Implementing NutriSTEP Ontario - June 09 Webinar

Implementing NutriSTEP ® in Ontario
June 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)

Ethical Screening…
Refer
Provide
Info
Monitor
Parent fills in tool Child not at nutritional risk Provide nutrition info Child at nutrition risk (mod or high) Physician Assess Treat Dietitian Assess Counsel Other Community Parent Programs/Workshops/Services

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 Sites June 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

Parent Phone Interviews
Total Packages Received: 364 (consent: 264)
Interviews conducted: 164
Participation Rate: 62%
43.3% 71 13 58 Thunder Bay 100% 164 35 58 Total 20% 32 9 10 Mod/ High Risk 80% 132 26 48 Low Risk ----- % 100.0% Total 21.3% Sudbury 35.4% York Region %

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 3 rd 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_address]

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_address]
Heather Keller: [email_address]
SDHU PHRED Program
Past project updates and documents: www.sdhu.com
Researcher:
Joanne Beyers: [email_address]
Nutrition Resource Centre
Provincial Program Coordinator:
Lee Rysdale: [email_address]

© 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.

Implementing NutriSTEP Ontario - June 09 Webinar

by Nutrition Resource Centre on Dec 12, 2010

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Implementing NutriSTEP Ontario - June 09 Webinar — Webinar Transcript