1. A Child Care Center Intervention Promoting Policy and Menu Change in Early Care and Education in Ohio Autumn Trombetta MS, RD, LD Cheryl Graffagnino MS, RD, LD

2. Obesity In Ohio(BMI > 95% %ile) Newborns 10-17 yr olds2 Adults2 2-5 yr olds1 <5% 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% NS ¹ Pediatric Nutrition Surveillance System (PedNSS), CDC and ODH, 2006 2 Ohio Family Health Survey (OFHS), ODJFS/ODH/ODI/ODMH, 2008

3. Program Development • Began in 2004 • Focus groups with parents • Identified child care providers as trusted source of health information • Created training & toolkit for child care provider staff

4. Evolution of a Statewide Initiative • Began in 2010 • Voluntary designation • Provides Step Up To Quality • Education CEUs • Monitored through Professional Development Registry

5. Becoming an Ohio Healthy Program.. • Attend Step Up To Quality approved trainings • Implement a healthy policy • Increase the nutritional content of menus • Include parent participation

6. Becoming an Ohio Healthy Program…1. SUTQ-Approved Trainings • Session 1: Healthy Habits (10 Hour series) • Healthy Activity • Healthy Eating and Feeding • Healthy Growing • Healthy Families • Session 2: Healthy Menus (2.5 hours) • Session 3: Healthy Policies (2.5 hours)

7. Becoming an Ohio Healthy Program…2. Implement a Healthy Policy • “Television, video, computers and other visual recordings shall not be used with children under two years of age.” • “Breastfeeding mothers shall be provided a private and sanitary place to breastfeed their babies or express milk. The area will have an electrical outlet, comfortable chair, and nearby access to running water.” • “Staff members consume the same food and drinks as the children. Staff members do not consume other foods and drinks in front of the children. “

8. Becoming an Ohio Healthy Program…3. Ohio Healthy Programs Menu • Includes variety every day of the week • Non-fried Vegetables • Whole Fruit • Whole Grain Food • Offers fried foods no more than twice a week • Offers only low fat milk (1% or skim) to children ages 2 and up (adapted from Healthier US School Challenge 2010)

9. Becoming an Ohio Healthy Program…4. Parent Participation • Parent Bulletin Board • Parent Newsletter

10. Statewide Train-The-Trainer • Local Resource and Referral agencies • 27 Education Specialists • Ohio Department of Health’s Healthy Child Care Ohio • 37 Nurses • 1 Dietitian

11. Ohio Healthy Programs Results • January 2010 – March 2011 • 65 statewide trainers • 349 trainings • 1300 child care staff • 608 centers • 13 Ohio Healthy Programs

12. Local Programming • Recruiting child care centers • Technical assistance • RD and/or DTR • 2 week menu review and recommendations • Parent/Policy Handbook review and recommendations • Environmental Assessment

13. Local Programming • Sustainable Supporting Materials • $100 for Ohio Healthy Program Menu • $100 for Ohio Healthy Program designation • $100 per policy • maximum of $300

14. Intervention MeasureCenter Policies • Since January 2011 • 26 licensed centers • 404 policies(mean=15): • 284 nutrition • 9 breastfeeding • 110 physical activity • 10 Nutrition and physical activity promotion for parents

15. Child Care Centers & Number of Policies by Zip, Columbus, OH

16. Adult Obesity by Zip CodeColumbus, Ohio

17. Pre- & Post Intervention Measures Menu Changes 29.0% 287.6% 53.2% 27.7%

18. Pre- & Post Intervention Measures Menu Changes 50.1% 56.6%

19. Next Steps • Statewide: • Incorporate Ohio’s Healthy Program criteria into statewide voluntary quality rating systems • Enhance parent engagement efforts • Local: • Ongoing evaluation of long-term, sustained environmental change • Continue to seek sustainable funding source

20. Questions? • Autumn Trombetta altrombetta@columbus.gov • Cheryl Graffagnino clgraffagnino@columbus.gov http://publichealth.columbus.gov/healthy-children-healthy-weights.aspx