1. Right from the Start: Assessing Child Care Settings in Multnomah County for Obesity Prevention Prepared for: Oregon Public Health Association Annual Conference October 19 th, 2010

2. Right from the Start Project Advisory Committee Dianna L. Pickett, Nurse Consultant, Coordinator: Healthy Child Care Oregon, Office of Family Health, Oregon Health Division Oregon Department of Employment, Child Care Division Eco-Healthy Child Care Program, Oregon Environmental Council Community Nutrition, Child Nutrition Programs Oregon Department of Education Child Care Improvement Program Office of Family Health, Oregon Health Division Healthy Start Initiative, Multnomah County Health Department Child Care Resource and Referral of Multnomah County Commission on Children, Families, and Community of Multnomah County Regional Practice Division - Pediatrics NWP, Kaiser Permanente NW Chronic Disease Prevention Program Multnomah County Health Department The Montessori House of St. John’s Barb's Home Daycare College of Health and Human Sciences, Oregon State University

3. Presentation Objectives To provide project history and background To outline the development of a novel survey assessment tool To describe methodology and share lessons learned from the survey implementation process To highlight next steps toward dissemination of findings

4. Why Obesity Prevention in Child Care? Nationally, 24.4% of children ages two through five years are classified as either overweight or obese. 1 The preschool period is a critical time for growth and development, and healthy eating and active play can help prevent later obesity. 2-4 In the US, nearly 74% of children ages 3 to 6 are in some form of non-parental care and just over half are in center- based child care. 5 ***With such large numbers of children in child care, child care providers are in a unique position to support and facilitate healthful eating and promote physical activity in young children.

5. Types of licensed child care in Oregon Child care center – designated facility for care of children; can care for unlimited number of children; must meet ratios; 30% are exempt from regulation Certified family child care home – single family dwelling; run by homeowner; can care for up to 16 children; none are exempt from regulation Registered family child care home – located in person’s home; can care for up to 10 children; minimally regulated ***most child care is unregulated in Oregon (type= family, friend, and neighbor)

6. Number of child care sites in Multnomah County

7. Capacity of each site in Multnomah County

8. Project History 2007 Healthy Kids Watch Less TV (HKWLTV) Retreat –Focus on children age 0-5 years –Identified child care settings OPHI and HKWLTV members wrote three grant proposals Success – Finally! –Northwest Health Foundation: September 2009 – August 2011

9. Project Objectives Objective 1: Prepare to conduct assessment of child care settings in Multnomah County, Oregon regarding practices for the prevention of childhood obesity. Objective 2: Conduct assessment of a universal sample of child care settings in Multnomah County, that care for children age 0-5 years. Objective 3: Translate assessment results into recommendations for training and support of child care providers and possible environmenta l or p olicy change, prepare for statewide assessment.

10. Four Areas of Assessment Breastfeeding support Nutrition Physical activity Screen time

11. Survey Development Initial plan to adapt NAP SACC and other validated surveys (e.g. BMER, ENHANCE) Input and review from project advisory committee (including child care providers, child health and child care experts) Development of a novel survey tool –59 question; 16 page booklet survey –Contains both quantitative/qualitative questions IRB approval from Oregon Public Health Division for study instruments and protocol

12. Testing the Survey Conducted 2 focus groups of registered home child care providers (16 participants) Child care providers completed survey and provided structured feedback about survey questions, design, and opinions about 4 topic areas Results of focus group informed revisions to final survey tool for implementation ***Focus group data is currently being analyzed

13. Survey Implementation - English Dillman Method - creates a social exchange relationship w/ structured, sequenced, and timed contacts to yield high response rate –Day 1: Pre-notice letter –Day 5-7: Survey w/ $2 bill and cover letter –Day 14-17: Reminder post card –Day 28-34: Replacement survey and cover letter to non-responders Targeted outreach via multiple child care networks –Both electronic, paper, and word of mouth

14. Survey Implementation - English Mailed paper surveys to a universal sample of all licensed child care settings in Multnomah County (approximately 750) Option to complete survey on-line –Less than 10% responded on-line IRB approval from Oregon Public Health Division for study protocol ***Current response rate 60 - 65%!!

15. Survey Implementation - Russian Key informant interviews with Russian-speaking child care consultants and experts who work directly with providers (CCR&R, CCD, CCIP) Revised Dillman method: – Day 1: Survey w/ $2 bill and cover letter –Day 21-28: Replacement survey and cover letter to non-responders –Targeted outreach via Russian language child care networks IRB approval for revisions to protocol ***Current response rate - approx. 60%!

16. Lessons Learned Survey development : No other tool exists that comprehensively assesses 4 key areas of obesity prevention Implementation : Following the well-tested Dillman method yields amazingly high response rate ** $2 bill offered w/ the survey vs. gift card/monetary gift post creates different relationship and exchange Survey Response : Child care providers responded well to survey as predicted by the Dillman method Special Population : Russian-speaking childcare providers responded well to survey w/ revised Dillman method Overall : This assessment project is intended to be a pilot with hopes of expanding state-wide

17. Next Steps Project Objective 3: Translate assessment results into recommendations for training and support of child care providers and possible environmental or policy change, prepare for statewide assessment –Review and interpret survey results (late fall/winter, 2010) –Develop recommendations for trainings and support, highlight best practices, and identify most prevalent missed opportunities (winter/early spring, 2011) –Disseminate findings and recommendations (late spring/early summer, 2011) –Identify future funding opportunities (late spring/early summer, 2011)

18. References 1. Ogden C, Carroll M and Flegal K. “High Body Mass Index for Age Among US Children and Adolescents, 2003–2006.” Journal of the American Medical Association, 299(20): 2401–2405, May 2008 2. Whitaker RC, Pepe MS, Wright JA, Seidel KD, Dietz WH: Early adiposity rebound and the risk of adult obesity. Pediatrics 1998, 101:E5. 3. Dietz WH: Periods of risk in childhood for the development of adult obesity-- what do we need to learn? J Nutr 1997, 127:1884S-1886S. 4.Dietz WH: “Adiposity rebound”: reality or epiphenomenon? Lancet 2000, 356:2027-2028. 5. Federal Interagency Forum on Child and Family Statistics: America’s Children: Key National Indicators of Well-Being, 2002. Washington, DC: U.S. Government Printing Office; 2002.

19. Thank you! For questions about Right from the Start please contact: Rachel Burdon Project Manager rachel@orphi.org