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Food Safety in Children with
Developmental Disabilities
Assignment # 4:
Presentation
Respite Care Inc.
Claire Calhoun
Kristin Lamb
Rachel Mostek
FSHN 451: Community Nutrition
12/11/2015
Honor Pledge: I have not given, received, or used any unauthorized assistance on this assignment.
Signature: ______________________________________
Signature: ______________________________________
Signature: ______________________________________
Food Safety Intervention Page 1 of 35
Table of Contents
Team & Work Distribution....................................................................................................................2
Team Members, Team Leader .........................................................................................................2
Work Distribution/Plan to Accomplish Team Project ...........................................................................2
Community Partner .............................................................................................................................4
Context: Target Audience & Community Description .............................................................................4
Problem Statement, Project Purpose & Brief Description .......................................................................5
Problem Statement ..........................................................................................................................5
Project Purpose...............................................................................................................................5
Description of Proposed Project .......................................................................................................6
Behavior Change Theory & Research Basis .........................................................................................8
Social Cognitive Theory (SCT) Definition...........................................................................................8
SCT Constructs Selected for This Project & Rationale .......................................................................8
Research Basis .............................................................................................................................10
Lesson Plan Table ............................................................................................................................14
Evaluation Table ...............................................................................................................................16
Logic Model......................................................................................................................................18
Presentation.....................................................................................................................................20
Summary of Findings ........................................................................................................................20
Reflection.........................................................................................................................................21
Acknowledgments.............................................................................................................................22
References.......................................................................................................................................23
Appendices ......................................................................................................................................25
Appendix 1: To evaluate the effects of a simplified hand washing improvement program in
schoolchildren with mild intellectual disability: A pilot study...............................................................26
Appendix 2: Understanding adherence to hand hygiene recommendations: the theory of planned
behavior........................................................................................................................................28
Appendix 3: When and how to wash your hands .............................................................................30
Appendix 4: Lesson Plan for Respite Care .....................................................................................32
Appendix 5: Pre and Post Intervention Observation Sheet ................................................................33
Appendix 6: Check List for Hand Washing Intervention ....................................................................34
Appendix 7: Telephone survery for Respite .....................................................................................35
Food Safety Intervention Page 2 of 35
TEAM & WORK DISTRIBUTION
TEAM MEMBERS, TEAM LEADER
Claire Calhoun, Team Leader
Kristin Lamb
Rachel Mostek
WORK DISTRIBUTION/PLAN TO ACCOMPLISH TEAM PROJECT
Assignment #1:
To complete assignment #1, we were able to evenly distribute all of the tasks in order to
accomplish this portion of the team project. Claire, the team leader, acted as the main
coordinator and contact source for Respite Care Incorporated by initiating the first
contact and setting up our first meeting. She also was in charge of researching regional
statistics and data for WTL #2, as well as participated and worked on all of the WTLs
and Assignment #1. Kristin was in charge of doing researching for the national statistics
on children with developmental disabilities for WTL #2. Kristin also did the main editing
for WTL #2 and WTL #3, and assisted with the completions of WTL #1 and Assignment
#1. Rachel did the research for the state data and statistics, organized the WTLs and
Assignment #1 into Google Documents, and did the final editing of Assignment #1.
Assignment #2:
For assignment #2, our team talked through concepts for our overall submission and
then split up some of the sections for initial drafting. The Context section was drafted by
Rachel. Rachel also did all of the document assembly, final editing, and formatting as
Food Safety Intervention Page 3 of 35
well as AMA citations. The Problem Statement, Description of Proposed Project, and
SCT Descriptions were drafted by Claire. The Project Purpose, Lesson Plan table, and
the Logic Model Table were drafted by Kristin. As a team, we reviewed our assignment
as well as gathered research and participated in the all of the Write to Learn
activities. Each member has also suggested and organized different activities for our
Respite Care volunteer hours.
Assignment #3:
In order to complete our assignment #3 our team worked together to complete all
aspects of this section. Rachel worked on creating the outline for the Lesson Plan for
Respite Care in appendix 4, the Pre and Post Intervention Observation Checklist in
appendix 5, the Checklist for the Hand Washing Intervention in appendix 6, the
Telephone Survey in appendix 7, the appendices, and all the formatting for the project.
Claire helped with the Evaluation Table, worked on revisions to assignment #2, updated
the Research Basis table, helped edit the lesson plan table from assignment #2 and
planned the post intervention activity. Kristin helped with the Evaluation Table, typed up
the summary of findings, wrote the revisions for the lesson plans in the appendix,
helped edit the lesson plan table from assignment #2 as well as researched and
summarized an article for the Research Basis Table.
Assignment #4:
Rachel worked on completing the Summary of Findings and Kristin and Claire worked
on filling in the information for the presentation slides and creating the Presentation
Description. The whole group worked together to edit and polish our Assignment #3
submission as well as our presentation.
Food Safety Intervention Page 4 of 35
COMMUNITY PARTNER
Respite Care is a non-profit organization that specializes in short and long-term care for
youth with developmental disabilities. Their goal is to enhance quality of life for the
youth and to help their families feel relieved by offering 24/7 supportive care. Respite
Care believes that "a child with a disability is a child first and that his or her challenges
are secondary.”1 This philosophy helps them guide their services to encourage social
and life skills while accommodating special needs at a reasonable price. According to
the Early Childhood Council of Larimer County, the average cost of childcare is $211
per week and Respite Care can provide additional services for children with
developmental disabilities at a comparable price that is specific according to the
parent’s income.2
CONTEXT: TARGET AUDIENCE & COMMUNITY DESCRIPTION
According to the Centers for Disease Control and Prevention, it was reported that
13.9% of children had a developmental disability in the United States in 2008.3 The
prevalence for children who have a developmental disability in Colorado in 2007 was
12.1% of the state’s population.4 Roughly 1 in 10 children living in Larimer County in
2011 have a developmental disability.5 Respite’s focus is specified to children with
developmental disabilities living here in Larimer County, CO. According to Natalia
Perea, the program director at Respite Care Inc., the three main developmental
disabilities they help includes autism, Down syndrome, and cerebral palsy. Individuals
with a chronic condition such as autism, Down syndrome, and cerebral palsy have an
Food Safety Intervention Page 5 of 35
increased risk of infection due to an altered range of lymphocytes and the inability to
produce appropriate antibodies.6 Due to this decreased immune function, there is a
major concern for food safety for this population. According to the 2010 Dietary
Guidelines, “hand washing is key to preventing contamination of food with microbes
from raw animal products and from people.”7 Respite Care Inc. is relevant to addressing
the problem of proper food safety, as they are directly responsible for the safety of the
children at Respite Care.
PROBLEM STATEMENT,PROJECT PURPOSE & BRIEF
DESCRIPTION
PROBLEM STATEMENT
Children with developmental disabilities have decreased immune function that causes
them to be more susceptible to infectious microbes. While lower than the national
average of 13.9%, currently 12.1% of kids in Colorado are living with a developmental
disability and that number is still rising. Teaching healthy food handling and food safety
behaviors will have a positive impact on preventing food related infections in this
population. The consequences of not addressing this problem are more doctor visits,
increased medical costs, and decreased quality of life. By supporting life skills and
behavior, Respite Care is encouraging children to develop healthy and safe food habits.
PROJECT PURPOSE
The purpose of our proposed project is to improve food safety procedures at Respite
Care by specifically working on hand washing techniques. The kids at Respite Care
specifically have a harder time recognizing social cues that would normally prompt the
Food Safety Intervention Page 6 of 35
need for hand washing. This can include when kids need to wash their hands before
preparing food, after coughing into their hands, after using the restroom, and before or
after touching their face. We want to focus on improving this behavior because we
believe it could truly benefit the individuals of this community, allowing them to practice
standard health safety habits that they can carry with them into the future.
Hand washing techniques are not only relevant to Respite Care, but it is also important
to all caregivers who work with people that have developmental disabilities. We believe
our program would address everyone within this community because hand washing can
prevent illness from spreading from one person to another, keeping everyone in the
community healthy. Microbes can get onto hands if someone touches an object that has
been contaminated by something that was coughed or sneezed on, and if that person
fails to wash their hands immediately, they can easily spread germs from one person to
another. This is why teaching people about hand washing helps them and their
communities stay healthy. According to the CDC, "hand washing education reduces
respiratory illnesses, like colds, in the general population by 16-21%" which proves how
much of an impact our proposed project can have on the Respite Care community in
general, including the caregivers.8
DESCRIPTION OFPROPOSED PROJECT
The project that we will use at Respite Care is an educational lesson that shows how
germs can spread through contact, and highlight the need for proper food safety and
hand washing behavior. To determine the success of our intervention, we will collect
Food Safety Intervention Page 7 of 35
some observational data about the children's self-initiated hand washing behavior as
well as adherence to prompted hand washing. These observations will take place at
Respite Care during volunteer hours each week leading up to and following the
intervention. The intervention will take place during a one-hour lesson at Respite
Care. The lesson will include a brief overview of germs and how they are linked to
illness. Then, to show the kids how germs are passed through a community, one child
will be picked as the "infected" person. This child will dip their hands into a plate of
paint, to represent the germs. This child will then be instructed to high-five or shake
hands with another child in the group as well as pick up an apple and pass it to another
participant, spreading the paint. This chain will continue through all the children in the
group. We will then talk about how the germs made it all the way around the table and
onto the apple. We will explain how washing their hands will keep the germs from
spreading any further. Once the children wash their hands, they will go back around the
circle shaking hands or giving high-fives to show that now none of the participants are
"infected." In the following weeks, we will plan activities for the kids that incorporate
food preparation and interaction and see if they self-initiate hand washing before the
activity. If they do not, we will also observe the adherence and attitude to prompted
hand washing.
Food Safety Intervention Page 8 of 35
BEHAVIOR CHANGE THEORY & RESEARCH BASIS
SOCIAL COGNITIVE THEORY (SCT) DEFINITION
According to Albert Bandura, the Social Cognitive Theory involves interacting with our surrounding social environment and
forming thoughts and beliefs that form our attitudes and how we respond to stimuli.9 The theory consists of a triangle of
the environment, personal, and behavioral factors which interact with each other and influences behavior.9 These factors
are important to know and understand when attempting to change peoples behaviors as it can help us to understand what
specific factors need to be in place in order to help our group at Respite Care efficiently learn and master food safety.
SCT CONSTRUCTS SELECTED FORTHISPROJECT & RATIONALE
The observational learning construct is defined as behavior change related to observed behavior of others.9 This is
displayed in our intervention by utilizing behavior modeling by peers and mentors at Respite Care. By seeing the
caregivers, volunteers and other Respite Care participants washing their hands before activities, it will help the children
learn successful hand washing behavior as well as the appropriate situations to wash their hands. Also, the use of a
visual representation of germs and asking the children to problem-solve a way to stop the paint spreading will help them
visualize the larger concept in a simple way. This will also encourage the kids to come to their own conclusion that hand
washing is an appropriate behavior when handling food and close interactions.
Food Safety Intervention Page 9 of 35
The behavioral capability construct is defined as the skills and understanding that are needed to accomplish a
specific behavior.9 This construct is displayed in our intervention by teaching the children the benefits of hand washing as
well as the steps required to effectively clean their hands. This will include a focus on using soap, scrubbing hands for the
suggested 20 seconds and rinsing. After learning the skill, they will be more likely to effectively wash their hands without
oversight.
The reciprocal determinism construct is defined as the way that people, actions and environments are interrelated.9
This construct will be displayed in our intervention by visually representing the spread of germs and how interactions with
their environment and other people can be a source of infection. This is the basis knowledge and example that
encourage the learned hand washing behavior to continue based on the children understanding its value.
Food Safety Intervention Page 10 of 35
RESEARCH BASIS
**Complete this table for two selected research studies that support your project design**
Citation
AMA format required; include
copy of article in appendices.
Setting &
Participants
Intervention
description
(include Social
Cognitive Theory
constructs)
Evaluation
strategies
(include how
SCT constructs
were measured)
Describe study
findings relevant to
your project
outcomes
Based on their
results, what
can you expect
from your
project?
Lee R, Lee P. To evaluate the
effects of a simplified hand washing
improvement program in
schoolchildren with mild intellectual
disability: A pilot study. Research in
Developmental Disabilities. 2014
(35); 3014-3025. doi:
10.1016/j.ridd.2014.07.016.
Refer to appendix 1 for an abstract
of study and reference if more
information on the study is needed.
20 school aged (6-
12) children with
mild developmental
disabilities in a
special education
school setting
Half of the students
were part of a
control group and
the other half of the
students were in
the intervention
group and received
a simplified 5 step
hand washing
intervention
demonstration for
15 minutes daily for
four weeks. The
students were
rewarded for good
hand washing by
earning a star on
their achievement
board.
SCT Constructs:
Environment -
creating a physical
representation of
germs and
demonstrating the
methods for
successful hand
washing as well as
modeling situational
cues for hand
washing.
The students
were then shown
their hand
washing
“success”
through glow
gel. The glow gel
is a plastic
“germ” gel that
glows under UV
lighting, and
provided a
picture of how
well the
participants
washed their
hands. The
pictures were
then ranked on a
0-4 scale to
provide pre and
post test
data. The SCT
Constructs were
measured by
how well the
children washed
their hands after
being exposed to
the intervention.
Students who were in
the intervention group
showed significant
improvement in hand
washing skills
compared to the
control group. This
suggests that the use
of multimedia support
and visualization of
quality results were
influential for
improving hand
washing ability. This
relates specifically to
our use of physical
and visual cues for
prompting desired
behaviors and our
ability to gauge
relative quality of hand
washing behavior.
These results
suggest that we
can expect our
intervention
project to
improve the
participant's
hand washing
skills significantly
compared to
groups who do
not get the
intervention.
Food Safety Intervention Page 11 of 35
Citation
AMA format required; include
copy of article in appendices.
Setting &
Participants
Intervention
description
(include Social
Cognitive Theory
constructs)
Evaluation
strategies
(include how
SCT constructs
were measured)
Describe study
findings relevant to
your project
outcomes
Based on their
results, what
can you expect
from your
project?
Behavioral -
capability training
and skill
development for
hand washing.
Personal -
reinforcement of
desired behavior
with tangible
reward system and
promoting self-
efficacy.
Reciprocal
Determinism -
using physical and
social cues to
prompt desired
behaviors that have
been improved
through modeling
and training and
reinforced with a
tangible reward.
O’Boyle CA, Henly SJ, Larson E.
Understanding adherence to hand
hygiene recommendations: the
theory of planned behavior.
American Journal of Infection
Control. 2001 (29); pp 352-360. doi:
120 Healthcare
professionals in a
hospital setting
were used in this
study
The purpose of this
intervention was to
determine how well
healthcare
professionals
adhere to proper
The associations
of cognitive
factors with hand
hygiene
compliance were
studied through a
The observed hand
washing adherence
during the post-
intervention period of
this study was 70%.
The study found that
Participants at
Respite Care will
only wash their
hands without
being prompted
to do so when
Food Safety Intervention Page 12 of 35
Citation
AMA format required; include
copy of article in appendices.
Setting &
Participants
Intervention
description
(include Social
Cognitive Theory
constructs)
Evaluation
strategies
(include how
SCT constructs
were measured)
Describe study
findings relevant to
your project
outcomes
Based on their
results, what
can you expect
from your
project?
10.1067/mic.2001.18405
Refer to appendix 2 for an abstract
of study and reference if more
information on the study is needed.
hand washing and
to study their
motivation behind
proper hand
hygiene. The theory
of planned behavior
was used as a
social cognitive
construct model to
determine whether
or not the health
care workers were
motivated to wash
their hands.
behavioral model
called the theory
of planned
behavior. An
observational
design was used
to collect data
from 120 nurses
employed in a
hospital setting.
The health care
professionals
provided
information
regarding their
motivational
factors and
intentions when it
comes to hand
washing. Each
participant
provided a self
report on how
often they follow
guidelines when
it comes to hand
hygiene. Two
weeks after the
original data was
taken, hand
hygiene
performance was
observed in the
same 120
participants. The
motivation towards
hand hygiene is more
directed towards the
need to wash hands,
rather than internal
motivational factors.
This relates to our
expected project
outcome, considering
participants have been
washing their hands
only when they feel
the absolute need to
and that their internal
motivation for hand
hygiene is low.
they feel the
absolute need to.
For example, the
teens will wash
their hands when
they can see
they are
physically dirty,
but when they do
not see physical
substance that
needs to be
washed off, they
will have no
internal
motivation to
follow proper
hand hygiene.
Food Safety Intervention Page 13 of 35
Citation
AMA format required; include
copy of article in appendices.
Setting &
Participants
Intervention
description
(include Social
Cognitive Theory
constructs)
Evaluation
strategies
(include how
SCT constructs
were measured)
Describe study
findings relevant to
your project
outcomes
Based on their
results, what
can you expect
from your
project?
results were
compared to the
original
observations.
Food Safety Intervention Page 14 of 35
LESSON PLAN TABLE
Specific 2010 Dietary or 2008 Physical Activity Guidelines for Americans emphasized: As part of the 2010 Dietary Guidelines, it is stated
that “ a healthy eating pattern needs not only to promote health and help to decrease the risk of chronic diseases, but it also should prevent
foodborne illness. Four basic food safety principles (Clean, Separate, Cook, and Chill) work together to reduce the risk of foodborne illnesses.”7
**Complete this table for each lesson developed**
Lesson Title Social Cognitive
Theory Constructs
Nutrition or Activity
Message(s)
Learning Objectives Learning Activities Instructional
Materials
Evaluation
Strategies for
learning objectives
“Clean it
Up!” This lesson
will help the
participants
understand visual
and social cues
for prompting
hand washing
behaviors as well
as demonstrating
and practicing
quality hand
washing
techniques.
Observational
Learning - This
construct is
included in our
lesson plan by
having the
participants
observe group
leaders and peers
during hand
washing
activities. This
includes
observing positive
verbal feedback
when others do a
good job,
encouraging them
to do their best.
Behavioral
Capability - This
construct is
included in our
lesson by
teaching and
explaining the
skills associated
Hand washing is
necessary for
proper cleanliness
and the
prevention of
obtaining harmful
microbes.
At the end of this
lesson, the
majority (>50%) of
the participants
will be able to
demonstrate
proper hand
washing
techniques as
measured by
observation. We
will be watching
the participants
wash their hands
to make sure they
are using soap
and scrubbing
their hands for at
least 20 seconds.
The observation
on whether or not
they properly
washed their
hands will be a
simple “yes” or
“no.”
.
Anchor: Have
the participants
think of a time
when their hands
have gotten dirty.
Add: A
discussion about
how not washing
hands can make
you sick.
Apply: Activity to
wash their hands
and show them
how to do so
properly. The
participants will
get their hands
dirty with paint
and spread the
paint amongst
the participants,
as well as have
them touch
various surfaces
to see how
microbes can
spread. Away: A
The instructional
materials we need
for this activity are
hand washing
instructions, non-
toxic washable
paint, butcher
paper, soap,
paper towels and
timers.
We will check for
cleanliness after
handwashing
through visual
observation to
check for
remaining spots
and help the
participants
recognize residual
paint. We will
record how long
they wash their
hands with the
timers. We will
note whether or
not they use soap
without being
prompted. We will
observe the
participants’ ability
to focus on the
task through its
completion by
observing
behavioral
clues. We will ask
Food Safety Intervention Page 15 of 35
Lesson Title Social Cognitive
Theory Constructs
Nutrition or Activity
Message(s)
Learning Objectives Learning Activities Instructional
Materials
Evaluation
Strategies for
learning objectives
with proper hand
washing skills and
giving the
participants an
opportunity to
practice and build
confidence in their
physical
movements.
Reciprocal
Determinism -
This construct is
included in the
fact that the social
environment and
activity are
motivators for the
participants to
want to wash their
hands as well as
modeling
successful hand
washing within
their peer group.
discussion about
why and when to
wash hands and
the importance of
doing so. Have
the participants
brainstorm when
it’s a good time
to wash hands.
the participants
about their
attitudes toward
washing their
hands to gauge
their enthusiasm
on a general scale
of very averse,
averse, neutral,
enthusiastic, and
very enthusiastic.
Food Safety Intervention Page 16 of 35
EVALUATION TABLE
Process Evaluation (these are
measures that will tie to the activities
and participants you outlined in your
logic model)
Impact Evaluation (these tie to the
learning objectives, behavioral
intent, skill demonstrations, etc.,
listed in your lesson plan table
and short term outcomes in your
logic model)
Outcome Evaluation (these tie to the
medium term outcomes listed in your
logic model).
Definition (include
reference)
Process evaluation is a reflection
of how well the intervention was
administered in order to
determine the areas of
improvement. 13
Impact evaluation means
assessing that results are
direct effects of our
intervention.13
Outcome evaluation measures the
number of participants who were
able to change behavior.13
Specific purpose of each
type of evaluation for our
project
The specific purpose is to make
sure that our group was able to
fulfill all tasks of the intervention
in the way we intended and to tell
us if we met our outcome
expectancies of delivering a
successful intervention by
properly completing our checklist.
The purpose of impact
evaluation is to tell us if the
audience actually understood
our intervention and they were
able to learn the importance of
hand washing and how to do
so properly.
The specific purpose of our
outcome evaluation is to measure
the amount of people that change
their habits related to hand washing
as a result of our intervention, and
whether that amount of people met
our expected outcome
1 to 3 4-part objectives for
each type of evaluation
(action, population,
measure of success, time
frame)
1. At the end of our hand washing
intervention, we will have
involved each participant with a
one-on-one interaction of how to
wash his or her hands, as
measured by our observation.
2. At the end of our hand washing
intervention, we will have
explained how germs are spread
to each of the participants, as
measured by our observation.
3. At the end of our hand washing
1. After going through our
painting activity explained in
appendix 4, each participant
will have a better
understanding of how germs
are spread and how they can
be avoided, as measured by
our post-intervention
observation sheet in appendix
5..
1. 6 months later, 50% of
participants will be able to
demonstrate proper hand washing
techniques, as measured by a
survey.
2. 6 months later, 50% of
participants will demonstrate social
awareness by recognizing
appropriate times to wash their
hands, as measured by a survey.
Food Safety Intervention Page 17 of 35
Process Evaluation (these are
measures that will tie to the activities
and participants you outlined in your
logic model)
Impact Evaluation (these tie to the
learning objectives, behavioral
intent, skill demonstrations, etc.,
listed in your lesson plan table
and short term outcomes in your
logic model)
Outcome Evaluation (these tie to the
medium term outcomes listed in your
logic model).
intervention, our group will have
completed all components listed
on the checklist in appendix 6, as
measured by our observation.
2. After teaching the
participants how to effectively
wash their hands which is
explained further in appendix
3, the majority (>50%) of
participants will be able to
demonstrate proper hand
washing techniques, as
measured by our observation.
3. After going through our
painting activity explained as a
part of our lesson plan in
Appendix 4, each participant
will have an increased social
awareness of when it is
appropriate to wash their
hands, as measured by our
observation.
Method/s used to measure
each objective for each
type of evaluation
Observation while completing the
checklist in Appendix 6.
Observation while completing
the pre and post intervention
checklist in Appendix 5.
Telephone survey to current staff
members at Respite as seen in
Appendix 7.
Summary of actual results
OR expected results from
each type of evaluation
method described above
Our actual results showed that
we were successful in completing
all of our objectives by going
through our checklist during the
intervention and making sure that
we covered everything we
intended to.
The hand washing activity the
teens willingly participated in
gave them a better social
awareness of when to wash
their hands, which was a direct
result of our demonstration.
The expected results will be
determined by the telephone
survey as seen in appendix 7. If our
results come out as expected, 50%
of the participants will be able to
demonstrate social awareness by
knowing when and how to properly
wash their hands.
Food Safety Intervention Page 18 of 35
LOGIC MODEL
Inputs Outputs Impact -- Outcomes
Activities Participation Short Medium Long
Food Safety Intervention Page 19 of 35
Inputs Outputs Impact -- Outcomes
Activities Participation Short Medium Long
What was invested by
you & others?
Time from both the staff,
ourselves, and the
participants of respite
care.
Supplies: soap, paper
towels, recording
material like pens and
paper, washable paint,
fruit, and ect.
Assistance from respite
care in order to help the
facilitation during the
lesson and to keep them
washing their hands
even after we are gone.
Research from our group
to make sure our
program is relevant.
What did you do?
Pre-intervention phase:
*Observe the participants at Respite Care
and their food safety skills.
* hand washing habits- observe if the
participants use soap and how long they
scrub their hands for
*proper food handling techniques-
observe whether or not participants use
utensils or grab food with their hands.
Intervention phase:
*implement an educational activity that
teaches the participants about the
importance of hand washing.
*This will include an activity that
demonstrates how easily germs spread
by having the kids put paint on their
hands and touching objects to show the
spread of germs (germs are represented
by paint in the activity).
*Proper hand washing will be
demonstrated by CSU nutrition students
and the participants will be asked to
wash their hands following the same
procedures
Post Intervention Phase:
*Observe participants to see if they
wash their hands properly before eating
 Note whether or not they wash
their hands without being
asked to do so.
Ref er to appendix 4.
(Process Evaluation)
Who did you
reach?
*Respite Care
Caregivers
*Respite Care
Participants
(Process
Evaluation)
What did they
learn? What were
their immediate
changes?
*Skills - Displayed
how to effectively
wash their hands
with soap and water
for 20 seconds.
*Knowledge -
Learned how germs
are spread and how
it can be avoided
*Social Awareness -
Recognize social
cues that prompt
hand washing
behavior
(Impact
Evaluation)
What actions
(behaviors) are
they now
doing?
*Washing their
hands before
handling food
*Washing their
hands after
eating or touching
their mouth/face
*Washing their
hands after using
the bathroom
*Washing their
hands after close
interactions with
others
*Washing their
hands when they
see they are
physically dirty
(Outcome
Evaluation)
How will health
conditions
improve?
*Decreased incidence
of illness
*Increased hygiene
*Decreased days
missed from school
and other learning
environments, like
Respite Care
(Outcome
Evaluation)
Assumptions (beliefs you have aboutyour project, the people involved,
and the way you think the project will work)
External Factors (environmentin which your project exists,interacts
with and influences the impactof your project)
We believe that the participants are capable ofwashing their hands
properly but we believe they will almostalways need some prompting to
do so.We believe that the paint activity will help the participants
understand the need to wash their hands without prompting.
The environment of Respite Care itselfis a fun place for the participants to
be, so we may be dealing with some distractions thatare out of our control
and highly unpredictable.Participants thatare distracted from these
external sources maynotget as much outof the projectthan those who
were not distracted.
Food Safety Intervention Page 20 of 35
PRESENTATION
We will be presenting our project in conjunction with the group who worked with
the younger participants of Respite Care. The presentation will begin with a description
of the community partner and service learning activities that we participated in. This will
lead into an overview of the intervention project that each group created based on the
needs of our specific Respite Care audiences. We will elaborate on the learning
activities and strategies that were implemented in our interventions, as well as the
outcomes and possibilities for improvement. At the end of our presentation we will leave
time for questions and comments.
SUMMARY OF FINDINGS
During our pre-intervention activity at Respite Care (as referred to in appendix 4),
we found that most of the participants washed their hands immediately after the activity
without being prompted to do so. Some of the teens ran their hands under water without
the use of soap, while others washed their hands properly with soap and water.
The day of our intervention, the teens were able to touch paint that represented
microbes. After touching the paint and watching the nutrition students demonstrate how
to properly wash hands, every one of the participants were willing to wash their hands.
While observing their hand washing skills, we found that most of the participants
washed with soap and water, while a few of the participants had to be reminded to use
soap to get the germs off. The teens seemed to enjoy this activity, as most of them
played along with the idea of the paint representing germs.
The post-intervention data was collected the following week. After our craft
activity and before the participants ate the snack provided, we observed the teens to
Food Safety Intervention Page 21 of 35
see if they wash their hands with or without being prompted to do so. We found that the
participants all wanted to wash their hands without being prompted. We also observed
that all participants used effective hand washing techniques (as referred to in appendix
3). It is important to note that only three out of the seven individuals that participated in
the hand washing intervention were able to be at the post-intervention.
During service learning experiences following post-intervention, we noted an
observable difference in the hand washing behavior of the participants. To conclude,
individuals that participated in the intervention overall needed less prompting and were
able to practice effective hand washing techniques.
REFLECTION
During our service learning experiences and hand washing intervention at
Respite, our group learned to create lessons that allowed for different teens to expand
the constructs of a lesson and to make sure to account for individual skill level. We
found that the individuals of Respite had a wide range of abilities, and that it was
important to make sure that everyone could feel included in every activity.
From the information gathered from our project, our group believes that
caretakers and students who desire to work with individuals with developmental
disabilities would be to apply and effectively use this information. Knowing the
importance of teaching individuals of this population in a way that is tailored to each
person’s unique needs is critical in teaching new skills, like hand washing.
There were two major limitation our group ran into while working on this project.
The first limitation of completing this community intervention was the issue of time. Only
having one semester to get to know a community well enough to be able to deliver an
Food Safety Intervention Page 22 of 35
effective intervention is not an easy task. This leads into the second limitation that our
group had. The individuals at Respite have a wide range of developmental disabilities,
which made it hard to come up with a problem that all of the individuals could relate too.
This also limited us from doing a nutritional specific intervention because all of the
individuals had unique nutritional needs. Our group eventually noticed a hand washing
problem with the majority of the individuals and we were able to effectively come up with
an appropriate intervention.
If we were able to repeat this intervention again, we would want to make sure
that we could measure our results better. All of the individuals that participated in the
intervention were not all able to attended the pre and post interventions.
Our project contributes to the field of community nutrition by promoting positive
behavior change, encouraging preventative health measures through food safety, and
addressing a specific problem that is tailored to one community.
ACKNOWLEDGMENTS
We would like to thank Respite Care and the teen participants for their time and
participation with our project. Between providing all the materials for snacks and
activities, encouraging engagement and creating a positive environment, their support
and enthusiasm were essential to the success of our intervention.
Food Safety Intervention Page 23 of 35
REFERENCES
1. Specialized Care. Respite Care Inc website. Available at:
http://respitecareinc.org/specialized-care. Updated 2015. Accessed October 5, 2015.
2. Paying for Child Care. Early Childhood Council of Larimer County website.
Available at: http://www.ecclc.org/families/child-care-referrals/paying-for-child-
care. Updated 2015. Accessed September 20, 2015.
3. Boyle CA, Boulet S, Schieve LA, et al. Trends in the Prevalence of
Developmental Disabilities in US Children 1997-2008. Pediatrics.
2011;127(6):1034-1042.doi:10.1542.2010-2989.
4. Local Disability Data for Planners. Disability Population Statistics for Colorado
website. Available at:
http://disabilityplanningdata.com/site/state_population_table.php?state=colorado.
Updated 2007. Accessed October 25, 2015.
5. Birth Defects. Compass of Larimer County website. Available at:
http://www.larimer.org/compass/birth_defects_h_ph.htm. Updated 2012.
Accessed September 20, 2015.
6. Manzardo AM, Dhillon S, Butler MG. Plasma Cytokine Levels in Children with
Autistic Disorder and Unrelated Siblings. International Journal of Developmental
Neuroscience. 2012;30(2):121-127.doi:10.1016/j.ijdevneu.2011.12.003.
7. Dietary Guidelines. Health.gov website. Available at:
http://health.gov/dietaryguidelines/. Updated 2010. Accessed October 25, 2015.
Food Safety Intervention Page 24 of 35
8. Show Me the Science- Why Wash Your Hands?. CDC website. Available at:
http://www.cdc.gov/handwashing/why-handwashing.html. Updated 2015.
Accessed October 25, 2015.
9. Bandura A. Social Cognitive Theory. Annals of child development. Vol. 6. Six
theories of child development. Greenwich, CT: JAI Press. 1989.
10.Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement
program in schoolchildren with mild intellectual disability: A pilot study. Research
in Developmental Disabilities. 2014 (35); 3014-3025. doi:
10.1016/j.ridd.2014.07.016.
11.O’ Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene
recommendations: the theory of planned behavior. American Journal of Infection
Control. 2001 (29); pp 352-360. doi: 10.1067/mic.2001.18405
12.When & How to Wash Your Hands. Center for Disease Control website.
Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html.
Updated 2015. Accessed October 25, 2015.
13.Nutrition Education: Principles of Sound Impact Evaluation. USDA: Food &
Nutrition Service website. http://www.fns.usda.gov/nutrition-education-principles-
sound-impact-evaluation.html. Updated 2005. Accessed November 12, 2015.
Food Safety Intervention Page 25 of 35
APPENDICES
Appendix 1: To Evaluate the Effects of a Simplified Hand Washing Improvement
Program in Schoolchildren with Mild Intellectual Disability: A Pilot Study
Appendix 2: Understanding adherence to hand hygiene recommendations: the theory of
planned behavior
Appendix 3: When and How to Wash your Hands
Appendix 4: Lesson Plan for Respite Care
Appendix 5: Pre and Post Intervention Observation Sheet
Appendix 6: Checklist for Hand Washing Intervention
Appendix 7: Telephone Survey for Respite
Food Safety Intervention Page 26 of 35
APPENDIX 1: TO EVALUATE THE EFFECTSOF A SIMPLIFIEDHAND WASHING IMPROVEMENT PROGRAM IN
SCHOOLCHILDREN WITH MILD INTELLECTUAL DISABILITY:A PILOTSTUDY
Abstract:
A quasi-experimental study using a pretest–posttest design with a control group was
used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene
improvement program by schoolchildren with mild intellectual disability (MID). A total of
twenty schoolchildren aged 6–12 years old with MID (12 males) were recruited and they
were assigned into intervention (n= 10) and control (n= 10) groups. To evaluate the
quality of their hand washing, Glow gel, which contains plastic simulated germs that are
visible under an ultra-violet lamp, was applied to participants’ hands to assess the
quality of hand washing by comparing the amount of visible Glow gel before and after
hand washing using a 4-point scale. Four raters used this 4-point scale to assess the
quality of hand washing through digital photo images of the participants’ hands. A total
of eight digital photos per participant were taken. A fifteen-minute hand washing training
session was conducted every school day for 4 weeks for the intervention group. Those
in the control group received no training. A multimedia visual package on steps of hand
washing was presented together with a reward system, whereby a number of stars were
earned each week depending on the quality of hand washing. Results showed
encouraging findings, as the schoolchildren in the intervention group showed significant
improvement in hand washing ( p < 0.001) and the improvement was stronger than that
of the control group ( p = 0.02). To conclude, a systematic instruction emphasizing
multimedia visualization in a hand washing improvement program can be successfully
implemented in a special school, and the effect of integrating multimedia visuals in the
hand hygiene program could improve hand hygiene among schoolchildren with MID.
Food Safety Intervention Page 27 of 35
Reference:
Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement
program in schoolchildren with mild intellectual disability: A pilot study. Research in
Developmental Disabilities. 2014 (35); 3014-3025. doi: 10.1016/j.ridd.2014.07.016.
Food Safety Intervention Page 28 of 35
APPENDIX 2: UNDERSTANDING ADHERENCE TOHAND HYGIENE RECOMMENDATIONS: THE THEORYOF
PLANNED BEHAVIOR
Abstract:
Background: Most health care workers (HCWs) are aware of the rationale for hand
hygiene procedures, yet failure to adhere to guidelines is common. Little is known about
factors that motivate HCWs to practice hand hygiene. Purpose: The purposes of this
study were to (1) estimate adherence to hand hygiene recommendations; (2) describe
relationships among motivational factors, adherence, and intensity of nursing unit
activity; and (3) test an explanatory model for adherence to hand hygiene guidelines
based on the theory of planned behavior (TPB). Method: A longitudinal, observational
design was used to collect data from 120 registered nurses employed in critical care
and postcritical care units. Nurses provided information about motivational factors and
intentions and a self-report of the proportion of time they followed guidelines. At least 2
weeks later, the nurses' hand hygiene performance was observed while they provided
patient care. Structural equation modeling was used to test the TPB-based
model.Results: Rate of adherence to recommendations for 1248 hand hygiene
indications was 70%. The correlation between self-reported and observed adherence to
handwashing recommendations was low (r = 0.21). TPB variables predicted intention to
handwash, and intention was related to self-reported hand hygiene. Intensity of activity
in the nursing unit, rather than TPB variables, predicted observed adherence to hand
hygiene recommendations. Conclusions: The limited association between self-reported
and observed hand hygiene scores remains an enigma to be explained. Actual hand
hygiene behavior may be more sensitive to the intensity of work activity in the clinical
setting than to internal motivational factors. (Am J Infect Control 2001;29:352-60.)
Food Safety Intervention Page 29 of 35
Reference:
O’Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene
recommendations: the theory of planned behavior. American Journal of Infection
Control. 2001 (29); pp 352-360. doi: 10.1067/mic.2001.18405.
Food Safety Intervention Page 30 of 35
APPENDIX 3: WHEN AND HOWTO WASH YOUR HANDS
1.1.1 When should you wash your hands?
 Before, during, and after preparing food
 Before eating food
 Before and after caring for someone who is sick
 Before and after treating a cut or wound
 After using the toilet
 After changing diapers or cleaning up a child who has used the toilet
 After blowing your nose, coughing, or sneezing
 After touching an animal, animal feed, or animal waste
 After handling pet food or pet treats
 After touching garbage
1.1.2 How should you wash your hands?
 Wet your hands with clean, running water (warm or cold), turn off the tap, and apply
soap.
 Lather your hands by rubbing them together with the soap. Be sure to lather the
backs of your hands, between your fingers, and under your nails.
 Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday"
song from beginning to end twice.
 Rinse your hands well under clean, running water.
 Dry your hands using a clean towel or air dry them
Food Safety Intervention Page 31 of 35
1.1.3 What should you do if you don’t have soap and clean, running water?
Washing hands with soap and water is the best way to reduce the number of germs on
them in most situations. If soap and water are not available, use an alcohol-based hand
sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly
reduce the number of germs on hands in some situations, but sanitizers
do not eliminate all types of germs.
Hand sanitizers are not as effective when hands are visibly dirty or greasy.
How do you use hand sanitizers?
 Apply the product to the palm of one hand (read the label to learn the correct
amount).
 Rub your hands together.
 Rub the product over all surfaces of your hands and fingers until your hands are dry.
Reference:
CDC. When & How to Wash Your Hands. Handwashing.2015 Available at:
http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 25,
2015.
Food Safety Intervention Page 32 of 35
APPENDIX 4: LESSON PLAN FOR RESPITE CARE
Day 1: Pre intervention day
 Introduce ourselves
 Get started on activity for the day
o Bring in shaving cream and set up area for activity
o Prompt the participants to spray shaving cream on table and encourage them to play with
it
o After 15-20 minutes, have the participants help with cleaning up the shaving cream.
o This is when we will observe the participants to see it they wash their hands with out
prompting to do so
 Get started on a next activity including cookie decorations
o Have them be creative with their cookie and give them 15-20 for decorating and eating
o Help them clean up area by swiping, washing counters, and observe again to see if they
know when to wash their hands without being prompted
 Thank them for their time and tell them we will be back again next week
Day 2: Intervention day
 Introduce ourselves
 Get started on paint activity
o Rub paint on participants hands
o Tell them paint is representative of microbes
o Have them touch other hands so they can see how germs are spread
o Have them touch the table as another example of how germs are spread
 Debrief activity with them
o By the end they should feel the need to wash their hands thoroughly with soap and water
 Next activity showing them how to wash their hands
o Follow instructions indicated by appendix 3
 Talk about when they should wash their hands
o Have them brainstorm some ideas of when is appropriate
 Start snack activity
o Have participants prepare chocolate covered fruit with their recently washed hands
o Have participants help clean up and wash their hands again when they are done
 Thank them for their time for the day and tell them we will be back the following week
Day 3: post-intervention day
 Introduce ourselves
 Get started on a craft activity
o Have participants pick out a piece of colored paper
o Help them trace their hand on the paper
o Cut out their hand print and have them decorate it as a turkey
 Start the next activity by setting up chips and dip for their snack
o Observe whether or not participants wash hands without being prompted to do so
o Observe how effective their hand washing seems to be
o Allow them to dip chips in their choice of dip that will be in their individual bowl to prevent
germs
o Have them help with clean up and observe if they fell like washing their hands again
 Thank them for their time
Food Safety Intervention Page 33 of 35
APPENDIX 5: PRE AND POST INTERVENTION OBSERVATION SHEET
Participant
name:
Felt need
wash hands
without
prompting
Washed
hands
Soap
was
used
Hands
appeared
clean
Washed
hands for
longer
than 20
seconds
Other
things to
note
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13
Food Safety Intervention Page 34 of 35
APPENDIX 6: CHECK LIST FOR HAND WASHING INTERVENTION
Checklist completed by: __________________________________
Date:_____________________
Section of intervention:
Time pertaining
sections of the
intervention:
Completed?
Introduction: names 4:00-4:01pm
Introduction: introduce what we are planning on doing
today including: a paint activity, learning how to wash
hands, and making dark chocolate covered fruit.
4:01-4:04pm
Begin paint activity: introduce activity by explaining
that the paint will represent germs and explain that we
will have them touch objects and other’s hands to
show how easy it is to spread germs
4:04-4:07pm
Squeeze some paint in the hands of 3-5 volunteers
and have them begin the activity
4:07-4:15pm
Explain how easy germ are spread and end the paint
activity
4:15-4:18pm
Begin hand washing activity: explain washing their
hands often can help protect them against getting sick
4:18-4:20pm
Explain the process of how to wash their hands with
the visual help of our “how to” poster
4:20-4:23pm
Have one on ones with each participant and make
sure everyone is involved and all hands are clean
before starting the food activity
4:23-4:35pm
Begin food activity: get all of the participants to get
gloves on and explain that we will be dipping fruit in
dark chocolate for the snack
4:35-4:40pm
Have the participants pick their own fruit and dip the
fruit in the chocolate by themselves. Once participants
are done dipping the fruit in the chocolate they may
go enjoy their snack
4:40-4:55pm
Help clean up and thank everyone for their time and
tell them that we will be back next week to do another
craft and snack (this is when we will see if they
remember to wash their hands before preparing food
after they have dirtied their hands with craft time)
4:55-5:00pm
Food Safety Intervention Page 35 of 35
APPENDIX 7: TELEPHONE SURVERY FOR RESPITE
TELEPHONE SURVEY ON HAND WASHING INTERVENTION
Respite Care Inc.
To be administered to 10 employees 6 months after intervention
Script:
Hello, this is ________________________________ from Colorado State University, 6 months ago we
did a hand washing intervention with some participants at Respite and we were inquiring whether we
could get your opinion on how some of the participants have been affected by this intervention.
If they allow for the telephone survey go forward, if they decline the telephone
interview, ask to talk to the direct supervisor to get any interview with them.
Questions:
Please respond to the first few statements with whether you agree or
disagree.
1. The majority of participants wash their hands more often than before
the intervention.
2. The majority of participants need prompting the wash their hands.
3. When washing hands, the participants wash for more than 20
seconds.
4. When washing hands, the participants use soap.
5. When washing hands, the participants use a towel or something
clean to dry their hands off with.
6. The hand washing intervention made an impact on the participants.
7. The majority of participants recognize when it is appropriate to wash
their hands.
8. The majority of participants wash their hands less often than before
the intervention.
9. The majority of participants do not require prompting on when it is
time to wash their hands.
10. When washing hands, the participants wash for less than 20
seconds.
11. When washing hands, the participants don’t use soap.
12. When washing hands, the participants use their shirt or some other
surface to dry their hands with.
13. The hand washing intervention made little to no impact on the participants.
14. The majority of participants can not recognize appropriate times to wash their hands.
The next section requires a little more information so please respond with the best answer that
you see fit.
1. How many of the participants wash their hands without being
prompted?
2. How many of the participants wash their hands for 20 seconds
or more with soap and use an appropriate drying technique?
3. How many of the participants have an understanding of what
germs are and how they are spread?
4. Is there anything you would improve about the intervention?
5. What was the most affective part of the intervention?
6. Anything else you would like to share with us at this time?
Thank you for answering our questions! We appreciate your time and
wish everyone at Respite the best! Have a great day!
Circle One
1. Agree/ disagree
2. Agree/ disagree
3. Agree/ disagree
4. Agree/ disagree
5. Agree/ disagree
6. Agree/ disagree
7. Agree/ disagree
8. Agree/ disagree
9. Agree/ disagree
10. Agree/ disagree
11. Agree/ disagree
12. Agree/ disagree
13. Agree/ disagree
14. Agree/ disagree
1.
2.
3.
4.
5.
6.

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Assignment #4_ final no mark up

  • 1. Food Safety in Children with Developmental Disabilities Assignment # 4: Presentation Respite Care Inc. Claire Calhoun Kristin Lamb Rachel Mostek FSHN 451: Community Nutrition 12/11/2015 Honor Pledge: I have not given, received, or used any unauthorized assistance on this assignment. Signature: ______________________________________ Signature: ______________________________________ Signature: ______________________________________
  • 2. Food Safety Intervention Page 1 of 35 Table of Contents Team & Work Distribution....................................................................................................................2 Team Members, Team Leader .........................................................................................................2 Work Distribution/Plan to Accomplish Team Project ...........................................................................2 Community Partner .............................................................................................................................4 Context: Target Audience & Community Description .............................................................................4 Problem Statement, Project Purpose & Brief Description .......................................................................5 Problem Statement ..........................................................................................................................5 Project Purpose...............................................................................................................................5 Description of Proposed Project .......................................................................................................6 Behavior Change Theory & Research Basis .........................................................................................8 Social Cognitive Theory (SCT) Definition...........................................................................................8 SCT Constructs Selected for This Project & Rationale .......................................................................8 Research Basis .............................................................................................................................10 Lesson Plan Table ............................................................................................................................14 Evaluation Table ...............................................................................................................................16 Logic Model......................................................................................................................................18 Presentation.....................................................................................................................................20 Summary of Findings ........................................................................................................................20 Reflection.........................................................................................................................................21 Acknowledgments.............................................................................................................................22 References.......................................................................................................................................23 Appendices ......................................................................................................................................25 Appendix 1: To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study...............................................................26 Appendix 2: Understanding adherence to hand hygiene recommendations: the theory of planned behavior........................................................................................................................................28 Appendix 3: When and how to wash your hands .............................................................................30 Appendix 4: Lesson Plan for Respite Care .....................................................................................32 Appendix 5: Pre and Post Intervention Observation Sheet ................................................................33 Appendix 6: Check List for Hand Washing Intervention ....................................................................34 Appendix 7: Telephone survery for Respite .....................................................................................35
  • 3. Food Safety Intervention Page 2 of 35 TEAM & WORK DISTRIBUTION TEAM MEMBERS, TEAM LEADER Claire Calhoun, Team Leader Kristin Lamb Rachel Mostek WORK DISTRIBUTION/PLAN TO ACCOMPLISH TEAM PROJECT Assignment #1: To complete assignment #1, we were able to evenly distribute all of the tasks in order to accomplish this portion of the team project. Claire, the team leader, acted as the main coordinator and contact source for Respite Care Incorporated by initiating the first contact and setting up our first meeting. She also was in charge of researching regional statistics and data for WTL #2, as well as participated and worked on all of the WTLs and Assignment #1. Kristin was in charge of doing researching for the national statistics on children with developmental disabilities for WTL #2. Kristin also did the main editing for WTL #2 and WTL #3, and assisted with the completions of WTL #1 and Assignment #1. Rachel did the research for the state data and statistics, organized the WTLs and Assignment #1 into Google Documents, and did the final editing of Assignment #1. Assignment #2: For assignment #2, our team talked through concepts for our overall submission and then split up some of the sections for initial drafting. The Context section was drafted by Rachel. Rachel also did all of the document assembly, final editing, and formatting as
  • 4. Food Safety Intervention Page 3 of 35 well as AMA citations. The Problem Statement, Description of Proposed Project, and SCT Descriptions were drafted by Claire. The Project Purpose, Lesson Plan table, and the Logic Model Table were drafted by Kristin. As a team, we reviewed our assignment as well as gathered research and participated in the all of the Write to Learn activities. Each member has also suggested and organized different activities for our Respite Care volunteer hours. Assignment #3: In order to complete our assignment #3 our team worked together to complete all aspects of this section. Rachel worked on creating the outline for the Lesson Plan for Respite Care in appendix 4, the Pre and Post Intervention Observation Checklist in appendix 5, the Checklist for the Hand Washing Intervention in appendix 6, the Telephone Survey in appendix 7, the appendices, and all the formatting for the project. Claire helped with the Evaluation Table, worked on revisions to assignment #2, updated the Research Basis table, helped edit the lesson plan table from assignment #2 and planned the post intervention activity. Kristin helped with the Evaluation Table, typed up the summary of findings, wrote the revisions for the lesson plans in the appendix, helped edit the lesson plan table from assignment #2 as well as researched and summarized an article for the Research Basis Table. Assignment #4: Rachel worked on completing the Summary of Findings and Kristin and Claire worked on filling in the information for the presentation slides and creating the Presentation Description. The whole group worked together to edit and polish our Assignment #3 submission as well as our presentation.
  • 5. Food Safety Intervention Page 4 of 35 COMMUNITY PARTNER Respite Care is a non-profit organization that specializes in short and long-term care for youth with developmental disabilities. Their goal is to enhance quality of life for the youth and to help their families feel relieved by offering 24/7 supportive care. Respite Care believes that "a child with a disability is a child first and that his or her challenges are secondary.”1 This philosophy helps them guide their services to encourage social and life skills while accommodating special needs at a reasonable price. According to the Early Childhood Council of Larimer County, the average cost of childcare is $211 per week and Respite Care can provide additional services for children with developmental disabilities at a comparable price that is specific according to the parent’s income.2 CONTEXT: TARGET AUDIENCE & COMMUNITY DESCRIPTION According to the Centers for Disease Control and Prevention, it was reported that 13.9% of children had a developmental disability in the United States in 2008.3 The prevalence for children who have a developmental disability in Colorado in 2007 was 12.1% of the state’s population.4 Roughly 1 in 10 children living in Larimer County in 2011 have a developmental disability.5 Respite’s focus is specified to children with developmental disabilities living here in Larimer County, CO. According to Natalia Perea, the program director at Respite Care Inc., the three main developmental disabilities they help includes autism, Down syndrome, and cerebral palsy. Individuals with a chronic condition such as autism, Down syndrome, and cerebral palsy have an
  • 6. Food Safety Intervention Page 5 of 35 increased risk of infection due to an altered range of lymphocytes and the inability to produce appropriate antibodies.6 Due to this decreased immune function, there is a major concern for food safety for this population. According to the 2010 Dietary Guidelines, “hand washing is key to preventing contamination of food with microbes from raw animal products and from people.”7 Respite Care Inc. is relevant to addressing the problem of proper food safety, as they are directly responsible for the safety of the children at Respite Care. PROBLEM STATEMENT,PROJECT PURPOSE & BRIEF DESCRIPTION PROBLEM STATEMENT Children with developmental disabilities have decreased immune function that causes them to be more susceptible to infectious microbes. While lower than the national average of 13.9%, currently 12.1% of kids in Colorado are living with a developmental disability and that number is still rising. Teaching healthy food handling and food safety behaviors will have a positive impact on preventing food related infections in this population. The consequences of not addressing this problem are more doctor visits, increased medical costs, and decreased quality of life. By supporting life skills and behavior, Respite Care is encouraging children to develop healthy and safe food habits. PROJECT PURPOSE The purpose of our proposed project is to improve food safety procedures at Respite Care by specifically working on hand washing techniques. The kids at Respite Care specifically have a harder time recognizing social cues that would normally prompt the
  • 7. Food Safety Intervention Page 6 of 35 need for hand washing. This can include when kids need to wash their hands before preparing food, after coughing into their hands, after using the restroom, and before or after touching their face. We want to focus on improving this behavior because we believe it could truly benefit the individuals of this community, allowing them to practice standard health safety habits that they can carry with them into the future. Hand washing techniques are not only relevant to Respite Care, but it is also important to all caregivers who work with people that have developmental disabilities. We believe our program would address everyone within this community because hand washing can prevent illness from spreading from one person to another, keeping everyone in the community healthy. Microbes can get onto hands if someone touches an object that has been contaminated by something that was coughed or sneezed on, and if that person fails to wash their hands immediately, they can easily spread germs from one person to another. This is why teaching people about hand washing helps them and their communities stay healthy. According to the CDC, "hand washing education reduces respiratory illnesses, like colds, in the general population by 16-21%" which proves how much of an impact our proposed project can have on the Respite Care community in general, including the caregivers.8 DESCRIPTION OFPROPOSED PROJECT The project that we will use at Respite Care is an educational lesson that shows how germs can spread through contact, and highlight the need for proper food safety and hand washing behavior. To determine the success of our intervention, we will collect
  • 8. Food Safety Intervention Page 7 of 35 some observational data about the children's self-initiated hand washing behavior as well as adherence to prompted hand washing. These observations will take place at Respite Care during volunteer hours each week leading up to and following the intervention. The intervention will take place during a one-hour lesson at Respite Care. The lesson will include a brief overview of germs and how they are linked to illness. Then, to show the kids how germs are passed through a community, one child will be picked as the "infected" person. This child will dip their hands into a plate of paint, to represent the germs. This child will then be instructed to high-five or shake hands with another child in the group as well as pick up an apple and pass it to another participant, spreading the paint. This chain will continue through all the children in the group. We will then talk about how the germs made it all the way around the table and onto the apple. We will explain how washing their hands will keep the germs from spreading any further. Once the children wash their hands, they will go back around the circle shaking hands or giving high-fives to show that now none of the participants are "infected." In the following weeks, we will plan activities for the kids that incorporate food preparation and interaction and see if they self-initiate hand washing before the activity. If they do not, we will also observe the adherence and attitude to prompted hand washing.
  • 9. Food Safety Intervention Page 8 of 35 BEHAVIOR CHANGE THEORY & RESEARCH BASIS SOCIAL COGNITIVE THEORY (SCT) DEFINITION According to Albert Bandura, the Social Cognitive Theory involves interacting with our surrounding social environment and forming thoughts and beliefs that form our attitudes and how we respond to stimuli.9 The theory consists of a triangle of the environment, personal, and behavioral factors which interact with each other and influences behavior.9 These factors are important to know and understand when attempting to change peoples behaviors as it can help us to understand what specific factors need to be in place in order to help our group at Respite Care efficiently learn and master food safety. SCT CONSTRUCTS SELECTED FORTHISPROJECT & RATIONALE The observational learning construct is defined as behavior change related to observed behavior of others.9 This is displayed in our intervention by utilizing behavior modeling by peers and mentors at Respite Care. By seeing the caregivers, volunteers and other Respite Care participants washing their hands before activities, it will help the children learn successful hand washing behavior as well as the appropriate situations to wash their hands. Also, the use of a visual representation of germs and asking the children to problem-solve a way to stop the paint spreading will help them visualize the larger concept in a simple way. This will also encourage the kids to come to their own conclusion that hand washing is an appropriate behavior when handling food and close interactions.
  • 10. Food Safety Intervention Page 9 of 35 The behavioral capability construct is defined as the skills and understanding that are needed to accomplish a specific behavior.9 This construct is displayed in our intervention by teaching the children the benefits of hand washing as well as the steps required to effectively clean their hands. This will include a focus on using soap, scrubbing hands for the suggested 20 seconds and rinsing. After learning the skill, they will be more likely to effectively wash their hands without oversight. The reciprocal determinism construct is defined as the way that people, actions and environments are interrelated.9 This construct will be displayed in our intervention by visually representing the spread of germs and how interactions with their environment and other people can be a source of infection. This is the basis knowledge and example that encourage the learned hand washing behavior to continue based on the children understanding its value.
  • 11. Food Safety Intervention Page 10 of 35 RESEARCH BASIS **Complete this table for two selected research studies that support your project design** Citation AMA format required; include copy of article in appendices. Setting & Participants Intervention description (include Social Cognitive Theory constructs) Evaluation strategies (include how SCT constructs were measured) Describe study findings relevant to your project outcomes Based on their results, what can you expect from your project? Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study. Research in Developmental Disabilities. 2014 (35); 3014-3025. doi: 10.1016/j.ridd.2014.07.016. Refer to appendix 1 for an abstract of study and reference if more information on the study is needed. 20 school aged (6- 12) children with mild developmental disabilities in a special education school setting Half of the students were part of a control group and the other half of the students were in the intervention group and received a simplified 5 step hand washing intervention demonstration for 15 minutes daily for four weeks. The students were rewarded for good hand washing by earning a star on their achievement board. SCT Constructs: Environment - creating a physical representation of germs and demonstrating the methods for successful hand washing as well as modeling situational cues for hand washing. The students were then shown their hand washing “success” through glow gel. The glow gel is a plastic “germ” gel that glows under UV lighting, and provided a picture of how well the participants washed their hands. The pictures were then ranked on a 0-4 scale to provide pre and post test data. The SCT Constructs were measured by how well the children washed their hands after being exposed to the intervention. Students who were in the intervention group showed significant improvement in hand washing skills compared to the control group. This suggests that the use of multimedia support and visualization of quality results were influential for improving hand washing ability. This relates specifically to our use of physical and visual cues for prompting desired behaviors and our ability to gauge relative quality of hand washing behavior. These results suggest that we can expect our intervention project to improve the participant's hand washing skills significantly compared to groups who do not get the intervention.
  • 12. Food Safety Intervention Page 11 of 35 Citation AMA format required; include copy of article in appendices. Setting & Participants Intervention description (include Social Cognitive Theory constructs) Evaluation strategies (include how SCT constructs were measured) Describe study findings relevant to your project outcomes Based on their results, what can you expect from your project? Behavioral - capability training and skill development for hand washing. Personal - reinforcement of desired behavior with tangible reward system and promoting self- efficacy. Reciprocal Determinism - using physical and social cues to prompt desired behaviors that have been improved through modeling and training and reinforced with a tangible reward. O’Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American Journal of Infection Control. 2001 (29); pp 352-360. doi: 120 Healthcare professionals in a hospital setting were used in this study The purpose of this intervention was to determine how well healthcare professionals adhere to proper The associations of cognitive factors with hand hygiene compliance were studied through a The observed hand washing adherence during the post- intervention period of this study was 70%. The study found that Participants at Respite Care will only wash their hands without being prompted to do so when
  • 13. Food Safety Intervention Page 12 of 35 Citation AMA format required; include copy of article in appendices. Setting & Participants Intervention description (include Social Cognitive Theory constructs) Evaluation strategies (include how SCT constructs were measured) Describe study findings relevant to your project outcomes Based on their results, what can you expect from your project? 10.1067/mic.2001.18405 Refer to appendix 2 for an abstract of study and reference if more information on the study is needed. hand washing and to study their motivation behind proper hand hygiene. The theory of planned behavior was used as a social cognitive construct model to determine whether or not the health care workers were motivated to wash their hands. behavioral model called the theory of planned behavior. An observational design was used to collect data from 120 nurses employed in a hospital setting. The health care professionals provided information regarding their motivational factors and intentions when it comes to hand washing. Each participant provided a self report on how often they follow guidelines when it comes to hand hygiene. Two weeks after the original data was taken, hand hygiene performance was observed in the same 120 participants. The motivation towards hand hygiene is more directed towards the need to wash hands, rather than internal motivational factors. This relates to our expected project outcome, considering participants have been washing their hands only when they feel the absolute need to and that their internal motivation for hand hygiene is low. they feel the absolute need to. For example, the teens will wash their hands when they can see they are physically dirty, but when they do not see physical substance that needs to be washed off, they will have no internal motivation to follow proper hand hygiene.
  • 14. Food Safety Intervention Page 13 of 35 Citation AMA format required; include copy of article in appendices. Setting & Participants Intervention description (include Social Cognitive Theory constructs) Evaluation strategies (include how SCT constructs were measured) Describe study findings relevant to your project outcomes Based on their results, what can you expect from your project? results were compared to the original observations.
  • 15. Food Safety Intervention Page 14 of 35 LESSON PLAN TABLE Specific 2010 Dietary or 2008 Physical Activity Guidelines for Americans emphasized: As part of the 2010 Dietary Guidelines, it is stated that “ a healthy eating pattern needs not only to promote health and help to decrease the risk of chronic diseases, but it also should prevent foodborne illness. Four basic food safety principles (Clean, Separate, Cook, and Chill) work together to reduce the risk of foodborne illnesses.”7 **Complete this table for each lesson developed** Lesson Title Social Cognitive Theory Constructs Nutrition or Activity Message(s) Learning Objectives Learning Activities Instructional Materials Evaluation Strategies for learning objectives “Clean it Up!” This lesson will help the participants understand visual and social cues for prompting hand washing behaviors as well as demonstrating and practicing quality hand washing techniques. Observational Learning - This construct is included in our lesson plan by having the participants observe group leaders and peers during hand washing activities. This includes observing positive verbal feedback when others do a good job, encouraging them to do their best. Behavioral Capability - This construct is included in our lesson by teaching and explaining the skills associated Hand washing is necessary for proper cleanliness and the prevention of obtaining harmful microbes. At the end of this lesson, the majority (>50%) of the participants will be able to demonstrate proper hand washing techniques as measured by observation. We will be watching the participants wash their hands to make sure they are using soap and scrubbing their hands for at least 20 seconds. The observation on whether or not they properly washed their hands will be a simple “yes” or “no.” . Anchor: Have the participants think of a time when their hands have gotten dirty. Add: A discussion about how not washing hands can make you sick. Apply: Activity to wash their hands and show them how to do so properly. The participants will get their hands dirty with paint and spread the paint amongst the participants, as well as have them touch various surfaces to see how microbes can spread. Away: A The instructional materials we need for this activity are hand washing instructions, non- toxic washable paint, butcher paper, soap, paper towels and timers. We will check for cleanliness after handwashing through visual observation to check for remaining spots and help the participants recognize residual paint. We will record how long they wash their hands with the timers. We will note whether or not they use soap without being prompted. We will observe the participants’ ability to focus on the task through its completion by observing behavioral clues. We will ask
  • 16. Food Safety Intervention Page 15 of 35 Lesson Title Social Cognitive Theory Constructs Nutrition or Activity Message(s) Learning Objectives Learning Activities Instructional Materials Evaluation Strategies for learning objectives with proper hand washing skills and giving the participants an opportunity to practice and build confidence in their physical movements. Reciprocal Determinism - This construct is included in the fact that the social environment and activity are motivators for the participants to want to wash their hands as well as modeling successful hand washing within their peer group. discussion about why and when to wash hands and the importance of doing so. Have the participants brainstorm when it’s a good time to wash hands. the participants about their attitudes toward washing their hands to gauge their enthusiasm on a general scale of very averse, averse, neutral, enthusiastic, and very enthusiastic.
  • 17. Food Safety Intervention Page 16 of 35 EVALUATION TABLE Process Evaluation (these are measures that will tie to the activities and participants you outlined in your logic model) Impact Evaluation (these tie to the learning objectives, behavioral intent, skill demonstrations, etc., listed in your lesson plan table and short term outcomes in your logic model) Outcome Evaluation (these tie to the medium term outcomes listed in your logic model). Definition (include reference) Process evaluation is a reflection of how well the intervention was administered in order to determine the areas of improvement. 13 Impact evaluation means assessing that results are direct effects of our intervention.13 Outcome evaluation measures the number of participants who were able to change behavior.13 Specific purpose of each type of evaluation for our project The specific purpose is to make sure that our group was able to fulfill all tasks of the intervention in the way we intended and to tell us if we met our outcome expectancies of delivering a successful intervention by properly completing our checklist. The purpose of impact evaluation is to tell us if the audience actually understood our intervention and they were able to learn the importance of hand washing and how to do so properly. The specific purpose of our outcome evaluation is to measure the amount of people that change their habits related to hand washing as a result of our intervention, and whether that amount of people met our expected outcome 1 to 3 4-part objectives for each type of evaluation (action, population, measure of success, time frame) 1. At the end of our hand washing intervention, we will have involved each participant with a one-on-one interaction of how to wash his or her hands, as measured by our observation. 2. At the end of our hand washing intervention, we will have explained how germs are spread to each of the participants, as measured by our observation. 3. At the end of our hand washing 1. After going through our painting activity explained in appendix 4, each participant will have a better understanding of how germs are spread and how they can be avoided, as measured by our post-intervention observation sheet in appendix 5.. 1. 6 months later, 50% of participants will be able to demonstrate proper hand washing techniques, as measured by a survey. 2. 6 months later, 50% of participants will demonstrate social awareness by recognizing appropriate times to wash their hands, as measured by a survey.
  • 18. Food Safety Intervention Page 17 of 35 Process Evaluation (these are measures that will tie to the activities and participants you outlined in your logic model) Impact Evaluation (these tie to the learning objectives, behavioral intent, skill demonstrations, etc., listed in your lesson plan table and short term outcomes in your logic model) Outcome Evaluation (these tie to the medium term outcomes listed in your logic model). intervention, our group will have completed all components listed on the checklist in appendix 6, as measured by our observation. 2. After teaching the participants how to effectively wash their hands which is explained further in appendix 3, the majority (>50%) of participants will be able to demonstrate proper hand washing techniques, as measured by our observation. 3. After going through our painting activity explained as a part of our lesson plan in Appendix 4, each participant will have an increased social awareness of when it is appropriate to wash their hands, as measured by our observation. Method/s used to measure each objective for each type of evaluation Observation while completing the checklist in Appendix 6. Observation while completing the pre and post intervention checklist in Appendix 5. Telephone survey to current staff members at Respite as seen in Appendix 7. Summary of actual results OR expected results from each type of evaluation method described above Our actual results showed that we were successful in completing all of our objectives by going through our checklist during the intervention and making sure that we covered everything we intended to. The hand washing activity the teens willingly participated in gave them a better social awareness of when to wash their hands, which was a direct result of our demonstration. The expected results will be determined by the telephone survey as seen in appendix 7. If our results come out as expected, 50% of the participants will be able to demonstrate social awareness by knowing when and how to properly wash their hands.
  • 19. Food Safety Intervention Page 18 of 35 LOGIC MODEL Inputs Outputs Impact -- Outcomes Activities Participation Short Medium Long
  • 20. Food Safety Intervention Page 19 of 35 Inputs Outputs Impact -- Outcomes Activities Participation Short Medium Long What was invested by you & others? Time from both the staff, ourselves, and the participants of respite care. Supplies: soap, paper towels, recording material like pens and paper, washable paint, fruit, and ect. Assistance from respite care in order to help the facilitation during the lesson and to keep them washing their hands even after we are gone. Research from our group to make sure our program is relevant. What did you do? Pre-intervention phase: *Observe the participants at Respite Care and their food safety skills. * hand washing habits- observe if the participants use soap and how long they scrub their hands for *proper food handling techniques- observe whether or not participants use utensils or grab food with their hands. Intervention phase: *implement an educational activity that teaches the participants about the importance of hand washing. *This will include an activity that demonstrates how easily germs spread by having the kids put paint on their hands and touching objects to show the spread of germs (germs are represented by paint in the activity). *Proper hand washing will be demonstrated by CSU nutrition students and the participants will be asked to wash their hands following the same procedures Post Intervention Phase: *Observe participants to see if they wash their hands properly before eating  Note whether or not they wash their hands without being asked to do so. Ref er to appendix 4. (Process Evaluation) Who did you reach? *Respite Care Caregivers *Respite Care Participants (Process Evaluation) What did they learn? What were their immediate changes? *Skills - Displayed how to effectively wash their hands with soap and water for 20 seconds. *Knowledge - Learned how germs are spread and how it can be avoided *Social Awareness - Recognize social cues that prompt hand washing behavior (Impact Evaluation) What actions (behaviors) are they now doing? *Washing their hands before handling food *Washing their hands after eating or touching their mouth/face *Washing their hands after using the bathroom *Washing their hands after close interactions with others *Washing their hands when they see they are physically dirty (Outcome Evaluation) How will health conditions improve? *Decreased incidence of illness *Increased hygiene *Decreased days missed from school and other learning environments, like Respite Care (Outcome Evaluation) Assumptions (beliefs you have aboutyour project, the people involved, and the way you think the project will work) External Factors (environmentin which your project exists,interacts with and influences the impactof your project) We believe that the participants are capable ofwashing their hands properly but we believe they will almostalways need some prompting to do so.We believe that the paint activity will help the participants understand the need to wash their hands without prompting. The environment of Respite Care itselfis a fun place for the participants to be, so we may be dealing with some distractions thatare out of our control and highly unpredictable.Participants thatare distracted from these external sources maynotget as much outof the projectthan those who were not distracted.
  • 21. Food Safety Intervention Page 20 of 35 PRESENTATION We will be presenting our project in conjunction with the group who worked with the younger participants of Respite Care. The presentation will begin with a description of the community partner and service learning activities that we participated in. This will lead into an overview of the intervention project that each group created based on the needs of our specific Respite Care audiences. We will elaborate on the learning activities and strategies that were implemented in our interventions, as well as the outcomes and possibilities for improvement. At the end of our presentation we will leave time for questions and comments. SUMMARY OF FINDINGS During our pre-intervention activity at Respite Care (as referred to in appendix 4), we found that most of the participants washed their hands immediately after the activity without being prompted to do so. Some of the teens ran their hands under water without the use of soap, while others washed their hands properly with soap and water. The day of our intervention, the teens were able to touch paint that represented microbes. After touching the paint and watching the nutrition students demonstrate how to properly wash hands, every one of the participants were willing to wash their hands. While observing their hand washing skills, we found that most of the participants washed with soap and water, while a few of the participants had to be reminded to use soap to get the germs off. The teens seemed to enjoy this activity, as most of them played along with the idea of the paint representing germs. The post-intervention data was collected the following week. After our craft activity and before the participants ate the snack provided, we observed the teens to
  • 22. Food Safety Intervention Page 21 of 35 see if they wash their hands with or without being prompted to do so. We found that the participants all wanted to wash their hands without being prompted. We also observed that all participants used effective hand washing techniques (as referred to in appendix 3). It is important to note that only three out of the seven individuals that participated in the hand washing intervention were able to be at the post-intervention. During service learning experiences following post-intervention, we noted an observable difference in the hand washing behavior of the participants. To conclude, individuals that participated in the intervention overall needed less prompting and were able to practice effective hand washing techniques. REFLECTION During our service learning experiences and hand washing intervention at Respite, our group learned to create lessons that allowed for different teens to expand the constructs of a lesson and to make sure to account for individual skill level. We found that the individuals of Respite had a wide range of abilities, and that it was important to make sure that everyone could feel included in every activity. From the information gathered from our project, our group believes that caretakers and students who desire to work with individuals with developmental disabilities would be to apply and effectively use this information. Knowing the importance of teaching individuals of this population in a way that is tailored to each person’s unique needs is critical in teaching new skills, like hand washing. There were two major limitation our group ran into while working on this project. The first limitation of completing this community intervention was the issue of time. Only having one semester to get to know a community well enough to be able to deliver an
  • 23. Food Safety Intervention Page 22 of 35 effective intervention is not an easy task. This leads into the second limitation that our group had. The individuals at Respite have a wide range of developmental disabilities, which made it hard to come up with a problem that all of the individuals could relate too. This also limited us from doing a nutritional specific intervention because all of the individuals had unique nutritional needs. Our group eventually noticed a hand washing problem with the majority of the individuals and we were able to effectively come up with an appropriate intervention. If we were able to repeat this intervention again, we would want to make sure that we could measure our results better. All of the individuals that participated in the intervention were not all able to attended the pre and post interventions. Our project contributes to the field of community nutrition by promoting positive behavior change, encouraging preventative health measures through food safety, and addressing a specific problem that is tailored to one community. ACKNOWLEDGMENTS We would like to thank Respite Care and the teen participants for their time and participation with our project. Between providing all the materials for snacks and activities, encouraging engagement and creating a positive environment, their support and enthusiasm were essential to the success of our intervention.
  • 24. Food Safety Intervention Page 23 of 35 REFERENCES 1. Specialized Care. Respite Care Inc website. Available at: http://respitecareinc.org/specialized-care. Updated 2015. Accessed October 5, 2015. 2. Paying for Child Care. Early Childhood Council of Larimer County website. Available at: http://www.ecclc.org/families/child-care-referrals/paying-for-child- care. Updated 2015. Accessed September 20, 2015. 3. Boyle CA, Boulet S, Schieve LA, et al. Trends in the Prevalence of Developmental Disabilities in US Children 1997-2008. Pediatrics. 2011;127(6):1034-1042.doi:10.1542.2010-2989. 4. Local Disability Data for Planners. Disability Population Statistics for Colorado website. Available at: http://disabilityplanningdata.com/site/state_population_table.php?state=colorado. Updated 2007. Accessed October 25, 2015. 5. Birth Defects. Compass of Larimer County website. Available at: http://www.larimer.org/compass/birth_defects_h_ph.htm. Updated 2012. Accessed September 20, 2015. 6. Manzardo AM, Dhillon S, Butler MG. Plasma Cytokine Levels in Children with Autistic Disorder and Unrelated Siblings. International Journal of Developmental Neuroscience. 2012;30(2):121-127.doi:10.1016/j.ijdevneu.2011.12.003. 7. Dietary Guidelines. Health.gov website. Available at: http://health.gov/dietaryguidelines/. Updated 2010. Accessed October 25, 2015.
  • 25. Food Safety Intervention Page 24 of 35 8. Show Me the Science- Why Wash Your Hands?. CDC website. Available at: http://www.cdc.gov/handwashing/why-handwashing.html. Updated 2015. Accessed October 25, 2015. 9. Bandura A. Social Cognitive Theory. Annals of child development. Vol. 6. Six theories of child development. Greenwich, CT: JAI Press. 1989. 10.Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study. Research in Developmental Disabilities. 2014 (35); 3014-3025. doi: 10.1016/j.ridd.2014.07.016. 11.O’ Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American Journal of Infection Control. 2001 (29); pp 352-360. doi: 10.1067/mic.2001.18405 12.When & How to Wash Your Hands. Center for Disease Control website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Updated 2015. Accessed October 25, 2015. 13.Nutrition Education: Principles of Sound Impact Evaluation. USDA: Food & Nutrition Service website. http://www.fns.usda.gov/nutrition-education-principles- sound-impact-evaluation.html. Updated 2005. Accessed November 12, 2015.
  • 26. Food Safety Intervention Page 25 of 35 APPENDICES Appendix 1: To Evaluate the Effects of a Simplified Hand Washing Improvement Program in Schoolchildren with Mild Intellectual Disability: A Pilot Study Appendix 2: Understanding adherence to hand hygiene recommendations: the theory of planned behavior Appendix 3: When and How to Wash your Hands Appendix 4: Lesson Plan for Respite Care Appendix 5: Pre and Post Intervention Observation Sheet Appendix 6: Checklist for Hand Washing Intervention Appendix 7: Telephone Survey for Respite
  • 27. Food Safety Intervention Page 26 of 35 APPENDIX 1: TO EVALUATE THE EFFECTSOF A SIMPLIFIEDHAND WASHING IMPROVEMENT PROGRAM IN SCHOOLCHILDREN WITH MILD INTELLECTUAL DISABILITY:A PILOTSTUDY Abstract: A quasi-experimental study using a pretest–posttest design with a control group was used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene improvement program by schoolchildren with mild intellectual disability (MID). A total of twenty schoolchildren aged 6–12 years old with MID (12 males) were recruited and they were assigned into intervention (n= 10) and control (n= 10) groups. To evaluate the quality of their hand washing, Glow gel, which contains plastic simulated germs that are visible under an ultra-violet lamp, was applied to participants’ hands to assess the quality of hand washing by comparing the amount of visible Glow gel before and after hand washing using a 4-point scale. Four raters used this 4-point scale to assess the quality of hand washing through digital photo images of the participants’ hands. A total of eight digital photos per participant were taken. A fifteen-minute hand washing training session was conducted every school day for 4 weeks for the intervention group. Those in the control group received no training. A multimedia visual package on steps of hand washing was presented together with a reward system, whereby a number of stars were earned each week depending on the quality of hand washing. Results showed encouraging findings, as the schoolchildren in the intervention group showed significant improvement in hand washing ( p < 0.001) and the improvement was stronger than that of the control group ( p = 0.02). To conclude, a systematic instruction emphasizing multimedia visualization in a hand washing improvement program can be successfully implemented in a special school, and the effect of integrating multimedia visuals in the hand hygiene program could improve hand hygiene among schoolchildren with MID.
  • 28. Food Safety Intervention Page 27 of 35 Reference: Lee R, Lee P. To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study. Research in Developmental Disabilities. 2014 (35); 3014-3025. doi: 10.1016/j.ridd.2014.07.016.
  • 29. Food Safety Intervention Page 28 of 35 APPENDIX 2: UNDERSTANDING ADHERENCE TOHAND HYGIENE RECOMMENDATIONS: THE THEORYOF PLANNED BEHAVIOR Abstract: Background: Most health care workers (HCWs) are aware of the rationale for hand hygiene procedures, yet failure to adhere to guidelines is common. Little is known about factors that motivate HCWs to practice hand hygiene. Purpose: The purposes of this study were to (1) estimate adherence to hand hygiene recommendations; (2) describe relationships among motivational factors, adherence, and intensity of nursing unit activity; and (3) test an explanatory model for adherence to hand hygiene guidelines based on the theory of planned behavior (TPB). Method: A longitudinal, observational design was used to collect data from 120 registered nurses employed in critical care and postcritical care units. Nurses provided information about motivational factors and intentions and a self-report of the proportion of time they followed guidelines. At least 2 weeks later, the nurses' hand hygiene performance was observed while they provided patient care. Structural equation modeling was used to test the TPB-based model.Results: Rate of adherence to recommendations for 1248 hand hygiene indications was 70%. The correlation between self-reported and observed adherence to handwashing recommendations was low (r = 0.21). TPB variables predicted intention to handwash, and intention was related to self-reported hand hygiene. Intensity of activity in the nursing unit, rather than TPB variables, predicted observed adherence to hand hygiene recommendations. Conclusions: The limited association between self-reported and observed hand hygiene scores remains an enigma to be explained. Actual hand hygiene behavior may be more sensitive to the intensity of work activity in the clinical setting than to internal motivational factors. (Am J Infect Control 2001;29:352-60.)
  • 30. Food Safety Intervention Page 29 of 35 Reference: O’Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American Journal of Infection Control. 2001 (29); pp 352-360. doi: 10.1067/mic.2001.18405.
  • 31. Food Safety Intervention Page 30 of 35 APPENDIX 3: WHEN AND HOWTO WASH YOUR HANDS 1.1.1 When should you wash your hands?  Before, during, and after preparing food  Before eating food  Before and after caring for someone who is sick  Before and after treating a cut or wound  After using the toilet  After changing diapers or cleaning up a child who has used the toilet  After blowing your nose, coughing, or sneezing  After touching an animal, animal feed, or animal waste  After handling pet food or pet treats  After touching garbage 1.1.2 How should you wash your hands?  Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.  Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.  Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.  Rinse your hands well under clean, running water.  Dry your hands using a clean towel or air dry them
  • 32. Food Safety Intervention Page 31 of 35 1.1.3 What should you do if you don’t have soap and clean, running water? Washing hands with soap and water is the best way to reduce the number of germs on them in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs. Hand sanitizers are not as effective when hands are visibly dirty or greasy. How do you use hand sanitizers?  Apply the product to the palm of one hand (read the label to learn the correct amount).  Rub your hands together.  Rub the product over all surfaces of your hands and fingers until your hands are dry. Reference: CDC. When & How to Wash Your Hands. Handwashing.2015 Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 25, 2015.
  • 33. Food Safety Intervention Page 32 of 35 APPENDIX 4: LESSON PLAN FOR RESPITE CARE Day 1: Pre intervention day  Introduce ourselves  Get started on activity for the day o Bring in shaving cream and set up area for activity o Prompt the participants to spray shaving cream on table and encourage them to play with it o After 15-20 minutes, have the participants help with cleaning up the shaving cream. o This is when we will observe the participants to see it they wash their hands with out prompting to do so  Get started on a next activity including cookie decorations o Have them be creative with their cookie and give them 15-20 for decorating and eating o Help them clean up area by swiping, washing counters, and observe again to see if they know when to wash their hands without being prompted  Thank them for their time and tell them we will be back again next week Day 2: Intervention day  Introduce ourselves  Get started on paint activity o Rub paint on participants hands o Tell them paint is representative of microbes o Have them touch other hands so they can see how germs are spread o Have them touch the table as another example of how germs are spread  Debrief activity with them o By the end they should feel the need to wash their hands thoroughly with soap and water  Next activity showing them how to wash their hands o Follow instructions indicated by appendix 3  Talk about when they should wash their hands o Have them brainstorm some ideas of when is appropriate  Start snack activity o Have participants prepare chocolate covered fruit with their recently washed hands o Have participants help clean up and wash their hands again when they are done  Thank them for their time for the day and tell them we will be back the following week Day 3: post-intervention day  Introduce ourselves  Get started on a craft activity o Have participants pick out a piece of colored paper o Help them trace their hand on the paper o Cut out their hand print and have them decorate it as a turkey  Start the next activity by setting up chips and dip for their snack o Observe whether or not participants wash hands without being prompted to do so o Observe how effective their hand washing seems to be o Allow them to dip chips in their choice of dip that will be in their individual bowl to prevent germs o Have them help with clean up and observe if they fell like washing their hands again  Thank them for their time
  • 34. Food Safety Intervention Page 33 of 35 APPENDIX 5: PRE AND POST INTERVENTION OBSERVATION SHEET Participant name: Felt need wash hands without prompting Washed hands Soap was used Hands appeared clean Washed hands for longer than 20 seconds Other things to note 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13
  • 35. Food Safety Intervention Page 34 of 35 APPENDIX 6: CHECK LIST FOR HAND WASHING INTERVENTION Checklist completed by: __________________________________ Date:_____________________ Section of intervention: Time pertaining sections of the intervention: Completed? Introduction: names 4:00-4:01pm Introduction: introduce what we are planning on doing today including: a paint activity, learning how to wash hands, and making dark chocolate covered fruit. 4:01-4:04pm Begin paint activity: introduce activity by explaining that the paint will represent germs and explain that we will have them touch objects and other’s hands to show how easy it is to spread germs 4:04-4:07pm Squeeze some paint in the hands of 3-5 volunteers and have them begin the activity 4:07-4:15pm Explain how easy germ are spread and end the paint activity 4:15-4:18pm Begin hand washing activity: explain washing their hands often can help protect them against getting sick 4:18-4:20pm Explain the process of how to wash their hands with the visual help of our “how to” poster 4:20-4:23pm Have one on ones with each participant and make sure everyone is involved and all hands are clean before starting the food activity 4:23-4:35pm Begin food activity: get all of the participants to get gloves on and explain that we will be dipping fruit in dark chocolate for the snack 4:35-4:40pm Have the participants pick their own fruit and dip the fruit in the chocolate by themselves. Once participants are done dipping the fruit in the chocolate they may go enjoy their snack 4:40-4:55pm Help clean up and thank everyone for their time and tell them that we will be back next week to do another craft and snack (this is when we will see if they remember to wash their hands before preparing food after they have dirtied their hands with craft time) 4:55-5:00pm
  • 36. Food Safety Intervention Page 35 of 35 APPENDIX 7: TELEPHONE SURVERY FOR RESPITE TELEPHONE SURVEY ON HAND WASHING INTERVENTION Respite Care Inc. To be administered to 10 employees 6 months after intervention Script: Hello, this is ________________________________ from Colorado State University, 6 months ago we did a hand washing intervention with some participants at Respite and we were inquiring whether we could get your opinion on how some of the participants have been affected by this intervention. If they allow for the telephone survey go forward, if they decline the telephone interview, ask to talk to the direct supervisor to get any interview with them. Questions: Please respond to the first few statements with whether you agree or disagree. 1. The majority of participants wash their hands more often than before the intervention. 2. The majority of participants need prompting the wash their hands. 3. When washing hands, the participants wash for more than 20 seconds. 4. When washing hands, the participants use soap. 5. When washing hands, the participants use a towel or something clean to dry their hands off with. 6. The hand washing intervention made an impact on the participants. 7. The majority of participants recognize when it is appropriate to wash their hands. 8. The majority of participants wash their hands less often than before the intervention. 9. The majority of participants do not require prompting on when it is time to wash their hands. 10. When washing hands, the participants wash for less than 20 seconds. 11. When washing hands, the participants don’t use soap. 12. When washing hands, the participants use their shirt or some other surface to dry their hands with. 13. The hand washing intervention made little to no impact on the participants. 14. The majority of participants can not recognize appropriate times to wash their hands. The next section requires a little more information so please respond with the best answer that you see fit. 1. How many of the participants wash their hands without being prompted? 2. How many of the participants wash their hands for 20 seconds or more with soap and use an appropriate drying technique? 3. How many of the participants have an understanding of what germs are and how they are spread? 4. Is there anything you would improve about the intervention? 5. What was the most affective part of the intervention? 6. Anything else you would like to share with us at this time? Thank you for answering our questions! We appreciate your time and wish everyone at Respite the best! Have a great day! Circle One 1. Agree/ disagree 2. Agree/ disagree 3. Agree/ disagree 4. Agree/ disagree 5. Agree/ disagree 6. Agree/ disagree 7. Agree/ disagree 8. Agree/ disagree 9. Agree/ disagree 10. Agree/ disagree 11. Agree/ disagree 12. Agree/ disagree 13. Agree/ disagree 14. Agree/ disagree 1. 2. 3. 4. 5. 6.