Healthy Habits Start Early: Evaluation Results and Recommendations

The Healthy Habits Start Early (HHSE) intervention was implemented by Iowa Department of Education’s Team Nutrition Program and evaluated by the University of Iowa. The intervention sought to improve child care environments in day care homes and child care centers, train staff to provide healthy meals in their day care, deliver nutrition education through a United States Department of Agriculture developed curriculum, and engage staff, parents, and the community around healthy eating practices among children. HHSE was delivered separately to two populations that participated in the Child and Adult Care Food Program (CACFP): home day care providers and child care centers. The programs were delivered between July 2018 and December 2018 for the home day care providers and October 2018 and March 2019 for the child care centers. While the components were largely the same between the two populations, how the project was implemented and who implemented it varied between home providers and child care centers. The overall components are described in Table 1. 

For home day care providers, their home sponsor organization delivered the intervention to the home providers using a train-the-trainer model. Team Nutrition trained each home sponsor organization and reached out to each of the 21 home sponsor organizations in Iowa to apply to participate in the project and provide the intervention to their home day care providers. Team Nutrition also invited the home sponsors to attend a training, “Culinary Skills for Healthy Meals in CACFP”, which included meal pattern training developed by the Institute for Child Nutrition (ICN) and training on culinary skills for center directors and home sponsor organizations. We intended for 10 home sponsor organizations to participate in the project, with each delivering the program to 40 home day care providers. If a home sponsor was selected to participate, they would then host a training on the HHSE project for their home providers on CACFP meal patterns, the HHSE intervention, and the evaluation activities. Participating home sponsors also provided each home provider with the nutrition education component, the Grow it, Try it, Like it curriculum at the provider training. 

We also partnered with Child Care Nurse Consultants (CCNCs) to encourage child care centers throughout the state to apply to participate in the HHSE project. We intended for 30 child care centers to participate. In partnership with the Iowa Department of Public Health, we trained 15 CCNCs to provide technical assistance to child care centers on implementing the intervention and completing the evaluation activities. Each CCNC visited participating centers three times. During visit one, CCNCs provided training on NAP SACC (Nutrition and Physical Activity Self-Assessment for Child Care) to the center and completed the Minnesota Mealtime self-assessment. Center directors completed the NAP SACC online tool and worked with the CCNC to develop an action plan based on the results during visit two. CCNCs also provided the Grow it, Try it, Like it curriculum to centers during visit two. During visit three, CCNCs provided any technical assistance needed to complete the NAP SACC again as a post evaluation and again completed the Minnesota Mealtime self-assessment. Center directors and staff also attended the ICN training mentioned above.