Leveraging Public and Private Partnerships to Promote Healthy Children and Families

Mary Kate Mouser

Executive Director

Nemours Health and Prevention Services

April 6, 2013

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Learning Objectives

At the end of the session, you will:1. Understand the challenge we currently

face in promoting healthy weight for children

2. Be able to describe public and private partnerships models to combat childhood obesity in the community

3. Be able to identify specific achievements and lessons learned brought about by these partnerships

4. Apply this information to your work

Delaware Survey of Children’s Health Q: What is the percentage of overweight and obese

children and youth ages 2-17 in Delaware? 40%

Q: What percentage of Delaware kids are drinking LESS than two sugar sweetened beverages per week?57.3%

Q:  What is the average number of days per week Delaware teens are getting 60+ minutes of physical activity?4 days

Q: By age 2, an average child in Delaware has watched how many hours of TV?657 hours

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Why Nemours?

Nemours exists to serve the needs of children and families—within and outside of the walls of our pediatric health care facilities.

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Determinants of Health

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Quality health care 10%

Social/environmental 20%

Genetic 30%

Behavior 40%

McGinnis, J.M. et al. Health Affairs 2002;21(2):78-93 5

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What is the Vision?

Safe communities, neighborhoods and buildings that support active living as part of every day life.

What is the Vision?

Fresh, local, and

healthy food isavailable andaffordable in

allcommunities

and neighborhoods

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What is the Vision?

Schools and child care agencies promote physical activities and incorporate them throughout the day.

Schools and child care agencies offer and promote healthy food and beverages to students.

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How We Work: In Partnership

NHPS’ Mission: Working with others to help children live healthier lives.

• Through partnerships we create policy and system changes that will change the way children live, learn and play

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Partnerships• Schools and Districts • Child Care Centers • Community Health Centers • Delaware Colleges and

Universities • Statewide Advisory Councils • County Government in Sussex, Kent, and

New Castle• State and County Park System • State Government Agencies

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Schools Can Be Physically Active Places

Back in the early days of NHPS, we surveyed Delaware parents:

84 percent of them said that inadequate physical activity in children was a problem, AND

95 percent said that schools have a role to play in addressing childhood obesity.

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Schools Can Be Physically Active Places

What schools want:Physical activity that is easy to implement;Physical activity that doesn’t detract from study;Physical activity that doesn’t add costs.

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Schools Can Be Physically Active Places

Delaware HB 471 passed in 2006 – Called for a pilot program to

implement150 min/week of physical education/activity

Response:– Partnered with Delaware Department of

Education to provide technical assistance and evaluation for the pilot

Result:– Confirmation that it is possible to provide

150 minutes physical education/activity week

– Examples of how to do it

Schools Can Be Physically Active Places

Delaware HB 372 passed in 2006– Required fitness assessment in 4th, 7th,

9/10th grades in all public and charter schools

Response:– Partnered with Delaware Department of

Education to analyze the FITNESSGRAM data

Result:– Delaware specific data showing that

students who are more physically fit have: Higher state test scores in reading and

math Better attendance

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Schools Can Be Physically Active Places

As our work took off, schools were now requesting more:– Training and tools to

implement physical activity in school

Response:– NHPS applied for the Carol

M. White Physical Education Program grant (US DOE)

– $1.2 million over 3 years

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Make School A Moving Experience

Goal:-150 minutes of moderate to vigorous physical activity per week

Plan: -Each school created their own combination of:

Physical education Classroom activities Recess activities Other adaptations to the

schedule

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Make School A Moving Experience

Results:

74 public elementary schools (~72%) voluntarily incorporated 150 minutes of physical activity into the school week, many still continuing their work

40,000+ students participated in increased physical activity at school, annually

2,000+ teachers/staff trained to provide physical activity

http://vimeo.com/nhps/morningaccouncements

Partnering with School Nurses

We promote health—but some children have sickness or health issues in school.

Chronic conditions such as asthma, anaphylaxis, Type I diabetes, epilepsy, obesity and mental health concerns may impact the students ability to be in school and ready to learn

School nurses requested improved communication with Nemours clinicians and access to health information of their students/Nemours patients.

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Parent / Guardian

School Nurse

Nemours

Provider

STUDENT

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Partnering with School Nurses

Partnering with School Nurses

A multi-disciplinary team was formed to develop a way to facilitate the exchange of medical/education information between school nurses and Nemours clinicians.

There were people who said “it couldn’t be done” because of the rules and regulations protecting student /patient privacy.

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A HIPAA / FERPA compliant authorization form was designed to obtain parental consent for the exchange of information

This form also reinforces the role of the school nurse as part of the care team

Information Shared:

• Treatment –example: care plans

• Non-treatment – example: immunizations, lead levels, TB screenings

• Education – example: attendance, medication compliance, frequency at nurse’s office

• Nemours Providers can access the form at this link: http://teamshare/patient/proj/pcforms/Delaware%20Valley%20Forms/Forms/AllItems.aspx

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Partnering with School Nurses

School Districts (19/19)

Appoquinimink Brandywine Caesar Rodney Cape Henlopen Capital Christina Colonial Delmar Indian River Lake Forest Laurel Milford New Castle County Vo-Tech Polytech Red Clay Seaford Smyrna Sussex Tech Woodbridge

Charters (12/22)

Charter School of Wilmington

DE College Prep Academy

Kuumba Academy

Moyer Academy

Newark Charter

Reach Academy

Sussex Academy of Art/Science

Thomas Edison Charter

Gateway Lab School

Prestige Academy

East Side Charter

Odyssey

Current Districts/Charters Participating

Improved communication across the continuum of care / minimize miscommunication

Provider access to School Nurse’s clinical input and assessment

Possible reduction in the need to contact the provider office for routine information

Recognition of School Nurse as part of the care team

Greater efficiency by School Nurses in accessing student medical information allowing them to reinforce instructions given to families and better coordinate the care provided in the school environment

Improved health outcomes for patients/students

Benefits

Healthy Child Care Settings

Changes in policy set the stage:

A partnership with the Department of Education led to new nutrition guidelines for food served in licensed child care settings

A partnership with the Office of Child Care Licensing led to new regulations for healthy eating and physical activity

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Healthy Child Care Settings

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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 action steps- Endorsed by the USDA

Child Care Learning Collaborative- 28 centers completed 5 sessions- Receive insight, experience from 4 pilot site champions- Receive hands-on techniques to imbed physical activity

into the day, increase fruits and vegetables on the menu, and receive parental support for healthy foods brought into the center

Healthy Child Care SettingsResults of Work

• Healthy eating practices increased

• Physical activity practices increased

• Increases in provider knowledge about nutrition and physical activity

• Changes in centers’ written nutrition and physical activity policies

• Changes in center practices

• Supports to keep the regulations strong

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National Partnership:Let’s Move! Child Care

Goal: Create strong practice change in child care settings across the country to improve healthy eating, physical activity and screen time behaviors for children

External Partners: Office of the First Lady, Domestic Policy Council, CDC, Administration for Children and Families, Child Care Aware of America, University of North Carolina, Healthy Kids, Healthy Future Steering Committee

Healthy Child Care Settings:It Takes Time

2006 2007 2008 2009 2010

Child Care Pilots

Child Care Learning Collaborative

CACFP Regulations in Effect

Provider Workshops CACFP Trainings/Team Nutrition Trainings

DE Institute for Excellence in Early Childhood

Office of Child Care Licensing Rules for Healthy Eating and Physical Activity in Effect

2011 2012Healthy Kids Healthy Future

Steering Committee

Let’s Move! Child Care

Nat’l ProviderCollaboratives

Healthier Vending and Concessions

May 20, 2010 Governor Markell’s Executive Order #19: Established a Council on Health Promotion and Disease Prevention

“In carrying out its charge, the Council shall endeavor to ensure that the State, as an employer, set the standard for workplace health promotion and disease prevention, including healthy foods in vending machines, physical activity opportunities, and health promotion benefits to state employees and their families”

Healthier Vending and Concessions

Nemours developed a guideto healthier vending and Concessions, with the easy to use “go, slow and whoa:terminology.

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Munch Better in the Great Outdoors

Munch Better in the First State

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Partnerships for Healthy Vending

State Parks Policy

2012

State Buildings

Pilot

AI duPont

and Nemours Facilities

2010 Currently

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Lessons Learned

• Prevention is not the top priority on everyone’s agenda Need to make sure our partners’

priorities are connected to our priorities

Listening is key: acknowledge barriers and find solutions

Share results: national groups were interested in Delaware child care work

• Community is dynamic and changing: be ready to adapt

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Collaboration=Increased Impact

Multiple partners, multiple strategies and commitment add up to increased impact

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An Ambitious Goal

• Creating healthy, active environments will take the combined efforts of entire communities

• The health of future generations is at stake

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Mary Kate MouserExecutive Director

Nemours Health & Prevention Services252 Chapman Road, Suite 200

Newark, DE 19702mmouser@nemours.org