredictable. Participants that are distracted from these external sources may not get as much out of the project than those who were not distracted.


PRESENTATIONWe will be presenting our project in conjunction with the group who worked with

the younger participants of Respite Care. The presentation will begin with a description

of the community partner and service learning activities that we participated in. This will

lead into an overview of the intervention project that each group created based on the

needs of our specific Respite Care audiences. We will elaborate on the learning

activities and strategies that were implemented in our interventions, as well as the

outcomes and possibilities for improvement. At the end of our presentation we will leave

time for questions and comments.

SUMMARY OF FINDINGSDuring our pre-intervention activity at Respite Care (as referred to in appendix 4),

we found that most of the participants washed their hands immediately after the activity

without being prompted to do so. Some of the teens ran their hands under water without

the use of soap, while others washed their hands properly with soap and water.

The day of our intervention, the teens were able to touch paint that represented

microbes. After touching the paint and watching the nutrition students demonstrate how

to properly wash hands, every one of the participants were willing to wash their hands.

While observing their hand washing skills, we found that most of the participants

washed with soap and water, while a few of the participants had to be reminded to use

soap to get the germs off. The teens seemed to enjoy this activity, as most of them

played along with the idea of the paint representing germs.

The post-intervention data was collected the following week. After our craft

activity and before the participants ate the snack provided, we observed the teens to


Instructions: Complete as part of Assignment 3


Instructions: Complete as part of Assignment 4; provide a summary of what will be included in your presentation – this should be no more than 1-2 paragraphs.


see if they wash their hands with or without being prompted to do so. We found that the

participants all wanted to wash their hands without being prompted. We also observed

that all participants used effective hand washing techniques (as referred to in appendix

3). It is important to note that only three out of the seven individuals that participated in

the hand washing intervention were able to be at the post-intervention.

During service learning experiences following post-intervention, we noted an

observable difference in the hand washing behavior of the participants. To conclude,

individuals that participated in the intervention overall needed less prompting and were

able to practice effective hand washing techniques.

REFLECTIONDuring our service learning experiences and hand washing intervention at

Respite, our group learned to create lessons that allowed for different teens to expand

the constructs of a lesson and to make sure to account for individual skill level. We

found that the individuals of Respite had a wide range of abilities, and that it was

important to make sure that everyone could feel included in every activity.

From the information gathered from our project, our group believes that

caretakers and students who desire to work with individuals with developmental

disabilities would be to apply and effectively use this information. Knowing the

importance of teaching individuals of this population in a way that is tailored to each

person’s unique needs is critical in teaching new skills, like hand washing.

There were two major limitation our group ran into while working on this project.

The first limitation of completing this community intervention was the issue of time. Only

having one semester to get to know a community well enough to be able to deliver an




effective intervention is not an easy task. This leads into the second limitation that our

group had. The individuals at Respite have a wide range of developmental disabilities,

which made it hard to come up with a problem that all of the individuals could relate too.

This also limited us from doing a nutritional specific intervention because all of the

individuals had unique nutritional needs. Our group eventually noticed a hand washing

problem with the majority of the individuals and we were able to effectively come up with

an appropriate intervention.

If we were able to repeat this intervention again, we would want to make sure

that we could measure our results better. All of the individuals that participated in the

intervention were not all able to attended the pre and post interventions.

Our project contributes to the field of community nutrition by promoting positive

behavior change, encouraging preventative health measures through food safety, and

addressing a specific problem that is tailored to one community.

ACKNOWLEDGMENTSWe would like to thank Respite Care and the teen participants for their time and

participation with our project. Between providing all the materials for snacks and

activities, encouraging engagement and creating a positive environment, their support

and enthusiasm were essential to the success of our intervention.




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Accessed October 25, 2015.

9. Bandura A. Social Cognitive Theory. Annals of child development. Vol. 6. Six

theories of child development. Greenwich, CT: JAI Press. 1989.

10.Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement

program in schoolchildren with mild intellectual disability: A pilot study. Research

in Developmental Disabilities. 2014 (35); 3014-3025. doi:

10.1016/j.ridd.2014.07.016.

11.O’ Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene

recommendations: the theory of planned behavior. American Journal of Infection

Control. 2001 (29); pp 352-360. doi: 10.1067/mic.2001.18405

12.When & How to Wash Your Hands. Center for Disease Control website.

Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html.

Updated 2015. Accessed October 25, 2015.

13.Nutrition Education: Principles of Sound Impact Evaluation. USDA: Food &

Nutrition Service website. http://www.fns.usda.gov/nutrition-education-principles-

sound-impact-evaluation.html. Updated 2005. Accessed November 12, 2015.


APPENDICESAppendix 1: To Evaluate the Effects of a Simplified Hand Washing Improvement

Program in Schoolchildren with Mild Intellectual Disability: A Pilot Study

Appendix 2: Understanding adherence to hand hygiene recommendations: the theory of

planned behavior

Appendix 3: When and How to Wash your Hands

Appendix 4: Lesson Plan for Respite Care

Appendix 5: Pre and Post Intervention Observation Sheet

Appendix 6: Checklist for Hand Washing Intervention

Appendix 7: Telephone Survey for Respite


Instructions: Complete with every Assignment as applicable (may not have appendices for Assignment 1, but will definitely need to update for Assignments 2, 3, and 4).Each Appendix should start on a NEW page. Separate each appendix with a page break. After you have inserted each appendix, you must update your table of contents to reflect the titles and page numbers. This is automatically done by left-clicking (selecting) in the table of contents and selecting “update all” on the tab that appears just to the left of the title.


APPENDIX 1: TO EVALUATE THE EFFECTS OF A SIMPLIFIED HAND WASHING IMPROVEMENT PROGRAM IN SCHOOLCHILDREN WITH MILD INTELLECTUAL DISABILITY: A PILOT STUDY

Abstract:

A quasi-experimental study using a pretest–posttest design with a control group was

used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene

improvement program by schoolchildren with mild intellectual disability (MID). A total of

twenty schoolchildren aged 6–12 years old with MID (12 males) were recruited and they

were assigned into intervention (n= 10) and control (n= 10) groups. To evaluate the

quality of their hand washing, Glow gel, which contains plastic simulated germs that are

visible under an ultra-violet lamp, was applied to participants’ hands to assess the

quality of hand washing by comparing the amount of visible Glow gel before and after

hand washing using a 4-point scale. Four raters used this 4-point scale to assess the

quality of hand washing through digital photo images of the participants’ hands. A total

of eight digital photos per participant were taken. A fifteen-minute hand washing training

session was conducted every school day for 4 weeks for the intervention group. Those

in the control group received no training. A multimedia visual package on steps of hand

washing was presented together with a reward system, whereby a number of stars were

earned each week depending on the quality of hand washing. Results showed

encouraging findings, as the schoolchildren in the intervention group showed significant

improvement in hand washing ( p < 0.001) and the improvement was stronger than that

of the control group ( p = 0.02). To conclude, a systematic instruction emphasizing

multimedia visualization in a hand washing improvement program can be successfully


implemented in a special school, and the effect of integrating multimedia visuals in the

hand hygiene program could improve hand hygiene among schoolchildren with MID.

Reference:

Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement

program in schoolchildren with mild intellectual disability: A pilot study. Research in

Developmental Disabilities. 2014 (35); 3014-3025. doi: 10.1016/j.ridd.2014.07.016.


APPENDIX 2: UNDERSTANDING ADHERENCE TO HAND HYGIENE RECOMMENDATIONS: THE THEORY OF PLANNED BEHAVIOR

Abstract:

Background: Most health care workers (HCWs) are aware of the rationale for hand

hygiene procedures, yet failure to adhere to guidelines is common. Little is known about

factors that motivate HCWs to practice hand hygiene. Purpose: The purposes of this

study were to (1) estimate adherence to hand hygiene recommendations; (2) describe

relationships among motivational factors, adherence, and intensity of nursing unit

activity; and (3) test an explanatory model for adherence to hand hygiene guidelines

based on the theory of planned behavior (TPB). Method: A longitudinal, observational

design was used to collect data from 120 registered nurses employed in critical care

and postcritical care units. Nurses provided information about motivational factors and

intentions and a self-report of the proportion of time they followed guidelines. At least 2

weeks later, the nurses' hand hygiene performance was observed while they provided

patient care. Structural equation modeling was used to test the TPB-based

model.Results: Rate of adherence to recommendations for 1248 hand hygiene

indications was 70%. The correlation between self-reported and observed adherence to

handwashing recommendations was low (r = 0.21). TPB variables predicted intention to

handwash, and intention was related to self-reported hand hygiene. Intensity of activity

in the nursing unit, rather than TPB variables, predicted observed adherence to hand

hygiene recommendations. Conclusions: The limited association between self-reported

and observed hand hygiene scores remains an enigma to be explained. Actual hand


hygiene behavior may be more sensitive to the intensity of work activity in the clinical

setting than to internal motivational factors. (Am J Infect Control 2001;29:352-60.)

Reference:

O’Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene

recommendations: the theory of planned behavior. American Journal of Infection

Control. 2001 (29); pp 352-360. doi: 10.1067/mic.2001.18405.


APPENDIX 3: WHEN AND HOW TO WASH YOUR HANDS

1.1.1 When should you wash your hands?

Before, during, and after preparing food

Before eating food

Before and after caring for someone who is sick

Before and after treating a cut or wound

After using the toilet

After changing diapers or cleaning up a child who has used the toilet

After blowing your nose, coughing, or sneezing

After touching an animal, animal feed, or animal waste

After handling pet food or pet treats

After touching garbage

1.1.2 How should you wash your hands?

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply

soap.

Lather your hands by rubbing them together with the soap. Be sure to lather the

backs of your hands, between your fingers, and under your nails.

Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday"

song from beginning to end twice.

Rinse your hands well under clean, running water.

Dry your hands using a clean towel or air dry them


1.1.3 What should you do if you don’t have soap and clean, running water?

Washing hands with soap and water is the best way to reduce the number of germs on

them in most situations. If soap and water are not available, use an alcohol-based hand

sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly

reduce the number of germs on hands in some situations, but sanitizers

do not eliminate all types of germs.

Hand sanitizers are not as effective when hands are visibly dirty or greasy.

How do you use hand sanitizers?

Apply the product to the palm of one hand (read the label to learn the correct

amount).

Rub your hands together.

Rub the product over all surfaces of your hands and fingers until your hands are dry.

Reference:

CDC. When & How to Wash Your Hands. Handwashing.2015 Available at:

http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 25,

2015.


APPENDIX 4: LESSON PLAN FOR RESPITE CARE Day 1: Pre intervention day

Introduce ourselves Get started on activity for the day

o Bring in shaving cream and set up area for activityo Prompt the participants to spray shaving cream on table and encourage them to play with

ito After 15-20 minutes, have the participants help with cleaning up the shaving cream.o This is when we will observe the participants to see it they wash their hands with out

prompting to do so Get started on a next activity including cookie decorations

o Have them be creative with their cookie and give them 15-20 for decorating and eatingo Help them clean up area by swiping, washing counters, and observe again to see if they

know when to wash their hands without being prompted Thank them for their time and tell them we will be back again next week

Day 2: Intervention day Introduce ourselves Get started on paint activity

o Rub paint on participants handso Tell them paint is representative of microbeso Have them touch other hands so they can see how germs are spreado Have them touch the table as another example of how germs are spread

Debrief activity with themo By the end they should feel the need to wash their hands thoroughly with soap and water

Next activity showing them how to wash their handso Follow instructions indicated by appendix 3

Talk about when they should wash their handso Have them brainstorm some ideas of when is appropriate

Start snack activityo Have participants prepare chocolate covered fruit with their recently washed handso Have participants help clean up and wash their hands again when they are done

Thank them for their time for the day and tell them we will be back the following weekDay 3: post-intervention day

Introduce ourselves Get started on a craft activity

o Have participants pick out a piece of colored papero Help them trace their hand on the papero Cut out their hand print and have them decorate it as a turkey

Start the next activity by setting up chips and dip for their snacko Observe whether or not participants wash hands without being prompted to do soo Observe how effective their hand washing seems to beo Allow them to dip chips in their choice of dip that will be in their individual bowl to prevent

germso Have them help with clean up and observe if they fell like washing their hands again

Thank them for their time


APPENDIX 5: PRE AND POST INTERVENTION OBSERVATION SHEETParticipant name:

Felt need wash hands without prompting

Washed hands

Soap was used

Hands appeared clean

Washed hands for longer than 20 seconds

Other things to note

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13


APPENDIX 6: CHECK LIST FOR HAND WASHING INTERVENTION

Section of intervention:Time pertaining sections of the intervention:

Completed?

Introduction: names 4:00-4:01pmIntroduction: introduce what we are planning on doing today including: a paint activity, learning how to wash hands, and making dark chocolate covered fruit.

4:01-4:04pm

Begin paint activity: introduce activity by explaining that the paint will represent germs and explain that we will have them touch objects and other’s hands to show how easy it is to spread germs

4:04-4:07pm

Squeeze some paint in the hands of 3-5 volunteers and have them begin the activity 4:07-4:15pm

Explain how easy germ are spread and end the paint activity 4:15-4:18pm

Begin hand washing activity: explain washing their hands often can help protect them against getting sick 4:18-4:20pm

Explain the process of how to wash their hands with the visual help of our “how to” poster 4:20-4:23pm

Have one on ones with each participant and make sure everyone is involved and all hands are clean before starting the food activity

4:23-4:35pm

Begin food activity: get all of the participants to get gloves on and explain that we will be dipping fruit in dark chocolate for the snack

4:35-4:40pm

Have the participants pick their own fruit and dip the fruit in the chocolate by themselves. Once participants are done dipping the fruit in the chocolate they may go enjoy their snack

4:40-4:55pm

Help clean up and thank everyone for their time and tell them that we will be back next week to do another craft and snack (this is when we will see if they remember to wash their hands before preparing food after they have dirtied their hands with craft time)

4:55-5:00pm

Checklist completed by: __________________________________

Date:_____________________


APPENDIX 7: TELEPHONE SURVERY FOR RESPITE

TELEPHONE SURVEY ON HAND WASHING INTERVENTIONRespite Care Inc.

To be administered to 10 employees 6 months after intervention

Script:Hello, this is ________________________________ from Colorado State University, 6 months ago we did a hand washing intervention with some participants at Respite and we were inquiring whether we could get your opinion on how some of the participants have been affected by this intervention.If they allow for the telephone survey go forward, if they decline the telephone interview, ask to talk to the direct supervisor to get any interview with them.

Circle One

1. Agree/ disagree

2. Agree/ disagree

3. Agree/ disagree4. Agree/ disagree

5. Agree/ disagree

6. Agree/ disagree

7. Agree/ disagree

8. Agree/ disagree

9. Agree/ disagree

10. Agree/ disagree11. Agree/ disagree

12. Agree/ disagree

13. Agree/ disagree

14. Agree/ disagree

Questions:Please respond to the first few statements with whether you agree or disagree.

1. The majority of participants wash their hands more often than before the intervention. 2. The majority of participants need prompting the wash their hands.3. When washing hands, the participants wash for more than 20 seconds.4. When washing hands, the participants use soap.5. When washing hands, the participants use a towel or something clean to dry their hands

off with.6. The hand washing intervention made an impact on the participants.7. The majority of participants recognize when it is appropriate to wash their hands.8. The majority of participants wash their hands less often than before the intervention.9. The majority of participants do not require prompting on when it is time to wash their

hands.10. When washing hands, the participants wash for less than 20 seconds.


11. When washing hands, the participants don’t use soap.12. When washing hands, the participants use their shirt or some other surface to dry their

hands with. 13. The hand washing intervention made little to no impact on the participants.14. The majority of participants can not recognize appropriate times to wash their hands.

The next section requires a little more information so please respond with the best answer that you see fit.1.

2.

3.

4.5.6.

1. How many of the participants wash their hands without being prompted?2. How many of the participants wash their hands for 20 seconds or more with soap and

use an appropriate drying technique?3. How many of the participants have an understanding of what germs are and how they

are spread?4. Is there anything you would improve about the intervention?5. What was the most affective part of the intervention?6. Anything else you would like to share with us at this time?

Thank you for answering our questions! We appreciate your time and wish everyone at Respite the best! Have a great day!

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