The Early Care and Education Innovation Collaborative (ECE IC) is an ad hoc activity associated with the Roundtable on Obesity Solutions at the National Academies of Sciences, Engineering, and Medicine (The National Academies). This ad hoc convening activity fosters information sharing and collaboration toward the Roundtable aims as well as progress on findings highlighted in prior National Academies reports.

Any activities and products associated with this collaborative do not necessarily represent the views of any one organization, the Collaborative, the Roundtable, or the National Academies and have not been subjected to the review procedures of, nor are they reports, products, or activities of the National Academies.

Background

With 29.1% of 2–4 year olds enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children categorized as living with overweight or obesity in 2016, we know obesity prevention efforts must target our youngest children. One of the best places to reach young children with obesity prevention efforts is the early care and education setting (ECE). The use of ECE facilities – including child care centers, home-based child care, Head Start programs, preschool and pre-kindergarten programs – has become the norm in the U.S. Improving the ECE environment will help children develop a foundation of healthy habits for life. Standards and best practices for obesity prevention in ECE have been established by expert groups; however, there remain gaps in information and barriers to implementation. The ECE IC has convened four working groups to improve ECE facility-level policies, practices, and environments through the Child and Adult Care Food Program (CACFP), family child care (FCC) parent and caregiver engagement, and quality and rating improvement systems (QRIS). The QRIS working group is no longer active.

To begin to understand the work going on in this sector, the Robert Wood Johnson Foundation provided support for a review of the literature to help identify gaps, using the CDC’s Spectrum of Opportunities Framework for State-Level Obesity Prevention Efforts Targeting the Early Care and Education Setting report as a touchstone.

• Journal Article: Ward et al. 2017. Strength of obesity prevention interventions in early care and education settings: A systematic review.

Two publications were developed based off the work and early discussions of the collaborative. Support for these publications was provided by the Robert Wood Johnson Foundation.

• Journal Article: Woo Baidal et al. 2016. Risk factors for childhood obesity in the first 1,000 days: A systematic review. American Journal of Preventative Medicine 50(6):761-779.
• Journal Article: Tandon et al. 2016. The relationship between physical activity and diet and young children’s cognitive development: A systematic review. Preventive Medicine Reports 3(June):379-390.

CHILD AND ADULT CARE FOOD PROGRAM (CACFP)

CACFP has been a focus of the ECE IC since October 2015. In 2018, Child Care Aware of America and the Food Research and Action Center (FRAC) conducted research on the relationship between Child Care Resource and Referral Agencies and CACFP. The result of this work was summarized and presented on a webinar hosted by FRAC. The webinar summarized three case studies showing how state and local Child Care Resource and Referral Agencies can promote and support Child and Adult Care Food Program participation. It includes presentations from Missouri, Virginia, and North Carolina to highlight best practices, lessons learned and emerging opportunities. Support was provided by United Way Worldwide.

• Webinar Executive Summary: Child Care Resource and Referral and the Child and Adult Care Food Program: Strengthening Food Access for Children through Child Care Systems

CAREGIVER ENGAGEMENT

In response to an identified gap in the knowledge base, the ECE IC initiated the Ohio Healthy Families pilot project aimed at building the knowledge base on parent engagement and healthy eating/physical activity practices in ECE settings. This project, operated by Nemours emerged from a forum held by the ECE IC in August 2014 to bring together experts in family engagement and childhood obesity prevention. The goal of the project was to weave together two interventions—one targeting providers (Ohio Healthy Programs) and the other caregivers (Homestyles)—to promote healthy practices in the ECE setting and at home.

The caregiver engagement workgroup then identified a need for actionable information on responsive feeding for child care providers in centers and in family child care homes. They developed an educational training module on responsive feeding practices.

• Educational Module: The responsive feeding module is an online course for early care and education providers (Head Start and Early Head Start teachers, family child care providers, child care providers) that educates on responsive feeding best practices, and on how to implement responsive feeding best practices in ECE settings. The responsive feeding module was developed in collaboration with members of the collaborative, Nemours, Nestle, and Penn State to operationalize healthy, evidence-based infant feeding practices for child care providers. Members of this group published a preliminary analysis (below) of the learning module. Support was provided by Nemours National Office of Policy and Prevention and Nestlé Nutrition Institute.
• Abstract: Formative evaluation of an online responsive feeding training program for early childhood education professionals
• 5-Part Webinar Series: A 5-part webinar series was developed to translate key learnings to policymakers and ECE providers of the Roundtable on Obesity Solution’s workshop summary, Obesity in the Early Childhood Years: State of the Science and Implementation of Promising Solutions and Nemours’ campaign Healthy Kids, Healthy Future: Opportunities for Action. Support for the webinars was provided by Nemours.

QUALITY AND RATING IMPROVEMENT SYSTEMS (QRIS)

The ECE IC identified gaps in the group’s knowledge on the presence of healthy eating and physical activity (HEPA) standards in state quality rating and improvement systems (QRIS) in October 2014. Duke University’s Healthy Eating Research funded Nemours to survey state QRIS administrators on the presence of HEPA in their QRIS standards, and the ECE IC advised on the project. In June 2016, the collaborative was briefed by the project consultant on the outcome of the efforts of the IC, and a white paper was published with the results.

• White Paper: State Quality Rating and Improvement Systems: Strategies to Support Achievement of Healthy Eating and Physical Activity Practices in Early Care and Education Settings

The QRIS work group pursued a project to support South Carolina QRIS coaches and technical assistants in their work with family child care providers. Family child care providers work in unique and varied environments, and they face obstacles in implementing healthy eating and physical activity-focused QRIS standards. A toolkit was developed to support Quality Rating and Improvement System coaches and technical assistants on ways to implement healthy eating and physical activity practices into child care homes, specifically to support South Carolina’s new QRIS.

• Toolkit: Supporting ABC Quality Providers to Achieve Nutrition and Physical Activity Standards