MISSOURI RECOMMENDATIONS IN ACTION: Improving Nutrition, Physical Activity & Screen Time Child Care Standards This is an exciting recommendation because as Dr. Wifly mention yesterday – most of the standards in MO current child care licening rules haven’t‘ been updated for more than 20 years. This recommendation gives us the opportunity to evaluate and align licensing rules in the state with some of the best practices Dr. Gable highlighted that can impact child care environments

MO Eat Smart Standards adopted into the MO Accreditation Rules Timeline & History MO Eat Smart Standards adopted into the MO Accreditation Rules MOCAN Child Care Workgroup Strategic Plan identifies need for licensing rule enhancement 2012: Child Care Aware of MO launches CDC and Nemours funded “Taking Steps to Health Success” Early Care and Education Learning Collaboratives 2012: MOCAN Child Care Workgroup identifies in strategic plan a need for enhanced child care licensing rules MOCAN commits to exploring strategies for updating current rules 2013: CDC releases a 50 state analysis of child care licensing rules in comparison with the Caring for our Children best practice standards (developed by the American Academy of Pediatrics and American Public Health Asoc.) Analysis shows opportunities for improvement in MO – 47 standards that were partially addressed or not addressed at all in the MO Licensing Rules For example MO rule language does not address allowable screen time or require space for onsite breastfeeding 2014: Children’s Service Commission convenes the Sub-Committee of Childhood Obesity. Sub-Committee puts forth the recommendations re: obesity prevention in early childhood = update child care licensing rules MOCAN group begins to apply their efforts to plan implementation of the Commission's recommendations.

Timeline & History MOve Smart & Breastfeeding Friendly Child Care Certifications launched 2013: CDC 50 State Analysis - MO child care compared with Caring for Our Children (CFOC) best practice standards, identifies opportunity for licensing rule enhancement 2014: Children Service Commission, Sub-Committee on Childhood Obesity Recommendations 2012: MOCAN Child Care Workgroup identifies in strategic plan a need for enhanced child care licensing rules MOCAN commits to exploring strategies for updating current rules 2013: CDC releases a 50 state analysis of child care licensing rules in comparison with the Caring for our Children best practice standards (developed by the American Academy of Pediatrics and American Public Health Asoc.) Analysis shows opportunities for improvement in MO – 47 standards that were partially addressed or not addressed at all in the MO Licensing Rules For example MO rule language does not address allowable screen time or require space for onsite breastfeeding 2014: Children’s Service Commission convenes the Sub-Committee of Childhood Obesity. Sub-Committee puts forth the recommendations re: obesity prevention in early childhood = update child care licensing rules MOCAN group begins to apply their efforts to plan implementation of the Commission's recommendations.

Children’s Services Commission-Subcommittee on Childhood Obesity Recommendation: Prevention in Early Childhood The Missouri Department of Health and Senior Services updates child care center and home licensing rules to align with latest evidence on standards for feeding practices, nutrition, physical activity, and screen time limitations to prevent obesity and support long-term health. Through a network of collaborating partners, the Department assures training and support services are available for child care professionals to achieve full compliance with new standards. 2012: MOCAN Child Care Workgroup identifies in strategic plan a need for enhanced child care licensing rules MOCAN commits to exploring strategies for updating current rules 2013: CDC releases a 50 state analysis of child care licensing rules in comparison with the Caring for our Children best practice standards (developed by the American Academy of Pediatrics and American Public Health Asoc.) Analysis shows opportunities for improvement in MO – 47 standards that were partially addressed or not addressed at all in the MO Licensing Rules For example MO rule language does not address allowable screen time or require space for onsite breastfeeding 2014: Children’s Service Commission convenes the Sub-Committee of Childhood Obesity. Sub-Committee puts forth the recommendations re: obesity prevention in early childhood = update child care licensing rules MOCAN group begins to apply their efforts to plan implementation of the Commission's recommendations.

Children’s Services Commission-Subcommittee on Childhood Obesity Recommendation: Prevention in Early Childhood The Missouri Department of Health and Senior Services updates child care center and home licensing rules to align with latest evidence on standards for feeding practices, nutrition, physical activity, and screen time limitations to prevent obesity and support long-term health. Through a network of collaborating partners, the Department assures training and support services are available for child care professionals to achieve full compliance with new standards. 2012: MOCAN Child Care Workgroup identifies in strategic plan a need for enhanced child care licensing rules MOCAN commits to exploring strategies for updating current rules 2013: CDC releases a 50 state analysis of child care licensing rules in comparison with the Caring for our Children best practice standards (developed by the American Academy of Pediatrics and American Public Health Asoc.) Analysis shows opportunities for improvement in MO – 47 standards that were partially addressed or not addressed at all in the MO Licensing Rules For example MO rule language does not address allowable screen time or require space for onsite breastfeeding 2014: Children’s Service Commission convenes the Sub-Committee of Childhood Obesity. Sub-Committee puts forth the recommendations re: obesity prevention in early childhood = update child care licensing rules MOCAN group begins to apply their efforts to plan implementation of the Commission's recommendations.

Children’s Services Commission-Subcommittee on Childhood Obesity Recommendation: Prevention in Early Childhood The Missouri Department of Health and Senior Services updates child care center and home licensing rules to align with latest evidence on standards for feeding practices, nutrition, physical activity, and screen time limitations to prevent obesity and support long-term health. Through a network of collaborating partners, the Department assures training and support services are available for child care professionals to achieve full compliance with new standards. 2012: MOCAN Child Care Workgroup identifies in strategic plan a need for enhanced child care licensing rules MOCAN commits to exploring strategies for updating current rules 2013: CDC releases a 50 state analysis of child care licensing rules in comparison with the Caring for our Children best practice standards (developed by the American Academy of Pediatrics and American Public Health Asoc.) Analysis shows opportunities for improvement in MO – 47 standards that were partially addressed or not addressed at all in the MO Licensing Rules For example MO rule language does not address allowable screen time or require space for onsite breastfeeding 2014: Children’s Service Commission convenes the Sub-Committee of Childhood Obesity. Sub-Committee puts forth the recommendations re: obesity prevention in early childhood = update child care licensing rules MOCAN group begins to apply their efforts to plan implementation of the Commission's recommendations.

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers MOCAN began the planning process Goal: Leverage the expertise of childcare & child health professionals, experts and advocates Ensure the process is participatory to ease both passage and implementation Identify Opportunities for Enhancement: Using the CDC Analysis and new CACFP standards (proposed rule comment ended in April) – identify areas that could be enhanced and updated (as well as the other’s Dr. Gable mentioned yesterday – the IOM 2011, Let’s Move Child Care Goals) Identify feasible areas for impact based on: Low fiscal impact - on centers and state agencies Enforceabiltiy Impact on childhood obesity (non) Controversial Invite child care professionals, experts & advocates to participate in statewide survey to discern potential, feasible changes

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers Based on survey results work with practitioners, state agencies (esp. SCCR) and experts to develop legal and implementable rule language

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers Working with SCCR to ensure there are tracking and enforcement mechanisms in place

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers Input of practitioners to understand the challenges when the rubber meets the road Asking child care professionals and administrators: “What issues arise when trying to implement the proposed licensing rule changes?”

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers Look around this room: What resources and knowledge exist here: Professional development and training? Technical assistance to child care? Grant opportunities to child care facilities? Expertise around nutrition? Built environment? Physical Activity? Breastfeeding? Together we can develop resources that respond to the barriers identified by child care experts and professionals

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers Propose new rule language through the regulatory process with the confidence that it is: Legal Enforceable Impactful Resources and information is available to ensure child care facilities can successfully implement

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers - It will be vital to engage the parrtnership of state agencies like DHSS and other advocates who have been through the rule change process before to navigate the rule passage process Strategies may include… Engaging child care providers and advocates to publicly support the rule changes Engaging legislators in education regarding rule change impacts, and support for enhancements

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers

Taking Action : A Participatory Process Identify opportunities for enhancements Develop implementable rule language Create strategies for tracking and enforcement Follow and advocate for rule adoption process Pass new licensing rule Conduct public awareness and marketing campaign Propose new rules language Develop responses and resources to overcome implementation barriers Anticipate implementation barriers Important to raise awareness among childcare professionals, administrators and families about the rule change Provide education and marketing regarding strategies for implementation

Taking Action : A Participatory Process TOWN HALL MEETINGS SOCIAL MEDIA & PARTNER NETWORKS STATEWIDE SURVEY WEBINARS There are a number of potential strategies to implement through out this participatory process: Statewide survey or child care providers and advocates to discern which rules Town hall meetings to develop and refine rule language Webinars to get feedback on potential rules and identify needed resources for implementation Build awareness and leverage advocates through social media and existing networks These strategies would be used throughout the process in combination and under the direction of a core planning team. The goal of the Core Planning team is to coordinate existing efforts and use the collective expertise to direct and guide this robust, inclusive effort Child Care Aware is positioned to lead this effort, with the support and guidance of vital partners with this expertise including… Need to expand this core planning team to include experts in child care regulation including the section for child care regulation – in order to align our efforts with those of the oversight that Pat will talk about later CORE PLANNING TEAM

Taking Action : Who Plays a Role? PEDIATRICIANS & MEDICAL EXPERTS EARLY CHILDHOOD ADVOCATES & EXPERTS FUNDING & SUPPORT ACADEMICS & RESEARCHERS CHILD CARE PROFESSIONALS What’s needed to move this recommendation forward and who can play a role? Child Care professionals will play a vital role in participating in the survey and offering feedback throughout the process Pediatrician & medical experts, Academics and researchers in the field of childhood health, development and obesity prevention will lend their expertise to refining the potential rules to maximize impact on obesity prevention and childhood health Early Childhood advocates and experts will vital to engage throughout the process to guide the process and ensure that rules are implementable and relevant to the child care setting. Especially important to have the involvement of the child care regulation experts at SCCR and the oversight of the Department of Health and Senior Services which Pat will talk about later… Lastly… the support and funding of local and statewide foundations will allow this process to be carried out in a comprehensive and inclusive way

Taking Action : Possible Outcomes QUALITY MANAGEMENT POLICY/ REGULATORY EDUCATION FINANCE RESTRUCTURING Develop new child care professional development materials/ opportunities Peer-to-peer coaching for child care facilities Inform decision-makers Offer incentives for practice change Subsidy reimbursement based on best practice compliance Streamline early child care systems Coordination of early childhood health funding in MO Explore QRIS Licensing rule updates Change in laws Further updates to MO accreditation standards What’s needed to move this recommendation forward and who can play a role? Child Care professionals will play a vital role in participating in the survey and offering feedback throughout the process Pediatrician & medical experts, Academics and researchers in the field of childhood health, development and obesity prevention will lend their expertise to refining the potential rules to maximize impact on obesity prevention and childhood health Early Childhood advocates and experts will vital to engage throughout the process to guide the process and ensure that rules are implementable and relevant to the child care setting. Especially important to have the involvement of the child care regulation experts at SCCR and the oversight of the Department of Health and Senior Services which Pat will talk about later… Lastly… the support and funding of local and statewide foundations will allow this process to be carried out in a comprehensive and inclusive way

Discussion Pit falls and perspectives on participatory processes The voluntary practice to policy to Policy “tipping point”: Does it exist? What are the indicators? What’s the role of research?: Wonky to working in our favor, successful strategies for engaging academics and applying research to policy What’s needed to move this recommendation forward and who can play a role? Child Care professionals will play a vital role in participating in the survey and offering feedback throughout the process Pediatrician & medical experts, Academics and researchers in the field of childhood health, development and obesity prevention will lend their expertise to refining the potential rules to maximize impact on obesity prevention and childhood health Early Childhood advocates and experts will vital to engage throughout the process to guide the process and ensure that rules are implementable and relevant to the child care setting. Especially important to have the involvement of the child care regulation experts at SCCR and the oversight of the Department of Health and Senior Services which Pat will talk about later… Lastly… the support and funding of local and statewide foundations will allow this process to be carried out in a comprehensive and inclusive way

Director of Wellness Initiatives Child Care Aware® of Missouri Megan Klenke Director of Wellness Initiatives Child Care Aware® of Missouri megan@mo.childcareaware.org (314) 754-1603 What’s needed to move this recommendation forward and who can play a role? Child Care professionals will play a vital role in participating in the survey and offering feedback throughout the process Pediatrician & medical experts, Academics and researchers in the field of childhood health, development and obesity prevention will lend their expertise to refining the potential rules to maximize impact on obesity prevention and childhood health Early Childhood advocates and experts will vital to engage throughout the process to guide the process and ensure that rules are implementable and relevant to the child care setting. Especially important to have the involvement of the child care regulation experts at SCCR and the oversight of the Department of Health and Senior Services which Pat will talk about later… Lastly… the support and funding of local and statewide foundations will allow this process to be carried out in a comprehensive and inclusive way