Statewide Recognition & Facility-level Intervention Programs

3States use branded recognition programs to officially promote ECE facilities that meet a set of predetermined criteria for policies and/or practices. They differ from QRIS in that they are focused on a specific topic area that might be narrow, such as breastfeeding support or broad, such as obesity prevention.

Facility-level interventions encompass a defined set of activities that take place directly within ECE facilities during a set period of time. Activities included in many facility-level intervention include staff training, self-assessments, action planning, and implementing a specific curriculum. Numerous facility-level interventions, especially curricula, are available such as: the Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC); Eat Well, Play Hard in Child Care; Grow it, Try it, Like it; and Color Me Healthy (contact for information on evidence-based facility-level interventions).

Recognition and intervention programs should be explicitly connected to a state’s early learning standards.


  1. Maintain an ongoing, statewide recognition program that includes obesity prevention requirements (ideally in conjunction with a specific facility-level intervention that assists providers to meet requirements).
  2. Promote a specific obesity prevention intervention (or ensure that core obesity prevention content is included in existing, state-supported ECE facility interventions).
  3. Ensure that ECE facilities statewide have access to benefits/incentives for participating in at least one obesity prevention intervention.

State Example: North Carolina NAP SACC

North Carolina (NC) implemented NAP SACC in ECE facilities in many of the 100 counties in the state.

How It Came About

The NC Partnership for Children ( became interested in statewide dissemination of NAP SACC based on pilot test results. The Partnership operates the Smart Start program, NC’s early childhood infrastructure. The Smart Start program is implemented at the local level, and these agencies serve as a statewide system of ECE resources. Through a collaboration, including the Partnership, the NC Division of Public Health and UNC-Chapel Hill NAP SACC was implemented across much of the state.


In NC, NAP SACC relies on trained health consultants (i.e., child care health consultants, nurses, health educators, nutritionists, and other health professional) familiar with ECE facilities, to implement the intervention. Consultants working with the facilities completed four-hours of web-based training on implementation of the intervention, nutrition, physical activity and healthy weight in young children. Consultants helped recruit ECE centers to participate in the statewide program by letter, phone, or in-person.

In 2011, NAP SACC became part of a state initiative called “Shape NC: Healthy Starts for Young Children” to help prevent obesity in ECE centers. The first cohort of centers began the program in May 2011, and project funding concluded in December 2013.  Through funding from The Blue Cross and Blue Shield of North Carolina Foundation, the NC Partnership for Children is implementing a comprehensive intervention to create early childhood wellness champions among ECE professionals. The overall goal of Shape NC is to ensure that children attending ECE facilities are served nutritious foods, engage in physical activity, have naturalized outdoor learning environments and have teachers modeling healthy behaviors.  The Shape NC program was implemented in 20 counties over the three years of the grant.  ECE centers in each of these counties received intensive technical assistance to become a model center and demonstration site for centers in the surrounding area.

Lessons Learned

  • Incentives for ECE facilities 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.
  • Some ECE 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.
  • Training is highly recommended to increase the skills, knowledge, and confidence of the consultants and to promote implementation of the core elements of the intervention.
  • Continuing education credits from the state agency that oversees ECE can provide an additional incentive for participation in the NAP SACC intervention. Often, ECE providers are required by the state licensing agency to complete continuing education each year. Offering continuing education credits was a significant incentive for providers to participate in the NAP SACC workshops.
  • It is essential to tailor the NAP SACC self-assessment to ensure that responses on the tool are consistent with or even exceed state licensing requirements (see for information on your state licensing and administrative regulations).



  1. Ammerman AS, Ward DS, Benjamin SE, Ball SC, Sommers JS, Molloy M, Dodds JM. An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design. Prev Chronic Dis [serial online] 2007;4(3). Available from