Background

Young people living in out-of-home care (due to the presence of neglect, abuse and/or unsafe and unstable family environments) are at substantially increased risk of disordered or problematic eating, overweight and obesity, and associated morbidities. Here, we describe the conception, modification and large-scale roll-out of Healthy Eating Active Living Matters (i.e., HEALing Matters, HM), developed for OoHC and designed to strengthen the therapeutic and healthy lifestyle capacities of care staff responsible for these young people (aged approximately 12-18 years).

Methods

A pilot evaluation of the HM program in residential OoHC targeted their direct-care staff, providing professional development and resources to facilitate healthy lifestyle behaviour changes among the children; the program was evaluated using a randomised trial, in 48 OoHC residences (25 allocated randomly to the intervention and 23 to the control) across three community service organisations in Victoria, Australia.

Results

Young people in the HM intervention, compared to the wait-list control group, resulted in observed positive changes in both healthy eating and physical activity habits, as well as adolescent self-esteem and independent living skills. Limitations of the program included: (1) lack of a trauma informed philosophy and a (2) lack of cultural connectedness to Aboriginal and Torres Strait Islander children. Based on extensive stakeholder engagement, HM is now delivered within a framework that is informed by attachment, trauma, and resilience theories. Importantly, HM recognises that food and physical activity are a powerful way of demonstrating trust, care, predictability, flexibility, and attuned parenting.

Conclusions

We are now scaling up HM across the state of Victoria with government funding. We have co-designed an implementation road map and tool kit to support this scale up. We share the journey of this complex intervention and implementation.