A Matter of Balance:

Volunteer Lay Leader Model

Key Elements in the Translation of a Professionally Lead Program

Joint Conference of NCOA and ASA March 2006

Peggy Haynes, MPA

Partnership for Healthy Aging

Tara C. Healy, MSW, PhD University of Southern Maine

A Matter of Balance Volunteer Lay Leader Model

Administration on Aging Grant Partners:

Southern Maine Agency on Aging

MaineHealth’s Partnership for Healthy Aging

Maine Medical Center Division of Geriatrics

University of Southern Maine, School of Social Work

Grant # 90AM2780

Falls: Epidemiology of the Problem

Major cause of injury and death for older adults

Falls are the leading cause of injury hospitalization in Maine* *Healthy Maine 2010

1/3 to 1/2 of older adults acknowledge fear of falls

Fear of falling is associated with:

decreased satisfaction with life

depression

decreased mobility and social activity

increased frailty

increased risk for falls as a result of deconditioning

A Matter of Balance: Managing Concerns About Falls

Eight 2-hour classes designed to help participants learn:

• To view falls and fear of falling as controllable

• To set realistic goals for increasing activity

• To change their environment to reduce fall risk factors

• To promote exercise to increase strength and balance

Original outcomes research conducted by the Roybal Center for the Enhancement of Late-Life Function at Boston University.

Administration on Aging Grant

2003- AoA three year partnership to increase older adults access to evidence-based prevention initiatives

Grant Goals: • Maintain fidelity to the original MOB

curriculum

• Test whether a volunteer lay leader model is successful when compared with original research

• Share our approach with others in Maine and around the country

Grant #90AM2780

A Matter of Balance Volunteer Lay Leader Model

Guided by a Project Advisory Committee A Matter of Balance participant and coach AARP Maine City of Portland Maine Center for Disease Control and Prevention Maine Nutrition Network Maine Office of Elder Services Maine State Housing Authority New England Rehabilitation Hospital of Portland University of New England, Geriatric Education Center Osher Lifelong Learning Institute

Designed to benefit community-dwelling older adults who:

are concerned about falls

have sustained a fall in the past

restrict activities because of concerns about falling

are interested in improving flexibility, balance and strength

are age 60 or older, ambulatory and able to problem-solve.

Role of Lay Leaders

Team coaching

Peer modeling

Facilitation

Training and Recruitment

Potential partners

• RSVP

• Senior Colleges

• Senior Housing

Class graduates

Strategies for a Volunteer Model

Volunteer Lay Leader Model

• Coach training

• Mentor Model

• Observation and feedback

• Communication & Support

Volunteer Coaches

Age Group 59 or less

Age group 65 +

Women

Education: some college or more

70% (17)

30% (10)

79% (27)

90% (31)

N=53

Challenges and Lessons Learned

Clarity of volunteer commitment

Feedback loop

• Observations

• Participant satisfaction survey

Community recruitment partners:

• RSVP

• OLLI

• Resident Service Coordinators

Tension: Implementation Fidelity and Adaptation

Adaptations:

Classes taught by volunteer lay leaders instead of healthcare professionals

Participant workbook developed and coach manual modified

Exercises modified

Healthcare connection via guest therapist

Participants recruited through: Community organizations’ newsletters

Outreach presentations to: Aging network

Community centers & faith-based organizations

Clubs, libraries, social gatherings

Physician practices

Housing coordinators

Maintaining Fidelity

Original research curriculum used

Two day coach training based on original MOB leader manual

Health care professionals and master trainers observe volunteer coaches during: • two day training

• a MOB/VLL class

Use of a mentor model – new volunteers are paired with an experienced coach

Course evaluation and level of confidence post training

Follow-up survey at 6 mos. after leading MOB/VLL

Focus groups

Fidelity: Training Program for Volunteers

Coach Self-Reported Confidence

Post Training

Follow-up

6 mos.

Confident/

Totally Confident in Leading MOB

90%

(n=27)

96%

(n=26)

Confident/

Totally confident

Exercises

97%

(n=30)

100%

(n=27)

Coach Self-Reported Confidence

Post Training

Follow-up

6 mos.

Confident/

Totally Confident in Answering Questions

90%

(n=28)

93%

(n=25)

Confident/

Totally confident

Home Safety Check list

97%

(n=30)

100%

(n=26)

Coach Self-Reported Experiences at 6 Month Follow-up: “Better or A Lot Better”

Sense of accomplishment 80% (20)

Purpose in life 48% (12)

Can make a positive difference in another person’s life

76% (19)

Feelings about your health 48% (12)

Confidence in managing falls yourself

84% (21)

Key Findings from Coach Focus Groups

Respect for maintaining fidelity • Highlighted the importance of cognitive

restructuring by focus on attitude change in the first three classes

• Importance of mental exercises

• Able to discuss curriculum in detail

Mentor system highly valued • Aware of learning through this system

Key Findings from Coach Focus Groups

Benefits of Coaching • Rewarding – especially seeing older

adults gain more independence

• Coaches & participants have fun

Challenges of Coaching • Nervous about facilitating the group

• Managing group dynamics

• Participants with hearing problems

Participant Outcomes

MOB Original

Research

MOB/VLL

6 Weeks

Falls Management***

Falls Efficacy*

Falls Control***

Exercise Level ***

Social Activity***

6 Months

Falls Management***

Falls Control*

Falls Efficacy***

Exercise Level **

Monthly Falls*

12 Months

Falls Management**

Exercise Level***

6 Weeks

Falls Management***

Falls Efficacy**

6 Months

Falls

Management*

12 months Falls Management**

Falls Efficacy**

*p<.05 **p<.01 ***p<.001

Findings: Participant Outcomes

Comments:

I am more aware of my surroundings. I take time to do things and don’t hurry.

I have begun to exercise and am looking forward to a walking program.

I have more pep in not being afraid.

Participant Outcomes 97 % - more comfortable talking about fear of falling

97 % - feel comfortable increasing activity

99 % - plan to continue exercising

98 %- would recommend A Matter of Balance * % who agree to strongly agree

State of Maine

A Matter of Balance Dissemination

Dissemination Activity

14 Master Trainer sites

31 Master trainers

588 older adult participants

114 volunteer coaches trained statewide

A Matter of Balance Volunteer Lay Leader Model

For more information please contact:

Partnership for Healthy Aging

465 Congress Street, Suite 301

Portland, Maine 04101

(207) 775-1095 pfha@mmc.org