Frequently Asked Questions

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.

In 2020, in response to the global pandemic of COVID-19, MaineHealth’s Partnership for Healthy Aging piloted a translation of the in-person A Matter of Balance program to be delivered virtually. Training and implementation of the Matter of Balance Virtual Translation (MOB-V) became available in 2021. The virtual translation still uses trained lay leaders to reach older adults utilizing a secure online platform to help reduce the fear of falling and to increase activity levels.

How long is the Matter of Balance class?

The Matter of Balance in-person class consists of 8 two-hour sessions, which can be held twice a week for 4 weeks or once a week for 8 weeks. The Matter of Balance Virtual Translation has an additional session so it consists of 9 two-hour sessions which can be held once a week for 9 weeks or twice a week for 4.5 weeks.

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. Each two-hour session includes a 10 minute break for the opportunity to socialize, move around and have a light refreshment if desired.

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, videos and exercise training. Participants receive a workbook to use during the sessions, and to keep as a reference when the class is over. 

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
• For the Matter of Balance Virtual class participants need to have the technology to join a virtual session (tablet, laptop, or desktop computer with camera, if necessary a smartphone with a camera can be used)

What do participants learn?

The program enables participants to achieve significant goals. They gain confidence by learning to:

• View falls as controllable
• Identify common factors that contribute to falls
• 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 8 - 12 participants (no fewer than 8, no more than 12). 

What space and equipment is needed to host A Matter of Balance?

For in-person A Matter of Balance Classes: The classroom should be ADA-accessible and have enough space for each participant to exercise and move around comfortably. The room should have sturdy chairs not on wheels and tables, preferably set up in a U-shape. It is helpful to have space to set up snacks and a resource table. The materials needed include name tags, attendance sheet, pencils, markers, tape, flip chart and stand, TV with DVD player, participant workbooks, and healthy snacks for each session.

For the Virtual Translation of A Matter of Balance the platform requirements are:

• Must have privacy settings and able to last uninterrupted for 2+ hours,
• All participants need to be seen on the screen at the same time
• The leaders need to have the ability to share their screen for showing curriculum content such as videos, flip charts and exercises.

Technology equipment needed for Master Trainers and Coaches to lead A Matter of Balance Virtual Translation may include laptop, desktop, camera, Bluetooth microphone/headset, virtual platform subscription, and any technology that you want to loan to your participants.

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
• Dependability
• Ability to use technology to provide either:
  • Matter of Balance in-person Coach Trainings and/or facilitate community classes including: audiovisual equipment (TV/DVD, overhead projector), and/or
  • Matter of Balance Virtual Coach Training to facilitate virtual community classes including: computer hardware, platform software, cameras, and audio equipment.
• 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 20 hour Master Trainer Training 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 in person or on a virtual platform
• 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. Master Trainers can also lead Matter of Balance classes with another Master Trainer or coach.

What is the recommended class size for a Coach training?

The Coach training is most effective with 6 - 12 people, however you can train as few as 1 coach as needed to support your program.

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
• Enthusiasm
• Dependability
• 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 an additional 4 hours of training to lead virtual community classes (if applicable)
• 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 in-person classroom with supplies and refreshments
• Prepare the virtual meeting room for flip charts, video links, and timed break
• 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
• For an in-person Matter of Balance session the Guest Healthcare Professional demonstrates 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). During the virtual Matter of Balance class the Guest Healthcare Professional does not demonstrate this.
• The Guest Healthcare Professional should be prepared to answer questions from participants in the class on falls, and preventing falls.

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:

• Organizations must have a License to Use to offer the Matter of Balance program through their agency.
• Organizations need at least one Master Trainer in good standing on their License to Use in order to offer Matter of Balance in-person and virtual programming.
• Master Trainers complete the virtual MOB-V training in order to train Coaches virtually and to offer and supervise virtual Matter of Balance community classes.
• Master Trainers participate in Quarterly Master Trainer Update meetings held on Zoom in January, April, July and September to stay current on the Matter of Balance program.
• Coaches complete an 8 hour coach training based on original A Matter of Balance curriculum (fidelity stressed) to lead the in-person classes. An additional 4 hours of training are required for coaches to lead the Matter of Balance Virtual Translation classes.
• Master trainers observe and evaluate volunteer coaches during training and while leading a Matter of Balance class. Coaches receive both written and verbal feedback to help skill development and to maintain fidelity to the program.
• Master Trainers provide an annual 2.5 hour Coach Update Training to review the MOB program and fidelity
• Master Trainers develop connections with and schedule a Guest Healthcare Professional 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 virtual Master Trainer Session is $2000.00 + $65.00 Shipping and Handling per person. This 20 hour, 4-day training session includes all materials for MOB and MOB-V to implement the program and train coaches.

MaineHealth can work with your organization to offer a training for your group to become Master Trainers. Please contact us at PFHA@mainehealth.org or 207-661-7120 to discuss the needs of your group.

Once you are trained as a Master Trainer, there are costs associated with training lay leader Coaches and providing A Matter of Balance classes:

• Coach Training is 8 hours (usually two 4-hour sessions) for in-person MOB community classes, conducted by the Master Trainer(s). Costs to consider include Coach Handbooks, staff time, light refreshments, room and audio/visual equipment. If the Coach training is conducted virtually costs to consider in addition to those listed above are technology hardware for Master Trainers and Coaches (laptop or desktop, camera, audio equipment) the platform subscription, and the training needed to operate the technology hardware and software.
• Coach training for leading virtual Matter of Balance community classes is an additional 4 hours after attending the initial 8 hour training.
• The Matter of Balance in-person class involves eight 2-hour sessions. The Matter of Balance – Virtual Translation is 9 two-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, any technology needed such as laptops, cameras, Bluetooth headset and platform subscription.

Master Trainers are provided with digital links for the MOB Toolkit 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):

Digital copies of the DVD’s are provided for MOB-V at no additional cost.

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.