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Active & Healthy Families

A Pediatric Overweight Group Appointments Program

What is Active & Healthy Families?

Active & Healthy Families (AHF) is a family-based medical group appointment program of Contra Costa County Public Health Clinic Services located in Contra Costa County, California. The program consists of five-2 hour sessions every other week for 10 weeks, which teaches healthy eating and exercise habits.

Target Population

The AHF program is a model intended for low-income families in the prevention and treatment of childhood obesity who are served by Federally Qualified Health Centers (FQHC). This program is currently offered in three of Contra Costa County's federally qualified health clinics and has been replicated by FQHCs in two other counties in Northern California.

Goal of the AHF Program and the Stages of Change Approach

The AHF program is designed as first level of family education and support regarding obesity prevention and lifestyle modification. The Four Stages of Change model is the approach used in helping participants succeed in adopting healthier lifestyle/behaviors.

At the first session, most of the participants are either in the Precontemplation or Contemplation Stage. The education provided at each of the AHF sessions assists participants in deciding a specific change/s in their day to day living. This part of the program is the Preparation Stage. The Action Plan and Step Tracking tools are introduced at the end of the first session to assist participants in progressing to the Action Stage. The Action Stage is where participants choose a specific change/s to work on and implement in their daily living. Successful completion of the AHF program is for the participant to reach the Action Stage by the end of the last session (5th session). Arriving at the Action Stage would set the foundation for families to make the new behavior/s part of their lifestyle. Incorporating the new behaviors over time would be referred to as the Maintenance Stage.

The following topics are covered in the five-2 hour sessions: definition and consequences of overweight and obesity, sugar sweetened beverages, parenting, nutrition labels, breakfast, healthier snacks, fast foods, appropriate portion sizes, meal planning, screen time, physical activity, emotional eating and daily stress.

Important Features of the AHF Program

A key feature of the AHF program is the delivery of its sessions by a provider TRIAD consisting of a Physician/Nurse Practitioner, a Nutritionist and a Community Health Worker.

Other important features of the AHF program include:

  • Culturally tailored curriculum
    The program is culturally tailored to three low-income population groups:
    Latinos, African Americans and Multi-Cultural English-speaking families. The AHF program for Latino families which is delivered in Spanish is referred to as Familias Activas y Saludables (FAS). The AHF program for the other two groups are referred to as AHF for African American families and AHF for English-speaking Multi-cultural families.
  • Engages children and families
  • 5-biweekly group medical appointments
  • Interactive learning and individual action plans in each appointment

The program is open to children age 5-12 years with BMI of 85 percentile and above. A parent is required to attend each session with the child.

Familias Activas Y Saludables

Familias Activas y Saludables (FAS), the AHF program currently featured in this site is delivered in Spanish and is culturally tailored to meet the needs of Latino families.

Background Information of FAS

Latinos have the highest prevalence of obesity in Contra Costa County for youth age 2-19 years (PedNSS, 2010). Many Latinos face barriers to maintaining good health, such as limited access to health insurance, language, culture and immigration. In response to the need and the barriers facing the Latinos, FAS is culturally and linguistically-tailored for the Latino families. This model is currently available in the following federally qualified health clinics (FQHCs) in different areas of Contra Costa County:

  • Meadow Homes Elementary School-Based Clinic in Concord, California
  • Parkside Elementary School-Based Clinic in Pittsburg, California
  • Marsh Elementary School-Based Clinic in Antioch, California

Evaluation of the FAS Program

During the fall of 2012 and spring of 2013, the FAS program was evaluated by the University of California in Berkeley with funding by Safeway Foundation in a randomized controlled study. Changes from baseline to post-intervention (10 weeks) in BMI, fasting blood sugar and blood lipids were compared between the intervention and the wait-list control group. The study took place in two Contra Costa County FQHCs. The participants were 40 Latino children aged 5 to 12 years with a body mass index (BMI) of 85 percentile and above and their parents.

Results of the University of California (Berkeley) FAS Randomized Controlled Study

Among the first 23 participants enrolled, there was a significant weight loss for the intervention group versus the control group (-0.5 lbs vs +2.0 lbs, p=0.012) and significant change in BMI (-0.6 kg/m² vs +0.1 kg/m², p=0.004). There was a trend for differences in change in triglycerides (-14.8 vs +4.8, p=0.12) as well. Attendance to the AHF sessions among the intervention group was high, ranging from 82% to 98%.

AHF Program for African American Families

The AHF program culturally tailored for African American families just completed the pilot phase and will be available for implementation this fall, 2014 in one of Contra Costa County's federally qualified health clinic.

AHF program for English-speaking Multicultural Families

The AHF program for the English-speaking multicultural will be piloted in the spring of 2015.

If you plan to replicate the AHF Program for Latinos, referred to as Familias Activas y Saludables (FAS) program in a federally qualified health clinic, please read the Introduction to the Training Site below prior to Registration and Log in.


Introduction to the Training Site

To All Future Users of the AHF-FAS Training Website,

Familias Activas y Saludables (FAS) was developed and implemented collaboratively by Contra Costa's Child Health & Disability Prevention (CHDP) program, Ambulatory Care and Integrative Health Program and the Reducing Health Disparities Division. Based on the results of the randomized controlled study by the University of California, Berkeley (which showed significant improvement in the intervention group versus the control group in regards to weight loss, BMI and trend in triglycerides), dissemination of the program has the potential to improve child health on a large scale. This program is ideal for primary care intervention in FQHCs serving a population that is predominantly Latino.

In 2013, the FAS program received the first place award in the American Journal of Preventive Medicine Childhood Obesity Challenge, Seeking Innovative Solutions at Reducing Obesity. Also in 2013, the FAS program was presented at the 7th Annual Childhood Obesity Conference (Mini-Plenary-Eliminating Health Disparities) in Long Beach, CA.

This training site intends to provide all the materials, handouts and curriculum of the FAS program in Spanish and English including the AHF team members' script/talking points. The FAS program has been replicated in FQHC's in two other counties in California and in Contra Costa County's school-based clinics with good results.

To ensure a successful replication of the FAS program in your own clinic, it is strongly recommended to complete all the steps listed in the Activity Checklist (below) prior to start of the FAS curriculum training.

Sincerely,

Annabelle Cadiz, MS, RD
Consultant, AHF Program
Contra Costa County Public Health
Daniela Jaramillo, RD
AHF Team Nutritionist
Contra Costa County Public Health

Activity Checklist - STEPS in the Replication of
Familias Activas y Saludables (FAS) Group Appointment Program

  STEPS Responsible Party Date Completed
1 Understand the program's goal All team members  
2 Get administration's support MD/NP  
3 a) Establish the team members (triad):
  • Physician/Nurse Practitioner
  • Nutritionist (RD)
  • Community Health Worker
b) Requirements for team members:
  • Bilingual (English/Spanish)
  • Experience with pediatric population
  • Training/background in motivational Interviewing with individual/group is highly recommended
c) Certified medical assistant (CMA) for MD/NP
MD/NP, Administration  
4 Address billing/reimbursement (FQHC), fees for service; funding for session snacks, materials Administration  
5 For first AHF series:
Recruitment of at least 25 participants from Spanish speaking families, 5-12 yo, BMI > 85% and goal of 10-12 attendees for each session. From medical records of patients (5-12 yo) who visited clinic in past year
Clinic nurse  
6 Physician Referrals of qualified patients to FAS to take place at least 3 months prior to 1st Session. AHF Participation Flow Chart MD/NP  
7 Identify a meeting place for the FAS sessions (location should accommodate at least 30 people and be big enough to split parents and children for different activities) Administration  
8 To start at least a month before series begins
a) Prepare FAS handouts, forms, posters, purchase incentives and materials needed in each of the 5 sessions
b) Prepare educational materials to be used in session 1, 2 and 3
Summary of handouts, forms, incentives, posters and materials
RD/CHW  
9 Designate program evaluator (CHDP Nutritionist, Health Plan representative, etc.) All team members and administration  

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Contact Us

Daniela Jaramillo, RD
AHF Team Nutritionist
Contra Costa County Public Health
925-313-6213
ahf@hsd.cccounty.us