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Communities Preventing Childhood Obesity Priester 2013



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  • 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?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: BUILDING:
  • 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.


  • 1. The Communities PreventingChildhood 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
  • 2. Innovative Aspects 7 states collaborating Community capacity development approach Ecological Model of Childhood Overweight  Rural communities  Low-income families  Preschool-aged children
  • 3. Ecological Model of ChildhoodOverweight Socioeconomic Neighborhood status safety Foods School available Parent’s School lunch in home weight PEprogram 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
  • 4. Community Development ApproachGrowing 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.
  • 5. Making an Impact How can a community create an environment where the healthy choice is the easy choice?
  • 6. Role of a CoalitionCommunity coalitions consist of public- and private-sector organizations that,together with individual citizens, work to achieve a shared goal through thecoordinated 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!
  • 7. Success of a Coalition Relies on capacity-building ability of the coalition
  • 8. Barriers to CoalitionSuccess Lack common vision Lack formalizationLack clearly defined roles Failure to reevaluate Failure to act Failure to commit
  • 9. An effective approach to support community development forsustained community change initiatives
  • 10. 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
  • 11. Coaching EffectiveCommunity 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.
  • 12. Planned Approaches to Community InterventionRobinson &Green (2011)
  • 13. At the Heart of CoachingProcess to identify: Current situation Direction and desired outcome Alternatives and implications Choice making Action planning and implementation Reflection, modification and new goal setting
  • 14. Community Coaching for sustainedchange initiativesReadiness 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 respondResiliency Consider sustainable structure/ownership
  • 15.  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
  • 16. 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
  • 17. Community Healthy LivingIndex 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
  • 18. Active Where? ParentSurvey 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
  • 19. Coalition Self-Assessment Annually Identify strengths and weaknesses Determine if available resources are sufficient Determine stage of readiness related to purpose and goals of coalition
  • 20. 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
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. Reference sBhattacharyya, 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.