Kim L. - Facilitator

Go ahead and get us started.

So now we're live.

I'm gonna have you go ahead and start with an introduction of yourself. I'm gonna have you just say your name and the program you facilitate.

So, my name is Kim Lombard, and I feel so. It's so weird hearing yourself. Yeah, you gotta get used to it. So I facilitate the stepping on program.

Perfect. And then let me just have you say it one more time.

I'm Kim Lombard, and I facilitate the stepping on program.

Perfect. I just learned a little bit more about that program last week.

Okay.

Very exciting. I learned I have bad shoes. So how did you become a part of the program?

Well, through my job at freighter hospital, I do injury prevention, outreach and education. As part of that, we track our injury mechanism. So Falls is actually the leading cause of hospitalizations for older adults. And I've been familiar with stepping on for about 14 years. I've been a facilitator with that. One reason why we offer this program is because it's very effective. So we know that there are risk factors for older adults. We know that there are things that we can do to prevent those injuries.

We also know that falls are not a part of aging, that it's most definitely preventable. So there's really power in understanding that through behavior change and through this program, that people can actually have healthier, better lives and reduce falls and ultimately stay out of the hospital and live independently.

Absolutely. 14 years. Wow. That's amazing. So how did you get connected to the program 14 years ago?

Well, in Wisconsin, stepping on is pretty prevalent. So the organization that oversees stepping on is called WIHA, the Wisconsin Institute for Healthy Aging. At that time, I worked in La Crosse, Wisconsin, and there was some funding opportunity for people to get trained in this program. We're really connected in the Falls prevention realm. There's many coalitions throughout the state of Wisconsin that are very coordinated. They're multidisciplined, so there's many people kind of at the table. So that's how I first learned about stepping on, was through the La Crosse County Falls prevention Coalition, and there was funding available.

Gotcha. And just to talk a little bit more about yourself, are you from Milwaukee? Born and raised. What's kind of your story?

I'm actually from La Crosse, so La Crosse is my hometown. That's where I went to school. So I got my degree in community health education from there. I worked there for about seven years. After that, I lived in Rochester, Minnesota, for five years. So I've only been in Milwaukee for the last four years working at freighter.

Oh, wow. Nice. Okay. And so in doing facilitation for 14 years, I'm sure you've watched the program expand and grow, and you've been able to have a really keen insight into opportunities and reflection. So let's talk about that. What would you say is the most impactful part of this program?

Definitely the changes that we see. So it's really powerful. As a health educator, we don't always see the outcomes of our prevention work. When we do prevention, you know, it's something that can happen down the road. There really is no kind of face to face, you know, unless we're doing evaluation to just show that the program is effective. But really, with stepping on, you see the change process throughout those seven week programs. So as people are coming in and participants are sharing about changes that they've made, it's just such a powerful thing to be able to see changes happening right there in front of your eyes. They're sharing about the footwear that they've come to find out that was unsafe, or maybe their medication needs to be.

Maybe they need to see a pharmacist to have their medications checked. So we're really having these discussions in class and having an opportunity for people to share and reflect on those changes, and it's such a powerful way to see that change process. This program also does show the increased confidence. So many times people, they're falling because they are maybe fearful of falling. It can actually be a risk factor for future falls. So one of the evidence for this program is increasing confidence as well as reduced falls. We notice a 31% reduction in falls for people who take this program to that point.

I had the pleasure to have a conversation with another participant, and he spoke to the impact of the program really being an epiphany or aha moment for him. And he said, you know, one of the things that he had to learn was how to prioritize himself. And he said, you know, it made me realize I do want to be here for the next ten to 15 years for my wife. I want to be present, and there are just things that, small things that I can do that can reassure my likelihood of being able to be here to support her in the way that she needs. With that, have you or can you recall other similar stories or highlights from participants that have gone through this program with you?

I would say it's hard to pinpoint a specific, maybe something that was shared. We have these peer facilitators, so a peer facilitator might be somebody that's actually been through the program, and now they're helping and assist, facilitate their own stepping on program with an engaged facilitator in those situations. Those are people who have already seen the benefits of stepping on. So they've had successes. They've changed, maybe an aspect of their own life, and then they're willing to give back and share those experiences throughout the program with the stepping on participants. And really, every time we do a class or a course or these weekly sessions, participants are coming and sharing about the changes. So today we had a class, and it was session five of stepping on. So people came in.

Last week was session four. So last week we learned about footwear and choosing safe footwear. And today a participant came to class and she said she brought her shoe and showed everybody how it's unsafe. So she went through her closet, found her unsafe shoe, brought it to class, and just really, you know, shared with the group that this shoe is unsafe, and I'm not going to wear it anymore. So it's really, really powerful to see the sharing that happens in stepping on as well as just the change. Like, people are making changes as they go, and it's really the group that is providing the encouragement as facilitators. One thing I love about stepping on is we never lecture, so we're really going in to having discussions around many different topics that might put somebody at risk for falls. So with that, there's power, because these are adults.

Right. And not everybody wants to be told what to do. That's really not how we learn, but how this program is designed is it's really meant to have a conversation around these topics, which then gives people the freedom to make their own choice and to have these powerful change processes happen.

Absolutely. And I love that you're able to, it's incremental, but the, the speed in which it happens is powerful. Over the course of one class, we come back and we're already thinking about application of the learning. So that's an amazing benefit and powerful story of the impact of the class itself. I think one other thing that I'm hearing is a sense of community, and then thinking about the older adults that you're working with, particularly how important is it for programs like this to create a sense of community for older adults?

Yeah, I love that you asked that question, and I really think there needs to be research that's done in this area, because I have seen friendships made as a result of this program. I think when people get together in a group, especially a group that is going on for over two months, meeting weekly. People establish strong relationships with their peers. So that's one thing that hasn't been researched as far as, like, people gaining friendships out of this program. But I've literally seen it happen. And so I think it's nice to have that. Generally, when we hold a program, at least with freighter, we're going into a community. We typically rotate our workshops, so we're really trying to target certain communities or populations.

So just going and establishing a connection, perhaps with the church or a place of living. So senior living community, those are really kind of hotspots for being able to fill your courses, but also garnering participants to attend and reaching the right people. So I really think that's really powerful that you mentioned a sense of community, because I do think that these programs not only build support from your peers, but also an opportunity for the community, the host site, to support the community.

Absolutely. And in carrying along conversations related to community and thinking about who you feel could best benefit, let's talk about what your analysis of kind of like the class has been from a representation standpoint. What do you feel are opportunities to continue to diversify? Who is present and who do you feel has really been engaging with these courses the most?

Well, I would say that it's important to go where programs are not being held. And right now in our community, North Milwaukee really is pretty sparse when it comes down to stepping on programs. There's many organizations offering stepping on. It might be a local county health department, it might be a local hospital. So they're kind of scattered out throughout our community and our city. But when we look at the map and we look at where programs have traditionally been held, North Milwaukee just hasn't really been, you know, we haven't seen as many programs in that area. So I feel very strongly that we need to go where people are, and I feel very strongly that we need to serve communities that aren't being served. Also another just avenue.

You know, we really want to focus on people that are at risk for falls. Right. That could be anybody. So sometimes we use our hospital data to identify locations, like high locations of fallers. If we can map that, we're also identifying communities. So if we see a lot of, you know, higher rates of individuals in a specific community that are coming to our hospital as a result of a fall, that would be an indication that we should target that community.

That makes total sense. And I know when you reference North Milwaukee and when we think about Milwaukee is still, unfortunately, an extremely segregated area. And so we know just from data, anecdotally, who tends to be within that population are a lot of african american or black individuals. And so in thinking about the opportunities to engage more black residents into these programs, I know you called out faith based organizations. I absolutely agree with that. Do you think there are other avenues that the program could consider in doing marketing or outreach to really target some of those black residents to be interested in the program?

Yeah, I think hosting programs at faith based community centers is a great thought. Independent living facilities, also where seniors are living, senior living meal sites would perhaps be a good location. In my mind, going to where people are at really makes sense. It's convenient. There might be restrictions like transportation and just other things that we want to get rid of those barriers. We want to knock down those barriers and make it easy for people to attend. One thing that we did to reach North Milwaukee and just african american families is right now we're hosting a program at Greater Galilee Community center. So we did a targeted mailing.

We were able to use patient data to pull freighter patients who are living in that zip code. If they have a primary care provider, it didn't matter if they had a previous fall, but those who are 16 up, we sent them a letter to give them information. We actually had a really good outcome with that. 86% of our participants heard about the program through that mailing. We did have a smaller class than I guess we would have wanted the attendance. We had a full class, and then there were some people who didn't show. We had some no shows, but the group that we have is great. And it really, that marketing method really worked very well for us.

I love that. I love that it was data informed because, you know, that's really going to help you to get the individuals. Now, what you brought up was something interesting, right? And we see this across the board with a lot of programs, but one of the things that we're trying to identify is retention and how to keep people on for the duration because it is a two month program. So what do you think may be some of the barriers for or challenges residents or facilitators may have when it comes to keeping retention high?

That's a good question. I think people need to find value in the program. So if they are coming to session one and you notice they didn't come back to session two or three, generally we want to give them a call and find out, hey, what's going on, really to make sure, one, they're safe, they're not hospitalized, or we just want to make sure they're okay. And what was the deciding factor? Sometimes we get feedback back. Sometimes it's just bad timing. Like lots of times family issues come up. My brother is sick, my mother, I'm taking care of my significant other. So a lot of times it seems to be health issue related.

Sometimes people, I think they come in. If they don't sign themselves up, that also is an indication that they might not fully be invested and they might not fully be interested. So if their spouse signs them up or a daughter or a son, generally those are the ones that might drop out because they're just, you know, somebody else is making them do it or asking them to do it. I don't think that they're really, they didn't have that buy in. We have pretty good turnout throughout our seven weeks. Generally, people don't want to miss our classes. I think part of that is the facilitator. Facilitator's ability to make people feel comfortable.

People want to feel heard. People want to feel listened to. The way that stepping on is set up, if you facilitate it correctly, it's going to be really open dialogue and engagement. You're going to hear from everybody. You really want to make it very inclusive. I do think it matters if the facilitator, if they lecture or if they say maybe negative comments, that can definitely put a kind of a bad taste in some people's mouths. So I really think the facilitator, their personality, it really does matter. And just as far as how you're approaching your group members and respecting and open communication is just so, so important and people generally just want to feel heard.

Absolutely. I think you brought up some really amazing points from thinking about buy in. I think who signs up is important. I absolutely agree that the personality of the facilitator makes a lot of a difference because, you know, if you make me feel like I'm going to have fun while I'm learning and it, to your point, it's also a safe space and I can share my experiences, I'm certainly going to be willing to come back and bring my shoes and say, hey, these are my bad shoes and I'm no longer going to wear them. But in thinking about from your experience as a facilitator, are there other barriers or challenges that we maybe aren't considering that we should be addressing? And if so, are there thoughts on maybe how we can start to address challenges if there are additional challenges that we need to be more mindful of?

Can you elaborate on challenges, like for the participants?

For the participants and it could be, honestly, it can be a participant challenge or a facilitator challenge. Maybe there are parts of the curriculum that you feel we don't have the opportunity to elaborate on as much. Maybe it could be a challenge with trying to get so much in within this window of time. Maybe on the participant side, you know, transportation may be something. It sounds like, you know, to the point of buy in, that's a challenge. But in just thinking through, how do we best support facilitators with the programming? How do we best support community members in being interested? And then when they become a participant, retaining them throughout the duration? What are just things that we should be more mindful of?

Well, I would say so recently. So, like Costa program, we used to charge a fee for participants to attend. Just this last year, we stopped and we made it. And so now people can give a donation if they choose or they don't have to. We're fortunate right now that we have funding through Milwaukee county to support some of the cost of this program. But I wonder if, you know, having a free program, sometimes when you establish a small fee that builds buy in so people feel like, I paid for something, I'm going to get something out of it. When you don't charge a fee, you really leave it open for people to not show, which is what we've experienced with our most recent workshop. Half.

Half have not showed. So I think other incentives could perhaps work to keep them engaged. I was just talking, just the opportunity for your group to come talk to our participants. I was talking to one of our participants today and she said, I wish I would have known about that ahead of time, that there would be this hundred dollar incentive at the end. You know, I really think that would help people come to this workshop. And I said, yeah, you're right. Like, that is a big incentive. So I think, you know, there's probably ways that we can work around that.

We still want to offer it, make sure that people can take it regardless of cost. But how can we still ensure that we have a full group or a full class? Because there is cost on our end to hold these programs, to have staff come out, there is quite a bit of cost. So I think incentives would be really nice, some type of incentive to keep them coming. Sometimes people just want a meal. It would be really thoughtful. We do provide snacks and beverages, and we give them weights, and they get free materials and free handouts. However, I think there might need to be something a little bit more to keep them to really, again, maybe build that buy in transportation might be another barrier for some. I typically always try to find resources for folks.

So if I know somebody struggling with transportation, I'll connect them to the resources available in their community. So that seems to resolve perhaps the issue also with stepping on, I guess some barriers could be that they're just not appropriate for the program. So somebody might be at risk for falling, but there are certain requirements that we have to lay out. So 60 and older, living independently, they should be able to mobilize with a cane or alone. If they use a Walker full time, that's an area where they probably wouldn't be. They might not be appropriate for the program. And so it's difficult when somebody calls in and they need a program of some type of assistance or some type of therapy, but perhaps this program might not be the right program for them. So again, we're usually trying to just offer additional resources, link them to talk to their provider, to perhaps get into therapy, really trying to provide them something so that we're not just closing the door and saying, hey, see you.

But, you know, what can we offer them and how can we help them to the next stage or the next level?

Absolutely. I love that. It sounds like there is a lot of independent navigation happening, which I appreciate and I know community members and participants appreciate. I think the barriers that you've called out and some of the solutions to them are very doable and things that can, you know, in increments start to produce a scalable impact. Excuse me, I'm just going to kind of reference this. You started to talk about, in thinking about what we know opportunities are and aligning goals that the program has, one of the goals is to just better engage the black community within Milwaukee and across, you know, Milwaukee county. And we started to talk about, you know, what are ways to better engage just people in general and like North Milwaukee. But in thinking about black audiences, because that's a focus, I just want to ask, is there, are there any other improvements, changes, or recommendations you would offer about how to specifically better engage this community?

Well, I think you're onto it. You're going to be talking to a lot of participants who are black. So I think asking them personally is really going to give some good feedback and really finding what works for them when they come to a workshop, what engages them to sign up for a workshop like this. But again, just really kind of going back as far as, from my perspective, reaching people where they are going to the community, not really expecting community members to come, you know, to drive 20 minutes to a different location. So I do think it's important to hold programs where participants are, you know, going directly to them. And sometimes that is, establishing partnerships with host sites and organizations where we can hold these programs is also kind of a key thing. But really, I think we just need to ask, like, what brings you here and why does this program interest you and how can we be better?

Perfect. So one of the closing questions, and I'm just being mindful of time, you're doing a great job.

Thanks, Bill.

The last question is for someone you're trying to encourage to become a facilitator. Facilitator. What would you tell them about the role and why they should consider it? So in your 14 years of doing this, why would you tell someone, hey, you should do this with me as well?

Oh, well, I would recommend that people become facilitators of stepping on for many reasons. One, it's valuable. So if you care about your community, if you care about the older adult population, it's something that we know works. So we know that stepping on works and how can we share it? People that have been through the program, I mentioned that peer facilitator opportunities. So sometimes we are able to pull people from class. Sometimes I'll give an announcement to the whole group. Sometimes we'll just speak with somebody directly if we think that there would be a really good fit. If they have the personality, which is, you know, more non judgmental, open, friendly, they might be a good fit.

Sometimes people have previous, they might be a retired nurse or a teacher. So it really kind of fits very well with what they did in their professional career for just any kind of facilitator, I would just say that it's just such a powerful program. You know, you really get to see the change process happening before your eyes. So if you're looking to make a change in your community, if you're really looking to educate some people in a wonderful way with a wonderfully designed program that perhaps they would want to become a stepping out facilitator.

Perfect. All right, well, let me.