What’s new with NAP SACC ?

Center TRT Webinar SeriesCenter TRT Webinar Series

Other webinars in the series:

• NCPP Healthy Food Environments NCPP Healthy Food Environments Pricing Incentive – 1/24/11

• Trailnet HAVC – 3/8/11• NYC Health Bucks – May 2011

Visit: www.center-trt.org for up-to-date information

What we will cover todayWhat we will cover today

• Overview of Center TRT• What is NAP SACC? What is NAP SACC? • Center TRT Review of NAP SACC• Tips for Successful Implementation• Challenges to NAP SACC Implementation• Strategies to overcome Challenges• Evaluation• Evaluation

Center for Training and Research Translation g(Center TRT)

Two main functions:Two main functions:• Training ▫ In-personp▫ Web-based

• Translation and Dissemination of best available evidence

Center TRT Website: www center trt orgCenter TRT Website: www.center-trt.org

NAP SACC I l i T i i

www.center-trt.org Trainings Web-Based Trainings

NAP SACC Implementation Training

g g g

What isWhat is…

Nutrition AndAnd Physical ActivitySSelfAssessment for Child CareCare

NAP SACC StepsNAP SACC Steps

1 S lf A t1. Self-Assessment

2. Action Planning/Goal Setting

3. Workshop Delivery

4. Targeted Technical Assistance

5 Evaluate revise and repeat5. Evaluate, revise and repeat

Core Elements of NAP SACCCore Elements of NAP SACC

G l S tti d A ti Pl i• Goal Setting and Action Planning• Continuing Education for Child Care

ProvidersProviders• Skill Building Activities• Technical Assistance and ConsultationTechnical Assistance and Consultation• Follow-up and Reinforcement

Evidence Base for NAP SACCEvidence Base for NAP SACC

C t TRT R i f th E id • Center TRT Review of the Evidence from:o Research – effect on improved PA and o Research effect on improved PA and

Nutrition policies/practices from findings in peer-reviewed journal1

P i i i i i o Practice – main intervention strategies (approaches) used in NAP SACC

1Ward DS. Benjamin SE, Ammerman AS, Ball SC, Neelon BH, Bangdiwala SI. Nutrition and physical activity in child care: Results from an environment intervention. Am J Prev Med 2008;35(4):352-356.

Evidence Base for NAP SACCEvidence Base for NAP SACC

R h C t th t l t d • Research – Centers that completed most/all of NAP SACC components improved Nutr/PA polices and practices/ p p

• Practice – NAP SACC includes the following intervention strategies:o Social Supporto Increased availability of healthy foodso Increased time for PA through active playo Increased time for PA through active playo Increased access to places for PA through

changes to indoor/outdoor space

Potential for Public Health ImpactPotential for Public Health ImpactUsing the RE-AIM framework2:• Reach – high numbers of children in childcare

setting• Effectiveness – NAP SACC centers more likely to y

make significant nutrition policy changes• Adoption – 73% statewide adoption rates and

adopted/adapted in other statesp / p• Implementation – easy to implement with

provided materials and technical support at a low cost

• Maintenance – likely given low cost and if able to use existing infrastructure (e.g., child care health consultants)

2www.re-aim.org

NAP SACC program identified as one of three model programs to address obesity prevention in child care.

Tips for Implementing NAP SACC SuccessfullyNAP SACC Successfully

NAP SACC iNAP SACC is..

a Planning Model – not a curriculum• As a planning model, the NAP SACC program

h l id if d dd h

a Planning Model not a curriculum

helps centers identify and address changes to their nutrition and physical activity environment

• Curricula (such as Color Me Healthy or Eat Well Play Hard) provide materials that can be used to Play Hard) provide materials that can be used to deliver lessons to children during organized educational sessions

NAP SACC iNAP SACC is: • A great tool for addressing continuous quality A great tool for addressing continuous quality

improvement in nutrition and physical activity environments at childcare

• Designed to address changes in areas

• Can be guided toward areas in need changes in areas

where a center feels ready and able

toward areas in need of change by an effective, patient NAP ySACC consultant (such as coach!)

Using NAP SACC and Using CurriculaUsing NAP SACC and Using CurriculaNAP SACC helps centers Areas identified by NAP pidentify areas that need

improvement

N t iti d h i l • Nutrition education

ySACC planning can be

addressed by curricula

• Nutrition and physical activity curricula can be used to address areas id ifi d f h

Nutrition education provided to children 1x per week or more

Ph i l A i i d i identified for change through the NAP SACC planning process

• Physical Activity education (motor skill development) is provided for children 1x per week or more through a standardized curriculum

• Teacher-led physical Teacher led physical activity is provided to all children 2x per day or more

NAP SACC C i l d A hNAP SACC: Curriculums and Approaches

Eat Well Play Hard and NAP SACCEat Well Play Hard and NAP SACC

• EWPH was developed in New York StateEWPH was developed in New York State• 10 module curriculum developed for 3 and 4 yr olds

and their parentsp• To be delivered by a dietician• http://www.health.state.ny.us/prevention/nutrition/cacfp/

ewphccs_curriculum/index.htm

C l M H lth d NAP SACCColor Me Healthy and NAP SACC• CMH was developed by NC p y

Cooperative Extension and NC Division of Public Health

• CMH Toolkit includes: 12 lessons, picture cards, a cd, posters, and parent newsletters

• Providers can attend a train the trainer training or order a toolkit online with a

i i ltraining manual http://www.colormehealthy.com/

Animal Trackers and NAP SACC• Animal Trackers is a complete motor skills and

physical activity curriculum developed by Dr. Christine Williams, MD, MPH,

nutrition specialist and Director of the Children’s pCardiovascular Health Center at Columbia University’s Children’s Hospital.

• Curriculum includes: Workbook featuring over 60 activities spread out over 10 units. A music CD A poster set featuring the animal stars of Animal TrackersA poster set featuring the animal stars of Animal Trackers. 10 Family Take Home Activities

• Williams et al Increasing Physical Activity in Preschool: A Pilot Study • Williams et al. Increasing Physical Activity in Preschool: A Pilot Study to Evaluate Animal Trackers. Jrnl of Nut Ed Behav. Jan 2009.

http://www.healthy-start.com/

I am Moving I am Learning and NAP SACCDeveloped by:• Nancy Elmore Head Start ProgramNancy Elmore, Head Start Program Manager, Region III •Amy Requa, Pediatric Nurse Practitioner and Region III TA Health S i li tSpecialist• Dr. Linda Carson, Director of the West Virginia Motor Development Center, WVU

• IM/IL’s mission is to increase moderate and vigorous physical activity every day, improve the quality of movement activities intentionally planned and facilitated by adults and promote healthy intentionally planned and facilitated by adults, and promote healthy food choices every day.

• IM/IL uses a train-the-trainer model with directors and their management teams attending a 2½ day training The individual management teams attending a 2½ day training. The individual Head Start Program decides how they will implement the goals of IM/IL with their classrooms, families, and communities.

Wh ’ D li i NAP SACC?Who’s Delivering NAP SACC?

Sponsors “NAPSACC Consultant”

• State or local public • Child Care Health p bhealth departments

• Colleges or universities

Consultant

• Child Care Resource and g

• Food Trust

• Childcare organizations

Referral Staff

• Health educator • Childcare organizations

• Others • Nutrition educator or Registered Dietician

• Childcare director

States Using NAP SACC InterventiongMaterials

NAP SACC Project

N th C liNorth Carolina

• In 2007-08 with help from Blue-Cross • In 2007-08, with help from Blue-Cross Blue Shield, Smart Start funded a pilot grant program to implement NAP SACC in g p g p67 childcare centers

• Similar program was implemented in 2008-09

Initial Results• Using the NAP SACC self-assessment ratings (Range: 1.0=Less Healthy t0 4.0=Best Practices)▫ Baseline Score: 2.6▫ Follow-up Score: 3.1

i h i i i li i• Centers with Written Nutrition Policies▫ Baseline: 34%

Follow up: 58%▫ Follow-up: 58%• Centers with Written Physical Activity Policies▫ Baseline: 12%Baseline: 12%▫ Follow-up: 53%

N th C liNorth Carolina• NAP SACC• NAP SACC

• Preventing Obesity by • Preventing Obesity by Design (POD)

• Be Active Kids

IOWA• Pilot programs lead • NAP SACC consultant Pilot programs lead

by department of public health

NAP SACC consultant sets appointment for Action Planning but

• Collaboration from U. of Iowa

comes early (by permission) and

bobserve• Uses observations to

help guide the center help guide the center in selecting areas for change g

Mi i i iMississippi

• n= 15 child care centersJ k MS• Jackson, MS

• Plan to hire 15 Nutrition Educators to work one on one with centers on one with centers

A iArizona• ARIZONA: Yuma CountyARIZONA: 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. 2009 Apr;10(2 Suppl):156S-167S.Promot Pract. 2009 Apr;10(2 Suppl):156S 167S.

• Pilot program in 30 Centers and 1800 children• NAP SACC materials were adapted to fit the local p

community▫ 7 workshops additional workshop was developed to raise awareness

of childhood obesity and recruit centers to participate in the programthe program

second additional workshop consisted of completing the self-assessment

Arizona ResultsNutrition

Arizona-ResultsNutrition

• Increased provision of whole grains• Staff increased involvement in gauging hunger• Parents were given guidelines that were enforced

about foods brought in for parties and celebrationsPhysical ActivityPhysical Activity

• Increased visible support and making positive statements

• Provided an indoor play space and portable play equipment

• Play environment changes such as rearranging Play environment changes such as rearranging equipment to accommodate more running and games.

P l iPennsylvaniaKeystone Kids Go! is led by the Pennsylvania y y y

Department of Education, Division of Food and Nutrition

PPartners: ▫ PA Departments of Health and Public Welfare▫ Office of Child Development and Early Learning TuscaroraOffice of Child Development and Early Learning, Tuscarora

Intermediate Unit, ▫ Pennsylvania Nutrition Education Network,

Penn State Cooperative Extension▫ Penn State Cooperative Extension, ▫ Head Start, Family Literacy Programs, ▫ ECELS, ▫ Lancaster General Hospital, ▫ Food Trust

P l i PilPennsylvania- PilotPilot Design Pilot Implications

▫ n=14 centers ▫ March- June 2010

h (f d

Pilot Design Pilot Implications▫ TIU developed an online

NAP SACC Professional Development Module for ▫ 2.5-3 months (focused on

individual nutrition and pa goals)

Development Module for directors

▫ The Professional

▫ 11/14 centers completed the process successfully

Pilot Findings ▫ The Professional Development Modules are currently being pilot tested with an additional 15 process successfully

▫ Adaptations to original NAP SACC model had positive

with an additional 15 centers

SACC model had positive outcomes and have supported sustainability

P l i O h H iPennsylvania- On the Horizon

A toddler enjoys dancing with a pony-on-a-stick, one of the engaging new props from our Fitness BagsFitness Bags.

A teacher enjoys a gross motor activity with her class, supporting our goal of increasing teacher participation in fitness activities.

N Y kNew 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 g pp ySACC process

N Y k R ltNew York-Results• Active vs. Passive Consultant Support▫ N= 65 child care centers reached across NY Active support consultants delivered NAP SACC on average to

4 6 centers per consultant 4.6 centers per consultant Passive delivered NAP SACC on average to 2.5 centers per

consultantA ti d i t lt t h d i il h d i il ▫ Active and passive support consultants showed similar showed similar success, but active support consultants showed success, but active support consultants showed greater fidelity to the NAP SACC processy p

• Years 2-5 will focus on ▫ providing training to consultants who can be provided

active mentoring

Challenges to NAP SACCChallenges to NAP SACC Implementationp

Challenges

I d t i f t t t id th • Inadequate infrastructure to provide the NAP SACC program

k h d li• Workshops delivery

• Personal Health of Child Care Providers

• Lack of Motivation from Centers

• Lack of knowledge of local resources• Lack of knowledge of local resources

Inadequate infrastructure to provide the NAP SACC program

• Resources vary from state to state

• Some states have begun to leverage alternative g gresources

• Look for new partnersLook for new partners

• Starting small (pilot programs may allow states to being NAP SACC implementationto being NAP SACC implementation

Li it d ti f t h i l i tLimited time for technical assistance• Step 4 (Technical Assistance) is thought to be

one of the most important steps in the NAP SACC program

• However, some consultants have large case loads and limited time for TA

• This requires creativity and innovation. Examples include:

▫ Providing group TA by setting up a listserv or Discussion board for centers

▫ Sending text messages to support/reinforce▫ Setting up a website to share successes

Personal Health of Child Care Providers• Childcare providers themselves may have health

problems such as poor diets, inactivity, and obesity

• These low-health conditions may interfere with NAP SACC implementation

• In NC, we received feedback that providers were saying, “What about me?”

• To address this challenge, consider providing an enhanced workshops on personal health, look p p ,for local resources for weight management, diet counseling, and activity opportunities

Workshop Delivery• Offer workshops at convenient times for staff Offer workshops at convenient times for staff

such as evenings and weekends

• Provide multiple dates for centers you are • Provide multiple dates for centers you are working with and/or have center trainings for several centers

• Learn to be creative in delivery: provide workshops during naptime, send text to cell workshops during naptime, send text to cell phones, develop workbooks, use on-line delivery

Lack of motivation from centers• Organizational behavior change usually occurs Organizational behavior change usually occurs

in a 20-60-20 fashion• 20 % are early adopters: these are centers that y p

respond to opportunities without great effort required

• 60% are slower to change but can be motivate, but may need a little more support

% t b ti t d t l t d i th • 20% may not be motivated – at least during the time frame in which you are working

• Remember that readiness is a clue to when • Remember that readiness is a clue to when change can occur

Lack of knowledge of local resources• Look into what other state and local agencies in Look into what other state and local agencies in

your area are doing in relation to child care

• Look into what local Colleges and Universities are doing in your area related to child care

• Check with your Child Care and Resource and R f l A iReferral Agencies

H NAP SACC i b i f li hHow NAP SACC is being use for policy change

idi hild l i /li i• Guiding Child Care regulations/licensing

• Quality rating and improvement systemsQ y g p y

• Education & Professional DevelopmentDevelopment

National Resource Center forHealth and Safety in ChildHealth and Safety in Child Care and Early Education

NAP SACC was cited in New Updated Caring for our Children Guidelines: http://nrckids.org/CFOC/Children Guidelines: http://nrckids.org/CFOC/

C i SComing Soon…..NAP SACC: Media Reduction Module

Materials Included• Intervention Materials

NAP SACC: Media Reduction Module

▫ Media Self-Assessment▫ Media Workshop

• Technical Assistance Materials▫ Facility Handouts▫ Technical Assistance Manual▫ Sample Child Care Media

Use Policy• Parent Toolkit

d▫ Handouts▫ Rate your Family Media

A SACC A A ONAP SACC EVALUATION

P g E l tiProgram Evaluation

Process Evaluation Outcome Evaluation

• Monitoring Guide • NAP SACC Self-g

• Staff Workshop Evaluation

Assessment Instrument

• EPAOEvaluation EPAO

P E l tiProcess Evaluation

• Monitoring Guideg

• Staff workshop evaluation

NAP SACC Self-AssessmentNAP SACC Self Assessment

N trition Ph sicalNutrition Physical Activity

9 nutrition 6 physical9 nutrition areas of assessment

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.

Environment and Policy Assessment and Observation (EPAO)

• Purpose: To objectively and Purpose: To objectively and effectively describe the nutrition and physical activity environment and practices of child care facilities.

• Components:▫ Direct Observation – includes only

hi h bb h dthings that you observeobserve that day

▫ Document review – includes things gthat have writtenwritten documentation

Ward D, Hales D, Haverly K, et al. An instrument to assess the obesogenicenvironment of child care centers. Am J Health Behav. Jul-Aug

2008.;32(4):380-386

Email: napsacc@unc eduEmail: napsacc@unc.eduWeb: www.napsacc.org