Denver Notes Page

Tuesday, April 25^th

Sarah

Time	Topic	Internal Notes
9am to 10:15am	Setting the Scene	MEND: can we use it, can we use pieces of it without branding/paying? Propose in Year 6, use money for data/implementation instead of MEND kits, etc…. Use the things that still work. Keep CDC happy, but share what works and what is realistic (can and cannot do)
10:15 – 11:45 am	High level overview: What do FQHCs need to do this work?	No MEND kits, but evidenced-based practice tools 2. Champions (at least two staff members who LOVE this work) 3. Exposure/training of the skill of facilitation (consider non-provider/clinician to facilitate curriculum, use provider/clinician for 1:1 time) i.e. pregnancy centering program 4. Reimbursement for non-clinicians, i.e. CHW --look to new CPT code for family health weight. Cautionary tale: Diabetes Prevention Program---certification needed, must meet quality requirements, reimbursement insignificant 5. Counting “touches” --creative ways 6. Training on family healthy weight 7. Data infrastructure--what can we measure and how do we track it. Framework for evaluation--feasible/meaningful. Program + IT person--give them). A template for the data guy plus (data request form + data dictionary) 8. Staff 9. Basic curriculum with “at the end of this program, your participants should be able to…..”--COMMIT is it’s own curriculum. Include competencies 10. Cultural adaptations 11. Goals and definition of success (not necessarily weight loss, but rather lifestyle skills 12. Trauma informed and behavioral health approach Other notes: Expand to CBOs (include them) to reach out; recruit from CBOs Include role of PCAs /community partnerships and include preventive screenings Implementation guide that includes different pathways, approaches (provider, vs inside/outside, etc..) Scaling group sessions in a variety of ways to access (clinic, virtual, mobile clinic, mobile virtual). Intensity=small n and low reach. Reach=larger n but less intensity. What is your CHC’s love language--productivity or quality?
11:45-12:45 pm	Goals, Scopes, and Outcomes: Dreaming Big	Local: Robust program accessible to my whole health center and community. Engage with anyone who wants it. Accessible to all: language, culture Building strong collaborations with other orgs in your community that do children/family work -->Community-wide Warm hand-offs for participants, such as behavioral health, DURING the program (not after) Work with school districts State: Train the trainer--set up other CHCs (formal, but accessible). Form Master Trainers within states National: COMMIT becomes like a DPP, etc…. People want it and it’s accessible Doing more for people who have less access--equity through FQHCs Legacy teams becomes a steering group and influential in growing ---this group has the credentials Insurance companies recognizing work and pay out---establish a payment model Prevention model vs. sickness model Lend and borrow credibility with AAP Clinical Practice guidelines All: PCA/Network conferences Resources Staff joy Dynamic and engaging connection
2:00 pm – 2:45pm (45min)	Implementation guide step 1: ASSESS PERSONNEL AND RESOURCE CAPACITY WARNING: DO NOT START Lack of personnel (both in #s or in interested) Health center culture not open to prioritizing it, doesn’t care about health outcomes, innovations Health center is having budget cuts If a health center doesn’t have non-billable ancillary services already OTHER NOTES Budgeting could be put under Diabetes Prevention Program Use key words: SDOH, food insecurity, etc… Use the power of pictures, stories, etc..	Personnel Assumption below is one program; justification for staffing Choose staffing when you have the funding Staffing roles: title and responsibilities, specify by need to have, vs. nice to have. You need minimum 3 people--facilitator, movement and someone who goes in-between, also has roles of Project manager (full time) , program coordinator (full time). Consider interns/students for bonus. Project manager chooses everyone else and identifies a champion Ideal skills Experience working with kids and families Experience with fitness, training expected Teaching experience, facilitation a plus, experienced presenters Someone who can “read a room” and adapts Someone who can be creative; learn Tech savvy: What’s App, way to connect, texting Language: (content would be needed far in advance) Cultural adaptations--i.e. understands the population that you are serving. I.e. Cafecita time: 6pm--”feed them and they will come” Food preparation course may be needed (OSHA) Other standards based on location and their rules. Extra staff: Medical assistants with good knowledge of EHR, Referrals, plus vitals Nice to haves: Dietician (3 sessions + cooking classes), behavioral health consultant (2 sessions) Utilize CBO staff (i.e. staff at YMCA) to set up, help with program, may use some of their own resources 4 weeks lead time training + curriculum tweaking (some of which happens while running the program) Staff training: 2 days of full training 1 day of catch training Resources Equipment: measuring, movement (1 of everything for every kid), incentives, vitals (STEP, nurse on a stick), AV Equipment, poster boards, etc…. Welcome Packet (incl Golden Ticket), addressed to kid. Space (two spaces--large enough for a big crowd and activities space) Food supplies and snacks plus food preparation AV PREP TIME and CLEAN UP TIME (generally 1 hr before and 1 hr after): i.e. cooking shows Referrals Access to referrals plus training around referrals/workflow and how to access EHR Access and how to navigate it (access, process and complete)
3:00 – 3:45pm WHAT WE DON’T WANT	Implementation guide step 2: SELECT A CURRICULUM AND DELIVERY APPROACH Other notes: Do Open House or Session 0 to gauge time/modality of interested participants (4 weeks out) Partner, look for other opportunities to dovetail with other programs going on in your org.	How should a health center choose a curriculum Evidence based with metrics (data) Room for adaptations or what that looks like (i.e. can use/change and just use logo). Possibly modifications built in already or curriculum owner also makes modifications for you. Cost What training is involved Suitable for population? Languages? Hours/time commitment for participants Age groups What resources are needed (personnel/supplies). Goals/objectives for health centers Labs: AIC, Fatty Liver, BP, stress strategies Weight loss BMI vs. healthy lifestyle Multimedia capabilities Scalability DELIVERY Focus on in-person or hybrid (cooking goes well) Transportation Privacy Access In-person social component key (kids/parents together, then separate, then together again) Connections Coffee Motivation
3:45 – 4:30 pm	Implementation guide step 3: DETERMINE BILLING/ SUSTAINABILITY	Potential to add billing codes we KNOW get reimbursed (pediatrician or provider visit and/or dieticians, behavioral health). May include a disclaimer about state billing codes or specific map Include a billing/coding person in these conversations Link to staff satisfaction (not just productivity) Documentation tips/tricks

Jonathan

Time	Topic	Internal Notes
10:15 – 11:45 am	High level overview: What do FQHCs need to do this work?	Using MEND - proprietary, some change the name to adapt to local context but some people like the MEND term since people are familiar Give the kids modified materials Cost! MEND not made for scale Major barrier - no train the trainer model, need to send someone to get trained
11:45-12:45 pm	Goals, Scopes, and Outcomes: Dreaming Big
2:00 pm – 2:45pm (45min)	Implementation guide step 1: ASSESS PERSONNEL AND RESOURCE CAPACITY	Group 2: Assess how many people you need to implement each session and how many sessions you want to have Step one: What is the scope of what we want to deliver? Who, what, when, where Establish a billing plan, base the rest of the plan on that Ex. for Arizona, has providers at beginning visit so they can bill, every Saturday for 10 weeks When events will happen and time commitment Where will the event happen, what space is available List of administrative and clinical tasks that need to be performed - identify if they have staff that can do that and which staff can step away from their day to day, if they need to hire other people Paying staff to stay later/flexible work schedule Staff for active program time and also planning & administrative time needed Staff time to familiarize themselves with the curriculum beforehand as well Who needs to be involved at every level (admin coordinator, CFO, etc.) Admin - get administration involved to get buy in and understanding of the program Financial capacity Run the data Target of how many families participating Resources for data and analysis (time and money for IT staff) Warm hand-offs - could there be someone that day that could do short visit May not be able to bill for all visits, but have patients go through short consultations to give them a taste Need to have outcomes data to show that this does improve health outcomes Financial model Encounters on the parent, parents get screenings as well Encounter for every person who comes in the door even if it’s not billable co-pays Patients used to no-cost, even a low-cost program can be a barrier Most people will come up with a small amount of money if they understand why they are asking for it and what they are going to get Tell patients about the entire cost of the program and what the patients are contributing? Insurance may or may not ask if they asked the patient for a co-pay, write it off anyways - say there’s a co-pay but don’t send them a bill? Can get into trouble with Medicare, FQHCs have stricter guidelines Depending on state/location, need to look into co-pay regulations ahead of time Most people who show up are on Medicaid so used to no co-pays
3:00 – 3:45pm	Implementation guide step 2: SELECT A CURRICULUM AND DELIVERY APPROACH	Lots of curriculums out there, main ones are MEND and YMCA program, others are out there Level of evidence base? Completeness? All parameters that go into pediatric weight management A lot are focused mainly on weight, not overall healthy lifestyle - coining it as disease prevention Perception of weight is different 26 hours or less? (26 is the gold standard of behavioral health change) but what is a realistic time commitment? Cultural competency? MEND curriculum is very formal and terms are not as relevant, difficult to translate Applicable to target population? Ex. low literacy, health literacy level, age group Haven’t been able to find for adolescent Does the curriculum have an associated cost? Training or certification required? self-guided? Accepted curriculum for payment or recognition How much people time are you giving to the curriculum? Need to choose something based upon capacity MEND not a lot of lifestyle intensive Delivery - accessibility and ease of access Virtual, hybrid, in person? Asynchronous? Text message reminder? Having something that doesn’t have a venue may be more helpful for a potential HC that is curious doesn’t have the resources or space - could do a hybrid Time? Regular business hours, weekend Need to be flexible in delivery, can’t just be married to one model Should include families who may not be able to take kids to babysitter, consider having another staff person who can entertain kids
3:45 – 4:30 pm	Implementation guide step 3: DETERMINE BILLING/ SUSTAINABILITY

Naomi

Time	Topic	Internal Notes
10:15 – 11:45 am	High level overview: What do FQHCs need to do this work?	during clinic hours vs. after clinic hours distinction include provider information (medical vs. wellness distinction) MEND term/name usage? materials? Modified materials - mend curriculum is valuable (MS) Borinquen created their own curriculum (fit family club) MEND materials too expensive - practical about what works and balance CDC wants/needs Shortage of human resources (MS) need data proficient staff (barrier) - train the trainer document encounters in CBO visits - visit at beginning and the end - church program (who are the patients?) - rural vs city focus on PCAs, FQHC, Community partnerships preventative screenings to increase rates (good collaboration) between CBO and FQHCs addressing venue, transport, and human resource barriers caregiver focus and integration - recruitment barriers recruit parents and not the children (bring children along) courting provider (find provider that is passionate about healthy weight) NEED BUY IN at least 2 staff who want to do it payment or not models how to facilitate in MEND training - FQHCs need facilitation skills - someone who knows they don’t know (so they don’t assume or veer from subject) - centering program (providers un the room, group sessions and provider pulls each patient) different ways we’ve structured the programs and work flows - meet needs of leader, resources and infrastructures (stories, case studies) - how to identify champion, how to recruit etc. promote reimbursement - state by state basis - CHW billable hours (codes) CDC new cpts provider billing - wrap around services - want encounter numbers reimbursement model + staffing model + technology needs to transition to population health focus where are there tools, where are lacking, QI opportunities Scaling up (group program is the way forward) - time constraints - how can we reach them in more innovative ways (video?) - core groups and other resources for people who cant attend and more affordable reach vs. # of touches - opportunity with intensive programs less reach - figure out love languages of orgs (what matters most to your org) - productivity, high number of billable visits - reach (multidisciplinary clinics - not much data/evidence - different engagement required) - reach is concentrated El Rio - 26 hour intervention transition - creative about counting touches Program needs to be where the patients live/are - accommodate to patient needs Take practitioner with you to meet patients (billable) - dedicated staff member - mobile clinics - provider virtual visit and have patients do visits in the mobile clinic (where they are/live) while provider is at different location - insurance/Medicaid system Cautionary tales (watch out for) - site restrictions - lessons learned from mistakes we’ve made High level resources - what are example of innovations in that space - practical implementation Dietitians on same team - can’t bill for group - behavior health can bill for groups 10/15 min to go through consult individually based on current stats - use medical provider - ddp program - weigh in every week (MEND) Trauma informed training Data infrastructure (measure + tracking not recreating wheel) - CMO decision? Framework for evaluation - locally feasible and most meaningful - surveys etc. consistent metrics - blood pressure -Promise 29 - data person (explain what they need/parameters/template (questionnaire) - EHR dependent) - drawing from reporting tool - make it generic enough? alerts on eligibility - IT person in house (resource dependent) curriculum competencies' that families have at the end of this (YR 6) - more robust training and curriculum model needs to actual say what to talk about instead of empty framework/infrastructure - accessible - implementation guide is training - MEND curriculum pieces we like or our own development Cultural adaptation and language - facilitator manual Goal of 10 week program - success metrics for more money - but medically they can’t loose weight so fast - goal and definition of success - may not use it now but integrated into mindset/life skills - teach basic skills that they need for healthy life style - increase in ability for physical activity - effectiveness looks at BMI - recovery heart rate metrics** - changing mindset that physical activity is fun (no more negativity, more confidence) - level set with what we see as successful - advocate for long term skills and life style changes - importance of behavioral health (key components)
11:45-12:45 pm	Goals, Scopes, and Outcomes: Dreaming Big	Local: Robust program but accessible to all patients and community - local and expand to state/national - having it at multiple sites, multitude of times, different languages building strong collaboration with strong family/child emphasis - YMCA, church, schools - community wide program vs just patients Warm hand offs - behavioral health services - champion at another org to connect them before they leave the program (need can be greater than what is currently offered) work with school districts - MEND could be easily integrated into schools (infrastructure is there) - model to present to school and they can pay for it prevention and health rather than sickness model State: Train others CHCs in state through PCA - formal training (video, virtual training vs. book learning) in order to implement - set curriculum - master trainers - work shops with other FQHCs - have a couple trainings per month (funding) - in person built into NACHC conference - pre- conference trainings (multiple places) Champion - lived experience - passion - empowerment - core like minded people National: COMMIT could be made their own, recognition nationally, standard/cdc program doing more to reach people who have less opportunity - support FQHCs (equity) National steering group to move the program forward - adapt our own developed curriculum and develop it in other states (advisory panels) insurance reimbursement model new pediatric guidelines - lend credibility to mend/commit - lifestyle and medical support Don’t stress weight loss instead health weight maintenance = working out (mood, fitness) provider support and resources staff enjoy this work - team based care, different access and touches - how can we integrate the good into primary care appointments comradery and community based care - enjoyable and fun to share experiences - instructor connection - need the right staff Give the person who is delivering the content the confidence and the power (don’t stress about doing it right or having the right numbers) - motivator = human interaction and connection and point of views/perspectives referral phone call hook - making it special - organic conversations - group peer support - do what works - not either or - trauma informed care - meet people where they are
2:00 pm – 2:45pm (45min)	Implementation guide step 1: ASSESS PERSONNEL AND RESOURCE CAPACITY	resource capacity - environmental scan - prompting questions of things to look for - food banks - training for catch - free memberships for teens (planet fitness) Core team Roles within program require specific abilities/skills - look within org and see who fits the bill for that Doesn’t have to be the provider - need to be lead by someone working in that space of the content area (needs to be peds or gp or dietitian) - programmatic space, dietitian, provider someone who can do the practice piece who can actual deliver and implement and someone who can do data/IT Make those assessments at the onset additional, c suite buy in and grant writing/billing person for sustainability exercise/physiologist expert right people in the right role - can be right role inside and outside of the FQHC (person experience etc.) resources lead to partnerships (CBOs that already have a space and where you can hold the meetings/exercise) giving people something every time they come - find companies that will do donations - incentives community effort to make them feel a sense of ownership staff for after school - ask to use their personnel - mutual benefits (better behavior) - CBO want you to come and use their resources How many hours a week is this person going to be allocated to this program based on curriculum requirements consider free help - internships/students - maybe volunteers? Culture of caring - patient outcomes, personnel engagement Pre existing ancillary services that don’t bill - other grants and programs that don't build - culture of giving and innovation - administration is open to figuring things out - pilot program? Childhood obesity under diabetes prevention billable under goals SDOH, food insecurity - show and track that with numbers t Importance of community approval and recognition - know your administration and how to make the ask (this is adorable work) - anecdotal stories (personas/case studies) Continually reporting Not the right time: Human personnel is vital pandemic health center culture - not concerned about health outcomes or improvements (need to care) Budget cuts
3:00 – 3:45pm	Implementation guide step 2: SELECT A CURRICULUM AND DELIVERY APPROACH (mend, what commit should be in the future, what needs to be considered, what do you need to think through delivery wise, high level)	use MEND as a roadmap/framework - program can work but adjustments needed to fit community needs Implementation team reached out to someone else who already completed MEND curriculum that is evidence based - doesn't need to be MEND specifically but one that has been proven, intensive and comprehensive No provider curriculum from scratch without vetted references AAP guidelines to use to ensure evidence based programs - use as a resource - needs to align with goals of organization current quality measure - SDOH - make sure curriculum with address some of those items that are being tracked by org and of interest barrier - coordinating working care giver schedule with child extracurriculars/schedules - consider days, times and schedules, audience - negotiate time to bring in family unit feasibility assessment for both internal and external needs allow for pop in, be very flexible - starting out gauging interest first series build upon each other but classes further along can pick it up when able to individualize cohort based on what works for participants opening conversation - recruitment, starting date, golden ticket - come together and talk about it and take ownership of schedule - then let them decide - open house (feasibility and helps with retention) could be on zoom complete evidence based curriculum (not just one or two parts) - goals, triggers, mindset - for sustainability and long term adaptability - nutritional relevance to population/community needs - transferable Age - 3 different age levels -adapt to those age groups Virtual or hybrid - videos/texts - variety of modalities Cost associations - training and certification requirements No venue - once a month and then meet online - different modalities could cut costs Flexibility of delivery - options for delivery - focus group (open house then one on one meeting) - opportunities and what works best for you - Zero session (planning) needs to be goal driven - put it into practice + support Don't want: to rigid too much focus on weight loss not too expensive no extreme methods - needs to be evidence based need to be able to tailor/meet people where they are
3:45 – 4:30 pm	Implementation guide step 3: DETERMINE BILLING/ SUSTAINABILITY	Complete encounter in order to be billable childhood obesity no billing no matter the state bill based on symptoms Make sure providers are aware - top codes that we know can be reversed and provider guidance - need vitals and real notes Documentation is important - can’t leave encounter blank - using macros (don’t say the same thing every time) jump off funding - grant funding (resources) - needs to be built in from the beginning so it can be built on throughout the program took from MEND program and used it as an example for larger grant funding for fitness center at the clinic - took what they were doing and with documentation used it as justification for other major funding opportunities Grant writer - national listing for available grants - cooking up health - small bites (Borinquen) - partnership funding how to advocate to C suite - productivity to provider (seeing more patients in less time), entertaining to providers, data and vitals to show/justify the need for the program hire/hours justification - clinical hours (not taking them away from anything else) cant do after school because there would be additional costs - funding dependent roles/jobs - need more sustainable streams of income central set of information of what state to state dependent billing person is important to the process (need to bridge the gap and include them from the beginning) diverse roles is important for a larger understanding of the process introduce them to provider and staff to the beginning understand roles and specific function areas (definition of the role) generating billing, encounter for mend program Show board members how much money is being brought in Medicaid expansion charge the same amount regardless of insurance type - look the other way if a child doesn't have insurance - come up with sliding scale package - program overall cost not individual class cost - must follow HRSA guidelines - needs to be approved/cleared by board and must be posted Initial visit in person, report vitals each week - documents separately for each one - state and payer dependent - as long as the provider has some individual contact with patient and vitals then you can bill quantify staff satisfaction other specialties for billings - dietitian - codes and group vs. individual - productivity focus to pay for everything else Look at the surveys together tomorrow - readiness assessment - questions that are important to patient needs/tracking goals RD AND map - resource on dietitian billing Health fair - go around to every department and learn about different work/grants/job duties etc relationship building and communication Assessment of what we did previously that did not work, middle (what’s working) and end (what we can do better next time) CHW model ** leverage other outcomes the org is interested in tracking - immunization, food insecurity etc. warm hand offs, other resources, support for the larger patient needs, visibility and documentation

Billing Codes

L83: Acanthosis nigricans

R7309: Other abnormal glucose

E7800: Pure hypercholesterolemia, unspecified

E782: Mixed hyperlipidemia

E781: Pure hyperglyceridemia

R748: Abnormal levels of other serum enzymes

E806: Other disorders of bilirubin metabolism

R7401: Elevation of levels of liver transaminase levels

Wednesday, April 26th

Sarah

Time	Topic	Internal Notes
9:20 – 10:05 am	Implementation guide step 4: PLAN SPACE AND TECHNOGY	TECHNOLOGY Considerations Ask technological capabilities of participants Consider lack of cellular plans, may use Wifi instead Program/Facilitator needs to be tech savvy…understanding all tools, EHR, report Involve IT/Data analyst who understands what data in/data out When using Zoom, one person to host/logistics, one person to facilitate Tools Direct Text messaging (back and forth) Text reminders What’s App for each cohort Facebook page Zoom Fitbits EHR Teams (internal use only) SPACE Use the space you have, especially after-hours (i.e. lobby) Advantage having it in your clinic---others can see the fun/health and participants can see the health center as more than just treatment/sick Optimal to have two rooms (One for parents/kids and one for activity for kids) Gathering Space Chairs Tables Activity Space Open Space Basketball (indoor or outdoor) Evening classes: good lighting AV PA System--for voice and music Projector/screen Storage for materials Outdoor Consider safety, weather, lighting--add more staff Initial Assessment/Final Assessment
10:20– 11:05 am	Implementation guide step 5: CONFIGURE WORKFLOW SAMPLE CHECKLIST	Start Pre: Decide program Decide schedule Find/confirm facility Find/confirm staff Prepare recruitment flyer Champion Recruiter (health center staff +/or community) Get registration Get referrals from Providers EHR search Community referrals Send flyer to those referred/recommended and community Call those referred to confirm Conduct surveys Assessment Option 1: Schedule providers for jump start Contact patients for “jump start” or healthy growth check, kick off and schedule into provider visit slot Option 2: Take into consideration most recent visit Do basic intake during first session May use mobile unit Session 0 Option 1: Keep participants who are availability, waitlist to those who are not Option 2: Confirm participant availability SESSIONS (4 hour commitment for 3 people for a 1 hour class) Pre (pre-checklist): curriculum modifications, shopping and supply list, set up During Post: clean up, documentation Evaluation final day of class and faculty (surveys) Final Report
1:00 pm – 1:45pm	Implementation guide step 6: RECRUITMENT STRATEGY	N/A
2:00pm – 2:45 pm	Implementation guide step 7: PROGRAM EVALUATION AND REFLECTION Appendix: PRAPARE MEND Questionnaire Other questionnaires that participants use	What is the end goal? --improve health outcomes? --productivity? --encounters? Evaluating Health Self reported data Labs Recovery HR Qualitative Activity tracker Consider two different kinds of surveys: 1) Program evaluation and 2) Personal information/strengths/challenges Who offers the surveys and who analyzes the surveys? Community voice-->co-design “what would YOU consider success?” Consider any other QI tracking, ie. PRAPARE….don’t need to re-ask those. Asking those questions is only valuable if you can do something about it?? Often we are the first people to ask families these types of questions Can an individual survey lead to individual tailoring to meet needs? Fidelity Observations Feedback on and by facilitators (during and after) (Process measure) Certain items are non-negotiable (we can make recommendations)
2:45 – 3:45 pm	DISSEMINATION PLANNING
3:45 – 4:45 pm	WRAP UP (1 hr to wrap up at least)

Jonathan

Time	Topic	Internal Notes
9:20 – 10:05 am	Implementation guide step 4: PLAN SPACE AND TECHNOLOGY	Collaborating with outside partners, space at health center like conference room space Reservation tech, may not always go through Taking surroundings into consideration Loud - “teach with the clinics not at the clinics,” let the clinic managers know and they can help decide where Indoor/outdoor space? Consider alternatives & consider with parties who may need to know, reservation system - community room but then need to confirm with CEO who uses it for meetings Would they want to hold it virtually? Show videos and also demonstrate Works for some, not others - can get family participation Don’t always have the space to run around Give families balls, equipment beforehand mix it up with yoga, HIIT Assessing the cost of space, convenience, safe Outdoors - liability insurance, may not cover outside of the health center Security - tried to have them outside in the parking lot but not as safe at night and may need extra security Reserve space in the parking lot beforehand Referrals in the EHR system - MEND specific referrals Appointment types in the system - helps for tracking and recording Making sure that everyone knows what they are and how to use them - front office staff, billing Tech support for virtual, others Reserve time for prep and clean up Using text message for confirming appointments, reminders, information (education & marketing) Used WhatsApp for groups - helps them to be connected with others as well Equipment & IT - projector, monitors, USB, etc. Dreaming big - hard surface not carpeted surface Any needed equipment in the room fits what you plan to do - ex. chairs and tables that fit the purpose, can be put aside Welcome-ness of the space - for example, LGBTQ group that may not feel safe in more public areas of the spaces Section in implementation guide for: Did you know - you can do___, you can try ___, You can try using lobbies after hours Need to have own Zoom license, each facilitator/instructor has to have their own - safety issues Had to petition to get licenses
10:20– 11:05 am	Implementation guide step 5: CONFIGURE WORKFLOW	Create a checklist, schedule meetings with the team to prepare before - clear expectations of what everyone’s job will be Big event at the end, would want to call ahead to make sure they have availability for large events - make sure the company credit card works! Have contingencies in place in case of emergencies If you need to get a hold of parents, change of venue, give yourself enough time to do that Order of supplies How are we scheduling? Within EMR with automatic reminders, outsider of EMR? Best practice is EMR but can also use Excel, others Duplicating a lot of work Decision structure for reminder, who is responsible for it? Call asking if they’re interested, if yes, follow up call and welcome package Warm hand-off, works because they are in the same clinic Staff schedules them before they leave - reduces time you have to call people If no, ask if they want individual RD appointment “Appointment zero,” give them information and give them a chance to choose modality, time, etc. Solidify schedule - pick a start date before or pick with the group? Usually have it decided beforehand, giving choices is difficult to accommodate (resources and staff available, etc.) Pull school district schedule, holidays, sports, catechism, etc. to inform schedule Notify manager of space, reservations are made Last minute confirmation of space, getting food/snacks, food handlers are certified, materials to distribute like recipes
1:00 pm – 1:45pm	Implementation guide step 6: RECRUITMENT STRATEGY	Speak at pediatric monthly meeting Manager and provider meeting Prepare fliers, social media (fb, tiktok, insta), HC website All-staff email - 80% of employees are patients Primary care & Behavioral health embedded in depts, let the appropriate people know Mostly pediatricians and family medicine Multiple language Prepare scripts for phone calls that go out MA sends out flier to everyone on referral list by email, then calls using the script, tries to schedule into assessment day, calls a second time Warm hand off Reminder call the day before Don’t postpone, just keep going Low turnout - allow families to start 1 or 2 weeks late but after that is less than ideal Have to be in by class 2 at El Rio Criteria of people that are accepted into the program is important Age, BMI range, just do all families BMI - 95 percentile for provider referrals Anything off in vitals or come up in check ups or even if parent is interested Careful with family dynamic, older kids have to take care of younger kids Do’s and don’ts Haven’t seen positive outcome from cold calling Don’t recommend run lists from EMR from eligibility, get enough referrals from providers Can pull from EMR to get an idea of what the population is, if you have a good idea of how you want it to work, have buy-in from providers, can start referring internally before cold calling For phone calls, helps to have someone who has done or has seen the program to be able to answer questions Who do you decide where the fliers go to? Criteria - child has to be a patient Group visits are not ideal for new patients, needs to be an established patient - had to have individual visit first Tried to recruit at YMCA with fliers but only able to accept patients ***Who you consider to be completers
2:00pm – 2:45 pm	Implementation guide step 7: PROGRAM EVALUATION AND REFLECTION	**Weight vs health - what are we really trying to do? MEND includes wellness, mental health, bullying, etc. but outcomes are focused on decreased weight Cautious about the expectation that when spreading, some may focus on decreased weight as the main goal & outcome Don’t look only at weight as risk factor, need to incorporate others
2:45 – 3:45 pm	DISSEMINATION PLANNING
3:45 – 4:45 pm	WRAP UP (1 hr to wrap up at least)

Naomi

Time	Topic	Internal Notes
9:20 – 10:05 am	Implementation guide step 4: PLAN SPACE AND TECHNOLOGY	What would it take for you to attend these sessions? sourcing from clinic or community (hybrid) - depends on focus on fqhc (better outcomes from in patient fqhc outcomes or for the community health outcomes) - community partnerships - leadership dependent powerpoint potentially for visual learners Zero session - understand how and where people like to receive and accept information (health center environment is uncomfortable at times) think about the emotion behind an environment - parent accepting information vs child Comfortable in a community center - medical distrust Creative on how we are using the technology - family rely on hybrid model Needs to be discussed at the onset - need something established (can’t double book) nuances ahead of time as it relates to space - same with outside spaces (making sure schedule is established ahead of time Important to have someone good with data/EHR is apart of the team Documentation is a key element of implementing the program and promotion have a designated photographer - evidence for your organization and outside funding clarifying roles - establish who is setting up and pre-plan having a large enough space (kids but also plan for additional family members - cultural competency) look for spaces that are large enough - multipurpose room - an additional room far away from the kids (so parents wont peek in) outside space as well lifestyle program that they choose based on modality and room and tech needs (mend model) - hybrid, virtual, in person only mindset needs to be flexible - pivot constantly - no expectations How are you implement the program in clinic or community organization - ask about audience and their needs (caregivers needs) - working parents (hybrid options) - make concessions - parents via zoom kids in person storage space space exercise space - in clinic or community center visible space (to promote and interest others) Template EHR
10:20– 11:05 am	Implementation guide step 5: CONFIGURE WORKFLOW	Donation letters for supplies Forms Admin work - templates for data collection etc. Timeline Eligibility - from EHR or community interest (BMI determination) or provider identify (situational awareness for family interest) Reach out/contact participants - on going - up until the start date Identify program delivery and staffing capabilities and availabilities MA reach out, reminder email, follow up with another phone call Open house - eliminate barriers, meet staff, orient with space (week before start date) - zero session - focus group and questionnaire + Encounters and growth charts/vitals individually or as a group for billable service - or before state date/jump off Start date: knowing the goal, questions and what they will be doing and excepted of with and without the kids - how to do the activities right (jump jacks, plank) others are healthy eating and wellness - homework (checklist with point system for activity and cooking) - bingo (one minute plank or snack for a fruit) catch introduction - incentives throughout the program - parents get a separate introduction to share and get oriented MA programing behind the scenes - reminder phone calls and emails (continuous engagement) Providing groceries from cooking class - coordinate with registered dietitians - recipes and necessary groceries facilitators handle break down and clean up An hour before to debrief about the previous session and then to prep for the next
1:00 pm – 1:45pm	Implementation guide step 6: RECRUITMENT STRATEGY	When you prepare to recruit - have someone on team who is the point person (from neighborhood/community - help sell the program) Dove tail with established program or cohort within org - combine resources and population of focus is the same - relationships already established and may already have point person - parent coordinators (use same resources) always over recruit - a portion will not show up recruit in may and program starts in June - need constant engagement and communication Highlight benefits and how this program have value Referrals - pull from EHR - starts with providers - provider meeting - spotlight to program and distribute flyers - need to be visually appeals - good marketing/materials + simple/plan language Recruit within program (flyers in the program and through the instructors) Partnerships spreading the word Word of mouth and family connections Use champions in the group - empower people to help others - use relationships Recruitment at elementary school (flyers) Presence in the community - networking - open houses when they have events - making your presence known social media - marketing coordinator Facilitator calls for referral calls (most knowledgeable on the program to answer patient questions) Develop scrips - yes/no - if/then languages/cultural adaptations initial phone call - yes/no list - facilitator reach out with more details and then schedule them for a jump start (open house/jump start/zero session) - agendas, surveys, expectations/goals Deadline for recruitment - cut off point - some leeway for information gaps/late joiners doctor write prescription for the mend class - spoke with provider would really like you to attend - I’ll let them know you don’t want them to attend (motivation to attend) - hook them with the resources and make it interesting If one person showed up - we missed you, what could we have done better - logistical confusion, covid, family emergency - opportunity to make it up - delayed starts if not enough interest
2:00pm – 2:45 pm	Implementation guide step 7: PROGRAM EVALUATION AND REFLECTION	mend targets/goals what is the definition of success? weight vs. health what is health? qualitative QI and implementation science satisfaction survey hesitations # of steps - score cards - physical activity tracking step tracker only ask questions on survey that the program addresses need mental health professional to support emotional questions make sure kids and parents are taken care of during survey time setting expectations and why we are doing the survey trust
2:45 – 3:45 pm	DISSEMINATION PLANNING	Testing with come to the table attendees affinity groups - nachc how were you recruited, what made you stick and why adoption and implementation change wellness program to adults for mend legacy team can serve as test group for implementation guide
3:45 – 4:45 pm	WRAP UP (1 hr to wrap up at least)

Denver Notes Page

Tuesday, April 25th

Sarah

Jonathan

Naomi

Wednesday, April 26th

Sarah

Jonathan

Naomi

Tuesday, April 25^th