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Smart Start and NAP SACC – A Statewide Collaboration to Address Childhood Overweight in Child Care. 2008 National Smart Start Conference Koury Center, Greensboro, NC. Cynthia D. Turner, MS, NCPC’s Health Consultant Sarah Ball, MPH, RD, NAP SACC Project Coordinator. Objectives.

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smart start and nap sacc a statewide collaboration to address childhood overweight in child care

Smart Start and NAP SACC – A Statewide Collaboration to Address Childhood Overweight in Child Care

2008 National Smart Start Conference

Koury Center, Greensboro, NC

Cynthia D. Turner, MS, NCPC’s Health Consultant

Sarah Ball, MPH, RD, NAP SACC Project Coordinator


Learn about unique collaboration between Smart Start and NAP SACC

Recognize the need to improve children’s nutrition and physical activity environments in child care settings

Encourage increased participation in NAP SACC Program


Smart Start Vision

Every child reaches his or her potential and is prepared for success in a global community

what is smart start
What is Smart Start?
  • Created in 1993 by Governor James Hunt
  • Initiative to address the needs of children birth-5 years old
  • Funding for 78 public-private partnerships, which include all 100 counties in the state
  • Local planning and decision making linked to outcomes for young children




The Problem: National and State Obesity Epidemic

Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2006(*BMI 30, or about 30 lbs. overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: Behavioral Risk Factor Surveillance System, CDC.




potential causes of childhood overweight obesity
Potential Causes of Childhood Overweight / Obesity

Behavioral Factors - large portion sizes, fast food, high sugar beverages, high calorie snack foods,

decrease in children’s physical activity,

increase in screen time

Environmental Factors – family role models at home; child care provide healthy eating and physical activity practices; lack of community sidewalks, bike paths and parks

Genetic Factors - may increase a child’s chance for being overweight; exists in conjunction with environmental and behavioral factors

consequences of childhood overweight obesity
Consequences ofChildhood Overweight / Obesity

Medical risks - cardiovascular disease, hypertension, asthma, type 2 diabetes, premature death;

Psychosocial risks - low self-esteem, depression, hinders academic and social functioning;

Economic Cost - increase in medical expenses, reduction in economic, opportunity / productivity, time lost from work or school, increased child care costs, annual cost to NC taxpayers = $2.1 Billion

nap sacc activity




What’s it all about?

what is
What is…



Principles Guiding NAP SACC Development

  • Keep the process simple and practical
  • Design it for dissemination
  • Build on existing public health infrastructure
  • Use a self-assessment to motivate and engage child care providers to improve their polices, practices, and environment.
intervention structure
Intervention Structure
  • Health professional who works with child care (e.g., Child Care Health Consultant) and is trained to deliver intervention
  • Center moves through the 5-step intervention at their own pace (suggest ~ 6 mo.)
  • Consultant provides education, technical assistance and support.
nap sacc steps
  • Self-Assessment
  • 2. Action Planning/Goal Setting
  • 3. Workshop Delivery
  • 4. Targeted Technical Assistance
  • 5. Evaluate, revise and repeat
step 1 self assessment
Step 1: Self-Assessment
  • Center director completes self-assessment instrument with help from key staff, such as the cook, teacher or program planner.
  • This should be done without Consultant help.
nutrition and physical activity key areas
Nutrition and Physical Activity Key Areas
  • Fruits and Vegetables
  • Meats, Fats, and Grains
  • Beverages
  • Menus and Variety
  • Feeding Practice
  • Foods Outside of Meals and Snacks
  • Supporting Healthy Eating
  • Nutrition Education
  • Nutrition Policies
  • Active Play and Inactive Time
  • Play Environment
  • Supporting PA
  • PA Education
  • PA Policies
step 2 action plan
Step 2: Action Plan
  • Initially, director chooses 1 nutrition, 1 physical activity, and 1 other key area to improve.
  • Improvements chosen should be facility guided with the Consultant available only for assistance and support.
step 3 deliver workshops
Step 3: Deliver Workshops
  • The NAP SACC Consultant delivers the 5 workshops to child care staff at a mutually agreeable time and place.
  • These are currently approved for CEUs in North Carolina.
step 4 provide technical assistance
Step 4: Provide Technical Assistance
  • Regular follow-up with center to see how they are doing.
  • This offers them a means of support, helps break through barriers they may be facing, and facilitate the changes they hope to make.
  • This may be the most important step in the process!!
step 5 evaluate revise and repeat
Step 5: Evaluate, Revise and Repeat
  • This is not a finite process, but evolving over time.
  • After 6 months or earlier if necessary, director completes the self-assessment again.
  • What has changed? Did they make the improvements they chose? What would they like to do next?
tool kit components
Tool Kit Components
  • Intervention Tools
  • Technical Assistance Materials
  • Informational Materials

NAP SACC Toolkit

tool kit components25
Tool Kit Components
  • Intervention Tools
  • Self-assessment
  • Sample self-assessment
  • Self-assessment Instruction Sheet
  • Action Planning Document
  • Sample Action Planning Document
  • 5 NAP SACC workshops with activities
tool kit components26
Tool Kit Components
  • Technical Assistance Materials
  • Technical Assistance Manual
  • Facility Key Area Handouts
  • Parent Handouts for Providers
  • Sample nutrition and physical activity policy
tool kit components27
Tool Kit Components
  • Informational Materials
  • Recruitment letter for providers
  • NAP SACC informational brochure for parents
  • Best Practice Recommendations
  • Certificate of Completion for Providers
nap sacc dissemination
NAP SACC Dissemination
  • NAP SACC was selected for dissemination as an effective practice-based intervention
  • Center for Research Translation and Dissemination has sponsored the preparation of NAP SACC for web-based dissemination

Training and all materials available online

  • 3 core modules & 3 supplemental modules
  • Activities and quizzes built in.


smart start and nap sacc
Smart Start and NAP SACC

Why Smart Start’s Collaboration with NAP SACC?

NC’s childhood overweight / obesity epidemic

Smart Start’s support of nutrition and physical activities

Smart Start’s commitment to CCHC projects

NAP SACC’s research and evaluation data

NAP SACC’s strong support and commitment

2007 09 nap sacc pilot grant project
2007-09 NAP SACC Pilot Grant Project

Proposal Requirements:

  • Statement of Need
  • Description of Target Population
  • Program Implementation
  • Community Collaboration
  • Proposed Budget – 2 years; Grant awards for centers and/or CCHCs
2007 09 nap sacc pilot grant project32
2007-09 NAP SACC Pilot Grant Project

Five Step Implementation Plan:

  • Start up & Orientation
  • Quality Assurance for Model Fidelity
  • Technical Assistance
  • Evaluation
  • Reporting
start up orientation
Start Up & Orientation

Grantees contacted by Grant Owner

Webcasts to “walk-through” project

Site visits and/or conference calls

Ongoing technical assistance – Spanish version materials

quality assurance for model fidelity
Quality Assurance for Model Fidelity

NAP SACC Pilot Grant Requirements:

Smart Start Grantees/Partnerships

Child Care Centers

Consultants (CCHC / RDs)


Two on-site visits/yr to NAP SACC Grantees

Quarterly “Check-ins” each year

ncpc pilot requirements
NCPC Pilot Requirements

Smart Start Partnerships:

A minimum of ten 3-star licensed centers with at least 20 children enrolled in each center; OR

A sufficient number of 3 to 5-star licensed centers that have at least 75% of the total children enrolled in all 3 to 5-star licensed centers must participate OR

A minimum of 200 children (2-5 year olds) to participate.

Community collaboration, supervision, financial contribution, etc.

ncpc pilot requirements36
NCPC Pilot Requirements

Child Care Centers:

Commit to participate in NAP SACC for at least six months.

Participation is limited to centers that have not previously participated in NAP SACC.

Ensure that key staff complete five, mandatory trainings

Personnel / Consultants:

State-trained Child Care Health Consultants (CCHC) or pediatric-trained Registered Dieticians (RD

CCHC/RDs must complete a 4-hour NAP SACC training OR

complete web-training available after January 2008

CCHC/RDs must be hired by Nov. 16, 2007

pilot requirements
Pilot Requirements

Projected Outcomes

Increase the number of early care and education environments implementing healthy nutrition and physical activity practices.

75% of child care centers that participate will complete their Action Plan to incorporate improved nutrition and physical activity practices.

75% of child care centers that complete their Action Plan will demonstrate improvement in nutrition and physical activity practices as measured by pre- and post-assessment scores.

ncpc technical assistance
NCPC Technical Assistance

Grantee Owner to provide ongoing technical assistance to NAP SACC Grantees:


Conference Calls


Site visits

Tour of NAP SACC project

ncpc evaluation
NCPC Evaluation

Purpose of Evaluation:

To learn if NAP SACC is making a difference in the nutrition and physical activity practices in child care centers.

To ensure that NAP SACC programs are reaching the intended target population.

ncpc evaluation40
NCPC Evaluation

Evaluation Components:

Pre- and Post-Self Assessments

Center Profile Cover Sheet

Outputs / Counts:

Participating Centers

Participating Children

Outcomes / Results

Narrative / Success Stories

ncpc reporting
NCPC Reporting

Type of Reports:

Programmatic / Evaluation Reports

Financial Reports

Grantees to submit written and electronic reports to NCPC / contracted evaluator

NCPC will report to Key Stakeholders (e.g., General Assembly)

panel discussion
Panel Discussion

NAP SACC Grantees:

Guilford County Partnership for Children

Orange County Partnership for Children

Person County Partnership for Children

Stanly County Smart Start Partnership for Children

thank you for coming
Thank you for Coming!!!

Cynthia Turner, MA, Health Consultant

The North Carolina Partnership for Children, Inc.

Planning and Program Department

Sarah Ball, MPH, RD, Project Director

Center for Health Promotion and Disease Prevention

University of North Carolina at Chapel Hill

Phone: 919-966-6035;

questions evaluation conclusion
Questions, Evaluation, Conclusion

“Don’t step on it…it makes you cry.”