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Shape NC Phase II Evaluation Year 2 Report February 24, 2016

Authors:Allison De Marco, MSW PhD

Scientist and Adjunct Assistant ProfessorFrank Porter Graham Child Development Institute

School of Social WorkUniversity of North Carolina at Chapel Hill

Molly De Marco, MPH PhDResearch Scientist and Research Assistant Professor,

Department of Nutrition, Gillings School of Global Public HealthUNC Center for Health Promotion and Disease Prevention

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Table of ContentsList of Tables and Figures……………………………………………………...………………..4

Executive Summary…………………………………………………………..………………….7

Summary of Progress…………………………………………………………………….9

Key Findings from Shape NC Phase II Year II……………………………….……………….10

Child Healthy Weight (BMI)……………………………………..…………………….10

Child Care Program Best Practices (Go NAP SACC self-assessment)………………10

Hub Specialist and TA Services Provided……………………………………………..11

Resources Leveraged……………………………………………………………………11

Web Series……………………………………………………………….……………….11

Background: Description of Shape NC Phase II……………………………………………...12

Shape NC Phase I……………………………………………………….………………13

Shape NC Phase II……………………………………………………………………...14

Community Engagement Case Study Highlight: Buncombe Partnership…………..18

Phase II Evaluation Overview…………………………………………………………….……19

Community Engagement Case Study Highlight: Down East Partnership……..…...23

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Results for Phase II Year II…………………………………………………………………….23

Numbers Served………………………………………………………………………...23

Resources Leveraged…………………………………………………….……………...25

Community Engagement Case Study Highlight: Onslow Partnership…………..….27

MELC Performance…………………………………………………………………….28

Graphs of Change in Criteria A from Wave I and Wave II for MELCs………………32

Significance Tests Comparing Wave I and Wave II…………………..………………43

Improvement for MELC Sites………………………………………………………....44

Improvement for Expansion Sites ……………………………………………………46

Wave II Child BMI……………………………………………………………………..46

Community Engagement Case Study Highlight: Randolph Partnership……………52

Web Series……………………………………………………………….………………53

Conclusions…………………………………………………………………………………..….56

References………………………………………………..……………………………………...58

Appendices……………………………………………………..………………………………..60

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List of Tables & FiguresTable 1.Shape NC Phase II Priority Outcomes by Project Component

Table 2. Data Collection Periods for Logs by Region and Type

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Table 3. Service Counts from TA/CES/Hub Logs

Table 4. Resources Leveraged

Table 5. MELC Performance Summary Table

Table 6. Model Early Learning Centers Meeting Criterion A (55% of all Indicators)

Table 7. Summary Table of Whether Each Center met all Demonstration Site Criteria (B)

Table 8. Improvement Table for MELC programs

Table 9. Comparison of proportion of Criteria A standards met between Wave I and II for MELC sites

Table 10. Percent Met Overall and for each Area for Expansion Sites

Table 11. Demographic characteristics of all children enrolled in the selected child-care programs

Table 12. BMI for Age-Weight Status Categories

Table 13. BMI Percentile Categories for Children in Shape NC Centers, Phase II Baseline

Table 14. Weight Status by Program Type

Table 15. Weight Status by Race/Ethnicity

Table 16. BMI Percentile by Race/Ethnicity

Table 17. Weight Status by Region

Table 18. BMI Percentile by Region

Table 19. Weight Status by Gender

Table 20. BMI Percentile by Gender

Table 21. Weight Status by Full-time/Part-time

Table 22. Weight Status by Length of Enrollment

Table 23. Weight Comparison from Phase I to Phase II Waves

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Table 24. Performance on Web Series

Figure 1. Shape NC Grant Recipients – March 2015

Figure 2. Shape NC Phase II Conceptual Model

Figure 3. Overall Change in Criteria A from Wave I to Wave II

Figure 4. Change in Criteria A from Wave I to Wave II: Anson Children's Center

Figure 5. Change in Criteria A from Wave I to Wave II: Chatham Child Development Center

Figure 6. Change in Criteria A from Wave I to Wave II: Excel 3

Figure 7. Change in Criteria A from Wave I to Wave II: Friendly Avenue Christian Preschool

Figure 8. Change in Criteria A from Wave I to Wave II: Excel Christian Academy

Figure 9. Change in Criteria A from Wave I to Wave II: Haywood Community College

Figure 10. Change in Criteria A from Wave I to Wave II: Kids Company - Henson Drive

Figure 11. Change in Criteria A from Wave I to Wave II: Little Faces Child Development Center

Figure 12. Change in Criteria A from Wave I to Wave II: Lulu's Child Enrichment Center

Figure 13. Change in Criteria A from Wave I to Wave II: Precious Resources

Figure 14. Change in Criteria A from Wave I to Wave II: Nash Community College Child Care

Figure 15. Change in Criteria A from Wave I to Wave II: Small Beginnings CDC

Figure 16. Change in Criteria A from Wave I to Wave II: Spanish For Fun Academy

Figure 17. Change in Criteria A from Wave I to Wave II: The Early Learning Center

Figure 18. Change in Criteria A from Wave I to Wave II: The Growing Place

Figure 19. Change in Criteria A from Wave I to Wave II: Wayne Community College Child Care Center

Figure 20. Change in Criteria A from Wave I to Wave II: Verner

Figure 21. Percent of Participants Reporting Behavior Changes by Area

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Executive SummaryShape NC: Healthy Starts for Young Children is a six-year, $6 million partnership between The Blue Cross and Blue Shield of North Carolina (BCBSNC) Foundation and The North Carolina Partnership for Children, Inc. (NCPC) created to address early childhood obesity. Shape NC assists communities across North Carolina in their efforts to improve environments where young children spend a significant amount of time to help ensure that their earliest experiences with food and physical activity inspire a lifetime of healthy behaviors. This is accomplished by creating a strong and vital network of local experts and programs to provide ongoing support to centers in instilling healthy behaviors early on that create a solid foundation for a healthy life. Three of the major statewide programs are:

Be Active Kids: The signature health program of the Blue Cross Blue Shield of North Carolina Foundation to increase physical activity of both children and adults in early care and education settings.

Preventing Obesity by Design (POD): A project of the Natural Learning Institute at North Carolina State University, which promotes the importance of the natural environment in the daily experience of all children.

Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC): An online tool for early care and education programs interested in building healthy eating and physical activity habits in children developed at the University of North Carolina at Chapel Hill.

During Phase I, the initiative engaged 19 communities spanning 27 counties across North Carolina—eight communities joined in March of 2011 (cohort 1), ten communities joined in September 2011 (cohort 2), and one final community joined in March of 2013. Activities within each community included organizing an Early Childhood Obesity Prevention Team that focused on community-wide efforts, and working with a designated child care center to transform it into a model for nutrition and physical activity best practices for other local centers.

During Phase I, evaluation data were collected from participating communities on a quarterly basis starting in September of 2011 to track Shape NC efforts and assess progress toward key goals. While September 2011 is considered to represent baseline data, cohort 1 communities and centers had been engaged in the program for six months by that point.

Phase I saw a number of major accomplishments. Participating child care centers nearly doubled the number of best practices adopted, increasing the percent of best practices met from 40 percent to 74 percent. Significant improvements occurred in active play time, limiting screen time, offering of healthy food and beverages, and outdoor play. Child care centers exceeded Phase I Year 3 milestones for active

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play time and offerings of healthy fruits, and made significant improvements in providing vegetables and lean protein. Other accomplishments included:

Children’s Weight: Over the course of each school year, trends showed the percent of children who reached a healthy weight gradually improved.

Active Play: The percent of children provided with 90 minutes or more of physical activity daily rose from 51 percent to 85 percent.

Fruit: The percent of children provided with fruit two or more times per day rose from 34 percent to 80 percent.

Vegetables: The percent of children provided with vegetables two or more times per day rose from 32 percent to 60 percent.

Beans and Lean Meats: The percent of children provided with beans or lean meats one or more times per day rose from 9 percent to 40 percent.

Outdoor Learning: 19 child care centers made improvements to outdoor learning environments including additions such as bike paths and vegetable gardens.

Child Care Center Staff: 74 staff members improved at least one of their own health behaviors, including eating more fruits and vegetables, getting more physical activity and drinking less sugar sweetened beverages.

Additionally, local action planning teams engaged a diverse community membership that worked effectively to create and implement Early Childhood Obesity Prevention Action Plans. Action planning team accomplishments included:

Smart Start Local Partnerships brought together a wide variety of people and organizations including health departments, child care programs, cooperative extension, local colleges and universities, and health care providers. They created a shared vision and worked to achieve their common goals. The teams were very effective in implementing Early Childhood Obesity Prevention Action Plans.

Smart Start Local Partnerships raised over $1.2 million in additional resources in the form of volunteer hours, donations of services, cash donations, and grant funding.

These improvements in Shape NC Model Early Learning Centers from Phase I greatly increased the percentage of children exposed to physical activity and good nutrition.

Given the success of Phase I, Phase II seeks to grow by taking the Shape NC model to scale. The BCBSNC Foundation has funded the continuation of this partnership with NCPC for an additional three years. This report describes the progress of the Shape NC work through the second year of Phase II. Shape NC Phase II maintains the four Smart Start Local Partnership Hubs. Each provides training and more intensive services to four to five other Shape NC Local Partnerships within their region. Each Hub has a Hub Specialist and a part-time Community Engagement Specialist. Hub Specialists continue to provide technical assistance to the Model Early Learning Centers (MELCs) to assist them in becoming Demonstration Sites for the new Shape NC-participating centers. Phase II also includes active community engagement using the ABLe Change framework and on-line training for child care staff across the state.

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Summary of Progress

Outputs Year 2 Progress1. MELCs becoming Demonstration Sites Target: 12 72. Additional Shape NC Child Care Centers Target: 240 1483. ABLe Change Communities Target: 8 4 (4 additional have been selected and will begin

implementing community engagement strategies in Y3)4. Increase in healthy weight Target: Decrease in BMI 6.5% decrease in BMI of children for all centers

7.5% decrease in BMI of children for MELCs 6.4% decrease in BMI of children for Expansion Sites

5. Child Care Providers participating in on-line professional development Target: 2000 738 post-tests completed

Expected Results1. Increase in knowledge of best

practices related to health, nutrition, and physical activity in child care settings

30.9% increase in knowledge of best practices from pre to post-test. This was a statistically significant increase.

2. Increase in percent of best practices within child care programs implementing Go NAP SACC

20.6% increase in percent by MELCs, 44 Expansion Sites also saw improvement in at least one area, although percent increase is not possible because all centers did not assess all Go NAP SACC indicators during this wave.

3. For those not participating in Go NAP SACC, participants will increase knowledge in other ways

Web series participants, whose centers don’t already participate as MELCs or Expansion Sites, improved their knowledge of best practices by 33% from pre to post-test survey.

Community Outcomes1. Increase in knowledge about

community engagementAll Hub partnerships reported statistically significant shifts in their understanding of ABLe Change community engagement strategies and intended actions, including how to gather family input, seek root causes, and promote member engagement.

2. Participants apply the knowledge to the ongoing community engagement process and developing and implementing a local plan responsive to family voice in addressing key issues related to early childhood obesity

The 4 Hub partnerships have all created local plans utilizing the community engagement process informed by the ABLe Change Framework

3. The local system is enhanced in its ability to support healthy weight for young children. In particular, the local system is more responsive

In case study interviews all participants detailed concrete ways in which their local system is actively engaged in addressing child health, including support for local child care programs, implementation of places for active play,

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to family needs, more coordinated, and easier to access.

engagement of parents in reviewing of materials, and even financial decision-making in the case of one partnership.

Key Findings from Shape NC Phase II Year IIChild Healthy Weight (BMI)

For all children in both Expansion Sites and MELCs with data at each wave, the percent of children at normal/healthy weight increased by 5.4%; this increase was 7.6% for MELCs. The percent of children at normal/healthy weight decreased slightly, 2%, for Expansion Sites.

Children enrolled in MELCs with 2 waves of data saw statistically significant decreases in BMI percentile.

Children enrolled in selected Expansion Sites with 2 waves of data also experienced statistically significant decreases in BMI percentile.

For all children with complete data: Tests of significance comparing children’s BMI Percentile at Wave I and Wave II

indicate a significant decrease for the White, Black, and Latino children. The portion of both male and female children at normal/healthy weight saw a

statistically significant increase from Wave I to Wave II. For most regions there were fewer children in the obese and overweight groups

from Wave I to Wave II, with the exception of the Mid-East region The portion of children at normal/healthy weight increased for each region aside

from the Mid-East Region.

Child Care Program Best Practices (Go NAP SACC self-assessment)

Overall, MELCs improved 20.6% from attaining an average of about 63% of items at Wave I to an average of about 76% items at Wave II.

No new MELCs have attained demonstration site status during Wave II. Six programs are close to obtaining Demonstration site status Sixteen of the 17 MELCs with data improved on Criteria A at Wave II, some

substantially – Lulus from 63% to 96%, (a 52.4% increase), Excel Christian from 53% to 83% (a 56.5% increase), and Chatham from 48% to 78% (a 62.3% increase)

For the MELC item-level comparisons from Wave I to Wave II, nine saw improvements, one saw a decline, and seven had mixed results (both improvements and declines for various items).

MELCs, as a group, improved in the proportion of indicators met within Criteria A and also within each area for Criteria A from Wave I to Wave II.

MELCs had statistically significant improvements from Wave I to Wave II for Breastfeeding, Physical Activity, and Outdoor Learning.

Expansion Sites had statistically significant improvements from Wave I to Wave II for Breastfeeding, Physical Activity, and Screen time. For the Expansion Site comparisons from Wave I to Wave II, 44 saw improvements, four saw declines, five had mixed results, and three were not rated due to lack of Wave I data.

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Hub Specialist and TA Services Provided

A total of 4,577 services, including trainings, assessments, staffing of special, events, and technical assistance, were provided to parents, child care centers and child care staff, community organizations, and Expansion Sites.

Parents were served 755 times, centers 208 times, child care staff 3,355 times, community-based organizations 58 times, and Expansion Sites 63 times.

138 trainings were provided on topics such as Breastfeeding Friendly Child Care, Playground Safety, and Be Active Kids.

Resources Leveraged

A total of $286,769.52 was leveraged by Smart Start Local Partnerships, Model Early Learning Centers, and Expansion Sites to support Shape NC Phase II initiatives.

The resources leveraged includes the equivalent of $62,308.83 in volunteer hours (1,186 hours).

$191,800.60 in grant funds were leveraged for Shape NC related activities.

Web Series

Participants, including teachers, directors, owners, and technical assistance providers, had a 30.9% increase in their knowledge of best practices from pre to post, going from 66.9% to 87.6%. This was a statistically significant increase.

Participants reported a number of behavior changes as a result of completing the web series.

Those who had already been participating in Shape NC improved their knowledge of best practices by 21%, while those introduced to Shape NC through this online series improved their knowledge of best practices by 33% from pre to post-test survey. The participants who had already been exposed to Shape NC started with a higher baseline of knowledge compared to the non-Shape NC participants (71% vs. 66%).

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Background: Description of Shape NC Phase IIIn the last 20 years, obesity rates in U.S. children and youth have skyrocketed (Ogden, Carroll, Kit, & Flegal, 2012; Pate, Davis, Robinson, Stone, McKenzie, & Young, 2006; Singh, Kogan, VanDyck, 2010). According to the Centers for Disease Control and Prevention, 17% of approximately 12.5 million children ages 2 – 19 years are obese (CDC, 2012). In North Carolina, the rate of overweight among young children aged 2 to less than 5 is 16.2% and 15.5% for obesity (CDC, 2010). The rates were 14.6% and 13.4% respectively for NC adolescents (CDC, 2009a). This is alarming as an increasing amount of data suggests that being overweight during childhood and adolescence is significantly associated with insulin resistance, dyslipidemia

(disruption in the amount of lipids in the blood, typically elevated), and elevated blood pressure later in life (Daniels, 2006). Furthermore, children who are overweight or obese during early childhood are at increased risk of becoming overweight or obese adults (Brisbois, Farmer, & McCargar, 2012). About one third of overweight preschool children and about one half of overweight school age children remain overweight in their adult years (CDC, 2009b). In addition, children consume relatively few servings of fruits and vegetables even though we know that early exposure to such foods leads to the development of life-long healthy food habits (Johnson, 2000). Research has shown that eating and activity

habits learned during these early years tend to track as children age (Jones, Hinkley, Okely, & Salmon, 2013; Kwon & Janz, 2012; Mikkila, Rasanen, Raitakari, Pietinen, & Viikari, 2004; Pearson, Salmon, Campbell, Crawford, & Timperio, 2011). The implementation of physical activities in child care settings can increase light and moderate/vigorous physical activity among young children in child care and is particularly effective when activities are teacher-directed (De Marco, Zeisel, Odom, & Kurgat, in press, 2014 online). Child care settings may be a particularly rich avenue to combat overweight and obesity as 249,654 children in North Carolina are in regulated child care settings (NCDCDEE, 2014). North Carolina’s Shape NC: Healthy Starts for Young Children initiative is one such project.

Shape NC: Healthy Starts for Young Children is a six-year, $6 million initiative of Blue Cross and Blue Shield of North Carolina (BCBSNC) Foundation and The North Carolina Partnership for Children, Inc. (NCPC) created to increase the number of children starting kindergarten at a healthy weight. Shape NC has purposefully directed its efforts at early childhood, as this developmental period has been identified as a critical period for obesity development. Shape NC works with local communities to support the creation of environments that foster healthy eating and physical activity behaviors in young children. Efforts are targeted toward those settings where young children spend a significant amount of time to help ensure that their earliest experiences with food and physical activity inspire a lifetime of healthy behaviors.

Shape NC helps communities and child care centers develop environments, practices and policies that encourage young children to be healthy. This is accomplished by creating a strong and vital network of local experts and programs to provide ongoing support to centers in

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Child care settings may be a particularly rich avenue to combat overweight and obesity as 249,654 children in North Carolina are in regulated child care settings (NCDCDEE, 2014).

instilling healthy behaviors early on that create a solid foundation for a healthy life. Three of the major statewide programs are:

Be Active Kids: The signature health program of the Blue Cross Blue Shield of North Carolina Foundation to increase physical activity of both children and adults in early care and education settings.

Preventing Obesity by Design (POD): A project of the Natural Learning Institute at North Carolina State University, which promotes the importance of the natural environment in the daily experience of all children.

Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC): An online tool for early care and education programs interested in building healthy eating and physical activity habits in children developed at the University of North Carolina at Chapel Hill.

Shape NC Phase I

During the first three years, the initiative engaged 19 communities spanning 27 counties across North Carolina - eight communities joined in March of 2011 (cohort 1), ten additional communities joined in September 2011 (cohort 2), and one final community joined in March of 2013. Activities within each community included organizing an Early Childhood Obesity Prevention team that focused on community-wide efforts, and working with a designated child care center to transform it into a model for nutrition and physical activity best practices for other local centers. These designated child care centers were called Model Early Learning Centers (MELCs).

Evaluation data were collected from participating communities on a quarterly basis since September of 2011 to track Shape NC efforts and to assess progress toward key goals. While September 2011 is considered to represent baseline data, cohort 1 communities and centers had been engaged in the program for six months. Major accomplishments are highlighted below.

Child care centers across North Carolina almost doubled the number of healthy best practices adopted, increasing the percent of best practices met from 40 percent to 74 percent. Significant improvements occurred in increasing active play, limiting screen time, offering of healthy food and beverages, and including outdoor play.

Child care centers are exceeding Year 3 milestones for active play time and offerings of healthy fruits, and have made significant improvements in providing vegetables and lean protein. These center accomplishments include:

Children’s Weight: Over the course of each school year, trends showed the percent of children who reach a healthy weight is gradually improving.

Active Play: The percent of children being provided with 90 minutes or more of physical activity daily rose from 51 percent to 85 percent.

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In Shape NC Phase I, child care centers across North Carolina almost doubled the number of healthy best practices adopted, increasing the percent of best practices met from 40 percent to 74 percent.

Fruit: The percent of children being provided with fruit two or more times per day rose from 34 percent to 80 percent.

Vegetables: The percent of children being provided with vegetables two or more times per day rose from 32 percent to 60 percent.

Beans and Lean Meats: The percent of children being provided with beans or lean meats one or more times per day rose from 9 percent to 40 percent.

Outdoor Learning: 19 child care centers made improvements to outdoor learning environments including additions such as bike paths and vegetable gardens.

Center Staff: 74 staff members at child care centers improved at least one of their own health behaviors, including eating more fruits and vegetables, more physical activity and less sweetened beverages.

Additionally, local action planning teams have engaged diverse community membership that worked effectively to create and implement Early Childhood Obesity Prevention Action Plans. These accomplishments include:

Smart Start Local Partnerships bringing together a wide variety of people and organizations including from health departments, child care programs, cooperative extension, local colleges and universities, and health care providers. They created a shared vision and worked to achieve their common goals. The teams have been very effective in implementing Early Childhood Obesity Prevention Action Plans.

Smart Start Local Partnerships raising over $1.2 million in additional resources in the form of volunteer hours, donations of services and securing additional grant funding.

Shape NC Phase II

Given the success of Phase I, Phase II seeks to grow by taking the Shape NC model to scale. The BCBSNC Foundation has funded the continuation of this partnership with NCPC for an additional three years. Shape NC Phase II maintains the four Smart Start Local Partnership Hubs (See Appendix for Shape NC definitions). Each provides training and more intensive services to

the four-to-five other Shape NC Local Partnerships within their region. Each Hub Partnership has a Hub Specialist and has added a part-time Community Engagement Specialist. Hub Specialists continue to provide technical assistance to the Model Early Learning Centers (MELCs) to help them to become Demonstration Sites for the new Shape NC-participating centers. Hub Specialists also provide coaching to local technical assistance staff for implementing health

changes in the new centers. The Community Engagement Specialists work to move local communities forward in their efforts to support early childhood healthy weight promotion and obesity prevention. The community engagement, evidence-based framework, ABLe Change, is being piloted in the four Hub partnerships. In Year 3 the ABLe Change model will expand to at least four new partnerships. Shape NC Phase II involves communities in 27 North Carolina counties (see Figure 1).

Figure 1. Shape NC Grant Recipients – March 2015

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In Phase II Shape NC will expand to 240 new centers. A cadre of 40 Technical Assistance (TA) staff (~10/region) have been trained in Shape NC and support and coach new centers in the implementation of Shape NC best practices. The components of Phase II are 8 ABLe Change Communities; 18 MELCs, 12 Demonstration Sites reaching a level of excellence from among the 18 MELCs; 240 new child care centers/family child care homes; and 2000 child care providers who will participate in online professional development for early childhood obesity prevention and Shape NC implementation strategies.

Components of Phase II:

8 ABLe Change Communities- In Year 2 of Phase II, the four Hub Local Partnerships continue to receive coaching and mentoring in implementation of the ABLe Framework’s system change approach and strategies. In Year 3, four additional Local Partnerships will have the opportunity to be trained in the ABLe Change Framework. The ABLe Change Framework guides local communities in design and implementation of community change efforts. This evidence-informed framework has been used successfully in Michigan’s Great Start Early Childhood Initiative to influence community change. Training, consultation, and coaching on use of this framework is provided by the System exChange Team led by Dr. Pennie Foster-Fishman of Michigan State University. The goal is to create community-wide systems to support healthy weight in young children.

18 Model Early Learning Centers- The Model Early Learning Centers (MELCs) will continue to improve on best practices and work toward Demonstration Site status. Best practices and children’s BMI is measured at MELCs every 6 months to track progress. The goal is to see if

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MELCs increase their percentage of best practices and if the percentage of children at a healthy weight increases after attending the center.

12 Demonstration Sites- In Phase II, the goal is for at least 12 of the 18 Model Early Learning Centers to reach a level of excellence and become Demonstration Sites for new centers in the surrounding community. Staff at the Demonstration Sites will be trained to provide on-site tours for other centers to see the nutrition, physical activity, and outdoor learning environments in action and learn about how these improvements were accomplished.

240 Additional Child Care Sites- Approximately 20 new centers/family child care homes per region per year (a total of 240) will be selected by Local Partnerships to participate in Shape NC. These centers, with the support of a technical assistance provider, will complete the Go NAP SACC assessments every 6 months with the goal of increasing best practices by 20% in at least one content area the first year and an additional 10% from baseline each year after that.

2000 Child Care Providers- 2000 child care providers across the state will participate in online professional development for early childhood obesity prevention and Shape NC implementation strategies. The goal is for the providers to increase their knowledge in healthy best practices and apply their new knowledge either professionally and/or personally.

Expected Outcomes The Shape NC Phase II Conceptual Model depicts the primary intended outcomes for this initiative (Figure 2).

Figure 2. Shape NC Phase II Conceptual Model

Four of the five components specifically focus on child care programs. NCPC anticipates these components will yield the following outcomes:

Increase in knowledge of best practices related to health, nutrition, and physical activity in child care settings.

Increase in percentage of best practices within child care programs implemented through Go NAP SACC.

For those not participating in Go NAP SACC, participants will apply knowledge in other ways to promote healthy weight for young children.

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In addition, eight communities will adopt the ABLe Change framework. These communities are expected to experience the following outcomes:

Increase in knowledge about community engagement. Application of knowledge to the ongoing community engagement process. Participants

will be able to develop and implement a local plan responsive to family voice in addressing key issues related to early childhood obesity.

Enhancement of local system‘s ability to support healthy weight for young children. In particular, the local system is more responsive to family needs, more coordinated, and easier to access.

These components are intended to work together to contribute to an increase in percentage of children at a healthy weight.

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Community Engagement Case Study Highlight ~

Buncombe Partnership for Children

The Buncombe Partnership for Children’s community engagement efforts have centered on their significant strides in engaging key stakeholders. Building parent engagement has been a main focus of these efforts. One of the first ways parents within the community have been engaged is through surveys administered at community events. These surveys queried parents on their family’s diet and physical activity behaviors. Another avenue for engagement has been the development of Affinity Groups. One of the key Affinity Groups is for parents. The partnership has contracted with an organizer who has a background in community organizing, specifically to work on engagement through the Parent Affinity Group. The Partnership brought in the leader of the local Positive Parenting Program to conduct a PhotoVoice project with parents. This PhotoVoice endeavor has been a significant catalyst for this Partnership around community engagement and is getting broader attention.

In addition, this partnership has embraced pieces of the ABLe Change model such as Results-Based Accountability, Root Cause Analysis, and 6 Simple Rules to significantly alter the way they conduct their activities including meetings.

Phase II Evaluation OverviewThe following section details the evaluation questions (4) and the research methods. This section provides an overview of the procedures for data collection and describes the measures. Copies of each measure/data collection tool can be found in the appendices.

Evaluation Question 1: How many people and organizations participated in each component of Phase II?

Data for EQ1 is being collected monthly through updated NCPC Tracking Logs completed by the Hub Specialists, Community Engagement Specialists, and TA Specialists (Year 1) and the Hub Specialists and TA Specialists (Year 2 on). The tracking logs ensure that data is collected uniformly across the state. Data analysis is primarily descriptive. The tracking logs are used to gather the following information:

● Number and types of community organizations that are participating (ABLe Change)● Number of parents participating (ABLe Change)● Number of child care centers participating (ABLe Change, Demo Sites , MELCs,

Expansion Sites, Online Training)● Number of child care staff participating (ABLe Change; Demo Sites , MELCs, Expansion

Sites, Online Training)● Number of TA Contacts (Expansion Sites)● Number of trainings offered (to obtain participant counts; Online Training)

Evaluation Question 2. To what degree does each component of Shape NC Phase II achieve the related priority outcomes?

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Buncombe Partnership for Children

The Buncombe Partnership for Children’s community engagement efforts have centered on their significant strides in engaging key stakeholders. Building parent engagement has been a main focus of these efforts. One of the first ways parents within the community have been engaged is through surveys administered at community events. These surveys queried parents on their family’s diet and physical activity behaviors. Another avenue for engagement has been the development of Affinity Groups. One of the key Affinity Groups is for parents. The partnership has contracted with an organizer who has a background in community organizing, specifically to work on engagement through the Parent Affinity Group. The Partnership brought in the leader of the local Positive Parenting Program to conduct a PhotoVoice project with parents. This PhotoVoice endeavor has been a significant catalyst for this Partnership around community engagement and is getting broader attention.

In addition, this partnership has embraced pieces of the ABLe Change model such as Results-Based Accountability, Root Cause Analysis, and 6 Simple Rules to significantly alter the way they conduct their activities including meetings.

Table 1.Shape NC Phase II Priority Outcomes by Project Component

Part A: Community Engagement (ABLe Change). The Shape NC team has identified priority outcomes for each component of the model as indicated in Table 1. The first four outcomes listed are related to ABLe Change. They will be assessed using the existing pre/post survey to measure change over time. In Year 3, depending on the completeness of the data and the number of waves, we may conduct latent growth modeling to determine if there are patterns within the data, i.e. if some programs continue to improve while others stagnate or decline. We will use this longitudinal analysis technique to estimate growth on various outcomes over time and investigate how the Shape NC Phase II program as a treatment condition influences the growth trajectory of various outcomes.

We will also examine the community and organizational characteristics that predict group membership. Community characteristics of interest include rurality, racial and ethnic composition, poverty level, region, and economic distress as measured by county tier from the US Census and the NC Department of Commerce. Characteristics at the organization level include size and age, as well as star rating, teacher education, number of teachers, and number of children served for child care centers, obtainable from the NCDCDEE.

In addition to the quantitative data, we developed case studies in two regions, West and Mid-East, and completed interviews in the other two regions, East and Mid-West, to gather more information on the progress of the ABLe Change communities on each of the four outcomes. Data collection tools were developed in consultation with NCPC and Shape NC staff and approved by UNC’s Institutional Review Board. The guide included questions about experiences with implementing Shape NC activities in each community, including how each interviewee got

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involved in this work, how that work has developed, and the kinds of activities she/he has participated in.

For the case studies, we interviewed 5-7 people in each community to learn about experiences engaging the community in improving childhood health. Participants included the Hub Specialist, the Community Engagement Specialist, the Hub Executive Director, other key staff members, and members of the community who are involved in the community engagement portion of Shape NC. Evaluation staff recruited participants via telephone or email for an interview. Interviews were conducted in person and lasted 60-90 minutes. Written consent was completed. The information garnered was used to explore the inputs that go into creating a successful community engaged program to aid in replication.

All interviews were audio-recorded and transcribed. To identify key themes the researchers read through all of the transcripts and the interview guide and developed initial codes. We then coded each transcript looking for themes and patterns. Themes related to benefits, barriers, strategies, parental engagement, and community changes. Follow-up data will be collected in Year 3 to illuminate progress made on community engagement plans.

Part B: Increase in Knowledge of Best Practices (On-line Training). Child care providers have the opportunity to participate in on-line training modules related to the 5 areas of best practice: Breastfeeding, nutrition, physical activity, outdoor learning environments, and screen time. The first round of trainings occurred from X to X. Participants completed surveys and quizzes both before and after the training. This data is now being processed and cleaned for data analysis.

Part C: Increase in Percentage of Children at a Healthy Weight (Child BMI Percentiles). The priority child health outcomes, as shown in Table 1, will be assessed by collecting data to determine the percentage of children in the MELCs and selected Expansion Sites (2/region) that are at a healthy child weight. Two Expansion Sites have been randomly selected for each region so that we will be

able to compare progress in the new programs. Based on procedures described by Vaughn (2013), height and weight data, along with child age and gender, is collected every 6 months by the Hub Specialists and used to calculate BMI, BMI percentile, BMI z-score, and percent of children at normal weight (defined as BMI for sex and age below the 85th percentile). This longitudinal child-level data will effectively track changes in healthy weight. The first wave of height/weight data was collected in November 2014, the second in May 2015, and the third in November 2015. In these centers data was collected for every child in attendance on the data collection day who was two to four years of age and had parental consent. We developed an ID scheme that will allow children to be tracked over time. A sample height/weight data collection form and instructions can be found in the appendices.

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To obtain a percentile ranking, BMI was plotted on the CDC’s BMI-for-age growth charts for girls and for boys. The percentile was used to identify children who are underweight (<5th percentile), healthy weight (5th-85th percentile), overweight (85th-95th percentile), and obese (≥95th percentile). In addition to the BMI data, we have added data from the NC-NPASS Surveillance System to make comparisons to children not in the Shape NC program. The NC-NPASS data does not provide a perfect comparison as data is only collected from children seen in Public Health sponsored WIC and child health clinics, and some school based health centers.

Part D: Increase in Best Practices in Child Care Settings (Go NAP SACC Data). Every six months MELCs and Expansion Sites are completing the Go NAP SACC assessment to determine their progress towards attaining best practices in five key areas: Breastfeeding, nutrition, physical activity, outdoor learning environments, and screen time. At baseline each center completes the entire assessment. MELCs complete the full assessment at each round. Expansion Sites select areas in which they want to focus and only complete the relevant assessment sections. This data is then analyzed to determine progress. Data from the first two round of Go NAP SACC data collection are presented in this report. The third round of data collection is in the analysis phase.

Evaluation Question 3. The five components of Shape NC Phase II are layered, building on one another. Communities potentially receive various combinations of activities. Which individual or combination of components appears to be most effective? How do organization and community characteristics, including leadership, affect the results?

There are six most common combinations of Shape NC Phase II components anticipated:

(1) ABLe Change + MELC Demo Site + MELC + Expansion Sites + Online Training;

(2) ABLe Change + MELC + Expansion Sites + Online Training;

(3) MELC Demo Site + MELC + Expansion Sites + Online Training;

(4) MELC + Expansion Sites + Online Training;

(5) Expansion Sites + Online Training;

(6) Online Training

In the coming year, we will examine the outcomes from Go NAP SACC (physical activity, nutrition, outdoor learning environments, screen time, and breastfeeding) to determine if the layering of components in certain communities is more successful.

We will use hierarchical linear modeling (HLM) to estimate the effects of individual and combined components of the Shape NC Phase II program on outcomes comparing across groups. Pairwise comparisons among different levels of Shape NC Phase II program implementation will also be conducted to determine which individual or combination of program components appears to be most effective. We will control for important child-, family-, classroom-, center-, and community-level covariates in our analytic models based on past literature, our research team’s professional judgment, and statistical model selection criteria.

Evaluation Question 4. Shape NC Phase II represents a significant “scaling up” from Shape NC Phase I, with modifications to the model to engage many more child care centers. To what extent

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has the scaled up Shape NC Phase II been able to achieve results similar to Shape NC Phase I? What does this suggest for an optimal Shape NC model, reaching as many children as possible while still achieving results?

To address this evaluation question, we will make statistical comparisons between program effect estimates resulting from the Shape NC Phase II study with corresponding program effect estimates from Shape NC Phase I. We will reanalyze Phase I data using the same statistical modeling approach as the Phase II study to make comparisons between Phase I and II as valid as possible.

In addition to statistical modeling to address this question, we will also conduct qualitative interviews with a subsample of the executive directors of Smart Start Local Partnerships in “scale up” communities to determine the impact that Shape NC Phase II components have had on their communities. We will work with NCPC and Shape NC staff to identify and interview Executive Directors from communities with each common combination of Shape NC components. If similar data exists from Phase I, we will compare Phase I and Phase II data on community impact.

Results for Phase II Year IINumbers Served

This section details results for Evaluation Question 1 (EQ1): how many people and organizations have participated in each component of Shape NC Phase II thus far. Table 2 provides information on when the log data was reported for each region and each log type. For

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Down East Partnership for Children

The Down East Partnership for Children has a long history of community engagement that they built upon when becoming a Shape NC Partnership. Their key community engagement successes as a Shape NC Partnership have been the development of a FIT Team and a church network.

A major effort of the partnership has been the development of a FIT (Families Involved Together) Team, a parent advisory board. The FIT Team’s goal is to improve the health of their children, themselves, and ultimately the community. They meet regularly and choose the focus of their work based on ideas from the Partnership.

The Partnership has developed a network of 44 churches. Through this network, the partnership has collaborated with these churches to change their policies around the food that is served at church events. The Partnership

the most part data was logged from January through September 2015. For two sets of logs, Hubs in the Western Region and TA in the Mid-East Region, logs were completed from January through August 2015.

Table 2. Data Collection Periods for Logs by Region and Type

Region Type of Log Period of CollectionWest Technical Assistance (TA) January – September 2015 Hub Specialist (HUB) January – August 2015Mid-East Technical Assistance (TA) January – August 2015 Hub Specialist (HUB) January – September 2015East Technical Assistance (TA) January – September 2015 Hub Specialist (HUB) January – September 2015Mid-West Technical Assistance (TA) January – September 2015 Hub Specialist (HUB) January – September 2015

Results for this round of data collection can be found in Table 3 below, presented by region, and summarizes the technical assistance provided and the support given by the Hub Specialists. The table provides counts for the total number served, number of parents served, number of child

care centers and child care staff served, number of community organizations served, number of trainings, and number of Expansion Sites served. We also provide a grand total to give a sense of what is provided for the full initiative.

A total of 4,577 services were provided. Extrapolating from Table 3, over this time period, Shape NC Phase II served parents 755 times (e.g. provided nutrition information), centers 208 times (e.g. revisions to breastfeeding policy), child care staff 3,355 times (e.g. screen time training; breastfeeding friendly child care; shared Shape NC information), community-based organizations 58 times (e.g. event promoting physical activity and nutrition), and Expansion Sites 63 times (e.g. discussed outdoor play equipment; preparation for upcoming Environment Rating Scale Assessment). In addition, 138

trainings were provided on topics such as breastfeeding friendly child care, playground safety, and Be Active Kids. Child care center staff members were the most common recipients of services by both the Technical Assistance Staff and Hub Specialists. It is important to note that there were additional events and counts that could not be captured on the logs.

Table 3. Service Counts from TA/CES/Hub LogsRegion Stakeholder TA Hub Region TotalsWest (Buncombe) Parents 0 0 0

Centers 19 11 30Center Staff 125 255 380Community Organizations 3 10 13Trainings Offered 15 10 25Expansion Sites 10 0 10Total Counts 172 286 458

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Shape NC Phase II served parents 755 times, centers 208 times, child care staff 3,355 times, community-based organizations 58 times, and Expansion Sites 63 times.

Mid-East (Down East)

Parents 100 108 208

Centers 36 16 52Center Staff 728 212 940Community Organizations 3 5 8Trainings Offered 39 4 43Expansion Sites 17 0 17Total Served 923 345 1268

East (Onslow) Parents 20 22 42Centers 17 14 31Center Staff 220 86 306Community Organizations 3 11 14Trainings Offered 12 17 29Expansion Sites 15 0 15Total Served 287 140 437

Mid-West (Randolph)

Parents 430 75 505

Centers 72 23 95Center Staff 1202 527 1729Community Organizations 8 15 23Trainings Offered 9 32 41Expansion Sites 21 0 21Total Served 1742 672 2414

Grand Total 3124 1453 4577

Resources Leveraged

Local Partnerships participating in Shape NC reported resources leveraged for Shape NC-related activities between January 2014 and April 2015. Resources include supplies, grants, cash donations, and volunteer time (converted into financial contributions) for the Local Partnership and/or the participating child care centers.

A total of $286,769 was leveraged and used for Shape NC-related improvements. Examples include, but are not limited to, the following:

Added a deck, benches, and landscaping to the center’s outdoor learning environment. Hosted a nutrition community event for families. Purchased tricycles, adaptive tricycles, and helmets for children at the child care center. Installed a concrete pathway and raised garden beds in the outdoor learning environment. Spread mulch, planted vegetables, and installed climbing logs. Held a community event and shared Shape NC information with 1500 families.

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A total of $286,769 was leveraged and used for Shape NC-

related improvements.

Local Partnerships will submit their resources leveraged in January 2016 and again before the end of Shape NC Phase II in December 2016.

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Table 4. Resources Leveraged

Region Region LPVolunteer

hours

Volunteer hours as financial

contribution* Supplies Cash Grants TOTALSWest Buncombe Buncombe 459.75 $9,870.83 $17,000.00 $26,870.83

Verner Resources Leveraged

Buncombe MELC 352 $8,931.52 $35,000.00 $43,931.52

Alexander 104 $2,232.88 $80.00 $2,312.88

Region A 80 $1,717.60 $6,717.60 $8,435.20

Mid-East Down East Albemarle 24 $515.28 $515.28

Chatham $6,500.00 $6,500.00

Down East $61,833.00 $61,833.00

Orange 249 $5,346.03 $850.00 $750.00 $6,946.03

Nash Community College

Down East MELC $5,000 $5,000.00

East Onslow Carteret 216 $4,637.52 $2,132 $6,769.52

Onslow 120 $2,576.00 $6,882.55 $9,458.55

Wayne 35 $724.50 $724.50

Excel 3 Onslow EC 3 $64.41 $800.00 $500.00 $500.00 $1,864.41

Kids and Co Onslow EC 3 $64.41 $186.74 $251.15

Precious Resources Onslow MELC $215.00 $215.00

Mid-West Randolph Alamance 25 $536.75 $40.00 $576.75

Iredell 15 $315.00 $3,813.80 $4,128.80

Mecklenburg 198 $4,251.06 $4,251.06

Randolph 814 $17,712.75 $3,500.00 $250 $60,750.00 $82,212.75

ACC Anson Randolph EC 1 $21.47 $60.00 $81.47

Excel Lifespan Randolph EC 9 $128.82 $6,100.00 $5,000.00 $11,228.82

Morven Randolph EC 24 $515.00 $515.00

Open Doors Randolph EC 100 $2,147.00 $2,147.00

TOTALS 1186 $62,308.83 $11,490.80 $21,169.29 $191,800.60 $286,769.52

* Average NC amount for 2014 Volunteer time is $21.47 per hour. Source: https://www.independentsector.org/volunteer_time

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Color Codes:MELC or Expansion Site

West Local Partnership

Mid-East Local Partnership

East Local Partnership

Mid-West Local Partnership

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Onslow County Partnership for Children

The Onslow County Partnership for Children is actively using the ABLe Change Framework to shape their community engagement activities. One of these activities has been the implementation of a survey to gauge the needs of the community. In addition, the Partnership is collaborating with a number of key organizations in the county including The County Department of Health and Cooperative Extension to engage community members.

Best Practices in Child Care Settings: Go NAP SACC Data

Wave II of Go NAP SACC data collection for Shape NC Phase 2 was gathered and sent to the evaluation team in May 2015. The data was cleaned, errors were addressed, and analysis was completed in October 2015. Findings are presented for the 17 out of 18 MELCs that completed this round of data collection related to Criteria A and B. Criteria C related to outdoor learning environments was not collected during this wave. We also report on the overall improvement made by the Expansion Sites and comparisons between Wave I and Wave II.

Criterion A: Meet 55% of all indicators across 5 areas (Child Nutrition, Breastfeeding/Infant Feeding, Physical Activity, Outdoor Play, and Screen Time)

Criterion B: Meet all selected indicators across 4 areas (Child Nutrition, Physical Activity, Outdoor Play, and Screen Time)

Criterion C: Have completed Phase I of Outdoor Learning Environment (OLE) Installation

MELC Performance

No new programs have attained Demonstration Site status during Wave II as Criteria C was not collected. Results are summarized in Table 5 below. For Criterion A, two new programs met that requirement - meeting at least 55% of all Go NAP SACC indicators. For Criteria B, 4 MELCs have now attained the required performance level – meeting the 22 selected items across each area.

Table 5. MELC Performance Summary TableCategory Score# of MELCs meeting Criterion A Wave I 10 Wave II 12 (2 additional)Average # of items attained across MELCs (Criterion A) Wave I 61.6% Wave II 75.9%# MELCs meeting Criterion B Wave I 0 Wave II 4Average # of Criterion B indicators met (total possible = 22) Wave I 13 (59%) Wave II 15 (68%)

The table below provides results for Criteria A. The numbers in parentheses indicate the standard number of items in each area. Notes at the end of the table indicate when there are fewer items available for some of the MELCs, for example, in Screen time, if a program doesn’t have a TV at all there would be fewer items to score.

BF = Breastfeeding & Infant Feeding, CN = Child Nutrition, PA = Infant and Child Physical Activity, OP = Outdoor Play & Learning, SC = Screen time

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The grey shading indicates which programs attained Criteria A at each wave. Ten programs maintained their completion of Criteria A. The orange shading highlights the two programs that attained this criterion during this wave of data collection – Chatham Child Development Center and Excel Christian Academy.

Table 6. Model Early Learning Centers Meeting Criterion A (55% of all Indicators)

Provider BF (8 or 20)a CN (45)b PA (22)c

OP (18) d SC (12)e Total % met

Reach Criterion

AAnson Children’s Center Wave I 7 30 12 10 6 65 55.1% Y Wave II 7 37 15 11 7 77 65.8% YChatham Child Development Center Wave I 6 26 10 8 7 57 48.3% N

Wave II 13 40 19 13 3 88 77.9% YExcel 3 Wave I 9 33 7 9 3 61 51.7% N Wave II 14 26 9 10 3 62 54.9% NExcel Christian Academy Wave I 0 34 13 8 8 63 53.4% N

Wave II 0 38 17 13 11 79 83.2% YFriendly Avenue Christian Preschool Wave I 6 42 22 17 12 99 83.9% Y

Wave II 17 44 22 18 12 113 96.6% YHaywood Community College Wave I 11 28 8 3 7 57 48.3% N

Wave II 11 21 13 9 7 61 52.1% NJumpin’ Jacks/Windsorf Wave I 6 18 7 5 7 43 36.4% N

Wave II -- -- -- -- -- -- -- XKids Company – Henson Drive Wave I 10 20 4 5 5 44 37.3% N

Wave II 12 26 9 9 8 64 54.7% NLittle Faces Wave I 9 34 8 5 7 63 53.4% N

Wave II 10 28 6 2 3 49 43.4% NLulu’s Child Enrichment Center Wave I 11 33 14 9 7 74 62.7% Y

Wave II 20 42 21 17 12 112 95.7% YNash Community College Child Care Wave I 15 39 19 16 6 95 80.5% Y

Wave II 15 41 18 15 5 94 83.2% YPrecious Resources Wave I 10 17 10 6 3 46 38.9% N

Wave II 10 21 13 6 3 53 46.9% NSmall Beginnings Child Development Center

Wave I 1 41 17 13 9 81 68.6% YWave II 1 36 14 14 12 77 77.0% Y

Spanish For Fun Academy Wave I 12 38 18 14 10 92 77.9% YWave II 17 41 21 16 8 103 91.2% Y

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The Early Learning Center Wave I 14 40 18 14 12 98 83.1% YWave II 20 44 22 17 12 115 98.3% Y

The Growing Place Wave I 10 45 20 16 8 99 83.9% YWave II 20 43 21 17 12 113 96.6% Y

Verner Child and Family Center Wave I 19 40 17 11 3 90 76.3% YWave II 20 44 22 18 7 111 98.2% Y

Wayne County Community College Child Care Center

Wave I 6 37 17 14 7 81 68.6% YWave II 10 37 19 14 5 85 75.2% Y

aFor Small Beginnings and Excel Christian Academy total possible is only 8bExcel Christian Academy has a total of 43 possible cSmall Beginnings = 18 items, Excel CA = 17 itemsdSmall Beginnings = 17 items, Excel CA = 16 itemsePrecious Resources, Wayne, Little Faces, Nash, Spanish for Fun, Excel #3, Chatham, Verner = 8, Excel CA = 11fDid not collect data in Wave II and no longer participating in Shape NC

The next table summarizes the results for MELCs in attaining Criteria B. Again, the numbers in parentheses indicate the standard number of selected items in each area. Notes at the end of the table indicate when there are fewer items available for some of the MELCs. The shading indicates where a program met the criteria for each area. Four programs attained all the criteria for Criteria B in this round of Go NAP SACC data collection: Friendly Avenue Christian Preschool, Lulu’s Child Enrichment Center, The Early Learning Center, and Verner Child and Family Center. These three also all met Criteria A.

Table 7. Summary Table of Whether Each Center met all Demonstration Site Criteria (B)

Provider CN (11) PA (4) OP (6) SC (1)a Whether Criterion B was met

Anson Children’s Center Wave I 8 1 2 0 NWave II 10 1 3 0 N

Chatham Child Development Center Wave I 8 1 3 0 NWave II 8 2 4 0 N

Excel 3 Wave I 7 1 4 0 NWave II 6 1 4 0 N

Excel Christian Academy Wave I 7 2 1 0 NWave II 10 4 4 1 N

Friendly Avenue Christian Preschool Wave I 10 4 5 1 NWave II 11 4 6 1 Y

Haywood Community College Wave I 8 1 0 0 N

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Wave II 2 1 3 0 NJumpin’ Jacks/Windsorb Wave I 2 1 0 0 0

Wave II X X X X XKids Company – Henson Drive Wave I 6 0 1 0 N

Wave II 6 2 3 0 NLittle Faces Child Development Center Wave I 10 1 0 0 N

Wave II 8 0 0 0 NLulu’s Child Enrichment Center Wave I 9 2 3 0 N

Wave II 11 4 6 1 YNash Community College Child Care Wave I 8 4 5 0 N

Wave II 10 1 4 0 NPrecious Resources Wave I 6 0 1 0 N

Wave II 6 0 1 0 NSmall Beginnings Child Development Center Wave I 10 3 5 0 N

Wave II 10 4 5 1 NSpanish For Fun Academy Wave I 10 3 4 1 N

Wave II 11 4 5 0 NThe Early Learning Center Wave I 10 3 4 1 N

Wave II 11 4 6 1 YThe Growing Place Wave I 11 4 5 0 N

Wave II 11 4 5 1 NVerner Child and Family Center Wave I 11 2 2 0 N

Wave II 11 4 6 0 YWayne County Community College Child Care Center Wave I 7 2 3 0 N

Wave II 7 3 3 0 NaPrecious Resources, Wayne, Little Faces, Nash, Spanish for Fun, Excel #3, Chatham, Verner = 0 itemsbDid not collect data in Wave II

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Graphs of Change in Criteria A from Wave I and Wave II for MELCs

The figures below chart the change over time in the percent of items met aggregated across MELCs (Figure 3) and for each MELC individually (Figures 4-20). The blue lines indicate the change. The orange dotted lines indicate the target of 55% of items. Overall, programs increased from attaining an average of about 63% to an average of about 76%. Sixteen of the 17 MELCs with data have improved, some substantially – Lulu’s went from about 63% to 96%, Excel Christian improved from 53% to 83%, and Chatham increased from 48% to 78%.

Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

63.06%75.93%

Figure 3. Overall Change in Criteria A from Wave I to Wave II

Note: Dotted orange line indicates the target of 55%

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Sixteen of the 17 MELCs with data have improved, some substantially – Lulus went from about 63% to 96%, Excel Christian improved from 53% to 83%, and Chatham increased from 48% to 78%.

Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

55.10%

65.81%

Figure 4. Change in Criteria A from Wave I to Wave II: Anson Children's Center


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

48.31%

77.88%

Figure 5. Change in Criteria A from Wave I to Wave II: Chatham Child Development Center


Chatham Child Development Center (Figure 5) achieved a sufficient percentage to attain Criteria A at Wave II.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

51.69% 54.87%

Figure 6. Change in Criteria A from Wave I to Wave II: Excel 3


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

83.90%

96.58%

Figure 7. Change in Criteria A from Wave I to Wave II: Friendly Avenue Christian Preschool


Excel 3 has just attained Criteria A (Figure 6) during this round of assessment, while Friendly Avenue (Figure 7) is well above the cut point and continues to improve.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

48.31%52.14%

Figure 9. Change in Criteria A from Wave I to Wave II: Haywood Community College


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

53.39%

83.16%

Figure 8. Change in Criteria A from Wave I to Wave II: Excel Christian Academy


Excel Christian Academy (Figure 8) made a substantial improvement in their assessment from Wave I to Wave II.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

37.29%

54.70%

Figure 10. Change in Criteria A from Wave I to Wave II: Kids Company - Henson Drive


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

53.39%

43.36%

Figure 11. Change in Criteria A from Wave I to Wave II: Little Faces Child Development Center


Kids Company – Henson Drive (Figure 10) improved quite a bit from Wave I when it was only meeting about 37% of indicators. Little Faces Child Development Center actually experienced a decline between waves. This might be due to the fact that the Smart Start partnership in that county was undergoing significant changes that may have impacted the capacity of the Shape NC Technical Assistance Specialist to work with the center.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

62.71%

95.73%

Figure 12. Change in Criteria A from Wave I to Wave II: Lulu's Child Enrichment Center


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

38.98%46.90%

Figure 13. Change in Criteria A from Wave I to Wave II: Precious Resources


Lulu’s Child Enrichment Center has seen substantial improvement in attaining best practices on the Go NAP SACC assessment. It is well above the 55% criterion at Wave II. Precious Resources continues to improve, getting closer to attaining 55%.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

68.64%77.00%

Figure 15. Change in Criteria A from Wave I to Wave II: Small Beginnings CDC


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

80.51% 83.19%

Figure 14. Change in Criteria A from Wave I to Wave II: Nash Community College Child Care


Both Nash Community College Child Care and Small Beginnings CDC are well above the 55% mark and continued to improve at Wave II.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

83.05%

98.29%

Figure 17. Change in Criteria A from Wave I to Wave II: The Early Learning Center


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

77.97%91.15%

Figure 16. Change in Criteria A from Wave I to Wave II: Spanish For Fun Academy


Spanish for Fun and The Early Learning Center improved considerably at Wave II both attaining over 90% of the child care best practices.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

83.90%96.58%

Figure 18. Change in Criteria A from Wave I to Wave II: The Growing Place


Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

68.64% 75.22%

Figure 19. Change in Criteria A from Wave I to Wave II: Wayne Community College Child Care

Center


Similarly, The Growing Place, Wayne Community College Child Care Center, and Verner (below, Figure 20) improved considerably at Wave II both advancing well beyond the 55% criterion.

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Wave I Wave II0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

76.27%

98.23%

Figure 20. Change in Criteria A from Wave I to Wave II: Verner


Table 8 shows change across the two waves of Go NAP SACC child care best practices data for the MELCs. All Model Early Learning Centers (MELCs) assessed all five areas and hence improvement, or lack thereof, can be seen for all MELCs on all areas. Of the MELCs with both Wave I and Wave II data (17), 10 saw improvements overall and across all 5 areas and 7 saw more mixed results, with improvements in some areas and declines in others. The numbers in the columns labeled “Difference” provide the difference in percent (either positive or negative) between Wave I and Wave II.

Table 8. Improvement Table for MELC programs

Total Score Breastfeeding Child Nutrition Physical Activity Outdoor Play Screen Time

Program % WI % WII Differen

ce% WI %

WII Difference

% WI % WII

Difference

% WI

% WII

Difference

% WI

% WII

Difference % WI %

WIIDifferenc

e Anson Children's Center

78% 85% +7 51% 62% +11 88% 94% +6 83% 89% +6 82% 89% +7 79% 88% +9

Chatham Child Dev Center

78% 92% +14 70% 90% +20 84% 97% +13 77% 95% +12 83% 90% +7 63% 66% +3

Excel Learning Center #3

80% 83% +3 63% 86% +23 89% 83% -6 76% 83% +7 85% 89% +4 78% 59% -19

Excel Christian Academy 85% 90% +5 20% 26% +4 94% 97% +3 93% 100% +7 83% 92% +9 93% 100% +7

Friendly Ave 91% 97% +6 58% 87% +29 98% 99% +1 100% 100% 0 99% 100% +1 100% 100% 0

Windsor Jumping Jacks

74% --- NA 70% --- NA 72% --- NA 77% --- NA 75% --- NA 81% --- NA

Kids & Co - Henson Dr 70% 80% +10 65% 80% +15 76% 84% +8 64% 74% +10 74% 76% +2 65% 81% +16

Little Faces 75% 74% -1 65% 70% +5 87% 84% -3 75% 67% -8 61% 65% +4 73% 72% -1

Lulu's Child Enrichment Center

84% 99% +15 69% 100% +31 89% 98% +9 90% 99% +9 85% 99% +14 83% 100% +17

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Total Score Breastfeeding Child Nutrition Physical Activity Outdoor Play Screen Time

Program % WI % WII Differen

ce% WI %

WII Difference

% WI % WII

Difference

% WI

% WII

Difference

% WI

% WII

Difference % WI %

WIIDifferenc

e

Currin Child Dev Center of Nash

93% 94% +1 86% 86% 0 94% 97% +3 97% 95% -2 97% 96% -1 84% 91% +7

Precious Resources 67% 74% +10 63% 65% +2 81% 88% +7 68% 78% +10 64% 68% +4 47% 53% +6

Small Beginnings 91% 90% -1 43% 34% -9 98% 94% -4 96% 93% -3 94% 96% +3 90% 100% +10

Spanish for Fun Academy

90% 97% +7 74% 91% +16 96% 98% +2 94% 99% +5 93% 97% +4 84% 100% +16

The Early Learning Center

95% 99% +4 90% 100% +10 97% 99% +2 95% 100% +5 94% 99% +5 94% 100% +6

The Growing Place 93% 99% +6 69% 100% +31 100% 97% -3 95% 99% +4 97% 99% +2 100% 100% 0

Verner Center 89% 99% +10 99% 100% +1 93% 99% +6 78% 100% +12 86% 100% +14 72% 97% +15

Wayne Community College

84% 88% +4 53% 67% +14 94% 94% 0 93% 95% +2 93% 93% 0 79% 84% +5

Haywood Community College

70% 79% +9 68% 78% +10 79% 76% -3 63% 86% +23 56% 75% +19 75% 85% +10

Significance tests comparing Wave I and Wave II

Looking at the raw summary scores between Wave I and Wave II, significant improvements based on t-tests were found for the total score, Breastfeeding, Physical Activity, and Outdoor Play (on both actual score and percent). Screen time only saw a significant improvement based on percent. Child Nutrition was significant for both measures at the trend level (p = .06).

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Table 9 provides a comparison of MELC achievement on Criteria A from Wave I to Wave II. One MELC did not have Wave II data. MELCs, as a group, improved in the proportion of indicators met within Criteria A and also within each area for Criteria A.

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Table 9. Comparison of Proportion of Criteria A Standards met between Wave I and II for MELC Sites

Variable Wave n M (SD) Min MaxProportion Criteria A Met Wave I 18 0.64 (0.17) 0.38 0.89

Wave II 17 0.76 (0.19) 0.43 0.98Proportion Breastfeeding Criteria A Met Wave I 18 0.47 (0.22) 0 0.95

Wave II 17 0.64 (0.30) 0 1Proportion Child Nutrition Criteria A Met Wave I 18 0.74 (0.19) 0.38 1

Wave II 17 0.79 (0.18) 0.47 0.98Proportion Physical Activity Criteria A Met Wave I 18 0.63 (0.25) 0.18 1

Wave II 17 0.77 (0.24) 0.27 1Proportion Outdoor Play Criteria A Met Wave I 18 0.57 (0.24) 0.17 0.94

Wave II 17 0.72 (0.25) 0.11 1Proportion Screen Time Criteria A Met Wave I 18 0.62 (0.19) 0.38 1

Wave II 17 0.73 (0.26) 0.38 1

5 MELC sites did not meet Criterion A in either wave; 10 MELC sites met Criterion A in both waves; 0 MELC sites moved from meeting to not meeting Criterion A between the 2 waves, 2 MELC sites moved from not meeting to meeting Criterion A between the 2 waves. The changes overall and for each area were statistically significant increases.

Comparison of proportion of sites which met criterion B between Wave I and II for MELC sites

There were no MELC sites that met criterion B in Wave I, and there were 4 sites that met criterion B in Wave II. Statistical tests can’t be conducted because there is no variation in whether Criterion B was met in Wave I data.

Improvement for MELC Programs

Overall, for the MELCs the total mean score was 382.9 (SD=41.8) at Wave I compared to a mean of 412.8 (SD=48.7) at Wave II. This change was statistically significant (t (16) = 5.1, p<.01).

Changes achieved statistical significance

For all MELCs the Wave I mean for Breastfeeding was 57.4 (SD=20.2) compared to a mean of 68.8 (SD=24.7) at Wave II. This change was statistically significant (t (16) = 5, p<.01).

For Physical Activity, MELCs improved from a mean of 72.8 (SD=10) at WI to 78.8 (SD=9.43) at WII. This change was statistically significant (t (16) = 3.2, p<.01).

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MELCs, as a group, improved in the proportion of indicators met within Criteria A and also within each area for Criteria A.

For Outdoor Play, MELCs improved from a mean of 59.4 (SD=9.4) at WI to 63.8 (SD=8.2) at WII. This change was statistically significant (t (16) = 4, p<.001).

Change was not statistically significant

For Child Nutrition, MELCs improved slightly from a mean of 159.2 (SD=16.79) at WI to 165.8 (SD=14.1)

at WII. This change was not statistically significant (t (16) = 2.0, p=.06). Lastly, for Screen Time, MELCs improved slightly from a mean of 34.1 (SD=8.5) at WI

to 34.6 (SD=11.4) at WII. This change was not statistically significant (t (16) = 1.0, p=.33).

Expansion Site Comparisons

The results of total actual score comparison between Waves I and II for Expansion Sites are not meaningful as many Expansion Sites completed questions in all 5 content areas in Wave I, but were only required to choose one content area to focus on and complete the Go NAP SACC assessment for in Wave II (though they could have selected more than one; Table 10). As a result, the huge difference between Wave I and II on that variable only reflects the fact that Expansion Sites had less data in Wave II than I. Comparisons of each individual area (Breastfeeding, etc.) are meaningful as the t-test reflects the difference of a particular form for Expansion Sites which had data for both waves. Of the 100 Expansion Sites with Wave II data, 67 completed the Breastfeeding form, 66 completed the Child Nutrition form, 70 completed the Physical Activity form, 70 completed the Outdoor Play form, and 58 completed the Screen Time form. Over half (52%) completed all 5 forms (32% completed 1, 11% completed 2, 3% completed 3, and 2% completed 4). All the changes are statistically significant improvements aside from Screen Time.

Table 10. Proportion Met Overall and for each Area for Expansion SitesVariable Wave n M (SD) Min Max

Proportion Met Overall Wave I 56 0.47 (0.15) 0 0.73Wave II 53 0.56 (0.21) 0.18 1

Proportion Breastfeeding Met Wave I 54 0.43 (0.21) 0 0.85Wave II 23 0.65 (0.27) 0 1

Proportion Child Nutrition Met Wave I 55 0.55 (0.15) 0.18 0.84Wave II 19 0.62 (0.24) 0 0.96

Proportion Physical Activity Met Wave I 55 0.41 (0.21) 0 0.91Wave II 25 0.58 (0.24) 0.18 1

Proportion Outdoor Play Met Wave I 54 0.41 (0.20) 0.11 0.89Wave II 25 0.45 (0.15) 0.22 0.72

Proportion Screen Time Met Wave I 53 0.45 (0.13) 0.17 0.67Wave II 13 0.48 (0.14) 0.29 0.75

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MELCs obtained statistically significant improvements from Wave I to Wave II in best practices related to breastfeeding, physical activity, outdoor play, and child nutrition.

Improvement for Expansion Sites

Comparisons of each individual best practice area are meaningful as the t-test reflects the difference of a particular area for Expansion sites that had data for both waves.

Changes achieved statistical significance

For all Expansion Sites the Wave I mean for Breastfeeding was 55.5 (SD=22.1) compared to a mean of 72.3 (SD=21.2) at Wave II. This change was statistically significant (t (20) = 5, p<.01).

For Physical Activity, Expansion Sites improved from a mean of 61 (SD=15.3) at WI to 70.1 (SD=10.3) at WII. This change was statistically significant (t (21) = 4.8, p<.001).

For Outdoor Play, Expansion Sites improved slightly from a mean of 52.2 (SD=8.8) at WI to 54.5 (SD=7.4) at WII. This change was statistically significant (t (22) = 5, p<.001).

Change was not statistically significant

For Child Nutrition, Expansion Sites improved slightly from a mean of 144.3 (SD=12.9) at WI to 149.2 (SD=39.1) at WII. This change was not statistically significant (t (17) = .16, p=.87).

For Screen Time, Expansion Sites improved slightly from a mean of 28.6 (SD=8.2) at WI to 30.8 (SD=10.9) at WII. This change was not statistically significant (t (9) = 1.9, p=.09).

Wave II Child BMI

In May 2015, the Shape NC Hub Specialists collected heights and weights for children aged two to five in the MELCs and two randomly selected Expansion Sites per region. Of the 928 children enrolled at Wave II, height and weight data was collected with 682 children who were present and had parental consent, representing 68% of children enrolled at Wave II. The data was then used to calculate BMI Percentiles as well as to determine the number of children who are underweight, normal/healthy weight, overweight and obese.

Body Mass Index (BMI) is weight in kilograms divided by the square of height in meters (HHS, 2015). For children, BMI is age- and sex-specific. In children, a high amount of body fat can lead to weight-related diseases and other health issues, while being underweight can also put children at risk for health issues. Table 11 (below) describes all children enrolled in the selected study child care programs at Waves I (November 2014) and all children enrolled at Wave II (May 2015). The remainder of the tables provides descriptive data for all children, while tests of significance are conducted only for children with data from both Wave I and Wave II.

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Expansion Sites saw statistically significant improvements from Wave I to Wave II in best practices related to breastfeeding, physical activity, and outdoor play.

Table 11. Demographic characteristics of all children enrolled in the selected child-care programs

Characteristic Wave I (n=970)Mean (SD) or Number (%)

Wave II (n=928)Mean (SD) or Number (%)

Female 394 (48.6%) 438 (47.9%)Race/Ethnicity White Black Latino/a Other*

505 (63.3%)164 (20.6%)75 (9.4%)54 (6.8%)

566 (61%)190 (20.5%)81 (8.7%)91 (9.8%)

Full-time 756 (93%) 850 (93.9%)Enrolled for 6 months or more 550 (68%) 711 (76.6%)Age Group (Classroom composition) Twos Threes Twos-Threes Threes-Fours Fours Fours-Fives Fives

118 (16.3%)97 (13.4%)52 (7.2%)

146 (20.2%)126 (17.4%)133 (18.4%)52 (7.2%)

161 (18.9%)135 (15.9%)63 (7.4%)

155 (18.2%)142 (16.7%)138 (16.2%)57 (6.7%)

Region West Mid-West Mid-East East

252 (31%)202 (24.8%)161 (19.8%)198 (24.4%)

277 (29.8%)331 (35.8%)84 (9.1%)

236 (25.4%)MELC 579 (76.9%) 655 (70.6%)BMI Percentile 61.5 (28.8) 57.5 (29.4)

Note: This data is for all children, not just those with data in both waves.*Other = Asian, American Indian, Native Hawaiian/Pacific Islander, two or more races, other, and not identifiable

Table 12, below, provides a description of the percentile cutoffs for underweight, normal/healthy weight, overweight, and obese that we use to define weight status and create categories.

Table 12. BMI for Age-Weight Status CategoriesWeight Status Category Percentile RangeUnderweight Less than the 5th percentileNormal or Healthy Weight 5th percentile to less than the 85th percentileOverweight 85th to less than the 95th percentileObese Equal to or greater than the 95th percentile

Source: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Table 13 provides a breakdown of weight group status and BMI Percentile for all children with data in the Shape NC child care centers in Wave I, in Wave II, and in North Carolina for comparison. From Wave I to Wave II slightly more Shape NC children were in the normal/healthy weight range and fewer were in the overweight or obese range. Moreover, the percent of Shape NC children at a healthy weight was higher at both waves than for children in North Carolina as a whole.

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http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Table 13. BMI Percentile Categories for Children in Shape NC Centers, Phase II Baseline Weight Status Number (Percent) of

Children in Shape NC Centers, WI (n=728)

Number (Percent) of Children in Shape NC Centers, WII

(n=682)

North Carolina*

Weight Group* Underweight 34 (4.7%) 33 (4.9%) 4,935 (4.7%) Normal/Healthy Weight 496 (68.1%) 488 (71.8%) 66,975 (63.5%) Overweight 119 (16.4%) 94 (13.8%) 17,022 (16.1%) Obese 79 (10.9%) 65 (9.6%) 16,478 (15.6%)BMI Percentile 61.7 (28.3) 57.3 (29.4) ---

*2010 NC-NPASS data from children seen in North Carolina Public Health Sponsored WIC and Child Health Clinics and some School Based Health Centers http://www.nutritionnc.com/pdfPregPed/ncpass/2010/TableCountyObesityRates.pdf

Table 14 provides descriptive data for the 549 children with both WI and WII data. The change in weight group was statistically significant (X2[9] = 536.52, p<.001). The decrease in BMI Percentile was statistically significant (t[548] = 5.7, p<.001).

Table 14. BMI for Children in Shape NC Centers with Wave I and II Data (n=549)Weight Status Number (Percent) of

Children in WI Number (Percent) of

Children in WII Weight Group* Underweight 21 (3.8%) 28 (5.1%) Normal/Healthy Weight 382 (69.6%) 396 (72.1%) Overweight 90 (16.4%) 74 (13.5%) Obese 56 (10.2%) 51 (9.3%)BMI Percentile* 61.7 (28.3) 57.7 (29.2)

* p<.01

We then broke out the BMI data by MELC and Expansion Site. There were 405 MELCs and 144 Expansion Sites with data at both Waves I and II (Table 15). For the 405 MELC children with both waves of data, change in BMI Percentile was statistically significant (t[404] = 4.9, p<.001). For the Expansion Sites, based on BMI percentile for 144 children with both WI and WII data, this change was also statistically significant (t[143] = 2.9, p<.01) and

Table 15. Weight Status for MELCs (N=405) and Expansion Sites (N=144)

Weight StatusWave I Wave II

MELC Expansion Site MELC Expansion Site BMI Percentile* 60.2 (29.5) 66.1 (24.2) 55.7 (29.8) 61.9 (27.7)

* p<.01

Tables 16 and 17 provide descriptive statistics for race and ethnicity across the two waves using data from all children who provided data at either wave of data collection. From Wave I to Wave II, for White children, more are represented in the normal/healthy group than in the other 3

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http://www.nutritionnc.com/pdfPregPed/ncpass/2010/TableCountyObesityRates.pdf

weight groups (Table 16). For Black children there are slightly fewer in each group with the exception of the underweight group, which increased by about 4 percentage points. At Wave II there were more Latino children in the underweight and normal/healthy weight groups and fewer in the overweight and obese groups. Finally, for the “Other” group (Asian, American Indian, Native Hawaiian/Pacific Islander, two or more races, other, and not identifiable) more children were represented in the underweight and obese groups.

Table 16. Weight Status by Race/Ethnicity

Wave IWave II

Underweight

Normal/

Healthy Weight

Overweight Obese

Underweight

Normal/

Healthy Weight

Overweight Obese

White 26 (5.7%)

312 (68.3%)

75 (16.4%)

44 (9.6%)

17 (3.9%)

322 (73.7%)

61 (14%)

37 (8.5%)

Black 5 (3.6%)

93 (66.4%)

24 (17.1%)

18 (12.9%)

9 (7.7%)

76 (65%)

19 (16.2%)

13 (11.1%)

Latino

047

(67.1%)10

(14.3%)13

(18.6%)2

(3%)49

(74.2%)6

(9.1%)9

(13.6%)Other 3

(6%)37

(74%)8

(16%)2

(4%)5

(8.3%)41

(68.3%)8

(13.3%)6

(10%)Total 34 489 117 77 33 488 94 65

Table 17 provides means and standard deviations for BMI Percentile for the children in Shape NC programs who had data in both waves. BMI Percentile decreased for each racial group between Wave I and Wave II. Tests of significance comparing children’s BMI Percentile at Wave I and Wave II indicate a significant decrease for the White, Black, and Latino groups. This change was not significant for the “Other” group.

Table 17. BMI Percentile by Race/EthnicityWave I Wave II Significance Test*

Race/Ethnicity Mean (SD) Mean (SD) t-testWhite (N=361) 60.4 (28.4) 58.0 (28.4) t(360)=3.1**Black (N=87) 64.9 (28.0) 57.5 (31.8) t(86)=3.6**Latino/a (N=56) 68.6 (26.2) 58.6 (29.4) t(55)=4.0**Other (N=45) 58.0 (29.4) 52.1 (31.9) t(44)=1.5

**p<.01

The following two tables below provide descriptive statistics on weight status by Shape NC region. Using data from all children, between Waves I and II, percentages fluctuated both directions in the four weight groups (Table 18). For most regions there were fewer children in the obese and overweight groups from Wave I to Wave II, with the exception of the Mid-East region, for both the obese and overweight groups and for the obese category in the East Region

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(obese group very slightly increased). The portion of children at normal/healthy weight increased for each region aside from the Mid-East Region.

Table 18. Weight Status by Region

Wave IWave II

Underweight

Normal/

Healthy Weight

Overweight Obese

Underweight

Normal/

Healthy Weight

Overweight Obese

West 5 (2.3%)

143 (66.5%)

39 (18.1%)

28 (13%)

6 (2.8%)

153 (71.8%)

31 (14.6%)

23 (10.8%

)Mid-West 21

(10.7%)121

(61.7%)28

(14.2%)

26 (13.3%

)

22 (8.9%)

170 (68.8%)

31 (12.6%)

24 (9.7%)

Mid-East

3 (2.1%)

106 (75.2%)

18 (12.8%)

14 (9.9%)

1 (1.4%)

50 (72.5%)

10 (14.5%)

8 (11.6%

)East 5

(2.8%)126

(71.6%)34

(19.3%)11

(6.3%)4

(2.6%)115

(76.2%)22

(14.6%)10

(6.6%)Total 34 496 119 79 33 488 94 65

At Wave II, child care programs in the Mid-West Region had the lowest mean BMI percentile at 51.9 (SD = 32.3) and the West Region had the highest percentile at 62.2 (SD = 27.2). There was some difference between Wave I and Wave II and these differences were statistically different for three of the four regions, when looking at children with data from both data collection points (Table 19).

Table 19. BMI Percentile by RegionWave I Wave II Significance Test*

Region Mean (SD) Mean (SD) t-testWest (N=173) 64.9 (26.4) 62.4 (27.3) t(172)=2.6**Mid-West (N=160) 58.2 (32.4) 49.4 (32.8) t(159)=4.7***Mid-East (N=98) 60.0 (27.5) 58.3 (29.0) t(97)=0.8East (N=118) 63.3 (25.3) 59.7 (25.9) t(117)=2.9***

**p<.05, ***p<.01

Table 20 presents weight status data by gender. The portion of both male and female children at normal/healthy weight increased from Wave I to Wave II: a 5% increase for males and a 4% increase for females.

Table 20. Weight Status by Gender

Weight StatusWave I Wave II

Male (n=378) Female (n=350) Male (n=360) Female (n=320)Underweight 14 (3.7%) 20 (5.7%) 17 (4.7%) 16 (5%)Normal/Healthy Weight 260 (68.8%) 236 (68.2%) 261 (72.5%) 227 (71%)

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Overweight 57 (15.1%) 62 (17.7%) 47 (13.1%) 47 (14.7%)Obese 47 (12.4%) 32 (9.1%) 35 (9.7%) 30 (9.4%)

Table 21 reports data for children in care part-time versus full-time, both by weight group. The portion of children at normal/healthy weight increased for children in care part and full-time. BMI Percentile is also reported.

Table 21. Weight Status by Full-time/Part-time

Weight Status

Wave I Wave IIPart-time (n=34) Full-time

(n=694)Part-time (n=30)

Full-time (n=642)

Underweight 2 (5.9%) 32 (4.6%) 6 (6.7%) 30 (4.7%)Normal/Healthy Weight 24 (70.6%) 472 (68%) 22 (73.3%) 459 (71.5%)Overweight 6 (17.6%) 113 (16.3%) 2 (6.7%) 92 (14.3%)Obese 2 (5.9%) 77 (11.1%) 4 (13.3%) 61 (9.5%)

Table 22 illustrates weight status data by length of enrollment. The majority of children have been enrolled for 6 months or more. Both the ‘Less than 6-months Group’ and the ‘6-months or More Group’ saw an increase in the amount of children in the normal/healthy weight range across data collection waves.

Table 22. Weight Status by Length of Enrollment

Weight Status

Wave I Wave IIEnrolled < 6

months (n=227)

Enrolled 6 months+ (n=501)

Enrolled < 6 months (n=133)

Enrolled 6 months+ (n=546)

Underweight 6 (2.6%) 28 (5.6%) 5 (3.8%) 28 (5.1%)Normal/Healthy Weight 154 (67.8%) 342 (68.3%) 95 (71.4%) 392 (71.8%)Overweight 37 (16.3%) 82 (16.4%) 21 (15.8%) 73 (13.4%)Obese 30 (13.2%) 49 (9.8%) 12 (9%) 53 (9.7%)

Table 23 provides a test of significance based on BMI Percentile for the children who had both WI and WII data for gender, attendance (part-time/full-time), and length of enrollment. There was a statistically significant change for both males and females. For part-time enrollees, based on BMI percentile for the 20 children with both WI and WII data, this change was statistically significant (t[19] = 4.3, p<.01) and for the 529 children enrolled full-time with both waves of data, this change was also statistically significant (t[528] = 5.1, p<.01). Looking at BMI Percentile for length of enrollment, only children in the 6+ group had a statistically significant change (t[470]=5.3, p<.001 compared to t[77]=2.1, p=.4).

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Table 23. BMI Percentile and Test of Significance by Gender, Attendance, and Length of Enrollment (N=549)

Wave I Wave II Significance TestGender Mean (SD) Mean (SD) t-testFemale (n=264) 61.5 (28.3) 57.6 (29.3) t(263)=3.9*Male (n=285) 61.9 (28.4) 57.1 (29.5) t(284)=4.1*AttendancePart-time (n=20) 62.9 (27.7) 48.6 (34.3) t(19) = 4.3*Full-time (n=529) 61.7 (28.3) 57.7 (29.2) t(528) = 5.1*Length of EnrollmentEnrolled < 6 months (n=78) 63.2 (24.8) 59 (26.8) t[77]=2.1Enrolled 6 months+ (n=471) 61.5 (28.8) 57 (26.8) t(470)=5.3*

*p<.01

The final table, 24, looks at BMI for all children across data collection waves for Shape NC Phases I and II. The portion of children at a healthy weight range has grown as BMI Percentile has decreased from Phase I to Phase II.

Table 24. Weight Comparison from Phase I to Phase II Waves Phase I Phase II Baseline June 2012 September

2012June 2013 November

2014May 2015

Number of children 252 273 291 286 970 928

Normal weight (%)BMIBMI percentile

65.7%16.6

64.5%

68.5%16.5

63.2%

61.6%16.5

66.0%

66.0%16.5

65.8%

68.1%16.4

61.5%

71.8%16.2%57.5%

[% normal weight]% White% African American% Hispanic

---------

---------

---------

---------

68.3%66.4%67.1%

73.7%65%

74.2%

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Randolph County Partnership for Children

The Randolph County Partnership for Children has been conducting community-engaged activities since its inception. This pre-dates Shape NC. In the beginning a county-wide assessment was conducted to decide on benchmarks for the work. Child care centers and even the business community have been heavily involved. The Partnership has integrated the community, particularly parents, into all aspects of its work. A key community engagement strategy is their Parents as Teachers (PAT) program. A key win for the Partnership, using techniques learned through the ABLe Change training, was to

Web Series

Knowledge Change. 738 participants completed the Healthy Starts in Early Care and Education Professional Development Series and the pre- and post-test surveys. Table 25 provides the list of knowledge questions used and the scores on the pre- and post-test surveys for each one. Participants improved in their scores on each. The average across all questions for the pre-test was 66.9% with participants improving to 87.6% by the post-test, a statistically significant improvement.

Participants whose child care facilities participated in Shape improved their knowledge of best practices by 21%, while participants whose centers did not participate in Shape improved their knowledge of best practices by 33% from pre- to post-test survey. The Shape NC-facility participants started with a higher baseline of knowledge compared to the non-Shape NC-facility participants (71% vs. 66%).

Table 25. Performance on Web SeriesQuestion Pre-test

% Respondents with Correct

Answer

Post-test % Respondents

with Correct Answer

1. How many adults in the United States are overweight or obese?

40% 70.2%

2. How many children eat the recommended minimum of 5 servings of fruits and vegetables each day?

53% 74%

3. What does breastfeeding help prevent? 79.1% 97.6%4. Which of the following statements about rice cereal

is NOT accurate?60.5% 90.6%

5. Which statement/statements are true regarding whole grains?

23.5% 48.9%

6. True or false? To offer a variety of foods, menus should be cycled every three weeks or more and change seasonally.

92.4% 98.4%

7. What is the correct term for this definition: developmental activity that is planned and supervised by a parent, caregiver or teacher?

90% 96.3%

8. Infants should be taken outside at least ____ time(s) per day and tummy time should be provided to non-crawling children ages 0-12 months (infants) ____ time(s) per day. Fill in the blanks with the correct numbers.

67.2% 95.6%

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Randolph County Partnership for Children

The Randolph County Partnership for Children has been conducting community-engaged activities since its inception. This pre-dates Shape NC. In the beginning a county-wide assessment was conducted to decide on benchmarks for the work. Child care centers and even the business community have been heavily involved. The Partnership has integrated the community, particularly parents, into all aspects of its work. A key community engagement strategy is their Parents as Teachers (PAT) program. A key win for the Partnership, using techniques learned through the ABLe Change training, was to

9. True or False? State of North Carolina regulations allow children to eat vegetables or fruit from the center’s vegetable garden.

80.2% 98.2%

10. Contact with nature influences child development in many ways. Check all that are true.

52.9% 84.2%

11. True or False? Children birth to two years should never have screen time.

75.1% 97.1%

12. True or False? Parents and teachers should receive education or professional development on screen time at least twice a year.

80.5% 98%

Mean Score (SD, range)* 66.9% (SD = 15.3; 25-100%)

87.6% (SD = 11.1; 33-100%)

*p < 0.05

Behavior Change. Behavior change following the completion of the web series was measured by asking participants to report what changes they had made in their personal or professional lives after taking the course. Participants were able to specify changes in five areas: breastfeeding and infant feeding, child nutrition, physical activity, outdoor learning environments, and screen time. The majority of participants reported making changes in all areas (see Figure 21 below).

Figure 21. Percent of Participants Reporting Behavior Changes by Area

Breastf

eeding

and I

nfant

Feed

ing

Child Nutr

ition

Physic

al Acti

vity

Outdoo

r Lear

ning E

nviro

nmen

t

Scree

n Tim

e0%

20%

40%

60%

80%

100%

In the area of breastfeeding, many participants reported making changes in their child care programs, including this feedback: “We have actually started encouraging new moms to come to center to breastfeed. We have set up room and gotten information packages from the health department to give out.” Others mentioned making personal changes: “I plan to try and breastfeed my baby exclusively for at least the first six months” and “Before I thought breastfeeding was taboo, however, now I consider a great option and will even try it when I have a child.”

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Over 70% of participants reported making changes in the area of child nutrition. One participant reported, “At home we (as a family) have cut down on a few of our unhealthy snacks, and added more fruits and vegetables.” In the child care setting participants reported a number of changes, including: “Incorporating new and exciting ways to introduce healthy alternatives to the children I interact with daily,” “I plan to plant a garden in the spring at our center,” and “I have been a better role model for healthy eating, incorporated more health related topics in my lessons, and advocated for transformation of our current menus.”

Physical activity saw the most reported change, with close to 90% of participants reporting making healthy changes. One respondent reported making changes to her child’s routine at home: “I never really kept track of how much time my son was spending being physically active. I always just assumed he was getting enough because he maintains a healthy weight and is constantly moving. I am now making a point to calculate how much time he spends being physically active and even planning activities for him to do at home. It kind of makes me feel like a PE teacher, but he thinks it makes playing active games a lot more fun when there are some planned activities thrown in the mix.” The changes are also being made in participants’ own lives: “I'm attempting to do 30 minutes of aerobic exercise four times per week. I ran/jog/walked for 30 minutes twice last week.” In addition, child care providers are making changes in their programs, including: “Made my lesson plans more physically active and get my children outside more and move with them!” and “Being more intentional about getting my preschoolers outside for their entire scheduled time not letting less ideal weather conditions keep us inside! Also, I am being more aware of providing more structured physical activity inside and outside the school classroom.”

Changes to outdoor learning areas were also very common. Many participants reported adding features to their outdoor environments, such as “Added extension to play area for more space and trike path is being added right now to add the looping path instead of linear.” Participants are also sharing what they learned with colleagues: “I am working to get my director to improve our Outdoor Learning Environment with added natural materials. I showed her the video on OLE and printed some of the handouts provided.” These changes have also extended to participants’ personal lives: “I have added things to my backyard for him to play with such as sticks and rocks. He LOVES the loose parts and is very creative. My lawnmower doesn't love the loose parts as much :) but my son is getting better about clearing the yard when he's finished playing.”

Finally, nearly 80% of web course participants reported making changes around screen time. Changes are taking place both in the home:

I am guilty of letting my child spend way too much time playing his iPad. Even though he likes to play Minecraft which allows him to be creative, he could easily spend 2+ hours a day on that game. The time he plays it the most is when we are in the car going from one place to the other. I am starting to think of different games we could play in the car that has him looking up at the beautiful world instead of down at his screen.

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And in child care settings: “We sent home notices about screen time to parents and placed posters around the childcare center for parents to see” and “Establishing a written policy for screen time based on best practice.”

Participants also provided the following feedback on the web series itself:

BTW I watched the first video and activity and you guys have “hit it out of the park.” This is exactly what we needed. You have accomplished in one video what I have tried to tell the staff for 2 years.

I really enjoyed this type of training. I didn't have to leave my family to attend a training and it was offered for free (my enrollment is low right now so I especially enjoyed getting that many hours at no charge). It was easy to navigate through the course as well. The presenters were very knowledgeable of the topics they discussed and were pleasant to listen to. I learned many things I did not know. I will definitely take another course/topic like this should one be offered.

The whole course really motivated me to keep doing what I'm doing and gave me some new ideas to try, especially for the outdoor environment.

The course was very well put together, very easy to navigate, and very informative in a very casual relaxed way.

I have completed the Shape NC Course and wanted to give a shout out for a good job. I have so many good notes to share with my staff at the next staff meeting.

Conclusions

Through Shape NC Phase II, partnerships are making substantial progress towards improving the health of children in participating child care programs and in the community. Major progress has been made in achieving the goal of 12 Model Early Learning Centers attaining Demonstration Site status at seven centers, with several more poised to join in 2016. The number of participating child care programs has increased to 148 in 2015, on the way to reaching the target of 240. Program-level improvements can also be seen in the change in scores on the Go NAP SACC assessments over time. MELC scores increased 20.6% across time. Moreover, work with these programs is leading to increases in healthy weight status for enrolled children, especially those in MELCs who have seen a 7.6% increase in healthy weight.

Further, in addition to the programs reached directly through Shape NC, many others are impacted through the web series that provides content on best practices in key areas including child nutrition, breastfeeding, and outdoor play. To date, 738 child care providers have participated in the course and both the pre and post surveys, close to 79% of them not in Shape NC programs. These participants made significant improvements in knowledge from pre- to post-test and also reported making both personal and professional changes based on course content.

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There have also been impacts at the community-level. This was seen in both increases in knowledge on the ABLe Change Framework survey and information collected during case study interviews.

Recommendations. We recommend a closer look is taken at which centers and children Shape NC programming is effective for. Toward this end, we will look at data needs and plan for multivariate data analysis to respond to the evaluation questions that address which set of Shape NC activities make the most impact on the desired outcomes. In particular, this will address the following evaluation questions:

Which individual or combination of components appears to be most effective? How do organization and community characteristics, including leadership, affect the

results?

Next Steps. We will collect follow-up data via phone survey with the 2 ABLe Change regions that participated in case study interviews (Buncombe and Down East) to provide updates on their community engagement activities.

In addition, once the data is collected we will analyze Go NAP SACC data for the 7 sites participating in the Breakthrough Series Collaborative. The goal will be to compare the GNS data on those indicators they select for the action plan.

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References

Bollen, K. A., & Curran, P. J. (2006). Latent curve models: A structural equation perspective (Vol. 467). John Wiley & Sons.

Brisbois, T. D., Farmer, A. P., & McCargar, L. J. (2012). Early markers of adult obesity: a review. Obesity reviews: an official journal of the International Association for the Study of Obesity; 13(4):347-367.

Centers for Disease Control and Prevention. (2009a). The 2009 Youth Risk Behavior Survey. Division of Adolescent and School Health. Retrieved from http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Centers for Disease Control and Prevention. (2009b). Obesity prevalence among low-income, preschool-aged children. Mobility and Mortality Weekly Report. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm

Centers for Disease Control and Prevention. (2010). Pediatric Nutrition Surveillance System, Table 6 (PedNSS). Division of Nutrition, Physical Activity, and Obesity. 2010 Retrieved from http://www.cdc.gov/pednss/pednss_tables/tables_health_indicators.htm

Centers for Disease Control and Prevention. (2012). Childhood Overweight and Obesity, Atlanta, GA. Retrieved from http://www.cdc.gov/obesity/childhood/

Daniels, S. R. (2006). The consequences of childhood overweight and obesity. The Future of Children, 16, 47–67. doi:0.1353/foc.2006.0004

De Marco, A. C., Zeisel, S., Odom, S. L, & Kurgat, B. (in press; 2014 online). An Evaluation of a Program to Increase Physical Activity for Young Children in Child Care. Early Education & Development. doi: 10.1080/10409289.2014.932237

Haas, J. S., Lee, L. B., Kaplan, C. P., Sonneborn, D., Phillips, K. A., & Liang, S. Y. (2003). The association of race, socioeconomic status, and health insurance status with the prevalence of overweight among children and adolescents. American Journal of Public Health, 93, 2105-2110. doi:10.2105/AJPH.93.12.2105

HHS. (2015). About Child and Teen BMI. Available: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Johnson, R. K. (2000). Changing eating and PA patterns of US children. Proceedings of the Nutrition Society, 59:295-301.

Jones, R. A., Hinkley, T., Okely, A. D., Salmon, J. (2013). Tracking physical activity and sedentary behavior in childhood: a systematic review. American Journal of Preventive Medicine; 44(6):651-658.

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Kwon, S., & Janz, K. F. (2012). Tracking of accelerometry-measured physical activity during childhood: ICAD pooled analysis. Int J Behav Nutr Phys Act; 9:68.

Lanza, S. T., Patrick, M. E., & Maggs, J. L. (2010). Latent transition analysis: Benefits of a latent variable approach to modeling transitions in substance use. Journal of drug issues, 40(1), 93-120.

Mikkila, V., Rasanen, L., Raitakar, O. T., Pietinen, P., & Viikari, J. (2004). Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study. European Journal of Clinical Nutrition; 58(7):1038-1045.

Miller, J., Rosenloom, A., & Silverstein, J. (2004). Childhood obesity. The Journal of Clinical Endocrinology and Metabolism, 89, 4211-4218. doi:10.1210/jc.2004-0284

North Carolina Division of Child Development and Early Education. (2014). NC Child Care Snapshot. Retrieved from http://ncchildcare.dhhs.state.nc.us/general/mb_snapshot.asp

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief, 82, 1–8. Retrieved from http://stacks.cdc.gov/ObjectView?pid=cdc%3A11838&dsid=DS1&mimeType=application%2Fpdf

Pate, R. R., Davis, M. G., Robinson, T. N., Stone, E. J., McKenzie, T. L., & Young, J. C. (2006). Promoting physical activity in children and youth a leadership role for schools: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in collaboration with the councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation, 114(11), 1214-1224.

Pearson, N., Salmon, J., Campbell, K., Crawford, D., & Timperio, A. (2011). Tracking of children's body-mass index, television viewing and dietary intake over five-years. Preventive Medicine; 53(4-5):268-270.

Sherry, B., Mei, Z., Scanlon, K. S., Mokdad, A. H., & Grummer-Strawn, L. M. (2004). Trends in state-specific prevalence of overweight and underweight in 2- through 4-year-old children from low-income families from 1989 through 2000. Archives of Pediatric & Adolescent Medicine, 158, 1116-1124. doi:10.1001/archpedi.158.12.1116

Singh, G. K., Kogan, M. D., & Van Dyck, P. C. (2010). Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Archives of pediatrics & adolescent medicine, 164, 598-607. doi:10.1001/archpediatrics.2010.84

Steinberger, J. & Daniels, S. R. (2003). Obesity, insulin resistance, diabetes, and cardiovascular risk in children: An American Heart Association scientific statement. Circulation, 107, 1448-1453. doi:10.1161/01.CIR.0000060923.07573.F2

Vaughn, A. (2013). Shape NC Annual Report. Available: http://www.smartstart.org/wp-content/uploads/2013/04/Shape-NC-Annual-Report-2012_FINAL.pdf

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Appendices

1. Shape NC Definitions2. Go NAP SACC Materials3. BMI forms4. Case study materials5. Expansion Site Go NAP SACC Improvement Table

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Shape NC Definitions

1. Shape NC Hub Local Partnership: Hub Local Partnerships function as regional lead agencies in the implementation of Shape NC services. Each partnership employs a Hub Specialist and a Community Engagement Specialist to support the Shape NC initiative. In addition to identifying and supporting their local Model Early Learning Center and Expansion Sites, they also convene the Local Partnerships in their region to collaborate on Shape NC work, host content trainings and engage with TA providers in the region to support Expansion Sites. The Hub Partnerships support the Shape NC evaluation process and the Shape NC professional development online series. The Hub Local Partnerships develop Community Action Plans to incorporate Shape NC into their ongoing work. They are also piloting the use of the ABLe Change Framework for broader community engagement.

2. Shape NC Local Partnership: Local Partnerships implement Shape NC services in their communities, Model Early Learning Centers, and Expansion Sites. The lead staff, as well as 1-2 technical assistance providers, works to support these centers to make healthy changes. The Local Partnerships develop Community Action Plans to incorporate Shape NC into their ongoing work. The Local Partnerships collaborate with one another and the regional Hub Partnership to attain the Shape NC milestones and goals.

3. Hub Specialist: Hub Specialists are employed by the Shape Hub Local Partnerships and support the Shape NC work in their regions. The Hub Specialists coordinate and support content trainings, provide direct and intensive TA to the Model Early Learning Centers in their region, coordinate and coach TA staff working with Expansion Sites and collect data for evaluation.

4. Community Engagement Specialist: The Community Engagement Specialists (CESs) are employed by the four Hub Local Partnerships to support Shape NC within the Hub Local Partnership communities. The CESs participate in the ABLe Change Framework training and process, facilitate community groups, work with partnership lead staff to develop parent and key stakeholder engagement strategies and support the Shape NC evaluation process.

5. Shape NC Technical Assistance Staff: A Technical Assistance provider works on the Shape NC initiative in Expansion Sites in one or more of the Go NAPSACC content areas by guiding center staff through the Go NAPSACC assessment, creating action plans and supporting implementation of healthy changes.

6. Model Early Learning Center (MELC): An early care and education center selected, via an application process, by a Smart Start Local Partnership to participate in Shape NC and receive funding to develop and implement programming that supports healthy weight, good nutrition, and enhanced outdoor learning environments. MELCs use Go NAP SACC best practices and work toward becoming Demonstration Sites.

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7. Demonstration Site: A designation that a Model Early Learning Center may apply to receive when it demonstrates a high level of best practice implementation. Demonstration Sites provide tours and guided observations for other centers in the community interested in learning about programming that supports healthy weight, good nutrition, and enhanced outdoor learning environments. The criteria for Demonstration Site status is:a. 55% of Go NAP SACC best practice indicators are met1 b. All of the specific best practice indicators outlined in the Demonstration Site Criteria are

met; andc. Phase I of the site’s outdoor learning environment installation is complete.

8. Expansion Site: A site selected, via an application process, by a Smart Start Local Partnership to participate in Shape NC Phase II and receive a one-time stipend to meet Go NAP SACC best practice indicators.

9. Go NAP SACC Assessment: The assessment tool used in Phase II of Shape NC to assess a Model Early Learning Center, Demonstration Site, or an Expansion Site’s progress in meeting healthy best practices for the children in care.

10. Programming: Child care center activities that contribute to meeting Go NAP SACC best practices.

11. SMART Goal: S.M.A.R.T. goals are goals that are specific, measurable, attainable, relevant, and time-bound.

12. Individualized Action Plan: The action planning document is a tool used by the Shape NC Technical Assistance Specialist and Shape NC Expansion Site staff to identify and record each MELC’s and Expansion Site’s selected SMART goals and objectives for implementing improvements in at least one of the 5 best practice areas. The child care center staff and TA Specialist work together to address the selected goals, identify new goals, and provide additional follow-up, noting all action on the individualized action plan.

13. Community Action Plan: A plan created by each Smart Start Local Partnership participating in Shape NC in collaboration with community partners, to address major needs of the community related to promoting healthy weight in early childhood.

14. Regional Strategic Plan: A plan created by each Hub Local Partnership to address the strategies across the assigned region that will be implemented to ensure that both the quantity of Expansion Sites and the quality of Shape NC supports within participating sites meet the statewide Shape NC program goals.

1 This measure is equivalent to the former criteria of meeting 75% of Shape NC Assessment best practice indicators.

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Shape NC Demonstration Site Criteria

In addition to meeting the following Go NAP SACC indicators, the center must also meet 55% of Go NAP SACC indicators and have completed Phase I of OLE installation in order to be considered eligible to become a Demonstration Site.

Child Nutrition CN- Q1: Our program offers fruit (not juice) 2 times per day or more (Half-day: 1 time per day or more) CN- Q2: Our program offers fruit that is fresh, frozen, or canned in juice (not in syrup), every time fruit is served CN- Q3: Our program offers vegetables 2 times per day or more (Half-day: 1 time per day or more) CN- Q4: Our program offers dark green, orange, red, or deep yellow vegetables one time per day or more CN-Q5: Our program offers vegetables that are cooked or flavored with meat fat, margarine, or butter rarely or never CN- Q6: Our program offers fried or pre-fried potatoes less than 1 time per week or never CN-Q7: Our program offers fried or pre-fried meats or fish less than 1 time per week or never CN-Q8: Our program offers high-fat meats less than 1 time per week or never CN-Q9: Our program offers meats or meat alternatives that are lean or low fat every time meats or meat alternatives are served CN- Q14: Drinking water is available indoors and outdoors, where it is always visible and freely available CN- Q45: Our written policy on child nutrition includes 9-10 of the following topics:

Foods provided to children Beverages provided to children Creating healthy mealtime environments Teacher practices to encourage healthy eating Not offering food to calm children or encourage appropriate behavior Planned and informal nutrition education for children Professional development on child nutrition Education for families on child nutrition Guidelines for foods offered during holidays and celebrations Fundraising with non-food items

Physical Activity PA- Q1: The amount of time provided to preschool children for indoor and outdoor physical activity each day is 120 minutes or more (Half-day: 60 minutes or more) PA- Q4: The amount of adult-led physical activity our program provides to preschool children each day is 60 minutes or more (Half-day: 30 minutes or more) PA- Q13: Teachers take the following role during preschool children’s physically active playtime- they supervise, verbally encourage, and often join in to increase children’s physical activity PA- Q22: Our written policy on physical activity includes 7-8 of the following topics:

Amount of time provided each day for indoor and outdoor physical activity Limiting long periods of seated time for children Shoes and clothes that allow children and teachers to actively participate in physical activity Teacher practices that encourage physical activity

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Not taking away physical activity time or removing children from long periods of physically active playtime in order to manage challenging behaviors

Planned and informal physical activity education Professional development on children’s physical activity Education for families on children’s physical activity

Outdoor Play and Learning OPL- Q8: The outdoor play space for preschool children includes 8 play areas or more OPL- Q9: Your program’s garden grows enough fruits and/or vegetables to provide children meals or snacks during 1 or more seasons OPL- Q10: In our program, the path for wheeled toys is paved and 5 feet wide or wider OPL- Q11: The shape of the path for wheeled toys is curved and looped OPL- Q12: In our program the path for wheeled toys connects to different parts of the outdoor play space with all 3 of the following connections:

Connects to building entrances Connects the building to play areas Connects different play areas to each other

OPL-Q20: Our written policy on outdoor play and learning includes 6-7 of the following topics: Amount of outdoor playtime provided each day Ensuring adequate total playtime on inclement weather† days Shoes and clothes that allow children and teachers to play outdoors in all seasons Safe sun exposure for children, teachers, and staff Not taking away outdoor playtime in order to manage challenging behaviors Professional development on outdoor play and learning Education for families on outdoor play and learning

Screen Time ST-Q12: Our written policy on screen time includes 5-6 of the following topics:

Amount of screen time allowed Types of programming allowed Appropriate supervision and use of

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BMI Data Collection Materials

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Instruction for Height and Weight Form

Blank form(s) should be provided to the 2, 3, and 4 year old classroom teacher(s) approximately 1 week prior to the scheduled visit by the Hub Specialist to measure children’s height and weight.

The classroom teachers will need to fill out the first 6 columns, including:

Child Name = Please list the first and last name of each child who is going to have their height and weight measured. Do not include the names of children whose parents have indicated that they do not want their child to be measured.

Birthdate = For each child listed, please provide their date of birth. Be sure to include the month, day, and year. Please use the following format to record birthdates: mm/dd/yy.

Child Sex = For each child listed, please indicate whether they are a boy or girl. Please use the following abbreviations to indicate child sex.

- M = male or boy- F = female or girl

Race/Ethnicity = While race and ethnicity may be difficult to judge, please try your best to provide the race/ethnicity of each child listed. Please use the following abbreviations and definitions.

- C = Caucasian - AA = African American or Black- H = Latino, Spanish, or Hispanic origin- A = Chinese, Korean, Indian, Filipino, Vietnamese, Japanese origin

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- AI = American Indian or Native American ancestry and tribal affiliations- PI = Native Hawaiian/Other Pacific Islander- M = Two or more races- O = Race is other than one of the options listed above- U = Unable to provide description of child’s race/ethnicity

Part-time vs. Full-time Care = For each child listed, please indicate whether they are enrolled in your care on either a part-time or full-time basis. Please use the abbreviations and definition below.

- PT = part-time care or 20 hours per week or less- FT = full-time care or more than 20 hours per week

Length of Enrollment = For each child listed, we would like to assess how long they have been enrolled at your center. Be sure to consider all time they have spent at the center, even if they have been assigned to a different classroom. Please indicate if they have been at your center for 6 months or more using the following abbreviations.

- Y = child has been enrolled at our center for 6 months or more- N = child has been enrolled at our center for less than 6 months

Classroom teachers should be sure to have the first six columns of information completed before the arrival of the hub specialist.

Hub Specialists will retrieve the partially completed forms from the classroom teachers and use them to record height and weight data for each child listed on the form.

Reminders when measuring HEIGHT:

To correctly set-up stadiometero Make sure the vertical sections of the stadiometer are put together so that the numbers are

in increasing numerical order (lowest numbers at the bottom and highest numbers at the top).

To take height measurement*o Make sure that the child’s shoes are removedo Make sure that you are using inches to measure the child’s heighto Make sure to measure height to the nearest 1/8 of an inch. For example: 42 3/8 in.

Reminders when measuring WEIGHT:

To turn the scale on o Press large blue button on the front side of scaleo Wait for the scale to zero before taking weight measurements

To take weight measurement*o Make sure that the child’s shoes are removedo Make sure that the scale is set to measure weight in pounds (lb)o Make sure the scale is reading zero before having the child step onto the scaleo Record the child’s weight as it appears on the scale. Be sure to capture 1 decimal place.

For example: 35.6 lbs.

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*For any additional questions regarding height and weight measurement, please refer back to your training manual.

Hub specialists SHOULD NOT fill in the last two columns (age in months, participant ID). These columns will be completed by evaluation staff once forms have been returned.

Once height and weight measures have been recorded, Hub specialists should return completed forms to the evaluation project office using the following address:

Attn: Allison De Marco MSW PhDFrank Porter Graham Child Development InstituteUniversity of North Carolina – Chapel HillSheryl Mar North Building, #130517 S. Greensboro StreetCarrboro, NC 27514

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Case Study Materials

Shape NC Child Care Center & Community Engagement

Case Study Telephone/Email Recruitment Script

Hi {insert name}

{if via telephone: My name is Molly De Marco. I am a researcher at UNC-Chapel Hill}

We are looking for people, 18 years and older, who have participated in Shape NC child care center and community engagement activities. We would like to learn about your experiences with implementing Shape NC activities in your community. Overall, we are interested in learning about how you and/or your organization got involved in this work, how that work has developed, and the kinds of things you have done.

We are interested in interviewing you. The interview should last about 60 minutes. You will receive $10 in cash for your time.

Would you be willing to be interviewed? If so, can we set up a time to conduct the interview?

{If no answer and a message is left: Please call Molly De Marco at: 919-966-9563 if you have any questions or would like to set up an interview.}

Thank you,

Molly

Assistant Director for Evaluation and Research FellowCenter for Health Promotion & Disease Prevention (a CDC Prevention Research Center)andResearch Assistant ProfessorDepartment of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel Hill1700 Martin Luther King, Jr. Blvd., CB# 7426Chapel Hill, NC 27599-7426(919) 966-9563 work(541) 231-3292 cell(919) 966-3374 faxhttp://www.hpdp.unc.edu/

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http://www.hpdp.unc.edu/

tel:(919)%20966-3374

tel:(541)%20231-3292

tel:(919)%20966-9563

University of North Carolina at Chapel HillConsent to Participate in a Research StudyAdult Participants

Consent Form Version Date: 2/22/15IRB Study #14-2538Title of Study: Shape NC Phase II EvaluationPrincipal Investigator: Allison De MarcoPrincipal Investigator Department: Frank Porter Graham Child Development CenterCo-Investigator and Project Director: Molly De MarcoCo-Investigator phone number: (919) 966-9563Co-Investigator Email Address: [email protected] Source and/or Sponsor: Blue Cross Blue Shield Foundation_________________________________________________________________

What are some general things you should know about research studies?You are being asked to take part in a research study. Joining the study is voluntary.You may refuse to join, or you may withdraw your consent to be in the study, for any reason.

Research studies are designed to obtain new knowledge. This new information may help people in the future. You may not receive any direct benefit from being in the research study.

Details about this study are discussed below. It is important that you understand this information so that you can make an informed choice about being in this research study.

You will be given a copy of this consent form. You should ask the researcher named above, or staff members who may assist her, any questions you have about this study at any time.

What is the purpose of this study?The purpose of this research study is to learn about your experiences with implementing Shape NC activities in your community. Overall, we are interested in learning about how you and/or your organization got involved in this work, how that work has developed, and the kinds of things you have done.

You are being asked to be in the study because you have been involved with a child care center and/or it’s community engagement activities sponsored by Shape NC.

How long will your part in this study last?Your part in the study will last up to 90-minutes, the time it takes to participate in a interview. There will be no additional follow-up after that session.

What will happen if you take part in the study?If you take part in this study, you will participate in an interview that will last up to one (1) hour. During this interview, a study team member will ask you to answer questions about your experiences with implementing Shape NC activities in your community. You can skip any questions that you do not want to answer.

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You are free to share as much information about your own experience as you wish.

What are the possible benefits from being in this study?Research is designed to benefit society by gaining new knowledge. There are no specific benefits to you from participating in this study.

What are the possible risks or discomforts involved from being in this study?There are no known risks for participating in this study. You should report any problems to the researcher.

How will information about you be protected?Records will be secured on password-protected computers at the University of North Carolina. We will not collect names or other information during the interview, which can link you as an individual to the information you share as part of this study.

An audio recording of this interview will be stored on password-protected computers and deleted from recording devices. You can request that recording devices be turned off at any time during the listening session. Check the line that best matches your choice:

_____ OK to record me during the study

_____ Not OK to record me during the study

What if you want to stop before your part in the study is complete?You can withdraw from this study at any time. For example, if you choose not to participate or to skip answering any questions, nothing will happen to the benefits you receive. The researchers also have the right to stop your participation at any time.

Will you receive anything for being in this study?Participants will receive $10 in cash as an incentive to participate in the study. We are required by the university to collect your signature when you receive cash or a gift card. We will collect this information on a payment verification form. This form with your name and will be kept separate from the answers you provide during the listening session.

Will it cost you anything to be in this study?It will not cost you anything to be in this study.

Who is sponsoring this study?This research is funded by the Blue Cross Blue Shield Foundation of North Carolina. This means that the research team is being paid by the sponsor for doing the study. The researchers do not, however, have a direct financial interest with the sponsor or in the final results of the study.

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What if you have questions about this study?You have the right to ask, and have answered, any questions you may have about this research. If you have questions about the study, complaints, concerns, or if a research-related injury occurs, you should contact the researcher listed on the first page of this form.

What if you have questions about your rights as a research participant?All research on human volunteers is reviewed by a committee that works to protect your rights and welfare. If you have questions or concerns about your rights as a research subject, or if you would like to obtain information or offer input, you may contact the Institutional Review Board at 919-966-3113 or by email to [email protected]. Participant’s Agreement:

I have read the information provided above. I have asked all the questions I have at this time. I voluntarily agree to participate in this research study.

______________________________________________________Signature of Research Participant

____________________Date

______________________________________________________Printed Name of Research Participant

______________________________________________________Signature of Research Team Member Obtaining Consent

____________________Date

______________________________________________________Printed Name of Research Team Member Obtaining Consent

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Case Studies of Shape NC CommunitiesInterview Guide

Interviewer Instructions: The following questions are to be asked in interviews with participants. Begin with the opening statements (i.e., introducing the session) before proceeding with the specific content questions. Use the following specific probes, as well as the general probes described in the data collection guidelines, to obtain thorough and descriptive information to each question. It is critical that you ask enough follow-up and clarification questions to make sure that the participant(s) has provided information that specifically answers the question that was posed.

Potential Interviewees may include the Community Engagement Specialist, the Hub ED, the Lead Staff member, and the Hub Specialist in each community. We will also ask interviewees who else they think should be included.

Introducing the Interview

Thank you for agreeing to participate in today’s interview. We will have 60-90 minutes to talk about your experiences with implementing Shape NC activities in your community. Overall, we are interested in learning about how you and/or your organization got involved in this work, how that work has developed, and the kinds of things you have done.

All information discussed today will remain confidential to the study. We will be audiotaping and taking notes during the interview, which will be kept anonymous. Your name will not be associated with the transcript of the interview.

Do you understand all that I have stated? Check to see that participant agrees. Yes_____ No________

Do you have any questions before we begin?

Okay then, let’s get started.

Case Study Questions

DemographicsTitle:Organization:Length of time in organization:Length of time in community:Length of time working on Shape NC activities:Race/ethnicity:Gender:Age:

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First, we’d like to ask you some questions about your community, the Shape NC efforts in your community, and the work you have done.

1. How would you describe your community? [Probes: is it rural/urban? Racially/ethnically diverse? Economically distressed/vibrant?]

2. How did your Shape NC community engagement group(s) form? [Probes: was there a key stakeholder who engaged the rest? What role did the Community Engagement Specialist play in leading/organizing/facilitating the group (s)?]?

3. Why did you choose to get involved with the Shape NC efforts?

4. Talk a little about your role with Shape NC. What kinds of things have you done personally as part of the Shape NC partnership/group?

5. What community engagement activities has your partnership undertaken? [Probe: we are interested in understanding how you have sought to involve community members, including families and child care staff.]

6. What factors have facilitated this community engagement? [Probes: What role has the Hub Specialist played? The Executive Director? Pennie and/or Erin with the ABLe change? Etc.]

7. How successful have you been in making sure the team reflects the composition of your community (thinking broadly about class, race/ethnicity, age)?

a. Who was engaged? [Probes: faith communities; rural communities?}b. Do you think everyone who should be involved is?c. Who has been missing? Why?d. How did you go about making sure voices were heard?

8. How do you embed obesity prevention activities in the activities of your child care center and/or within the community? [As relevant to respondent]

9. How have you engaged parents to participate in the Shape NC community engagement work? a. Are they parents of children in the MELC, or in Expansion Sites? b. How have you engaged them—in the broader community work, or in the improvements

going on directly at the child care centers?c. What have been your successes with engaging parents in this project?d. What have been your challenges in engaging parents in this project?

Now we have some questions for you about the ABLe Change framework and your experiences with it in your community.

10. Did you use the ABLe framework and tools? a. If so, for what activities?

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b. How important were the ABLe framework and tools to your community engagement work?

c. What have been your experiences using the ABLe Change framework?d. What successes have you had so far with using the ABLe change techniques?e. What challenges have you experienced in implementing ABLe change?f. What are your next steps with ABLe change?g. What projects have you worked on that were developed from the ABLe Change

framework?

11. Did your partnership implement any of the ‘6 Simple Rules?’ If so, which ones?

12. What have been your experiences implementing the ‘6 Simple Rules?’

13. What have been your experiences implementing the Systems thinking/scanning methods?

Now we’d like to ask you some questions about the successes and challenges you have faced during your work with Shape NC.

14. What do you see as successes of the Shape NC work in your community?[Probe: Please address all Shape NC activities, including the broader ABLe community engagement work and the work focused on the MELCs and Expansion Sites.]

15. Describe how you see the ABLe work integrated with the work at the child care centers [Probe: Have you seen much overlap? Have they been distinct projects?]

16. What have been your partnership’s challenges to engaging the community to prevent childhood obesity?

a. What strategies have you implemented to address these challenges?

17. What changes have you seen in your community as a result of this work?

18. What changes would you like to see in your community as a result of this work? [Probe: What are the next steps?]

19. Are there any others you think we should talk with?

Thank you so much for your participation. We really appreciate all the information you have shared with us.

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Comparison of Wave I and Wave II Scores for Expansion Sites

Program

Total Score Breastfeeding Physical Activity Child Nutrition Outdoor Play Screen Time

% WI % WII Change % WI % WII Change % WI % WII Change % WI % WII Chang

e % WI % WII Change % WI % WII Chang

eAngel

Garden 71% 86% 21% 20% N/A N/A 81% N/A N/A 81% N/A N/A 72% 86% 19% 55% N/A N/A

Asheville City

Schools 84% 90% 8% 86% N/A N/A 82% N/A N/A 87% 90% 3% 78% N/A N/A 79% N/A N/A

Building Blocks for Tiny Tots

87% 86% -1% 82% 86% 5% 92% N/A N/A 92% N/A N/A 81% N/A N/A 75% N/A N/A

Center for Children Cottage

68% 83% 21% 65% 86% 32% 52% 78% 50% 77% 88% 14% 83% 82% -1% 52% 56% 8%

Center for Children D.C. at Kilgo

74% 86% 16% 76% 90% 18% 74% 85% 15% 78% 88% 13% 75% 86% 15% 52% 56% 8%

Central Center for Children

and Families

78% 73% -5% 49% N/A N/A 81% N/A N/A 83% N/A N/A 73% 73% 0% 80% N/A N/A

Chapel Hill Coop.

Preschool78% 65% -17% 46% N/A N/A 62% 65% 5% 90% N/A N/A 89% N/A N/A 68% N/A N/A

Charlotte Bilingual

Preschool2% 77% 3859% 3% N/A N/A 1% 91% 9000% N/A N/A N/A N/A 70% N/A N/A 57% N/A

Chestnut Street

Head StartN/A 86% N/A N/A N/A N/A N/A 86% N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Child Care Network 79% 91% 16% 66% 84% 27% 84% 93% 11% 86% 95% 10% 76% 89% 17% 63% 92% 46%

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Program




e#73

Childcare Network

#7870% 84% 19% 76% N/A N/A 59% 89% 51% 79% N/A N/A 61% 78% 28% 60% N/A N/A

Discovery Harbor 76% 84% 11% 64% 79% 23% 81% 90% 11% 82% 81% -1% 75% 88% 17% 67% 85% 27%

Eggleston’s Playground 79% 76% -3% 67% N/A N/A 85% N/A N/A 84% N/A N/A 72% 76% 6% 81% N/A N/A

Eliada Child Dev

Services88% 91% 4% 93% 91% -2% 83% N/A N/A 90% N/A N/A 82% N/A N/A 85% N/A N/A

Excel #1061% 79% 28% 57% 81% 24% 58% 76% 18% 71% N/A N/A 53% N/A N/A 47% N/A N/A

Excel #1171% 74% 4% 62% 75% 21% 75% N/A N/A 78% N/A N/A 64% 74% 16% 66% N/A N/A

Excel #1365% 74% 12% 49% N/A N/A 57% N/A N/A 82% N/A N/A 63% 74% 17% 47% N/A N/A

Excel #1468% 78% 14% 69% N/A N/A 56% N/A N/A 76% N/A N/A 65% 78% 20% 59% N/A N/A

Excel #585% 92% 8% 76% 89% 17% 98% 100% 2% 85% 96% 13% 94% 92% -2% 63% 69% 10%

Excel #867% 69% 2% N/A N/A N/A 72% N/A N/A 75% N/A N/A 61% 69% 13% 41% N/A N/A

Fairview Child and

Family Center

88% 96% 10% 84% N/A N/A 88% N/A N/A 91% 96% 5% 89% N/A N/A 81% N/A N/A

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Program




eFirst

Baptist Church

CDC

75% 82% 9% 76% 82% 8% 67% N/A N/A 82% N/A N/A 61% N/A N/A 85% N/A N/A

First Church of God Day School

81% 73% -10% 20% 26% 30% 79% 96% 22% 91% N/A N/A 85% N/A N/A 81% N/A N/A

God’s Little Acre N/A 78% N/A N/A 80% N/A N/A 74% N/A N/A 80% N/A N/A 85% N/A N/A 67% N/A

Good Shepherd 89% 81% -9% 80% 81% 1% 94% N/A N/A 91% N/A N/A 93% N/A N/A 81% N/A N/A

Humble Beginnings Child Care

70% 34% -52% 75% 100% 33% 63% N/A N/A 73% 0% -100% 67% N/A N/A 65% N/A N/A

J-Bear CDC71% 84% 18% 85% 91% 7% 66% 86% 30% 73% 79% 8% 67% 90% 34% 54% 73% 35%

Kids & Company –

Newkirk64% 71% 12% 70% N/A N/A 59% N/A N/A 71% 73% 3% 51% 64% 25% 52% 77% 48%

Kids and Company – College Rd.

71% 67% -7% 78% N/A N/A 65% N/A N/A 77% N/A N/A 65% 67% 3% 58% N/A N/A

Kidz are Fun CDC 72% 89% 23% 57% 84% 47% 65% 94% 45% 88% 93% 6% 68% 83% 22% 65% 83% 28%

Kinder-Noggin 57% 63% 11% N/A 31% N/A 42% 78% 86% 57% N/A N/A 75% N/A N/A 52% N/A N/A

Little Dreamers 68% 69% 2% 60% N/A N/A 64% 69% 8% 77% N/A N/A 72% N/A N/A 52% N/A N/A

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Program




eChildcare

Macon Program

for Progress

90% 99% 10% 87% 99% 14% 85% N/A N/A 96% 99% 3% 89% N/A N/A 85% N/A N/A

Millersville CDC 80% 88% 9% 67% N/A N/A 84% 88% 5% 89% N/A N/A 76% N/A N/A 73% N/A N/A

Morven Head Start 63% 75% 19% 49% N/A N/A 81% N/A N/A 53% N/A N/A 66% 75% 14% 82% N/A N/A

Mount Olive

Kiddie Kollege

68% 70% 3% 59% N/A N/A 66% 70% 6% 77% N/A N/A 68% N/A N/A 60% N/A N/A

New Beginnings 78% 98% 26% 63% 98% 56% 73% N/A N/A 87% N/A N/A 75% N/A N/A 83% N/A N/A

Onslow County

Child Care Dev Center


Open Doors

Center for Children

71% 64% -9% 20% N/A N/A 75% N/A N/A 82% N/A N/A 67% 64% -4% 66% N/A N/A

Our Children’s

House51% 85% 67% 46% N/A N/A 56% N/A N/A 51% N/A N/A 69% 85% 23% 23% N/A N/A

Precious Memories Preschool

86% 94% 9% 60% N/A N/A 85% 99% 16% 92% 92% 0% 92% N/A N/A 73% N/A N/A

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Program




eRehobeth II

80% 70% -12% 70% 52% -26% 86% 84% -2% 81% 68% -16% 82% 72% -12% N/A 88% N/A

Shepherd’s Way Colfax 65% 83% 28% 53% N/A N/A 70% N/A N/A 71% N/A N/A 67% 83% 24% 56% N/A N/A

Shepherd’s Way Day

School89% 100% 13% 79% 100% 27% 94% N/A N/A 88% N/A N/A 97% N/A N/A 83% N/A N/A

Stepping Stones 85% 98% 15% 86% N/A N/A 80% 98% 23% 89% N/A N/A 81% N/A N/A 85% N/A N/A

Sunflower Seeds 84% 78% -7% 78% 85% 9% 88% N/A N/A 94% N/A N/A 79% N/A N/A 58% 67% 16%

The Children’s Center of Asheboro

88% 92% 5% 77% 92% 19% 89% N/A N/A 91% N/A N/A 96% N/A N/A 85% N/A N/A

The Children’s

Early School


The Growing

Patch76% 85% 13% 58% N/A N/A 78% 85% 9% 88% N/A N/A N/A N/A N/A 47% N/A N/A

The Growing

Years65% 69% 6% 60% N/A N/A 56% 75% 34% 78% N/A N/A 60% 63% 5% 47% N/A N/A

Think and Grow 82% 78% -5% 87% N/A N/A N/A 82% N/A 84% 82% -2% 86% N/A N/A 44% 41% -7%

University Child Care 85% 96% 12% 95% N/A N/A 92% N/A N/A 88% 96% 9% 72% N/A N/A 63% N/A N/A

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Program




eCenter

Wee are the World Child Care Center 2

68% 81% 19% 62% N/A N/A 69% 81% 17% 79% N/A N/A 57% N/A N/A 48% N/A N/A

N/A = program did not complete that form

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