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Eat Well Play Hard in Child Care Settings

Implementation

How It Works:

Secure funding: In 2010, 50% of the Eat Well Play Hard in Child Care Settings (EWPHCCS) costs were funded by Federal SNAP-Ed funds, and 50% by non-Federal, non-cash (in kind) contributions. Salaries and benefits accounted for about 77% of all program costs.  

Establish partnerships and roles:

  • EWPHCCS program is coordinated and overseen at the state level by three NYSDOH senior staff.  Staff members and their roles: CACFP bureau director is responsible for the fiscal and organizational integrity of the program; the EWPHCCS program director and contract manager are responsible for program operation, quality assurance, and oversight of subcontracting agencies. 
  • EWPHCCS is implemented throughout New York State through seven subcontracted agencies: six Child Care Resource and Referral agencies (CCR&R), and the New York City Department of Health and Mental Hygiene (NYCDOHMH).  According to the SNAP-Ed evaluation report, “CCR&Rs are ‘natural partners’ for implementing EWPHCCS since they already provide technical assistance and training to child care facilities in their regions, and are a trusted source of information for the child care provider community and the families they serve.”

Hire and train direct educators (RDs) to deliver the intervention: CCR&Rs and NYCDOHMH hire and train registered dietitians (RDs) to be the direct educators, who are responsible for recruiting centers and delivering the EWPHCCS curriculum to child care centers.  

Enroll eligible childcare sites: Each direct educator (RD) recruits 13-15 child care centers; each center must have 50% or more of enrolled families eligible for free or reduced-priced meals.  Each year, the NYSDOH prepares a list of eligible sites for direct educators to use in their recruitment.  

Recruit parents/caregivers for classes: The most common recruitment methods are mini-posters displayed in child care centers, and colorful flyers distributed to parents.  Recruitment materials include the schedule of parent classes and a description of small, $4-or-less, incentives for parents who participate in classes (incentives are often related to cooking, such as a vegetable scrubber or a peeler). 

  • In a marketing session for parents and guardians, the RD discusses potential topics and determines the best days and times to conduct parent classes.
  • Prior to the start of classes, the RD conducts a minimum of one marketing session for staff to promote understanding and clarify expectations of the center staff and parents.

Deliver EWPHCCS curriculum, including classroom activities for children, and caregiver classes:

  • The direct educator (a registered dietician, or RD) delivers both the child and parent/caregiver lessons. They are also responsible for completing administrative documents required by New York State Department of Health (NYSDOH).
  • The EWPHCCS curriculum includes ten modules that focus on healthy eating and physical activity and include separate child and parent/caregiver lessons, activities, and handouts. The activities for both children and parents are designed to be interactive and support the objectives of the lesson. 
  • Based on individual child care center goals as identified by the NAP SACC assessment, the RD and child care center director select six child and parent lessons to teach at each center.  Lessons are taught separately to children and parents on a weekly basis over a six- to ten-week period.
  • Child lessons are designed to last 20-30 minutes.  The RD uses color photos, stories, puppets and other interactive activities to captivate and involve the children.  The activities provide children with “hands on” learning opportunities, including preparing and sampling healthy foods and age-appropriate physical activities.
  • At the end of each lesson, children take home a newsletter which introduces their families to the lesson of the day, and includes a recipe, activities, and suggestions for extending the lesson to the home.  Handouts are available in seven languages: English, Spanish, Chinese, Russian, Arabic, French and Haitian Creole.
  • In parent/caregiver classes, the RD uses the EWPHCCS curriculum to teach the families of preschool children corresponding lessons about nutrition and physical activity; parent classes last about 30-60 minutes.
  • When working with parents/caregivers, the RD uses emotion-based learning techniques to create a comfortable class environment where family members are willing to participate in an open and honest atmosphere.  These include using open-ended questions, affirmations, reflective listening, and summarizing.1

During regular class time, child care center staff reinforce EWPHCCS lesson messages:

  • Direct educators (RDs) offer classes for child care center staff on at least 2 of the following 5 topics: childhood obesity, healthy eating, physical activity, personal health and wellness, and working with families. RDs also have the option of using the EWPHCCS staff curriculum. Child care center staff are awarded continuing education credits for their participation.
  • Child care staff receive brief handouts to use for message reinforcement; these materials describe the lesson’s educational objective and a simple activity that teachers can use to reinforce the EWPHCCS messages in their classrooms, especially during mealtimes. 

Send program materials home with children: Parent newsletters and any additional handouts are sent home in children’s backpacks.

Evaluate: Each month, for every center they work with, direct educators submit work plans and class attendance sheets.  NYSDOH managers review the reports. 

Provide continuous training, support, and oversight:

  • Direct educators (RDs) are required to participate in bi-annual quality assurance and training meetings lead by the state health department. Quarterly conference calls are also held with RDs and NYSDOH staff.
  • Program managers visit the direct educators at least twice annually to observe their teaching and offer feedback. 

Keys to Success

  • Partner with Child Care Resource and Referral (CCR&R) or equivalent agency to work directly with child care centers; they are key for center recruitment and program success.
  • To ensure quality control and delivery of the intervention as intended, be consistent with record keeping, site visit training, and meetings.
  • For smooth delivery of the EWPHCCS program, involve child care center directors.  Some directors have been successful at increasing participation in caregiver classes by personally reaching out and encouraging caregivers to attend the classes.
  • Parents/caregivers are reached through multiple channels, such as marketing, newsletters, classes, and child/teacher feedback.
  • By reinforcing EWPHCCS messages in their classrooms, child care center teachers increase children’s exposure to messages about healthy eating and physical activity.
  • Food preparation and/or food tasting activities are typically included in both child and caregiver classes because 1) children enjoy being helpers, 2) they are encouraged to try new foods and 3) parents benefit from food preparation and/or handling skills.

Barriers to Implementation  

  • Caregiver participation in weekly classes is low, though many caregivers do report using the take-home materials.  Reasons for low attendance range from busy schedules to caregivers’ belief that they are providing their children with a healthy diet. 
  • Given the diversity of children and caregivers participating in the EWPHCCS program, language and preparing a variety of culturally acceptable foods can be a challenge.
  • Ensuring program buy-in from some child care center directors can be a challenge.
  • While caregivers like the recipes and shopping ideas the program provides, they also mention that fresh fruits and vegetables are sometimes too expensive to purchase.
  • Some CCR&Rs do not have the funds to hire highly skilled RDs as direct educators.


1 Norris, Joye. “Ya Gotta Have Heart”  Eat Well Play Hard in Child Care, Training, Albany, NY April 2012