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1 Commonwealth of Massachusetts Department of Public Health Worksite Wellness Program Toolkit Version 3.1, July 2009 2 Credits: This toolkit was developed by the Worksite Wellness team at the Massachusetts Department of Public Health in collaboration with Mari Ryan of Advancing Wellness. Feedback If you have questions on the content of this Toolkit, or would like to provide feedback or results from using this guide contact Lisa Erck, email: email@example.com or Maria Bettencourt, e‐ mail: email@example.com. Version 3.1, June 2009 3 Table of Contents Table of Contents............................................................................................................................ 4 Introduction .................................................................................................................................... 6 Types of Worksite Wellness Programs ......................................................................................... 10 Overview of Program Development Cycle.................................................................................... 12 Step 1 Obtain Mandate for Wellness Program............................................................................ 14 Step 2 Compose Wellness Team.................................................................................................. 24 Step 3 Research & Discovery/ Identify Needs ............................................................................ 36 Step 4 Formulate Goals & Objectives ........................................................................................... 79 Step 5 Plan Development ............................................................................................................. 93 Step 6 Plan Approval .................................................................................................................. 177 Step 7 Implement the Plan ......................................................................................................... 181 Bibliography ................................................................................................................................ 187 Glossary…………………………………………………………………………………………………………………………………189 Workplace Wellness Toolkit Workplace Wellness Toolkit Introduction Worksite Wellness Toolkit Page | 6 Introduction Worksite Wellness Programs in Massachusetts Today Massachusetts, similar to most of the nation, is facing an increased burden of illness related to a variety of risk factors and chronic conditions. One in every three Massachusetts adults is affected by a chronic disease, including obesity, asthma, heart disease, diabetes, or stroke (Health, 2006). While this chronic disease burden seems astounding, the economic burden is even more overwhelming. In 2005, total hospital charges approached the $3.2 billion mark for chronic diseases (Policy, Fiscal Year 2005). Having a healthier workforce benefits both employers and employees. There is expanding evidence that Worksite Wellness Programs not only improve individual employee health but • reduce sick leave absenteeism by 28%, • reduce healthcare costs by 26%, • reduce workers' compensation by 30%, • and produce a $5.93‐to‐$1 savings‐to‐cost ratio. (Chapman L. S., 2003) The impact of Worksite Wellness Programs on adults and their families can be significant considering 66% of adults, or 3,122,010 people, are in the Massachusetts workforce (Bureau, 2006). Active living, healthy eating, managing stress, and avoiding tobacco are essential in lowering the risk of chronic disease. The majority of adults spend most of their waking hours at work. The Worksite can make it easier for employees to change their behaviors by creating a culture of health. This toolkit provides a guide for employers, employees, and their loved ones to change their environment and behaviors to improve health and reduce the burden of chronic disease. "It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change." The Institute of Medicine Worksite Wellness Toolkit Page | 7 Once largely stand alone enhancements, Wellness Programs are becoming fully integrated within worksites. Worksite Wellness Programs, in coordination with health and safety initiatives and health benefit design programs, are providing more effective ways to deliver information about how to utilize existing healthcare benefits to improve health. By creating a culture of health, with senior management support and dedicated resources towards health improvement, worksites are able to integrate wellness into the overall vision and mission statement of the organization. Worksites can create new policies and changes in the worksite environment to support health and wellness. For example, employers can negotiate with companies to place healthy foods in vending machines, or improve stairwells or outdoor spaces to support opportunities for physical activity. What is the Massachusetts Plan for Worksite Wellness The vision of the Massachusetts Worksite Wellness Initiative is that all worksites in Massachusetts will provide social, cultural and physical environments that support optimum employee health and well‐being. Our mission is to promote worksite wellness through information, training, regulation and technical assistance. The Massachusetts Worksite Wellness Initiative has three goals related to three outcome areas: employees, worksites and communities. • Worksite Wellness program strategies will improve the health and well‐being of all employees across the Commonwealth. • Worksite Wellness will result in healthier worksites that result in positive returns on investment for employees and employers. • Worksite Wellness will support the creation of healthy communities and improved health systems and public policies that improve population health. Worksite Wellness Toolkit Page | 8 The Toolkit This Worksite Wellness Program Toolkit was developed to provide a guide and tools for planning a Worksite Wellness Program. Best practices research frequently cites having a formal planning process as a critical success factor for a Worksite Wellness Program (Goetzel, Ozminkowski, Asciutto, Chouinard, & Barrett, 2001). This toolkit describes the complete steps necessary for creating a successful Worksite Wellness Program at a company or worksite. It incorporates the best thinking of experts in the field; including all steps in this process will lead to the greatest success. The appendices in this toolkit include resources that can assist worksites with improving opportunities for physical activity, access to and consumption of healthy foods, and access to smoking cessation treatment. In addition, there are descriptions and examples of policies that make it easier for all employees to engage in healthy behaviors. Finally, for employees with or at high‐risk for developing chronic conditions there are suggestions and resources on how to improve screening and disease management. Worksite Wellness Toolkit Page | 9 Types of Worksite Wellness Programs A worksite wellness program is "an organized program in the worksite that is intended to assist employees and their family members (and/or retirees) in making voluntary behavior changes which will reduce their health and injury risks, improve their health consumer skills and enhance their individual productivity and well‐being." (Chapman L. S., 2005) The wellness program should address those areas of highest risk for the employee population. The most prevalent programs offered by employers as part of wellness programs are: • Back care and injury prevention • Physical exercise • Stress management • Tobacco use • Substance abuse prevention. Additional programs that constitute the 'core' of wellness programs include: • Weight management • Medical self‐care • Consumer health education • Cholesterol reduction • Nutritional interventions • Selected biometrics testing • Hypertension management. Worksite Wellness Toolkit Page | 10 Program Design The program model used to organize the wellness program is an important decision for the organization. The model selected will be driven from the needs and interests of the employee population, and the goals for the program, as established by the wellness team and management sponsor. The following models illustrate program options: Figure 1 – Worksite Wellness Program Models (Chapman L. S., 2005) Quality of Work Life programs typically cost $10 ‐ $45 per employee per year, exclusive of staffing costs. The return on investment (ROI) is between 0:1 and 1:1.5 (expressed as a cost/benefit ratio). A Traditional program model typically costs between $46 and $150 per employee per year, and is supported by a dedicated staff person and a formal budget. A ROI of 1:3.0 can be expected within 12‐14 months of program initiation. The Health and Productivity Management Model (HPM) ranges from $300 to $1,000 per employee, with anticipated ROI of 1:3.6 to 1:7.0 (Chapman, 2005) Worksite Wellness Toolkit Page | 11 Overview of Program Development Cycle The Massachusetts Worksite Wellness Initiative has adopted a seven step process for developing a comprehensive wellness program plan. For the purposes of this toolkit, the seven step process was adopted from the Wellness Program Development Cycle and is shown in Figure 2 (Ryan & Chapman, 2008). Figure 2 ‐ Wellness Program Development Cycle Worksite Wellness Toolkit Page | 12 Worksite Wellness Program Development Cycle The following is a brief overview of the planning steps: 1. Obtain Mandate for Wellness Initiative – in this step the mandate for the wellness program is obtained from senior management. 2. Compose Wellness Team – the wellness team is identified, mobilized and a structure is established for the planning effort. 3. Research & Discovery/Identify Needs – in this step a variety of organizational data is gathered relevant to the worksite population and existing programs. The material is evaluated to answer specific questions and identify key characteristics about the target population, and identify and document interests and needs for the proposed worksite wellness program. 4. Formulate Goals & Objectives – wellness program goals and objectives are defined using information from the research and discovery activities. 5. Plan Development –interventions are selected and program activities defined to accomplish the program goals and objectives. The anticipated effect and outcome measures are defined and will serve as the means by which program results are measured going forward. 6. Plan Approval – in this step the detailed program proposal including economic justification is developed, then submitted for review and approval to garner full support for the plan. 7. Implement Plan– this step encompasses the tasks for developing the full program implementation plan and carrying out the plan. The goal of this process is to create a detailed plan for the wellness program, identify the steps needed to realize that vision, documents those steps in a plan that works, and is easy to understand and implement. Worksite Wellness Toolkit Page | 13 Step 1 Obtain Mandate for Wellness Program Worksite Wellness Toolkit Page | 14 Step 1 – Obtain Mandate for Wellness Program Background The purpose of this step is to gather support from senior management of the organization. This step encompasses the tasks that must be accomplished prior to formal initiation of the program. The worksite wellness program must have a clear mandate from the organization's senior management. Without it, the program is bound to struggle to obtain resources, support and participation. Senior management controls the resources you will need to plan, implement and evaluate the wellness program. Their direct participation validates the importance of the program to all employees. Receiving this mandate is typically the result of establishing an understanding of the values and benefits of such programs with key members of the management team. Senior managers are also responsible for establishing and modifying organizational policies. To be successful, the wellness program will need supportive organizational policies. In successful Worksite Wellness Programs, senior managers lead their organizations by example. The successful Worksite Wellness Program is integrated into the organizational structure and is highly valued by company management. Wellness programs and activities are clearly aligned with company‐wide goals and a budget for Worksite wellness has been established. Senior management's role is to communicate the importance of the Worksite Wellness Program to all employees and to create a culture of health in the organization. These senior managers ensure that sufficient financial resources are allocated to wellness, that the health goals of the organization are measured, and that staff is held accountable for meeting the goals. They also ensure that managers and supervisors are educated and supportive of the Worksite Wellness Program. Worksite Wellness Toolkit Page | 15 Tasks 1. Identify a wellness sponsor 2. Understand the organization's priorities 3. Identify organizational values 4. Identify benefits of the program 5. Gather information on leadership style Tools Worksheet 1 – Obtain Mandate – Working Notes Worksite Wellness Toolkit Page | 16 Task Detail 1. Identify a Wellness Sponsor The mandate from senior management is usually supported by a 'sponsor'. The sponsor is typically a senior manager/executive within the organization who is willing to be visible and active in supporting and promoting the wellness program. Ideally this should be the Chief Executive Office, Director, Commissioner or the Chief Human Resources Officer (Ryan & Chapman, 2008). 2. Understand the Organization's Priorities The worksite wellness program must align with and support the overall priorities of the organization. The program should seek alignment by understanding the strategy, mission, vision, objectives, and financial position of the organization. The wellness program should be positioned to support the short‐ and long‐term strategic goals. 3. Identify Organizational Values Gathering information about the organization's values will lay the groundwork for positioning and planning the wellness program. Look at the organization's history, policies, culture, and community interactions. 4. Identifying Benefits of the Program Management's job is to meet their objectives. In order to support this, the wellness program must be able to demonstrate value and benefits to the organization. It is important to research and document the potential outcomes the wellness program can provide to the organization. Resources and support for wellness programs result from having clearly stated values and benefits. Identifying values and benefits that are relevant to the organization will facilitate the process for obtaining and maintaining the leadership mandate. Table 1 outlines values and benefits of wellness programming. (Chapman L. , 1997) By familiarizing yourself with these potential values and benefits, you can determine which are important to your organization's decision makers. These values and benefits will serve as a foundational element of the wellness program plan. 5. Gather Information on Leadership Style An understanding of how decisions are made in your organization will help you prepare and present the supporting information and plan in a way that will be well received. Consider the organization's management styles such as decision‐making style (committee or independently) and information style (detailed report with charts and Worksite Wellness Toolkit Page | 17 graphs or presentation and discussion of concepts/ideas) to support overall planning and communication of the wellness program. Tools: Use Worksheet 1 – Obtain Mandate – Working Notes to consolidate working notes on these key readiness topics. Worksite Wellness Toolkit Page | 18 Table 1 - Values and Benefits Associated with Health Promotion Programming The following are representative worksite focused values and benefits (Chapman L. , 1997) Value or Benefit Statement Supporting Data and/or Documentation Increased worker morale Studies using survey instruments that measure employee morale, industry or trade association data, human resource annual surveys with carefully selected questions. Potentially greater employer loyalty Survey results and patterns over time, use of loyalty proxy questions, and survey or focus group findings Improved employee resiliency and Studies from psychological and exercise physiology literature decision making quality Positive public and community Recognition awards for local or peer employers, coalition or community consortium relations activities, industry and trade show‐case or write‐ups. Increased worker productivity Business and industrial management studies, selected studies from the worksite health promotion literature, local or trade data using collective productivity indicators. Informed, health care cost‐conscious Studies and anecdotal articles about consumer activism, scores from consumer workforce health knowledge surveys, survey results on self‐efficacy and consumerism. Recruitment tool Social psychology literature and business survey literature, selected labor market survey data. Retention tool Social psychology literature and business survey literature, selected labor market survey data. Opportunity for cost savings from A large number of worksite health promotion studies that address sick leave reduced sick leave absenteeism absenteeism effects, survey data from National Institutes of Occupational Health & Safety (NIOSH) and from trade and industry associations. Opportunity for cost savings from Articles on worksite health promotion studies and their impact on disability days, reduced short‐ and long‐term benefits and business surveys, risk management literature. disability claims Opportunity for cost savings from A moderate number of articles on the evaluation of worksite health promotion decreased health care utilization programs and their impact on health care costs, the medical care research literature and the managed care research literature, which also contain a variety of references; another major set of references are the actuarial studies that have been done on the relationship of health risks to health costs. Opportunity for cost savings via: Studies of early medical or disability retirement from the benefits, disability Reduced premature retirement management, and actuarial literature. Opportunity for cost savings via: Worksite health promotion evaluation literature, business and benefits Decreased overall health benefit costs management literature, trade or competitor information. Opportunity for cost savings via: Worksite health promotion evaluation literature, risk management literature, safety Fewer on‐the‐job accidents literature, NIOSH publications, publications of the Bureau of Labor Statistics. Opportunity for cost savings via: Casualty underwriter's publications and risk management literature. Lower casualty insurance costs Opportunity for cost savings via: Business literature plus projections at various sick leave and disability reduction Smaller total workforce levels, review of personal replacement cases that have occurred in the last 2 to 5 years. Opportunity for cost savings via: Occupational health literature and payroll system coding data. Reduced medical leave time Opportunity for cost savings via: Occupational health literature and occupational health unit data. Reduced occupational medical costs Worksite Wellness Toolkit Page | 19 The following are representative community focused values and benefits (see cited article for full list): Provides a model for other local Community health promotion literature and community organization literature organizations plus Robert Wood Johnson Community Snapshots Project Improves quality of life of citizenry Community Health Care Forum materials and National League of Cities Publications Helps improve the general economic Community health promotion literature and national econometric studies and well‐being of communities through analysis the improvement in general health status and productivity The following are representative individual focused values and benefits (see cited article for full list): Increased morale via employer's, Social psychological and psychological literature provider's or community's interest in their health and well‐being Increased knowledge about the Attitude and correlated research within the health promotion and health relationship between lifestyle and education literature. health Improved health and quality of life Literature surrounding the use of SF12 and SF36 and self‐reported perception of through reduction of risk factors health status Reduced work absences Attitude and correlated research within the health promotion and health education literature Reduced out‐of‐pocket and premium Attitude and correlated research within the health promotion and health costs for medical care education literature plus Bureau of Commerce and Census publications Worksite Wellness Toolkit Page | 20 Exercise – Values and Benefits of the Wellness Program The purpose of this exercise is to identify the values and benefits that you believe are most important for your organization's wellness program. Using Table 1, identify the top three value or benefits statements: Statement 1: __________________________________________________________ Statement 2: __________________________________________________________ Statement 3: __________________________________________________________ Worksite Wellness Toolkit Page | 21 Worksheet 1 – Obtain Mandate - Working Notes Wellness Sponsor Who is the leadership "sponsor" for the worksite wellness program? Organization's priorities and goals What are the organization's strategic priorities and goals? What values and benefits will the initiative provide (insert results from Values and Benefits Exercise) Identify the values and benefits that the organization will realize from the wellness program. What are the leadership styles of key members of management Identify the individual values and their key leadership styles Worksite Wellness Toolkit Page | 22 Worksite Wellness Toolkit Page | 23 Step 2 Compose Wellness Team Worksite Wellness Toolkit Page | 24 Step 2 - Compose Wellness Team Background The wellness program is not something one person owns or creates – it takes a cross‐functional team to plan for and implement a successful program. This step encompasses the tasks that must be accomplished to create the stakeholder group that will provide input to the planning process. A wellness team is an essential part of a Worksite Wellness Program infrastructure. The role of the wellness team is to communicate, participate, motivate, and support the Worksite Wellness Program. Key components to a successful wellness team are: • Members are formally appointed and it is clear that senior management values the work of the team. • Members have wellness responsibilities written into job descriptions and performance reviews. • The team is publicized throughout the organization and employees know that wellness is an organizational priority. • There is a dedicated "wellness leader and wellness champion" in charge of managing the wellness team and responsible for communicating and supporting wellness initiatives at the Worksite. • The team has strong leadership from a person who can develop agendas, manage personalities, define priorities, effectively communicate, and motivate others. • Members represent all segments of the employee population (including shift workers and workers with disabilities). • The team meets regularly to assess company needs and design, implement, and evaluate the Worksite Wellness Program. (Hunnicut, 2007) Employers and employees should be well represented on a wellness team that helps design and implement the Worksite Wellness Program. A wellness team should include senior management, human resources, and representatives from major areas or divisions within the worksite. It should meet as needed to develop, implement, and evaluate the Worksite Wellness Program. The team assesses the needs and desires of employees as well as the work environment. By knowing the resources for wellness activities that exist Worksite Wellness Toolkit Page | 25 within the company and the needs and desires of the employees, a wellness team can develop a tailored program with the greatest impact. The wellness team may identify external partners to help implement the program. For example, if a large number of employees have weight concerns, the employer might negotiate with a local "Y" or gymnasium for group membership rates or with the city or town to create new walking or bicycle paths. Physical activity could be increased by identifying a convenient walking route, forming walking groups, and limiting (or even eliminating) company meetings during lunch times. Tasks 1. Define your team's composition 2. Identify the Wellness Champion 3. Assemble the team 4. Establish team protocols 5. Hold team kickoff meeting Tools Worksheet 2 – Worksite Wellness Team Meeting – Sample Agenda Worksheet 3 – Worksite Wellness Team Program Scope – Working Notes Worksite Wellness Toolkit Page | 26 Task Detail 1. Define your team's composition The wellness team should be made up of representatives from the various stakeholder groups within the organization. The type and structure of the team will depend on your organization size. Depending on your organization, you may need two collaborative groups: • The wellness committee or advisory group is an oversight group that has formal responsibility for promoting, guiding and supporting the wellness program. The members of the committee should have health promotion responsibilities as part of their job description (Hunnicut, 2007). • The wellness committee: o Represents all stakeholder groups (employees, management, labor, etc.) who will ultimately participate in the programs; o Advocates for worksite policies and environments that support the wellness program; o Serves as champions for the wellness program; o Consists of people supportive of health promotion concepts and people initiatives; o Includes people who are part of or influencers of the approval process. • The wellness planning team is a subset of the wellness committee and is responsible for the planning activities of the wellness program in conjunction with the wellness committee. In addition to wellness committee members, this group may consist of people who have job functions specifically related to the implementation of the wellness program, such as health and safety, occupational health, and human resources. Keep in mind that the groups responsible for the wellness program will vary based on the size of the organization. In smaller organizations one group will assume these responsibilities. Worksite Wellness Toolkit Page | 27 2. Identify the Wellness Champion The team needs to have a designated leader – the Wellness Champion. This person should have demonstrated leadership skills, a good understanding of the organization's priorities as well as the vision for the wellness program. The Wellness Champion should represent the values of a healthy lifestyle and be a role model for others in the organization. The Wellness Champion should have energy; strong interpersonal, communication and management skills; and be politically savvy. The Wellness Champion is the process leader for the team and should be able to: • Help the team focus on content by taking full responsibility for managing the process. • Act as a sounding board for information, thoughts and ideas. • Help the team avoid making errors that are either conceptual or process‐ oriented. • Help the team make sure to cover everything that needs to be covered. • Keep the team on schedule and move meetings along. • Tone down overly dominant personalities and make sure that any disagreements get expressed. • Ensure a realistic understanding of resource requirements and availability. 3. Assemble the Team Team Composition Research from the Wellness Council of America (WELCOA) suggests that the committee and team members should be appointed, rather than be volunteers (Hunnicut, 2007). Appointments made be senior management demonstrate a level of commitment that reinforces the support for and importance of the initiative. The individuals appointed should have both the time and interest to undertake this role. With a mandate from senior management, each participant in the wellness program should be given time to participate and have these responsibilities added to their role or job description. The team should represent a variety of viewpoints, perspectives, diversity, and personalities. Participation on the wellness committee should be viewed as a prestigious opportunity to help create a better organization, rather than a series of meetings that take the individual away from more important work assignments (Goodstein, Nolan, & Pfeiffer, 1993). Worksite Wellness Toolkit Page | 28 A scan of the organization should be undertaken to identify any other committees or groups who are doing wellness related work, such as a safety committee, an informal walking club, etc. Table 2 identifies a list of possible team wellness committee and planning team members. Table 2 ‐ Wellness Committee and Planning Team Members • Benefits manager • Communications staff • Disability management Coordinator • Employee activities • Employee assistance • Employee health services coordinator program manager manager • Fitness center staff • Human resources manager • Facilities manager (including cafeteria and vendor) • Labor relations manager • Medical director • Occupational health services manager • Risk manager • Wellness staff • Worker compensation manager (Chapman, 2007) Additional resources may be required on an ad‐hoc basis, such as internal support from marketing, communications, information systems, financial services, etc; as well as external expertise from vendors or consultants. These resources should be identified and their roles defined in the planning process. Team size Depending on the size of the organization, the wellness committee may consist of 15‐20 people. The planning team may consist of fewer – three to five people. The team should be of a manageable size encompassing different perspectives, while allowing for productive dialog. 4. Establish Team Protocols Once the team has been assembled, the next step is to establish protocols for the team's work efforts. These protocols will help the team stay focused and on task. Team Meetings The team should meet on a regular and predictable schedule, at least monthly, so that team members can plan this into their work schedule. The regularity of the meetings also demonstrates a commitment to the work of the team, and provides accountability to agreed‐upon deliverables. During the planning process, more meetings or a special Worksite Wellness Toolkit Page | 29 planning retreat may be required. Meetings should have a formal agenda and have minutes taken to record decisions and actions resulting from the meeting. Planning Time Frame Depending on the nature of the organization and the levels of support, the planning process may take between two and six months. An organization initiating a wellness program for the first time should plan on the longer timeframe. An organization with an existing wellness program will require less time to refresh the plan on an annual basis. Project Management As with any major effort, discipline needs to be applied to organize and manage resources to complete the project within the defined scope, on time and within budget. "Project management is the application of knowledge, skills, tools, and techniques to project activities to meet project requirements." (A Guide to the Project Management Body of Knowledge, 2000) Formal project management techniques contribute to the success of a project. Specific areas of focus to consider for managing the wellness program planning project include: • Project Scope Management – processes required to ensure that the project includes the appropriate work tasks and activities required to complete the project successfully. • Project Time Management – even with a strong mandate from senior management, time will be constrained and needs to be carefully planned and managed. Time management processes include scheduling and managing activity completion in a timely manner • Human Resource Management – making effective use of the people allocated to the project will include organizational planning, resource acquisition and team development. • Project Communications Management – entails the processes to ensure timely and appropriate creation, collection, distribution and storage of project information. Elements to consider include a communications plan, information distribution practices, and status reporting to the Wellness Team, sponsor and senior management. Worksite Wellness Toolkit Page | 30 It is beyond the scope of this Toolkit to provide extensive detail on project management topics. More information on project management practices is available from the Project Management Institute (http://www.pmi.org). 5. Hold Team Kickoff Meeting As the wellness program commences, kickoff meetings will help set the framework and ground rules under which the planning process will be undertaken. These meetings are intended to establish a purpose and build energy for the initiative, while delivering the message that the participation and commitment of the participants is critical and valued. Meeting Preparation and Agenda Each meeting should have an agenda. In developing the agenda, a process should be established for team members to provide input on agenda topics. A person should be indentified who will take and distribute minutes of each meeting. Worksheet #2‐ Team Meeting – Sample Agenda is a sample meeting agenda that can be modified, as needed, for the initial meeting. Creating an Open and Positive Environment An important part of the kickoff is to establish a shared purpose for the team's efforts and to create energy and buy‐in within the group for that purpose. Ingredients for a successful kickoff include: • The goals, outcomes and purposes of what's being proposed are vividly clear. • The opportunity for participants to contribute and feel part of the planning process. • The events and activities of the group reflect the values of the planning process and organization. • An open, honest communication style is established to minimize suspicion, doubt, or mistrust. • Participants feel their time is well used and that the outcomes of the session have value. • Expectations of clear and specific actions to follow the session are well communicated. (Napier, Sidle, & Sanaghan, 1998) The planning process should be a vibrant process that is intended to encourage people to constructively contribute while respecting the views and values of each individual on the team. (Bradford, Duncan, & Tarcy, 2000). Worksite Wellness Toolkit Page | 31 Exercise – Wellness Team Composition Use this worksheet to identify each of the groups within the organization that should be considered for representation on the Wellness Team. Identify groups that represent significant portions of the employee population and various demographic or types of work groups. Examples of these groups are: • Individual Departments • Union/Non‐Union • Salaried/Hourly • Females/Males • Office workers/Field workers • Professional/Administrative Worksite Wellness Toolkit Page | 32 Worksheet 2 – Worksite Wellness Team Meeting – Sample Agenda [Organization Name] Worksite Wellness Team Meeting [DATE] AGENDA Call to Order [Wellness Champion] Purpose [Wellness Champion] [Provide framing for Wellness Team and reason for mandate] Introductions Team Members Introduce yourself by providing your name, department, role, and health and wellness preferences. Distribute Team Contact List (name, phone, email address) Team Name [If the team does not have a name, it may be appropriate to start by selecting a name for the group] Decision Making Process Role of the Wellness Team Role of the Planning Team Scope of the Wellness program – Worksheet #3 [When a wellness program is first started, the parameters of the program need to be defined. Worksheet #3 provides some general parameters that will help define the scope of the initiative.] Meeting Schedule Adjourn Worksite Wellness Toolkit Page | 33 Worksheet 3 – Worksite Wellness Team Program Scope – Working Notes Participation Who should the program be targeted to and why. What resources are available Identify the organizational (people, facilities, money, etc.), community and regional resources. Decision making Identify how and when key decisions will be made. Program linkages and integration Identify how the wellness program will be linked and integrated with other related programs such as employee and benefit policies, disability management, worker's compensation, etc. Worksite Wellness Toolkit Page | 34 Worksite Wellness Toolkit Page | 35 Step 3 Research & Discovery/ Identify Needs Worksite Wellness Toolkit Page | 36 Step 3 - Research & Discovery/Identify Needs Purpose The purpose of the Research and Discovery/Identify Needs step is to collect pertinent information that will support the development of the Program Plan. Data may be collected both internally from human resources, benefits, and finance; as well as externally, from health care providers, other employers, national health promotion organizations and conferences, as available. Tasks 1. Identify data sources 2. Collect data 3. Identify needs Tools Sample Interest and Needs Survey MDPH Worksite Health Improvement Survey Summary of Worksite Wellness Program Data Worksite Wellness Toolkit Page | 37 Task Detail 1. Identify Data Sources In building a results‐oriented Workplace Wellness Program, it is important to collect information to better understand the workplace environment and the health risks of employees. There are several types of data that can be gathered to help make this assessment. Data will come from a variety of sources. The first step is to identify all possible data sources. As part of the planning process, you want to look at the data and research information collected to answer a few key questions: • What are the interests of the population? • What is driving costs? Look at internal factors such as cost and utilization as well as external factors, such as the providers, other users and technology. • What are the underlying risks within the population? • What is the future needs (control costs, improve benefits, improve morale or productivity)? Data sources should be considered from two perspectives: primary and secondary data sources. Primary Data Primary data is specific data about the population that the program will address. Consideration of the target population for the wellness program should be determined prior to initiating the data collection process. For example, if the wellness program is to be offered to both employees and spouses/partners, data for these populations should be collected. Primary data sources will provide detailed actual information about your population. This information should be aggregate information, not containing individual identifiers, in consideration of privacy and HIPPA regulations. Table 3 identifies primary data sources. Worksite Wellness Toolkit Page | 38 Table 3 ‐ Primary Data Sources Type of Data Source Population Demographics Human Resources Sick leave/absenteeism Human Resources/Benefits Disability claims Human Resources/Benefits Worker's compensation claims Human Resources/Benefits Employee turnover Human Resources/Benefits Health care plan costs Human Resources/Benefits Family Medical Leave Act (FMLA) data Human Resources/Benefits Environmental Scan/Health Culture Audit Employee Wellness Program Interest and needs survey Employee Wellness Program Health Risk Assessment (HRA) Employee Wellness Program Wellness Programming Employee Wellness Program Focus group Employee Wellness Program Health care claims including trends Health Insurance Provider Prescription data Health Insurance Provider Facilities review Facilities Management Community resources such as health clubs, Various (community health holistic health providers, etc. department, telephone directory) • An Environmental Scan, or health culture audit, is a tool that employers can use to assess the health environment of the worksite. The environmental scan looks at both the policies (e.g., flextime or smoking restrictions) and environment (e.g., on‐site walking paths or vending machine food choices) that influence health status. In addition to assessing the workplace environment, it is necessary to understand the specific interests and health risks of employees. Employee interest surveys, employee health risk appraisals, health screening results, and health insurance claims data can be used to build a solid foundation for the wellness program. • The Employee Interest Survey will uncover the met and unmet health interests of the employees. By administering an employee interest survey, employers are able to ensure that interventions are of interest and importance. It's best to conduct focus groups to talk with employees before developing the employee interest survey in order to truly understand the scope of what health improvement topics are of interest to them. Worksite Wellness Toolkit Page | 39 • A Health Risk Appraisal (HRA) is an electronic or paper tool used to assess an individual's risk of developing a disease. The HRA organizes and calculates individualized health risk information, compares it to standardized data for normal risk, and provides general quantitative measures of the individual's risk of acquiring a disease. Companies can purchase an HRA from an outside vendor. Many health insurance companies offer HRA's to their members. All individual information is confidential and the company should only have access to aggregate HRA information. No company employee should have access to an individual employee's HRA. A list of HRAs available from Massachusetts health insurance companies is provided in the Resource section of this Toolkit. • Health Screenings involve a number of physical measures such as blood pressure, body composition, cholesterol, glucose, and body mass index. These measures detect diseases and provide employees with a baseline assessment of their health. In order for a workplace to truly analyze the health status of their employees, screening results can be paired with health risk appraisal information. The results of the health screening should be shared with the employee and they should be encouraged to discuss the results with their primary care physician. • Health Insurance Claims including pharmaceutical costs, workers' compensation costs, and medical costs can be analyzed to determine the specific health conditions facing employees. Claims data may be available through insurance brokers and/or insurance companies. This baseline data of employee health risks and behaviors will paint a picture of the workplace. The key to making data collection work is confidentiality. Employees need to be assured that the employer will not have access to any individual employee health data. In addition, it should be communicated that the employer will receive only aggregate reports of the overall findings (from health screenings, claims data, and HRA data). Health claims data, while considered a key indicator of the value and effectiveness of wellness programs, has many limitations. The first is that health claims data may be hard to get. Insurers and third party administrators (TPA) may be unwilling to part with the data. To be meaningful, a minimum of 500 lives is needed to have statistical significance. Health plan data can tell you what conditions are being treated but not why those conditions exist. Worksite Wellness Toolkit Page | 40 Secondary Data Secondary data is supporting data that will provide evidence of health promotion program results and best practices, industry trends, etc. Table 4 identifies secondary data sources. Table 4 ‐ Secondary Data Sources Type of Data Source Data from Literature PsychInfo Medline (http://www.ncbi.nlm.nih.gov) Education Resource Information Center (ERIC) Cumulative Index to Nursing & Allied Health Literature (CINAHL) BIOETHICSLINE Government Health Data such as National Center for Disease Control and Prevention Center for Health Statistics http://www.cdc.gov/nchs State Health Status and Health Coverage Kaiser Family Foundation State Health Trends Facts http://www.statehealthfacts. org Worksite Wellness Best Practices Other employer groups with established wellness programs or organizations such as WELCOA www.welcoa.org Worksite Wellness Certification Programs National Wellness Institute www.nationalwellness.org New Program Considerations If your organization is planning a wellness program for the first time, you will probably not have HRA nor needs assessment data. The employee data from Human Resources identified in Table 3 should be available within any employee organization. Health claims data will provide important information about utilization of services which are driving health care costs. Conducting a needs assessment and environmental survey may be a necessary first step to understanding your population and their interests. Worksite Wellness Toolkit Page | 41 2. Collect Data Assignments for collecting data should be distributed among the members of the Wellness Program Planning team. A Sample Needs/Interest Survey and Environmental Survey has been provided as a guide to gathering key data. Establish an organized approach to collecting and storing the data. The information should be easily identifiable and the sources clearly noted. 3. Identify Needs The data collected will provide you with a view of the health practices of the employee population, their preferences and interests. Complete the Summary of Worksite Wellness Program Data form to synthesize the information collected and identify the needs for your organization's Worksite Wellness Program. Worksite Wellness Toolkit Page | 42 Worksite Wellness Toolkit Page | 43 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Worksite Wellness Needs/Interest Survey This is a sample survey that can be used in your organization as a way of gathering baseline information on the employee populations' interests and needs. The survey can be implemented electronically using internet services such as SurveyMonkey or Zoomerang. Consider selecting a tool that allows each person to get a copy of their data. The collected data will then be analyzed for trends. Worksite ________________________ Department ______________________ Date____________________________ Tell Us About Your Health Habits 1. How strongly do you agree or disagree with the following statement? I would change my lifestyle and behaviors if the quality of my health and life would improve. ○ Strongly agree ○Agree ○ Disagree ○ Strongly disagree 2. Which answer best describes how you feel about the following: I have no I have no I plan to I plan to I have I have need to plans to do within do in a been been the next 6 month doing less doing months than 6 more than months 6 months Increase cardiovascular ○ ○ ○ ○ ○ ○ activity Increase fruit and ○ ○ ○ ○ ○ ○ vegetable intake Increase strength building ○ ○ ○ ○ ○ ○ exercises Reduce my stress level ○ ○ ○ ○ ○ ○ Lose weight ○ ○ ○ ○ ○ ○ Eat less fatty foods ○ ○ ○ ○ ○ ○ Reduce alcohol intake ○ ○ ○ ○ ○ ○ Stop tobacco use ○ ○ ○ ○ ○ ○ Worksite Wellness Toolkit Page | 44 3. What is your current weight in pounds? Weight _______lbs 4. Date you were weighed or you weighed yourself _____________ 5. What is your current height? Height _____feet ____ inches 6. Blood Pressure The last time you had your blood pressure taken, was it: ○ Lower than average ○Normal ○ Higher than average ○ High 7. Cholesterol The last time you had your cholesterol level tested, was it: ○ Lower than average ○ Normal ○ Higher than average ○ High 8. General Health For your age would you say in general your health is: ○ Excellent ○ Good ○ Fair ○ Poor ○ Bad 9. I last visited my primary care physician: ○ In the last month ○ 2-6 months ago ○ Over 1 yr ago 10. In the last six months, how many times have you visited a doctor? ○ Zero ○1 ○2 ○3 ○4 ○5 ○ 6+ 11. In the last six months, how many days have you been absent from work due to illness or injuries? If none, enter zero. ○ Zero ○1 ○2 ○3 ○4 ○5 ○ 6+ 12. In the last six months, how many days were you in the hospital as a patient? Please exclude days hospitalized for a normal pregnancy. ○ Zero ○1 ○2 ○3 ○4 ○5 ○ 6+ 13. which of the following categories would you place yourself: ○ I'm not interested in pursuing a healthy lifestyle ○ I have been thinking about changing some of my health behaviors ○ I am planning on making a health behavior change within the next 30 days. ○ I have made some health behavior changes but I still have trouble following through ○ I have had a healthy lifestyle for years. Worksite Wellness Toolkit Page | 45 Current Health Habits and Interests The following questions are about your current health habits and interest in pursuing a healthier lifestyle. 14. Generally how many days per week do you participate in aerobic physical activity? If none, enter zero. ○ Zero ○1 ○2 ○3 ○4 ○5 ○ 6+ 15. Generally, how many strength training sessions do you do a week? ○ Zero ○1 ○2 ○3 ○4 ○5 ○ 6+ 16. How many servings of fruit and or vegetable do you eat per day? What is a serving size of fruit? ¾ cup 100% fruit juice, ½ cup chopped, cooked, raw or canned vegetables or 1 medium piece of fruit (i.e. a baseball). ○ Zero ○ 1-2 ○ 3-4 ○ 5-5 ○ 5-6 ○ 6+ 17. How many servings of whole grain foods do you eat per day? 'What is a serving size of whole grains? 1 slice of whole-wheat bread, 1 cup oatmeal, ½ cup cooked brown rice. ○ Zero ○ 1-2 ○ 3-4 ○ 5-5 ○ 5-6 ○ 6+ 18. Which of the following best describes your tobacco habits? ○ I have never used tobacco ○ I formerly used tobacco products, but no longer ○ I currently smoke or use tobacco products (e.g. chewing tobacco) 19. If you do currently smoke or use tobacco, have you ever attempted to quit? ○ Yes ○ No Worksite Wellness Toolkit Page | 46 20. If you still smoke or use tobacco products, what reasons has kept you from quitting? (check off all that apply) ○ No interest in stopping ○ Afraid of gaining weight ○ Helps relieve stress ○ Other (please describe)___________________________________________ 21. In the past year, have you intensely experienced any of the following symptoms for 2 weeks or more? Yes No Feelings of hopelessness ○ ○ or guilt Loss of appetite, weight ○ ○ gain/loss Decreased energy/ fatigue ○ ○ Persistent sadness ○ ○ Insomnia/oversleeping ○ ○ Difficulty making decisions ○ ○ Lack of interest in activities ○ ○ you once enjoyed Persistent or troublesome ○ ○ anxiety 22. How has a health condition (either physical or emotional) impaired your work in the past 6 months? ○ None ○ I'm about 5-10% less productive at work ○ I'm about 10-25% less productive at work ○ I'm about 25-35% less productive at work ○ I'm about 35% less productive at work Worksite Wellness Toolkit Page | 47 Program Interests 23. Consideration is being given to the focus of the program that will be offered at __________ (Company Name) as part of the Worksite Wellness Initiative. Please indicate below which of these program areas interest you and your likelihood of participating in them by placing a number from 1 to 5 next to your areas of interest - The number "1" indicating that you be least likely to participate and "5", the highest number indicating that you would be most likely to participate ___ Yoga ___ Meditation ___ Low impact physical activity ___ Stress management ___ Exploring spirituality ___ Laughter club ___ Individual wellness coaching ___ Back care ___ Eating behaviors/quality of diet ___ Active parenting ___ Asthma management ___ Mind/body/ connection ___ Getting more physically active ___ Older Adult care topics ___ Life simplification ___ Financial wellness ___ Exploring purpose and values ___ Back to nature ___ Aerobic exercise class ___ Weight management program ___ Confidential health screening ___ Intramural sports league activity ___ Health fair ___ Fitness or wellness challenge ___ Walking event or club ___ Sleeping better ___ Consumer health education ___ Medical self-care training ___ Monthly wellness seminar ___ Smoking cessation program ___ Blood pressure screening ___ Nutritional information session ___ Blood test for cholesterol ___ Self esteem workshop ___ Diabetes management ___ Other (please specify) 24. What is the best way for you to receive health information (choose two): ○ Community based-programs ○ Health advice telephone line ○ Internet-based information ○ Newsletter ○ Personal counseling ○ Printed material Worksite Wellness Toolkit Page | 48 ○ Self-help guide books ○ Support groups ○ Worksite based programs 25. Would you personally participate in a wellness program if we offered one? Yes ○ No ○ 26. Would you participate in the wellness program on your own personal time? (i.e. before work, after work, or during lunch) Yes ○ No ○ 27. What would motivate you to participate in a wellness program? ○ Incentives tied to insurance premiums ○ Monetary incentives ○ Days off ○ Merchandise or other promotional products ○ Other (please describe)__________________________________ 28. What is the biggest barrier that would keep you from participating in a worksite wellness program? ______________________________________________________________________ ______________________________________________________________________ ________________________________________________________________ If you would like to volunteer to help with the wellness program, please complete the following information: Name _________________________ Email: ________________________ Phone: ________________________ Specific interest, skills, areas of expertise: __________________________________________________ Any additional comments or suggestions for a wellness program for employees? ______________________________________________________________________ Worksite Wellness Toolkit Page | 49 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Massachusetts Worksite Health Improvement Survey - 2008 A. About Your Organization A1. How many full-time and part-time employees work in your organization? Less than 25 25 to 49 50 to 99 100 to 250 250 to 499 500 to 999 1000 or more A2. What percentage of your employees are: ______ Full time? ______ Part time? A3. What percentage of your employees have: ______ Less than a high school diploma ______ High school diploma and no college ______ Some college, but not a 4-year college degree ______ A 4-year college degree ______ A Master's degree ______ Post-Master's degree A4. Who is your health insurance provider? ('X' all that apply) Blue Cross Blue Shield Fallon Community Health Plan Harvard Pilgrim Healthcare Health New England Neighborhood Health Plan Tufts Health Plan United Healthcare Don't offer health insurance at this time Other (please specify) Other:_____________________________________________________________________________________ Worksite Wellness Toolkit Page | 50 A5. Does your organization self-fund ("self-insure") it's health insurance plan? Yes No Don't know A6. How many shifts does your organization work per day? One Two Three Other (describe below) Other:_____________________________________________________________________________________ A7. What percentage of your employees (both full and part-time) are in the following racial/ethnic categories? ______ Hispanic or Latino ______ White ______ Black or African American ______ Asian ______ Native Hawaiian or Other Pacific Islander ______ American Indian or Alaska Native ______ Other (please specify)____________________________________________ ______ Don't know A8. What percentage of your employees are women?__________________ A9. What percentage of your employees are covered by collective bargaining agreements/unions? 0% 1% to 25% 26% to 50% 51% to 75% 76% to 100% Don't know A10. What percentage of your employees speak ENGLISH as their primary language? 0% 1% to 25% 26% to 50% 51% to 75% 76% to 100% Don't know Worksite Wellness Toolkit Page | 51 A11. What percentage of your employees spend more than half of their work hours sitting at desks or work stations? 0% 1% to 25% 26% to 50% 51% to 75% 76% to 100% Don't know A12. What percentage of your employees have access to a computer at work? 0% 1% to 25% 26% to 50% 51% to 75% 76% to 100% Don't know B. Worksite Health Promotion The following questions are about company policies and resources that address optimal employee health and well-being at work (e.g. opportunities to participate in physical activity, healthy food choices, smoking cessation programs) Yes No Don't Know B1. In the past year, has your organization asked employees what types of health promotion programs and services they would like? ........... 1a. If yes, are employees surveyed annually to determine their needs? .. B2 Does your organization have a worksite wellness committee?................... 2a. If yes, is that committee made up of individuals from different levels of your workforce?..................................................................... B3. Do you have an annual budget for health promotion? ................................ 3a. If yes, how much (in dollars)?______________________________ B4. Does your organization calculate the Return on Investment (ROI) for worksite health? .......................................................................................... Worksite Wellness Toolkit Page | 52 4a........If yes, what are the calculations based on? ('X' all that apply) Absenteeism Presenteeism Health care costs Employee turnover Family medical leave Workers compensation costs Short-term disability costs Other (describe below) Other: _________________________________________________________________________________ B5. Does your organization routinely collect or monitor any of the following information? ('X' all that apply) Paid work time missed due to personal illness (sick days) Employee turnover Health insurance claims Pharmacy claims Workers' compensation claims Short-term disability claims Long-term disability claims Aggregate Health Risk Assessment (HRA) health data Presenteeism (Impaired productivity at work due to personal health conditions). Don't know Yes No Don't Know B6. In the past year, has your organization offered a Health Risk Assessment (a tool used to assess an individual's risk of developing a disease or condition)? ........................................................................................... 6a. ____________________________________ If yes, how often? Yes No Don't Know 6b........ If yes, are the results systematically tracked and shared with employees? ......................................................................................... 6c.If yes, is that information used to negotiate health insurance plans? 6d.................If yes, is this service available to spouses/dependents? 6e...................................... If yes, is this service available to retirees? B7. Do your health insurance benefits cover preventive services for employees? ........................................................................................ Worksite Wellness Toolkit Page | 53 7a. If yes, which services are included? ('X' all that apply) Blood pressure screening Breast cancer screening Cervical cancer screening Cholesterol screening Colorectal cancer screening Depression screening Diet and nutrition counseling Disease management services Hearing screening Infectious disease screening Influenza immunizations Mental health services Obesity screening Osteoporosis screening Prostate cancer screening Safety/injury and violence prevention Skin cancer screening Substance abuse/alcohol services Tobacco cessation Type 2 diabetes screening Vision screening Other services (please describe below) Other services:______________________________________________________________________________ B8. In the past year, has your organization offered any of the following on-site health screenings or preventive services? ('X' all that apply) Blood pressure screening Cholesterol screening Blood glucose screening Cancer screening Body Composition/BMI measurement Tobacco cessation Other screenings (describe below) Don't know Other:_____________________________________________________________________________________ Yes No Don't Know 8a. If yes, are the results systematically tracked?..................................... 8b. If yes, is that information used to negotiate insurance plans? ............ 8c. If yes, are the results shared with the employee's primary care physician?............................................................................................ Worksite Wellness Toolkit Page | 54 B9. In the past year, has your organization offered on-site health education classes, workshops, lectures, or special events on any of the following topics? ('X' all that apply) Nutrition or healthy eating Tobacco cessation Weight management Physical activity and/or exercise Stress management and/or yoga Chronic Disease Self Management Signs and symptoms of chronic diseases Depression Arthritis Other (describe below) Don't know Other:_____________________________________________________________________________________ B10. Through which of the following are health promotion programs offered at your workplace? Health insurance provider Company-sponsored Other (please specify) Other:_____________________________________________________________________________________ 10a. If you have health promotion programs that are sponsored by your health insurance company, who are they available to? ("X" all that apply) Insurance-subscribing employees Non-insurance-subscribing employees Spouses Retirees B11. Does your organization provide any of the following incentives or rewards to employees who engage in healthy behaviors? ('X' all that apply) Incentives tied to insurance premiums Monetary incentives Days off Other (describe below) Don't know Other:_____________________________________________________________________________________ Yes No Don't Know B12. Does your organization have an on-site exercise facility? .......................... Worksite Wellness Toolkit Page | 55 12a. If yes, what kind? ("X" all that apply) Aerobic equipment Running track Strength training equipment Other (please describe below) Other:_____________________________________________________________________________________ 12b. When is the exercise facility open? ("X" all that apply) Before work hours After work hours During work hours Yes No Don't Know 12c. Is the facility open for all shifts? .......................................................... 12d. Is the facility free or discounted to employees? .................................. 12e. Can family members of employees use the facility? ........................... 12f. Are the facilities accessible to people with disabilities? ...................... 12g. Does the facility provide group exercise classes?.............................. B13. Does your organization explicitly promote the use of the stairs?................ 13a. If yes, are the stairs: ('X' all that apply) Well-lit Maintained Advertised Centrally located Yes No Don't Know B14. Does your organization subsidize memberships to off-site physical activity facilities directly or through a health plan?...................................... 14a. If yes, is this offered to all employees? ............................................... B15. Does your organization encourage employees to bike or walk to work?... B16. Do employees have a clean place where they can eat meals with co-workers?................................................................................................. 16a. If yes, does this facility have a refrigerator? ........................................ 16b. If yes, does the facility have a microwave or oven?............................ Yes No Don't Know B17. Can employees in your organization obtain food or snacks at the workplace? ................................................................................................ Worksite Wellness Toolkit Page | 56 17a. If yes, where are foods or snacks available at your worksite? ('X' all that apply) Cafeteria Break room or company kitchen Canteen truck Vending machines Other (describe below) Other:_____________________________________________________________________________________ B18. Does your organization have a written policy to ensure that healthy food items are offered for any of the following? Vending machines Meetings or catered events Other (describe below) Don't know Other:_____________________________________________________________________________________ B19. Does your organization provide point of purchase nutrition information at any of the following places? Yes No Don't Know a. In the cafeteria? ................................................................................... b. In the canteen truck? ........................................................................... c. In vending machines?........................................................................... B20. Can your employees obtain any of the following foods in the workplace? ('X' all that apply) Fresh fruit and vegetables 100% fruit juice Low salt foods Fresh salads with low fat dressings 1% or skim milk Fat free or low fat yogurt Don't know Yes No Don't Know B21. Does your organization subsidize food items by charging more for high fat/high sugar items and less for healthier items?....................................... B22. Where is smoking permitted during work hours? ('X' all that apply) No where on company property Anywhere outside Anywhere outside except for in designated areas Anywhere outside except for near doors and windows In shared company vehicles Worksite Wellness Toolkit Page | 57 In personal vehicles Don't know Yes No Don't Know B23. Does your organization have a written policy governing employee smoking during the work day? .................................................................... B24. Does your organization have a written policy that governs an employee's ability to smoke outside of work hours?................................... Yes No Don't Know B25. Is the sale of tobacco products prohibited at the worksite? (i.e. at newspaper stands or other on-site stores or in vending machines) ........... B26. What type of assistance is offered to help people quit smoking? ('X' all that apply) Prescription medications through health insurance coverage Discounts or co-pay offsets on medications Free nicotine patches or other medications provided by the employer Free smoking cessation program on-site Smoking cessation programs offered through health plans Reimbursement for medications or smoking cessation counseling Other incentives to quit smoking (please describe below) Don't know Other:_____________________________________________________________________________________ Yes No Don't Know B27. Does your organization have a written drug and alcohol free workplace policy? ........................................................................................ B28. Does your organization mandate pre-employment drug testing for new hires? ................................................................................................... B29. Does your organization offer employees a convenient and private place (besides the bathroom) to test blood sugar with a blood glucose monitor? B30. Does your organization have an on-site health clinic?.......................…….. 30a. If no, does a mobile health unit regularly frequent your worksite?...... B31. Are your employees allowed to use paid work time to participate in health promotion activities?......................................................................... 31a. If yes, is this for: On-site, employer-sponsored activities Off-site activities not sponsored by employer Yes No Don't Know B32. Does your organization have a formal written policy allowing flexible work Worksite Wellness Toolkit Page | 58 schedules to accommodate personal/family needs? .................................. B33. Does your organization have an on-site childcare or daycare facility?....... B34. In which of the following ways does your organization support new parents? ('X' all that apply) Written maternity policy Written paternity policy Flextime options for new parents Access to a lactation consultant A lactation room at the worksite Storage facility for equipment Refrigeration for milk Other (describe below) Don't know Other:_____________________________________________________________________________________ B35. Does your organization have written policies specifically designed to prevent or minimize stress? ........................................................................ 36a. If yes, what types of policies do you have? ('X' all that apply) Strategies to address child-care issues Strategies to address elder-care issues Telecommuting Regular social events Flexible work scheduling Grievance procedures Extended disability or sick time allowance Employee Assistance Program (EAP) Sexual harassment policy Other (describe below) Other:_____________________________________________________________________________________ C. Occupational Safety and Health The following questions are about company policies and resources that address safety and health hazards at work (e.g. unguarded machines, slippery floors, noise, heavy lifting, chemical exposures, poorly designed equipment, work stress). Yes No Don't Know C1. Does your organization have a worksite committee that is responsible for dealing with workplace health and safety hazards?...................................................................................................... Worksite Wellness Toolkit Page | 59 1a. If yes, is that committee made up of individuals from different levels of your workforce?....................................................... 1b. If no, does your organization have at least one designated person who is responsible for addressing workplace safety hazards? ........... C2. Does your organization have a written policy or procedure for: Yes No Don't Know a. Reporting work-related injuries?.......................................................... b. Reporting unsafe working conditions? ................................................ c. Investigating how work-related injuries happened? ............................ C3. Does your organization conduct audits or inspections to identify worksite health and safety hazards on a regular basis? ............................. C4. Does your company reward employees (e.g. paid time off, bonuses, prizes, etc.) for periods of time when there are no injuries reported?......... C5 Does health and safety count in supervisors' and managers' promotions, pay raises, or bonuses? .......................................................... C6. Does your organization maintain a log of work-related illnesses and injuries (OSHA log)?............................................................................. Yes No Don't Know C7. Do company managers analyze workers' compensation claims data and/or injury log data to plan workplace health and safety activities? ........ C8. How often do those responsible for workplace health and safety at your worksite coordinate their efforts with managers responsible for health promotion or wellness activities? Always Often Sometimes Never Don't know Not applicable (not engaged in workplace health promotion activities) Yes No Don't Know C9. Are specific means, such as forms or suggestion boxes, available for employees to report health and safety hazards, problems, or concerns to senior management?............................................................................... Worksite Wellness Toolkit Page | 60 C10. Are efforts usually made to seek input/ideas from affected employees before supervisors or management make decisions about new work processes, work schedules, etc.? Always Often Sometimes Never Don't know Yes No Don't Know C11. Does your organization have a written seatbelt policy that requires employees to wear seatbelts when on company business or when operating company equipment? ................................................................. D. Emergency Response The following questions are about company policies and environments that address emergency response at work. Yes No Don't Know D1. Does your organization offer emergency medical response training to employees? ................................................................................................. 1a. If yes, which of the following are offered? ('X' all that apply) First aid Cardiopulmonary Resuscitation (CPR) Automated External Defibrillator (AED) Epi-Pen Yes No Don't Know D2. Does your organization have at least one Automated External Defibrillator (AED) prominently located at your worksite?........................... D3. Does your organization have at least one first aid kit prominently located at your worksite?............................................................................. D4. Does your organization have a written response plan for medical emergencies?.............................................................................................. D5. Does your organization have a written emergency procedures plan for fire evacuation, bomb threats, natural disasters, or a pandemic? .............. 5a. If yes, does this protocol identify and assist people with disabilities during an emergency?......................................................................... Worksite Wellness Toolkit Page | 61 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Worksite Wellness Program Data Summary Data Item Source Employee Population Information 1. Number of employees ____ Human Resources 2. Gender demographics Female ____% Male ____% Human Resources 3. Age distribution of employees: Human Resources a. 18 – 23 ____% e. 50 – 59 ______% b. 24 –29 ____% f. 60 – 65 ______% c. 30 –39 ____% g. over 65 ______% d. 40 –49 ____% Health Risk 4. Top 3 risks identified from HRA data or needs survey (for example, diabetes, heart disease, etc.) Assessment (HRA) or Lifestyle a. Risk 1_________________________________________ Questionnaire or MDPH Worksite b. Risk 2 ________________________________________ Wellness c. Risk 3 ________________________________________ Needs/Interest Survey Health Risk 5. Top 3 interests identified from interest survey (for example, weight management, stress, etc.) Assessment (HRA) or Lifestyle a. Interest 1 ______________________________________ Questionnaire or MDPH Worksite b. Interest 2 ______________________________________ Wellness c. Interest 3 ______________________________________ Needs/Interest Survey Worksite Wellness Toolkit Page | 62 Organizational Information Employee Benefits or 6. Health care cost per employee (total payments divided by Human Resources number of participating employees) a. 2007 ________ b. 2006 ________ c. 2005 ________ 7. What has been the organization's experience in terms of Human Resources or absenteeism? Finance/Payroll a. Average number of days per employee used ________ b. Total number of days of sick leave used in: i. 2007 ________ ii. 2006 ________ iii. 2005 ________ 8. What are the future needs for the wellness program, as Executive Sponsor of defined by the organization's management (for example, Wellness Program control costs, improve morale, improve productivity)? a. Future Need 1 __________________________________ b. Future Need 2 __________________________________ c. Future Need 3 __________________________________ 9. What policy changes do you envision working on? For Wellness Team and/or example, no smoking policy, healthy catering policy. Executive Sponsor of Wellness Program a. _____________________________________________ MDPH Environmental b. _____________________________________________ Survey c. ______________________________________________ Worksite Wellness Toolkit Page | 63 10. What environmental or cultural changes do you envision Wellness Team and/or working on? For example, access to stairwells, point of Executive Sponsor of purchase signs in cafeteria, etc. Wellness Program a. ______________________________________________ b. _____________________________________________ c. ______________________________________________ 11. What other changes do you envision working on? Wellness Team and/or Executive Sponsor of a. ______________________________________________ Wellness Program ____ b. _____________________________________________ _____ c. ______________________________________________ ____ Worksite Wellness Toolkit Page | 64 Worksheet 4 – Worksite Wellness Program Data Worksheet 1. The following number of individuals will be eligible to participate in the proposed program: Category of Eligible Individuals Number Percent Covered Under your Eligible1 Health Benefits Program2 Full‐time employee members Spouses/domestic partners of members Retired employee members Spouses of retired members Others (Specify) Total Eligible 2. The approximate annual cost per employee per year for each of the following: Category of Cost PEPY Cost3 Self‐insured? Insured? Indemnity health plan(s) Yes No Yes No PPO health plan(s) Yes No Yes No HMO plans Yes No Yes No Prescription drugs Short term disability Yes No Yes No Long term disability Yes No Yes No Worker's compensation Yes No Yes No Sick leave If you have several health plans please Employee health services provide a composite rate for each of the plan types. Include direct administrative EAP costs. Put "NA" for "not applicable" where Other appropriate. Total 1 Number of individuals that will be eligible to participate in the proposed program. 2 The percent of the eligible population in each category that are eligible for health benefit coverage or the percent actually covered. (Indicate which applies) 3 PEPY (per employee member per year) = Total cost/Total full time employee members Worksite Wellness Toolkit Page | 65 The composite annual growth rate for all of your health plans combined on a per covered employee member per year basis: 2003 2004 2005 2006* 2007* Composite growth rate for % % % % % all health plans combined * = estimated 4. Health plan anniversary date: (Check one) January 1 Comments: May 1 July 1 October 1 Other: (Please specify) _____________________ Additional Comments: 5. What was your composite per employee per year health plan cost for all health plans for each of the following years? 2001 2002 2003 2004 2005 Composite health benefit plan cost for all employees each year 6. Identify which wellness and health management interventions were available to your employees in the last program year or cycle4. List additional information under "Comments" or on another sheet. 4 The "Yes" and "No" response reflects whether the type of program intervention was offered to members in the last program cycle. The "Percent Eligible" column is intended to reveal what proportion of the eligible members identified in #1 above had access to that specific type of intervention. The "Percent Utilized" reflects the percent of eligible employees who had actually utilized or participated in that specific program intervention. Worksite Wellness Toolkit Page | 66 Type of Program Intervention Yes No Percent Vendor or Any Utilizing Comments Health risk appraisal? Health advice line? (such as NurseLine) Health Coaching Disease Management Programs Wellness newsletter ( Monthly? Quarterly? Other?) Medical self‐care text? (Which one?) Fitness facility use? (On‐site or off‐site?) Walking program? Smoking cessation program? EAP? Health fair? Fun run or community event? Biometric screening? (Cholesterol, BP etc.)5 Weight management program? Hypertension control? Internet access (for health information)? Intranet access (for health information)? General wellness education? Stress management? Disease management programs? Low back pain prevention? Home injury prevention? Vehicular injury prevention? Recreational injury prevention? Education on use of dietary supplement? Intervention and follow‐up with high risk? Medical self‐care training? Consumer health training? Nutrition education? Chair massage? Recreational sports league? Resiliency education? Spiritual health? 5 Please indicate what biometric tests have been included in past programming under "Comments" section below. Worksite Wellness Toolkit Page | 67 Ergonomics? High risk pregnancy prevention? (Others: please specify) 7. Please describe how much wellness activity has been offered or delivered across your entire work force or any limitation that may have affected your previous wellness efforts. 8. What proportion of your employee work force is covered by a collective bargaining agreement? ____% If a portion of your work force is unionized, please indicate the unions involved and the percent of your work force that are members of each union. Name of Union Percent of Details of Contract Status Work Force Total Percent Unionized 9. Provide any additional information that is relevant to the proposed program planning process. Worksite Wellness Toolkit Page | 68 10. Supplemental Documentation Checklist. Place an "X" in the appropriate box and enclose the following supporting documentation or provide a web address below for those items listed below: Will obtain Not Obtained (indicate available date) Latest company annual report Copies of main versions of Summary Plan Descriptions (SPDs) for main health plans Any plans that describe health or wellness initiatives Any descriptive materials outlining the wellness program components Any data from a wellness interest survey Any evaluation reports for wellness program Any consultant recommendations concerning wellness program Most recent health risk appraisal (HRA) cohort group report General company information or mission statement Vendor reports Results from any wellness program participant survey Claims data on potentially modifiable conditions/ diagnoses Data on distribution of multi‐year health plan claims by Major Diagnostic Categories (MDCs) Data on participation of current or past wellness programs Demographic and/or health need data on the population Focus group or market research data on employee wellness needs and interests Staff directory Table of organization Wellness program budget (Most recent period) (Chapman, Unpublished client documents) Worksite Wellness Toolkit Page | 69 Worksite Wellness Toolkit Page | 70 Wellness Program Master Worksheet The Wellness Program Master Toolkit worksheet is used to collect and summarize the program information. It will also be used as a method of presenting the plan for review to the Wellness Team and management. Throughout the remaining steps in the planning process, we will use this worksheet to collect the information. Worksite Wellness Toolkit Page | 71 Exercise – Data Summary The first entries in the Worksite Wellness Program Master Worksheet will summarize the information gathered in the previous steps. Using the blank template provided, complete the top portion of the worksheet. Worksite Wellness Toolkit Page | 72 Case Study Worksite Wellness Toolkit Page | 73 Case Study The following case study of a non‐profit employer has been developed to demonstrate the key processes involved in planning a worksite wellness program. Some of the data you collected for your organization during Steps 1‐3 may bear a resemblance to this data, as it is based on characteristics of the general population of Massachusetts. Worksite Wellness Toolkit Page | 74 Neighborhood Social Service Agency This social service agency provides support to individuals with disabilities in the MetroWest community. The organization has 250 people at the headquarters office and 500 people providing services to the agency's clients. The target population for the "Working on Wellness" pilot is employees at the headquarters location. The headquarters office is located in downtown Waltham, and while there is bus service, most employees drive to work. The building is a four story building with an elevator and accessible stairwells. There is an on‐site cafeteria, and each floor has a kitchen and vending machine. Smoking is not allowed inside the building, but smokers do stand outside the front door to smoke. Health insurance coverage pays for all standard medical screenings with a co‐payment required. A $150 per year reimbursement is available for health club memberships. A YMCA is located 2 miles from the office. In addition to the information on the following pages of the Program Data Summary, we know the following about this organization from the Health Improvement Survey: • All employees in the target population are full time and work one shift, during regular business hours • 40% of the employees have a college degree • The organization's health insurance provider is Blue Cross Blue Shield • There is a union for administrative staff, representing 40% of employees in the target population • English is the primary language and 68% are White, 10% Hispanic, 17% Black and 5% other. Worksite Wellness Toolkit Page | 75 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Worksite Wellness Program Data Summary Data Item Source Employee Population Information 1. Number of employees _250___ Human Resources 2. Gender demographics Female _70___% Male _30___% Human Resources 3. Age distribution of employees: Human Resources a. 18 – 23 _5___% e. 50 – 59 __20___% b. 24 –29 _10__% f. 60 – 65 __15___% c. 30 –39 _15__% g. over 65 __10___% d. 40 –49 _25__% 4. Top 3 risks identified from HRA data or needs survey (for Health Risk example, diabetes, heart disease, etc.) Assessment (HRA) or Lifestyle a. Risk 1____Overweight or Obese (38% or 95 people)___ Questionnaire or MDPH Worksite b. Risk 2 ____Smokers (20% or 50 people) ____________ Wellness c. Risk 3 ____Lack of regular physical exercise (83%)____ Needs/Interest Survey 5. Top 3 interests identified from interest survey (for example, Health Risk weight management, stress, etc.) Assessment (HRA) or Lifestyle a. Interest 1 ____Walking Club____________________ Questionnaire or MDPH Worksite b. Interest 2 ____Weight Management______________ Wellness c. Interest 3 ____Smoking Cessation_______________ Needs/Interest Survey Worksite Wellness Toolkit Page | 76 Organizational Information Employee Benefits or 6. Health care cost per employee (total payments divided by Human Resources number of participating employees) a. 2007 _$8,715 (+7%)__ b. 2006 _$8,145 (+9%)__ c. 2005 _$7,473_______ 7. What has been the organization's experience in terms of Human Resources or absenteeism? Finance/Payroll a. Average number of days per employee used ___10_____ b. Total number of days of sick leave used in: i. 2007 ___2,350_____ ii. 2006 ___1,925_____ iii. 2005 ___2,275_____ 8. What are the future needs for the wellness program, as Executive Sponsor of defined by the organization's management (for example, Wellness Program control costs, improve morale, improve productivity)? a. Future Need 1 __control health care costs_______ b. Future Need 2 __decrease sick time/increase productivity c. Future Need 3 __improve morale______________ 9. What policy changes do you envision working on? For Wellness Team and/or example, no smoking policy, healthy catering policy. Executive Sponsor of Wellness Program a. ___healthy eating options_____________________ MDPH Environmental b. ___increasing physical activity _________________ Survey c. ___smoke free work environment________________ Worksite Wellness Toolkit Page | 77 10. What environmental or cultural changes do you envision Wellness Team and/or working on? For example, access to stairwells, point of Executive Sponsor of purchase signs in cafeteria, etc. Wellness Program a. __review cafeteria food options and subsidy options___ b. __consider smoking cessation support programs_____ c. __access to stairwells___________________________ 11. What other changes do you envision working on? Wellness Team and/or Executive Sponsor of a. __smoke free campus___________________________ Wellness Program b. __encouraging physical activity___________________ c. __flextime policies_____________________________ Worksite Wellness Toolkit Page | 78 Step 4 Formulate Goals & Objectives Worksite Wellness Toolkit Page | 79 Worksite Wellness Toolkit Page | 80 Step 4 – Formulate Goals & Objectives Purpose The purpose of this step is to define the goals and objectives for the program. Tasks 1. Define goals and objectives 2. Review with Wellness Team and Management Tools Sample Goal Planning Worksheet Worksheet #4 – Goal Planning Worksheet Worksite Wellness Program Master Worksheet Worksite Wellness Toolkit Page | 81 Task Detail 1. Define goals and objectives Now that the needs for the wellness program have been determined, the next step is to formulate the goals and objectives for the program. Goals are broad statements that provide the overall context for what the wellness program is trying to accomplish. Goals need to be "realistic enough to attain and yet demanding enough to bring about a clear improvement in the problem area" (Chenoweth, 2007). Objectives are more concrete statements describing what the program is trying to achieve. The objective should be specific and measurable, so that they can be used to evaluate your program. SMART Goals The following is a common approach to defining goals. 1. Specific ‐ A specific goal has a much greater chance of being accomplished than a general goal. To set a specific goal you must answer the six "W" questions: Who: Who is involved? What: What do I want to accomplish? Where: Identify a location. When: Establish a time frame. Which: Identify requirements and constraints. Why: Specific reasons, purpose or benefits of accomplishing the goal. EXAMPLE: A general goal would be, "Reduce absenteeism." But a specific goal would say, "Reduce the number of sick days taken by employees at headquarters by 20% by January 1, 2009." 2. Measurable ‐ Establish concrete criteria for measuring progress toward the attainment of each goal you set. When you measure your progress, you stay on track, reach your target dates, and experience the exhilaration of achievement that spurs you to continue the effort required to reach your goal. To determine if your goal is measurable, ask questions such as... How much? How many? How will I know when it is accomplished? 3. Attainable ‐ When you identify goals that are important to the organization and the participants, you begin to figure out ways you can make them come true. Any goal can be achieved when a plan is established and a time frame is established that allows those steps to be carried out. Goals that may have seemed far away and out of Worksite Wellness Toolkit Page | 82 reach eventually move closer and become attainable, not because the goals shrink, but because of the steps undertaken to make it happen. 4. Realistic ‐ To be realistic, a goal must represent an objective toward which the organization and the team are both willing and able to work. A goal can be both high and realistic; the Wellness Team and management can provide input on what is reasonable. But be sure that every goal represents substantial progress. A high goal is frequently easier to reach than a low one because a low goal exerts low motivational force. A goal is probably realistic if those responsible for executing truly believe that it can be accomplished. Additional ways to know if a goal is realistic is to determine if something similar has been accomplished in the past or ask what conditions would have to exist to accomplish this goal. 5. Timely ‐ A goal should be grounded within a specific time frame. With no time frame tied to it there's no sense of urgency. If you want to implement a new policy, when do you want to do it by? "Someday" won't work. But if the goal is anchored in a timeframe, "by May 1st", then you've set a definable end point to achieve the goal. 2. Review with Wellness Team and Management Building acceptance for the plan can be accomplished by doing incremental reviews with the Wellness Team and Management. A perfect opportunity to do this is upon completion of the Goals and Objectives phase. Worksite Wellness Toolkit Page | 83 Table 7 Sample Wellness Program Goals and Objectives Goal Objectives Develop wellness program • Form a Wellness Committee with clearly defined membership, goals infrastructure to support a culture of and outcomes by May 2008 healthy lifestyles • Hire a Wellness Director with experience in planning, developing and managing employee wellness programs, by June 2008. • Conduct an environmental audit by August 2008. Reduce the overall health plan growth • To achieve a 2% reduction in health care claim costs by December rate cost trends for the next fiscal year 2008. from what is expected. Reduce health related costs, • To achieve a 10% reduction in self‐reported sick leave by December specifically: sick leave, worker's 2008. compensation, short‐term disability, • To achieve a 5% reduction in worker's compensation claims by long‐term disability and presenteeism. December 2008. • To achieve a 10% reduction in short‐term disability due to injuries by December 2008. Increase productivity among associates • To achieve at least a 10% reduction in self‐reported sick leave through reduced absenteeism, amount the full cohort of associates completing an HRA in 2007 improved presenteeism and reduced when compared with their 2008 HRA responses. disability Achieve a ROI for the wellness initiative • To complete a formal evaluation of the first year of the program that balances program costs versus (2007) by March 1, 2008 benefits • To issue an evaluation report by April 30, 2008 Make significant progress in integrating • To integrate an HRA into the 2008 open enrollment process for employee benefits, policies, programs health benefit covered associates and spouses and as a requirement and services. for participation in the wellness program for all others by January 1, 2009. • To have 100% of health benefit eligible associates and benefit covered spouses complete an HRA by January 1, 2008. • To have 50% of associates attend a program roll‐out workshop/webinar by September 30, 2008. • To have another 25% of associates complete the web‐based version of the program roll‐out workshop by December 21, 2008. To develop and implement a wellness • To formally launch wellness program in January 2009, including a initiative that receives national new disease management program. attention as a model for our industry. • To conduct a program planning session that refines the wellness initiative for the 2009 program year by October 1, 2008. • To have a sample of first year participating associates indicate their satisfaction with the new wellness program with an average satisfaction score no lower than 8 on a 1‐10 scale (with 1 = poor and 10 = excellent) as part of the formal evaluation of the wellness initiative by February, 2009. Reduce health care costs associated • To identify most costly clinical conditions for population based on with specific conditions claims data by January, 2009. • To evaluate condition management program by March, 2009. Worksite Wellness Toolkit Page | 84 Goal Objectives Implement diabetes management • To enroll 75% of identified diabetics in diabetes management program for all identified and pre‐ program by January 1, 2009. diabetic • To reduce costs associated with diabetic episodes by lessening the severity of their condition by January 1, 2009. • To increase awareness of clinical compliance through enrollment in a self‐management program by February 1, 2009. • To educate population on impact of lifestyle habits by December 1, 2009. To create a smoke‐free work • To reduce the number of employees that use tobacco products environment from 20% to 12% by July 2009. • To achieve a 10% reduction in the amount spent on medical claims related to tobacco use and related diseases by January 1, 2010. • Implement a no‐smoking policy by July 1, 2009. • Offer free smoking cessation program to smokers in May, 2008. • Offer free smoking cessation aids such as patches and medications to participants of smoking cessation classes in May, 2008. To maximize participation in wellness • Implement an annual HRA that is tied to an incentive with the goal programs. of achieving a minimum of a 75% participation rate by January 1, 2009. • Integrate HRA into new hire orientation by January 1, 2009. • Offer HRA as a pre‐requisite to open enrollment registration for employee benefits by November 15, 2009. Provide an annual employee wellness • Design a wellness fair program plan that provides a variety of health fair screenings, educational information and program materials for employees by October 2008. • Achieve 60% participation rate in health fair for pilot employee population. To encourage employees to be more • Organize a lunch‐time walking club and provide pedometers to all physically active most days of the week participants by June 30, 2008 • Implement a stair use program to encourage use of facility stairways by September 1, 2008. • To offer an Active Living Every Day behavior change program by September 15, 2008. • Implement and communicate a flexible work policy where employees can participate in wellness activities as long as it doesn't interfere with their base business by January 2009. • To secure discounted fitness center memberships for local clubs by December, 2008 • Procure bike rack and designate bike parking by July 2008. Worksite Wellness Toolkit Page | 85 Goal Objectives To offer a variety of stress • Secure EAP availability for a lunch‐and‐learn by July, 2008. management programs aimed at • To offer stress management lunch‐and‐learns every other month decreasing the percentage of beginning in January, 2009. employees who experience physical • Secure a room that can be designate as a meditation/quiet room. health consequences as a result of excessive stress. Implement Weight Management • Secure an instructor, time and room to offer the Weight Watchers. programs to decrease the amount of All programs will be available on‐site for 12‐weeks beginning in overweight employees from 68% to September, 2008. 50% by 2010. • Secure Weight Watchers on‐line 12‐week program and discounted employee rates by September, 2008. • Offer continuously implemented, back to back, on‐site and on‐line 12‐week Weight Management programs to employees who are overweight (BMI >25) by September, 2008. To reduce the number of injuries • Implement a back care program by August, 2008 classified as low back pain events, • Identify and train employee leaders in at risk areas how to sprains and strains by 2010. implement a pre‐work stretching routine by August, 2008. • To implement pre‐work stretching programs during first 10‐minutes of each workday in all at risk areas by August, 2008. • To provide a quarterly back care workshop to all employees beginning in January, 2009. To create an environment that • Assess food options in on‐site vending machines and negotiate with improves access to and provides vendor for healthful snack products by August, 2008. options for healthy food choice • Establish food catering policies and recommendations for healthy choices by July 2008. • To offer healthy eating lunch‐and‐learns every quarterly beginning in January, 2009. Worksite Wellness Toolkit Page | 86 Case Study - Neighborhood Social Service Agency – Program Goals and Objectives Based on the data provided through the environmental analysis and interest and needs survey, the key goals and interests for employee wellness at Neighborhood Social Service Agency were: smoking cessation, weight management and healthy food choices. These goals are particularly important since the target population is over 40 years old, a primarily sedentary group with a high percentage of overweight/obesity and associated risks for chronic illness such as diabetes and heart disease. The Wellness Team worked on defining goals to impact the identified wellness needs and interests while ultimately addressing management's goals to decrease health care costs, reduce sick time, improvement productivity and enhance employee morale. The following are the goals and objectives selected by the Wellness Team at Neighborhood Social Service Agency. Goal Objectives Promote a tobacco‐free • To reduce the number of employees that use tobacco employee population products from 20% to 10% by January 2009. • Identify strategies to support employees that currently smoke to reduce their tobacco intake by August 2008 Support employee weight • Increase by 25% the number of overweight employees management goals in the participating in regular physical activity and making worksite setting healthy food choices by January 2009. Promote a healthy worksite • Identify and implement policies, practices and environment through policy and environmental supports that will support employee environmental approaches. health by January 2009. Worksite Wellness Toolkit Page | 87 Worksite Wellness Toolkit Page | 88 Worksheet #4 – Program Goals and Objectives Using the SMART goals framework, identify two or three goals and the associated objectives for the Worksite Wellness pilot to address the risks, needs and interests of your organization. Use the Wellness Program Master Worksheet, found on the Toolkit CD, to record each goal and objective. Goal Objectives • • • • • • • • • • • • • • • • • • • • Worksite Wellness Toolkit Page | 89 Worksite Wellness Toolkit Page | 90 Wellness Program Master Worksheet An organization may use a number of models or methods for composing a Wellness Program Plan, such as a Logic Model or a Master Worksheet to outline the major components of a comprehensive plan. A description of the Logic Model with an example is provided in the Resources section. For purposes of the Toolkit, we will use the Master Worksheet to illustrate the major sections of a Wellness Program, combining the 7‐step approach with a simplified documentation process. The necessary details for each intervention documented separately on intervention Planning Worksheets. The Wellness Program Master Worksheet is used to collect and summarize the program information. It will also be used as a method of presenting the plan for review to the Wellness Team and Management. Throughout the remaining steps in the planning process, we will use this Worksheet to collect key information and serve as the basis for the organization's overall Wellness Program Plan. It's important to start by completing information gathered in the first three steps of the Wellness Program planning process in the beginning of the Worksheet, and then identifying goals and objectives of the Intervention Plan, in the first two columns highlighted below. Worksite Wellness Toolkit Page | 91 Worksite Wellness Toolkit Page | 92 Step 5 Plan Development Worksite Wellness Toolkit Page | 93 Worksite Wellness Toolkit Page | 94 Step 5 – Plan Development Purpose Now that you have developed your goals and objectives, the next step is to identify the individual interventions for each objective and define evaluation activities. While the interventions may seem obvious after defining the goals and objectives, there are a number of factors to consider. A hallmark of a successful Worksite Wellness Program is that it is available to all employees, regardless of health status, language, work shift, or level of ability. It should help healthy people stay healthy. It should help those at risk for developing a disease by reducing their risks and should help those with a chronic condition prevent it from getting worse. In addition to offering programs for all employees, it's been shown that incentives are needed to encourage greater participation in wellness activities. Behavior change needs to be rewarded. A variety of incentives can be offered, not all need to be monetary. Tasks 1. Identify population segments for the selected interventions 2. Plan interventions 3. Define evaluation/assessment methods for the intervention Tools Worksheet #5 – Intervention Planning Worksheet Worksite Wellness Program Master Worksheet Worksite Wellness Toolkit Page | 95 1. Identify population segments for wellness programs When planning interventions, a number of factors about your population need to be taken into consideration: 1) the diversity of your employees (age, sex, cultural background, education, etc.), and 2) the interest and needs of employees. The more information you have about the employees in your organization, the better you will be prepared to provide effective interventions. In addition to the interest and needs survey completed by employees, you may consider additional data collection sources such as health risk profile and risk segmentation data. These two types of data can be obtained from a variety of data sources such as Health Risk Assessments (HRAs), health claims, worker's compensation claims, etc. Segmentation is the process of dividing the employee population into subgroups based on characteristics and demographics that may influence their health related attitudes, beliefs and behaviors. The goal of segmentation is to have the broadest reach with a group of people having similar characteristics. Segmentation information is valuable for both planning and recruiting employees to participate in selected wellness activities or programs. Relationship among the population segments is another aspect of the segmentation analysis for consideration. Table 8 identifies specific planning implications for selected population segments. (McKenzie, Neiger, & Smeltzer, 2005) (Wilson & Glaros, 1994) Table 8 ‐ Population Segment Intervention Characteristics and Implications Segment Characteristics Planning Implications Age and Gender distribution • Age and gender distribution will impact planning and need to be considered relative to risks as well as interests. For example, for a primary population of middle age women, interventions such as screenings (pap, mammography, diabetes) as well as educational programs focused on menopause would be appropriate considerations. • If retirees are eligible for the program, their age demographics and risk factors may have an impact on program offerings. They may also desire a connection to the Worksite. Wellness program may provide the social support connection they are seeking. • Attention should be paid to gender‐based differences in attitudes and perceptions about health behaviors. For example, a highly choreographed exercise class might have stronger appeal to women, than men. Challenge programs may be more appealing to men who generally like competitive programs, whereas women might prefer programs that offer supportive situations. • Considerations should be given to several program tracks throughout the year that address both age and gender. Marital status • Marital/domestic partner status is a consideration since program participation may increase if spouses/partners are eligible. Worksite Wellness Toolkit Page | 96 Segment Characteristics Planning Implications Spouses/partners can have significant impact on health care claims costs. • A key skill of behavior change is seeking and gaining social support (Aldana, 2005). Support from family members may be an important success factor in behavior change programs such as smoking cessation, healthy eating, diabetes management or increasing physical activity. • Considerations should be given to communications such as newsletters targeted to family members. Family Status • Family status may impact programming offerings and scheduling. In many settings, women are often more likely to assume child care responsibilities, thus impacting scheduling. This may influence time, location and availability of child care during program offerings. Number of worksites and size of • The number of worksites and number of employees at each site will each impact considerations such as staffing, types of programs and facilities. Consideration should be paid to subsidiaries, regional centers, remote or small locations, home‐based workers, or functional groups. • Companies with large populations at many sites might addresses staffing by designating an individual at each location to have wellness coordination responsibilities. This might be part of an existing HR or Benefits position or, depending on the size of the location, a separate position. • An organization with many small, geographically distributed locations or a population of home‐based workers may have to consider technology‐ based programs and solutions rather than site‐based solutions. • Offering equality in offerings is another consideration. For example, if you have two locations of approximately the same size in a close geographic area, in order to provide equality in offerings you may need to consider an exercise facility or cafeteria in both locations rather than just one. Education level • Education level may influence learning styles, reading levels and receptivity to programs. For example, less educated workers might prefer in‐person presentations and videos to written materials. Reading levels should be considered when developing written materials if there are significant populations with lesser amounts of education. • When implementing internet‐based or computer‐based programs, consideration should be given to the level of computer skills of the target population. Income level • Income levels will influence whether individuals hold second jobs, can afford activity co‐payments, or can afford walking shoes. Access to computers • Depending on the type of workforce (knowledge workers versus field or production workers), not all program participants may have access to a computer. If your program offerings include internet‐based programs, information or tools, provide consideration or alternatives for this segment of the population. An approach might be to provide access to public computers at worksites. Multiple shifts • Work environments that have multiple shifts or 7x24 operations need to provide the same access to wellness programming for all shifts. For example, if a health fair is planned, the fair should be scheduled so that it overlaps multiple shifts or all shifts. Worksite Wellness Toolkit Page | 97 Case Study - Neighborhood Social Service Agency – Population Segments The information gathered in the Research & Discovery Step provided details about the population of this organization. Population Characteristic Intervention Approach 70% female • Consider offering interventions that provide group or social interaction situations such as Weight Watchers at Work or lunch‐and‐learn programs. 75% of population is over the age of • Consider encouraging employees to utilize health 40 insurance coverage to get recommended screenings such as blood pressure, cholesterol, glucose, colorectal, bone density, etc. Target population at a single • Intervention planning needs to be site specific, as worksite the populations at different sites may have different characteristics, needs or interests. 38% of employees overweight or • Consider interventions that will address weight obese management. • Consider interventions that will encourage physical activity. • Consider interventions that will address healthy eating. 20% of employees are smokers • Consider interventions that will address smoking cessation. 83% lack regular exercise • Consider interventions that will encourage physical activity. 2. Plan interventions a. Review the research to determine what interventions are most effective and appropriate for your target population Review literature and other sources, to determine what the best practices/evidence is for the interventions you are proposing to implement. You are more likely to get support for your program if you can back up your interventions with research that demonstrates its effectiveness. More importantly, you are more likely to see results with interventions proven to be effective. Refer to the Resources Section at the end of this chapter for resources and evidence‐based interventions. Worksite Wellness Toolkit Page | 98 b. Identify intervention components Consider implementing interventions that include multiple approaches, as research has demonstrated that multiple‐prong approaches tend to be most effective. For example, creating a no‐smoking policy is one element of an overall approach to reducing tobacco use by employees. Other components would address creating awareness (information to help participants understand the health topic), supporting behavior change (offering smoking cessation programs), implementing policies (no smoking policy) and biometrics or biomedical (biometric testing, offering smoking cessation aids). Biometrics tests measure biological data (i.e., blood pressure, cholesterol, etc.). Table 9 shows some selected components for interventions. Table 9 ‐ Select Intervention Components Awareness Behavior Change Environmental/ Biometrics/ Policy Support Biomedical • Newsletters • Weight Management • Smoking policies • Biometric Screening • Self‐Care Manuals • Fitness Facilities/ • Workstation (e.g. blood pressure, • Health Risk Membership ergonomics cholesterol, BMI, Assessment • Smoking Cessation • Job safety and injury others) • Lunch and Learn Group Program prevention policies/ • Smoking Cessation Programs • Counseling/Coaching practices Aids (not clear • Health Fair Services • Emergency response example • Posters • Chronic disease self‐ programs • Immunizations (Flu management • Vending machines, Shots) Catering and Cafeteria Worksite Wellness Toolkit Page | 99 Table 10 ‐ Sample Intervention Components Intervention Awareness Behavior Change Environmental Biometrics Support Smoke Free • No smoking • Smoking • No smoking • Smoking cessation Workplace signs Cessation policies aids Classes Weight • Newsletters • Weight • Vending • Biometric Management mailed to home Watchers at Machine Screening • Cafeteria Point Work Policies (cholesterol, blood of Purchase pressure, body Information composition, fasting blood sugar) Worksite Wellness Toolkit Page | 100 Case Study – Neighborhood Social Service Agency - Intervention Selection Based on the information gathered in the previous steps, the column at the right has been completed with the selected interventions to address the needs of target populations (segments) at the Neighborhood Social Service Agency pilot employee population. Goal Objectives Interventions Promote a tobacco‐ • To reduce the number of • Offer free smoking cessation free employee employees that use tobacco program to smokers, running population products from 20% to 10% by continuously from July to January 2009. December 2008. • Identify strategies to support • Offer free smoking cessation employees that currently aids such as patches and smoke to reduce their tobacco medications to participants of intake by August 2008 smoking cessation classes from July to December 2008. • Implement a no‐smoking policy by January 1, 2009. Support employee • Increase by 25% the number • Offer Weight Watchers at weight management of overweight employees Work on‐site for 17‐weeks goals in the worksite participating in regular beginning in September 2008. setting physical activity and making • Secure Weight Watchers on‐ healthy food choices by line 19‐week program and January 2009. discounted employee rates by September 2008. • Offer continuously implemented, back‐to‐back, on‐site 17‐week and on‐line 19‐week Weight Management programs to employees who are overweight (BMI >25) by September 2008. • Organize a volunteer‐led Employee Walking Program at lunchtime by June 2008, with a "Walk Across Massachusetts" challenge. Promote a healthy • Identify and implement • Develop a Stairwell Campaign worksite environment policies, practices and to encourage use of building through policy and environmental supports that stairs by June 2008 environmental will support employee health • Evaluate vending machine by January 2009. options and make approaches. recommendations by August Worksite Wellness Toolkit Page | 101 Goal Objectives Interventions 2008, to achieve goal of 75% healthy items by January 2009. • Working with cafeteria management, develop plan by September 2008 for offering healthier food options. • Establish food catering policies and recommendations for healthy choices by July 2008. Worksite Wellness Toolkit Page | 102 c. Intervention Delivery Considerations Consider the variety of ways that people learn – visual (looking at images, body language, demonstrations), auditory (hearing the spoken word), or kinesthetic (doing and interacting) when selecting your intervention. Plan to use a variety of media forms for both promotion and delivery of interventions–print (newsletters, posters), computer‐based (emails, portals), in‐person (events, lunch‐and‐learns), and telephonic (coaching). When planning and delivering behavior change interventions that teach new skills, provide opportunities where those skills can be practiced. For example, if an active living program for a sedentary population encourages increasing physical activity, the worksite may ensure that stairwells are accessible and well lit, implement a stair‐use campaign and promote use of stairwells through signage and other incentives (improved lighting, art work, appealing paint). d. Budget Considerations Budget and resources needed to deliver proposed interventions need to be considered during the planning stage. The budget should ensure that financial resources needed to achieve program goals are available and requested as part of the approval process. Resources take many forms. When planning your budget, consider some of the following resource and expense needs: personnel for planning, program facilitators, clerical/administrative staff, evaluators, curriculum materials; incentives; equipment; marketing/promotion; postage, space, supplies, and travel. Start by identifying all available free resources when selecting program interventions; such as topical literature or resources from organizations such as state/local government, national disease organizations, etc. Free Resources Examples of free resources in Massachusetts • Department of Public Health (DPH)‐Educational materials on a variety of health topics are available free of charge through the MA Health Promotion Clearinghouse • DPH‐Women's Health Network provides free breast and cervical cancer screening and diagnostic services, and health education services to low income, uninsured women at over 90 locations throughout the state screening program Worksite Wellness Toolkit Page | 103 • DPH‐Men's Health Partnership provides risk‐reduction education and clinical screening for uninsured and underinsured Massachusetts men at 12 sites across MA • DPH‐Keep Moving, a program run through the Healthy Aging and Health and Disabilities Unit at DPH provides free training on how to set up a walking club • Most if not all of the DPH program provide training and/or technical assistance and referrals as appropriate on the their particular focus area • The Department of Conservation and Recreation oversees the "Great Park Pursuit", an initiative to encourage families to use the outdoors and state parks Incentives Another budget consideration is incentives. Research has shown that incentives encourage participation and encourage accomplishment of personal health enhancement objectives. The extent to which an incentive produces behavioral compliance with its requirements is called motive force. Incentives may take the following forms and are usually used to reward a variety of behaviors, such as participation, registration, completion, adherence or specific actions. Table 11 shows types of incentives and their impact. Table 11 –Incentives Types Type Description Advantages Disadvantages Merchandise or Materials goods such as Easy, inexpensive, Must fit population to be material goods t‐shirts, hats, gym bags adaptable to sub‐groups effective; once the goods are given, then no more motive force Immediate The power of the cash Offer the broadest Considered taxable income financial rewards reward or gift card is appeal of all incentives so the size of the actual that it can be converted reward is reduced after into goods or services of taxes are taken out the recipients choosing Future financial Rewards are given at Can cost less due to Loss of motive force due to reward the end of a program discounting function of deferred gratification cycle or a rebate is money. Can offer higher given at the end of a rewards than period of time immediate cash rewards Avoid immediate Avoidance of a required Immediate in nature, Usually associated with financial cost cost, such as program providing the short duration behaviors, fees or co‐payment impression of 'saving so used at one point in money' time, not over time Avoid future Avoidance of a future Has time value Magnitude needs to be financial cost cost, such as advantages for the great enough to create a contribution to health employer and can fit desired level of motive plan coverage or health with benefits design of force. club membership total compensation Immediate time Personal time off for Has broad appeal to If leave levels are already off use as the person employees. This is a generous, this may not wishes, provided non‐taxable event. have much motive force. Worksite Wellness Toolkit Page | 104 immediately Future Time Off Personal time off for Has broad appeal to Motive force may be low use as the person employees. This is a due to delay before time wishes, provided at a non‐taxable event. can be used later time (Chapman, Using Wellness Incentives, 2002) Wellness programs costs will vary depending on the model, type of interventions, extent to which incentives are used and the number of employees served (See page 10 in the Introduction section for types of program models and the estimated return on investment ‐ ROI). Table 12 shows sample wellness program budgets, exclusive of staff. Table 12 – Sample Wellness Program Budget (Chapman, 2005) Model Cost/Employee/Year Quality of Work Life $10 – 45 Traditional $46 – 150 Health and Productivity Management $151 – 400 e. Identify and document interventions Having now considered the various components, segments and implications, the work of defining each intervention can begin. Planning the details of each individual intervention may be a multi‐step process, depending on how much information is available at the time. For example, you may identify a desired intervention such as offering free smoking cessation aids to support the goal of creating a tobacco free environment. Additional research may need to be conducted in order to identify budget considerations such as coverage under insurance prescription benefits, cost of copayments, etc. Details such as program resources, costs, etc. will be required to complete the budget for the overall plan. Worksheet #5 Intervention Planning Worksheet will provide a guide on the level of detail required to plan and implement each intervention. Worksite Wellness Toolkit Page | 105 Worksite Wellness Toolkit Page | 106 Exercise – Intervention Selection Using the information from the previous steps, the next step is to identify the selected interventions that will produce the desired results for the specified goals and objectives. Enter the information in the right hand column. Use the Wellness Program Master Worksheet, found on the Toolkit CD, to record each intervention. Goal Objectives Interventions • • • • • • Worksite Wellness Toolkit Page | 107 Worksite Wellness Toolkit Page | 108 Transcribe the information gathered on target population and selected interventions directly into the corresponding sections of the Master Worksheet. Worksite Wellness Toolkit Page | 109 3. Define evaluation/assessment methods for the intervention For Worksite Wellness Programs to succeed, evaluation is part of ongoing quality assurance and improvement. Evaluation helps companies celebrate successes and improve programs to meet the needs of the company and its employees. Evaluation also enables senior management and the wellness team to measure the Return on Investment (ROI) of interventions and direct future efforts. In addition, evaluation can be used to assess the performance of the team. It is important to plan the program evaluation in concert with planning the program. It is essential to identify how each intervention will be evaluated and assessed as part of the overall Wellness Program Plan. Evaluation and assessment should be considered at various points in the program. For example, it might be conducted at the end of an activity or month, depending on the type of intervention. Ongoing evaluation allows for mid‐course changes or adjustments in the program based on feedback and response from the participants. Evaluation at the end of a specific program assesses the impact on knowledge, attitudes, skills, beliefs and behaviors of the participants. A sample of assessment questions and evaluation methods is available in Table 13. Table 13 – Evaluation/Assessment Samples Assessment Evaluation Method Participation – how many employees were served? Program Sign‐up Sheets Participation Feedback ‐ How did the participants Participant Feedback/Session like the program? How did it affect them? Evaluation Forms Outcomes/Impact ‐ What improvements in HRA Cohort Analysis individual health or risk factors occurred? Program Cost ‐ How much did the program cost? Budget Documents Program Objectives – Did the program meet the Program Work Plan and Intervention stated objectives Planning Worksheets Environmental Impact ‐ What types of Observational/written policies environmental or policy changes were made to create an environment and culture of wellness? Worksite Wellness Toolkit Page | 110 Case Study – Neighborhood Social Service Agency – Evaluation Plans Based on the information gathered in the previous steps, the column at the right has been completed with the selected evaluation methods measure the results of the interventions implemented at the Neighborhood Social Service Agency. Goal Objectives Interventions Evaluation Plans Promote a tobacco‐free • To reduce the number of • Offer free smoking cessation • Weekly program sign‐in employee population employees that use tobacco program to smokers, running sheets products from 20% to 10% by continuously from July to Post program survey to January 2009. December 2008. determine time smoke free • Identify strategies to support • Offer free smoking cessation aids • Counts of aids provided to employees that currently smoke to such as patches and medications participants. reduce their tobacco intake by to participants of smoking • Policy enacted and enforced August 2008 cessation classes from July to starting in Jan 2009 December 2008. • Budget documents • Implement a no‐smoking policy by January 1, 2009. Support employee • Increase by 25% the number of • Offer Weight Watchers at Work • Sign‐in sheets for weekly weight management overweight employees on‐site for 17‐weeks beginning in meeting goals in the worksite participating in regular physical September 2008. • Document number of staff setting activity and making healthy food • Secure Weight Watchers on‐line who sign‐up and regularly choices by January 2009. 19‐week program and discounted participate in online program employee rates by September • Track employee participants 2008. in lunchtime walking • Offer continuously implemented, program back‐to‐back, on‐site 17‐week and • Identify interest and on‐line 19‐week Weight participation of employees in Management programs to walking challenge employees who are overweight • Budget documents (BMI >25) by September 2008. Worksite Wellness Toolkit Page | 111 Goal Objectives Interventions Evaluation Plans • Organize a volunteer‐led Employee Walking Program at lunchtime by June 2008, with a Walk across Massachusetts's challenge. Promote a healthy • Identify and implement policies, • Develop a Stairwell Campaign to • Direct observation of number worksite environment practices and environmental encourage use of building stairs by of employees using stairs through policy and supports that will support June 2008 • Reports from vending environmental employee health by January 2009. • Evaluate vending machine options machine vendor on purchase and make recommendations by history. approaches. August 2008, to achieve goal of • Reports from Food Service on 75% healthy items by January purchase trends 2009. • Budget documents • Working with cafeteria management, develop plan by September 2008 for offering healthier food options. • Establish food catering policies and recommendations for healthy choices by July 2008. Worksite Wellness Toolkit Page | 112 Exercise – Evaluation Plan Using the information from the previous steps, the next step is to identify the methods of evaluating each intervention to ensure the program produces the desired results for the specified goals and objectives. Enter the information in the right hand column. Use the Wellness Program Master Worksheet, found on the Toolkit CD, to record each evaluation method. Goal Objectives Interventions Evaluation Plans • • • • • • • • • • • • Worksite Wellness Toolkit Page | 113 Worksite Wellness Toolkit Page | 114 Transcribe the information gathered on the evaluation plan directly into the corresponding section of the Master Worksheet. Worksite Wellness Toolkit Page | 115 Worksite Wellness Toolkit Page | 116 Worksheet #6 – Intervention Planning Worksheet Guide This detailed Planning Worksheet should be completed for each intervention that will be included in the program plan. This worksheet addresses a level of detail sufficient to be able to identify all resources required to plan and implement the program, including logistical and administrative details. Complete one worksheet for each individual intervention. Intervention Name Program Description Brief description, program mix, intensity level, Type of Intervention Behavioral, Awareness, Biomedical, Environmental Need program fulfills Reference Program Needs from Data Collection Problem Identification Substantiation for need (reference data such as cost or claims data) Target Population Segment specifics Goal From goal planning Objectives From goal/objective planning Expected Outcomes/Benefits Describe outcomes and benefits this intervention will provide Skill Building Skills developed/practice opportunity Activities/Evaluation List activities that will make up the intervention. Use the second column to document how each will be evaluated. Supportive Environment Describe environmental policies or physical changes that Policies support this intervention Program Plan Budget Identify all program costs Program Staffing Who will deliver? Skill set required Delivery Logistics Where to be delivered, equipment/materials required, Supplies required Marketing and Promotion Describe how program will be marketed to prospective participants Recruitment Tactics Describe specific tactics that will be used to recruit participants Incentives Type of program (merchandise, cash, contribution, time off recognition) Implementation Timeline Kick off date, duration Clearance/consent Is medical clearance or informed consent required for requirements participation? Tracking Process Will tracking of participants be required Program Maintenance Ongoing communication, promotion, staffing, program modifications based on feedback Sources: (Baun & Pronk, 2006) (The Health Communication Unit of the Center for Health Promotion, 2001) Worksite Wellness Toolkit Page | 117 Case Study – Neighborhood Social Service Agency - Intervention Worksheet Intervention Name Program Description Weight Watchers at Work Type of Intervention Weight Management Need program fulfills Reduce the number of employees who are overweight or obese by supporting employee weight management goals. Problem Identification 38% of pilot employee population are overweight or obese Target Population All pilot group employees Goal Support employee weight management goals in the worksite setting Objectives Increase by 25% the number of overweight employees participating in regular physical activity and making healthy food choices by January 2009. Expected Outcomes/Benefits Reduction in the percentage of employees who are overweight and obese. Evaluation Process/Techniques Sign in sheets from each weekly meeting Evaluation and post program survey to participants Skill Building Food Selection Meal Ideas and Cooking Tips Eating Out Staying Motivated Getting Support Importance of Being Physically Active Activities/Evaluation Weekly meetings Weekly evaluation of conducted by a trained program meeting Weight Watcher facilitator. Recording of participants results Supportive Environment Policies Vending machines Cafeteria food options plan Walking club Intervention Execution Plan Budget Program costs required to meet minimum of 20 participants. Program Staffing Provided by Weight Watchers Delivery Logistics Meeting Room scheduled for 17 weeks Marketing and Promotion Distribution of materials to all employees Worksite Wellness Toolkit Page | 118 Posters in cafeteria, break rooms, rest rooms Paycheck mailer two weeks prior to program start date Recruitment Tactics Promotional materials distributed Incentives Partial fee reimbursement based on successful completion of program and reaching goal Implementation Timeline June 1 Contact Weight Watchers to request program July 1 Preliminary notifications August 1 Marketing activities August 30 Program sign‐up September 9 Program start Clearance/consent requirements Provided by Weight Watchers Tracking Process N/A Program Maintenance Coordination of start dates and promotion of each new 17 week program Worksite Wellness Toolkit Page | 119 Worksite Wellness Toolkit Page | 120 Exercise – Intervention Planning Using the information from the Step 3 (Research & Discovery/Identify Needs) and Step 4 (Goals and Objectives) exercises complete this worksheet for each individual intervention that will be included in the Worksite Wellness program. A blank form is found on the Toolkit CD. Intervention Name Program Description Type of Intervention Need program fulfills Problem Identification Target Population Goal Objectives Expected Outcomes/Benefits Evaluation Process/Techniques Skill Building Activities/Evaluation Supportive Environment Policies Intervention Execution Plan Budget Program Staffing Delivery Logistics Marketing and Promotion Recruitment Tactics Incentives Implementation Timeline Clearance/consent requirements Tracking Process Program Maintenance Worksite Wellness Toolkit Page | 121 Worksite Wellness Toolkit Page | 122 Case Study - Sample Master Worksheet The following provides an example of how information gathered and defined from Steps 1‐7 may be transcribed directly into the Master Worksheet, providing an overview of the Worksite Wellness Program. Worksite Wellness Toolkit Page | 123 Worksite Wellness Toolkit Page | 124 Intervention Planning Resources The following information provides information that will be helpful when selecting and planning the worksite wellness program interventions. These resources include policies, programs and information sources. Physical Activity Policies, Programs, and Resources Nutrition Policies, Programs, and Resources Smoking Cessation Policies, Programs, and Resources Stress Management Policies, Programs, and Resources Workplace Policies that Address Optimal Employee Health and Well-being Lactation Support Policies, Programs, and Resources Sleep Health Policies, Programs, and Resources Workplace Policies that Address Asthma Worksite Wellness Toolkit Page | 125 Worksite Wellness Toolkit Page | 126 Physical Activity Policies, Programs, and Resources Policies • Flextime is an option for all employees to use to be physically active during the work day. • Flextime is available to hold information and education meetings during the work day to encourage healthy behaviors (e.g., physical activity during the lunch hour, walking clubs, or on‐site healthy nutrition programs). • Meetings are planned so that, after every hour of being seated, employees/visitors are encouraged to move for 3 minutes. • Organization‐wide healthy meeting guidelines that encourage regular physical activity breaks and provide information for physical activity opportunities are adopted. • Health insurance companies that cover the agency's employees will provide reimbursement for personal fitness assessments. • On‐site physical fitness facility. • Employee membership in local health clubs is subsidized or reimbursed. • All new worksite construction/renovations will include accessible showers, accessible changing areas, and access to opportunities for walking. • Secure bicycle storage is provided on‐site. Programs In addition to traditional organized company sports teams and events, there are a number of easy to implement and inexpensive initiatives that the wellness team can consider for the workplace. Here are some ideas: • If the workplace has more than one floor, consider a Stairwell Campaign; encourage employees to use the stairs instead of the elevator/escalator. Work in cooperation with the building's maintenance or operations department to ensure that stairs are well lighted, safe, and clean. Incorporate motivational messages at the "point‐of‐decision." Posting these next to the elevator to encourage the question: "Should I take the elevator or use the stairs?" These messages are meant to cue people to action, so posting them where the individual is about to act is an opportunity to help encourage them to think about making a healthy choice. Suggested sources for Walking Programs that incorporate stairwell programs are: o American Cancer Society (www.cancer.org) o American Heart Association (www.heart.org) o CDC's StairWELL to Better Health site located at www.cdc.gov/nccdphp/dnpa/hwi/toolkits/stairwell/index.htm • Starting an Employee Walking Program is easy with a little planning. Steps include: o Developing an employee walking club name, e.g., the "Plymouth Rockers" o Recruiting volunteer walking group leaders/captains; establish roles Worksite Wellness Toolkit Page | 127 o Developing walking schedules (time/place to meet, time/length walk, etc.) o Planning walking routes along with placing mile markers where possible o Distributing walking maps o Creating alternate or indoor routes to use during inclement weather o Helping participants establish weekly/monthly goals o Printing cards for walkers to keep track of their progress o Providing free or low‐cost educational materials on the benefits or physical activity for employees o Distributing pedometers for participants to keep track of their steps o Posting progress in a central location o Assessing workplace walkability with this Walkability Audit: http://www.cdc.gov/nccdphp/dnpa/hwi/toolkits/walkability/index.htm • Creating friendly physical activity contests with incentives can help employees have fun and reduce stress while, at the same time, develop new healthy behaviors at work. Consider: o Organizing walking teams to "Walk across Massachusetts," " March into May" or a local scavenger hunt o Establishing guidelines and incentives (e.g., a day off, gift coupons, a "choice" parking space, etc.) for individual and team participants o Providing free pedometers to keep track of participants' steps o Organizing up‐dates on the workplace's walking teams' or individuals' progress as they "Walk Across Massachusetts" or "March into May" o Creating an awards/recognition event for participating teams and individuals. • Offering on‐site fitness classes during the work day (e.g. yoga classes) • Other efforts to promote more opportunities for employees to be physically active during the work day include: o Creating and distributing maps of walking and bicycling paths with measured distances in/near the worksite and in the local community o Establishing regular short‐term opportunities to allow employees to practice new physical activity (or other wellness) behaviors in a safe setting, such as "Walk to Work Day" or "Take the Stairs for a Week" o Asking Senior Management to sign a policy or proclamation supporting physical activity as a means of promoting employee wellness for all employees; include formal recognition of, and events or activities for, participants o Working with health insurance companies to reduce rates for employees who are physically active on a regular basis. • An evidence‐based program for increasing physical activity called "Active Living Every Day" was developed at the Cooper Institute and is available from Human Kinetics http://www.activeliving.info/index.cfm Worksite Wellness Toolkit Page | 128 Resources • Physical Activity Toolkits http://www.cdc.gov/nccdphp/dnpa/hwi/toolkits/other_physical_activity.htm • Physical Inactivity Cost Calculator http://www.ecu.edu/picostcalc/ • Tips to Help You Get Active (National Institute of Diabetes and Digestive and Kidney Diseases): www.win.niddk.nih.gov/publications/tips.htm • What Is Physical Activity? (United States Department of Agriculture): www.mypyramid.gov/pyramid/physical_activity.html • Updated Physical Activity Guidelines (American College of Sports Medicine): www.acsm.org • Physical Activity for Everyone (CDC): www.cdc.gov/nccdphp/dnpa/physical/everyone.htm • Physical Activity in Your Daily Life (American Heart Association): www.americanheart.org/presenter.jhtml?identifier=2155 • America on the Move www.americaonthemove.org • Green Streets Initiative www.gogreenstreets.org • Motivational physical activity signs (CDC): www.cdc.gov/nccdphp/dnpa/hwi/toolkits/stairwell/motivational_signs.htm • Walk Boston www.walkboston.org • Yoga and stretching desk videos (Alberta Centre for Active Living): www.centre4activeliving.ca/workplace/trr/tools.html • StairWELL to Better Health Program Ideas on worksite stairwell interventions http://www.cdc.gov/nccdphp/dnpa/hwi/toolkits/stairwell/index.htm • Virgin HealthMiles Inc. www.virginhealthmiles.com • Shape Up The Nation www.shapeupthenation.com Worksite Wellness Toolkit Page | 129 Nutrition Policies, Programs, and Resources A healthy diet and good eating habits is an essential component of wellness. Always having healthy choices, whether in vending machines, in cafeterias, at meetings/ conferences, at parties/events, or in break rooms, will encourage employees to eat healthy throughout the day. Policies Access to Healthy Foods • Use the 2005 United States Dietary Guidelines for Americans as a basis for making decisions when making food purchases and preparing recipes and meals • Establish healthy food and beverage purchase guidelines (using the dietary guidelines)for the organization's funded meetings, trainings and events • Require the purchase of locally produced food including fruits and vegetables or other foods if appropriate • Implement a policy that promotes healthy snacks in vending machine and company concession stands • Adopt a policy that promotes healthy foods through educational programming • Develop a policy and make available appropriate physical space to support breastfeeding moms • Develop a food safety policy that addresses proper food storage, food handling, hand washing and spills Food/meal program guidelines Follow the 2005 United States Dietary Guidelines for Americans when making food purchases and preparing recipes and meals. These guidelines should be used in all aspects of the Food Services operations (patient meals, cafeteria service, vending operations and catering services). • Transition to using only non‐saturated/trans fat‐free cooking oils in food • Develop and implement a reasonable timeline to eliminate purchase of packaged food products that contain Saturated and Trans fats (listed as hydrogenated or partially hydrogenated vegetable oils on labels). • Purchase low‐fat and non‐fat dairy and meat products. • Develop strategies to purchase local food products including locally grown fresh fruits and vegetables in season. • 100% fruit juices are available in all settings i.e. no "juice drinks" with less than 100% juice should be made available through meal service or vending machines. Worksite Wellness Toolkit Page | 130 • Reduced fat sources from hydrogenated and partially hydrogenated fats; use fats from vegetable sources. • 0 Trans fats – product labels must state 0 grams of Trans fat/serving • Procurement of Meats, Poultry, Dairy and Seafood which do not have inappropriate antibiotic use Programs • Implement informational campaigns that educate employees about the Food Guide Pyramid and about the importance of a well‐balanced meal plan that includes eating whole grains, low‐fat products, fruits and vegetables. • Coordinate on‐site healthy nutrition programs with food services so that healthy eating messages are supported by more nutritious foods in the cafeteria and in a visually pleasing manner. • Arrange for on‐site "brown‐bag lunch n' learn" education programs, e.g., with dietitians or health educators from local hospitals, universities, etc. Utilize some of the free or low‐ cost speakers and/or resources that are available through many of the voluntary health organizations. • Arrange for Weight Watchers Program on site for employees interested in losing or maintaining a health weight. • Implement a program that helps employees connect with nutrition assistance programs such as food stamps. • Implement a program that helps employees identify low‐cost healthier food choices through point‐of‐purchase nutrition information on menu items in a cafeteria or vending machines. • Establish a nutrition information hotline or "Ask the Dietitian" program that enables employees to get answers to individual nutrition related questions. • Implement a refrigerator cleaning schedule. Resources Massachusetts • Massachusetts Department of Public health Nutrition and Physical Activity Unit http://www.mass.gov/dph/dphorg2.htm • Massachusetts Health Promotion Clearinghouse http://www.maclearinghouse.com • Farm to Table: Working with Local Farmers to Access Fresh Fruits and Vegetables: Resource Guide (http://www.mass.gov/agr/massgrown/nutritioncouncil.htm) • Dept of Agricultural Resources http://www.mass.gov/agr/massgrown/nutritioncouncil.htm • Mass in Motion http://www.mass.gov/massinmotion • The John C. Stalker Institute of Food and Nutrition has The A‐List, of vending and snack products that meet the Massachusetts A La Carte Food & Beverage Standards to Promote a Healthier School Environment (Massachusetts Standards). Worksite Wellness Toolkit Page | 131 • Massachusetts Partnership for Healthy Weight (www.MPHW.org) • The Massachusetts Dietetic Association (www.,massnutrition.org) lists registered dietitians who are available for presentation in their MDA Speakers Bureau http://www.eatrightma.org/resources/speaker_request.php and will link you to the American Dietetic Associations to the Find a Nutrition Professional for a listing of RD available to counsel patients http://www.eatrightma.org/content4087. • Massachusetts Breastfeeding Coalition http://massbfc.org/index.php • The Massachusetts Food Safety Partnership www.mafoodsafetyeducation.info • Fresh to You: a discount, high quality fresh fruit and vegetable delivery program for worksites www.freshtoyou.com National • Local Harvest: Listing of farmers markets, farm coops http://www.localharvest.org/ • The Worksite Wellness Kit: Washington State Dept of Health. Contains various policies for different settings such as worksites, community, health care and schools, as well as specific nutrition policies http://www.doh.wa.gov/cfh/NutritionPA/our_work_sites/worksite_data/Worksite_welln ess_toolkit.htm • The American Cancer Society's Food & Fitness resource http://cancer.org/docroot/PED/ped_3.asp • The American Diabetes Association Nutrition & Recipes resource https://www.diabetes.org/nutrition‐and‐recipes/nutrition/overview.jsp • The Center for Disease Control and Prevention (http://www.cdc.gov/) Information on the Fruit and Vegetables More Matters campaign; prevention and control of obesity; food safety and health information. • The Center for Science in the Public Interest is a nutrition advocacy organization. http://www.cspinet.org/. They have a Nutrition Action Health newsletter, information on food safety and Eating Green and other food policies. • The U S Department of Agriculture website has much information on many topics related to agriculture. May be best known for the new Food Pyramid Steps to a Healthier You http://www.mypyramid.gov • US Dept of Health and Human Services Dietary Guidelines for Americans (http://www.health.gov/DietaryGuidelines/). • Nutrition Environment Assessment, Michigan Department of Community Health, 2005 http://www.mihealthtools.org/neat/NEAT_Print_Version.pdf • Developing a Breastfeeding Work Policy http://www.wicworks.ca.gov/breastfeeding/EmployerResources/BFWorkPolicy.pdf • Writing and Evaluating a Breastfeeding Policy http://www.babyfriendly.org.uk/pdfs/audit_policy_tool_community.pdf Worksite Wellness Toolkit Page | 132 • Workplace Breastfeeding Support http://www.usbreastfeeding.org/Issue‐ Papers/Workplace.pdf • The CDC Guide to Breastfeeding Interventions http://www.cdc.gov/breastfeeding/pdf/BF_guide_2.pdf • Workplace Breastfeeding Support, United States Breastfeeding Committee, 2002, http://www.usbreastfeeding.org/Issue‐Papers/Workplace.pdf • Fight Bac!: Food Safety website http://www.fightbac.org/ Worksite Wellness Toolkit Page | 133 Vending Machines and Concession Stands Although on‐site vending machines and concession stands are convenient for employees to grab a snack during the workday, many are filled with low‐nutrient, high‐calorie food and beverages such as candy bars, chips, and sugary drinks. By replacing these unhealthy options with more nutritious, healthful foods, the Wellness Team can make positive environmental changes to support healthy behavior. The overall guiding principle is to offer healthy choices while still allowing for free choice. The recommendation is that 75% of the total foods in the machines follow the guidelines in Table 1 below. Therefore, 25% of foods would remain unchanged, to provide people both healthy and less healthy choices. By establishing the policy of 75% healthy foods in vending machines, the work environment becomes more conducive to employees who are interested in having healthier food options as a way to promote their own health and prevent chronic disease. The guidelines used for vending machines and concession snack items incorporate the Dietary Guidelines for Americans 2005 (DGA) and the 2005 Guidelines for Food & Beverage Sales in British Colombia Schools by the Ministry of Education and Ministry of Health. The guidelines encompass nutrient dense items that are low in fat, sugar, sodium and calories. The Dietary Guidelines for Americans provides evidence‐based advice on promoting health and on reducing risk for major chronic diseases through diet and physical activity3. Worksite Wellness Toolkit Page | 134 Table 1: What is a "Healthier" Snack Option? Calories • 200 calories or less per portion Fat • No more than 35% total calories from fat • Less than 10% total calories from saturated fat • No trans fat Sugar • No more than 35% total calories from sugar • <15g sugar in energy bars5 • <12g sugar in candy bars5 Sodium • <140mg sodium per serving 5 Adapted from National Academies' Committee on Nutrition Standards for Foods in Schools Guidelines for Food & Beverage Sales in British Colombia Schools by the Ministry of Education and Ministry of Health On-Site Cafeterias and Restaurants It's important to build a relationship with the food services suppliers (in‐house or outside vendors) of the cafeteria as well as with the purchasing department to effectively coordinate the efforts to promote healthy nutrition. Planning together with the right players at the table ensures success. Make changes gradually and be sure to offer choices, e.g., be sure that non‐ fat, low‐fat and whole milk products are provided. Following are some ideas for creating a workplace that supports healthy nutrition: • Coordinate and launch company‐wide information campaigns that educate employees about the Food Guide Pyramid and about the importance of a well‐balanced meal plan that includes eating whole grains, low‐fat products, fruits and vegetables. Work with the food services unit or outside vendor and purchasing department to provide healthier food choices, and have these items identified where they are served in the cafeteria. A number of resources to help you with ideas for these activities are provided through state and local voluntary health organizations, including: o The American Cancer Society's Food & Fitness resource (http://www.cancer.org/docroot/PED/ped_3.asp); o The American Diabetes Association Nutrition & Recipes resource (https://www.diabetes.org/nutrition‐and‐recipes/nutrition/overview.jsp). o The American Heart Association's resource that focuses on African American populations, the AHA Search Your Heart program (http://www.americanheart.org/presenter.jhtml?identifier=3041580) o Boston Best Bites (email@example.com). Coordinate on‐site healthy nutrition programs with your food services unit or outside vendor so that healthy eating messages are supported by more nutritious foods in the Worksite Wellness Toolkit Page | 135 cafeteria. Arrange for on‐site "brown‐bag lunch n' learn" education programs, e.g., with dietitians or health educators from local hospitals, universities, etc. Utilize some of the free or low‐cost resources that are available through many of the voluntary health organizations. Work with your food services supplier to develop menus with calorie counts, heart healthy and other nutrition information. Print and circulate weekly menus with calorie counts and nutrition information for the weeks' menus. Print nutrition information on cafeteria placemats, e.g., use placemats that show a healthy meal with normal portion sizes and plenty of fruits, vegetables and whole grain options on the plate. Substitutions can be made during preparation of meals offered and substitutions can be made to existing menus to promote health. The Wellness Team may choose to use the Boston Best Bites model, where the restaurant would feature at least one appetizer, entrée and dessert that follow heart healthy criteria, with each item highlighted on the menu. Nutrition Education Events The Workplace Wellness Program can also provide useful information about nutrition, how to buy and prepare healthy foods, and how employees and their families can incorporate healthier food choices into their diet. Offering lunch time educational classes for employees will support and encourage them in their decisions for healthy eating. As part of this effort, the Wellness Team could invite a representative from their local community health center or a local hospital registered dietitian (RD) to be a guest speaker at an employee lunch time educational workshop. An employee survey could be used to identify topics of particular interest to be addressed by the guest speaker. Typically, this would be a combination of a culinary demonstration and preparation tips, taste testing of healthy recipes, and tips on how to modify recipes to be healthier while still being tasteful and appealing. Local Restaurants People in the United States eat out in a restaurant or other commercial food establishment an average of 4.2 times per week, according to Meal Consumption Behavior — 2000, a recent report by the National Restaurant Association. Lunch is the meal most likely to be prepared in a commercial setting, whether the meal is eaten in the restaurant or taken out. Approximately 2 meals pre week are eaten from a commercial establishment17. When dining out, it is easy to eat more calories and fat than you would if you had prepared your own meal. However, more restaurants are changing their menus and cooking processes to support healthy diets. It is important not to be shy about making special requests and substitutions. Equally important is to control the portion size by asking for smaller portions, sharing entrees with a companion, or putting half of your meal in a to‐go box to enjoy another Worksite Wellness Toolkit Page | 136 time, before you dig in. Here are some tips for healthy dining out. Also, remember that the same tips apply to prepared, ready‐to‐eat foods that many supermarkets and specialty stores offer for you to take home when you're in a rush. Tips for Eating Out • Request that your meal be prepared with vegetable oil (canola, olive, corn, soy, sunflower or safflower) or soft margarine instead of butter. Ask for soft margarine for your bread. • Have gravy, sauces, and dressings served on the side. • Ask if the restaurant has fat‐free or 1 percent milk instead of whole milk. • Even if they aren't on the dessert menu, many restaurants can offer you fruit or sorbet instead of high‐fat pastries and ice creams. • Eat a little less at noon to save for a special dinner later, but don't skip meals, since it might cause you to overeat later. • Eat a piece of fruit or have a glass of water with lemon 30 minutes before your meal so you are able to make better food and portion choices. • Avoid buffets and all‐you‐can‐eat specials. • Fried, au gratin, crispy, escalloped, pan‐fried, breaded, batter‐dipped, tempura, sautéed or stuffed foods are high in fat and calories. Look instead for grilled, broiled, flame‐ cooked, steamed, poached, roasted, or baked. • Avoid croissants, biscuits, pot pies, quiches, and pastries. Pick hard rolls, bread sticks (if not brushed with butter), French bread, or whole‐wheat buns. • For sauces, stick to wine, or thinned, stock‐based sauces. Avoid thick butter sauces and cream sauces. If you're unsure, ask the waiter. • Choose salads made with rich dark greens like spinach, arugula, and romaine rather than pale iceberg lettuce. • Ask to substitute a baked potato instead of French fries or have a side salad, steamed vegetables, or a cup of broth‐based soup. • Skip the mayonnaise and special sauces and ask for extra lettuce, tomatoes, onions and mustard on sandwiches. • If ordering pizza, ask for extra vegetable toppings and skip the meats and extra cheese. • Remember to count alcohol calories as part of your meal, as it is very high in calories and can prevent you from making healthy food choices. Adapted from: University of Wisconsin Hospitals and Clinics Authority (http://www.uhs.wisc.edu/docs/uwhealth_eating_out_203.pdf) Worksite Wellness Toolkit Page | 137 Food Sanitation A healthy environment should include food sanitation policies to prevent food borne illness. The Wellness Team should create a regular cleaning and monitoring program to be sure break rooms and equipment are cleaned, and refrigerators and other appliances are cleaned and running properly. Office Refrigerator Temperatures • Install thermometers in both the refrigerator and the freezer at eye level. • Maintain the refrigerator at a temperature of 40 degrees F or below, and the freezer temperature at 0 degrees F or below. • The refrigerator should not be too full; cool air must circulate to maintain proper temperature. • Establish a no tolerance policy on refrigerator overcrowding using language that states that stacking of food containers on top of each other is prohibited. Give a designated Food Safety Monitor clearance to throw out items that violate this policy. Assignments • An employee should be assigned to check temperature daily with appliance thermometer • Keep some type of marking pen/tape in the break room for people label their food with their name and date. • Assign 1 or 2 people to be held accountable for cleaning out the refrigerator once a week – rotating this responsibility will help to convince everyone to follow the policies. Cleaning • All refrigerators should be cleaned regularly using warm soapy water to wash the interior walls and shelves, the exterior walls, door handles, and gasket. • Use a clean cloth or paper towels with hot water and a mild detergent like dish soap • Work from top to bottom to prevent dripping on surfaces that are already clean • Add two tablespoons of baking soda to one quart of warm water to wash inside • Rinse everything with warm water and dry with a clean cloth. Policy • Designate a day and time each week that food in the refrigerator is thrown away • Develop a policy with input from staff and post in the break room. • Post food safety signs in the kitchenettes to educate employees on the proper storage and handling of leftovers, hand washing, and cleaning up of spills. • Include employees in the policy making process to foster a sense of shared responsibility and respect. Worksite Wellness Toolkit Page | 138 Implementing a Kitchenette Sanitation Program • Establish a regular cleaning and monitoring schedule on a master calendar. • Assign teams of employees (by division or randomly) to cleaning and monitoring duties and record on the master calendar. • Post the master calendar in a visible location of the kitchenette and email it to all employees. • Offer incentives to teams for performing cleaning duties such as contests. • Develop a chart that provides information on how to clean each piece of equipment in the kitchenette to post in an easily accessible place (see below example). Equipment Frequency Method Cleaning Product Sink 2 x / month Pour cleaning solution Solution of 1 tsp bleach in down sink 1 quart cool water Toaster 1 x / week Remove crumbs according None to manufacturer's directions Refrigerator 1 x / week Discard all contents. Wipe Solution of 1 tsp white down unit with cleaning vinegar in 1 quart warm sponge water. DO NOT USE CHEMICALCLEANERS! Microwave 1 x / week Wipe down sides, door, Same as for refrigerator and bottom of oven with cleaning sponge. Wash glass turntable. Counters 1 x / day Wipe down with cleaning Same as for refrigerator sponge Sponges 1 x / week (replace Soak Solution of 1 tsp bleach in every 2 weeks) 1 quart cool water Dish towels 1 x / week Launder Laundry detergent Trash can 2 x / month Wipe down with cleaning Solution of 1 tsp bleach in sponge and soak 1 quart cool water *If your organization operates a restaurant or concession stand, the Food Service Director must be trained in food safety and sanitation and must follow your state sanitation code. For further information, contact your state health department. Worksite Wellness Toolkit Page | 139 Marketing Plan for Healthy Vending Machines A marketing plan will raise awareness about the policies being implemented. Employees need to be aware of the changes being made to the worksite food venues in order to make healthy behavior changes. Guidelines for introducing healthy alternatives in vending machines 1. Begin by substituting a few items at a time. 2. Promote these options and use discounted pricing for the healthy options while increasing the pricing on unhealthy options. 3. Promote the healthier options to employees by sending out memos as well as by providing information on the company's website, i.e. marketing campaign. 4. Provide the opportunity for employees to provide feedback. Marketing Ideas for Healthy Vending Awareness A marketing campaign is important to create awareness for the healthy vending policy. The success of the program relies on the receptiveness of the employees through awareness promotion. Below is list of marketing tactics a company can employ. These examples are geared toward marketing at the MA Department of Public Health, and can be easily adapted to fit any company. Please see Appendix H for sample posters, flyers, and handouts that can be used to market your program. 1) Motivational posters describing healthy changes with nutrition requirements of replacements and benefits of healthy snacking, placed in strategic locations, such as: a) On walls adjacent to elevators b) In staff kitchenettes c) Next to vending machines d) On stairwell doors 2) Rating guide in vending machines to guide consumers on the healthiness of snacks and beverages. Some types of rating guides to include are: a) Traffic Light: i) Red: Choose rarely; limit consumption to as little as possible; high in calories/fat/sodium. ii) Yellow: Choose occasionally; use caution when choosing to control portion sizes; medium calorie/fat/sodium content. iii) Green: Best choice; choose these healthy options first; low in calories/fat/sodium.7 b) Change pricing stickers to color codes of health (green for healthy snacks). c) Healthier snacks placed at eye level, less‐healthy snacks placed on lower/upper shelves. Worksite Wellness Toolkit Page | 140 3) Write up simple fact sheets or any policy changes in newsletters, to post on the website, or to send via email to employees. Include a letter from the commissioner to endorse initiatives. 4) Ask for employee input in snack and beverage selections and ask for feedback on any changes made. Worksite Wellness Toolkit Page | 141 Guidelines for Healthy Vending Machines Guidelines for Snacks Vending machines often contain many low‐nutrient foods such as candy and sugary drinks. Substituting some of the candy with dried fruit or granola bars, for example, would be a healthy replacement option. Additionally, including a variety of 100% fruit and vegetable juice, sparkling water, and unsweetened iced teas will provide healthier alternatives to soda and other sugary drinks. A healthy vending machine item should meet nutrition criteria for a healthy snack. The nutrition facts label found on food packaging can be used to determine if a snack is deemed healthy. 1. Check the serving size: Remember calories and other nutrient values are listed only for 1 serving, not for the whole container! 3. Understanding Daily Values %DV of ≤ 5% is low 2. Next check total calories and fat: Choose low for saturated fat, cholesterol and sodium Choose foods %DV of ≥ 20% is high with fewer calories per serving to lose or Choose high for help maintain weight vitamins, minerals and fiber Choose foods with less saturated fat and 0 grams of trans fat Worksite Wellness Toolkit Page | 142 Guidelines for Fat Intake The 2005 Dietary Guidelines for Americans recommend keeping total fat intake between 20‐ 35% of a person's total calories. Monounsaturated and polyunsaturated fats are considered healthy fats, because they help to lower bad cholesterol (LDL) and raise good cholesterol (HDL). Saturated fats and trans fats are considered unhealthy fats. Saturated fats are the largest dietary contributor to high cholesterol, and should be limited to 10% of total daily calories. Trans fats comes from partially hydrogenated oils or hydrogenated oils, and are detrimental to health because they raise bad cholesterol (LDL) and lower good cholesterol (HDL). Even if a nutrition facts label reports 0 g of trans fat, it is important to remember that this number means there is less than 0.5 g of trans fat in each serving. If the ingredients list contains "partially hydrogenated oil," then the product contains less than 0.5 g of trans fat per serving. Consuming more than 1 serving of the product may result in consumption of a significant amount of trans fat. Guidelines for Sugar Intake The Dietary Guidelines for Americans recommends limiting intake of food with added sugars and caloric sweeteners3. Some commonly used added sugars in foods are: high fructose corn syrup, sucrose, glucose, corn syrup, fructose and maple syrup. A good tip is to check the order of ingredients in the label. When sugar is listed further down on the list of ingredients, the item contains a smaller amount of added sugar. For specific foods, the 2005 Guidelines for Food & Beverage Sales in British Colombia Schools by the Ministry of Education and Ministry of Health recommends less than 15 grams of sugar for energy bars and less than 12 grams for candy bars5. Explanation of Sodium Claims on Food Labels6 Sodium‐free: less than 5 milligrams (mg) per serving Very low sodium: 35 mg or less per serving or, if the serving is 30 grams (g) or less or 2 tablespoons or less, 35 mg or less per 50 g of the food Low‐sodium: 140 mg or less per serving or, if the serving is 30 g or less or 2 tablespoons or less, 140 mg or less per 50 g of the food Light in sodium: at least 50 percent less sodium per serving than average reference amount for same food with no sodium reduction Lightly salted: at least 50 percent less sodium per serving than reference amount. (If the food is not "low in sodium," the statement "not a low‐sodium food" must appear on the same panel as the "Nutrition Facts" panel.) Reduced or less sodium: at least 25 percent less per serving than reference food. The FDA and USDA state that an individual food that has the claim "healthy" must not exceed 480 mg sodium per reference amount. "Meal type" products must not exceed 600 mg sodium per labeled serving size6. Worksite Wellness Toolkit Page | 143 Rationale for Healthier Foods in Vending Machine Items Beverages Recommendation Rationale Milk: non‐fat or low‐fat or 1% Adults need at least 1000mg of Calcium daily. Non‐fat or low‐fat milk is lower in calories and saturated fat. 100% fruit Juice or vegetable juice or contains One serving 100% fruit or vegetable juice is 50‐70% juice with no added sugar in serving considered one serving of fruit or vegetable. size of 6‐8oz Plain or pure water Water is a great thirst quencher and has no calories or fat and is essential for the body. Sports Drinks are recommended for individuals who are involved in endurance or performance sports4. Snacks Recommendations Rationale Whole grain bars, crackers, and chips (baked) The Dietary Guidelines for Americans recommends choosing fiber‐rich and whole grains often. Whole grains are high in fiber and complex carbohydrates. Snacks should be between 150‐200 calories per packet or bar, thus promoting weight maintenance. Snacks should also contain no trans fat (hydrogenated oils and partially hydrogenated oils) Choosing low sodium snacks provides the opportunity to keep within the limits of the daily recommendation of 2,300mg of sodium, thus reducing the risk of hypertension. Good source of protein and high in monounsaturated fat. Should be consumed in small portions – 1 serving can provide more that 150 calories. Great source of vitamins, mineral, fiber and phytonutients and are low in calories. Low‐sodium/lightly salted/reduced snacks Nuts and seeds Fresh fruit and vegetables Worksite Wellness Toolkit Page | 144 Helpful Resources for Healthy Vending Machine Policies Many companies are aware that a healthy diet is important in the prevention chronic disease and as a result have produced products that are low in calories, fat, and sugar. Company Name Email Address Phone number Good Health Food Inc www.goodhealthnaturalfoods.com 631‐261‐2111 Kashi www.kashi.com 877‐747‐2467 Eat Smart www.eatsmartsnacks.com 800‐233‐7125 Every Day Fruit www.everydayfruit.com 888‐262‐3997 Sensible Foods www.sensiblefoods.com 888‐222‐0170 Nutritious Creations www.snacksforlife.com 631‐666‐9815 Source: www.vendingconnection.com/yphealth.html Please view the John Stalker Institute A‐list for distributors of healthy vending machine items, at http://www.johnstalkerinstitute.org/vending%20project/alist.pdf. To contact distributors that offer healthy choices, please visit: http://www.johnstalkerinstitute.org/vending%20project/distributor.pdf. Worksite Wellness Toolkit Page | 145 Selected Existing Vending Policies Policy title Summary Date State Policy details started Vending Machine 50% of all food and 12‐15‐04 Contra Costa http://www.publichealthadvo policy beverages sold in County CA cacy.org/PDFs/02_Contra%20 facilities owned and operated by the county Costa%20Vending%20Fact%20 must meet specific Sheet_final.pdf nutrition standards Public Vending 100% of healthy snacks 5‐23‐06 Chula Vista CA http://www.preventioninstitut Machines in city and beverages in all e.org/sa/policies/pdftext/Chul facilities public vending machines aVistaVendingPolicy.pdf On‐Site Food 50% food and beverages 7‐1‐04 Marin County http://www.banpac.org/pdfs/ Vending vending in four DHHS CA healthy_vending/marin_count office locations y.pdf Healthy food and Stipulates that all San 3‐14‐06 San Jose CA http://www.preventioninstitut Drink for City Jose City Public Libraries e.org/sa/policies/policy_detail library Vending to stock only healthy Machine food and drinks in their .php?pid=89 vending machine Healthy Food and States that all vending 6‐12‐06 San Jose CA http://www.preventioninstitut Drink for City Wide machines in city owned e.org/sa/policies/policy_detail Vending Machines and operated locations to include at least 50% .php?pid=100 healthy food and beverage choices Healthy Snack in No less that 50% healthy 8‐12‐06 Santa Ana http://www.preventioninstitut Vending Machine food and beverages CA e.org/sa/policies/policy_detail at City Owned provided in all vending Facilities machines located at city .php?pid=176 owned facilities Worksite Wellness Establishes healthy food 5‐1‐06 Clark County http://www.preventioninstitut Nutrition Policy and beverages purchase WA e.org/sa/policies/policy_detail guidelines .php?pid=203 Healthy Choice Set guidelines to provide San Diego CA http://www.preventioninstitut options in Vending healthy options in e.org/sa/policies/policy_detail Machines on vending machines on County Property county property .php?pid=204 Health Food Policy 50% of food and 11‐15‐05 Santa Clara http://www.preventioninstitut beverages sold in county County CA e.org/sa/policies/policy_detail vending machines meet specific nutrition .php?pid=209 guidelines Worksite Wellness Toolkit Page | 146 The Health Guidelines for items in San Antonio http://www.healthcollaborativ Collaborative vending machines Texas e.net/assets/pdf/vendingcriter ia.pdf B. C. Public Provides Nutrition 11/06 Public Buildings http://www.lcs.gov.bc.ca/Heal Buildings Policy Criteria for a variety of in B.C thierChoices/pdf/CompletePol Paper food groups icy.pdf Sources: www.preventioninstitute.org/sa/enact/members/index.php www.lcs.gov.bc.ca/healthierchoices/pdf/completepolicy.pdf Worksite Wellness Toolkit Page | 147 Worksite Nutrition Criteria The task of creating healthy cafeteria meal and snack options may seem daunting initially, but these specific guidelines and simple substitutions can alleviate the burden. The purpose of this guide is to rid the ambiguity of what is considered healthy and to aid in development of a healthy cafeteria policy in the workplace. A workplace cafeteria can transition modifications into a healthy policy by following the nutrition criteria. The "Suggested Substitutions for Healthier Menus" list presents the conventional item on the left ("Instead of current"), and suggests examples to meet the nutrition criteria (Substitute with…). Employees will value the healthy suggestions and options while cafeterias can use health as a marketing tool to increase business. Nutrition Criteria Boston Public Health Commission's Boston BestBites Standards for Adult Portions Appetizer (or snack) Entrée Dessert Total <150 <650 <200 calories < 5 grams <1.6 grams Saturated <1.2 grams (<7% of (<7% of fat (< 7% calories) calories) calories) No partially No partially No partially Trans fats hydrogenated fats hydrogenated hydrogenated fats fats Sodium < 150 mg <750 mg < 150 mg (Salt) Source: http://www.bphc.org/programs/initiative.asp?i=260&p=190&b=2&d= Sodexho's Your Health Your Way Nutrition Criteria for Entrées • Less than 30% calories from fat • No more than 3 grams saturated fat • Less than 100 mg cholesterol • Less than 1000 mg sodium • Less than 600 calories • At least 3 grams of fiber Worksite Wellness Toolkit Page | 148 Suggested Substitutions for Healthier Menus Breakfast Instead of Current… Substitute with… Pancakes 100% whole grain flour pancake mix French Toast Egg substitutes, 100% whole gratin bread, non-fat or low-fat milk Syrup Fruit puree, fresh fruit, apple sauce Scrambled Eggs Egg substitutes, egg whites Bacon Turkey bacon or soy bacon Sausage Turkey sausage or vegetarian sausage Corned Beef Hash Smoked salmon Dry Cereal 100% Whole grain cereal, less than 16grams sugar per serving: (ex: Kashi, Chex, Special K) Hot Cereal Whole grain, use non-fat or low-fat milk in preparation Plain Bagel, Bread, English Muffin 100% whole grain Muffins Substitute oil with non-fat or low-fat plain yogurt, applesauce, or mashed bananas. Add non-fat or low- fat milk to liquefy Cream Cheese Non-fat or low-fat Lunch Instead of Current… Substitute with… Sandwiches • Meats Lean, chicken and turkey, vegetarian (tofu, hummus) • Bread 100% whole grain bread, pitas, wraps • Condiments Use non- or low-fat condiments on side Salad Bar • Dressings, Toppings Low-fat, dried Fruits, 100% whole grain croutons, sunflower seeds • Iceberg Lettuce Add dark-green salad: Mesculun, Romaine, Arugula, Spinach • Potato Salad Healthy oil mayonnaise (ex: Smart Balance), non-fat or low-fat mayonnaise (Hellman's, Miracle Whip) • Pasta Salad Use 100% whole grain pasta, low-fat dressing, add chopped vegetables • Jello, Pudding Fresh fruit salad Entrée Meats Use: chicken breasts, trimmed of excess fat; broiled or grilled fish Substitute: ground Turkey (90% lean) for ground beef. Sauces, Gravy Sauce/gravy on side Soups • Cream Based Replace half of the cream with non-fat or low-fat milk • Broth Based Low sodium broth Worksite Wellness Toolkit Page | 149 French Fries Oven baked potato sticks, sweet potato "fries" Sautéed Vegetables Steamed, roasted, no added salt White Rice Whole grain rice: brown, basmati, long grain, wild. No butter, salt Mashed Potatoes With skin, add herbs, non-fat or low-fat milk Snacks Instead of Current… Substitute with… Chips Baked chips, pretzels, pita chips, 100% whole grain chips Candy Bars 100% whole grain granola bars Fruit Snacks Dried fruit Fruit Cups in syrup Fruit cups in water, fresh fruit salad Yogurt w/ fruit on bottom < 20 g of sugar per 4 oz or 30g of sugar per 6 oz, Non- fat or low-fat Granola 100% whole grain granola: (ex, Kashi, Kelloggs) Crackers Cracker combos with fresh vegetables and hummus Beverages Instead of Current… Substitute with… Whole Milk Non-fat or low-fat milk (8 oz), soy, lactose-free Soda Sparkling water, diet, caffeine free Coffee w/ cream Non-fat or low fat milk, soy milk Juice Drinks 100% juice, low-sodium vegetable juice Iced Teas Unsweetened, diet Worksite Wellness Toolkit Page | 150 Existing Cafeteria and Restaurant Policies The following are examples of policies that already exist regarding healthy eating in cafeterias and restaurants. Create and implement your own policies that meet you worksite's needs by drawing from currently existing guidelines. Also use the tips listed above as a guide for healthy commercially‐prepared foods. Cafeteria Policies Resource Location Description Website CDC Garden Market CDC Pilot Project Description http://www.cdc.gov/nccdphp/dnpa/ Example • Planning process hwi/toolkits/gardenmarket/example • Promotion .htm • Evaluation • Lessons learned Healthful choices at Worksite • 5 sample worksite http://www.co.tompkins.ny.us/well work Wellness for policies on healthy food ness/worksite/workwell/foodpolicy. Tompkins County, choices html#2 NY • Catering Policy Template Healthful Eating NY State Description of activities: http://www.health.state.ny.us/prev Department of • Improve Cafeteria ention/worksite/healthful_eating.ht Health Options m • Improve Vending Machine Options • Direct Market Fresh Produce at Worksites • Create a Food Policy Worksite Nutrition Mecklenburg • Employee Wellness http://www.fitcitychallenge.org/Wor Fit City Challenge County, NC Article Archive ksite/ShowNutrition.aspx?ID=1 Healthy Weight • Fit City Workplace tool Fit City for Worksite Task Force kit http://www.fitcitychallenge.org/Wor Wellness ksite/Resources.aspx California Fit State of Guidelines to implement http://www.dhs.ca.gov/ps/cdic/cpns Business Kit California, healthy cafeteria choices. /worksite/download/FitBusinessKitT Department of Fax sheet to communicate ools/Healthy%20Dining%20Menu%2 Healthy Dining Menu Human Resources healthy requests with food 0Guidelines_Final.pdf Guidelines service provider NC HealthSmart North Carolina Examples of worksite food http://www.eatsmartmovemorenc.c Worksite Wellness Division of Public policies om/Resources/wwtoolkit/eatsmart. Toolkit: Eat Smart Health Posters to motivate html employees The Mayor's San Francisco Environmental strategies for http://sfworks.org/docs/shape_up_6 Challenge "Shape up Shape Up SF food policy: ‐07.pdf SF" Coalition Work Web Toolkit Work Web Guidelines Worksite Wellness Toolkit Page | 151 Resource Location Description Website Eat Smart Workplace • Program nutrition Cafeteria Program Ontario, Canada standards and http://eatsmart.web.ca/en/workplac requirements e Restaurant Policies Resource Location Description Website Healthy Dining • Restaurants consult http://www.health Healthy Dining in Corporate Office company to analyze and ydiningfinder.com/ Collaboration with 4849 Ronson Court, display healthy menu site/ National Restaurant Suite 115 options Association San Diego, CA 92111 • Guidelines/criteria • Participating restaurants • Nutrition info on healthy options Boston Best Bites Boston Public Health • Guidelines for participating http://www.bphc. Commission, Mayor restaurants based on the org/programs/initi Menino American Heart ative.asp?b=2&d= 1010 Massachusetts Association &p=190&i=260 Ave • Logo for healthy menu Boston, MA items Ruby Tuesday, Inc All National Chain • Smart EatingTM lists http://rubytuesday Restaurants calories, grams of fat, net .com/menu/smart carbohydrates, and fiber Eating.asp for healthy options • Downloadable nutrition information Sodexho Foodservice Nationwide • "Your Health Your Way" http://www.yourh Corporate Office Cafeteria Guidelines ealthyourwayonlin Corporate Gaithersburg, MD • Vending Program e.com/about_fram Responsibility 1‐800‐SODEXHO • Food Facts, Handouts eset.htm • Talk to Dietitian Worksite Wellness Toolkit Page | 152 Useful Resources on Food Sanitation 1. http://www.dec.state.ak.us/eh/fss/establishments/stickers.htm: printable kitchen sanitation stickers (for general kitchen area, for fridge, sanitizing solution recipe, hand washing, proper fridge temperature) 2. http://www.mass.gov/?pageID=eohhs2subtopic&L=5&L0=Home&L1=Provider&L2=Guid ance+for+Businesses&L3=Food+Safety&L4=Retail+Food&sid=Eeohhs2: MA state policies and procedures for food and kitchen sanitation 3. http://pubs.cas.psu.edu/freepubs/pdfs/ui302.pdf: detailed instructions on cleaning a refrigerator 4. www.foodsafety.gov: wealth of links for consumers and industry food service professionals 5. http://www.cfsan.fda.gov/~dms/ftteats.html: tips for employees of how to safely store and eat a packed lunch Worksite Wellness Toolkit Page | 153 Sample Fact Sheet to Post on Vending Machines Hungry for a snack? Before you push that button, take a moment to consider your options... and your health! Snacks can be an important part of a healthy diet, depending on the foods you choose. Snack smart by choosing foods that meet these six nutritional criteria1: • Low in calories • Low in total fat • Low in saturated fat • Trans fat free • Low in sugar, relative to weight • Contains plenty of fiber or protein Vending machine items are categorized below according to their nutritional quality. And remember: the keys to healthy snacking are balance, variety, and moderation! = Best Choice: These items meet all 6 of the healthy criteria: Nature Valley Crunchy Granola Bars Snyder's Mini Pretzels Stacy's Cinnamon Sugar Baked Pita Chips Luna S'mores Bar = Choose Occasionally: These items meet 5 of the 6 healthy Act II Light butter Popcorn (1 cup popped) Oreo Cookies (3 cookies) Austin Cheese Crackers with Peanut Butter Ruffles Baked! Cheddar and Sour Cream Crisps Austin Toasty Crackers with Peanut Butter Kar's Original Unsalted Trail Mix (1 oz) Baked Lay's Crisps (1 oz, or 11 crisps) Mixed Berry Fruity Snacks (10 pieces) Balance Bar Gold (1 bar) Sun Chips (1 oz) Big 'n Crunchy Salted Peanuts (1 oz) Zoo Animal Crackers Chex Mix Traditional (2/3 cup) NutriGrain Apple Cinnamon Cereal Bar = Choose Rarely: these items meet fewer than 5 of the healthy Crunch Crisp Junior Mints Doritos Nacho Cheese O'Brien's Beef Sticks Duplex Sandwich Cremes (3 cookies) Planter's Salted Peanuts Famous Amos Chocolate Chip Cookies Skittles Original Fruit Flavor Worksite Wellness Toolkit Page | 154 Sample Lunch Time Workshop Flyer Snacks can be a great part of a healthy diet. They keep you energized, while providing your body with the nutrients it needs. Snack smart by choosing foods that meet these six nutritional criteria: • Total Calories: 250 calories or less • Total Fat: 7 grams maximum per serving, or less than 30% of calories from fat • Saturated Fat: 3 grams maximum per serving, or less than 10% of total calories from saturated fat • Trans Fat: Trans fat free (less than 0.5grams/serving), unless already a low fat food (3grams fat or less) • Sugars: No more than 35% sugar by weight • Fiber: At least 3 grams of fiber per serving -OR- Protein: At least 3 grams of protein per serving Rationale behind fiber "or" protein as a nutrient criteria: Many healthy snacks that help to stabilize blood sugar levels can contain fiber and no protein (fruit and vegetables), or protein and no fiber (yogurt and other low-fat dairy). While a combination of both is ideal, if an item is a good source of one or the other (3 grams or more per serving), it meets the nutritional criteria. Please join us for more information on healthy eating in the workplace at: Add Location (Bring your lunch and eat while you learn something new) Add Date & Time Worksite Wellness Toolkit Page | 155 Sample Flyer for Lunch Time Employee Workshop Making Health Work at Work Lunch and Learn Series (Bring your lunch while you learn something new) Add Location Date & time Come join us for a discussion of a variety of nutrition "hot" topics including: Trans Fats, food labels; planning a healthy event/meeting/ party; and vending machine changes at MDPH. . The workshop will also feature Meredith Berger, a Culinary & Nutrition Graduate Student at BU who will share some tips on preparing taste, fast lunch & snack recipes. Worksite Wellness Toolkit Page | 156 Sample Lunch Time Employee Workshop Outline National Nutrition Month Employee Brown Bag Lunch Presentation March 2008 1) Intro (2 minutes) a) What Worksite Wellness is b) Healthy eating as an essential component c) What DPH has been doing 2) Fruits and Vegetables – More Matters (5 minutes) a) Why fruits and vegetables are important b) How to incorporate more fruits and vegetables into daily life 3) Healthy Meeting/Events Guide (5 minutes) a) Hints/tips b) What to look out for/avoid c) Sample menus 4) Vending Machines (5 minutes) a) In progress: aiming for 75% of vending machine items to be deemed "healthy" b) How to read the nutrition label i) Trans fats discussion ii) Serving sizes c) Red, Yellow, Green tools that are posted on vending machines 5) Bringing your own food (5 minutes) a) "You Make it Best" tool – Making your own healthy snacks to bring to work b) Portion control 6) WIC (2 minutes) 7) Student chef demonstration (15 minutes) Worksite Wellness Toolkit Page | 157 Sample Lunch Time Employee Workshop Evaluation Form "Making Health Work at Work" Evaluation Form 3.20.2008 How did you hear about this workshop? ______ Advertisements at DPH ______ Word of mouth ______ Commissioners email Other (please specify): _______________________________________________ 1. Did you notice the nutrition month displays in the lobby? ______ Yes ______ No Were they informative? ______ Yes ______ No Suggestions: __________________________________________ 2. Did you find this workshop informative? ______ Yes ______ No What aspect did you find most helpful? ______ PowerPoint _____ Handouts ______ Food display Other (please specify): ____________________________ Please list any other topics you are interested in seeing presented in the future: 1. 2. 3. Are you aware of the healthy changes being made to the vending machines at DPH? ______ Yes _____ No 4. Are you planning to make healthy changes to your diet? _____ Yes _____ No Did this presentation affect that? _____ Yes _____ No 8. Other Comments/Recommendations: Worksite Wellness Toolkit Page | 158 Sample Beverage Facts Handout (front side) Worksite Wellness Toolkit Page | 159 Water: • Water is an "Excellent Choice" when choosing a beverage. It's healthy, low cost, and has no calories. • Our body is made up of 50-75% water, so we need to give the body what it needs. • Recommendations are 4-8 cups including high water content foods for ages 2-12 years, and for adults 8 cups or more a day. • Carry a water bottle with you to remind you to drink enough. Worksite Wellness Toolkit Reduced Fat (1%‐2%) or Skim Milk: • Once a child reaches 2 years of age it is recommended to switch from whole milk to reduced fat or skim milk, the fat in whole milk and other foods can lead to conditions such as heart disease or obesity. • Choosing milk as a healthy beverage during the day can help to meet your daily calcium requirements. Sample Beverage Facts Handout (back side) 100% Fruit Juice: • Some juices may seem healthy but be sure to read the label. • Look for the words "100% juice" and "Unsweetened"- these are the best choices. • Stay away from words like "Cocktail" or "ades"- these have little juice and more sugar. • Juice is not recommended for children under 6 months of age. For ages 1-6 years only 4-6 oz. per day is recommended and should be given in a cup (never a bottle). Older children and adults should not consume more than 8-12 oz. per day. • Enjoy whole fruit instead of juice. It has more fiber and less calories. Other Beverages: • Beverages containing High Fructose Corn Syrup (HFCS) contain the same amount of calories as table sugar and studies are finding that they may be harmful to your health by increasing weight gain(Be on the look out for new studies on HFCS). • On average, soda and fruit-flavored drinks account for 30% of the calories we eat. In addition to the excess calories you get by drinking these products, HFCS may also cause you to eat more since they may make you feel less full than other foods with the same amount of calories. • Sports drinks such as Gatorade or Powerade are designed for the endurance athlete. For the average athlete and as a regular beverage these added calories are unnecessary. • Energy drinks such as Red Bull may give you a "pick-me-up" when you are tired, but the high amount of calories from straight sugar may bring you right back down later, and could cause weight gain if drunk regularly. Page | 160 National Nutrition Month- March 2006 Nutrition & Physical Activity Unit, Division of Community Health Promotion, Massachusetts Department of Public Health References 1. Visscher TL, Seidell JC. The public health impact of obesity. Annual Review of Public Health 2001: 22:355‐75. 2. Healthy People 2010. Available at: http//www.Healthypeople.gov/ 3. Dietary Guidelines of America. Available at www.health.gov/dietaryguidelines/ 4. Barry MP, Lawrence EA, George MB, Benjamin C, Balz F, Walter WC. A New proposed guidance system for beverage consumption in the United States. Am J Clin Nutr 2006; 83:529 – 42. 5. Ministry of Labour and Citizens' Services. Healthier Choices in Vending machines in B.C. Public Buildings. www.lcs.gov.bc.ca/healthierchoices/pdf/completepolicy.pdf Accessed on November 2007. 6. Nutrient Claim Guide. Available at: www/fda.gov/fdac/foodlabel/sodium.html 7. Choosing Healthy Snacks. www.tompkins‐co.org/wellness/worksite/ Accessed November 2007. 8. Intake of sugar‐sweetened beverages and weight gain: a systematic review. Vasanti S Malik, Matthias B Schulze and Frank B Hu. American Journal of Clinical Nutrition, Vol. 84, No. 2, 274‐288, August 2006. http://www.ajcn.org/cgi/content/abstract/84/2/274 Accessed December 2007. 9. Drink More Diet Soda, Gain More Weight? http://www.webmd.com/diet/news/20050613/drink‐more‐diet‐soda‐gain‐more‐weight Accessed December 2007. 10. Health Management Research Center. The Ultimate 20th Century Cost Benefit Analysis and Report: The University of Michigan; 2000. p. 1‐39. 11. Chapman LS. Proof Positive: An Analyses of the Cost‐Effectiveness of Worksite Wellness. 4th ed. Seattle, WA: Summex Corporation; 1999. 7. Chapman LSM. Clearing Up the Productivity "Fog". The Art of Health Promotion 1999; 3 (5): 1‐12. 12. Workplace Safety Tool Kit http://nonprofitrisk.org/tools/workplace‐safety/public‐ sector/topics/fs/risk‐ps.htm. Accessed January 29, 2008. 13. Food Reflections: Cleaning Up the Office Refrigerator. http://lancaster.unl.edu/food/ftsep02.htm. Accessed January 29, 2008. 14. The Pennsylvania State University, College of Agricultural Science: Cleaning Your Refrigerator http://pubs.cas.psu.edu/FreePubs/pdfs/ui302.pdf. Accessed January 29, 2008. 15. Hunnicutt, D., 10 Secrets of Successful Worksite Wellness Teams. WELCOA's Absolute Advantage Magazine, 2007. 6(3): p. 6‐13. 16. Americans' Dining‐Out Habits http://www.restaurant.org/rusa/magArticle.cfm?ArticleID=138. Accessed April 8, 2008. Worksite Wellness Toolkit Page | 161 Smoking Cessation Policies, Programs, and Resources The Massachusetts Smoke‐free Workplace Law effective July 5, 2004, prohibits smoking in workplaces, including private offices, taxis, restaurants and bars in order to protect employees and the public from secondhand smoke. This law amends the 1988 Massachusetts Clean Indoor Air Law. Secondhand smoke, also known as environmental tobacco smoke (ETS), is the combination of smoke exhaled by a smoker and smoke from a burning cigarette, cigar or pipe. This combination is dangerous for both the smoker and the nonsmoker. Secondhand smoke contains a mixture of more than 4,000 chemicals, more than 50 of which are cancer‐causing agents (carcinogens). Cities and towns may have additional local secondhand smoke regulations that are stricter than the state law. For information about local tobacco control regulations, contact your local health department/board of health. Policies • The sale of tobacco products at the worksite is prohibited • Tobacco advertisements are prohibited at the worksite • Smoking is prohibited except for designed outside areas • Smoking is prohibited on all worksite property • Tobacco use is prohibited on paid time • Tobacco use is prohibited at all workplace‐sponsored events • The worksite will provide free, accessible, on‐site tobacco treatment and will publicize its availability • The worksite will provide on‐demand access, directly or through purchased health insurance coverage, to free or low cost smoking cessation counseling and all FDA approved medication Programs funded by Massachusetts Tobacco Control Program The Try‐to‐Stop Tobacco Quitline (1‐800‐Try‐to‐Stop) provides confidential telephone information, referral and counseling at no charge to smokers and support to quit or make a quit attempt. Counseling is available in English and Spanish and through interpreters in all other languages. QuitWorks (www.quitworks.org) is a free, evidence‐based stop‐smoking service developed by the Massachusetts Department of Public Health in collaboration with all major health plans in Massachusetts. QuitWorks links providers and their patients who want to quit smoking to the full range of the state's tobacco treatment services. All it takes to use QuitWorks are a clinician, a patient who uses tobacco, and the QuitWorks tools. Heath care providers enroll patients who smoke in QuitWorks by faxing a completed referral form to the Try‐to‐Stop Tobacco Quitline. Trained telephone counselors then contact patients proactively to provide counseling and send Worksite Wellness Toolkit Page | 162 providers fax‐back reports on each patient's progress. QuitWorks can fit into routine patient care ‐ whether the setting is an office practice, a hospital, a health center, a public health program or a worksite. www.TrytoStop.org is a website for smokers that includes expert advice, self‐directed quitting tools, resources and information. Additional information about secondhand smoke and tobacco prevention are available at www.makesmokinghistory.org. Free educational materials on smoking cessation and secondhand smoke are available at the MA Health Promotion Clearinghouse www.maclearinghouse.com Resources • The Massachusetts Smoke‐Free Workplace Law effective 07/05/2004, prohibits smoking in workplaces, including private offices, taxis, restaurants and bars in order to protect employees and the public from secondhand smoke. The law amends the 1988 Massachusetts Clean Indoor Air Law. Information is available at www.mass.gov/dph/mtpc. Some local municipalities have stricter regulations than the state law. For more information about local tobacco control regulations, contact your local health department or board of health. • Make It Your Business www.makeityourbusiness.net • Resources for quitting smoking: o www.trytostop.org o www.smokefree.gov o American Cancer Society: www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_Quitting_Smoki ng.asp?from=fast o American Heart Association: www.americanheart.org/presenter.jhtml?identifier=3038010 o American Lung Association: http://www.lungusa.org/site/c.dvLUK9O0E/b.22931/k.8550/Smoking_Cessation _Support.htm o The EX Campaign: www.becomeanex.org • CDC tobacco information: www.cdc.gov/tobacco • Massachusetts tobacco information: www.makesmokinghistory.org • Massachusetts information about addictions: www.talkaboutaddiction.org Worksite Wellness Toolkit Page | 163 Stress Management Policies, Programs, and Resources Policies • Policies that support a culture of workplace flexibility having a variety of work options: o Flextime: Workday start and end times differ from the workgroup's standard, yet the same number of hours per day is maintained o Compressed Workweeks: Full‐time options that allow employees to work longer days for part of the week or pay period in exchange for shorter days or a day off during the week or pay period o Part‐time: Working less than 35 hours a week o Job Sharing: Full‐time position shared by two people, each working part‐time hours o Telecommuting: Working from a remote location one or more days a week o Working Remotely: Working full‐time from a remote location • Worksite provides directly or promotes health insurance companies that sponsor programs for stress reduction or related issues (e.g. relaxation training, assertiveness, communication, time management, conflict resolution) • Written job descriptions for each employee with defined clear expectations that are set by the employees manager • Scheduled group stretch breaks • Ergonomically designed workstations will be available to all employees • Mentoring opportunities for employees • Policies to address dependent care issues • Domestic violence awareness seminars for employees • Regular social events are supported • Extended disability or sick time allowances and grievance procedures • An Employee Assistance Programs (EAP) is available, free of charge, for all employees • Sexual harassment and non‐violence policies (including domestic violence) policy • Policies to prevent against frequent involuntary overtime • Ensure that employees have input into management decisions about physical space, new work procedures and work schedules that impact them • Efforts made to seek input/ideas from affected employees before supervisor or management make decisions about physical aspects of the work environment (e.g. equipment, furniture, work space layout), new work procedures, or work schedules • Policies allowing employees paid work‐release time to attend evaluated worksite‐based parenting education programs such as "Talking Parents, Healthy Teens: A Worksite‐ Based Program for Parents to Promote Adolescent Sexual Health" www.cdc.gov/pcd/issues/2006/oct/06_0012.htm Programs • Training on meditation, muscle relaxation, tai chi, and other relaxation methods • Providing physical space for meditation and other relaxation Worksite Wellness Toolkit Page | 164 • Providing a walking route and/or exercise space for use during work hours • Offering periodic massage therapy at the workplace • Insurance sponsored programs for stress reduction or related issues (e.g. relaxation training, assertiveness, communication, time management, conflict resolution). Resources • The Center for the Promotion of Health in the New England Workplace: http://www.uml.edu/centers/cph‐new • Employers Against Domestic Violence: www.employersagainstdomesticviolence.org. • Women's Bureau‐ U.S Department of Labor: http://www.we‐inc.org/flex.cfm. • "Talking Parents, Healthy Teens: A Worksite‐based Program for Parents to Promote Adolescent Sexual Health" www.cdc.gov/pcd/issues/2006/oct/06_0012.htm • The Boston College Center for Work and Family: http://www.bc.edu/cwf • Center for Mindfulness, Healthcare and Society Stress Reduction Program http://www.umassmed.edu/Content.aspx?id=41252 • Worksite‐based Program for Parents to Promote Adolescent Sexual Health" www.cdc.gov/pcd/issues/2006/oct/06_0012.htm. • Expanding Our Understanding of the Phsychosocial Work Environment; A Compendium of Discrimination, Harassment, and Work‐Family Issues: http://www.cdc.gov/niosh/docs/2008‐104 • The Center for Stress Reduction at UMASS Medical School: http://www.umassmed.edu/Content.aspx?id=41252 • Sloan Work and Family Research Network: http://wfnetwork.bs.edu • National Institute of Occupational Safety and Health. (1999) Stress at Work. DHHS (NIOSH) Publication Number 99‐101. Available online at: http://www.cdc.gov/niosh/stresswk.html • The Salter School's Massage Therapy Program: http://www.salterschool.com • Parenting in the Workplace Institute: http://www.parentingatwork.org/ Worksite Wellness Toolkit Page | 165 Workplace Policies that Address Optimal Employee Health and Well-being Suggested Policies that Support Safety in the Workplace • Installation of Automatic External Defibrillators (AED's) and First Aid kits at the worksite • All employees will have first aid training with a refresher course every 2 years • All employees will have Cardiopulmonary Resuscitation (CPR) training with a refresher course every 2 years • All employees will have Automatic External Defibrillators (AED) training with a refresher course every 2 years • All employees will have Epi‐Pen training • Written emergency response plan for medical emergencies (e.g. heart attack, asthma attack) • Established policy for reporting injuries at work that is well publicized to all employees and easy to follow • Written occupational health and safety policy and/or program • Worksite will have a dedicated person, group or committee who is responsible for employee health and safety • Policies insuring that occupational safety and health audits, inspections, or walk‐arounds are carried out on a regular basis • Written seatbelt policy that requires employees to wear seatbelts when on company business or operating company equipment Suggested Policies that Support Substance Abuse Prevention in the Workplace • Impose and enforce a drug‐free workplace policy • Managers are required to attend a training session on the signs and symptoms of substance abuse • Mandatory pre‐employment physicals/testing that cover tobacco cessation, depression screening and other health risks are required for all employees • An Employee Assistance Program (EAP) will be provided for all employees • Work with insurance companies to provide reimbursement for needed treatment for a substance use disorder Worksite Wellness Toolkit Page | 166 Lactation Support Policies, Programs, and Resources Breastmilk is the ideal source of infant nutrition. Breastfeeding protects infants—and their mothers—from innumerable illnesses and chronic health conditions. Experts universally recommend exclusive breastfeeding for the first year of life, yet returning to work is a significant challenge many new mothers face in reaching this important goal. Employers have the opportunity to ease this challenge with a small investment of time, money, and flexibility by offering their employees policies and programs that support breastfeeding in the workplace. Providing accommodations for breastfeeding also offers tremendous rewards for employers, including health care cost savings, reduced absenteeism, and improved employee morale and retention. Policies • Development of a written policy describing the employer's lactation support program and prohibiting harassment and discrimination against breastfeeding employees. • Sufficient maternity leave (at least six weeks) for mothers to allow the establishment of breastfeeding. • Flexible work arrangements for mothers returning to work, such as part‐time work, job sharing, flextime, compressed work week, telecommuting or a phase‐back to full‐time work load over several weeks or months. • Sufficient break time to breastfeed (if infant is on site or nearby) or express breast milk at work, allowing at least two 20 – 30 minute breaks (one morning and one afternoon) during an eight hour shift. Programs • Lactation support programs enable mothers to continue to provide breast milk to their infants upon return to the workplace. o Minimal requirements for an employer lactation support program include: A clean, private multi‐purpose space (that is not a restroom) with a comfortable chair and an electrical outlet A sink, soap and paper towels near the designated breastfeeding/pumping space o More comprehensive lactation support programs include: A designated space used only as a "Nursing Mothers' Room" that includes a small refrigerator and a sink An employer‐provided hospital grade electric breast pump for shared use by employees, and access to pump collection kits required for its use Worksite Wellness Toolkit Page | 167 Access to breastfeeding support and education from a trained lactation professional Resources • Food and Drug Administration, Breast Pump Information http://www.fda.gov/cdrh/breastpumps/ • Massachusetts Breastfeeding Coalition, Breastfeeding and the Workplace http://massbfc.org/workplace/ • Sloan Work and Family Research Network, Policy Briefing Series, Breastfeeding and the Workplace http://wfnetwork.bc.edu/pdfs/policy_makers14.pdf • The United States Breastfeeding Committee, Workplace Breastfeeding Support Position Paper & Checklist: http://www.usbreastfeeding.org/Issue‐Papers/Workplace.pdf http://www.usbreastfeeding.org/Issue‐Papers/Checklist‐WP‐BF‐Support.pdf • Vermont Department of Health, Breastfeeding Friendly Employer Project: http://healthvermont.gov/family/breastfeed/employer_project.aspx • Work and Pump, Breastfeeding Information and Support for Working Mothers: http://www.workandpump.com/ Worksite Wellness Toolkit Page | 168 Sleep Health Policies, Programs, and Resources Sleeping well for an adequate amount of time is essential for good health and high quality of life. There is increasing evidence that insufficient sleep and a variety of sleep disorders are risk factors for a number of medical and psychiatric conditions including heart disease, hypertension, diabetes, depression and cancer. In addition, sleep disturbances result in higher rates of motor vehicle accidents, reduction in job performance and more job‐related injuries and accidents. Programs o On site education seminars on the importance of good sleep health and how to obtain better sleep o On line sleep health education program o On line sleep disturbance screening questionnaire o Providing a physical space for napping during breaks o Evaluating workplace lighting to improve alertness o For 2nd and 3rd shift employees, making taxi vouchers available for those who believe they are too sleepy to drive home Resources o Harvard Medical School Division of Sleep Medicine Sleep and Health Education Program: http://understandingsleep.org o American Academy of Sleep Medicine: http://www.sleepeducation.com o The Harvard Medical School Guide to a Good Night's Sleep (Harvard Medical School Guides) by Lawrence Epstein and Steven Mardon o National Sleep Foundation: http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2420541/k.9E5A/How_Sleep_Works .htm Worksite Wellness Toolkit Page | 169 o National Center on Sleep Disorders Research: http://www.nhlbi.nih.gov/about/ncsdr/index.htm o Institute of Medicine/National Academies Press: Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem http://www.nap.edu/catalog.php?record_id=11617 o Harvard Business Review, October 2006, Reprint R0610B: Sleep Deficit The Performance Killer‐‐A Conversation with Harvard Medical School Professor Charles A. Czeisler http://www.hbr.org Worksite Wellness Toolkit Page | 170 Workplace Policies that Address Asthma The environment plays an important role in causing and making asthma worse. Research has shown that exposure to mold, cockroaches, mice, certain chemicals (sensitizers and irritants), and other factors can cause asthma or make asthma worse. Recent survey data in Massachusetts show that nearly one in ten adults have current asthma, and nearly one in five of those adults with asthma report that conditions at their current workplace either caused their asthma or made their asthma worse. Improving asthma requires both good medical management and improving the workplace environment. This section focuses on assisting employers with improving the workplace environment. Because work environments vary significantly from office buildings to construction sites, this section recommends policies based on the work setting. Suggested Policies that Support Safe Work Environments for Persons with Asthma State and federal law requires reasonable accommodations of persons with asthma, if the asthma meets the criteria for disability. However, employers should consider policies that accommodate all persons with asthma, even if not required by law, as they will help ensure healthy employees and reduce absenteeism due to asthma. • Reasonable accommodations should be instituted for any employee with doctor‐diagnosed asthma who documents that certain environments at work aggravate or cause their asthma. Such accommodations can include: relocation of office to a site that does not aggravate asthma or carpet removal. The employer should work with the employee's physician (with the employee's consent) to identify and remediate any workplace asthma triggers. • If the asthma qualifies as a disability, the employer should consult with legal counsel to ensure they meet legal requirements. Suggested Policies that Support Preventing Asthma Symptoms in the Office and School Environment • Develop smoke‐free policies that discourage smoking at entrances to buildings and near air intakes • Enforce anti‐idling requirements with particular attention to idling at school entrances and near air intakes • Prevent moisture incursion—address plumbing or roof leaks immediately; remediate water damage • Ensure ventilation systems are working in accordance with state building code, ASHRAE standards, and recommendations by the Massachusetts Department of Public Health6 o Operate at all occupied times o Provide fresh air 6 http://www.mass.gov/?pageID=eohhs2terminal&L=6&L0=Home&L1=Consumer&L2=Community+Health+and+S afety&L3=Environmental+Health&L4=Environmental+Exposure+Topics&L5=Indoor+Air+Quality&sid=Eeohhs2 &b=terminalcontent&f=dph_environmental_c_iaq_overview&csid=Eeohhs2 Worksite Wellness Toolkit Page | 171 o Replace or clean filters on a regular schedule • Ensure that construction, renovation or repair activities are isolated from occupants. Select building materials that do not emit formaldehyde to the environment • Institute Integrated Pest Management systems that remove pests without hazardous pesticides o Remove trash daily o Reduce clutter to prevent pest infestations • Avoid use of air fresheners in bathrooms and kitchen areas and discourage the use of perfumes by occupants • Take steps to limit dirt brought into the building o Provide walk‐off mats at entrances o Reduce clutter to make it easier to clean • Use Environmentally Preferable Products (EPP) for cleaning as recommended by the MA Operational Services Division. Make sure that any use of cleaning or other chemicals that cause asthma are disclosed to employees as required by law. • Install easy to clean surfaces – flooring, counter tops, kitchens. Carpets require extra care— avoid spills, prevent dust and dirt incursion, and use HEPA vacuum cleaners in schools. Suggested Policies that Support Preventing Asthma Symptoms in Health Care Settings • Address all indoor air quality issues recommended in office and school environments • Develop a policy that limits use of chemicals and products with asthma‐causing ingredients o Provide alternatives to latex gloves in all areas o Develop safer cleaning practices; use disinfectants appropriately and selectively only where needed o Avoid exposures to glutaraldehyde, formaldehyde and other known asthma‐ causing agents o Develop floor care strategies that limit floor stripping Suggested Policies that Support Preventing Asthma Symptoms in Manufacturing, Construction, and Service Industries • Comply with OSHA Hazard Communication Standard which requires training about chemicals in the work environment • Develop policies that review chemical ingredients and minimize use of chemicals in the workplace known to cause or exacerbate asthma (see the table for likely hazards by industry.) o Ensure that safety and health committees address hazards for asthma o Encourage review of chemicals for hazards for asthma o Pay attention to cleaning products that cause asthma symptoms in product users and bystanders • Ensure that workplace exposures are evaluated for any employee with new‐onset asthma • Provide respirators on a voluntary basis for employees who seek extra protection from certain exposures Worksite Wellness Toolkit Page | 172 ASTHMA-CAUSING AGENTS Examples by occupations at risk Industry Exposures Agriculture Animal urine/dander, Grain dusts, Grain mites, Insects Animal Handling Animal urine/dander Baking Enzymes (fungal amylase), Flour/grain dust, Grain mites Carpentry Acrylate, Amines, Diisocyanates, Epoxy resins, Wood dusts Cleaning, Janitorial Work Cleaning products, Dusts, Molds Daycare Cleaning products, Dusts, Latex gloves (natural rubber), Molds Electronics Amines, Colophony, Metals, Soldering flux Hairdressing Henna, Persulfate Health Care Formaldehyde, Glutaraldehyde, Latex (natural rubber), Methyldopa, Penicillins, Psyllium Laboratory Work Animal urine/dander, Bird feathers, Enzymes, Formaldehyde, Glutaraldehyde, Insects, Latex (natural rubber) Machining/Tool setting Metal working fluids, Oil mists Office Work Cleaning materials, Dusts, Molds Pharmaceuticals Cephalosporins, Pancreatin, Papain, Pepsin, Psyllium Photography Complex amines Plastics/Rubber Anhydrides, Diisocyanates Manufacture Sawmills Wood dusts (Eastern white/western red cedars, mahogany, oak, redwood) Seafood Processing Crabs, Prawns Teaching Cleaning products, Molds, Dusts Textile Manufacture Dyes, Gums Welding Welding fumes, especially stainless steel Table adapted from New York State Department of Health Worksite Wellness Toolkit Page | 173 Additional Useful Web Sites and Links to Cost Calculators The following websites contain information that employers can use to find information about workplace health promotion programs. • C. Everett Koop National Health Awards Winners: http://healthproject.stanford.edu/koop/work.html • Diabetes at Work: www.diabetesatwork.org • Guide to Community Preventive Services: www.thecommunityguide.org • Healthy Workforce 2010: www.prevent.org/images/ • Massachusetts Health Promotion Clearninghouse: http://www.maclearinghouse.com/ • National Business Group on Health: www.businessgrouphealth.org/ • Partnership for Prevention: www.prevent.org • Partnership for Workplace Mental Health: www.workplacementalhealth.org • U.S. Centers for Disease Control and Prevention: www.cdc.gov • Wellness Council of America: www.welcoa.org Links to Cost‐Calculators Alcohol Misuse • George Washington University Alcohol Treatment ROI Calculator, http://www.alcoholcostcalculator.org/roi/ Diabetes • Diabetes at Work, Conducting a Diabetes Assessment. General Assessment Tool. http://www.diabetesatwork.org Obesity and Physical Activity • CDC's LEAN Works Obesity Cost Calculator http://www.cdc.gov/leanworks/ • American Cancer Society ROI Calculator for Obesity and Physical Activity, Worksite Wellness Toolkit Page | 174 http://www.acsworkplacesolutions.com/obesitycalculator.asp • Magellan Health Services Obesity Cost Calculator http://www.magellanassist.com/customer/services/obesitycost/default.asp • Quantifying the Cost of Physical Inactivity http://www.ecu.edu/picostcalc Return on Invesment of Wellness Programs • WellSteps ROI Calculator http://www.wellsteps.com/resources/resources_tools.php Tobacco • American Cancer Society ROI Calculator for Tobacco, http://www.acsworkplacesolutions.com/tobaccocalculator.asp • America's Health Insurance Plans (AHIP) and Center for Health Research, Kaiser Permanente Tobacco ROI calculator, http://www.businesscaseroi.org/roi/default.aspx Worksite Wellness Toolkit Page | 175 Worksite Wellness Toolkit Page | 176 Step 6 Plan Approval Worksite Wellness Toolkit Page | 177 Worksite Wellness Toolkit Page | 178 Step 6 – Plan Approval Purpose In this phase, the task is to seek approval for the plan from the Wellness Team, Wellness Committee (as appropriate), the program sponsor and the organization's management. Tasks 1. Prepare Wellness Program Plan using Master Worksheet 2. Present to Wellness Team for Review 3. Present to Management for Approval Tools Wellness Program Master Worksheet (From Step 4 & 5) Intervention Worksheets (From Step 5) Worksite Wellness Toolkit Page | 179 1. Prepare Wellness Program Plan using Master Worksheet The length and level of detail of the program plan will usually be determined by the managers who have approval authority over the proposed program and the culture of the organization. The complexity of the approval process will vary based on the size and management structure of the organization. The format and level of information required should be defined prior to developing a formal Plan for approval. Considerations When preparing your plan for approval, some of the following considerations may be helpful to incorporate: • Identify the rationale for selecting specific goals, objectives and interventions. For example, weight management was selected as a goal in the case study because 38% of the target population is overweight or obese; or a walking program was selected as an intervention because 83% of the employees lack regular physical exercise. • Identify the long‐term expected outcomes and potential for return on investment (ROI) as a reflection of the values and benefits of the program. For example, reduced absenteeism, reduced health care costs and improved morale are likely outcomes as measured by the baseline data gathered in Step 3. 2. Present Plan to Wellness Team for Review Now that the plan has been developed, the next step is usually to get formal review and approval for the program plan. Define the approval process based on the level of review and input that the key stakeholders require. For example, if the Wellness Team has been involved or provided input during the planning process, a detailed review should be scheduled with this group. Various levels of management may be involved in preliminary reviews of drafts before presenting the final plan to the senior management. Keep the plan in draft format until all key stakeholders have reviewed it and their suggestions and input have been incorporated. 3. Present Revised Plan to Management for Approval It is important to understand the organization and approach the approval process with a high degree of political acumen. If support hasn't been gathered informally prior to seeking approval for the plan, it can get derailed quickly for some unanticipated technical or political reason. Make sure the type of presentation style of the managers is fully understood, so that you are presenting the plan in the most appropriate format Use Wellness Program Master Worksheet as a guide for the contents of the plan. Worksite Wellness Toolkit Page | 180 Step 7 Implement the Plan Worksite Wellness Toolkit Page | 181 Worksite Wellness Toolkit Page | 182 Step 7 – Implement the Plan Purpose The final step is to implement the program. Now that the program is approved, it is time to begin implementation of the wellness program. Implementation will "convert planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, regulations, and organizational actions of new programs" (Timmreck, 1997). The plan should provide a reasonably detailed roadmap for the implementation activities and should be referenced often. Tasks 1. Review and Discuss Implementation Considerations Tools Wellness Program Master Worksheet (From Step 5 & 6) Worksite Wellness Toolkit Page | 183 1. Implementation Considerations Putting the Wellness Program into action may require a phased approach such as conducting a pilot with a small portion of the population phasing in or initiating a total program launch. This model should be considered based on the available budget and resources and level of investment required by the proposed interventions. Leadership Support Support from management is a critical success factor for worksite wellness programs. Throughout the program implementation, it is important to keep management informed about the program and have them demonstrate visible support for the program, in the forms of ongoing communication to encourage participation, physical presence at program activities, and personal participation in award/recognition events. Project Management A system and processes should be established to manage the financial, human and technical resources required to deliver the programs. Utilizing the detailed program plans, identify the many detailed tasks that are required to execute the programs. Consider using tools such as Excel worksheets and Gantt or PERT charts to manage the details. Resources on Gantt and PERT charts can be found at Project Management Institute (www.pmi.org). Communication and Promotion Effective marketing and promotion will help ensure high levels of participation. Use a variety of media to provide the message, such as posters, email, paycheck inserts, etc. When creating the materials, make them attractive and professional in appearance so as to capture potential participants' attention. During the planning process, consider using this as an opportunity to let employees know that planning is underway, what to expect and the timeline for the planning effort. If this is not done formally, it will happen informally through the 'grapevine'. Don't underestimate the role the 'grapevine' plays in communications. Planned and purposeful 'grapevine' communications is also a valid and powerful approach. During planning, consideration should be given to the promotion of both the individual interventions, as well as the overall wellness program. A program kickoff event should be included in the plan as a way of introducing the initiative and creating a positive Worksite Wellness Toolkit Page | 184 image for the program. Creating a 'brand' or program identity and developing standards for the program's image is indispensable in establishing credibility and creating appeal for the program. Marketing and promoting the wellness program and selected intervention activities is an ongoing activity requiring a great deal of attention. Strategies for Enhancing Participation Participation in the wellness program is critical to the program's success. Without it, the expected outcomes for health status improvement and economic return, will not results. Consider the following strategies when addressing participation: • Better program positioning • Better alignment to areas of interest of participants • Improving program design • Improving access to programs • Improving or increasing promotion activities • Increasing level of policy support • Enhancing management support • Utilizing more personal contact • Using more incentives • Enhancing cultural norms. (Chapman, 1998) Get Feedback It is a good rule of thumb to start off slowly with the program components that are most likely to succeed or by offering a few high visibility programs at the beginning. (Chapman, 2005) It is also important to design activities that will produce early successes in your overall wellenss program. Establish checkpoints during the implemenation to ensure that you are getting feedback on how the program is going and assuring success. Program Evaluation As each individual intervention comes to an end, a series of program closure activities should take place. These include compiling feedback and evaluation data, review of outcome measures in the context of goals and objectives, and follow‐up on any outstanding items with program participants. Ongoing programs will require continued marketing to keep them visible and well attended. Worksite Wellness Toolkit Page | 185 Use the evaluation information to provide periodic updates to the Wellness Team and Management. Keeping the program visible to them will help them see the ongoing benefits and impact of the program. (Aldana, 2005) (Baun & Pronk, 2006) (Chapman, 2005) (Chenoweth, 2007) (McKenzie, Neiger, & Smeltzer, 2005) (The Health Communication Unit of the Center for Health Promotion, 2001) (Wilson & Glaros, 1994) Worksite Wellness Toolkit Page | 186 Bibliography A Guide to the Project Management Body of Knowledge. (2000). v1.2. Project Management Institute. Aldana, S. G. (2005). The Culprit and the Cure. Mapleton, UT: Maple Mountain Press. Baun, W. B., & Pronk, N. P. (2006). Good programs don't just happen‐they're planned! ACSM's Health & Fitness Journal , 10 (3), 40‐43. Bradford, R. W., Duncan, J. P., & Tarcy, B. (2000). Simplified strategic planning. Worcester, MA: Chandler House Press. Bureau, U. C. (2006). Current Population Survey. Chapman, L. S. (2005). Planning Wellness: Getting Off to A Good Start. Seattle, WA: Summex Health Management. Chapman, L. S. (2003). Meta‐evaluation of worksite health promotion economic return studies. The Art of Health Promotion, American Journal of Health Promotion . Chapman, L. S. (2002). Using Wellness Incentives. Seattle, WA: Summex Corporation. Chapman, L. S. (1998). Maximizing Program Participation. American Journal of Health Promotion . Chapman, L. S. (1997). Securing Support from Top Management. The Art of Health Promotion , 1‐7. Chenoweth, D. H. (2007). Worksite health promotion (Second edition). Champaign, IL: Human Kinetics. Goetzel, R. Z., Ozminkowski, R. J., Asciutto, A. J., Chouinard, P., & Barrett, M. (2001). Survey of Koop Award Winnerss: Life‐Cycle Insights. The Art of Health Promotion , 1‐12. Goodstein, L. D., Nolan, T. M., & Pfeiffer, J. W. (1993). Applied strategic planning: a comprehensive guide. New York: McGraw Hill. Hunnicut, D. (2007). The 10 Secrets of Successful Worksite Wellness Teams. Omaha: Wellness Council of America (WELCOA). McKenzie, J. F., Neiger, B. L., & Smeltzer, J. L. (2005). Planning, implementing & evaluating health promotion programs. San Francisco: Pearson Benjamin Cummings. Worksite Wellness Toolkit Page | 187 Milstein, B. W. (2000). A Framework Featuring Steps and Standards for Program Evaluation. Health Promotion Practice , 221‐228. Napier, R., Sidle, C., & Sanaghan, P. (1998). High Impact Tools and Activiities for Strategic Planning. New York: McGraw Hill. Policy, M. D. (Fiscal Year 2005). Inpatient Hospital Cae Mix and Charge Data. Ryan, M. A., & Chapman, L. (2008). Planning Worksite Health Promotion Programs: Models, Methods and Design Implications. American Journal of Health Promotion , in press The Health Communication Unit of the Center for Health Promotion. (2001). Introduction to health promotion program planning. Toronto: University of Toronto. Timmreck, T. (1997). Health services cyclopedia dictionary. Boston, MA : Jones & Bartlett. Wilson, B. R., & Glaros, T. E. (1994). Managing Health Promotion Programs. Champaign, IL: Human Kinetics. Worksite Wellness Toolkit Page | 188 GLOSSARY Asthma – a chronic disease characterized by constriction and inflammation of and overproduction of mucus in the airways causing shortness of breath, wheezing and other breathing difficulties. Acute episodes known as asthma attacks are perpetrated by the immune system in response to external stimuli. Automatic external defibrillator (AED) – A device that detects irregular heart rhythms and delivers an electrical pulse to correct them. Biometric screening – screens various physiological indicators, often including BMI, cholesterol, glucose and blood pressure in order to determine the overall state of a person's health Blood glucose – The main sugar found in the blood and the body's main source of energy. Blood pressure – The force blood exerts against the walls of the arteries as the heart pumps. Blood pressure is typically recorded as two numbers: the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). For example: 120/70. Body mass index (BMI) – A measure of weight in relation to height that is used to screen for overweight and obesity. Cardiopulmonary Resuscitation (CPR) – A lifesaving technique useful in many emergencies in which someone's breathing or heartbeat has stopped. Cardiovascular disease (CVD) – Any disorder that affects the ability of the heart and blood vessels to function normally. Cardiovascular disease includes stroke and heart disease. Worksite Wellness Toolkit Page | 189 Centers for Disease Control and Prevention (CDC) – The Centers for Disease Control and Prevention serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States through a variety of means including disease surveillance, operational research and national health programs Cholesterol – A soft, waxy substance, manufactured by the body and found in certain foods. Excess cholesterol can build up in blood vessels, contributing to cardiovascular disease. Colorectal – describes the lower area of the digestive system spanning the colon in the lower small intestines and rectum in the lower large intestines. Colorectal cancer – is a cancer originating in this area of the digestive system. Along with heredity and prior disease, certain environmental factors are thought to increase the likelihood of colorectal cancer including physical inactivity, alcohol consumption and diet. Diabetes – A disease in which the body does not produce or properly use insulin. The major types of diabetes are: Type 1 – A disease in which the body does not produce insulin, most often occurring in children and young adults, although can occur at any age. Type 2 – A disease in which the body does not produce enough insulin or cannot properly use the insulin it does make. It is the most common form of the disease, accounting for 90‐95% of all cases of diabetes. Gestational – Glucose intolerance (the inability of the body to efficiently convert carbohydrates into energy) during pregnancy. Prediabetes – A condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Worksite Wellness Toolkit Page | 190 Employee Assistance Program (EAP) – programs offered at the employer's discretion by the employer aimed at providing assistance to employees for adverse life or health conditions Employee Interest Survey – A survey to uncover the met and unmet health interests of the employees. Ergonomics – the discipline of designing workplace equipment to allow maximum comfort and impose minimum strain in order to maximize productivity and minimize as much as possible the conditions that arise from long‐term exposure to certain kinds of strain including carpal tunnel syndrome, eye strain, back pain, etc. Family Leave Medical Act (FMLA) – prescribes the conditions under which employees must be granted twelve weeks of unpaid leave per twelve month period in order to take care of certain personal and medical emergencies. Glucose – Known colloquially as 'blood sugar' glucose is a simple sugar and the most common molecule converted into energy by the human body. Glucose molecules are also stored in the form of fat or glycogen for later use. Health Insurance Portability and Accountability Act (HIPAA) – a two‐part Congressional Act divided into part one which discusses the availability and breadth of health insurance for group and some individual policies. The second section addresses privacy of medical and medical payment records both in terms of non‐disclosure and by outlining standards by which privacy is to be enforced. Health Risk Assessment (HRA) – An electronic or paper tool used to assess an individual's risk of developing a disease. The HRA organizes and calculates individualized health risk information, compares it to standardized data for normal risk, and provides general quantitative measures of the individual's risk of acquiring a disease. Worksite Wellness Toolkit Page | 191 Heart disease – Any disease or condition of the heart. Abnormalities of the arteries, valves, and muscle of the heart are all forms of heart disease. Hypertension (high blood pressure) – Blood pressure that is consistently above 140/90 or above 130/80 for those with diabetes. Chronic hypertension has hereditary and environmental components which include diet, smoking and stress. Insulin – A natural hormone made by the pancreas that is needed to convert sugar, starches, and other food into energy needed for daily life; it controls the level of sugar (glucose) in the blood. Insurance claims – Claims including pharmaceutical costs, workers' compensation costs, and medical costs that can be analyzed to determine the specific health conditions facing employees. Claims data may be available through insurance brokers and/or insurance companies. Lactation – the body's production of milk, in this Toolkit relating to breastfeeding Mammography – imaging of the breast tissue using x‐rays used in breast cancer detection National Institute for Occupational Safety and Health (NIOSH) – a subsidiary of the Centers for Disease Control and Prevention concerned with research and implementation of programs relating specific to the impact of the work place on an individual's safety and health National League of Cities – an organization providing information and political resources as well as idea exchange to the cities and elected officials thereof Obesity – An excessively high amount of body fat in relation to lean body mass. Obesity is defined as a Body Mass Index of 30 or more for both men and women. Worksite Wellness Toolkit Page | 192 Osteoporosis – Osteoporosis is condition wherein bone mineral density (BMD) decreases resulting in increased bone fragility resulting in a high probability of fractures and breaks in bones from falls as well as an increase in the severity of these injuries. Symptoms of advanced osteoporosis include shrinking and disability. Overweight – Excess weight for height. A Body Mass Index between 25 ‐ 29.9 is considered overweight for adults. Children are considered overweight when their BMI is at or above the 95th percentile for their sex and age. Papanicolaou (Pap) test – Named for the doctor who developed the screen, a Pap test or "smear" swabs the cervix and screens the retrieved cells for signs of cervical cancer. Pap tests are crucial for early detection of cervical cancer. Risk factor – A behavior, clinical condition, or characteristic that is associated with an increased possibility of developing a chronic illness. Stroke – Brain cell damage caused by either insufficient blood flow (ischemic stroke) or bleeding (hemorrhagic stroke) in part of the brain. A stroke can impair movement, vision, and speech, among other functions. Wellness – The optimal balance between body, mind, and spirit, regardless of health status or ability. Wellness involves conscious choices and responsible actions which are influenced by one's social and physical environment. Wellness Council of America (WELCOA) ‐ A not‐for‐profit, non‐governmental organization dedicated to the improvement of the health and general well‐being of the American worker, WELCOA provides resources and assistance to people in a position to effect program adoption and/or policy changes at the corporate level. Worksite Wellness Toolkit Page | 193
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