Nemours’ Integrated Approach to Child Health and Obesity Prevention in Delaware

1. Nemours’ Integrated Approach toChild Health and Obesity Prevention in Delaware Debbie I. Chang, MPH Vice President, Policy & Prevention November 18, 2009

2. Nemours Integrated Child Health System Nemours is a non-profit organization dedicated to children's health & health care. Nemours operates the Alfred I. duPont Hospital for Children and outpatient facilities in the Delaware Valley and specialty care services in Northern/Central Florida. Building new state-of-the-art Children’s Hospital in Orlando area. Nemours offers a continuum of care as health and prevention services are coupled with research, education, advocacy, and clinical treatment. Nemours focuses on child health promotion and disease prevention to address root causes of health. First initiative is preventing childhood obesity Complements and expands reach of clinicians using broader, community-based approach 0 2

3. Conceptual Model: Key Influences on Children’s Health • A healthy child includes a balance of physical, emotional, cognitive & social well-being. • Petals represent determinants of health as well as leverage points for improving health. A child’s interaction with, and the effects of, these influences vary over time and are often dependent upon age and developmental stage.

4. Policy and Practice Changes Lead to Behavior Change Policy andpractice changes afford the greatest potential to transform the areas where children live, learn, and play. Ultimately, they will enable behavior changes that lead to positive health outcomes for children.

5. Policy and Practice Policy and Practice Change Agenda Change Agenda that evidence the that evidence the to build and to build and usefulness of usefulness of sustain sustain the Healthy Healthy Community Community Children Children Capacity Infrastructure that supports that support that leads to that leads to Behavior Behavior Change Change The NHPS Model: Working with Over 200 Community Partners Changing the health status and well-being of the most children possible through the deployment of evidence based policies and practices. Seeking the highest sustainable impact with the most efficient use of resources.

6. Going to Where the Children Are With 5-2-1-Almost None • Together We Can Make Delaware’s Kids the Healthiest in the Nation • Kids Can’t Do It Alone • 5-2-1-Almost None • Integrated into all 4 sectors • Community • School • Child Care • Primary Care • Helping accelerate policy and practice changes

7. A Day in the LifeMultiple Sources of Influence in a Child’s Day 12:00 AM 9:00 PM Sleep Community/ Family 6:00 PM 6:00 AM Time with parent Afterschool Primary Care Child Care/ School 8:00 AM 3:00 PM 9:00 AM 12:00 PM

8. 8:00 AM – 6:00PM;3:00 PM – 6:00PMIn Delaware Child Care/Afterschool CareREACH: 54,000 children in all licensed child care Children In Child Care Are: Consuming whole grains and for those over 2 years old - 1% or nonfat milk Consuming only 1 serving of 100% juice per day; water as good option Consuming limited sugary/fried foods No TV except special occasions or teaching activities; especially infants & toddlers Participating in 20 minutes of vigorous activity for every 3 hours in care Supporting Policy Action: Nutritional regulatory change applicable to both family and child care center settings, through the Child and Adult Care Food Program (CACFP) and Office of Child Care Licensing (OCCL) Regulatory change to increase physical activity and limit screen time in all family and child care center settings, through the OCCL Enacted Delaware S.B. 222, establishing Stars for Early Success quality rating system including focus on physical and emotional health

9. NHPS Working to Support Practice Changes in Child Care • Child Care Learning Collaborative • Teams of Center Director and staff from 28 centers completed 5 sessions; on-site TA • Received insight, experience from 4 pilot site champions • improved food service and menu options • Engaged parents to support new policies • Best Practices Guide • NHPS collaborated with the Delaware Child and Adult Care Food Program (CACFP) to co-author Best Practices for Healthy Eating: A Guide to Help Children Grow Up Healthy embodying the Nemours 5-2-1-Almost None message • Provides recommended guidelines • Endorsed by the USDA

10. NHPS Working to Support Practice Changes in Child Care • University of Delaware Institute for Excellence in Early Childhood • Collaboration between Nemours and the University to develop and spread NHPS best practices through the training of early child care providers statewide • Locus of responsibility for training, on-site technical assistance and quality rating system – including health policy and practices as component • Capacity for research, monitoring and data analysis regarding child care system • Data for Change Policy Briefs • NHPS has released 3 child care briefs • Improving Children’s Health through Delaware Child Care Policy • Making Delaware Early Child Care Environments Healthier • Transforming Children’s Health: How Four Child Care Programs made Positive Changes in their Environments

11. Tools for Child Care • Planning Healthy Meals Tool Kit • A “how to” guide for implementing the CACFP Best Practices Guide • menu planning/affordability tip sheets recipes handouts for families portion sizes • Companion guide: Best Practices for Healthy Eating – for teachers, policy leaders and parents • NAPSACC • A nationally recognized assessment tool developed by University of North Carolina • Child Care Directors collect baseline data on current state of policies and practices in their centers • NHPS and UNC worked together to create infant and toddler tool – BABYNAP • Child Care Collaborative Tool Kit with DVDs • Interactive instruction for center directors to teach center staff to implement healthy eating and physical activity best policy and practices • Sesame Workshop/NHPS “Health Habits for Life” Preschool Toolkit • Designed for classroom teachers as lesson plans and activities for 3 - 5 year olds • Influences practice change with concrete healthy eating/physical activity lessons • Distributed over 705 kits to teachers that reach more than 13,000 children • Helps children develop positive associations with healthy foods and physical activity

12. Addressing Concerns and Lessons Learned Provider Issues and Solutions See Handout on Promoting Children’s Health through Regulatory Changes and Creating Solutions to Provider and Director Concerns • “Too expensive” • “Fresh fruits and veggies are not practical” • “Kids won’t eat or drink new things” • “Families are resistant”

13. Child Care Results • Preliminary results indicate 81% of child care centers participating in the NHPS learning collaborative made significant changes in their healthy eating and physical activity practices • Evaluation supported in part by the RWJ Foundation • Some of the policy changes included: • More structured physical activity indoors and outdoors • Family style meals with teachers coaching children • Policies for parent provided food • Policy is being implemented at the center level • The greatest changes came in centers with the most room for improvement • Policy supported with training and TA in Quality Rating System and requirements for licensing • Helps to clear confusion and promote buy-in • Ongoing implementation through statewide Institute for Excellence in Early Childhood

14. Implementation Lessons in Child Care • Key to success is to make sure child care providers have a forum to share concerns and that they are heard. • Assure that solutions are developed to address the concerns identified. • Critical to ensure that policies and practices are both: • Integrated into the daily routines of centers and family care • Integrated into the provider support systems – training, TA, QRS • Collaboration and dialogueare essential to understanding the concerns and effectively addressing the issues • Important to engage state leaders and state agencies early • Funding streams need to be developed and advocated for by all players • Tools are neededfor providers and directors with practical lessons and easy-to-use materials

15. Implementation Lessons in Child Care • Information can be delivered in many different ways such as: • Incorporating information into standard child care training and education • Holding specific meetings to get input • Holding training collaboratives where a number of centers work together to share best practices and address issues • Identifying champion providers or centers that illustrate that the changes can be successfully implemented • Important to be nimble and opportunistic

16. Collaboration is Key:Healthy Kids, Healthy Future Conference • Partners: • CDC • RWJF • MCHB Support from the Altarum Institute • Attendees • Leaders from 20 states • Advocates and thought leaders in: • child health promotion • obesity prevention (physical activity and nutrition) • early education • Goals: • Identify and disseminate best policies and practices • Determine how to best advance policy and practice improvements at the national and state levels • Communicate the research and identify research gaps

17. Common Themes: Champions are critical Collaboration and coordination is critical at multiple levels Cross fertilization between health and education is paramount Common message across agencies is paramount Parental involvement is vital Provider collaboration is key in many areas such as planning, training, staff modeling Family based care and licensed day care Opportunities: Web-based clearing house Use SNAP-Ed. funds Innovative ways to increase funding to programs Federal standards are needed Nutrition standards as a condition of licensing Access to and Maximizing CACFP funds Common Themes/Opportunities for the Future According to our Nation’s Leaders in the Field

18. Healthy Kids, Healthy FutureNext Steps • Planning  Steering Committee • Ensure representation from early education • Meeting monthly • White paper dissemination • Website • Presentations • Resource center/national clearinghouse • Listserve • Blog • Webinars in 2010

19. Visit www.Healthykidshealthyfuture.com

20. www.growuphealthy.org www.healthykidshealthyfuture.com Vice President of Policy and Prevention Nemours 252 Chapman Road, Christiana Building, Suite 200, Newark, DE 19702 (p) 202-457-1440 (e) dchang@nemours.org