CPPW Everyone Swims! Focus Group Summary and Development of Policy and System Change Priorities

1. CPPW Everyone Swims! Focus Group Summary and Development of Policy and System Change Priorities January 11, 2011

2. Everyone Swims! Goal Increase widespread access to pools and water recreation throughout King County among low income and culturally/ethnically diverse populations Goals of Focus Group Needs Assessment: Summarize what we learned about family perceptions related to Everyone Swims objectives Identify barriers and opportunities most critical to meeting the ‘Everyone Swims’ goal Discuss and prioritize policy and system changes

3. In the Media A recent news headline: ‘Pool boots kids who “might change the complexion”: Campers sent packing after first visit to swim club’ July 29, 2010; NBC Philadelphia

4. Everyone Swims!’ Focus Group Methods • Reviewed by Children’s Institutional Review Board (IRB) • Used PRECEDE model to inform question development1 • Work with project partners to recruit families representing populations of focus • Incentives: Focus group participants were given a grocery gift card, child care to attend the meeting, and light snacks • Meetings conducted by culturally appropriate moderators • Notes transcribed during focus group discussions • Developed themes for review with partners to identify key opportunities and barriers

5. Everyone Swims! Focus Groups

6. Focus Group Assessment

7. Predisposing Factors Assessed Antecedents to behavior change that provide the rational or motivation for the behavior1 • Knowledge of scholarships • Parent or caregiver experience with swimming (including fear of pools and beaches) • Access to current information about the registration process and swimming pools • Knowledge of what to expect at swimming pools • Beliefs about swimming as a life skill • Availability of role models • Perceptions of water cleanliness and sanitation

8. Enabling Factors Assessed Antecedents to behavioral or environmental change that allow a motivation to be realized 1 • Language, time and financial constraints • Ease and transparency of swimming lesson scholarship process • Ease of registration process • Ease of access to programming based on time of day • Availability of programming for special groups (ie. gender swims for Somali community, organized swims for overweight or obese children) • Access to information about swimming from a trusted source • Access to and comfort with swimwear

9. Reinforcing Factors Assessed Factors following a behavior that provide the continuing reward or incentive for the persistence of the behavior 1 • Experience with a swimming program, including programs for special groups • Experience with swimming teachers and pool staff (demeanor, cultural sensitivity and languages spoken) • Availability of reminder phone calls for swimming lessons • Gaining skills and progressing in swimming ability • Ease of reenrollment • Perception of benefits (learning new skill and exercise) as compared to costs (time, money, effort to go swimming)

10. Themes

11. Scholarships for swim programming • Focus Group Themes • Lack of knowledge about where to go and how swimming lessons are organized (in terms of age or level) • Challenge of paying for lessons for many children and consider family swim lessons to be a more affordable option for larger families • Felt uncomfortable when asked to provide bank account information • Appreciative that the family’s information was stored in the system after the first application to facilitate ease of reapplication • Applying that requires multiple tries is embarrassing • Families want to know if they qualify before they apply • Families don’t know about scholarship opportunities • Interest in scholarships for open/family swims and pool parties “I could never afford swimming before, and it is a huge effort to get here. I had to make a huge life change.” -Odessa Brown Community Clinic Parent

12. Screening for Swim Ability • Focus Group Themes • Clinic providers and staff are viewed as a trusted source of information about the importance of swimming • Parents in all groups believed that swimming was good for health and potentially weight loss and maintenance, but did not express much interest in special swimming opportunities for children who are obese or overweight • Parents emphasized belief in the value of swimming as a safety skill • Swimming can be presented as both a safety issue and an opportunity for physical activity “Present it as a safety issue and then give some resources. Docs should say: 1: ‘ What kind of sports do you do?’ 2: ‘Swimming is something to look into’. 3: ‘Everyone should know how to swim.’ “ -George Pocock Rowing Foundation Parent

13. Referrals to Pools and Water Rec Programs • Focus Group Themes • Need to lessen confusion of finding a pool or water program • Special programming for clinic patients and families offered at a partner pool are appreciated by those involved in programs for ease of use and sense of belonging • Families may need help with forms and what to do, especially the first time “It’s probably the last thing we ever think of doing because the kids don’t know how to swim and it’s much easier to take them to a soccer game.” – Seattle Children’s Spanish Speaking Parent

14. Programming for special populations • Focus Group Themes • Family swim sessions and swimming lessons viewed as too short • All groups viewed gender only swims viewed as pools making effort to include all cultures • Somali women focus group participants unanimously agreed that they could only participate in swimming if there were gender-specific swims • Parent-child swim lessons wanted, should allow multiple children with parent • Adults expressed water phobias, but have desire to set an example for their children • Parents thought children would be less embarrassed if there are other kids like them, in terms of learning to swim when they are older, or swimming for weight loss • Acceptable swimwear is important to feel sense of belonging • Hispanic and Vietnamese group participants expressed concern about water being clean • Value in finding out about water recreation opportunities in places common to culture • African-American participants expressed concern about discrimination at pools is a concern “The doctor explained it to me—I can do swimming or walking. My main concern is privacy and do not have a ride. But, it would be really nice to have person who speaks my language at the pool teaching the swimming lessons.” -Columbia Health Center Somali speaking parent

15. Development of Priority Policy and System Changes

16. Discussion and Prioritization of Ideas • Discussion of ideas for policy and systems change –clarification and addition of what’s missing • Group exercise to rate each idea: Nominal Group Process • Each partner organization to choose top 2 priority and system changes in each area • Scholarships • Referrals • Screenings • Special programming

17. Scholarship Policy and Systems Change • If a child is on Medicaid, Head Start, eCap, Step Ahead, or free/reduced school lunch automatically qualify • Swimming program information is provided to Everyone Swims community clinics in pool catchment area • Partner with other non-profits to offer swim programming through dedicated source of scholarship funding • Scholarship forms available to print from pool website • Scholarship extended to community center/other physical activities • Scholarship information is available in other languages • Swimming program information is available in other languages • Can apply for scholarship online • Family does not have to pay upfront for swim lessons and then be reimbursed later • Scholarship offered for family swim • Scholarship offered for open swim • Scholarships offered for swim lessons • Review, edit scholarship form for readability and ease of use for diverse populations • Scholarship guidelines posted online and in print • ‘Sponsor a child’ Scholarship program • Scholarship forms available when pool is closed • Scholarship extended to include swimming parties (perhaps as an incentive) • Scholarship applications are reviews and families are notified within 48 hours • Donation field for scholarship fund when signing up for programming • Public swim offered for $1 once a month

18. Referral Policy and Systems Change • Clinic actively gives out swimming/water recreation information • Clinic has scholarship forms available • Clinic fills out a “referral form” and faxes/emails to pool • Clinics have video options to play in waiting rooms • Clinic provides hands on assistance to help family fill out scholarship form • Clinic has water recreation/swimming information in waiting room • Clinic provides list of referred families to pool

19. Swim Ability Screening Policy and Systems Change • Clinic makes referral to water recreation/swimming when appropriate • Clinic has standard tool system in place to assess swim ability of child at 5-6 year old well child check • Providers recommend swimming as a physical activity • Clinic has standard tool system to assess patient (any age, e.g.: parents) interest and barriers to swimming/water recreation • Providers screen for swim ability for other ages

20. Special Programming Policy and Systems Change • Clinic partners with pool/water recreation facility on a special program • Clinic partners with pool/water partners facilitate equipment for swimming (suits, etc) • Targeted outreach to first time and diverse communities • Pool offers child-parent beginning swim program • Clinic partners with pool/water recreation facility on a 1-2x year Pool Party • Pool partners to offer gender only swim for girls and women • Pool partners to offer gender only swim for boys and men • Pool/clinic partner to offer special program for obese/overweight children/teens/adults • Pool partners to offer a group swim

21. CPPW Everyone Swims! Thank you to the families and partner pools, water recreation organizations, and clinics for helping to make this happen. For more information contact: Elizabeth ‘Tizzy’ Bennett, Everyone Swims Co-Manager, Elizabeth.Bennett@Seattlechildrens.org, 206-987-5718 Mo Pomietto, Everyone Swims Co-Manager, Mo.Pomietto@Seattlechildrens.org, 206-987-3917 Sarah Stempski, Everyone Swims Program Coordinator, Sarah.Stempski@Seattlechildrens.org, 206-987-4182