Eating habits and health in residential care

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Eating habits and health in residential care

Hello All,

My name is Matt and I currently work in an after-school/residential setting with adolescent girls. One of our girls (I'll call her Jessica) is struggling with poor health and hygiene. Staff is taking steps to correct her hygiene problems but our attempts to help her to improve on her health habits are not very successful. Her main issue is eating too much of the wrong kind of food. We have set up "expectations" as to the amount and quality of food she is permitted to eat. The problem, in my opinion, is that her peers do not have to follow the same expectations. Jessica is a youth that wants desperately to connect with her peers; she rebels against anything that singles her out. Staff is trying to model appropriate eating habits but it is not enough. My thought is that my program needs to make massive, program-wide changes. Our refrigerators and cabinets are filled with frozen, preserved, and processed foods. It is rare that a meal is cooked from its raw, fresh ingredients. I know that changing my program's shopping, eating, and cooking habits is the only way to best provide for the youth in our care but how do I do it? I need advice – Lord knows I don't have stellar eating habits either. Where do I start? I'm also concerned with the impact such a change would have on our other youth. Of course it would make them healthier but I'm afraid that it will register for them as just one more way my program is attempting to "control their lives," (a sentiment too often expressed by my kids). Jessica's health needs to be addressed, how can I help her? Any and all advice is greatly appreciated.

Thanks and take good care,
Matt Fasano
...

Hey Matt!

It sounds like you have a battle on your hands!! It's hard to tell youth what they need and have them listen. One suggestion I have would be to include all the youth in cooking. Get out some recipe books, talk about foods they like to eat and taste's and spices they love to eat and then include them!! I find the best way to get a child/youth to eat anything is to let them make it themselves.

They are then feeding themselves and creating something from nothing which fosters self esteem. Pizza can be healthy, just provide healthy ingredients.

Smoothies are also a great way to get children/youth to eat some fruit.

Taco's, fajita's etc. My favorite website is allrecipes.com.

Start with one ingredient and let the youth experiment!! Good luck!!

Robyn Harold
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Matt:

I work with a population of children on the Autism Spectrum. Since most of our children are on multiple medications, they have gained weight prior to coming to us. We have been successful in having them lose weight by creating a healthy choice eating plan for all. Before each meal, all our children (no matter if they have a weight issue or not) walk a couple laps around our courtyard. Then following a meal, they repeat this. Our children who have significant weight to lose, get seconds on fruits and vegetables. We also celebrate our children's successes when they lose weight and become more mobile and less sedentary. We monitor all the children's weight and height each month so no child feels that they are being singled out. Hope this helps.

Camille Regan
Oklahoma
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This is a tough one. Because aside from changing the menu for everyone there is also a budget issue. Whole wheat pasta costs more than Ramen Noodles. So . . . I would suggest you talk to your supervisor, ask to bring your ideas to the table at a staff meeting, ask about calling your county extension service for help in revamping, and then come up with a plan. Change is difficult, but this is a very positive one. DO IT.

Sandy Goodman,
Riverton, WY
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Hi Matt,

I think perhaps if some very small gradual changes were made it would be easier for the young people to accept. You didn't explain why frozen and processed food is predominant in the residential unit, maybe it is it a time or staffing issue.. so I'm not sure how helpful my suggestions will be..

From my understanding of your comments, Jessica has different expected amount and quality of food she is permitted to eat? If her peers in the unit are allowed to eat whatever they like I think this may lead her to rebel and feel even more isolated. I feel that you are right in saying the food quality and eating habits of the entire unit will have to change. If the 'wrong kind of food' is not available in the unit then they will be less likely to eat it. I think that by providing ready healthy options at the times Jessica is most prone to snacking or over-eating may be a very practical way to improve her eating habits. It can be done in a very subtle way, she may already be feeling self conscious so talks and rules about healthy eating may just make her feel worse.

The same issues came up for a young person I was working with. I found that by having homemade soup ready when all of them came home from school "I thought it would be nice since its so cold out" meant that they were then too full to snack on their usual cookies. A chopped fruit salad for later on in the evening also helped avoid snacking before bedtime. I think making healthy options available, like putting a bowl of fruit on the kitchen counter or for example if bread is to be served with a meal putting a slice for everyone out instead of the whole packet, makes it easier for young people to make better snack decisions unconsciously. Involving the young people in cooking will also encourage them to eat the (healthy) food they make, to enjoy it, and also let them feel in more control and not the workers "controlling their lives". I don't think you should be worried about the impact healthy eating changes would have on the other kids, if it is done slowly and without big attention drawn from workers that its a 'healthy option' they probably will not even notice.

I think it will definitely help if you can get more creative thinking about food in the residential unit and if staff not only model but become very enthusiastic about good food and vocalise how delicious it is during mealtimes. If you can start to make some meals from scratch buy a food processor which will let you hide lots of nutritious vegetables, like spinach for example, in soups and sauces. Switching from frozen and processed to home-made will also up the levels of vitamins and minerals the young people are getting from their meals which is so necessary to their energy and concentration levels and also to their healthy development.

Home-made does not have to happen every day, it is understandable that there may not be enough time or that other pressing needs will have to be dealt with, however I think that if you start to make some changes Jessica will find it much easier to eat healthier.

I hope this is helpful and wish you all the luck,

If you would like some recipies feel free to contact me!

Aisling Malone
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Hello, my name is Tacee and I am new to the CYC-net. I have suggestions for eating habits for youth.

One thing that you could try is to find out what vegetables, fruit, etc. that they do enjoy that is fresh and create meals from that.

Also, including the youth in finding recipes that they would like from recipe books. (Books that you provide for them which contains a nutritional value).

After, maybe, include them in making the grocery list and the shopping?

I hope this helps.

Thank you,
Tacee Francis
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Hi Matt,

I agree with your point that it will likely require a whole shift in the environment in order to support Jessica's learning in health living. I feel like an attitude of approaching the issue with "corrections" and "expectations" will only set up this child for failure, possibly contributing to Jessica's issues. I think if you involve the youth in the process of developing a menu, a shopping list, going to buy the ingredients together and then actually preparing the meals together (can even do ahead of the time and freeze things) it will be the beginning of a shift for all the staff and the youth. When you involve the youth it will foster independence, pride and institute some life-long healthy living skills. I'd even call a chef at a local restaurant or somewhere like that and see if they would donate a few hours of their time to come and meet with the youth and prep a meal together, your local health department might support sending out a nutritionist to come and speak with the youth also. Maybe you could brain storm with the youth also some sort of challenge with this.

Good luck Matt, update us on what you decide to try and how it goes!

Danielle Jimeno
Surrey Memorial Hospital
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Hi Matt,

I can definitely relate to your situation when looking at ways to alter or incorporate new ideas or processes within the various organizational "systems". I think one thing I learned was that being an ally is incredibly important and that change at the organizational level can take time. Working with the staff and youth, children and families as an ally is all about ensuring everyone feels they are a part of the process and that there isn't one person calling the shots.

I think you are at a great starting point in that you sound like you have the determination and hope that change is possible.

What about conducting a survey asking the staff, students and parents what/if they would like to see anything change, and also asking questions around how the students and parents feel about the food that is consumed by the students at school, and if certain foods are consumed more than others and why. Finally, asking questions that may help you unveil what course of action parents, staff and students would like to see? (Checking into what they think would be an effective solution) That might provide some insight into their perspectives, needs, concerns, on food and health, the potential barriers to optimal health and also the possible factors that may be in place that encourage good eating habits or health care.

Overall the survey could be a good starting place for conversation around health, during the creation of the survey you could ask tell the students and Jessica etc about this project and ask her and their input, check in and see what questions they would like to see asked etc.

After the survey depending on your findings a possible starting place could be:

For example: Maybe forming a health committee or "eat right" committee or group, that would be made up of students and a facilitator (possibly yourself?). "Jessica" could be offered the opportunity to join the group, which would then provide means to peer interaction and lead to group cohesion and group aid over time. The group could meet once a week and discuss different topic around health, such focuses like self-concept/self-esteem, media analysis, etc., etc., could be addressed with the hopes of reaching the students from the inside, exploring why taking ourselves

If you did have a group this group could organize school events around the given topic. There could be incentives (if realistic given your setting) such as a school dance etc. It wouldn't be about controlling what kids bring to school in their lunch the focus would be on somehow encouraging better choices that are realistic to all children and families. This is where parental support would be huge. However it would be very important for all children and families to be included and feel a part of the process, a concern for me would be would if some families can't afford better choices or maybe do not have the access to those better choices etc., etc., so it would be important to ensure that people do not begin to feel blamed or guilty for eating certain foods. For example, if there are vending machines or the frozen food you mentioned etc, if that food was changed for a period of time let's say 2 weeks or a week to start that may be one way to approach it, so that it would be about the school making the change to incorporate and support better choices so that when kids buy food at school or eat the food you provide them that its healthy.

Another idea for the group and for Jessica would be again as I mentioned holding events, one could be (depending on the age of the children/youth) having a cooking class where one of the students can lead it, or lead it with you, and then show the others how to do it. It may be a great chance to give Jessica a greater sense of autonomy, independence and confidence.
(just an idea)

As for Jessica, I would focus on self-esteem/self-concept, and strength-building materials, a girls group could work well or one to one if you do some work with her on that. I think encouraging a child; youth positives, strength's and accomplishments are critical to building up a positive self-esteem.

Looks like you have a great opportunity and its good to hear how motivated and committed you are to the children and youth you are working with,

All the best to you,

Vanessa Lalonde
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Hey Matt,

Great job is recognizing the opportunity here. In general, managers don't have the time or energy to deal with all the employees who come up with the current problem of the day and say "fix it." It distracts us from what we need to attend to. That said, the opportunity for you telling your company and boss, "Here's how I can help in this area, here are some ideas." I suggest you do your research first and have a strong intention to follow through on making improvements.

Speaking about Jessica, you should include her on developing her own plan. She may not meet your standards but that's fine because she first needs to know that she can succeed at goals she sets, however small. If you try to make her meet your expectations, she may fail and then begin or continue a cycle of thinking that she "is always a failure", "she can't do anything right," "everything is so hard," etc. If she can go a week eating a piece of fresh fruit every day, that may be success for her and can help her build good habits.

Speaking for program changes, there is so much media and research going in your favor. You can show the films "Supersize Me" and "Fast Food Nation" and then design a project with the kids if they are interested in making better food choices and perhaps influencing the larger program. Our utility bill went through the roof one month and we asked the kids for their help. They researched on the internet, suggested higher efficiency light bulbs, closing the shades during the hot day, asked for cooperation in turning off lights and air conditioning units and even created signs to remind everyone and themselves about conserving energy. Our kids are all immigrants who were not familiar with computers and did not speak English so they had limitations. The cool thing is I didn't tell them what to do, they told us.

The BIG KEY is that you focus on developmental outcomes and NOT just achievement outcomes. Yes, the kids we worked with helped reduce the bill, but they learned how to research on the computer, they learned how to problem solve and work together, they developed their creativity and experience in tackling issues of conservation, they developed their presentation skills, and they developed familiarity with success. They choose the direction of the project.

Good Luck Matt! Get the kids involved in this problem if you can. They will amaze you with the information they can collect and the changes they can implement! Also, if you live in the states, check out bountiful baskets on the internet. It's the cheapest way to get more fresh fruit, vegetables and fiber into your diet.

Alfonso Ramirez, Jr.
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Hi Matt,

You have addressed a seemingly common issue with adolescent girls – hygiene and body image. While i do see the need to rejig your program food plan that meets more with Canada's food guide I also wonder if there is more that is happening for "Jessica." Could her eating be about comfort eating and it serves an emotional need for her? While concerning and certainly not uncommon, adolescent girls (as others as well) have sought emotional refuge in food.You indicated that she struggles with relating to her peers and I
wonder if there is something else that is going on for her as well. In terms of the girls seeing a change in meal plan as your attempt to "control their lives" perhaps this could be stated as a response to the need for healthier eating habits and the impact this will have on their well-being.
Just a thought

Donicka Budd
Toronto, ON
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I think that knowledge is the key. The more you know what to do the more you have control to change. Start with the basics and read the labels. Most general populations can't even do that. Then learn what happens to the starches, carbs, proteins, and sugars etc after you eat them. What your body does with them. I am only a personal trainer but a dietitian might help you. There are colleges nearby that have "almost grads" that might help for free for the paper you write on them. (I mean they help you and you refer them or write a paper about what they did for your group.) Maybe an internship?

I don't help with the food where I work but I do come across residents that talk of the protein drinks. I then start giving them the knowledge they need to make good eating habits BEFORE choosing something that doesn't do what they THINK it should do for them. Off the subject but that is my reference. I did help by pointing out the foods that have a lot of protein and lead them to choose better foods at the table.
Children need knowledge. They search for it they just don't always like reading it.

An interesting book is The Fidget Factor by Frank I. Katch, and Victor L. Katch, with Gene Brown saw it for a penny on amazon.com. Another book is the Suzanne Summers books. She has about three of them and all talk about how you body breaks down food and combined carbs and proteins. Interesting read. Some can follow the diet but others can receive some knowledge from the books.

Does this person have history of heart, cholesterol, or disease in family? If it is just weight that is the issue, then please think twice about this. YOU DON"T NEED TO BE FAT TO BE UNHEALTHY. AND NOT ALL FAT PEOPLE ARE UNHEALTHY.............. just fat. BMI (body mass index) and other health measurements should also be looked at. Most people don't know what that is either. Exercise is the other tool for a healthy life style.

Health history is a large issue and should be looked at along with eating habits. Just telling someone that if you lose weight you will be healthy is wrong and will always be wrong.

Donna Wilson
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Hi Matthew,

Perhaps having a nutritionist or dietician speak to the whole group would be helpful. I find for teens it has to be fun and interesting enough for them to take notice and want to change. I too have self educated myself about proper nutrition but teens being informed is one way to support Jessica and her peers. Also, suggesting to your boss about preparing meals from scrap would encourage better eating habits for everyone...there are so many easy and delicious recipes out there now. Hope this helps.

Muriel
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My setting, which is a different population being developmental disabilities, is currently addressing dietary/food habit/weight gain issues.

We are bringing in all community nursing etc. supports to advise staff and set guidelines for nutrition, and help us create long term plans to gradually change staff and residents' habits. There is always a wide range of beliefs amongst staff regarding nutrition, so it can be tricky. This way we remove some of the potential for staff conflict by having guidelines that we should be using anyway from the health care teams. So this involves a complete review, from shopping, budget and individual health plans. There is plenty of health/medical/research info available now re the long term health risks for young people with poor diets. Diabetes and heart disease should be enough of a reason for everyone in a role of responsibility to get on board with basic nutrition guidelines.

One change at a time/or slow change is a good approach. Too much at once is usually too hard for anyone. Start by cutting out a few obvious "poor" nutrition choices from the shopping. You are right, if it is there, people will eat it and if it is not, they won't!

In British Columbia schools are now required to follow nutrition guidelines:
mostly/occasional/never choices. Your jurisdiction may have some community initiatives you can incorporate. Skin care might be a hook to get teens on board; also media role models. Structure in treats so they are clearly still there, is another idea.

Good luck!

Yana Maltais
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Hi Matt,

I think your concern is genuine; great inquiry.

Currently, I am a Social Work Intern at The Hospital For Sick Children in Toronto, and I work with young people in improving their quality and quantity of food and water intake as a means to improving their Urological functioning (bladder, kidney's, sex development etc). My background is CYC, primarily in Residential Care, so I feel your pain in preparing healthy meals!

The method that I employ in altering food consumption (and type) is very much phase like. For 4 days I ask the young person to record what they are eating into a food journal (Thursday-Sunday). Once they have completed this, it provides the young person and I a baseline to work from. We evaluate what healthy food they actually enjoy eating, along with the not so healthy foods. I challenge them each week to make a change; for example consuming 1 more glass of water in a day than they usually do. The process does take a while, however I think that repetition and consistency leads to a change in behavior. This may also be an appropriate method considering the peer/social environment.

My past experience of managing a home for adolescent females, I think, has taught me to do more thinking and less cooking! For example, during the week the girls would volunteer to cook one evening during the week (with available support if needed). The meals were required to be balanced, and they would often enjoy finding recipes on the internet to try out. A great resource that I have found to be helpful in terms of obtaining fresh produce is registering with a food share in your community if possible. The produce is grown locally and is sometimes delivered right to the Residence.

Finally, when youth communicate that they feel they are "being controlled" when it comes to food, I often respond by reminding them that I care about their health and that they deserve to lead healthy lives.

Most of my resources are Toronto based, however feel free to contact me if you would like more information: lisa.azzopardi@sickkids.ca

Best of luck,
Lisa Azzopardi
...

Hi Matt,

I work at a young parent program for parents who are finishing their high school. We have similar problems with our clientele. Some things we've done that have been very successful are: #1 Only provide healthy food! The occasional treat is fine but if there is only processed food available most of our society is not growing up with fresh food and learning how to cook it. #2. Offer cooking classes. Perhaps a staff could find some simple but healthy recipes and once a week whoever is interested could join in cooking and eating the food. This has been extremely successful for our girls. Most of them genuinely do not know how to cook and are excited to learn how to make cheap, healthy, delicious recipes. #3. Have the staff work together.

Inform yourselves about what is healthy and learn more about what is nutritious. I know Health Canada offers lots of information online and I am sure that lots of other health units have information available as well.

Some grocery stores even offer a tour that helps you find the healthiest food, compare prices, etc. #4. Find how what resources you have in your area. Our local university has sent students who are studying in courses such as dental hygiene to do presentations (they have to do it for their course anyway) about good oral hygiene. Sometimes it is more effective coming from someone else! #4. Have the same rules for everyone. We all need to have good hygiene and should have healthy eating/living habits so it is only fair to expect that from everyone. This can be done slowly and in fun ways such as the cooking class or other group activities. You don't have to cut out all junk food, just cut back. Most people find they enjoy fresh food more and feel better.

I hope this helps! You're off to a good start by being aware of the situation and taking the first steps to change it!

Callie Zerr
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Hello Matt,

Our culture has deviated too far from what a 'home' cooked meal looks like. For children in care, or poverty, food all too often resembles the box it came in. Crappy food tastes good: salt, sugar and fat. I remember my job in a residential home and the scary food the kids ate. I am convinced it is contributing to health issues such as obesity, asthma, diabetes, school performance, behavioural issues...

There are so many ways to bring back the celebration of food and enjoy the food. Include the kids in menu planning, recipe searches, shopping, cooking, and discussions of nutrition that these kids all so badly need.
Just because one kid is skinny now, does not mean she will stay that way with processed food as the main source of fuel.

Start with getting the kids to help with raw food snacks. Challenge them to discover a new fruit. Have a contest of 'name that vegetable' then do a taste test. Plant a garden. Watch Supersize Me or read books by Eric Schlosser. I will never, not ever, eat at a Fast Food joint again.

Laura
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Hi Matt,

I totally understand your dilemma.

I too deal with children that do not have proper eating habits and the problem is compounded by the massive amount of advertising budget that unhealthy food companies have to exploit their wares. It is insidious! Have you considered making small changes at first? For instance start by having fruit available, like apples, bananas and oranges that the girls could just take when they wanted to. After that, perhaps having one raw veggie at meal time, like cut carrots. I find that children tend to eat more veggies when they have a dip, so you could find a lower fat, lower salt content dip.

These small changes can eventually add up to healthier eating. There is a ton of information and studies available related to behaviour and healthy eating. You may want to consider accessing some of this data to buttress your position as to why administration should make these healthy eating changes. And of course, though you may not think that there is an effect, practicing what you preach goes very far indeed, even on a sub-conscious level.

So, start with yourself!
Good luck, my thoughts are with you,
Ann Marie Beals
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Hi Matt,

When my center tried to change their unhealthy meals they started with have dietitian students (from Pitt) come in and make parfaits with every class because it was a fun way to introduce more foods. I'm not sure what is and isn't allowed at your school but maybe the employees could make a healthy snack every once in a while to set up better habits. Even though the children I teach are much younger they are still very picky eaters and would rather have junk food than the lunch that is served to them. Now that the only options are healthier ones they have become used to this change and now like to eat the food. I'm sure it's really hard to an almost teenager and to have to deal with all of other peers seeing that what you are eating is different. It seems that having a program wide change would be a great method to make everyone aware of nutritious foods and will make them lead healthier and happier lives. I hope this helps you and your students!

Kathleen Buffa
...

Comment on Dean's statement.

I really liked your idea of growing your own vegetables. Not only is it great to be outdoors, and physical connecting with the earth even in the simplestform of pulling weeds, but to see your owncare put into something that grows, and in turn nourishes you body is awesome. I did thiswith my kidsat a full day care program a few years back and to this day they still grow their own peas, corn, cucumbers. Coming from homes that don't always provide the healthiest of snacks these children really enjoy eating the fruits of their labour.

Sharon Glover
...

I relate to children being sent to childcare programs with food not suitable for the time of day or even their bodies. I manage a daycare and we decided to create a Healthy Food Idea brochure for the parents to take. It was an informal method of providing ideas to the parents without signaling or judging any of the parents. It can be difficult to talk with parents about how they parent in regards to food choices especially with families who are not financially stable to pay for a lot of healthy food items. Another activity we have done in our programs is gather grocery store flyers and have the children create a healthy food idea picture as an art project. It's a fun way of discussing different food choices and sometimes the children see new healthy items that they ask their parents for when grocery shopping.

Alison Friesen
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Hi Matt,

I think this is a great question with a potentially great potential for positive change. I totally agree that making a change would benefit everyone in the house. How about putting a spin on it to engage the whole house in learning how to cook. The major reason why we buy packaged and processed foods is because it takes little effort to prepare. By cooking the food from scratch, you would use fresh ingredients, and therefore making healthier eating choices. This is a life skill that is passed over and is not given adequate instruction and practice. Baking cookies a few rare times, or making mini pizzas does not count as learning how to prepare meals. Why should this girl be centered out and feel like she is being punished for being fat? Kids, no matter what age, like helping in the kitchen and contributing in making a meal. I think you would find very positive results, health benefits aside, in both self-esteem and taking ownership within the program.

Julia Evangelisto
...

Hello Matt,

I used to work in a group home and I suggested to the residents to grow our own veggies. They were all against the idea at first, then when they saw how great it was to be outside, most of them wanted to plant their own veggies. It worked for them, not sure if it would work for all. They seemed to enjoy growing and eating their product at the dinner table. I also introduced them to non-dairy eating, more organic living, eating healthy, staying away from all the rBGH in milk, anyway, Robyn's comments about getting them to help cook their food is a great way for interaction and learning.

Best of Luck!
Keep it homegrown, Dean :)

Henry Laviolette
...

Hi Matt,
In reply to your concern for Jessica’s eating habits, I think a great way to start would be to teach all of the girls the importance of nutrition and possibly set a particular time of the day to bring forth knowledge about the different types of food, what is healthy, what is a moderate amount of food that girls their age should be consuming, discussions of the different food groups and the importance of incorporating a certain amount of food from each group daily. This way they are aware of the benefits certain foods can have for them and especially for Jessica, she can understand why it is important for her health to utilize this knowledge. Informing her of why she is being expected to eat a certainamount of food and why the other girls are allowed to eat more than her will make her more willing and able to be in support of this if she is aware that it will benefit her. Giving a list of healthy alternatives from each food group to the girls and asking them to circle which food products they like and then incorporating those foods into your program. Setting up a schedule for the daily meals that will be served may also be helpful.

Aside from the eating aspect of this, including more physical activity and teaching the girls the importance of being active could help with the eating habits issue. Group physical activities would also allow all the girls to connect with each other and allow Jessica in particular to not feelleft out.

Just a few thoughts, good luck to you!

Lindsey Byrnes
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There is also a commercial on now in Atlantic Canada that speaks to the very issue of families growing their own gardens and children helping take care of them. They claim the children are more apt to eat it if they took care of it...interesting....:)

Muriel
...

Healthy eating habits are oh so important, but it must be taught to parents. Being a headstart teacher I have parents that bring their children to school before 9am with cookies, 20 oz bottles of pop, bags of hot chettos, bags of candy, etc. When they come in you have to bribe them to eat some breakfast or even to save it for later. Even if parents don't have time in the mornings there is a lot more quick healthy choices for breakfast they just have to be shown somehow someway for the sake of the children.

Terra Campbell

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Eating habits and health in residential care