Stepping OnPresented by the

Wisconsin Institute for Healthy Aging, Wisconsin Department of Health

Services, and their partners

Why is Stepping On Needed?• 1 in 3 adults aged 65+ falls every year• Falls-related injuries are the leading cause

of death in Wisconsin for older persons• Majority of falls occur at home• Falls are not a normal part of aging; they

are preventable

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Consequences of Falls

• 40% of nursing home admissions had a fall in the prior 30 days

• WI Hospital and ED visits = $800M each year• 70% of costs are borne by Medicare & Medicaid• Cost of doctor visits, time off work, caregivers, etc.,

in addition to ED costs• Emotional toll• Fear of falling leads to reduced activity and

isolation, causing and increased risk for falls

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The Stepping On Program• Developed in Australia by Dr. Lindy Clemson, OT• Tested/implemented in community setting• 2-hour sessions once a week for 7 weeks• Follow-up home visit • Follow-up booster session• 8-12 participants• Led by 2 trained Leaders

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Stepping On

•Evidence-based•Meets AoA’s highest standard•Developed by Dr. Lindy Clemson and Megan Swann•Brought to U.S. by UW’s Dr. Jane Mahoney•Developed over years of:

– pilot-testing– refinement– evaluative research

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Stepping On’s Core Principles• Facilitation to effect behavior change• Decision-making as a process• Principles of adult education• Self-efficacy as a tool for change• Mastery experience as a tool for change• Group process• Preventive Framework

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Outcomes

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• Intervention group: 31% reduction in falls• Maintained confidence in more mobile ADL tasks• Used more protective behaviors• After 14 months– 59% still doing exercises– 70% followed up with home visit recommendations– More subjects had vision checks– Less likely to start taking new psychotropic drug

Target Population• Age 60+• At risk of falling• Has fallen in past year or has a fear of falling• Lives in own home or apartment• Cognitively intact• Walks independently or with cane; walker

occasionally or for outdoor use• Speaks and understands English or the language

in which the class is being provided

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Stepping On is CDC-Approved because it’s “Multifactorial”

• Strength and Balance Exercises• Vision• Medication Review• Home Modification

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Topics• Building trust, risk appraisal• Strength and balance exercises, homework• Home hazards and safety modifications• Community safety• Bone health• Medication management• Sleep medication alternatives• Safe footwear and safe clothing• Vision and falls

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Stepping On: By the Week1. Introduction, Overview, Choosing What to Cover2. The Exercises and Moving About Safely3. Advancing Exercises and Home Hazards4. Vision and Falls, Community Safety and Footwear5. Medication Management, Bone Health and Sleeping Better6. Getting Out and About7. Review and Plan Ahead

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Dissemination in Wisconsin• Began in Wisconsin in 2007• Range of agencies offer the workshop• Range of sites host the workshops• Range of professionals or lay

individuals who serve as leaders

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Leader Qualifications and Characteristics

• Health care provider, aging network professional, public health educator, or fitness instructor

• Experience leading groups of older adults• Can demonstrate exercises, modify, and

advance• Comfortable tightly following manual

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Leader Expectations• Attend entire 3 full-day Leader training• Work with a sponsoring organization• Lead workshops in pairs, both trained or 1 + peer• Lead at least 2 workshops each year• Follow program manual• Secure and distribute weights to workshop participants• Prepare and use a Stepping On Display• Copy and distribute Exercise Manual and handouts• Invite, prepare, and host 4 guest experts• Follow WIHA administrative protocols

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Are You Ready?• Identify the local sponsoring organization• Have 2 individuals trained or ready to be trained as Leaders• Communicate with the local ADRC/aging unit

to coordinate• Together, review the Planning Guide (see next slides)

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Stepping OnLeader & Local Partner Organization

Planning Guide

• Identify local sponsoring organization• If not the county ADRC/aging unit, make contact with it• Identify 2 Leaders – already trained or need training?• Select dates and times for first workshop• Select and reserve site, room, room arrangement• Will workshop be free or a fee?• What agency will submit workshop notification to WIHA?• What agency will receive workshop registrations?

Continued...

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Stepping OnPlanning Guide, cont’d

• Outreach and Marketing– See WIHA website materials – don’t reinvent the wheel– Presentations – Health care provider recommendations

• Supplies needed– Display– Exercise Manual and other weekly handouts Projector / DVD player– Easels, blank flipchart pads– Refreshments – Data Collection materials

• Funding Needed?

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Website for Leaders

www.wihealthyaging.org–Click on FOR LEADERS ONLY–Click on Stepping On– username: leaders@wihealthyaging.org password: wihaleaders

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Support for Leaders• WIHA website• Listserv• WIHA Leader Newsletter• Regular Leader conference calls or

meetings where available• Technical assistance• Leader Coaching and Fidelity Coaching• Healthy Aging Summit

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Leader Training• Come in pairs, or alone only if county already has a

trained Leader with whom to partner • 3 full days – must attend all to learn:– Evidence base for falls prevention– Underpinning concepts of Stepping On– Curriculum for Stepping On– Group facilitation techniques, including practice– Marketing, recruiting, partnership strategies

• Learn WIHA protocols and support available• During first workshop, may have fidelity coaching session

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Leader Training – To Apply:• Leader Application – link on WIHA website• Complete application; pay fee• Commit to requirements• Attend in pairs, unless already a leader in

county • Commit to requirements• With Sponsoring Organization, complete

Planning Guide• 20-person limit

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WIHA Collects Data On:• Leaders• Workshops• Participants• Why? –Funders–Policymakers–Program planning

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? ? ? Questions ? ? ?

• Betsy Abramson 608-243-5691 betsy.abramson@wihealthyaging.org

• Valeree Lecey 262-785-2577 valeree.lecey@gwaar.org

• Anne Hvizdak 715-677-3037 anne.hvizdak@dhs.wisconsin.gov

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THANK YOU!We look forward to working with you to expand Stepping On in Wisconsin