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NCMP: Routine Feedback in Walsall Joanne Kirkby (Acting) Healthy Weight Commissioner (Children) Healthy Weight NCMP: Routine Feedback in Walsall Joanne Kirkby (Acting) Healthy Weight Commissioner (Children) Healthy Weight Team, Public Health

2005/06 to 2007/08 Walsall has always fed back height and weight, one of few 2005/06 to 2007/08 Walsall has always fed back height and weight, one of few PCTs to do so • YR, Y 6 and Y 10 • Contact number for parents to call 06/07 = 10 calls, 4 YR and 6 Y 6 70% calls ‘are my child’s height and weight healthy? ’ 07/08 = 40 calls 13 Y 10, 12 Y 6 and 12 YR (3 not recorded) 43% ‘are my child’s height and weight healthy? ’ 15% calls to convert from metric to imperial 5% calls to revisit as absent Healthy Weight Team, Public Health

2008/09 • Strong position: feedback process and resources in place • Checks are in 2008/09 • Strong position: feedback process and resources in place • Checks are in place at various stages to ensure any database or data handling errors during the process are identified before letters are sent out to pupil’s home addresses……………… • We learnt some lessons the hard way!!! Healthy Weight Team, Public Health

Feedback Process with Checks In School Check: Measurements taken in private area. No information Feedback Process with Checks In School Check: Measurements taken in private area. No information disclosed to child, peers or teachers. Check: pupil with same names/similar names-check DOB or with teacher (age dependent) Check: Information (name, DOB, gender, ethnicity, address with postcode) saved onto encrypted USB stick. Check: Hard copy of data transported in locked briefcase. Healthy Weight Team, Public Health

In Office: Data Entering Database saved onto shared drive from USB and deleted from In Office: Data Entering Database saved onto shared drive from USB and deleted from the USB Check: Original database from school is saved in ‘originals folder’ on shared drive Database copied over to spread sheet template and saved as school name on shared drive Check: Measurements entered onto the spread sheet (and checked against name) from paper data sheet Check: data sorted to check for extreme height and weight values Check: Sorting errors: approx 10% of records are checked against original database from school and measurement sheet Check: School data: approx 10% of records are checked against child health system

In Office: Mail Merge A mail merge is carried out from excel onto a In Office: Mail Merge A mail merge is carried out from excel onto a ‘Walsall Child Measurement Programme Letter’ for pupils in independent/private schools (all years) and for all Y 10 children For Y 6 and YR children in the NCMP, the data is copied into the ‘Parental Feedback Tool’. Letters are produced from the tool Pupils who were absent, refused or who were opted out also have a letter produced from the excel spreadsheet Check: the number of letters is the same as the number of records Check: letters document to be saved on shared drive for future reference Healthy Weight Team, Public Health

In Office: Sending Out Letters Check: All letters to be sent out in an In Office: Sending Out Letters Check: All letters to be sent out in an A 5 envelope with a return address label on back All schools and years: to be sent out with ‘Change 4 Life’ leaflet YR/Y 6 Ovw and V Ovw letters and YR/Y 6/Y 10 not measured (all schools): above and a ‘Why your child’s weight matters’ leaflet Check: name and measurements on letter are to be checked against name and measurements on hard copy Check: approx 10% of letters to be checked against database to ensure address, DOB and postcode are correct Check: if address, DOB and full name was entered manually, these must be checked for data entry errors before letters are sent out. Date letters are sent out to be recorded on overlay sheet and in booking database. Number of days for feedback is then calculated NCMP guidance < 6 weeks Walsall: reason entered on system if > 3 days

2008/09: The Unknown! • Pilot: 929 feed back letters sent in Dec 08 • 2008/09: The Unknown! • Pilot: 929 feed back letters sent in Dec 08 • One number • 8 calls • Routine feedback from Jan 09 • Involved in the feedback research • All calls logged and coded-database developed • Where possible I recommend plotting separate ht and wt centiles, builds a picture Healthy Weight Team, Public Health

Feedback Summary 24/06/09 YR Y 6 Letters Sent 2937 2918 Phone Calls 65 (2. Feedback Summary 24/06/09 YR Y 6 Letters Sent 2937 2918 Phone Calls 65 (2. 2%) 70 (2. 4%) Absent/Opt Out 23 (35%) 1 (1. 4%) V Ovw/Ovw Signposted 14 (22%) 33 (47%) V Ovw/Ovw Angry 10 (15%) 11 (16%) V Ovw/Ovw No Signpost 8 (12%) 13 (19%) Second recruitment Letter Underweight 5 (7. 1%) 3 (4. 6%) Healthy Weight Team, Public Health 1 (1. 7%)

Angry Parents: Themes • Wording of letter – What if child sees letter? – Angry Parents: Themes • Wording of letter – What if child sees letter? – Concerns about eating disorders • one threatened to sue if child developed eating disorder (Y 6 mum) – Tone: impersonal/rude • Waste of public resources – Money should be being spent on tackling this at ‘ the coalface’ e. g. equipment and people in schools Healthy Weight Team, Public Health

Angry Parents: Themes • Complexity of measurements – ‘Since when has a few pounds Angry Parents: Themes • Complexity of measurements – ‘Since when has a few pounds been a cause for concern’ (mother of YR child) – Generalising children using BMI – ‘I buy her age 14 clothes which fit her round the waist and in length, so she is in proportion’ (mother of Y 6 child, went from fairly angry to ok and signposted) – 152. 4 cm, 58. 9 kgs 100 th centile for BMI. 91 st for ht and >98 th for weight. 10 kgs over healthy weight range. • Healthy Weight/Overweight cut off – Children around 91 st centile Healthy Weight Team, Public Health

Raising the issue/consistent messages - ‘My GP has never said anything’ - ‘She attends Raising the issue/consistent messages - ‘My GP has never said anything’ - ‘She attends the children's hospital and the consultant has never said she is overweight’ - ‘Health Visitor says she's fine’ - ‘We have recently moved and he’s had a health check at new practice, she (practice nurse) said he was a tall lad and underweight…. I think I would believe someone with a medical qualification over your letter’ (Dad of Y 6 boy: 1. 511 m, 47. 3 kg, 93 rd centile for BMI and 75 th for ht, 91 st for wt) - ‘Wii fit says he's ok’ (Mother of YR boy: 100 ht and 99. 6 th for wt, 7 lbs over healthy weight range) Healthy Weight Team, Public Health th centile, 119 cm, 27. 6 kg, 91 st centile

Angry Grandparents: email ‘Just for your information my grandson has been with his mother Angry Grandparents: email ‘Just for your information my grandson has been with his mother to see his local G. P and the contents of your letter was discussed. The Dr weighed and measured Sam and calculated his BMI to be 18. 9, the Dr said that anything under 25 was absolutely fine and said Sam's weight and height was perfect!! The Dr has logged this on the computer at the surgery. ’ Healthy Weight Team, Public Health

Angry Parents: Themes • Denial? ? Mum: angry, child is not overweight, she is Angry Parents: Themes • Denial? ? Mum: angry, child is not overweight, she is ‘big boned and dietician’ under JK: ‘do you mind me asking what she's under dietician for? ’ Mum: ‘I took her because of her weight’ Child’s measurements: 100 th centile for BMI 161. 4 cm 67. 8 kg. 99. 6 th for ht and just above 99. 6 th for wt. Mum kept cutting me off, no reasonable discussion to be had. Mum hung up. Healthy Weight Team, Public Health

Positive Calls • ‘He's always been a big lad, but I know he has Positive Calls • ‘He's always been a big lad, but I know he has a tummy……. I work nights and it’s difficult but I know that’s no excuse’ (Mum of YR child, 100 centile and 1 stone 3 lbs over healthy weight range) th • ‘Just need something like this to kick start me to do something about it’ (Mum of Y 6 child 133. 2 cm and 43. 9 kgs, 99 centile, 6 kgs th overweight) • ‘Weight off my shoulders’ • ‘Knew she was overweight, just didn’t realise by how much, its quite shocking’ (Mum of Y 4 child (Brownhills Cohort), 100 centile, 2 stone th overweight) Healthy Weight Team, Public Health

Calls with Engaged Parents • Diet: 5 a day and Activity: 60 minutes • Calls with Engaged Parents • Diet: 5 a day and Activity: 60 minutes • Portion Sizes: ‘me sized meals’ • Body shape: distribution • Small sustainable changes • Change 4 Life and Free Swimming • Weight maintenance not weight loss • Parental weight • Family changes, support of the family, role models • Passing on details to a service Healthy Weight Team, Public Health

What its All About……? Thanks for your letter regarding my son’s weight. To be What its All About……? Thanks for your letter regarding my son’s weight. To be honest, I had acknowledged myself that his weight was becoming a problem so we have made some positive changes as a family. As a single Mum working full time, I'm not able to spend as much time with my kids as I would like, I buy treats to make me feel less guilty. I do cook healthy family meals but I know it's snacks and lack of exercise that have contributed to the gradual weight gain. I haven't made a big deal out of it, I have made it 'getting healthy' for all of us. I know what it's like to the other extreme as I was overweight as a child and a flippant comment from my Father resulted in me suffering from Anorexia and bulimia, something I don't want for either of my children. As a family, we are now trying to take more exercise together. The kids have a choice of fruit and yoghurt for dessert and fruit for snacks. I haven't cut out all the treats as gradual changes are better as we are aware. I just hope we can maintain it! Healthy Weight Team, Public Health