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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. 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?
The original program, A Matter of Balance: Managing Concerns About Falls, was developed and evaluated by the Roybal Center for Enhancement of Late-Life Function at Boston University, with a grant from the National Institute on Aging. Under the original model, a healthcare professional - usually a nurse or physical therapist - delivered the program which involves 8 two-hour sessions.
In October 2003, MaineHealth's Partnership for Healthy Aging, Southern Maine Agency on Aging, Maine Medical Center's Geriatric Center and the University of Southern Maine received grant funding from the Administration on Aging to translate A Matter of Balance into a program that uses volunteer lay leaders instead of healthcare professionals to deliver the Matter of Balance class. Because the Matter of Balance Lay Leader Model uses volunteer lay leaders instead of healthcare professionals, it reduces the cost to deliver the program. Therefore, it can be offered more frequently, reaching a significantly higher number of older adults.
How long is the Matter of Balance class?
The Matter of Balance class consists of 8 two-hour sessions, which can be held twice a week for 4 weeks or once a week for 8 weeks. Each two-hour session includes a break for light refreshments. Early sessions focus on changing attitudes before attempting changes in actual behavior. The exercise component, which begins in the third session, takes about 30 minutes of the session to complete.
What does the class include?
A Matter of Balance uses a variety of activities to address the fear of falling and teach fall prevention strategies. Activities include group discussion, problem-solving, skill-building, assertiveness training, videotapes and exercise training.
Who should attend?
The program is designed to benefit older adults who:
- Are concerned about falls
- Have sustained falls in the past
- Restrict activities because of concerns about falling
- Are interested in improving flexibility, balance and strength
- Are age 60 or older, community-dwelling and able to problem solve
What do participants learn?
The program enables participants to achieve significant goals. They gain confidence by learning to:
- View falls as controllable
- Set goals for increasing activity
- Make changes to reduce fall risk at home
- Exercise to increase strength and balance
What is the recommended class size?
Because the class involves group discussion and problem-solving, the ideal class size is 10 - 12 participants (no fewer than 8, no more than 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 player, participant workbooks, and healthful snacks for each session.
What is a Master Trainer?
A Master Trainer is responsible for teaching the Matter of Balance curriculum to Coaches and providing them with guidance and support as they lead the Matter of Balance classes.
What qualities and experience are necessary 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
- Comfort with teaching, leading group discussion and role play
- Willingness to learn about and support the principles and protocols of evidence-based programs
- Enthusiasm about being a member of a team
- Ability to use audiovisual equipment (TV/DVD, overhead projector)
- Ability to perform range-of-motion and low-level endurance exercises and to demonstrate A Matter of Balance exercises
- Ability to carry up to 20 pounds
- Life experiences are valued, with an education or healthcare background a plus
How do you become a Master Trainer?
You must attend a two-day master trainer session offered by MaineHealth's Partnership for Healthy Aging to earn A Matter of Balance Master Trainer Certification. We recommend that two staff members from an organization be trained to assume responsibility for the program. All materials necessary to implement the Matter of Balance program in your community are provided at the training session.
As a result of the training, you will become a Master Trainer prepared to:
- Recruit and train volunteers to lead A Matter of Balance classes
- Coordinate the program in your community
- Market the program to older adults
- Evaluate outcomes
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
Who leads the Matter of Balance classes?
A Matter of Balance classes are led by volunteer Coaches who have completed an 8-hour training program. Coaches teach classes in pairs.
What is the recommended class size for a Coach training?
The Coach training is most effective with 6 - 12 people.
What is a Matter of Balance Coach?
A Coach co-leads the Matter of Balance class sessions with another Coach. Two Coaches are required to teach the class to participants.
What qualities and experience are necessary to become a Coach?
- Good communication and interpersonal skills
- Willingness to lead a small group
- Interest in working with older adults
- Life experiences are 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 Matter of Balance classes within one year of certification
What are the Coach's responsibilities?
- Prepare for each class by reviewing the Matter of Balance manual and materials
- Organize the classroom with supplies and refreshments
- Present the class according to the directions, training and materials provided
- Encourage interactive discussion about the concepts and skills presented
- Demonstrate and coach the exercises outlined in the Matter of Balance Program
- Monitor and connect with each participant
- Promote socialization and a solution-oriented environment among the participants
- Have fun!
What is a Guest Healthcare Professional?
A Guest Healthcare Professional (GHP), usually a physical therapist, occupational therapist or registered nurse, is invited to attend a Matter of Balance session to share information and answer questions about reducing fall risks. The GHP 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 GHP also discusses the use of assistive devices and home and community safety. The Master Trainer makes arrangements with the GHP to visit during Session 4 or Session 7.
What qualifications and experience are required for a Guest Healthcare Professional?
- Education Degree as Physical Therapist, Occupational Therapist, Nurse, Exercise Physiologist, Chiropractors, Medical Doctors and Doctors of Osteopathy
- Advanced students in the fields of Physical Therapy, Occupational Therapy, Nursing, or Exercise Physiology may be appropriate
- Awareness of fall prevention strategies
- Knowledge of the Matter of Balance program
- Good communication and interpersonal skills
- Ability to discuss fall prevention with a small group
What are the Guest Health Care professional's responsibilities?
- Review the Guest Healthcare Professional Handbook to understand the fundamentals of the curriculum
- Review the Frequently Asked Questions located in the Handbook
- Make arrangements with the Master Trainer to visit a class for 45 minutes - 1 hour
- Demonstrate how to respond to a fall if one should occur and how to safely get up from the floor (the class participants will not try this during the session)
- Answer questions from participants in the class
What are the class outcomes for the Matter of Balance Lay Leader Model?
After completing A Matter of Balance*:
- 97% of participants are more comfortable talking about fear of falling
- 97% feel comfortable increasing activity
- 99% plan to continue exercising.
- 98% would recommend A Matter of Balance
* Participant class evaluation percentage who agree to strongly agree.
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
How is program fidelity 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 Matter of Balance class using the Guest Healthcare Professional Handbook as a resource
What are the costs to implement the Matter of Balance program?
The cost to attend a Master Trainer Session is $1550.00 per person. This 2-day training session includes breakfast, lunch and all materials (Master Trainer Manual with Toolkit CD; Fear of Falling: A Matter of Balance and Exercise: It's Never Too Late DVDs).
Partnership for Healthy Aging can also send a team of two Lead Trainers to your site to train a group of 11-20 people to become Master Trainers. The fees are based upon the size of the group as follows:
11 - 15 people: $16,000* plus $220 per person for materials
16 - 20 people: $18,500* plus $220 per person for materials
*Travel, meals and lodging for the two Lead Trainers will be charged at cost.
Once you are trained as a Master Trainer, there are costs associated with training lay leaders (Coaches) and providing A Matter of Balance classes:
- Coach Training is 8 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.
- The Matter of Balance Class involves 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
Fear of Falling and Exercise: It's Never Too Late DVD Set $164.76/set
A Matter of Balance DVD $11.00
Where can I purchase the materials?
The materials are provided upon completion of the Master Trainer session. You must be a Master Trainer to order additional materials.