This document summarizes a partnership between the Maryland Expanded Food and Nutrition Education Program (EFNEP) and local community health clinics to address childhood obesity. The partnership developed a pilot program called Transforming Lifestyles Project that implements policies, systems, and environmental changes in clinics. This includes adding physical activity screening questions to patient records and referring overweight pediatric patients to EFNEP for nutrition education. The program aims to evaluate this clinical linkage using surveys with 40 parent-child dyads. Recommendations for developing similar partnerships emphasize collaborating with clinics, gaining senior support, piloting changes, training staff, and using a comprehensive, culturally-sensitive approach.

1. Community-Clinical Linkages:
Lessons from the Maryland Expanded Food
and Nutrition Education Program (EFNEP)
Christine Morioka, MPH (c), Intern
Mira Mehta, PhD, Director
State of Maryland EFNEP Program
University of Maryland Extension
College Park, MD
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2. Presentation Outline
¤ Part 1: Introduction to EFNEP
¤ Part 2: Introduction to EFNEP clinical
collaboration: Transforming Lifestyles Project
¤ Part 3: Recommendations for developing
projects with clinic-based community partners
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3. Part 1
Introduction to the EFNEP Program
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4. About EFNEP
Expanded Food and Nutrition
Education Program is….
¤ USDA funded nation-wide program
that unites federal, state, and local
resources to provide free nutrition
education courses to limited-income
families and youths
¤ Operates through the Extension/
Outreach Mission of the Land-Grant
Universities in every state, the District
of Columbia, and the six U.S. territories
Maryland EFNEPà University of Maryland,
College Park
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5. Focus of EFNEP
¤ Diet quality
¤ Physical activity
¤ Food resource management
¤ Food safety
¤ Food security
Source: CDC, littlerockfamily.org
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6. EFNEP Programming
¤ 8-12 hours of nutrition
and physical activity
lessons
¤ Culturally sensitive
¤ Interactive
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7. EFNEP Education Model
Paraprofessionals (Peer Educators)
¤ Indigenous to community
¤ Trained and supervised by state university and locally-based
professional EFNEP staff/faculty
¤ Recruit families and receive referrals
¤ Recruit volunteers to assist with program delivery
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8. EFNEP Evaluation Procedures
¤ Evaluation activities:
¤ Pre-post intervention surveys (parents and children)
¤ Policies, systems, and environmental change (PSEs) research
¤ Annual Budgets
¤ 5-year program plan
¤ Reporting tool: (WebNEERS)
¤ Nationally standardized
¤ Web-based platform
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9. Part 2
EFNEP Clinical Partnership: Transforming Lifestyles Project
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10. EFNEP Clinical Partnership
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11. History of Partnership
• EFNEP and Community Clinics Inc. united under the common goal
of helping to prevent obesity in Maryland.
• Partnership developed to refer obese/overweight patients to
EFNEP for free nutrition/physical fitness education programming
• CCI and EFNEP develop pilot project to implement PSE change
and to evaluate the referral program
• Receive funding from Regional Nutrition Education Centers of
Excellence (RNECE) and UMD IRB approval
• Project Implementation (ongoing)
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12. Transforming Lifestyles Project (TLP)
Who
Partnership between Maryland EFNEP and local safety net
clinics. Participants are pediatric patient/parent dyads (N=40)
What
Quasi-experimental pilot program to implement a Policies,
Systems, and Environmental (PSE) change to prevent/reduce
childhood overweight and obesity in a clinical setting.
Where
Community Clinics Inc. (Federally Qualified Health
Centers/Safety net clinics) health centers in Montgomery and
Prince George’s counties in Maryland
When 2014-present
Why
Expand the scope of practice and referral system of health
care providers working in safety-net clinics which serve limited-
income families in order to prevent/reduce childhood
overweight and obesity
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13. PSE Change
¤ Screener questions: Incorporate 2 physical activity questions into the
clinics’ Electronic Health Record (EHR) as a vital sign reading for every
patient
¤ Referral: Physician refers overweight/obese pediatric patient/parent
dyads to EFNEP to be enrolled and randomly assigned to the TLP
experimental or control group
¤ Resources: Patients receive information about free physical activities to
try and local resources in their local community
Adult Questions 1. On average, how many days per week do you engage in moderate or greater
physical activity, like a brisk walk?
2. On those days, how many minutes do you engage in activity at this level?
Youth Questions 1. How many hours does your child spend watching television or playing video
games each day?
2. On average, how many days per week does your child engage in active play?
What kinds of activities does your child enjoy?
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14. TLP Evaluation Assessments
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15. Project Progress
Step Project Activity Status
1 Establish partnership with CCI ✔
2 Develop physical activity screener questions ✔
3 Pilot test screener questions at CCI health center ✔
4 Develop evaluation survey tools (clinic staff, parents, children) ✔
5 Translate all survey tools to Spanish ✔
6 Receive RNECE grant to implement project ✔
7 Establish MOU between EFNEP, UMD and Clinics ✔
8 Submit proposal for UMD IRB approval ✔
9 Hire research assistants and train staff (research and clinic) ✔
10 Incorporate screening questions into the clinics’ EHR ✔
11 Referral of pediatric patient/parent dyads to EFNEP ✔
12 Consent, enrollment, and random assignment to control/experimental groups ✔
13 Implement programming ongoing
14 Enter/Analyze survey data ongoing
15 Disseminate findings ongoing
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16. Part 3
Recommendations for Clinic-Based Health Education Projects
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17. Recommendations
¤ Collaborate with local safety net clinics in your area—they appreciate
and need your help!
¤ Maintain or develop “buy-in” from senior management at clinics to
implement and evaluate PSE change
¤ Pilot test the PSE change and elicit feedback from clinic and project
staff– they know what will/won’t work best!
¤ Train clinic and project staff extensively once protocols are established
¤ Focus on a comprehensive approach:
¤ Primary care delivery approaches
¤ Family-based education
¤ Culturally competent, learner-centered curriculum
¤ Paraprofessional education model
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18. Thank you to our funders!
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19. THANK YOU!
Christine Morioka, MPH (c)
Graduate Intern
University of Maryland Extension
Expanded Food and Nutrition Education Program
christine.morioka@gmail.com
Mira Mehta, PhD
Director
University of Maryland Extension
Expanded Food and Nutrition Education Program
mmehta@umd.edu
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