Obesity and Healthy Living

Telford and Wrekin LA and PCTKit Roberts: Group Specialist Commissioner (01952 388890)Nat Davies: Community Nurse, Joint Community Learning Disability Team(01952 381420)

A SUCCESS STORY(However….one down, several

more to go!!)

Nat Davies and Jenny Gater

BACKGROUND We are a Joint Community Learning

Disability Team Consisting of 8 nurses and 1 Health

Facilitation Assistant Referrals are made to nurses and then

Jenny becomes involved

BARRIERS No support network Carers and family Consistency of support from all involved Knowledge base of all involved Lack of accessible information Level of understanding of the Service User Accessibility of exercise Coordinating appointment times Consistent feedback from staff Size – transport issues, exercise Lack of transport available Motivation of carers

He hasn’t had any cake

this week

He’s taken Mr Kipling to

college every day this week

Can’t I just put something in

the microwave

He only eats

what I give him

He’s not eating rubbish you know

He should be on a diet and just eat

salad

Weight loss, weight loss, weight loss!!

Day ServicesParents

College

Individual

Weightwatchers that’s the answer!!

He’s a big lad, he needs more than that for his

tea!!

He needs to have a

pudding after his tea

Slimming World!!!

Cabbage soup diet

How about eating

everything in moderation?

He needs his food, it keeps

him quiet

EVERYONE AT HOME

He’s in danger of

developing health

problems

He can eat chocolate if he wants to

Keeping in touch Contact with carers was maintained by

Jenny , his key worker attended as many appointments as she could in order to maintain consistency of information but it was identified that it was difficult to engage all carers

Food Project Workers became involved and completed training sessions for carers

Exercise was increased at Day Services and Physiotherapy became involved develop a programme

The story….. Referral made to Community Team, joint visit

took place with Community Nurse and Jenny Started attending day services and weighed

weekly by Jenny Jenny referred him to Why Weight Plus (BMI >30) Supported by Jenny and carer for a 1:1 session

every 3 weeks and continued weekly monitoring by Jenny

Jenny liaised with Day Services regularly. (They reported all large lunch boxes!!)

The story continued… Jenny continued to liaise with all involved

including Community Nurse , continued monitoring weekly + regular weigh in

Also continued input with carers to ensure that advice from Food Project Workers was being followed

OT became involved to support him in developing new skills – self care, how to make a sandwich

In 2 years he lost approximately 10 stone

And now….. He has more of an understanding of a

healthy eating plan He has maintained his weight loss with

minimal input (supported by carers alone) He now plays football and goes bowling,

swimming and walking

Ongoing Training for carers with Food Project Workers –

identifying all residential services and offering them FREE training

Jenny has developed close links with the Health Improvement Team

Hoping to develop healthy eating sessions that adults with a mild learning disability can access

Signposting – Walk about Wrekin Extend Gym session/gym buddies

Project Planning – back to Kit PCT identified small sum of money (£40K) Focus on two residential homes (Downing and Carwood)

as they are self contained and allow us to maintain some boundaries and control during the project.

Target dates: Dec 2011 – March 2012 – pre project April – Dec 2012: Project live Jan – March 2013: Project evaluation and de-briefing April 2013: CCG, mainstreaming

Make sure we keep everyone aware and informed of progress

Involvement Advocacy (Taking Part) central to the Project Programme of consultation and engagement with

service users, staff, carers, families, health and social care professionals, private and third sector organisations working with adults with learning disabilities (including LDPB, Listen Not Label, SPIC, carer’s Partnership Board, Links/Healthwatch)

Meeting Psychologist next week to discuss involvement Recruitment and engagement of staff and clients onto

the programme (due consideration should be made to mental capacity and those requiring specialist nutrition)

Development of programme plan incorporating consultation outputs

Project Objectives To identify the component parts of developing a good practice model

to achieve the aim of reduction in ALD obesity linked to healthy living (residents and staff);

To identify barriers to reduction in ALD obesity and a strategic approach, with action plan to address the same;

To undertake research into addressing and reducing ALD obesity with a strong link to healthy living

To produce evidence that demonstrates outcomes and achievements throughout the duration of the project

To evaluate the approach used during the project, so as to highlight best practice and model approaches that can be disseminated to others.

To establish an infra structure to addressing the issue of ALD obesity and healthy living enabling the practice to be mainstreamed throughout T&W, post project

Project Delivery A holistic, consistent approach to discussing and supporting behaviour

change (for residents and staff) A range of opportunities for and facilitate physical activity for clients each

day (including local leisure services provision). Provide healthy food options for staff, clients and carers at every meal to

meet the CQC Guidance document (any additional costs to be investigated) Provide training/information/workshop sessions to clients, families & carers

-make healthy choices & aid weight mgt. Provide training to staff to facilitate the above in a consistent manner (this

should be evaluated on a rolling basis to assess effectiveness and modifications made accordingly)

Invest in training and development for people with learning disabilities, families, carers to enable them to be better supported where they live.

Support clients to access mainstream or specialist weight management services where required (this may include slimming clubs, exercise referral or weight management activity classes, weight management clinics at surgeries or hospitals, dieticians etc depending on local availability).

Project Delivery Provide early intervention, and timely support and services that will meet

the individual needs (including communication needs) of clients who are showing early signs of developing weight management problems and the associated health conditions.

Provide improved data collection methods to support local needs analysis for learning disability and obesity agendas.

Work closely with local health promotion teams to ensure that the services offered are evidence based and guided by best practice.

Work closely with local GPs (with whom residents at Downing and Carwood are registered) to ensure that obesity, physical activity and healthy eating measures are incorporated into the annual health check at an individual level and feature in the residents’ individual care plans (Develop GP champions)

Incorporate messages on smoking cessation Incorporate messages on safe and sensible alcohol consumption (CMO

Guidelines) Embed culture of making informed healthy behaviour choices throughout

the settings

Project Evaluation (Wolverhampton University) The overarching project will reflect the outcomes of the LD and obesity charter.

Each project will reflect different sections of the "Actions to be taken" which are indicated in the Charter. On this basis there is potential for the following projects to be carried out:

1. A project on healthy life style choices with residents and staff using health needs assessment and gap analysis

2. A meta-analysis which will look at best practice in ALD and healthy life style3. A policy analysis to look at current and local policy in this area and possibly

compare this with international policy.4. Epidemiological data collection of health measurements undertaken during the

course of the project and other related surveillance data5. An evaluative review of staff attitudes and views looking at potential barriers,

success indicators etc.

Each project would have it’s own aims and objectives Contribute to the overarching aims of the bigger project. Each student would have their own academic supervisor One key person to oversee the bigger project & reporting back to the PCT Collate a research paper.

Project Link to ‘dog walking’ Jodie Grimley – CareDogs to support the Healthy

Lifestyles project for ALD.  The work will centre around Downing and

Carwood. This will involve 4 phases of work:

1. taking suitable dogs into the homes to get to understand dogs, build confidence and be trained on how to handle dogs

2. walking in the dogs in a suitable location3. walking the dogs in the locality4. for those who are interested, exploring the

opportunities to walk the dogs of people in the local community either on a voluntary basis or as a social enterprise.

Jodie’s approach will not focus on lecturing about healthy lifestyles but will focus on the benefits that the dogs feel by being active.

Obesity and Healthy Living

Telford and Wrekin LA and PCTKit Roberts: Group Specialist Commissioner Nat Davies: Community Nurse, Joint Community Learning Disability Team