Step It Up: Taking Steps to Healthy Success

The Step It Up: Taking Steps to Healthy Success (Step It Up) Project, which is based on the Nemours Children’s Health System’s National Early Care and Education Learning Collaboratives (ECELC) Project, aims to promote healthy environments by changing policies and practices in early care and education (ECE) settings in the following five topic areas: Breastfeeding & Infant Feeding, Child Nutrition, Infant & Child Physical Activity, Outdoor Play & Learning, and Screen Time.

The Step It Up model incorporates ECELC implementation components, including Learning Sessions (LSs), Technical Assistance (TA), and Long-Term Action Plans. Prior to this round of Step It Up, there was a similar learning collaborative specifically for Family Child Care (FCC) programs conducted in three counties within Kansas which began in the fall of 2014. In order to account for differences between center-based and FCC programs, modifications were made to the original ECELC project components. These changes included the incorporation of four, six-hour long LSs instead of the ECELC’s five full-day sessions. All other components remained consistent.

Kansas’s Step It Up: Taking Steps to Healthy Success (Step It Up) Project aims to work towards making improvements to policies and practices in child care programs with regard to breastfeeding, child nutrition, physical activity, outdoor learning, and reductions in screen time. Step It Up is an extension of the National Early Care and Education Learning Collaboratives Project (ECELC) and uses a similar learning collaborative model.

Step It Up: Taking Steps to Healthy Success has made great improvements in promoting healthy eating and physical activity. The topics of Child Nutrition and Infant & Child Physical Activity had the highest number of increases in best practices. Breastfeeding & Infant Feeding had the highest percentage of best practices being met at pre-assessment (55%).

The Gretchen Swanson Center for Nutrition (GSCN), an independent research organization in Omaha, NE, evaluated 49 FCC programs and 11 center-based programs participating in the second year of Step It Up for a total of 60 ECE programs. This round began in September 2015 and was supported with funding from the Kansas Health Foundation. The evaluation of Step It Up examined the effects of the modified ECELC model on outcomes (as reported via self-assessment using the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) across all participating programs, as well as a more in-depth, contextual analysis across a sample of programs (20% or 12 programs), and by monitoring of technical assistance (TA) received by participating programs.

Statistically significant improvements were made in all five NAP SACC topic areas. Additionally, there are some noteworthy differences described below.

The topics of Child Nutrition and Infant & Child Physical Activity had the highest number of increases in best practices (5.2 and 3.1, respectively). This is not surprising, as these two topic areas are the stalwarts of the project. The remaining topic areas, Breastfeeding & Infant Feeding, Outdoor Play & Learning, and Screen Time, each improved by about the same number of best practices (1.6, 1.7, and 1.5, respectively).

While the topic area of Breastfeeding & Infant Feeding only increased by 1.6 best practices, it did have the highest percentage of best practices being met at pre-assessment (55%). And while Outdoor Play & Learning only increased by 1.7 best practices, the percentage of best practices being met from pre-assessment to post-assessment was relatively higher than that of Infant & Child Physical Activity (46% to 57% for Outdoor Play & Learning compared to 41% to 56% for Infant & Child Physical Activity). Screen Time was the only topic area where less than half the best practices were reportedly met at post-assessment (44%). Although these results are collective for FCC and center-based programs, FCCs offer a unique environment as children are often cared for in living quarters. Therefore, it is not surprising that overall, participating programs generally made less improvements in Screen Time.