1. Leveraging Public and Private Partnerships to Promote Healthy Children and Families Mary Kate Mouser Executive Director Nemours Health and Prevention Services April 6, 2013

2. 2 Learning Objectives At the end of the session, you will: 1.Understand the challenge we currently face in promoting healthy weight for children 2.Be able to describe public and private partnerships models to combat childhood obesity in the community 3.Be able to identify specific achievements and lessons learned brought about by these partnerships 4.Apply this information to your work

3. Delaware Survey of Children’s Health Q: What is the percentage of overweight and obese children and youth ages 2-17 in Delaware? 40% Q: What percentage of Delaware kids are drinking LESS than two sugar sweetened beverages per week? 57.3% Q: What is the average number of days per week Delaware teens are getting 60+ minutes of physical activity? 4 days Q: By age 2, an average child in Delaware has watched how many hours of TV? 657 hours 3

4. Why Nemours? Nemours exists to serve the needs of children and families—within and outside of the walls of our pediatric health care facilities. 4

5. Determinants of Health 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Quality health care 10% Social/ environmental 20% Genetic 30% Behavior 40% McGinnis, J.M. et al. Health Affairs 2002;21(2):78-93 5

6. 6 What is the Vision? Safe communities, neighborhoods and buildings that support active living as part of every day life.

7. What is the Vision? Fresh, local, and healthy food is available and affordable in all communities and neighborhoods. 7

8. What is the Vision? Schools and child care agencies promote physical activities and incorporate them throughout the day. Schools and child care agencies offer and promote healthy food and beverages to students. 8

9. How We Work: In Partnership  NHPS’ Mission: Working with others to help children live healthier lives. Through partnerships we create policy and system changes that will change the way children live, learn and play 9

10. Partnerships Schools and Districts Child Care Centers Community Health Centers Delaware Colleges and Universities Statewide Advisory Councils County Government in Sussex, Kent, and New Castle State and County Park System State Government Agencies 10

11. Schools Can Be Physically Active Places Back in the early days of NHPS, we surveyed Delaware parents:  84 percent of them said that inadequate physical activity in children was a problem, AND  95 percent said that schools have a role to play in addressing childhood obesity. 11

12. Schools Can Be Physically Active Places What schools want: Physical activity that is easy to implement; Physical activity that doesn’t detract from study; Physical activity that doesn’t add costs. 12

13. Schools Can Be Physically Active Places  Delaware HB 471 passed in 2006 – Called for a pilot program to implement150 min/week of physical education/activity  Response: – Partnered with Delaware Department of Education to provide technical assistance and evaluation for the pilot  Result: – Confirmation that it is possible to provide 150 minutes physical education/activity week – Examples of how to do it

14. Schools Can Be Physically Active Places  Delaware HB 372 passed in 2006 – Required fitness assessment in 4 th, 7 th, 9/10 th grades in all public and charter schools  Response: – Partnered with Delaware Department of Education to analyze the FITNESSGRAM data  Result: – Delaware specific data showing that students who are more physically fit have:  Higher state test scores in reading and math  Better attendance 14

15. Schools Can Be Physically Active Places As our work took off, schools were now requesting more: – Training and tools to implement physical activity in school Response: – NHPS applied for the Carol M. White Physical Education Program grant (US DOE) – $1.2 million over 3 years

16. 16 Make School A Moving Experience Goal: -150 minutes of moderate to vigorous physical activity per week Plan: -Each school created their own combination of:  Physical education  Classroom activities  Recess activities  Other adaptations to the schedule

17. 17 Make School A Moving Experience Results:  74 public elementary schools (~72%) voluntarily incorporated 150 minutes of physical activity into the school week, many still continuing their work  40,000+ students participated in increased physical activity at school, annually  2,000+ teachers/staff trained to provide physical activity  http://vimeo.com/nhps/morningaccouncements http://vimeo.com/nhps/morningaccouncements

18. Partnering with School Nurses  We promote health—but some children have sickness or health issues in school.  Chronic conditions such as asthma, anaphylaxis, Type I diabetes, epilepsy, obesity and mental health concerns may impact the students ability to be in school and ready to learn  School nurses requested improved communication with Nemours clinicians and access to health information of their students/Nemours patients. 18

19. Parent / Guardian School Nurse Nemours Provider STUDENTSTUDENT 19 Partnering with School Nurses

20.  A multi-disciplinary team was formed to develop a way to facilitate the exchange of medical/education information between school nurses and Nemours clinicians.  There were people who said “it couldn’t be done” because of the rules and regulations protecting student /patient privacy. 20

21.  A HIPAA / FERPA compliant authorization form was designed to obtain parental consent for the exchange of information  This form also reinforces the role of the school nurse as part of the care team Information Shared: Treatment –example: care plans Non-treatment – example: immunizations, lead levels, TB screenings Education – example: attendance, medication compliance, frequency at nurse’s office Nemours Providers can access the form at this link: http://teamshare/patient/proj/pcfor ms/Delaware%20Valley%20Form s/Forms/AllItems.aspx http://teamshare/patient/proj/pcfor ms/Delaware%20Valley%20Form s/Forms/AllItems.aspx 21 Partnering with School Nurses

22. School Districts (19/19)  Appoquinimink  Brandywine  Caesar Rodney  Cape Henlopen  Capital  Christina  Colonial  Delmar  Indian River  Lake Forest  Laurel  Milford  New Castle County Vo-Tech  Polytech  Red Clay  Seaford  Smyrna  Sussex Tech  Woodbridge Charters (12/22)  Charter School of Wilmington  DE College Prep Academy  Kuumba Academy  Moyer Academy  Newark Charter  Reach Academy  Sussex Academy of Art/Science  Thomas Edison Charter  Gateway Lab School  Prestige Academy  East Side Charter  Odyssey Current Districts/Charters Participating

23.  Improved communication across the continuum of care / minimize miscommunication  Provider access to School Nurse’s clinical input and assessment  Possible reduction in the need to contact the provider office for routine information  Recognition of School Nurse as part of the care team  Greater efficiency by School Nurses in accessing student medical information allowing them to reinforce instructions given to families and better coordinate the care provided in the school environment  Improved health outcomes for patients/students Benefits

24. Healthy Child Care Settings Changes in policy set the stage:  A partnership with the Department of Education led to new nutrition guidelines for food served in licensed child care settings  A partnership with the Office of Child Care Licensing led to new regulations for healthy eating and physical activity 24

25. Healthy Child Care Settings 25  Best Practices Guide  NHPS collaborated with the Delaware Child and Adult Care Food Program (CACFP) to co-author, Best Practices for Healthy Eating: A Guide to Help Children Grow Up Healthy embodying the Nemours 5-2-1-Almost None message  Provides recommended action steps  Endorsed by the USDA  Child Care Learning Collaborative  28 centers completed 5 sessions  Receive insight, experience from 4 pilot site champions  Receive hands-on techniques to imbed physical activity into the day, increase fruits and vegetables on the menu, and receive parental support for healthy foods brought into the center

26. Healthy Child Care Settings Results of Work Healthy eating practices increased Physical activity practices increased Increases in provider knowledge about nutrition and physical activity Changes in centers’ written nutrition and physical activity policies Changes in center practices Supports to keep the regulations strong 26

27. National Partnership: Let’s Move! Child Care  Goal: Create strong practice change in child care settings across the country to improve healthy eating, physical activity and screen time behaviors for children  External Partners: Office of the First Lady, Domestic Policy Council, CDC, Administration for Children and Families, Child Care Aware of America, University of North Carolina, Healthy Kids, Healthy Future Steering Committee

28. Healthy Child Care Settings: It Takes Time 2006 2007 2008 20092010 Child Care Pilots Child Care Learning Collaborative CACFP Regulations in Effect Provider Workshops CACFP Trainings/Team Nutrition Trainings DE Institute for Excellence in Early Childhood Office of Child Care Licensing Rules for Healthy Eating and Physical Activity in Effect 20112012 Healthy Kids Healthy Future Steering Committee Let’s Move! Child Care Nat’l Provider Collaboratives

29. Healthier Vending and Concessions  May 20, 2010 Governor Markell’s Executive Order #19: Established a Council on Health Promotion and Disease Prevention  “In carrying out its charge, the Council shall endeavor to ensure that the State, as an employer, set the standard for workplace health promotion and disease prevention, including healthy foods in vending machines, physical activity opportunities, and health promotion benefits to state employees and their families ”

30. Healthier Vending and Concessions Nemours developed a guide to healthier vending and Concessions, with the easy to use “go, slow and whoa: terminology. 30

31. Munch Better in the Great Outdoors Munch Better in the First State 31

32. 32 Partnerships for Healthy Vending State Parks Policy 2012 State Buildings Pilot AI duPont and Nemours Facilities 2010 Currently

33. 33 Lessons Learned Prevention is not the top priority on everyone’s agenda  Need to make sure our partners’ priorities are connected to our priorities  Listening is key: acknowledge barriers and find solutions  Share results: national groups were interested in Delaware child care work Community is dynamic and changing: be ready to adapt

34. 34 Collaboration=Increased Impact Multiple partners, multiple strategies and commitment add up to increased impact

35. 35 An Ambitious Goal Creating healthy, active environments will take the combined efforts of entire communities The health of future generations is at stake

36. 36 Mary Kate Mouser Executive Director Nemours Health & Prevention Services 252 Chapman Road, Suite 200 Newark, DE 19702 mmouser@nemours.org