Joanne Kirkby Walsall presentation for web by 043f75Yj


									    NCMP: Routine Feedback
                          in Walsall
                         Joanne Kirkby

     (Acting) Healthy Weight Commissioner (Children)

Healthy Weight Team, Public Health
2005/06 to 2007/08
   Walsall has always fed back height and weight, one of few PCTs
   to do so
       • YR, Y6 and Y10
       • Contact number for parents to call

   06/07 = 10 calls, 4 YR and 6 Y6
   70% calls ‘are my child’s height and weight healthy?’

   07/08 = 40 calls 13 Y10, 12 Y6 and 12 YR (3 not recorded)
   43% ‘are my child’s height and weight healthy?’
   15% calls to convert from metric to imperial
   5% calls to revisit as absent

Healthy Weight Team, Public Health

   • Strong position: feedback process and resources in

   • Checks are in place at various stages to ensure any
   database or data handling errors during the process
   are identified before letters are sent out to pupil’s home

   • We learnt some lessons the hard way!!!

Healthy Weight Team, Public Health
  Feedback Process with Checks
                                     In School

      Check: Measurements taken in private area. No information disclosed
                        to child, peers or teachers.

         Check: pupil with same names/similar names-check DOB or with
                             teacher (age dependent)

         Check: Information (name, DOB, gender, ethnicity, address with
                   postcode) saved onto encrypted USB stick.

            Check: Hard copy of data transported in locked briefcase.

Healthy Weight Team, Public Health
                         In Office: Data Entering

  Database saved onto shared drive from USB and deleted from the USB

Check: Original database from school is saved in ‘originals folder’ on shared

Database copied over to spread sheet template and saved as school name
                            on shared drive

Check: Measurements entered onto the spread sheet (and checked against
                    name) from paper data sheet

     Check: data sorted to check for extreme height and weight values

 Check: Sorting errors: approx 10% of records are checked against original
              database from school and measurement sheet

Check: School data: approx 10% of records are checked against child health
                             In Office: Mail Merge

   A mail merge is carried out from excel onto a ‘Walsall Child Measurement
   Programme Letter’ for pupils in independent/private schools (all years) and
                               for all Y10 children

    For Y6 and YR children in the NCMP, the data is copied into the ‘Parental
              Feedback Tool’. Letters are produced from the tool

    Pupils who were absent, refused or who were opted out also have a letter
                     produced from the excel spreadsheet

       Check: the number of letters is the same as the number of records

    Check: letters document to be saved on shared drive for future reference

Healthy Weight Team, Public Health
                         In Office: Sending Out Letters

 Check: All letters to be sent out in an A5 envelope with a return address label on

          All schools and years: to be sent out with ‘Change4Life’ leaflet

YR/Y6 Ovw and V Ovw letters and YR/Y6/Y10 not measured (all schools): above
               and a ‘Why your child’s weight matters’ leaflet

 Check: name and measurements on letter are to be checked against name and
                      measurements on hard copy

Check: approx 10% of letters to be checked against database to ensure address,
                        DOB and postcode are correct

   Check: if address, DOB and full name was entered manually, these must be
             checked for data entry errors before letters are sent out.

Date letters are sent out to be recorded on overlay sheet and in booking database.
                  Number of days for feedback is then calculated
                             NCMP guidance < 6 weeks
                  Walsall: reason entered on system if > 3 days
  2008/09: The Unknown!
  • Pilot: 929 feed back letters sent in Dec 08
           • One number
           • 8 calls
           • Routine feedback from Jan 09
           • Involved in the feedback research

  • All calls logged and coded-database
  • Where possible I recommend plotting separate
  ht and wt centiles, builds a picture

Healthy Weight Team, Public Health
Feedback Summary
      24/06/09              YR          Y6

      Letters Sent          2937        2918
      Phone Calls           65 (2.2%)   70 (2.4%)
      Absent/Opt Out        23 (35%)    1 (1.4%)
      V Ovw/Ovw             14 (22%)    33 (47%)

      V Ovw/Ovw Angry       10 (15%)    11 (16%)
      V Ovw/Ovw No          8 (12%)     13 (19%)

      Second recruitment                5 (7.1%)
      Underweight           3 (4.6%)    1 (1.7%)

Healthy Weight Team, Public Health
Angry Parents: Themes
  • Wording of letter
      – What if child sees letter?
      – Concerns about eating
          • one threatened to sue if child
          developed eating disorder (Y6 mum)
      – Tone: impersonal/rude
  • Waste of public resources
      – Money should be being spent on tackling this
      at ‘ the coalface’ e.g. equipment and people in

Healthy Weight Team, Public Health
Angry Parents: Themes
      • Complexity of measurements
          – ‘Since when has a few pounds been a cause
          for concern’ (mother of YR child)
          – Generalising children using BMI
          – ‘I buy her age 14 clothes which fit her round
          the waist and in length, so she is in proportion’
          (mother of Y6 child, went from fairly angry to ok and signposted)
          –152.4cm, 58.9kgs 100th centile for BMI. 91st for ht and >98th for weight. 10kgs
          over healthy weight range.

      • Healthy Weight/Overweight cut off
          – Children around 91st centile

Healthy Weight Team, Public Health
 Raising the issue/consistent
     - ‘My GP has never said anything’
     - ‘She attends the children's hospital and the consultant
     has never said she is overweight’
     - ‘Health Visitor says she's fine’
     - ‘We have recently moved and he’s had a health check
     at new practice, she (practice nurse) said he was a tall
     lad and underweight….I think I would believe someone
     with a medical qualification over your letter’ (Dad of Y6 boy: 1.511
     m, 47.3kg, 93rd centile for BMI and 75th for ht, 91st for wt)

     - ‘Wii fit says he's ok’ (Mother of YR boy: 100                 th   centile, 119cm, 27.6kg, 91st centile
     ht and 99.6th for wt, 7lbs over healthy weight range)
Healthy Weight Team, Public Health
    Angry Grandparents: email

  ‘Just for your information my grandson has been with his
  mother to see his local G.P and the contents of your
  letter was discussed.

  The Dr weighed and measured Sam and calculated his
  BMI to be 18.9, the Dr said that anything under 25 was
  absolutely fine and said Sam's weight and height was

  The Dr has logged this on the computer at the surgery.’

Healthy Weight Team, Public Health
  Angry Parents: Themes
  • Denial??
            Mum: angry, child is
            not overweight, she is ‘big boned and                       under
            JK: ‘do you mind me asking what she's under
            dietician for?’
            Mum: ‘I took her because of her weight’
  Child’s measurements: 100th centile for BMI 161.4 cm 67.8kg. 99.6th for ht and just
  above 99.6th for wt.

  Mum kept cutting me off, no reasonable discussion to be
  had. Mum hung up.
Healthy Weight Team, Public Health
 Positive Calls
  • ‘He's always been a big lad, but I know he has a
  tummy…….I work nights and it’s difficult but I know that’s
  no excuse’ (Mum of YR child, 100 centile and 1 stone 3 lbs over healthy weight range)

  • ‘Just need something like this to kick start me to do
  something about it’ (Mum of Y6 child 133.2cm and 43.9kgs, 99 centile, 6kgs


  • ‘Weight off my shoulders’
  • ‘Knew she was overweight, just didn’t realise by how
  much, its quite shocking’ (Mum of Y4 child (Brownhills Cohort), 100 centile, 2 stone


Healthy Weight Team, Public Health
Calls with Engaged Parents
  • Diet: 5 a day and Activity: 60 minutes
  • Portion Sizes: ‘me sized meals’
  • Body shape: distribution
  • Small sustainable changes
  • Change4Life and Free Swimming
  • Weight maintenance not weight loss
  • Parental weight
  • Family changes, support of the family, role models
  • Passing on details to a service
Healthy Weight Team, Public Health
  What its All About……?
 Thanks for your letter regarding my son’s weight. To be honest, I had
 acknowledged myself that his weight was becoming a problem so we
 have made some positive changes as a family.

 As a single Mum working full time, I'm not able to spend as much time
 with my kids as I would like, I buy treats to make me feel less guilty. I
 do cook healthy family meals but I know it's snacks and lack of
 exercise that have contributed to the gradual weight gain.

 I haven't made a big deal out of it, I have made it 'getting healthy' for all
 of us. I know what it's like to the other extreme as I was overweight as
 a child and a flippant comment from my Father resulted in me suffering
 from Anorexia and bulimia, something I don't want for either of my

 As a family, we are now trying to take more exercise together. The kids
 have a choice of fruit and yoghurt for dessert and fruit for snacks. I
 haven't cut out all the treats as gradual changes are better as we are
 aware. I just hope we can maintain it!
Healthy Weight Team, Public Health

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