Prepared by Kathy Richardson

Falls Program Coordinator SES LHN and ISLHN

Clinical Support Division

Health Reform Transitional Organisation Southern

STEPPING ON PROGRAMAdapting a mainstream program for CALD communities access

Multicultural Health Forum – 10 May 2011Translating Research into Practice

Stepping On Program Overview

� Community based 7 week education program

on falls risk factors and prevention strategies

for community dwelling older persons� Target group: people aged 65 years + who

had a fall in last year or are afraid of falling

� Randomised trial Clemson et al ( 2004): falls reduced by 31% in participants 12 months after

program completion

Initial Adaptation to CALD populations-

University of Sydney & SWAHS- 2007

� University of Sydney (Clemson and Lovarini) CALD

Stepping on project and partners: former Sydney

West AHS, NGO’s and local councils.

� Capacity building: AHS &external organisations

� Piloted program in 7 different CALD languages

� Project evaluated & sustainability issues

Older CALD community falls injury hospitalisation separations SESIH 2009-2010

Table 8 CALD community with highest age percentage of falls injury hospitalisation in 2009/2010

CALD group Language

by largest population

older population group

Population aged 65

years and over

Number of Falls injury

hospitalisations 65+

2009/2010

% of population

aged 65+ with

falls injury

hospitalisation

Italian 5159 178 3.45

Greek 4456 205 4.6

Chinese 3942 80 2.03

Macedonian 1997 40 2.0

German 1433 63 4.40

Egyptian-Arabic 892 79 7.06

Dutch 810 60 7.41

Source: K Richardson (2010) Community falls injury hospitalisation 2005-06 to 2009-10

Report for Area Falls Injury Prevention Steering Committee- December 2010

CALD community falls data for ISLHNTop 15 birth countries- falls injuries 65+

Source: Performance Management Unit falls injury hospitalisation report:

April 2011

Former SESIH Stepping on program 2008 adaptation for CALD communities

� Negotiated partnership between Area Falls Program, Multicultural Health Service (MHS) and Health Promotion

� Met with SWAHS Falls Program Coordinator and Meryl Lovarini Univ of Sydney in 2008 to discuss their project

� Area Falls Coordinator developed a planning guide to assist MHS staff piloting new stepping on programs

� Identified the CALD communities with highest proportion of older people (ABS data) and highest number of falls injury hospitalisations (HOIST data) for pilot programs

� Liaison between Population Health and Allied Health to arrange Allied Health facilitation of CALD pilot program

� Program facilitator training conducted by one of Stepping on program authors: Megan Swann, St Vincents CHC

Initial CALD Pilot - Greek community Wollongong- April 2009

� Program Administrator- Greek Multicultural Health worker

� HPS falls prevention awareness session to day care centres

� MHS recruited participants from community networks and ensured they obtained their GP clearance

� Falls Program met cost of translating participant resources

� Community venue provided by CALD community organisation and risk assessment completed for venue

� SESIH transported participants to the program venue

� Program duration - 8 weeks instead of 7- extra week to do program pre-measures testing with health care interpreters

� Adjusted session duration time from 2 to 2.5 hours to allow time for healthcare interpreters to do interpreting

Greek Stepping On Program Participant and service outcomes

� Program retention level: 13/19 (68.4%)

� Attendance- average weekly- 14.5 participants

� Objective measures- balance & muscle strength: 62% improved between pre and post test

� Subjective measures- 83% reported functional capacity improvement at end of program

� Participant feedback- liked program exercises, social contact, provision of transport and positive attitude of presenters and MHS contact person

Greek Stepping On Program Participant and service outcomes- cont.

� 3 month follow up session- participants reported:

- 12/13 still doing their exercises;

- 8/13 had vision checked or had

appointment for vision check;

- 12/13 had medications reviewed.

� 5/13 (38.5%) fell in the 3 months following program

� MHS capacity building- learning to administer a

new program & preparing the evaluation report

Greek Community Stepping On Program Participant Group- April 2009

Participant learning how to get up from a fall safely

Participant

testing with

physiotherapist-

near tandem

stand test for

balance

Italian Stepping On Program

Warrawong - October 2009

� Program Administrator- Italian Multicultural Health worker recruiting participants from her community networks

� Community centre venue: close to where participants live and used to attending centre for other programs

� Community centre schedule required changing program exercise session to run in first instead of second hour

� Resource translation costs met from Falls program

� Transport not required as participants walked to venue

.

� Participants- 20 females (males would like a program)

� Attendance- average weekly attendance: 95%

� Program retention: 20/20 completed program (100%)

� Objective test measures: all participants improved on

either their balance or muscle strength

� Subjective measures: participants reported functional

capacity- 50% improved

Italian Stepping On Program

Participant and service outcomes

:

�MHS capacity building- administering new program

and preparing program evaluation report with support

�3 month follow up session- participants reported:

� 20/20 doing exercises: 3x wk (13) and 2x wk (7)

� 17/20 had vision checked or appt for check;

� 8/20 -medications reviewed by GP or pharmacist;

� 1/20 (5%) had a fall in 3 months post program

Italian Stepping On Program

Participant and service outcomes- cont.

Italian Community Stepping On Program Participant Group- 2009

Participant

Testing by

Physiotherapist

with Assistance

of Interpreter

NSW Health grant funded

Stepping on program 2010-11

� MHS and Area Falls Program negotiated with SGMRC (external NGO) to administer Greek program

� Program Administrator- increased hours of existing Greek speaking part-time staff member

� Program facilitators- attempted to recruit Greek speaking unsuccessfully, then used mainstream facilitators + health care interpreters

� MHS mentoring of NGO new program administrator

� 1st Greek program- May 2010 successful- valued by clients & agency running the program

� 2nd Greek program conducted in October 2010

� 3rd program planned for 2011 in Macedonian language

St George Migrant Resource Centre Program – 2010Program outcomes- May 2010 + booster Oct 2010

� Retention: 13/14 participants completed (93%)

� Objective Measures Improvement:

- Balance ( NTS) 57% and TUG ( muscle strength) 71%

- 3 month booster: 8/14 attended (57%) with 63%

passing the NTS test (TUG not completed)

- Subjective measures improvement: FESI 36% reported

improvement at end of 8 week program

St George Migrant Resource Centre Program – 2010Program outcomes- May 2010 program + booster

� Participants recruited from several day care centres-

so some participants knew people already in group

� Literacy issues in own language prevented many

participants from completing their weekly homework

� Exercise level was maintained by participants during

program, but declined by 3 month booster session, so

exercise session introduced into Day Care programs

SGMRC GREEK COMMUNITY STEPPING ON PROGRAM JULY 2010

St George Migrant Resource CentreStepping on program 2010- graduates

Macedonian program- initial pilotIllawarra – Port Kembla Feb 2011

� Program Administrator (s)- MHS Macedonian worker

recruiting participants and ISLHN Administrator-recording test measures for entry in database

� Participants: All females- 17 commenced program

� Program facilitator- piloted OT instead of PT and were fortunate to have a Macedonian speaking OT

� Transport- 4 participants came with Macedonian Welfare Association bus & 15 with private transport

Macedonian program- initial pilot program results Feb 2011

� Retention rate: 11/17 completed (64.7%)

� Attendance: Average 7.5 sessions for 11 completed

� Objective measures improvement:

- Muscle strength: TUG 82%; STS 91%;

- Balance: NTS 45.5% (81.8% passed test)

� Subjective measures: FESI test not yet completed

� Booster session scheduled late June 2011

Macedonian community stepping on program participant group- Feb 2011

CALD programs planned 2011-12 grant

SES LHN

� Russian (external NGO)

TBC

� Macedonian (external

NGO) confirmed SGMRC

� Arabic ( external NGO)

confirmed SGMRC

IS LHN

� Greek ( MHS and Allied

Health) TBC

� Italian (MHS and Allied

Health) TBC

� Macedonian (External

NGO) TBC

Learning from translating research into

practice: CALD Stepping On programs

� Collaborative partnership between MHS, HPS, Area Falls Program, Allied Health & Healthcare Interpreters

� Planning new CALD programs- need 6 months lead time for MHS and Allied Health team including translations

� MHS worker contact person- CALD groups respond well to this, which benefits program recruitment and retention

� Teamwork and communication is critical to program success with the CALD program implementation

Barriers to implementing

CALD stepping on programs

� Participant literacy level low in own language

impacts ability to read translated handouts

� Low number of bilingual fitness providers for

providing ongoing CALD exercise programs

� Time and personnel intensive and more expensive to

deliver a CALD program than mainstream program

� Sustainability: limited internal Allied Health capacity

results in funding external NGOs to run CALD program (which adds to program delivery cost)

Other considerations with CALD programs

� General practitioner support of program is important for recruiting CALD people and obtaining their GP clearance.

� Ongoing program funding is needed to provide regular CALD program access rather than ‘one off’ programs

� CALD programs previously piloted - the translations are available which reduces overall program costs

� CALD groups - Falls injury hospitalisation data used to prioritise which CALD community stepping on programs are planned (CALD groups= 15.7% total falls injury data)

The Stepping On Project Team

� CALD Stepping on program planning initiated by

Area Falls Program Coordinator in 2008 (SESIH)

� Multicultural Health, Health Promotion and Allied

Health Managers supported CALD program pilots

� Successful pilots run in 2 CALD languages by 2009

with commitment of MHS workers to pilot program

� SESIH applied for NSW Health grant in late 2009

� Stepping On Project Advisory Group set up Feb 2010

� Stepping on Project Coordinator started May 2010

Multicultural Health Service CALD Program Administrators

From the left:

Anica

Petkovski-

Macedonian

program

Helen Tsalidis-

Greek program

August Farina-

Italian program

Population Health: Falls Program Coordinator, Stepping on Project Coordinator and HPS HPO

Stepping on Project Coordinator: Blanche Kairies

Email: Blanche.Kairies@ sesiahs.health.nsw.gov.au

Mobile: 0400-771281

Kathy Richardson, Falls Coordinator

giving a certificate to a graduate of the

Macedonian Stepping On Program

Janet Jackson, Health Promotion Officer,

Health Promotion Service who conducted

pre-program falls risk awareness sessions

Allied Health Team + Interpreters

Megan-

Physiotherapist (far left)

Julie – Physiotherapist (left) and

Malena – Italian Interpreter (right)

Marian-Physiotherapist

Trish-Physiotherapist

Other team members included: Occupational Therapist, Pharmacist, Dietitian and Jo Scard ISLHN Program Administrator

Stepping on

Project

Coordinator

Blanche Kairies

Mobile

0400 771281