Technical Assistance

sp-technicalTechnical assistance, within the context of ECE, is the provision of expert advice and guidance to ECE providers. Technical assistance is provided to improve the quality of care provided by changing practices. In defining technical assistance, Child Care Aware uses the term “on-site technical assistance” and describes it as the “intentional use of various strategies over time to improve the child care program quality of provider practices through visits to child care programs.”1 On-site technical assistance encompasses observation, assessments, support, and monitoring.
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As ECE facilities strive to improve the quality of care and instruction they provide, particularly through measures such as QRIS, the need for technical assistance increases. Nationally, the largest network of ECE technical assistance providers is through the CCR&R network. However, a number of health professionals provide technical assistance to ECE providers in most or some states, including child care health consultants, Cooperative Extension agents, physicians (particularly through the state chapter of the American Academy of Pediatrics), county and state nutritionists, and health department nurses. Technical assistance is also provided by staff from the state licensing agency as well as from the Child and Adult Care Food Program.
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Massachusetts links each ECE facility with a health consultant (a Massachusetts-licensed physician, registered nurse, nurse practitioner or physician’s assistant with pediatric or family health training and/or experience). Connecticut also requires ECE facilities to use health consultants. Moreover, Connecticut requires facilities have a written plan for consultation that includes a registered dietitian consultant available for advice regarding nutrition and food service.2 In some states child care health consultants have been systematically trained in nutrition and physical activity to provide technical assistance to ECE facilities participating in the NAP SACC intervention (see section on Facility-Level Interventions).
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Nutrition professionals can provide technical assistance to ECE programs on menu planning, nutritional assessment of meals and snacks, training for foodservice personnel, and nutrition education for ECE providers, children, and families. Experts in physical activity can help ECE providers promote energy expenditure in young children through active play and reduced screen time. Studies have shown that ECE provider education3 and training4,5 in physical activity both help to increase children’s level of physical activity. In one study, training was positively associated with time children spent in moderate to vigorous physical activity and negatively associated with time children spent in sedentary behaviors.4

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In 2009, a series of focus groups with ECE providers was held in Delaware to discuss technical assistance needs related to nutrition and physical activity.  Providers acknowledged the need for additional training and technical assistance, and identified a number of resources that would be helpful to them in promoting physical activity and healthy eating, particularly with respect to engaging children in structured physical activity. They requested training in this and other obesity prevention areas.
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State Example: Minnesota

Minnesota’s (MN) state training and technical assistance program for ECE providers, developed by the MN Department of Health (MDH), aims to encourage providers to adopt policies and engage in new practices related to healthy eating and physical activity in ECE settings. The MDH trains and supports local health department professionals to deliver the training and technical assistance to ECE providers in their catchment areas. The train-the-trainer model allows for widespread dissemination of the program. The training and technical assistance program includes:

  • Assessment of the ECE environment using NAP SACC;
  • Provider training related to healthy eating for young children;
  • Provider training related to physical activity for young children;
  • Technical assistance related to implementation of nutrition and physical activity best practices;
  • Technical assistance related to adoption of nutrition and physical activity policies.

Specifically, the training and technical assistance includes information on improved menus, positive mealtime environments, appropriate serving sizes for young children, adult role modeling, integration of changes into the daily schedule and curriculum, parent engagement, and opportunities for children to participate in both structured and unstructured physical activity on a daily basis.

How It Came About

Instead of enacting statewide policies for obesity prevention in ECE settings, MN opted to take a “bottom-up” approach. The MDH encouraged ECE providers to engage in practices and adopt their own policies related to healthy eating and physical activity.

Implementation

The MDH follows the train-the-trainer model by providing training to staff from local, city, or county health departments (LPH), who then use regional trainings to disseminate the training and technical assistance program to ECE providers across the state. For nutrition, MDH used the “Learning about Nutrition through Activities” (LANA) curriculum developed and tested by MDH staff. Initially, live trainings for LPH staff and ECE providers were provided by MDH staff. Since then, additional public health staff have attended trainings offered by trained State Health Improvement Program (SHIP) grantees or used the training tools available on the MDH LANA training page to prepare to deliver live trainings to ECE providers in their areas. MDH provides print and electronic materials, as well as ongoing technical assistance, to trainers in MN. The curriculum is available for free online (www.health.state.mn.us/lana) and can also be purchased (Learning Zone Express, www.learningzonexpress.com/, Product: # 822202). A Spanish language supplement is available for the LANA curriculum.

Hundreds of ECE providers have been trained in LANA and assisted in making action plans and implementing changes in their practices, and then embedding their new practices in policies. NAP SACC was used before and after LANA implementation to pinpoint practices to be improved and to chart providers’ progress. LPH staff have compiled information about changes in practice and policy, as measured by these pre- and post-assessments, and found improvements for both nutrition and physical activity.

MDH used a similar model for physical activity training based on I Am Moving, I Am Learning (IMIL). MDH hired three certified Head Start trainers to offer a 3-day train-the-trainer workshop to 50 potential trainers from counties around the state. Local public health staff were encouraged to assemble teams to help them train ECE providers, so the group included their community partners from CCR&R, CACFP, Head Start, ECE licensing, public schools, special education, Early Childhood Family Education, YMCA, child care centers, among others. NAP SACC was used for assessment before and after physical activity-related supports, and the process again included training, changes in practice, and changes in policy to reflect practice. LANA and IMIL trainings continue to be supported by MDH across the state.

Lessons Learned

  • It is crucial that materials and resources are available to trainers and ECE providers in a variety of formats, including some at low or no cost. In MDH’s case this was accomplished by posting materials online for free download, by arranging for materials to be published for purchase by ECE facilities with multiple classrooms or locations and a larger materials budget, and by supplying trainers with electronic materials, to be printed in color or black and white, in the quantities needed, as budgets allowed.
  • Training alone is not sufficient to change practice. It must be accompanied by initial and ongoing support, resources, guidance, and facilitation of peer exchange in order to be effective and sustained.
  • Using a practice-to-policy approach rather than the reverse is more labor-intensive, but can create greater buy-in on the part of the ECE providers and minimizes the need for enforcement of policies created at a higher level.

 

References

  1. NACCRRA. Knowledge Into Practice: NACCRRA’s Survey of Child Care Resource & Referral On-Site Technical Assistance. 2010. Available from http://www.naccrra.org/publications/naccrra-publications/#34.
  2. Jennifer McGrady Heath. Creating a Statewide System of Multi-Disciplinary Consultation for Early Care and Education in Connecticut. 2005. http://nitcci.nccic.acf.hhs.gov/resources/10262005_93815_901828.pdf.
  3. Dowda M, Pate RR, Trost SG, Almeida MJ, Sirard JR. Influences of preschool policies and practices on children’s physical activity. J Community Health 2004;29(3):183-96.
  4. Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The childcare environment and children’s physical activity. Am J Prev Med 2008;34(1):23-9.
  5. Dowda M, Brown WH, McIver KL, et al. Policies and characteristics of the preschool environment and physical activity of young children. Pediatrics 2009;123(2):e261-6.
  6. USDA, Food and Nutrition Service. Memo to Regional Directors, Special Nutrition Programs, All Regions; and State Agencies, Child Nutrition Programs, All States: Geographic Preference for the Procurement of Unprocessed Agricultural Products in the Child Nutrition Programs. November 13, 2009. USDA Memo SP 30-2008. Available from http://www.fns.usda.gov/cnd/governance/Policy-Memos/2010/SP_08_CACFP_05_SFSP_06-2010_os.pdf.