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KIDS N FITNESS 4ALL(For All Learning Levels)
Brenda Manzanarez, MS, RDDiabetes & Obesity Program
Megan Lipton-Inga, MA, CCRP Ellen Iverson, MPHSamantha Garcia, MS
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Disclosure
• Nothing to disclose
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Background• Kids N Fitness (KNF) was created in 2000 at Children’s
Hospital Los Angeles by a multidisciplinary team• Adaptations: original research regular classes (ages 8-16),
Junior (ages 3-7), church (Sunday school), afterschool with teens, summer camps.
• Key Program Elements:
Family-Centered Health Education
• Parent and child learn together
• Children learn from others in a social setting
• Parents have a support space
Physical Activity
•Dedicated time to be active
•Exercise with fun games
•Learn new ways of movement
Goal Setting & Self-Monitoring
• 5 weekly goals• Track daily
behaviors
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Energy Intake
Energy Expenditure
Individual Factors
Environmental Settings
Social Norms and Values
Communities
Worksites
Health Care
Schools and Child Care
Home
Demographic Factors (e.g., age, sex, SES, race/ethnicity)
Psychosocial Factors
Genetics-Environment Interactions
Other Factors
Government
Public Health
Health Care
Agriculture
Education
Media
Land Use and Transportation
Communities
Foundations
IndustryFoodBeverageRetail
Leisure and Recreation
Entertainment
Physical Activity
Sectors of Influence
Food & Beverage Intake
Social Ecological Model
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Community Partnership
Train Staff
•5 promotoras•1 lead KNF
coordinator•Volunteers
•Mock teachings•Program logistics
•Recruitment•Coordination•Volunteers•Staff debrief
Observe
•Lead CHLA Staff –main observer
•Noted:•Curriculum
adherence•Engagement with
audience•Program logistics•Questions by
audience
Provide Feedback
•Missed topics•Explanation of
topics
Follow-up & Reinforcement
•Routine check-ins• Increase confidence•Troubleshooting•Support
2015 – Partnership began- Regular Kids N Fitness2017 – 2018 - grant funding for ASD programming- KNF4ALL (All Learning Levels)
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Needs in the Community
• South LA is one of the poorest in the county, and most under-resourced regions– Children:
• 68% Latino, 27% African American– Adults:
• 42% have less than a HS education, 52% not born in US– Families:
• 34% live below 100% of the Federal Poverty Level• St. John’s Well Children and Family Health
Center– Center for Autism and Developmental Disorders
• Comprehensive, interdisciplinary care• Serve over 275 children with ASD• Waitlist over 100 patients
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ASD children stats
• 1 in 59 children• More common in boys
– 4x higher than girls
• DSM-V diagnosis
• ASD characteristics:– Issues with verbal and non-verbal communication– Impaired social interactions– Repetitive behaviors– Limitation in activities and interests
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Co-occurring Physical & Mental Health Conditions
• Feeding issues– Selective eating (picky eating)– Pica (eating non-food items)– Chronic overeating leading to obesity
• Gastrointestinal (GI) problems– Limits food options nutritional deficiencies
• Attention-deficit/hyperactivity disorder (ADHD)• Obsessive compulsive disorder (OCD)• Anxiety - Depression• Disrupted sleep - Epilepsy• Schizophrenia - Bipolar Disorder
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Social Ecological Model to Create Change
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Why is it an issue?
LA children living with a special health care need
15%
Lack of early interventionLess than 1 in 3
receive timely developmental
screenings
Difficulty accessing
medical care12.9% Latino6% African American12.6% Asian (LAC-DPH, 2011, 2015)
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Access?
Perceived neighborhood
safety
77.8% vs 92.7%(LAC-DPH, 2015)
Children with ASD & Obesity
23.4%(2010 Natl Survey of Children’s Health)
Easy access to a park or
playground or other safe
place to play
85.8% vs. 89.3%(LAC-DPH, 2015)
Access to fresh fruit/vegetables as “excellent or
good”
69.4% vs. 88.3%(LAC-DPH, 2015)
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Pilot Goals
1. Feasibility– Will families come?– Will children with
ASD be receptive to health topics?
– How easy will it be to make changes?
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2. Observations for future interventions
– Test simple modifications to ASD population
– What worked?– What didn’t work?
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Program Stages
CHLA KNF Psychologist Case
Manager KNF
Coordinator Promotora
Multidisciplinary
meetings
Refe
rral
&
Enro
llmen
t
Surv
ey
Ori
enta
tion
Clas
ses
Feed
back
Psychologist &/or MD referral
Case Manager referral
KNF Coordinator Promotora
Planning phase
Implementation & Observations phase
KNF Coordinator 1 Promotora 1-2 Applied Behavioral
Therapists (ABA) 2-4 Volunteers Case Manager 1 CHLA KNF staff
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Program Format
Structure-focused Agenda
poster Shorter didactics Story telling Tactile Arts & Crafts
Individual-based Smaller groups Activity stations Yoga videos
Exposure to familiar and non-familiar foods
Precut foods Self-selected
items Parent role-
modeling by eating along child
Daily logbooks Weekly goals
Continued nutrition education Space for sharing Brainstorm goal implementations Peer support & empowerment
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Program Stats
32 families participated
3 Cohorts
18 families completed program (4+classes)
56% Retention Rate
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During Nutrition Lessons…
• Well received:– Following an agenda– Repetition– Positive
reinforcement of behaviors (stickers, clapping, high-fives)
– Activities tied to nutrition
• My Plate collage• Coloring handouts
• Observations:– Children needed
increased wiggle breaks
– Parents became distracted with disruptive behaviors
– Engaged with children
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During Physical Activity…
Observed Challenges:• Some games were
noisy• Too much
stimulation• Did not want to
separate from parent
• Crying; mostly younger kids
Adaptations:• 1:1 - 1:3
adult:child ratio• Focused on
stations and individual activities
• Calmer activities
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Yoga is a success!
• Cosmic Kids Yoga• Dora the Explorer
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Food
“He doesn’t like that. He is not going to eat it!”
Re-frame comments:
• What colors do you see?
• Let’s make this shape!
• You are doing such a good job at trying…!
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Parent Feedback• “Thank you for the opportunity to help me
understand”• “A bit more time to learn”
Content
• “That my son got so involved in it”• “The excitement of my kids each class”• “My child tries new foods now”
Enjoyed aspects
• “It gave me ideas”• “It was a good way to get the kids to understand
things”Snacks
• “I want to learn more”• “My child is communicating with me more about
his food selections and he has motivation to play and do exercise more”
• “My child exercises more and is willing to eat more fruits”
• “Before eating my child will observe the food and critique it to make sure it is”
Other suggestions
or comments
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Staff & Volunteer Feedback
Daily short debrief after
each class
Implement changes & observe
Debrief & get mini-training
from ABA
10-15 minutes What worked Challenges Parent perspective/
insight ABA feedback about
behaviors
Ease of adaptation Acceptability
Staff perspective Observer perspective ABA mini-training Weekly emails with
noted challenges and changes
Psychologist & Case Manager support
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In Summary & Future Goals
• Despite low attendance, benefits can be seen by those who attended
• More programming and research are needed
• Incorporate a stronger social-behavioral therapy component into the curriculum
• Focus groups• Imbed into education/therapy after
initial diagnosis
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For questions about the presentation:Brenda Manzanarez, MS, RD
Health Education Leader, Clinical Dietitian
For questions about the Kids N Fitness Program:Megan Lipton-Inga, MA, CCRP
KNF Program [email protected]
(323) 361-5423
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References