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Stepping On - Scaling Program Delivery - Update 5/29 (Attachments, Solution with scalability)

Let's raise accessibility to the Stepping On program by including a virtual classroom.

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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

We want older adults to remain active and participate in life to its fullest. Stepping On is an evidence based program that reduces falls by 30% by providing participants with knowledge about fall risk factors such as home environment, medications, and vision. Participants are also given balance and strength exercises and encouraged to develop habits for regular engagement. This program is for seniors who are mobile, cognitively aware and able to participate in a daily exercise program.

The details below are taken from the Wisconsin Institute for Healthy Aging's site.

About the Program:

"Stepping On is a high-level, evidence-based program proven to reduce falls and build confidence in older people. A community-based, small-group workshop, Stepping On was developed in Australia and tested in a randomized trial where it demonstrated a 31% reduction in falls.  Wisconsin developed an American version of Stepping On with support from the Centers for Disease Control and Prevention (CDC) that has been tested in the United States and shown to achieve a 50% reduction in falls. Independent researchers have concluded that the success of Stepping On is attributable to Program Leaders' adherence to the program's Key Elements."

To read more about the research done on the program, please click here: https://wihealthyaging.org/_data/files/National_Stepping_On/Clemson_JAGS_2004_-_Falls.pdf

"Stepping On is designed specifically for people who are: 

1) at risk of falling, 

2) have a fear of falling, or 

3) who have fallen one or more times. 

Participants meet for two hours a week for seven weeks.  Workshops are facilitated by trained Leaders and provide a safe and positive learning experience.

It is the process in which the program is taught that makes it effective. Classes are highly participative; mutual support and success build participants’ confidence in their ability to manage their health behaviors, reduce their risk of falls, and maintain active and fulfilling lives."

The Stepping On 7 week program includes (as noted on the SteppingOn.Com site):

Week Content
1 Introduction- Building trust, overview of program aims, sharing fall experiences, choosing what to cover and balance and strength exercises.
2 Exercises and moving about safely - Review and practice exercises, explore the barriers and benefits of exercise, moving about safely – chairs and steps, learning not to panic after a fall.
3 Home hazards - Identify hazards in and about the home and problem solving solutions.
4 Community safety and footwear - Generate strategies to get around the local community and reduce the risk of falling. Learn about the features of a safe shoe and identify clothing hazards.
5 Vision and falls and vitamin D - Recognize the influence of vision on the risk of falling. Review strategies to reduce risk of falling from dysfunction. Identify the importance of vitamin D, sunlight and calcium to protect from fall injury.
6 Medication management - Identify medication risks and falls. Explore strategies to reduce risk of falls from medication side effects or misuse. Identify behaviour and sleep alternatives to taking sedatives. Review of exercises. Strategies for getting out and about in the local community safely. Practice safe mobility techniques learned during the program in a nearby outdoor location.
7 Review and plan ahead. Graduation ceremony.


The Problem:

Currently, Stanford Healthcare offers the Stepping On program for free at various senior centers through the aid of a grant. At most, we are able to offer 5-6 sessions per year. With a maximum class size of 14 students, this does not allow for large-scale reach.

The Solution:

We are proposing a virtual class of 10-14 participants that would be offered via a Skype/Google Hangout type of service, and facilitated by a trained Stepping On leader and peer leader.  

Initially, the virtual class size would include 5-7 participants (half the amount that is number recommended for Stepping On). The trial would be kept simple, with an assistant managing the tablet in the classroom and muting/unmuting as needed to allow the virtual participants to participate in discussions.  We would be able to compare retention and satisfaction information from our virtual class to classes physically offered in our community, and make modifications before offering a second class.  

Gradually increasing the number of participants in subsequent offerings would afford us the opportunity to determine the optimal online community size.  Too few members might not allow enough interaction, and too many participants may affect sociability, cohesiveness, respect, and trust that are important when discussing sensitive fall prevention topics and developing behavioral change. 

We have chosen to maintain the group component of this program rather than design and offer an online program as we have found that being amongst a group of peers who are facing similar challenges and sharing their own fall stories and tips are powerful motivators. 

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

We have already been conducting Stepping On classes in the community and have received good feedback. Please see the attached document on user feedback.

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

How would you scale this program while maintaining the fidelity of the program?

How long has your idea existed?

  • Over 1 year

This idea emerged from

  • An Individual

Tell us about your work experience:

We are both Occupational Therapists and currently working with Stanford Health Care in the Farewell to Falls Program and as instructors for Stepping On. We have several years of experience both as Occupational Therapists and working with older adults in the community.

How would you describe this idea while in an elevator with someone?

Stepping On is an evidence based program that reduces falls by 30% by providing participants with knowledge about fall risk factors and developing habits for exercises. Keys to the program’s success are education, peer interaction and support for behavioral change. We want to add an online delivery model, which would make it available to a wider number of participants.

How does your idea demonstrate our Criteria of Affordability?

The Stepping On program is provided by a variety of facilities and instructors nationwide and costs/fees for participation may vary. Currently we are providing this program through Stanford Health Care with the assistance of grants. This covers the cost of a 5-6 classes per year and allows us to offer the program for free. By including an online classroom, we are hoping to reach a wider number of participants with minimal cost increase. We would continue to offer the program for free.

How does your idea demonstrate or plan to demonstrate scalability?

Keys to this program’s success are education, peer interaction and support for behavioral change. This program is expensive to offer because of the need for a leader who understands aging, guest speakers (including a physical therapist, pharmacist, and vision specialist), and it is center-based. We want to discover if the model can be successfully transferred to an online delivery model, which would make it less expensive and available to a wider number of participants regardless of location.

How do you plan to measure the impact of your idea?

Currently participants are given a balance test at the first and then the seventh class. At the last class, they are also asked for feedback on exercise follow-through, new falls and satisfaction. With our first virtual classroom, we would compare the results of pre and post balance tests for the in-person classroom participants vs. the results of the virtual classroom participants to measure impact. The same would be done for exercise follow-through, falls, retention and satisfaction rates

What are your immediate next steps after the challenge?

The first step after the challenge would be to formally adjust the lesson plan to take into account the virtual classroom - i.e. determine what materials would need to sent and when to include virtual participants. Then we would set a date and location for the next Stepping On class and confirm that the location would agree to participate in a virtual classroom trial. If so, next steps would include training their team on how to describe and register participants for this trial program.

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