A Matter of Balance:
Volunteer Lay Leader Model
Key Elements in the Translation of a Professionally Lead Program
Joint Conference of NCOA and ASA March 2006
Peggy Haynes, MPA
Partnership for Healthy Aging
Tara C. Healy, MSW, PhD University of Southern Maine
A Matter of Balance Volunteer Lay Leader Model
Administration on Aging Grant Partners:
Southern Maine Agency on Aging
MaineHealth’s Partnership for Healthy Aging
Maine Medical Center Division of Geriatrics
University of Southern Maine, School of Social Work
Grant # 90AM2780
Falls: Epidemiology of the Problem
Major cause of injury and death for older adults
Falls are the leading cause of injury hospitalization in Maine* *Healthy Maine 2010
1/3 to 1/2 of older adults acknowledge fear of falls
Fear of falling is associated with:
decreased satisfaction with life
depression
decreased mobility and social activity
increased frailty
increased risk for falls as a result of deconditioning
A Matter of Balance: Managing Concerns About Falls
Eight 2-hour classes designed to help participants learn:
• To view falls and fear of falling as controllable
• To set realistic goals for increasing activity
• To change their environment to reduce fall risk factors
• To promote exercise to increase strength and balance
Original outcomes research conducted by the Roybal Center for the Enhancement of Late-Life Function at Boston University.
Administration on Aging Grant
2003- AoA three year partnership to increase older adults access to evidence-based prevention initiatives
Grant Goals: • Maintain fidelity to the original MOB
curriculum
• Test whether a volunteer lay leader model is successful when compared with original research
• Share our approach with others in Maine and around the country
Grant #90AM2780
A Matter of Balance Volunteer Lay Leader Model
Guided by a Project Advisory Committee A Matter of Balance participant and coach AARP Maine City of Portland Maine Center for Disease Control and Prevention Maine Nutrition Network Maine Office of Elder Services Maine State Housing Authority New England Rehabilitation Hospital of Portland University of New England, Geriatric Education Center Osher Lifelong Learning Institute
Designed to benefit community-dwelling older adults who:
are concerned about falls
have sustained a fall in the past
restrict activities because of concerns about falling
are interested in improving flexibility, balance and strength
are age 60 or older, ambulatory and able to problem-solve.
Role of Lay Leaders
Team coaching
Peer modeling
Facilitation
Training and Recruitment
Potential partners
• RSVP
• Senior Colleges
• Senior Housing
Class graduates
Strategies for a Volunteer Model
Volunteer Lay Leader Model
• Coach training
• Mentor Model
• Observation and feedback
• Communication & Support
Volunteer Coaches
Age Group 59 or less
Age group 65 +
Women
Education: some college or more
70% (17)
30% (10)
79% (27)
90% (31)
N=53
Challenges and Lessons Learned
Clarity of volunteer commitment
Feedback loop
• Observations
• Participant satisfaction survey
Community recruitment partners:
• RSVP
• OLLI
• Resident Service Coordinators
Tension: Implementation Fidelity and Adaptation
Adaptations:
Classes taught by volunteer lay leaders instead of healthcare professionals
Participant workbook developed and coach manual modified
Exercises modified
Healthcare connection via guest therapist
Participants recruited through: Community organizations’ newsletters
Outreach presentations to: Aging network
Community centers & faith-based organizations
Clubs, libraries, social gatherings
Physician practices
Housing coordinators
Maintaining Fidelity
Original research curriculum used
Two day coach training based on original MOB leader manual
Health care professionals and master trainers observe volunteer coaches during: • two day training
• a MOB/VLL class
Use of a mentor model – new volunteers are paired with an experienced coach
Course evaluation and level of confidence post training
Follow-up survey at 6 mos. after leading MOB/VLL
Focus groups
Fidelity: Training Program for Volunteers
Coach Self-Reported Confidence
Post Training
Follow-up
6 mos.
Confident/
Totally Confident in Leading MOB
90%
(n=27)
96%
(n=26)
Confident/
Totally confident
Exercises
97%
(n=30)
100%
(n=27)
Coach Self-Reported Confidence
Post Training
Follow-up
6 mos.
Confident/
Totally Confident in Answering Questions
90%
(n=28)
93%
(n=25)
Confident/
Totally confident
Home Safety Check list
97%
(n=30)
100%
(n=26)
Coach Self-Reported Experiences at 6 Month Follow-up: “Better or A Lot Better”
Sense of accomplishment 80% (20)
Purpose in life 48% (12)
Can make a positive difference in another person’s life
76% (19)
Feelings about your health 48% (12)
Confidence in managing falls yourself
84% (21)
Key Findings from Coach Focus Groups
Respect for maintaining fidelity • Highlighted the importance of cognitive
restructuring by focus on attitude change in the first three classes
• Importance of mental exercises
• Able to discuss curriculum in detail
Mentor system highly valued • Aware of learning through this system
Key Findings from Coach Focus Groups
Benefits of Coaching • Rewarding – especially seeing older
adults gain more independence
• Coaches & participants have fun
Challenges of Coaching • Nervous about facilitating the group
• Managing group dynamics
• Participants with hearing problems
Participant Outcomes
MOB Original
Research
MOB/VLL
6 Weeks
Falls Management***
Falls Efficacy*
Falls Control***
Exercise Level ***
Social Activity***
6 Months
Falls Management***
Falls Control*
Falls Efficacy***
Exercise Level **
Monthly Falls*
12 Months
Falls Management**
Exercise Level***
6 Weeks
Falls Management***
Falls Efficacy**
6 Months
Falls
Management*
12 months Falls Management**
Falls Efficacy**
*p<.05 **p<.01 ***p<.001
Findings: Participant Outcomes
Comments:
I am more aware of my surroundings. I take time to do things and don’t hurry.
I have begun to exercise and am looking forward to a walking program.
I have more pep in not being afraid.
Participant Outcomes 97 % - more comfortable talking about fear of falling
97 % - feel comfortable increasing activity
99 % - plan to continue exercising
98 %- would recommend A Matter of Balance * % who agree to strongly agree
State of Maine
A Matter of Balance Dissemination
Dissemination Activity
14 Master Trainer sites
31 Master trainers
588 older adult participants
114 volunteer coaches trained statewide
A Matter of Balance Volunteer Lay Leader Model
For more information please contact:
Partnership for Healthy Aging
465 Congress Street, Suite 301
Portland, Maine 04101
(207) 775-1095 [email protected]