Objectives
Participants will be able to:
• Describe effective strategies to promote nutrition
and physical activity best practices/policies in
licensed child care and preschool settings
• Discuss the effective follow-up/technical
assistance.
• Find available resources
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Statewide Health Improvement Program
• Created by Minnesota Legislature in 2008 as
integral part of health care reform
• Focused on reducing chronic diseases caused
by lack of physical activity, poor nutrition, and
tobacco use
• Schools, worksites, healthcare, and community
settings
• Choices limited to activities leading to
healthier environments, policies, or system
changes to assure sustainability
3
Bloomington Public Health
Bloomington Public Health serves the suburban
cities of Bloomington, Edina, and Richfield
(population = 166,062)
• Major areas of public health
o
o
o
o
o
Health promotion and planning
Clinical services/Disease prevention and control
Family Health
Senior Health
Emergency Preparedness
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Dakota County Public Health
Dakota County is the third most populous county in MN.
(population=398,552)
• Major areas of public health
o Health promotion and planning
o Clinical services/Disease prevention and control
o Family Health
o Senior Health
o Emergency Preparedness
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Why Child Care?
72% of Minnesota children under 6
have all parents in the workforce*
50% and 75% percent of children’s daily
calories are received at a child care
facility
*Children’s Defense Fund January 2011
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Healthy Habits in Preschoolers
• Preschool—critical time for development
• Time to start healthy eating habits
– Reduces risk for chronic disease, heart disease, stroke,
and obesity
– Link between childhood obesity and obesity later in life
– Children learn healthy (or unhealthy) eating habits at a
very young age
7
How Do Childcare
Providers/Educators Impact Healthy
Eating and Activity?
•
•
Children look up to their teachers and often
“model” their own eating/activity habits
based on watching others.
Providers can make changes to create a
better “food and activity environment” so
it’s easier for children and staff to make
healthier choices.
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Strategies
1. Provide evidence-based
nutrition/physical activity training
2. Develop action plan
3. Provide follow-up and technical
assistance
4. Adopt nutrition/physical activity policies
based on best practices
9
Healthy Eating and Learning through Play
HELP
for Child Care
Implement policies and practices in
licensed child care and preschool settings
that
• support healthy eating
• support physical activity
10
Strategy 1 - Training
 Learning About Nutrition through Activities (LANA)
 I Am Moving I am Learning (IMIL)
 Nutrition and Physical Activity Self Assessment for
Child Care (NAPSACC)
LANA Program: http://www.health.state.mn.us (Search LANA Preschool Program)
NAPSACC: http://www.center-trt.org/index.cfm?fa=opinterventions.download&intervention=napsacc
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LANA Program Description
• Developed by the Minnesota Department of Health and
the University of Minnesota*
• A program for children, parents and teachers in childcare
settings to:
– Increase children’s exposure to a wide variety of fruits and
vegetables
– Increase children’s consumption of fruits & vegetables
– Decrease children’s pickiness & neophobia
• Uses tastings, cooking activities, menu changes, stories
and curriculum activities to make children more familiar
with and more likely to eat vegetables and fruits
*NCI funded
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LANA Program Description
• “LANA the Iguana,” the puppet mascot for the
program, encourages kids to help make and eat fun
and healthy foods
• Eight “target” fruits and vegetable selected:
 Apricots
 Strawberries
 Broccoli
 Sugar snap peas
 Cherry tomatoes
 Sweet potato
 Kiwi
 Sweet red pepper
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Dakota County Pilot -The Method
• Partnered with Social Services to obtain list of
Dakota County licensed family daycare providers
• Piloted with 75 licensed childcare providers and
the 500 children and families they served
• Trained home child care providers on curriculum
• Distributed curriculum, materials and puppet
• Incentives included two grocery gift cards and
fruit and vegetable toy set
• Surveyed providers and parents for evaluation
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LANA Program Library Kits
Available for checkout from the
Dakota County Public Libraries
• Kits include:
– a LANA the Iguana puppet
– simple games
– a special LANA story
– other theme-related
purchased books
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Evaluation Plan
• Initial provider survey at orientation training
• Process evaluation
(3 months later)
• Parent survey
(5-7 months later)
• Site visit
(6-7 months later)
• Final provider survey
(8 months)
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Outcomes
Providers participating reported:
• 67% of the children were more likely or much more likely
to eat fruits
• 78% were more likely to eat vegetables
• 92% were more likely or much more likely to try new
foods
• 76% of providers offered F&V more often at snack time.
• 96% providers offered a greater variety of F&V
• Majority of parents reported reduced “pickiness” and
the fear of trying new foods
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I Am Moving I Am Learning
A program of Head Start
Goals
• Increase moderate to vigorous physical
activity during daily routines
• Improve the quality of structured
movement activities intentionally
facilitated by adults
18
Physical Activity Guidelines
for 3 to 5 year olds
• At LEAST 60 minutes and up to
several hours of daily,
unstructured active play
• 60 min daily of structured
active play
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How Do Childcare
Providers/Educators Impact
Increased Activity?

Create a better “physical activity
environment” so it’s easier for children
and staff to make more active choices.

Show children/families that being active
is fun, rewarding and important.
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Integrating LANA and IMIL
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Strategy 2 - Develop an Action
Plan
Key Area
Best Practices
Facility Name: XYZ Child Care
• Offer fruit (not juice) at least 2x a day. (3)
Fruits and Vegetables
• Serve fruit canned in its own juice (not syrup),
fresh, or frozen all of the time. (4)
• Offer vegetables, not fried, at least 2x a day. (3)
• Offer vegetables, other than potatoes, corn or green
beans 1 or more times per day. (1)
• Prepare cooked vegetables without added meat fat,
margarine or butter. (2)
Rating Scale: 1 = Best Practice Rarely or Never met
3 = Best Practice met Most of the time
2 = Best Practice met Some of the time
4 = Best Practice met All of the time
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Strategy 3 - Follow-up/
Technical Assistance
• Follow-up visits/phone calls
– 3, 6, 12 months
• E-Newsletter
• Email communication
Newsletters: http://www.ci.bloomington.mn.us/
Search - HELP newsletters
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Strategy 4 - Adoption Of
Nutrition/Physical Activity Policies
Based on Best Practices
• Emphasized in training
• Part of action plan
• Sample policies
• Financial incentive
• Individual assistance
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Identified Need for
Quality Improvement
Identified weaknesses (problems to solve) of initial work and
evaluation plans
• Frequency of follow-up undetermined
• Structure of follow-up visits undetermined
• Success of intervention not defined (no aim)
• Disconnect between LANA training goal & SHIP intervention
goal
• Undefined criteria for effective policies
Additional problems to address
• Multiple staff, unfamiliar with SHIP, assigned to follow-up
activities
• Limited SHIP staff availability of time-needed structure in place
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Project AIM Statement
By January 2011, 80% of the 1st trained *cohort of
child care/ preschool programs and facilities will
have adopted/strengthened a nutrition policy that
includes at least 3 changes that increase access to
nutritious foods, increase consumption of healthy
foods, or decrease consumption of unhealthy foods.
*(Cohort participated in an initial nutrition workshop, follow-up visits, and received
ongoing TA.)
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PDSA Cycle: Link LANA Training
and SHIP Goal
Plan and Do: Revised training
and incorporated lessons
learned (policy language)
from 1st training into similar
SHIP intervention regarding
Physical Activity
Act: Have since incorporated
policy component into both
nutrition and physical
activity trainings.
Study: 22% of facilities listed a
policy in their action plan in the
first training. Following
incorporation of a policy
component into next training,
73% of facilities listed a
“policy” as a goal in their
action plan.
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Evaluation
 Pre and Post nutrition/physical activity
assessment (NAPSACC)
 Follow-up visits/phone calls – 3, 6, 12
months
 Key informant interviews at end of
intervention for qualitative feedback
 Policy tracker
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Results: Did we achieve our AIM??
Change in nutrition practices in BER child care facilities* and
preschools, Oct 2009-Oct 2010
14
12
12
10
8
8
8
6
5
4
4
4
4
4
2
0
0
no changes, but
progress towards
implementing changes
0
1 practice change
2 practice changes
6 months
3 or more practice
changes
new/strenthened policy
12 months
*Total of 20 facilities at 12 months (13 child care centers/preschools, 2 ECFE programs, 5 family providers)
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AIM Achieved!
20
18
16
14
12
85%
12 months
10
18 months
8
6
4
38%
2
0
nutrition policies adopted/strengthened
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Key Informant Interviews
(5 preschools, 8 childcare centers, and 5 in-home providers interviewed)
Childcare providers were very satisfied with the
assistance given by the Bloomington Public Health
(BPH) staff.
• Follow-up process
– Discussing Challenges and Barriers
– Reviewing goals from action plans and progress
towards those goals
• Technical Assistance
– Personal contact
– E-newsletter/email blasts
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Dakota County Results – Healthy Eating
• 339 licensed child care providers and Early Childhood Educators
LANA trained (215 sites)
• Reached 3,900 children in Dakota County
• 100% completed action plans
• 93% of sites completing the pre and post NAPSACC improved
nutritional practices
• 52 sites (24%) developed written nutrition policies with
improved practices
• 69% of children were eating more fruits and vegetables than
they had before provider attended LANA training
• 63% of children now more open to eating fruits and vegetables
than before provider attended LANA training
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Parent Praise for LANA
“The LANA program has not only benefited by kids in
your daycare, but our whole family. My twins have been
shown a whole new world of great foods that not only
taste good but are so good for them. We have the usual
grapes, apples, strawberries, etc., but now we have
moved onto kiwi, apricots and broccoli. There are so
many ways to eat them that the kids don’t realize they
are eating healthy foods they never knew before. [My
son] brought his cookbook to the store and we came
home with bags and bags of fruit and vegetables and is
so excited to make EVERYTHING!!! As parents I think it is
great to have the kids try new foods while at daycare
since we know kids are parents have a different
relationship than with their care provider.”
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Dakota County Results – Active Child Care
• 316 licensed child care providers and Early Childhood Educators
IMIL trained (93 sites)
• Reached 3,117 children in Dakota County
• 100% completed action plans
• 67% improved their physical activity practices by increasing
physical activity time and reducing screen time
• 57 sites (61%) developed written physical activity policies
• After providers completed IMIL training, 61% of preschoolers
engaged in 60 minutes of teacher-led physical activity 4 days a
weak, compared with 32% before training
• Very popular, 50 training slots filled up in just 2 hours
• Six IMIL library kits developed and put in circulation
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Conclusions and Lessons Learned
Child care and preschool settings can make
dramatic changes to improve nutrition
• Quality training essential
• A variety of follow-up methods needed
to ensure progress
• Relationships and individual technical
assistance very important
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Conclusions and Lessons Learned
Sustainability depends on adopting policy and
making environmental change
• Professional consultation key to successful
environmental change
• Intensive focus on and support needed for
policy adoption
• Set the bar high.
(Total facilities 39; children affected ~4,000; 71% nutrition policies)
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Sustainability
Continue partnership with Childcares
through:
•Monthly e-newsletter
•Technical assistance
•Statewide Child and Adult Care Food
Care Program (CACFP) monitors
trained in LANA
•Continuing search for future funding
for expansion
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“Each of you has so much to offer when it comes to helping our
children make healthy choices. You know more about food than almost
anyone—”
(Michelle Obama - Let’s Move Event 6/4/2010)
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More Information
www.ci.bloomington.mn.us
www.dakotacounty.us
www.health.state.mn.us
search “LANA”
Contact:
Bloomington Public Health Department
Joan Bulfer, Health Promotion Health Specialist
952.563.8992
[email protected]
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Questions?
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