1. 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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. 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?”

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Director of Wellness Initiatives Child Care Aware® of Missouri
Megan Klenke
Director of Wellness Initiatives
Child Care Aware® of Missouri
(314)
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