August 2023
Pediatric sports medicine physicians Michele LaBotz, MD, and Sarah Hoffman, DO, join us to introduce the concept of physical literacy and share resources that primary care providers can use to assess and improve the physical literacy of their pediatric patients.
Additional Information
Let’s Go! Physical Literacy Resources: letsgo.org/physicalliteracy
Mike: This is BACON, brief news from the MaineHealth Accountable Care Organization. A monthly podcast for health care providers. I'm Mike Clark.
Heather: And I'm Heather Ward. Mike and I are practicing physicians who participate in the MaineHealth ACO.
Mike: In this episode, we're joined by two pediatric sports medicine docs who will introduce new tools to help PCP's build the physical literacy of their young patients.
Heather: Well, okay. I'm not entirely sure what physical literacy means, but I would love to learn about it.
Mike: Well, you know, I'm going to just Google it right now to get a definition, so like we're kind of ready for the interview. And, you know, we all know that if it's on the internet, it's probably accurate, right?
Heather: Mike using Dr. Google, really? That's not good. Let's get the real experts in here quick.
Mike: All right? Sounds like a plan. All right, Heather, here's a good one. Ready? Individuals who are physically literate move with competence and confidence in a wide variety of physical activities that benefit the healthy development of the whole person.
Heather: Oh, wow. Well, that's a start. Let's find out if it's on the mark. Joining us right now are doctors Michelle LaBotz and Sarah Hoffman, pediatricians and sports medicine physicians who work with the Let's Go! program. Michelle practices formerly at InterMed Sports Medicine but is now fully committed to this special work. And Sarah is at MMP Orthopedics and Sports Medicine. Welcome, Michelle and Sarah.
Michelle: Thanks for having us.
Sarah: Thanks.
Mike: So, all right, first question, how was that definition of physical literacy I just gave?
Michelle: Well, it's a good start there. As you may or may not have seen on Google, there are a lot of different definitions of physical literacy. We, for our effort, have chosen to use one of the more comprehensive definitions that includes both the physical or the motor capabilities of young people, as well as what are known as kind of the cognitive and affective domains. So that's things like motivation and confidence and knowledge about the importance of different types of physical activity and then behavior, right? Are they actually engaging in physical activity? So the the definition that that we have kind of operationalized has really encompasses that kind of more broad definition. A lot of times you'll hear people when they talk about physical literacy, they'll really be focusing just on the motor components, right? The capacity of kids to have kind of some fundamental movement skills. But we have chosen something more broadly than that.
Heather: Thanks, Michelle. That was really helpful. So it sounds like, though, that this is an essential part of prevention. And Sarah, I'm wondering if you could talk a little bit about how you're getting the message out to providers about physical literacy. Just seems to me like all providers, not just primary care doctors, all providers should really be fluent in this and really understand what physical literacy is and how to educate our pediatric population about that.
Sarah: Yeah. So I'm Sarah Hoffman, and Michelle and I have been working on this project for quite some time and it's grown to the point where now we are working with Let's Go! 5 2 1 0 and their program to help deliver the messaging that we've developed to help people figure out how to get kids to move more time. So we all know that moving 60 minutes a day, an hour or more every day is what children are recommended to do. But telling them to move more isn't always effective if they're not moving well. And so that's where physical literacy has come in. So it's been a natural partnership for us to work with Let's Go! in their programming because they've got their five fruits and vegetables, two hours or less of recreational screen time, one hour or more of physical activity and zero sugary drinks message that a lot of people in the community are really familiar with. And they have a lot of tools and resources on their website as well as in the community with champions who work with schools and programs across the state to really get kids more engaged in healthy lifestyles and habits. So this was a natural fit. As we've worked with Let's Go, we've been able to take the opportunity to build and grow our network of community members who are aware of the importance of physical literacy and how it influences how kids move.
Heather: So I have a follow up to that. And just wondering like really, what are the steps that like I would need to take in order to become an advocate for physical literacy for my pediatric patients?
Michelle: The first thing, and this was a heavier lift, I think, than Sarah and I anticipated in that, you know, our initial efforts were to implement physical literacy screening in health care provider offices, with the thinking being that for some patients, low physical literacy is a barrier to physical activity. So, the way we typically have counseled patients, you know: "go out and do more, put on your shoes, go for a walk." If the physical literacy level is low, that kid's not going to be able to do it no matter how much you push them to do so. And the comparison that Sarah and I often make is with reading literacy, right? If kids don't learn to read well and aren't confident that they know how to read well, they're not going to read enough no matter how much we push them. And so, the corollary could be said for physical literacy. If kids don't learn how to move well and they don't have the confidence that they know how to move well, they're not going to move enough no matter how much we push them to do so.
Michelle: And just to clarify, when we talk about moving, well, we're not talking about being an athlete and having high level of athletic skills. We're talking about having those fundamental motor skills, the ability to run and jump and kick and throw so that they can go out and have fun and play with their peers and engage in healthy levels of active play. And so that's kind of the foundation for it. And so Sarah and I were thinking, well, let's kind of, you know, kind of come up with a workflow that will enable health care providers to screen for physical literacy in their offices. Well, we come to find out that physical literacy was a foreign concept. Think as as you and Mike kind of discussed earlier, that I think people have an intuitive sense of what physical literacy is once you introduce it as a concept unique and separate from physical activity, it's a determinant of physical activity. We actually had to do a lot of education just on the concept before we could even start to talk about implementation.
Mike: So, I'm curious and I don't know who wants to take this question. Maybe, maybe you, Sarah, how did you become interested in this work? Where was the hook that pulled you into the work around physical literacy?
Sarah: So Michelle and I actually got introduced to this work because there were a few other providers in the community that were wondering why are kids not moving enough and how do we get them there? And so, this really built out of their interest and pulling us into the conversation. This feels like a predictor of why some kids at least are not moving enough. And so, to find a different way of approaching that problem, trying to figure out how kids are moving and that this is a concept that most people in the health care world are not really familiar with. But you ask any physical educator in a school system, they know about this. This is what they're trying to do in PE classes. But we got interested, both of us, I think, for slightly different reasons. But similarly, we've seen so many kids who are high level athletes, right? They are playing sports non-stop, but they come in for repetitive injuries. And these patterns are probably built-in by not having some of the right building blocks to get them to where they've gotten athletically. So just because somebody is very active doesn't always mean that they're building blocks and skills were developed in a pattern that's working well for them. So in a combination of trying to figure out how to get kids moving more, figuring out how to partner with them and finding motivating ways to get them to move more. If we don't address this area, this is definitely a big gap and it's a great opportunity really for all of us to address physical activity levels.
Mike: I immediately am wondering, as a family doc, what are the opportunities for me to step up and participate with this with my patients? Where do I start?
Sarah: So that's a great question. And we Michelle and I are the co-founders of Physical Literacy for All Youth in Maine, which we labeled Play Me. This was a group of us that came together. Oh, gosh, four plus years ago. Now to try to address this concept and try to figure out how to get kids moving more through addressing physical literacy. And we developed some tools where Michelle was referencing screening in health care practices. And there's a quick tool that we adapted from the Canadian group that is halo up there, who had developed a great set of tools with a study with a bunch of kids, over 10,000 children were studied. That broke it down into kind of the most pertinent pieces to do a quick in-office screen. And then you can triage kids into seems like they probably have the physical literacy skills they need versus kids who seem like they are at high risk of lacking those physical literacy building blocks. And so we developed that tool first, and then we realized, well, once you've identified that somebody needs help with their physical literacy, then what? So, then we expanded, and we now have tools that you can access as a physical therapist or as an after-school program for the Y or anyone should be able to access all of these materials through Let's Go! website to understand how to assess physical literacy skills in children and then go forward with trying to help those kids who need extra help.
Sarah: And this really can apply to all kids. So when we talk about those after school programs or community rec programs or camps through the summer, they can all use these tools to help build physical literacy skills in all children. But obviously when we identify children who are lacking in the health care setting, we might need to help enlist like a physical therapist or somebody who can do more one-on-one work. But these tools have, you know, a brief screen and then a more in depth screen that somebody can do in a physical therapy office or a different setting, which has more space. We even have an option for places that don't have big spaces to do a lot of those running and jumping and obstacle course activities, which honestly, the kids find the most fun, I think, through our work so far. This is supposed to be a place where people can go from all aspects of people who care for children from community settings as well as health care practices to learn more about the concept and then have some tools to access to utilize to help our patients and get families on board with understanding the importance as well as getting kids physical literacy skills built up where they seem like they are lacking.
Heather: Okay. That's that is all really great information. So as a as a primary care provider, where would I go to really get my hands on this information and these tools?
Michelle: So this is Michelle. So on the Let's Go website, there is a physical literacy dedicated section, so it's letsgo.org/physical literacy, all one word. And in there we have manuals that we have aimed to be soup-to-nuts for health care providers as well as for rehabilitation specialists, community based organizations as well as families. And in that there is some background information on the concept of physical literacy. In a couple of the QI projects that we've done in terms of implementing physical literacy screening into healthcare provider offices, we heard back that providers really wanted some specific scripting in terms of how do you introduce this concept to families. So we've tried to do that. There is in-depth descriptions of the two step screening process that we do have workflows that we have gotten the feedback that worked very well both in primary care as well as in a specialty clinic caring for children with obesity. And then we've got kind of mitigation strategies. So, you know, how do you code this? You know, when do you need to think about referring somebody to physical therapy? When can they go to is it appropriate to go to community based resources? How can parents access additional support in the schools? And then we have a lot of resources for families in there as well.
Heather: Well, that's fantastic. I'm definitely going to check those out. So Michelle and Sarah, thank you so much for joining us. This has been very eye opening.
Sarah: Thanks for having us.
Michelle: Yeah, thanks for giving us the opportunity to share the work.
Mike: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page MaineHealthACO.org/BACON. You can also find a link to the Let's Go physical literacy materials on our web page as well. And if you have questions, comments or suggestions, we'd love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.
Heather: BACON is produced by the MaineHealth Accountable Care Organization. Thanks for joining us. See you next time.
Mike: See you next time.
Heather: And I'm Heather Ward. Mike and I are practicing physicians who participate in the MaineHealth ACO.
Mike: In this episode, we're joined by two pediatric sports medicine docs who will introduce new tools to help PCP's build the physical literacy of their young patients.
Heather: Well, okay. I'm not entirely sure what physical literacy means, but I would love to learn about it.
Mike: Well, you know, I'm going to just Google it right now to get a definition, so like we're kind of ready for the interview. And, you know, we all know that if it's on the internet, it's probably accurate, right?
Heather: Mike using Dr. Google, really? That's not good. Let's get the real experts in here quick.
Mike: All right? Sounds like a plan. All right, Heather, here's a good one. Ready? Individuals who are physically literate move with competence and confidence in a wide variety of physical activities that benefit the healthy development of the whole person.
Heather: Oh, wow. Well, that's a start. Let's find out if it's on the mark. Joining us right now are doctors Michelle LaBotz and Sarah Hoffman, pediatricians and sports medicine physicians who work with the Let's Go! program. Michelle practices formerly at InterMed Sports Medicine but is now fully committed to this special work. And Sarah is at MMP Orthopedics and Sports Medicine. Welcome, Michelle and Sarah.
Michelle: Thanks for having us.
Sarah: Thanks.
Mike: So, all right, first question, how was that definition of physical literacy I just gave?
Michelle: Well, it's a good start there. As you may or may not have seen on Google, there are a lot of different definitions of physical literacy. We, for our effort, have chosen to use one of the more comprehensive definitions that includes both the physical or the motor capabilities of young people, as well as what are known as kind of the cognitive and affective domains. So that's things like motivation and confidence and knowledge about the importance of different types of physical activity and then behavior, right? Are they actually engaging in physical activity? So the the definition that that we have kind of operationalized has really encompasses that kind of more broad definition. A lot of times you'll hear people when they talk about physical literacy, they'll really be focusing just on the motor components, right? The capacity of kids to have kind of some fundamental movement skills. But we have chosen something more broadly than that.
Heather: Thanks, Michelle. That was really helpful. So it sounds like, though, that this is an essential part of prevention. And Sarah, I'm wondering if you could talk a little bit about how you're getting the message out to providers about physical literacy. Just seems to me like all providers, not just primary care doctors, all providers should really be fluent in this and really understand what physical literacy is and how to educate our pediatric population about that.
Sarah: Yeah. So I'm Sarah Hoffman, and Michelle and I have been working on this project for quite some time and it's grown to the point where now we are working with Let's Go! 5 2 1 0 and their program to help deliver the messaging that we've developed to help people figure out how to get kids to move more time. So we all know that moving 60 minutes a day, an hour or more every day is what children are recommended to do. But telling them to move more isn't always effective if they're not moving well. And so that's where physical literacy has come in. So it's been a natural partnership for us to work with Let's Go! in their programming because they've got their five fruits and vegetables, two hours or less of recreational screen time, one hour or more of physical activity and zero sugary drinks message that a lot of people in the community are really familiar with. And they have a lot of tools and resources on their website as well as in the community with champions who work with schools and programs across the state to really get kids more engaged in healthy lifestyles and habits. So this was a natural fit. As we've worked with Let's Go, we've been able to take the opportunity to build and grow our network of community members who are aware of the importance of physical literacy and how it influences how kids move.
Heather: So I have a follow up to that. And just wondering like really, what are the steps that like I would need to take in order to become an advocate for physical literacy for my pediatric patients?
Michelle: The first thing, and this was a heavier lift, I think, than Sarah and I anticipated in that, you know, our initial efforts were to implement physical literacy screening in health care provider offices, with the thinking being that for some patients, low physical literacy is a barrier to physical activity. So, the way we typically have counseled patients, you know: "go out and do more, put on your shoes, go for a walk." If the physical literacy level is low, that kid's not going to be able to do it no matter how much you push them to do so. And the comparison that Sarah and I often make is with reading literacy, right? If kids don't learn to read well and aren't confident that they know how to read well, they're not going to read enough no matter how much we push them. And so, the corollary could be said for physical literacy. If kids don't learn how to move well and they don't have the confidence that they know how to move well, they're not going to move enough no matter how much we push them to do so.
Michelle: And just to clarify, when we talk about moving, well, we're not talking about being an athlete and having high level of athletic skills. We're talking about having those fundamental motor skills, the ability to run and jump and kick and throw so that they can go out and have fun and play with their peers and engage in healthy levels of active play. And so that's kind of the foundation for it. And so Sarah and I were thinking, well, let's kind of, you know, kind of come up with a workflow that will enable health care providers to screen for physical literacy in their offices. Well, we come to find out that physical literacy was a foreign concept. Think as as you and Mike kind of discussed earlier, that I think people have an intuitive sense of what physical literacy is once you introduce it as a concept unique and separate from physical activity, it's a determinant of physical activity. We actually had to do a lot of education just on the concept before we could even start to talk about implementation.
Mike: So, I'm curious and I don't know who wants to take this question. Maybe, maybe you, Sarah, how did you become interested in this work? Where was the hook that pulled you into the work around physical literacy?
Sarah: So Michelle and I actually got introduced to this work because there were a few other providers in the community that were wondering why are kids not moving enough and how do we get them there? And so, this really built out of their interest and pulling us into the conversation. This feels like a predictor of why some kids at least are not moving enough. And so, to find a different way of approaching that problem, trying to figure out how kids are moving and that this is a concept that most people in the health care world are not really familiar with. But you ask any physical educator in a school system, they know about this. This is what they're trying to do in PE classes. But we got interested, both of us, I think, for slightly different reasons. But similarly, we've seen so many kids who are high level athletes, right? They are playing sports non-stop, but they come in for repetitive injuries. And these patterns are probably built-in by not having some of the right building blocks to get them to where they've gotten athletically. So just because somebody is very active doesn't always mean that they're building blocks and skills were developed in a pattern that's working well for them. So in a combination of trying to figure out how to get kids moving more, figuring out how to partner with them and finding motivating ways to get them to move more. If we don't address this area, this is definitely a big gap and it's a great opportunity really for all of us to address physical activity levels.
Mike: I immediately am wondering, as a family doc, what are the opportunities for me to step up and participate with this with my patients? Where do I start?
Sarah: So that's a great question. And we Michelle and I are the co-founders of Physical Literacy for All Youth in Maine, which we labeled Play Me. This was a group of us that came together. Oh, gosh, four plus years ago. Now to try to address this concept and try to figure out how to get kids moving more through addressing physical literacy. And we developed some tools where Michelle was referencing screening in health care practices. And there's a quick tool that we adapted from the Canadian group that is halo up there, who had developed a great set of tools with a study with a bunch of kids, over 10,000 children were studied. That broke it down into kind of the most pertinent pieces to do a quick in-office screen. And then you can triage kids into seems like they probably have the physical literacy skills they need versus kids who seem like they are at high risk of lacking those physical literacy building blocks. And so we developed that tool first, and then we realized, well, once you've identified that somebody needs help with their physical literacy, then what? So, then we expanded, and we now have tools that you can access as a physical therapist or as an after-school program for the Y or anyone should be able to access all of these materials through Let's Go! website to understand how to assess physical literacy skills in children and then go forward with trying to help those kids who need extra help.
Sarah: And this really can apply to all kids. So when we talk about those after school programs or community rec programs or camps through the summer, they can all use these tools to help build physical literacy skills in all children. But obviously when we identify children who are lacking in the health care setting, we might need to help enlist like a physical therapist or somebody who can do more one-on-one work. But these tools have, you know, a brief screen and then a more in depth screen that somebody can do in a physical therapy office or a different setting, which has more space. We even have an option for places that don't have big spaces to do a lot of those running and jumping and obstacle course activities, which honestly, the kids find the most fun, I think, through our work so far. This is supposed to be a place where people can go from all aspects of people who care for children from community settings as well as health care practices to learn more about the concept and then have some tools to access to utilize to help our patients and get families on board with understanding the importance as well as getting kids physical literacy skills built up where they seem like they are lacking.
Heather: Okay. That's that is all really great information. So as a as a primary care provider, where would I go to really get my hands on this information and these tools?
Michelle: So this is Michelle. So on the Let's Go website, there is a physical literacy dedicated section, so it's letsgo.org/physical literacy, all one word. And in there we have manuals that we have aimed to be soup-to-nuts for health care providers as well as for rehabilitation specialists, community based organizations as well as families. And in that there is some background information on the concept of physical literacy. In a couple of the QI projects that we've done in terms of implementing physical literacy screening into healthcare provider offices, we heard back that providers really wanted some specific scripting in terms of how do you introduce this concept to families. So we've tried to do that. There is in-depth descriptions of the two step screening process that we do have workflows that we have gotten the feedback that worked very well both in primary care as well as in a specialty clinic caring for children with obesity. And then we've got kind of mitigation strategies. So, you know, how do you code this? You know, when do you need to think about referring somebody to physical therapy? When can they go to is it appropriate to go to community based resources? How can parents access additional support in the schools? And then we have a lot of resources for families in there as well.
Heather: Well, that's fantastic. I'm definitely going to check those out. So Michelle and Sarah, thank you so much for joining us. This has been very eye opening.
Sarah: Thanks for having us.
Michelle: Yeah, thanks for giving us the opportunity to share the work.
Mike: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page MaineHealthACO.org/BACON. You can also find a link to the Let's Go physical literacy materials on our web page as well. And if you have questions, comments or suggestions, we'd love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.
Heather: BACON is produced by the MaineHealth Accountable Care Organization. Thanks for joining us. See you next time.
Mike: See you next time.