Abstract
Sustained implementation of moderate to high-intensity interventions to treat childhood obesity meets many barriers. This report uses the Centers for Disease Control and Prevention's (CDC's) Replicating Effective Programs framework to describe and evaluate the implementation of a 5-year health care-community collaborative program.
Interviews with program leadership provided information on setting, organizational culture, program creation and adaptation, and costs. Administrative data were used for number of sessions and their characteristics; referrals; and 2018-2019 participant enrollment, attendance, completion numbers, and completer outcomes.
Preconditions for this program were high childhood obesity prevalence, and the complementary strengths of the health care organization (primary care treatment referral stream, population health orientation, alternative Medicaid funding) and the community organization (accessible space and time, staffing model, and organization mission). Preimplementation steps included collaborative design of a curriculum and allocation of administrative tasks. Implementation led to simultaneous deployment in as many as 17 community locations, with sessions offered free to families weekday evenings or weekends, delivered in English or Spanish. From 2018 to 2019, 2746 children were referred from nearly 300 providers, 832 (30.3%) enrolled, and 553 (66.3%) attended at least once, with 392 (70.8% of attenders and 47.1% of enrolled) completing the program. Outcomes in completers included improvement in %BMI
[-2.34 (standard deviation, SD 4.19)] and Progressive Aerobic Cardiovascular Endurance Run (PACER) laps [2.46 (SD 4.74)],
< 0.0001 for both. Evolution, including in referral process, Spanish program material and delivery, and range of ages, occurred continuously rather than at discrete intervals. Major system disruptions also affected the implementation. Maintenance of the program relied on the health care organization's administrative team and the collaboration with the community organization.
This program's collaboration across organizations and ongoing adaptation were necessary to build and sustain a program with broad reach and positive health outcomes. The lessons learned may be helpful for other programs.
