Chapter 3: Implementation of STEP

Staying Healthy Through Education and Prevention (STEP)

Closeup on woman in exercise class

Overview

This chapter will help you decide whether the STEP program is right for your community and will guide you through successful planning and implementation of the program. The chapter contains a variety of questions for you to consider in implementing the program, including equipment, facilities, finances, and enthusiasm on the part of staff and residents. As you review this chapter, you will be able to determine your organization's readiness to implement the STEP program.

After considering the questions posed in this chapter, if you decide to implement STEP, then you are well on your way through the planning stages. The chapter will advise you on additional steps to take to prepare for the successful rollout of this exciting program. The checklist at the end of the chapter will help you organize and implement a successful STEP program.

Objectives

After reading this chapter, you will be able to:

  • Assess your organization's readiness to implement the STEP program in your community.
  • Develop an implementation plan to bring the STEP program to your community.
  • Identify resources and materials needed to implement the STEP program.

Key Points

This chapter will help you evaluate whether STEP would be beneficial to your community by asking you to assess:

  • Need and interest.
  • Support from leadership.
  • Facilities and staff.
  • Budget.

If you are ready to implement STEP, the chapter will help you:

  • Develop a budget.
  • Identify and recruit staff.
  • Identify training needs and resources.
  • Acquire equipment.
  • Orient and train staff.
  • Recruit STEP participants, schedule classes, and maintain these activities once the program has begun.

Introduce the STEP Program to Senior Leaders in Your Organization

Before implementing the STEP program in your community, it is important to gain support and buy-in from your organization's senior leaders. Their support will ensure that you receive the needed time and resources to succeed as you move forward. Key leaders and staff in your community will need to review the STEP Implementation Guide, paying attention to the chapters on STEP Program Leader training [Chapter 4, Recruitment of Participants, Chapter 5, Physical Activity Intervention, Chapters 6 and 7, and Behavior Coaching (Chapter 8).

Determine the Need for STEP in Your Community

Before you commit time and resources to implementing the STEP program, you need to determine if your community needs the program or is interested in it. Key questions to ask are:

  • Do you have a sufficient number of residents in your community who would be interested in being more physically active in general? Would they be interested in the STEP program in particular?
  • Would the STEP program be a new and valuable added service in your community, or do you have other similar programs currently offered to your residents?

Determine Your Organization's Readiness To Implement the STEP Program

Form a workgroup or project team to assess whether implementation of the STEP program is feasible. Review the following questions with your team members to determine your community's ability to go forward with the STEP program:

Senior Leadership Buy-In

  • Is senior leadership willing to support the STEP program financially and programmatically (investing in time, space, staff, and equipment)?
  • Will senior leadership commit to using existing or new staff to build and sustain the STEP program?
  • Is senior leadership willing to commit existing or new resources to build and sustain the STEP program?

Physical Environment/Space

  • Does your community have a walking route that is at least 200 feet long?
    • Is your community's walking route level to the ground?
    • Does your walking route allow at least two people to walk side by side?
    • Does your community have indoor and outdoor options for walking?
  • Does your community have sufficient space to hold STEP behavior sessions and exercise classes?
  • Can the room accommodate chairs, participants, and equipment comfortably and safely?
    • Do you have a physical space for the strength training classes that is 400 square feet or larger?
    • Will there be enough space between chairs so that participants can hold their arms out to the sides without touching one another?

Program Development

  • Can you offer STEP programs at times and places that are convenient for your participants?
  • Will you be able to recruit a sufficient number of participants on an ongoing basis to justify the investment in developing the STEP program?
  • Do you plan to have the STEP program replace an existing program, or will it be added to your current program offerings? Will STEP compete with other fitness activities?
  • Does your community have staff available to promote the STEP program from within and build excitement among potential participants?
  • If needed, does your community have access to fitness and behavior coaching experts who could lead STEP training prior to program implementation? If not, do you have staff with this expertise?

Funding

  • If outside training is desired, is your organization willing to commit the time and resources to train STEP staff? Do you need to establish a budget to cover costs of any additional equipment, staff, and participant materials not currently available on your campus?

Develop a Budget

The STEP program was developed to be incorporated into an existing recreation/wellness program in senior housing communities. Therefore, the cost of implementing the STEP program should be limited to training costs (if you bring in an outside consultant or workshop instructor), printing, and purchase of ankle weights.

Ongoing costs would be limited to the cost of participant handouts for the coaching sessions. Staff time spent in planning and facilitating the STEP program would not be an additional cost unless your community elected to include the STEP program in an expansion of the number of programs and services offered or you decided to hire new staff. In most communities, existing staff can be trained to coordinate and administer the program on an ongoing basis.

Incentives are another optional expense. It is important to have incentives to motivate participants but you do not have to incur significant costs to provide them. For example, when participants reach an important milestone in the program, they can mark their progress on a map or hold a small celebration or trip to the movies. Some facilities find rewards such as key chains, coffee mugs, or other knickknacks highly motivating, but they do come at a cost. You need to decide what incentives will work best for your participants and how much you are willing to spend.

Below is a worksheet to develop your budget.

STEP Budget Worksheet

STEP Training
Instructor/trainer cost (if needed)$_______________
Exercise Equipment
Ankle weights$_______________
Chairs (if needed)$_______________
Pedometers (optional)$_______________
Printing
STEP Implementation Guide$_______________
Participant handouts$_______________
STEP recruitment flyers/posters$_______________
STEP participant incentives (optional)$_______________
Total$_______________

Identify and Recruit STEP Program Staff

To ensure success of the STEP program, you need to have an individual designated to coordinate the STEP program and facilitate the STEP classes. Questions to ask are:

  • Have you identified a Program Coordinator who is motivated, organized, and able to ensure that the STEP program runs smoothly? This person would communicate program needs to senior leadership, manage the STEP program schedule, and perform other day-to-day support activities.
  • Have you identified one or more staff members to be STEP Instructors who are energetic, experienced in leading group programs, and happy working with older adults?
  • How many actively involved staff members will you need to run STEP based on the size of your community and the anticipated level of interest?

Identify Training Needs and Resources

It is important to determine the training needs of your staff before offering the Training Workshop described in Chapter 2. There are several categories of needs to consider.

Training Demands

  • Do you have a sufficient number of staff who need training to justify a group training/workshop environment?

Staff Skills and Competencies

  • What knowledge and experience does your staff have leading strength training exercises?
  • What knowledge and experience does your staff have with behavior coaching techniques?
  • Do your STEP Instructors have any previous training or certification in fitness or personal training for older adults? Remember that this is helpful but not necessary to run STEP successfully.

Identify and Recruit Experts for Training

  • Do you want to seek the advice of an outside consultant?
  • If so, have you identified a trainer with significant experience in senior fitness and lifestyle change who would be willing to train your staff using the STEP implementation Guide materials?

Acquire STEP Program Equipment

You'll need to purchase STEP program equipment before the Training Workshop. An important part of the training includes the STEP Instructors practicing with the actual equipment that residents will use during STEP classes. You will need the following equipment:

  • Walking courses: Although only one walking course is required for STEP, it is helpful to have a few alternatives so that participants do not get bored, and so that both indoor and outdoor options are available in response to changing weather or seasons.
  • Ankle weights: A pair of ankle weights should be available for each class participant.
    • The style of ankle weights should be such that weights can be added or removed as needed.
    • For the STEP study, we used 5-lb pairs that adjust in ¼-lb increments and 10-lb pairs that adjust in ½-lb increments. Ankle weights can be purchased through your local sporting good store or fitness catalogs.
  • Chair with no arms: Each participant will need a sturdy chair.
    • The ideal chair should have a firm seat with no arms.
    • The chair should be high enough so that when participants sit all the way back their feet barely touch the floor.
    • The back of the chair should be high enough so that participants can hold onto it while standing behind it. (graphics)
    • Adjustments: For tall participants or in settings where participants' feet don't completely touch the floor when sitting down, you may need to make adjustments so that they can use proper form (visit Chapter 7).
      • For tall participants, you may need to use a taller chair, stack two chairs, or place a pillow or towel on the seat.
      • For short participants, you may need a shorter chair or a sturdy support under their feet, such as a large book.

Provide Training to Staff on STEP Exercise Program and Behavior Coaching

Proper training of your staff is critical for the successful implementation of the STEP program. Chapter 4 outlines the content of the training you should provide. As you set up the staff training, ask these questions:

  • Does each staff member and instructor have a copy of the STEP Implementation Guide?
  • Have you confirmed the availability of your fitness expert if you are using one?
  • Have you identified the speakers (your coordinator and a fitness instructor) who will train the rest of your staff?
  • Does the training classroom have sufficient space for demonstration and practice of the STEP exercise program?

Recruit STEP Participants

Chapter 5 offers numerous suggestions and ideas for recruiting participants. As you prepare to recruit participants, ask the following:

  • Have you identified your target participants? Who are they?
  • How many participants do you want to recruit? Is there a limit to the number of participants you can accommodate?
  • Have you identified your recruitment strategies? How can you get people interested?
  • What is your timetable for recruiting participants? When will you stop recruiting and start the program?
  • Who will be responsible for coordinating recruitment activities?

Schedule STEP Classes

Once you have recruited your participants, you want to begin your STEP program as quickly as possible, before their enthusiasm fades or they commit to other activities.

  • Have you identified a room or location that is centrally located or convenient for your participants?
  • What times are your STEP program leaders available to lead classes?
  • How will you communicate the STEP class schedule to participants?
  • Have you planned for preparation and setup time for STEP program leaders in your scheduling of STEP classes?
  • How many STEP classes are you able or willing to offer each week? (Each STEP class is 1 hour.)

Plan Ongoing Support and Evaluation of Your STEP Program

After staff training is complete and your STEP program is underway, what plans are in place for maintaining the fidelity of the program and tracking its effectiveness?

  • How often do you plan to review and evaluate STEP program leader skills and competencies in facilitating the STEP program? How will you do this?
  • Will your outside consultants (if used) be available to provide review and reinforcement of training principles to your STEP Instructors once the program is underway?

STEP Implementation Checklist

  • ___ Introduce the STEP program to senior leaders in your organization.
  • ___ Determine the need for STEP in your community.
  • ___ Determine your organization's readiness to implement the STEP program:
    • ___ Senior leadership buy-in
    • ___ Physical environment/space
    • ___ Program development
    • ___ Funding
  • ___ Develop a budget.
  • ___ Identify and recruit STEP programming staff.
  • ___ Identify training needs and resources:
    • ___ Training demands
    • ___ Staff skills and competencies
    • ___ Experts for training:
    • ___ Behavior coaching
    • ___ Fitness expert
  • ___ Acquire STEP program equipment:
    • ___ Ankle weights
    • ___ Chairs
    • ___ Space for coaching sessions, discussion, and exercise
  • ___ Provide orientation and training to staff on STEP exercise program and behavior coaching modules.
  • ___ Recruit STEP participants.
  • ___ Schedule STEP classes.
  • ___ Plan ongoing support and evaluation of STEP program:
    • ___ Fitness and coaching experts to provide review and reinforcement of training principles
Current as of February 2011
Internet Citation: Chapter 3: Implementation of STEP: Staying Healthy Through Education and Prevention (STEP). February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/stepmanual/step3.html