Evaluation of the Regional Health Eating Programme Yorkshire and

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Evaluation of the Regional Health Eating Programme Yorkshire and Powered By Docstoc
					          Evaluation of the Regional Healthy Eating
            Programme Yorkshire and Humber




                  Lindsay Blank, Fiona Ford, Liddy Goyder,
                  Paul Bissell, Jenna Williams, Paul Naylor,
                        Jean Peters, Christine Smith.



                                        March 2009




ScHARR, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent
Street, Sheffield S1 4DA. Tel 0114 222 0853 (LB) www.Sheffield.ac.uk/ScHARR
l.blank@sheffield.ac.uk
Contents
Methods                                                                     3

Results                                                                     4

- Evaluation of healthy eating projects in early year’s settings            4

- Baseline evaluation of healthy eating in schools through ‘growing’ food   8

- Evaluation of promoting healthy eating in leaving care teams              10

Conclusions                                                                 13

Analysis                                                                    14

Recommendations                                                             15

Appendix A

- Example drawings                                                          16




                                                                                 2
Methods

Regional Public Health Groups across the country have received development funding
to support new healthy eating initiatives in their regions. In 2007-08, Yorkshire &
the Humber focused its funding on three key areas: nutrition and healthy eating in
early year‟s settings, nutrition and healthy eating in schools, through a focus on
„growing‟ food, and promoting community consumption of fruit and vegetables
through leaving care teams. In total, seven projects were developed, with the nutrition
and healthy eating in schools being managed and counted as one project, although it is
being implemented in ten schools.

Project summary:

1.   Nutrition and healthy eating in early year’s settings
       One breastfeeding project at the Arnold Children‟s Centre, in Rotherham;
       A weaning project at Batley East Children‟s Centre, Kirklees
       „Healthy Start‟ a weaning project at East Marsh Children‟s Centre in
          Grimsby, North East Lincolnshire and;
       A cookery course for young parents, at Marshlands Children‟s Centre in
          Goole, East Riding.

2.   Nutrition and healthy eating in schools through ‘growing’ food
     Ten Primary Schools (4 in Barnsley and 6 in Sheffield) within the region are
     focusing on „growing‟ food. This is being project managed by Stockbridge
     Technology Centre.

3.   Promoting healthy eating in leaving care teams
       A cookery project in a leaving care team in Hull;
       A cookery project in a leaving care team in Wakefield.

The evaluation of the Yorkshire and Humber Regional Healthy Eating programme
was conducted between October 2007 and May 2008. The initiatives included in this
programme were evaluated in three streams which relate to their settings. As a result
this evaluation report is presented as three separate evaluations, along with overall
recommendations including implications for policy and practice. The
recommendations relate specifically to those interventions conducted in the Leaving
Care Teams and Children's Centres. For the school based interventions a baseline
evaluation only was commissioned owing to the timescale of these projects relative to
the evaluation schedule.




                                                                                     3
Results

1. Evaluation of nutrition and healthy eating projects in early year’s
   settings

Evaluation scenario
This evaluation, conducted between October 2007 and May 2008, considered the
implementation of four nutrition and healthy eating projects implemented in early
year‟s settings. Through the application process, four Sure Start Children‟s Centres
were identified as suitable. It was agreed at the outset that the key features of the
evaluation approach would be to understand the local context of each project, input to
programme design from the outset, provide an evidence base where possible for
different approaches, and help contribute to plans that were targeted and achievable.

As the numbers of families in each project were small, and the timescale short,
quantitative and qualitative results from individual projects were not considered to be
useful for others wishing to learn the lessons. For this reason, the second part of the
evaluation plan concentrates on advising the Regional Public Health Group on how to
develop a standardised approach to the development and monitoring of
nutrition/healthy eating initiatives in children‟s centres. As part of this evaluation, a
dissemination event was held at one of the children's centres. This enabled all of the
early year‟s projects to learn about one another, as well as share resources, best
practice, lessons learned, and future plans.

Evaluation findings
Breastfeeding project, Arnold Children’s Centre, Rotherham
The aim of this project was to increase breastfeeding among parents within a 30%
most disadvantaged super output area. . Under the Department of Health‟s „Healthy
Eating Objectives‟, plans were developed with local partners on how breastfeeding
initiation and continuation rates could be improved. The reach area for the Arnold
Children‟s Centre was identified within the Breastfeeding Health Equity Audit as
having the lowest breastfeeding rates in the Borough, and therefore was seen as a
good location to implement the project.

The objectives of the project included providing training for the children‟s centre staff
to enable them to have the necessary skills and knowledge to provide the right
promotional advice for families and the wider community, with a particular focus on
hard to reach families. The project also looked at identifying breastfeeding peer
supporters within the local community, as well as encouraging pregnant women into
the centre. To achieve these objectives, the project funding paid for a breastfeeding
support worker (two days per week) to oversee a breastfeeding event, parent-craft
classes, antenatal home visits and breastfeeding support visits. This aimed to create a
more joined-up service between midwifery and health visiting and provide continuous
support to parents. Staff also followed the UNICEF UK Baby Friendly Initiative
(BFI) guidelines to achieve accreditation and to further strengthen the project.

Breastfeeding awareness at the centre was raised through the breastfeeding event and
also through training and awareness sessions held with staff. The breastfeeding event


                                                                                       4
was held at the Arnold Centre, and attended by thirty-six individuals. Of these,
thirteen were potential future breast feeders, four were potential peer support workers,
and the remainder were health professionals and children's centre staff. The event
included the benefits of breastfeeding for baby, mother and society, comparisons of
breast milk and formula milk, practical ways to support breastfeeding mothers and a
quiz to challenge common myths and preconceptions. Breastfeeding resources,
including breast pumps and videos were also purchased and made available for hire
from the Arnold Children‟s Centre. A local children's centre manager with an
excellent track record of improving breastfeeding initiation and duration rates helped
and supported the Arnold Children‟s Centre staff and was seen to be a crucial factor
for the success of this project.

It was noted that children‟s centres often struggle to find the space for health
activities, and that breaking down professional and organisational barriers through
different or new ways of working, is very challenging, but local feeling is that this
project has begun that process and begun to alter ways of working. The project was
too short to identify breastfeeding initiation rates after birth; however, this is
something that the Arnold Children‟s Centre would be encouraged to monitor.

The intention is to roll out this project throughout children‟s centres in Rotherham,
and additional funding already secured from the PCT for more breast pumps.

Weaning Project, Batley East Children’s Centre, Kirklees
The aim of this project was to improve knowledge and practice around weaning in
South Asian families, using locally recruited South Asian parents/grandparents as
volunteers. The volunteers (six parents and one grandmother) had undertaken a basic
food hygiene course and a five week course on understanding weaning, preparing
simple home made weaning foods and running weaning food demonstrations.

The five-week course allowed participants to share their experiences with one another
about their own children, and look at the literature that was available from health
professionals. This progressed over the course to purchasing and comparing food and
drinks promoted for weaning, and being able to analyse the amount of salt and sugar
in ready prepared food, before using fresh fruit and vegetables to cook their own
weaning meals. These freshly cooked meals could then be compared to the pre-
prepared products previously purchased, and being able to demonstrate the benefits of
the freshly prepared weaning meals. The final week allowed participants to prepare a
display to take to weaning demonstrations, and prepare „weaning boxes‟ containing
equipment and locally available foods, which could be purchased at the
demonstrations.

Throughout the training, the volunteers all became more confident and able to
participate in group discussions, and have progressed to giving weaning
demonstrations at the one stop shop, a joint session for mothers and infants run by
local health visitors and children‟s centre staff. In addition, a stall with weaning
information was taken to a local school fair by some of the volunteers, and a weaning
party was held at the children‟s centre.

This project suffered slightly from an overall lack of weaning resources both locally
and nationally that are appropriate for South Asian and immigrant communities, as


                                                                                      5
many resources are targeted at a White, British audience. This raised questions as to
whether pictorial guides would be more successful, especially where there are low
English literacy levels, rather than information in any particular ethnic minority
language. It may also be necessary to incorporate traditional foods used by the target
community. The group also experienced difficulties as there was an expectation by
the organisers that the volunteers would act as translators for attendees of the classes.
This caused resentment amongst some of the volunteers, as they were distracted from
doing what they had trained to do and were not been paid for their translation skills.

This project is still developing and the next steps are to roll out the weaning events
across other children's centres in the area, attend health fairs and events in local
settings, and to produce a recipe book. The funding for these next steps has yet to be
secured but there have been discussions between the project lead and her line manager
as to the implications of her spending time supporting the volunteers to roll out the
weaning parties to others in the locality (instead of her actual job as an outreach
worker). In terms of the weaning book, no funding has been identified and there is a
high risk of inappropriate and inconsistent advice being provided if nutrition/dietetic
mentoring unavailable.

‘Healthy Start’ Project, East Marsh Children’s Centre, Grimsby
The aim of this project, named „Healthy Start‟ (not to be confused with the
Department of Health‟s national Healthy Start programme), was to develop a pictorial
resource to promote healthy weaning, to be used as an outreach tool by a children's
centre nursery nurse to encourage and support healthy eating habits in harder to
engage families. An outreach care pathway approach, based on guidance from the
national Child Health Promotion Programme and local service agreements between
health and early year‟s agencies, was used to engage families. The objectives of the
project were to increase the level of understanding that parents have of the importance
of healthy weaning, to increase the use of homemade foods for weaning, and to
measure the impact of pictorial information and outreach work on levels of
engagement and lifestyle changes.

The pictorial resource was developed and is now in use. It has been found to be
particularly beneficial when discussing weaning with BME parents, new parents,
teenage parents and those with learning difficulties or low literacy skills. Feedback
from participants said that it was easy to follow, promoted discussion, dispelled
myths, used powerful visual imagery and broke down barriers. However, the
development of the resource was very time consuming in terms of preparing and
piloting the booklet. The project staff felt that the availability of senior colleagues
resulted in delays, as did the conflicting advice received from different health
professionals. There were also many revisions to the content of the booklet, which
added extra time, and therefore extra costs to the production. However, it was felt that
these iterations did improve the quality, and acceptability and usability of the booklet,
so although time consuming, did lead to a better product. The approach used to
engage families was also found to be time consuming, and the initial home visits
became much longer due to use of the booklet. This implication would have to be
balanced against the benefits brought by the project.

By identifying and visiting families with a child aged around 4 months, and then
engaging with them, as well as providing equipment and simple step by step recipes


                                                                                       6
were seen as particularly important steps in this project. Feedback highlighted that
providing some free fruit and vegetables could have further strengthened this
approach. It is also important to note that some parents had very limited knowledge
around how to peel and chop the fruit and vegetables, so any advice given should try
not to make any assumptions about people‟s knowledge.

The booklet has been seen as a pilot for North East Lincolnshire and is due to be
rolled out to a further 13 children's centres. It is anticipated that the local authority
will fund this roll out.

Cookery project for young parents’, Marshlands Children’s Centre, Goole
The aim of this project was to build young parent's transferable skills, knowledge and
confidence in preparing and cooking a wide range of foods including fruit and
vegetables using the Food Standards Agency model1. A young person's family
support worker was funded by the project. Two drop-in sessions (co-facilitated by
health visitors) were undertaken to identify target young people who were then
encouraged to come to the 10-week programme. Eight young people subsequently
attended, who had a total of ten children between them.

The opinion of the young parents were sought about the areas they would like to
cover to encourage ownership, as well as consulting with them on the day and time
that would be most suitable for attendance. Suggestions from the group for inclusion
in the programme included ways to get toddlers to eat healthily, cooking skills, food
hygiene, a better understanding of food groups and eating healthily during pregnancy.
From these suggestions, a 10-week plan was drawn up. The drop-ins were very
informal and covered a variety of food and eating topics.

The support worker was instrumental in ensuring attendance of the young people, by
sending text message reminders the day before each session, providing free child care
if needed and collecting the participants from their homes to ensure attendance.
Feedback from attendees said this made them feel valued and included, and helped
further attendance. Attendees also reported the course provided them with more
information about the food choices available to them, and some reported that they had
tried new foods. The visual tools such as the pictorial weaning guide and food plate
and portion sizes were all found to be particularly useful. All enjoyed being able to
take home food at the end of the session, and this encouraged further attendance. The
attendees visibly grew in confidence during the ten weeks, and provided support to
one another, which brings about additional health benefits in terms of social capital.

This type of project is very labour intensive in terms of both preparations for the
sessions and delivery. Anecdotal evidence from staff suggested that attendance by the
young people would have been almost none existent without constant reminders from
the support worker. Although nothing was done to formally assess their changes in
knowledge attitudes towards healthy eating attendees said it had helped break bad
eating habits and most said there had been improvement in their food choice, or they
had been able to make a more informed choice. Many of the attendees simply wanted
to learn how to cook, without being too concerned about healthy meals.


1
    http://www.food.gov.uk/multimedia/pdfs/foodcompetencydraftria.pdf   .


                                                                                       7
2. Baseline evaluation of nutrition and healthy eating in schools, with
   a focus on food ‘growing’ projects

Evaluation scenario
This baseline evaluation, conducted between October 2007 and March 2008,
considered ten schools in Barnsley and Sheffield which are the sites of the school
food growing projects. Visits were made to five case study schools (three in Sheffield
and two in Barnsley) which were selected through discussions with the local Healthy
Schools Lead, in order to represent schools with different environments and
populations, after school club verse curriculum/classroom approaches, and staff with
varying degrees of knowledge relevant to the projects:

Sheffield
School A - city centre, ethnically mixed
School B - city centre, majority white
School C - edge of city

Barnsley
School D - village
School E - centre of town

The adults involved in the food growing projects were interviewed, mostly in small
focus groups. Participants in these groups included teachers, classroom assistants,
healthy schools co-ordinators and children's centre staff as appropriate to each site. A
drawing exercise was also conducted with the children who will be taking part in the
food growing project. The children were asked to draw a picture of the food they
would like to grow in the school garden and a second picture of them eating the food
once it had grown. This exercise was designed to capture their knowledge of, and
attitudes to, food growing at baseline (before the project commenced). The remaining
five schools were asked to complete the drawing exercise in the absence of the
evaluator. The protocol for the drawing exercise is given in appendix A.

Evaluation findings
As of March 2008, most of the schools were preparing to begin the food growing
projects in the summer term, shortly after the Easter holidays. Raised beds and/or
planters had been delivered to all the sites visited, and soil, seeds and planting
equipment were expected in April. All the schools had done some preparatory work
with the children who were going to take part in the project, including visiting the site
of the school garden and discussing with them what was going to happen there. All
the schools had selected one or two classes to take ownership of the project although
the involvement of after school clubs, holiday schools and parents/community
members were also being considered.

In the schools we visited all the staff involved in the project were very enthusiastic
about the potential, although some were apprehensive as they felt that their own lack
of experience in growing food might affect the success of the project. Their initial
involvement with the project varied from those who had volunteered due to a personal
interest, to those who felt the project had been „dumped on them‟. These differing
start points may be interesting to follow through in terms of the relative success of the


                                                                                       8
projects. As well as learning about growing food, providing an opportunity to improve
the children's knowledge and experience of different foods as well as their attitudes
towards eating well, the teachers also identified wider curriculum opportunities. These
included speech development, respect for the environment and property, and taking
responsibility.

In the drawing exercises the most popular items which the children drew were
potatoes, carrots and strawberries. In all they drew forty-one different items of
varying suitability for growing in a school garden. The least suitable food items drawn
were sausages, sweets and kebabs, with other foods being unsuitable only for the local
environmental context or time-scale e.g. watermelon, coconut, orange, and apples. A
few children also drew non-food items e.g. flowers, leaves and dandelions, but the
possibility of growing flowering plants alongside the vegetables had been discussed in
some schools. There were variations between the items drawn in different schools -
the school with the highest BME population drew items which were not seen in other
schools e.g. chilli, mint. The age of the children does not appear to have a particular
bearing on the type of, or overall number of food items they drew. The main
challenges in the drawing exercise were ensuring that the teaching staff did not
influence the children's choices and steer them towards more suitable or predictable
items and this has clearly introduced bias into some of the sets of drawings. The other
problem was „table effect‟ where children sitting around the same table produced
highly similar drawings however, this is a well known and documented occurrence in
this setting.

In terms of drawing the meal, this varied more between the schools in terms of the
children's age and ethnicity. In the school with a high BME rate the majority of
children drew a meal taking place around a dining table involving a large number of
their extended family. In the other schools small groups were drawn eating together
for example “me and my sister” or “me and my mum”. Varying numbers of children
drew themselves eating alone in each school, and this was particularly prevalent in
one school in particular. The children described a number of locations for the meal,
most described their home, and specific rooms were mentioned frequently - dining
room, kitchen and living room/lounge/front room most commonly, but also "my
bedroom" and "the shed" were mentioned. Some children also drew picnics or meals
taking place outside in the garden and others drew their meal taking place at school in
the dining hall. This part of the exercise was more related to the children's age with
the reception class struggling to draw any representation of a meal in many cases and
with very few children being able to name the particular location either within their
home or elsewhere where they would like the meal to take place.

3. Evaluation of promoting healthy eating in leaving care teams

Context
Each healthy eating programme was based on six, weekly sessions, designed for a
maximum for 6 individuals. All the young people attending these groups had recently
left state care (either foster care or children's homes) and were living independently.
Some were attending college courses and other training, whilst others had little
engagement with „mainstream‟ society and lived very chaotic lives. As such, their
ability to attend the cookery sessions on a regular basis was limited by their life
circumstances. Many were facing multiple challenges in their lives (anecdotal


                                                                                     9
evidence from interviews/observation included frequent re-homing, pregnancy,
having a child taken into care, knife/gang crime, drugs misuse) and as such their
commitment to a cookery course had to be weighed up against other pressures and
priorities. These disruptive backgrounds coupled by a lack of role-modelling often
from both family and carers meant that at this stage in their life course although
independent, they often lacked the skills and maturity of young people from more
conventional family backgrounds. . It is important to note that many care-leavers will
have received a confusing array of messages about diet and healthy eating, especially
if they have had a number of in-care placements, where different
carers/establishments may have given different ideas of what a healthy diet
constitutes. These contextual factors, along with the timescales in delivering the pilots
and subsequent delivery model chosen, must be taken into consideration when
looking at the findings and recommendations of this evaluation.

Evaluation findings

Hull
Two separate visits were carried out to the cookery session held in Hull. Fifty pounds
worth of free fruit and vegetables were provided and used at the session every week.
These were highly visible and mainly included apples, bananas, grapes, and pears
along with soup packs of carrot and onion. Some work had also been done by the
health trainers around healthy eating where this has fed into the individual targets
young people had set with their trainers. Around 30 young people were involved in
the cookery sessions to date.

Visit one
Seven participants completed a questionnaire at the beginning of the course, but only
one of them attended the focus group session, despite the fact that they had all
committed to attend. However, as this group was identified as being particularly
problematic as they were not in education, employment or training (NEET), then
perhaps this could have been expected. From the questionnaire responses, three
respondents had said that they intended to try and eat healthier food, but identified
barriers in the form of the expense of buying better food, poor provision of shops in
the area, and a lack of knowledge in preparing meals. All of the respondents had some
understanding of what foods were healthy, but none were able to associate poor diet
directly to any illness or health problem. The attendee didn‟t use the recipe sheets
provided, preferring to watch the tutor and copying their actions. This was due to
reservations about being able to follow a recipe, even if it was simplified. However,
the attendee felt that by watching and learning, she would be able to go home and
recreate the meal without the need for the recipe. Feedback was that the taking part
was good, rather than just observing.

Visit two
At the second visit, there was a different group present to those that had previously
been visited. There were four young people at this session, two of whom were regular
attendees. The session took place in a Youth Centre, close to the Young Person‟s
Support Service base.

The session was run by a community chef and support worker. The group cooked
pizza from a recipe sheet, which used clear and simple instructions which included


                                                                                      10
large colour photos. Each young person worked independently to make their own
pizzas. The community chef was very good at demonstrating the recipes and
managing the session. He asked questions about previous weeks, and ensured that the
young people had an active role in the session, rather than passively copying what
others were doing. At times, the staff steered the session, and did activities that the
young people could have been involved in i.e. weighing and measuring the
ingredients.

At the end of the session, each young person was provided with a bag of ingredients
which included everything that they would need to cook the food from the session
again at home. Many of the young people said that this had encouraged them to cook
the meals again at home. At the end of the session, the group were provided with £20
of cooking equipment.

Observations suggested that the cookery sessions provided a positive, encouraging
environment and the young people learned skills in food preparation, kitchen hygiene
and learning to follow a recipe. There was a real sense of pride among the young
people about the skills they were acquiring, and everyone was keen to do things
correctly. The session was very calm and organised, with a focus on preparation time
and keeping organised and clearing surfaces the whole way through.

Although the session was very positive in many ways, the opportunities to promote
healthy eating were missed. For example, healthier pizza toppings could have been
discussed. This is due to some extent to the focus of the course being on cooking
skills, and the community chef, who saw his remit as teaching the young people how
to cook, not to teach them to cook healthily. However, for many people, gaining the
confidence to cook is the first step towards eating more healthily, and it may be
necessary to establish cooking skills, before trying to learn about healthy eating too.

Wakefield
During the evaluation timeframe, Wakefield ran two cookery courses. One was at a
local supported lodging and the other was at the Signpost Centre.

Signpost Centre
Two visits to the Friday afternoon group at the Signpost Centre were completed. At
the first session, five young people were present. They cooked pasta dishes, healthy
French bread pizzas and prepared salads. Malt loaf and fresh fruit were also served.
All of the young people were referred to the sessions by support workers and given
leaflets containing information about the sessions, however, the young people felt that
it was their decision to attend. To aid attendance, daily travel tickets were provided,
and these were seen as beneficial by the young people.

Healthy eating was a key focus of the session and the young people all acknowledged
that eating well could be important. There were disagreements over whether eating
healthily was more expensive than eating junk or takeaway food, and also around
different types of fat, and whether they were all unhealthy. There were discussions
over whether instruction was enough or whether recipe cards would have aided
instruction, as they weren‟t provided. All of the young people had an interest in
cooking and were aware that there were local shops and discount supermarkets in
their local area, so didn‟t see access as a barrier.


                                                                                    11
On the second visit, three of the same attendees were there. They cooked healthy
vegetable and lentil soup which was served with wholemeal bread. They also
completed a quiz to test their learning from the sessions, although the poor reading
and writing skills of the attendees impaired their ability to answer the questions. In
comparison to the first session, the young people were all much more confident in the
kitchen, and had learnt how to chop vegetables without having to ask or be shown
what to do. They also took ownership of the session, and decided amongst themselves
who would prepare which ingredients. The second group was led by a different food
worker to the first, who wasn‟t as encouraging, and tended to carry out some of the
tasks alone rather than with the whole group.

The feedback from the young people showed that they had struggled to connect what
they had learnt in the sessions with their own life, although some say they had tried
new foods. All of the participants developed food preparation skills and were aware of
the basic principles of food hygiene. However, the focus group discussions suggested
that this had little impact on the attendee‟s diets away from the sessions and so,
although knowledge of healthy eating/cooking had increased, there wasn't any real
attitude or behaviour change.

Supported lodgings
This session was suggested as it was thought that by being situated at the supported
lodgings, it would encourage attendance, as there was no travelling involved, and the
attendees would be more relaxed being in familiar surroundings, but this wasn‟t found
to be the case. Two young people attended, despite six being expected, and appeared
they appeared very uncomfortable. Both attendees said that their main source of
cooking was to use the microwave, and although they appeared disinterested in the
Government‟s 5 A Day campaign, their motivation for attending was to learn how to
cook all different foods.

The relationship between the carers and young people was very open, humorous and
positive but this created a rather chaotic session which was difficult to manage and
control. As a result, although there were positive aspects in terms of building on the
relationship between the carers and the young people, this particular session was less
successful in terms of acquiring knowledge or skills about cooking or eating healthily.
For future sessions of this kind to be successful, it may be necessary to work with the
carers first, especially as they expressed a lack of skills and knowledge around
cooking.

Conclusions

Nutrition and healthy eating in early year’s settings
In all of the projects the input from staff, both those employed by the projects and
those staff already in place, was vital to their success. In most cases, the numbers
involved to date have been relatively small which makes it impossible to draw
conclusions on cost effectiveness or appropriateness for wider provision. Families
need more than knowledge to improve their diets, they need the skills to change;
information campaigns must be coupled with other services and interventions if they
are to bring about large changes in often complex and habitual lifestyle behaviours.




                                                                                    12
Time was spent at the beginning of the projects advising the Children‟s Centres how
to initiate and implement their healthy eating projects, where to find existing national
nutrition resources such as the FSA „cook and eat‟ tools, and advising them about
national guidelines or „blueprints‟ such as the NICE maternal and child nutrition
guidance. This gap in staff knowledge increases the risk of inappropriate and
inconsistent advice being given and this risk is further increased if public health
nutrition/dietetic mentoring is unavailable. There are questions at all the children's
centres about how best the lessons learned from these projects can be disseminated
and used by others developing similar initiatives.

Nutrition and healthy eating in schools, with a focus on ‘growing’
food
Overall, there is substantial enthusiasm for the food growing projects from both the
adults and children in all the schools we visited. Most of the children have a good
knowledge of the types of food they might be able to grow in their gardens although
suggestions varied in their suitability in terms of the local climate and context. Very
few entirely inappropriate suggestions were made (i.e. sausages and kebabs). Very
few of the children or adults involved in the project have previous experience of
growing food so it will be interesting to see how successful the projects are in terms
of how much food they produce. Returning to the schools later in the project would
allow us to assess what the children (and adults) have learned from being involved
and whether their have been any changes to their knowledge and attitudes towards
fresh, healthy food.

Promoting healthy eating in leaving care teams
There are two separate considerations when evaluating the cooking courses. Firstly,
should they be recommended as interventions to undertake with this client group, and
secondly, if they are to be undertaken, what recommendations for best practice can be
made.

These short cookery courses are an extremely positive way to engage the young
people and are highly successful in terms of social capital and confidence building.
They were also successful in improving knowledge around food preparation, food
hygiene and kitchen safety. However, the young people often do not associate what
they learn in the cookery classes with their „real lives‟ and as such do not transfer the
practices into their everyday cooking and eating. This is hardly surprising for a course
run over a few weeks as established practices and habits are extremely challenging to
alter. For some, this sort of intervention provides a vital stepping stone to begin the
process of re-integration into mainstream society. As such, the direct aims of
improving the diets of young people leaving care are not always met, but there are
many other positive outcomes which more realistically reflect the young people's
personal situations. Therefore, we would suggest that such cookery courses are still
very positive experiences for this client group, with many strong health outcomes,
even if these are not always directly related to the healthy eating objectives. However,
it is necessary to learn from and build on these examples so that future interventions
in this area can begin to become more successful in terms of changing attitudes and
practices.




                                                                                      13
The sessions observed increased the young people's knowledge of healthy eating, both
in terms of a basic understanding of the requirements for a balanced diet, and the
reasons why it is important to eat well. This raises questions about the viability of
running such a short course with young people who have reached an age where they
are already living fairly independently and have developed eating habits which for
many reasons they are „unwilling‟ to adapt, despite the increase knowledge they have
gained. There are wider implications in terms of increased confidence and motivation
to attend regularly which their support workers may be able to use to develop other
areas of their lives, and will to lead to increased health benefits for participants.

Future activities around healthy eating programmes for young people leaving care
need to consider what the best age for these interventions might be. Although there is
some worth in providing such courses at age 15-16 years, when the process for
planning for leaving care begins, it could be too early in people‟s lives. This is
because there will be other higher priorities associated with leaving care than healthy
eating. Once individuals leave care and become more established within their new
homes and communities, healthy eating will become more of a priority, which could
mean that they are more open and willing to take part in a healthy eating programme,
although the benefits and costs of each approach would have to be looked at in detail.


Analysis

Four key areas were identified where potential barriers exist to generating successful
outcomes and where recommendations for policy and practice can therefore be made.
These four areas are:

1. Those receiving the interventions
 Eating well isn‟t always a high priority in the sometimes „hectic‟ lifestyles of the
    young people in the leaving care teams, and this must be taken into account when
    establishing the expected impact of such interventions.
 In the communities in which the interventions are based, healthy eating is still not
    seen as normal and the young people/parents don't want to appear different to
    others – this also has an impact on expected outcomes.

2. Those providing the interventions
 Those who are delivering the interventions must receive adequate training and
    skills in order to ensure success.
 Other community members (e.g. carers) should only be involved if they are made
    aware of and fully support the aims of the intervention, as if not the focus can be
    lost.

3. The interventions themselves
 Many of these interventions are very short and may not be at the right stage in a
    person's life, in terms of leaving care or becoming pregnant/having a child.
    Consider implementing interventions earlier in the life course before behaviours
    are developed which are difficult to adapt, or alternatively, try to identify
    „windows‟ of opportunity in people‟s life stages.
 The delivery cost can be high if interventions are resource intensive. Poor
    attendance should be anticipated and factored into costs.


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   Some practices vital to success (e.g. driving to pick up young mums to bring to
    sessions) need to be factored into costs.

4. Future take up after the interventions
 Shopping guidance is essential in any cooking intervention.
 Perceived norms impact on the potential success of these interventions in the
    long term and this must be factored into the expected outcomes.



Overall recommendations
For any future projects within these settings, we would recommend that:

   There is thorough and ongoing training of all staff delivering the interventions.
   Interventions that improve access to fruit and vegetables - e.g. providing free or
    cheap may be the most cost effective way to improve diet.
   Sustainability of the interventions is an essential consideration.
   If budgets dictate short interventions, lasting outcomes should be the
    key objectives.




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Appendix A
Example drawings from the children involved in the school growing
project




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