Every Little Step Counts for Latino Child Health

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Salud Heroes
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Yolanda Konopken knows 1 in 10 people have diabetes in Arizona.

Her program to help families manage diabetes has been at full capacity for years at the Society of St. Vincent de Paul in Phoenix (41.3% Latino population).

Konopken wanted to do more to prevent unhealthy weight from causing diabetes in younger children.

She had an idea to start a new, bilingual education program to provide support and counseling for families with children at risk of diabetes.

She worked hard to develop a bilingual curriculum and launch a fun program that involves the whole family in a series of culturally relevant classes to build children’s self-esteem and positive lifestyle behaviors, such as cooking healthier foods and getting active.

The Crisis of Obesity in Arizona

Yolanda Konopken and her team at the Society of St. Vincent de Paul in Phoenix, AZ, started a program to help residents learn how to have healthier lifestyles.

Arizona has the nation’s 34th highest rate of adult obesity (28.4%) and the 24th highest diabetes rate (10.1%).

The Society of St. Vincent de Paul—a group dedicated to feeding, clothing, housing, and healing Phoenix individuals and families with nowhere else to turn—recognized this crisis years ago.

In 1999, the group hired Yolanda Konopken to direct its Family Wellness Program.

The program’s main component is diabetes self-management education to improve people’s ability to live with diabetes on a daily basis.

Regularly serving close to 200 Latino adults, the program was working at full capacity for several years.

They recognized early in this work that children were increasingly affected, too.

The Family Wellness Program works with school-based health clinics. They found that hundreds of children needed help to reduce overweight and obesity.

“We knew we couldn’t help everyone, but we knew we also needed to do something,” Konopken said.

But how could they help more children?

Building a Bilingual Program for Healthy Kids

Konopken and her staff brainstormed ideas.

They started by developing a plan for a program that would help children who had the highest needs—Latinos with a body mass index (BMI) higher than the 95th percentile for obesity and who also had several core morbidities related to diabetes.

“Our goal was to develop a program that would impact family behaviors which would then influence the children” to develop lifelong healthy habits for everyone and reduce disease risk, Konopken said.

Konopken and her team started building a bilingual program curriculum for family education and prevention in nutrition and weight management, self-esteem, medical services, and counseling.

For example, each week, they wanted program staff to introduce new, healthy recipes to families and children in the program to get them excited about tasting and trying new foods. This would help them envision healthier ways of eating and living.

“We wanted to develop activities that got the families thinking on their own on how to solve problems and get involved in addressing the health issues that they had,” said Maria Silva, Registered Dietitian and Education Programs Manager with the Society of St. Vincent de Paul. “We didn’t want to tell them or lecture them because that is not how you get people engaged and excited about working on their own health.”

The program, Every Little Step Counts, started in 2012.

Program staff are bilingual. They recruit participants via referrals from partners, including the clinic of Society of St. Vincent de Paul, school health clinics, and Phoenix Children’s Hospital.

Following an initial exam that includes a discussion of medical history and a physical, Every Little Step Counts children and parents attend a series of culturally appropriate healthy lifestyle education classes that deal with issues such as the connection between weight, health, nutrition, and diabetes.

“We present things in a culturally relevant way so that it’s easy for a family to incorporate better foods and activities into their life,” Konopken told her organization’s newsletter. “It’s about making exercise a form of play and bonding for the family.

In addition to implementing healthy eating changes, the program also focuses on the mental health of its participants, especially in nurturing self-esteem. Children and parents in the program learn about dealing with issues that encourage healthy eating and self-efficacy.

About three months after the end of the classes, participants return for a one-on-one appointment with a dietician to discuss any issues in maintaining behavior change.

Children continue with follow-up sessions on problem solving, dietary adjustments, and counseling.

The staff with the Every Little Step Counts program counsels and educates participants on how to achieve and maintain a healthy lifestyle.

Positive Impact and a New Social Media Component

Since Every Little Step Counts began, results have been extremely positive.

Of the 102 initial enrollees at the beginning of the program, 60.6% had elevated fasting insulin levels, 9.4% had impaired fasting glucose, 32.1% had high triglyceride levels, 39.4% had high total cholesterol, 68.6% had low HDL cholesterol, and 43.0% had high LDL cholesterol, according to staff-collected data.

The 50 youth who returned for post-intervention labs had a 3.8% reduction in BMI (p < 0.01) over an average of 13 months. They also reduced total cholesterol by 5.4% (p < 0.01) and LDL cholesterol by 8.6% (p < 0.01), and increased HDL cholesterol by 9.3% (p < 0.01). There was a decrease for fasting insulin of 24.0% (p < 0.05).

There was no significant difference in the risk factors measured at initial enrollment for youth who completed follow up testing and those who did not, Konopken said.

The “eye test” reveals a successful program, too.

On almost a daily basis, Family Wellness Program staffers see their patients adopting many of the practices preached in Every Little Step Counts. Families are more diligent and interested in improving their health. Many have seen how important it is not just for themselves, but most importantly, for their children.

By setting good examples for them, but modeling healthy behavior for them, they will impact their children and their children’s children for years to come, Konopken said.

“It’s about making positive imprints so that people have good experiences with healthy choices,” she said.

The program itself also has grown to keep up with ever-evolving health standards as well as the latest technology trends and the interests of the population they serve.

These evolutions, including adding an interactive social media component, had made the program even more successful.

“We are really doing everything we can to reach out to the community,” Silva said. “We do posts on Facebook, we are on Instagram, and we have our own dedicated page on the St. Vincent de Paul website. Anything and everything we can do to get our message out there that is what we are trying.”

Konopken said the program has broad appeal in Latino and other communities.

“Our long-term goal is to create a culturally appropriate, evidence-based program that can be incorporated and adopted into every healthcare system in the country,” Konopken said. “It’s not just prevention and wellness, it’s something that can be adopted into an overall healthcare practice. This isn’t just for the Latino community who needs it, but for everyone. We think everyone can do what we’re doing.”

By The Numbers By The Numbers

37

Percent

of Head Start and Early Head Start participants are Latino.

This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.

The stories are intended for educational and informative purposes. References to specific policymakers, individuals, schools, policies, or companies have been included solely to advance these purposes and do not constitute an endorsement, sponsorship, or recommendation. Stories are based on and told by real community members and are the opinions and views of the individuals whose stories are told. Organization and activities described were not supported by Salud America! or the Robert Wood Johnson Foundation and do not necessarily represent the views of Salud America! or the Robert Wood Johnson Foundation.

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