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

Policy and funding context 2006 The Australian Better Health Initiative NSW Parenting Program 2008 Pilot of the MEND program 2011 National Partnership Agreement on Preventive Health Go4Fun in all Local Health Districts 2014 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

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 Well @ School, Crunch & Sip Junior Community Finish With The Right Stuff sport Community Go4Fun

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 2015. Louise L. Hardy, Seema Mihrshahi, Joanne Gale, Binh Nguyen, Louise A. Baur and Blythe J. O’Hara

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

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.

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 2015 1.0FTE + HCI Manager) Local Health Districts – funded positions in each participating LHD

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

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

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

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

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

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

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

Service improvement study The pragmatic design

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

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

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

Communication Visit our website www.go4fun.com.au Like us on Facebook

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