Smart Start and NAP SACC – A Statewide Collaboration to Address Childhood Overweight in Child Care

1. Smart Start and NAP SACC – A Statewide Collaboration to Address Childhood Overweight in Child Care 2008 National Smart Start Conference Koury Center, Greensboro, NC Cynthia D. Turner, MS, NCPC’s Health Consultant Sarah Ball, MPH, RD, NAP SACC Project Coordinator

2. Objectives Learn about unique collaboration between Smart Start and NAP SACC Recognize the need to improve children’s nutrition and physical activity environments in child care settings Encourage increased participation in NAP SACC Program

3. Smart Start Vision Every child reaches his or her potential and is prepared for success in a global community

4. What is Smart Start? • Created in 1993 by Governor James Hunt • Initiative to address the needs of children birth-5 years old • Funding for 78 public-private partnerships, which include all 100 counties in the state • Local planning and decision making linked to outcomes for young children 4

5. Why NAP SACC? The Problem: National and State Obesity Epidemic

6. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2006(*BMI 30, or about 30 lbs. overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC. 1998 1990 2006

7. Obesity in ChildrenAges 2-5 years old

8. NC Childhood Overweight Data 8

9. Overweight Children by Age, Hispanicity, and Gender 9 3/13/2014 9 9

10. Potential Causes of Childhood Overweight / Obesity Behavioral Factors - large portion sizes, fast food, high sugar beverages, high calorie snack foods, decrease in children’s physical activity, increase in screen time Environmental Factors – family role models at home; child care provide healthy eating and physical activity practices; lack of community sidewalks, bike paths and parks Genetic Factors - may increase a child’s chance for being overweight; exists in conjunction with environmental and behavioral factors

11. Consequences ofChildhood Overweight / Obesity Medical risks - cardiovascular disease, hypertension, asthma, type 2 diabetes, premature death; Psychosocial risks - low self-esteem, depression, hinders academic and social functioning; Economic Cost - increase in medical expenses, reduction in economic, opportunity / productivity, time lost from work or school, increased child care costs, annual cost to NC taxpayers = $2.1 Billion

12. NAP SACC ACTIVITY SCARF PLAY!!

13. NAP SACC What’s it all about?

14. What is… NutritionAndPhysicalActivitySelfAssessmentforChildCare

15. Principles Guiding NAP SACC Development • Keep the process simple and practical • Design it for dissemination • Build on existing public health infrastructure • Use a self-assessment to motivate and engage child care providers to improve their polices, practices, and environment.

16. Intervention Structure • Health professional who works with child care (e.g., Child Care Health Consultant) and is trained to deliver intervention • Center moves through the 5-step intervention at their own pace (suggest ~ 6 mo.) • Consultant provides education, technical assistance and support.

17. NAP SACC Steps • Self-Assessment • 2. Action Planning/Goal Setting • 3. Workshop Delivery • 4. Targeted Technical Assistance • 5. Evaluate, revise and repeat

18. Step 1: Self-Assessment • Center director completes self-assessment instrument with help from key staff, such as the cook, teacher or program planner. • This should be done without Consultant help.

19. Nutrition and Physical Activity Key Areas • Fruits and Vegetables • Meats, Fats, and Grains • Beverages • Menus and Variety • Feeding Practice • Foods Outside of Meals and Snacks • Supporting Healthy Eating • Nutrition Education • Nutrition Policies • Active Play and Inactive Time • Play Environment • Supporting PA • PA Education • PA Policies

20. Step 2: Action Plan • Initially, director chooses 1 nutrition, 1 physical activity, and 1 other key area to improve. • Improvements chosen should be facility guided with the Consultant available only for assistance and support.

21. Step 3: Deliver Workshops • The NAP SACC Consultant delivers the 5 workshops to child care staff at a mutually agreeable time and place. • These are currently approved for CEUs in North Carolina.

22. Step 4: Provide Technical Assistance • Regular follow-up with center to see how they are doing. • This offers them a means of support, helps break through barriers they may be facing, and facilitate the changes they hope to make. • This may be the most important step in the process!!

23. Step 5: Evaluate, Revise and Repeat • This is not a finite process, but evolving over time. • After 6 months or earlier if necessary, director completes the self-assessment again. • What has changed? Did they make the improvements they chose? What would they like to do next?

24. Tool Kit Components • Intervention Tools • Technical Assistance Materials • Informational Materials NAP SACC Toolkit

25. Tool Kit Components • Intervention Tools • Self-assessment • Sample self-assessment • Self-assessment Instruction Sheet • Action Planning Document • Sample Action Planning Document • 5 NAP SACC workshops with activities

26. Tool Kit Components • Technical Assistance Materials • Technical Assistance Manual • Facility Key Area Handouts • Parent Handouts for Providers • Sample nutrition and physical activity policy

27. Tool Kit Components • Informational Materials • Recruitment letter for providers • NAP SACC informational brochure for parents • Best Practice Recommendations • Certificate of Completion for Providers

28. NAP SACC Dissemination • NAP SACC was selected for dissemination as an effective practice-based intervention • Center for Research Translation and Dissemination has sponsored the preparation of NAP SACC for web-based dissemination

29. Training and all materials available online • 3 core modules & 3 supplemental modules • Activities and quizzes built in. 29

30. Smart Start and NAP SACC Why Smart Start’s Collaboration with NAP SACC? NC’s childhood overweight / obesity epidemic Smart Start’s support of nutrition and physical activities Smart Start’s commitment to CCHC projects NAP SACC’s research and evaluation data NAP SACC’s strong support and commitment

31. 2007-09 NAP SACC Pilot Grant Project Proposal Requirements: • Statement of Need • Description of Target Population • Program Implementation • Community Collaboration • Proposed Budget – 2 years; Grant awards for centers and/or CCHCs

32. 2007-09 NAP SACC Pilot Grant Project Five Step Implementation Plan: • Start up & Orientation • Quality Assurance for Model Fidelity • Technical Assistance • Evaluation • Reporting

33. Start Up & Orientation Grantees contacted by Grant Owner Webcasts to “walk-through” project Site visits and/or conference calls Ongoing technical assistance – Spanish version materials

34. Quality Assurance for Model Fidelity NAP SACC Pilot Grant Requirements: Smart Start Grantees/Partnerships Child Care Centers Consultants (CCHC / RDs) Additionally: Two on-site visits/yr to NAP SACC Grantees Quarterly “Check-ins” each year

35. NCPC Pilot Requirements Smart Start Partnerships: A minimum of ten 3-star licensed centers with at least 20 children enrolled in each center; OR A sufficient number of 3 to 5-star licensed centers that have at least 75% of the total children enrolled in all 3 to 5-star licensed centers must participate OR A minimum of 200 children (2-5 year olds) to participate. Community collaboration, supervision, financial contribution, etc.

36. NCPC Pilot Requirements Child Care Centers: Commit to participate in NAP SACC for at least six months. Participation is limited to centers that have not previously participated in NAP SACC. Ensure that key staff complete five, mandatory trainings Personnel / Consultants: State-trained Child Care Health Consultants (CCHC) or pediatric-trained Registered Dieticians (RD CCHC/RDs must complete a 4-hour NAP SACC training OR complete web-training available after January 2008 CCHC/RDs must be hired by Nov. 16, 2007

37. Pilot Requirements Projected Outcomes Increase the number of early care and education environments implementing healthy nutrition and physical activity practices. 75% of child care centers that participate will complete their Action Plan to incorporate improved nutrition and physical activity practices. 75% of child care centers that complete their Action Plan will demonstrate improvement in nutrition and physical activity practices as measured by pre- and post-assessment scores.

38. NCPC Technical Assistance Grantee Owner to provide ongoing technical assistance to NAP SACC Grantees: Webcast Conference Calls Emails Site visits Tour of NAP SACC project

39. NCPC Evaluation Purpose of Evaluation: To learn if NAP SACC is making a difference in the nutrition and physical activity practices in child care centers. To ensure that NAP SACC programs are reaching the intended target population.

40. NCPC Evaluation Evaluation Components: Pre- and Post-Self Assessments Center Profile Cover Sheet Outputs / Counts: Participating Centers Participating Children Outcomes / Results Narrative / Success Stories

41. NCPC Reporting Type of Reports: Programmatic / Evaluation Reports Financial Reports Grantees to submit written and electronic reports to NCPC / contracted evaluator NCPC will report to Key Stakeholders (e.g., General Assembly)

42. Panel Discussion NAP SACC Grantees: Guilford County Partnership for Children Orange County Partnership for Children Person County Partnership for Children Stanly County Smart Start Partnership for Children

43. Thank you for Coming!!! Cynthia Turner, MA, Health Consultant The North Carolina Partnership for Children, Inc. Planning and Program Department cturner@ncsmartstart.org www.smartstart.org Sarah Ball, MPH, RD, Project Director Center for Health Promotion and Disease Prevention University of North Carolina at Chapel Hill Phone: 919-966-6035; ball@email.unc.edu www.napsacc.org

44. Questions, Evaluation, Conclusion “Don’t step on it…it makes you cry.”