Design and Approach of the Healthy Weight Clinic Pediatric Weight Management Intervention Package and Implementation: Massachusetts-CORD 3.0

Fiechtner, Lauren; Castro, Inês Rugani Ribeiro de; Ayala, Sujata G; Velez, Desiree Sierra; Lindros, Jeanne; Perkins, Meghan; Baker, Alison; Salmon, Jeremiah; Biggs, Vincent; Cannon-Smith, Gerri; Smith, Justin D.; Simione, Meg; Gortmaker, Steven L.; Taveras, Elsie M.

doi:10.1089/chi.2021.0177

Cited by 9 publications

(11 citation statements)

References 35 publications

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“…The active intervention, referred to as family-based behavioral treatment , has been tested before in non–primary care settings and led to sustained improvements in both parent and child weight outcomes . The PLAN trial advances the field by embedding this previously tested obesity treatment intervention into pediatric primary care practices, which is in line with other recent attempts to improve the reach of pediatric weight management programs by situating them outside of specialty clinics . However, the average effect on child weight in this study was lower than what has been reported in previous trials of family-based behavioral treatment, falling below the threshold of a clinically meaningful weight change .…”

supporting

confidence: 51%

Behavioral Interventions for Treating Childhood Obesity

Heerman

Paul

Staiano

2023

JAMA

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supporting

confidence: 51%

Behavioral Interventions for Treating Childhood Obesity

Heerman

Paul

Staiano

2023

JAMA

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“…Our findings from this study, informed our discussions in our technical assistance calls which occurred every 2 weeks throughout the intervention with implementing staff and our stakeholder meetings. In addition, the group curriculum, provider training, how to form clinic-community partnerships, how to create a sustainable model and addressing social determinants of health and barriers to retention and engagement have been integrated into our current HWC package that was created in collaboration with the American Academy of Pediatrics Institute for Childhood Healthy Weight and funded by the Centers for Disease Control for national dissemination ( 27 , 28 ). The program is now being implemented by eight health centers in Mississippi and Massachusetts.…”

Section: Discussionmentioning

confidence: 99%

Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention

Persaud

Castro

Simione

et al. 2022

Front. Public Health

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BackgroundMulti-sector stakeholder engagement is essential in the successful implementation, dissemination, and sustainability of pediatric weight management interventions (PWMI), particularly in low-income settings where sustainability relies on external policies and reimbursement. The objective of this study was to engage stakeholders (1) to inform the creation of the intervention with adaptations needed for a successful PWMI in a primary care and community setting and (2) to identify barriers and facilitators to implementation and dissemination.MethodsWe sought to examine the perspectives of local, state, and national clinic and community stakeholders during the pre-implementation period of a two-arm, randomized trial of a Health Weight Clinic PWMI conducted in two health centers and a modified—Healthy Weight and Your Child PWMI at two local YMCAs that serve a predominantly lower income, Hispanic community. The Consolidated Framework for Implementation Research interview guide served as a template for the study but was modified to fit the PWMIs and the various professional roles. Interviews were transcribed and analyzed using the framework analysis approach and themes were linked to the CFIR domains and constructs.ResultsTwenty-six stakeholders perceived the following as needed components of a PWMI: a formal curriculum with illustrative examples, a patient- and family-centered program, group visits, and high-quality multidisciplinary personnel. These findings led to the creation of a group visit curriculum, implementation trainings and cross-site collaborative technical assistance. Additionally, creating partnerships between community and clinical organizations, and addressing patient barriers and unmet social needs (i.e., transportation, food) were identified as facilitators to successful implementation. These results led to the creation of community resource guides, connections to community organizations, and screening and referring for unmet social needs. Perceived facilitators of dissemination included proving cost-effectiveness of the PWMI to inform insurance reimbursement for long-term sustainability. Therefore, we collected cost data and engaged with Medicaid officials to discuss reimbursement.ConclusionFindings highlight the importance of engaging multi-sector stakeholders pre-implementation to ensure the components valued are included, ensuring the program minimizes barriers to participation, considering how staff training can improve implementation and how collected outcomes can inform sustainability and dissemination of PWMIs in clinic and community settings.

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“…This created a complete conceptual model of which strategies would be used to overcome barriers identi ed by stakeholders. (19) Moreover, including adaptations suggested by pre-implementation sites stakeholders could help create a sense of ownership of the intervention amongst staff in the Mississippi FQHC's and keep them engaged to continue to offer HWC to their communities past the study period. As HWC moves into dissemination stages, understanding these determinants as categorized using CFIR, and with associated evidence-based strategies to overcome barriers and leverage facilitators, can help facilitate adoption in new sites.…”

Section: Discussionmentioning

confidence: 99%

“…Additional details about HWC have been published. (19) The FQHCs implementing HWC are located in the Delta region of Mississippi. These FQHCs serve a large proportion of children from families with lower income and Black children.…”

Section: Participants and Settingsmentioning

confidence: 99%

“…The ndings of this pilot study will then inform the nal iteration of the package and the necessary implementation supports for subsequent nationwide dissemination. (19,20) These interventions address childhood obesity at multiple levels through the integration of clinical decision support tools and community-speci c behavior change support resources in the primary care setting.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Adoption of a Pediatric Weight Management Intervention (PWMI): a Qualitative Study

Velez

Gundewar

Persaud

et al. 2022

Preprint

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BackgroundChildhood obesity is highly prevalent in the US and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the determinants to successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites. MethodsWe interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME).ResultsIn pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described.ConclusionUnderstanding the determinants to adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.

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Design and Approach of the Healthy Weight Clinic Pediatric Weight Management Intervention Package and Implementation: Massachusetts-CORD 3.0

Cited by 9 publications

References 35 publications

Behavioral Interventions for Treating Childhood Obesity

Behavioral Interventions for Treating Childhood Obesity

Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention

Determinants of Adoption of a Pediatric Weight Management Intervention (PWMI): a Qualitative Study

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