Implementing and Evaluating a School-Based PSE Change-Making Strategy

1. A School-Based PSE Change-Making Strategy that Works: How to Implement and Evaluate It Jini Puma, PhD Charlotte Farewell, PhD candidate Rocky Mountain Prevention Research Center University of Colorado Denver

2. Learning Objectives • Increase awareness of an evidence-based strategic planning process to make best practice healthy eating and physical activity PSE changes in school-based settings • Increase awareness about “menus of research-based PSE changes” that promote healthy eating and physical activity created for preschools and elementary schools that can be used by all SNAP-Ed implementing agencies doing school-based work

3. Early Childhood Obesity • 1 in every 4 preschool children are overweight or obese • Low-income and ethnic minority children are disproportionately affected by obesity • Early development of gross motor skills and eating attitudes and behaviors are shaped in the first five years of life

4. The Role of Early Childhood Education (ECE) Settings • Over 11 million children under six spend an average of 30 hours a week in non-parental care • Making healthy Policy, System, and Environment (PSE) changes in ECE settings has the potential to impact children’s physical activity and healthy eating behaviors (and reduce childhood overweight and obesity)

6. Why PSE’s? • Ongoing • Foundational: Often produces behavior change over time • Community-/population-Level • Part of a Wellness Policy • Sustainable

8. What is the COWP PSE Process?

9. COWP PSE Process • Key Ingredients • Center-based wellness Team • Director participation • COWP facilitator • Interdisciplinary (4-8 participants) • 4-6 monthly meetings • 3 change-making strategies • Goal: 4 health-promoting PSE changes implemented

10. Strategy 1: Strengths and Needs Assessment

11. Menu of Evidence-Based Best Practices: Sample of Healthy Eating-Related PSE’s

12. Menu of Evidence-Based Best Practices: Sample of Physical Activity-related PSE’s

13. Strengths and Needs Assessment • Review Menu of Healthy Eating and Physical Activity PSE Best Practices • Assess current level of implementation (Not, Partial, and Full) of all PSE practices

14. Strategy 2:Prioritizing PSE Changes IS IT FEASIBLE? IS IT IMPORTANT?

15. Importance and Feasibility • Consider the following when thinking about IMPORTANCE of a best practice in your ECE center • Evidence-based? • How often will it impact children? • Will this affect all preschool-aged children or just some groups? • Consider the following when thinking about FEASIBILITY of a best practice at your ECE center • Will this cost money? • Will this cost time? • Do staff and administrators support this?

16. Importance and Feasibility

17. Strategy 3: Action Planning

18. Action Planning

19. Action Planning Remember: Consider the following: Getting approval for the change Getting buy in from key stakeholders Putting the change in place Communicating the change to school and community Planning for sustainability

20. COWP Wellness Policy Poster

21. Follow-up and On-going Support with Implementation • PSE toolkits • Technical assistance follow-up • Ongoing quarterly meetings with wellness team and wellness champions

22. Evaluation and SNAP-Ed Indicators Medium-Term Outcomes: Changes adopted by the end of the COWP PSE Process • MT5: Nutrition Supports • MT6: Physical Activity Supports Long-Term Outcomes: PSE Changes sustained over time • LT5: Nutrition Supports • LT6: Physical Activity Supports

23. Evaluation of PSE changes • Instrument: Outcome Evaluation Form, measures implementation and sustainability of PSE changes after completion of the PSE Process • Completed by Director/Wellness Champion • Completed: • 1-month, 6-months, 1-year, 2-years

24. Outcomes to Date (through 2018) Medium-Term (MT5 & 6) • 657 adopted changes across 125 ECE settings (average of 5.3 changes/setting) • 47% focused on healthy eating changes • 53% were focused on physical activity changes

25. Outcomes to Date • Long-Term (LT5 & 6) • After 6 months, 48% of the changes adopted are fully implemented • After 1 year, 66% of the changes adopted are fully implemented • After 2 years, 70% of changes adopted are fully implemented

26. Sustainability of PSE Changes

27. What Providers have said about the COWP PSE Process • “I would tell them to do it, definitely. It’s a way of getting the blinders off and getting some new ideas and good things to happen in your school.” • “It was a very good experience. I never once went, “Oh I wish I didn’t have to go!” • “I enjoyed the brainstorming and hearing people’s ideas… because even though you may have a good idea, someone might add a little twist to it and that makes it that much better… it’s like two brains are better than one.”

28. COWP PSE PROCESS - Looking Ahead… • Currently piloting various adaptations of the COWP PSE process: • Professional Development and Technical Assistance Format • Remote Facilitation Format • Home-Based ECE settings • Total Worker Health Adaptation • Analyzing factors related to successful dissemination and implementation of PSE changes in ECE settings

29. Resources • Culture of Wellness in Preschools website - http://cowpprogram.com • Integrated Nutrition Education Program – PSE tool for elementary schools Contact Julie Atwood at julie.atwood@ucdenver.edu

30. Thank You! Jini Puma, PhD jini.puma@ucdenver.edu Charlotte Farewell, PhD Candidate charlotte.farewell@ucdenver.edu