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ABC Grow Healthy (South Carolina)


Intent of the intervention

The ABC Grow Healthy Initiative, designed to promote healthy eating and physical activity in the child care setting, is an emerging intervention.

To promote health and well-being among children, the South Carolina Department of Health and Environmental Control (DHEC) partnered with the South Carolina Department of Social Services (DSS) to develop and enhance nutrition and physical activity-related standards for incorporation into the existing statewide ABC Child Care Quality Rating and Improvement System (ABC Quality).

The nutrition and physical activity standards are named ABC Grow Healthy, in recognition of the ABC Quality's ultimate ownership of the standards. The purpose of the ABC Grow Healthy standards is to increase children's physical activity and consumption of healthy foods, while in the child care setting. The focus of this document is the development, implementation, and evaluation of the ABC Grow Healthy standards.

The integration of new nutrition and physical activity standards into the ABC Quality system for child care centers was an administrative policy change. The policy seeks to create change in behaviors and health status via organizational policy changes as well as changes in staff practices.

The components of the ABC Grow Healthy administrative policy are:

  • ABC Grow Healthy Best Practices: Nutrition Standards
  • ABC Grow Healthy Best Practices: Physical Activity Standards

The standards adopted by ABC Quality are on a 5 level continuum, from A+ to C quality levels. Checklists that show the nutrition and physical activity standards are available in the Intervention Materials section of the template.

The targeted outcomes for ABC Grow Healthy are:

  1. Increased number of centers with nutrition and physical activity policies.
  2. Healthier environments in child care centers as a result of implementation of nutrition and physical activity policies.
  3. Behavioral outcomes for children in participating child care centers:
    • Increase in child consumption of fruits and vegetables and other healthy foods (i.e., lean meats, whole grains, etc.), while in care of provider over long term.
    • Increase in child physical activity while in care of provider over long term.

Intended Population: The primary audience for this policy intervention is children attending child care programs. Children range in age from birth through 12 years.

Setting(s): The setting for this intervention is child care centers.


ABC Quality, established in 1993, is a voluntary program. ABC Quality is part of the Division of Early Care and Education at DSS, which also includes the Child and Adult Care Food Program (CACFP), ABC Child Care Voucher System, Child Care Licensing, and the SC Center for Child Care Career Development. Centers apply to participate in ABC Quality and strive to achieve compliance across the comprehensive quality standards, which now include nutrition and physical activity. By participating in ABC Quality, providers agree to unannounced reviews by ABC Quality monitors to assess compliance with the comprehensive standards. Comprehensive standards include some that are mandatory and others that are scored as part of a classroom observation. Participating providers receive public recognition of their quality rating and the option to participate in the ABC Child Care Voucher System to serve families receiving child care vouchers. If serving families that receive child care vouchers, providers receive higher reimbursements at higher levels of quality and lower reimbursements at lower levels of quality. The highest level of reimbursement goes to Level A+ centers and descending levels of reimbursement are provided to A, B+, B, and C level centers.

In 2008, a South Carolina team participated in the Southern Collaborative on Obesity Reduction Efforts Leadership Summit. This spurred a planning effort focused on integrating nutrition and physical activity into the ABC Quality system. South Carolina also received funding from the Council of State Governments to pilot a small initiative with five child care sites to improve quality related to nutrition and physical activity.

In 2010, DHEC received a Communities Putting Prevention to Work (CPPW) grant from CDC to collaborate with ABC Quality to create and implement a state-level policy centered on establishing and implementing nutrition and physical activity standards in the state's quality rating and improvement system. A pilot of the proposed standards was conducted from February 1 — June 30, 2011 in 19 child care centers serving over 3,500 children ages birth to 12 years. Based on feedback received from providers and experts during the pilot, the wording of standards was modified and the number of standards was reduced. This pilot evaluation, conducted by DHEC, was part of the state's CPPW project; more information about this evaluation is available throughout this template. After the pilot, the nutrition and physical activity standards (ABC Grow Healthy) were adopted by the ABC Quality system in January 2012 with an effective date of October 1, 2012. In advance of the effective date, DHEC and DSS representatives conducted workshops and discussions with child care providers around the state to increase awareness of the standards and expected compliance.

Length of time in the field: The ABC Grow Healthy standards became effective October 1, 2012 with the potential to impact approximately 1,100 child care centers in the state.