National Early Care & Education Learning Collaboratives

Allison Gertel-Rosenberg, MSDirectorNational Prevention & Practice

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In Appreciation

In appreciation of the ongoing work of the ECELC team:

Julie Shuell Roshelle Payes Erica Cooper Laurie Chow All State Coordinators and State Partners in Arizona, Indiana,

Kansas, Missouri, Florida, and New Jersey

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Nemours Overview

Nemours– Internationally recognized children’s health system– Offers pediatric clinical care, research, education, advocacy and

prevention programs

Nemours National Office of Policy and Prevention– Focuses on national policy and practice changes, build on what we

learn in clinical practice and spread/scale it.– Areas of emphasis:

Promoting population health and prevention Supporting healthy development and prevention in early care

and education settings Addressing the unique needs of children in health and quality

initiatives

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Recognizing the Importance of Early Care and Education (ECE)

ECE is an optimal point of intervention for obesity prevention:

Childhood obesity is a widespread epidemic impacting the 12 million children who spend time in ECE settings

More than a quarter (26.7%) of the children 2- to 5-years-old are overweight or obese

Evidence-based research supports the need to provide healthy nutrition and physical activity environments for children at young ages

Nemours is committed to helping to reduce the prevalence of childhood obesity and increase healthy eating and physical activity in children

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Childhood Obesity Prevention in Early Care & Education Provides Opportunities to…

Impact the 12 million children who spend time in out of home care Influence change in a setting where young children spend a

significant portion time Engage in primary prevention Avoid the default of only

thinking about K-12 Act locally and nationally

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Nemours – Building Expertise in Delaware

Nemours Health and Prevention Services (NHPS) developed the Child Care Learning Collaborative (2008-present)

– Empowers child care providers with the tools to increase opportunities for healthy eating and physical activity for children in their care

Positive Results– 100% of participating centers made changes to either

healthy eating or physical activity practices and policies

– 81% of participating centers made changes to both healthy eating and physical activity practices and policies

Examples of practices and policies changed:– Making self-serve water available to children at all times– Replacing whole milk with 1% or skim milk, and– Creating a policy that devotes at least 60 minutes per day to active play

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“It is important that centers ensure that children eat healthy and engage in physical activities as this is the cornerstone of healthy development. Having specific guidelines

instituted by the Office of Child Care Licensing ensures that centers have a framework to utilize in creating their center and family policies. The implementation of these guidelines has not been difficult. Yes, it does take some creativity and thought process to change our menus or to pack a nutritious lunch, but the end result is that children are eating healthy.”

Cheryl Clendaniel, Early Childhood Administrator, The Learning Center

National Early Care and Education Learning Collaborative Project 5 Year Cooperative Agreement (2012-2017)

– Centers for Disease Control and Prevention Y1: 6 pilot states (AZ, FL, IN, KS, MO, NJ)

– 30 ECE programs per collaborative– Pre-determined number of collaboratives/state

» 27 collaboratives total– Initial target:

» High-capacity programs» Low-income, high-risk

Out Years: – Spread within existing states/expand to additional states

» Family Child Care settings» Tribal programs

CDC/Nemours partnering with State Health Departments and other organizations to implement

Initial evaluation data available in Summer 20148

Who Are the States?

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4 collabs; 81 programs; 9,346 kids

9 collabs; 180 programs; 14,208 kids

5 collabs; 115 programs; 112,060 kids

4 collabs; 50 programs; 10,142 kids

3 collabs; 71 programs; 6,102 kids2 collabs;

49 programs; 4,327 kids

What Do The Centers Involved Look Like?

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What Do The Centers Involved Look Like?

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What Do The Centers Involved Look Like?

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ECE Learning Collaborative Model

An intervention to improve physical activity, screen time, food, beverage, and breastfeeding practices, policies, and the overall ECE environment that is aligned with:– Caring for Our Children (3rd Edition); Preventing Childhood Obesity

in Early Care and Education Programs (2nd Edition)– The goals of Let’s Move! Child Care

ECE providers are: – Equipped with tools and resources to involve children in healthy

habits– Empowered to engage families in shared support of children’s

optimal health, development and learning

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Key Elements of the Model

Community of learners: A year-long adventure!

Network of shared ideas and mutual support

Access to high quality resources

Development of skills, collaboration, leadership, efficacy

Action planning and implementation

Partnerships with families in support of children

ECE Learning Collaborative Model

Learning Collaborative– Approximately ECE Programs (in a targeted geographic area)

Self-Defined Leadership Team (1 – 3 people)

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Food Service Personnel

Lead Teacher

Owner/Director

30 ECE Programs

Self-Defined Leadership Team

ECE Learning Collaborative Model

Taking Steps to Healthy Success Curriculum– 5 Learning Sessions

In-Person Session (Collaborative)– Facilitated by: State implementing partner– Audience: 30 ECE Programs Leadership Teams

Homework Session (ECE Program)– Facilitated by: “Leadership Team”– Audience: ECE Program Staff

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HW LS1 HWLS2 HWLS3 HWLS4 HWLS5

Each “in-person session” is spaced approximately 6 – 8 weeks apart to provide enough time for the homework activities.

Homework includes: • Abridged learning session• Action task

Taking Steps to Healthy Success Curriculum

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Taking Steps to Healthy Success Curriculum

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HomeworkLS1 HomeworkLS2 HomeworkLS3 HomeworkLS4 HomeworkLS5

Why Should We Change?

Go NAP SACC assessment

What is Our Role in Making Healthy Changes?

Pilot Action PlanPilot Storyboard

How Can We Continue to Make Healthy Changes?

Year Long Action PlanNew Storyboard

How Can We Engage Families as Partners?

Continue Year Long Action Plan *emphasis on families

Update Storyboard

Celebrating Success:Our Plans in Action!

Continue Year Long Action Plan

Resources

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Connecting the Dots in States with ECE and Child Health

Trainers that support ECE centers could be dual functioning as child care health consultants, QRIS improvement specialists, CACFP monitors, Cooperative Extension agents, or licensing staff.

Learning sessions and homework could earn CEUs for ECE staff and/or clock hours towards licensing requirements. Participation could also be linked to additional points in a QRIS.

Best practices around childhood obesity prevention could be built into state standards and/or continuous quality improvement for QRIS, CACFP, licensing, professional development.

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Connecting the Dots in States with ECE and Child Health (continued)

Learning collaboratives can be used as a strategy to meet state goals around obesity prevention, particularly for low income children under 5.

ECE programs following best practices are excellent places to refer high risk families with history of obesity.

Additional support for ECE programs seeking to meet best practices can come from AAP chapters, health departments, children’s hospitals, pediatricians, private insurers and health foundations.

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Lessons Learned So Far

There is a lot going on at the state and local level in early childhood and children’s health (i.e. Medicaid expansion, QRIS). Integrating this intervention with existing efforts is critical for sustainability.

State based organizations (public and private) have varying degrees of skill and bandwidth to absorb funding and implement a new initiative.

Providers aren’t comfortable with technology as a major tool for training and technical assistance.

Trainers skills and personality matter immensely to provider engagement.

In a voluntary program, you can expect a level of self-selection with providers that are willing and able to participate.

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Acknowledgements and Disclaimers

Nemours is currently funded by the Centers for Disease Control and Prevention (CDC) under a five-year Cooperative Agreement (1U58DP004102-01) to support states in launching ECE learning collaboratives focused on obesity prevention.The views expressed in written meeting materials or publications by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

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Questions/Comments

If you have any further questions or would like to provide additional feedback,

please contact me at:

Allison Gertel-RosenbergDirector National Prevention & Practice

Allison.GertelRosenberg@nemours.org; 302-444-9171

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