Last Updated: May 8, 2019

Author:You First Program, Vermont Department of Health

This performance measure helps us assess performance based on quantity; a higher percentage is better.

You First is a prevention program funded by the Centers for Disease Control (CDC) that works to remove barriers that may prevent women from getting important health screenings related to breast, cervical and heart health. You First works to decrease the morbidity of breast cancer, cervical cancer, and cardiovascular disease in Vermont women.

You First offers heart health screenings for women ages 40 to 64 in order to assess their risk of cardiovascular disease. Once a You First member is current on their cardiovascular screen, they are eligible for Lifestyle Programs (LSP), Fitness Programs (FP) Health Coaching (HC), and/or other exercise/nutrition related services.
You First originally served women at or below 250% of the Federal Poverty Level who did not have insurance or were underinsured. In the spring of 2015, the CDC granted VDH permission to enroll female Medicaid beneficiaries between the ages of 30 – 64 in the program. Then, if the Medicaid beneficiary is eligible, the program may pay for approved lifestyle or fitness programs. In January 2016 Medicaid members comprised 6% of members, by December 2016 they comprised 26%.

You First  staff work out of the VDH office on Cherry Street in Burlington. In order to increase the reach of the program and to work with potential and current members in their own communities, You First has contracted with Federally Qualified Health Centers (FQHCs) and the Vermont Coalition of Clinics for the Uninsured (VCCU) to hire Clinic Champions. Clinic Champions have been tasked with finding and enrolling eligible women into the program, as well as to outreach to the larger community in an effort to increase the heart disease screening rates in their county.

Partner FQHCs include Northern Counties Health Care, Northern Tier Center for Health (NOTCH), and Springfield Medical Health Systems.

Partner VCCU Free Clinics include Bennington Free Clinic, Good Neighbor Health Clinic in White River Junction, Health Assistance Program at UVM Medical Center in Burlington, Health Connections at Gifford in Randolph, Open Door Clinic in Middlebury, People’s Health & Wellness in Barre, Putney Community Health Connections, Rutland Free Clinic, Valley Health Connections in Springfield, & Windsor Community Health Clinic at Mount Ascutney Hospital.

Through participation in LSPs, women learn about healthy behaviors and receive support on how to integrate these behaviors into their daily lives. The CDC pre-approves all LSPs offered by You First, and each of these evidence-based lifestyle programs must
(1) show effectiveness in improving diet and physical activity,
(2) incorporate national diet and lifestyle recommendations, and
(3) are culturally appropriate and delivered using easy-to-understand language.

Targeted heart healthy interventions  have been shown to reduce cardiovascular risk factors in adults and hence are recommended to those with risk factors.
In addition to LSPs, You First can pay for one or more health coaching session for members who may not be ready to commit to the more-intensive weekly meetings offered by the LSPs. Members are strongly encouraged to consider in-person coaching sessions offered by their local Community Health Teams, hospital nutrition counseling services or fitness centers. When a member enrolls in one of our 25+ statewide partnering fitness centers, she is encouraged to participate in health coaching either over the phone or in person so that progress can be monitored and supported. If a member is interested in a fitness center that is not currently partnered with You First, we will contact them to see if a partnership can be established.

Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reductions in Adults: A Scientific Statement from the American Heart Association can be found at
http://circ.ahajournals.org/cgi/content/full/122/4/406.

Screening results, health risk assessments, readiness-to-change status and client goals and preferences are used to determine if a You First member is referred to a specific lifestyle program or if other healthy behavior support options such as health coaching or other community-based resources are more appropriate.

To increase lifestyle program and health coaching participation and completion of recommended sessions in 2019, You First will:
•follow up with women periodically to encourage participation and discuss any barriers; * empower clinic champions to contact hard-to-reach participants within their caseload and encourage one health coaching session to explore a manageable level of participation. *encourage clinic champions to make appointments with screened members to complete goal sheet in person and to discuss all  options related to fitness, nutrition or tobacco cessation. *encourage members to pair weight management programming with fitness programming to maximize health benefits and long-term success. *periodically remind members of their stated goal sheet goals to reinforce the "why" behind their need to participate. *Foster relationships with Curves and other fitness center managers to ensure their "buy-in" related to members' program success.
•offer transportation and other incentives to reduce barriers to participation;
•offer multiple Lifestyle Program options in order to meet varying and diverse participant needs, such as programs that offer services in the evening and on weekends;
•work with community health workers to encourage women to participate;
•use motivational interviewing particularly when an individual is having difficulty maintaining behavior change;
•establish a relationship with the member's provider to reinforce goals;
•provide tips and tools for self-monitoring of progress;
•offer materials/items to support maintenance of heart healthy behaviors (e.g., cookbooks, pedometers, healthy tips newsletters);
•refer women to other community-based resources to support their goals;
•involve family members and friends for additional support;
•encourage social support or environments that reinforce behavior change, including using social media.