www.letsgo.org

Tory Rogers, MDBarbara Bush Children’s Hospital at Maine Medical Center

(207) 662-4982 rogerv@mmc.orgOctober 7th, 2013

www.letsgo.org

What I want to talk about today?

What is Let’s Go! – The First 5 years 2006-2011– Birth to the awkward tween years

Let’s Go! 2011-2016 – The Teen years

Evaluation Data – What is working

What we could have done better

2

www.letsgo.org

Now…… What do you want me to talk

about???

3

www.letsgo.org

Let’s Go!Core Principles Environmental and policy change influences behavior change Interconnectivity across settings is essential Strategies are evidence based and continuously evaluated

www.letsgo.org

www.letsgo.org

Tools, Resources, and Trainings

www.letsgo.org

Why Environmental/Policy Change?

Policies Environments

Activities

www.letsgo.org 8

1. Provide healthy choices for snacks and celebrations; limit unhealthy choices.

2. Provide water and low fat-milk; limit or eliminate sugary beverages.

3. Provide non-food rewards.

4. Provide opportunities for children to get physical activity every day.

5. Limit screen time.

Let’s Go! Key Strategies for Success – Priority Strategies

www.letsgo.org 9

Let’s Go! Key Strategies for Success – Supporting Strategies

6. Participate in local, state and national initiatives that promote HEAL.

7. Engage community partners to help support and promote HEAL at your site.

8. Partner and educate families in adopting and maintaining a lifestyle that supports HEAL.

9. Implement a staff wellness program that includes HEAL.

10. Collaborate with food and nutrition programs to offer healthy food and beverage options.

www.letsgo.org 10

www.letsgo.org 11

www.letsgo.org 12

www.letsgo.org 13

www.letsgo.org 14

StoryWalks

www.letsgo.org

Marketing Campaign

www.letsgo.org

It Worked!

Environments are ChangingPolicies are being Implemented

Healthy Behaviors are increasingObesity appears to be leveling

off

www.letsgo.org

Greater Portland Reach

As of June 2011, Let’s Go! had engaged the following in the 12 Greater Portland communities:

• 56 schools educating more than 23,000 students;

• 8 district-wide school nutrition programs serving over 20,000 students;

• 34 child care programs caring for over 1,400 children;

• 28 after school recreation programs serving over 1,800 students;

• 29 healthcare sites; and

• 7 of Greater Portland’s largest employers.

www.letsgo.org

60 Let’s Go! Sites (in Greater Portland) Reported Implementing Let’s Go! Strategies in 2010-11

*Strategy was implemented in year five or sustained from a previous year, in most classrooms or school- or program-wide.

Strategies Elementary

SchoolsChild Care Programs

After School Programs

Healthy choices for snacks/celebrations 24/29 (83%) 16/16 (100%) 15/15 (100%)

Participate in initiatives that promote HEAL 25/29 (86%) 11/16 (69%) 8/15 (53%)

Include community organizations 12/28 (43%) 6/16 (38%) 11/15 (73%)

Involve and educate families 27/29 (93%) 16/16 (100%) 5/15 (33%)

Encourage water and low fat milk 24/29 (83%) 16/16 (100%) 13/15 (87%)

Discourage the use of food as a reward 26/29 (90%) 16/16 (100%) 12/15 (80%)

Incorporate physical activity into the day 21/28 (75%) 15/16 (94%) 7/15 (47%)

Develop 5-2-1-0 staff wellness program 16/29 (55%) 4/16 (25%) 15/15 (100%)

Collaborate with nutrition program 19/21 (90%) Not measured 4/15 (27%)

Implement or strengthen wellness policy 16/28 (57%) 6/15 (40%) Not measured

Number (%) that Implemented Strategy*

www.letsgo.org

Let’s Go! School Nutrition Initiative

Let’s Go! led 35 schools in reaching the USDA’s Healthier US School Challenge.

Healthier US School Challenge Criteria• A different fruit and vegetable every day•At least three dark green or orange vegetables per week•Offer legumes at least once per week•Offer whole grains three times per week•Offer only low fat or fat free milk•Offer nutrition education•Provide at least 45 minutes of physical education per week

Technical assistance, tools, and resources were provided by Let’s Go! during workgroup meetings, phone calls and emails as they improved the nutritional quality of school meals.

Only 2% of schools in the nation have achieved this award.

www.letsgo.org

There are 14 Let’s Go! Practicesin Greater Portland

A recognized Let’s Go! Healthcare site must meetbasic criteria for the following three components:

1. Connect to their community and the Let’s Go! community efforts Hang a Let’s Go! poster in waiting room and exam rooms

2. Accurately weigh and measure patients Determine Body Mass Index (BMI), BMI percentile, and

weight classification in patients > 2 yrs.

3. Have a respectful conversation around weight Use the 5210 Healthy Habits Questionnaire

www.letsgo.org

Parents’ Awareness Increased Significantly from 2007 to 2011

422% Increase

293% Increase

Note: In 2007 n=802; in 2009 n=800; in 2011 n=801

293% Increase

422% Increase

422% Increase

293% Increase

10% 14%

45% 43%47%55%

Let's Go! Campaign 5-2-1-0 Message

% Who Heard of Campaign and Message

2007 2009 2011

www.letsgo.org

Exposure to Let’s Go! in Multiple Settings Increased Parents’ Awareness of 5-2-1-0

153% Increase 153%

Increase

Note: In 2011 n=801

153% Increase

34%

64%

85%

No Exposure 1 to 2 3 or more

Number of Settings Exposed to Let's Go!

% Who Heard of 5-2-1-0 Health Message, by Exposure (2011)

www.letsgo.org

Exposure to Let’s Go! in Multiple Settings Increased Parents’ Knowledge of 5-2-1-0

Note: In 2011 n=801

51% Increase

51% Increase

39%51%

58%

No Exposure 1 to 2 3 or more

Number of Settings Exposed to Let's Go!

% Who Provided Correct Numbers for All Four 5-2-1-0 Recommendations, by Exposure (2011)

www.letsgo.org

Child’s Adherence with “5” and “0” Behaviors Increased Significantly from 2007 to 2011

Note: In 2007 n=802; in 2009 n=800; in 2011 n=801

63% Increase

18% Increase63%

Increase

18% Increase18%

63%

22%

66%

26%

69%

"5" or More Fruits & Vegetables Daily

"0" Sugar Sweetened Beverages

% Reported Child (<18 yrs.) Adheres to "5" and "0" Recommendations

2007 2009 2011

www.letsgo.org

Overweight and Obesity Prevalence for Ages 3-18 in Greater Portland Trended Down, While U.S. Rate Remained the Same

33%

32%

32%

31%

NOTE: NHANES data reflect 2006 and 2008 rates, and include ages 2-19. Greater Portland: In 2006 n=3,051; in 2009 n=3,132.

0%

5%

10%

15%

20%

25%

30%

35%

2006 2009

% Overweight and Obese (Age 3-18)

Greater Portland

U.S. (NHANES)

www.letsgo.org

Overweight and Obesity Prevalence Decreased for Females Age 3-5 in Greater Portland

63% Increase

18% Increase

31%

25%

2006 2009

% Overweight and Obese Females 3-5 yrs in Greater Portland

Note: In 2006 n=157; in 2009 n=133

www.letsgo.org

Let’s Go! 2011-2016

Our teen years - growing up and out

27

www.letsgo.org

0

50

100

150

200

250

300

350

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

Growth of Let's Go! Engaged Sites (2006-2013)Schools Child Care After School Healthcare School Nutrition

www.letsgo.org

Let’s Go! Dissemination Statewide

www.letsgo.org

Survey Response Rates

30

324

194

117152

787

261

166

92135

654

Child Care School After School Healthcare Total

Registered Sites Completed Survey

81%86%

79% 89%

83%

www.letsgo.org

Let’s Go! Reach Across Four Sectors(Survey Participants)

31

Area of Reach Child Care School

After School Healthcare

Counties 16 15 15 21Towns 132 106 59 86Sites 261 166 92 135Students/Patients 7,388 53,626 7,016 343,223

www.letsgo.org

Implementing Five Priority Strategies

32

*Implementation in schools and after school programs is in most or all classrooms; child care is program wide.**This year, the survey included questions about limiting unhealthy choices for snacks and celebrations, but those responses are not included in the analysis for this strategy; they will be included next year.***The school and after school surveys did not include a question about milk; it’s a requirement for all schools participating in the national school meals program.

Strategy Implemented* Child Care

(n =261)School

(n =166)

After School (n =92)

1. Provide healthy choices for snacks and celebrations; limit unhealthy choices.**

72% 65% 83%

2. Provide water and low fat milk; limit or eliminate sugary beverages.***

68% 75% 92%

3. Provide non-food rewards. 95% 55% 80%4. Provide opportunities for children to get physical activity every day.

72% 80% 95%

5. Limit recreational screen time. 82% 72% 96%

www.letsgo.org

Implementing Five Supporting Strategies

33

Strategy Implemented* Child Care

(n =261)School

(n =166)

After School (n =92)

6. Participate in local, state, or national initiatives that support healthy eating and active living.

51% 61% 61%

7. Engage community partners to help support healthy eating and active living at your site.

43% 63% 55%

8. Partner with and educate families in adopting and maintaining a lifestyle that supports healthy eating and active living.

70% 66% 54%

9. Implement a staff wellness program that includes healthy eating and active living.

56% 55% 32%

10. Collaborate with Food Nutrition Programs to offer healthy food and beverage options.

63% 64% 65%

*Implementation in schools and after school programs is in most or all classrooms; child care is program wide.

www.letsgo.org

Policies are Changing (Schools & After School Programs)*

Due to their involvement with Let’s Go! in the past year:

56% of schools did more to implement the district wellness policy and its recommendations around physical activity and healthy eating (n=166).

49% of schools reported their district strengthened their wellness policy to support the 5-2-1-0 messages or strategies (n=166).

61% of after school programs either created, implemented or strengthened an existing wellness policy and its recommendations around physical activity and healthy eating (n=92).

*This policy question was not included in the child care survey this year.

34

www.letsgo.org

Healthcare Practices Meeting Basic Criteria

35

Meet BASIC Criteria for Three ComponentsHealthcare

(n =135) 2012-2013

Healthcare(n =99)

2011-2012

1. Connect to your community & the Let's Go! Community EffortsLet's Go! poster is displayed in practice waiting area. 96% 86%

Let's Go! poster is displayed in all exam rooms. 76% 43%

2. Accurately weigh & measure patients

At well child visits, all providers routinely have BMI determined for patients age two years and older.

96% 86%

3. Have a respectful conversation around weight

At well child visits, all providers routinely counsel on HEAL using the 5-2-1-0 Healthy Habits Questionnaire.

71% 55%

www.letsgo.org

Reach of School Nutrition Workgroups

36

Let's Go! School Nutrition Workgroup

Startup Year Districts Schools Students

Greater Portland 2007-2008 12 76 31,557Southern Maine 2010-2011 12 64 27,307Somerset 2010-2011 7 27 7,168Lincoln/Knox 2012-2013 6 32 7,818Oxford/Androscoggin 2012-2013 9 53 20,303

Total 46 252 94,153

www.letsgo.org

Nudging Kids Toward Healthy Choices

Changes made as a result of school nutrition initiative: Decreased the portion size of a la carte items. Increased number of locations that fruit is available. Moved healthier items to high traffic areas. Offered cut up fruit such as apples and oranges. Put healthy options at eye level. Added new entrees or sides. Offered free samples of new menu items. Encouraged staff to use verbal reminders to encourage fruit and

vegetable consumption. Required cash for a la carte or less healthy items.

Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate was 100%. Questions were grouped around six categories of best practices: manage portion size, increase convenience of healthier items, improve visibility, enhance taste expectations, utilize suggestive selling, and set smart pricing strategies.

37

www.letsgo.org

Impact of School Nutrition Program Changes

38

100%

88%

100%

72%

Students liked at least some of the changes

Students are making healthier choices

Purchase of produce increased

Purchase of whole grains increased

% of Schools Reporting Change (n=25)

Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate was 100%.

www.letsgo.org

Let’s Go! Recognition ProgramSites of Distinction

Eligibility for Schools, Child Care and After School Programs: Implement all 5 priority strategies: BRONZE 1-4 enforced written policies: SILVER All 5 enforced written policies: GOLD

Note: Written policies will be reviewed by Let’s Go! staff.

Eligibility for Healthcare Practices: Display a Let’s Go! poster in the waiting room and all exam rooms

where pediatric patients are seen. All providers determine BMI for patients age two years and older. All providers use the 5-2-1-0 Healthy Habits Questionnaire at well

child visits.

39

www.letsgo.org

Let’s Go! Sites of Distinction

40

324

194

117152

787

9257 61 77

287

Child Care School After School Healthcare Total

Registered Sites Recognized Sites

28% 29% 52% 51%

36%

www.letsgo.org 41

www.letsgo.org

Let’s Go! Is Changing Environments About 7 in 10 child care sites are providing healthy choices for snacks and celebrations and

opportunities for recommended levels of physical activity. Nearly all child care sites rarely or never use food to encourage positive behavior. The vast majority of child care sites are limiting screen time. More than two thirds of schools are providing healthy choices for snacks and celebrations and are

limiting unhealthy choices. More than 7 in 10 schools have implemented strategies around physical activity, water and sugar-

sweetened beverages, and screen time. In the past two years, purchase of whole grains and produce has increased in over 100 schools that

have been part of the Let’s Go! school nutrition program. About three-quarters of school nutrition programs are certified in the new federal meal pattern. The vast majority of after school programs have implemented all five priority strategies. Nearly all healthcare practices display the Let’s Go! poster in their waiting areas and routinely

determine BMI for their pediatric patients. Over three quarters of healthcare practices display the Let’s Go! poster in all exam rooms where

children are seen. In 7 in 10 healthcare practices, all providers routinely use the 5-2-1-0 Healthy Habits survey.

42

www.letsgo.org

Our Work is Not Done

More trainings are needed around wellness policies. – Schools located within the same school district in as many as 23 of 55

districts reported different policy information.

Increase the reach of School Nutrition Workgroups.– Establish workgroups across all regions of the state.– Continue trainings for Dissemination Partners to facilitate workgroups

in their regions.

More trainings are needed in the healthcare sector.– Especially with larger practices (>5 clinicians).

43

www.letsgo.org

Key Learnings…….

Consistency in message and approach is critical

Working across a community wherever kids live, learn, work and play is essential

It’s the environment, not the activities that matter most

Partnerships and Collaboration are paramount Innovation and risk taking have been key to

our success

44

www.letsgo.org

Some of our challenges (mistakes)

Not fully understanding and acknowledging the current efforts on the ground

Moving too fast and getting ahead of people Trying to please everybody Making things too complicated Not publishing sooner

45

www.letsgo.org

Local and State Partners

Let’s Go! Dissemination Partners, including participating Healthy Maine Partnerships and health care systems

Participating Schools, Child Care Programs, Healthcare Practices, After School Programs, Employers and Communities

Maine Center for Disease Control and Prevention

Maine Department of Education

Maine Bureau of Parks and Lands

Maine Department of Health and Human Services, including Maine Head Star

University of Maine Cooperative Extension

Maine Dairy and Nutrition Council

Community based programs working to increase physical activity and healthy eating in Maine,) for ex. WinterKids

Maine After School Network

www.letsgo.org

National Partners

National Initiative for Children’s Healthcare Quality (NICHQ)

Let’s Move

American Academy of Pediatrics (AAP)

American Medical Association (AMA)

National Convergence Partnership

Innovators and Risk Takers all over the country

And You!

www.letsgo.org

Let’s Go! Is Generously Funded by Our:Founding Partners

Platinum Sponsors

Additional FundersAmerican Academy of Pediatrics/Healthy Active Living, Fairchild Semiconductor, Leonard C. & Mildred F. Ferguson Foundation, Maine Department of Health & Human Services/ARRA, The Rite Aid Foundation

Gold SponsorsSilver Sponsors

Walmart Jane’s Trust

Bronze Sponsors

The Bingham Program, Convergence Partnership, The Mattina R. Proctor Foundation, Sam L. Cohen Foundation

Francis Hollis Brain Foundation, Poland Spring, Rite Aid Foundation,Visiting Board of BBCH, Estate of Mary R. Hodes

www.letsgo.org

Comments Thoughts

Questions

49