A Matter of Balance: Volunteer Lay Leader Model Key Elements in the Translation of a Professionally

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A Matter of Balance Volunteer
Lay Leader Model Key Elements in the
Translation of a Professionally Lead Program

• Joint Conference of NCOA and ASA
• March 2006
• Peggy Haynes, MPA
• Partnership for Healthy Aging
• Tara C. Healy, MSW, PhD
• University of Southern Maine

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A Matter of Balance Volunteer Lay Leader Model

• Administration on Aging Grant Partners
• Southern Maine Agency on Aging
• MaineHealths Partnership for Healthy Aging
• Maine Medical Center Division of Geriatrics
• University of Southern Maine, School of Social
  Work

Grant 90AM2780
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Falls Epidemiology of the Problem

• Major cause of injury and death for older adults
• Falls are the leading cause of injury
  hospitalization in Maine Healthy Maine 2010
• 1/3 to 1/2 of older adults acknowledge fear of
  falls
• Fear of falling is associated with
• decreased satisfaction with life
• depression
• decreased mobility and social activity
• increased frailty
• increased risk for falls as a result of
  deconditioning

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A Matter of BalanceManaging Concerns About Falls

• Eight 2-hour classes designed to help
  participants learn
• To view falls and fear of falling as controllable
• To set realistic goals for increasing activity
• To change their environment to reduce fall risk
  factors
• To promote exercise to increase strength and
  balance
• Original outcomes research conducted by the
  Roybal Center for the Enhancement of Late-Life
  Function at Boston University.

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Administration on Aging Grant

• 2003- AoA three year partnership to increase
  older adults access to evidence-based prevention
  initiatives
• Grant Goals
• Maintain fidelity to the original MOB curriculum
• Test whether a volunteer lay leader model is
  successful when compared with original research
• Share our approach with others in Maine and
  around the country
• Grant 90AM2780

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A Matter of BalanceVolunteer Lay Leader Model

• Guided by a Project Advisory Committee
• A Matter of Balance participant and coach
• AARP Maine
• City of Portland
• Maine Center for Disease Control and Prevention
• Maine Nutrition Network
• Maine Office of Elder Services
• Maine State Housing Authority
• New England Rehabilitation Hospital of Portland
• University of New England, Geriatric Education
  Center
• Osher Lifelong Learning Institute
• Designed to benefit community-dwelling older
  adults who
• are concerned about falls
• have sustained a fall in the past
• restrict activities because of concerns about
  falling
• are interested in improving flexibility, balance
  and strength
• are age 60 or older, ambulatory and able to
  problem-solve.

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Role of Lay Leaders

• Team coaching
• Peer modeling
• Facilitation

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Training and Recruitment

• Potential partners
• RSVP
• Senior Colleges
• Senior Housing
• Class graduates

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Strategies for a Volunteer Model

• Volunteer Lay Leader Model
• Coach training
• Mentor Model
• Observation and feedback
• Communication Support

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Volunteer Coaches

• Age Group 59 or less
• Age group 65
• Women
• Education some college or more

• 70 (17)
• 30 (10)
• 79 (27)
• 90 (31)

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Challenges and Lessons Learned

• Clarity of volunteer commitment
• Feedback loop
• Observations
• Participant satisfaction survey
• Community recruitment partners
• RSVP
• OLLI
• Resident Service Coordinators

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Tension Implementation Fidelity and Adaptation

• Adaptations
• Classes taught by volunteer lay leaders instead
  of healthcare professionals
• Participant workbook developed and coach manual
  modified
• Exercises modified
• Healthcare connection via guest therapist
• Participants recruited through
• Community organizations newsletters
• Outreach presentations to
• Aging network
• Community centers faith-based organizations
• Clubs, libraries, social gatherings
• Physician practices
• Housing coordinators

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Maintaining Fidelity

• Original research curriculum used
• Two day coach training based on original MOB
  leader manual
• Health care professionals and master trainers
  observe volunteer coaches during
• two day training
• a MOB/VLL class
• Use of a mentor model new volunteers are paired
  with an experienced coach

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Fidelity Training Program for Volunteers

• Course evaluation and level of confidence post
  training
• Follow-up survey at 6 mos. after leading MOB/VLL
• Focus groups

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Coach Self-Reported Confidence
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Coach Self-Reported Confidence
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Coach Self-Reported Experiences at6 Month
Follow-up Better or A Lot Better
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Key Findings from Coach Focus Groups

• Respect for maintaining fidelity
• Highlighted the importance of cognitive
  restructuring by focus on attitude change in the
  first three classes
• Importance of mental exercises
• Able to discuss curriculum in detail
• Mentor system highly valued
• Aware of learning through this system

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Key Findings from Coach Focus Groups

• Benefits of Coaching
• Rewarding especially seeing older adults gain
  more independence
• Coaches participants have fun
• Challenges of Coaching
• Nervous about facilitating the group
• Managing group dynamics
• Participants with hearing problems

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Participant Outcomes

• MOB Original Research

• MOB/VLL

• 6 Weeks
• Falls Management
• Falls Efficacy
• Falls Control
• Exercise Level
• Social Activity
• 6 Months
• Falls Management
• Falls Control
• Falls Efficacy
• Exercise Level
• Monthly Falls
• 12 Months
• Falls Management
• Exercise Level

• 6 Weeks
• Falls Management
• Falls Efficacy
• 6 Months
• Falls
• Management
• 12 months
• Falls Management
• Falls Efficacy
• plt.05 plt.01 plt.001

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Findings Participant Outcomes

• Participant Outcomes
• 97 - more comfortable talking about fear of
  falling
• 97 - feel comfortable
  increasing activity
• 99 - plan to continue exercising
• 98 - would recommend A Matter of Balance
• who agree to strongly agree

• Comments
• I am more aware of my surroundings. I take time
  to do things and dont hurry.
• I have begun to exercise and am looking forward
  to a walking program.
• I have more pep in not being afraid.

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State of Maine A Matter of Balance Dissemination
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Dissemination Activity

• 14 Master Trainer sites
• 31 Master trainers
• 588 older adult participants
• 114 volunteer coaches trained statewide

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A Matter of BalanceVolunteer Lay Leader Model

• For more information please contact
• Partnership for Healthy Aging
• 465 Congress Street, Suite 301
• Portland, Maine 04101
• [phone] pfha_at_mmc.org