Alison Berglund, SPT
BACKGROUND:
As most of my classmates know, I am very passionate about working with older adults. This interest has been longstanding, as I had many opportunities throughout high school and college to work with individuals in the geriatric population. Working as a caretaker for a sweet woman with dementia during her last few months of life and helping my grandmother during her battle with dementia were difficult experiences, but immensely rewarding and eye-opening. I quickly realized that our older adult population is all too often overlooked and vastly underappreciated. My passion for working with the geriatric population deepened throughout PT school as I had several opportunities to continue working with older adults in the community through volunteer experiences and during my clinical rotations.
One experience that I particularly enjoyed was volunteering for CHAMP (Community Health and Mobility Partnership), which is a community-based falls prevention program that began in 2009.1 The mission of this program is to reduce falls risk in older adults through prescription of a personalized home exercise program which includes muscle strength, balance, and mobility exercises.1 I was excited to have the opportunity to become more involved with this program during my third year through an independent study in the fall semester and my capstone project in the spring semester.
PROJECT OVERVIEW & PURPOSE:
As the population in the United States ages, falls are becoming a growing problem. It is estimated that every year 30% of older adults fall, resulting in injury and costly hospital admissions.2 Therefore, as our population ages, implementing effective community-based programs to decrease falls risk of older adults should be a mission and priority of clinicians working with this population. CHAMP is one program that addresses the needs of this population, with the incorporation of the evidence-based Otago exercise program to prescribe participants home exercises.3 During the initial visit, participants are provided with a calendar to record their exercises and falls each day of the month. However, many participants report that they often forget to utilize these calendars. Therefore, the focus of my capstone project was to increase the utility of these calendars.
STATEMENT OF NEED:
The falls and exercise calendars are an important part of CHAMP, as they help participants stay on track with their exercise programs and serve as a reminder to perform exercises and walk daily. At the start of the fall semester, I had the opportunity to volunteer at a CHAMP event at Pennybyrn Retirement Facility and interviewed each participant. I spoke with the returning participants about their satisfaction with CHAMP, adherence with their exercise programs, and their perceptions of the utility of the falls/exercise calendars. The vast majority of participants reported that the number one barrier to filling out the exercise calendar was forgetfulness. After discussion with Dr. Vicki Mercer and CHAMP site coordinators, it was decided that participants should receive a check-in phone call one week after their initial CHAMP visit. The aim of the follow-up phone call policy is to help participants remember to fill out these calendars, ensure they do not have questions about exercises, and hopefully improve their adherence to the home program.
PRODUCTS:
The first product I created for this project was a follow-up phone call script that DPT students will utilize when conducting calls. I also created a PowerPoint presentation and conducted a training session for students who will be performing the follow-up phone calls. The presentation included an overview of CHAMP, the purpose of the follow-up phone calls, and case scenarios designed to engage the audience and encourage critical thinking about challenges that may arise during the calls. I also created a post-training quiz to assess comprehension of the audience members. Finally, I created an annotated bibliography that describes the facilitators and barriers to exercise in the older adult population. When conducting follow-up phone calls for CHAMP, it will be important to understand barriers that may affect a participant’s willingness or ability to exercise. I was able to share some of these barriers and possible strategies to help participants overcome them during the training session.
Annotated Bibliography-Facilitators:Barriers to Exercise
EVALUATION:
During the process of creating the products for my capstone, I was able to utilize feedback from my advisor and committee members to improve my materials. I also gained feedback about the phone call script from current and future CHAMP coordinators at a meeting held in February.
To assess the effectiveness of my presentation and quality of my PowerPoint, I created a post-presentation evaluation form for audience members to complete. The form includes questions about the overall quality of my work, how prepared audience members feel to conduct follow-up calls after participating in the training, and suggestions to improve the effectiveness of the presentation. Overall, the trainees reported that they felt the presentation was effective and that they are confident in their abilities to perform the phone calls.
SELF-ASSESSMENT:
Overall, I am satisfied with the products I created for the implementation of a follow-up phone call policy for CHAMP. I enjoyed starting this project by interviewing CHAMP participants, which allowed me to identify their needs and change my project accordingly. I also had the opportunity to collaborate with CHAMP site coordinators and peers during the course of this project. I found this to be a valuable learning experience and appreciated the feedback I received in order to improve my materials and ensure that they most appropriately addressed the needs of CHAMP participants.
I feel that my training session was successful as well. Since I had completed follow-up phone calls myself prior to holding the training, I felt prepared to provide the audience with information about strategies to improve effectiveness of the calls as well as challenges they may encounter. I am hopeful that this new policy will help CHAMP participants stay on track with their programs and increase their use of the falls/exercise calendars. I am thankful for the opportunities I have had to volunteer with CHAMP and help to implement a new policy.
ACKNOWLEDGMENTS:
I would like to thank my advisor, Vicki Mercer PT, PhD for her feedback and support throughout the process of creating this project. Her assistance in the development of the project initially as well as in the improvement of my materials throughout the semester is much appreciated. I would also like to thank her for all of the time and energy she has invested in the development and coordination of CHAMP. I have witnessed first-hand how valuable CHAMP has been for so many older adults who would not have access to such a program without Dr. Mercer’s hard work and devotion. I would also like to thank Gabrielle Scronce, PT, DPT and Kayla McBane for serving as my committee members and providing me with feedback about the project. Finally, thank you to my classmate, Anna Speer, for your help and support during the last year. I had fun collaborating and volunteering with you!
REFERENCES:
- Vicki Mercer. CHAMP Policies and Procedures Manual. CHAMP Policies and Procedures Manual. 2018. https://ncchamp.org/materials. Accessed March 17, 2019.
- Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc 2018;66(4):693-698. doi:10.1111/jgs.15304.
- Campbell AJ, Robertson MC. Otago exercise programme to prevent falls in older adults. New Zealand: Otago Medical School, University of Otago; 2003.
- Image: https://www.google.com/search?q=otago+exercise+program+elderly&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiT9Ni9psjhAhUChOAKHejcDGsQ_AUIDygC&biw=1194&bih=699#imgrc=Rek72IeMgcp5dM:
8 Responses to “Implementation of CHAMP Follow-Up Phone Call Policy”
Anna Speer
Alison,
Thank you so much for this excellent contribution to the CHAMP program! I believe the implementation of follow-up phone calls addresses a key need within the program. I know that many of the older adults who I have worked with through the CHAMP program had not completed their calendars, and could not provide a reliable verbal estimate of how often they had been performing the exercises. This made it difficult at times to determine the participants’ adherence level, and if their exercises should be progressed. Adherence is crucial for the fidelity of the Otago program, so I am very excited for this new piece to be added to encourage participant adherence. I thought that your training materials were very clear and easy to follow. I especially liked that you provided example scenarios for students to think through. I believe this was a great way to help those being trained to process and practically apply the information that you taught in the previous slides. I am looking forward to seeing this tool applied in the program! Your passion for geriatrics is evident, and I am sure the same enthusiasm and quality that is present in this project will carry forward into your career as a clinician.
Anna S.
Alison Berglund
Thank you so much, Vicki. I enjoyed working with you and appreciate all of the helpful feedback you provided throughout the semester!
Vicki Mercer
Alison – Thanks so much for your hard work on this project! I think the follow-up phone calls are a wonderful addition to the CHAMP program, and hopefully will facilitate adherence to the Otago exercise recommendations. I look forward to your future contributions to physical therapy services for older adults!!
Alison Berglund
Thank you so much for your kind words, everyone! I appreciate that you each took the time to read through my materials and provide feedback.
Deb—I am very thankful to have you as a classmate as well! It has been a pleasure getting to know you throughout the last few years. Your passion for “optimizing movement” is truly evident both inside and outside of the classroom!
Kevin—thanks for your comment and great question! Part of the initial visit at CHAMP is an assessment of cognition, so we are aware of participants who have more trouble with memory. Currently, there is no difference in our protocol for administering exercises to participants with memory impairment. However, in my experience, volunteers do try to encourage participants to post the calendar on the refrigerator or a location they view often to serve as a reminder to perform the exercises. Please let me know if you have any other recommendations!
AJ—I am so glad that we share this passion of working with older adults. I have not yet had an issue with communicating over the phone about the exercises since we only discuss the exercises if a participant has a specific question about one that was administered. I absolutely agree that demonstration is imperative, so we ensure that volunteers provide demonstration and verbal cueing at all CHAMP visits. Thank you for your comment and for sharing about your personal experience with CHAMP!
Debbie—thank you so much for reading through my capstone as well as for your help throughout this process. It is very much appreciated!
Debbie Thorpe
Alison
You have developed some great products for this project! I am sure that the CHAMP team will be able to use these products to train CHAMP volunteers in the future.
Great work!
Alexandra J Francioni
Alison,
Great job on your capstone project! It makes me so excited to see someone enthusiastic about the older adult population and fall prevention! As someone who has participated in CHAMP clinics, I can really attest to the need you are filling. Even when my own family member attended CHAMP, she still did not follow through with her exercises. I think the call-in from a healthcare professional adds a level of accountability and motivation for that person that a family member cannot provide. Did you find that it was difficult to explain or describe their exercises over the phone if participants did not have the printed copy in front of them? My experience with older adults is that demonstration is imperative and can smooth out communication barriers, such as hearing loss or cognitive decline.
The materials you have created seem to really enhance the amazing work CHAMP and the OTAGO Exercise Program are already doing for this population. The standardization and forethought you provide seem to be great tools for any student or clinician to implement in order to provide the best care over the phone.
Excellent work,
AJ
kbond2
Alison,
Excellent work on your capstone! My last clinical rotation was at Carol Woods Retirement Community and I worked solely with older adults. Falls were the primary concern for all the residents and most of the residents had a fear of falling on some level. As part of therapy, we had them doing home exercises, which many of them were compliant with; however, one of the barriers we had to overcome was “forgetfulness.” I definitely see the need for your capstone and the CHAMP program seems to address an area of falls prevention that is often neglected.
I like all of your products! I think they are excellent materials to help address missed exercises. My one question is about those older adults who have more advanced stage memory loss. One of my patients at Carol Woods had great mobility, however, she had Alzheimer’s that had made her very forgetful. We had written down exercises and put them in big green folders and she misplaced them. She would miss appointments because of pure forgetfulness. Does the CHAMP program and you calls sheet accommodate patients of this status? I think that your capstone materials would be more beneficial than our system was for our patient, but would you treat them differently based on memory status? Your PowerPoint provides great information about the CHAMP program and Otago program, both of which are large programs! I have used the Otage program exercises with many patients and think that all older adults should be aware of them. Once again, great job on your capstone! I know that you will find enjoyment and fulfillment working with older adults!
Kevin
Deborah Guthmann
Alison,
It has truly been an honor to witness your passion and work throughout this program. I am so excited for the geriatric patients you will care for during your career. As evidenced by your life and choice of capstone, you truly understand the value and remarkable nature of this patient population—and your energy is contagious. This capstone was a perfect end to your didactic portion of PT school. I feel that it captures a bit of what brings you to this serving profession. It provides an evidenced based, practical, implementable intervention to improve the safety and quality of life of the older adults you care so much about.
I have provided a bit of feedback on each of your products. The phone call script was comprehensive, easy to follow, and simple to teach. It guides the caller through each option and leaves room for critical thinking. I would feel comfortable using it without any further training! The annotated bibliography was excellent. It correlates with your capstone well, supporting your decision to use phone calls for accountability, encouragement, and feedback in order to develop a habit of exercise and self-reflection (i.e. falls reporting). I especially appreciated the “relevance” portions of each article you reviewed. It directly ties the literature to your work and the CHAMP initiative to provide falls prevention to the community. You have a rare and valuable gift of simplifying complex research while maintaining the integrity of the research. Definitely keep using that skill! Your CHAMP presentation is a straightforward, engaging presentation that overviewed every aspect of your project. If I was unfamiliar with CHAMP or Otago HEPs, this PowerPoint would provide all the needed pieces in a digestible manner. That is quite a feat—to hone a “fire hydrant” amount of information into a manageable report. Your ability to communicate well has been highlighted through this project.
I truly enjoyed reading through your capstone. It was made even more meaningful having known you for the past three years—I am thankful to have you as a classmate and to share in your passion and commitment to the geriatric population.