Right from the Start: Assessing Child Care Settings in Multnomah County for Obesity Prevention

1. Right from the Start: Assessing Child Care Settings in Multnomah County for Obesity Prevention Prepared for: Oregon Public Health Association Annual Conference October 19th, 2010

2. Right from the Start Project Advisory Committee • Dianna L. Pickett, Nurse Consultant, Coordinator: Healthy Child Care Oregon, Office of Family Health, Oregon Health Division • Oregon Department of Employment, Child Care Division • Eco-Healthy Child Care Program, Oregon Environmental Council • Community Nutrition, Child Nutrition Programs Oregon Department of Education • Child Care Improvement Program • Office of Family Health, Oregon Health Division • Healthy Start Initiative, Multnomah County Health Department • Child Care Resource and Referral of Multnomah County • Commission on Children, Families, and Community of Multnomah County • Regional Practice Division - Pediatrics NWP, Kaiser Permanente NW • Chronic Disease Prevention Program Multnomah County Health Department • The Montessori House of St. John’s • Barb's Home Daycare • College of Health and Human Sciences, Oregon State University

3. Presentation Objectives • To provide project history and background • To outline the development of a novel survey assessment tool • To describe methodology and share lessons learned from the survey implementation process • To highlight next steps toward dissemination of findings

4. Why Obesity Prevention in Child Care? • Nationally, 24.4% of children ages two through five years are classified as either overweight or obese.1 • The preschool period is a critical time for growth and development, and healthy eating and active play can help prevent later obesity.2-4 • In the US, nearly 74% of children ages 3 to 6 are in some form of non-parental care and just over half are in center-based child care.5 ***With such large numbers of children in child care, child care providers are in a unique position to support and facilitate healthful eating and promote physical activity in young children.

5. Types of licensed child care in Oregon • Child care center • designated facility for care of children; can care for unlimited number of children; must meet ratios; 30% are exempt from regulation • Certified family child care home • single family dwelling; run by homeowner; can care for up to 16 children; none are exempt from regulation • Registered family child care home • located in person’s home; can care for up to 10 children; minimally regulated ***most child care is unregulated in Oregon (type= family, friend, and neighbor)

6. Number of child care sites in Multnomah County

7. Capacity of each site in Multnomah County

8. Project History • 2007 Healthy Kids Watch Less TV (HKWLTV) Retreat • Focus on children age 0-5 years • Identified child care settings • OPHI and HKWLTV members wrote three grant proposals • Success – Finally! • Northwest Health Foundation: September 2009 – August 2011

9. Project Objectives • Objective 1: Prepare to conduct assessment of child care settings in Multnomah County, Oregon regarding practices for the prevention of childhood obesity. • Objective 2: Conduct assessment of a universal sample of child care settings in Multnomah County, that care for children age 0-5 years. • Objective 3: Translate assessment results into recommendations for training and support of child care providers and possible environmental or policy change, prepare for statewide assessment.

10. Four Areas of Assessment • Breastfeeding support • Nutrition • Physical activity • Screen time

11. Survey Development • Initial plan to adapt NAP SACC and other validated surveys (e.g. BMER, ENHANCE) • Input and review from project advisory committee (including child care providers, child health and child care experts) • Development of a novel survey tool • 59 question; 16 page booklet survey • Contains both quantitative/qualitative questions • IRB approval from Oregon Public Health Division for study instruments and protocol

12. Conducted 2 focus groups of registered home child care providers (16 participants) Child care providers completed survey and provided structured feedback about survey questions, design, and opinions about 4 topic areas Results of focus group informed revisions to final survey tool for implementation ***Focus group data is currently being analyzed Testing the Survey

13. Dillman Method - creates a social exchange relationship w/ structured, sequenced, and timed contacts to yield high response rate Day 1: Pre-notice letter Day 5-7: Survey w/ $2 bill and cover letter Day 14-17: Reminder post card Day 28-34: Replacement survey and cover letter to non-responders Targeted outreach via multiple child care networks Both electronic, paper, and word of mouth Survey Implementation - English

14. Survey Implementation - English • Mailed paper surveys to a universal sample of all licensed child care settings in Multnomah County (approximately 750) • Option to complete survey on-line • Less than 10% responded on-line • IRB approval from Oregon Public Health Division for study protocol ***Current response rate 60 - 65%!!

15. Survey Implementation - Russian • Key informant interviews with Russian-speaking child care consultants and experts who work directly with providers (CCR&R, CCD, CCIP) • Revised Dillman method: • Day 1: Survey w/ $2 bill and cover letter • Day 21-28: Replacement survey and cover letter to non-responders • Targeted outreach via Russian language child care networks • IRB approval for revisions to protocol ***Current response rate - approx. 60%!

16. Lessons Learned • Survey development: No other tool exists that comprehensively assesses 4 key areas of obesity prevention • Implementation: Following the well-tested Dillman method yields amazingly high response rate ** $2 bill offered w/ the survey vs. gift card/monetary gift post creates different relationship and exchange • Survey Response: Child care providersresponded well to survey as predicted by the Dillman method • Special Population:Russian-speaking childcare providers responded well to survey w/ revised Dillman method • Overall: This assessment project is intended to be a pilot with hopes of expanding state-wide

17. Next Steps Project Objective 3:Translate assessment results into recommendations for training and support of child care providers and possible environmental or policy change, prepare for statewide assessment • Review and interpret survey results (late fall/winter, 2010) • Develop recommendations for trainings and support, highlight best practices, and identify most prevalent missed opportunities (winter/early spring, 2011) • Disseminate findings and recommendations (late spring/early summer, 2011) • Identify future funding opportunities (late spring/early summer, 2011)

18. References • Ogden C, Carroll M and Flegal K. “High Body Mass Index for Age Among US Children and Adolescents, 2003–2006.” Journal of the American Medical Association, 299(20): 2401–2405, May 2008 2. Whitaker RC, Pepe MS, Wright JA, Seidel KD, Dietz WH: Early adiposity rebound and the risk of adult obesity. Pediatrics 1998, 101:E5. 3. Dietz WH: Periods of risk in childhood for the development of adult obesity--what do we need to learn? J Nutr 1997, 127:1884S-1886S. 4. Dietz WH: “Adiposity rebound”: reality or epiphenomenon? Lancet 2000, 356:2027-2028. 5. Federal Interagency Forum on Child and Family Statistics: America’s Children: Key National Indicators of Well-Being, 2002. Washington, DC: U.S. Government Printing Office; 2002.

19. Thank you! For questions about Right from the Start please contact: Rachel Burdon Project Manager rachel@orphi.org