King County Steps to Health
401 - 5th Avenue, Suite 900
Seattle, WA 98104
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King County Steps to Health is a federally-funded program lead by community partners and Public Health - Seattle & King County, focusing on the areas of asthma, diabetes, obesity, nutrition, physical activity and tobacco. |
Steps to Health aims to:
- reduce the impact of chronic diseases through preventing and controlling asthma, diabetes and obesity.
- promote a comprehensive approach that coordinates actions at the individual, family, clinical, school and community levels and integrates interventions addressing multiple chronic conditions.
- reduce health disparities due to chronic illness by reaching social and ethnic groups that are disproportionately affected.
The Steps Consortium is open to any organizations, agencies and individuals interested in the Steps initiative. There are currently more than 75 members, including community-based organizations, health care providers, hospitals, health plans, clinics, universities, faith-based groups, government agencies and school districts.
Diabetes in King County, April 2007
The number of people in King County with diabetes doubled in the past decade. Such a rapid increase in the occurrence of a chronic illness is very rare. Diabetes now affects 84,000 adults in King County or 5.8% of the adult population.
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The area of focus for Steps interventions includes the southern part of Seattle and adjacent communities in south King County, including Renton, Highline, SeaTac, Burien, Tukwila, Des Moines, Normandy Park, White Center and Boulevard Park. This area includes three school districts. The area has a population of 352,836 living in 151,389 housing units.
Demographics of project area
- 14.4% African American, 8.9% Hispanic/Latino, 3.9% Vietnamese
- 30.4% of people live below 200% of the Federal Poverty Line (FPL)
Target population for interventions
- People with household incomes less than 200% of Federal Poverty Line (FPL)
- English, Spanish and Vietnamese-speaking people
Burden of disease
- Diabetes: 140.2/100,000 project area residents were hospitalized for diabetes in 2001, twice the rate of the rest of the county; county-wide, African-American diabetes death rates are higher than African American rates in any of the 10 largest U.S. counties.
- Obesity: Over the last 15 years, adult obesity more than doubled and overweight increased by one-fifth in King County; 59% of the project area residents are overweight and 16% are obese.
- Asthma: 181.8/100,000 project area residents were hospitalized for asthma in 2001, twice the rate of the rest of the county; 335/100,000 project area children were hospitalized for asthma, a rate 2.5 times higher than the rest of the county.
Risk Behaviors
- 82.1% of adults do not engage in regular and sustained physical activity
- 75.6% of adults do not eat the recommended five servings of fruits and vegetables a day
- 28.7% of adults smoke, compared to 19.3% in the rest of the county
- Review a range of policies to prevent and control chronic illness, including:
- Health system policies that address cultural competence in asthma, diabetes, and obesity clinical management.
- School policies that support students with asthma and diabetes, discourage sales of non-nutritious foods, and encourage physical activity.
- Housing and community development policies that support physical activity, nutrition and healthy indoor environments.
- Develop mechanisms to promote policy change:
- Develop capacity for using Health Impact Assessment to promote consideration of health impacts of policy and planning decisions.
- Develop capacity of community members to participate in public processes that review proposed policy and planning decisions with substantial health impact.
- Create Neighborhood Health Justice Committees, provide education/advocacy training, promote grassroots mobilization and policy development.
- Complete a comprehensive School Health Index (a CDC assessment and planning guide) to identify targets for interventions in Steps schools.
- Implement a comprehensive, prevention-oriented health curriculum.
- Train high school students to mentor at-risk 8th graders in after-school program: workshops, recreational activities, community service, advocacy.
- Build capacity to address specific health issues and to impact institutional change within individual schools or within the districts by:
- Providing FTE or extra-hours for a health advocate to implement a project that results in institutional change to improve the health of students or staff.
- Providing incentives for sites to implement activities suggested by School Health Index findings.
Media:
- Develop common messages, develop radio/TV/print ad materials, provide advertising in versions that are culturally/linguistically appropriate in Spanish and Vietnamese, conduct a media campaign, and develop speakers bureau.
- A kit will be developed and pilot tested on audiences of preschool teachers and child care providers to assist parents, child care providers and preschool teachers to become more vigilant about the influence of advertising on food choices of young children and children to become more critical and skeptical viewers of food commercials.
Community-based:
- Support community health workers who make home visits to encourage asthma and diabetes self-management and provide community outreach and education.
- Train child care providers in asthma management and breast-feeding promotion.
- Work in collaboration with clergy and health ministry members to provide cardiovascular health and outreach and education in churches which includes information assessments and screenings, referral to education/self-management classes and support groups, provision of action plans for participants.
- Promote environmental and programmatic interventions to encourage physical activity (e.g., running for adolescent girls, walking groups, biking to school, mentors, personal trainers) and good nutrition (e.g., food preparation demonstrations, healthy snacks).
- Promote worksite wellness: work with businesses to, identify needs and resources for worksite health promotion activities, assist businesses to create worksite action plans.
- Implement key elements of the chronic illness care model to improve quality of care.
- Use chronic disease and wellness coordinators to facilitate systems change to implement quality improvement activities, link patients with community resources, and provide limited case-management services.
- Expand and establish new and existing registries for tracking for diabetes, obesity and asthma.
- Increase resource support and provider knowledge about motivational interviewing and developing patient self-efficacy for use in providing culturally appropriate counseling to patients.
- Provide training to providers in asthma, diabetes and obesity management including academic detailing.
- Establish a reporting system of asthma and diabetes visits for epidemiological surveillance and possibly clinical follow-up.
- Enhance communication between hospitals, primary care providers, and health plans and develop protocols to improve notification of primary providers regarding emergency department and hospital discharges among their patients.
- Medicaid Managed Care Organizations
- Initiate and maintain health plan level interface to provide assistance, support, facilitation, technical assistance and resource support to Harborview Medical Center and Highline Community Hospital as well as providing a forum for the health plan to observe the implementation of this program as a possible model to manage chronic illnesses in the managed care environment.
Evaluation
Steps evaluation includes process, formative, and summative/outcome components:
- Process. Describe the interventions, assess the extent to which the Steps interventions are implemented (including numbers of people reached), and identify challenges and lessons learned.
- Formative. Provide the Consortium with feedback for on-going program improvements and mid-course corrections.
- Summative/Outcome. Measure changes in intermediate and long-term outcomes and assess the contribution of the Steps interventions in achieving those outcomes. Indicators will be developed for each of the intervention activities and tracked over time.
Complementary initiatives in the community
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Federally funded:
- The REACH 2010 (Racial and Ethnic Approaches to Community Health) is an 86-member CDC-funded community-based coalition focusing on eliminating diabetes-related disparities in King County. It focuses on African-American, Hispanic/Latino and Asian-American/Pacific-Islander populations with its culturally-competent intervention plan.
Local Initiatives that support STEPS:
- The King County Asthma Forum, supported by the Robert Wood Johnson Foundation's Allies Against Asthma Program, Medicaid and local government, has 70 organizational members. It is implementing an community action plan that reduces the impact of asthma among low-income children through in-home support, improving the quality of asthma care, supporting schools and childcare providers in managing asthma, and assisting neighborhood asthma committees address asthma in their communities.
- The King County Physical Activity Coalition supports initiatives promoting physical activity. The Coalition consists of more than 15 local government agencies, schools, academic institutions, health care organizations and other organizations.
Funding for these materials was supported by Cooperative Agreement Number 03135 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services or the U.S. government.
Currently funded projects
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| Organization |
Project Title |
| Girls on the Run |
Girls on the Run |
| Seattle Parks & Recreation |
Sound Steps |
| Center for Multicultural Health |
Healthy Sundays |
| Harborview Medical Center |
Quality improvement and linkage |
| Children's Hospital and Regional Medical Center |
Quality improvement and linkage |
| Highline Community Hospital |
Quality improvement and linkage |
| Seattle Public Schools |
Coordinators |
| Seattle Public Schools, Highline School District, Tukwila School District |
Champions |
| Tukwila Schools Collaborative |
Pathways |
| Seattle Public Schools, Highline School District |
Great Body Shop |
| Seattle Public Schools, Highline School District |
School Health Index |
| Harris and Smith Public Affairs / Public Health Communications |
Steps to Health Communication Media (includes mini-grants) |
| Gilmore Research Group |
Evaluation |
| Group Health Community Foundation |
Evaluation |
| Action for Media Education |
Food for Thought |
| Children's Hospital and Regional Medical Center |
Strong Kids |
| Cascade Bicycle Club Education Foundation |
Bicycling for Lifelong Health |
| Austin Foundation |
Youth and Fitness |
| Feet First/Public Health Environmental Health |
Promoting Healthy Built Environments |
| Childcare, Public Health - Seattle & King County |
Fuel and Play |
| King County Asthma Forum, Public Health - Seattle & King County |
Community Health Workers |
| Last Name |
First Name |
Agency |
| Aitken |
Martha |
WSU Extension |
| Lacet |
Blishda |
REACH |
| Austin |
Willie |
Austin Foundation |
| Bruemmer |
Barbara |
UW Center for Public Health Nutrition |
| Concannon |
Colleen |
Highline Medical Group-Roxbury Clinic |
| Denver |
Aimee |
Highline School District |
| Dixon Docter |
Alicia |
Children's Hospital & Regional Medical Center |
| Dosset |
Linna |
YMCA of Greater Seattle |
| Drewnowski |
Adam |
UW Center for Public Health Nutrition |
| Harris |
Laird |
Harris and Smith Public Affairs |
| Jensen |
David |
Seattle Parks and Recreation |
| Johnson |
Gary |
Public Health—Seattle & King County |
| Krieger |
Jim |
Public Health—Seattle & King County |
| Lessler |
Dan |
Harborview Medical Center |
| Quinn |
Lisa |
Feet First |
| Salas |
Deborah |
Tukwila Community Schools Collaboration |
| Lewis |
Jill |
Seattle Public Schools |
| Love |
Devon |
Center for Multi Cultural Health |
| Merculief |
Melissa |
Community Health Plan of Washington |
| Nelson |
Penny |
King County Asthma Forum |
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step here
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REACH Coalition
The mission of the REACH 2010 Coalition is to reduce diabetes health disparities experienced by communities of color.
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King County Asthma Resources
 An estimated 22,209 King County children under 18 have asthma. It is the second leading cause of hospitalization in children in King County.
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Physical Activity
 For good health every person should do 30 minutes or more of moderate-intensity physical activity throughout the day on five or more days of the week.
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