Pilot Project to Integrate Community and Clinical Level Systems to Address Health Disparities in the Prevention and Treatment of Obesity among Ethnic Minority Inner-City Middle School Students: Lessons Learned

Table 4

B’N Fit POWER integration of screening, diagnosis, and enrollment procedures.

Procedures	Existing PS-95 structure	B’N Fit POWER intervention at PS-95	Implementation challenges	Solutions to challenges
Screening for students with BMI ≥ 85th percentile	(i) Schoolwide NYC fitnessgram screening not routinely accessed as screening tool by MMCC or SBHC staff; (ii) No routine screen by MMCC/SBHC staff	(i) Opt-out letter sent home to all students in 5th–7th grade registered in afterschool; (ii) Afterschool program screening: (1) Height/weight (PI); (2) Fitnessgram (physical activity specialist); (3) B’N Fit POWER survey (youth leaders); (4) Healthy lifestyle handout; (iii) EMR review of students in SBHC	(i) EMR identification of students with BMI > 85th percentile did not reduce stigma; (ii) Low numbers screened in afterschool program; (iii) Inadequate B’N Fit staff training of onsite MMCC staff; (iv) Lengthy questionnaires difficult to understand and complete; (v) Weight and height assessments by offsite PI unsustainable	(i) Consent letter sent to all students in school; (ii) Schoolwide NYC fitnessgram data obtained by physical Education staff; (iii) Access for all students; (iv) B’N Fit staff training of educational consultant to train teachers to conduct questionnaire screening; (v) Questionnaire shortened to 25 online items
Diagnosis	(i) No routine protocol for communicating overweight or obesity to at-risk youths; (ii) SBHC BHA not always focused on screening for BMI ≥ 85th percentile	(i) Students with BMI ≥ 85th percentile recruited during routine interactions with MMCC and MSHP; (ii) Emphasis was placed on explaining physical activity and health benefits of the program; (iii) Telephone outreach by B’N Fit staff; (iv) Distribution of flyers; (v) Family information session	(i) Telephone outreach by B’N Fit staff unsustainable; (ii) Low attendance at family information session	(i) NYC fitnessgram height and weight data provide shared recruitment list; (ii) MMCC focus outreach on students in afterschool; (iii) SBHC focus outreach on students not in afterschool
Enrollment	(i) Self-referral to SBHC; (ii) Self-referral to MMCC afterschool program	(i) Self-referrals; (ii) Telephone outreach; (iii) Flyer distribution; (iv) Information session; (v) Target 85% of enrollees with BMI ≥ 85th percentile	(i) Delays in getting students enrolled in both MMCC afterschool program and SBHC related to interinstitutional communication challenges	(i) Bidirectional referrals; (ii) Hired program monitor for referrals protocol implementation

BHA: Brief Health Assessment; PI: principal investigator; EMR: electronic medical record.