High Five for Kids
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High Five for Kids is a primary care-based, pediatric weight management intervention for 2-6 year old children with a body mass index (BMI) ≥95th percentile, or between the 85-95th percentile with a parent who has overweight. It is a collaboration between Harvard Vanguard Medical Associates and the Department of Population Medicine (DPM) at Harvard Medical School and the Harvard Pilgrim Healthcare Institute. High Five for Kids was funded by the National Institute of Health.
High Five for Kids is a cluster-randomized controlled trial to prevent pediatric obesity. At the time that it was implemented, High Five for Kids was one of only a few studies focused on addressing obesity in the primary care setting. It was conducted in 10 primary care pediatric offices of Harvard Vanguard Medical Associates (HVMA), a multi-specialty, group practice providing pediatric care to a diverse patient population in eastern Massachusetts. Five practices were assigned to the intervention group, and five to a usual care (control) group. BMI was the primary outcome, and the intensive intervention period was one year, followed by a one year maintenance period.
High Five for Kids enrolled children ages 2 – 6 years with body mass index (BMI) ≥ 95th percentile or 85th- < 95th percentile if at least one parent was overweight.
The overarching model for this intervention was the Chronic Care Model, which emphasizes the need for change and involvement of all members of a primary care practice team to produce functional patient outcomes. For High Five for Kids, this included training everyone from front desk staff and medical assistants to nurses and pediatricians. High Five for Kids also included enhancements to the electronic medical record (EMR) system to assist clinicians with decision support, patient tracking, follow up, scheduling, and billing.
The primary intervention for High Five for Kids was conducted by Advance Practice Clinician nurses (APCs), who used motivational interviewing to conduct chronic disease management visits with intervention participants and provided stage-matched materials to families based on readiness to change. Primary behavioral targets included fast food, sugary sweetened beverages, and TV time.
- Initial visit outline
- Follow-up visit outline
- Menu of target behaviors
- Counseling script and MI road map
- Talking points to overcome barriers to behavior change
- Cue cards for High Five visits
- Cue cards for well child checks
- Intervention site workflow
- Coding reference sheet
- Clinician newsletters
- Stage-matched handouts English Spanish
- healthy drinks
- TV/TVs in bedrooms
- active play
- fruits and vegetables
- healthy meals
- Behavior tracking calendar
- Schedule of study activities
- Additional handouts to support behavior change
- Placemat (incentive)
- Taveras, E. M., Gortmaker, S. L., Hohman, K. H., Horan, C. M., Kleinman, K. P., Mitchell, K., Price, S., Prosser, L. A., Rifas-Shiman, S. L., & Gillman, M. W. (2011). Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Archives of pediatrics & adolescent medicine, 165(8), 714–722. https://doi.org/10.1001/archpediatrics.2011.44
- Rifas-Shiman SL, Taveras EM, Gortmaker SL, Hohman KH, Horan CM, Kleinman KP, Mitchell K, Price S, Prosser LA, Gillman MW. Two-year follow-up of a primary care-based intervention to prevent and manage childhood obesity: the High Five for Kids study. Pediatr Obes. 2017 Jun;12(3):e24-e27. doi: 10.1111/ijpo.12141. Epub 2016 May 27. PMID: 27231236; PMCID: PMC6067009.
- Cespedes EM, Horan CM, Gillman MW, Gortmaker SL, Price S, Rifas-Shiman SL, Mitchell K, Taveras EM. Participant characteristics and intervention processes associated with reductions in television viewing in the High Five for Kids study. Prev Med. 2014 May;62:64-70. doi: 10.1016/j.ypmed.2014.02.005. Epub 2014 Feb 8. PMID: 24518002; PMCID: PMC4106410.
For more information about High Five for Kids, contact Sarah Price at email@example.com.