The Communities Preventing Childhood Obesity project aims to prevent childhood obesity through a multi-state, multi-disciplinary collaboration funded by USDA. The project uses an ecological model and community development approach, working with coalitions in 7 states to implement evidence-based nutrition and physical activity interventions. Intervention communities receive a community coach to support capacity building and sustainability. Impact is measured through pre/post assessments of children, parents, and communities.
2. The Communities Preventing
Childhood Obesity project
Multi-state
IN, KS, MI, ND, OH, SD, WI
Multi-disciplinary team Start a community
development
Nutrition
intervention to
Physical activity
prevent childhood
Community development obesity.
Family and youth development
Funded by USDA Agriculture and Food Initiative
(AFRI) Grant
3. Innovative Aspects
7 states collaborating
Community capacity development approach
Ecological Model of Childhood Overweight
Rural communities
Low-income families
Preschool-aged children
4. Ecological Model of Childhood
Overweight
Socioeconomic
Neighborhood
status
safety
Foods
School available Parent’s School
lunch in home weight PE
program Dietary Weight Physical status program
Parent’s
intake activity s
dietary Status
intake Monitoring
TV hours
Nutritional Sedentary Ethnicity
Work
knowledge behaviors
demand Parent’s activity
s Encouragemen patterns
t of activity
Accessibility of recreational facilities,
convenience foods, and restaurants
5. Community Development Approach
Growing evidence shows that obesity is driven by the environment.
(Schwartz & Brownell, 2005)
For people to make behavior changes that
support healthy lifestyles, they must exist in
an environment where the healthy choice is
the easy choice.
Environmental changes can improve the
health of the whole community, not just
individuals.
6. Making an Impact
How can a
community create
an environment
where the healthy
choice is the easy
choice?
7. Role of a Coalition
Community coalitions consist of public- and private-sector organizations that,
together with individual citizens, work to achieve a shared goal through the
coordinated use of resources, leadership, and action. (IOM, 2005)
Create a
sense of
Engage Coalitions: community
residents The vehicle for
in the
cause successful
change at the
community
level!
8. Success of a Coalition
Relies on
capacity-building
ability of the
coalition
9. Barriers to Coalition
Success
Lack common
vision
Lack formalization
Lack clearly defined
roles
Failure to reevaluate
Failure to act
Failure to commit
10. An effective
approach to support
community
development for
sustained community
change initiatives
11. What is Community Coaching?
“A Community Coach is a
guide who supports
communities and
organizations in identifying
and achieving their goals.”
(Emery, Hubbell, & Miles-Polka, 2011)
Works as a process coach
with a group or coalition
Ensures efforts follow community
development principles of good
practice
12. Coaching Effective
Community Development
A process that aims to
support citizens in their
efforts to “build solidarity
and agency through self-
The process of help, felt needs, and
helping citizen participation”
(Bhattacharyya, 2004, p. 5)
groups organize and
act to address
shared concerns.
14. At the Heart of Coaching
Process to identify:
Current situation
Direction and desired
outcome
Alternatives and implications
Choice making
Action planning and
implementation
Reflection, modification and
new goal setting
15. Community Coaching for sustained
change initiatives
Readiness Prepare coalition and community
Relationships Develop effective working Relationships
Results Coach for Action
Reach Help the team think community-wide
Reflection Guide the coalition to review, revise, and respond
Resiliency Consider sustainable structure/ownership
16. All communities:
Methods ○ Child Ecological Model
Assessment
14 communities
○ Receive menu of evidence-
○ 2 in each state based interventions
(1 intervention, 1 control) ○ Implement 1 physical activity
Comparable in size and and 1 nutrition intervention
demographics ○ Receive $5000/year for 4
○ Rural community years
○ Exhibit community
readiness Intervention communities:
○ Has an existing community ○ Hire a Community Coach
coalition ○ Receive Community Coach
training
17. Measuring Impact
Child Ecological Model Assessment toolkit:
Community Healthy Living Index assessments
○ Community-at-Large
○ Neighborhood
○ Early Childhood Program
Active Where? Parent Survey
Coalition Self-Assessment
18. Community Healthy Living
Index
http://www.ymca.net/chli-about/
Pre-test / Post-test Assessments:
Does not include Community-at-Large
anthropometric data Neighborhood
Assesses Early Childhood Program
“Community and
Demographic” ring
Identifies community-
wide factors where
improvements can be
made
19. Active Where? Parent
Survey
http://www.activelivingresearch.org/node/11951
Pre-test / Post-test
Assesses “Community and Demographic”
and “Parenting / Family Characteristics” rings
Considers home, neighborhood, park, and school
environments related to physical activity and
eating
Low-income parents of preschool-aged
children
21. Toolkit
Menus of evidence-based curricula and strategies
Nutrition menu
Physical activity menu
Organized by the Ecological Model of Childhood
Overweight
Updated frequently
Online access
22. Toolkit
Leadership For Healthy Communities: Action
Strategies Toolkit
Leadership strategies and programming tools to create
healthy communities for children
Nutrition and Physical Activity Environments in
Licensed Child Care
Policy strategies to promote healthy eating and increase
physical activity in child care facilities
HAPPE: Toddlers in Physical Play
Motivates and engages toddlers in physical play and builds
basic motor skills that are the foundation for lifetime activity
23. Final year
Year 4:
• Post
Year 1: Year 3/4: assessments
Community Implement
interventions • Continue
assessment community
development
Post assessments completed
Intervention communities:
Develop sustainability plan to continue project
Control communities:
Receive training in community coaching
24. How is Extension helping impact your environment?
Socioeconomic
Neighborhood
status
safety
Foods
School available Parent’s School
lunch in home weight PE
program Dietary Weight Physical status program
Parent’s
intake activity s
dietary Status
intake Monitoring
TV hours
Nutritional Sedentary Ethnicity
Work
knowledge behaviors
demand Parent’s activity
s Encouragemen patterns
t of activity
Accessibility of recreational facilities,
convenience foods, and restaurants
25. Reference
s
Bhattacharyya, J. (2004). Theorizing community development. Community Development , 34(2), 5-34.
Butterfoss, F. D., Goodman, R. M., & Wandersman, A. (1993). Community coalitions for prevention and
health promotion. Health Education Research, 8(3), 315-330.
Emery, M., Hubbell, K., & Miles-Polka, B. (2011). A Field Guide to Community Coaching.
Hargrove, R. (2008). Masterful coaching. Pfeiffer.
Luloff, A. E., & Bridger, J. (2003). Community agency and local development. In D. Brown and L. Swanson
(eds), Challenges for rural America in the Twenty-first century, University Park, PA: Pennsylvania
State University Press.
Luloff, A.E., & Swanson, L.A. (1995). Community agency and disaffection: Enhancing collective resources. In
L. Beaulieu and D. Mulkey (Eds.), Investing in people: The human capital needs of rural America,
Boulder, CO: Westview Press.
Institute of Medicine. (2005)
Schwartz, M. B., & Brownell, K. (2005). The need for courageous action to prevent obesity. In D. Crawford, R.
W. Jeffrey (Eds.), Obesity prevention and public health (pp. 307-330). New York, NY: Oxford
University Press.
Schwarz, R., Davidson, A., Carlson, P., & McKinney, S. (2005). The skilled facilitator fieldbook: Tips, tools, and
tested methods for consultants, facilitators, managers, trainers, and coaches. Jossey-Bass.
Swanson, L. (2001). Rural policy and direct local participation: Democracy, inclusiveness, collective
agency, and locality-based policy. Rural Sociology, 66, 1-21.
Wilkinson, K. P. (1991). The community in rural America (No. 95). Praeger Pub Text.
Wolff, Tom. (1994). Coalition building tip sheets. Amherst, MA: AHEC/Community Partners.
Notes de l'éditeur
Abby
AbbyThe Communities Preventing Childhood Obesity project, or CPCO, combines the efforts of Extension specialists across seven states in the areas of nutrition, physical activity, community development and family and youth development, all with the common goal to start a community development intervention to prevent childhood obesity. With the help of funding by the USDA Agriculture and Food Initiative (AFRI) Grant, the CPCO project aims to identify factors that influence childhood obesity and ways to create and sustain opportunities leading to healthy lifestyles among rural communities.
BRANDY?The Cooperative Extension systems in seven states are working with rural communities, such as yours, to build the capacity of communities to develop,implement, and evaluate programs that strengthen networks that support healthy lifestyles.The Ecological Model of Childhood Overweight is used to guide the project. This model focuses on the environment of low-income, preschool-aged children living in rural communities.
BRANDY?For many years and much effort, studies have shown that programs that focus on only one aspect of health do not adequately address the risk factors in a child’s life that influence obesity. A community-wide solution is most effective and is most sustainable. The Ecological Model of Childhood Overweight focuses on characteristics of that could affect a child’s weight status in relation to the multiple environments surrounding that child. This model forces us to consider the whole community in which the child lives by looking at the combined effects of three outer rings of the model: the community at large, parenting and family factors, and individual behaviors that impact a child’s weight. COMMUNITY and DEMOGRAPHIC FACTORS:The outside ring of the model includes community-wide factors and demographics.Local environment: This ring displays factors of a community’s local environment. For example, communities can provide access to places where families can be active together – such as parks and recreational facilities. Neighborhood safety and availability of convenience foods and restaurants are also factors of the local environment to consider.School environment: Communities can also implement and support policies - such as school lunches without pop/sodas - which improve the health of everyone.Childcare providers may be trained in the latest activity curriculum and community members join together to implement healthy food drives for local childcare centers. Population-based characteristics: Ethnicity, socioeconomic status, PARENTING AND FAMILY CHARACTERISTICS:We shouldn’t forget that children are not usually responsible for their own healthy eating, activity and sedentary behaviors. Typically, family members model the behavior for children to learn. Though health is associated with genes and physiology, children ‘pick-up’ behaviors by observing their parents: eating the same food their parents eat, observing family members’ activity levels and learning that healthy eating and physical activity are valued habits in their family.
BRANDY?
BRANDY?How Can the Community Make an Impact to Make Health the Easy Choice?How Can Extension help the Community Make an Impact to Make Health the Easy Choice?
AbbyA coalition plays an important role in implementing the ideas that may eventually lead to change. A coalition is in a unique position within the community to create a sense of community by engaging everyone in solutions. Coalitions are the vehicle for getting changed underway.NOTE:IOM—Coalitions should be formed to promote community-wide efforts or “cross-cutting programs.” The IOM recommends coalitions form to expand existing efforts focusing on issues such as tobacco and alcohol use, automobile safety, and sex education to include an emphasis on obesity.
AbbyIn order for a coalition to help build community capacity to support change, a coalition must first be effective in building the coalition’s capacity.The coalition cannot be effective in achieving long-term goals if it can’t survive long-term itself. It’s success depends on the “longevity” or capacity-building ability of the coalition. (JA Alexander)PUZZLE: http://allthingsd.com/files/2012/04/puzzle-pieces-2.jpegCAPACITY BUILDING: http://cesd.az/cso/image/Capacity_Building.jpg
AbbyLack common vision:Disagreement among coalition members about coalition’s purpose and goals. (Tom Wolff)Lack formalization:Influenced by common vision—The degree to which rules, roles, and procedures are defined. AKA “routinization”: Persistent implementation of the operation. (FD Butterfoss)Mission statement, goals, and objectives defined?Policies and procedures in place?Clearly defined roles?Lack clearly defined roles:Failure to identify central leader/leadership roles leave the coalition floundering, acting with no clear direction.Coalition never moves forward, directionally, towards ACTIONLeader who fails to delegate—members feel powerless and uninvolvedFailure to reevaluate:If coalitions do progress and move forward, growing capacity and possibility of further success is limited if an evolving coalition doesn’t adjust their needs, purpose, and goals. Reevaluation may also be needed if coalition is unable to progress. Objectives may need to be redefined. More attainable goals must be set in order to achieve them, build member satisfaction, and eventually member commitment. Failure to act:Long-winded planning process with no action discourages involvement of members, especially those who are action-oriented (Members valuable to the coalition for this quality).Evidence of action (perceived as “success”) attracts action-oriented members who would likely help coalition to succeed.Failure to commit: (the following--FD Butterfoss)Members who perceive coalition as beneficial (influenced by a common vision they support, evidence coalition is taking action on that vision)are more satisfied (higher member satisfaction) more likely to collaborateHighly satisfied members perceive coalition as:organized (formalization)having strong/effective leadershipStrong member commitment = durable coalition
This project is implementing an approach for supporting community coalitions called Community Coaching.
Community Coaching has been described as “An adaptive process tailored to unique community contexts to guide systemic change via participant empowerment” or, “A Community Coach is a guide who supports communities and organizations in identifying and achieving their goals.” Community coaching takes popular effectivecoaching methods and applies them to public intervention strategies. Community Coaching is a variation on personal and business coaching. A community coach works with a group or coalition, and works as a process coach to ensure efforts follow community development principles of good practice.
Community Coaching recognizes that the work of the team or coalition being coached can be considered community Development. From an interactional field perspective, a community is a constantly changing environment characterized by community action and social interaction (Swanson 2001, Wilkinson 1991). As the various social fields adapt and respond to a changing environment, groups and organizations take on the quality of agency, which includes not only the motives to act, but also the capacity to do so (Luloff & Swanson, 1995; Swanson, 2001; Wilkinson, 1991). Community Development facilitates both community action and interaction. Efforts which support group formation and action on a community scale to address shared concerns or respond to changes involves the development of citizen agency to effectively respond to change. This is community development. Bhattacharyya (BAH Ta Char e ya)(2004) describes community development work as a process that aims to support citizens in their efforts to “build solidarity and agency through self-help, felt needs, and participation” (p. 5).
Community Intervention is often characterized as Technical, Conflict, or self-help approaches. This chart, adapted from Robinson and Greens’ 2011 Introduction to Community Development, reflects on Intervention characterizations. The philosophy of Community coaching most closely aligns with the “Self-Help” Characterization of Community Development – where the focus of power is held within the citizens of the community. Community Coaching builds citizen and group agency and capacity to self-assess, prioritize, engage others, and act on decisions important to the community. That said, an effective community coach also encourages the coalition to consider when technical assistance and conflict approaches may be appropriate.
At the Heart of Coaching.. Is a process of continuous assessment, review of vision, goal setting, decision making, and action, with the benefit of follow-up and reflection. This is similar to coaching that might take place on an individual level with a personal or business coach.
Consider sustainable structure/ownershipEmery, Hubbell, & Miles-Polka (2011)At a community level, however, Coaching is an intervention that encourages effective group process.While community coalitions focus on the topic and projects at hand, community coaches help also keep a focus on effective PROCESS for group development and community development. A community coach may help the coalition determine their: Readiness = to address difficult change (may involve community understanding of issues and inclusion of appropriate participants)Relationships = including trust and collaboration (involves the development of social capital)Results = by encouraging the establishment of traceable change indicatorsReach = encouraging community teams to take on projects “Large enough to matter.”Reflection = to continuously evaluate, re-assess approaches, and celebrate success.Resiliency = including thoughts of how project investment and effort will be sustained. Through establishing a trusting relationship with the community coalition, the community coach will expand the impact of the work of the coalition, and support the sustainability of the intended community change. As a community development approach, Community Coaching also supports these Community development principles of good practice as established by the Community Development Society.We believe that community coaching is an effective service role that Extension professionals can provide when working with community groups, whether it is for creating change around community level human, environmental, social, economic, political, or cultural initiatives.
Previous efforts in prevention of childhood obesity have focused on individual changes over time, improved nutritional status and increased physical activity. As important as these approaches are, we believe that the Ecological Model asserts that those changes are not sufficient, nor easily achieved in isolation from the larger ecological context. Especially considering the challenges of rural, low income communities. Therefore, our units of study are the communities, 2/state, n=14All communities take part in the assessments, all receive the menu and the funds.The intervention communities receive the services of a Community coach.
The challenge of measuring impact given the design of this project is challenging. We weren’t doing food recalls or weighing children.We looked for assessments that looked at the ecology, the coalitions and we included the voices of the families of interest.
Coalition members think they really “know” their communities. However, they see them from their own socio-economic lens. Choosing CHLI, the Community Healthy Living Index was a way to engage coalition members in investigating their communities. The coalitions broke into teams and used this Index from the YMCA. We chose three sections.
Active Where? Parent Survey was one of my favorites. This was an opportunity to include the voices of the families in the planning process. The Parent Child Survey was done as a paper assessment with assistance from our county Extension colleagues. We modified a few questions that sounded too urban. One unexpected outcome was that one parent joined the coalition after taking the survey.
The Coalition Self-Assessment came to us from Allies against Asthma. This asked individual members to comment on the coalition. We expect to see changes over time in the coalitions both in membership and functioning.
ANNCoalitions will create and implement a plan based on the findings from the Child Ecological Model Assessment Tool Kit, and will implement at least one nutrition and one physical activity strategy to prevent childhood obesity. Organized by the Ecological Model of Childhood Overweight:Community-at-LargeNeighborhoodEarly ChildhoodParent and FamilyGuidelines and Policies
ANN
ANNIn addition, an evaluation plan is being developed using Developmental Evaluation techniques.
Abby will lead a discussion around the ecological model.