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PS 025 375

Enhancing Health in the Head Start Workplace. Training

Guides for the Head Start Learning Community.

Bowman (James) Associates, San Francisco, CA.

Administration for Children, Youth, and Families (DHHS),

Washington, DC. Head Start Bureau.

ISBN-0-16-042679-0

96

141p.; For other guides in this series, see ED 348 160, ED

398 220-222, and PS 025 367-376.

105-93-1578

U.S. Government Printing Office, Superintendent of

Documents, Mail Stop: SSOP, Washington, DC 20402-9328.

Guides Non-Classroom (055)

MF01/PC06 Plus Postage.

*Employee Assistance Programs; *Employees; *Health

Education; Health Needs; *Health Programs; *Health

Promotion; Obesity; Physical Health; Preschool Education;

Resource Materials; Smoking; Staff Development; Stress

Management; Training Methods; Workshops

*Employee Health; Health Behavior; Health Policy; *Project

Head Start

This training guide is intended to increase the

understanding and skills of Head Start managers and directors to: (1)

identify the ways in which employee health affects the organization's

effectiveness; (2) design training programs that encourage employees to

improve their own health; (3) understand how the organization contributes to

the overall health of its employees; and (4) implement policies that allow

employees to enjoy the best health possible. Each of the guide's five modules

details module outcomes, key concepts, background information, questions for

discussion, learning activities, points to consider, and ideas to extend

practices. Handouts are included for each module. Module 1 addresses the

question, "why care about health in the workplace?" and focuses on the

concerns that many managers and Head Start Policy Council members have about

working on employee health issues. Module 2 addresses the question, "what

does wellness mean for our staff members?" recasting worksite health

promotion on a personal level. Module 3 addresses the issue of making changes

in behavior for better health and applies the latest research and practice on

self-change to the health needs of Head Start staff. Module 4 addresses

creating a healthy organizational climate, and includes the work

environment's effect on employee health. The final module takes these four

broad principles and applies them to the significant staff health issue of

being overweight. Contains 11 print and 3 organizational resources. (SD) ********************************************************************************

Reproductions supplied by EDRS are the best that can be made

from the original document. ********************************************************************************
U.S. DEPARTMENT OF EDUCATION

Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC)

This document has been reproduced as

received from the person or organization

originating it.

Minor changes have been made to

improve reproduction quality.

Points of view or opinions stated in this

document do not necessarily represent

official OERI position or policy. HEAD START®

4 Tral g Guides for the

F)1- Head Star. t Learning Community

Enhancing Health

in the Head Start

Workplace

1111111111.Mm...-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

Administration on Children. Youth and Families

Head Start Bureau

BEST COPY AVAILABLE

2

fj

v.
9

ISBN 0-16-042679-0

780160 426797 3

0000
HEAD START®

Enhancing Health in the

Head Start Workplace

Training Guides for the

Head Start Learning Community

,ssRvice,s.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

Administration on Children, Youth and Families

Head Start Bureau

411Pdaa
This national training guide was developed by James Bowman Associates, San Francisco,

California, under contract #105-93-1578 of the Head Start Bureau, Administration for

Children and Families, Department of Health and Human Services.

Photo courtesy of Peggy da Silva, MPH, of San Francisco, Ca.

1996

5
Contents

Preface ix

Introduction 1

Overview 1

Purpose 1

Audience 1

Performance Standards 1

Orientation to the Guide 2

Definition of Icons 5

At A Glance 6

Module I 9

Why Care About Health in the Workplace? 9

Outcomes 9

Key Concepts 9

Background Information 10

Activity 1: What's With the Children Today? 13

Activity 2: How Healthy Is This Workplace? 16

Activity 3: The World of Workplace Health Promotion 18

Next Steps: Ideas to Extend Practice 21

Handout A: Scripts for Teachers 23

Handout B: Healthy Workplace Survey 25

Handout C-1: Support Employee Health 29

Handout C-2: Reduce Health Care Costs 31

Handout C-3: Improve Employee Morale and Productivity 33

Handout C-4: Reduce Absenteeism 35

Enhancing Health in the Head Start Workplace v
Contents

Module 2 37

What Does Wellness Mean for Our Staff Members? 37

Outcomes 37

Key Concepts 37

Background Information 38

Activity 1: The Wellness Continuum 40

Activity 2: Health Risk Appraisal 43

Personal Health Risk ReportSample Copy 45

Activity 3: Screenings Are Not Just For Kids 51

Activity 4: Culture, Community, and Health 53

Next Steps: Ideas to Extend Practice 57

Handout D: What Is Wellness? 58

Handout E: Personal Risk Analysis Questionnaire 59

Handout F-1: Screenings Are Not Just for KidsTable 1 63

Handout F-2: Screenings Are Not Just for KidsTable 2 64

Handout F-3: Screenings Are Not Just for KidsTable 3 65

Handout F-4: Screenings Are Not Just for KidsTable 4 66

Module 3 67

Making Changes in Behavior for Better Health 67

Outcomes 67

Key Concepts 67

Background Information 68

Activity 1: Affirming My Capabilities 72

Activity 2: Batting Practice for Our Team, Part 1 74

Activity 2: Batting Practice for Our Team, Part II 77

Activity 3: Toward a Better Back 80

Activity 4: Is My Colleague Ready for Change? 84

Activity 5: The Self-Change Contract 87

Next Steps: Ideas to Extend Practice 89

Handout G: Batting Practice 91

Handout H-1: Limiting Fat to 30% of Daily Calories 95

Handout H-2: Limiting Fat to 30% of Daily CaloriesSample

Menus 96

vi Enhancing Health in the Head Start Workplace
Contents

Handout I: Strategies to Help Change 97

Handout J: The Basic Back 98

Handout K: Ready to Change? 99

Handout L: Self-Change Contract 100

Module 4 101

Creating a Healthy Organizational Climate 101

Outcomes 101

Key Concepts 101

Background Information 102

Activity 1: Goals and Roles 104

Activity 2: Our Organization's Working Styles 107

Activity 3: Supporting Healthy Behaviors 109

Activity 4: Community Resources 111

Next Steps: Ideas to Extend Practice 112

Handout M: What Do the Shapes Mean? 113

Handout N: Healthy People 2000 114

Module 5 115

Weight and WellnessA Classic Worksite Issue 115

Outcomes 115

Key Concepts 115

Background Information 116

Activity 1: Exercising Our Way to Better Weight Together 119

Activity 2: Consulting on Weight and Wellness 123

Next Steps: Ideas to Extend Practice 125

Handout 0: Where We Are With Weight and Exercise 126

Handout P: Exercise Facts 127

Handout Q: Ready to Change to More Exercise? 128

Enhancing Health in the Head Start Workplace vii
Contents

Continuing Professional

Development 129

Resources 131

Workplace Health and Behavior Change Theory 131

Resource Booklets for Employee Health Promotion 133

Organizations 134

Head Start Resources and Policies 135

viii Enhancing Health in the Head Start Workplace
Preface

o.

People come to their work in Head Start because they care about children,

families, and their communities. Head Start employees are ambassadors.

Their words and actions spread Head Start's messages of empowerment,

diversity, caring, nurturing, and healthy futures for all children. The ripple

effect from a healthy Head Start organization enhances the quality of life

of many more people than the employees, or even program participants.

The organization and its employees are constantly giving, constantly

shifting to meet one challenge after another. It's easy to get so involved in

the day-to-day demands of an excellent early childhood and family

support program that we forget to take the time to care for the

organization and all its personnel. As Head Start managers and directors,

we have reports to write, disputes to settle, outreach to conduct, and

agreements to execute. When do we get the time to consider the myriad

needs of staff? When is there time to consider our own health, let alone

how our approach to wellness infuses our organization's well-being?

All Head Start managers realize the importance of nurturing and

supporting their staff Enhancing Health in the Head Start Workplace is

filled with practical information on employee health and strategies for

promoting both individual health and organizational health. As many

businesses and corporations know, employee health affects the bottom

line. In Head Start, the "bottom line" is an excellent program for the

families in our communities. Only employees in good healthin the

many connotations of that wordcan offer excellent services. Therefore,

time spent with employee health and team building, with ensuring a safe

and well-functioning workplace, is time spent on meeting that bottom line.

This is a functional guide in the series Training Guides for the Head Start

Learning Community. The foundation guide for the health section is

Laying a Foundation in Health and Wellness. The foundation guide

introduces the concepts and skills needed to develop a strong Head Start

health program. Staff who embrace those concepts will be positive role

models for the families they serve. Use the foundation guide with staff

first, and refer to it often. Other training guides in the series are

referenced as appropriate.

Three notes of caution about using this guide:

The activities are designed to enhance an already adequate Head

Start organization. This guide will not be useful for an agency in the

midst of great change or difficulty. Such an organization will need

more intensive consultation in organizational development.

Enhancing Health in the Head Start Workplace ix

10
Preface

Leadership of these activities can be a delicate challenge. It is best

to use staff or consultants who are well-trained and experienced in

health education and organizational development. The trainer/coach

should have a strong grasp of sensitive issues that arise over health

status and health behavior change, and over questions of healthy

teams functioning in the special work environment of child care and

family support.

Leaders must create a safe situation in which change is possible.

One way this can be done is to make maintaining confidentiality

about sensitive health issues a priority in the organization. Also,

supervisors will need to continuously check themselves to be sure

they are not moving beyond supporting and into pushing.

Environments can be made to encourage changesometimes in

strong waysbut real change is developed from within.

This training guide was developed over many months. We solicited ideas

from the Head Start Bureau in Washington, D.C., regional ACYF offices,

Technical Assistance Support Centers (TASCs), and Resource Access

Projects (RAPs) for Head Start.

We thank the Head Start programs that allowed us to visit and field test

activities and the many Head Start staff around the country who gave

feedback during conferences and regional trainings. We revised many

activities and concepts based on this feedback.

We hope you will enjoy these activities and learn ways to nurture and

empower employees to seek their own wellness. Their wellness will

spread to the entire community affected by Head Start.

JAN

Enhancing Health in the Head Start Workplace
Overview

Introduction

Purpose With Enhancing Health in the Head Start Workplace, Head Start

managers and directors will increase their understanding and skills to:

Audience

Performance Standards

Identify the ways in which employee health affects the

organization's effectiveness.

Design training programs that encourage employees to improve their

own health.

Understand how the organization contributes to the overall health of

its employees.

Implement policies that allow employees to enjoy the best health

possible.

This guide is for Head Start directors, managers, and members of the

grantee and/or delegate board, Policy Council, and Health Services

Advisory Committee. It is for anyone who has influence over the physical

and social setup of a workplace, employee health benefits, and the design

of employee health training programs. The combination of activities

provides management team members the opportunity to consider their

own health and wellness, to collaborate with other managers to improve

how they promote staff health, and to present the message of health

promotion to staff in workshop or coaching sessions.

Head Start Program Performance Standards require that staff be taught

principles of "preventive health" and safety. The Performance Standards

also require staff to teach children and parents positive health behaviors.

Staff communicate healthy practices best when they themselves

understand and commit to them.

12

Introduction 1
Introduction

Orientation to the Guide

Enhancing Health in the Head Start Workplace gives managers and

directors an overview of the important issues in planning health

promotion activities or policies. The broad principles that apply to

worksite health are outlined in the first four modules. Within the modules,

some activities focus on health topics such as stopping smoking, team

building, stress management, back injuries, and primary health care.

The possible topics are endless, so these topics are used as examples.

They focus on building managers' skills in applying the broad principles

to the topics most relevant to their own programs.

Module 1: Why Care About Health in the Workplace? addresses

the concerns that many managers and Policy Council members have

about working on employee health issues.

- Is it really important?

What have other companies done about this, and did it help?

Module 2: What Does Wellness Mean for Our Staff Members?

moves worksite health promotion to the personal level, thus assuring

that it is meaningful.

- What do our employees care about?

What is going on in the community that is important to our

employees' health?

Module 3: Making Changes in Behavior for Better Health applies

the latest research and practice on self-change to the health needs of

Head Start staff.

- How do we use the worksite to support healthy behaviors?

Module 4: Creating a Healthy Organizational Climate addresses

the work environment's effects on employee health.

What is a healthy organizational climate?

How do we develop a healthy climate in our workplace?

13

2 Enhancing Health in the Head Start Workplace
Introduction

The fifth and final module takes the four broad principles and applies

them to a significant staff health issue: being overweight. In the needs

assessment that preceded development of these training guides, 50 health

coordinators from Head Start programs nationwide were asked to identify

major staff health needs; nearly all mentioned obesity. As a health

concern, obesity is uniquely challenging. Science does not agree on a

definition or level of medical risk; society has strong, sometimes

conflicting, attitudes toward weight; millions of people are trying

usually unsuccessfullyto lose weight; cultural beliefs about nutrition,

exercise, and attractiveness are often contradictory.

Module 5: Weight and WellnessA Classic Worksite Issue walks

coordinators through the planning and application of strategies to

help their staff members achieve healthy weights.

Why is this topic important to our workplace?

How do our staff members feel?

What strategies for change are effective with this problem?

How do we create a climate that supports physical and

emotional health regarding weight?

Trainer's note:

If you don't want to address the topic of weight, apply the principles to a topic more relevant to your staff

Introduction 3
Introduction

Each of the five modules contains learning opportunities for workshop

sessions (12-25 people) and coaching (2-3 people). All have the following

sections:

Outcomes are the skills that staff acquire by participating in the

module's activities.

Key Concepts are the main ideas in each module. These sections

can be used as handouts or overheads.

Background Information elaborates on the key concepts. This

section can be used as a coaching resource or as an outline for a

group presentation. Background information sections also can be

used for handouts or as overheads in workshops.

Questions for Discussion/Reflection end each background section.

These questions can initiate discussion in workshops or coaching

sessions, or serve as prompts for staff journals.

Learning Activities build the skills needed to achieve the outcomes.

Managers can use workshop activities, coaching activities, or a

combination by adapting activities to the size of the group, and to its

composition: be it the management team, staff from one component

area, or staff and board members together.

Points to Consider, listed at the end of each activity, can be used as

discussion prompts while working through the activity.

Next Steps: Ideas to Extend Practice are additional activities to

reinforce the expected outcomes and help transfer skills from the

training sessions to the workplace.

Handouts are included at the end of each module to be reproduced

as needed for participants.

b

4 Enhancing Health in the Head Start Workplace
Introduction

Definition of Icons

Coaching

A training strategy that fosters the development of skills

through tailored instruction, demonstrations, practice, and

feedback. The activities are written for a coach to work

closely with one to three participants.

Workshops

A facilitated group training strategy that fosters the development of skills through activities which build on learning

through group interaction. These activities are written for

up to 25 participants working in small or large groups with

one or two trainers.

Next Steps:

Ideas to Extend Practice

Activities assigned by the trainer immediately following

the completion of the module to help participants review

key information, practice skills, and examine their progress

toward expected outcomes of the module.

Continuing

Professional Development

Followup activities for the program to support continued

staff development in the regular use of the skills addressed

in a particular training guide. It includes:

1) opportunities tailored to the participant to continue

building on the skills learned in the training; and

2) ways to identify new skills and knowledge needed to

expand and/or complement these skills through opportunities in such areas as higher education, credentialing, or

community educational programs.

13

Introduction 5
Introduction

At A Glance

Modules Activity Time Materials

Module 1:

Why Care About

Health in the

Workplace?

Activity 1: What's With

the Children Today? (W)

20-35

minutes

Handout A

Activity 2: How Healthy

Is This Workplace? (C)

30-45

minutes

Handout B

Activity 3: The World of

Workplace Health Promotion

(W)

45-60

minutes

Handouts C: 1-4

Module 2:

What Does Wellness

Mean for Our Staff

Members?

Activity 1: The Wellness

Continuum (W)

25

minutes

Handout D

Activity 2: Health Risk

Appraisal (C)

40

minutes

Handout E

Activity 3: Screenings Are

Not Just for Kids (W)

30-40

minutes

Handouts F: Tables 1-4

Activity 4: Culture,

Community, and Health (C)

45-60

minutes

Module 3:

Making Changes in

Behavior for Better

Health

Activity 1: Affirming My

Capabilities (W)

20-30

minutes

Activity 2: Batting Practice

for Our Team: Parts I & II

(W)

60-90

minutes

Handout G

Handouts H: 1 & 2

Handout I

Activity 3: Toward a

Better Back (W)

30

minutes

Handout J

Activity 4: Is My Colleague

Ready for Change? (C)

30

minutes

Handout K

Activity 5: The Self-Change

Contract (C)

30

minutes

Handout L

Module 4:

Creating a Healthy

Organizational Climate

Activity 1: Goals and Roles

(W)

30-45

minutes

Activity 2: Our Organization's

Working Styles (W)

30-45

minutes

Handout M

Activity 3: Supporting Healthy

Behaviors (W)

30

minutes

Handout N

Activity 4: Community

Resources (C)

20

minutes

6 Enhancing Health in the Head Start Workplace

1?
Introduction

I Modules Activity Time Materials

Module 5:

Weight and WellnessA

Classic Worksite Issue

Activity 1: Exercising Our

Way to Better Weight

Together (W)

45-60

minutes

Handouts K, 0, P, & Q

Activity 2: Consulting on

Weight and Wellness (C)

45

minutes

Handout L

(C) = Coaching Activity

(W) = Workshop Activity

Coaching Preparation Note:

Coaching activities often ask the participants to go into the

workplace or the community to talk with others, observe others' behaviors, or try out healthy behaviors themselves. The

times in this chart include only the time the participants and

coach spend together.

BEST COPY AVAILABLE

Introduction 18 7
Module 1

Why Care About Health in the Workplace?

Outcomes After completing this module, participants will:

Understand the connection between employee health and job

performance.

Describe how employees and their organizations benefit from

workplace health promotion activities.

Key Concepts The workplace is ideal for developing and maintaining healthy habits

because:

Most adults spend a great deal of time at work.

It is often easier to make healthy changes in lifestyle with group

support.

People in helping professions must nurture themselvesat home and

at workto provide services to others effectively.

Each Head Start workplace is a unique environment that affects

workers' health.

Health promotion activities at work can enhance job satisfaction,

increase productivity, decrease absenteeism, and reduce health care

costs.

../11.11

19

Why Care About Health in the Workplace? 9
Module 1

Background Information A. Health in the Workplace

Health in the workplace has always been important. However, as the

disasters of the Industrial Revolution demonstrated, managers did not

always care about workers' health. The early labor movement directed

some attention to workplace safety and health, and many labor unions

today continue to focus on these issues. For the past 20 years, the number

of companies sincerely concerned about workplace safety and employee

wellness has increased dramatically because:

Many businesses provide health insurance coverage to employees

and are concerned when employee illness leads to higher medical

care costs.

The 1970s' "fitness craze" attracted many business leaders. They

saw that their health improved through wellness activities and they

wanted to make that level of health available to employees. Many

people also realized the importance of work as a source of

satisfaction and contributor to mental health.

The connection between workers' health and their job performance

became clear. Whether for a manager with many decisions to make

and many staff to supervise, or for a worker on an assembly line

health matters. Job performance is compromised when the worker is

struggling with health problemsmental, physical, socialat work

or off the job. A work experience that fits the worker leads to

personal health and higher productivity.

It is the law. Congress established the Occupational Safety and

Health Administration in 1970 to enforce laws and regulations

related to workplace safety and health. Workplaces are required to

provide safety equipment to workers, to post information about

workplace safety, and to provide education on specific practices.

Since OSHA was established, workplace fatalities have been cut in

half.

B. The Power of the Group

Full-time workers spend more than a third of their waking hours on the

job, so their workplace must be a good place to learn about and practice

positive health behaviors. The physical and social environments at work

are both important to health:

20

10 Enhancing Health in the Head Start Workplace
Module 1

The workplace can affect our health through:

lighting

air quality

safety of the doorways, stairs, and play areas

noise, violence, or natural beauty in the work area and

surrounding neighborhood

Co-workers can:

Be a great strength to others who are improving their health.

Establish norms and practices that are detrimental to health.

Support or hinder the day-to-day tasks on the job.

Staff members working together can improve their health by changing

their workplace, social, and physical environments, and by supporting

each other as they make changes for individual health or better work

practices.

Although major challengesmental illness, domestic violence, cancer,

drug abuse problemsto the health of team members cannot be

completely addressed by workplace intervention, each member's efforts to

handle such problems can be supported.

C. Unique Challenges of the Head Start Workplace

The Head Start workplace presents unique challenges to employee health.

It serves children, with all of the joys and frustrations that children bring

to a day. It also serves families with limited finances who may be stressed

in various ways. Since many staff members come from the communities

they serve and have experienced the stresses Head Start families face,

they may find special challenges in maintaining perspective and a

professional distance from the families they work with.

Early childhood education and child care is a demanding profession that

faces unique pressures:

There is little down time; children are always "on."

Emotions are engaged as fully as intellects.

Why Care About Health in the Workplace? 11
Module 1

Questions for Discussion/

Reflection

Society undervalues the efforts of early childhood professionals.

Child care providers are unrealistically expected to be even better

than the average parent, while caring for children in the absence of

their parents.

The time for adult communication and problem-solving is limited.

Staff may feel that they communicate better with children than with

adults.

Because of these special issues, it is critical that child care workplaces set

aside time for staff needs. And while it certainly is important when any

worker's job performance suffers, the average librarian can have an off

day and the books won't notice. Children are acutely aware of the

equilibrium of those around them and very vulnerable to the effects of ill

health on their caregivers.

If you have worked for many years, have you noticed a change in the

attitude of staff and managers toward workplace health?

Are there situations at your workplace that you believe enhance your

health? Are there situations that you believe compromise your

health?

22

12 Enhancing Health in the Head Start Workplace
Activity I:

Module 1

What's With the

Children Today?

Purpose: This activity demonstrates the strong interplay between staff

wellness and children's behavior, and recognizes the impressive work of

Head Start staff.

For this activity you will need:

Name tags

Flip chart paper and markers

Writing materials

Handout A: Scripts for Teachers

Step 1: Ask participants to form two groupsone group of three or four

and a group of eight to 12. First group is composed of staff,

second of children. Each group selects a recorder/observer. The

groups will be acting out a scene at a Head Start program on a

Monday morning.

Step 2: Staff group (smaller group): Each participant, except the

observer, receives a script from Handout A: Scripts for

Teachers. Option: staff could write their own scripts. Besides

individual challenges, the Head Start program is undergoing

significant expansion and must deal with lots of new families.

Step 3: Children's group (larger group): Each participant takes the role

of a child in the Head Start program. Tell the group: Each of you

write your name on the name tag and choose an age from six

months to five years. You represent the range of children in

Head Startthink for a moment about the child you are.

Step 4: Allow time for everyone to settle into their roles. Tell the

"children" to open the scene by approaching staff with all of

their normal needs on a Monday morning. The children may

have to exaggerate their behavior a bit to create the needed

effect.

Observers: Watch the interactions between the children and staff

and take notes.

23

Why Care About Health in the Workplace? 13
Module 1

Step 5: After five to 10 minutes, stop the group. Ask children: Are your

needs being met? Answer will likely be no. Ask participants to

continue for five more minutes, acting like children whose needs

are not being met.

Step 6: On a large sheet of flip chart paper, make four columns, two

labeled "staff' and two "children." Under the "staff' column,

write "do" and then "feel." Under the "children" column, write

"feel" and then "do."

Call the group together. Ask recorders to report on what they

saw.

For staff group recorder: What did staff do? What feelings

did you pick up?

For child group recorder: How did children feel? What did

they do?

Note responses on flip chart paper.

Step 7: Ask the groups:

Do you have anything to add to what the recorders/

observers presented?

How do staff cope with personal challenges in the face of

children's needs?

What personal health issues posed the biggest obstacle to

staff dealing well with the children?

How does this activity relate to your Head Start Center?

How can you be better prepared to deal with the constant

needs of the children in your care?

2

14 Enhancing Health in the Head Start Workplace
Module 1

Points to Consider: The challenge of facing a number of children with lots of needs is

great. We recognize the skills and commitment of all Head Start and

child care providers.

Children don't wait. Their needs are immediate. On the flip chart,

we have noted that with children feelings come first, then they act.

Children need adults to help them to cope with day-to-day needs.

They are not good at holding off their needs for a more convenient

time. If not responded to, their demands escalate.

Staff have learned to rise to the occasionthey often suppress their

feelings so that they can get the job done. They also may feel that

their own needs are not equally important"this child needs me

right now!" This is very helpful for the childrenand the

programin the short run.

However, there are long-term consequences in terms of staff

wellness. People who are under constant pressure without support

eventually lash out at others or develop stress-related illnesses.

25

Why Care About Health in the Workplace? 15
Module 1

Activity 2:

How Healthy Is

This Workplace?

Purpose: Managers get to consider the ways in which the Head Start

workplace supports and diminishes the health of employees.

Two management team members might want to do this coaching activity

together. It also could be used with less senior staff, with the manager as

the coach.

For this activity you will need:

Writing materials

Handout B: Healthy Workplace Survey

Step 1: Meet with the staff who will be part of this coaching situation.

Tell them about the overall concept of health in the workplace;

let them know they will be looking at the Head Start workplace

to identify positive and negative aspects of health in the

workplace.

Lead a discussion of the ways health can be affected at work.

Ask, What do you think of when you hear, "health in the

workplace?" And: Why should we look at our place of work and

its impact on our health?

Be sure to consider the physical environment, the type of work,

and the norms of the work group regarding health-related

behaviors such as smoking, exercise, or assertive

communication.

Step 2: Distribute Handout B: Healthy Workplace Survey. Tell the

participants they will be taking two to three hours over the next

week to survey the workplace and note all health-supporting and

health-diminishing factors. Tell them to look for both hard facts

and anecdotes. Discuss where to look for records, statistics, and

other information.

Step 3: After completing Handout B, participants discuss their findings.

Ask them to identify one thing they can do to make their

workplace more supportive of workers' health.

26

16 Enhancing Health in the Head Start Workplace
Module 1

Points To Consider:

Step 4: Ask whether a group of staff members would compare their

survey results, then present the findings to the Head Start

Advisory Council (HSAC), management team, or the Policy

Council.

Workplaces affect health in many wayssome are obvious, others

subtle. We have to look carefully for situations that affect health but

may not be obvious.

Sometimes it is easier to engineer a change in a person's workplace

than to change her behavior. For example, it is simpler to install a

handrail on a staircase than to convince people never to hurry down

the stairs. On the other hand, making large changes in the workplace

environment to increase safety can be very difficult. Think of the

health hazards in your workplacecan they be addressed most

effectively by personal change or by changing the physical setting?

27

Why Care About Health in the Workplace? 17
Module 1

Activity 3:

The World of

Workplace

Health

Promotion

Purpose: Participants learn of successful approaches at other companies

and apply them to the needs of the Head Start workplace.

For this activity you will need:

Handout C-1: Support Employee Health

Handout C-2: Reduce Health Care Costs

Handout C-3: Improve Employee Morale and Productivity

Handout C-4: Reduce Absenteeism

Four flip charts and markers

Step 1: Review for the group the general concepts of workplace health

promotion from the background information. Companies with

programs generally look for results in four areas:

Support employee health (reduce risk factors for long-term

chronic illness, promote health and encourage wellness,

reduce illness and injury).

Reduce health care costs.

Improve attitudes, morale, and productivity of employees.

Reduce absenteeism.

Step 2: Explain that this activity will hold four round-table discussions.

Volunteers will be asked to lead the discussion in each of the

four areas. The leaders will be given information about other

companies' successful programs.

The round-table participants' task will be to develop approaches

to the four areas that are most applicable to the Head Start

situation.

2E

18 Enhancing Health in the Head Start Workplace
Module 1

Step 3: Ask for four volunteers, one to lead each group:

Support employee health

Reduce health care costs

Improve attitudes/morale/productivity

Reduce absenteeism

Give each leader the handout relevant to his group's topic. Ask

each leader to take his position at one of four tables. At each

table place a flip chart on which to write plans.

Step 4: Allow everyone a moment to get up, stretch, and give the

leaders time to read their handouts. Then ask all of the

participants to join the round table of the topic that most

interests them. Ask the leaders to give a synopsis of the

programs described in their handouts.

Step 5: Give each group 20 to 30 minutes to discuss its particular topic.

Ask the members to talk about the following points and to be

prepared to report back to the full group about their discussion.

Post these questions on a sheet of paper visible to all:

What are the issues in Head Start around this general topic?

What have other employers tried?

What could our Head Start program try?

What are the barriers to our health promotion efforts?

How will we address those barriers?

What one health promotion activity do we plan to

introduce? Outline a plan to introduce this activity.

Step 6: Gather the groups together and ask each small group to report on

its suggestions.

29

Why Care About Health in the Workplace? 19
Module 1

Points to Consider: Health promotion activities can have wide-ranging benefits that

cross the various benefit groups.

While companies are very different, you can learn from the efforts

of others. Ask the group if anyone knows of any Head Start

programs that have successfully instituted workplace health

promotion activities.

Evaluation of worksite health promotion is difficult. Only a few

companies have conducted rigorous evaluations; others could

probably give anecdotal evidence of improvement in workers' health

and other benefits.

3D

20 Enhancing Health in the Head Start Workplace
Module 1

Next Steps:

Ideas to

Extend Practice

1. Based on information gathered in the activities, plan two things that

would improve health in your workplace. First, make a physical

change, something in the setup or layout of your center. Involve all

of the staff in the second change; for example, agree to help each

other to have a moment of respite when needed during a hectic day.

2. The new Smoke-Free Policy at Head Start centers is an excellent

example of a change in the workplace that promotes health. Review

Information Memorandum Log No. ACYF-IM-HS-95-19. Consider

the facts on smoking and health and the guidelines for the policy.

Choose several people to interview about this policy. Talk with

front-line staff, managers, parents, Policy Council members and

Head Start Advisory Council (HSAC) members. What is their

perspective on this policy? Is it working well? Have there been

problems? Prepare a report for the Policy Council, including

suggestions for changes to improve implementation.

3. The federal Occupational Safety and Health Administration (OSHA)

and state offices with similar responsibilities protect workers' safety

in various ways. What OSHA regulations are important in the child

care setting? (Suggestions: lifting limits, fall protection, infectious

disease control, computer workstation design.) Contact your local,

federal, or state OSHA office to arrange a visit to your Head Start

center to discuss health and safety issues with staff and interested

parents. OSHA offices offer free consultation to help workplaces

improve health and safety. See Resources.

4. With a group of managers or Policy Council members, assess the

cost to your program of a specific health problem. What health

problem is common among your staff? Following is an example of

one calculation:

Equitable Life Assurance estimated the cost of one person with a

chronic headache in 1978 at $3,394.50 per year':

a. Visits to employee health center

b. Time away from work

c. Work interference due to symptoms

d. Work interference affecting supervisors

e. Work interference affecting co-workers

f. Work interference affecting subordinates

473.14

56.61

2,206.95

72.80

542.88

42.12

1 J. Manuso, "Testimony to the President's Commission on Mental Health, Panel on

Costs and Financing," Report of the President's Commission on Mental Health,

(Washington, D.C.: U.S. Superintendent of Documents, 1978), vol. 2, appendix.

3L

Why Care About Health in the Workplace? 21
Module 1: Why Care About Health in the Workplace?

Handout A: Scripts for Teachers

Susan's Story

Susan, a Head Start family service worker/classroom aide, arrived at work this morning with a bad

cold. She has two children at home with the same symptoms. Her three-year-old was up most of

the night with a cough. Susan feels she should be home with her children, but she knows that the

other family service worker is attending a funeral today. Her mother is at Susan's house taking

care of the childrenSusan got up at 5 a.m. to bring her mother across town to her house.

Lei-Chun's Story

Lei-Chun is a young Head Start teacher's aide. She has lived in this country for only two years,

and finds the culture challenging but interesting. She wants to be as "American" as possible.

However, her parents find many things wrong with American culture and want Lei-Chun to

behave as a proper girl from her home country. Over the weekend, Lei-Chun argued fiercely with

her parents about her friends. Just last night, she told her parents that she is planning to move out

of the family home to live with her boyfriend, and that made them angry. Lei-Chun also worries

about the financial implications of setting up a household on two small salaries.

Matthew's Story

Matthew is the head teacher in this Head Start classroom. He enjoys his work and does his best to

prepare the children for their futures. He lives only three blocks from the Head Start Center, and is

very active in community activities. His neighbors recently gained control of some property that

has been neglected for yearsovergrown with weeds and a site for drug dealing and other

unsavory activity. This property is now going to become a community garden, but the neighbors

must work quickly to transform it, build fences, and be sure that no one trashes it. Matthew spent

all weekend putting up fences, digging holes, planting fruit trees, and supervising neighborhood

teenagers on the construction crew. His back is killing him!

32

Enhancing Health in the Head Start Workplace 23
Module 1: Why Care About Health in the Workplace?

Handout B: Healthy Workplace Survey

Instructions: Consider how your Head Start workplace affects health. First find who keeps various

types of information. The following questions are just a beginning, a springboard from which to launch

a closer look at your workplace, and really consider how health is supported or diminished there.

(1) Statistics on Injuries/lllnesses

a. What staff injuries occurred at your center in the last year?

b. Which injuries were the most common?

c. Which staff illnesses could have been caused through exposure at the workplace?

d. Which illnesses were the most common?

Other Notes on Injuries/Illnesses:

33

Enhancing Health in the Head Start Workplace 25
Module 1: Why Care About Health in the Workplace?

Handout B: Healthy Workplace Survey (continued)

(2) The Physical Environment

a. What is it like to walk around your center? Are the walkways clear?

b. Are the stairways safe (not too steep, slip-resistant)? Are there handrails?

c. Are items stacked so that they could fall on staff or others?

d. Are all the items that you need in your work within reach?

e. Is the play area outside clean, clear of debris, and shaded from the hot sun?

f. Are exit doorways clearly marked and easy to use?

g. Do the windows open to allow fresh air in the building, or does the air flow adequately

through an internal ventilation system?

h. How are the administrative workplaces set up? Enough light? VDT screens? Chairs that

support the lower back? Wrist rest-pads for typists?

Other Notes on the Physical Environment:

34

26 Enhancing Health in the Head Start Workplace
Module 1: Why Care About Health in the Workplace?

Handout B: Healthy Workplace Survey (continued)

(3) Office/Center Norms Related to Healthy Behaviors

a. What kind of snacks are served at staff meetings?

b. What beverages are available and usually consumed? Coffee, tea, juice, soda...

c. Is it easy to get a drink of water?

d. What is the staff's attitude about those who exercise during breaks?

e. Is there support for time to vent, relax, or get away from a trying situation?

Other Notes on Norms for Healthy Behavior:

35

Enhancing Health in the Head Start Workplace 27
Module 1: Why Care About Health in the Workplace?

Handout B: Healthy Workplace Survey (continued)

(4) Health Promotion Activities

a. Does your center promote any organized health activities? (Walking groups, healthy

eating clubs, support groups for weight management, smoking restrictions, etc.)

b. Are employees regularly screened for cholesterol level, blood pressure, various cancers,

or other health indicators?

Other Notes on Health Promotion Activities:

(5) Health Education Opportunities

a. Does your program have health education materials for employees?

b. Do you have speakers or discussion groups on health topics?

Other Notes on Health Education:

3 6'

28 Enhancing Health in the Head Start Workplace
Module 1: Why Care About Health in the Workplace?

Handout C-1: Support Employee Health 2 3 4

South Central Community Head Start began a special wellness program in 1988,

focusing on fitness, weight loss, and healthy eating. When the staff members started,

only six exercised regularly, yet the entire staff calculated that collectively they were

2,155 pounds overweight. After two years of the program, 90% of the staff members

were exercising at least three times per week and, with 100% of staff members participating in the wellness workshops, they had lost 375 pounds.

The Police Department in Northrhine-Westphalia, Germany, developed a stressmanagement program in 1983 to enable police officers to handle their daily duties more

effectively by reducing stress and improving communication. Some officers got extensive training, then trained others. After four years, they claimed a drastic reduction in

the use of guns (demonstrating improved coping skills) and fewer complaints by citizens

at police stations.

New England Telephone banned smoking in all work areas, offering free on-site stop-

. smoking classes. Twenty months later, the company surveyed employees and found that

21% of respondents who smoked at the time of the ban had quit, a much greater impact

than expected.

Rohm & Haas studied the relationship between participation in the company's physical

fitness program and employee fitness. The researchers found that employees in the

fitness program significantly improved in several health and fitness measures, including

blood pressure, weight, endurance, and overall fitness.

Baltimore County School District instituted a wellness program for staff, featuring

fitness rooms, health screenings, and walking teams. Teachers reported fewer colds and

being better able to deal with stress on the job. Blood pressure and breast cancer screenings resulted in early detection of life-threatening illnesses.

2 National Resource Center on Worksite Health Promotion, Promoting Health at Work,

(Washington, D.C.: 1992).

3 Stephen M. Weiss, Jonathan E. Fielding, and Andrew Baum, eds., Health at Work,

(Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1991).

4 NEA Today, "Wellness at Work." (February 1992).

Enhancing Health in the Head Start Workplace 37 29
Module 1: Why Care About Health in the Workplace?

Handout C-2: Reduce Health Care Costs 2 3 4

Northern Telecom's health program combined information, environmental change,

social support, and primary and secondary prevention services to motivate employees to

practice healthy behaviors and use the health care system wisely. The company analyzed

insurance claims data on diagnostic categories likely to be affected in the short run by

lifestyle change and found total costs dropped 5.8%. The program's return on investment was three to one.

AT&T instituted a comprehensive health promotion program called Total Life Concept

(TLC). Core components are: exercise, back care, weight management, smoking cessation, blood pressure control, cholesterol/nutrition monitoring, cancer screening/awareness, stress management, and interpersonal communications. The savings associated

with the 1,000 employees who quit smoking are an estimated $4,000 per employee per

year. These employees will visit a doctor less often, have fewer total sick days when

faced with a serious illness, and enjoy a heightened quality of life.

Control Data began StayWell in 1978. The program includes an awareness phase for

managers and employees; two health-risk assessmentsone for the organization and

one for individual employees; and a behavior change phase with instructor-led and selfstudy courses on fitness, smoking cessation, stress management, driving safety, nutrition, weight control, back care, and health care consumerism. The activities can be used

as a coordinated program or stand-alone.

The company hired an actuarial firm to study excess costs of bad health habits. They

divided employee health behavior into three risk categories. The excess claims of the

high-risk group over the low-risk group were 11% for weight, 114% for exercise, 118%

for smoking, 11% for hypertension, and 113% for seat-belt use. Looking more closely at

one risk: seriously overweight employees are 48% more likely to have claims exceeding

$5,000 during a one-year period than those at normal weight levels.

GE Aircraft Engines of Cincinnati, Ohio, compared medical costs for members of its

fitness center with a control group of nonmembers. They found that although members

experienced higher medical costs than the control group prior to joining, members'

medical costs were significantly lower 18 months later. The study concluded that the

fitness center helped control costs by increasing the speed with which members recover

from illness. GE Aircraft Engines estimated its annual savings at $540,000, plus productivity savings of 760 fewer days spent in the hospital per year.

Enhancing Health in the Head Start Workplace 31

3 a
Module 1: Why Care About Health in the Workplace?

Handout C-2: Reduce Health Care Costs (continued)

McDonnell Douglas Corporation restructured its Employee Assistance Program (EAP)

in 1995 to add more effective early intervention for employees with substance abuse or

mental health problems, greater involvement of supervisors, more intensive tracking of

employees during treatment, and long-term follow-up. A five-year cost-benefit study

revealed that the restructured EAP yielded a return on investment of four to one, a projected savings of $5.1 million over the next three to four years.

Coca-Cola targeted back injuries in its disease and disability prevention programs,

offering daily stretching activities and workshops on back care and exercise. Special

Nautilus machines to enhance back safety are available at 12 bottling sites. The fourminute daily stretching program alone saved the company $300 per employee per year

in employee replacement costs.

Levi Strauss & Company reduced the number of low birth weight babies among its

female employees through its Healthy Beginnings prenatal health program. A pregnant

employee responds to a questionnaire on medical history and lifestyle and, if found at

risk for delivering a low birth weight baby, she receives regular telephone calls from a

nurse to answer questions, remind her of doctor appointments, and remind her to follow

her doctor's advice. Employees not at risk can call the nurse with questions about pregnancy and childbirth. Research shows that every instance of low birth weight baby

averted by prenatal care saves $14,000 in health care costs.

Baltimore County School District instituted a wellness program for school staff that

offered fitness rooms, health screenings, and walking teams. The coordinator reported

that last year Baltimore County's insurance rate increase was the lowest in the state. The

wellness program definitely played a role. Blood pressure and breast cancer screenings

resulted in early detection of life-threatening illnesses.

2 National Resource Center on Worksite Health Promotion, Promoting Health at Work,

(Washington, D.C.: 1992).

3 Stephen M. Weiss, Jonathan E. Fielding, and Andrew Baum, eds., Health at Work,

(Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1991).

4 NEA Today, "Wellness at Work." (February 1992).

32 3 °cul

Enhancing Health in the Head Start Workplace
Module 1: Why Care About Health in the Workplace?

Handout C-3: Improve Employee Morale and Productivity 2 3 4

Tenneco started a comprehensive health promotion program with fitness as the most

important component. Strong white-collar employee participation in the on-site exercise

program correlated with above-average job performance. During a four-year period,

turnover was significantly higher among non-exercisers than among exercisers after

taking into account age, gender, general job category, and duration of employment.

AT&T's health promotion program is called Total Life Concept (TLC). Core components are: exercise, back care, weight management, smoking cessation, blood pressure

control, cholesterol/nutrition monitoring, cancer screening/awareness, stress management, and interpersonal communications. AT&T employees participating in TLC reported feeling more productive and energetic, and that the quality oftheir work life

improved as a result of the program. They also reported feeling more positive toward

AT&T, co-workers, and their supervisors.

Baptist Medical Center of Columbia, South Carolina, asked supervisors to rate employee performance and attitudes before and after participating in the center's Target

Life health promotion program. Work performance, satisfaction with work, absenteeism,

and behavior problems all had improved.

Southern California Edison (SCE) introduced its disease prevention program at the

same time it proposed the first changes in its health benefits plan in 37 years. The company attributes the success of labor negotiations over these changes in benefits to the

perception that the disease prevention components are beneficial to employees. The

Good Health Rebate and the Preventive Health Account programs emphasize to employees the connection between disease prevention and cost savings, and enhance SCE's

image as a company that promotes health.

Conoco employees reported in a survey that implementation of a health and fitness

center was a positive sign from management. More than three-quarters said that the

health and fitness center affected the work atmosphere positively.

41)

Enhancing Health in the Head Start Workplace 33
Module 1: Why Care About Health in the Workplace?

Handout C-3: Improve Employee Morale & Productivity (continued)

Holyoke/Chicopee Head Start began offering health and dental insurance coverage,

tuition reimbursement, and other perks to attract and nurture quality personnel. The

organization was named 1995 Nonprofit Employer of the Year by the Employers' Association of Western Massachusetts. Staff greatly appreciate the support offered to them in

their own health care and advancement of personal and professional goals.

2 National Resource Center on Worksite Health Promotion, Promoting Health at Work,

(Washington, D.C.: 1992).

3 Stephen M. Weiss, Jonathan E. Fielding, and Andrew Baum, eds., Health at Work,

(Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1991).

4 NEA Today, "Wellness at Work." (February 1992).

34 A Enhancing Health in the Head Start Workplace

14
Module 1: Why Care About Health in the Workplace?

Handout C-4: Reduce Absenteeism 2345

Control Data began StayWell in 1978, and has refined the program over time. StayWell

includes an awareness phase for managers and employees; two health-risk

assessmentsone for the organization and one for individual employees; and a behavior

change phase with instructor-led and self-study courses on fitness, smoking cessation,

stress management, driving safety, nutrition, weight control, back care, and health care

consumerism. The activities can be used as a coordinated program orstand-alone.

Control Data looked at health risks related to absenteeism in six areas: smoking, weight,

nutrition, exercise, stress, and seat belt use. Except for nutrition, high-risk individuals

were absent due to illness more than low-risk individuals. As the number of risk factors

of an employee rises, so does absenteeism.

Du Pont evaluated its workplace health program in a two-year study involving more

than 40,000 blue-collar employees. The company found that work sites with the

program reported a 14% decline in disability days, compared with a 5.8% decline at

non-program sites. By the end of the second year, the health promotion program

returned $2.05 for every $1 invested due to lower disability-related absenteeism.

The Travelers Insurance Company estimated it saved $3.40 for every $1 invested in

health in 1990. Travelers' program, Taking Care, includes information and programs for

lifestyle management and medical self-care, and a fitness center. A significant portion of

the savings resulted from reductions in program participants' absenteeism, which

declined an average of 1.2 days per participant.

Johnson & Johnson's program Live for Life includes: (1) a health screening that

includes questionnaire, health measurements, and counseling; (2) a communications

program that includes newsletters, health fairs, contests, posters, etc.; (3) a lifestyle

seminar to introduce employees to the program; and (4) a variety ofbehavior-changeoriented action programs on subjects such as how to stop smoking, control weight,

manage stress, reduce blood pressure, eat better, and keep fit.

Johnson & Johnson evaluated the impact of its employee health promotion program at

nine work sites over a three-year period. Mean levels of absenteeism among wage

earners who had access to the program declined over the study period and were

significantly lower than mean absenteeism levels among workers not exposed to the

program.

42

Enhancing Health in the Head Start Workplace 35
Module 1: Why Care About Health in the Workplace?

Handout C-4: Reduce Absenteeism (continued)

General Mills compared absenteeism rates of field sales employees who participated in

a voluntary, self-directed health promotion program with field employees who did not

participate. Before the program began, the absenteeism rate for both groups was the

same. With the program, the rate of absenteeism among participants dropped

significantly compared to the nonparticipants' rate.

Sisters of Providence Hospital set up a Wellness Challenge program to improve the

overall health of their workforce while reducing medical and workers' compensation

claims. Staff members could earn a $250 wellness bonus for meeting criteria in stress

management, injury prevention, on-site massage, cancer prevention, nutrition and

exercise education, weight management, smoking cessation, cholesterol education,

quarterly health screenings, wellness video library. Employees who reached the

established criteria were called "Wellness Winners." These employees used 1,224 hours

less sick leave from 1991 to 1992 and lowered health-care-use costs by $55,924 during

that same period.

Decker Family Development Center (DFDC) provides a nurse practitioner on-site who

handles most primary health care needs for the program's children. DFDC has also made

the nurse practitioner's services available to staff members for questions and assessment

of health issues for themselves and their children. This access to quality primary health

services has allowed staff members to reduce absenteeism because they can get concerns

addressed on-site rather than taking time off from work for medical appointments or

treatment for minor conditions. Conditions handled on-site include ear infections,

annual physical exams, ringworm infections, and TB tests.

2

3

4

5

National Resource Center on Worksite Health Promotion, Promoting Health at Work,

(Washington, D.C.: 1992).

Stephen M. Weiss, Jonathan E. Fielding, and Andrew Baum, eds., Health at Work,

(Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1991).

NEA Today, "Wellness at Work." (February 1992).

Office of Disease Prevention and Health Promotion, Health Promotion Goes To Work:

Programs With An Impact, (Washington, D.C.: U.S. Dept. of Health and Human

Services, 1993).

36 Enhancing Health in the Head Start Workplace
Module 2

What Does Wellness Mean for Our Staff Members?

Outcomes After completing this module, each participant will:

Have developed a personal definition of her own wellness, which

will frame her efforts toward personal change.

Identify those aspects of community and culture that she will use to

support wellness activities, and those aspects that must be changed

to improve her wellness.

Key Concepts A person's situation, family, and health history create the starting

point on the journey to wellness.

Primary health care includes services from health care providers and

all of the self-care activities that prevent illnesses and injuries.

Wellness is a continuously evolving principle for each person, and

represents a goal of health, which is "the best way it can be!"

What Does Wellness Mean for Our Staff Members? 37

44
Module 2

Background Information A. Health and Wellness Within Community

Each of us is born into a situation that affects our health. Our situation can

have positive features: loving parents, clean air, safe places to play. There

also can be negative aspects: a crowded housing situation, violent

neighbors, not enough money for food and clothes, a family history of

alcoholism or other disease.

As we consider ways to be healthier, it is important to understand how our

cultures and communities support our efforts to be healthy. Sometimes we

must work around situations that do not support us. Sometimes we can

identify certain people who help us to feel healthier. We also look for

places where we can do healthy things: eat nourishing foods, get exercise,

stop smoking.

We can work with others to improve the social and physical environments

of where we live, work, and play. It is most effective for individuals to

share their concerns and set common goals to achieve change.

B. Primary Health Care Services and Self-Care

Much money and attention are paid for dramatic surgeries and lifesaving

emergency medical actions. These are wonderful when needed. However,

we can keep ourselves from most illness and injury if we take advantage

of simple health services: screenings such as mammograms and

cholesterol checks, family planning, immunizations, and regular dental

cleanings. We can help prevent ill health and injuries by washing our

hands, taking time to relax, eating nutritious food that is low in fat, and

wearing car seat belts.

C. Wellness Is Health "The Best Way It Can Be!"

After we take care of the basics of our health, we realize what can be

changed in our situations and what cannot (at least for the moment!).

Then we work for the best health we can achieve. "Health" may be the

same for everyonewe all feel healthy when we don't have a cold or

other illness, we all need air to breathe that is low in pollutants, and we

all need enough food to give us energy to go onbut wellness is a very

individual concept. Whatever our age, or our physical or mental

capabilities, whatever our living situations, we decide for ourselves what

"wellness" means. It is important to know our own definition of wellness,

because that ideal picture is what gives us the motivation to make

whatever changes are necessary to improve our health.

45

38 Enhancing Health in the Head Start Workplace
Module 2

Questions for Discussion/

Reflection

How do you think your community is affecting your health?

positively?

negatively?

How do you keep yourself healthy?

When do you feel the "best you can be"?

What positive health belief or practice is common in your circle of

friends, family, culture?

4

What Does Wellness Mean for Our Staff Members? 39
Module 2

Activity I:

The Wellness

Continuum

Purpose: Participants will define "wellness" as the first step in making

plans for healthy behavior change. Two concepts are important:

Wellness is defined personally and differs for each person.

Wellness is a condition of well-being beyond the absence of disease

or pain.

For this activity you will need:

Handout D: What Is Wellness?

Writing materials

Step 1: Explain that we will be working on an overview of health, and

that describing a picture of our own health is the first step. Ask

the participants to get comfortable, close their eyes, and relax.

Take a few deep breaths.

Read aloud, at a relaxed pace, the following:

"Commend yourself for being part of this workshop. We are

trying to build a better health program for our Head Start Center,

and we know that health begins with us. The healthier we are,

the healthier our interactions with children and families can be.

"This is an imaginary journey through a day in your life. It can

be a day which has actually happened, or you can make up this

day as we go along. It is your dayno one will ask you to share

more about it than you want to.

"I would like you to imagine yourself waking up in the morning.

Where are you? Is anyone with you? What is it like in your

room, your space? This is a 'perfect day,' remember, so think

about how you wake up... Now imagine getting out of bed...

shower, breakfast, coffee... What do you think of doing this

morning?... Who is with you?... Where do you go? What is the

weather like?... It's around noon... Is it lunchtime?... Time to

go shopping or take a walk?... Alone or with others?... What do

you do?... How do you spend the afternoon?... What do you do

4?

40 Enhancing Health in the Head Start Workplace
Module 2

in the evening?... Imagine yourself going to bed... How do you

feel?... Are you very tired from lots of activity or are you full of

energy and willing to stay up late?

"Now take a few deep breaths and bring yourself back to the

room."

Step 2: Ask the group to think about their "perfect day" and make notes

on what made it "perfect." Was it time alone? Time with

friends? Lots of activity? A feeling of contentment because

someone else was taking care of details?

Ask the group if there are any difficultiesfor example,

someone whose "perfect day" is unattainable, which makes the

person unhappy. If that is the case, focus on the specific

"goodness" that the person valuessomething achievable. For

example, someone might visualize being the richest woman on

Earth and waking up in a palace. Try to discover the feeling that

she is seeking, and that it is probably, at least somewhat,

achievable through resources near at hand. Generally, it is quite

OK to dream!

Step 3: Distribute Handout D: What Is Wellness? Ask participants to

look at the arrow, noting that the middle of the line is "not sick."

Consider that their "perfect day" is probably their definition of

high-level wellness, indicated at the right hand side of the page.

Reinforce the idea that wellness is a very personal goal. Each

individual will be different.

Ask participants to think about how they feel day-to-day. Ask

them to mark an "X" on the continuum to indicate where their

day-to-day life falls. There are many reasons for the differences

between our "perfect day" and our everyday life. Some of these

are in our control, others are not.

Now in the first section underneath the arrow, ask them to:

Make notes regarding the features of your day that

contributed to wellness.

In the second section ask participants to:

Make notes indicating the forcespositive and negative

that contribute to your current state of wellness.

48

What Does Wellness Mean for Our Staff Members? 41
Module 2

Points to Consider:

Consider things that you do yourselfsuch as eat well and

readand forces that affect you within your community and

culture, including commitments that sap energy, a stream

running nearby that gives a peaceful feeling, a neighbor who

is difficult.

Step 4: Discuss the concepts of Illness, Midpoint, and Wellness and

emphasize the personal nature of the definitions, yet the ways

that people's common experience shapes our common

definitions.

Look at the arrow. Notice that there is a middle point labeled "not

sick." Our medical care system can get us to this level. The

screenings and well-care that our system offers are important to this

level. We need services and self-care (breast self-exam, brushing

and flossing teeth, food safety, clinical care for illnesses) to get us to

that level. Anyone with a mark lower than this midpoint probably

needs some medical care, self-care, or screening.

Beyond the midpoint, we move toward wellness. Imagining our

perfect day gives us a picture of our personal definition of wellness.

We all probably share some desires for wellness, but each of us has

individual needs and desires, too. In planning to improve our own

health, we must look at what we want. Items listed under "what I

could do to improve my wellness" are what each person is willing to

address. Items not listed are things the person probably is not ready

to change.

Do this activity at the beginning of staff wellness activitiesor as

an initial activity for the group that is planning the activities. Staff

should keep their own arrow throughout the activities. Consider how

each mark moves over time. We hope that it will move toward

wellness. Each person's definition of wellness will get modified as

he moves toward the goal.

This is a touchstone for people, what is real for them. Only if

wellness activities help people move toward their own concept of

wellness will they be interested in the activities.

49

42 Enhancing Health in the Head Start Workplace
Module 2

Activity 2:

Health Risk

Appraisal

Purpose: Participants get a clear picture of their health status, using

computer-generated data from a national sample of the same age and sex.

For this activity you will need:

One copy of Handout E: Personal Risk Analysis Questionnaire for

each participant

#2 pencils

Coach Preparation Note:

Many versions of the Health Risk Appraisal (HRA) are available. One example is included here. Costs of calculating an

HRA vary, but expect to pay about $15 per questionnaire for

processing. We recommend that you fill out the HRA to get

familiar with the instrument and arrange the activity for staff

members. Before meeting with your staff, find out what health

promotion programs and counseling are available in the community. Recruit health educators, nurses, or other medical

professionals or students in university health care programs to

act as HRA counselors. Your organization's insurance carrier

might have health education staff who can help.

Step 1: Present the Health Risk Appraisal (HRA) to your staff

participants. Be up-to-date on current recommendations for

cholesterol levels, adult exercise requirements, and weight/

height information.

Step 2: Give each participant a copy of Handout E: Personal Risk

Analysis Questionnaire. Tell them to look it over and to ask any

questions about the form. Explain that this form is confidential.

Make arrangements so that staff can turn in their forms

confident that other staff members won't look at them.

Step 3: Participants fill out their forms in private, and turn them in

without name attached. The forms are scored on-site or sent to

the central office for scoring.

What Does Wellness Mean for Our Staff Members? 43
Module 2

Points to Consider:

Step 4: Return scored forms to the participants without reviewing them,

since this is confidential information. See the following pages

for a sample of the "Personal Health Risk Report" that each staff

member will receive. Let them know that they now have four

options:

1. Make an appointment to go over the report with you, if they

wish you to offer health counseling. At this meeting, be

prepared to offer suggestions to support any changes the

staff person wishes to make. Have information about

community programs to help them stop smoking, lose

weight, get dietary counseling, receive screening, and begin

other healthy practices.

2. Pair up with a peer to review reports and discuss possible

health behavior change. These partners should be prepared

to offer each other ongoing support.

3. Meet with one of the community counselors to get an

interpretation of the report and plan behavior change.

4. Keep their information to themselves but use it for

encouragement in whatever self-change they choose.

Step 5: Meet with your management team, review the "Group Risk

Summary Report," which profiles the health status for the entire

employee group. Discuss how to address common health risks of

your group.

People will have varying responses to the HRA printout. Some will

get positive messages about their health behaviors and some may be

discouraged by the risks they see. Be prepared to support and

encourage. Everyone can make some changes that will improve

health and longevity.

Based on the HRA information, managers can decide which health

promotion activities their employees most need and desire. If some

behavior change is needed, but is not recognized by the employee(s),

the HRA sometimes can be the extra nudge that makes the risk real,

which leads to motivation to change.

5

44 Enhancing Health in the Head Start Workplace
Module 2

Personal Health Risk ReportSample Copy

Personal Health Risk Report

This is the only copy of your

personal and confidential

health risk report.

123123123 Female Age 34 October 27, 1995

There are some factors affecting your health that you can't change - like your sex and

age. Other factors are under your control. This report stresses those things that

YOU CAN DO to protect your health.

YOUR WELLNESS SCORE is 79

1 0

I V

10 20 30 40 50 60 70 80 90 100 . TOP SCORE

You could gain 21 WELLNESS POINTS

Based on your answers to the PRA Risk questionnaire, your Wellness Score is 79. By

making the recommended changes, you can increase your score to a maximum of 100 points.

GOOD HABITS TO IMPROVE YOUR RISK PROFILE: WELLNESS POINTS TO GAIN:

Low alcohol risk - Exercise 3 or more times a week 6 Safe driving speed - Lower blood pressure from 156/94 to under 138/88 5 + You don't use smokeless tobacco - Always wear your seat belts 5 You don't smoke - Improve your HDL level 2 - Lower cholesterol from 210 to under 200 1 - Get regular pap teats 1 - Reduce your weight (target range: 112 -124) 1

This chart tells how you rank on leading health risks for a woman of 34:

Top Risks for

Woman of 34: III Your risk now. all - With recommended changes. These changes would lower your risks:

Heart Attack

Breast Cancer

Motor Vehicle Crash

Stroke

Suicide

c Low Risk

1 1 1111115===1111111151

flifliWORMINE I

High Risk »

MINIEVEMENVION

Reduce blood pressure, Reduce cholesterol,

Increase HDL, Lose weight, Exercise 3+ times a

week. A low-fat diet and regular exams might reduce

risk. Wear seat belts.

Reduce blood pressure.

Get help from a health professional if needed.

1/4 Average Risk 1 1 L- Twice or Higher Average Risk

1/2 Average Risk J 1 L_ 1 1/2 Times Average Risk

About Average Risk

What Does Wellness Mean for Our Staff Members?

5 2 BEST COPY AVAILABLE 45
Module 2

Personal Health Risk ReportSample Copy (continued)

123123123 Female Age 34 Page 2

ROUTINE PREVENTIVE SERVICES FOR WOMEN YOUR AGE

Dental exam

Blood Pressure and Cholesterol test

Pap smear test Rectal exam

Rubella vaccine (if not already immune)

Tetanus-Diphtheria booster shot (every 10 years)

October 27, 1995

GENERAL RECOMMENDATIONS FOR EVERYONE

Exercise briskly for 15 - 30 minutes at

least three times a week Use good eating habits by choosing a

variety of foods that are low in fat and

cholesterol and high in fiber

Learn to recognize and handle stress - get

help if you need it

YOUR PERSONAL BASIC HEALTH MEASURES

Blood pressure: 156/94 ** indicates High Blood Pressure **

The ideal range is 138/88 or under

Cholesterol: 210 mg/d1 ** indicates High Cholesterol **

The ideal range is 200 or under

HDL: 38 mg /dl Ratio: 5.5

Diabetes: NO You reported that you don't have diabetes.

Weight: 158 lbs. Height: 5' 3" ** about 34% overweight **

The ideal range for SMALL frame is 112 - 124

*** MORE ABOUT YOUR PERSONAL RISKS... WITH SUGGESTIONS *** YOU'RE A NON-SMOKER:

By not smoking you have avoided THE number-one preventable cause of illness and death.

YOUR BLOOD PRESSURE - 156/94 - IS HIGH:

Hypertension (high blood pressure) is too serious a condition to be treated lightly.

Your blood pressure is higher than it should be. Be sure to monitor your blood

pressure regularly and follow your doctor's suggestions concerning medication,

exercise, diet, and weight control.

YOUR CHOLESTEROL - 210 - IS MODERATELY HIGH:

It is a good idea to know your level and try to keep it below 200. Limiting fat and

cholesterol in your diet, and exercising regularly are your best lines of defense. Get

your cholesterol level checked again in six months.

WEIGHT:

Your weight of 158 pounds is over the desirable maximum of 124 lbs for your height of

5' 3" and SMALL frame size. Reduce your weight to the desirable range (112 124 lbs)

with a program of sensible diet and exercise.

EXERCISE: LESS THAN ONCE/WEEK

Regular exercise will help you maintain your ideal weight and optimal health. Pick

activities you enjoy, and get going on a fitness program that will improve your health.

5 3

BEST COPY AVAILABLE.

46 Enhancing Health in the Head Start Workplace
Module 2

Personal Health Risk ReportSample Copy (continued)

123123123 Female Age 34 Page 3 October 27, 1995

PAP TEST:

It is in your best interest to have a periodic Pap Test. Remember, cervical cancer is

curable if found early. Don't delay in making an appointment.

MAMMOGRAM:

It is recommended that you get a baseline mammogram between the ages of 35 and 40.

BREAST EXAM:

You can take precautions against breast cancer. By practicing breast self-examination

every month, your chances of discovering a problem early (while it can be treated

effectively) are greatly increased. Additionally, you should get a clinical breast

exam by a doctor or a nurse every year.

A SPECIAL MESSAGE FOR WOMEN:

Because you are a woman, you are at risk for developing brittle bones (osteoporosis).

Your best defense is to eat a balanced diet with enough calcium, get regular exercise,

and don't smoke. Osteoporosis is a preventable disease.

Remember that early and frequent prenatal care is important for both mothers and

babies. If you become pregnant -- get medical care early, avoid tobacco and alcohol,

and eat a balanced, healthy diet.

OCCASIONAL SEAT BELT USE:

Each year automobile accidents kill and cripple tens of thousands of people. It is the

number-one cause of death for people under 40. By wearing seatbelts all the time you

will greatly decrease your chance of serious injury or death.

DIETARY FATS:

You reported that you eat foods like fatty meats and eggs every day. At any age,

eating a lot of food high in saturated fat is risky. It can lead to problems like

hardening of the arteries (arteriosclerosis) and obesity. You can help by eating less

fried foods, meat, cheese, and whole milk.

DIETARY FIBER:

You reported that you don't eat high-fiber foods on a daily basis. Eating high fiber

foods reduces your risk of certain cancers. Fiber should be part of any balanced diet.

Examples of high fiber foods include: whole grain cereals and breads, fruits, and some

vegetables like peas and beans.

YOUR ALCOHOL USE, 5 DRINKS PER WEEK, IS MODERATE:

By keeping your alcohol consumption at a moderate or low level, you help protect your

health, your family, and your career.

IF YOU ARE SEXUALLY ACTIVE:

You can prevent sexually transmitted diseases, including AIDS, as well as preventing

unwanted pregnancies, by safe sex practices such as the use of condoms. For more

information, contact your local health care provider. For specific information on

AIDS, call the national AIDS hotline at 1-800-342-AIDS (2437).

What Does Wellness Mean for Our Staff Members? 47

BEST COPY AVAILABLE
Module 2

Personal Health Risk ReportSample Copy (continued)

123123123 Female Age 34 Page 4 October 27, 1995

This Health Risk Appraisal is different from an examination by a doctor or other health

care provider. It can't diagnose illness or identify medical problems. It does identify areas of risk that you can improve by making lifestyle changes.

Build a plan of action, get help if you need it... and make changes gradually. If you

have lots of changes, it's best to tackle a few at a time. Whether it's a little

weight you want to lose, a cigarette habit that needs to go, or just remembering to

fasten your seat belt every time you drive, you CAN succeed. You'll feel

better and improve your odds for a long and healthier life if you do. Good Luck!

This sample report provided by Eris Survey Systems, Inc.

56

48 Enhancing Health in the Head Start Workplace
Module 2

Personal Health Risk ReportSample Copy (continued) O

1MTAIIIIIN

111111WEVIMMIIIMMIN o SURVEY SYSTEMS, INC.

Octfluc Q4a4kra Reia14/

The Personal Risk Analysis

Group Risk Summary Report

Data from Personal Risk Analysis surveys are combined to provide a Graphic Group Report

for your organization. The report reflects your company's unique risk concerns for identifying

preventable disease indicators. Employers can use the aggregate information from the Graphic

Group Report in setting organizational goals used to plan health promotion programs.

The risk factors included in this report are easily and visually depicted in graph form.

Basic to all reports are the following graphs: Health Risk Status of Your Group, Demographics

Age Groups by Sex, Risk Factors that Contribute to Preventable Deaths In Your Group, and

Preventable Deaths by Disease Category. The risk factors included were chosen because of

their clear, quantifiable contribution to death and disability.

For maximum results, identify high risk, high impact areas in your group,

then develop targeted health promotion programs.

Health Risk Status

of Your Group

This graph summarizes the overall risk profile for your

group. It identifies the number and percentage of your

group that are at "high risk" for early death from disease or

accidents. The graph also shows the size of the "low risk"

and "medium risk" groups.

Risk reduction programs save lives and money.

Example:

"Moderate Risk" refers to U.S. averages

not Ideals. On the average, too many

Americans smoke, don't get enough

exercise, eat too much fat, and are over- weight. People in the moderate risk

category could benefit from health promotion programs that move them to low

risk.

High Risk

220 (6%)

BYIIC Bid Itan If Yaw Crap

Low Risk

725 (21%)

56

Moderate Risk

2561 (73%) What Does Wellness Mean for Our Staff Members? 49

BEST COPY AVAILABLE,
Module 2

Personal Health Risk ReportSample Copy (continued)

Demographics

Age Groups by Sex

This graph breaks down your group by age

and sex subgroups. Although older people face

increasingly higher risks of death and disease, young

people are also affected by smoking, diet, and safety

practices.

Health promotion programs make sense

for people of both sexes and all ages.

IgnigriPics Age CMS by Su

Under 25 years

COUNT, 481

25-34

years

35-44 yearn

1217 933

45-54

years

55-64 year°

556 272

65 years

and over

47 Risk Factors that Contribute to Preventable

Deaths in Your Group

Risk factors are conditions that shape the odds for early death and disability. They include habits

such as smoking and lack of exercise, and clinical measures, such as blood pressure and cholesterol.

Nearly half of the 2.15 million deaths in the U.S. in 1990

Mit Falai e 1 halphis b Prrniedi Islam I YE Crup could have been prevented through behavioral changes. ROL

<1%. Smokeless Tobacco

<1% Pelvic Exams

ale

Menonograt: Weight

2% Speediv

Seat Belts

8%

Blood Pressure

10%

Smoking

30%

Alcohol

11% Cholesterol

13%

The graph shows how each of the risk factors measured

by the questionnaire contributes to preventable deaths

In your group. These estimates use an algorithm which

compares respondents' risk profiles with a national

database of people with similar risk profiles.

Preventable Deaths by Disease Category

This graph predicts the relative rank

of several major causes of deaths in your

group. Predictions are made based on the

likelihood of preventable deaths over

the next ten years.

Healthy behavior changes made

now will reap an even bigger benefit

in the years to come.

Premed* Deaths by Disease Category

All Other Causes

<1% Cirrhosis of the Liver

3% Other Cancers

5%

Lung Cancer/Pulmonary Olsen.

15%

Heart Attack and Stroke

58%

Accidents

19%

Note: Predictions are made

for only the next ten year

period. This underestimates

the total Impact of risk

factors for heart attack and

cancer for young people,

because damage can

accumulate for years and

only result in disease after

2430 years not just the

ten years reflected here.

50 Enhancing Health in the Head Start Workplace

BEST COPY AVAILABLE 57
Module 2

Activity 3:

Screenings Are

Not Just for Kids

Purpose: Managers will become familiar with the various screenings and

primary care activities for adults. They will consider ways to make these

services available to staff.

Trainer Preparation Note:

Before this workshop, find out what screening and self-care

options are available in your community. Review the Head

Start Program Performance Standards regarding screenings

for children. Some of your HSAC members can refer you to

adult screenings and well-body care. Contact local hospitals,

public health departments, health maintenance organizations,

and voluntary agencies for information on support groups,

educational materials, and other resources. You also can

review the training guide, Well-Child Health Care,

Screening, & Assessment, for background on screening.

For this activity you will need:

Handouts F: Screenings Are Not Just for KidsTables 1-4

Markers and flip chart

Blackboard or overhead projector

Step 1: Review Handouts F: Screenings Are Not Just for KidsTables

1-4. You could make overhead transparencies of these handouts

or copy the information onto a flip chart. Note the Head Start

Program Performance Standards' requirements for screenings

and well-child health care for children. Discuss with participants

the general concept of screening as an adult health service.

Step 2: Divide the participants into groups of four to five people each.

Distribute those who have the most formal education or

experience in health topics throughout the groups. Give each

group several copies of one of the four handouts. (Each group

will be looking at one set of screenings.)

What Does Wellness Mean for Our Staff Members? 58 51
Module 2

Step 3: Ask the groups to fill in the blank sections of Handout F. Tell

them they do not need all of the facts; we will complete the

chart together after their discussions. Ask them to make notes

about their understanding of the purpose and frequency of the

various screenings, and to make special note of how easy or

difficult it is to get these screenings done in their own

community.

Step 4: Allow the groups 10 to 15 minutes to work on the charts.

Step 5: With the entire group, briefly review the purpose and

recommended frequency for each screening or primary care item

(the first two columns on the chart).

Step 6: Again work in small groups. Ask each group to highlight one

screening they consider important for adults that is not practiced

regularly by their co-workers.

Step 7: Give each group a sheet of flip chart paper. At the top of the

sheet they should write the screening or primary care activity

that is needed but not getting done. Ask them to consider the

barriers and to brainstorm ways that it could be made more

accessible.

Step 8: Ask the groups to share the four strategies.

Points To Consider: Screenings are as important for adults as for children.

There are often barriers to access for adultsno insurance coverage,

not enough time, fear of results. Pay special attention to community

resources that improve access.

What has been your Head Start program's experience with insurance

coverage for well-care? What screenings are included? If any are not

included, why not? What are the barriers to full coverage for staff?

Can these barriers be overcome?

5

52 Enhancing Health in the Head Start Workplace
Module 2

Activity 4:

Culture,

Community,

and Health

Purpose: Participants will make a picture that shows how individual

wellness is woven into the context of community, and develop a

centerwide health perspective to see what could be done to improve the

community's health.

Coach Preparation Note:

If you choose to do this activity with a larger group of staff

people, follow the instructions as written through Step 6. Then

post the weavings around your workshop room. Ask staff members to do a "gallery walk" and review each others' weavings.

Then discuss:

What major aspects of community and culture were raised?

What supports wellness and what works against it?

Based on this information, what should we do to improve

our community so that it supports health better?

For this activity each participant will need:

Bright and bold writing materials

20 strips of 1"-by-8" colored paper (10 strips in each of two colors)

Wellness pinwheel made of construction paper, approximately

3"-by-3"see accompanying sample below

Glue or glue stick, scissors, hole puncher, and string

60

/71fironmero\

What Does Wellness Mean for Our Staff Members? 53
Module 2

Step 1: Explain that, over the course of a few weeks, participants will be

decorating the center with images of health supports and

challenges within the local community. Their "weavings" will

be the first, and they are asked to gather others from parents,

staff, and children.

Step 2: Ask participants to think about their own wellness and what

"wellness" means to them in each of the five dimensions of

health.

Step 3: Ask them to write their names on the pinwheel shape; this will

be the center of the weaving.

Step 4: Now ask them to consider the larger community: their

neighborhood, city, reservation, farmers' co-op, etc.

Consider how aspects of the larger community contribute to

their own wellness, positively and negatively. Using the first 10

strips (color "positive") write five to 10 supports for health and

wellness. Write the words at the edge or end of the strip of

paper. For example, positive notes could be:

My reservation is surrounded by beautiful mountains.

We have a great hospital and health department here.

We have great ethnic diversity with general harmony.

We have lots of dentists.

Step 5: Now take the "negative" colored strips and list up to 10 factors

that negatively affect health and wellness. Examples could be:

There is great poverty in our town.

Violence among youth has increased lately.

Our housing is very old and lead-based paint is a problem.

Step 6: Weave the strips together so that all of the colors show. When

you have a little mat, glue the shape with the person's name in

the center. Punch a hole at the top and run string through. Hang

the weaving somewhere in the center.

6

54 Enhancing Health in the Head Start Workplace
Module 2

Coach's note:

If you choose two colors and designate one negative and one

positive, all of your weavings will have some similarity, and it

will be easy to note what supports and what detracts from

health. You probably will find that people weave in different

shapes, even with the same materials, and this is good. You

could vary the colors by using one color pair for staff, one

color pair for adult family members, and another color pair for

the children's weavings.

Step 7: Over the next several days, choose some other people with

whom to work, doing the same activity, using two colors to

represent positive and negative impacts on wellness. Choose

fellow staff members, parents, or children. Either work with

them to make the weavings or simply talk with them, then make

the weavings yourself. Over time a pattern will emerge that

shows the pictures of wellness of those associated with this

Head Start program.

Step 8: Coach and partners should consider which major aspects of

community and culture were raisedthose that supported

wellness and those that worked against it. What common themes

do we see in the weavings of our colleagues and families? Based

on this information, what should we do to improve our

community so that it supports health better?

62

What Does Wellness Mean for Our Staff Members? 55
Module 2

Points to Consider: Wellness, like a weaving, is put together from many overlapping

strands. The strands can be seen distinctly but hold each other

together in a certain pattern. What happens when we remove one

strand? Does the weaving hold? Must something be put in that

strand's place? How does this demonstrate the ways that different

factors affect our lives and our wellness?

Wellness is both individual and affected by culture and community.

Positive and negative aspects of culture and community should be

considered in plans to increase individual wellness.

There is only so much anyone can do alone to increase wellness:

quit smoking, start walking, change diet. Beyond such activities

sometimes before such activities can be startedwe must work

together to be sure that we are around people and in places where

wellness can grow.

63

56 Enhancing Health in the Head Start Workplace
Module 2

Next Steps:

Ideas to

Extend Practice

1. Wellness is a concept that evolves over time. It is interesting to note

people's perceptions at different stages of life. With your own

definition of wellness in mind, take note of the behavior and

attitudes of four other people: two children and two elders. Try to

consider people you feel belong to the same culture as you. Watch

them and talk to them and consider what their definitions of

personal wellness might be. Anything they would like to change

about their situation or their health habits? Are there aspects of the

children's wellness that you remember from growing up? Can you

see yourself as an elderin what ways are you like and in what

ways unlike the older people you know?

2. Encourage all staff members to complete the Health Risk Appraisal.

Maybe your program's insurance carrier will sponsor the activity,

paying for the forms and processing and supplying expert

counseling. Give the health coordinator information about aggregate

health risks for the group. This can be an excellent springboard to a

staff meeting discussion regarding the general health risks for this

particular staff group. See if the staff would like to consider some

group efforts to change those risks.

Special Note: Confidentiality will be very important in

sponsoring this type of activity.

3. As a next step beyond the Screenings Are Not Just for Kids activity,

ask participants to further research any screening that interests them.

Ask them to call community resources for information about that

screening or service. Be sure to include information on insurance

coverage, free screenings, or other information related to financial

coverage for this screening. Head Start staff can collaborate, share

these resources, and begin a library or resource center for primary

care.

64

What Does Wellness Mean for Our Staff Members? 57
Module 2: What Does Wellness Mean for Our Staff Members?

Handout D: What Is Wellness?

Dis - ease Optimal Health

Pain/Suffering Energy/Vigor

Unhappiness Joy

Not Sick

What does "high level wellness" mean to me?

Why is my "X" placed where it is? What could make me more well? What helps me

to keep a good level of health right now?

65

58 Enhancing Health in the Head Start Workplace
Module 2: What Does Wellness Mean for Our Staff Members?

Handout E: Personal Risk Analysis Questionnaire

This questionnaire will ask you about your health and lifestyle habits. Your answers will be entered into a computer program. Your confidential personal

report will give you information about your major health risks, your healthy

habits, and habits you might change to reduce your risks.

This Health Risk Appraisal is NOT a substitute for a physical check-up; it can't

tell you if you're sick. It can give you ideas for healthy living and for minimizing

your risks of being sick or injured in the future. It is not designed for people who

have heart disease, cancer, kidney disease, or have other serious problems. If

you have one of these conditions and want to do a health risk appraisal, please

ask your doctor or nurse to go over the report with you.

Directions: To get the most accurate results, answer each question as well as

you can. If you don't know the answer to a question, leave it blank.

Partcipant ID Number:

(FILL IN THIS NUMBER IN BOXES AT RIGHT) Write your number here, then enter your number in the grid to the right. You

may need this number to pick up your report.

INSTRUCTIONS

Please use a No. 2 Pencil only to complete this survey. Make dark, black marks that fill the response

box completely. To change an answer, erase cleanly

then re-mark. CORRECT ?;R E41; PARTICIPANT ID NUMBER

A

v ql

t,

i, ii 'V,

m . 03

130 00

133 C33 00

GO 13:1 ES:1 CEO 010 00 1:10 00 130

. 00 13:1

. 1. AGE -in years

2. SEX - PLEASE MARK MALE OR FEMALE

3. Have you ever been told that you have diabetes (or sugar diabetes)?

4. Are you now taking medicine for high blood pressure?

5. How many cigars do you usually smoke per day?

6. How many pipes of tobacco do you usually smoke per day?

7. How many times per day do you usually use smokeless tobacco?

(Chewing tobacco, snuff, pouches, etc.)

8. DO YOU SMOKE CIGARETTES?

How would you describe your cigarette smoking habits?

9. IF YOU SMOKE NOW

How many cigarettes a day do you smoke? GO TO 11

10. IF YOU USED TO SMOKE

a. How many years has it been since you quit smoking?

b. In the 2 years before you quit, what was the average number of

cigarettes per day that you smoked?

For example, if your answer Is 5', enter '05°

11. In general, how satisfied are you with your life?

12. Considering your age, how would you describe your overall physical health?

Enhancing Health in the Head Start Workplace

MO 1. Age

al P7,1St 1,51

00

00

00

1.1 2. PI Male P Female 133 00

3. p Yes PI No rm

03:1 mg 4. 0 Yes 1:=1 No None 1 2 or More tio 5. I=1 I=1

ti 6. I=1 0 0 7. =I I=

8. 1= Never Smoked - GO TO QUESTION 11

O Used to Smoke - GO TO QUESTION 10

CI Still Smoke Now - GO TO QUESTION 9

9. 10a. Years inb. Clga atlas Ouf Before Quit

r th.1

OD 0:0 OZI 0=1

1:2:1 01C CO

010 40. 133 00

0E1 00

40 GO

&Er LEO Val GEO

111 00, cs0

im 11. p Mostly satisfied p Not satisfied

=I Partly satisfied

NI 12. = Excellent r= Fair NM =I Good r= Poor PAGE 1

6 6 Bur COPY AVAI1ABLE

59
Module 2: What Does Wellness Mean for Our Staff Members?

Handout E: Personal Risk Analysis Questionnaire (continued)

13a. Car/TruckNari 13b. Motorcycle ---.-1---77,

,

13. In the next 12 months, how many thousands of miles will you probably travel

by each of the following?

(NOTE: U.S. average for cars is 10,000 miles) ,000

OM CO get) GO r 1110 ED 1:1X1* OD :',, :' a. Car, truck, or van:

CM CO rim co , b. Motorcycle: I= CD 09:1 cm ' Ges 13:1 6114- GO ',' 029 OD 82b cm ',' azi ® ;to cm ®a-.1 ISO GO

0310 GO MO EU

Ilia OD 8)D3 CEO ,:. 14. 0 Walk 0 Mid or Full-size car 14. On a typical day, how do you USUALLY travel?

0 Bicycle 0 Truck or van (Mark one only)

0 Motorcycle 0 Bus, subway, or train

0 Sub-compact or CI Mostly stay home

compact car 15. 0 Never, 0% = NeertYAlwaYe 80-99% 15. What percent of time do you usually buckle your safety belt when driving or

0 Seldom, 1-39% 0 Always, 100% riding?

0 Sometimes, 40-79%

16. cm 75% to 100% p Less than 25% 16. If you ride a motorcycle or all-terrain vehicle (AN), what percent of the time

0 25% to 74% 0 Does not apply to me do you wear a helmet?

17. 0 Within 5 mph of limit 0 11-15 mph over limit 17. On the average, how close to the speed limit do you usually drive?

0 6-10 mph over limit 0 More than 15 mph over 18. Driinikpg 19. Alcohol 18. How many times in the last month did you drive or ride when the driver had Dr vino Dri nks perhaps too much alcohol to drink?

CO

OD 4:103 0:1 19. How many drinks of alcoholic beverages do you have in a typical week?

tsii OD Min CO A drink is a 12 oz. bottle or can of beer, a 5 oz. glass of wine, a 12 oz.

QM OD Ei53 CEI winecooler, or a shot of liquor.

[ice

GM

GO

CIEI Mt 020. GOon

tuo CO GO CIO For example, if your answer is "7", enter "07". =

MD

GO

DO

ain, Lam - GO If you don't drink, enter "00".

UM On, arci OD (MEN GO TO QUESTION 29)

20. 0

11 or under 12-13 14 or older

20.

WOMEN

At what age did you have your first menstrual period?

21. 0 0

No Under Children 20 0 0 0

20-24 25-29 Over 30 21. How old were you when your first child was born?

22. 0 Less than 1 year ago 0 3 or more years ago

0 1 year ago 0 Never

2 years ago

22. About how long has it been since your last breast x-ray (mammogram)?

23. 0 p None One

p p

2 or More Don't know

23. How many women in your natural family (mother and sisters only) have had

breast cancer?

60 Enhancing Health in the Head Start Workplace 6?
Module 2: What Does Wellness Mean for Our Staff Members?

Handout E: Personal Risk Analysis Questionnaire (continued)

24. Have you had a hysterectomy operation? (Removal of your uterus) = 24. I=1 Yes 0 No

25. When did you last have a pap smear? NI 25. 0 Less than 1 year ago = 3 or more years ago

= 0 1 year ago 0 Never

= 0 2 years ago

26. How often do you examine your breasts for lumps? 26. 0 Monthly 0 Rarely or never

INN 0 Once every few months

27. When did you last have your breasts examined by a physician or nurse? No 27. 0 Less than 1 year ago 0 3 or more years ago

O 1 year ago 0 Never

0 2 years ago

28. About how long has it been since you had a rectal exam? III 28. 0 Less than 1 year ago 0 3 or more years ago

= 0 1 year ago 0 Never

(WOMEN GO TO QUESTION 30) = 0 2 years ago

MEN

29. About how long has it been since you had a rectal or prostate exam?

= 29. 0 Less than 1 year ago 0 3 or more years ago

= 0 1 year ago = Never

= CI 2 years ago

30. How many times in the past year did you experience or witness emotional or

physical threats or abuse or become involved in a violent fight where there

was a good chance of a serious injury?

IN 30.0

so o

4 or more time CI 1 time or never

2 or 3 times 0 Not sure

31. In an average week, how many times do you engage in physical activity

(exercise or work which lasts at least 20 minutes without stopping and which

is hard enough to make you breathe more heavily and your heart beat faster)?

NM 31. 0o = o

Less than 1 time per week

1 or 2 times per week

At least 3 times per week

32. Do you eat some food every day that is high In fiber, such as whole grain bread, cereal,

fresh fruits or vegetables?

32.0 Yes 0 No

33. Do you eat foods every day that are high in choloesterol or fat, such as fatty meat,

cheese, fried foods or eggs?

En 33. I= Yes 0 No

34. Have you suffered a personal loss or misfortune in the past year that had a

serious impact on your life? (For example, a job loss, disability, separation,

jail term or the death of someone close to you.)

= 34.0 Yes, 1 serious loss or misfortune

EN o Yes, 2 or more 0 No

35. Race No 35. p = 0 m 0 = 0

Aleutian, Alaska native, Eskimo or American Indian

Asian 0 White

Black Cl Other

Pacific Islander P Don't know

36. Are you of Hispanic origin such as Mexican-American, Puerto Rican or Cuban? NE 36.0 Yes 0 No

37. What is the highest grade you completed in school? NI 37. 0 = 0 m 0 = 0

Grade school or less CI Some college

Some high school 0 College graduate

High school graduate

Post graduate or professional degree

Enhancing Health in the Head Start Workplace 61

6 3
Module 2: What Does Wellness Mean for Our Staff Members?

Handout E: Personal Risk Analysis Questionnaire (continued)

. O Health professional

CI Manager, educator, professional

O Technical, sales or administrative support

0 Operator, fabricator, laborer

I=1 Student = Homemaker = Sided ads

O Retired 0 Service I=1 Unemployed

1=1 Other

MEN AND WOMEN CONTINUED

38. What Is your Job or occupation?

(Mark only one)

39. = Yes 0 No 39. Do you presently have a personal physician?

I= No, but would like physician referral information

a. Stroke 0 Yes 0 No

b. Diabetes = Yes = No

c. Cancer I=1 Yes = No

d. Heart Disease 0 Yes = No

e. High Blood Pressure = Yes cl No

f. High Cholesterol = Yes CI No

40. Has a natural brother, sister, child or parent had any of these?

(Mark yes or no on EACH line)

/ \

STOP \ / Clinical Measures

This section to be completed by clinical staff

41. Height 43. Body Fat Fee Inches Pounds Percent

CO

EX3 00

00

CD

IMO CO 1103 CEO ISO MO 120 arm

OM CO 1ED OM 0 OM 0E0 CO LED 13933 CO CEO 'CO DM

CO DIE CM CO CEO M 0E33

00 (Eitl CEO M GEO GO 003

E303 EMI OCI 0333 00 CEO 00 MI MO

CO LED ELI CEI = Small 130 OD 1M MB 1= Medium

CIE M ECM O Large

44. Frame

45. Total Chol MOD 038 CID

13310 C11311

46. HDL Choi.

113111

47. Blood Sugar

CE0

IMO

X48. Blood Pressu e Wort NONo) Diastofic sow No.) Blood Pressure / Rarlile ME IMO 00 1E3 1333 M l=

LED EID3 0 038 OM CC High MD MEI CO MD GM CM

MD GM En CEO CO 0

GEO OD G1133 CAZ1 Low or

03113 00 Ego r:53 Normal C313 00 0E3 CIO MO CC1 0133 CO I=1

03110 M ®0E1 Don't 13033 OD m353 on Know

.

49. Flex

Inches

41. Height - (without shoes) 42. Weight - (without clothes)

43. Percent body fat

44. What Is your body frame size?

45. TOTAL cholesterol level?

48. HDL cholesterol?

47. Blood sugar (glucose) level?

48. Blood pressure today?

If you don't know the numbers,

mark one of the BP Range boxes.

49. Bads flexibility to Inches?

LP 2381

62 Enhancing Health in the Head Start Workplace

BEST COPY AVAILABLE
Module 2: What Does Wellness Mean for Our Staff Members?

Handout F-1: Screenings Are Not Just for KidsTable 1

Screenings

....i.,,..r

What Is It?

What Is It For?

a

How Often Do

We Need It?

How Easy Is It

To Do/Receive?

Personal or

Community

Barriers/Other

Comments

Hemoglobin/

Hematocrit

Tuberculosis

Blood Pressure

Sexually

Transmitted

Diseases

70

Enhancing Health in the Head Start Workplace 63
Module 2: What Does Wellness Mean for Our Staff Members?

Handout F-2: Screenings Are Not Just for KidsTable 2

How Often Do

We Need It?

How Easy Is It

To Do/Receive? Screenings What Is It?

What Is It For?

Personal or

Community

Barriers/Other

Comments

Immunizations

--I

Colon Cancer

(hemocult &

sigmoidoscopy)

Self-Testicular

Exam (for men)

Self-Breast

Exam

(for women)

Cholesterol

64 Enhancing Health in the Head Start Workplace
Module 2: What Does Wellness Mean for Our Staff Members?

Handout F-3: Screenings Are Not Just for KidsTable 3

Screenings

What Is It?

What Is It For?

How Often Do

We Need It?

How Easy Is It

To Do/Receive?

Personal or

Community

Barriers/Other

Comments

Dental Exam

Physical Exam

height

weight

overall

well-being

Eye Exam

glaucoma

vision

Pap Smear/

Pelvic Exam

(for women)

7-7

Enhancing Health in the Head Start Workplace 65
Module 2: What Does Wellness Mean for Our StaffMembers?

Handout F-4: Screenings Are Not Just for KidsTable 4

' Screenings What Is It?

What Is It For?

How Often Do

We Need It?

How Easy Is It

To Do/Receive?

Personal or

Community

Barriers/Other

Comments

Diabetes

(blood sugar)

Intestinal

Parasites

Skin Cancer

Mammogram

(for women)

73

66 Enhancing Health in the Head Start Workplace
Making Changes in Behavior for Better Health

Module 3

Outcomes After completing this module, participants will:

Key Concepts

III

Understand the principles of behavior change.

Develop a plan for improving personal health.

Practice strategies to support co- workers' efforts to change their

behavior.

Habitshealthy and unhealthyare acquired over time. We keep

them because they work for us in some way; therefore, change is

challengingbut possible.

A person goes through several different stages when trying to change.

To provide support, a friend or co-worker must first know how the

person feels about making the change. What stage is he in? Once the

current stage is identified, the helper uses different strategies during

the different stages of change. Stages are:

precontemplation

contemplation

preparation

action

maintenance

74

Making Changes in Behavior for Better Health 67
Module 3

Background Information A. Habits

We all have learned to cope with life's many demands in a variety of

ways. We learn how to get the food we need, the love we need, and we

learn to get around from place to place to get our business done. Some

things we do to manage our lives are healthy: communicate clearly with

others, feed ourselves wholesome food, ride our bicycles to the store or

park. These things work for us.

Some of the ways we cope are not so healthy, but in some way these work

for us too. We find that a few drinks of beer calm us down after a hectic

day, smoking a cigarette keeps us away from sweets. We learn that being

harsh with children keeps them quiet, at least for a time. These are

unhealthy behaviors. Over the long haul, they are detrimental to us and the

people around us. We would be better off if we changed these patterns.

But are we ready?

B. Stages of Change

At some point, most people decide to change some problem behavior. Or,

they are pushed toward change by loved ones, co-workers, or policies.

Some people succeed in changing, some don't. Some succeed after many

tries. Is there any logic to the change process? Researchers believe there

is. Instead of jumping into the change, going through several stepsin

sequenceincreases the chance of success. Different strategies at

different times help move the change process along.

"Stages of Change" theory outlines five stages that a person must go

through when altering behavior. The following descriptions of each stage

include helpful strategies.

Precontemplation: People in this stage are not yet ready to change. They

are not concerned about their problems, though others might be. During

this stage, the following strategies are helpful:

consciousness raising: The person is given as much information

about the problem as she will accept.

social liberation: Establishing social groups and situations that

support the healthy behavior and discourage the unhealthy.

helping relationships: Having people who support the person's

change, but are not aggressive and pushy, is helpful at this stage and

throughout the change process.

75

68 Enhancing Health in the Head Start Workplace
Module 3

Contemplation: People in this stage are aware of their problem and want

to change, but believe they will change "someday." Helpful strategies

during this stage are:

emotional arousal: Becoming disgusted with the behavior or fearful

about the condition of her life helps a person who is contemplating

change to move forward.

self-re-evaluation: Becoming thoughtful about the change, what the

change might mean to the person's life, assessing the pros and cons,

and making a decision.

Preparation: At this stage, the person begins making concrete plans to

change. Helpful strategies at this stage include:

commitment: The person makes an announcement about the change,

sets a date, plans several small steps toward the change, makes a

comprehensive plan of action and considers possible pitfalls.

self-re-evaluation

Action: This is the most active stage of change. Most health promotion

and behavior change programs fall within this area. These programs teach

a variety of strategies, including:

countering: Substituting a healthy behavior for an unhealthy one, or

replacing negative, self-defeating thoughts with positive ones.

Exercise, relaxation, and assertiveness are important activities in

this process.

environmental control: The person takes specific steps to avoid

places, people, and situations that encourage the negative behavior-

-and to be in places and with people who support positive behavior.

rewards: To reinforce the behavior change, it is most helpful to set

up a system of rewardssmall rewards for small steps and larger

rewards for bigger achievements in change. Behavior-change

contracts are very effective.

Maintenance: The change has occurred and during this stage the person

is working to avoid a relapse. Helpful strategies during this stage are:

countering

environmental control

rewards 76

Making Changes in Behavior for Better Health 69
Module 3

At what point is it clear that a person has changed? The sixth stage is

beyond change:

Termination: At this point the person no longer is interested in the

negative behavior and has no desire for it, even in situations where the

behavior used to be common. She has truly given it up and become

thoroughly committed to a healthy behavior. She feels confident of being

able to continue the healthy behaviors, having incorporated them into her

lifestyle.

It is important to realize that, with most behavior changes, people do not

go through the stages of change in a linear fashion and come out

presto!changed!on the other end. Rather, the process of change is

like a spiral, with people moving up the spiral toward action and

maintenance, but relapsing and returning to earlier stages once ormore

throughout the change process. When someone is moving successfully

toward change, however, she usually does not relapse all the way back to

precontemplation. There will be a setback to contemplation and

preparation, then movement ahead again. Those in maintenance may have

a setback, then set up another plan of action.

C. How the Head Start Workplace Can Help Staff Make Healthy

Changes

The workplace is where healthy behaviors can be supported or threatened.

When people decide to change, they need the support of all who are close

to themfamily and friends of course, and co-workers. By understanding

when a person is ready for change a co-worker can offer the needed

support.

It is important to realize that, at any given time, people who share the

same negative health behavior most likely will be at different stages in

their willingness to change. It is very easy for those of us who are

enthusiastic about health promotion to try to push people into change

before they are ready. We offer them action-oriented programs when they

are not interested. For example, stop-smoking programs are active. The

prospective quitter must take time to attend meetings, organize his life to

make cigarettes less available, designate areas or times for smoking. He

must try to avoid smoking at times he is usually smoking, and substitute

other behaviors for smoking.

However, recent research indicates that, among current smokers, only

10%45% are ready for action; 30%-40% are contemplating quitting

7?

70 Enhancing Health in the Head Start Workplace
Module 3

smoking, and 50%-60% are in the precontemplation stagethey have no

interest in changing their behavior now6.

Any health coordinator or manager must assess an individual's or group's

readiness for change before beginning any behavior change activities.

Upon assessment, strategies can be matched to the stage.

There are two strategies helpful to anyone in any stage of change. Social

liberation involves techniques of altering the person's environment and

social circle to discourage undesirable behaviors and encourage positive

behaviors. Helping relationships offer support for any movement toward

change.

D. What Do We Do About People Who Are Not Ready to Change?

A manager or supervisor often is aware that an employee's behavior or

habit is a problem; it affects more than the individual and is detrimental to

the workplace. However, the staff person doesn't want to change and

won't join a health promotion program. Does the manager ignore the

problem? Definitely not, though this is certainly a touchy situation. For

the good of the workplace, the supervisor must try to encourage change.

Clear understanding of the staff person's perspectivereadiness to

changeis critical. The staff member may not be good-humored about

trying to change. One administrator recalled a cigarette smoker who got

hostile when anyone suggested she stop smoking, considering it a form of

harassment. The supervisor in such a situation should not give up. Rather

apply, very carefully, the appropriate strategies for a person in the

precontemplation stage of change.

Questions for Discussion/ Think of a recent change. Which steps (stages) did you go through

Reflection to make the change?

As a supervisor, how do you feel about intervening in your staff

members' health issues? When is it justified? When is it not

justified?

6

James Prochaska, Carlo DiClemente, and John Norcross, "In Search of How People

Change," American Psychologist, (September 1992).

Making Changes in Behavior for Better Health 78 71
Module 3

Activity 1:

Affirming My

Capabilities

Purpose: Participants are encouraged to see themselves as capable of

change, based on their own experiences.

For this workshop you will need:

Flip chart paper

Markers

Step 1: Ask participants to recall a time when they needed to make a

change, any kind of change, that they are willing to discuss.

Step 2: Ask each person to choose a partner, introduce himself, and

describe a change he needed to make. He tells the partner what

was hard about making the change and what helped him to get

through it. Tell how he succeeded. Give the pairs approximately

five minutes to talk.

Step 3: Ask the participants to switch roles. This time the other partner

should describe a change she has made.

Step 4: Ask the partners to introduce each other by simply stating their

name and the successful change made. Be sure to encourage

applause for the changes! Affirm the fact that they all have made

changes in their lives.

Step 5: On the flip chart paper, draw the following chart:

Things that Helped

1 Barriers

79

72 Enhancing Health in the Head Start Workplace
Module 3

Step 6: Ask the group to share anything that was helpful in making the

change.

Step 7: Ask the group to share whatever was not helpful in making the

change. As the various ideas are shared, list them on the chart.

Step 8: Look for commonalities among what helped and what hindered,

though the changes that were made differed.

Step 9: Let the participants know that, based on their experiences, they

are both well qualified for making changes themselves and well

qualified to help and support others to make changes.

Points to Consider: There are innumerable changes possible to improve our health.

Although they differ, there are commonalities.

The "things that helped" on the chart are examples of various

strategies that help the change process. The "barriers" are either

basically unhelpful actions or helpful strategies applied in the wrong

way and/or at the wrong time.

80

Making Changes in Behavior for Better Health 73
Module 3

Activity 2:

Batting Practice

for Our Team

Part I

Purpose: This activity demonstrates the stages of change, shows that

different staff members will be in different stages at any one time, and

builds skills in helping co-workers change.

Trainer Preparation Note:

This is a two-part activity. The first part is strictly a for-fun,

nonthreatening illustration of the stages of change. Part two

asks the participants to place themselves at their appropriate

stages with a real-life change (low fat diet). It is a fairly complex activity, so take it slowly and allow people lots of time to

process the information.

For Parts I & II of this activity you will need:

At least 10 people

Five stages-of-change signs to post

Flip chart paper

Markers

Handout G: Batting Practice

Handout H-1: Limiting Fat to 30% of Daily Calories

Handout H-2: Limiting Fat to 30% of Daily CaloriesSample

Menus

Handout I: Strategies to Help Change

Step 1: Review briefly the "Stages of Change" description in

Background Information. But do not give a detailed lecture, as

this activity is designed to elicit an understanding of the stages

from the group. Tell them to pretend that they are a baseball

team that has been losing a lot lately and the manager believes

it's because the team is not hitting well. She says that they need

more batting practice. She has called a team meeting to

announce her plan to cancel the daily team meetings at which

they review their games. Instead, they will practice batting.

74 Enhancing Health in the Head Start Workplace

81
Module 3

Step 2: Divide the participants into five groups. Tell them that each

group is at a different stage in this process of change toward

more batting practice.

Step 3: Distribute Handout G: Batting Practice to the groups. Tell them

you have given them some ideas about how their group thinks,

but their task is to add to those ideas. They will be asked, after

about 10 minutes, to present their position on this topic

increased batting practiceto the whole team.

Step 4: Give the groups five to 10 minutes to develop their positions.

Step 5: Now ask each group to present its position on the proposed

change.

Step 6: On flip chart paper, list the groups by letter: A, B, C, D, E.

Make notes on their positions.

Group Position on

Batting Practice

Stage.of

Change

A

B

C

D

E

Step 7: After the groups have given their positions, return to the

concepts of stages of change, and fill in the third column. The

groups will fall out as:

A = precontemplation

B = contemplation

C = preparation

D = action

E = maintenance

Making Changes in Behavior for Better Health

82

75
Module 3

Points to Consider:

Look at the examples they have given to demonstrate their

positions on batting practice. Highlight the points that best

illustrate that stage of change.

Step 8: Review for the group the basics concepts:

Change occurs in stages.

Helping: Use different strategies for different stages.

The team "manager" is like many well-meaning health promotion

managers. She has decided what the problem iswith some good

evidenceand decides to jump straight into the action stage.

However, not all members of her team are with her.

Note that various strategies help people move from one stage of

change to the next. Using the wrong strategy generally results in no

change. This manager tried "countering"substituting one behavior

(batting practice) for another (team meetings to review games). Her

strategy is only effective with group Cthe group in action stage.

This team had more people interested in change than is typical. With

health behavior changes, it is more likely that large numbers of

people will not be interested in action.

83

76 Enhancing Health in the Head Start Workplace
Module 3

Activity 2:

Batting Practice

for Our Team

Part II

Purpose: This activity demonstrates the stages of change, shows that

different staff members will be in different stages at any one time, and

builds skills in helping co-workers change.

Step 1: Remind the group that there are various strategies to help people

move along the stages of change, including support when they

are in maintenance. In workplace health promotion, it is useful

to have the group agree that an issue needs to be addressed.

However, it will take different strategies to reach different

people.

Review for the group, from Background Information, the details

on the strategies that are effective at various stages of change.

Step 2: Tell the group we now will look at an area that is very popular

in health promotion circles: the low-fat diet. Current

recommendations are that the American diet should be reduced

to less than 30% fat, a significant change for most people.

Step 3: Give out Handouts H-1 and H-2: Limiting Fat to 30% of Daily

Calories, which describes a diet with under 30% of fat calories.

Ask people to consider this carefully. Post the stages-of-change

signs.

After about five minutes, ask if people are willing to stand

beneath the sign that representsat this timetheir own

readiness to change to an under-30% fat diet.

Step 4: Ask whether anyone is willing to explain why he is in a

particular stage. Verify that members of each group are correctly

identifying their stage. Confirm examples of beliefs, feelings

and actions that are characteristic of each stage as they are

brought up.

Step 5: Explain that a helper in behavioral change presents strategies

that will move the person from his current stage into the next.

Just one step...not all the way to the end! So our goal, for

example, is to move the Precontemplators into the

contemplation stage.

Be prepared with one strategy (see Background Information)

that is recommended for encouraging people in each stage of

change. For example, precontemplators may be reached through

consciousness-raising.

84

Making Changes in Behavior for Better Health 77
Module 3

Refer to Handout I: Strategies to Help Change. You may wish to

post this chart or a portion of it to stimulate discussion.

Step 6: Ask your participants to sit in groups composed of those who

stood under the same sign. Tell them they will be helpers for the

group that is lower on the change scale than their own group.

They will be brainstorming activities that are examples of a

strategy that is useful for this group. These activities will likely

be familiar to them, because they will have gone through this

stage to get to their current place.

Step 7: Cut Handout I: Strategies to Help Change into five pieces. Give

each group a piece, based on the chart below:

Group B (Contemplators) gets Group A Strategies

(Precontemplators).

Group C gets Group B strategies.

Group D gets Group C strategies.

Group E gets Group D strategies.

Group A (Precontemplators) gets Group E Strategies

(Maintenance). The trainer will probably need to give the

most support to this group, as they are working on an

unfamiliar level.

Trainer's note:

Within any strategy are many activities that can be undertaken

(review Background Information). Ask the group to brainstorm

ways that co-workers might use this strategy to encourage

group members along the road toward change.

Step 8: Give the groups 10 to 15 minutes to come up with their ideas.

Ask each group to share a few of the activities with the entire

group. As each group presents its helping strategies, ask the

members of the group that is being helped to respond: Could this

work? Would it interest them? What modifications to the

activities might make them more effective?

85

78 Enhancing Health in the Head Start Workplace
Module 3

Points to Consider: Dietary changes are usually significant. People tend to like the way

they eat. It is perfectly understandable that in this area most people

will be Precontemplators. Probably in your group people will be

standing all along the continuum.

Did you come up with four or five activities within your strategy to

encourage change? Be creative!

8

Making Changes in Behavior for Better Health 79
Module 3

Activity 3:

Toward a Better

Back

Purpose: Managers will learn to apply the principles of behavior change

to a common physical ailment, back pain, and demonstrate the

contemplation and preparation stages of change.

For this activity you will need:

Handout J: The Basic Back

Flip chart paper

Markers

Step 1: Ask how many participants have ever been concerned about

possible damage to their back through working with young

children. (If all share this concern, that's good. All are at least in

the contemplation stage of change.)

Step 2: Share some Back Facts? :

About 80% of adult Americans experience serious back pain

at some time.

Why?

The back is involved in almost every move we make.

Backs are wonderfully flexible and strong, but that

combination makes them vulnerable to injury.

Being erect puts extra pressure on lower back vertebrae, the

lumbar region where the back is most curved and pain most

often strikes.

Sometime from age 30 to 50, your discsthe fibrous pads

that cushion the vertebraestart to lose water and elasticity,

making them less able to absorb shock.

87

80 Enhancing Health in the Head Start Workplace
Module 3

To prevent back injuries:

Build strong, flexible muscles to support the back and

internal organs.

Learn to move in ways that protect the back's natural

curves.

Step 3: Distribute Handout J: The Basic Back. Ask the participants to

look at the drawing of the spine and to note the four basic

curves. Ask them to gently move those parts of their own backs

to become aware of those parts. Suggest, for example, that they

feel their backs as they stand, sit, and bend gently from one side

to the other.

Step 4: Tell the participants to consider various activities that Head

Start staff members perform each day. We want them to think

carefully about how they perform each action, paying special

attention to their backs.

Read slowly from the following list, pausing after each activity

to allow people to visualize their actions. After they visualize an

action, ask the members to raise their hands if they see possible

back injury in that activity.

Teaching/Classroom Staff

getting set up in the morning

greeting children

greeting parents

settling into a circle for story time

refereeing a dispute between two three-year-olds

changing an infant's diaper

setting up lunch

eating lunch

helping children during outdoor play

lifting a child with weak legs to the play table

cleaning up after snack

Making Changes in Behavior for Better Health 81

8 3
Module 3

Administrative Staff

writing reports

making a presentation to the Policy Council

talking on the phone to an angry parent

negotiating for health services from a local agency

Family Services and Program Support Staff

driving the bus

preparing meals

driving to home visits with families

setting up for a parent education program

Step 5: For each activity for which hands were raised, note that activity

on the flip chart. Comment on the large number of activities that

have the potential to cause back pain or injury.

Step 6: Ask everyone to choose one activity that gave them a

"twinge"an activity they recognized as having caused back

pain in the past. Ask them to note that activity on the top of

Handout J.

Step 7: Ask each participant how she performs this activity now. They

should look at the drawing of the spine and contemplate how

this activity might be straining the back. Why do it this way? Is

it easier? Faster? Is it a habit they picked up from someone else?

Make notes in the left column.

Step 8: Ask each person to choose a partner and prepare for change. Is

the partner motivated to make some changes? Now discuss how

to change each potentially harmful activity to protect the back.

Bend differently? Get help? Relax while doing it? Take breaks?

Make notes in the far right column of the page.

Step 9: Bring the group back together and ask for volunteers to share

what they have written. Take note of the reasons they give for

acting as they do. Look for alternative ways to carry out this

task. This is the preparation stage of behavior change.

8

82 Enhancing Health in the Head Start Workplace
Module 3

Points to Consider:

Step 10: Encourage group members to put their plans into practice,

getting support from their partners or other members of the

group.

Most health-damaging behaviors are the result of habits. We are

used to doing it that way. Often we are unaware of how our bodies

are affected.

Back protection is a relatively simple behavioral change. Though we

may have fallen into certain habits, we usually are not as committed

to our ways of moving and lifting as we are to, for example, what we

eat. Protecting one's back is not a value-laden situation. It is a good

idea to begin behavioral change with something that is not

associated with strong cultural or social values. Success in this

encourages people to take on other challenges.

The steps we went through here are the first steps in behavior

change:

We all were beyond the precontemplation stage...we

recognized the need to change how we use our backs.

We contemplated the behavior and gained further

understanding of our behavior and its consequences.

We prepared for action by making a plan.

University of California, Berkeley, The Wellness Encyclopedia, (New York: Houghton

Mifflin Company, 1991).

Making Changes in Behavior for Better Health 90 83
Module 3

Activity 4:

Is My Colleague

Ready for

Change?

Purpose: Managers and supervisors learn how to analyze a staff

member's readiness to change.

This activity is designed for a pair of coordinators/managers to work

together. Each will keep a journal as they learn to read the cues that

indicate the stages of change.

For this activity you will need:

Writing materials and notebook for each participant

Handout K: Ready to Change?

Step 1: Discuss with your partner a common situation among

supervisors: the realization that a staff member has a habit or

behavior that negatively affects her work. Have you had this

experience? What did you do? Some examples of problem

behaviors:

cigarette smoking that causes excessive work breaks or

illnesses

excessive anxiety that prevents the person from coping with

normal job stresses

drinking alcohol at lunch, which affects afternoon

performance

refusal to use a seat belt when driving, which gives the

wrong message of safety to children and parents

disorganization, which leads to lost records, or chronic

lateness, which results in missed appointments

Step 2: Agree to maintain strict confidentiality during this activity. The

activity does not require you to share personal information about

other staff members; however, if something is revealed,

confidentiality must be protected.

9

84 Enhancing Health in the Head Start Workplace
Module 3

Step 3: With your partner, review Handout K: Ready to Change?

Referring to Background Information in your discussion, be sure

that you are both clear on the important concepts at each stage.

Talk with your partner about a personal change that you have

worked on in the past:

How easy or hard was it to make that change?

What helped and what hindered your change?

Now consider a change that you have thought of making, or that

someone has encouraged you to make.

How do you feel about making that change?

At what stage of change are you?

Looking at a concrete example for yourself and discussing it

with your partner can help both of you to clarify the concepts.

Coach/Partner's note:

Handout K: Ready for Change? is a simple example of the

"Stages of Change" with sample activities that help at each

stage. There are many more activities. For additional ideas,

consider your gut feelings about what might help and consult

other sources on stages of change.

Step 4: During the next week to 10 days, each partner should choose a

staff person with a problem behavior. If it seems appropriate,

talk with the staff person. If not, simply observe. Each day, take

a few moments to note in your journal what you observe.

Identify this person's stage of change on this particular problem.

Use Handout K as a guideline.

Your journal should describe the problem situation, give

examples of the problem behavior, explain why the behavior is a

workplace problem, and mention anything you know about that

person's readiness for change.

Step 5: Meet with your partner. Clarify for each other information about

stages of change and offer support as you each do your

assessment.

Making Changes in Behavior for Better Health 85

92
Module 3

Point to Consider:

Each partner should critique the other's research into the

problem, suggesting other aspects of this type of problem

behavior or clues about readiness to change.

Step 6: Next, in your journal, consider strategies and activities that

could help move the staff person with a problem from her

current stage to the next stage. Consider how you, as a

supervisor, can apply the theories on stages of change to

addressing a real problem in your own workplace. Be sure to

consider both personal changes that the person can make and

changes in the workplace that can encourage change.

Look to your partner for encouragement and to be sure that you

both stay clear in your roles. Avoid intervening in the staff

person's problem unless there is a serious impact on the

workplace or the person asks for your help.

Supervisors want staff members to change behaviors that are

detrimental to workplace functioning. Sometimes they jump in to

push for change, knowing that it is for the common good. This

activity is geared to encourage supervisors to slow down and look

carefully at the staff person's readiness for change, so that the

supervisor can design interventions that will be successful for

everyone.

9

86 Enhancing Health in the Head Start Workplace
Activity 5:

The SelfChange

Contract

Module 3

Purpose: Supervisors and peers learn to coach a person through a small

behavior change, offering guidance, encouragement, and support. This

demonstrates the action stage of change.

For this activity you will need:

3"-by-5" cards

Handout L: Self-Change Contract

Step 1: Determine, with your partner, the desired behavior change. Ask

your partner to observe his behavior over the next week,

observing when the behavior occurs, what leads to it, what

might be a trigger. See which situations might encourage a new

positive behavior (such as taking up walking) or discourage a

negative behavior (such as being where smoking is not allowed).

Step 2: Meet with your partner to discuss his observations and to fill out

Handout L: Self-Change Contract. This contract is for a twoweek period, to try out the change. Discuss the anticipated

barriers, what to do to help meet his goals and who could be

expected to help.

Step 3: Ask your partner to take 14 of the 3"-by-5" cards and carry them

throughout the two weeks. At the end of each day, he should

make notes about the day, including what was successful, what

was not. These notes will help in your discussion at the end of

two weeks.

Step 4: Be available throughout the two weeks for support and

encouragement.

Step 5: At the end of the two weeks, meet to discuss the behavior

change. Be sure that your partner has rewarded himself, as

agreed, for successes.

Step 6: Discuss the degree of success. How could this be made better?

What does your partner want to do to continue this change?

How can you help?

94

Making Changes in Behavior for Better Health 87
Module 3

Point to Consider: Behavior change is challenging; habits are entrenched. Be very

supportive of small increments of improvement in healthy behavior.

A contract is useful for someone who is ready to change. It will not

be helpful for anyone who is not ready to take action for change.

Many people do not believe that they need rewards; they believe that

good behavior is its own reward. Encourage them to reward

themselves in small ways. Rewards really do seem to help with the

change process.

95

88 Enhancing Health in the Head Start Workplace
Module 3

Next Steps:

Ideas to

Extend Practice

1. Determine which staff members are ready for action on a

certain behavioral change. Form a support group for this change.

Agree to meet, to talk and work together, and to provide

ongoing support for each other.

2. Explore your community to learn whether someone has

expertise in behavioral changes within the work setting. Invite

that person to a staff meeting and discuss the changes your

group is makingask for feedback and suggestions.

3. Expand upon the beginnings in Activity 5: The Self-Change

Contract, and encourage staff members to keep a journal that

documents their long-term efforts toward changing a health

behavior. This can be a personal document that needn't be

shared with a coach.

93

Making Changes in Behavior for Better Health 89
Module 3: Making Changes in Behavior for Better Health

S Handout G: Batting Practice

Group A: You are the pitchers on the team. You can't hit and you don't intend to

learn to hit better. You are convinced that what the team needs is:

A different pitching rotation.

More team meetings to review games.

Group B: You are older players who have seen this team go up and down. You

have been thinking about what the team needs to improve its

performance and you believe:

We could use more batting practice.

We also need more fielding practice.

We soon will face some really lousy teams, so maybe we don't

need to change just now

97

Enhancing Health in the Head Start Workplace 91
Module 3: Making Changes in Behavior for Better Health

Handout G: Batting Practice (continued)

Group C: You are enthusiastic rookies eager to try anything to improve the team.

You have been listening to the coaches and fully agree that this team

needs batting practice. You believe this because the team batting

average is below .225 and last year the team had great hitters and won

the pennant. You are:

Studying the hitting patterns of the league's best hitters.

Looking at catalogues for new bats.

Group D: You are a group that has decided batting practice is needed, and

already have started to work on it by:

Pairing up to practice your swings.

Lifting weights to increase the power of your swing.

9 a

92 Enhancing Health in the Head Start Workplace
Module 3: Making Changes in Behavior for Better Health

Handout G: Batting Practice (continued)

Group E: You are the team's star hitters. You have always been good hitters, and

this year you average over .300. A couple of you, however, have been

in slumps this month. You believe that the team needs:

Longer practices.

Another batting coach to offer more support, because you are a bit

depressed about the slumps.

99

Enhancing Health in the Head Start Workplace 93
Module 3: Making Changes in Behavior for Better Health

Handout H-1: Limiting Fat to 30% of Daily Calories

....1 co

...----- t,ii 0x

CA LT

How much fat can I

have?

It depends on your calorie

needs. The Dietary

Guidelines recommend

that Americans limit fat in

their diets to 30 percent of

calories. This amounts to

53 grams of fat in a

1,600-calorie diet, 73

grams of fat in a

2,200-calorie diet, and

93 grams of fat in a

2,800-calorie diet.

You will get up to half

this fat even if you pick

the lowest fat choices

from each food group and

add no fat to your foods

in preparation or at the

table.

You decide how to use the

additional fat in your

daily diet. You may want

to have foods from the

five major food groups

that are higher in fat

such as whole milk

instead of skim milk. Or

you may want to use it in

cooking or at the table in

the form of spreads,

dressings or toppings.

A01.451...

bologna = 16 grams

cheese = 12 grams

mayonnaise = 8 grams

tt,.13

cem.00

36 grams or 9 teaspoons of fat

The fat in some foods add up quickly. A bologna and

cheese sandwich made with 2 slices (2 oz.) of

bologna, 2 slices (11/2 oz.) of cheese, and 2 teaspoons

of mayonnaise counts up to about 36 grams of fat,

about 9 teaspoons. However, a similar sandwich

made with lean beef, lettuce, tomato, and lowfat

mayonnaise, and served with a cup of nonfat milk

instead of the cheese, has only about 6 grams of fat.

Note: 4 grams of fat =1 teaspoon.

Here are some

selection tips

Use lean meats and Read nutrition and

skim or lowfat dairy ingredient labels on

products. food packages to

check the kinds and

amounts of fat they

contain.

Use unsaturated

vegetable oils and

margarines that list

a liquid vegetable

oil as the first

ingredient

on the

label.

Limit use of food

products that contain

large amounts of

saturated fats. Examples

are nondairy creamers

and rich baked products

such as pie crusts and

other pastries, cakes and

cookies.

Enhancing Health in the Head Start Workplace 100

95
Module 3: Making Changes in Behavior for Better Health

Handout H-2: Limiting Fat to 30% of Daily CaloriesSample Menus

Total Calories: 1,979

% Fat: 28

Total Calories: 2,248

% Fat: 27

Total Calories: 2,993

% Fat: 29

Breakfast: Breakfast: Breakfast:

1/2 cup orange juice 1 cup orange juice 1 cup orange juice

3/4 cup corn flakes 3/4 cup corn flakes 3/4 cup presweetened corn

1 cup nonfat skim milk with 1/2 english muffin flakes

vitamin A 1 tsp. margarine 1 bagel

1 cup skim milk 2 tsp. margarine

1 cup skim milk

Lunch: Bag Lunch: Sandwich Shop Lunch:

1/2 banana tuna sandwich: roast beef sandwich

1 cheeseburger 2 slices of bread 2 cups tossed salad

1 small order of french fries 3 oz. water pack tuna 3 tsp. thousand island dressing

1 diet cola tomato, celery, relish 1 medium cola

1 tsp. catsup 4 tsp. mayonnaise

3/4 oz.. bag pretzels

4 homemade oatmeal cookies

1 medium cola

Snack: Snack: Snack:

1 bagel 4 multigrain, low-fat crackers turkey & cheese sandwich:

2 tsp. jelly 3/4 oz. low-fat cheese 2 slices of bread

1 cup fruit punch drink water or noncaloric beverage 1 oz. turkey breast

1 oz. low-fat cheese

lettuce, tomato, pickle

2 tsp. mayonnaise

3/4 oz. bag pretzels

5 .ginger snaps

1 cup orange juice

Dinner: Dinner: Dinner:

chicken stir-fry: 3 oz. broiled chicken breast, 3 oz. chicken cacciatore

3 oz. skinless, roasted no skin 1/2 cup green beans with tub

chicken meat 1 boiled potato with tub margarine

1/4 cup broccoli, chopped, r a w margarine

4 tomato slices

1 cup rice with tub margarine

1 slice of bread

1/4 cup onions, chopped, raw 1 slice of bread 1-1/2 tsp. margarine

1/4 cup carrots, no salt 2 tsp. margarine 15 grapes

1 tsp. soy sauce 1/2 cup strawberries 1 cup nonfat yogurt, fruit

1/3 cup white rice 1 container nonfat yogurt flavor

1 cup mung bean sprouts water or noncaloric beverage water or noncaloric beverage

1 tbsp. corn oil

1 cup instant, unsweetened tea

Dessert: Dessert: Dessert:

1 cup ice cream-10% fat 1 homemade cupcake 1/8 of 9" homemade apple pie 1/2 cup diet soda 1 cup skim milk 1 cup skim milk

96 Enhancing Health in the Head Start Workplace

10;
Module 3: Making Changes in Behavior for Better Health

Handout I: Strategies to Help Change

Group Sample Strategy Other Strategy

,.,..Taiakiii.--

A: Precontemplators

11111/ ....... Consciousness Raising

- posters in staff room

tasting of delicious low-fat foods

B: Contemplators Emotional Arousal

- models of fattyfoods to be disgusted by

- lovely pictures of people who are

healthy and trim

scary stories of people who became very

ill after practicing unhealthy behaviors

C: Preparation Commitment

- make plan of action

- go public

- set a date

D: Action Contracts & Rewards

- write up contract

- choose specific rewards

- reinforcement for behavior

E: Maintenance Countering

- relaxation

- positive self-statements

- any alternative behaviors (substitutions)

- .

Enhancing Health in the Head Start Workplace 1U:

97
Module 3: Making Changes in Behavior. for Better Health Handout J: The Basic Back Activity: Ilow 1 Do Things Now & Why What 1 Can Change 98 Enhancing Health in the Head Start Workplace 103 1U.
Module 3: Making Changes in Behavior for Better Health

Handout K: Ready to Change?

Area of Change Considered:

Questions Stage of Change/How To Help

Is the person:

uninterested in the subject?

not admitting a need for change?

not receptive to discussion of this?

Precontemplation:

gently provide information

gently recommend change

help person to be in places that encourage

change and that don't encourage the old

behavior

Is the person:

aware of the need for change?

talking about possibilities?

confident that she will make a change soon?

Contemplation:

provide facts

be willing to listen

encourage emotional responses to the

negative aspects of the current behavior

Is the person:

making concrete plans to change?

evaluating the pros and cons of the change?

Preparation:

support in preparation for action

be willing to listen, but do not push

offer information on helping groups or

programs

Is the person:

actively changing now?

ready to write a contract for change?

enrolled in a class or participating in a

group?

Action:

participate together in healthy activities

provide agreed-upon rewards

help person to find alternative behaviors,

substitutions; rearrange situations to decrease

"cues" for old behavior

Is the person:

already changed; concerned about relapse?

Maintenance:

be on call for support

give regular reinforcement and compliments

105

Enhancing Health in the Head Start Workplace 99
Module 3: Making Changes in Behavior for Better Health Handout L: Self-Change Contract 100 106' Enhancing Health in the Head Start Workplace 107
Module 4

Creating a Healthy Organizational Climate

Outcomes After completing this module, participants will:

Key Concepts

Improve their skills as part of a well-functioning team that supports

the health practices of workers.

Identify which community agencies can help to promote staff health.

Draft recommendations for wellness-enhancing policies to submit to

the Policy Council.

A supportive work environment encourages team spirit and provides

a good background for staff members' efforts toward their own

wellness.

Team functioning is improved by:

having shared goals and agreed-upon expectations for each

member's work performance

understanding and accommodating diversity in cultural

background, abilities and disabilities, lifestyle, language, and

work styles

encouraging open communication and attending to different

communication patterns among team members

making the team a supportive and safe place to share challenges

and frustrations

having effective methods to resolve conflicts

Workplaces that nurture the skills and practices noted above

contribute positively to their workers' mental health and enhance

these workers' ability to model healthy behaviors for the community.

Work groups can link with community agencies that offer many

health-supporting services and activities: e.g., EAPs, recreation

centers, stop-smoking programs, 12-step programs, support groups.

Creating a Healthy Organizational Climate 101

1O&
Module 4

Background Information A. Organizational Climate

We all belong to a variety of cultures. We are part of U.S. culture, and

part of our own ethnic, religious, and neighborhood cultures. As part of

those cultures we have much in common, yet each of us is unique. People

coming together in a workplace form another culture. They share a great

deal of time together (about half of their waking hours) and are engaged

with each other and with the larger community in which their organization

functions. Because their work is overlapping, they develop certain

systems to assure a smooth functioning of the work day and the

accomplishment of necessary tasks. In most organizations, there are two

cultures:

The official culture. This directs members' work through guidelines

on hours, dress, and manner of interacting with co-workers and

community members. This culture is often expressed in written rules

and policies.

The real culture. This is the subtle feeling a person gets when she

enters the workplace. These are all of the unexpressed norms of the

workplace, things the employee doesn't know until she has worked

there for a while, such as expectations of effort, hours worked vs.

hours clocked, acceptable language, attitudes toward clients,

acceptance of variety in work style.

As with any culture, there are varying degrees of "fit" among the

members. Some people are comfortable at a workplace right away. Others

are somewhat uncomfortable. These workers either adjust to the majority

culture, make changes, or move on to more comfortable workplaces. Our

vision for Head Start workplaces is that they will be open to diverse

cultures so that a wide variety of workers can feel comfortable and

productive.

B. The Workplace and Health

People who are uncomfortable and unhappy in their workplaces are likely

to be unhealthy. To compensate for their discomfort, they may act out in

ways that make other workers uncomfortable, or they may take on

unhealthy behaviors to comfort themselves (e.g., overeating, working

excessively hard, refusing to communicate, being frequently absent, using

alcohol or other drugs to calm down at the end of the day).

The most effective teams of workers will share goals and have clear

understandings of roles and responsibilities. They will allow a diversity in

work styles, supporting each other in their own ways of getting the work

102 Enhancing Health in the Head Start Workplace

0
Module 4

Questions for Discussion/

Reflection

done. They also will support the variety of personal health habits that lead

to wellness.

When working with children, certain basic requirements limit the

acceptable work styles. Children are active, engaging and playful, so

people whose work styles require great structure and quiet are probably

not suited to interact daily with children. It is a challenge for a supervisor

to select staff who represent the qualities necessary for the child care

workplace, recognizing that many people can work in this setting but a

few cannot.

Trainer/Coach's note:

Concepts in this module are related to concepts in the Management series of Training Guides for the Head Start Learning

Community and to the technical guide Promoting Mental

Health.

C. The Benefits Package

Employers provide many benefits to workers in addition to their salaries:

health insurance (preventive and therapeutic services), life insurance, paid

time off, employee assistance and wellness programs, and flexible leave

to care for children or other dependents. Salaries and benefits play an

important part in the development and maintenance of a healthy

workplace.

Consider the workplaces you have experienced over the course of

your career. Can you identify factors that led to a good or a bad fit?

What are the special characteristics necessary for work in Head

Start? How do diverse styles complement each other?

Creating a Healthy Organizational Climate 103

110
Module 4

Activity I:

Goals and

Roles

Purpose: The team members clarify the organization's goals and their

roles to encourage smooth functioning.

This activity is most effective when the participants represent a variety of

disciplines within the management team.

For this activity you will need:

Blackboard or flip chart

Writing materials for participants

Six to 10 large sheets of construction paper

Large marker for each participant

Brightly colored circles of paper, about 3" in diameter, at least three

for each participant

Tape or pushpins

Step 1: Post the mission statement from the Head Start enabling

legislation on the blackboard or flip chart. Make sure the

participants are familiar with this statement, understand it, and

recognize where it comes from. The statement:

The overall goal of the Head Start Program is to bring about a

greater degree of social competence in children of low-income

families. By social competence is meant the child's everyday

effectiveness in dealing with both present environment and later

responsibilities in school and life. Social competence takes into

account the interrelatedness of cognitive and intellectual

development, physical and mental health, nutritional needs, and

other factors that enable a developmental approach to helping

children achieve social competence.

Step 2: Ask participants if they have anything to add to thisanything

that they feel is crucial to their own Head Start agency's goals,

which may not be explicit in the legislated goal. Add those

words to the Head Start mission statement. Confirm that the

additional statements reflect the mission of this Head Start

program.

1L ,L

104 Enhancing Health in the Head Start Workplace
Module 4

Step 3: Ask your participants to form pairs, and each person should take

five minutes to describe her job to her partner. The partner

should listen closely and take notes.

Step 4a: After five minutes, ask them to switch roles and have the other

partner describe his work.

Step 4b: (For Trainer) While the group is doing this activity, take large

sheets of construction paper and write the main phrases from the

Head Start mission statement or the local program mission

statement on different sheets. For example, one sheet might

read, "build child's everyday effectiveness," another "cognitive

and intellectual development of children," or "assist low-income

families." Post these on walls around the room.

Step 5: Give each person three circles of paper. Now ask each partner to

take a few moments to reflect on the other's role, and to choose

three key responsibilities that describe what this person does.

Write one key responsibility on each circle, with the person's

name. Have extra circles available if needed.

Step 6: Ask them to get up and stick each circle under the appropriate

large construction paper sign, indicating which part of the

mission the role supports. If a circle does not fit under any part

of the mission, hold it.

Step 7: Explore five main questions:

Do our roles fit nicely under the mission?

Are what we do and what we believe we must do congruent?

Do parts of the mission get too much attention?

Do we do anything that does not support any part of the

mission? (These are the circles that don't have a home.)

Is there any part of our mission that is not articulated?

Step 8: Discuss the following questions: What does this exercise tell us

about how we see our roles and our mission? Do we need to

make any changes in how we organize our work? If we agree

that sharing a mission is important, how can we restructure our

working situation so that we all share in the mission?

112

Creating a Healthy Organizational Climate 105
Module 4

Points to Consider: Understanding clearly an organization's goals is the first key to

effective operations. If all are in agreement with the goals, they can

work together in harmony.

Consider what happens to an organization when not all of its

members agree on its goals. How can sharing goals help a team to

perform better?

The second key is to clearly articulate each player's role in meeting

the organization's goals. Notice how jobs are distributed. Is there

too much overlap? Is anyone spread in too many directions?

Reinforce the main point of goal and mission statements: They give

us something to work toward, a common place toward which we

travel.

1 1

106 Enhancing Health in the Head Start Workplace
Module 4

Activity 2:

Our

Organization's

Working Styles

Square Triangle

Purpose: Managers will identify their own work styles and see them in

the context of others' work styles, and develop skills to work with staff

with differing styles more effectively.

For this activity you will need:

Handout M: What Do the Shapes Mean?

A box

Many cutouts (about 6" by 6") of the following shapes:

Rectangle Circle Squiggle

Step 1: Explain that there are many ways of looking at working styles,

and today we are using shapes to describe our styles.

Step 2: Pass a box containing the cutout shapes around the room. Ask

each person to select a shape he thinks could represent his

working style. Ask him to think about why this represents his

style and to write notes on the back of the shape.

Step 3: Ask the group members to get up and gather at five tables, one

table for each shape.

Step 4: In the smaller group, they should tell each other why they chose

the shapes they did. If needed to prompt discussion, distribute

Handout M: What Do the Shapes Mean?

Step 5: Now ask each group to choose a reporter to lead the group in a

discussion of similarities in style within the group. Then ask

them to consider a workplace situation for their group: You have

just had a very bad experience with a parent in Head Start. The

parent is angry because her child has been teased by other

children and you are being blamed; you are very upset. How

Creating a Healthy Organizational Climate 107

1I
Module 4

Points to Consider:

would you handle that? Consider how your co-workers could

help you.

Step 6a: (For Trainer) While the groups are discussing, prepare a flip

chart paper with the five symbols drawn across the top.

Step 6b: After 10 minutes, bring the groups together. Ask the reporter for

each group's shape to briefly describe the working style or

characteristics of their group. Then ask them to respond to the

question about the difficult situation.

Step 7: As each group reports, write key words on flip chart paper

underneath the group's symbol, indicating how the members

would like to be helped in the difficult situation.

Step 8: Discuss what's alike and different about how people want to be

helped.

Step 9: Consider the following questions: Do we, as program managers,

directors and Policy Council members, establish the climate for

staff to work through difficult situations? To help each other?

To receive support? How can we improve our climate?

Step 10: If time permits, pose additional challenging situations to the

group. Distinguish between the members' differing needs and

styles to handle the same situation.

Within our work group are people with several different styles, and

they differ in the ways they want help from their co-workers.

Understanding a co-worker's style and needs will make you much

more effective in supporting that worker.

Managers and board members are largely responsible for workplace

climate. They can make it welcoming and supportive of staff by

recognizing a variety of work styles and needs.

115

108 Enhancing Health in the Head Start Workplace
Module 4

Activity 3:

Supporting

Healthy

Behaviors

Purpose: Managers will increase their program planning and evaluation

skills by framing the Head Start workplace's health promotion activities

within the national goals of Healthy People 2000.

For this activity you will need:

Flip chart paper

Markers

Handout N: Healthy People 2000

Step 1: Just as organizations have goals for effective functioning,

people have goals for long and healthy lives. Distribute Handout

N: Healthy People 2000 or use it as an overhead. Many people

and organizations across the country are working on the goals in

the Healthy People 2000 initiative. Workplaces are important in

achieving the goals.

Step 2: Tell the group about the three major domains in the Healthy

People 2000 goals:

Health Promotion strategies are related to individual

lifestylepersonal choices are made in a social context and

can have a powerful influence over one's health prospects.

Health Protection strategies are related to environmental or

regulatory measures that confer protection on large

population groups.

Preventive Services include counseling, screening,

immunization, or other medical interventions within clinical

settings.

A workplace that wants to support workers' health in these areas

needs an integrated approach. This group will be asked to draft

an integrated approach to three issues.

Step 3: Divide your group into three sections. Assign each section an

area: Health Promotion, Health Protection, Preventive Services.

Ask them to refer to Handout N: Healthy People 2000 and select

one topic to address.

Creating a Healthy Organizational Climate 109

116
Module 4

Points to Consider:

Step 4: List on a flip chart the areas that an integrated approach will

consider:

personnel policies

work environment rules

medical benefits

workplace activities

health education resources

retirement plans

Step 5: Give each group a large sheet of paper and markers. Ask them to

choose a reporter. List a chosen topic at the top. Underneath the

topic, ask them to list anything they can do within their Head

Start program to encourage workers' health in this area. They

need to consider the integrated approach and include something

for each section.

Step 6: Give the groups about 10 minutes to work. Then ask them to

post their sheets and report to the group which activities they

want to pursue.

Step 7: As each reporter lists his group's strategies, the others in the

group can ask about the strategy and come up with more ideas

for achieving the goal. Also ask the group to list any barriers to

achieving the goal. Brainstorm ways to overcome these barriers.

Note community resources for any of the changes.

Step 8: Encourage them to submit their recommended changes to the

center Policy Council, after checking with the director to make

sure they have considered all the barriers.

Being part of a national campaign can help you find resources and

validate your work.

An integrated approach to workplace health takes into account more

than what we normally think of as health promotion activities.

Policies are important, too.

110 Enhancing Health in the Head Start Workplace

.11.?
1111 Activity 4:

Module 4

Community

Resources

Points to Consider:

Purpose: Participants will build skills by investigating the community to

identify resources for staff health needs.

Coach Preparation Note:

This activity will be most useful if a staff person is paired with

a Health Services Advisory Committee member or a Policy

Council member.

Step 1: With the coaching participant(s), pick one health need that is

important to your staff. Guidance in selecting this need could

come from the results of other activities in this guide, such as

How Healthy Is This Workplace (Module 1Activity 2) or

Culture, Community, and Health (Module 2Activity 4).

Step 2: Identify an HSAC or Policy Council member who has an

interest in employee wellness. Ask that person to meet with one

or two staff members to identify resources. The meeting could

be in person or over the phone. Set up that meeting.

Step 3: Ask the HSAC or Policy Council member to suggest to the staff

any community resources that could help meet the identified

health need.

Step 4: After the staff person has researched the suggested community

resources, she should submit a report to the committee. Ask for

the committee's support as you institute this wellness promotion

service/resource.

HSAC and Policy Council members have a wealth of knowledge and

experience within the community. They are often difficult to bring

to meetings, but might be willing to meet with one or two staff in an

informal setting.

The combination of committee and staff member working together

adds strength to the recommendations for change when the issue

comes to the decision-making body.

Creating a Healthy Organizational Climate 0 111
Module 4

Next Steps:

Ideas to

Extend Practice

1. Refer back to Module 3 and consider the stages of change. Look at

your organization in light of the changes proposed to improve

employee health. At what stage of change is the organization? Are

the administrators at different stages of change? What can you do to

move the administrators closer toward action on the desired change?

2. We have a mission statement for the entire organization. In small

work groups, or individually, write a mission statement for a small

group or self. Clarify with the supervisor that the smaller mission is

compatible with the larger, then keep that as support for what you

are doing.

119

112 Enhancing Health in the Head Start Workplace
Module 4: Creating a Health Organizational Climate

Handout M: What Do the Shapes Mean?8

Square:

Triangle:

Rectangle:

Circle:

Squiggle:

Good at following rules

Organized

Every pencil in place in the office

Likes things in writing

Tends toward solitary pursuits

Organized and systematic

Likes to do the "right" thing

Good at politics

Can get overcommitted and burn out

Decisive and ambitious

A power player

A shape in transition, thinking of making major life change

Creative, open to suggestions, loves ideas and opportunities

Sometimes appears scattered

Speaks what is on his or her mind

Not time-conscious

People lover and pleaser of others

Tries to avoid conflict or hurting anyone's feelings

Good at talking with people

Puts others' needs first

Office is home-like and comfortable

Good cook and likes to socialize

Creative, wants excitement

Procrastinates routine work, then zooms to get things done

Has a short attention span and hates routine

Artistic and dramatic

Spontaneous

Talks quickly

8 Adapted from: Susan Dellinger, Psycho-Geometrics, (Englewood Cliffs, N.J.: Prentice

Hall, 1990).

Enhancing Health in the Head Start Workplace

120

113
Module 4: Creating a Healthy Organizational Climate

Handout N: Healthy People 2000

Healthy People 2000 has three goals:

Increase the span of healthy life for Americans.

Reduce health disparities among Americans.

Achieve access to preventive services for all Americans.

And more than 300 measurable objectives related to the following areas:

Health Promotion

Physical Activity and Fitness Nutrition

Tobacco Alcohol & Other Drugs

Mental Health & Mental Disorders Family Planning

Educational & Community-Based Programs Violent & Abusive Behavior

Health Protection

Unintentional Injuries Occupational Safety and Health

Environmental Health Food & Drug Safety

Oral Health

Preventive Services

Maternal & Infant Health Heart Disease & Stroke

Diabetes & Chronic Disabling Conditions Cancer

Sexually Transmitted Diseases HIV Infection

Immunizations & Infectious Diseases Clinical Preventive Services

114 Enhancing Health in the Head Start Workplace

12
Module 5

Weight and WellnessA Classic Worksite Issue

Outcomes After completing this module, participants will:

Apply the general principles of health promotion in the workplace

(described in Modules 1-4) to the issue of weight and wellness.

Develop strategies, as a team, to help staff achieve healthy weights.

Key Concepts Why be concerned about weight in the workplace?

Severe overweight, underweight, and eating disorders can affect a

worker's performance.

.Severe overweight, underweight, and eating disorders cause physical

and emotional pain for those affectedon and off the job.

Workplaces have their norms that affect workers' weight, and can

help or hinder workers to achieve healthy weights.

What does weight mean for our staff members?

Workers' feelings about their bodies, and their individual concepts

of "right weight," affect their emotional health.

Workers' size can affect their willingness to engage in a variety of

health-promoting activities, including exercise.

Weight is a very touchy issue and can lead to conflict and confusion.

How have people managed change in the area of weight control?

Society pushes our readiness to change with many advertisements

for weight control.

Changing body size in adults is extremely difficult.

Changing for better health with a focus away from weight is a

philosophy that shows great promise.

How can we create a climate where healthy weights are the norm?

A healthy workplace will foster a climate of acceptance and

nondiscrimination.

The workplace will also encourage healthy exercise and low-fat

eating.

Weight and WellnessA Classic Worksite Issue 122 115
Module 5

Background Information A. Prevalence of the Problem

There is little agreement on what constitutes a weight problem. However,

there are three general categories of weight problems: overweight,

underweight, and eating disorders. This table gives the generally

suggested weights for adults.

Heightt Adult Weight in Pounds

4'10" 91 to 119 cr

4'11" 94 to 124

5'0" 97 to 128

5,1,, 101 to 132

5'2" 104 to 137

5,31, 107 to 141

5'4" 111 to 146

5,5,, 114 to 150

5'6" 118 to 155

5'7" 121 to 160

5'8" 125 to 164

5'9" 129 to 169

5'10" 132 to 174

5'11" 136 to 179

6'0" 140 to 184

6'1" 144 to 189

6'2" 148 to 195

6'3" 152 to 200

6'4" 156 to 205

t Without shoes. t Without clothes. cr The higher weights in the

ranges generally apply to men, who tend to have more muscle and bone;

the lower weights more often apply to women, who have less muscle and

bone. Source: Derived from National Research Council, 1989

116 Enhancing Health in the Head Start Workplace 123
Module 5

There is cause for concern if a person weighs 20% above or below the

suggested range. Frame size, amount of muscle vs. fat tissue, heredity and

health conditions can affect weight. Someone outside of the range may be

enjoying excellent health, and people well within the recommended

ranges can have a variety of problems related to eating and weight.

At least one in four adult Americans is overweight. Far fewer Americans

are under their recommended weights. How many people suffer from a

weight or eating disorder is unknown.

B. Effects of Weight Problems 9 10 11

Weight affects health in at least three dimensions:

Physical HealthHealth care professionals and researchers agree

that extreme overweight and extreme underweight are associated

with increased risk of illness, injury, and death. Being overweight

can cause high blood pressure, strokes, joint problems, and can limit

mobility. Being underweight can decrease bone density, which

increases risk of fractures, and suggests there are inadequate

nutrients for growth. People who worry about weightwhether

overweight or underweightoften diet, which risks their physical

health. Frequent dieting stresses the cardiovascular system and

jeopardizes the person's nutritional well-being. Anorexia (refusing

to eat to the point of starvation) and bulimia (eating great quantities

of food, then vomiting/purging) are both very hazardous behaviors

of people who are not generally considered overweight.

Mental/Emotional HealthPeople whose physical appearance is

not valued by their peer group suffer in self-esteem. Those who go

to great lengths to alter their physical shape (for example, through

severe weight reduction diets or excessive bodybuilding) may lose

perspective on other important aspects of their lives and feel like a

failure when their desired changes do not occur.

Social HealthSome people believe that being against "fatness" is

the last acceptable prejudice in our society. It is well-documented

that people larger than the norm have greater difficulty in finding

jobs and housing and are less likely to develop happy relationships.

124,

Weight and WellnessA Classic Worksite Issue 117
Module 5

C. Weight in the Workplace

A workplace is a sociable place, but a person's weight or preoccupation

with weight/eating/exercise can cause friction. Cultures differ on their

perspectives about food, weight, attractiveness, and physical exercise

which translate into people's attitudes and behaviors. As with any health

issue, job performance can suffer from a weight problem. One Head Start

director was concerned because she needed to make special

accommodations for a home visitor whose large size affected her

mobility; a health coordinator expressed concern that a teacher's

preoccupation with dieting was affecting her willingness to serve children

she perceived as "too fat" as much food as they wanted.

D. Addressing Problems with Weight

The great majority of Americans trying to change their weight are trying

to lose weight. But, despite great effort and millions of dollars spent on

weight loss products and programs, success rates are very low. Many

people drop out of weight loss programs; of those who complete a

program nearly all regain the weight within a year.

The great unlikelihood of adult Americans significantly reducing their

weight has led one large health maintenance organization to tell its

practitioners to stop advising people to lose weight and to focus instead

on making changes in behavior that can lead to overall good health. These

changes might, indeed, lead to weight loss, but the goal is overall health.

Questions for Discussion/ Has concern with weight been an issue in your workplace? How has

Reflection it been addressed?

9

John P. Foreyt and Georganna Leaves ley, "Behavioral Treatment of Obesity at the

Worksite," Health at Work, (Hillsdale, NJ: Lawrence Erlbaum Associates, 1991).

10 U.S. News & World Report, "Fat and Fit," (May 16, 1994).

11 Kaiser Permanente Medical Care Program in Northern California, Health and Weight

at Kaiser Permanente: A Draft Discussion Paper, (August 1994).

118 1 25 Enhancing Health in the Head Start Workplace
Activity 1:

Module 5

Exercising Our

Way to Better

Weight Together

Purpose: Managers will develop a centerwide plan to increase the

number of staff enjoying healthy weights, decrease bad feelings among

staff regarding weight issues, and promote increased activity regardless of

size.

This activity is for health coordinators or other managers.

For this activity you will need:

Handout K: Ready to Change? (Module 3)

Handout 0: Where We Are with Weight and Exercise

Handout P: Exercise Facts

Handout Q: Ready to Change to More Exercise?

Flip chart paper

Markers

Step 1: Review the background information on Wellness and Weight.

Tell the group that we are gathering to discuss a plan for

promoting healthy weights among all staff.

Review the four principles of worksite wellness, as described

previously in this training guide:

Why be concerned about this problem?

What does this issue mean to our staff members?

Are we ready for change? What strategies might work?

How can we create a climate to support this change?

Step 2: In this step, we will consider the first two principles. Distribute

Handout 0: Where We Are With Weight and Exercise, and ask

each staff person to fill it out.

Weight and WellnessA Classic Worksite Issue 119
Module 5

Step 3: After participants have completed the questionnaire, engage in a

group discussion. Using two separate sheets of flip chart paper

(or two sections of blackboard), lead a discussion on the first

two principles:

Why do we care about this?

What does our staff think about this?

Step 4: The group will supply reasons for developing staff wellness

activities related to weight and wellness.

Step 5: The third principle is "Are we ready for change?" and "How

have people managed in the area of weight control?" There are

many ways that a person can change her behavior to achieve

"weight-wellness": eat less, weigh every day to check, exercise

more, buy new clothes, eat certain kinds of foods, develop a

different attitude. There are pros and cons to each of these

approaches except:

Exercise!

Becoming more active is a no-lose situation. Physical activity is

good for people regardless of their weight. If weight loss is a byproduct of increased exercise, that is well and good. Therefore, a

worthwhile goal for staff health is to get everyone moving in a

way that is comfortable.

Step 6: Tell the group that now you will be looking at staff readiness to

make a specific change: more physical activity. Distribute

Handout P: Exercise Facts. Be sure that everyone is clear on the

suggested change: more moderate-intensity exercise for staff.

Step 7: Now ask participants to consider the members of their work

group in terms of readiness for change. Distribute Handout Q:

Ready to Change to More Exercise? and ask the group to fill it

out. Distribute Handout K: Ready to Change? as background

information.

Trainer's note:

Your processing of this step will vary depending on the makeup of your group. If your participants all come from one group

that works together day-to-day, you can fill out Handout Q

together. If several work groups are represented, they can work

in teams or individually. Represent each team/group by letter

A, B, C, etc., in your discussion.

120 Enhancing Health in the Head Start Workplace
Module 5

Step 8: Use another sheet of paper and ask participants to describe their

staff members in terms of their readiness for change. You will

want a table such as the one below. _ Goal; To increase the level of activity/exercise among staff members'

Group

Name

%

Precontemplators

%

Contemplators

%

Preparers

%

Actives

%

Maintainers

A

B

C

D

E

With your participants, determine which is the largest group.

Are the majority of staff members not interested in activity and

not willing to become more active (Precontemplators)? Or is

your largest group already committed and ready to jump into

whatever exercise program they can find (Preparers)? Your

next steps will focus on this group.

Step 9: Your participants will now split into two planning teams. One

team will look at strategies to encourage exercise that focus on

the individual staff members. (Refer to Module 3: Making

Changes to Behavior for Better Health.) The other team will

consider what can be done to encourage an organizational

climate that promotes active lives for staff members. (Refer to

Module 4: Creating a Healthy Organizational Climate.) Divide

into the two groups: Individual Activities and Organizational

Change.

Step 10: Give each group a sheet of paper and a marker and ask the

participants to brainstorm ideas for a Head Start Center: What

can be done to encourage activity among staff members? Allow

10 minutes for brainstorming.

Step 11: Bring the groups back together and ask them to present their

strategies. Discuss with the groups the steps to put this plan into

action. Where are the supports? What barriers can be expected?

What resources will we use to overcome barriers?

Weight and WellnessA Classic Worksite Issue 1 23

121
Module 5

Points to Consider:

Step 12a: (If your group represents staff from one center): Ask for a

small team of volunteers who will take the leadership in

implementing this plan. Agree that the group will report

progress and difficulties at management team meetings so that

the plan can be revised as needed.

Step 12b: (If your group represents managers from several centers):

Divide the group so that all of those who work closely can

develop one plan. Ask each small group to establish a plan for

implementing the best suggestions from the brainstorming:

What do they want implemented at their own center? Ask

them to make a plan for review and revision over time.

Each of the previous modules covered an important principle in

work site health promotion. It is important to consider each step in

designing a program. How did this work with Weight and Wellness?

Which steps and which of the principles are easiest? Which are most

difficult?

Be sure that your participants' strategies to encourage change match

the stages of change identified in Step 8.

12

122 Enhancing Health in the Head Start Workplace
Activity 2:

Module 5

Consulting on

Weight and

Wellness

Points to Consider:

Purpose: Managers will improve their skills in helping staff to move

toward greater wellness with their weight.

For this activity you will need:

Handout L: Self-Change Contract (Module 3)

Step 1: Review the background information on weight and wellness.

Work with a staff person who has expressed interest in this

issue. Be sure the person wants you to coach her on this

behavior change.

Step 2: Ask her why she has concerns about weight. Does she consider

herself overweight, underweight, or excessively preoccupied

with weight and food? Is she concerned about other staff

members' attitudes toward her?

Step 3: Assess her readiness to make changes toward greater wellness.

Is she ready to become more active? To reduce the fat in her

diet? To engage in activities that support her for herself so she is

more comfortable with her size?

Step 4: Ask her to propose one area of change that she is ready to make.

Work through the change with her, using Handout L: SelfChange Contract from Module 3: Making Changes in Behavior

for Better Health. Offer encouragement and support as she goes

through the change process.

Step 5: Assess the organizational climate for supporting this staff

member in her desired change. What could be done to improve

support?

Be sure that you take enough time to assess your staff member's

readiness to change. Be sure that she has not decided to change

because of pressure from others. People succeed in making changes

when they want to change for themselves, not for others.

Weight and WellnessA Classic Worksite Issue 123
Module 5

Lack of exercise and a high-fat diet may not be the only reasons a

person is overweight. Some people eat poorly because of illness or

depression. It is important to assess the situation clearly. If you

suspect that you are unable to handle some complicating factors,

enlist the staff member's primary health care provider and

specialists in your community if necessary.

132

124 Enhancing Health in the Head Start Workplace
Module 5

Next Steps:

Ideas to

Extend Practice

Consider another significant staff health issue. For example: bad

teeth, risky driving habits, over-reliance on alcohol for celebrations.

Follow the Module 5 process to develop a plan to address this issue.

2. Look in the community for supportive programs or people dealing

with healthy weight. Are there exercise programs especially for

large women? A nutritionist who is a whiz at converting favorite

recipes to lower-fat variations? Are there public figures who exude

health and vigor regardless of size? Invite these people to your

center for discussions.

3. Explore weight-reduction programs for those who wish to use them.

Develop expertise in evaluating these programs in terms of their

philosophy, cultural appropriateness, success rates, and long-term

maintenance.

132

Weight and WellnessA Classic Worksite Issue 125
Module 5: Weight and WellnessA Classic Worksite Issue

Handout 0: Where We Are with Weight and Exercise

Consider your Head Start center staff. Is anyone at your center overweight?

Does that affect their job performance? How?

Is anyone on your staff underweight? Does that affect their job performance? How?

Are any staff overly preoccupied with weight or dieting? Do you suspect any of them have an

eating disorder? Does that affect their job performance? How?

Like most Americans, your center's staff members probably are not very physically active. Are there job

problems based on inactivity? What are the problems?

How does your staff feel about overweight, underweight, fatness, dieting, and bingeing?

13 (2)

126 Enhancing Health in the Head Start Workplace
Module 5: Weight and WellnessA Classic Worksite Issue

Handout P: Exercise Facts

Lack of exercise is associated with lower productivity, less mental alertness, feeling sluggish, heart

problems, high blood pressure, excess weight and back and joint problems. Moderate physical activity can

reduce risks in all of these areas. Physical activity is also an excellent stress reducer and muscle

strengthener. 12 13 14 15

Moderate Exercise Goal:

20-30 minutes of aerobic activity (active enough to make you sweat and/or breathe heavily) at

least three times a week.

- OR

An accumulation of physical activity (even if it is not strenuous) of 30 minutes every day, done at

one time or spread throughout the day.

Activities That Condition Heart and Lungs:

aerobic dancing bicycling

cross-country skiing hiking (uphill)

ice skating/hockey jogging

jumping rope rowing

racquet sports climbing stairs

swimming mowing lawn

walking briskly cleaning house

Ways to Become More Active Throughout the Day:

Walk at lunchtime.

Take the stairs instead of the elevator.

If you take public transportation, get off a few blocks before your usual stop and walk the rest of

the way.

Walk or ride a bicycle on errands.

If you drive, park a few blocks from your destination and walk.

12 Krames Health Information Library, Fitness, (Daly City, California: 1983).

13 National Heart, Lung and Blood Institute and American Heart Association, Exercise

and Your Heart, (Bethesda, Md.: August 1993), NIH Publication No. 93-1677.

14 National High Blood Pressure Education Program, Working Group Report on Primary

Prevention of Hypertension, (May 1993), NIH Publication No. 93-2669.

15 Russell R. Pate, et al., "Physical Activity and Public Health," Journal of American

Medical Association, (February 1, 1995), Vol. 273, No. 5.

Enhancing Health in the Head Start Workplace

134

127
Module 5: Weight and Wellness A Classic Worksite Issue

Handout Q: Ready to Change to More Exercise?

Given the concept of exercising for health, consider your co-workers. How ready are they

to add more physical activity in their daily lives? Can you place each co-worker at a

specific stage of change? Refer to Handout K: Ready to Change? for clues.

In the table below, summarize your work group. Fill in the table, indicating the percentage

of your co-workers in the precontemplation stage, the percentage in the contemplation

stage, etc.

Stage of Change Percentage of

Co-Workers

Precontemplation

Contemplation

Preparation

Action

Maintenance

Total: 100%

128 Enhancing Health in the Head Start Workplace
Continuing Professional Development

1. Investigate local community colleges or universities for courses on

health education and health promotion.

Look especially for those which delve deeper into the theory of

"stages of change." Expand the information given in this guide in

Module 3: Making Changes in Behavior for Better Health and

become an expert on identifying the characteristics of the various

stages of change.

By increasing your knowledge in this area you will be able to assist

staff members who wish to make healthy behavior changes and

managers who want to set up health promotion programs.

2. Go to the library or a bookstore and read a book on an area of

wellness that interests you.

Look at listings for lectures or seminars on different wellness topics.

Invite someone to look into this area with you. When you have

learned more, share your information with family, friends, and

colleagues.

3. Choose one topic discussed in this training guide that interests you,

for instance:

smoking cessation

exercise

weight management

stress management

back care

etc.

Explore your community for specialists in these issues. See how

many strategies there are for helping people make this behavior

change. Present your findings at your next staff meeting.

136

Enhancing Health in the Head Start Workplace 129
Resources

Workplace Health and Briggs Myers, Isabel. Gifts Differing. Palo Alto, Calif.: Consulting

Behavior Change Theory Psychologists Press, 1980.

This book describes the Myers-Briggs Type Indicator (MBTI), a

personality-type indicator widely used in business. The book

offers insight into why people act differently: because they look

at the world differently. It offers suggestions for working with

people with different personality types, suggesting patterns of

communication that will be most useful with different types.

There are many books on MBTI, and because of its wide use it

is recommended that managers have a basic understanding of

the concepts behind the MBTI.

DeFiese, Gordon and Fielding, Jonathan. "Health Risk Appraisal in the

1990's: Opportunities, Challenges and Expectations." Annual

Review of Public Health. Volume 11. 1990.

This article is a good overview of the development of the health

risk appraisals over the past 20 years. It discusses limitations of

the instruments and their potential usefulness in an employee

wellness program. The authors also note some areas where there

may be further development in health risk appraisals over the

next several years.

Minkler, Meredith A. "Ethical Challenges for Health Promotion in the

1990s." Wellness Lecture Series. Berkeley: 1993.

This 14-page paper provides an overview of challenges facing

those who wish to work in health promotion challenges

concerning the concept of individual responsibility for health vs.

the "response-ability" of people trapped in unhealthy situations.

The author, a professor at the University of California at

Berkeley School of Public Health, suggests that for most lowincome people, threats to health come more from economic and

social inequities than from individual health choices.

Minkler gives examples from several cities in California,

describing how efforts to address "health" issues were irrelevant

until finances, crime, or advertising campaigns were taken into

account. She advocates for new efforts in health promotion that

draw strongly from the concept of the "common good," and

work for policies that make it possible for all members of a

community to achieve good health.

13?

Enhancing Health in the Head Start Workplace 131
Resources

National Heart, Lung and Blood Institute. Strategy Development

Workshop for Public Education on Weight and Obesity:

Summary Report. Bethesda, Md.: September 1992.

This summary of sessions at the workshop is divided into simple

sections: epidemiology, strategies for prevention, issues in

education, and communication strategies. The workshop

considered obesity in children and adults. A great deal of

background information is given, along with current research on

health effects of obesity and treatments. The report addresses

physical and social consequences of weight problems.

Prochaska, James 0., et al. Changing for Good. New York: William

Morrow and Company, Inc., 1994.

The authors have interviewed thousands of people over the past

several years, investigating how people make behavior changes

around a variety of problems: smoking, weight loss, distress/

depression, safer sex practices, and more. Through their

research they have developed the concept of "stages of change"

as a multistage process. Their research has shown that different

practices help people at different stages of change and that

applying the right practices enhances the chance of success in

making the change. The six stages of change are:

precontemplation, contemplation, preparation, action,

maintenance, and termination. This book is for a lay audience

and includes engaging case stories and self-assessment quizzes.

Though written for individuals interested in self-change, the

book also would be very helpful for anyone responsible for

planning health promotion activities for others.

U.S. Department of Labor. Trends in Health Benefits. 1993. Available

from the Government Printing Office, Washington, D.C. 20402.

This book surveys the types and availability of health and

wellness benefits offered to employees in the United States. It

discusses various types of health care financing, considers

reasons for the recent rise in health care costs, and summarizes

types of benefits available to workers in various industries. It is

helpful in that it gives a complete picture of what is offered

currently in the United States, allowing a manager to decide

whether her company's benefits are generous, average, or

below-average. By applying these statistics and analyses to her

own situation, a manager could use the information to design or

justify programs that might reduce health care costs.

133

132 Enhancing Health in the Head Start Workplace
Resources

Resource Booklets for

Employee Health Promotion

Muchnick-Baku, Sonia and Caroline McNeil. Healthy People 2000 at

Work: Strategies for Employers. Washington, D.C.: National

Resource Center on Worksite Health Promotion, Washington

Business Group on Health, 1991.

Taking specific objectives from Healthy People 2000, this

booklet offers specific information for employers. It gives clear

guidance on applying HP 2000 strategies to worksites, with

suggestions for large and small employers.

National Heart, Lung and Blood Institute. Finding Resources for Healthy

Heart Programs at Work. Bethesda, Md.: U.S. Department of

Health and Human Services, Public Health Service, National

Institutes of Health, NHLBI, 1992. NIH Publication No. 92-737.

This is a good resource for anyone beginning an employee

health program. It is very clearly written and contains lots of

information about resource publications and organizations.

Although its focus is healthy hearts, it is applicable to a wide

range of topics, since cardiovascular health encompasses many

related topics.

U.S. Department of Health and Human Services, Public Health Service.

Healthy People 2000: National Health Promotion and Disease

Prevention Objectives. 1991. Available through the Government

Printing Office, Washington, D.C. 20402-9325.

Healthy People 2000 is a statement of national opportunities.

Although the federal government facilitated its development, it

is the product of a national effort, involving 22 expert working

groups, a consortium that has grown to include almost 300

national organizations, and all state health departments. The

usefulness of this document lies in its inspiration to all

American agencies to collaborate on common objectives. It

gives baseline data on many health issues, so that program

managers can compare the health status of their own group with

others in the country. There is specific information on ethnic

minority populations and age-specific groups.

139

Enhancing Health in the Head Start Workplace 133
Resources

Organizations National Institute for Occupational Safety and Health (NIOSH)

4676 Columbia Parkway

Mail Stop C-19

Cincinnati, Ohio 45226-1998

Telephone: (800)-35-NIOSH Fax: (513) 533-8347

NIOSH is part of the federal Centers for Disease Control and

Prevention and is responsible for conducting research and

making recommendations for the prevention of work-related

illnesses and injuries. NIOSH will investigate potentially

hazardous working conditions as requested by employers or

employees. It has a large number of publications on workplace

health. Information on publications and NIOSH activities can be

requested through its 800 number.

Occupational Health and Safety Administration

U.S. Department of Labor

200 Constitution Avenue NW

Washington, D.C. 20210

Telephone: (202) 219-4667 Fax to receive documents: (900) 555-3400

Publications department fax: (202) 219-9266

OSHA is the primary federal agency concerned with workplace

safety. It enforces workplace safety rules and offers consultation

to businesses to improve workplace health and safety. By calling

the OSHA fax number, more than 200 brief documents are

available for the nominal telephone charge of $1.50 per minute.

Washington Business Group on Health (WBGH)

777 N. Capitol Street NE, Suite 800

Washington, D.C. 20002

Telephone: (202) 408-9320 Fax: (202) 408-9332

WBGH, a national nonprofit organization, promotes corporate

competitiveness, productivity, and the well-being of American

workers and their families through national health system

reform. WBGH has 200 members, mostly Fortune 500

companies, whose staffs include some of the nation's most

knowledgeable, progressive, and successful health care

managers. WBGH and its member companies have been

involved in public- and private-sector efforts to improve health

care delivery for more than 20 years. WGBH offers conferences,

meetings, and publications that address the spectrum of

workplace health issues.

140

134 Enhancing Health in the Head Start Workplace
Resources

Head Start Resources

and Policies

Information Memorandum: "Smoke Free Environment Materials."

(April 17, 1995) Log No. ACYF--IM-HS-95-19

This IM gives information on the Smoke-Free Policy and lots of

background information on smoking and health. It also covers

the many questions that might arise from staff members and

others regarding this policy, and suggests ways to smooth

implementation.

Resource Guide on Head Start Employee Assistance Programs.

Washington, D.C.: U.S. Department of Health and Human

Services, Head Start Bureau, 1993. Available through the Head

Start Publications Center.

This 16-page booklet gives an overview of Employee Assistance

Programs (EAPs): the objectives of the programs, the different

models available, how to start one, and brief descriptions of

Head Start programs with EAPs in operation.

1 4 1

Enhancing Health in the Head Start Workplace 135

*U.S. G.P.O.:1996-721-277
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