Transcript NAP SACC Intervention: Changes in Nutrition and Physical

N AT I O N A L S M A R T S TA R T C O N F E R E N C E
G R E E N S B O R O N C , M AY 2 - 5 , 2 0 11
SANDRA CIANCIOLO RN BSN MPH
DEBRA GARRETT RN MPH CCHC
PENN GRUEHN PHRDH CCHC
PAT R I C I A I S B E L L P H D , M P H , M E d
J O N AT H A N K O T C H M D M P H FA A P
SESSION LEARNING OBJECTIVES
Participants will:
1. Understand national initiatives for healthy and safe child care
supported by the US Maternal and Child Health Bureau.
2. Learn about North Carolina’s system of health consultation
and its efforts to meet national goals to improve the quality of
child care.
3.Recall the role of Child Care Health Consultants (CCHCs) in
collaborating with others to prevent child maltreatment and
reduce the risk of childhood obesity in child care.
4. List examples of the impact of CCHC in local communities.
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SANDRA CIANCIOLO
N AT I O N A L T R A I N I N G
INSTITUTE FOR
C H I L D C A R E H E A LT H
C O N S U LTA N T S
HISTORY
• About 25 years ago, the US Department of Health and Human
Services’ Maternal and Child Health Bureau noted an increase in the
number of mothers of young children in the workforce.
• Thus, enrollment of young children in early care and education settings
steadily increased.
• With increasing enrollment came increased exposure to respiratory
and gastrointestinal illnesses and other risks.
•State regulations of child care settings vary widely and do not ensure
consistent minimum health and safety best practice.
•
In 1992, US DHHS supported efforts such as the creation of Caring For
Our Children Health and Safety Performance Standards: Guidelines for
Out-of Home Child Care Programs to promote health and safety.
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HISTORY CONTINUED
Since 1995, the US DHHS has supported efforts to disseminate CFOC
and enhance early care and education through:
1. Healthy Child Care America Campaign (HCCA):
• American Academy of Pediatrics’ Child Health Provider Partnership
•The National Resource Center for Health and Safety in Child Care
and Early Education
•The National Training Institute for Child Care Health Consultants
2. Grants to states for building systems, creating partnerships and
enhancing existing efforts
3. Grants to states for Early Childhood Comprehensive Systems
building around 5 components: medical care/medical home, family
support, parent education, early care and education, and socialemotional development of young children
4. Full or partial funding for technical assistance partners too
numerous to name
5. Funds to create Early Childhood Advisory Councils with the goal of
developing a strategic plan for early childhood in each state.
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NATIONAL TRAINING INSTITUTE (NTI)
As one of 3 technical assistance partners of Healthy Child Care
America, NTI has, since March 1999,
•
Created an evidenced based curriculum based on CFOC
•
Trained 462 instructors of CCHCs
•
Who have conducted over 250 State CCHC trainings and
•
In doing so, prepared over 4,800 CCHCs
•
Provides consultation to state CCHC leaders
•
Works with national partners to advance health and safety in early
care and education settings
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NATIONAL PICTURE OF CCHC TRAINING*
No plans
Number of States
and DC
25
Plans to
Currently trains
8
18
*info based on
report s to NTI
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REASONS FOR NOT TRAINING CCHCs
1. Lack of funding and political support
2. ‘No demand’
3. ‘Have enough CCHCs’
4. Changes in program leadership
5. Shifting priorities
6. Reason not given
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STATES WITH FUTURE PLANS TO TRAIN CCHCs
Alabama
Arkansas
Georgia
Idaho
Missouri
Nevada
New York
Ohio
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STATES THAT CURRENTLY TRAIN CCHCs
Arizona
Colorado
Connecticut
Hawaii
Illinois
Iowa
Kentucky
Louisiana
Maine
Massachusetts
New
North
Hampshire Carolina
North
Dakota
Pennsylvania
Rhode
Island
Texas
Vermont
Virginia
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DEBBIE GARRETT
NORTH CAROLINA
STATE CHILD HEALTH
NURSE CONSULTANT
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HISTORY OF CCHC IN NORTH CAROLINA
• 1980s: Registered Nurses hired by a few local health
departments to work with “day care” programs. Focus on
communicable disease and direct service to Child Care
Programs.
• Early 1990s: Additional RNs hired by local health
departments. Focus on identification and treatment of
disease. Direct service and education continue to be
offered.
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HISTORY OF CCHC
• 1995: Beginning of Healthy Child Care NC through
NC DHHS, Division of Public Health
• 1996: Pilot NC CCHC Training
• NC Child Care Health & Safety Resource Center
developed as a resource for CCHCs, other
professionals working with child care, and parents.
1-800 CHOOSE 1 line operated through Resource
Center.
• Annual Healthy Child Care NC Educational
Conference
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HISTORY OF CCHC LATE 1990s-EARLY
2000s
• NC CCHC Training focused on consultation
model. Most NC CCHC Programs offering
consultation as opposed to direct service
• UNC-CH School of Public Health takes
responsibility for NC Health & Safety Resource
Center and NC CCHC Training course
• NC CCHC Training becomes combination of
web based and face to face training
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HISTORY OF NC CCHC
• Annual Healthy Child Care NC Educational
Conference becomes Annual NC CCHC
Educational Conference
• Staff from NC Child Care Health & Safety Resource
Center coordinate conference
• NC CCHC training course offered as a Community
Health Nursing course at two state universities.
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HISTORY OF CCHC
• NC CCHC Association developed. Membership is
voluntary.
• Sub-committees develop policies, mentor other
CCHCs, recommend best practice, develop
standardized care plans for chronic disease,
promote CCHC as a profession.
• NC CCHC Association takes responsibility for
planning annual educational conference
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ACCOMPLISHMENTS OF THE NORTH
CAROLINA CCHC ASSOCIATION
• Development of Professional Practice
Statement and Code of Ethics.
• Influence change at policy level by
advocating for health and safety in ALL
out-of-home care settings.
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THANK YOU!!!
• NC DHHS/NC Division of Public Health
• Division of Child Development
• North Carolina Partnership for Children/ Smart Start
• And, all of our many community partners
… for supporting CCHC Programs
throughout
the state!
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QUESTIONS?
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PATRICIA ISBELL
A CHILD MALTREATMENT PREVENTION PROJECT
THE UNIVERSITY OF NORTH CAROLINA
AT CHAPEL HILL
GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH
DEPARTMENT OF MATERNAL AND CHILD HEALTH
FUNDED BY THE DUKE ENDOWMENT
ACKNOWLEDGEMENTS
Jonathan Kotch, Principal Investigator, Distinguished Professor, Department of
Maternal and Child Health, Gillings School of Global Public Health
Mary Piepenbring, Vice President, The Duke Endowment
Brenda Boberg, Executive Director, Family Support Network of Eastern North
Carolina
Lisa Woolard, Executive Director of the Beaufort/Hyde Partnership for Children
Teresa LaRiche, Executive Director Family Support Network of the Crystal Coast
Tristan Bruner, Program Evaluator, Lenoir/Green Partnership for Children
Becki Brinson, Program Evaluator, Beaufort/Hyde Partnership for Children
Adib El Amin, Child Care Health Consultant, Lenoir/Greene Partnership for
Children
Heather Carter, Child Care Health Consultant, Lenoir/Greene Partnership for
Children
Glenda Pasko, Child Care Health Consultant, Beaufort Hyde Partnership for
Children
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OBJECTIVES
Participants will be able to:
1. list three components of an ecologic, community
based model of child maltreatment prevention.
2. describe three characteristics of a child
maltreatment prevention project that utilizes out-ofhome child care settings for intervention.
3. describe the child maltreatment prevention role of
a Child Care Health Consultant.
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GUIDING PRINCIPLE
Change Requires:
• Knowledge
• Attitude
• Behavior
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BACKGROUND
Bronfenbrenner (1979) emphasized an approach that extends beyond
interactions/involvement in immediate settings (microsystem) to
larger contexts in which development occurs.
These contexts include:
•
the mesosystem, where microsystems such as home and school
environments interact
•
the exosystem where social and community networks such as
hospitals, neighborhood centers, churches interact
•
the macrosystem where larger social, cultural, and political norms
exist
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MODEL
The FFCC Project uses “prevention strategies involving a
continuum of activities that address multiple levels of the
model. These activities are developmentally appropriate and
this approach is more likely to sustain prevention efforts over
time than any single intervention” (CDC, 2007).
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WHY OUT-OF-HOME CHILD CARE?
According to the US Census Bureau
• 31% of America’s children under 5 years of age are cared for
in organized child care settings including child care centers
and family child care homes, preschools and Head Start
Programs (Overturf Johnson, 2005).
• Child care is uniquely suited as a venue for accessing a
substantial minority of the community’s preschool children.
• More parents and children consistently participate in child
care centers than any other setting prior to school age.
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Gutterman (1997) reported that “by
screening participants and targeting
services to only those in the highest-risk
categories, interventions may screen out
those who are most responsive to
treatment”.
27
WE DIDN’T……
• Go out and create new curricula
• Go out and create new
screening/assessment tools
28
WE DID……
• Put the concept of social ecology to work
• Use a “new” professional, Child Care Health
Consultant
• Involve multiple local agencies and
community individuals in the planning
process
• Utilize validated curricula
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THE FAMILY FRIENDLY CHILD CARE MODEL
Public Awareness
Professional Papers
Local Advisory Board
Incredible Years
Family Support Network
CSEFEL
Screenings,
Intervention
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2005-2007 CHILD MALTREATMENT NUMBERS BY
COUNTY
1,168
1200
1,048
1000
800
772
674
Investigated
600
Substantiated
280
400
189
176
200
102
0
2005
2007
Beaufort County
2005
2007
Lenoir County
Source: The Annie E. Casey Foundation, Kids Count 2010 Data
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WHAT ARE WE MEASURING?
• Child
• Social Emotional Development
• Challenging Behaviors
• Family
• Risk factors
• Depression
• Knowledge of Parenting
• Child Care Center
• Staff Depression
• Staff Satisfaction
• Classroom Environment
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WHAT ARE THE INTERVENTIONS?
• Child
• CSFEL trained staff
• Referral to Medical Home with follow-up services as needed
• Family
• Parenting Pages
• Incredible Years Classes
• Family Support Network services
• Out-of-Home Child Care Centers
• Child Care Health Consultant services
• CSEFEL trained programs
• Monthly Feedback from the Event Sampling Form
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CHILD INFORMATION
TOTAL NUMBER OF CHILDREN IN THE STUDY=484 56% MALE 44% FEMALE
Age of Children in 6 Month intervals
80
70
60
50
40
30
20
10
0
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WHAT IS CSEFEL?
• The Center on the Social and Emotional Foundations of Early
Learning-a national resource center funded by the Office of Head
Start and the Child Care Bureau
• Module 1-Promoting Children’s Success: Building Relationships and
Creating Supportive Environments
• Module 2-Social-Emotional Teaching Strategies
• Module 3-Invividualized Intensive Interventions: Determining the
Meaning of Challenging Behavior
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WHAT IS THE INCREDIBLE YEARS?
• A Parent Education Package developed by Carolyn WebsterStratton,
University of Washington
• 14 weekly sessions with homework and trainer follow-up
between sessions
• Goals
1.To Reduce Conduct problems
2.To provide a cost-effective, community-based, universal
prevention program designed to promote social competence
and prevent maladapted behavior
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NUMBER OF OUT-OF-HOME CHILD CARE
PROGRAMS CHILD HAS EVER PARTICIPATED IN
Six
4
Five
8
8
Four
42
Three
116
Two
274
One
0
50
100
150
200
250
300
37
TOTAL NUMBER OF FAMILIES WHO SIGNED
CONSENT FORMS AND FILLED OUT
PAPERWORK=484
Type of Community
14%
53%
32%
Urban (city)
Rural
Suburban
38
YEARLY FAMILY INCOME
120
100
80
60
40
20
0
39
CAREGIVER LEVEL OF EDUCATION
160
140
120
100
80
60
40
20
0
40
OUT-OF-HOME CHILD CARE STAFF
• 100% of the staff in 28 Center-based facilities
participated in the study.
• 248 Staff completed study forms and participated in
CSEFEL training.
• 99% (245) are Female.
• 1% (3) are Male.
• Mean age of 36 with a range of 19-72 years.
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HIGHEST LEVEL OF EDUCATION
Completed Graduate School
Some Graduate School
Completed 4-year…
Some 4-year College/University
Completed Community College
Some Community College
Completed High School
Some High School
0
3
8
23
20
60
98
8
3
20
40
60
80
100
42
STAFF SATISFACTION
Morale is High
Always
Frequently
Somewhat
Sometimes
Seldom
Never
0
20
40
60
80
100
120
43
ENOUGH TIME TO DO THE JOB
140
120
100
80
60
40
20
0
44
LINKING IT ALL TOGETHER
Child Care Health Consultant
“a health professional who has an interest in
and experiences with children, has knowledge
of resources and regulations and is comfortable
linking health resources with facilities that
provide primarily education and social services”
Caring For Our Children, National Health and Safety Performance Standards:
Guidelines for Out-of-Home Child Care Programs, 2nd Edition, 2002, p32.
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PENN GRUEHN
GUILFORD COUNTY
DEPARTMENT OF PUBLIC
HEALTH
J O N AT H A N K O T C H 1,
A B B E Y A L K O N 2,
A N G E L A C R O W L E Y 3,
SARA BENJAMIN NEELON4
1 University
of North Carolina at Chapel Hill
University of California San Francisco
3 Yale University
4 Duke University
2
ACKNOWLEDGEMENTS
Impossible without Sarah Hartmann, Sherika Hill,
Michelle Masson, Viet Nguyen, Roberta Rose, Eric
Savage, Linda Shipman, Cynthia Wallace, Suzanne
Weber, Pan Yi, and Lori Yu
Supported in part by Maternal and Child Health
Bureau grant #R40MC08727
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BACKGROUND
• 31% of America’s children under 5 years of age are
cared for in organized preschool settings (Johnson,
2002).
• In the 2003-2004 NHANES, 26.2% of 2 to 5 year olds
were either overweight or at risk for overweight (Ogden
et al., 2006).
• The Nutrition And Physical activity Self-Assessment in
Child Care (NAPSACC) pilot intervention shows
promise as an approach to promote healthy weight
environments in preschool settings (Benjamin et al.,
2007).
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STUDY AIM
To evaluate the Nutrition and Physical Activity Selfassessment for Child Care (NAP SACC) intervention
conducted by nurse child care health consultants in
child care centers in California (CA), Connecticut
(CT), and North Carolina (NC)
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METHOD
• 18 licensed child care centers (6 in each state)
• served 3-5 year olds
• received federal subsidy or participated in food program for
low-income children
• providers spoke English
• Matched on size and proportion of children on
subsidy
• Randomly assigned to NAP SACC intervention or
control
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THE INTERVENTION
• NAP SACC workshops for child care providers





Childhood obesity
Healthy eating for young children,
Physical activity for young children,
Personal health and wellness
Working with families to promote healthy behaviors
• NAP SACC workshop for parents

Nutrition and physical activities
• Child care health consultation over 6-7 months



Mean time spent during consultation on-site = 78 minutes
Mean time spent for off-site (phone, email) consultation = 27 minutes
Mean # of consults per site = 15 (12 on-site and 3 off-site)
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MEASURES
 Descriptive statistics
 Independent samples t-tests to compare
intervention and control groups
 ANOVA to compare characteristics by state
 Regression or paired t-test to analyze change from
pre- to post-intervention
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OUTCOMES
Changes in:
 child care teacher knowledge and attitudes
 parents’ knowledge
 child care center written policies
 children’s dietary intake
 children’s physical activity, and
 children’s BMIs
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RESULTS
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PROVIDER DEMOGRAPHICS (N=137)
Demographics
CT
CA
NC
Total
Some community
college or less
24
17
28
69
Community college
grad or more
25
35
8
68
Child care provider
education*
*p<.05
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FAMILY ETHNICITY* (N=581)
Ethnicity
CT
CA
NC
Total
111
28
141
280 (48%)
African American
21
31
49
101 (17%)
Latino
30
44
12
86 (15%)
Asian
1
69
4
74 (13%)
19
9
7
35 (6%)
1
0
5
6 (1%)
183
181
218
581 (100%)
White
Mixed, Other
Missing
Total
*p<.05
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CHANGES IN PROVIDER KNOWLEDGE [MEAN (SD)]
Workshop
Topic
Pre-Workshop
PostWorkshop
Change†
Childhood
Obesity
2.4 (.6)
2.9 (.8)
.5 (1)*
Healthy Eating
2.1 (1)
3.5 (.8)
1.4 (1)*
Physical
Activity
2.9 (.8)
3.0 (.6)
.1 (.8)
Personal
Health &
Wellness
2.5 (.9)
3.2 (.8)
.72 (.9)*
Working with
Families
3.5 (.7)
3.8 (.5)
.3 (.8)*
*p<.05
† 75 < n < 83
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CHANGE IN PARENTS’ KNOWLEDGE [MEAN (SD)]
Workshop
Topic
Family
Workshop
Pre-Workshop
PostWorkshop
Change†
2.2 (.9)
3.4 (.9)
1.2 (1)*
*p<.05
†
n = 75
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CHANGES IN CENTER–LEVEL HEALTH AND SAFETY
POLICIES N = 18 [MEAN (SD)]
Preintervention
Postintervention
Change
Intervention
1.2 (1.6)
6.7 (4.7)
5.5 (4.2)
Control
1.6 (1/8)
1.6 (1.8)
0
0 (0)
3.7(3.2)
3.7 (3.2)
0.1 (0.4)
0.1(0.3)
0
Policy
Nutrition*
Physical Activity*
Intervention
Control
*p<.05
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CHANGES IN CHILD-LEVEL PHYSICAL ACTIVITY
[Mean (SD)]
Intervention
(n=56)
Control
Sedentary*
-4.3 (3.2)
4.5 (3.5)
Moderate to
vigorous
5.6 (2.0)
3.0 (2.1)
Outside activity
4.7 (4.6)
-3.8 (4.2)
Gross motor activity
-1.1 (4.4)
-10.2 (4.2)
Activity Observed
(n=48)
*p< 0.1
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Changes in Child-Level BMI
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CONCLUSIONS
• Demographic differences
 Not significant between intervention & controls
 Significant differences between states were controlled for in
the analyses.
• Knowledge changes
 There was a positive increase in knowledge for the
providers at 4 of the 5 workshops.
 Parents who attended the nutrition and physical activity
workshop increased their knowledge.
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CONCLUSIONS CONT’D.
• Intervention centers had more written nutrition and physical activity policies
complying with National Health and Safety standard than did controls.
• Children in the intervention centers had fewer sedentary behaviors than
children in control centers.
• BMI
 Intervention centers had a decrease in the proportion of obese children
and an increase in the proportion of overweight children.
 On the other hand, there was an increase in the proportion of obese
children in the control centers and a decrease in the proportion of
overweight children.
 It is possible, therefore, that during the NAPSACC intervention obese
children in intervention centers shifted to the overweight category while
overweight children became obese in the control centers.
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REFERENCES
1. Benjamin SE, Ammerman A, Sommers J, Dodds J, Neelon B,
Ward DS. Nutrition and Physical Activity Self-assessment for
Child Care (NAP SACC): Results from a pilot intervention. J
Nutr Educ Behav 2007;39:142-149.
2. Johnson JO. Winter 2002. Who’s minding the kids? Current
Population Reports P760-101. Washington DC: US Census
Bureau http://www.census.gov/prod/2005pubs/p70-101.pdf.
3. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ,
Flegal KM. Prevalence of overweight and obesity in the united
states, 1999-2004. JAMA 2006;295:1549-1555.
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