1. Go4Fun NSW Healthy Children Initiative *NSW Office Preventive Health
Santosh Khanal
Senior Evaluation Officer*
Christine Innes-Hughes
Manager, NSW Healthy Children Initiative*
*NSW Office Preventive Health
Acknowledgement: Deb Welsby,
Local Health District Teams, Better Health Company,

2. Policy and funding context
2006 The Australian Better Health Initiative
NSW Parenting Program
Pilot of the MEND program
National Partnership Agreement on Preventive Health Go4Fun in all Local Health Districts
NSW Healthy Eating and Active Living Strategy
2015 NSW Government election commitment Go4Fun as part of type 2 diabetes prevention effort
ABHI– strengthened focus on preventive health and early intervention
NSW response was to develop the
2008 Pilot - (now known as Go4Fun) was piloted in 3 Area Health Services – Greater Western, Greater Southern and Sydney South West for 12 months

3. Current delivery context
NSW Office of Preventive Health - Healthy Children Initiative programs in children’s settings:
Early Childhood Munch and Move
Primary schools Live Life School, Crunch & Sip
Junior Community Finish With The Right Stuff
sport
Community Go4Fun

4. Evidence base
Demonstrated effectiveness through randomised control trials of MEND program in UK 1,2
Process evaluation of Go4Fun demonstrated that we are reaching our target group3
Scalability demonstrated while maintaining program fidelity and outcomes 4,5
References
1.Randomized Controlled Trial of the MEND Program: A Family-based Community Intervention for Childhood Obesity. Obesity 2012.Paul M. Sacher, Maria Kolotourou, Paul M. Chadwick, Tim J. Cole, Margaret S. Lawson, Alan Lucas and Atul Singhal
2. Outcomes Following the MEND 7–13 Child Weight Management Program Childhood Obesity June 2015 Volume 11, Number 3 Maria Kolotourou, Duncan Radley, Catherine Gammon, Lindsey Smith, Paul Chadwick, DClinPsy and Paul M. Sacher
3. Process evaluation of an up-scaled community based child obesity treatment program: NSW Go4Fun, BMC Public Health 2014, 14:140. Welsby D, Nguyen B, O’Hara B, Innes-Hughes C, Bauman A and Hardy LL.
4. From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale International Journal of Obesity (2014) 38, 1343–1349 J Fagg1, P Chadwick, TJ Cole, S Cummins, H Goldstein, H Lewis, S Morris, D Radley, P Sacher and C Law
5. Translational research: are community-based child obesity treatment programs scalable? BMC Pubic Health Louise L. Hardy, Seema Mihrshahi, Joanne Gale, Binh Nguyen, Louise A. Baur and Blythe J. O’Hara

5. Go4Fun Program Overview
A community-based child obesity treatment program (secondary prevention)
AIM: to improve health, fitness, self esteem and confidence in overweight and obese children.
Program eligibility:
Aged 7 to 13 years
Overweight or obese (≥ 85th BMI percentile for age and gender)
Parent/carer available to attend each session

6. Program design 10 weeks 2 sessions per week (until 2014)
2 hours per session.
Multidisciplinary including:
- Family involvement
- Practical education in nutrition and diet
- Increasing physical activity
- Behaviour change goal setting
, running parallel with school terms.

7. Model of Service Delivery
Funding and performance agreement with service delivery partner
Better Health Company (private public partnership)
Referral line
Resources and equipment
Data and data management system
Reporting
Quality framework
Quality improvements
BHC contract – centralised enquiry line, placement in programs, management of program kits and equipment for LHDs via an equipment shop, quality improvements, implementation of quality framework, data management and data management system and generation of portfolio reports.
Office of Preventive Health – 1.0FTE + HCI manager
(from July FTE + HCI Manager)
Local Health Districts – funded positions in each participating LHD

8. Model of Service Delivery
Service Level Agreement - Ministry of Health and Local Health Districts
Local Health Districts (LHDs)
Prevalence based targets (July 2011 to June 2015)
Currently targets based on indicative number of programs
Dedicated positions funded within LHDs
Oversight
NSW Office Preventive Health
State level coordination, performance monitoring, evaluation, marketing and communications

9. Evaluation and monitoring
Monitoring - routine business process
Program Reach (July 2011 to July 2015)
Number of programs: 652
Total children enrolled: 6,178
Total children completed: 5,301
Number of once per week programs: 232
7051 confirmed

10. Evaluation and monitoring
Program outcomes (mean)
BMI: -0.6 kg/m2
Waist circumference: -1.5cm
Physical activity: +3.6hours per week
Sedentary behaviours: -2.8hours per week
Self esteem: statistically significant improvements
Fruit and vegetable intake: statistically significant improvements
Mature program – routine process evaluation as part of quality processes, monitoring of outcomes and quality improvement framework implemented
Identifies quality activities eg data quality issues
Generates research eg 1/week RCT and medium term follow up; incentivisation trail, Aboriginal Go4Fun

11. Monitoring by disadvantage
Household characteristics
Health care card status mother
Aboriginality
Part of routine monitoring is to monitor by disadvantage to ensure we are not widening the health gap

12. Service improvement study
Background
A 2012 program review found twice per week attendance requirement for families a barrier to participation
A once per week delivery model was developed in partnership with the Better Health Company
It needed to be ensured that the reduced program frequency would not disadvantage participants

13. Service improvement study
Aims
To compare the effectiveness of the once per week model with the standard twice per week at program completion and six months follow up
Health: BMI z-score
Behavioural: Physical and sedentary activities
Psychosocial: Global self-esteem
To compare the program attendance between the once per week and twice per week delivery approaches

14. Service improvement study
Methods
Cluster randomised controlled trial: rigorous
Pragmatic design: real world implementation
53 sites across 11 Local Health Districts
494 families
Measurements at program start and completion and six months follow up

15. Service improvement study
The pragmatic design

16. Service improvement study
Results
Once per week delivery model was equally effective to the twice per week model
Attendance patterns were similar between the two delivery models

17. Service improvement study
Implications
Once per week delivery model was made the standard delivery approach for the program
Program has become more accessible to families with work and other commitments
Cost efficiency has been achieved with no compromises to program outcomes
Important contribution to academic knowledge about program frequency for childhood obesity

18. Future systems improvements and efficiency gains
Incentivisation trial with Department of Premier and Cabinet
Flexible, non face to face delivery
Enhanced post program support model
Particularly around maintaining physical activity
Go4Fun for Aboriginal Families

19. Communication
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20. Questions?