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The Steps to a HealthierUS 5-year cooperative agreement program funds States,
cities, and tribal entities to implement chronic disease prevention efforts
focused on reducing the burden of diabetes, overweight, obesity, and asthma and
addressing three related risk factors: physical inactivity, poor nutrition, and
tobacco use.
For FY 2003, the U.S. Department of Health and Human Services (HHS) allocated
$13.6 million to fund 24 communities, including Seattle and King County; in FY
2004, HHS allocated $35.8 million to increase funding to the existing 24
communities and to fund an additional 16, for a total of 40 communities.
Project Area
- Six contiguous cities in south Seattle and southwest King County,
Washington (population 352,836); includes three school districts.
Target Population
- Households with incomes below 200% of the Federal Poverty Level, including
English-speaking, Spanish-speaking, and Vietnamese-speaking people.
Steps Activities
Media
Develop common messages; develop radio, television, and print ad
materials; provide advertising in versions that are culturally and
linguistically appropriate in Spanish and Vietnamese; conduct a media
campaign; and develop a speakers' bureau.
Develop and pilot test a kit to help parents, child care providers, and
preschool teachers become more vigilant about the influence of advertising on
the food choices of young children and to teach children to become more
critical viewers of food commercials.
Policy
Review policies designed to prevent and control chronic illness, including
health system policies that address cultural competence in asthma, diabetes,
and obesity clinical management; school policies that support students with
asthma and diabetes, discourage sales of non-nutritious foods, and encourage
physical activity; housing and community development policies that support
physical activity, nutrition, and healthy indoor environments.
Develop
mechanisms to promote policy change, including building capacity for using
health impact assessments to promote consideration of the health effects of
policy and planning decisions; building capacity of community members to
participate in public processes that review proposed policy and planning
decisions with substantial health impact; and creating Neighborhood Health
Justice Committees , provide education and advocacy training, and promote
grassroots mobilization and policy development.
School
Complete a comprehensive School Health Index (a Centers for Disease
Control and Prevention assessment and planning guide) to identify targets for
interventions in Steps schools.
Implement a comprehensive, prevention-oriented health curriculum.
Train high school students to mentor at-risk eighth graders in
after-school programs, such as workshops, recreational activities, community
service, and advocacy.
Build capacity to address specific health issues and create institutional
change within individual schools or within the districts by providing
full-time equivalent or extra hours for a health advocate to implement a
project that results in institutional change to improve the health of students
or staff and by providing incentives for sites to implement activities
suggested by School Health Index findings.
Community
Support community health workers who make home visits to encourage asthma
and diabetes self-management and provide community outreach and education.
Train child care providers in asthma management and breastfeeding
promotion.
Work in collaboration with clergy and health ministry members to provide
cardiovascular health and outreach and education in churches, including
information assessments and screenings, referral to education or
self-management classes and support groups, and provision of action plans for
participants.
Promote environmental and programmatic interventions to encourage physical
activity (e.g., running for adolescent girls, walking groups, biking to
school, mentors, personal trainers) and good nutrition (e.g., food preparation
demonstrations, healthy snacks).
Workplace
Promote worksite wellness: work with businesses to identify needs and
resources for worksite health promotion activities and assist businesses to
create worksite action plans.
Health Care
Implement key elements of the chronic illness care model to improve the
quality of care.
Use chronic disease and wellness coordinators to facilitate systems change
to implement quality improvement activities, link patients with community
resources, and provide limited case management services.
Expand and establish new and existing registries for tracking diabetes,
obesity, and asthma.
Increase resource support and provider knowledge about motivational
interviewing and developing patient self-efficacy for use in providing
culturally appropriate counseling to patients.
Establish a reporting system of asthma and diabetes visits for
epidemiologic surveillance and, possibly, clinical follow-up.
Provide training to providers in asthma, diabetes and obesity management.
Enhance communication between hospitals, primary care providers, and
health plans and develop protocols to improve notification of primary care
providers regarding emergency department and hospital discharges among their
patients.
Initiate and maintain an interface at the health plan level to provide
assistance, support, technical assistance, and resource support to Harborview
Medical Center and Highline Community Hospital. Provide a forum for the health
plan to observe the implementation of this program as a possible model for
managing chronic illnesses in the managed care environment
Evaluation
HHS will provide training and technical assistance to help each Steps
community develop measurable program objectives and specific indicators of
progress and use relevant data to support ongoing program improvement. HHS will
also conduct a national evaluation of the entire program. Existing data sources,
such as the Behavioral Risk Factor Surveillance System and the Youth Risk
Behavior Surveillance System, will be used to identify and measure program
outcomes and assess progress toward program goals.
Community Consortium
The Steps Consortium is open to all organizations, agencies, and individuals
interested in the Steps initiative. As of winter 2004, the consortium currently
has more than 75 members, including community-based organizations, health care
providers, hospitals, health plans, clinics, universities, faith-based groups,
government agencies, and school districts.
Seattle and King County Steps Contact
Lorrie Alfonsi, L.S.W.
Project Manager
Public Health–Seattle and King County
999 Third Ave, Suite 1200
Seattle, WA 98104
(206) 205-0932
(206) 296-0166 fax
lorrie.alfonsi@metrokc.gov
http://www.metrokc.gov/health/steps/index.htm
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