Childcare That Counts: Pilot Demonstrates Health Improvements in Quality Improvement Project

Following implementation of the program: • Children participated in an average of 29 minutes of activity, a 71% increase in physical activity. • Prior to CKC, there was no nutrition education; with CKC, an average of 23 minutes per week was devoted to nutrition education. • Ninety-three percent of staff surveyed agreed or strongly agreed that they would recommend the program. Measurable but beyond scope of physical activity improvements: From the CATCH student survey, T1 to T2: • Percentage of children who had no fruit the previous day decreased from 13% to 9%. • Percentage of children who correctly indicated they should eat “at least five” servings of fruit and vegetables each day increased from 34% to 55%. • Percentage of children who reported that they “almost always or always” choose low-fat or skim milk over “regular milk” increased from 35% to 51%. • Percentage of children who thought “low-fat or skim milk” was better for their health than ”regular milk” increased from 45% to 73%. • Percentage of children who reported they were “very sure they could drink low-fat or skim milk instead of regular milk” increased from 31% to 51%. • Percentage of children who indicated they were “very sure” they had the ability to take the skin off chicken and not eat the skin increased from 49% to 58%. Site instructor survey: • 80% felt kids were more active with CATCH. • 76% felt kids liked the activity program. • 88% would recommend the activity program. • 93% would recommend the nutrition component.

The YMCA and COV programs adopted CKC into their curricula and have maintained the program with their funding. The YMCA has also gone on to develop additional youth activity programming after the implementation of CATCH in its childcare settings created interest in this type of program for children not enrolled in their childcare programs. The project coordinator wrote a successful Washington Quality Enhancement grant application, and the YMCA was awarded a $3,000 grant to use for fresh fruit and vegetables during the project. (A narrative report for the grant is attached.) The infusion of funding for healthy fruits and vegetables really enhanced the nutrition curriculum without causing financial burden on the YMCA and also demonstrated to YMCA staff and parents that children would try and like new healthy foods.

SNAP should have provided training to the YMCA staff and volunteers who assisted with the youth fitness testing. Adherence to testing protocol may not have been uniform, which resulted in poor data. In regard to site staff, Skagit County Public Health Department was aware at the instructor training that there were staff who did not practice regular physical activity or value nutrition education and that their personal values may have impacted how the program was implemented at their site. In the case of the YMCA, the director had mandated participation. SNAP had to work closely with the YMCA to ensure that collection of data was performed and that it was done as designed. Even though the detailed information on how to administer the tests was discussed and then given to the site instructors, a few instances of staff not following protocol or understanding what was expected were encountered, and this was corrected. The following is a copy of what was shared with site staff in a special meeting on this topic: In the initial survey of the students involved in the CATCH program, there were some issues identified in terms of completion of the survey. A few of these problems were: • Multiple answers for one question • Questions not answered • Skipped pages • Incorrect survey form Some suggestions for improving the data collection with the surveys are as follows: • Select a day for surveying that most to all of the students in grades 3 through 5 will be there. • Start the survey close to the beginning of the program so that students who leave earlier will have time to finish the survey. • If students have a question, have them raise their hand and assist them in figuring out which choice best represents them. • Once the survey is turned in, look through it to make sure each question has been answered and that no pages have been skipped. • If the group of students is younger, then a good option might be to go through the survey with them page by page as a group. This could help to prevent students from missing pages and questions altogether. • Every school should use the survey provided in PDF form by e-mail. The Washington Elementary School site will use the survey form provided in the CATCH program manual. If any site administers the incorrect survey, it will have to be redone. SNAP had the opportunity to have the University of Washington provide site staff with Screen Time Reduction training, and staff were given access to the program materials. Screen time was not part of the project; however, staff used the Screen Time Reduction materials and these did have an impact for some students in reducing screen time. A few questions should have been asked about this in the instructor survey. From the instructor survey, it appeared that some staff needed assistance but did not ask for it, which impacted their experience of the program. The Skagit County Public Health Department did not ask staff to identify which site they were associated with, but it would have been useful to have known that so as to work with individual staff. SNAP did not include the parent component of the program other than via the newsletters. It was felt that it would have been valuable to invite parents to learn more about the project as well as the results. It was very valuable to hire Westra Research to assist with the evaluation component of the project. Westra really made a difference in how the evaluation was conducted (and that it was conducted at all). Liz McNett Crowl, Project Coordinator, noted, “Everything went really well for our pilot. We learned a lot and would make only a few changes if we replicated this project or one similar.”

The YMCA and COV programs adopted CKC into their curricula. SNAP recommend continuing to collect body mass index (BMI) measurements and conducting fitness testing annually to further evaluate program results over time. HCP will be working with the leadership team and stakeholders to develop and adopt an action plan. Using the lessons learned from this pilot and the action plan, Skagit County Public Health Department will explore opportunities to replicate this pilot program in different settings, such as early learning or for-profit childcare sites and will look at new project ideas.