Did you bring the calendar? How do you like using it? Is it helping you and your child to work on accomplishing your goals?

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1 APC Follow-Up Visit Objectives Record height and weight measurements (MA). Smart Text survey. Continue to build rapport. Review previous sessions. Follow up on goals set at last visit/call. Assess interest/readiness to change. Set new goal(s), if appropriate. Summarize visit. Give stage and behavior-appropriate materials to participant. Schedule follow-up call. Review Last Session Assess where the participant stands with regard to what they mentioned the last time you spoke. Summarize any goals they may have set at that time. Last time we spoke you were planning to serve a vegetable every day for dinner, limit your child s TV viewing to 1 hour per day and to take your child to play outside 3 times a week. How is that going? Did you bring the calendar? How do you like using it? Is it helping you and your child to work on accomplishing your goals? Ask the child what Boingo says about juice or any other behavior you talked about previously. SMART TEXT FOLLOW-UP QUESTIONS Use the Smart Text responses and a review of notes from your previous visits and calls as a guide for conversation about behaviors that they have been working on or might be willing to consider working on at this time. If they have met the goal they set the last time you spoke with them, congratulate them. Focus on reinforcing/building self-efficacy and play the role of cheerleader /supporter. Everyone appreciates acknowledgement of self-improvement efforts! It s sounds like you have accomplished most of your goals...how do you feel about that? [reinforce feelings of pride/accomplishment]. How did you do it? Assess level of difficulty in meeting the goal to help you frame future goal setting. Who helped you reach your goal? Who made it difficult? How did you handle the difficulties?

2 2. Assess Motivation/Readiness to Change The participant s responses to the Smart Text survey should help guide you into a conversation about specific behaviors. Remind them about the goal of High Five for Kids. To promote healthy growth in children, High Five for Kids recommends the following: SHOW MENU OF TARGET BEHAVIORS No TV in the room where your child sleeps. Limit TV to 1 hour or less per day. Limit fast food to 1 x week at most. Limit sugar-sweetened beverages to 4 oz. a day. Eat 5 servings of fruits and vegetables every day. Have 1 hour of active play every day. How does this sound to you? If you decide to start working on any of these behaviors, I could work with you, if you like. What would you like to do? 3. Not Ready or Unsure If they are not ready to work on any behavior change, express understanding (e.g. It sounds like you re not ready to even think about changing your child s eating habits or activities right now, and that s OK). Emphasize that the decision to change is up to them. You sound really clear that you are not interested in making changes in your child s eating/ activity/tv habits right now. Could you tell me a little more about that? What s making you feel that way? If they are unsure if they are ready to work on any behavior change, express understanding (e.g. It sounds like you re not sure about changing your child s eating habits or activities right now, and that s OK). Emphasize that the decision to change is up to them. You seem comfortable with what you are doing now and unsure about making changes in your child s eating/activity/tv habits right now. Could you tell me a little more about that? What s making you feel that way? Explore what would have to change for them to be more interested in changing their child s health behaviors? Discuss possible benefits that the participant sees in changing their child s health behaviors at some future point in time. Explore reasons for lack of motivation (e.g. past failures, too much effort, etc.). 2

3 REVIEW TARGET BEHAVIORS No TV in the room where your child sleeps. Limit TV to 1 hour or less per day. Limit fast food to 1 x week at most. Limit sugar-sweetened beverages to 4 oz. a day. Eat 5 servings of fruits and vegetables every day. Have 1 hour of active play every day. What other goals would you like to set to work on from now until next time we see each other? Remind them to use the calendar to work on the new goals. If they have not met the goals they set at the last visit, assess what got in the way. What do you think would need to be different for you to accomplish your goal? It must be frustrating to feel it s so difficult to [reduce the amount of TV your child watches]. What do you feel you are able to do at this point? Because they were not able to achieve all of their goals last time, a focal point of this visit should be stumbling blocks. Reflect on what kept them from achieving the goal(s) set during the previous session. Sometimes not achieving one's goals can be a learning experience, so ask the participant what can be learned from this experience. Don t focus too much on what they didn t achieve, but probe for small steps towards the goal that maybe the participant did accomplish. Has anything changed to make them now feel more ready to work on this goal? If not, explore whether there is another goal that they might want to work towards. If goals were not set during the last call, ask whether they gave any more thought to what you discussed during that session. Has anything changed since we last spoke? NO: Briefly summarize what was discussed and ask if they have any questions. Move to talking about the menu and assessing whether they now are ready to start working on any behavior. YES: Ask what their thoughts are and address any concerns that come up. 3

4 If still unsure or not ready to change: Explore barriers to thinking about change: social factors economic factors time constraints Explore past change attempts. Reinforce self-motivational statements and any steps they are taking towards their goals. Are they willing to think about these health behaviors some more, or to take any other steps at this point? Yes: Move to Ready to Work on Health Habits (section 4) Unsure: Acknowledge that the participant is ambivalent. Discuss the ambivalence; try to tip the balance in the direction of perceived benefits/motivation. It sounds like you re concerned that too much fast food is not part of a healthy diet for your child, but right now you just can t see how you could realistically avoid it, given your busy schedule. Discuss possible benefits from target behavior changes at some future point in time. Offer support for smaller steps. (read the materials, limit TV time in the bedroom). 4. Ready to Work on Health Habits If they are ready to work on a behavior (set goals): Review menu. Ask participant to choose the behaviors they would like to work on. Ask participant how they plan to make these changes. Focus on specific and realistic short-term goals. Some people have said that it is helpful to set goals that are specific as well as realistic (e.g. I m going to cut back on the number of times each week we eat fast food. Since Sundays are the one day I always cook, I ll double the recipes and freeze the leftovers to reheat during the week ). What do you think would be a realistic goal for you? When you think about this goal, how realistic does it seem to you? Can you see yourself doing this over the next week? How hard do you think it will be to do it and stick with it? If appropriate, reflect what you ve learned from the participant s social context. Who or what are sources of support in their every day life (e.g. family, friends, neighbors, work)? It seems like eating dinner together with the TV off may help you feel more connected with your family. It sounds like meeting your neighbor and her kids at the park after dinner would give you time to socialize and your kids time to play outside. 4

5 Anticipate what stumbling blocks might come up. Explain that even when someone sets very realistic and reasonable goals, things can still get in the way. After the participant sets a goal, you can move directly into a discussion of what might get in the way of achieving it, and help them to develop a plan to avoid these problems. Especially try to identify and address social-contextual factors. You ve done a great job at setting some very reasonable goals. Is there anything that might get in the way of meeting your goals? Is there anything we can do now to make a back-up plan in the event that this happens? Now that you have decided that you want your child to eat more fruits and vegetables, think about your daily life --What could get in the way of doing this? What has helped you to cut back on the amount of time your child spends watching TV? How are you planning to keep it this way? Strategize with participant about ways to overcome stumbling blocks. Encourage participant to suggest options. If participant struggles to come up with options, you may offer some examples. -- Review the Talking Points to Overcome Barriers to Behavior Change reference page for examples of barriers and ways to overcome them. Tell participant you will have a follow-up visit with them in six weeks to see how they re doing (see section 8). 5. Introduce Self-Monitoring Calendar (if not previously used) Show calendar to parent and child. Show Boingo to the child and explain to the child what Boingo recommends for them to grow healthy and strong. Check off the goal they are going to work on and give them the stickers to use for tracking. Ask that they put the calendar up in a visible place, like on the refrigerator door, to remind them of the goal(s) they are planning to work on with their child. You can give them a High Five magnet to hang it up with. Show parent and child how to use the stickers to keep track of how they are doing working towards it on a day-to-day basis. Tell them that you will review it with them when you next speak, and ask that they bring it back to show you at the next visit. 5

6 6. Visit Summary Summarize the high points of the discussion, including any goals to work on for next time. We ve covered a lot today. It has been great to have a chance to work together! Before we finish, I d like to review the goals you set, to be sure that I have them right. Do those goals still sound reasonable to you? Is there anything else that you would like to add? Do you have any questions or concerns about what we talked about today? 7. Visit Materials Give the participant materials about the behaviors discussed in the encounter and specific to the participant s level of readiness to change. They can add these to their High Five for Kids binder. Are they not yet ready to plan to make changes? Did you Know? Are they ready to try and make some changes? Lets get started Have they made changes and need some reinforcement? Keep it up! 8. Schedule Next Appointment Let participant know that you would like to set up a time to follow up with them and see how they are doing. Schedule an appointment. Thank them for their time speaking with you today. 6