Potential Public Health Impact
Reach: The potential reach for this administrative policy is moderate to strong. While the ABC Grow Healthy standards are comprehensive as they target both nutrition and physical activity environments within child care centers, where approximately 85,000 children attend, the participation in the ABC Quality system is voluntary, thus likely limiting its potential for reach.
Effectiveness: While no outcome data on behavior change or health status were available to support this administrative policy (as of this review), based on the evidence from similar policies and given that the strategies are evidence-based, there is considerable potential for effectiveness in changing the nutrition and physical activity behaviors of the children attending child care centers, ultimately influencing health status.
Adoption: Based on the number of Level B+ and B centers reviewed (518 centers) during Year 1 (2012-2013) of the standards, the rate of adoption appears to be relatively high as it ranged between 52% and 77% for the mandatory nutrition policy and 47% and 69% for the mandatory physical activity policy. The rate of adoption for components of the nutrition policy also appears to be relatively high as it ranged between 60% and 85% compliance. There are currently no available data related to Level B+ and B classroom observation standards. Also, no data are currently available for A and C-level centers. Based on available data, the potential for adoption across various child care centers appears high due to the feasibility of the standards, and the relatively high percentage of child care centers complying with the nutrition and physical activity standards in year one. Additionally, while no specific details are available, financial incentives for participation are significant, thus the potential and motivation for child care centers to adopt the policy is further increased.
Implementation: Prior to finalizing the standards, an extensive pilot evaluation was conducted in 2011 to assess feasibility of implementing the standards. The final standards adopted by the ABC Quality system were carefully selected based upon provider input and expert opinion, thus one may conclude the administrative policy could be feasibly implemented. While the pilot evaluation was only conducted with B+ and B level centers, its potential for adoption across various child care centers appears high due to the systematic process of determining what standards may be most feasible for the given environment. Similar to adoption, the reimbursement incentive may further increase likelihood of implementation. Additionally, ABC Quality assessors complete unannounced site visits to monitor implementation of the ABC Grow Healthy standards, which can help ensure ongoing implementation and compliance.
Maintenance: Once implementation of the administrative policy is complete, maintenance seems feasible since the components do not necessarily require extensive resources for sustainability. Furthermore, the reimbursement incentive is likely to encourage maintenance. In addition, the ABC Quality system that the ABC Grow Healthy nutrition and physical activity standards are integrated into, has been in existence for 20 years. Taking all these points into consideration, the potential for maintenance of this administrative policy is high.