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2013 Model Practices (Public)Application Name: 2013 Model Practices (Public) : Marshall County Health Department : Team Ultra Applicant Name: Mrs. Wendy Rose, QI/PM coordinator; Preparedness Crdnt; Grant Write Application Title: Team Ultra Please enter email addresses you would like your confirmation to be sent to. wendyd.rose@ky.gov Practice Title Team Ultra Submitting LHD/Agency/Organization Marshall County Health Department Head of LHD/Agency/Organization Lisetta Whitworth Street Address 307 E. 12th Street Practice Contact Person Wendy Rose Title Laboratory Director/Agency Grant Writer Submitting LHD/Agency/Organization Web Address (if applicable) www.mcphd.org Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status)
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.
In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice? The Marshall County Health Department is a single county health department located in far Western Kentucky. The department provides services for 31,448 citizens of the county. Marshall County has one public school district which, during school year 2012-2013, has an enrollment of 4,649 students. In 2005, the Marshall County Health Department, partially in response to the push-down from the Kentucky Department for Public Health to increase physical activity in school-aged children, created Team Ultra. Marshall County is a rural area and the opportunities for after-school activities, outside of organized sports, are limited. The county does not have organizations such as the YMCA or public fitness centers for school-aged children. The Marshall County Health Department had to be creative in how to meet the promotions advocated by the State. Thus, with the help of an established elementary school running club, Team Ultra was born. The program started in one elementary school and has grown into all six elementary schools in the county for 2nd – 5th graders. Students stay for one and a half hours after school, one day a week, with adults from the Health Department, school system and other community agencies. Team Ultra revolves around teaching students about physical activity, good nutrition and good character. The intended population for this project is approximately 10% of the 2,207 elementary school students in the Marshall County School District. The target population includes male and female 2nd – 5th grade students, who are primarily Caucasian with moderate socio-economic status. According to the CDC and the Kentucky Behavioral Risk Factor Surveillance System Data (BRFSS), 16.5% of Kentucky’s youth are obese and 31.8% of adults are as well. The United States averages are 13.0% and 27.5%, respectively. Specifically in Marshall County, 28% of adults are indentified as obese and the Kentucky average is 27%. 61% of Marshall Countians are indentified as overweight. It is apparent that Kentucky residents are at risk for higher than normal percentages of obese and overweight people. It is also a known and documented fact that traits and habits learned early in life, will carry over into adulthood. It is the intent, that through the collaboration between Marshall County Health Department and Marshall County School District, in the way of Team Ultra, healthy behaviors and practices can be instilled and reinforced in the participants’ minds so that healthy behaviors and practices become a way of life. If the children of today become more healthy and adopt positive behavior patterns, that will make them healthier, productive adults of tomorrow. This program has been funded primarily by local tax monies from its inception, indicating the value and importance of this program. Team Ultra has been successful due to the dedication of key individuals in the Health Department that designed, implemented and are carrying out this program. The program has grown to all elementary schools and will often have a ‘waiting list’ for children to participate. Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. . You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles, etc. Describe the public health issue that this practice addresses. (350 word limit) Team Ultra addresses two key public health issues - physical activity and nutrition. It is recognized that physical activity and proper nutrition are essential components of a healthy lifestyle. It is documented that implementing healthy lifestyle choices helps to reduce the risk of a myriad of chronic diseases including diabetes, caused by unhealthy weight and eating practices. The gravity of these public health issues is evidenced by the initiatives promoted by local, state and federal programs. One example of a federal initiative is the ‘Let’s Move!’ program launched by First Lady Michelle Obama in 2010 to “solve the challenge of childhood obesity within a generation, so that children born today will grow up healthier and able to pursue their dreams.” Team Ultra has been encompassing several elements of the ‘Let’s Move!’ program for 8 years by teaching participants about proper nutrition choices and engaging them in vigorous physical activity. National research suggests that children between the ages of 6 and 17 years need to be active (moderate to vigorous activity level) for 60 minutes each day. Team Ultra ‘coaches’ also give the participants ideas and suggestions for physical activities that can be performed at home without costly equipment – thus making physical activity possible regardless of economic status. At two of the elementary schools, Team Ultra participants have worked to plant raised-bed gardens to grow produce. These gardens are community collaborations – several individual and businesses donated labor and/or materials to make this vision a reality and school personnel and Team Ultra participants are responsible for the day to day maintenance of the gardens. This has been such a positive program, that other schools are interested in having a garden at their sites. Team Ultra participants learn how to grow their own produce and several students have begun to grow produce at their homes. With the rising costs of fresh produce and the limited number of ‘farmer’s markets’ in Marshall County, teaching and empowering Team Ultra participants to grow their own produce will help make them, and their families, more self-sufficient regarding the availability of fresh and affordable produce. What process was used to determine the relevancy of the public health issue to the community? (350 word limit) Several years ago, when the Kentucky Department for Public Health ‘pushed down’ increased physical activity initiatives, the Marshall County Health Department realized that creativity would be needed to address this issue, especially in the school aged population. Health Department personnel were assisting an elementary school with their after school, ‘running club’ and Team Ultra formed from that initial group of 20 students. Marshall County is rural and, outside of organized sport activities, does not offer much in the way of organized physical activity opportunities, such as the YMCA, community recreation centers or ‘activity groups’ at local parks. While Marshall County does have several community parks with walking trails, basketball courts and tennis courts, there are limited opportunities for organized activity for school aged children, outside of organized sports. Kentucky routinely has indicators in categories of Fruit and Vegetable consumption, obesity and recommended physical activity that are poorer than the national average. According to the CDC, in 2009, Kentucky’s average of youths consuming >5 servings of fruits and vegetables per day for the past 7 days was 14.2% and the national average was 22.3%. Youth obesity, as defined by BMI above sex and age specific 95th percentile, in Kentucky was 16.5% and the national average was 13.0%. The percentage of physical activity for youth in Kentucky - 60 min / day that increased the heart rate and caused the subjects to breathe hard for the last 7 days – was 21.9% and nationally the average was 28.7%. It is apparent that Kentucky’s youth are underperforming, with regards to these indicators, when compared nationally. How does the practice address the issue? (350 word limit) Team Ultra shows participants how to engage in physical activity without using expensive items or equipment thus making physical activity available to anyone. Participants are taught easy ways to increase the amount of daily physical activity by doing simple things such as taking the stairs instead of an elevator and doing outdoor chores. Team Ultra coaches demonstrate ways that physical activity can be fun and stress to the participants that increasing the amount of daily physical activity does not have to be daunting task. Participants are also encouraged to integrate their family into physical activities done while at home. Many suggestions are made, during Team Ultra, to involve the entire family unit. By utilizing school-based greenhouses and raised-bed gardens, Team Ultra assists children in learning about growing produce and adopting healthy eating choices. The students have a sense of pride and ownership in seeing the ‘fruits of their labor’ through the growing and cultivating of produce. The ‘garden’ part of Team Ultra helps participants become familiar with how to grow fresh produce which could empower them toward self-sufficiency and help ensure access to healthy fruits and vegetables. Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support) Not applicable Is the practice new to the field of public health? If so, answer the following questions. Yes What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. An extensive internet search was performed using keywords such as childhood obesity, physical activity, nutrition education and after school programs and no similar programs were indentified. Also, a search of NACCHO’s Toolbox yielded no results similar to the Team Ultra program How does this practice differ from other approaches used to address the public health issue? Team Ultra directly engages participants in ‘hands-on’ activities rather than classroom-type instruction. Students participate in physical activities that can be replicated at home to help encourage physical activity amongst the entire family unit. Incorporating the garden component into Team Ultra, illustrates how persistence and hard work can pay off in the form of edible produce. A unique aspect of Team Ultra is the character building lessons the coaches incorporate into each session. Team Ultra designers felt reinforcing good character traits, such as respect for yourself and others, courtesy, fairness and citizenship would assist in guiding the participants to productive lifestyles. While participants are ‘learning’, they are engaged in a type of physical activity. At times, Team Ultra has addressed geography/history/math during the sessions. Each participant was asked a place they would like to travel to in the world. Team Ultra staff then divided the participants into teams and assigned at-home activities (i.e., jogging for 15 minutes = 10 miles) that accumulated for each student to help get their team to the group destination. Upon, ‘arrival,’ students were then provided facts about the city and/or country of their destination. At the end of the school year, Team Ultra participants are brought together for a ‘Field Day.’ Field Day consists of various physical activities throughout the day, a chance for the participants to interact with participants from the other schools and a final chance to pass along nutrition, character and physical activity information before the end of the school year. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population? How does this practice differ from other approaches used to address the public health issue? Who were the primary stakeholders in the practice? The primary stakeholders are the Marshall County Health Department, Marshall County School District, Family Resource Centers, elementary students and Marshall County citizens.
What is the LHD's role in this practice? The Marshall County Health Department is the lead agency with Team Ultra. Health Department personnel formulated and implemented the curriculum. A Health Department representative leads each Team Ultra session and is ultimately responsible for each session’s content and activities. What is the role of stakeholders/partners in the planning and implementation of the practice? Until just a few years ago, Health Department personnel were the only adults staffing each Team Ultra session. Recently, school district and family resource personnel have assisted during each session. Although the Nutrition Services Supervisor guides the school gardens, it is up to the individual school to identify staff personnel who will be responsible for the day to day operation of the gardens. Health Department personnel are always receptive to input and ideas from stakeholders on ways to improve Team Ultra. What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals. The Marshall County Health Department works closely with school and Family Resource personnel at each elementary school to ensure adequate supervision is available during each Team Ultra Activity. Periodic discussions are held with school and Family Resource personnel about the program’s curriculum and ways to further meet the needs of the target population. Team Ultra is promoted, in the community, by the Marshall County Health Department through press releases, newspaper features and local radio outlets. Other shareholders will promote Team Ultra, as appropriate, given the requirements of their organization. Describe lessons learned and barriers to developing collaborations. As with most ventures in this current economic climate, lack of time and limited financial resources are two issues that pose barriers to developing additional collaborations. Everyone is learning how to ‘do more with less’ and sometimes that stretches personnel and resources very thin. Unfortunately, Team Ultra may not been viewed as a ‘priority’ program for organizations not currently directly involved. One way to help overcome this could be more prominent promotion of the program in the community to allow community members to see the benefit of a program that encompasses so many elements to help children grown into productive adults. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
One objective of Team Ultra is to encourage participants to get at least 60 minutes of physical activity each day and have healthy eating habits. Team Ultra coaches cannot follow the participants daily to ensure that 60 minutes of physical activity is obtained or what the participant eats daily, so this is a difficult area to measure. It is also realized that only having Team Ultra one day a week, there might be decreased impact when compared to a program that was held more often. Currently, the measures of Team Ultra are more program output related. During the program’s tenure, enrollment numbers have steadily increased and school district interest has elevated to the point Team Ultra is in all the elementary schools. Periodic information is distributed to participants and encouraged to share the information at home. This is approximately 200 households that Team Ultra reaches in an indirect way. Although BMI data is collected yearly by the school district, Team Ultra personnel have not been able to analyze the yearly data, yet. A goal of Team Ultra is to evaluate if a difference in BMI-for-age of children as they progress through the program is noticed. Are improvements seen as the participants move into middle and high school? This type of program output assessment would measure the impact of the promotion of physical activity and nutrition in the program. Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Another objective is to model and stress character building as a way to help lead a healthier lifestyle. This objective can be viewed as ‘all-encompassing’ as a strong character will help participants follow through with good nutrition choices and making physical activity a part of their daily life. Sadly, some children don’t have consistent role models for what is good character. Team Ultra hopes to provide that, at least once a week, to the participants. Several of the Team Ultra coaches are in the schools more than just once a week, in the capacity of performing their jobs. So, many times, participants see the coaches more than just once a week and a bond is able to be formed between the coach and the participant. As with Objective #1, the measurement of this objective in a work in progress. Team Ultra coordinators are working with school district personnel to see if permission can be granted for Team Ultra coordinators to access school district measures such as attendance and disciplinary records of Team Ultra participants to compare those results with the results of the entire population (i.e., grade). If Team Ultra is allowed access to this information, it could measure two things 1) the impact of promotion of physical activity/nutrition as it affects health/sickness as demonstrated through attendance records and 2) measure how the component of character promotion has impacted the participants regarding disciplinary actions. Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? Specific tasks for each Team Ultra session are tailored to what coordinators feel that particular group needs. Each session includes vigorous physical activity, an educational component that could be geared toward nutrition, health education topics (i.e., smoking and tobacco use, importance of adequate sleep, head lice, etc.) and a character building example/lesson. While in Team Ultra, all participants are expected to be respectful of their peers and coaches and disrespectful attitudes are not tolerated. What was the timeframe for carrying out these tasks? Team Ultra has evolved to what it is today, over a period of several years. Each year a new lesson is learned and that knowledge is applied when designing the curriculum for the next year. As stated earlier, each Team Ultra session is approximately one and one-half hour long. Please provide a succinct outline of some basic steps taken in implementing your practice. A good relationship with school district personnel is essential to implementing a program like Team Ultra. The school district must buy into the concept since Team Ultra is held on school property and geared toward children in the district. Once approval is given from all needed organizations/agencies, then the program can be publicized to the targeted population. Before the program is started, proper staffing needs to be obtained. The staffing can come from agency or school district personnel or other community stakeholders. It is recommended to have a nurse on-site during each session in case an injury occurs. What were some lessons learned as a part of your program's implementation process? One thing that Team Ultra coaches have observed is the attitude of the participants regarding being healthy and fit versus being athletic. Participants see that you do not have to be a star athlete to be fit and lead a healthy lifestyle. Participants embrace the teamwork concept during Team Ultra. Personnel who are in the schools during the course of their job duties have seen that Team Ultra participants seem to naturally emerge into leadership roles at their school. Being part of a ‘group’ helps elevate participants’ self-esteem and confidence. During Team Ultra’s tenure, coordinators have learned that they have to be flexible and always have a back-up plan. There is no way every possible outcome could be anticipated and in the event of personnel sickness, inclement weather, other obligations for the facility and parents not being timely in pick their children up, alternative activities and ways to complete those activities should be thought out. Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services. The main cost of implementing this is staff salaries. The equipment used during Team Ultra is usually provided by the physical education department at the schools or is equipment the Health Department already owns. There is a nominal cost of Team Ultra shirts for the staff and participants. At this time, there is no charge for participating in Team Ultra. Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. Now, stakeholder commitment is strong. The school district and family resource centers feel this program is worthwhile enough to continue sending personnel to help staff each session. The school district allows the use of their facilities and equipment and Team Ultra coordinators do not see this level of commitment changing in the near future. Describe plans to sustain the practice over time and leverage resources. Marshall County Health Department is in the process of establishing a Community Health coalition that will merge the existing county health coalitions (i.e., tobacco, cancer) into a single group. By informing the new Health Coalition about programs such as Team Ultra, it can aid in informing community groups about the needs of Team Ultra and to ask additional partners to ‘come to the table’ and assist with Team Ultra in ways of personnel time and promotion of the program. Practice Category Choice 1: Chronic Disease (Obesity) Practice Category Choice 2: Practice Category Choice 3: Check all that apply. Colleague in my health department NACCHO Web Site E-mail from NACCHO Are you a previous applicant? No |
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