A Child Care Center Intervention

Promoting Policy and Menu Change in Early Care and Education in Ohio

Autumn Trombetta MS, RD, LDCheryl Graffagnino MS, RD, LD

Obesity In Ohio (BMI > 95% %ile)

¹ Pediatric Nutrition Surveillance System (PedNSS), CDC and ODH, 20062 Ohio Family Health Survey (OFHS), ODJFS/ODH/ODI/ODMH, 2008

Newborns 2-5 yr olds1 Adults210-17 yr olds2

<5% 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% NS

Program Development

• Began in 2004 • Focus groups with parents

– Identified child care providers as trusted source of health information

• Created training & toolkit for child care provider staff

Evolution of a Statewide Initiative

• Began in 2010• Voluntary designation• Provides Step Up To Quality • Education CEUs• Monitored through

Professional Development Registry

Becoming an Ohio Healthy Program..

1. Attend Step Up To Quality approved trainings

2. Implement a healthy policy

3. Increase the nutritional content of menus

4. Include parent participation

Becoming an Ohio Healthy Program…

1. SUTQ-Approved Trainings

• Session 1: Healthy Habits (10 Hour series)– Healthy Activity– Healthy Eating and Feeding– Healthy Growing– Healthy Families

• Session 2: Healthy Menus (2.5 hours)

• Session 3: Healthy Policies (2.5 hours)

Becoming an Ohio Healthy Program…

2. Implement a Healthy Policy

• “Television, video, computers and other visual recordings shall not be used with children under two years of age.”

• “Breastfeeding mothers shall be provided a private and sanitary place to breastfeed their babies or express milk. The area will have an electrical outlet, comfortable chair, and nearby access to running water.”

• “Staff members consume the same food and drinks as the children. Staff members do not consume other foods and drinks in front of the children. “

Becoming an Ohio Healthy Program…

3. Ohio Healthy Programs Menu

• Includes variety every day of the week– Non-fried Vegetables– Whole Fruit– Whole Grain Food

• Offers fried foods no more than twice a week

• Offers only low fat milk (1% or skim) to children ages 2 and up

(adapted from Healthier US School Challenge 2010)

Becoming an Ohio Healthy Program…

4. Parent Participation

• Parent Bulletin Board• Parent Newsletter

Statewide Train-The-Trainer

• Local Resource and Referral agencies – 27 Education Specialists

• Ohio Department of Health’s Healthy Child Care Ohio – 37 Nurses– 1 Dietitian

Ohio Healthy Programs Results

• January 2010 – March 2011– 65 statewide trainers– 349 trainings – 1300 child care staff – 608 centers– 13 Ohio Healthy Programs

Local Programming

• Recruiting child care centers• Technical assistance

– RD and/or DTR– 2 week menu review and

recommendations– Parent/Policy Handbook review

and recommendations– Environmental Assessment

Local Programming

• Sustainable Supporting Materials– $100 for Ohio Healthy Program

Menu– $100 for Ohio Healthy Program

designation – $100 per policy

• maximum of $300

Intervention Measure

Center Policies

• Since January 2011• 26 licensed centers • 404 policies(mean=15):

– 284 nutrition• 9 breastfeeding

– 110 physical activity– 10 Nutrition and physical

activity promotion for parents

Child Care Centers & Number of Policies by Zip, Columbus, OH

Adult Obesity by Zip CodeColumbus, Ohio

29.0%

53.2%

27.7%

287.6%

Pre- & Post Intervention Measures

Menu Changes

50.1%

56.6%

Pre- & Post Intervention Measures

Menu Changes

Next Steps

• Statewide:– Incorporate Ohio’s Healthy Program criteria into

statewide voluntary quality rating systems– Enhance parent engagement efforts

• Local:– Ongoing evaluation of long-term, sustained

environmental change– Continue to seek sustainable funding source

Questions?

• Autumn Trombettaaltrombetta@columbus.gov

• Cheryl Graffagninoclgraffagnino@columbus.gov

http://publichealth.columbus.gov/healthy-children-healthy-weights.aspx