IHP 670 Module 9 Final Project Example

Steady Steps: A Three-Year Proposal to Prevent Falls Among Older Adults in Alder County

[Student Name]

Southern New Hampshire University

IHP 670: Program Design, Planning and Evaluation

Module Nine Final Project

[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.

Steady Steps: A Three-Year Proposal to Prevent Falls Among Older Adults in Alder County

The Alder County Public Health Department requests $1.2 million over three years from the state's older adult injury prevention fund to launch Steady Steps, a falls prevention program for county residents aged 65 and older. This proposal describes the need, the program and its evidence, how it will be delivered and evaluated, what it will cost and how it will continue.

Summary

Each year, falls send about 2,900 of the county's older residents to emergency departments, put 610 in the hospital and kill 38, yet only one small evidence-based class operates locally. Steady Steps will offer tai chi for balance and a seven-session group program at all nine senior centers and the YMCA, link primary care screening to classes and provide transportation. Over three years it aims to enroll 1,800 older adults, reduce participants' falls by 20% and reduce county emergency visits for falls by 10%.

Statement of Need

About 30% of county adults 65 and older report falling each year, slightly above the national rate. Fall death rates exceed the state average, and rural townships have admission rates 40% higher than the county seat. Nearly half of older adults surveyed worry about falling, and many limit their activities as a result. Only one small evidence-based program operates countywide, and primary care clinics that screen for fall risk have nowhere to refer patients.

Program Design and Evidence

Sherrington et al. (2019), in a Cochrane review of more than one hundred trials, found that exercise reduced falls among older adults living at home, with balance-focused and combined programs and tai chi showing benefit. Steady Steps therefore centers on structured group exercise. Tai chi classes meet twice a week for 24 weeks; the seven-session program combines exercise with education about hazards and home safety. Primary care practices screen patients, review medications and refer at-risk patients electronically, and the coordinator follows up within a week. Volunteer drivers and a bring-a-friend policy address access and motivation.

Priority Population

The program serves all county adults 65 and older but prioritizes rural residents, people living alone, anyone with a recent fall and anyone afraid of falling. At least 40% of participants will come from these groups, and rural townships receive classes first.

Logic Model and Theory

Inputs of staff, instructors, space and clinic capacity support classes, screening, transportation and outreach. These produce class series, enrollment and referrals, leading in the short term to better balance, strength and confidence, in the intermediate term to continued exercise and fewer falls and in the long term to fewer injuries and emergency visits. Social cognitive theory explains the central link: progressive practice, peer role models and encouragement build the confidence that sustains exercise after classes end.

Objectives

Objectives cover delivery and results. By month six, twelve instructors will be certified. By the end of year one, classes will operate at all nine senior centers. By year three, 1,800 adults will enroll, at least 80% of clinics in both hospital systems will refer, participants attending two-thirds of sessions will report 20% fewer falls in the six months after classes than before and emergency visits after falls among residents over 65 will be 10% lower than at baseline.

Implementation

Durlak and DuPre (2008) found, across hundreds of studies, that programs delivered with higher quality produced substantially better outcomes. Steady Steps will move from four months of preparation to a three-site pilot, then to countywide delivery and finally to site ownership. Core elements, such as session frequency and movement progression, are fixed; class times and settings can be adapted. Two sessions in each series will be observed for fidelity, and a monthly dashboard will flag sites with attendance below 60%.

Evaluation

The RE-AIM framework of Glasgow et al. (1999) asks about five things: who is reached, what changes, which settings adopt the program, how well it is delivered and whether it lasts. The evaluation measures each: enrollment by priority group, balance tests and fall calendars compared with a wait-list group, the share of sites and clinics participating, fidelity and attendance and whether classes continue after year three. County emergency visit trends will be compared with two neighboring counties.

Budget

The three-year budget of $1.2 million covers a full-time coordinator, a half-time analyst, instructor pay and training, transportation, the referral build, outreach, evaluation supplies, equipment, indirect costs and a year-three transition reserve. Partners contribute space and volunteer time valued at about $86,000. The cost is about $667 per participant.

Table 1. Budget Summary

Note. Composite budget; in-kind support of about $86,000 not included.

Value

Carande-Kulis et al. (2015) found that three community programs for preventing falls, tai chi among them, returned more in avoided medical costs than they cost to deliver. A local estimate suggests Steady Steps could avoid roughly $180,000 a year in medical costs among participants alone, with savings accruing mainly to Medicare, Medicaid and health plans.

Sustainability

By year three, senior centers will schedule classes, local staff will train new instructors and referral will be routine in clinics. Continued funding will be sought from Older Americans Act health promotion funds, Medicare Advantage plans, hospital community benefit budgets and the county general fund, with agreements targeted by mid-year three and the reserve covering any gap.

Organizational Capacity

The health department has managed state and federal grants for two decades, operates an injury prevention unit and has an epidemiologist experienced with hospital discharge data. Letters of commitment from the Area Agency on Aging, YMCA, nine senior centers and both hospital systems accompany this proposal.

Conclusion

Steady Steps responds to a documented, costly and unequal problem with programs proven to reduce falls, delivered through trusted local settings and linked to primary care. With careful implementation, rigorous evaluation and a realistic sustainability plan, it offers the state a strong return on its investment and Alder County's older adults more years of safe, independent living. The department is ready to begin within thirty days of award.

References

Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost-benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65-70. https://doi.org/10.1016/j.jsr.2014.12.007

Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3-4), 327-350. https://doi.org/10.1007/s10464-008-9165-0

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

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