implementing nutristep ontario - june 09 webinar
DESCRIPTION
We would like to tell you about NutriSTEP®. This work has been led by dietitian researchers from the Sudbury & District Health Unit Public Health, Research, Education & Development (PHRED) program, NRC and the University of Guelph, Dr Heather Keller and Dr Janis Randall Simpson. As of spring 2007, NutriSTEP® has been a program of the Nutrition Resource Centre of the Ontario Public Health Association. NutriSTEP® is of interest to a number of programs and agencies that service young children and their families.TRANSCRIPT
Implementing NutriSTEP®
in OntarioJune 24, 2009
Provincial Webinar
Lee Rysdale, Joanne Beyers,
Dr. Janis Randall Simpson and Dr. Heather Keller
What We Will Cover
What is the NutriSTEP® Program Research background - validation of NutriSTEP®
Where NutriSTEP® is being implemented right now and ongoing evaluation
Natural fit as screening and/or surveillance tool with public health, education, primary health care
Opportunities, challenges and next steps
NutriSTEP® Program is … Parent-focused nutrition education
and skill building program that starts with: Nutrition risk screening index
for preschoolers (3-5 years) Multi-ethnic English and French Parent-administered - 5 minutes to complete
On-going collaborative practice-based research with University of Guelph, PHRED and others
Implementation Toolkit and resources NutriSTEP® Online Community
What NutriSTEP® Measures:Construct of Nutritional Risk
Physical growth/weight concern Food and fluid intake Physical activity and screen time Factors affecting food intake (food
security; psychosocial feeding environment)
Caregiver Resources - Education Booklets
Why NutriSTEP® Program?Canary in the Coal Mine
Screening, Parent Education and Skill Building… Leads to early identification and prevention of
nutrition problems in priority populations Increases nutrition awareness with families and
providers Means treatment can occur, reducing serious
consequences Helps manage scarce community resources Screening data can be used to monitor trends over
time (surveillance)
Refer
ProvideInfo
Monitor
Parent fills in tool
Child not at
nutritional risk
Provide nutrition
info
Child at nutrition risk (mod or high)
PhysicianAssessTreat
Dietitian
AssessCounsel
OtherCommunity
Parent Programs/Workshops/Services
Ethical Screening…
Referral Mapping®
Primary Sites for Screening…
CIHR Think Tank 2006
Screening fairs Day cares Kindergarten registration packages Doctors’ and primary health care offices Outpatient clinics Parent education programs
Evaluating Targeted SitesJune 2007-2009
Funded by NRC and Danone Institute grant Two feasible models for public health
Self-scoring and self-referral Administrator assisted scoring and referral
Ontario sites York Region-JK/SK registration packages Thunder Bay-Fair Start screening program, JK/SK
registration events Sudbury- new “Best Start” hubs in schools
Implementation Study Goal and Objectives
Goal To determine the resources required as well as the
feasible and appropriate processes for implementing NutriSTEP® in the Public Health system in Ontario
Objectives Implement NutriSTEP® screening based on the
proposed models Evaluate the targeted implementation of NutriSTEP®
Overall Results York Region-131(9.5%) were returned Thunder Bay-153 children were screened Sudbury-80 children were screened Only 2 parents in Thunder Bay and Sudbury
declined screening process Total: 364 NutriSTEP® and demographic
questionnaires returned Nutritional risk levels:
6% high risk 13% moderate risk 81% low risk
Low Risk Mod/ High Risk
Total %
Thunder Bay 58 13 71 43.3%
York Region 48 10 58 35.4%
Sudbury 26 9 35 21.3%
Total 132 32 164 100.0%
% 80% 20% 100% -----
Parent Phone Interviews Total Packages Received: 364 (consent: 264) Interviews conducted: 164 Participation Rate: 62%
Parent Thoughts on Score Low Risk
Reassured, happy, relieved, useful confirmation Moderate or High Risk
Often a chronic health or health history issue (e.g. anemia)
Confirmation of issues that were suspected Screening helped to see changes can be made and
reinforced importance of good eating habits Increased awareness of less healthful behaviours
(e.g. TV watching) Got caregiver resources
Parent Thoughts on Site Assisted Referral Model-Screening Fairs and Hubs
Good place, convenient, self-selection, missing those who need most
Multiple screens, some steps can get missed Concern about follow-up Lack of space, time, environmental issues for completion Site needs to be flexible-drop-in is not ideal for screening
Self Referral Model School is for everyone Being part of school entry package reinforced importance
and relevance Parents liked being able to take questionnaire home Increased awareness of nutrition issues
Parent Conclusions
Main Benefit Screening increased parent awareness
Barriers to Referrals/Screening Already aware Other situations take precedence No time to make changes
Need to ensure adequate follow-up of ‘at risk’ families
What We Found Out After Evaluating Three Sites
Assisted Referral Model Feasible, need for training of facilitators,
communication with numerous community partners Self Referral Model
Would likely work better if not part of a research project
Can reach a large number Good partnership opportunity for public health,
schools Did not overwhelm follow-up services Training about preschool nutrition for follow up by health
professionals may be needed
Key Learnings
Study settings and procedures may not be typical/usual
Nutrition concerns are complex to address We can screen, ID, refer and gather data well Ethical practice hard to do - follow-up with
parents is critical Measuring efficacy and effectiveness requires
long term evaluation efforts
Preschool Nutrition Modules “Primers”
Front line health professionals require extra training on preschool nutrition
Top five preschool nutrition issues identified as learning opportunities for Registered Dietitians (RDs): 1) growth assessment (part 1) – theoretical and
background information 2) growth assessment (part 2) - abnormal growth (failure to
thrive, overweight and obesity) and body image/self-esteem
3) nutritional assessment - developmental stages, parenting and the feeding environment
4) nutrient deficiencies - iron and vitamin D 5) food allergies and intolerances
RD Primers
March and April 2009- updated and refined; translated into French
English and French Primers posted on the NutriSTEP® website (www.nutristep.ca)
Ideally need to host a series of 5 web casts for Ontario RDs and their health care team members (public health, community, and clinical) - additional funds are required
Implementing NutriSTEP® in Ontario
Nutrition Resource Centre (NRC) University of Guelph / www.Flintbox.com PHRED Eat Right Ontario (ERO) Call Centre Ontario Public Health Standards (OPHS) Service Ontario
Eat Right Ontario Call Centre Parents
Standardized counseling tool covers low, moderate and high risk
Contact referral database-general, provincial, site specific
Will redirect parents to local health units and other referral sources
Practitioners Direct callers to Flint Box and NutriSTEP® website Future Role- a resource to assist agencies in setting
up a screening program
1- 877- 510- 510- 2
Fit with OPHS: Screening, Surveillance & Requirements
Related to Children
Foundational Standard: 1, 2, 3, 4, 5, 6
Chronic Disease Prevention: 1, 3, 7, 11
Child Health: 1, 4, 5, 6, 7, 8, 9,
11
NutriSTEP® and New Ontario Public Health Standards
Child Health Requirement # 11: The BOH shall facilitate access and support for families to complete screening tools(*19) to monitor their child’s health and development, and provide a contact for families to discuss results and arrange follow-up.
* …such as NutriSTEP®
School Readiness…if nutritionally well, ready to learn Where NutriSTEP® fits
JK/SK registration (York Region and TBay) Immunization/well child clinics (Calgary);
developmental screening fairs HBHC Program FHTs EDI for JK/SK (dovetail with parent survey
component – logical fit for NutriSTEP®) Local communities data available for surveillance and
planning Dental screening
Steps to Implementation NutriSTEP® Online www.nutristep.ca
Background, FAQs, Collaborative 3rd party site Implementation Toolkit, supportive resources
Flintbox www.flintbox.com Electronic questionnaire and license; online toolkit
Service Ontario www.serviceontario.ca/publications Print questionnaires (password protected side only) Electronic and print educational booklets
Nutrition Resource Centre www.nutritionrc.ca Provincial Program Coordinator:
Lee Rysdale: [email protected]
Implementation Toolkit English and French Online version
www.nutristep.ca www.flintbox.com
Binder/CD version NRC order form Provided on this
webcast Ontario only
NutriSTEP® Questionnaire
Electronic versions www.flintbox.com
Print versions www.serviceontario.ca/
publications (Ontario Health Units; password
protected side only)
www.serviceontario.ca/publications
Electronic and print Print versions from
ServiceOntario only English and French Cultural Adaptations
Summer/fall 2009 Chinese
Simplified Traditional
Vietnamese Punjabi
Steps Towards Implementation
Obtain the NutriSTEP® Implementation Toolkit Select a Site Coordinator Train those involved in the process Identify resources to meet needs including Eat
Right Ontario and the Call Centre Develop referral maps for services Monitor and evaluate process and outcomes Use results to inform practice and service
delivery
Some Next Steps Work towards a “one stop data shop” for
NutriSTEP® (for screening and surveillance purposes at all levels - national, provincial, regional and local)
NutriSTEP® validation with other age groups of children e.g. 18 months
NutriSTEP® validation in other languages
Long-term: Testing of effectiveness of preschool nutrition screening and outcomes
Take away Valid and reliable questionnaire-English and French Fills need for simple index for preschool screening Just completing the tool increases parent food and
nutrition awareness Caregiver resources well developed Integrates into existing programs with many different
partners e.g. ERO, HBHC, school readiness Reaches at risk, priority populations Can be used for screening and surveillance Requires enhanced capacity for provincial
coordination and evaluation
Acknowledgements University of Guelph
Researchers: Janis Randall Simpson: [email protected] Heather Keller: [email protected]
SDHU PHRED Program Past project updates and documents: www.sdhu.com Researcher:
Joanne Beyers: [email protected] Nutrition Resource Centre
Provincial Program Coordinator: Lee Rysdale: [email protected]
© 1998-2008. Sudbury & District Health Unit, Janis Randall Simpson, and Heather Keller. All Rights Reserved. The NutriSTEP® mark and Bear Logo are owned by the Sudbury & District Health Unit.
Refer to www.nutristep.ca for more information.