A Matter of Balance: Managing Concerns About Falls
Volunteer Lay Leader Model
Frequently Asked Questions
What is A Matter of Balance?
A Matter of Balance: Managing Concerns About Falls is a program designed to reduce the fear of falling and increase the activity levels of older adults who have this concern. It is based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University.
What is the volunteer lay leader model?
In October 2003, the Administration on Aging awarded three-year evidence-based disease prevention grants. Southern Maine Agency on Aging, MaineHealth's Partnership for Healthy Aging, Maine Medical Center Division of Geriatrics, and the University of Southern Maine School of Social Work received funding to translate A Matter of Balance into a program that uses volunteer lay leaders instead of healthcare professionals as facilitators and that would serve as an innovative national model for addressing fall prevention.
The volunteer lay leader model utilizes trained volunteers, called coaches, to conduct the class, which consists of eight two-hour sessions for groups of 10 to 12 participants. Because the A Matter of Balance Volunteer Lay Leader Model reduces the cost of the intervention, the program can be offered more frequently and in a wider variety of settings, thereby reaching a significantly higher number of older adults.
The A Matter of Balance Volunteer Lay Leader Model is a copyrighted program. Organizations can be licensed as master trainer sites to train coaches and implement the program.
Where can I purchase the materials?
You must become certified as a master trainer in order to receive the materials. The materials are provided upon completion of the master trainer session.
What are the components of A Matter of Balance?
A Matter of Balance is a structured group intervention that utilizes a variety of activities to address physical, social and cognitive factors affecting fear of falling and to teach fall prevention strategies. The activities include group discussion, problem-solving, skill building, assertiveness training, videotapes, sharing practical solutions and exercise training.
During the class, participants learn to:
- View falls and fear of falling as controllable (involves changing behavior with a focus on building falls self-efficacy, i.e., the belief that one can engage in an activity without falling).
- Set realistic goals for increasing activity (by instilling adaptive beliefs such as greater perceived control, greater confidence in one's abilities and more realistic assessment of failures).
- Change their environment to reduce fall risk factors (uses a home safety evaluation and action planner to reduce fall risk hazards in the home and community).
- Promote exercise to increase strength and balance.
Each of the eight sessions is two hours in length, including a break for light refreshments. Early sessions focus on changing attitudes and self-efficacy before attempting changes in actual behavior. The exercise component, which begins in the third session, takes about 30 minutes of the session to complete.
Who should attend A Matter of Balance?
The program was designed to benefit community-dwelling older adults who:
- Are concerned about falls.
- Have sustained a fall in the past.
- Restrict activities because of concerns about falling.
- Are interested in improving flexibility, balance and strength.
- Are age 60 or older, ambulatory and able to solve problems.
What is the recommended class size?
A Matter of Balance is a structured group intervention that utilizes a variety of activities such as group discussion, problem-solving, skill building, assertiveness training and sharing practical solutions. The ideal class size to facilitate discussion is 10-12 participants (minimum of eight, maximum of 14).
What space and equipment is needed to host A Matter of Balance?
The classroom should be ADA-accessible and have enough space for each participant to exercise and move around comfortably. The room should have chairs and tables, preferably set up in a U-shape, and a space to set up snacks. The materials needed include name tags, attendance sheet, pencils, markers, tape, flip chart and stand, TV with DVD/VCR, participant workbooks, and healthful snacks for each session.
What is a master trainer?
A master trainer is responsible for teaching the A Matter of Balance curriculum to coaches and providing them with guidance and support as they lead the A Matter of Balance classes. To implement A Matter of Balance, organizations identify key staff to attend a master trainer session. It is recommended that two staff members be trained to assume responsibility for the program.
What are the requirements to become a master trainer?
- Experience and interest in working with older adults.
- Knowledge about the special needs of older adults.
- Good communication and interpersonal skills.
- Experience with group process and facilitation.
- Comfortable teaching and leading group discussion and role-play.
- Willing to learn about and support the principles and protocols of evidence-based programs.
- Enthusiastic about being a member of a team.
- Able to use audiovisual equipment (TV/DVD).
- Able to perform range of motion and low-level endurance exercises and to demonstrate A Matter of Balance exercises.
- Able to carry up to 20 pounds.
- Life experience valued - with an education or healthcare background a plus.
How do you become a master trainer?
- Attend a two-day master trainer session offered by MaineHealth's Partnership for Healthy Aging and earn A Matter of Balance Master Trainer Certification. All materials necessary to implement A Matter of Balance are provided at the training. They include a Master Trainer Manual with numerous tools for program implementation, Coach Handbook, Participant Workbook and Guest Therapist Handbook. All materials are available on a CD-ROM. The program videos, Fear of Falling and Exercise: It's Never Too Late, are provided on DVD.
- PFHA staff are available to conduct the master trainer session at other locations, as requested.
What are the master trainer's responsibilities?
- Teach A Matter of Balance curriculum to the coaches according to the directions, training and materials provided.
- Assess each coach's understanding, ability and comfort with leading A Matter of Balance classes.
- Be available to answer questions and provide support for coaches.
- Observe and evaluate the volunteer coaches, using the Coach Observation tool and process.
- Encourage and collect feedback from coaches, using the Coach Feedback form.
- Pair experienced coaches with new coaches whenever possible.
- Recruit and train coaches, schedule classes, and recruit participants (depending upon organizational structure).
- Participate in quarterly conference calls with other master trainer sites.
- Measure outcomes and report quarterly.
What is the recommended class size for a coach training?
The training is most effective with six to12 coaches.
Who leads A Matter of Balance classes?
A Matter of Balance is led by volunteer coaches who complete an eight-hour training program. Coaches teach the class in pairs.
What are the requirements to become an A Matter of Balance coach?
- Good communication and interpersonal skills.
- Willingness to lead a small group.
- Interest in working with older adults.
- Life experiences valued - with education or healthcare experience a plus.
- Ability to perform range of motion and low-level endurance exercises.
- Ability to carry up to 20 pounds.
How do you become a coach?
- Attend eight hours of coach training taught by the master trainer(s) and earn A Matter of Balance Coach Certification.
- Attend 2.5 hours of coach training updates annually.
- Agree to coach two A Matter of Balance classes within one year of certification.
What is the role of the guest healthcare professional?
A healthcare professional (such as a physical therapist, occupational therapist or registered nurse) is invited to attend a session to provide information and answer questions about reducing fall risks. The guest reviews such things as how to get up and down from the floor safely, how to get out of bed or up from a chair more easily, and how to go up and down stairs. The guest also discusses the use of assistive devices and home and community safety.
What are the class outcomes for the A Matter of Balance Volunteer Lay Leader Model?
After completing A Matter of Balance:*
- Ninety-seven percent of participants are more comfortable talking about fear of falling.
- Ninety-seven percent feel comfortable increasing activity.
- Ninety-nine percent plan to continue exercising.
- Ninety-eight percent would recommend A Matter of Balance.
* Participant class evaluation: percentage who agree to strongly agree.
Preliminary findings of the participant outcome evaluation indicate that there were significant improvements for participants regarding their level of falls management, the degree of confidence participants perceive concerning their ability to manage the risk of falls and of actual falls; falls control, the degree to which participants perceive their ability to prevent falls; level of exercise; and social limitations with regard to concern about falling. These measures indicate that the program has been successful to date in reducing the fear of falling by increasing participants' confidence that they can manage falls risk better and actual falls if they occur and that they can take action to help reduce the risk of falling. In addition, participants indicated that their concerns about falling are interfering less with their social activity and reported that they have increased their exercise levels. (Healy, McMahon, Haynes, ASA/NCOA presentation, Sustainability Through Collaboration: An AoA Evidence-Based Prevention Program for the Elderly, March 2006.)
What tools are used to measure outcomes?
- Initial survey (given during the first class) with questions regarding falls management, social activity, exercise levels and background information.
- Last-class survey; repeat of questions regarding falls management, social activity and exercise levels.
- Last-class evaluation with questions concerning comfort in talking about fear of falling, changes made to environment, comfort in increasing activity levels, plans to increase activity levels and background information.
What have been the benefits for volunteer coaches?
Coaches have reported feeling better to a lot better in the following areas as a result of their involvement with A Matter of Balance:
- Sense of accomplishment.
- Purpose in life.
- Can make a positive difference in another person's life.
- Feelings about their health.
- Confidence in managing falls themselves.
(Healy, Haynes, ASA/NCOA presentation, A Matter of Balance: Volunteer Lay Leader Model: Key Elements in the Translation of a Professionally Led Program, March 2006.)
How is fidelity to the program maintained?
To maintain fidelity to the original program, the following strategies are used:
- Master Trainer Certification is required for an organization to implement the program.
- Two-day coach training based on original A Matter of Balance curriculum (fidelity stressed).
- Master trainers observe volunteer coaches during the two-day training and at A
- Matter of Balance class.
- Coaching skills observation and coach feedback process and forms have been developed.
- Collaboration with healthcare professionals to visit the A Matter of Balance class using the Guest Therapist Handbook as a resource.
What are the costs to implement A Matter of Balance?
- Master Trainer Session: two-day training; includes breakfast, lunch and all materials (Master Trainer Manual with CD-ROM, Fear of Falling and Exercise: It's Never Too Late DVDs).
Cost: $1,500 per person; recommend two staff attend if possible.
Fee for on-location training will be based on the number of staff trained and travel expenses.
Once you are trained as a Master Trainer, there are costs associated with training lay leaders (coaches) and providing MOB classes:
- Coach Training: eight hours (usually two 4-hour sessions) conducted by the Master Trainer(s). Costs to consider include Coach Handbooks, staff time and light refreshments, room and audio/visual equipment.
- A Matter of Balance Class: eight 2-hour sessions. Costs to consider include Participant Workbooks, refreshments for classes (approx. $5/person for eight sessions), Guest Healthcare Professional Handbook, room and audio/visual equipment.
Master Trainers are provided with a MOB Toolkit CD that contains all of the files to produce Coach Handbooks, Participant Workbooks and Guest Healthcare Professional Handbooks. They also receive copies of the DVDs used in classes. However, Partnership for Healthy Aging also makes the manuals and DVDs available to order for the following costs (does not include shipping and handling):
- Coach Handbook: $20.00
- Participant Workbook: $13.00
- Guest Therapist Handbook: $6.00
- DVD set (Fear of Falling and Exercise: It's Never Too Late): $164.76/set
- A Matter of Balance DVD: $11.00
- A Matter of Balance Lay Leader Model CD-ROM for Coaches: $2.00
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