What is the challenge or opportunity you are focusing on?

 

13% of children attending Ulster Hospital Outpatient clinics (OPC) area overweight and 15% are  obese.
These children are at risk of hypertension, diabetes and a shorter life expectancy unless action is taken!

 

The Ulster Hospital “Make Every Conversation Count” Quality improvement initiative was started in response to a snapshot audit (September 2017) demonstrating poor recognition of overweight/obese children by healthcare
professionals. Only 14% of children were recognised. Body Mass Index plotting was introduced to clinics through PDSA cycles and successfully increased recognition to 100%.

 The challenge is our response to this crisis. Staff focus groups and questionnaires demonstrated that doctors and nurses were struggling to address obesity with families due to embarrassment, time pressures, lack of
training, fear of damaging the clinician-family relationship and uncertainty as to where to signpost these families to.

Parent surveys (27/27) indicated that 100% of parents expect doctors to address childhood obesity with families and provide appropriate advice and referral if necessary. 100% (27/27) of parents expect a doctor will
have specialist training in how to do this. But there is no specific training currently available and there is no weight management service for children in Northern Ireland.  These are our challenges and our opportunities!

Our proposal is two fold:

1. Provide motivational interviewing (MI) skills training to all paediatric doctors and nurses working within our trust (SEHSCT) so that they become confident, well equipped and willing to address obesity with the families of overweight and obese children without fear or reluctance. It is important this subject is broached in a sensitive and empathetic manner. MI is increasing being recognised as an effective tool in the battle against childhood obesity. We piloted a short session of MI training for staff in the UHD delivered by clinical psychologists.  100% (20/20) of the healthcare professionals who attended and competed questionnaires “agreed” or “strongly agreed” that this training who change
   their clinical practice. We want to make this training available to all.

2.  Establish  a multidisciplinary childhood obesity service in our trust ( SEHSCT). Families of overweight/obese children have indicated that they are keen for a childhood obesity service. We want to co-produce this service with children and their parents. This service will be called “Fit for the Future” and be a coaching service. It  will empower families,
   rather than simply providing advice. We aim to start with a 12 week health coach programme for families which will be led by a clinical psychologist but supported by a Paediatric medical doctor, dietician and physiotherapist.

The £30,000 would allow us to pilot our “Fit for the Future” programme by covering the costs of the staff time and resources for a trial period of one year for a select group of children.

What is the benefit you hope to see?

The benefit is a brighter future for these children. Empower families to make positive changes.

Through weight management success we aim to reduce their  risks of developing obesity related illnesses. We hope to inspire our staff to  have those difficult conversations with families. The benefits will be two-fold. We want to motivate staff and improve their confidence.

What benefits do  you expect for the Q community

We aim to bring along the whole Q community on our QI journey to a fitter future for all children! We will share ideas with colleagues interested in health promotion and build mutually beneficial networks.  We will document our journey using videos, photos and stories to engage the Q community. We will welcome feedback from the
Q community and help others with similar projects. The core principles and learning from our project should be applicable to anyone within the Q community who is trying to influence individuals’ health behaviours be it weight loss in children or smoking cessation in adults!