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16 Jun 2009Principles of Healthy weaning. Use of dietary supplements. Sue Jones, Senior Pediatric Dietitian. Amanda Costello Breast feeding advisor

Maternal and Early Year’s Healthy Weight Service

    Project 2b - Development of an obesity prevention service

    Report to the Project Board - Training Update Report by: Rachel Walker

    thDate: 16 June 2009

    Following the selection of six sites (Dudley, Shropshire County PCT, Telford and Wrekin PCT, Walsall

    PCT, Wolverhampton PCT, Worcestershire PCT) to host a pilot of the Obesity Prevention Service

    work has continued in all sites to prepare for implementation. All sites recruited staff to provide the thservice and following a Training Development Seminar on March 4, a training programme for all staff

    was developed. Wolverhampton University, on behalf of the TPHN, was identified as the link

    organisation to support the development of training and delivery of the training programme.

    Each site approached recruitment of Healthy Weight Advisors in a slightly different way some

    recruited externally via open advertisements, others recruited via internal secondments or through

    extension of working time for existing posts. As a result, the 18 trainees entered the training

    programme with very different skills and knowledge. The background of trainees included Health

    Trainers, Weight Loss Mentors, Children’s Centre Family Support workers and Food Access workers,

    amongst others. It was agreed by Project Leads as part of the planning process that all trainees

    would undertake the entire 12 day training programme to ensure they developed all necessary

    competences and skills and enabled the group to develop a positive working relationship.

    thThe development workshop held on March 4 with all Project Leads identified the key areas of skill

    and knowledge required to operate the service. These were:

    ? Behaviour Change Theory and Practice

    ? Motivational Interviewing

    ? Communication Skills in particular verbal and interpersonal skills

    ? Goal setting and action planning

    ? Key Health messages especially around healthy eating, activity, breastfeeding and the

    introduction of solid food.

    In expressing interest to become a pilot site, each site had identified areas of skills and knowledge

    their PCT was proficient in. This information was utilised to identify trainers for the training scheme

    from participating pilot sites.

    The programme of instruction was divided into three stages of delivery over a 3 week period.

    ? Stage one focused on subject specific knowledge acquisition and lasted for a duration of five

    consecutive days.

    ? Stage two focused on the principles of behaviour change management and lasted for a

    duration of three days

    ? Stage 3 of the delivery focused on operational issues including the application of theory to


The training programme included the following content:

    Stage of Learning outcomes and Indicative content Facilitator training & title /speaker Day 1 Open and welcoming non verbal gestures and expressions and Rachel Walker:

    negative gestures to avoid Walsall PCT Operational details of the weight management service and the Introduction to

    benefits of the service role & maternal Describe the purpose of their role and infant Introduce themselves, their role and service to a prospective client weight How to open and close a client meeting management Nature and characteristics of a therapeutic relationship service Principles of working in partnership How to establish rapport

    Operational details of the service including documentation and materials to be used during sessions

    Principles of accountability

    Day 2: Characteristics and processes underpinning the art of clear Rachel Walker

    communication Walsall PCT Ability to make eye contact, ask open questions and listen attentively Communicating

    Ability to seek out accurate information, clearly summarise and health communicate a health message messages in a Demonstrate how they would check out understanding one to one Understanding Communication Dynamics & Working with Body relationship Language

    Describe a healthy diet Day 3: Clare Harland

    Describe how to making healthy choices on a budget Telford PCT Understanding Describe the principles of safe food preparation key health Describe a healthy diet in pregnancy Deborah messages Components of a healthy family diet Houston pertaining to Food preparation and hygiene Telford PCT family food and Making healthy choices on a budget

    nutrition Nutrition in pregnancy

    Normal weight gain in pregnancy

    BMI calculations

    Describe a healthy diet in pregnancy Day 4: Sue Jones, Describe how to make up a formula feed Understanding Senior Pediatric Describe the principles and benefits of breast feeding; Participants will key health Dietitian be able to describe messages * Why breastfeeding is a public health priority. pertaining to Amanda *The impact of not breastfeeding on maternal and infant health. maternal Costello Breast *How breastfeeding works feeding advisor weight *Practices that support breastfeeding management *Baby Friendly Initiative and WHO code on the marketing of breast Wolverhampton milk substitutes.

    Principles of Healthy weaning Use of dietary supplements


Day 5: Describe benefits of physical activity Sally Cornfield

    Understanding Describe consequences of inactivity on well being Dudley key health Benefits of being active

    messages Play and activity

    pertaining to Safe exercise in pregnancy (Participants must be prepared for a 30 exercise and minute walk)

    an active


    Describe unhealthy behaviours associated with weight management Anne Pledger Day 6:

    Explain the cultural or social roots of typical unhealthy behaviours in Walsall PCT relation to diet, parenting and physical inactivity How to

    Explain the process of cost benefit analysis assess a Kelly Hammond Explain typical barriers and facilitators to behaviour change client’s Walsall PCT Demonstrate their ability to check out understanding and respond to current client’s personal preferences and expectations Sue Caulfield behaviour Demonstrate their ability to raise sensitive issues Demonstrate Health Trainer completing a Health Behaviour Check Manager Theories of behaviour change management

    Principles of empowerment

    Principles of motivational interviewing

    Describe the principles of SMART goal setting Anne Pledger Day 7: Setting

    Describe the process of cost benefit analysis Walsall PCT behaviour Demonstrate a partnership approach to goal setting change goals Describe high-risk situations and what action they would take Explain how they would help a client consider what changes they

    might like to make. Kelly Hammond Demonstrate effective use of action planning and personal health Walsall PCT guide documentation

    How to gauge confidence Working with Differing Points of View

    Understanding Patterns, Habits and Beliefs Main points about Self-efficacy and health behaviours.

    Use of a behaviour change diary Anne Pledger Day 8:

    Preparing a client for set-backs and difficult situations Demonstrate Walsall PCT Maintaining how they would provide motivational feedback, use of confidence behaviour scores, and social support networks Demonstrate how they would offer clients praise

    Demonstrate how they would assess progress Kelly Hammond Main principles of the cognitive behavioural model of relapse Walsall PCT Communication skills

    Use of service documentation Factors that influence decision making -determinants of health and


    Day 9: Maternal and early years weight management programme evidencing Rachel

    competencies and portfolio development Goodman and

    Patricia Bond Use of portfolio and how to compile evidence for future accreditation WMPHTN of learning


    Demonstrate awareness of own role boundaries Day 10: Rachel Walker

    Demonstrate understanding of potential for conflicting health Walsall PCT Identification messages and Demonstrate conflict resolution skills in relation to the intervention management of Professional role boundaries particularly related to advising on risk parenting skills Scope of practice

    Examples of conflicting health messages and how to respond

    Demonstrate understanding of the role other key service Demonstrate Patricia Bond Day 11:

    knowledge of local community resources and community support Ability to Sign networks University of post and refer Demonstrate knowledge of how and when to refer a client to another Wolverhampton to other agency services and Principles of team working agencies Nature of interagency collaboration and policies drivers

    Referral criteria

    Overview of referral processes and procedures

    Evaluation of Course Additional knowledge, especially around Healthy Start and Parenting skills, will be added

    locally in addition to risk management, Lone Working and Child Concern training.


    Following the training course, all participants undertook an assessment in the format of a

    one-to-one session with an assessor. They had the opportunity of a formative assessment,

    whereby they were given feedback on their performance before the final summative

    assessment. Trainees were expected to demonstrate all the skills and knowledge they had

    gained during the training course. Of the 18 trainees, 15 completed the training course (3

    Shropshire staff were recruited late, and so were undertaking additional training locally). rdThere were 17 trainees who undertook formative and summative assessments on June 3 thand 4. 2 trainees did not pass their assessments and require further additional work before

    re-assessment can take place. It is anticipated that this will take place before the end of June


    Portfolio Building

    A key element of the training programme is the inclusion of work around portfolio building.

    This was to ensure that the training programme and the skills and knowledge required for the

    role of a Healthy Weight Advisor could be accurately documented both for and individual

    trainee’s future use and professional development, but also to enable wider development

    and documentation of the role of HWA and the skills and knowledge required to undertake

    the role. Each trainee has received instruction on how to build the portfolio for this role and

    has a copy of the Portfolio Development Guide for this service. It is anticipated that a further

    workshop is undertaken with trainees once they have commenced work in the role to support

    them in building their portfolios. The portfolios are based on the NHS Key Skills Framework

    and will allow trainees to use the evidence they gather to provide evidence of their

    development for progression within the NHS.



    The programme will be evaluated in two parts. The first part of the evaluation is a report into

    the student’s experiences of the training sessions. This information will be gathered from the

    feedback forms completed by participants at the end of each session and at the end of the

    12 days training. A report on this is due by end June 2009.

    Wolverhampton University will also be undertaking Focus Group work with all trainees to

    research the views and satisfaction of students and trainers with the training process. This

    work is due to take place in August with a report on the findings due to be completed by

    September 2009.


    Initial feedback from trainees about the course was largely positive. However, there were

    some areas for reflection:

    1. Trainees who entered with high levels of existing skills and knowledge felt that they

    should be offered a training programme which allowed them to access only the areas

    of skills or knowledge they were not already competent in

    2. There were some gaps in provision, trainees expressed the wish to undertake further

    training in parenting skills, cooking on a budget, food labeling and in providing

    activities for babies.

    3. Trainees would have welcomed the opportunity to practice their interviewing and

    motivational skills further before they undertook their assessment. This was partly

    due to the short timescales allowed for this project. 5

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