CHILDHOOD OVERWEIGHT TREATMENT PROGRAMME - SCOTT

Introduction

This is an individualised family childhood weight management programme based on the SCOTT project (Scottish Childhood Obesity Treatment). It is an office based one to one treatment programme which can be delivered in primary or secondary settings. It adheres to both the SIGN 115 and NICE 43 guidelines by educating on necessary changes in diet, physical activity and sedentary behaviour, while incorporating behavioural change techniques which are underpinned by theoretical models. Our programme gives service providers an important individualised family based paediatric treatment that can be adapted by health care professionals and service providers to suit local circumstances. It can be easily incorporated into a multi-stranded weight management strategy, thus enabling service providers to meet Government targets.

Importantly our treatment programme has been evaluated in an RCT and a qualitative study, both funded by the Scottish Chief Scientist Office; with results published in peer reviewed medical journals (Hughes et al 2008; Stewart et al 2008). The SCOTT project was the first British childhood obesity treatment RCT to be published in a peer reviewed journal, with the results showing a modest but real decrease in BMI SD score and measured improvement in quality of life.

Brief programme outline

This is a practical, best practice behavioural programme delivered on a one to one basis (i.e. one health professional to one family). It is an evidence based, published paediatric weight management programme that is reproducible within the NHS. The programme uses a family-centred approach where the child (and family) are enabled to take control of their own lifestyle changes. Various behavioural change techniques, guided by both the transtheoretical model of change and the social cognitive model of behaviour change are employed to enhance the child's and family's motivation for making healthier lifestyle changes. The programme consisted of a minimum of eight appointments, with at least 1 of these parents only; we recommended 10 appointments with 2 parent only sessions.

The programme is educational and children are encouraged to alter their diet using a modified traffic light scheme, to increase their physical activity to at last one hour per day and to restrict their screen time (TV viewing and playing computer/video games) to no more than two hours per day.

A paper describing the SCOTT intervention in more detail was published in 2005. (Stewart et al 2005) Continuing modification of the programme allows us to incorporate new evidence on childhood weight management as it is published.

CWC training and on-going mentoring

Initial training on programme over 2-3 days - depending on participants' experience.

On going support with trained staff receiving

Our programme of training and on-going mentoring support will help to ensure quality control of programme delivery. As well as allowing staff to reflect on their use of programme, extend their transferable skills and continue with clinical updates on best evidence for management of childhood obesity.

Benefits to Service Provider

  1. 1. Service providers will be able to meet Government targets on childhood obesity by delivering -
    • a paediatric weight management programme which is evidenced based, published and reproducible
    • a programme which focuses on health, well being and quality of life of children and their families
    • a quality patient centred programme which focuses on the child and family taking control of their health choices and weight management
    • a programme which promotes healthier lifestyle and physical activity
    • a programme that can be delivered close to need in primary, secondary or non NHS settings
    • a programme which ensures staff are continuously trained to a high level to deliver a quality service
    • o a care service which has the inbuilt facility to incorporate continuing advancements in the evidence base
  2. 2. Service providers are assured that patients are receiving a proven clinical service based on sound best practice evidence due to -
    • staff trained in delivering a childhood weight management programme incorporating behavioural change techniques (NICE and SIGN recommendations)
    • staff trained in the most up to date evidence on childhood obesity and weight management
    • service delivering an evidence based treatment programme
    • staff enabled with a 'tool kit' for managing childhood obesity
    • staff gaining transferral clinical skills
    • service delivering a treatment programme that complies with both NICE 43 and SIGN 115 guidelines
    • ongoing clinical support for childhood weight management team from leading UK experts in childhood obesity
    • assurance that staff's clinical skills are being regularly assessed and improved
    • staff will have knowledge of the most up to date research evidence on childhood obesity with the flexibility to incorporate new evidence in to the treatment programme
    • staff will have online access to other like minded and well trained practitioners in childhood obesity and weight management

Programme references

Hughes AR, Stewart L, Chapple J, Reilly JJ, et al Randomized controlled trial of a best practice individualized behavioral program for treatment of childhood overweight: Scottish Childhood Overweight Treatment Trial (SCOTT). Pedatrics;March 2008 (in press)

Stewart L, Chapple J, Hughes AR, Poustie V, Reilly JJ. Parents' journey through treatment for their child's obesity: qualitative study. 2008;93:35-39.doi:10.1136/adc.2007.125146

Stewart L, Houghton J, Hughes AR, Pearson D, Reilly JJ. Dietetic Management of Pediatric Overweight: Development of a practical and evidence-based behavioral approach. Journal of the American Dietetic Association 2005;105(Nov):1810-1815.

Service provider's responsibilities

The service providers will be responsible for

  1. Funding their staff to undertake all the training sessions and the treatment programme.
  2. Only nominating staff for training with sufficient experience and motivation to work in this area.
  3. Funding travel expenses for the training sessions either for their staff to a central training point or for the trainers to their premises.
  4. Supplying suitable training facilities for the initial and on going training.
  5. Collecting agreed data to be shared with the CWC for audit purposes.
  6. Entering into a legal agreement with the CWC for the undertaking of ongoing training and clinical support for a minimum period.

We anticipate that service providers would purchase the programme for a minimum of three years.


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