This article is part of Stories of Change, a series of inspirational articles of the people who deliver evidence-based programs and strategies that empower communities to eat healthy and move more. It is made possible with funding from Michigan Fitness Foundation.
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Many of the residents with cognitive impairments at adult foster care homes served by Copper Country Community Mental Health Services were surprised to learn that burritos don't have to contain meat, but can instead be filled with black beans and vegetables. And that's just one of the many healthy lessons they've learned through a program called Linking Lessons for People with Cognitive Disabilities, which offers nutrition and physical activity education and encouragement tailored to the needs of clients with cognitive impairments.
A highlight of the program in this setting is that the foster home staff attend the lessons and have made positive changes in shopping and food preparation. Besides implementing some of the nutrition recommendations, they can also remind and encourage the residents to choose healthy snacks, eat more fruits and vegetables, and be more active inside and outdoors. This program is a wonderful example of a teach-learn-apply approach involving both the staff and residents of these adult foster care homes.
Teresa Robins, a direct care staff member in one of those residential group homes, has been involved with the Linking Lessons program for about two years and has seen long-lasting changes in the residents she serves. She says residents are now more willing to try fruits and vegetables, and they're moving more as a result of the physical activities in Linking Lesson sessions, which are offered in the home where they live.
"Some of the guys that participate in those physical activities don't normally exercise at all," Robins says. "It's really nice to see the difference in how the program got our guys more active." By applying the nutrition and physical activity recommendations, this important population can decrease their risk for obesity and some chronic illnesses.
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A Linking Lessons kit.
The program is funded in part by a federal Supplemental Nutrition Assistance Program Education (SNAP-Ed) grant awarded by Michigan Fitness Foundation (MFF) and implemented through dedicated staff at Copper Country Mental Health Services. SNAP-Ed is an education program of the U.S. Department of Agriculture that teaches people eligible for SNAP how to choose healthier foods and be more physically active. As a State Implementing Agency for the Michigan Department of Health and Human Services, MFF offers competitive grant funding for local and regional organizations to conduct SNAP-Ed programming throughout Michigan.
The Linking Lessons nutrition program was developed by MFF using principles known to be effective with people who have cognitive disabilities. Messages are simple and are repeated and reviewed, with suggestions for how they can be implemented in everyday life. Each lesson includes a recipe, a food tasting, and a physical activity. Lessons cover topics including fruits and vegetables, healthy snacks, water and other healthy beverages, portion size, and the USDA's MyPlate food guide. Clients use recipes to prepare simple foods that don't involve turning on a stove, like cold corn salad and fruit slushies.
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Liz Holden, training and prevention specialist with the Copper Country Community Mental Health Institute, says each lesson is flexible and can last 20 to 45 minutes.
"About half of that is the lesson, and then we chat a little about a particular nutritional topic, and focus on a colorful poster," she says. "We talk about familiarity with different vegetables, drinking more water, and portion size."
The physical activity components of Linking Lessons are also tailored to clients' unique needs. Holden notes that some of the clients have physical disabilities in addition to their cognitive disabilities, so chair yoga exercises are a great way to get clients with all types of abilities moving. She also emphasizes that physical activity can be made fun by putting on some music and having a dance party for the movement portion of the lesson.
Group home staff are always present at the lessons so they can learn as well and reinforce lessons after Holden has left. Karen Fooce, a residential team leader at two of the adult foster care homes served by the program, says she appreciates that the lessons and physical activity are adapted not just for the people with cognitive disabilities but also can be adapted for special needs from home to home.
For instance, she says the strength bands Holden brings to some of the physical activity sessions are good for stretching leg muscles or for range-of-motion exercises for wheelchair users' arms.
"One of my residents got down on the floor and did stretching and thought that was pretty cool," Fooce says. "Liz coming to the home was something they would really look forward to every week."
Robins says it's not just clients who are getting healthier. She says staff have also benefited from trying new fruits and vegetables, and she has used some of the strategies with her own son, who is a picky eater.
"It's a really good thing and has taught the residents a lot more about healthier choices," Fooce says. "It has turned them on to different vegetables, and they're learning what their likes and dislikes are."
The original program's lessons spanned two weeks, with a series of four lessons for a total of eight weeks, but both staff and residents at all locations agreed to expanding the program to five lessons for a total of 10 weeks.
"We've done surveying of our residents and staff involved in the program, and we've seen really positive results," Holden says, including that 76% of residents were more physically active after going through the program than they were before.
She says she has good conversations while she's running the program, and staff say the effect has been lasting.
"Our residents are eating more vegetables, drinking more water, and having more conversations about cutting down on sugary drinks," Holden says. "One of the biggest things is that residents talk more about food choices after having this class. One fellow started not salting his food anymore because of this class and talking about the effects of having too much salt in the diet."
The COVID-19 pandemic and stay-at-home orders meant that Holden had to discontinue visiting the homes while the order was in place, but she continued to provide resource packets to staff with recipes and ideas for staying physically active.
This summer, Holden says she and other staff would like to try out new warm-weather activities.
"We're hoping for more lawn games like lawn bowling, ring toss, tossing the beanbag," she says. "At one group home, the staff plays Yahtzee with residents every day, and they ordered big inflatable beach ball dice. That little change gets them up and outdoors and standing while they play."