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Nutrition and Physical Activity Self-Assessment for Child-Care (NAP SACC)

Implementation

Note: This section of the template provides a succinct outline of the basic steps to implement the intervention. A more detailed implementation guide is available in Intervention Materials, providing a thorough description of the implementation process.

NAP SACC relies on trained consultants, familiar with child care facilities, to implement the intervention.  Consultants who will be working with child care facilities should complete four-hours of web-based training on implementation of the intervention, nutrition, physical activity and healthy weight in young children. Training is highly recommended to increase the confidence of the consultants and to promote implementation of the core elements of the intervention.  Consultants can recruit child care facilities to participate in the intervention by letter, phone, or in-person.  The intervention can be fully implemented in about six months; however, child care facilities may continue to use NAP SACC as part of quality improvement.  

 How It Works

  1. Self-Assessment: Prior to a site visit, the consultant mails a NAP SACC self-assessment instrument to the child care facility director, who completes the instrument with help from key staff, such as the cook, teacher or program planner. This tool assesses the facility on 14 key areas in nutrition and physical activity with response options ranging from minimal standard to best practice. This should be completed without Consultant help. [Note:The instrument is recommended for use as a self-assessment but not as a research tool to assess outcomes.] 

  2. Goal Setting and Action Planning: During a scheduled site visit, the Consultant reviews the entire self-assessment instrument with the child care facility director and talks about each key area. Based on self-assessment answers, facilities chose to improve at least 1 nutrition, 1 physical activity, and 1 other key area. The Consultant assists in the development of a facility-specific plan with action steps to implement the specific policy, practice and environmental changes they intend to address. Facility directors should be challenged to make positive and sustainable improvements. 

  3. Workshop Delivery: The NAP SACC Consultant delivers 5 ready-to-use workshops to the facility staff.  These workshops include: 1) Childhood Obesity, 2) Nutrition for Young Children, 3) Physical Activity for Young Children, 4) Personal Health and Wellness for Staff, and, 5) Working with Families to Promote Healthy Weight Behaviors.  Each workshop takes approximately 30-60 minutes to complete.  Delivery of the workshops can be tailored to meet the needs of the Consultant and facilities and to maximize staff participation.  For example, they may be delivered on site as a series during “nap time,” or on a Saturday as a single event.    North Carolina child care providers receive continuing education credits for attending the workshops.

  4. Targeted technical assistance: The NAP SACC Consultant maintains regular contact (recommend monthly, but more often if needed); contact can be through in-person meetings, telephone, or email) with the facility to provide support and guidance in making their improvements. NAP SACC provides technical assistance materials to Consultants which include: 1) the Consultant Technical Assistance Manual which provides tips for meeting Best Practice Guidelines, potential strategies for overcoming barriers to change, guidance on the rationale for each “best practice” recommendation, and associated references and resources; 2) handouts for the child care facility; and 3) handouts for parents.

  5. Evaluate, Revise, and Repeat: The NAP SACC self-assessment instrument is completed a second time (after 6 months or earlier if necessary) to see where improvement have or haven’t been made.  At this time Action Plans are revised to include new goals and objectives and technical assistance continues.

Keys to Success

  • Consistency with state licensing requirements: It is essential to tailor the NAP SACC assessment to ensure that responses on the tool are consistent with state licensing requirements for child care facilities.  In addition, collaboration with the state agency that oversees implementation of the Child and Adult Care Food Program is helpful.

  • Continuing education credits: Often, child care providers are required by the state licensing agency, to complete continuing education each year.  Offering CEUs through the child care licensing agency is an incentive for staff to participate in training.  

  • Setting achievable goals: Some facilities are overly anxious to “fix” everything at one time.  It is helpful to set smaller achievable goals and then add new goals as the facility succeeds at making change.

  • Incentives for child care facilities: Incentives in the form of small items that support organizational change (gift cards for classroom supplies, balls or hula hoops, activity or nutrition books for children) can be provided periodically.

  • Community resources: It is beneficial to link the child care centers to community resources in order to enhance their ability to implement change. 

  • Tailoring technical assistance: Some child care facilities may need lots of support and encouragement, while others may be able to accomplish change on their own so tailoring technical assistance to the needs of the facility is suggested.

  • Commitment: Gaining organizational commitment from child care facilities prior to implementation is essential.

  • Consultant attributes: Communication skills and experience of the Consultants working with child care centers is important to making the implementation work.

Barriers to Implementation

  • Scheduling: Initial meeting between the facility director and Consultant was often difficult to schedule.

  • Staff turnover: The child care industry has more frequent staff turnover that is seen in many other sectors.  This presents a challenge to implementation of any intervention that requires staff participation.

  • Control over food selection:  Many facilities have food catered and feel as if they have little control over changes to the foods served at the center.   These facilities may need more support to succeed.

  • Consultant time commitment: Consultants with many competing responsibilities had difficulty finding the time to provide adequate technical assistance and follow-up.

  • Child care Director commitment: Directors who were not committed and motivated to make changes were not as willing to find the time to work on implementing changes.  In some cases, another interested staff person at the facility can take a lead with support from the Director.

  • Consultant knowledge: Consultants who are not confident in their knowledge of nutrition and physical activity and feeding young children are less comfortable providing technical assistance to facilities.  Consultants may need training beyond that provided by NAP SACC to acquire what is needed to make the program work at their childcare facilities.

  • Addressing physical activity areas: Many times child care directors did not think that the center needed assistance with enhancing physical activity because they generally view the children as active (“hyperactive”) and because the children go outside to play.  Helping providers understand ACTIVE (climbing, running) vs. PASSIVE (sitting in the sand box) play may be helpful.

  • Food Access: Child care facilities often buy food at large discount clubs and through whole sellers.  This may limit access to whole grain products and fresh fruits and vegetables, while increasing access to inexpensive, commercially-prepared snacks and breakfast items.