IHP 670 Module 3 Milestone One Example

Milestone One: Framing Steady Steps, a Falls Prevention Program for Alder County

[Student Name]

Southern New Hampshire University

IHP 670: Program Design, Planning and Evaluation

Module Three Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone One: Framing Steady Steps, a Falls Prevention Program for Alder County

IHP 670 culminates in a full program proposal. This first milestone frames that program: why it exists, whom it serves first, what it will do and what evidence supports those choices. It builds directly on the needs assessment, which found that falls among Alder County's 64,000 older adults cause about 2,900 emergency visits a year and that almost no evidence-based programs exist.

Purpose Statement

Steady Steps aims to reduce falls and fall injuries among Alder County adults aged 65 and older by offering evidence-based balance and strength programs close to home, connecting primary care screening to those programs and reducing fear of falling so older adults stay active and independent.

Priority Population

All county adults 65 and older are eligible, but the program will prioritize those at highest risk and with the least access: residents of the three rural townships, people living alone, adults who have fallen in the past year and those who report fear of falling. These groups had the highest fall and admission rates in the needs assessment and the fewest services nearby.

A Complex Intervention

Steady Steps has several interacting parts delivered across different settings, which makes it a complex intervention. Craig et al. (2008), presenting updated Medical Research Council guidance, argued that such interventions should be developed systematically, drawing on evidence and theory, tested for feasibility, evaluated with methods suited to their complexity and implemented with attention to context. They stressed understanding how components work together and how local conditions shape results, rather than treating the program as a single pill.

Component One: Group Exercise

The core of Steady Steps is structured group exercise emphasizing balance and strength. Sherrington et al. (2019) concluded from their Cochrane review that regular exercise cuts the number of falls among community-dwelling seniors, and that balance-centered training and mixed programs show the steadiest gains. Tai chi also showed benefit. Steady Steps will offer a tai chi program designed for fall prevention, twice weekly for 24 weeks, and, for people wanting a briefer option, a seven-session group course that pairs home-safety education with exercise.

Can It Work in Community Settings?

Trials conducted by research teams do not always translate to community delivery. Li et al. (2008) adapted their tai chi fall prevention program for delivery by trained instructors in community senior centers and found that centers could adopt and deliver it with good fidelity and that participants improved on measures of balance and physical function. That experience supports using Alder County's nine senior centers as delivery sites.

Component Two: Clinical Screening and Referral

Primary care practices in both hospital systems will screen patients 65 and older for fall risk at annual visits using a brief three-question screen, review medications that raise fall risk and refer at-risk patients directly to Steady Steps classes through an electronic referral that the program coordinator follows up within a week.

Component Three: Access Supports

Because rural residents cited distance and transportation, the Area Agency on Aging's volunteer driver program will offer rides to classes, and classes will be scheduled in the three rural townships first. Participants can bring a friend, responding to focus group comments that companionship would encourage attendance.

Evidence Summary

The table summarizes the evidence base for each component and the local fit.

Table 1. Steady Steps Components and Evidence

Note. Composite summary for program planning.

What the Program Will Not Do

Framing also means choosing what to leave out. Steady Steps will not fund home modification grants, although it will provide home safety checklists and referrals to an existing home repair program for low-income seniors. It will not offer one-time lectures, which older adults in focus groups said they would not attend and which lack evidence of reducing falls. It will not duplicate the one existing falls program but will partner with it, offering its graduates a tai chi class as a next step. These choices keep the grant focused on the components with the strongest evidence and local demand.

Partners and Roles

The health department will lead the program and employ a coordinator. Senior centers will host classes and help recruit participants. The YMCA will train and supply instructors. Both hospital systems will embed screening and referral in primary care and consider referrals at emergency department discharge. The Area Agency on Aging will provide transportation and help reach homebound adults. A community advisory group of older adults, including residents of rural townships, will review plans and materials. Written agreements will set out each partner's responsibilities before classes begin.

Goal

Over three years, Steady Steps aims to enroll 1,800 older adults, with at least 40% from priority groups, and to cut the county's senior emergency visits for falls by a tenth. Detailed objectives will be developed in the next modules.

Scope

The program covers community-dwelling adults 65 and older in Alder County. It does not include nursing home residents, whose falls require facility-based approaches, or hospital inpatient fall prevention, which hospitals manage separately.

Questions for Later Milestones

How will activities lead to outcomes, and what theory explains that path? How will the program be implemented across senior centers and clinics with different capacities? How will its reach, effectiveness and fidelity be evaluated? And how will it be funded after the grant ends?

Conclusion

Steady Steps is framed as a complex intervention combining tested exercise programs, clinical referral and access supports, aimed first at the older adults most at risk and least served. The evidence and local assets support that design, and the next milestones will turn it into a logic model, implementation plan and evaluation. Each later step will be checked against this frame.

References

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ, 337, Article a1655. https://doi.org/10.1136/bmj.a1655

Li, F., Harmer, P., Glasgow, R., Mack, K. A., Sleet, D., Fisher, K. J., Kohn, M. A., Millet, L. M., Mead, J., Xu, J., Lin, M. L., Yang, T., Sutton, B., & Tompkins, Y. (2008). Translation of an effective tai chi intervention into a community-based falls-prevention program. American Journal of Public Health, 98(7), 1195-1198. https://doi.org/10.2105/AJPH.2007.120402

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (1), Article CD012424. https://doi.org/10.1002/14651858.CD012424.pub2