CYFAR Suite

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Market Statement

The Healthy Living Program (HeLP)/La Vida Saludable is an evidence-based, community-delivered, whole-family-inclusive lifestyle program designed to support mental health and healthy weight for teens from low-income families. HeLP was “designed for dissemination,” a paradigm that involves developing community-based programs from research knowledge through systematic, incorporation of stakeholder input through every stage of design and implementation/dissemination. Consistent with CBPR principles, this approach incorporates inherent wisdom/knowledge possessed by communities—critical to feasibility, acceptability, effectiveness, and sustainability. HeLP includes a teen component, parent/caregiver component, and family component, for four key modules. The teen component includes (i) teen group exercise training and (ii) teen group mindfulness training for stress management. School-age siblings participate in exercise training, and preschool-age siblings participate in a food exposure experience to increase acceptance of healthy foods. The parent/caregiver component includes (iii) parent education and tools (e.g., goal setting, structure) to support family lifestyle change. All caregivers are invited to attend (i.e., mother/father figures, grandparents, and so forth). The family component is skill-building through (iv) hands-on cooking, meal planning, shopping, and family mealtime, with all family members included.

Program Implementation

This past year, the CYFAR award provided the opportunity to further refine and optimize the Healthy Living Program (HeLP), along with making significant strides in implementing this whole family-inclusive, intensive (26+ hour) health behavior and lifestyle program in rural Southwest Colorado. The activities outlined in the state report primarily focus on the La Plata County site. To date, we have completed 8 intervention cohorts of HeLP to families in La Plata County, with 3 of those cohorts conducted during the 2024 reporting period—two intervention cohorts in Durango, Colorado and one cohort in Bayfield, Colorado. The Durango cohorts were delivered bilingually in Spanish and English, and the Bayfield cohort was delivered in English. Notably, cohort 5 was the largest group of families, to date, with 18 total participants, including 9 teens, 7 parents/guardians, and 2 siblings. Over the past year, our evaluation team continued to conduct focus groups with parents/guardians, adolescents, and HeLP facilitators in order to gather critical information that will help us to refine the HeLP delivery processes and content, ensuring ongoing optimization of HeLP for dissemination in rural Southwest Colorado. Over the past year, our team focused on refining the facilitator training procedures with the goals of (1) supporting facilitators to feel more prepared when delivering the program and (2) ensuring program fidelity as we scale out HeLP to Montezuma County and other locations within La Plata County. Evaluations (occuring at baseline, post-intervention, and one-year follow-up) from this year’s implemented cohorts is ongoing. Throughout the course of the past year, community engagement continued to be a pillar of HeLP implementation. We met quarterly with our La Plata County Community Advisory Board (CAB) to gather input on program implementation, evaluation planning, and community acceptability. Seven new members joined the La Plata County CAB, bringing the total to 13 CAB members in La Plata County. We held 4 La Plata County CAB meetings in the last year. Additionally, we successfully established a new Montezuma County CAB with 5 members and held 1 kick-off meeting. Moreover, we successfully hired a new team of facilitators for Montezuma County, with facilitator training scheduled to begin in ~March 2025. Our goal is to launch the first Montezuma County HeLP cohort in ~May 2025. Furthermore, within La Plata County, we continue to expand delivery sites. In particular, through engagement with the Southern Ute Indian Tribe Health Services, we are now on track to begin programming in Ignacio, Colorado, in the summer of 2025.

Community Integration

Community integration has been essential at every stage of this project. The program is delivered by a team of local community members who share lived experiences with our target rural population. Programming takes place at trusted, convenient locations in each town, identified by community members, which enhances acceptability and comfort for families and reduces barriers to participation. Collaboration with Community Advisory Boards (CABs) has been a cornerstone of our work. CABs have provided invaluable input on program evaluations, guided adaptations based on focus group findings, and supported efforts related to facilitator hiring and participant recruitment. Members of the CABs come from a variety of professional sectors—such as education, healthcare, youth services, and food resource allocation. During the most recent reporting period, we held 4 CAB meetings in La Plata County and welcomed 7 new members to the board. In addition to the ongoing CAB in Durango/Bayfield, we formed a new CAB in Montezuma County in 2024. This new board has already played a key role in identifying community locations for program delivery, determining preferred scheduling, and assisting with facilitator hiring in Montezuma County. We will continue to work closely with both CABs to guide the project’s development. The project team has also built strong community partnerships with organizations such as the Southern Ute Indian Tribe Health Services in Ignacio, United Way–Team Up, Montezuma County Extension, and the Public Health Department in Montezuma County. A large focus of these partnerships is referrals of participating families. Our partnerships have been key in promoting the program. In turn, we provide families with community resource referral support. Our community navigation of resources has historically ranged from medical care (40%), education (20%), mental health (13.3%), and food resources (6.7%), among others. Overall, community integration will remain a priority as we continue with this project.

Technology Integration

To date, technology has been used in several ways, including: 1) training community-based program facilitators with videos of mock sessions and training recordings; 2) hosting video-conference team meetings across all program sites; 3) holding hybrid and remote Community Advisory Board (CAB) meetings; 4) running program sessions for participants who are sick or during inclement weather; 5) reminding families of home practices between sessions; and 6) creating a program website for families and the community, serving as a tool for participant recruitment, community engagement, and as an ongoing resource for families who have completed the program. Recent progress in integrating technology into the Healthy Living Program (HeLP) has been made possible by the donation of 5 tablets from Cooking Matters (Nourish Colorado). While these tablets have not been widely used yet, they have been and will continue to be used as a tool to collect survey data from families during the pre- and post-program evaluation. Additionally, we plan to use these devices to support families in instances where program sessions need to be held virtually. This past year, we have sustained and established partnerships with pediatric healthcare groups that serve our target population. As part of these partnerships, we are working on enhancing technology through electronic health records and patient navigators to help streamline family referrals for the program.

Sustaining

To support the likelihood of long-term sustainability of The Healthy Living Program (HeLP), we are focusing on two key strategies: (1) securing funding from sponsors dedicated to youth, family, and community wellness, and (2) strengthening partnerships with community organizations that can support program implementation, such as schools and rural healthcare practices serving youth. We have applied for, and will continue to apply for, supplemental funding through federal and state sources. Additionally, we are committed to sustaining our existing partnerships with community organizations that have supported the project over the years, while expanding our network to include new partners in both La Plata and Montezuma Counties. Our collaborations with local school districts have been particularly effective in promoting HeLP. Furthermore, we are building connections with pediatric healthcare providers in Southwest Colorado who serve our target population and can refer families. These include Pediatric Partners of the Southwest, Every Child Pediatrics, the Southern Ute Indian Health Service, and others. Overall, these combined efforts are helping us expand the program and build a foundation for its long-term sustainability.

Short-Term Results

• Teens acquire the knowledge, skills, attitudes, and behaviors necessary for healthy stress management

  1. How many participated in the evaluation? 15

  2. Evaluation Type used: Stress management will be assessed with teen report on the Difficulties in Emotion Regulation Scale-Short Form, a questionnaire that asks teens to report on how they relate to or respond to their emotions. Teens also will complete the Life Skills CYFAR Common Measure.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up.

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 43 participants have completed these assessments.

• Teens will acquire the knowledge, skills, attitudes, and behaviors necessary for healthy eating as a result of program participation

  1. How many participated in the evaluation? 16

  2. Evaluation Type used: Eating behaviors will be evaluated using the free Automated Self-Administered 24-Hour Dietary Assessment Tool, which assesses dietary intake, including total energy intake, macronutrients, fruits/vegetable consumption, and overall quality of diet. The Reward Based Eating Drive Scale will be used to measure hedonic eating.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up.

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 40 participants have completed these assessments.

• Teens will acquire the knowledge, skills, attitudes, and behaviors necessary for enjoyment of physical activity as a result of program participation

  1. How many participated in the evaluation? 14

  2. Evaluation Type used: Physical activity enjoyment will be assessed with teen report on the Physical Activity Enjoyment Scale and self-efficacy on the Exercise Self-Confidence Survey. Physical activity frequency will be assessed with wrist-worn trackers (ActiGraph GT3X) to monitor objective changes in total/light/moderate-to-vigorous activity and sedentary time.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up.

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 44 participants have completed these assessments.

• Teens will acquire the knowledge, skills, attitudes, and behaviors necessary for positive sleep health (contributor to mental health, eating, and physical activity) as a result of program participation

  1. How many participated in the evaluation? 14

  2. Evaluation Type used: Wristworn trackers (ActiGraph GT3X) will be used to objectively measure sleep health, including duration and disturbances (e.g. awakenings, sleep-onset latency). Teens will report sleep quality on the Pittsburgh Sleep Quality Index.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up.

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 43 participants have completed these assessments.

Long-Term Results

• La Plata and Montezuma Counties will have increased capacity to support the mental health needs of teens in their communities

  1. How many participated in the evaluation? 15

  2. Evaluation Type used: Increased community capacity to meet mental health needs of teens will be measured in two ways: 1) focus groups with health educators and referring community to assess subjective experiences of changes in community capacity to meet the mental health needs of teens and 2)1-year follow-up changes in mental health using Difficulties in Emotion Regulation Scale-Short Form and Life Skills CYFAR Common Measure, will be compared relative to pre-program and post-program measures, among teens who participated in the program.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up.

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 43 participants have completed these assessments.

• La Plata and Montezuma Counties will have increased capacity to support healthier weight gain among teens in their communities

  1. How many participated in the evaluation? 15

  2. Evaluation Type used: Increased community capacity to support healthier weight gain of teens will be measured in two ways: 1) focus groups with health educators and referring community to assess subjective experiences of changes in community capacity to meet the physical health needs of teens and 2) 1-year follow-up changes weight gain (measured height/weight to compute raw BMI and age/sex-adjusted metrics), will be compared relative to pre-program and post-program measures, among teens who participated in the program.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up..

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 47 participants have completed these assessments.

• La Plata and Montezuma Counties will have increased capacity to support the metabolic health and reduced risk of obesity-related preventable chronic disease among teens in their communities

  1. How many participated in the evaluation? 13

  2. Evaluation Type used: Increased community capacity to support metabolic health/reduced risk of obesity-related preventable chronic disease in teens will be measured in two ways: 1) focus groups with health educators and referring community to assess subjective experiences of changes in community capacity to meet the physical health needs of teens and 2) 1-year follow-up changes in metabolic health (resting blood pressure, HbA1c average blood sugar by finger stick), and age/sex-adjusted metrics), will be compared relative to pre-program and post-program measures, among teens who participated in the program.

  3. When was it given or conducted? These evaluations were conducted at three different timepoints: 1) baseline/pre-program, 2) post-program, and 3) one-year follow-up.

  4. Analysis In progress

  5. Findings In progress

  5. Implications We will evaluate changes when we have reached the target sample of 100 adolescents. The reported number above is just for this reporting year. Since 2022, about 45 participants have completed these assessments.