Statewide Training for SNAP-Ed Local Implementing Agencies

Your SNAP-Ed Guide to the Dietary Guidelines

Facilitator’s Guide

This material was produced by institutions that represent SNAP-Ed in California, known as CalFresh, with funding from USDA SNAP-Ed. These institutions, the California Department of Social Services, the California Department of Public Health, UC CalFresh, California Department of Aging, and Catholic Charities of California, are equal opportunity providers and employers. CalFresh provides assistance to low-income households and can help buy nutritious food for better health. For CalFresh information, call 1-877-847-3663.

Table of ContentsGeneral Information...............................................................................................................3

Preparation............................................................................................................................4

Agenda..................................................................................................................................5

Facilitation Guidance.............................................................................................................6

Suggested Physical Activity...................................................................................................8

Suggested Ways to Evaluate................................................................................................9

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General InformationTarget Audience This Training is designed for SNAP-Ed State Implementing Agencies,

Local Implementing Agencies, their partners and subcontractors.

Overview This session is designed to help attendees understand how the Dietary Guidelines for Americans inform and translate to the work we do in SNAP-Ed.

Purpose This training is needed to assist LIAs, Subs and SIAs in understanding how the Dietary Guidelines for Americans inform and translate to the work they do in SNAP-Ed.

Duration 3 hours

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PreparationTrainer materials needed A/V needs

laptopprojectorspeakersflip chart pad and easelmarkerspostersDVDsIndex cardsotherTable materialspencils/pens/markerssticky notesmanipulatives (things to touch/play with)otherMiscellaneousblue tapesnacksother

Materials for Trainees Folder Content1. DGA Bingo/Warm up handout2. Workbook3. Eat Healthy Be Active handout

(https://health.gov/dietaryguidelines/workshops/DGA_Workshops_Complete.pdf) print pg 1-8 and1-9 only to analyze.

Links used in PPT Busy mom AD- https://youtu.be/dYSzAAM1BX8Prediabetes Risk Test – https://www.youtube.com/watch?v=s020q-FE0H4Doihaveprediabetes.orgPreventdiabetesstat.org – for providersMy Wins Videos -https://www.youtube.com/watch?v=V_UwhFSvd5w&index=2&list=PL8wgGeKVh_7d4x7icBCNj99MsachAAChiDGA Resources-http :// health.gov/dietaryguidelines/2015/resources.asp

Preparation prior to training Secure venue, secure all trainer materials needed. Make sure venue has internet and links work.

Room Setup Table groups of 4-8 depending on venue space and number of attendees.

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AgendaTime

Guidelines Section Leader

8:00 – 9:00 Set-Up

9:00 – 9:20 Welcome/Warm-Up Activity

9:20 – 10:00 Guideline Overview and new changes activity

10:00 - 10:30 Curriculum change example and sugar activity

10:30 - 10:45 PA Break

10:45 - 11:15 Recommendations vs. What we really eat

11:15 – 11:25 Barriers to Healthy Eating Patterns Discussion

11:25 – 11:35 Comparing SEM and Core Settings of DGA to SNAP-Ed Model

11:35 – 11:55 Pre-diabetes and SNAP-Ed Guidance

Skip Resources

11:55 - 12 Wrap-Up Activity

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Facilitation Guidance

Title Welcome/Warm-Up Activity

Time 20 minutes

Facilitator

Materials and Preparation Find someone who handout

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Activity 1-Flip Chart, have them put stickies to answer the following questions:1. What are two things you know about DGA?SuppliesFlip ChartMarkersStickiesImages for training: http://www.public-domain-image.com/free-images/people/children-kids/proper-nutrition-promotes-the-optimal-growth-and-development-of-children

Say: Well welcome everyone. We are excited to have you all here today. My name is Your Name Here and I’m with the Training Development and Support Team at CDPH I am going to be one of your SNAP-Ed Guides today. I’m also joined by my colleague (point to colleague) have him or her introduce themselves.

Say: We’d like to start the day off with a fun game of bingo. Explain Activity 2 have them pull out DGA Bingo Handout.Activity 2: Have participants mingle around the room and use the “DGA Bingo” handout to ask partner if there is a food on their hand out they love and if so how do they eat or prepare it. Incorporate bingo into this so that whoever gets 4 squares in a row first yells bingo. Explain that the winner will need to explain how other participants liked to prepare the food they marked off (Don’t worry about remembering the names of others.) Play music while activity is going on. (Prize is Chico Bags)Time:15 min max

Say: Now that we are a little more familiar with one another let’s go over the logistics for the day.

Instructions: Facilitator should go over logistics, Folder (Agenda page 1 of workbook) and a brief overview of what the goal of the training is. Location of restrooms and break, time of training, and what is in their folder.

Say: If you turn to page 1 of your workbook you will see the Agenda. Our time together today is from 9-12. Take a few moments to read over the Agenda. Explain that today’s training is a pilot and we realize we will need to make improvements. Let them know there has been a change in agenda. Prediabetes will be at the end of the day.

How many of you have experience working with DGA?

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Title Guideline Overview and new changes activityTime 40 min

Facilitator

Materials and Preparation DGA Changes Hand outFlip ChartMaterials to create an add(scissors, magazines, glue, markers)

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Group Discussion: What do you know about the DGA? How do you use the DGA? Talk about what was written on flip chart for Activity 1 to participants. Additional ideas to share out

• primary audiences are policymakers, as well as nutrition and health professionals, not the general public

• Provides Evidence based recommendations about components of a healthy and nutritionally adequate diet

• Focus on disease prevention rather than disease treatment

• Inform Federal food, nutrition and health policies and programs

Say: The Dietary Guidelines is a critical tool for professionals like us, to help Americans make healthy choices in their daily lives to help prevent chronic disease and enjoy a healthy diet. It serves as the evidence-based foundation for nutrition education materials that are developed by the Federal Government for the public. It’s used to inform USDA and Health & Human Services (HHS) food programs, such as the USDA's National School Lunch Program and School Breakfast Program, which feed more than 30 million children each school day, and the Special Supplemental Nutrition Program for WIC.

How many of you partner with the programs listed on this slide?Say: Federal law requires that SNAP-Ed promotes healthy food choices consistent with the most recent Dietary guidelines for Americans. In the 2017 SNAP-Ed Plan Guidance it refers to the DGAs and how it relates to SNAP-Ed work. This language can be found in your workbook on pages 3 and 4. When you get free time you can read over it. It can also be found in the 2017 SNAP-Ed Plan Guidance starting on page 18.

Say: So now that we know who and what the DGA is for let’s take a look at the five guidelines and how they relate to the SNAP-Ed work we do.

The first guideline is Follow a healthy eating pattern across the lifespan.(Have a volunteer read guidelines on slide)

This guideline embodies the idea that all food and beverage choices matter. Choosing a healthy

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Title Curriculum Change and Sugar Activity

Time 30 Min

Facilitator

Materials and

Preparation

Enjoy Healthy Food Curriculum Hand out https://health.gov/dietaryguidelines/workshops/DGA_Workshops_Complete.pdf print pg 1-8-1-9 only to analyze.Sugar Calculation HandoutFood label or actual product

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Time:10minActivity 4: Instruct Participants to pull out there sample curriculum handout for Eat Healthy Be Active Workshop 1 (https://health.gov/dietaryguidelines/workshops/DGA_Workshops_Complete.pdf) Print page 1-8 and 1-9 only for activity and review it.

Changes: p8 Take out 300 mg per day of dietary

cholesterol. Add Consume less than 10% of calories from

Added sugarsp9

Second bullet Prehypertension and Hypertension only instead of all categories listed.

Do: Read slide and so pair share then larger group share with participants.

Instructions: Leave up Instructions for Activity 4After 10-15 minutes have a few share out to larger group.

Then pair share what in workbook may need to be changed due to changes in new DGA? Have them also refer to page 2 of the workbook for new changes to the DGA.

Have a few share out to larger group.

Ask: What curriculum that you currently use will need to be updated?

Do: Read slide and debrief with participants.

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Title PA Break

Time 15 minutes

Facilitator

Materials and Preparation

Playing for Healthy choices selected card and PA Quiz. Set up 5 stations.

Instructions: Have 5 stations set up. Each station has one Playing for Healthy Choices card for the activity group will perform. Groups rotate stations doing the advanced reps on the Playing for Healthy Choices Card. Each Table will get a DGA PA Quiz handout. They will complete one question per station in any order. When everyone is completed sit down and go over answers.

Answers: 1.c,2.b,3.d,4.c,5.d (Read from Test Answers handout for Facilitator)

Suggested PA moves(Party Time, Jumping Jacks, Squat,Jab,Jab, Hamstring Curl and Cross Country)Instructions: Put up slide while PA Break is going on

Title Recommendations vs. What we really eat

Time 30 min.

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Title Recommendations vs. What we really eat

Facilitator

Materials and Preparation

Workbook

Say: Now we are going to discuss what DGA recommends we eat versus (next slide.)

Say: What we really eat.

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Say: Another part of the DGA includes a LOT of info about how what most American actually eat compares to these guidelines. Let’s take a closer look at some of this info.

Turn to page 10 of your workbooks called “Dietary Intakes Compared to Recommendations.” It looks like this!

Say: For now, let’s just focus on the very first food group - vegetables. This is on the top of the page.

Say: You can see the Orange bar. This is the percentage of ALL Americans who eat less than the recommended about of vegetables. Can anyone make out the percentage?

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Say: The blue bar is the percentage of Americans who do eat at least the recommended amount of veggies. This is about 16%.

Say: Notice how the ORANGE Bars are what DGA considers “unhealthy” behaviors, while the Blue Bars are what the healthy behaviors we want to encourage!

Say: Look at the graphs for fruits, total grains, dairy, protein foods, and oil comparing what we Americans actually eat vs what the DGA recommendations are. (Give them 30 seconds)What do you notice (Call out)

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Say: Now let’s look at the graphs for added sugars, saturated fats, and sodium. There are things the DGA recommends LIMITING. You’ll notice the colors have flipped BUT Orange still means Unhealthy and Blue healthy.

Say: The DGA has lots more charts like these. We’ll look at a few more. Turn to page 11 called Vegetables.These graphs get a lot more specific about gender and age.

You can see on graph on the left is just for boys/men, and the one of the right just for girls/women.

Say: This slide is zooming in on just the male part of the graph. At the bottom is the age ranges

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Say: On these graphs the blue bars are for the recommended intake. It’s a range because the amount recommended depends on how active you are. More active people will need more calories and foods from these groups, and less active people will need less of them.

Say: Finally, the little orange circle is what is average for all the people of this gender and age range. For example, for men who are over 71, the DGA recommends 2 ½ to 3 ½ cups each day. But the average actually eaten is a little higher than 1 ½ cups a day. That means most men over 70 are NOT getting enough veggies.

Say: Now look for your gender and age group. Also look for gender/age group for your family members. How do they compare?

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Activity 6 Say: Now let’s look at a few other charts –the dark green veggies, red/orange veggies, starchy veggies, other veggie and fruit.Focus on you and your family members.

What do you notice? Talk w/a partner or at your tables?We’ll hear your thoughts in a few minutes

Say: One last chart we’ll look at today is chart about Whole and Refined Grains

Say: This one is a bit different from all the rest.The blue bar is still for the recommended intake

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Say: However, on this chart the yellow bar is for REFINED grain intake. That’s of all the processed grain foods

Say: The green diamonds are for WHOLE Grain intake.Take a moment to review this chart. What strikes you about this one?

Say: We’ve talked quite a bit about some of the info the DGA has comparing the typical American intake for some food groups with the recommendations. Now that you are more familiar w/ this, we’d like you to consider how this relates to your work in SNAP-Ed. How can you see yourself using this info in the work that you do?Again talk in pairs/groups and we’ll hear your thoughts later5 min group/table5 – 10 debrief.

Title Barriers to Healthy Eating Patterns Discussion

Time 10 min.

Facilitator

Materials and Preparation Flip Chart Markers, Go into link show tool

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Activity 7Time:10 min

Instructions: Read question record ideas on Flip Chart

Say: The DGA identifies specific circumstances that can limit an individual’s or family’s capacity to choose a healthy diet to make healthy shifts to a healthy eating pattern. These barriers are Food Access, Household Food Insecurity and Acculturation on p 67 of DGA.

Say: What activities are you already doing to address these barriers? Let’s start with Food Access. Record share outs to solutions on flipchart. Then Household Food Insecurity, then acculturation.Barriers:

Food Access: Five strategies that county leaders can implement to increase residents’ access to healthy and affordable foods:*Improve healthy and affordable food optionsin existing stores*Promote supermarket development*Promote general economic development,land use and transportation policies thatincrease food access*Support farmers’ markets and communitygardens*Promote farm-to-school programsHousehold Food Insecurity: use a variety of strategies to make healthful foods more affordable at grocery stores, corner or country stores, farmers markets/urban farms, fruit and vegetable prescription programs, and community supported agriculture. Make nutritious foods more affordable for low-income children and families. Acculturation-The US continues to evolve as a nation of individuals and families who emigrate from other countries. Healthy eating patterns are designed to be flexible in order to accommodate traditional and cultural foods. Professionals can help individuals or population groups by recognizing cultural diversity and developing programs and materials that are responsive and appropriate to their belief systems, lifestyles and practices, traditions and other needs.Read DGA p67

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Title Comparing SEM and Core Settings of DGA to SNAP-Ed Models

Time 10 min.

Facilitator

Materials and Preparation

Say: So we have talked a lot about the first four guidelines of the DGA today so let’s take a look at the last guideline. This one is the key to sustainability and why PSE interventions are emphasized along with nutrition education and health promotion efforts. (Have volunteer read slide)

Say: Here is the new SEM graphic in your 2017 SNAP-Ed Plan Guidance. This comes directly from the 2015-2020 DGA. How do you all relate the core settings we just discussed to this model? What PSEs are you currently working on how do they fit into this model?(refer to next slide for participants to get a better description of the SEM breakdown)Activity 8: Participants share PSEs they are working on that are part of this model.(skip if already went over in activity 7)Background: The Dietary Guidelines for Americans continues to support and emphasize the role that Social and Cultural Norms and Values, Sectors and Setting have in improving health outcomes.The NEOPB media campaign aims at shifting social and cultural norms and values to support behaviors related to healthy eating and being physically activeThe NEOPB Partnership Plan specifically addresses the need to pursue and establish partnerships in each of the agriculture, communities of faith, education, government, retail, healthcareThe NEOPB Portfolios provide focus for interventions based on settingsAnd the nutrition education and physical activity interventions are directed towards the individuals

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Say: Does this look familiar to anyone? In 2010 DGA was the first time the DGA included the Socio-Ecological Model.

Say: Most of you are familiar with this.Read each level

Say: The 2015 DGA still has the SEM. It’s very similar to the 2010 version but does have a new graphic.

Say: You can see it still has the same 4 levels: Socio & Cultural Norms and Values, Sectors of influence including things like government, Health Care, Retail, etc.Settings – such as home, school, worksite, etc., and Individual Factors. In the 2015 version of the DGA they have added a bit explanation about how to use the SEM in planning.

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Say: This is an image straight from the 2015 DGA. What do you notice about this that is similar to the work you do? Participants should realize what they do ties in with this. (These are USDAs core settings) Where we work, play, live, shop, eat, worship. Page 70 of DGA goes over core settings and the importance of aligning settings with the DGA.Notes for more ideas if participants need more examples: Improved eating and physical activity behaviors may be sustained by implementing change at various levels of the Social-Ecological Model including the use of Smarter Lunchrooms in schools, CATCH or other PA curriculum in schools, and comprehensive nutrition programming such as the Shaping Healthy Choices Program. Adults are taught skills to sustain healthy lifestyle choices through curricula such as Plan, Shop, Save, Cook, Making Every Dollar Count and Eating Smart Being Active. (bolded above need approval from UC Cooperative Extension )

Shaping Healthy Choices is a comprehensive school-based program. It uses 2 curricula currently – Discovering Healthy Choices and Cooking Up Healthy Choices. Both are available at the UC Davis Center for Nutrition in Schools.

Title Prediabetes and SNAP-Ed Guidance

Time 40 min.

Facilitator

Materials and Preparation Video of www.doihaveprediabetes.org under Watch TV Campaigns at bottom of page.Workbook

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Say: How many of you are familiar with this? (Show of hands) Yes many of you should be. This is our go to for what is allowable in SNAP-Ed NEOP Programs. One thing we thought was important to touch on today is changes made to allowability in terms of diabetes prevention. Go to next slide.

Say: Turn to Page 8 of your workbook. Can I have a volunteer read language boxed in red?

The good news is you are already doing this work. The direct education classes, PSEs and other strategies you are using to prevent obesity align with what is used to prevent diabetes. The part of it SNAP-Ed doesn’t allow is the clinical aspect like diagnoses, treatment and education on diabetes.

We bring this up today because the DGA guidelines and recommendations were created to help with preventing conditions like diabetes and prediabetes(next slideSay: We know SNAP-Ed does not provide Medical Nutrition Therapy services to participants with diabetes but we can support the prevention efforts. One recent topic of discussion has been Prediabetes. Prediabetes is becoming an epidemic in our nation and there are many efforts going on nationally to help with prevention. By promoting healthy diet choices, like plenty of fruits and vegetables, whole grains, and healthy beverages-paired with the recommended amount of physical activity – the education you are providing is consistent not only with obesity prevention but also prevention of prediabetes.

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Say: How many of you are familiar with The National Diabetes Prevention Program? CDC-recognized lifestyle change programs are located in a variety of places throughout the nation, including at: health care clinics; community-based organizations; faith-based organizations; wellness centers; worksites; cooperative extension offices; and university-based continuing education programs. For a list of CA lifestyle change programs, see: https://nccd.cdc.gov/DDT_DPRP/CitiesList.aspx?STATE=CA Say: As we discussed earlier promoting, educating and supporting diabetes prevention is allowable. One way to do this is by partnering with programs like this one.

Say: all of our SNAP-Ed materials are consistent with diabetes prevention - healthy diet, physical activity and good beverage choices - in fact many of the speaking points mention prevention of type II diabetes, heart disease and certain cancers. The purpose of me saying this is to let you know you can easily reframe your approach where appropriate to mention that the materials you are using also help to support pre-diabetes prevention. Although you aren’t able to use CDC’s NDPP Curriculum you can refer a person to the program or be a part of monitoring for referrals to help promote this effort. You also have a responsibility to share community resources. Speaking of sharing resources I’d like to share with you some resources for the NDPP Campaign.

Background: Some counties are partnering with this CDC Program to help promote diabetes prevention. For example Fresno coordinates with the NEOP Program to offer cooking classes and other trainings to NDPP participants. Monterey has formed Local Action Network Meetings and is generating prevention screening referrals. Other counties involved in partnering with NPP are Alameda, Madera, Monterey, Sacramento, Fresno, Tulare, Merced, Shasta, San Joaquin and Sonoma. (Refer to example document)CDC-recognized lifestyle change programs are located in a variety of places throughout the nation, including at: health care clinics; community-based organizations; faith-based organizations; wellness centers; worksites; cooperative extension offices; and university-based continuing education programs. For a list of CA lifestyle change programs, see: https://nccd.cdc.gov/DDT_DPRP/CitiesList.aspx?STATE=CA. Interestingly, Solano County Public Health is listed as offering this program.

Say: NDPP has come up with some campaign ads we’d like to share. These messages are relevant, entertaining and timely. [Type text]

Title Resources

Time 5 min.

Facilitator

Materials and Preparation Resources handout, Play Video

Say: We all need materials that are easy to understand and share, such as an online searchable tool or document, an executive summary that highlights key takeaways from DGA and ready to use tools like infographics and social media messages. Next we are going to briefly review with you what resources are available that translate DGA from professional perspective to a public perspective.

Say: The Healthy Eating and Active Living Toolkit for Community Educators is available online for download. It includes 6 lessons that all must be taught. Good news is no Income Outcome Evaluation will need to be done for this toolkit and the lessons have been shortened from what was originally in the Fruit, Vegetable and Physical Activity Toolbox for Community Educators.

Say: Choosemyplate.gov has created various tools help individuals follow the key recommendations in the Dietary Guidelines for Americans, providing practical information to individuals, health professionals, nutrition educators and the food industry to help consumers build healthier diets with resources and tools for dietary assessment, nutrition education, and other user-friendly nutrition information. The online resources and tools can empower people to make healthier food choices for themselves, their families and their children. Let’s take a brief look at what tools they have available.Say: What is a “MyWin?” Making small changes and thinking of them as small victories=My Win providing sense of accomplishment.

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Say: The site also provides videos of real life family experiences that support helping with healthy changes. How many of you have seen these?If time allows Play video by clicking imagehttps://www.youtube.com/watch?v=V_UwhFSvd5w&index=3&list=PL8wgGeKVh_7d4x7icBCNj99MsachAAChiVideos can be found on https://www.choosemyplate. gov/families#top Under number 1. Videos featuring real families

Instructions: Review slide with link on resource handout and what is available on site.

Instructions: Review slide with link on resource handout and what is available on site. Same resource as previous slide but more detail on Tools and Resources.

Title DGA Travel Blog

Time 15 min.

Facilitator

Materials and Preparation

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Activity 9

Say: To wrap up today we want you to be the guide!

On page 18 of your workbook we’d like you to write about what you got out of today’s session. What you would recommend to other health professionals about DGA. Have a few participants share out key takeaways.

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Suggested Ways to Evaluate

1. Please respond to the questions below with the appropriate answer:

As a result of attending this training session I am better able to:

a. Objective #1

Strongly Agree ☐ Agree ☐ Disagree ☐ Strongly Disagree ☐ N.A. ☐

b. Objective #2

Strongly Agree ☐ Agree ☐ Disagree ☐ Strongly Disagree ☐ N.A. ☐

c. Objective #3

Strongly Agree ☐ Agree ☐ Disagree ☐ Strongly Disagree ☐ N.A. ☐

Please check ALL of the training activities below that were EFFECTIVE in meeting the course objectives.

This activity effectively contributed to the course objectives:

a. Activity #1 ☐

b. Activity #2 ☐

c. Activity #3 ☐

2. How likely are you to recommend this training session to someone else?

Very likely ☐

Somewhat likely ☐

Not very likely ☐

Does not apply ☐

3. What about this training session did you especially like?

4. What do you think would make this training session better?

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5. Any other comments?

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