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Shape NC: Healthy Starts for Young Children

creates a foundation for healthy, productive adults by focusing on early childhood physical activity and obesity prevention in children 0-5

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Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

We had excellent mentor feedback. We were encouraged to highlight what makes us unique in the field and focus on how scaleable and replicable our program will be in other communities and states.

Name or Organization

The North Carolina Partnership for Children (NCPC) administers the Shape NC program. Shape NC works w/three core partners: 1. Be Active Kids (BAK) A physical activity program for children ages birth to five. 2. Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC) - works with Early Care and Education (ECE) programs to improve healthy eating & activity. 3. Natural Learning Initiative’s (NLI) Preventing Obesity by Design, focuses on outdoor learning environment

Geography

NCPC is based in Raleigh, NC. Shape NC is currently in Durham, Wake, Wilson, and Randolph counties.

What is your stage of development?

  • Advanced Innovator with 3 to 10+ years of experience in ECD

Type

  • Non-profit

What is the stage of your proposal?

  • Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

Children can spend a significant portion of time in child care, thus these settings are fertile ground to implement best practices to decrease obesity and increase physical activity. A child’s experiences are lifelong determinants of health and well-being. Loading energies at the beginning of the children’s services continuum is immensely more cost-effective than paying for costly health care services later in life. Shape NC capitalizes on this with a focus on child care settings, ensuring a child's earliest experiences with food and physical activity inspire a lifetime of healthy behaviors.

Select an Innovation Target

  • Network: Connecting people with each other to enhance the reach or effectiveness of new or existing resources.

Tell us more about your innovation (1500 characters)

Shape NC aims to increase physical activity and decrease obesity in children 0-5 in Randolph, Wake, Wilson and Durham counties. In NC, 3 out of 10 low-income children, ages two to four are overweight or obese. Children who are obese by age 6 or overweight by age 12 have a > 50% likelihood of becoming obese adults. Shape NC was created as an innovative solution to prevent childhood obesity. Shape NC began in 2010 with funding from the Blue Cross Blue Shield NC Foundation (BCBSNCF) to improve health outcomes in child care settings. BCBSNCF recognized NCPC as early childhood experts with an established network across the state to implement this project. From 2010-2013, Shape NC engaged communities across 27 counties to improve healthy eating and active play for over 1,000 children. Child care centers almost doubled the number of best practices adopted, increasing the percent implemented from 40% to 74%. From 2013-2016, Shape NC scaled the program to engage 240 additional child care sites, reaching 10,000 children at 213 child care sites. Children in child care sites who implemented the full model over the past six years also realized a 6.9% decrease in Body Mass Index. Shape NC is now leveraging these successes through a deeper integration of content, training and technical assistance, focusing on four counties and 60 sites impacted by 2020. This phase also has a rigorous scaling, research and evaluation component to continue building positive impacts for childhood health.

What problem are you aiming to solve? (3 sentences)

According to the Centers for Disease Control and Prevention, about one in 8 preschoolers is obese in the US. Shape NC works to intervene early with children through child care sites to increase healthy eating, active play, and natural outdoor learning, with the intention of increasing the number of children entering kindergarten at a healthy weight and best ready to learn.

Explain your idea (5000 characters)

This three-year phase of Shape NC is a delayed treatment design. Each county recruits 10 child care sites annually, five treatment (immediate implementation), and five comparison (delayed implementation), with the exception of year three comparison sites who will not participate in implementation (sites will be incentivized for participation). Year one comparison sites will become treatment sites in year two, and year two comparison sties will become year three treatment sites. Each county is also required to have a Technical Assistance (TA) Specialist who provides training, TA and coaching to child care site staff. By the end of this phase, 60 child care sites will be actively implementing the Shape NC model. Throughout the project period, TAs and child care center staff will receive intensive training, technical assistance and coaching from the Shape NC team and core partners on best practices around physical activity, nutrition, and outdoor play and learning. In 2018, child care centers from current and previous Shape NC phases will participate in a one-day Shape NC Summit, held during the annual National Smart Start Conference, which will provide additional learning and networking opportunities for all participants, and is open to other interested conference attendees. The core partners for Shape NC, GNS, BAK and NLI, have countless years of experience in their respective fields and are fully vested in the Shape NC model. GNS is an evidence-based program based at the University of North Carolina at Chapel Hill Gillings School of Global Public Health that has worked with ECE programs for over a decade to promote healthy eating and physical activity within preschool populations nationally. GNS uses an online platform where child care center staff can assess their current best practice implementation, identify areas for improvement, and set measurable goals around five content areas: Infant & Child Physical Activity, Oral Health, Infant Feeding and Breastfeeding, Child Nutrition, Outdoor Play & Learning, and Screen Time. The GNS self-assessment tool has been used across the country and was used in 2016 by the Colorado Child and Adult Care Food Program (CACFP) to evaluate a training grant program. BAK is an evidence-based, award winning signature program of the BCBSNCF. This health program for children ages birth to five provides resources and education on the benefits of physical activity in early childhood in addition to teaching novel ways to be active using age and developmentally appropriate physical activity. BAK is also leading the training for Infant & Child Physical Activity content area of GNS. NLI, housed at North Carolina State University’s College of Design, promotes the importance of the natural environment in the daily experience of all children, through environmental design, action research, education, and dissemination of information. They are the are the foremost in the country in training, designing, and supporting the implementation of Outdoor Learning Environments (OLEs). NLI are expert landscape architects with ECE expertise. NLI works with child care sites to transform their existing traditional playgrounds into natural play and learning environments that offer diverse opportunities for increased physical activity and hands-on nutrition education, “edible landscapes” such as blueberry bushes, and vegetable gardens which are installed and managed by the centers. Additionally, NLI is leading the GNS training on Outdoor Learning and Play content area in GNS, helping to further integrate these best practices into center programs. NLI partners with communities across the country implementing the Preventing Obesity by Design model, including work in Colorado with the National Wildlife Federation to implement the ECHO (Early Childhood Health Outdoors) Initiative. Just within a few months of Shape NC, there has been a noted paradigm shift in the way center staff view physical activity. A child care center director from Durham County stated at a recent training, “traditionally, we are trying to keep kids safe and are constantly telling them to stop running, use walking feet and to have a seat. Not realizing that it’s our own comfort levels that we don’t want interrupted. We need to be open to kids being playful, running, moving anything that promotes movement and physical activities! Skip to the water fountain, jump up and down to wash hands, as long as their moving and being physical!”

Who benefits? (1500 characters)

The direct beneficiaries of Shape NC are the children and families enrolled in the child care sites funded by the project. Children enrolled in the first two phases of Shape saw a 6.9% decrease in Body Mass Index by the end of the six-year period. We anticipate even greater outcomes in this phase due to the “full vaccine” approach. Research shows direct links between healthy behaviors in children and youth to their academic achievement as measured by attendance, grades and graduation rates. Child care site staff will directly benefit. Child care facilities realized a 20% increase in the number of best practices consistently implemented around childhood nutrition and physical activity by the end of Phase II. 92% of staff who participated in a Shape NC online training course indicated they made healthy changes in their professional or personal lives three months after the course. Families and communities also benefit. The health of a community can be measured by the health of its children. Society benefits by creating healthier adults who can more effectively participate in the labor pool and to decreased health care costs long term. NCPC has a 25-year history of interacting with child care programs. NCPC was founded in 1993 to address a major problem in NC, children were coming to school unprepared to learn. Our mission is to advance a high quality, comprehensive, accountable system of care and education for each child beginning with a healthy birth.

What kind of impact will your idea have? (1500 characters)

Data indicates that obese children grow up to be obese adults. Obese adults have a higher risk of developing heart disease, type 2 diabetes, metabolic syndrome, and many types of cancer. Also, a longitudinal study by James Heckman found that the combination of education, health screenings and nutrition gave those children a much lower risk of cardiovascular disease, as well as metabolic diseases such as stroke and diabetes in their mid-30s. The study found that integration of early health and nutrition is critical for later adult health outcomes. Therefore, establishing healthy behaviors during childhood is easier and more effective than trying to change unhealthy behaviors during adulthood. Shape NC has the potential to impact not only children, but their caregivers in addition to the surrounding communities. Although Shape NC is based in child care centers, family and community engagement is a vital piece of the project. Child care centers are required to engage parents in Shape NC activities such as gardening and harvesting food grown at the center as well as through community awareness and engagement activities. One such community activity is called PLAYDAZE, which is an initiative of BAK. PLAYDAZE is designed to provide diverse play activities for toddlers through seniors and it can be as short as an hour or an entire weekend and implemented in neighborhoods or entire community parks. This year all four counties will host a PLAYDAZE.

How does or how could your idea impact low-income children? (1500 characters)

Shape NC is specifically designed to impact low-income children and communities. Counties that were selected to participate in Shape NC were required to have childhood obesity rates above the state average. In addition, child care sites that were selected in each county were required to accept child care subsidy, which indicates a family is below 150% of the federal poverty level. The four counties that are funded fully met requirements to participate in Shape NC: Durham County is the 6th most populous in the state, but approximately 50% of children in the county birth through five live in low-income families at or below 200% of federal poverty levels. The percent of low income children ages two to four who are overweight or obese in the county is 25.6%, and only 61.4% of children under 18 years of age are at a healthy weight. Randolph County is a mostly rural county in the center of the state and has a childhood poverty rate 28.7%, which has increased 11% since the 2007 Census. The obesity rate for children two - four is 29.1%. Wake County has approximately 5,000 low income children that receive subsidized child care, and 30.2% of these children ages 2-4 are overweight or obese. Wilson county is one of the top five poorest counties in the state and 28.2% of children under 18 live in poverty. Almost 34% of children zero to five live at or near the poverty level. The childhood obesity rate for children two - four is 31.9%.

Innovation: What makes your concept innovative? (5000 characters)

The main innovation of Shape NC is integrating three separate, but complementary programs with a healthy dose of technical assistance, both at the provider and TA level. After two phases (six years) of implementing this program, we have refined the program design. There is now a three year training curriculum, monthly partners meetings, integrated training content for a fully collaborative model to integrate the program work at the both the TA and providers levels. We have learned that the ‘full vaccine’ (in-depth implementation of all three component areas) yields the best results for children and families. Investing in our child care sites improves the quality of the site and is a long-term investment in a small business. The program supports a shift towards embracing health as a critical component of early childhood education. Similarly, as sites partner with and engage families in Shape NC the impact is compounded and reinforced. Shape NC programmatic partners are highly rigorous, and research based. The current phase includes quasi experimental research design expected to yield significant health outcomes. This, in addition to the length of the program implementation, helps solidify the impact of the program, making it easily scalable statewide in NC and in other states. Shape NC creates environments that intervein with toxic levels of stress and promote social emotional health and resilience in children. Being outdoors and physically active, having engaged adults, and nutrition are all protective factors which promote mental health and well being.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

NCPC understands that to scale this project up, funding and a robust network of strong partnerships is required. Shape NC currently has long-standing partnerships with our three core partners who are an integral part of this project. Embedding Shape NC practices into the child care system across the state is also a key strategy. NCPC will explore integrating Shape NC into the state’s star-rated child care licensing system. Three, four- and five-star child care sites would be automatically exposed to Shape NC which will more comprehensively integrate best practices that lead to increased physical activity and better nutrition for children, families and staff in their programs. Potential barriers could include difficulties integrating Shape NC into child care sites such as competing priorities, lack of community buy-in, and frequent staff changes. Additional barriers could be encountered in embedding Shape NC into the state’s star rating system as these changes will require modification to state law. The Shape NC model is easily scalable for any state or community that wants to address the high rates of obesity and lack of physical activity in children, particularly in rural areas where there is a lack of resources and higher numbers of financially and socially disadvantaged children. Core program components are available online. Shape NC trainings are recorded and will be available online. Program implementation is being thoroughly documented through detailed progress notes.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

NCPC has sustained and grown the Shape NC project for seven years. BCBSNCF was the original funder for Shape NC and has provided funding for all three phases of the project. As stated earlier, over the last six years Shape NC has reached over 10,000 and 213 child care sites modeling best practices. In 2016, NCPC was successful in leveraging the BCBSNCF funds to secure a five-year grant from the Corporation for National and Community Service to conduct a rigorous evaluation of Shape NC to determine if comprehensive implementation of all core components will have a positive impact on childhood physical activity and BMI. Shape staff will continue to seek funds to grow the Shape NC project statewide.

Business Viability: How viable is your business model? (5000 characters)

As this current iteration of Shape NC is still in development, staff have been in talks as to how the model can be action-ready to be replicated in other communities once this phase is completed. This action-ready model will be based on the results of the current phase evaluation, which will help determine what works with this iteration of Shape and what components are crucial to successfully address early childhood obesity. The primary barrier, as with most projects, is cost. NLI’s materials for developing OLEs can be found online for free. Although BAKs is mostly a North Carolina-based program, materials are available online and can be shipped for a nominal cost. GNS will be the costliest of the three core interventions, but as the Shape NC team is working to put together this action-ready curriculum, we will be negotiating with the core partners to ensure that this curriculum is duplicable AND affordable.

HCD: How have you used human centered design to build or refine your concept? (5000 characters)

Shape NC’s design lends itself to being human-centered. Outcomes will be measured at the center-, family-, and child-level. At the center level, Shape NC will measure the impact on the number of health and nutrition best practices implemented in treatment sites relative to comparison sites. To measure this, child care directors will be administered the Child Care Nutrition and Physical Activity Assessment Survey (Rudd Center for Food Policy and Obesity, 2008). This self-reported child-care director survey provides information about nutrition and the physical activity environment of child-care centers. At the family level, a survey will be administered at the beginning and end of year program year to parents of children enrolled in treatment and comparison centers. The questionnaire will measure parent perceptions of children’s food preferences and activity habits (to corroborate children’s self-reported preferences) and collect child and family demographic information. The questionnaire will ask for details about perceived changes in child food preferences and habits, and information such as child race, ethnicity, family size, and household income category. At the child level, we will also measure changes in children’s food preferences and habits and compare those results with that of their parents over time. We are asking children 10 questions regarding their food and activity preferences. Because no pre-existing food and physical activity preference measurement for children as young as two-years-old exists, and because this measure will be designed to complement the parent questionnaire, we developed items appropriate for young children based on items in the food and activity portions of the parent questionnaire.

Tell us more about you (3000 characters)

BCBSNCF recognized that healthy children grow up to be healthy adults, and the best time to address childhood obesity is before children enter school. Thus, BCBSNCF presented this project to NCPC due to our organization’s 24-year history in ECE and capacity to reach all 100 counties in the state through our [XX number] Local Partnerships. The most exciting part of this project is having the opportunity to have a significant impact on the health and wellness of North Carolinians we touch who will have the opportunity to grow up and be healthy, productive members of society. The Shape NC project team is very well versed in ECE and has extensive experience childhood physical activity and nutrition. The Project Coordinator for Shape NC formerly a Program Coordinator at the Durham County Partnership for Children and has a wealth of knowledge and experience in Early Childhood Education as well as how Smart Start local partnerships operate. She was also a kindergarten teacher in both urban and rural areas that were under-resourced; thus, she understands the challenges faced by rural communities in education as well as physical activity and healthy eating among children. She holds dual master’s degrees in Social Work and Public Administration. One Implementation Coach was most recently the Health/Nutritional Specialist at Orange County Head Start/Early Head Start. She holds a Masters of Public Health in Maternal and Child Health has been a Be Active Kids trainer since 2016. The second Implementation Coach has a bachelor’s degree in Family and Community Services and holds an Early Childhood Credential. What excites the Shape NC staff is primarily the collaboration during this phase. Bringing in counties who have previous Shape NC program experience, collaboration across child care providers, and the sharing of energy and ideas across our core partners is incredibly motivating and inspiring for us. The programmatic partners are more than willing to put in the work for the high level of collaboration Shape NC requires. We are also excited about incorporating lessons learned from the past phases into our design and implementation for phase three. Partnering with the National Research Implementation Network (NIRN) in 2018 is also an exciting next step. NIRN is an organization that assists partners with effective implementation of best practices for programs and organizational change for optimal outcomes. NIRN will help us strengthen Shape NC from an implementation science perspective in the areas of effective capacity building, implementation, scale up, and sustainability.

Do you have the people and partners you need to do what you’ve described? (600 characters)

Aside from the internal capacity of Shape NC staff, the project has the long-term support of the core partners, NLI, BAK and GNS. Shape NC would not be successful if not for the hard work and dedication of our partners in implementing this project. In addition, project staff has tapped into the knowledge and expertise of previous Shape NC sites who have agreed to provide mentorship, technical assistance and support to current and future Shape NC sites, which increases the likelihood of sustainability of this project long-term.

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

Shape NC would most benefit from any additional sources of funds and resources to grow this project. Shape NC will continue to leverage current funds to expand the project across the state. Shape NC would also benefit from policy experts who could guide our work with State lawmakers to change statutory policy that would mandate physical activity and nutrition best practices in all child care sites regulated by the state.

Would you like mentoring support?

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters)

Shape NC would also benefit from policy experts who could guide our work with State lawmakers to change statutory policy that would mandate physical activity and nutrition best practices in all child care sites regulated by the state.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).

www.smartstart.org http://www.smartstart.org/shape-nc-home/

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