BREAKING TRADITION: Engaging Physicians (Docs Adopt) in ...eatsmartmovemoresc.org/pdf/2017SummitPresentations...Harborview Elementary. Charleston County School District. School Wellness

B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in

S chool-bas ed Obes ity P revention

J anice D. K ey, MD

Director, MU S C B oeing C enter for C hi ldren’s Wel lnes s

T he MU S C B oeing C enter for C hildren’s Wel lnes swinning the 2 01 6 Healthcare Leader s hip C ouncil Wel lnes s Frontier s Award

T he MU S C B oeing C enter for C hildren’s Wel lnes s


S chool-bas ed Obes ity P revention• What is i t?

• How was it developed?

• What is work ing?

• Dis cus s ion

CDC S ocial E cological Approach to Obes ity P revention

http:/ / www.cdc.gov/ obes ity/ health_equity/ addres s ingtheis s ue.html

C hildhood Obes ity Toolk it with patients and famil ies

Docs Adopt S chool Health Initiative; S C P IT C

S C MA C hildhood Obes ity Tas kforce

S C DHE C Obes ity Action P lan

MUS C B oeing Center for Children’s Wellnes s :P rogram s and Activities

B ridge Walks and Wel lnes s C ommittees


S chool-bas ed Obes ity P revention What is i t?

• How was it developed?


• Dis cus s ion

Docs Adopt S chool Health Initiative©HE ALT HY S T R AT E G IE S AMON G

AWAR D WIN N IN G S C HOOLS2016-2017

S C HOOLSn=195/207(94%)

N (%)Fruit & vegetable tas tings 5 3 (2 7 % )

Water dr ink ing campaign 9 3 (4 8 % )

S chool garden 1 1 4 (5 8 % )Increas e phys ical activity 1 4 5 (7 4 % )

S mar t beverages 1 4 8 (7 6 % )

S mar t s nacks 1 2 1 (6 2 % )

Appl ied for wellnes s grant 1 2 5 (6 4 % )

S chool fundrais er for wel lnes s 1 2 7 (6 5 % )

S chool garden at Manning E arly Childcare, Clarendon 2 S chool Dis trict

Healthy Fundrais erS par tanburg 1 S chool Dis trict

K ines thetic Learning at Harborview E lementary

Charles ton County S chool Dis trict

S chool Wellnes s Checklis t 2 0 1 6 -1 7 Winners

B amberg 1 :R ichard Carroll E lementar y

B amberg 2 :Dis trict: Denmark-Olar High

S chool

Charles ton County S chool Dis trict:

Mar y Ford E lementar y

Clarendon County S chool Dis trict 2 :

Manning J unior High S chool

Colleton County S chool Dis trict: Colleton High S chool

Greenwood County S chool Dis tict5 0 :

Hodges E lementar y S chool


Dorches ter 2 : T ied: As hley R idge High & Flower town

High

B erkeley County: T ied – Wes tview Middle & S angree

E lementar y

Cherokee County: B lacks burg High

Potts town PA: (With Potts town Area Health & Wellnes s

Foundation)Ruper t E lementar y

R ichland 2 : (With Palmetto Health Children’s

Hos pital)B lythewood High

S par tanburg 1 :Landrum High


Florence 1 & 2(with McLeod Children’s Hos pital)

Florence 1 : S avannah Grove E lementar yFlorence 1 : S ouths ide Middle Florence 1 : Wils on High

Florence 2 : Hannah-Pamplico E lementar y/ Middle Florence 2 : Hannah-Pamplico High



How was it developed?


• Dis cus s ion

B ackground:• Effective obesity prevention must go beyond traditional

health care and address today’s “obesogenic” environment through policy, systemic and environmental (PSE) changes targeting improved nutrition and increased exercise.

• Childhood obesity prevention must be centered in schools as the “heart of health”

• Many health care organizations recommend that physicians become involved these public health efforts including the AMA, IOM, CDC, HRSA, AAP, and AAFP

• However implementation of school-based programs is difficult and including physicians even more so

GOAL 4 : E xpand the role of health care providers …in obes ity

prevention

“ Health care providers s hould increas e the s uppor t … for achieving better population health and obes ity prevention. …advocate for improved phys ical activity and diet oppor tunities in their patients ' communities . ”

GOAL 5 : Make s chools a national focal point for obes ity prevention

1 . Require quality phys ical education and oppor tunities for phys ical activity

2 . E ns ure s trong nutritional s tandards for all foods & beverages

3 . E ns ure food literacy

Public Health Approach for Obesity Prevention:IOM Accelerating Progress in Obesity Prevention 2012

Public Health Approach for Obesity Prevention:IOM Accelerating Progress in Obesity Prevention 2012

Com munity-bas ed P rogram Developm ent

Charles ton County Medical S ociety S chool Health Com mittee S outh Carolina Medical As s ociation Com munity Health Award 2 0 1 2

“ Enhancing school-based obesity prevention programs by including services for teachers” NIC HQ 2 0 10

7 S teps Works hop# 1 IDE N T IFY K E Y S TAK E HOLDE R S

Superintendent

Principal

Food Service

Teachers

School Nurse

PTA President

Parents

Others

# 6 E S TAB LIS HME NT OF A WE LLNE S S T E AMSet date with at least1 key s takeholder to as s is t in S HI

Decide which modules to com plete

Meet to review and establish next s tep

Hold regular scheduled meetings

< 1 hour

Provide HEALTHY snacks

Identify specific goals, activities & outcom es

CUMULATIVE ENROLLMENTIn wellness assessment

Teachers

Students

Family

Teachers

PAS

Annu

al M

eetin

gs, M

ay 2

-5, 2

009,

Bal

timor

e, M

D

B MI

2%

18%

25%

55%

Underweight HealthyOverweight Obese

1%12%

11%

21% 25%

30%

Underweight HealthyOverweight Obese IObese II Obese II

TEACHERS(n=207)

Mean 30 (16-58)*143/207 (69%)

Overweight/Obese*

STUDENTS(n=321)

Mean 22 (12-53)*138/321 (43%)

Overweight/Obese**p < 0.0001

Presented at the Pediatric Academic Societies 2009

PAS

Annu

al M

eetin

gs, M

ay 2

-5, 2

009,

Bal

timor

e, M

D

B LOOD P R E S S UR E

VariableStudentsN=300

TeachersN=204 p

SystolicMean (range)

109 (63-167) 124 (94-169) <0.0001

DiastolicMean (range)

67 (40-114) 79 (52-114) <0.0001

Normal# (%)

250 (83%) 66 (32%) <0.0001

S & D > 95%# (%)

5 (2%) 16 (8%) 0.0007


C OMP LI AN C E with 5 -2 -1 -0

0

5

10

15

20

25

30

35

40

% P

artic

ipan

ts

>5Fruits/Vegs

/ Day

<2 HoursScreen

Time / Day

>1 Hr PhysActivity /

Day

0 sugarsweetened

drinksStudents Teachers


WE IGHT LOS STeachers

(% that los t weight)

3 Months 7 1 % Overweight

6 0 % Obes e


3 5 % Obes e

S tudents

(% that had decreas e B MI Z s core)


7 2 % Obes e


6 7 % Obes e

B as is of Docs Adopt S chool Health Initiative© S chool level wellnes s committees

Committees s hould include many types of members

Wellnes s programs / s trategies s hould: B e evidence-bas ed Include s everal areas ( ie nutrition & phys ical activity) Include ever yone at the s chool (teachers & s taff & s tudents

& families ) B e s elected by the s chool to meet identified needs

Financial “ award” given directly to wellnes s committee Focus group targeted $ 1 ,0 0 0 and competition

P hys icians are interes ted in limited, nonclinical but effective role

(1) DOCS-ADOPT• Recruit local physicians to join school wellness committees• Collaborate with local medical organizations if available• Train physicians & school staff in obesity prevention efforts• Provide ongoing support for physicians• Display signage indicating participation of the doctor

(2) SCHOOL WELLNESS CHECKLIST©• Obtain district level support• Provide password protected web access for each school• Assist schools in establishment of wellness committees• Encourage school needs assessment (School Health Index/ Alliance for a Healthier

Generation)• Provide Checklist of evidence-based PSE changes from which schools can select

based on their needs assessment• Make it easy and free for schools to implement some strategies• Hold year end districtwide Wellness Achievement Celebration• Award incentive ($1,000) directly to wellness committees for schools with > 50

points (> 30 points for first year participants)• Award first prize to overall winning school ($2,000 & trophy)• Monitor Checklist activities and use of incentive awards• Evaluate and report results annually to districts and schools

School Wellness Checklist©

• Evidence-based strategies• Starts with SHI needs

assessment• 7 categories required

• Getting Started• Nutrition• Physical Activity• Stress Management• Wellness Culture• Employee Connections• Sustainability

• Online password protected site

• Wellness Achievement Celebration

• Annual awards ($1,000)• Overall winner ($3,000)

Together these form the Docs-Adopt School Health Initiative©

+

Par ticipating s chools2 0 0 8 -2 0 0 9

n= 1 1 CCS D

Par ticipating s chools2 0 0 9 -2 0 1 0

n= 1 1 CCS D

Par ticipating s chools that achieved award2 0 1 0 -1 1

n=2 3 CCS D


n=5 4 CCS D


n=9 3 (7 2 CCS D, 1 2 B CS D, 9 DD2 )


n=1 1 3 (6 9 CCS D, 2 2 B CS D, 2 2 DD2 )

2 0 1 3 -2 0 1 7 R FP E xpans ion P lan for the Docs Adopt S chool Health Initiative©

C ur rent E xpans ion P lan: Local community s uppor t for l icens ing fees & awards .

C ontact the MU S C B oeing C enter for C hildren’s Wel lnes s for more infor mation or to ar range a pres entation to an interes ted community s uppor ter

2 01 6 -2 01 7 :1 3 Dis tr icts2 7 5 S chools total2 07 S chools par ticipated1 9 5 S chools ear ned an award

E xamples of s trategies s elected by par ticipating s chools

Students at B elle Hall gather around their school garden

Devon Forest Healthy School P ledge driveD2 SD Water-Drinking C ampaign

Tasty Tuesday fruit cups

Dr. Jane C harles, adopting physician at Stall High School with Wellness Leader Danny Ilagan and school nurse,Treva Mardis.

Use of $1000 Wellness Awards

Fitnes s E quipment,

4 5 %

Health E d/ S creenin

g, 4 5 %N utr ition,

3 0%

I ncentives , 3 0%

Walk ing P rograms ,

1 8 %

Hos ting a Health E vent,

1 1 %

Docs Adopt School Health Initiative Operational TimelineAnnual training of doctor s and s chool wel lnes s leader s

Docs -Adopt P hys ician Training 2 0 1 4 E pidemiology and caus es of

obes ity

Recommendations for effective inter ventions

His tor y and replication

Components of Docs -Adopt S chool Health Initiative

Outcomes

S ucces s es Dr. Mike B owm anJennie Moore E lem entar y

2 0 1 3

www.mus c.edu/ leanteam




What is work ing?

• Dis cus s ion

Outcome E valuation:Focus Groups

Teachers• P hys icians attended

meetings infrequently

• P hys ician involvement ver y impor tant

• Ver y s atis fied with phys ician involvement

Doctors• Not able to attend many

meetings

• Not s ure if contributed s ignificantly

• Ver y s atis fied with involvement

Outcome E valuation:Par tners hip with medical organizations

• In counties with medical organizations, the Initiative collaborated with the local medical society in implementation of the Docs-Adopt component.

• Outcome evaluation found more rapid implementation and more physician participation when there was collaboration with a local medical society

Key J, Mar tin C, K ramer L , L inds trom C. R apid adoption of a s chool-bas ed obes ity prevention initiative that targets pol icy, s ys temic and environmental changes to improve nutr ition and increas e exercis e. The Obes ity S ociety, November 2 0 1 4 .

Dr. B ill Lom ax, Als ton Middle S chool- DC2 S D

There was s ignificantly m ore phys ician involvem ent in com munities that had a m edical organization

Docs-Adopt School Health Initiative©Summary of Outcomes

Increas ed s core over time (p<0 .0 2 2 )

Reduction in variance in T itle 1 s chools (p<0 .0 3 9 )

Increas ed s cores with phys ician adoption (p<0 .0 5 )*

Increas ed s cores as s ociated with healthier B MI (p<0 .0 5 )**

Increas ed s tudent attendance (p<0 .0 0 0 5 )

Decreas ed office referrals (p<0 .0 0 0 6 )

More rapid implementation when s uppor ted by a local medical organization (p<0 .0 5 )***

1 / 3 les s obes ity, improved behavior and attendance****

*Key et al PAS 2 0 1 3 ; **K ing et al PAS 2 0 1 4 , ***Key et al TOS 2 0 1 4****K ing et al PAS 2 0 1 5

The Docs-Adopt School Health Initiative©:

• Is a simple school-based intervention that is readily accepted by schools and physicians

• Leads schools to make many PSE changes targeting both healthy nutrition and increased physical activity

• Is unique in promoting physician involvement in school-based obesity prevention efforts

• Involves more physicians when there is support from a community medical organizations

Conclus ions :

References Key J, B r yne J, S aito A, P rendergas t M, Chambers J, S purlock D. The Docs -Adopt

S chool Wellnes s Initiative: An innovative program to involve doctors in s chool-bas ed obes ity prevention effor ts . Journal of the South C arolina Medical Association, Vol 1 1 0 (No3 ):9 4 -9 7 , 2 0 1 4 .

Key J D, Oexmann MJ, and Rus s ell AM. Community and s chool-bas ed inter ventions to prevent obes ity in children and adoles cents . Journal of the South C arolina Medical Association 1 0 5 :5 9 -6 3 , 2 0 0 9 .

Key J, Mar tin C, Oexmann MJ, S purlock D, Huls ey T. The Lean Team: E nhancing s chool-bas ed obes ity prevention programs by including s er vices for teachers . National Initiative for Children’s Healthcare Quality Annual Forum for Improving Children’s Healthcare and Childhood Obes ity Conference 2 0 1 0 .

Key J, Moore J, Mar tin C, K ing L . “ Docs -Adopt” : P hys ician par ticipation enhances s chool wellnes s initiatives . Pediatric Academic S ocieties , April 2 0 1 2 Abs tract 7 5 0 7 2 6 .




What is work ing?

Dis cus s ion

Documents

BREAKING TRADITION: Engaging Physicians (Docs Adopt) in ...eatsmartmovemoresc.org/pdf/2017SummitPresentations...Harborview Elementary. Charleston County School District. School Wellness