Statewide Implementation of the 'A Matter of Balance/Volunteer Lay Leader' Model

Despite challenges, it also became evident that some areas were able to build the necessary infrastructure to recruit larger numbers of seniors. Falls are a significant public health problem among older adults. For the 20% to 30% of seniors who experience moderate to severe fall-related injuries, the incident may act as a catalyst for a downward cycle, which may result in premature mortality without intervention efforts (Shekelle, 2003; Tinetti et al, 1994). Researchers at Boston University developed A Matter of Balance to help decrease older adults' anxiety about falling and increase their activity levels through exercises designed to reduce falls risks (Tennstedt, 1998). The efficacy of their behaviorally-based approach, using a trained health care provider to oversee the recommended exercises, was examined in a controlled randomized clinical trial. Immediately following the intervention, the experimental group showed a significant increase in the confidence to prevent and manage falls, and had fewer mobility and activity restrictions. Longterm effects included improved social functioning and mobility range. In 2003, the Administration on Aging the first of two major evidence-based disease prevention initiatives, which sparked a national movement to deliver evidence-based programs to seniors through the aging services network. This effort required programs to be 'scaled up' and delivered to large numbers of seniors. To meet the need to deliver prevention programming to the large numbers of anticipated older adults at risk, a second generation intervention was developed and tested by the Maine Partnership for Healthy Aging. The resulting program, A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL), has the potential to reach more people and achieve a greater public health impact (Healy, 2008; Partnership for Healthy Aging, 2009). AMOB/ VLL consists of eight two-hour sessions that teach behavioral skills for preventing and managing falls. The sessions also offer participants the opportunity to engage in physical activities that have been designed to increase the awareness of fall-related risk factors, help with informed decision making, and engage in exercises to promote strength and balance. Starting in 2006 with just one community, the State of Texas implemented AMOB/VLL as part of its Texas Healthy Lifestyles Program. With supplemental funding from the Department of Aging and Disability Services, the Texas Association of Area Agencies on Aging created a Texas Falls Prevention Coalition (http://texasfpc. org) to utilize local Area Agencies on Aging (AAAs) as the mechanism for delivering this program. This short program note will highlight the infrastructure that has made the statewide dissemination of AMOB/VLL possible, while providing initial programmatic findings and lessons learned. Further information can be obtained on the Evaluation Center Web-site http://srph.tamhsc.edu/research/texashealthylife styles/tfpc/tfpc~final-report-10.25aw.pdf. Research Findings In the first two years, a substantial infrastructure was developed through the training of almost 100 master trainers and more than 400 lay coaches. The establishment of this infrastructure enabled the statewide program to reach more than 3,000 participants (n=3,092) at 146 implementation sites through the delivery of 227 classes. Program fidelity was regulated and maintained through centralized master training, which was reinforced by detailed evaluation protocols, periodic check-ins, and retraining sessions. The majority of participants (76.4%) successfully completed the program. Program outcomes measured at baseline and the end of the program (that is, either 4 or 8 weeks) demonstrated the ability to achieve health outcomes similar to those found in the original studies. For example, significant improvements were found in terms of general health status, ability to prevent or manage falls, reduction of interference with normal activities, days being physically active, and self-reported falls. …