Rip-City Youth Fitness Program

The Rip City Youth Fitness Program
By: Casey J. Fields
June 5, 2013
Oregon State University
H 476 – Health Program Planning
Dr. Maxwell

TABLE OF CONTENTS

Abstract - P.2
Section 1: Background/Introduction
Justification for Program - P.3
Supporting Data/Statistics - P.4
Similar Programs of Relevance - P.7
How This Program Addresses Childhood Obesity - P.8
Section 2: Mission Statement, Goal & Objectives
Mission Statement & Goal - P.9
Predisposing Factors - P.9
Enabling Factors - P.10
Reinforcing Factors- P.11
Process, Behavioral, & Environmental Objectives - P.12
Section 3: Implementation
Five Program Components - P.12
Intervention Mapping Planning Model - P.16
Transtheoretical Behavior Model (Stages of Change)
- P.16
Barriers & Obstacles - P.17
Budget Sheet & Explanation - P.19
Section 4: Evaluation
Timeline - P.21
Process Evaluation - P.21
Section 5: References
ABSTRACT

Childhood obesity rates in the U.S. are on the rise, bringing about inconsequence ramifications that not only affect children now, but in the future. The Rip City Youth Fitness Program is designed to help elementary-aged children and their families adopt healthier eating habits, fitness behaviors and fight childhood obesity for current and future generations of citizens within the Portland Public Schools District in Portland, Oregon. The program implementation is based on the Transtheoretical Behavior Model, while the coordination is based on the Intervention Mapping Planning Model. The Rip City Youth Fitness Program will be somewhat of a breakthrough study/program, considering the lack of childhood obesity statistics recorded by any official organization for nearly the entire West Coast (CDC, 2013). Children will attend educational sessions to practice making healthy food and exercise choices, accomplished through guided discussions and various forms of hands-on activities. Parents will also participate in sessions, some solely for parents, and some in conjunction with their children. This is so parents develop skills that will encourage educated choices for improving overall well-being. These methods have been proven to work all over the world and there is a plethora of research that can attest to its effectiveness. (USDA, 2006)

BACKGROUND/INTRODUCTION

Justification for Program The relatively steady growth rate and high prevalence of childhood obesity in the United States over the past few decades is fairly well known throughout the country. Currently, there is a staggering amount of evidence that shows grave medical consequences as a result of obesity in youth. Furthermore, there are social and economic ramifications associated with childhood obesity. As a result, widespread concern for the issue has led to the publication of many review papers and monographs that highlight the importance of effective prevention and treatment programs for childhood obesity. In terms of prevention, school settings have been a frequent target for intervention programs, for they are able to reach a significant segment of the youth population. The Centers for Disease Control and Prevention (CDC) have issued numerous guidelines, which have emphasized the importance of school programs that address the physical activity levels and diets of children. While a variety of programs have been set forth, the overall effectiveness of most school-based programs on child health in general has been relatively poor. The main limitation in most of these incidents seems to be that many have not factored in the needed support from families and communities to allow behavior change to be consistent and last over a long period of time. Thus, it has been suggested that a more holistic approach aiming to influence lifestyle behaviors at the community, school and family levels may in fact prove to be far more successful in the prevention of childhood obesity. While the state of Oregon has one of the lowest prevalence percentages for childhood obesity (if not the lowest now) compared to the rest of the states, there are still large metropolitan areas such as the Portland, OR area that struggle to minimize health disparities due to the high diversity of socioeconomic status and demographics (CDC, 2013). However, as far as childhood obesity prevalence and incidence rates go within each individual city/region of Oregon, the statistics are minimal, similar with other West Coast states that haven’t yet experienced the obesity epidemic as intensely as further eastward states. This means that the conclusion of The Rip City Youth Fitness Program will potentially provide Public Health officials with valuable data that can more accurately help to monitor and control childhood obesity in the major city of Portland, OR.
Supporting Data/Statistics In 2010, the Healthy People initiative declared overweight and obesity to be the leading health problem for children and demanded a reduction in the proportion of overweight and obese children in the United States. However, according to data from the National Health and Nutrition Examination Survey (NHANES), the country as a whole has made little progress and is in no sight of reaching their target goal. (U.S. Department of Health and Human Services, 2013)
Results from the 2007–2008 NHANES, which measured height and weight in children, showed that 16.9% of children and adolescents ages 2–19 are estimated to be obese. Moreover, between 1976-1980 and 1999–2000, the prevalence of obesity greatly increased. While between 1999–2000 and 2007–2008, there was a slight, but non-significant increase in the prevalence of childhood obesity within all age groups. Results can be seen in Table 1 below. (CDC, 2013)

For a variety of health problems, there are significant race and ethnic disparities in relation to childhood obesity within the United States. Table 2 below shows the childhood obesity estimates by race and ethnicity for both boys and girls. (CDC, 2013)

As Table 2 indicates, in 2007-2008, the obesity rates were significantly higher among Mexican-American boys (26.8%) than among non-Hispanic white boys (16.7%) and similar trends were shown within girls. However, in the 1988-1994 bracket there was not a significant difference in the two ethnic groups. Moreover, it should be noted that all groups, no matter race or ethnic group saw a significant rise between 1988-1994 through 2007-2008. (CDC, 2013)
According to the CDC, the NHANES used household interviews along with physical examinations on each and every survey participant. During the physical examination, conducted in a mobile examination center, height and weight were measured as part of a more comprehensive set of body measurements. These measurements were taken by trained health technicians, using standardized measuring procedures and equipment. Observations for persons missing a valid height or weight measurement or for pregnant females were not included in the data analysis. (CDC, 2013)

In narrowing down these parameters to the Portland area, this particular location contains the bulk of health inequality and socioeconomic disparities leading to childhood overweight and obesity problems for Oregon, despite the fact that Oregon recorded a low 24.3% prevalence of overweight and obese children in 2007. The only states that had a lower prevalence were Utah and Minnesota, both at 23.1% (National Conference of State Legislatures, 2013). Beyond that, there is very minimal information available on the specifics of how childhood obesity has played out in the Portland Public Schools District, to also include the entire city of Portland itself. For this reason, the most narrowed down scope of our research and data collection has been based on the state of Oregon as a whole.
Regardless, overweight and obesity comprise the second leading cause of preventable death in Oregon, causing an estimated 1,500 premature deaths each year. In 2009, 36.1% of Oregon adults were overweight, and 24.1% were obese. The percentage of adults who were obese doubled from 11% in 1990 to >24% in 2009. This is why monitoring and regulating health deficiencies such as obesity is so vital, no matter where you are, so then preventative measures can be put in place to protect the health of future generations. Among Oregon eighth-graders, overweight prevalence has remained relatively stable during the past 10 years at around 15%, while obesity has steadily increased from 7.3% to 11.2%, according to the Oregon Healthy Teens Survey. (Oregon Public Health Division, 2012)
Another fact about the state of Oregon is that it is lacking in prevalence of recreational areas/facilities when compared to the remainder of the country. According to the Oregon Child Health 2010 Date and Resource Guide, the percentage of Oregonian parents with children ages 0 through 8 who live in neighborhoods without infrastructure for physical activity is lower than the United States average in multiple categories. These categories include: sidewalks or walking paths (Oregon – 20.6%; U. S. – 25.6%), parks or playground areas (Oregon – 13.9%; U. S. – 17.2%), and either a recreation center, community center, or boys’ or girls’ club (Oregon – 29.7%; U. S. – 34.7%). Refer to Chart 1 for a visual display of the percentage differences in each of the respective categories. (Oregon Department of Human Services, 2010)
Chart 1:
Similar Programs of Relevance While there are a number of different childhood obesity prevention programs throughout the country, the following three programs explain some of the different aspects and perspectives incorporated with this topic.
These programs provide a more comprehensive review of childhood obesity prevention by utilizing alternative parameters and different locations. All three of these programs were successful in meeting their goals and can be accessed through the “References” page at the end of this packet. The first program is MEND (Mind, Exercise, Nutrition, Do it). This is a significant program because of its high popularity and success, the emphasis on the family involvement aspect of childhood development, and since the subject count for the study is much lower in comparison to the other two programs listed below. A lower subject count allows for more control and more accurate of an analysis. Having a narrow age range of between 8 and 12 years old also helps with accuracy of results. Lastly, the study of this program measured for waist circumference, BMI, body composition, physical activity level, sedentary activities, cardiovascular fitness, and self-esteem, which is much more comprehensive and thorough in addressing as many factors as possible involved with the obesity epidemic. (Sacher,
2010) The second program is called Romp & Chomp. This is a good example because the study is focused on children between 0 and 5 years old, which is usually not included in most other community-based intervention programs for preventing obesity. Also, unlike the other two programs listed here, this one took place over four years instead of two, potentially allowing for a more accurate flow of data so that trends over time can be more simply identified and managed. Due to the infant-oriented age range, more emphasis is placed on family involvement, which provides a more extensive reference point for parents/guardians to learn how to raise their children to be as healthy as possible from birth. (de Silva-Sanigorski, 2010) The third program is APPLE (A Pilot Programme for Lifestyle and Exercise). This is another significant example because while most studies evaluate the effectiveness of curricular intervention programs, few studies such as this one have evaluated the effectiveness of non-curricular approaches. This means that the program utilized recreational areas and/or other various facilities as opposed to being incorporated with any school district jurisdiction (Taylor, 2007). While this factor – amongst some from the above programs – does not pertain to the Rip City Youth Fitness Program directly, it demonstrates the versatility of battling childhood obesity and informs the public on alternative approaches to potentially get to the same successful result.
How This Program Addresses Childhood Obesity The Rip City Youth Fitness Program intends to actively fight against childhood obesity and promote health, fitness, & nutrition throughout elementary schools within the Portland Public Schools District in Portland, OR. We will do our best to provide accurate and useful fitness information while continuously motivating children to exercise daily, eat well-balanced meals, and stay fit for life! Throughout the Portland Public Schools District, containing 58 active elementary schools and approximately 27,000 elementary school students, our plan is to establish one Licensed Nutritionist and one qualified Physical Activity Coordinator per school whom together will manage and be held accountable for everything that happens at their designated schools during the implementation process. These qualified professionals must not only be sound in their knowledge of health and wellness, but also know how to engage children in a fun, cheerful manner that encourages participation. The various components and other details of the execution scheme are found in the “Implementation” section.
MISSION STATEMENT, GOAL & OBJECTIVES
Mission Statement The purpose of the Rip City Youth Fitness Program is to provide educational values and active opportunities to minimize obesity for children of elementary school status and their parents/guardians residing in Portland, OR, so that the promotion of being healthy and staying physically active will encourage participants to independently engage in lifestyles as such.
Goal
The overlying goal for this program is for as many of Portland’s youth as possible to adopt the practices of a healthy lifestyle at an early age, minimizing the prevalence of obesity, in hope that they continue through adulthood, passing down their experience to further generations.
Predisposing Factors
According to the CDC, numerous studies indicate that there are certain genetic characteristics that may in fact increase ones susceptibility to excess weight. However, it should be noted that these genetic characteristics need to be present in conjunction with other contributing environmental and behavioral factors (a diet consisting of high-calorie foods and minimal physical activity for example) in order to have an impact on one’s weight. Nevertheless, it is possible for genetic factors alone to play a role in specific cases of weight gain. For example, the genetic disorder Prader-Willi Syndrome features obesity as a primary symptom. However, Prader-Willi Syndrome and other disorders like it are rare and the recent rise in rates of obesity within the general populous should not be attributed solely to genetic factors. The overall genetics of the human population has not altered for hundreds of years, but the prevalence of obesity in children for the past three decades nearly tripled. (CDC, 2013)
Because there are so many factors that contribute to childhood obesity that must interact with one another, it is impossible to specify one single behavior as the ‘cause’ of obesity. With that said, there are certain behaviors that can potentially lead to an energy imbalance that consequently leads to weight gain and obesity. (CDC, 2013)
Enabling Factors
Data collected by the CDC suggests that children may be spending less time engaged in physical activity during school hours. The daily participation in school physical education among adolescents has dropped by 14 percentage points over the past 13 years from 42% in 1991 to 28% in 2003. Additionally, less than one-third of high school students currently meet the recommended levels of physical activity. The studies show that children are spending considerably more amounts of time engaged with media devices than ever before. One of studies discovered that the time spent watching TV, videos, DVDs, and movies for 8-18 year olds averaged about 3 hours a day; and several studies have found a link between time spent watching TV and an increased rate in obesity. Hypotheses made by the CDC suggest that the use of modern day media, like watching TV, may: * Replace time children spend engaged in exercise, which can also lower metabolic rates * Contribute to a higher energy intake via mindless snacking and eating while watching TV * Influence children to choose more unhealthy foods via exposure to food advertisements
(U.S. Department of Health and Human Services, 2013) In addressing such problematic concerns, the environment within a community can greatly influence people’s access to physical activity, along with access to affordable and healthy foods. For the state of Oregon in particular, there is a significant demand for an increase in the amount of enabling factors accessible to children, as mentioned earlier in the introduction. The CDC asserts that a lack of sidewalks, safe bike paths, and parks in communities can make it challenging and discourage children from walking or biking to school as well as engaging in physical activity. Additionally, a lack of access to affordable, healthy foods can be a huge deterrent to purchasing healthy foods. (CDC, 2013)
Reinforcing Factors
Parents/guardians and the home environment can have a huge impact on the behaviors of a child and to their overall calorie intake. In most cases, parents are the role models in the home and their children are most likely to develop habits that co-inside with their parents. Likewise, data from the CDC states that about 80% of children aged five years and younger whose mothers work are in childcare for roughly 40 hours a week. So, it is reasonable to assert that the providers share a piece of the responsibility in the development of a child. (CDC, 2013)
Furthermore, estimates by the CDC suggest that childcare may be an easy setting to start introducing and developing healthy eating and physical activity habits. Moreover, because the majority of American youth aged 5–17 years are currently enrolled fulltime in school. Schools may prove to be the ideal setting for teaching children about healthy eating and the importance of physical activity. Luckily, according to the Institute of Medicine, many school districts are currently working to increase and implement new programs that focus on improving the eating habits as well as increasing the levels of physical activity of its students. (CDC, 2013)
Process Objective
By the end of 2013, the Program Director will have established methods for preventing childhood obesity and eradicating it within Portland’s youth, and individual school-based implementation within the school district will begin during first week of January 2014.
Behavioral Objective By the end of 2014, 75% of elementary school children who participate in the program will have both increased their daily rate of physical activity and reduced their average caloric intake by statistically significant amounts.
Environmental Objective By the end of 2013, the designated Recreational Construction Crew will have begun the preliminary steps to start developing areas for recreation and substantial physical activity to benefit communities with insignificant infrastructure for exercise, and finish by the end of 2014.
IMPLEMENTATION
Five Program Components * Children attend bi-weekly 1.5-hour sessions after school with qualified health educators to practice making healthy food choices and increase average physical activity rates * Parents will be given “learn-at-home” materials for increasing overall well-being that will provide family activities, discussions, goal setting techniques, and motivational guidance * Parents and their children together participate in separate 2-hour weekly meetings on healthy practices regarding consumption choices and physical activity habits * Incentives to promote program participation, to include free fruits & vegetables, gift cards, and exercise/sports equipment * Designated Recreational Construction Crew will establish/improve at least one recreational area within a 10-mile radius of each elementary school to make them more accessible and appealing to children
1) After-School Sessions (Children Only) While exact dates and times may vary from school to school, there will be health promotion sessions conducted twice a week (ideally on Tuesdays & Thursdays) by certified instructors that aim to help children make healthy food and exercising choices on their own will. Instructors will teach how a balanced diet and regular exercise are very important to the children. A balanced diet refers to the selection of foods with appropriate portions to provide adequate nutrients and energy for the growth of body tissues, strengthening the immune system, and keeping a healthy body weight. Apart from taking sufficient fluids everyday, children will be taught to eat according to the “MyPlate" model to stay healthy. 

As a reference point, instructors can explain the traditional Chinese diet where rice, vermicelli and noodles are staple foods, lots of vegetables and moderate amounts of meat, minimal preserved and processed foods, and utilizing healthy cooking methods that use little oil, is a perfectly balanced diet (CDC, 2013).
2) “Learn-at-Home” Materials
Parents/guardians are children’s most influential role models. Children are constantly absorbing and mimicking the behaviors they see. With that said, there are many ways to be a nutrition advocate for children in a fun and positive way. Helping children to learn healthy behaviors or to modify current behaviors can take time however; so being patient and positive as parents/guardians will benefit the whole family just by providing a good example through engaging in behaviors that potentially will be picked up by the children.
The materials to be provided for parents to reinforce healthy habits at home include many different methods to accommodate different learning styles. These methods include: modeling positive behaviors, discussing with children what they know/learned about healthy foods, sitting with them for a few minutes to play games, using recommended nutrition tools that are colorful and fun so that parents can use them with their kids, printing certificates for children and posting them as reminders of the healthy habits they are learning, setting healthy goals and establishing trackers for kids, cooking guides for learning about fun and healthy recipes, having children help out in the kitchen and/or garden, setting limits on TV and computer usage, and guiding children to approved websites that will promote education, healthy habits, and positive behaviors.
3) Family/Parent & Child Meetings Parents and their children will be asked to attend a 2-hour meeting once per week to teach and promote fun, interactive activities where families can not only learn about healthy living, but also have the opportunity to bond closer together through collaborative efforts. When children actively see their caregivers engaging in the same activities that they are partaking in, they feel more comfortable with continuing the activities and pay more attention to exactly what their caregivers tell them to focus on. Again, meetings will occur depending on the schedule for a particular school. There are a range of low-cost to no-cost activities provided by the staff to help caregivers incorporate healthy foods and physical activity into daily activities to make sure children are happy, healthy and ready to learn. Some of these activities include: 1) Bringing in new fruits or vegetables every week and using them to teach about the five senses (color? shape? smell? feel? taste?). 2) Exploring how food is grown by building classroom gardens or taking field trips to local orchards, farms, or fields. 3) Creating BINGO cards with healthy foods and teaching about the benefits of eating healthy foods (milk – bones & teeth, carrots – eyes, chicken – muscles, etc.). 4) Doing healthy cooking demonstrations to show that healthy, fresh food can be made at home and be fun. 5) Spending time each session to either go play on playgrounds, take nature walks, dance to music that promotes movement, or play games involving some sort of movement (Simon Says, Hide-and-go-Seek, Duck-Duck-Goose, Tag, Four-Square, Kickball, etc.).
4) Incentives A variety of free products promoting healthy eating and physical activity will be utilized as incentives for this program. Different incentives will be provided for each family/parent-child meeting and each children-only meeting to avoid redundancy and demonstrate different ways of addressing healthy lifestyles through proper food consumption and regular exercise. Some of these incentives include: fruits and vegetables (among other relevant, healthy foods) on display for participant consumption, gift cards for restaurants serving high-quality, fresh foods, exercise and sports equipment, activity booklets incorporating the development of healthy habits, and toys that require children to move around to be able to enjoy them.
5) Establish/Improve Recreational Sites While adhering to the program’s Environmental Objective of beginning preliminary steps toward establishing more effective areas of physical activity, a hired Recreational Construction Crew specializing in the development of playgrounds and parks is responsible for establishing and/or improving the quality of at least one recreational site within a 10-mile radius of each elementary school. For many of the schools, certain recreational areas will exist within two or more of the schools’ 10-mile radius, so then the Recreational Construction Crew isn’t overwhelmed with accommodating a new site for all 58 elementary schools. They will have plenty of time to simply start their plans by the end of 2013, and are projected to be finished by the end of 2014; the same time when children in the program are expected to achieve their hard-earned results. The Recreational Construction Crew is also responsible for developing their own timeframe and choosing which days to work, as long as they are averaging 20 hours/week, but the Program Director must approve it first.
Intervention Mapping Planning Model For this relatively new planning model, the kind of program that it addresses has to be based on theory and evidence. Due to the high success of other similar programs conducted around the country and internationally, it is fair to say that the theory of multi-level community collaboration for decreasing the prevalence of overweight/obese children over a significant time period can serve as the foundation for the Rip City Youth Fitness Program. (McKenzie, 2013) 1. Needs Assessment (Identify disparities, health issues, obstacles, etc.; for each school) 2. Matrices of Change Objectives (Develop realistic timeframe to achieve desired change) 3. Theory-based Methods and Practical Strategies (See Transtheoretical Behavior Model) 4. Program (Ensure all components correctly planned, adhering to timeline; staff trained) 5. Adoption and Implementation (Acquire interest and financial support; validate program) 6. Evaluation Planning (Set monitoring system to analyze data; make necessary changes)
Transtheoretical Behavior Model (Stages of Change) The Transtheoretical Model illustrates an individual’s progress through a series of six stages (pre-contemplation, contemplation, preparation, action, maintenance, termination) in the adoption of healthy behaviors or cessation of unhealthy ones (McKenzie, 2013). These steps represent ordered categories along a continuum of motivational readiness to change a problematic behavior. This model has proven successful with a wide variety of simple and complex health behaviors, including smoking cessation, weight control, sunscreen use, reduction of dietary fat, exercise acquisition, quitting cocaine, mammography screening, and condom use. (U.S. Dept. of Health & Human Services, 2013) Within the context of this childhood obesity prevention program, an obese child experiences pre-contemplation by simply having no intent to change their behavior due to being unmotivated and tending to avoid thought with regard to changing their diet and/or incorporating more physical activity in their life.
In the contemplation stage, the child can openly state their intent to change within the next six months, being more aware of the benefits of changing yet also remaining keenly aware of the costs. In the preparation stage, the child can intend to take steps to change, usually within the next month, and goes through more of a transition rather than a stabilizing phase. The action stage is when the child has made overt, realistic behavior modifications, such as working out on a more consistent basis and cutting down portions of food per meal, for fewer than six months. In the maintenance stage, the child works to prevent relapse and consolidate gains secured during the action stage. Finally, in the termination stage, the child no longer gives into temptation and has total self-efficacy, no matter what the stressor. (McKenzie,
2013)
Barriers & Obstacles As mentioned earlier, the topic of childhood obesity has so many variables that contribute to its prevalence and increasing incidence that the nature of the problem brings about a number of barriers and obstacles when approaching a solid solution to the problem. While there are a handful of more complex issues, we will be focusing on addressing the more common obstacles linked with fighting childhood obesity. The most common obstacles/barriers are time, money, cooking knowledge, food availability, food preferences of kids, and schedules. (CDC, 2013) To address a few of these issues, we have come up with some methods of approach that will help to diminish their presence. The challenge then is to come up with solutions to overcome personal obstacles. The following are two guidelines to use as a basis for common issues (learn more during program): (1) Money – most people are under the impression that healthy food, especially fruits and vegetables, is very expensive; possible solutions include local farmers markets, in-season fresh produce, frozen fruits and vegetables, buying sale items, freezing foods (fruits, vegetables, meats), and shopping around to find the less expensive stores near work, home, or child’s school. (2) Time – many people have no time to cook; possible solutions include finding recipes that require little cooking, putting kids to work, teaching them cooking and healthy eating skills at least once per week, making foods that freeze well and freeze them for a later date when there is no time to cook dinner, and going to restaurants and choosing healthier food options (most restaurants, delis, and even fast food restaurants have healthier food options). For example, instead of ordering a McDonald’s Big Mac and fries, order either a salad w/ low-fat dressing, the McVeggie burger or the Chicken McGrill sandwich.
Budget Sheet The requested funding for the Rip City Youth Fitness Program covers a 1.5-year span, pending additional years depending on the sustainment efficiency at the end of the initial 1.5-year timeframe. If the program proves successful by the end of 2014, the results will then be utilized to support request for future funding. The projected funding covers salaries for the Program Director, Licensed Nutritionists, Physical Activity Coordinators, and Recreational Construction Crew, and also covers costs for educational supplies, printing, incentives, office supplies, recreational equipment, and travelling expenses. The requested funding is $1,586,890. Refer to Table 3 for the projected line-item budget.
TABLE 3: Line-Item Budget Expenses | Amount | SalariesProgram Director – FTE = 100% | $60,000 | Licensed Nutritionists (58) – PTE = 25%5 hrs/week at $18/hour x ~52 weeks | $271,440 | Physical Activity Coordinators (58)–PTE=25%5 hrs/week at $15/hour x ~52 weeks | $226,200 | Recreational Construction Crew – PTE = 50%~20 hrs/week at $50/hour x ~77 weeks | $77,000 | Total of Salaries | $629,640 | Direct CostsEducational Supplies - $5,000/school(Curriculum Materials, etc.) | $290,000 | Office Supplies(Classrooms, Computers, Furniture, etc.) | Free (school-provided) | Printing~20% of Educational Supplies | $58,000 | Incentives - $7,500/school(Food, Gift Cards, Exercise Gear, Toys, etc.) | $435,000 | Recreation Equipment - $2,500/school(Construction Materials) | $145,000 | Total of Direct Costs | $928,000 | Indirect CostsTravelling - $250/employee (117)(Not including Construction Crew) | $29,250 | Total of Indirect Costs | $29,250 | Total Program Cost | $1,586,890 |

Explanation of Budget Sheet The Program Director will hold a Masters in a Public Health-related field. The director will be responsible for overall program implementation and facilitate the program services. The director will also be responsible for ensuring that outcome measurements are being taken accurately and track progress. The Program Director will oversee the monthly team meetings and assist in coordinating both the family and children-only seminars, with the assistance of the entire multidisciplinary team.
The Physical Activity Coordinators are part-time positions that require facilitating the after school program as well as participate in the multidisciplinary team meetings and family seminars. This position will be an Associate’s Degree level in Kinesiology or a related field. The Physical Activity Coordinators will be responsible for facilitating exercise activities and tracking the participants’ physical activity measurements in order to track outcomes. This position will also provide the physical education expertise to the family seminars.
The Licensed Nutritionists are part-time positions requiring a Bachelor’s Degree in Nutrition or a related field. The Nutritionists will teach the classroom curriculum and also participate in the multidisciplinary team meetings and family seminars. The Nutritionists will assist in developing the information given at the family seminars, distributing the “Learn-at-Home” materials, and must be available for consultation.
The designated Recreational Construction Crew is selected by the Program Director and essentially works separately from the rest of the program’s implementation procedures. Their rate of pay and work schedule are agreed upon between them and the Program Director. To ensure the completion of the Environmental Objective for this program, plenty of time is scheduled in advance for them to use all of the funds allotted for construction and/or improvement of recreational areas or facilities. This also allows both the monitoring and evaluating processes to be less of a workload for the Program Director to keep up with.
All of the salaries and estimates for direct costs were agreed upon prior to the program proposal, referring to an array of previous childhood obesity prevention programs, as well as recommendations from the Centers for Disease Control and Prevention and an organization called The Finance Project. (The Finance Project, 2004) (CDC, 2012)
EVALUATION
Timeline * July 1st (2013) – Hire Staff and begin planning process for all components * August 1st – All Staff trained, begin procuring individual methods to teach curriculum * November 1st – All Staff present materials to Program Director for approval * December 1st – Finalizations made, begin establishing work places within each school * January 1st (2014) – Program Implementation phase begins; Recreational Construction Crew finalizes plans on areas to construct/improve * *Monthly multidisciplinary team meetings conducted on the 1st of remaining months in 2014 for program evaluation, data analysis, and corrective measures for improvements* * December 31st, 2014 – Program Completion, all data collected for final analysis; Recreational Construction Crew finished with all new/improved recreation areas
Process Evaluation Each part of the program will be evaluated: nutrition education, physical activity, and recreational construction progress. Measures will be taken at the start and completion of each component. Where standardized measures are available, they will be used. If measures are not available, they will be developed in advance. Objective data, such as weight, food intake, and amount of exercise will be measured daily. All parties involved will be responsible for completing outcome measures: the children, the parents/guardians, the Physical Activity Coordinators, and the Licensed Nutritionists. Cumulative results will be presented at the multidisciplinary monthly meetings, so if changes are needed, they occur at monthly intervals.
References
CDC. (2013). Obesity facts. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/healthyyouth/obesity/facts.htm
CDC. (2012). Budget preparation guidelines. Centers for Disease Control and Prevention, Procurement and Grants Office (downloaded from CDC website). de Silva-Sanigorski, A. M., Bell, A. C., Kremer, P., Nichols, M., Crellin, M., Smith, M., Sharp, S., de Groot, F., Carpenter, L., Boak, R., Robertson, N., & Swinburn, B. A. (2010). Reducing obesity in early childhood: Results from romp & chomp, an australian community-wide intervention program. The American Journal of Clinical Nutrition, 91(4), 831-840. doi: 10.3945/ ajcn.2009.28826 McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2013). Planning, implementing & evaluating health promotion programs: A primer. (6th ed.). Glenview, IL: Pearson Education, Inc. NCSL. (2013). Retrieved from National Conference of State Legislatures website: http://www.ncsl.org/issues-research/health/childhood-obesity-trends-state-rates.aspx Oregon Department of Human Services; Office of Family Health. (2010). Oregon child health 2010 data and resource guide. Retrieved from: www.oregon.gov/DHS/ph/ch/data_resources.shtml. Oregon Public Health Division. (2012). State health profile: September 2012. Oregon Health Authority. Retrieved from: http://public.health.oregon.gov/About/Documents/oregon-state-health-profile.pdf Sacher, P. M., Kolotourou, M., Chadwick, P. M., Cole, T. J., Lawson, M. S., Lucas, A., & Singhal, A. (2010). Randomized controlled trial of the MEND program: A family-based community intervention for childhood obesity. Obesity, 18(S1), S62-S68. doi: 10.1038/oby.2009.433 Taylor, R. W., McAuley, K. A., Barbezat, W., Strong, A., Williams, S. M., & Mann, J. I. (2007). APPLE project: 2-y findings of a community-based obesity prevention program in primary school-age children. The American Journal of Clinical Nutrition, 86(3), 735-742. Retrieved from http://ajcn.nutrition.org/content/86/3/735.short The Finance Project. (2004). Financing childhood obesity prevention programs: Federal funding sources and other strategies. Retrieved from The Finance Project website: http://www.financeproject.org/publications/obesityprevention.pdf U.S. Department of Health and Human Services. (2013). Healthy people 2020. Retrieved from: http://healthypeople.gov/2020/default.aspx