KIDS N FITNESS 4ALL · – Chronic overeating leading to obesity ... eating along child Daily...
Transcript of KIDS N FITNESS 4ALL · – Chronic overeating leading to obesity ... eating along child Daily...
KIDS N FITNESS 4ALL(For All Learning Levels)
Brenda Manzanarez, MS, RDDiabetes & Obesity Program
Megan Lipton-Inga, MA, CCRP Ellen Iverson, MPHSamantha Garcia, MS
Disclosure
• Nothing to disclose
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Background• Kids N Fitness (KNF) was created in 2000 at Children’s
Hospital Los Angeles by a multidisciplinary team• Adaptations: original research regular classes (ages 8-16),
Junior (ages 3-7), church (Sunday school), afterschool with teens, summer camps.
• Key Program Elements:
Family-Centered Health Education
• Parent and child learn together
• Children learn from others in a social setting
• Parents have a support space
Physical Activity
•Dedicated time to be active
•Exercise with fun games
•Learn new ways of movement
Goal Setting & Self-Monitoring
• 5 weekly goals• Track daily
behaviors
Energy Intake
Energy Expenditure
Individual Factors
Environmental Settings
Social Norms and Values
Communities
Worksites
Health Care
Schools and Child Care
Home
Demographic Factors (e.g., age, sex, SES, race/ethnicity)
Psychosocial Factors
Genetics-Environment Interactions
Other Factors
Government
Public Health
Health Care
Agriculture
Education
Media
Land Use and Transportation
Communities
Foundations
IndustryFoodBeverageRetail
Leisure and Recreation
Entertainment
Physical Activity
Sectors of Influence
Food & Beverage Intake
Social Ecological Model
Community Partnership
Train Staff
•5 promotoras•1 lead KNF
coordinator•Volunteers
•Mock teachings•Program logistics
•Recruitment•Coordination•Volunteers•Staff debrief
Observe
•Lead CHLA Staff –main observer
•Noted:•Curriculum
adherence•Engagement with
audience•Program logistics•Questions by
audience
Provide Feedback
•Missed topics•Explanation of
topics
Follow-up & Reinforcement
•Routine check-ins• Increase confidence•Troubleshooting•Support
2015 – Partnership began- Regular Kids N Fitness2017 – 2018 - grant funding for ASD programming- KNF4ALL (All Learning Levels)
Needs in the Community
• South LA is one of the poorest in the county, and most under-resourced regions– Children:
• 68% Latino, 27% African American– Adults:
• 42% have less than a HS education, 52% not born in US– Families:
• 34% live below 100% of the Federal Poverty Level• St. John’s Well Children and Family Health
Center– Center for Autism and Developmental Disorders
• Comprehensive, interdisciplinary care• Serve over 275 children with ASD• Waitlist over 100 patients
ASD children stats
• 1 in 59 children• More common in boys
– 4x higher than girls
• DSM-V diagnosis
• ASD characteristics:– Issues with verbal and non-verbal communication– Impaired social interactions– Repetitive behaviors– Limitation in activities and interests
Co-occurring Physical & Mental Health Conditions
• Feeding issues– Selective eating (picky eating)– Pica (eating non-food items)– Chronic overeating leading to obesity
• Gastrointestinal (GI) problems– Limits food options nutritional deficiencies
• Attention-deficit/hyperactivity disorder (ADHD)• Obsessive compulsive disorder (OCD)• Anxiety - Depression• Disrupted sleep - Epilepsy• Schizophrenia - Bipolar Disorder
Social Ecological Model to Create Change
Why is it an issue?
LA children living with a special health care need
15%
Lack of early interventionLess than 1 in 3
receive timely developmental
screenings
Difficulty accessing
medical care12.9% Latino6% African American12.6% Asian (LAC-DPH, 2011, 2015)
Access?
Perceived neighborhood
safety
77.8% vs 92.7%(LAC-DPH, 2015)
Children with ASD & Obesity
23.4%(2010 Natl Survey of Children’s Health)
Easy access to a park or
playground or other safe
place to play
85.8% vs. 89.3%(LAC-DPH, 2015)
Access to fresh fruit/vegetables as “excellent or
good”
69.4% vs. 88.3%(LAC-DPH, 2015)
Pilot Goals
1. Feasibility– Will families come?– Will children with
ASD be receptive to health topics?
– How easy will it be to make changes?
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2. Observations for future interventions
– Test simple modifications to ASD population
– What worked?– What didn’t work?
Program Stages
CHLA KNF Psychologist Case
Manager KNF
Coordinator Promotora
Multidisciplinary
meetings
Refe
rral
&
Enro
llmen
t
Surv
ey
Ori
enta
tion
Clas
ses
Feed
back
Psychologist &/or MD referral
Case Manager referral
KNF Coordinator Promotora
Planning phase
Implementation & Observations phase
KNF Coordinator 1 Promotora 1-2 Applied Behavioral
Therapists (ABA) 2-4 Volunteers Case Manager 1 CHLA KNF staff
Program Format
Structure-focused Agenda
poster Shorter didactics Story telling Tactile Arts & Crafts
Individual-based Smaller groups Activity stations Yoga videos
Exposure to familiar and non-familiar foods
Precut foods Self-selected
items Parent role-
modeling by eating along child
Daily logbooks Weekly goals
Continued nutrition education Space for sharing Brainstorm goal implementations Peer support & empowerment
Program Stats
32 families participated
3 Cohorts
18 families completed program (4+classes)
56% Retention Rate
During Nutrition Lessons…
• Well received:– Following an agenda– Repetition– Positive
reinforcement of behaviors (stickers, clapping, high-fives)
– Activities tied to nutrition
• My Plate collage• Coloring handouts
• Observations:– Children needed
increased wiggle breaks
– Parents became distracted with disruptive behaviors
– Engaged with children
During Physical Activity…
Observed Challenges:• Some games were
noisy• Too much
stimulation• Did not want to
separate from parent
• Crying; mostly younger kids
Adaptations:• 1:1 - 1:3
adult:child ratio• Focused on
stations and individual activities
• Calmer activities
Yoga is a success!
• Cosmic Kids Yoga• Dora the Explorer
Food
“He doesn’t like that. He is not going to eat it!”
Re-frame comments:
• What colors do you see?
• Let’s make this shape!
• You are doing such a good job at trying…!
Parent Feedback• “Thank you for the opportunity to help me
understand”• “A bit more time to learn”
Content
• “That my son got so involved in it”• “The excitement of my kids each class”• “My child tries new foods now”
Enjoyed aspects
• “It gave me ideas”• “It was a good way to get the kids to understand
things”Snacks
• “I want to learn more”• “My child is communicating with me more about
his food selections and he has motivation to play and do exercise more”
• “My child exercises more and is willing to eat more fruits”
• “Before eating my child will observe the food and critique it to make sure it is”
Other suggestions
or comments
Staff & Volunteer Feedback
Daily short debrief after
each class
Implement changes & observe
Debrief & get mini-training
from ABA
10-15 minutes What worked Challenges Parent perspective/
insight ABA feedback about
behaviors
Ease of adaptation Acceptability
Staff perspective Observer perspective ABA mini-training Weekly emails with
noted challenges and changes
Psychologist & Case Manager support
In Summary & Future Goals
• Despite low attendance, benefits can be seen by those who attended
• More programming and research are needed
• Incorporate a stronger social-behavioral therapy component into the curriculum
• Focus groups• Imbed into education/therapy after
initial diagnosis
For questions about the presentation:Brenda Manzanarez, MS, RD
Health Education Leader, Clinical Dietitian
For questions about the Kids N Fitness Program:Megan Lipton-Inga, MA, CCRP
KNF Program [email protected]
(323) 361-5423
References