Hot Topics: New and Emerging Initiatives

Peter van Dyck: Debbie Maise, the Director of HRSA Women’s Health Office is going to give us an update on the Bright Futures for Women’s Health and Wellness Initiative--is it initiative?

Debbie Maise: I think it is initiative. We’re initiating Bright Futures for Women’s Health and Wellness, building on that successful model of Bright Futures for Infants, Children and Adolescents because we’re envious of that 12-year history of that initiative as we really are just laying the foundation for Bright Futures for Women’s Health and Wellness. And I want to give you a little preview of the tools that are under development for adolescent girls, for adults, for clinicians, for community groups, because we hope to make these useful to all of you in your daily work. Our Bright Futures steering committee is led by a group of women from across the country.

I want to acknowledge Millie Jones who’s sort of your liaison to that committee. Peter van Dyck heads the Executive Management Committee and they’ve been deliberating over the last two years on how to make this a primary prevention initiative. And one of the first things they did was to look at what are the issues that are affecting women’s lives, and through a process of data analysis, using the framework of the Healthy People 2010 Leading Health Indicators, they really chose two very important topics that have resounded in this meeting over the last three days. And the initial tools will be focused on physical activity and healthy eating, and really focusing on the nutrients that women need: calcium, iron, and folic acid.

So let me share with you what those tools look like today, and they’re really out in the field being tested as we speak. The components of them are self-assessment, giving girls and women the opportunity and the tools to empower themselves and to gain new knowledge about what is recommended in healthy eating and physical activity. So there’s about a half a dozen questions on physical activity, more than a dozen questions on healthy eating, and one of the things that’s very interesting and I want to acknowledge the contribution of our (inaudible) grantees because they said to us, “Well, you know eating takes place in the context of daily lives, so what about vending machines, and time of eating, and meals at home?” And so there’s a number of different questions that deal with not only what we consume and what’s recommended we consume, but the environment in which we all lead our daily lives. In addition to those questions on eating and activity, there’s also an opportunity for girls and women to self-assess their weight status. Do they perceive themselves to be at a healthy weight or over weight and obese?

One of the reasons I go into these questions is to give you an idea of what then becomes the foundation for starting a conversation with your clients, be they in a clinical setting, be they in a group setting, you know, each of these questions can be an opportunity to explore a little more deeply with that individual or with a group of women and girls, you know, where they are and what needs they have. There’s also a way in these booklets for girls and women to think about questions they might want to ask providers, and there are example of questions but there’s also spaces for them to write down their own questions. If this is used in a clinical encounter, there’s opportunities to do height and weight calculations, so that for adolescent girls we can put them on the growth chart. For adult women, we can put them on the body mass index scale, and once again, use that as an opportunity to have a conversation, comparing that, perhaps, to my own self-assessment about weight with what the actual measurements show. And then all of this is geared to goal setting, to really help that client set a goal, perhaps two goals, one in healthy eating and one in physical activity and so to leave that encounter or end this self-assessment by saying, “Here’s what I need to be doing different. Here’s my goal. Who can help me with this goal? When do I want to accomplish this goal?” And so we really hope to make this an empowerment tool for women as well as busy clinicians. In addition, one of the tools that’s being tested with adolescent girls is a backpack and wallet card as a little reminder. And I want to credit *Isadore O’Hare in or Division of Adolescent and School Health for that kind of tool as a reminder of five ways to chose to move and five ways to healthy eating.

It also comes with resources that include, you know, how to read the food guide pyramid, how to read the food label, an activity pyramid with ideas about how to operationalize this in your busy, daily life. These tools are actually being tested in Baltimore with adolescent girls in an interview that really will see whether or not the literacy level is set at a comprehension level the girls can use. We’re trying to determine whether they’re culturally appropriate and really, you know, sort of meet girls where they’re at, and we will use the findings from this interview process with girls to refine the adolescent tools. And we’re really pleased that the adult women’s tool is being tested in federally qualified health centers, in both English and Spanish, and every woman who’s seen over a three week period is going to have the opportunity to say, “Did this help me? Did this help me to have a conversation in this clinical setting? And is it empowering to me to go home and operationalize this?” So it’ll be a summary of experience. We’ll be able to analyze whether or not it made a difference whether the woman was there for a sick visit, a well visit, a prenatal visit. Is there a difference between women who self-described as healthy weight or over weight? So we’ll have a lot of different variables in this initial evaluation that will help us, again, refine this tool. Another part of this family of bright futures tools is a clinical guide or a program guide on getting started. Again, this is being tested in our federally qualified health centers and at a couple of other sites among our Bright Futures steering committee members.

This getting started guide makes suggestions about how to incorporate these tools into your programs, into your setting. It includes a Power Point to really introduce your staff to why is healthy eating and why is physical activity important. It really puts forward the data about how deficient women are across their life span, beginning with adolescent girls lagging behind adolescent boys in physical activity in high school. It shows how deficient women are in getting iron, folic acid, and calcium in their diets. I mean all of this sort of introduces dietary guidelines for women. It also includes in the getting started guide some counseling tips and ideas for assessing and getting started in this conversation. It really emphasizes the importance of doing height and weight measurements. It helps people to sort of demystify that body mass index for people and helps clinicians and program people talk about the importance of that tool in tracking where you are on that scale and then it gives ideas for helping individual clients to set goals. So we’re really excited about beginning Bright Futures for Women’s Health and Wellness with an OMD approved evaluation. All of the findings will be presented to Dr. van Dyck at our November Executive Management Committee and then we hope to take those refined tools through the various clearance processes in order to make them available to you early in 2004. In addition, to compliment these kind of individual self-assessment tools, which we hope will be on the web as well as in colorful booklet form to you, we have a community tool under development, again, to think about ideas for getting started, for how to do assessments.

There’s checklists for schools, for worksites, for community groups to use, ideas about partnerships, and then stories. We’re going to tell and have testimonials from programs across the country, some of which are represented in this room, about your community wide healthy eating and physical activity activities. Finally, and just beginning is some work on mental health in both the perinatal period and for women across the lifespan, and so those tools are just beginning with literature review, environmental scans, but we think the next area of bright futures really needs to go into that domain of emotional, spiritual, and psychological well being. So stay tuned, watch our website www.hrsa.gov/womanshealth. There’s a fact sheet about Bright Futures, goals, and mission, and vision statement, but soon we hope to have, hot off the presses, tools for you to use. Thank you and God Bless.