1. Stepping On Presented by the Wisconsin Institute for Healthy Aging, Wisconsin Department of Health Services, and their partners

2. Why is Stepping On Needed? 1 in 3 adults aged 65+ falls every year Falls-related injuries are the leading cause of death in Wisconsin for older persons Majority of falls occur at home Falls are not a normal part of aging; they are preventable 2

3. Consequences of Falls 40% of nursing home admissions had a fall in the prior 30 days WI Hospital and ED visits = $800M each year 70% of costs are borne by Medicare & Medicaid Cost of doctor visits, time off work, caregivers, etc., in addition to ED costs Emotional toll Fear of falling leads to reduced activity and isolation, causing and increased risk for falls 3

4. The Stepping On Program Developed in Australia by Dr. Lindy Clemson, OT Tested/implemented in community setting 2-hour sessions once a week for 7 weeks Follow-up home visit Follow-up booster session 8-12 participants Led by 2 trained Leaders 4

5. Stepping On Evidence-based Meets AoA’s highest standard Developed by Dr. Lindy Clemson and Megan Swann Brought to U.S. by UW’s Dr. Jane Mahoney Developed over years of: – pilot-testing – refinement – evaluative research 5

6. Stepping On’s Core Principles Facilitation to effect behavior change Decision-making as a process Principles of adult education Self-efficacy as a tool for change Mastery experience as a tool for change Group process Preventive Framework 6

7. Outcomes 7 Intervention group: 31% reduction in falls Maintained confidence in more mobile ADL tasks Used more protective behaviors After 14 months – 59% still doing exercises – 70% followed up with home visit recommendations – More subjects had vision checks – Less likely to start taking new psychotropic drug

8. Target Population Age 60+ At risk of falling Has fallen in past year or has a fear of falling Lives in own home or apartment Cognitively intact Walks independently or with cane; walker occasionally or for outdoor use Speaks and understands English or the language in which the class is being provided 8

9. Stepping On is CDC-Approved because it’s “Multifactorial” Strength and Balance Exercises Vision Medication Review Home Modification 9

10. Topics Building trust, risk appraisal Strength and balance exercises, homework Home hazards and safety modifications Community safety Bone health Medication management Sleep medication alternatives Safe footwear and safe clothing Vision and falls 10

11. Stepping On: By the Week 1. Introduction, Overview, Choosing What to Cover 2. The Exercises and Moving About Safely 3. Advancing Exercises and Home Hazards 4. Vision and Falls, Community Safety and Footwear 5. Medication Management, Bone Health and Sleeping Better 6. Getting Out and About 7. Review and Plan Ahead 11

12. Dissemination in Wisconsin Began in Wisconsin in 2007 Range of agencies offer the workshop Range of sites host the workshops Range of professionals or lay individuals who serve as leaders 12

13. Leader Qualifications and Characteristics Health care provider, aging network professional, public health educator, or fitness instructor Experience leading groups of older adults Can demonstrate exercises, modify, and advance Comfortable tightly following manual 13

14. Leader Expectations Attend entire 3 full-day Leader training Work with a sponsoring organization Lead workshops in pairs, both trained or 1 + peer Lead at least 2 workshops each year Follow program manual Secure and distribute weights to workshop participants Prepare and use a Stepping On Display Copy and distribute Exercise Manual and handouts Invite, prepare, and host 4 guest experts Follow WIHA administrative protocols 14

15. Are You Ready? Identify the local sponsoring organization Have 2 individuals trained or ready to be trained as Leaders Communicate with the local ADRC/aging unit to coordinate Together, review the Planning Guide (see next slides) 15

16. Stepping On Leader & Local Partner Organization Planning Guide Identify local sponsoring organization If not the county ADRC/aging unit, make contact with it Identify 2 Leaders – already trained or need training? Select dates and times for first workshop Select and reserve site, room, room arrangement Will workshop be free or a fee? What agency will submit workshop notification to WIHA? What agency will receive workshop registrations? Continued... 16

17. Stepping On Planning Guide, cont’d Outreach and Marketing – See WIHA website materials – don’t reinvent the wheel – Presentations – Health care provider recommendations Supplies needed – Display – Exercise Manual and other weekly handouts Projector / DVD player – Easels, blank flipchart pads – Refreshments – Data Collection materials Funding Needed? 17

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19. Website for Leaders www.wihealthyaging.org – Click on FOR LEADERS ONLY – Click on Stepping On – username: leaders@wihealthyaging.org password: wihaleaders 19

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24. Support for Leaders WIHA website Listserv WIHA Leader Newsletter Regular Leader conference calls or meetings where available Technical assistance Leader Coaching and Fidelity Coaching Healthy Aging Summit 24

25. Leader Training Come in pairs, or alone only if county already has a trained Leader with whom to partner 3 full days – must attend all to learn: – Evidence base for falls prevention – Underpinning concepts of Stepping On – Curriculum for Stepping On – Group facilitation techniques, including practice – Marketing, recruiting, partnership strategies Learn WIHA protocols and support available During first workshop, may have fidelity coaching session 25

26. Leader Training – To Apply: Leader Application – link on WIHA website Complete application; pay fee Commit to requirements Attend in pairs, unless already a leader in county Commit to requirements With Sponsoring Organization, complete Planning Guide 20-person limit 26

27. WIHA Collects Data On: Leaders Workshops Participants Why? – Funders – Policymakers – Program planning 27

28. ? ? ? Questions ? ? ? Betsy Abramson 608-243-5691 betsy.abramson@wihealthyaging.org Valeree Lecey 262-785-2577 valeree.lecey@gwaar.org Anne Hvizdak 715-677-3037 anne.hvizdak@dhs.wisconsin.gov 28

29. THANK YOU! We look forward to working with you to expand Stepping On in Wisconsin