Addressing overweight and obesity amongst children & young people in out-of-home care:
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The Healthy Eating, Active Living (HEAL Study) Rachel Cox Primary supervisors: Dr. Matthew Fuller - Tyszkiewicz & Dr. Louise Hardy
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Addressing overweight and obesity amongst children & young people in out-of-home care:
- 1. Addressing overweight and obesity amongst children & young people in out-of-home care: The Healthy Eating, Active Living (HEAL Study) Rachael Cox Primary supervisor: Prof. Helen Skouteris Associate supervisors: Dr. Matthew Fuller-Tyszkiewicz & Dr. Louise Hardy
- 2. Nearly a third of children were classified overweight (28.2%), and one-third were obese (34.6%) (n=78).
- 7. “The cooking and encouragement has been paying off. One of our young people was back in the kitchen creating a healthy meal for lunch the next day. He even requested photos be taken for his life book. BC* has been talking with staff about career opportunities and exploring the possibility of doing a hospitality traineeship.” “In the first three weeks since starting his personal training and new eating plan, Paul lost 10cm from his waist. The improvements in his physical and mental wellbeing are noticeable and he states he feels happier in himself. Paul has also started setting goals for when he has lost more weight, for example, he would like to join a basketball team and try swimming.” * Young peoples names have been changed for confidentiality purposes.
- 8. “The unit currently has four young people living there. HEAL has purchased gym and swim passes, and engaged the young in many new activities including, golf, bowling, go carts, beach days, and a snow trip. The young people are now going to the gym as a group and encouraging each other to keep fit.” • “HEAL has been working with David for 5 months now. When HEAL first engaged David was an active young person with limited resources and no extracurricular activities to use his energy. David also had behavioural issues that were distressing staff. When discussing what activities might appeal to David, it was established that he didn’t know how to swim. TheYMCA helped organise weekly swimming lessons and staff noticed a dramatic change in David’s behaviour - he engaging well with staff and the swimming teacher.” * Young peoples names have been changed for confidentiality purposes.
- 10. Acknowledgements Community Service Organisations Berry Street, Salvation Army Westcare, Wesley Mission Victoria & Department of Human Services Hurstbridge Farm Industry Partners YMCA Victoria, QUIT Victoria, Department of Sport and Recreation Victoria University of Stirling Food For Thought Project Team National Health and Medical Research Council Heart Foundation
Hinweis der Redaktion
- Hi everyone, my name is Rachael Cox and I am a current PhD student from the school of psychology at Deakin University, in Australia. I’m here today to talk to you about the HEAL program which we’ve been running in residential care in Victoria, Australia. HEAL stands for healthy eating, active living. Just to help give you some context – the project I’m going to described today, focuses only on children and young people living in residential OOHC. Throughout this presentation, you will probably hear we use the word ‘resi’ – this is Australian slang for residential care. Similarly to the UK, the residential care model is one where staff provide care for up to four children, in a group home environment. These units are run by community service organisations such as Berry Street. Current estimates indicate there are around 500 children living in residential care in Victoria.
- So, how did the HEAL Program come about? I thought I’d better begin by giving you a little bit of background to how the HEAL program came about. The HEAL program started after staff from Berry Street (Victoria’s largest community service organisation), self-reported that about 45% of the young people in residential care are overweight or obese. Staff also suggested that some young people gain weight excessively whilst in residential care. After hearing reports that a large percentage of young people in residential care were overweight or gaining excess weight whilst in care, two of my supervisors decided to conduct a systematic review which examined the literature on nutrition and weight-related issues for children in OOHC over the last decade. This review (which was done in 2011) revealed that there is a paucity of Australian research that has focused on the prevalence rates of overweight and obesity of children and young people in OOHC. Our review also revealed there a few interventions that specifically target weight gain, as part of an overall health assessment, and there are no standard recommendations about the food and physical activity environments provided in residential care, in Australia. This is surprising given the National focus on combatting child and adolescent obesity. We have since collected baseline data which confirmed that overweight and obesity is a significant issue for young people living in residential care in Victoria. Alarmingly, nearly a third of children were classified overweight (28.2%), and one-third were obese (34.6%). This data was obtained from a sample of 78 young people, which represents nearly a fifth of the population in Victoria. Although this sample is small (from a research perspective), this is a vulnerable population group who have complex needs in regards to their mental health, cognitive development and social interactions. I’m sure others at this conference can probably sympathise that this group can be a particularly challenging group to recruit for research. In addition to the young people, we also examined the weight status of the staff who care for them. 243 residential care staff self reported their height and weight and we found that 35.4% were overweight and 37.4% obese. These rates are about 10% higher than current estimates for adults in the general population in Australia. It is clear from these statistics that overweight/obesity is a significant issue amongst young people living in residential care in Victoria, but also for the staff who care for them.
- As a direct response to staff’s growing concern, as well as evidence of high prevalence of overweight and obesity in OOHC internationally, Berry Street developed a Health & Wellbeing program that was run in 5 residential units in Victoria, Australia) in 2010 (Northern Metro Region). The Berry Street HAWC program pilot tested having a Health & Wellbeing Coordinator work alongside young people and staff to improve their understanding and awareness of healthy living and it’s value, mentally and physically, as well as encourage them to participate in physical and other health activities. The pilot program resulted in: Healthier eating and physical activity habits of the young people Encouragement of, and role modelling of healthy eating and physical activity by staff, and Improved psychological wellbeing of the young people, that is, reduced symptoms of depression, anxiety and stress. The HEAL program was informed by Berry Street’s Health & Wellbeing program. In 2011, Deakin University partnered with Berry Street and The Salvation Army Westcare and applied for an Australian Research Council grant to measure the effectiveness of the HEAL program across two major community service organisations. Wesley Mission Victoria and the Department of Human Services, Hurstbridge Farm have also joined in the program. So far, it is estimated that the HEAL program has reached over 100 children and young people and over 200 staff across the state.
- The main objective of the HEAL study was to address risk factors of overweight and obesity among adolescents in out-of-home care (OOHC). HEAL is a dual intervention program which aims to: provide information and practical opportunities to help young people living in residential care make positive choices and behaviour changes in relation to eating and physical activity; as well as resource their professional carers to model and support this change. The HEAL intervention program is a 6 month program, with maintenance of the program offered for a further 6 months. Similarly to the pilot program, HEAL coordinators were appointed to meet with each young person one-on-one and develop an individual health plan that focuses on fostering a healthy lifestyle. They also offered further professional development for staff and educational sessions for young people, including healthy cooking classes, Masterchef competitions, and so forth. In addition, the HEAL program includes 12 fortnightly themes which aim to introduce a new topic relating to (i) healthy eating, (ii) physical activity, and (iii) wellbeing. In addition to the goal setting component, each participating unit received a HEAL resource folder which contained materials to aid discussions with clients around different health topics. The HEAL resource folder also included posters and handouts to introduce each new theme and suggestions for different activities to run with the young people. Each young person participating in the program received a welcome pack, which included a sports bag, drink bottle, MP3 player, Adidas cap, wristband and a pedometer. We also worked with some additional partners to help improve health outcomes for these young people in care. This included: YMCA Victoria: A formal partnership was formed with YMCA Victoria to help facilitate client’s access to a broad range of YMCA facilities. Through this partnership, every client participating in the HEAL program was offered a free 6 month YMCA gym membership. QUIT Victoria also came on board and provided smoking cessation skills training for the HEAL coordinators. QUIT Victoria also provided print resources for each unit including, health effects posters, stickers & information sheets, information on nicotine replacement therapy products and information on how to access Quitline. Finally, the Department of Sport and Recreation Victoria provided $5,000 to help encourage and support the young people to engage in physical activities, particularly those that encourage acquisition of lifelong skills, e.g. learning to swim or ride a bike.
- All staff and young people currently working or living in residential care across each participating organisation were invited to participate in the evaluation of the HEAL program. Half the Residential Units within each region of were randomised into the intervention and the other half into the wait-list control. This methodology enabled rigour whilst ensuring equity of access to the intervention, albeit on a delayed basis, to all young people being looked after by the community service organisation. Specific outcomes sought for the HEAL program group included: (1) greater consumption of fruit and vegetables, (2) decreased consumption of high fat, high sugar cordials, soft-drinks and juices and non-essential, energy dense snack foods, (3) improved knowledge regarding key aspects of healthy eating and physical activity, relevant to the prevention of obesity and improving health and wellbeing generally, (4) an increase in the number of days per week they are physically active for at least 60 minutes per day, lower levels of depressive, anxiety, and stress symptoms, lower body dissatisfaction, and greater self esteem and quality of life, and (5) lower Body Mass Index (BMI)-for-age z scores. Baseline data and 6 and 12-month follow up (post-program) data collection is now complete and the intervention is now finished.
- I am still analysing quantitative data from young people and staff and therefore an in-depth evaluation of the HEAL program has yet to be conducted. However, qualitative feedback provides promising evidence of a positive program impact, in relation to the young people’s eating and physical activity behaviours. Specifically, HEAL has resulted in: improved sleeping patterns of the young people; additional resources to help staff and young people reduce or quit smoking; an increase in the number of young people engaged in a community sports club; new sports equipment for some program units (i.e., basketball rings, new bikes); an increase in the number of young people participating in food preparation; a conscious effort by staff to provide healthy snacks and meals for the young people in their care; improved self-esteem, independent living skills and ‘healthy’ relationships, and an increase is young people engaged in new, outdoor activities (e.g., horse riding, camping)
- I think what we’ve learnt from this study, and what these case studies provide is evidence that both food and physical activity provide an everyday opportunity to not only help improve a young person’s physical health but to also improve their mental health and wellbeing.
- Currently, we are exploring ways to rollout the HEAL program in a cost effective, efficient way across the sector. We have partnered with the Centre for Excellence in Child and Family Welfare and the Department of Human Services to develop an online training module for residential care staff that will be rolled out state-wide. The aim of this training is to create uniformity across the sector in terms of knowledge (specific to the importance of healthy eating and being physically active). An online training program for HEAL is proposed to have the following benefits: The training can be offered to all agencies in Victoria who provide a residential care program. Knowledge translation: developing this program will allow us to share the learning's and positive outcomes of the program to date. An online program will reduce the cost of staff training for agencies. Development of the program will be a measureable outcome of my PhD project. The plan is for us to consult with the Centre for Excellence in Child and Family Welfare to map the online training content to an accredited unit of competency (specifically, Certificate IV in Child, Youth and Family Intervention). This will ensure the HEAL training becomes a part of a sustainable, accredited training for the Residential Care workforce. In addition, ongoing discussions have been held with Foster Care Association of Victoria, and Gateways Support Services in relation to expanding the HEAL program to other population groups in OOHC; namely, foster care and children with an intellectual and/or physical disability. The main objective of the next phase of the HEAL project is to create wider systemic change in order to improve both physical and mental health outcomes for young people in OOHC. We will be submitting an application to the National Health and Medical Research Council at the end of this year for a grant to support phase two of this project, an implementation trial. The primary aim of this trial will be to consider how can we make the necessary changes at a policy/practice level to reduce some of the barriers to enabling a healthier lifestyle for young people in OOHC. Consideration will be made at the government level (including the Department of Human Services & Department of Sports and Recreation), organisational level (this will include changes to staff recruitment within social welfare organisations and implementation of the online training program) and on ground (this will include the residential care unit and will focus on individual behaviours of the young people and staff). I hope that these changes will prevent poorer long-term outcomes, including reduced obesity and associated health impacts for these young people.
- I would like to acknowledge each of the young people and residential care staff who have participated in the HEAL program and associated research.