Running head: FINAL PROJECT 1

Final Project

Carole Fischer

Health and Wellness Programming: Design and Administration

HW425

April 1, 2015

FINAL PROJECT 2

Part 1: Community Health Promotion Plan

Target Population and Health Concerns Based on Census Information

According to the United States Census Bureau, the population of Larimer County as of

2013 was 315, 988. The demographic profile consisted of a population of whites (at 93.4%),

African Americans (at 1.0%), American Indian or Alaskan native (at 1.0%), Asians (at 2.2%),

native Hawaiians or Pacific islanders (at 0.1 %), mixed races (at 2.3%), and Hispanics or Latinos

(at 10.9%). The percentage of the population under the age of 5 was 5.5%, while the percentage

of persons ages 5-18 was 20.6%. The percentage of the population ages 18- 64 was 66.8%, and

the percentage for ages 65 and older was 13.5%. Similarly, the percentage of women to men was

50.3%. The socioeconomic profile consisted of a median household income of $58, 626. The

percentage of the population below poverty level was 14.1%. The information regarding infancy-

early childhood consists of a smaller percentage in comparison to the information regarding the

young adulthood and middle-aged to older adult population, reflecting the highest percentage.

In terms of epidemiological data, the Colorado Department of Public Health and

Environment provides several areas of interest in regards to health information, including: birth

data, mortality rates, population estimates, behavioral risk factors, birth defect rates, cancer

incidence, pregnancy risks, and injury hospitalizations. Similarly, COMPASS of Larimer County

also provides data regarding demographics, education, community living, crime rate, economy

and health. In 2011, the number of live births in Larimer County was 3, 317 (COMPASS, 2013).

In comparison, the number of infant deaths was 13. The leading causes for infant mortality were

congenital anomalies, pre-term/low birth-rate, Sudden Death Syndrome, problems related to

complications of pregnancy, and unintentional injury. Pressing health issues in regards to infancy

for Larimer County include: low birth-weight and birth defects (COMPASS, 2013). As of 2013,

1, 992 total deaths were reported as a whole population. For the entire population, heart disease

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was the leading cause of death (at 435). Other causes of death included, malignant neoplasms (at

430), unintentional injuries (at 133), cerebrovascular diseases (at 106), chronic lower respiratory

diseases (at 90), Alzheimer’s disease (at 77), suicide (at 56), diabetes (at 43), diseases of the

respiratory system (at 38), and influenza and pneumonia (at 36).

Overall quality of life in a community is influenced by many behavioral and

environmental factors, including (but not limited to) education level, drop-out rates, income,

employment rate, and even housing. Drop-out rates for Larimer County in 2011 were recorded

based on race/ethnicity (and also gender), with Native Americans (at 3.4%), Asians (at 0.9%),

African Americans (at 2.2%), Hispanics (at 42.7%), and whites (at 2.7%). However, overall

graduation rates were between 80-85% in 2012. In 2011, the percentage for those individuals

living in poverty was 14.2% (COMPASS, 2013). In 2011, 65.8% of the population owned a

home, while 34.2% rented. In 2010, over 3,000 people in Larimer County were homeless, either

living on the streets (single adult at 95%, families at 4%, and unaccompanied minors at 1%), in

an emergency shelter (single adult at 65%, families at 34%, and unaccompanied minors at 1%),

or living in transitional housing (single adult at 44%, families at 55%, and unaccompanied minor

at 1%). In addition, the overall unemployment rate in 2012 was 6.4%.

After reviewing the census information, as well as the epidemiological data, the target

population for my community-based health promotion program includes middle-aged adults and

the health priorities will consist of mental health and well-being (specifically depression) and

physical health (specifically obesity).

Mission Statement, Outcome Goals, and Outcome Objectives

The mission of the program is to address and improve the mental and physical health of

the middle-aged adult population of Larimer County by raising awareness, educating,

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encouraging community engagement, and providing resources. The goals of the program relate

to the health priorities addressed. These include: 1) reducing depression in adults, ages 45-54

through prevention and early detection and treatment; and 2) decreasing obesity in adults, ages

45-64 through prevention and strategic weight management methods. Three program outcome

objectives related to the goals described include:

By 2020, the depression rate for both male and female adults will decrease by 10%.

By 2020, the obesity rate among adults, ages 45-64, will decrease by 20%.

By 2020, 90% of older adults will have participated in at least one organized health

promotion activity in the preceding year.

Based on this information, relevant stakeholders for this program include the Larimer County

Department of Health and Environment, Fort Collins and Loveland recreational facilities, and

University of Colorado Health.

Sample Budget

Program Needs Cost

Salaries:

Coordinator

Support Staff (5)

Mental Health Professionals (4)

CAM Professionals (3)

Health Educators (3)

$36,000 per year

$30,000 per year ($150,000)

$57,000 per year ($228,000)

$21,000 per year ($63,000)

$48,000 per year ($144,000)

Supplies and services:

Duplication and printing:

Fliers for libraries, health facilities,

hospitals, and health department.

$130.00

$70.00

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Committee materials

Marketing supplies:

Office supplies

Computer supplies

Program Delivery:

Gift cards to health facilities—access to

gym, pools, and classes.

Gift cards to wellness clinics—for manual

therapies or classes

Mailing:

Postage (postage meter)

Advertising:

Local radio promotion

Local television network

Local newspapers

Rental Space:

Conference room

$150.00

$500.00

$180.00

$210.00

$24.99/month ($300.00)

$1,000.00

$2,000.00

Equipment:

Computer supplies:

Screening Program

iPads (5)

Telephone:

Fees

Program materials:

Curriculum supplies

$215.00

$945.00

$29.95/month ($359.40)

$3,000.00

Travel Expenses $1,000.00

Total per year $631,059.40

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Planning, Implementation, and Interventions

Planning and Implementation Timeline:

2015-2016

I. Plan the process

II. Engage stakeholders

III. Assess community health

IV. Assess system capacity

2017

V. Prioritize health issues

VI. Design the improvement plan

2018-2020

VII. Implement, promote, and monitor the health plan

VIII. Evaluate the plan

The program in discussion focuses on community involvement, social support,

awareness, and preventative education to enhance the mental and physical health of aging adults

in Larimer County. Two of the largest risk factors for the leading causes of death in Larimer

County include obesity and depression. Both influence the prevalence of cardiovascular disease,

diabetes, and suicide. Therefore, a potential funding source for this program is a grant entitled

“Prevention Research in Mid-life Adults.”

The purpose of this particular funding is to “1) Identify the unique characteristics of mid-

life adults that impact health and wellness and contribute to the prevention of disease and

disability; 2) Identify characteristics, influences, and indicators that are important for optimal

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health in mid-life adults; and 3) Develop strategies that promote health and wellness and prevent

illness in this population” (Grants.gov). The name of the sponsoring agency is National

Institutes of Health. The award amount is not specified, but is contingent upon the number of

applications accepted and the actual needs of the project. The maximum project period is 5

years. Eligibility requirements include: 1) Involvement in an organization, such as a higher

education institution, non-profit or for-profit, government (state, county, city, etc.), or foreign

institution; and 2) Registration with DUNS, SAM, eRA Commons, and Grants.gov.

The theory that would best fit my design would be the Social Cognitive Theory. This

theory relies on the confidence of an individual’s ability to engage in a specific behavior in the

belief that this behavior will result in a positive outcome (Hodges & Videto, 2010, p.150). This

theory best fits my program design because it relies on building skills to manage or maintain

specific behaviors regarding weight management and coping mechanisms or stress reduction

strategies to combat depression. The program in design relies on activities that work to provide a

social network or support system for those participating to ensure accountability and

connectedness. The purpose is to alter lifestyle habits in order to enhance quality of life for

middle-aged adults. In essence, it builds confidence in the participants through skill building,

ensures support through socialization, and provides positive benefits for the individuals

participating.

To address the outcome objective of decreasing the obesity rate by 20%, I propose to

provide monthly nutrition classes, in which participants learn about how the body processes

food, portioning, nutrients to sustain the body, meal-planning, and budgeting. To address the

outcome objective of decreasing depression rates by 10%, I propose to provide at least 2

depression screenings (at the beginning and at the end) to raise awareness and make referrals, 8

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support group or individual therapy sessions (depending upon level of depression), 6 week stress

management classes to increase coping skills, and 6 mind-body therapy sessions to decrease

stress and anxiety. To address the outcome of increasing older adults participating in health

promotion activities, I propose to provide free or reduced cost recreational activities, such as

fitness classes catered to this particular age group, or organized events that provide cooking

classes or lectures regarding tips for bettering health. The above activities not only provide

knowledge and skills, but they also encourage social support and community connectedness

which is important to sustain health habits and to decrease or prevent depression symptoms.

Evaluation and Sustainability

The evaluation for this program is an outcome evaluation. An outcome evaluation focuses on

whether or not the long-term goals of the program are attained, such as health status and quality

of life (Hodges & Videto, 2010, p. 209).Three questions related to this evaluation include:

1. Did depression rates decrease in the middle-age population of Larimer County?

2. Did obesity rates decrease in the middle-age population of Larimer County?

1. Did the program improve the overall mental and physical health of the middle-aged population of

Larimer County?

The types of data necessary to address the evaluation questions and the planned data collection methods

and instruments are addressed below:

1. Group and individual interviews will be conducted to address the program activities regarding

depression, as well as changes in behavior and emotional well-being. Additionally, the Larimer

County Health Department will be contacted regarding statistical information associated with

depression rates, risk factors, and suicide rates. University of Colorado Health will conduct a

secondary depression screening.

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2. Group and individual interviews will be conducted to address the program activities regarding

obesity, as well as changes in behavior and physical well-being. Additionally, the Larimer

County Health Department and University of Colorado Health will be contacted regarding

statistical information describing diseases and conditions associated with obesity, as well as

obesity rates.

3. A questionnaire regarding quality of life, healthful eating, and depression will be given to

participants. Additionally, the Larimer County Department of Health and University of Colorado

Health will be contacted regarding obesity and depression rates, as well as statistical information

regarding risk factors.

Based on the above timeline, the program in discussion will take a total of 5 years to plan and

implement. The plan addresses both mental health and physical health, specifically depression and

obesity, in middle-aged adults. The outcomes of the program include, decreasing the percentage of adults

with obesity or depression and increasing the percentage of adults who participate in a healthy lifestyle.

Program activities will include nutrition classes, group or individual therapy sessions, mind-body

therapies, stress management classes, and recreational classes. In order to accomplish this, various

positions are needed. For example, a coordinator and supporting staff are needed to carry out logistics and

make referrals. Mental health professionals will carry out evaluations of screenings and facilitate group or

individual therapies. Health educators will facilitate nutrition and stress management courses.

Complementary or alternative professionals will facilitate mind-body therapies. A potential barrier to

implementation may be the number of mental health professionals compared to the number of

participants.

According to Hodges and Videto (2010), “sustainability refers to the institutionalization of an

intervention so that it lasts beyond its original supporters, funding, adopters, and implementation

as long as necessary” (p.200). The community program in discussion utilizes screenings for

awareness, recreational classes, support groups, therapy, and nutritional and stress management

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classes to treat the emotional and physical wellbeing of middle aged adults at their current state,

but also to enhance quality of life. Factors that influence obesity and depression are social,

environmental, and behavioral. Maintaining both weight management and stress management

require self-efficacy (interest and motivation), but also support. In order to sustain the program,

or at least the outcomes, the support factor is the most important. Affordable mental health

professionals and continued depression screenings would need to be available to sustain

treatment for those already participating, but also for those who have yet to treat mental health

issues. In order to maintain weight, affordable food sources would need to be available (as most

retired middle-aged adults live on a fixed income), as well as access to a nutritionist. Senior

centers would also need to continue to encourage enrollment of fitness or educational classes—

with consideration of pricing and access to transportation.

Part 2: Workplace Health Promotion Program

Introduction to Workplace and Significance of Workplace

Individual and organizational workplace wellness programs are designed to positively

influence the health behaviors of employees (at work and outside of work) by promoting,

preventing, and providing resources (and support) to encourage and maintain a healthy lifestyle,

ultimately curbing the costs of health care and lessening the number of days off from work due

to sickness or health issues. These programs address health risks, conditions, and diseases

through skill building, awareness, and supportive social and physical environments, improving

and increasing long-term health. Workplace wellness programs also prevent injury and illness at

work. Individually, poor health can lead to financial struggle, but also fewer resources and

opportunities to recover health, so the significance of workplace interventions for wellness in this

sense is increased social status and better physical and emotional wellbeing. In conjunction,

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better overall health is also beneficial to the individual employee’s family life, but also to the

overall community. Workplace wellness programs also provide benefits, such as health

insurance, that not only benefit the individual, but also family members.

The workplace in which this program will be implemented is a school system,

specifically the Poudre School district of Larimer County, in which teachers and supporting staff

will receive benefits and interventions. According to the Annual Accountability Report for the

2012-2013 school year, there were 1,436 teachers, 1,587 classified employees, 1,917 certified

positions, and 111 administrative positions filled in the Poudre School District. The average age

group for teachers was 30-44, with the lowest number of teachers at ages at 24 and under. The

number of American Indian or Native Alaskan teachers was 2 (male). The number of Asian

teachers was 9 (4 female, 5 male). The number of African American teachers was 5 (4 female, 1

male). The number of Hispanic teachers was 88 (55 female, 33male). The number of teachers

with two or more races was 7 (5 female, 2 male). Finally, the number of Caucasian teachers was

1,644 (1,235 female, 409 male). Based on this information, the highest population was

Caucasian, female, and ages 30-44. With this in mind, in terms of individual needs, the program

designers would need to be conscious of the female population, including benefits that that

provide prenatal care, female medical care, and health benefits for family members. In terms of

organizational factors, the district relies heavily on money from tax payers (also a community

factor) and any money that is raised through the PSA (Parent Student Association). If the budget

is limited, then the program designers will have to be creative with funding and intervention

choices. In terms of community factors, the program would have to find facilities and healthcare

professionals that would be willing to work with the district and provide employees with

discounts for service. The average salary for teachers in Poudre School District is $49,508.45.

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Based on census information, in comparison to the average cost of living for the United States (at

100%), Larimer County is 12% higher, so this too needs to be taken into consideration when

providing benefits, such as insurance. Additionally, according to Kovess-Masfety, Sevilla-

Dedieu, Rios-Seidel, Nerriere, and Chee (2006), health risks for educators include: mental health

due to stress and physical conditions related to ears, nose, and throat, conjunctivitis, lower

urinary tract infections, and eczema/dermatitis, so medical care, as well as preventative care must

be provided to combat illness.

Mission Statements, Outcome Goals, and Outcome Objectives

The mission of the program is to care for the health and wellness of the employees of

Poudre School District by providing health benefits, preventative screenings, events, and health

and wellness activities to build skills and knowledge to encourage healthy living. The goals of

the program include:

Reducing stress factors in educators.

Building healthy behaviors in Poudre School District employees.

Three program outcome objectives include:

By the end of the first year, employees will have participated in at least 3 health and

wellness activities provided by the school district.

By the end of the first year, employees will be able to state at least 3 strategies for

reducing stress or anxiety.

By 2020, the number of annual preventative screenings will increase by 20%.

Budget

Program Needs Cost

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Salaries:

Wellness Coordinator (1)

Support Staff (5)

Mental Health Professionals (2)

Health Educators (2)

Website Builder (1)

Human resources benefits specialist (1)

$36,000 per year

$30,000 per year ($150,000)

$57,000 per year ($114,000)

$48,000 per year ($96,000)

$55,000 per year

$51,000 per year

Supplies and services:

Duplication and printing:

Fliers for Poudre School District offices

and schools

Committee materials

Marketing supplies:

Office supplies

Computer supplies

Program Delivery:

Cash Incentive for number of activities

particpated

Mailing:

Postage (postage meter)

Advertising:

Online Brochure

Website

$130.00

$70.00

$150.00

$500.00

$1,600

$24.99/month ($300.00)

Compensated through website builder’s pay

Equipment:

Computer supplies:

Screening Program

iPads (5)

Telephone:

$215.00

$945.00

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Fees

Program materials:

Curriculum supplies

$29.95/month ($359.40)

$3,000.00

Total per year $509,269.40

Funding

One potential source of funding is the Team Nutrition Training Grant. The purpose of

this grant is to expand and enhance training and educational activities to provide nutrition

education to students, teachers, parents, and other care givers (USDA). This grant fits the needs

of the workplace health promotion program in discussion because a school district wellness

program covers both employees and students.

Program Timeline

2015-2016

I. Assessment of workplace

II. Data on employee health collected

III. Assess resources

2017

IV. Create workplace wellness program

V. Secure resources

2018-2020

VI. Implement, promote, and monitor the health plan

VII. Evaluate the plan

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Program Planning and Governance, Support, and Implementation

The program will address wellness through physical, mental, emotional, and social

aspects. In terms of planning and policy making for the district, a committee will be formed to

support nutrition, physical fitness, and mental health interventions.

This committee will include a wellness coordinator, a human resources benefits

specialist, the University of Colorado Health system, at least 2 health educators, at least 2 mental

health specialists, and 1 classified staff member, licensed staff member, and non-instructional

staff member. These individuals will oversee health interventions, screenings, and benefits.

The program will consist of an annual preventative health screening, wellness challenges

throughout the year, and onsite health coaching with a health educator from a local fitness center.

The district will provide employees with various health plans based on financial needs, dental

and vision plans, life insurance, as well as an FSA. Environmental supports will consist of a

walk-in clinic provided by University of Colorado Health, a local fitness center, and a wellness

center (for mental health needs). Policies will include wellness opportunities for staff, providing

support services for mental health, integration of wellness teams, and promotion of proper

dietary habits.

Three activities the program will utilize to achieve the outcomes objectives include stress

management courses (to reduce stress and increase strategies for stress management), attendance

in fitness classes (to increase healthy habits), and participation in an annual preventative health

screening (to increase preventative screenings by 20%).

Evaluation and Sustainability

The evaluation for this program is a process evaluation. A process evaluation monitors

the organizational factors related to implementation, including use of programs and materials,

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satisfaction of participants, completeness of program delivery, etc. (Hodges & Videto, 2010, p.

208). A workplace wellness program should be monitored continually to make improvements for

employees. One evaluation question related to the program goals outlined is: Are staff members

participating in wellness activities offered through the district?

According to Hodges and Videto (2010), “sustainability refers to the institutionalization of an

intervention so that it lasts beyond its original supporters, funding, adopters, and implementation as long

as necessary” (p. 200). In order for this program to be continually successful, health will need to be

assessed annually to fit the needs of the health priorities of employees. Environmental changes will also

have to be made within in the workplace itself. For example, food and beverages offered will need to

correlate with nutrition guidelines set forth by the U.S. Dietary Guidelines. Physical fitness opportunities

will need to be provided throughout the day.

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References

Larimer county community health assessment and community health improvement plan. (2013,

February 13). Retrieved February 17, 2015, from

http://www.larimer.org/health/CHA_slides_21313.pdf

Larimer county health improvement plan. (2014).Retrieved February 17, 2015, from

http://www.larimer.org/health/chip_2014.pdf

Colorado health information dataset. (2011). Retrieved February 17, 2015, from

http://www.chd.dphe.state.co.us/cohid/Default.aspx

Larimer county, colorado quickfacts. (2013). Retrieved February 17, 2015, from

http://quickfacts.census.gov/qfd/states/08/08069.html

Hiller, A. (2011). City of loveland 2011 quality of life survey report. Retrieved February 17,

2015, from http://www.ci.loveland.co.us/modules/showdocument.aspx?

documentid=8017

City of fort collins citizen survey report of results. (2012, April). Retrieved February 17, 2015

from http://www.fcgov.com/citizensurvey/pdf/fort-collins-2012-report-final-2012-05-

03.pdf?1338315164

Executive summary. (2013). Retrieved February 17, 2015, from

http://www.larimer.org/compass/exec_summary.htm#title8

Hodges, B. C., & Videto, D. M. (2010). Assessment and planning in health programs, (2nd Ed.).

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objectives/topic/nutrition-and-weight-status

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Mental health and mental disorders. (2014). Retrieved from

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About our agency. (n.d.). Retrieved from http://allianceforsuicideprevention.org/about-us/

Department of health and human services. (2015). Prevention research in mid-life adults.

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098.html#_3._Additional_Information

Annual accountability report. (2013). Retrieved from https://www.psdschools.org/webfm/7030

Wellness at work. (2014). Retrieved from http://www.cdc.gov/features/workingwellness/

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http://www.cdc.gov/workplacehealthpromotion/pdfs/Workplace_Health_Program_Defini

tion_and_Description.pdf

Edgerter, S. , Dekker, M., An, J.,Grossman-Kahn, R., & Braveman, P. (2008). Work matters to  

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bac8-7d15343aacff/Issue%20Brief%204%20Dec%2008%20- %20Work%20and

%20Health.pdf

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from http://www.cde.state.co.us/cdereval/2013teachersbyethnicityraceandgenderpdf

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http://www.cde.state.co.us/cdereval/2013-14teachersagebytrendpdf

Colorado department of health. (2013). Teacher average salary and daily rate. Retrieved from

http://www.cde.state.co.us/cdereval/2013teacherfteaveragesalaryandaveragedailyratepdf

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Cost of living in Larimer county, co. (2014). Retrieved from

http://www.bestplaces.net/cost_of_living/county/colorado/larimer

Kovess-Masfety, V., Sevilla-Dedieu, C., Rios-Seidel, C., Nerriere, E., & Chee, C. (2006). Do

teachers have more health problems? Results from a French cross-sectional

survey.Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523205/

USDA. (2015). Team nutrition training. http://www.fns.usda.gov/tn/2015-training-grant-

application

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https://www.psdschools.org/webfm/7166

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