Delivering from a Distance: Reaching People at Home with the National DPP Lifestyle Change Program

May 21, 2020

Slide 1: Delivering from a Distance: Reaching People at Home with the National DPP Lifestyle Change

Program

Operator: We now have all of our speakers in conference. Please be aware that each of your lines is in a

listen only mode. I would now like to turn the conference over to Miriam Bell. Ms. Bell, you may

begin.

Slide 2: Moderator

Miriam: Thanks, John. Good afternoon and good morning to viewers on the West Coast, Alaska, and

Hawaii. Welcome to our webinar, Delivering from a Distance, Reaching People at Home with the

National DPP Lifestyle Change Program. My name is Miriam Bell, and I am the team lead for the

National Diabetes Prevention Program of CDC's Division of Diabetes Translation. I will be your

moderator today.

Slide 3: Adobe Chat Box

Throughout the webinar, please feel free to submit questions via the chat box. We've already seen that

several of you have checked in from all across the country, so welcome. We will do our best to

respond to chat questions during the webinar and will follow up after the event as well.

Presenters may also ask you to type answers in the chat box. You will see it at the upper right of

your screen.

Slide 4: Objectives for Today

Today's objectives are to identify at least one platform to use for distance learning delivery of the

National DPP Lifestyle Change Program, explain how to safely and securely collect participant

outcomes remotely, and describe two strategies for making distance learning sessions

interactive.

Slide 5: Transition Support

Since this public health emergency emerged, CDC has worked to support CDC's recognized organizations

in adjusting their lifestyle change programs to continue to offer the program to enrolled

participants. We learned early on that a chronic condition diagnosis was associated with a more

complicated disease process in those with coronavirus disease 2019 or COVID-19. This serves to

heighten the importance of prevention and highlights the role of interventions like the National

DPP in supporting the health of our nation. We've had numerous office hours and individual

calls with organizations on the topic of how to move forward in the face of this public health

emergency. We recognize that some of you are transitioning your in-person programs to

distance learning. Others are pausing your programs until such time as it is deemed appropriate

to bring in-person groups back together. In either instance, the Diabetes Prevention Recognition

Program, or DPRP, is supporting organizations by ensuring their recognition status is not lost due

to these uncertain times. Additionally, many of our partners have stepped up to make resources

and tools available for organizations. The Virginia Center for Diabetes Prevention and Education,

or VCDPE, and the Diabetes Training and Technical Assistance Center of Emory University, or

DTTAC, have both made available distance learning specific resources to help you during this

time of transition. Two other organizations, the National Association of Chronic Disease

Directors (NACDD), ProVention Health Foundation Health and Lifestyle Training or HALT, and

Fruit Street, a CDC-recognized distance learning organization with full recognition are offering

distance learning and online platforms for free during this time. Additionally, our partners at the

Centers for Medicare and Medicaid Services, or CMS, have implemented changes that allow for

easier enrollment as a Medicare Diabetes Prevention Program or MDPP supplier during this

public health emergency, including waiving the application fee, criminal background check, and

site visit. We are all committed to ensuring that participants have unfettered access to the

lifestyle change program in spite of the situation we all find ourselves in.

Slide 6: Presenter

It is a pleasure to introduce our two presenters today. First, we will hear from Anne Wolf. Anne is the

director of the Virginia Center for Diabetes Prevention and Education at the University of

Virginia. VCDPE has been engaged in diabetes tele-education for 12 years and has delivered the

National DPP lifestyle change program through distance learning for the past three years

achieving full recognition. As director, she serves not only as a master trainer for VCDPE's online

and in-person lifestyle coach training, but also helps to provide technical assistance and training

to all National DPP [providers], with a particular focus on Virginia. Anne earned her Bachelor of

Science in Nutritional Sciences from Cornell University and her Masters of Science from the

Harvard School of Public Health. Anne has been involved in telehealth since 2008 when she

worked with BMIQ, a secure platform that helps dietitians in medical practices optimize obesity

care through the use of technology. She has been actively engaged within the Academy of

Nutrition and Dietetics, including serving on the Telenutrition Evidence Analysis Library Panel,

speaking about telehealth at the Academy's Level Two Adult Weight Management Courses, and

developing a four-part online learning module on telehealth. She speaks regularly about

telehealth and distance learning.

Slide 7: Presenter

Our second presenter will be Sarah Piper. Sarah earned her Bachelor of Arts in Human Development

from Arizona State University and her Masters of Public Health from Emory University. Sarah is

also a certified diabetes educator. Sarah serves as the director of training for the Diabetes

Training and Technical Assistance Center, or DTTAC, at Emory University. In this role Sarah

designs, delivers, and directs DTTAC's in-person virtual and distance learning activities for the

National Diabetes Prevention Program. Sarah administers an organizational master trainer

program for DTTAC with over 100 organizational trainers, providing guidance, oversight, and

continuing education for their training delivery. In addition, Sarah serves as a lifestyle coach for

Emory University/Healthcare's delivery of the National DPP lifestyle change program to

employees. Prior to coming to Emory, Sarah has worked as a certified diabetes educator and

health educator in a variety of settings, including a local Atlanta nonprofit, Grady Health

Systems, and a rural Navajo reservation in New Mexico, to name a few. Sarah is a frequent

speaker on topics such as type 2 diabetes prevention, health literacy, facilitation skills, patient

empowerment, and behavior change. Like many National DPP suppliers, Emory has opted to

move their in-person groups to distance learning modality due to COVID-19. Sarah has been

delivering the lifestyle change program via distance mode for two groups for the past five

weeks. I now turn things over to Anne to begin her presentation on the practical considerations

when setting up your National DPP for distance learning. Anne.

Slide 8: PART 1 - Considerations for Distance Learning

Anne: Thank you so much, Miriam. And I'm so happy to be with you all today. Looking at the chat and

seeing people from all over—it's wonderful, so thank you for attending. It has been over eight

weeks since COVID-19 social distancing regulations came into effect. And many of you have

already begun to set up your programs for distance learning and have learned a great deal

already. So let's think about this as a time to not only learn from Sarah and myself and become

clearer on the issues, but also to share your experiences through a robust Q&A and chat.

Slide 9: Input

We're going to begin with a question for you. Start with our poll question. Poll question is where are you

in the spectrum of delivering the National DPP through distance learning? Thinking about it? In

the planning stages? Just getting your feet wet? Doing it a while, you are a distance learning

ace? All right. So I think you can see it right now that we have […] spectrum. So Sarah and I have

created this webinar for you to give you the entire spectrum of information. Thank you.

Slide 10: Key Telehealth Technologies

All right, so the distance learning delivery mode really encompasses two technologies. The first [is]

telephone or conference calls with a group, and [the second is] video teleconferencing, which is

the use of a platform that allows group participants to see and hear each other. Some people

can enter by phone alone when using this video teleconferencing. The key distinguisher around

distance learning compared to online delivery is that distance learning is live and it's

synchronous, meaning that the coach is facilitating the class at the same time that the

participant is attending the class.

Slide 11: Identifying a Platform

The first thing that we need to do is to identify whether we are going to use teleconferencing or video

teleconferencing for distance learning. And then next, identify which platform to use. In the next

few slides, we'll be reviewing some of the considerations when selecting a platform.

Slide 12: Teleconferencing

Let's start with teleconferencing. Teleconferencing is simply the use of the phone to hold your group

class. Today there's a great intersection between teleconferencing and video teleconferencing

since all non-free video teleconferencing platforms offer the option of calling in by phone. Still

there is great simplicity in having just a phone number to call to attend one's group meetings,

not wasting [those] precious minutes of our class time while we're waiting for others' video and

audio to connect. In fact, the DPP research trials follow-up group classes were all done by video

teleconferencing—I'm sorry, by teleconferencing. This option works best for participants with

no or poor internet connectivity, such as in rural communities throughout the States or for [...]

Just using the phone simplifies the entire setup process, because everybody knows how to use

the phone. There are vendors such as Free Conference Call, Why Pay, or Vast Conference, and

there are costs involved. If a free conference call service is used, then the participant uses their

service or minutes. And so for some participants, they may be paying for those calls. In addition,

teleconferencing services offer optional add-ons that can make it easier or free for participants

but will end up costing you some money. For instance, the toll-free option makes it free for the

participants, but you will pay the fee. And I figured out for a group of 10 people the cost is about

$14 per class. And that's about the same cost as a monthly fee of video teleconferencing, which

is a great segue into video teleconferencing.

Slide 13: Video Teleconferencing

Okay, the second distance learning technology is video teleconferencing. For this, both video and audio

are available so that you and the group can see and hear each other. This can work for anyone

with good internet access. If they can stream a movie, they can participate in video

teleconferencing. Do they need to be tech savvy? It's really not needed anymore. Before COVID-

19, many people were hesitant about using video teleconferencing, but now with friends and

family meeting regularly on Zoom and Google Hangouts and other platforms, many of those that

were tech fearful have traversed the territory and are now becoming tech comfortable. There

are many different platforms available, as shown in this slide. While we will share some of the

platform names as examples, please remember that you have to choose a platform that best

meets the requirements of your organization, and that CDC does not endorse specific products

or services. Next slide please.

Slide 14: How Do I Decide?

Okay, so when deciding upon what video teleconferencing platform to use, ask yourself the following

questions; it will help you to narrow your options: What engagement features do you want for

class delivery? How easy is it for the lifestyle coaches and the participants to use? How many

host licenses do you need and what are the costs? Am I being HIPAA-compliant with my

organization's or payors' requirements? Let's talk about each one of these questions.

Slide 15: Engagement Features

What engagement features do you want for class delivery? I'd like you to think about this as “must

have” versus “nice to have” features. Must have features, well nearly all platforms contain all

these must haves, but you really, really do have to have that audio and that visual so you can

see and hear each other. And you want that free phone option, because there are going to be

times when people are going to need to call in. You want to be able to see participants names

and who's speaking. And you want to have some ability to interact, so you want to be able to

show slides or share applications such as videos so that you can interact with the group. Not as

necessary but really nice to have are things like the whiteboard, where you can brainstorm with

your group, or the ability for your participants to share their screen. Breakout rooms really help

to bring people into a smaller environment for more intimate activities. There are polls and

there are reactions, and Sarah will be sharing examples of how to use these options. Next slide

please.

Slide 16: Ease of Use

The second consideration is ease-of-use. Assuming participants don't know how to use technology, a

platform that has an easy quick link that join[s] them to the meeting is more ideal than the two-

step process that uses a link up front but then asks participants to download the opener for

every class. You can use either, but if the platform downloads the opener, educate and train

your participants about this feature so that they don't think they are “downloading” something

unsafe to their computer. Yup, this has happened to me. Send your participants the link and the

phone number prior to each class to ensure the dial-in information is easily available. When

sending participants the link and the phone number, make sure that you only send one phone

number rather than copying and pasting the site's standard email that lists 12 different phone

numbers. That's just TMI (or just too much information), and it's overwhelming. Whatever

platform you use, provide your participants with simple training materials about how to get into

the system, when to arrive to class—that is ideally 15 minutes early for the first three weeks

until those tech issues start to calm down—and even some distance-learning etiquette tips will

help. Lastly, you also want a platform that's easy for you to use. Ultimately, all platforms are

similar. Make sure that you go on the platform with colleagues and practice a couple of times

before your class so that you can be relaxed and comfortable during class. Next slide please.

Slide 17: Host/Organizer Licenses

Video teleconferencing platforms license their software to you through host/organizer licenses and are

based on the class size and capacity needs. For instance, the company may offer their

professional license for $12 per host per month for the capacity of 150 participants in each class,

while their business license costs $16 per host per month for a larger class capacity of 250

participants. Given the small class size in our National DPP classes, we typically only need the

lower cost plan. A word of caution though: free plans often limit medium length to less than an

hour and do not offer the telephone call option, so these are not typically good options for the

distance learning delivery of the National DPP. The question often comes up to us as to how

many host/organizer licenses do I need? If you are an organization that has only one coach, you

only need one host license even if that coach gives 50 classes a week. The issue is trickier for the

large organizations like the Cooperative Extension and the Balm of Gilead that have many

coaches facilitating multiple classes every week. And the number of host/organizing licenses

boils down to the number of concurrent classes your coaches offer. That is, how many classes

are offered at the same time and day of the week? If there are 30 classes but only 2 concurrent

classes, then buy only 2 host/organizer licenses.

Slide 18: Health Insurance Portability and Accountability Act (HIPAA) Compliance

The final consideration is HIPAA compliance. HIPAA regulations were instituted in order to protect

people's private health information. It's the responsibility of organizations to comply with any

federal, state, or local laws governing individual level identifiable data, including HIPAA. Many

state and federal policies were loosened in response to the COVID-19 public health emergency,

allowing [National] DPP providers to use non-HIPAA- compliant platforms during this period. But

who typically must comply with HIPAA standards outside of this time period? Well, it's around

healthcare, so healthcare providers, hospitals, health clinics, pharmacies. And in addition to this,

organizations that receive reimbursement for the National DPP from a private health plan, such

as United or Aetna, as well as Medicare and Medicaid. The cost of the video teleconferencing

platform may vary based on HIPAA compliance. For example, Zoom is $12 per host per month

for their pro version, which is not HIPAA-compliant, but $200 per account per month for their

HIPAA-compliant version, which comes with 10 hosts. GoToMeeting and Webex, on the other

hand, are HIPAA-compliant even at their lower-cost versions. Regardless of whether or not you

need to use a HIPAA-compliant platform, all organizations should protect individual-level

identifiable data such as participant records, according to HIPAA.

Slide 19: Input

It's time for another poll question. Okay, so here it is: if you're already delivering the National DPP

through distance learning, what has been the most exciting part? And if you haven't yet started

offering it, what excites you the most about doing it? [Poll options: Connecting with my group

during this time of social distancing, understanding that this delivery mode can provide greater

access to my program, playing with new ways to facilitate a class, nothing- this is a really tough

change]. So far, we're seeing a lot of “understanding that this delivery mode can provide greater

access to my program.” Absolutely. We're also seeing equally “just connecting to your group

during this period of social distancing.” We're hearing a lot from people how it's so meaningful

to them that they're actually attending class more during this time. Wonderful, thank you all

very much.

Slide 20: Can I Receive Emails and Texts from Participants?

While HIPAA regulations have been loosened, it has always been okay for patients to send emails and

texts to their providers, even if it contains private health information. The Office for Civil Rights,

part of the Health and Human Services that oversees HIPAA regulations, states the following:

“HIPAA security rules do not apply to emails or texts from patients. A patient may send health

information to you using email or texting that is not secure. The health information becomes

protected by HIPAA rules once you receive it.” Therefore, once you receive private health

information from the patient by email or text, record it elsewhere, put it into a secure location,

and delete the email or text. The Office of Civil Rights also requests that you inform patients that

their personal email is not secure and offer them an alternative way to send information […to

you, such as] fax or phone line. Next slide please.

Slide 21: Capturing Participant Outcomes

So given that information, now you can understand how to collect your participants' outcomes when

delivering in distance learning mode. For weight, they can either email or text you their self-

reported weight or take a picture of their scale with their weight on it. They can also email and

text you their weekly physical activity minutes. And attendance is obtained by seeing or hearing

them at the meeting.

Slide 22: Final Pieces of Advice

I want to end by sharing some final pieces of advice. First, have a backup plan for technical difficulties. It

can be as simple as informing participants that when they are experiencing technical difficulties

that they can attend class by phone. Set up for the future in mind. Because so many providers

have set up telehealth relatively quickly during this public health emergency, this may have

compromised the type of distance learning program you would have ultimately provided. For

instance, we may not have adequately trained participants so that they are comfortable using

video teleconferencing platforms. Our facilitation skills are pretty new, so how can we improve

upon them? And we may be using a non-HIPAA-compliant platform even though we are

associated with a health system. Those of us in telehealth are hopeful that some of the stringent

rules and regulations that have been prohibiting telehealth access through reimbursement will

be reevaluated. But now that the initial push is over, this is a good time to develop a type of

distance learning program you really want by developing those access materials, training, and

licensing in a HIPAA-compliant platform if your organization requires it. Third tip is train, train,

and retrain. Make sure that everybody, including the participants, knows their roles and

responsibilities. Make it hard to fail through thorough training and practice. And last, just do it.

In the end, we all need to just do it. You will become proficient simply by doing it over and over

again. Please don't let the perfect be the enemy of the good. I will now turn things over to Sarah

to share guidance on facilitating lifestyle change programs effectively using distance learning.

Thank you so much.

Slide 23: PART 2 - Facilitating Over a Distance

Sarah: Thank you, Anne. And what a nice note to end on, don't let perfect be the enemy of good. So as

we go forward today, we're going to focus now on how do we use our strong lifestyle coach

facilitation skills in this new modality for many of us. So with that, let's begin. Next slide.

Slide 24: Fundamentals of the Lifestyle Coach Approach

So, our lifestyle coach approach. The most important thing to remember in our shift from in-person

delivery to distance learning is that our approach, our mission as lifestyle coaches, is the same

regardless of the delivery mode. Our approach, as you know, is to facilitate rather than teach, to

resist the temptation to answer all of the questions, and to believe in the participants' own

expertise to identify solutions and strategies that will work for them. So our approach is to

create a group environment where group members support and problem-solve with one

another in service of their lifestyle change goals. We have to believe that we can maintain these

approaches regardless of our modality. We may have to plan differently, adjust, adapt, and get

creative when needed, but it can be achieved. So changing our modality does not change our

mission to engage participants in their own self-discovery, problem-solving, and peer support.

Slide 25: Some Basics

So with that as our foundation, we're going to discuss just some basics of our facilitation in the distance

environment.

Slide 26: Acknowledge the Newness

So I think Anne laid the stage well the way she concluded, by talking a little bit about the adjustments

that we all have to make as coaches, as well as our participants. So just to normalize that [for] a

minute, you know, we should acknowledge the newness for us too, trying something new like

this is like trying on a new pair of shoes. We may know that it's time to get those new shoes, or

over time, but they are not as comfortable as the old ones. So when you first wear them it feels

a little awkward. It may rub on one part of your foot and take a few days to stretch out. So it is

as lifestyle coaches when we're trying something new with our groups. As Anne said in regards

to technology, we will all become more proficient or more comfortable by doing it over and over

again. So let's now consider how we might help our participants make this adaptation as well.

Slide 27: Ease Participants into Technology

So when we talk about using technology in general or specific platform tools that we're going to explore

in a moment, we need to remember that these again may be like new shoes for our participants.

So knowing your group will help you 1), you know, identify how accessible a platform we might

be using will be for individuals or the group. And 2), [this] will help us kind of know going in

about folks' comfort level and the way they may need support to make this transition. So

knowing these things will help drive some of your approaches in your early sessions in the

distance modality. So assuming that you feel many of your participants will adapt to tools and

technology, we want to ease folks in, we want to normalize things when they go awry, and we

shouldn't hesitate to shift gears if things are not working. What is most important is that our

group is gathering and connecting—bells or whistles or not.

Slide 28: Session Tips

So we're going to review on the screen just a few tips for facilitation in the distance modality. And we're

going to take a few minutes and go through each of these and talk about how they align with

our priorities as lifestyle coaches, as well as how, you know, some things to anticipate. So we're

going to go over some: how to establish group guidelines using icebreakers, facilitation skills, the

use of the CDC curriculum handouts, and creativity to aid us in having successful sessions.

Slide 29: Ground Rules for Distance Groups

So, ground rules from a distance. So like me when you begin your in-person programs, you engage in the

best practice of setting group ground rules. Whether you are starting a new group or

transitioning mid-program to distance [learning], your first distance session should include time

to set your distance group guidelines or at least revise the ones you've been operating under in

person. As you can see from the example slide depicted on the screen, we want to consider

having specific guidance around active participation, despite the fact we're not sitting around

the table together. We want to reinforce to focus and be present when you're there, despite the

temptations we all have behind the computer to perhaps multi-task. And we want to encourage

folks to do what they might not [do] in person, which is to state their name when they speak,

which will be especially important for those participants who may not be using their video but

[are] just on the phone. But beyond specific guidelines, just taking time again in your first

distance session, in those early sessions, or however often you need to acknowledge the shift

and help make it easier for all to engage is super important.

Slide 30: Begin Each Session with an Icebreaker

The next in our list of tips is probably a no-brainer for coaches. Many of you do icebreakers every week

of your sessions throughout the year, and others of us rely on them more in the early stages of

the program. But when we're talking about a distance session where we may be either

unfamiliar as participants with this way of connecting with people, or we may be programmed

from a work perspective to behave in a different, more reserved way, icebreakers can help with

that. So for one, icebreakers help and become kind of an easy way for you to take attendance

with who is there, especially again if you have some on the phone and some on video. Secondly,

icebreakers allow for all the participants' voices to be heard early in the session, which again

helps set the stage for their participation. Three, icebreakers—if they're fun and frivolous—can

add levity to the beginning of the session, which always helps. And four, it can lend itself to

setting the tone for the session content in a simple way. So for example, one lifestyle coach

opened her session on eating out with an icebreaker question to share their favorite type of

restaurant to dine at, or in times of pandemic to get takeout from. So icebreakers again can set

the tone for interaction.

Slide 31: Display Handouts to Guide the Conversation

All right, so displaying the CDC curriculum handouts. So while you and your organization will have to

consider how you will provide each person with their own copy of the CDC curriculum handouts,

it's helpful from a facilitation perspective to have the CDC curriculum handout displayed in your

distance learning platform. This makes for easy visual reference during your session. It helps

keeps the session conversation focused on the content at hand when you want it to be. So CDC

curriculum handouts—there's a variety of ways you can display those. You could screen share,

depending on your platform, directly from the CDC website or wherever you may have your CDC

curriculum files stored. Or you can display the participant handouts as slides. So, as you can see

on the screen, both the Virginia Center for Diabetes Prevention and Education and DTTAC have

the CDC curriculum participant handouts in slides and available for your use if that's helpful to

you. So, a word of caution, the temptation when you have slides on the screen just like we have

here today is that we slip into teacher/lecturer mode versus facilitator [mode]. So, as a gentle

reminder to us all, the slides are there for a visual reference to guide the group session, certainly

not as an invitation for us to become professorial.

Slide 32: Facilitation Skills

So let's focus on our facilitation skills. So most of us likely give thought before our sessions to which

techniques we might use in a particular session. Our facilitation strategies might be based on

what the topic is, the group dynamic or stage of development, or our group size. When

facilitating from a distance, especially the first few weeks and as we're wearing those new shoes

again, it is a good idea to have a general game plan for what facilitation approaches you will use.

Many coaches using distance modalities—and perhaps you're one of them—open up sessions

with a round-robin question, or we call it a carousel question, to warm up the group topic. An

example might be “we're going to go around the virtual room and when I call your name, I want

you to share a simple way to add physical activity to a busy day at home. Miriam, may you get us

started as an example.” One difference using this technique that you may have just noted in the

distance modality is that you will likely need to call on participants specifically to move the

carousel question around versus relying on your non-verbal cues as you might in person. Once

your group is more comfortable with your distance session, you may find that throwing out an

open-ended question is good enough to get the conversation going. An example of one such

question that might be enough to stimulate group conversation is the following: “Group, I want

you to think about what has been the hardest thing about being at home related to your

lifestyle change goals. I'll give you a minute to think about it and then you're invited to share

your thoughts when you're ready.” So, again, depending on your group's stage of development,

you may already know once you transitioned to distance that it takes very little to stimulate the

group to talk. For others of us, if we were earlier in our group's relationship building, we may

have to work a little harder in those first sessions to build that comfort with open-ended

questions as our starting point. So let's get some practice ourselves or perhaps just show off

your powerful questioning skills.

Slide 33: Input

We're going to ask you to use the chat box, which all of you are demonstrating great proficiency with,

and to give us an example of a great question that you use with your participants to start

conversations. So we're just looking for a couple of open-ended question examples. How’s your

week? What are you proud of, thanks Stephanie, what are you proud of this week? What's your

favorite summer treat? How do you feel now, and how do you want to feel at the end of the

day? Oh, they’re going so fast, wow! What is your biggest success this week? What's your

favorite successful goal with this past week? Great! See, I knew it, proficient. Tell me what has

been your greatest success this past week—I love that assumption that they've had some

success and getting them to focus on the bright side. Awesome, look at this. What tips from

today's conversation will you use this week? Great—bringing in that charge to apply what we've

discussed. Great! Super! So you get the idea and, you know, depending again on where your

group is in its development, they're going to be more or less ready in a distance format to just

take those questions and run with them. So again, starting with something a little more

structured like a carousel or round-robin to warm up the group may be a good place to start, but

you'll trust your group and your own insights as a coach to know when you can kind of shift it

around a bit.

Slide 34: Get Creative

So other facilitation skills, such as the ping-pong technique where you throw the question to the group,

which involves again redirecting one question to another; brainstorming; summarizing; and the

like, are also equally effective in the distance format. So our next tip, as you can see, is to get

creative. So I want you to consider what you're currently doing or what you did in the past in

your in-person sessions to make the content more engaging. I know many coaches do things like

bring in visual aids, [or] they may play a game relevant to the session topic or have props to

illustrate a point. So whatever you might have done in your in-person session to make the

content more fun, visual, relevant, or easy to relate to, you can find a parallel way to do that in

your distance session to accomplish the same thing. So [here’s] an example from a recent

distance session a coach facilitated. The session topic was food cues or triggers. And the coach

reported that in her in-person session, she found a really winning strategy for her where she

would make some microwave popcorn and hide it in the room. And it would always, of course,

be met with groans and comments about “how just the smell makes me want to eat it even if

I'm not hungry,” and such and such. And therefore, she had a wonderful segue into this topic

about the things that cue us to eat besides just hunger. So this coach was grappling with what to

do as something similar in her distance format and it turns out in her platform, she was able to

change her background, and she just changed it to the image of a donut shop. And lo and

behold, as her participants started to log, in the groans began. First about how the donut shop

was closed and then it became gosh, “I don't even like donuts, but those look so appetizing; it

makes me want one.” So her point was made to help make that connection. So a creative way.

(She did not, however, torture folks by keeping that background up the whole time.) So other

examples of creative tips for distance sessions include engaging in light physical activity together

during the sessions, just walking in place [or] using water bottles or soup cans to do some arm

presses. Showing a short videoclip that aligns with the session content. Or playing a quick

lifestyle change program trivia game. DTTAC has one for use on Common Ground. These are all

examples of making sessions fun and engaging.

Slide 35: Using Technology for Engagement

And let's turn our attention to some of those specific tools that were mentioned earlier and how they

might help us facilitate and engage groups in our distance modality.

Slide 36: Encourage Webcam Use

So a few minutes ago, Anne mentioned the “must have” and the “nice-to-have” features on your

teleconference platform. And I'm going to walk through how you can use some of those features

to keep your participants engaged and drive home important points. While the tools available to

you will vary based on the platform and the version of the platform, some of the features we

will discuss are available. So we're going to look at webcams (as you can see), whiteboards,

chats, and polls. So with webcams, when possible we want to encourage their use. It's ideal to

use them because it allows the group members to see each other. As you've likely experienced

in meetings and the like, having that image of someone or their face helps to stimulate your in-

person, simulate, I’m sorry, your in-person experience, helps increase engagement of the group,

and helps you as the coach gauge participant reactions and needs. If webcams are not possible

for your platform or for some or all of your participants, consider asking participants to provide

a photo of themselves that you can display as a way to make their presence appear as more

than just a name or a phone number. Of course, what's most important is that that participant is

present in whatever form and that we are intentional about including them in the session

conversation. So making that list of names we talked about as part of your icebreaker process

can help ensure those on the phone get included. I had an important learning over the last six

weeks with one of my groups that transitioned to distance that I'll share. And it reminded me to

be sensitive and responsive to participants' realities. After sending an email encouraging my

entire group to use their cameras, one participant shared with me privately that she did not feel

comfortable on camera. She expressed a feeling of exposure, having her image so close up when

she was talking and having her home environment on display made her uncomfortable. So this

was a really important lesson for me to remember that each participant's comfort and reality is

not the same, and that my job is just to help them feel connected to the group in whatever way

works for them. So I pass that lesson learned on to you.

Slide 37: Annotating (Drawing) and the Whiteboard

So another feature that some platforms offer is the ability to annotate, and along with that often comes

a whiteboard just like you might have in a room that you're facilitating. So combining that ability

to write or draw on the screen can allow you to do a variety of things. You saw a few slides ago

some pictures of emojis that a coach had put up to ask participants to choose the emoji that

best represented their food tracking experience that week. And she taught them how to circle

on the screen as a fun way to kind of get a pulse of the group. A whiteboard, as much as you

might use it in an in-person session, allows you to document ideas and challenges, [and] help

the group prioritize the conversation, to identify common themes, and to capture strategies for

specific lifestyle changes. So if you don't have this feature, you can still scribe group brainstorms

as you should, so you can refer back to them. And perhaps you may have an ability to even

provide a copy of those brainstorms to your participants if it's relevant or helpful to do so.

Slide 38: Chat Box

A couple more features, the chat box which you all are very familiar with here. You can use this in your

distance sessions. Some coaches may use it just as a way to vary up their techniques where they

might say all right, quickly everybody type in the chat box your favorite summer fruit. Just again

to kind of warm up the group. So the only caveat or caution that I would offer—and I know Anne

concurs, is we don't, you know, the nature of these groups is such that we're interacting. And

they're never so large that you couldn't hear everyone's voices. So a chat box should be used

truly as just a varying of your routine technique, but not one that you lean on to navigate the

entire hour-long session.

Slide 39: Polling

Similarly, polls as you've experienced here today allow folks to engage with fun. It's fun to see what

everybody's responses are. So putting up kind of relatively nonthreatening questions like you

see here, like what's your biggest challenge with eating out, can be a fun way to again get a

pulse of the group and see where people have commonalities, similarities, etc. But again, not

one we'd rely on all the time since this isn't a class or a webinar where they're asked to sit

quietly on mute.

Slide 40: Input

So speaking of polls, let's do our quick final poll of the day to see what kinds of features may exist on

some of the platforms you use. Which ones might you be inclined to use with your participants,

or you may already be using them? So chat box, polling, writing or drawing on the board or

slide? None of the above? I would be unlikely to use these? So we're pretty; so far, we're evenly

split. It looks like polling might be pulling ahead. Chat box is close behind. Those might be the

two that folks are most familiar with or have most easy access to. My participants are getting

really groovy with the writing on [the screen]. Sometimes they'll do it in spite of me, so that's

kind of a fun element that's emerged in the distance groups.

Slide 41: Record the Session

All right, well just to close out with just a couple of things. With the permission of your group

participants and the capabilities of your platform, you can record your session, and I find that

that can be helpful for two purposes. One, you could provide that recording to a participant who

had to miss a session. And it can also be development for you. You could listen to that session

for your own development as a coach to hear where you might be getting in your own way, if

you will.

Slide 42: Connecting Beyond the Session

And the last little thing I want to mention before we hand it back to Miriam…

Slide 43: Supporting Participants in Challenging Times

is just to remind us of the importance, regardless of everything we've talked about, about supporting

our participants during this challenging time. So the beauty of group sessions, as you know, at

the lifestyle change program, is how participants make the content of the curriculum relevant

through sharing of their challenges and strategies. And now more than ever, we would be

remiss if we did not give participants opportunities to talk about how this current pandemic

reality is affecting their process of change. So the bullets on the slide give examples of

conversations coaches are starting with their National DPP participants to help them stay

connected in their own journey of change, but acknowledge this challenging reality that we're

all in.

Slide 44: Staying Connected

And staying connected, whether your program is on pause—whether your program has transitioned or

somewhere in that realm—staying connected is so important. At minimum, we want to reach

out to our participants in formats that work for them and check in with our groups, follow up

with those who may have missed or aren't attending, to check in with folks who may need extra

support or referral. Some coaches have found encouraging support and accountability buddies

can also be welcomed and helpful during this time.

Slide 45: CDC’s Personal Success Tool

The last way we can stay connected has been provided to us from the CDC Personal Success Tool, which

if you have not seen it, you need to check it out. It is on the CDC's website under Tools and

Resources. And it is a tool that allows you to send modules that are themed to the CDC

curriculum that provide nudges, support, and reinforce the ideas that have been conveyed in

the sessions. This tool is based on evidence of behavioral science and has been tested by real

participants and coaches. So check that out as a way to again stay connected, but again to

reinforce and keep people's eyes on the prize of [type 2] diabetes prevention. So I am now going

to turn it over to Miss Miriam.

Slide 46: Resources

Miriam: Thanks, Sarah. And now actually I'm going to pitch it back to you in a couple of seconds. But I

would now like to invite Sarah and Anne to share information about the available resources that

they have through their respective organizations to support this work. So as you guys are

transitioning from in-person to distance learning delivery, these are two organizations that do

have resources that you might find helpful. So Anne, let me pitch it to you. And also, let's keep in

mind that we only have about 10 minutes left. So Anne, I'll let you go first.

Anne: Okay, thanks. So besides—you know—offering those online and in-person lifestyle coach

trainings, our center offers custom trainings and will soon be offering an advanced training in

distance learning with education (CEUs) really to dive a little bit deeper and help people feel

more comfortable. We also offer free resources around distance learning, including the recent

addition of a Spanish version of the Prevent T2 slide deck for distance learning. And then coming

in late summer, we will have an online self-paced CME [continuing medical education] training

available through the University of Virginia's Telehealth Village. Sarah.

Sarah: Thank you, Miss Anne. DTTAC again offers a variety of types of training and advanced training and

motivational interviewing, and health equity and the like. But I mostly want to call your

attention to Common Ground which is our online learning community that any coach

anywhere—you don't have to be affiliated or trained by DTTAC— can access. And we have a lot

of resources and tip sheets there around the COVID crisis and beyond, as well as a discussion

board where you can continue this kind of dialogue you're having in the chat box with other

coaches around the country, so I hope you'll check it out. Thanks, Miriam.

Miriam: Great. Next slide.

Slide 47: Other Resources

So Kathleen, actually my slide presentation froze up, so I'm on that slide that says other resources. So

thanks, Sarah and Anne. And as mentioned earlier, NACDD and Fruit Street are both offering

free access to their virtual platforms as well. We posted their websites for you to visit for more

information.

Slide 48: Lifestyle Coach Training Entities

And in addition to VCDPE and DTTAC, we'd also like to mention other training entities with whom CDC

has a memorandum of understanding to train lifestyle coaches and master trainers to deliver

the National DPP lifestyle change program. They all play a critical role to ensure that we have a

competent, well-trained workforce to support participants as they embark on the journey of the

lifestyle change program.

Slide 49: National DPP Customer Service Center

And lastly, I'd like to welcome you all to visit the National DPP Customer Service Center, which provides

organizations easy access to information and resources about prediabetes and the National DPP.

You can access training materials, toolkits, and videos; ask questions; and receive technical

assistance related to all aspects of the program.

Slide 50: Questions

And before my computer died, I saw that there were a lot of questions being generated in the chat box.

And, you know, several [were] related to organizations specific around data submission to the

Diabetes Prevention Recognition Program, or DPRP. And definitely I encourage you all who have

those type of data submission questions to log on to the National DPP Customer Service Center

and create an account, and that way that will allow you to pose your question and receive

technical assistance and get connected directly to the DPRP team. So now we have a few

minutes—I think we have eight minutes—to work through some questions. So a few questions

that I've jotted down that I will pitch to Anne and Sarah to kind of weigh in on. Let's see this first

one, and again there are a lot of questions in the chat—I've written down a few, definitely not

going to be able to get through them all. So we are going to be getting a transcript of this chat,

and we'll be taking a look at that. And actually the chat will probably inform future webinars

that we will be offering, especially due to the amount of interest that we've had in this initial

session. So the first question that I will go to is for those that have done videoconferencing DPP,

how many people do you allow to sign up for a class? How many is too many? So Sarah or Anne,

do you want to take a pitch at that?

Sarah: Yeah, go ahead Anne.

Anne: Okay. So I find personally when my class size gets too big, then I have a larger […]—I lose more

people. So I really do like to keep even the distance learning classes no more than 15–16 people.

Because it takes a lot of attention to bring to these people and to keep them engaged. And so,

that if I don't, it gets […]. I've heard of people doing 20, but I personally can't do that and I'm

pretty experienced. Sarah, what do you think?

Sarah: I 100% agree. I actually have two groups right now, one is seven and one is 14, and I'm finding

really […]. I find it really stressed with the 14, just because I feel like it's hard to […], the

conversation doesn't flow as quickly as it does in person. So you know, if you can by design keep

them a little smaller, I think the engagement will be easier. But if you're just switching over, then

you know you work with what you've got. But I would yes, refrain from the large groups.

Anne: Yeah, and even Tim writes in, 20 is a class not a coaching experience.

Sarah: Yeah.

Anne: Love that Tim, thank you.

Miriam: Okay, great. Next question for you both is, is can you use the combination of phone and video

for classes? Maybe some of the elderly can't do the computer format. What do you guys think of

that? Anne, do you want to take a […]

Anne: Sure. Yeah, I'll start.

Miriam: To answer that first? Okay.

Anne: Absolutely. No, we absolutely do both, that's why you have to have a phone number because

there are going to be technical issues or there are older people that can't get on or that's

something that always happens, so somebody always comes in by phone. The challenge is when

you're doing phone and visual is that you're going to need to share what's on the slide. If you

have a slide, really make sure that if there's any visual, you need to verbally say what it is so that

they can be a part of the group. So it is definitely a little bit more work and repetition, but it can

work. Sarah.

Sarah: Nope. Agree and that's my reality with my groups; I have some on the phone only. And so it's a

discipline for me to make sure I have those names written down or recognize that phone

number, so that I can, you know, bring them into the conversation for sure. But yes, we don't

want to exclude anyone based on their comfort or access.

Miriam: Great, and actually I'm a perfect example right now, because I'm having technical difficulties but

luckily, I dialed in on the phone so I'm still able to participate in this conversation. So the next

question is about recruitment. Before I got disconnected, I saw a lot of questions about

recruitment. So do you guys have any suggestions on recruitment for future classes if an

organization needs to use distance delivery? Sarah, [do] you want to answer this one first?

Sarah: You know, I mean—obviously your recruitment strategies vary based on the type of organization

and who you're accessing. I think you want to kind of modify your communication to explain

what's going to be needed to participate and reassure people they don't have to be tech savvy

or tech comfort[able] to participate. And upsell a couple of things, the ability to connect with

others that are going through similar challenges. And the benefit of prevention that we are now

seeing illuminated when it comes to risk for COVID-19 is another thing to consider. Anne.

Anne: Yeah. No, I've done a lot of these where when we recruit, we do in person, but I also do webinar

recruitment. So if you have a set audience, it makes it easier, such as an employer base. So

you're sending out not only—well, we can't do in-person recruitment right now, but you can do

recruitment through webinars and people will attend. And actually the people that are more

likely to attend my webinar are going to be those that are going to be using distance learning. So

that's a good way to challenge them—really hearing from you all is that when, you know, you're

working in the community and how you reach them that you're going to do, you know, sort of a

webinar recruitment session. And we have to think about those old-fashioned ways of flyers,

newspaper ads, that's all I can really think of.

Miriam: Great. Now here is just a general lifestyle coach [question], and I'm sure all the lifestyle coaches

will chuckle when I read this one that just came through. How do you get people who talk too

much and monopolize the conversation to stop talking?

Anne: I'm going to hand this to Sarah first. Sarah.

Sarah: Thanks, Anne. Goodness sakes. Well, you know, I could make a joke about the mute feature but I

wouldn't recommend it and it's not what we use. So—but you know, we talked about the ground rules

just like in person, and I think maybe even more so when you have your first session to talk about the

realities of what it's like. You know we've all, well not all, but many people have had that experience of

overtalking, interrupting on a conference call or the like. So to kind of acknowledgment that that's going

to happen, we're going to step on toes, that we want to have the same spirit that we have in person

where everybody's voice gets heard. So setting that expectation, and then you may sometimes have to

rely on some of those more structured techniques of facilitation where you're calling names and going in

circles kind of thing. Or just revisiting at the beginning of session, “hey, I want to make sure everyone's

voice, we're a big group and virtually it's little harder for us to get everyone heard.” So just kind of

reinforcing those values at the beginning of the session.

Anne: Yeah, and it's okay to—you know, to […] ah, it's okay to reach out to them privately and say hey,

I've noticed that, you know, that you're responding and it's wonderful, we love having you in class and

it's great. There are some quieter people as you may notice, and let's hold back a little bit. So it's okay to

take them aside on the phone privately and just as you would in a situation in person, private.

Miriam: That's great advice. Well, we are at the top of the hour. So thank you both to you Sarah and

Anne for facilitating such an informative webinar. And thank you to all of the participants who

are on the line. We hope that you found this information to be useful and beneficial and helpful.

Again, this webinar will be posted to the National DPP Customer Service Center in the coming

weeks. And again, everyone be safe and we appreciate your attendance. Thank you.