1. Ready or Not? Counseling on Physical Activity when participants are ready and when they’re not.

2. Counseling on Physical Activity Physical inactivity is a major contributor to the growing “ obesity epidemic ” and many other health problems.

3. Objectives By the end of this activity you will be able to: Demonstrate skills in identifying and selecting probes, affirmations and resources when assessing and counseling participants on physical activity. Use OEQs to probe caregiver’s readiness to change child’s activity level. Demonstrate skills in selecting physical activity education to assist caregivers who want to grow physically healthy children. Continue to use participant centered approach to address physical activity concerns when speaking with caregivers.

4. NOW in WOW For children: Describe how you include physically active play in your child’s day. How much time? _ None _ 15 minutes _ 30 minutes _ 1 hour _ more than 1 hour For women: Describe how you include physical activity in your day. How much time? _ None _ 15 minutes _ 30 minutes _ 1 hour _ more than 1 hour

5. Assess readiness for change What does the caregiver think about being active? How does the caregiver feel when their child is playing? Assess caregiver’s concern about child’s size and ability to be active?

6. Readiness for Change If they are… Our goal is to… Not ReadyRaise Awareness UnsureRaise Awareness and identify barriers to change ReadyDiscuss parent concerns and build on current strategies

7. Next 5 Steps 1.Probe readiness 2.Identify education topics to discuss based on readiness 3.Affirm and Ask Permission to educate on topic identified based on parent’s concern and the child’s risk codes 4.Provide resources to support education topic. 5.Use a closing affirmation

8. Gregory’s Background information Nutrition hx indicates: No medical conditions Mom states she needs to locate childcare for Gregory. She thinks he’s growing fine Gregory gets little or no exercise. He is in the 90 th percentile for all areas Premature He is two He eats fruits and veggies. He eats drinks 4-6 ounces of juice.

9. Ready or Not? If you hear…I think Gregory is growing fine? If you see…Gregory is in the 90 th percentile for his ht/wt.

10. Ready or Not? Do you think his parents are : Ready? Unsure? Not Ready ?

11. Ready or Not? Not Ready!

12. Readiness for Change If they are… Our goal is to… Not ReadyRaise Awareness

13. PROBING & RESOURCES Probe(s) I can see you are satisfied with the way Gregory is growing. According to his WIC growth chart he is at the 90 th percentile – when you hear 90th percentile what does that number mean to you? You stated earlier that Gregory engages in no active play?-can you tell me more about what he is doing? Possible Education Topics to give or discuss: Copy of growth chart to give to his HCP Active living for families Child’s Play

14. Affirm and Ask Permission You are doing a great job of raising Gregory! I can give you a copy of Gregory’s growth chart for you give to your HCP to discuss his growth. Or Would you like to discuss strategies parents have used to determine if their children are moving and playing enough? Let me know if you need any more information on getting your family more active.

15. Closing Affirmation Thank you for your time today. Gregory is so lucky to have a mom who takes such good care of him. Hopefully this referral will help you to locate a childcare for Gregory-let me know how that works out. If you get to a free moment take a look at that handout on Child’s play and we can discuss it when you are ready.

16. Reggie’s Background information Nutrition hx indicates: No medical conditions Reggie gets 15 minutes of play here & there. He is in the 95 th percentile for all areas Mom’s friend says trying to exercise with her children requires too much work. But she has another friend who takes her kids to the pool everyday to swim. He is three.

17. Ready or Not? If you hear… Mom states she has a friend who has tried exercise with her kids and it requires too much work and then she has another friend who takes her kids to the pool everyday to swim? If you see…Reggie is in the 95 th percentile for his ht/wt.

18. Ready or Not? Do you think his parents are : Ready? Unsure? Not Ready?

19. Ready or Not? Unsure!

20. Readiness for Change If they are… Our goal is to… UnsureRaise Awareness and identify barriers to change

21. PROBING & RESOURCES Probe You said Reggie is active for 15 minutes here & there during the week- could you tell me more about what he is doing on those days, or That’s good that he likes to play so What does Reggie do for fun? To keep physically active? Possible Education Topics to give or discuss: Copy of growth chart to give to his HCP Active living for families Child’s Play

22. Affirm and Ask Permission I can see you are trying to keep him moving. Tell me what he CAN do now, and, if you'd like, we can discuss some ideas about how you can help him do just a little more to get more active without being (hurt, embarrassed, exhausted-whatever seems appropriate).

23. Closing Affirmation I appreciate you coming in today. Here is the referral for a nearby community center, they offer play activities for children Reggie’s age - let me know how that works out.

24. Craig’s Background information Nutrition hx indicates: No medical conditions Craig gets 45 minutes of exercise a few times a week and plays everyday around the house. He is in the 85 th percentile for all areas Mom’s says she takes him to “play dates” with other parents and their children...Its great! He is four.

25. Ready or Not? If you hear…Since my last visit to WIC I have taken Craig to the neighborhood “play date” for toddlers for a 45 minutes every other day. If you see…Reggie has gotten taller and weight gain has slowed down.

26. Ready or Not? Do you think his parents are : Not Ready? Unsure? Ready ?

27. Ready or Not? Do you think his parents are : Ready!

28. Readiness for Change If they are… Our goal is to… ReadyDiscuss parent concerns and build on current strategies

29. PROBING & RESOURCES Probe(s) I can see you are satisfied with Craig’s development.– He has gotten taller and he looks great! You mentioned “play dates” with other parents and their children. How’s that working for you? Tell me more? Possible Education Topics to give or discuss: Copy of growth chart to give to his HCP Active living for families Child’s Play

30. Affirm and Ask Permission You have made a lot of healthy changes in balancing what you eat with what you do. Would it be okay to ask you another question about Craig? What do you think the next step is in becoming more physically active with Craig?

31. Closing Affirmation You are a real warrior! You are doing it all and keep up the good work with Craig! Let me know if you need any more information on keeping your family more active.

32. 5 Steps REVIEWED! 1.Probe readiness 2.Identify education topics to discuss based on readiness 3.Affirm and Ask Permission to educate on topic identified based on parent’s concern and the child’s risk codes 4.Provide resources to support education topic. 5.Use a closing affirmation

33. Your Closing Affirmation! You all are a real warriors! Keep up the good work! Let me know if you need any more information on keeping your WIC family more active.