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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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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Part 1 Introduction to the EFNEP Program

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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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Focus of EFNEP

¤  Diet quality

¤  Physical activity

¤  Food resource management

¤  Food safety

¤  Food security

Source: CDC, littlerockfamily.org 5

EFNEP Programming

¤ 8-12 hours of nutrition and physical activity lessons

¤ Culturally sensitive

¤  Interactive

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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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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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Part 2 EFNEP Clinical Partnership: Transforming Lifestyles Project

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EFNEP Clinical Partnership

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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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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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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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TLP Evaluation Assessments

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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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Part 3 Recommendations for Clinic-Based Health Education Projects

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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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Thank you to our funders!

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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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