Assessing the Current Status of Opportunities and Feasibility of Options for Change

opprtunity

 

Assessment Questions & Key Considerations

For each primary opportunity on the spectrum, consider the assessment questions listed below and review the key considerations outlined.
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  • What types of ECE facilities are regulated and do regulations vary by type?
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  • How many children participate in the different types of licensed care?
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  • What is the process for changing licensing and administrative regulations? If there is more than one process, what are the pros and cons of each?
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  • When were regulations last updated?
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  • How well do current regulations align with Caring for Our Children: Health and Safety Standards for Early Care and Education (CFOC) national standards for obesity preventing in ECE? (See Appendix H)
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  • How would proposed regulation changes be viewed by the ECE community?
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  • Do data exist that can help determine whether specific regulation changes might be more acceptable given current provider practices?
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  • Are there reasons to target regulatory change to all types of facilities in your state or just some?
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  • What is your State’s ‘readiness for change’ with respect to revising licensing requirements?  Click here for an assessment tool.
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  • What resources are needed to support ECE providers to successfully implement new regulations?
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Child and Adult Care Food Program

  • What proportion of eligible providers are not participating in the CACFP program?
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  • What are the barriers and facilitators of CACFP participation in your state?
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  • Do state paperwork requirements exceed federal requirements?
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  • What kind of training and technical assistance is currently available to facilities for participating in CACFP?
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  • Is CACFP participation promoted by licensing regulations or QRIS?
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  • Is the state currently working to increase participation? Have such efforts been made in the past?
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  • To what extent has obesity prevention been incorporated in the training and technical assistance provided under the auspices of CACFP? Do existing trainings incorporate obesity prevention messages? If no, has this been considered in the past?
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  • Are providers participating in CACFP given any incentives to achieve higher standards with respect to nutrition, breastfeeding, physical activity, or screen time?
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Quality Rating & Improvement System (QRIS)

  • Does you state operate a statewide QRIS? Is it a mandatory or voluntary system?
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  • Are any additional quality initiatives taking place in your state?
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  • To what extent are obesity prevention issues already incorporated (or under consideration) into your state’s QRIS or other quality initiatives?
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  • Where is there most room for improvement in state licensing regulations standards that might be amenable for inclusion in QRIS?
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Funding & Finance

  • What are the requirements for ECE programs to receive TANF reimbursements?
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  • Are CCDF resources going toward obesity prevention?
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  • Has your state applied for or been awarded a USDA Team Nutrition or Child Care Wellness grant?
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  • Have federal public health or SNAP-Ed funds awarded to your state or communities in your state been used for any activities focused on nutrition, physical activity, and obesity prevention in the ECE setting?
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  • What kinds of obesity prevention efforts are funded by private foundations in your state? Have private foundations considered efforts focused on the ECE setting?
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Pre-service and Professional Development

  • What are the minimum education requirements for each level of ECE providers in your state/community?  How are additional education opportunities for providers already supported?
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  • Does your state licensing and administrative regulations require training in the topices of nutrition, breastfeeding, physical activity, and screen time for either certification or professional development?
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  • Which vocational schools, colleges, and universityies education ECE providers?  Which offer ECE-related degrees?
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  • Do any ECE-related degree programs include training in obesity prevention?
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  • Who provides ongoing professional development training to ECE providers?  Do the trainings they provide include obesity prevention topics comprehensively?
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Facility-level Interventions

  • What types of obesity prevention interventions are currently being implemented in your state?
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  • Are any being implemented statewide now? In the past?
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  • How are these interventions delivered?
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  • Are obesity prevention curricula in use in your state? Which ones?
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  • How are these curricula disseminated?
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  • Is there an obesity-related curriculum that is distributed statewide?
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Technical Assistance

  • Who provides technical assistance to ECE providers? Is there a network of child care health consultants?
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  • What types of technical assistance for ECE providers are mandated in your state?
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  • Has CCR&R or Cooperative Extension staff in your state been involved in obesity prevention training or technical assistance for ECE providers?
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  • To what extent is obesity prevention information included in current ongoing technical assistance efforts for ECE providers? Are there unmet technical assistance needs related to obesity prevention?
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  • Does your state incorporate nutrition, breastfeeding, physical activity, and screen time concepts and standards into degree and certification programs for nurses, health educators, and other professionals who provide technical assistance to ECE providers?
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Access to Healthy Environments

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Farm to Preschool

  • Are there current farm-to-school/farm-to-preschool models in your state?
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  • Are ECE facilities interested in farm to preschool?
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  • Are there efforts to purchase local produce from a farmers’market in ECE?
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  • Are there efforts for ECE facilities to grow food their own?
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  • Are there efforts for ECE facilities to build direct relationships with local farmers?
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  • Are there efforts for ECE facilities to work together to form a purchasing cooperative?
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Joint Use

  • Does your state allow or encourage joint use agreements?
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  • Does your state have special rules regarding liability, fees, insurance, joint use, or applicability to schools or universities/colleges?
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  • Does existing legislation in your state support or require joint use agreements?
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Early Learning Standards

  • If your state already has early learning standards, do they include obesity prevention related standards? When were they last updated? Is there a time frame set for a future update?
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  • If your state is currently working to develop early learning standards, have those responsible been encouraged to consider to incorporating obesity prevention messages?
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  • If your state has decided not to develop standards at this time, what factors drove that decision? What would need to happen to make this a possibility in the future?
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  • What is your state’s willingness to implement early learning standards, or revise existing standards, to include obesity prevention?
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  • Do existing standards or ones under consideration complement other early childhood obesity policies in your state that are being developed or implemented?
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Family Engagement

  • Are there current efforts to reach families of children in ECE?
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  • Is there any information on familial needs related to ECE?
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  • Is there any information available on the expectations or attitudes families in your state have for obesity prevention efforts in ECE?
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  • Are there current effort to assist families in building skills in childhood obesity prevention and provide them with support?
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  • Are there models in your state of partnerships between parents and ECE programs to promote healthy behaviors to children?
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  • Are there efforts to support breastfeeding mothers in ECE?

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Determining Feasibility of Options and Garnering Support

Once the assessment is completed, the information gathered can be compiled into a state or community ECE Profile and reviewed at a stakeholder meeting. Publishing a professional report will help disseminate findings to all interested stakeholders. This report provides the launching point for developing an action plan for policy and practice change and might prove useful for garnering support and securing funding needed to implement plan elements. At the end of the assessment process, stakeholder groups should have a solid understanding of ECE infrastructure and be in general agreement about which opportunities to pursue in the short, mid, and long term.
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One way to gain early success in pursuing opportunities is to focus on those that offer the least amount of resistance and the greatest amount of support from key stakeholders—that is, a more easily attainable goal. Early success with this “low-hanging fruit” may build confidence and momentum for future efforts. A minor improvement may be the first step to achieve larger action plan goals. The Spectrum of Opportunity Rating Worksheet can help determine which opportunities are most feasible to pursue.

  • States differ in the types of facilities they govern (e.g. large and small family child care homes, large and small child care centers, and infant-only centers) and often have different sets of regulations for different facility types.  Some types of legally operating facilities, such as those affiliated with religious organizations, may be exempt from regulations.
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  • States differ on the process for changing regulations. A governing body empowered by the state ECE licensing agency may be responsible, or changes may have to occur through the state legislature. Some allow changes through either mechanism. Many states require a public comment period. Having stakeholder support before this stage is especially important to prevent the delay or even stall the process.
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  • Consider timing, as a number of ECE-related programs and policies happen on a regular schedule or have a narrow window of opportunity for change. For example, your state may evaluate their licensing and administrative regulations every 10 years. If you’ve missed this window, you may be more successful targeting another opportunity such as voluntary standards or QRIS, both of which would help lay the groundwork for a future regulation changes.
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  • The ECE community’s perspective on proposed regulation changes is critical. The change process should not be undertaken without their participation and support.
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  • The political climate in your state will affect the probability of successfully passing new regulations. Without the support of politicians and ECE regulators, change may not be possible.
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  • Members of the ECE community must have the training and resources they need to implement new standards. Conducting a survey or focus groups with a variety of members from the ECE community (family-home providers, center directors, teachers, health consultants, etc.) can help determine the type and amount of support and resources needed and identify how these needs can be reasonably met.
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  • Physical inspections of ECE facilities are conducted by trained professionals who critically observe and evaluate facilities for adherence to regulations. Consider the resources required to assess compliance of new regulations, as well as the frequency of inspections.
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  • Military ECE facilities in your state are regulated by the Department of Defense. To review policies and regulations from the Department of Defense and to see a list of military ECE facilities in your state, visit www.militaryhomefront.dod.mil.
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  • Some states preempt local jurisdictions from mandating higher standards through local board of health action or through other organizations. The Public Health Law Center—a nonprofit organization of law and policy specialists that help health leaders, officials, and advocates use the law to advance public health—conducted a 50-state review of statutes, regulations, and court cases relating to this preemption issue. Results of this analysis are available here.

It is important to understand how many facilities currently participate in CACFP and the primary reasons that eligible ones are not participating. The CACFP program office in your state may have some of this information, as might universities or research organizations. If information is not available, consider collecting data by surveying ECE facilities or conducting focus groups with providers.
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The paperwork required by federal and state governments for participation might be a barrier for some ECE providers. Explore opportunities to minimize state-level paperwork requirements that are outside of the federal requirements and consider whether technical assistance is or can be provided to providers interested in participating but concerned with the effort required to do so. Providing training on CACFP paperwork might help increase participation and prevent drop out.
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In addition to minimizing and assisting with paperwork requirements, states can work to increase participation in CACFP through:
– Coordination of subsidy, licensing, and food program agencies to conduct outreach and promotion;
– Inclusion of CACFP as part of ECE state agency quality plans, including QRIS (e.g., CACFP participation as a quality indicator); and
– Use of CACFP meal requirements as the ECE licensing and administrative regulation nutrition standards for all ECE facilities, regardless of program participation.

In some states, CACFP standards go beyond federal requirements. Information on some states and local jurisdictions that have done innovative work implementing improved nutrition and physical activity policies and standards at the state and local level has been compiled into The Child Care Wellness Tool Kit: Child and Adult Care Food Program by the Food Research and Action Center.

Most states have or are developing a statewide QRIS or other quality initiative. If your state is in the process of developing a QRIS, it may be good timing to get involved to champion the incorporation of obesity prevention strategies.

For states with significant barriers to incorporating obesity prevention standards into licensing and administrative regulations, QRIS may provide an easier avenue to incorporate these standards and serve as a stepping stone for future licensing regulation changes.

Financial support from the Child Care and Development Fund (CCDF) may be available to help obesity prevention efforts through QRIS. Four percent of CCDF is required to be allocated for strategies and efforts to improve the quality of ECE in states through a number of different approaches. QRIS and related quality initiatives afford states the means to communicate ECE quality with partners, funders, and parents and may be a good use of CCDF in your state.

Lack of consistency in standards and requirements between federal agencies can make it difficult for states and ECE providers to use funds for obesity prevention efforts. For example, the standards for nutrition may vary in different federal programs, and funding time frames and restrictions and administrative reporting requirements may require duplicate or inconsistent eligibility processes and reporting systems.

Some of the federal programs may have administrative requirements that are too burdensome for ECE providers that, generally, do not have the infrastructure or staff to support complex accounting and reporting requirements. State agencies can help relieve this burden by handling some of the requirements at the state level.

Changes made in 2013 to allowable activities under the federal Snap-Ed program allow states to use funds for policy and environmental change efforts targeting ECE, among other settings.

Typically, your state licensing and administrative regulations set some minimum standards for the education levels and required degree programs of ECE providers. These requirements may differ for each level of provider, including the teacher, assistant teacher, assistant director, and director. In some states, a degree itself is not enough—that degree must be in ECE or an equivalent degree that focuses on the education of young children. Many states have specified a particular number of hours for certification and professional development and also dictate the content of this training.

Colleges and universities are not the only institutes that educate and credential future ECE providers. Community colleges and vocational schools often play a prominent role.

Current pre-service and professional development programs rarely include content in obesity prevention. Although training requirements (initial certification and professional development) vary widely by state, professional development presents a viable opportunity to incorporate nutrition, breastfeeding, physical activity, and screen time. Historically, coordination has been lacking among organizations that provide education and certification, such as vocational technical high schools, community colleges, CCR&Rs, and Cooperative Extension programs. However, coordination is being improved in many states as they move toward developing comprehensive, coordinated ECE professional development systems.

ECE degree programs are often packed with coursework to meet a variety of other requirements including literacy and reading, math, cognitive development, and social and emotional development, leaving little room to add classes. Consider incorporating nutrition, breastfeeding, physical activity, and screen time messages into existing courses by adding a module or weaving obesity prevention messages throughout existing material.

ECE students may be interested in coursework that helps them learn about promoting their own health and well-being. This may be an entry into additional messages on child health promotion and obesity prevention.

The demands and needs of the ECE workforce are constantly evolving. Professional development assists the ECE workforce in keeping abreast of best practices in child care and early education. As states work to improve the quality of ECE through QRIS, early learning standards, and the recommendations from Early Childhood Advisory Councils, the need for professional development will only increase. Colleges and universities can work in partnership with ECE providers to develop a coordinated system of professional development coursework and credit.

Many interventions are not mutually exclusive.  A number of states have implemented curricula and assessments simultaneously.

Choose interventions that are evidence-based and tested for effectiveness when possible. There are scores of interventions available for ECE facilities, particularly curricula, but not all have been proven effective or are appropriate to use with certain children in specific settings. Consider the needs of ECE facilities in your state, and select a curriculum or intervention that helps meet those needs.

Don’t recreate the wheel. Take some time to research the wide variety of interventions, to determine which ones come closest to meeting all of your state’s needs and goals. If you don’t find exactly what you need, assess whether it will be more efficient to adapt what’s already available or develop something new. If you develop something new or significantly adapt existing interventions, it’s a good idea to partner with a university to pilot test them before implementing them statewide.

Some states have designated professionals (such as child care health consultants) who provide technical assistance to ECE programs. Since these professionals have certification or licensing requirements in order to provide such assistance, obesity prevention training could be incorporated into their existing certification and licensure programs. For example, all child care health consultants in North Carolina, who are typically nurses with little prior training in the prevention of childhood obesity, are required to complete an online training before they can practice. North Carolina has incorporated obesity prevention messages into their online training.

Infant/toddler specialist networks represent another group of health professionals providing technical assistance to ECE programs. Infant/toddler specialists provide support to ECE programs in a number of ways including consultation, training, and technical assistance. California has led the country in establishing this network of health professionals. These networks became more prevalent with the introduction of the Child Care and Development Fund (CCDF); in 2010, 23 states had an infant/toddler specialist network.

Physical activity experts are less prevalent than nutrition professionals. Some states have found it challenging to find physical activity experts to provide technical assistance to ECE programs. In fact, very few states have access to large numbers of physical activity professionals with training in early childhood physical activity. As we increase the demand for these individuals, we need to consider how to also increase the supply.

Initiating farm-to-preschool efforts presents a few unique challenges. ECE programs may have difficulty identifying distributors who specialize in local foods, and the minimum order required by these vendors may be too high and too expensive. ECE facilities might not have the space to grow their own fruits and vegetables. However, creative solutions are available to help combat these barriers. For example, ECE facilities may be able to purchase produce from local farmers’ markets. Alternatively, distributors/aggregators who specialize in local foods may deliver to facilities with adequate purchasing volume and conversely, smaller facilities can form purchasing cooperatives with other facilities to collectively buy larger amounts. For classroom, garden, and field-trip programs, age-appropriate curricula can be found from multiple sources.

Preschool is an ideal age to engage children in experiential learning activities, especially around garden-based education. Gardening provides a number of benefits. It introduces children to fresh, nutritious foods, some of which will be new to them. Children are more willing to try foods they have grown themselves. Gardening also provides an opportunity for physical activity and can enhance character-building skills such as the satisfaction and pride when children see the fruits of their labors and the opportunity to practice nurturing and teamwork.

An abundance of classroom activities can be used to teach about food and nutrition (See USDA’s Grow It, Try It, Like It garden themed nutrition education kit). An easy starting point is by introducing food tastings, especially of freshly harvested fruits and vegetables; cooking lessons also teach important life skills. In addition, food can be incorporated into math, science, health, literacy, and art lessons. Young children love to play in dirt, and are enthralled with the opportunity to grow their own food in gardens. Even when outdoor space is limited, very successful gardens can be grown in containers or in vertical planters.

Including family outreach in farm-to-preschool activities is critical. Families can reinforce the healthful eating concepts children are learning at ECE facilities, and conversely, children can carry home concepts they are learning at child care to help influence their families toward healthy eating at home. Ways to communicate to families include workshops, cooking demonstrations, newsletters, or community-supported agriculture/market basket programs, where families can get locally grown produce directly from a local grower via the ECE facility. Families may also choose to serve on school garden committees to help develop and care for school gardens.

Training and professional development for ECE providers can help them incorporate farm-to-preschool concepts into daily classroom activities. Trainings can highlight curricula and activities for classroom and outdoor activities, and are most effective when they model the interactive nature of farm to preschool, such as providing tastings. Offering continuing education credits, take-home materials, or compensatory time helps to incentivize these trainings for ECE providers.

Typically, joint use agreements provide community members access to school recreational facilities after hours while protecting schools from liability due to injury. It may be somewhat challenging to learn about specific joint use agreements throughout your state without asking each individual school system. To find out if your state encourages or even requires schools to provide community access to their facilities after school hours through joint use agreements, go to www.nplanonline.org/nplan/products/community-use-charts

Joint use agreements require careful planning. They require all parties involved to pay attention to detail, engage in open communication, and participate in up-front planning.

Joint use agreements can improve access to facilities and space for physical activity for both ECE facilities and members of the community. They are especially important for ECE facilities that have limited access to outdoor space and recreation facilities. A legal agreement with a local school district (either with the town/city/municipality or with the facilities directly) could provide ECE facilities with access to space for physical activity during non-school hours

The state department of education may require ECE programs to meet early learning standards to help children prepare for kindergarten. These standards may include obesity prevention messages, but this is not the norm. Check online or meet with your department of education to learn more about early learning standards in your state. If your state does not have early learning standards, this may be an opportunity to ensure that obesity prevention messages are incorporated into them from the outset.

Ensure early learning standards are developmentally appropriate to the infant, toddler, and preschool child.

Integrate obesity prevention-related materials into existing early learning standards training for consistency. Leverage resources and content from other early childhood obesity initiatives to ensure consistent messaging and knowledge.

Consider a number of potential early learning standard sources, especially leading national organizations such as Head Start and the National Association for the Education of Young Children

 Two primary ways to engage families in the process of improving policies and practices through the spectrum of opportunities include a public comment period where families are invited to share their thoughts and provide feedback on a specific ECE-related issue and surveys or focus-groups administered through ECE facilities. Public comment periods are most common when a state or local jurisdiction proposes new licensing and administrative regulations. However, they could resemble “town meetings,” where families are provided opportunities to comment on a variety of issues related to ECE. You may also consider partnering with a university or another agency to conduct surveys or focus groups with families.
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Families want to do the right thing for their children but don’t always have the skills, resources, and time to do so. As families strive to model a healthy lifestyle, some report having feelings of inadequacy due to lack of knowledge or skills. ECE settings can provide skill-building for families around cooking, meal planning, physical activity, and screen time. Through skill-building, families can reinforce healthy messages taught in the ECE setting at home. Families’ busy schedules may not allow for meal planning and extracurricular activities or playtime with children; and training and workshop participation as well as volunteerism may be limited because of work schedules. ECE facilities can provide support to families by making information readily available, such as family health resource lists, healthy recipes, ECE-to-home activities, and pantry lists. Consideration of families’ education and financial resources should be made when selecting outreach materials.
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Families of infants, particularly breastfeeding mothers, require additional communication with their ECE providers. ECE facilities can help support breastfeeding mothers by 1) communicating with them about their children’s needs, 2) not providing a bottle of breastmilk close to pick-up time, 3) offering a quiet and private place for breastfeeding mothers to nurse at the facility, and 4) not feeding breastfeeding infants other foods or formula without the consent of the mother. See the Appendix U for additional recommendations to promote breastfeeding in ECE.
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Families juggle multiple priorities and have different needs when it comes to ECE. Families often consider a number of variables when selecting ECE, but cost and accessibility are two primary concerns. Health promotion and obesity prevention are important, but may not be first on the list when considering options for ECE. Drawing attention to how well different facilities are doing with respect to obesity prevention can help remind families to take this under consideration when making decisions about ECE and will help create demand for ECE facilities that meet high obesity prevention standards.