1 Nutrition and Physical Activity in Child Care The NAP SACC Program Dianne Ward, EdD Department of Nutrition Center for Health Promotion and Disease Prevention University of North Carolina at Chapel Hill
3 Presentation Outline Present an overview of the NAP SACC program Explain how research evidence was used in the development of the NAP SACC program Describe how the NAP SACC program can be used with other approaches to address healthy weight development at child care settings Provide examples how the NAP SACC program is being used in other states Identify challenges and keys to success using the NAP SACC program
4 Obesity in Children Ages 2-5 Years Among preschool children aged 2 5, obesity increased from 5.0% to 10.4% between and % 14% 12% 10% 8% 6% 4% 2% 0% Total Boys Girls
5 F is for Fat Report: Maine Washington, D.C., July 1, Maine has the 35th highest rate of adult obesity in the nation, at 24.7 percent and the 39th highest of overweight youths (ages 10-17) at 28.2 percent Reported by Trust for America's Health the Robert Wood Johnson Foundation
6 CDC Grand Rounds: Childhood Obesity in the United States MMWR:January 21, 2011 / 60(02);42-46 The Maine experience Pediatric community partnered the Maine- Harvard Prevention Research Center & state CDC Maine Youth Overweight Collaborative (MYOC) started a simple message: In 2006, unique profit/nonprofit partnership formed, Let's Go! to take the message to: schools, child-care centers, communities, workplaces, after-school programs, and health-care settings.
7 Let s Go Core Principles Environmental and policy changes influence behavior change Interconnectivity across sectors is essential Strategies should be evidence-based and continuously evaluated.
8 The NAP SACC Program
9 What is Nutrition And Physical Activity Self Assessment for Child Care
10 NAP SACC Program Identified as one of three model programs to address obesity prevention in child care. The other programs noted were Nemours Childhood Obesity Model, supported by the Nemours Health and Prevention Services and I am Moving, I am Learning, a health promotion and obesity prevention enhancement developed for Head Start.
11 NAP SACC History NC Healthy Weight Initiative NAP SACC pilot program
12 Development Team
13 Intervention Development Interviews Focus Groups Standards review Research evidence Expert input Community Advisory Committee
14 Development Paper Ammerman AS, Ward DS, Benjamin SE, Ball SC, Sommers JK, Molloy M, and Dodds JM. An intervention to promote healthy weight: Nutrition and physical activity self-assessment for child care (NAP SACC) theory and design. Prev Chronic Dis Jul; 4(3):A67.
15 Additional Background Research Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, and Ward DS. The childcare environment and children's physical activity. Am J Prev Med Jan; 34(1):23-9. Ball SC, Benjamin SE, and Ward DS. Dietary intakes in North Carolina child-care centers: are children meeting current recommendations? J Am Diet Assoc Apr; 108(4):
16 Environment and Policy Assessment and Observation (EPAO) Purpose: To objectively and effectively describe the nutrition and physical activity environment and practices of child care facilities. Components: Direct Observation Document review Ward D, Hales D, Haverly K, et al. An instrument to assess the obesogenic environment of child care centers. Am J Health Behav. Jul-Aug 2008.;32(4):
17 NAP SACC Best Practice Recommendations for Nutrition and Physical Activity
18 References: Best Practice Guidelines Physical Activity: McWilliams C, Ball S, Benjamin S, Hales D, Vaughn A, Ward DS. Pediatrics, 2009;Dec;124(6): Nutrition: Benjamin-Neelon S, Ball S, McWilliams C, Vaughn A, Ward DS. Journal of American Dietetics Association, in review.
19 Nutrition Key Areas Fruits and Vegetables Meats, Fats, and Grains Beverages Menus and Variety Feeding Practices Foods Outside of Meals and Snacks Supporting Healthy Eating Nutrition Education Nutrition Policies
20 Physical Activity Key Areas Active Play and Inactive Time Play Environment Supporting PA PA Education PA Policies
21 Fruits & Vegetables Physical Activity (active play time)
22 Best Practices for Fruits and Vegetables Offer fruit (not juice) at least 2 times a day. Serve fruit canned in its own juice, fresh, or frozen all of the time. Offer vegetables (not French fries, tator tots, hash browns or dried beans) at least 2 per day. Offer vegetables, other than potatoes, corn or green beans 1 or more times per day. Prepare cooked vegetables without added meat fat, margarine or butter.
23 Best Practice Guideline Offer vegetables at least 2x a day (not including French fries, tator tots, hash browns or dried beans). Result: 23% met Guideline 16% None 62% Once 23% Two or more Offer vegetables, other than potatoes, corn or green beans 1 or more times per day. Result: 32% met Guideline 60% None 32% Once 7% Two or more
24 Best Practice Guideline Offer fruit (not juice) at least 2 times/day. Result: 44% met Guideline 7% None 41% Once 44% Twice or more Fruit (fresh, frozen, or canned in own juice) offered daily. Result: 19% met Guideline 43% None 38% Once 19% Twice or more
25 MVPA minutes per hour Minutes per hour of moderate or vigorous physical activity across 50 child care centers Average minutes of MVPA per hour: 5.58min ( 1.66)
26 Why Physical Activity in Child Care? The amount of physical activity children get is related to what child care center they attend Minutes of moderate or vigorous physical activity on an average day Lower 10 Average Upper 10 In one month the difference between the upper and lower groups is about 8 hours!
27 Teacher Led Activity and MVPA Minutes of MVPA across three levels of Teacher led activity < 1 per day per day 2+ per day Number of Teacher led physical activities per day
28 Results from the NAP SACC Evaluation Ward DS, Benjamin SE, Ammerman AS, Ball SC, Neelon BH, Bangdiwala SI. Nutrition and physical activity in child care: results from an environmental intervention. American Journal of Preventive Medicine. Oct 2008;35(4):
29 NAP SACC Evaluation Design Sample A convenience sample of 96 child care centers recruited from 33 North Carolina (NC) counties Centers represented all three regions of NC (Western, Eastern, and Central Piedmont). Most (n=84) were part of an evaluation of the NAP SACC intervention); 12 additional centers were part of an exploratory study to test the self-assessment instrument.
30 Change in EPAO Item Scores Nutrition Average Change Range Control (-19 to +15) Intervention (-11 to +29) Physical Act Mean Range High Control (-8 to +11) Intervention (-5 to + 15)
31 How does it work? Nutrition And Physical Activity Self Assessment for Child Care
37 Technical Assistance Step 4: Provision of Technical Assistance This may be the most important step in the process!! In-person, telephone, This offers... Support Encouragement Additional information A reminder of goals
38 Evaluate, Revise, Repeat Step 5: Evaluate, Revise, and Repeat Evaluate progress using repeat self-assessment. Revise, refine and add goals where necessary Celebrate the small changes, not just the big ones!
39 Center TRT Website:
40 NAP SACC Implementation Training Trainings Web-Based Trainings
41 NAP SACC is: A great tool for addressing continuous quality improvement in nutrition and physical activity environments at childcare Designed to address changes in areas where a center feels ready and able Can be guided toward areas in need of change by an effective, patient NAP SACC consultant (such as coach!)
42 NAP SACC is.. a Planning Model not a curriculum As a planning model, the NAP SACC program helps centers identify and address changes to their nutrition and physical activity environment Curricula, strategies, or program standards provide guidance or specific materials that can be used to guide practice or deliver lessons to children based on planning conducted using the NAP SACC program
43 NAP SACC: Curricula and Approaches
45 Who s Delivering NAP SACC? Sponsors State or local public health departments Colleges or universities Food Trust Childcare organizations Others NAPSACC Consultant Child Care Health Consultant Child Care Resource and Referral Staff Health educator Nutrition educator or Registered Dietician Childcare director
46 States Using NAP SACC Intervention Materials NAP SACC Project
47 Arizona ARIZONA: Yuma County Drummond et al. A pebble in the pond: the ripple effect of an obesity prevention intervention targeting the child care environment. Health Promot Pract Apr;10(2 Suppl):156S-167S. Pilot program in 30 Centers and 1800 children NAP SACC materials were adapted to fit the local community
48 New York 5 year state dissemination plan Goals of the evaluation plan To evaluate the expert training model as a viable approach for implementing NAP SACC statewide To evaluate the association between Active Organizational Support and fidelity to the NAP SACC process
49 Coming Soon.. NAP SACC: Media Reduction Module Materials Included Intervention Materials Media Self-Assessment Media Workshop Technical Assistance Materials Facility Handouts Technical Assistance Manual Sample Child Care Media Use Policy Parent Toolkit Handouts Rate your Family Media
50 North Carolina North Carolina is working with Smart Start and using NAP SACC to develop enhanced outdoor environments, active lessons, and improved nutrition (Blue Cross/Blue Shield sponsor)
52 NAP SACC Self-Assessment Nutrition 9 nutrition areas of assessment Physical Activity 6 physical activity areas of assessment 38 nutrition questions 18 physical activity questions The EPAO is an expansion of the self-assessment into a tool that is executed by objective, trained field observers through direct observation and document review.
Obesity Prevention in Child Care Overview of Intervention Points, Barriers and Gaps North Carolina Institute of Medicine February 17, 2012 Pat Hansen Shape NC Project Manager 1 Target Population Number
CROSSWALK PA S Initiatives and Let s Move! JANUARY 2012 Emerging research and evidence-based findings link s eating nutritious food, engaging in daily age-appropriate physical activities, and limited screen
Healthy Beverage Promotion with Early Care & Education Providers Julie Shuell, MPA Nemours Health System June 2015 Nemours is currently funded by the Centers for Disease Control and Prevention (CDC) under
Let s Move! Child Care Train the Trainer Webinar Linda Smith National Association of Child Care Resource and Referral Agencies (NACCRRA) Meredith Reynolds Centers for Disease Control and Prevention Dianne
Summary Introduction At a time when schools are intensely focused on academic achievement, the State of Hawaii Department of Education (HIDOE) Wellness Guidelines play an important role in helping students
Moving Guilford County toward a Healthy Weight Finding the Will and the Way White Paper Presentation August 31, 2009 Making Good Health Happen Moses Cone-Wesley Long Community Health Foundation UNC Center
What is Georgia Shape? Georgia Shape is the Governor s statewide, multi-agency and multi-dimensional initiative that brings together governmental, philanthropic, academic and business communities to address
The Prevention Status Reports (PSRs) highlight for all 50 states and the District of Columbia the status of public health policies and practices designed to prevent or reduce important health problems.
An issue brief from The Pew Charitable Trusts and the Robert Wood Johnson Foundation March 2014 Serving Healthy School Meals Colorado Schools Need Updated Equipment and Infrastructure Colorado at a glance
Teaching Manual for the Dietary Guideline Placemats 1 Lesson #1: The Placemat Description: This lesson will provide an overview of the purpose and message behind the placemats. Things to bring to the lesson:
To download the FMPC Grant Awards Application go to www.aafpfoundation.org/fmpc, then click on FMPC Grant Awards Program. ANSWERS FROM A TOP-SCORING 2013 FMPC APPLICATION Answers are taken directly from
Additional Resources Crosscutting School Health Index, Centers for Disease Control and Prevention apps.nccd.cdc.gov/shi/ Local Wellness Policy website, U.S. Department of Agriculture www.fns.usda.gov/tn/healthy/wellnesspolicy.html
Healthy Eating: In April, 2011 The National AfterSchool Association adopted these standards for Healthy Eating in Out-of-School Time Programs. Accordingly, new language addresses snack content and quality,
CCCC Webinar: Promoting Healthy Active Living in Early Education and Child Care Presenters: Meredith Reynolds, PHD Katy Levenhagen, MS, RD www.healthychildcare.org Meredith Reynolds PHD, CDC Obesity Prevention
Growing a School Garden the Golden Hill Learning Center Experience Jo Anne Judge-Dietz, Olmsted County Public Health Gordy Ziebart, Golden Hill Principal Caleb Langworthy, Garden Manager Golden Hill Students
Let s Go! Action Plan - Child Care Let s Go! is a nationally recognized program that promotes evidence-based strategies to increase healthy eating and active living among children through the age of 18.
THE NJ DEPARTMENT OF AGRICULTURE S JETS PLAY 60 EAT RIGHT, MOVE MORE PROGRAM 2014-2015 APPLICATION PACKET INTRODUCTION The NJ Department of Agriculture s Jets PLAY 60 Eat Right Move More program is a joint
RESEARCH Original Research Validity of a Measure to Assess the Child-Care Nutrition and Physical Activity Environment KATHRYN E. HENDERSON, PhD; GABRIELLE M. GRODE, MPH; ANN E. MIDDLETON, MPH; ERICA L.
2011-2012 Grant Application for the Healthy Schools Program Application Deadline September 28, 2011 by 3:00 pm Mail, Fax or Email Completed Grant Application to: Linda Graves, M.Ed. Prevention Specialist/Physical
THE MAINE EXPERIENCE Let s Go! Victoria W. Rogers, MD Director, The Kids CO-OP The Barbara Bush Children s Hospital Maine Medical Center 1 www.letsgo.org The Maine Story 2004: The Maine Youth Overweight
CACFP Best Practice Case Study Wisconsin Department of Public Instruction Promotes Nutrition and Physical Activity Policies in Child Care Hannah Martin and Geri Henchy Food Research and Action Center Overview
Making Healthy Food Choices Section 2: Module 5 1 Nutrition For Health What is healthy Tips on planning meals Making a shopping list/ Bulk orders Using WIC foods Cook and freeze What foods to choose How
Case Study: U.S. Department of Defense Initiatives June 2012 Case Study: U.S. Department of Defense Initiatives 1 Following the end of World War II, President Truman worried about the impact of poor nutrition
Patterns of health and disease are largely a consequence of how we learn, live and work A Province-Wide Life-Course Database on Child Development and Health Summary of Results April 2007 Principal Investigator
I. Philosophy and Commitment Levy County Wellness Plan The School Board of Levy County believes that good health fosters student attendance and student achievement. The Board also believes that a healthy
Prevalence of overweight/obesity Australian children, 1985-1997* 25 20 1985 1997 15 % 10 5 0 NSW Boys NSW Girls * Booth et al 2001 The myth of puppy fat! Overweight children have up to 50% chance of becoming
Healthy Schools Colorado Evaluation Findings Web-Enabled Database Tracking System Report Prepared by: Center for Research Strategies Karrie Witkind, M.S. Kaia Gallagher, Ph.D. 225 East 16 th Avenue, Suite
Building Healthy Communities: Engaging elementary schools through partnership 2015 2016 Request for Applications Applications due: March 2, 2015 More information can be found at bcbsm.com/buildhealth Engaging
DISTRICT WELLNESS PROGRAM Code No. 507.1 The board promotes healthy students by supporting wellness, good nutrition and regular physical activity as a part of the total learning environment. The school
C O M M O N T H R E A D S A U S T I N C H I C A G O D C L O S A N G E L E S J A C K S O N V I L L E M I A M I N E W Y O R K W H O W E A R E & W H A T W E D O COMMON THREADS TEACHES UNDERSERVED KIDS AND
HEALTHY RECOMMENDATIONS AND PORTION CONTROL FACTSHEET Dining Services Portion control can be a major obstacle, especially for college students with on-campus meal plans. As you can see on the table below,
Dublin Institute of Technology ARROW@DIT Articles School of Biological Sciences 2011-01-01 Developing a nutrition assessment tool for Irish pre-schools Charlotte Johnston Molloy Health Service Executive,
Wellness Policy The Colcord School District recognizes the relationship between academic achievement and student health and wellness. This policy reflects the Colcord School District s Board of Education
Second Grade Nutrition Lesson Plan Page 1 of 7 Dear Educator, As you know, a balanced diet is critical for optimal growth and development of children. While food is a necessary and delicious part of life,
CACFP BEST PRACTICE CASE STUDY IMPROVING CACFP IN NEW YORK STATE THROUGH EDUCATION AND POLICY CHANGE Overview The Child and Adult Care Fd Program agency within the New York State Department of Health (NYCACFP)
JACK KARDYS DIRECTOR Miami-Dade County Parks, Recreation and Open Spaces AFTERSCHOOL PROGRAM BACKGROUND One of the greatest healthcare challenges is childhood obesity Statistics are staggering Overweight
Healthy Eating You are what you eat! So before you even shop for food, it is important to become a well informed, smart food consumer and have a basic understanding of what a heart healthy diet looks like.
Healthy Eating; Traditional Eating Healthy eating in the modern world is not always easy. Fast food and prepackaged foods offer inexpensive and easy alternatives to healthier foods or cooking from scratch.
Caring for Infants and Toddlers: Nutrition and Physical Activity Best Practices Wednesday, April 22, 2015 1:00 to 2:30 PM ECELS-Healthy Child Care Pennsylvania Webinar Dr. Susan S. Aronson, MD, FAAP ECELS
Friends of School Health Testimony Expanding Funding for CDC School Health Programs Statement of Sharon Murray, MHSE, CHES Executive Director, Society of State Directors of Health, Physical Education and
Nutrition and Medicine, 2006 Tufts University School of Medicine Infant and Child Nutrition: Learning Objectives Margo N. Woods, D.Sc. 1. Explain the use of anthropometry and growth charts in the assessment
Healthy Schools Colorado 2010-2011 Report Report Prepared by: RMC Health Colorado Department of Education Center for Research Strategies Healthy Schools Colorado Project Evaluation Measures Update 2010-2011
Do children with diabetes need a special diet? No! The basic nutritional needs of a child or adolescent with diabetes is the same as their peers Healthy eating is important for all children Children with
5 A Day for Better Health Program USA World Health Organization Geneva, Switzerland August 26, 2003 Lorelei DiSogra, Ed.D. R.D. Director - 5 A Day Program National Cancer Institute Bethesda, MD Frances
A data table from The Pew Charitable Trusts and the Robert Wood Johnson Foundation Jan 2015 Snack Foods and Beverages In Washington D.C. Schools A comparison of state policy with USDA s nutrition standards
Make a Difference at Your School! CDC Resources Can Help You Implement Strategies to Prevent Obesity Among Children and Adolescents U.S. Department of Health and Human Services Centers for Disease Control
FACT SHEET N 394 UPDATED MAY 2015 Healthy diet KEY FACTS n A healthy diet helps protect against malnutrition in all its forms, as well as noncommunicable diseases (NCDs), including diabetes, heart disease,
Innovations in Population Health: Perspectives from an Integrated Child Health System Debbie I. Chang, MPH Vice President, Policy & Prevention October 18 th, 2013 Approaches to Population Health Two ways
Healthy Eating after Colorectal Cancer A dietary guide for optimising health after treatment for colorectal cancer Introduction Eat your way to a lower risk of cancer recurrence! Following treatment for
MAUMEE CITY SCHOOL DISTRICT 8510/page 1 of 6 WELLNESS As required by law, the Board of Education establishes the following wellness policy for the Maumee City School District. The Board recognizes that
Teachers Notes The eatwell plate The eatwell plate is a pictorial food guide showing the proportion and types of foods that are needed to make up a healthy, varied and balanced diet. The plate has been
Journal of Undergraduate Public Service Projects University of North Carolina at Asheville Community Engaged Scholar Program Volume IV, Issue 1 Eat Smart Move More North Carolina: Updating Policy Strategy
WELLNESS POLICY Code No. 507.9 The Chariton Community School District supports a healthy environment where students learn and participate in positive dietary and lifestyle practices. The board promotes
Boston Public Health Commission Healthy Food Procurement Guidelines Standards for Purchased Beverages and Foods Boston Public Health Commission Healthy Food Procurement Guidelines Standards for Purchased
CACFP BEST PRACTICE CASE STUDY WEST VIRGINIA CHILD CARE TAKES A LEAP OF TASTE Overview The Office of Child Nutrition within the West Virginia Department of Education has introduced enhanced nutrition standards
Bringing Down Blood Pressure with More Plant Foods and Less Salt Getting Started 1. Review lesson plan before each session. 2. Copy handouts: a. Blood Pressure Basics b. A Healthy Meal Plan c. Lower Sodium
HEALTHY RECIPES AND COOKBOOKS CHECKLIST Significant program resources are often devoted to recipes recipes are a significant part of food and nutrition education they are the practical application of the
DIABETES & HEALTHY EATING Food gives you the energy you need for healthy living. Your body changes most of the food you eat into a sugar called glucose. (glucose) Insulin helps your cells get the sugar
Purpose: New Beginnings School Foundation wellness policy was developed to fulfill the school s commitment to the health of its students, as well as to comply with the federal Child Nutrition Reauthorization
Comparison of Adolescent Weight Control Programs Cheryl Costomiris, MS, RD, CDE, CD Apple a Day Medical Nutrition Therapy Epidemiology Obesity is defined as BMI>/= 95 th %tile for age and gender At risk
Dietary advice for people starting treatment for Hepatitis C Information for patients Sheffield Dietetics Do I need to follow a special diet? You don t need to have a special diet but you should try and
Lesson Overview Lesson Participants: School Nutrition Assistants/Technicians, School Nutrition Managers, Child and Adult Care Food Program Staff, Teachers Type of Lesson: Short, face-to-face training session
Carbohydrate Counting for Pediatric Patients With Type 1 Diabetes Review Date 4/08 K-0591 Program Purpose To increase knowledge of carbohydrate counting and insulin management skills for those caring for
Good Food for Early Care and Education Diane Harris, Ph.D., M.P.H., C.H.E.S. Health Scientist and Team Lead, Healthy Food Environment Division of Nutrition, Physical Activity and Obesity Centers for Disease
Heidelberg School District Wellness Policies on Physical Activity and Nutrition Preamble Whereas, children need access to healthful foods and opportunities to be physically active in order to grow, learn,
1 MODULE 1: Nutrition Services Instructions: Carefully read over the questions and circle the most appropriate answer in the columns to the right of the question. Work with adults in your school to collect
A Call to Action Improving Nutrition, Physical Activity, and Learning California Healthy Kids Resource Center (C.H.K.R.C.) Partner: California Department of Education, Nutrition Services Division Welcome
Cornerstones of Care DIET/HEALTHY ACTIVITIES WELLNESS PLAN Committee Members: 05-17-2016 Director of Health services integration Cheryl Carson MS RD LD Nutritional Health Services: Personnel Manager, Administrative
School Nutrition Policy Background Overview: From what s offered in lunch lines to what s stocked in vending machines, schools are in a powerful position to influence children s lifelong dietary habits.
County of Santa Clara Public Health Department PH05 042710. DATE: April 27, 2010 Prepared by:. Colleen Martin Health Care Program Manager TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public
The Dietary Advice to Stop Hypertension eating plan 1 The Dietary Advice to Stop Hypertension (DASH) eating plan, developed by United States National Institute of Health, features plenty of fruits, vegetables,
Governor s Nutrition and Physical Activity Scorecard Purpose: To recognize and reward schools for implementing best practices that support proper nutrition and increased physical activity to promote student
THE GOOD NEWS about FRUITS & VEGETABLES Eating plenty of fruits and vegetables every day is an important part of a healthy, active lifestyle. It promotes good health and may help lower the chances of getting
Page1 Slide 1 Nutrition Science for Life Page2 Slide 2 Copyright Copyright Texas Education Agency, 2013. These Materials are copyrighted and trademarked as the property of the Texas Education Agency (TEA)
A data table from The Pew Charitable Trusts and the Robert Wood Johnson Foundation Jan 2015 Snack Foods and Beverages In South Carolina Schools A comparison of state policy with USDA s nutrition standards
Nutrition and Healthy Living 503.1 Policy Statement: Western School District promotes healthy food choices within the school environment, in accordance with the Provincial School Food Guidelines. 1. Application
Youth Soccer Players Nutrition Schedule Pride in the Program This is a guide used to assist in the healthy nutrition of a youth soccer player Table of Contents Typical Training Day Schedule..3 Tournament
Page 1 of 6 Program Focus Team Action Plan: Promote Healthy Eating and Physical Activity in Kansans 2014-2015 Situation: Nutrition and physical activity are important for overall health and confer benefits
My Diabetic Meal Plan during Pregnancy When you have diabetes and are pregnant, you need to eat small meals and snacks throughout the day to help control your blood sugar. This also helps you get in enough
William M. Davies, Jr. Career & Technical High School 50 Jenckes Hill Road, Lincoln, RI 02865 Phone/TDD: 401-728-1500 Fax: 401-728-8910 Educating a Technical Workforce for Rhode Island Victoria A. Gailliard-Garrick,
A data table from The Pew Charitable Trusts and the Robert Wood Johnson Foundation Jan 2015 Snack Foods and Beverages In Oklahoma Schools A comparison of state policy with USDA s nutrition standards This
Overweight, Obesity, and Diabetes in North Carolina Overweight, obesity, and diabetes are among the most costly and harmful health problems in North Carolina. Moreover, the rates of overweight, obesity,