Report 28 (Early Years Weight Mgt Prog).doc

Maternal and Early Years Interventions

to Address Food, Physical Activity and the Emotional Health & Well-Being

of Children & Their Families

– work to understand the evaluation frameworks underpinning these programmes

Rationale

In 2009/10 audits of Food and Health Activity and Physical Activity in the West Midlands were completed. The audits identified a number of interventions targeted at maternal and early years groups to address food, physical activity and the emotional health and wellbeing of children and their families.

In follow up to this work it was identified that there was a need to develop a clearer understanding of the evaluation frameworks underpinning these programmes.

The National Obesity Observatory have produced a Standard Evaluation Framework (SEF) for weight management interventions, however many of the programmes targeted at maternal and early years do not have a specific focus on weight management and therefore the tool was not directly applicable to this piece of work. However, it was agreed that this would be a useful tool to start comparing the methodologies used for evaluation.

It was agreed that all maternal and early years programmes identified from:-

·  the regional Food and Health Audit;

·  the regional Physical Activity Audit

·  the Children’s Centres Audit.

which had a food and physical activity focus targeted at early years settings, were contacted to identify:

1.  How the service was evaluated

2.  How programme evaluations compared to the Standard Evaluation Framework for Weight Management Programmes

3.  What areas of the SEF could be applied to maternal and early years interventions

4.  Numbers through the service and any data base of information they have

5.  Comparisons on outcomes for food, physical activity, emotional well being and overall weight gain/BMI

6.  The cost of the service

7.  The staffing required to deliver the service, competencies for delivery and training programmes.

Methodology

7 programmes were selected for inclusion. The quality of data provided on these programmes varied.

1.  Maternal and Early Years (MAEYS) Pilot / Dudley
Shropshire
Telford & Wrekin
Walsall
Wolverhampton
Worcestershire / A programme to provide 1:1 support services for women who are overweight or obese by supporting and promoting lifestyle changes recommended by a health care professional.
More information on this service is available in Appendix 1 and Appendix 2.
2.  Jumping Beans / Dudley / An obesity prevention programme open to all families with children aged 2-4 years.
An evaluation report of this service is available in Appendix 3.
3.  FAB Tots / Sandwell / An obesity prevention programme with 4 phases that targets pregnant women and families with children aged up to 3 years. The programme covers food and nutrition, physical activity/play linked to the child’s physical development, with an element of positive parenting to bring the programme together. The programme is designed to help parents develop the confidence and skills to make healthier choices for themselves and their families about food and nutrition and physical activity.
4.  Nurturing Health Award / Staffordshire / A nursery based scheme using a social marketing approach to behaviour change. The award is a universal prevention programme, although may also impact on overweight children and families. The award sets high quality standards for food and drink provision, the mealtime environment, physical activity and oral health for 0-5 year olds, and includes specific specialist training to support nurseries in achieving the award.
5.  MEND 2–4 / Walsall / A primary obesity prevention programme which can also be offered as a targeted treatment intervention for pre-school age children. The MEND 2–4 Programme is evidence-based, multicomponent and fun. It combines active play, healthy eating advice and parent/carer workshops for groups of 8 to 10 families in 10 x 90 minute weekly sessions. The programme focuses on enhancing parenting skills and improving key health outcomes in local communities. The programme’s primary aim is to encourage healthy habits around diet and activity from an early age. Secondary objectives include changes in a variety of health behaviours and psychosocial measures. A range of pre and post-programme measures are taken so that leaders and commissioners can monitor the impact of the intervention. An evaluation of this programme is available in Appendix 6.
6.  Fit Moms / Birmingham / Support for mums-to-be across Birmingham, giving them the support they need to achieve a healthy pregnancy. Fit Moms provides a free, three week course with monthly follow-ups, led by a dietitian and is aimed at pregnant women with a body mass index (BMI) of 30 or more.
An evaluation of Fit Moms is available in Appendix 4.
7.  Post natal size down / Birmingham / A weight management course for women who want to lose weight after they have had a baby. The course consists of 2hours a week for 6 weeks led by trained advisors. A free crèche is provided and courses are held at local venues. More details of the programme are available in Appendix 5.

Results

From the table below there is coverage of the essential criteria but

«  There are no consistent measures for physical activity, dietary intake or behaviour change collected across programmes

«  Reporting on outcomes is variable across programmes and therefore it is very difficult to make direct comparisons.

«  Programmes did not all have clearly outlined primary and secondary outcomes

«  Some of the programmes for early years do not have weight loss as a primary outcome and data on weight is not necessarily collected

«  very little data on cost

The schemes are covering different populations groups, although there is some overlap. The maternity and early years service and the fit moms and postnatal size down both cover pregnancy but postnatal size down is for 6-12 weeks as opposed to 2 years post pregnancy. Jumping beans and mini mend both target the 2-4 year age group Fab tots starts in pregnancy and is for children up to three years and the nurturing health award scheme is an award scheme for nurseries.

The maternity and early years have a very good evaluation as this was independently commissioned. Jumping beans and mini mend are also reporting positive evaluations.

Separate evaluations were not received for Fab Tots and Nurturing Health Award.

Recommendation

Report to be shared and services encouraged to set clear outcome measures and reporting methodologies to enable more consistent evaluation across programmes.

Janet Baker

December 2010

21

Report 28 (Early Years Weight Mgt Prog).doc

Standard Evaluation Framework Essential Outcomes

1. Title/name of intervention / Maternal and Early Years Service / Jumping Beans / FAB Tots / Nurturing Health Award Scheme / MEND 2 - 4 Walsall / Fit Moms / Postnatal Size Down - Birmingham /
2. Aims and objectives (including primary and secondary outcomes) / A programme to provide 1:1 support services for women who are overweight or obese by supporting and promoting lifestyle changes recommended by a health care professional.
Aims:
To minimise weight gain during pregnancy.
To support weight loss post pregnancy.
To prevent the development of obesity in infants up to the age of 24 months.
To promote healthy behaviours in the spheres of food and activity. / Jumping Beans aims to provide parents with toddlers aged 2-4 years and their families with the necessary skills and knowledge to make healthy choices. It is also used as a weight management service.
1) Work in partnership with Children Centres and Health Visitors.
2) Deliver Active Dudley sessions and provide knowledge, skills and confidence for carers to be more active with their children and reduce sedentary behaviour with the loan of a bag of equipment to encourage physical activity.
3) Share snack time together, exposing both children and their carers to different fruits and vegetables
4) Provide carers with the skills and knowledge through parent led workshops
5) Provide carers with handouts and information to support each session.
6) Provide a suitable staffed crèche. / A family based programme to provide practical activities that helps participants to develop the skills to make informed decisions and choices. These include understanding food labels, cooking activities and learning through play. It also links with external partners for programmes such as supermarket tours and visiting a local market garden to encourage the use of seasonal and local produce. / Universal prevention programme, although may also impact on overweight children and families.
Aims
1. To help prevent childhood obesity and positively influence health behaviours to improve the overall health and wellbeing of children and their families.
2. To provide workforce development for local businesses and support in improving standards of care for inspection and business promotional purposes. / MEND 2-4 is a primary obesity prevention programme which can also be offered as a targeted treatment intervention for preschool age children.
The primary outcome measures are healthy diet (increase in fruit and vegetable consumption, reduction in consumption of high fat, high sugar cordials, soft-drinks and juices and non-essential, energy dense snack foods) and physical activity and sedentary behaviours levels. Secondary outcomes include: eating habits, parental knowledge of nutrition, parental behaviours and cognitions pertaining to feeding, eating and physical activity and BMI z score. / A weight management group programme for pregnant women with a BMI >30.
To minimise weight gain during pregnancy to the levels set out by the US IOM guidance. / A 6 session selfreferral, weight management programme.
Weight loss, changes to eating behaviour and reported effects on health and well-being
3. Intervention timescale (exposure, quantity and duration) / A 3 phase programme.
Phase 1 Pregnancy
4 sessions – 12 -16wks (60 – 90 mins), 16 – 20 wks (30 mins), 20 – 24 wks (30mins), 28 – 32 wks (30 mins)
Phase 2 Post Birth
4 sessions – 2 wks post birth (30mins), 6 wks (60 mins), 12 – 16 wks (60 mins), 20 – 24 weeks (30 mins)
Phase 3 Family
4 sessions – 7 -9mths (30 mins), 12 mths (30mins) , 18mths (30mins), 22 – 24 mths (30 mins). / A 6 week programme for 90 mins each week.
30 mins Active Dudley programme, 15 mins snack time and 45mins parent led workshop / A 4 phase programme
1: Pregnancy (4 weeks), 2: Post pregnancy 4wks
3: Family phase 1 (6 - 12 months) 8wk
4: Family phase 2 (12 - 36 months) 8wks / Ongoing. Following an award pilot between October 2008 - March 2009. / 10 weekly sessions of 90 minute duration. / 1 ½ hour group session each week for 3 weeks followed by monthly 1:1 appointments up to the end of pregnancy / 6 week course with 2 follow up sessions in week 10 and week 14
4. Intervention delivery dates / Commenced May 2009 / Commenced September 2008 / Ongoing – Children’s Centres to deliver / Ongoing / September 2008 / Commenced March 2009 / Introduced in 2007
6. Location and setting / Usually in clients’ homes / Children’s Centres in Dudley / Children’s Centres in Sandwell / Targeted at nurseries with 3* Rate My Place and adequate or better Ofsted ratings and those offering full day care and food on site. Nurseries in Tamworth District and Stafford Borough currently have been awarded or are working towards being awarded. Staffordshire Moorlands District and South Staffordshire Seisdon PBC locality to start recruiting nurseries imminently. / Sure Start Children’s Centres. Details are recorded using MEND’s Operations Management and Monitoring System (OMMS) system. / Heart of Birmingham and South Birmingham PCTs. Run in Children’s Centres and provides free creche facilities. / Originally across 13 council wards and 3 Birmingham PCTs. Run in Children’s Centres and provides free creche facilities. Since 2009 run in Heart of Birmingham and South Birmingham PCTs.
7. Description of intervention:
• target population / Phase 1:
Mums BMI pre pregnancy >30 (or 25 if first pregnancy or with pre existing LTC) and eligible for Healthy Start
Phase 2:
Families where one or both parents are obese. Focus on maternal BMI 0–6 months post delivery
Phase 3:
Families of babies at risk of obesity (related to parental BMI) 6–24 months post delivery / Parents of toddlers aged 2 -4 years and their families / Expectant mothers, parents and children / 1. Children attending nursery who receive a varied and balanced diet, appropriate amounts, intensities and types of physical activity.
2. Children and their families who are involved in health-related learning activities.
3. Nursery businesses who benefit from business promotion.
4. Nursery staff who benefit from award staff development opportunities. / Families with young children aged 2–4 years, irrespective of weight / Pregnant women with a BMI >30 / Postnatal Women who want to lose weight after they have had a baby.
• content / Pregnancy Phase 1:
Limit weight gain, promote breastfeeding, promote a healthy lifestyle (5ADay, EatWell Plate, physical activity).
Postnatal Phase 2:
Postnatal weight reduction (via encouraging healthy eating and increased activity), breastfeeding support, preparation for weaning, promote Healthy Start.
Postnatal family phase2:
Weaning (following DH recommendations on timing and introduction of appropriate foods), active play, parenting skills, parental role, signposting, promote healthy lifestyle (family mealtimes, activity, EatWell Plate, 5ADay), Cook and Eat, supermarket tours/ food labelling knowledge. / Each session follows the same format which allows for familiarity which is important for the children of this age group.
The format is as follows:
Active Dudley (30 mins): A fun active session whereby parents engage in a structured activity session with their children.
Snack Time (15 mins): Snack time is for both parents and children together, with all leaders involved.
Parent workshops/ creche (45 mins): Parents attend a workshop covering different subjects each week whilst their children are cared for in a crèche.
Parent Workshops sessions include:-
• Getting it right for the whole family: Knowledge on Eatwell plate and food groups with an opportunity for individuals to look at how well their own meals reflect the Eatwell plate.
• Happy Healthy Families: A session looking at parenting and child’s behaviour utilising the Solihull approach.
• What’s in Our Food? Advice and education on food labels and what to look for.