King County Steps to Health

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.

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.

School-based:

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).

Workplace:

Promote worksite wellness: work with businesses to, identify needs and resources for worksite health promotion activities, assist businesses to create worksite action plans.

Healthcare:

Clinics

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.

Emergency departments

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

Federally funded:

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.