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Starting Early: Harris County

State: TX Type: Promising Practice Year: 2019

Harris County Public Health (HCPH) is the health department for Harris County, Texas the third most populous county in the United States. The HCPH jurisdiction includes approximately 2.2 million people within Harris County's unincorporated areas and over 30 other municipalities located in Harris County, Texas (not including the city of Houston). The Harris County population is younger and more ethnically diverse than both the Texas and U.S. population according the 2010 U.S. census.

According to the CDC, 1 in 4 children aged 2 to 5 are overweight or obese in the United States. In Texas, and Harris County, that number grows to 1 in 3 children. For the first time in history, children in Harris County could face a shorter lifespan than their parents because they are overweight and obese. Along with the adverse effects that obesity has on our children's health, childhood obesity also imposes considerable economic costs on our healthcare system and future workforce. Childhood obesity is an issue with multiple causes, therefore the solutions must be addressed by multiple sectors including early care and education.

Healthy Living Matters (HLM), a childhood obesity prevention collaborative led by HCPH, is working to prevent childhood obesity through policy and environmental change. Since 2010, HLM has engaged the ECE sector and has been successful in developing partnerships, implementing programs, and supporting systems-level change. The action plan for this work was modeled after the CDC's Spectrum of Opportunities Framework for State-Level Obesity Prevention Efforts Targeting the Early Care and Education Setting.

The first step in the implementation of the ECE action plan was to convene stakeholders who could inform and help support the plan. In 2016 HCPH established the HLM- Early Care & Education/Out-of-School Time (ECOS) Action Team. This group, representing 24 organizations, convenes monthly to discuss ways to advance the action plan and serve as a gateway to reach the sector on a broader health” platform. The ECOS Action Team helped establish our goals and objectives and as a result, we now have a robust list of accomplishments, to include: a monthly newsletter, resource guide, professional development offerings, and state-level projects being piloted in Harris County. The goals and objectives include:

Goal 1:  To engage more ECE professionals around obesity prevention.

Objectives:

Create an obesity prevention coalition made up of at least 20 ECE stakeholders.

Participate in at least one local ECE coalition and one state coalition.

Share obesity prevention resources with at least 500 ECE professionals.

Goal 2: Increase the number of professional development opportunities related to obesity prevention.

Objectives:

Provide at least one obesity prevention session at local ECE conferences.

Provide at least one capacity building opportunity to ECE stakeholders.

Train at least 25 local professionals to become Child Care Health Consultants.

Goal 3: Increase investments and opportunities to add visibility, value, and validation to the ECE sector.

Establish partnerships that can lead to ECE investments at the local level.

Pilot the OLE! Texas project in Harris County.

Develop/support a healthy child care recognition program.

In 2018 alone, we:

  • Convened ~20 individuals at monthly meetings
  • Participated in 3 local ECE coalitions and 3 state-level coalitions
  • Developed 10 newsletter issues and currently have 556 subscribers
  • Presented sessions at 6 statewide and 2 local conferences, training 274 individuals
  • Supported 14 opportunities for capacity building in obesity prevention topics
  • Recruited 3 ECE facilities to participate in the OLE! Texas program
  • Partnered on the development of a state-wide healthy ECE recognition to be piloted in Harris County

The biggest strength of our work is the level of engagement and commitment of our partners. Without their support the work would not be able to advance and we would not have the reach we currently do. Each of our partners has a broad, extensive network that extends across our large county and region, including the thousands of families connected to those networks. Another strength is the number of separate early childhood efforts we are involved in that have helped leverage resources and funding to Harris County.

Early childhood is a critical time for developing healthy habits and we know that this work will prove to have tremendous impact in preventing childhood obesity. Focusing on ECE programs we can help prevent obesity and ensure that all Harris County children arrive at Kindergarten ready to learn, play, and succeed.

To learn more about HCPH, visit https://publichealth.harriscountytx.gov/. To learn more about HLM, visit www.healthylivingmatters.net.

The Healthy Living Matters (HLM) mission began with planning objectives based on two public health planning models, Mobilizing for Action through Planning and Partnerships (MAPP) and Protocol for Assessing Community Excellence in Environmental Health (PACE-EH). HLM Planning Objectives were to:

Conduct various assessments specific to Harris County, including but not limited to evaluating barriers to active living and healthy eating

Promote and provide learning opportunities related to childhood obesity and policy strategy

Monitor ongoing federal, state and local legislation to track policy trends and developments

Identify local issues and prioritize policies that have an impact on childhood obesity

Ensure an evaluation process is in place that establishes accountability measures for maintaining key inputs to support the Collaborative

Develop a Community Action Plan to serve as a road map for policy implementation

To prepare our Policy Scan, the HLM Policy Team assessed and researched policies and practices across sectors impacting childhood obesity, including Early Care & Education (ECE). HLM reviewed issues related to health, nutrition, physical activity, and obesity in age groups from infants to age two and kindergarten to high school age. Issues were aligned, when possible, with existing or proposed state, county and city laws and ordinances. Community input was obtained through key informant interviews and community surveys. Further, stakeholders invited HLM to meetings where childhood obesity was discussed and where HLM could obtain feedback on priorities. Policy suggestions from community stakeholders were added to the policy scan.

Ultimately, 16 policies were prioritized by the stakeholders, community forums, and HLM. Of these policies, there are 4 that tie directly to the ECE sector:

1. Advocate for low-fat, low-calorie drinks in schools and ECE facilities.

2. Development of guidelines to educate and incent administrators, school teachers, ECE providers, and other staff to eat healthy and be physically fit as role models for children.

3.  Establish state, city, and/or county healthy schools and healthy ECE recognition programs with a training component.

4. Promote outdoor classrooms and incorporate active learning into core curriculum to increase physical activity in Harris County schools and ECE facilities.

HLM decided to learn more about the challenges faced by ECE professionals when providing healthy nutrition and physical activity opportunities to children in their care and decided to send out a county-wide survey. Four hundred ninety-seven respondents, representing various positions within ECE responded to the Healthy Living Matters: A Harris County Early Child Care Survey. Key findings revealed: Child care home respondents reported offering more fruits and vegetables to children in their care than respondents from child care centers.

Child care center respondents reported offering sweets/fatty/salty foods at a higher rate than they are offering fruits and vegetables.

The majority of child care providers reported making water readily available and refraining from offering sugary drinks to children.

Thirty-nine percent of child care providers reported offering 60 minutes of free play and 28.6% offered 60 minutes of structured play at least once per day.

Respondents reported that physical activity training opportunities are rarely offered to teachers or staff.

Additionally, HLM conducted focus groups with thirty child care home providers to learn more about their views on the importance of nutrition and physical activity, their perceived roles, and the training needed to provide a healthier environment for children in their care. The findings from the focus groups suggests that providers need assistance with implementing healthier eating and physical activity opportunities in their facilities.

When HCPH (through HLM) began to actively engage this sector and develop an action plan to help advance our policy priorities, the CDC's Spectrum of Opportunities Framework for State-Level Obesity Prevention Efforts Targeting the Early Care and Education Setting was used as the guide. This framework helped organized the goals, objectives, and strategies adopted by the HLM – Early Care & Education/Out-of-School Time (ECOS) Action Team. This framework also provided us with common language with which to approach the Texas Department of State Health Services (DSHS) for partnership opportunities, which landed HCPH a spot on the Texas Early Care Obesity Prevention Committee.  Opportunities like these are allowing us to influence state-level decisions that would not be possible at a local level.

Prior to this work there had been no coordinated obesity prevention efforts dedicated to the ECE sector in Harris County (or Texas). This practice, now going on its 3rd year, has gained tremendous support from both local and state-level partners. HCPH has been invited to present at national conferences to share its work in this area and guide others who are interested in working with this sector. HCPH has also been invited to sit on various local and state-level ECE committees to ensure that health is part of the conversation.

Problem Statement

Healthy Living Matters identified three priority communities – Kashmere Gardens, Near Northside and Pasadena - using multiple data sources that pointed to significant health disparities and potential inequities. Two out of the three communities are also considered child care deserts, however, all three are quality child care deserts as it relates to participation in Texas Rising Star, our states Quality Rating & Improvement System.

There are 2,851 ECE facilities in Harris County; of these facilities 1594 are centers and 1257 are homes.  For the most part, they are serving children ages birth to 5, in addition to school aged children during before and after school hours. Most facilities are full-time and caring for children between the hours of 6 AM – 6 PM, ranging in capacity from 4 children to 999. There is a voluntary Quality Rating & Improvement System (QRIS) in Texas called Texas Rising Star (TRS). The TRS standards for nutrition and physical activity are higher than the state's Child Care Licensing Minimum Standards. However, in Harris County only 213 facilities (7.5%) participate in TRS.

According to 2015 Census estimates, there are 4,434,257 people living in Harris County and of those 7.85 are children under five (347,531). Harris County is one of the most racially and ethnically diverse places in the United States due to the unique combination of location, opportunity, and economy. The county population's racial and ethnic breakdown is as follows: 42% Hispanic (1.9 million); 31% White, not Hispanic (1.4 million); 18.6% Black or African American (880,000); and 6% Asian (312,000). The racial demographics among children 0-4 years of age is: 40.6% Hispanic, 21.3% White, 18.3% Black and 19.8% Other, Asian or Mixed.

The median household income in Harris County is $54,457 (2011-2015), slightly higher than the national average of $53,889. However, household incomes in Harris County exhibit striking variations across zip codes. The 2015 Census estimates that 25% of all Harris County children live in poverty with 24.4% of children under the age of 5 without regard for race or ethnicity. A closer examination reflects the rate of kids living below the poverty line is highest for Blacks, Hispanics and Other races at 30-31% and lowest for Whites at 7.5%.

As are many communities throughout the United States, Harris County is concerned about the health of its children. It is estimated that 34% of Houston area children are overweight/obese. While the main cause of childhood obesity is an imbalance of the number of calories consumed and the amount of physical activity, there are many environmental factors that influence a child's opportunities to maintain a healthy weight. Childhood overweight/obesity rates in Harris County are higher in communities with higher rates of minorities and people living in poverty. Often, these communities have less access to healthy food and fewer opportunities to engage in physical activity outdoors.

In Texas, 16.3% of children ages 2 to 4 years in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program were overweight and 15.9% of children aged 2 to 4 years in WIC had obesity. Also 83.3% of infants were ever breastfed but only 52.1% of infants were breastfed for at least 6 months. In 2014, more than a quarter of children in Harris County (26%) were food insecure, living in communities classified as food deserts, and 34% of children under age 5 and 28% of children ages 5-17 receive food through SNAP.

There is less local early childhood data as it relates to physical activity, however, according a study by the Houston Parks and Recreation Department, 22% of Houston area children report not participating in physical activity for at least 1 hour per week. Moreover, more than half of Houston area children under age 19 do not use parks. Though Harris County has an abundance of parks and green space, it is not evenly distributed based on the population, as certain areas of the city have exceptionally low densities of park and green space. People's park use and physical activity are correlated with the proximity of a park to their residence; this trend is especially evident among young children ages 4-7. So more efforts need to be made to ensure access to parks and green space for all children.

Another resource to the field is the Child and Adult Care Food Program (CACFP). This program provides aid to child and adult care institutions for the provision of nutritious foods that contribute to the wellness, healthy growth, and development of young children, and the health and wellness of older adults and chronically impaired disabled persons. This program reimburses ECE facilities for the healthy foods they provide to children. However, in Harris County only 901 facilities (31.6%) participate in the CACFP.

Evidence of Best Practice

According to the County Health Rankings and Roadmaps, there is strong evidence that nutrition interventions in preschool and child care improve children's diets (Mikkelsen 2014Grantham-McGregor 2014, Larson 2011, Robinson 2014) and physical activity interventions increase their activity levels (Gordon 2013, Kreichauf 2012, Larson 2011, Ward 2010, Robinson 2014). However, additional evidence is needed to determine if these interventions reduce risk of overweight or obesity (Zhou 2014, Jaime 2008, Ward 2010).

Adhering to nutrition guidelines in preschool and child care can decrease children's fat intake and increase fruit and vegetable intake (Mikkelsen 2014, Jaime 2008). Implementing physical activity interventions can increase participant's fitness and motor skills (Ward 2010). In some circumstances, nutrition and physical activity interventions have been shown to reduce children's weight, body fat, or body mass index (BMI) (Mikkelsen 2014Bluford 2007, Zhou 2014).

Overall, interventions that increase time for physical activity, provide portable play equipment (e.g., balls and other objects), and include playground markings have been shown to increase moderate to vigorous physical activity (Kreichauf 2012, Broekhuizen 2014, Temple 2014). Researchers also recommend that child care centers provide teachers with training in how to integrate physical activity into learning to maximize effects on children's physical activity (Kreichauf 2012, Ward 2010, Mehtala 2014).

Harris County Public Health (HCPH) is the backbone organization for the Healthy Living Matters (HLM) collaborative. HLM has various action teams, including the Healthy Living Matters Early Care & Education/Out-of-School (ECOS) Action Team. The HLM ECOS Action Team has been working together since March 2016 to identify obesity prevention strategies that advance policy, systems, and environmental changes in ECE settings. The HLM-ECOS Action Team primarily consists of individuals who oversee policies or practices, or provide resources to the early care & education and/or out-of-school time sector. The ECOS Action Team was born out of the February 2016 Quarterly Meeting of the full HLM Collaborative. Since then the team, made up of 24 organizations, works to address childhood obesity by focusing on supporting policies and practices for healthy eating, physical activity, and staff professional development in the ECOS sector. The Action Team meets on a monthly basis and strategizes ways to advance policy priorities specific to this sector.

The Action Team meets on a monthly basis and strategizes ways to advance policy priorities specific to this sector. The organizations involved are:

  • Harris County Public Health: Local health authority for Harris County, TX and backbone organization for the HLM collaborative. Divisions/Offices represented are the Office of Policy and Planning, Nutrition and Chronic Disease Prevention Division (Chronic Disease Prevention Unit, WIC, and Health Impact Team). More information at http://publichealth.harriscountytx.gov/.
  • Harris County Public Library: Represents twenty-six branch locations throughout Harris County and is our key partner for parent engagement. More information at http://www.hcpl.net/.
  • Children's Learning Institute: Institute out of The University of Texas Health Science Center at Houston that applies cutting-edge research in child development and education to improve learning in children. More information at https://www.childrenslearninginstitute.org/.
  • Collaborative for Children: Nonprofit that strengthens early education throughout Greater Houston through professional development and quality improvement initiatives. More information at https://www.collabforchildren.org/.
  • Harris County Department of Education: Provides Head Start programming, and funding/ services to the out-of-school time community in Harris County. More information at http://www.hcde-texas.org/
  • Gulf Coast Community Service Association: Provides Head Start programming and other social services in the Harris County area. More information at https://www.gccsa.org/
  • Texas Children in Nature: Network of local partner organizations and individuals who are working together to connect children and families with nature in Harris County. More information at https://www.texaschildreninnature.org/
  • Recipe for Success Foundation: Nonprofit dedicated to combating childhood obesity by educating children to understand and appreciate food. More information at http://recipe4success.org/.
  • Texas Department of Family & Protective Services – Child Care Licensing Division: State agency responsible for regulating all child-care operations to protect the health, safety, and well-being of children in care. More information at https://www.dfps.state.tx.us/child_care/.
  • Agape Christian Preschool: Local child care facility. More information at http://www.agapepreschool.com.
  • Kids' Creche: Local child care facility. More information at http://www.agapepreschool.com. http://thekidscreche.com/
  • University of Houston Children's Learning Center: Local child care facility that caters to the staff and students of the University of Houston. More information at http://www.uh.edu/clc/about/index.html
  • YMCA of Greater Houston: Representing the local child care and out-of-school time programs being offered in the Harris County area. More information at https://www.ymcahouston.org/.
  • Houston Food Bank: Local food bank for the Harris County area, and largest in the nation, providing nutrition assistance, nutrition education, school-based programs, and SNAP application assistance.  More information at https://www.houstonfoodbank.org/.  
  • Creative Trainers & Consultants: Organization dedicated to providing quality training and consultation to early childhood professionals in the area. More information at http://www.creativetrainers.com/.
  • Harris County Precincts: Precinct partners help identify child health and wellness issues at a Precinct level and are key partners for community engagement. More information at https://www.harriscountytx.gov/.
  • Texas Department of State Health Services: State agency responsible for core public health functions and our partner on the OLE! Texas project. More information at http://www.dshs.texas.gov/Obesity/OLE/?terms=OLE!%20Texas.   
  • First3Years: Nonprofit dedicated to educating, advocating, and collaborating to advance the healthy development of infants and toddlers. More information at http://first3yearstx.org/.
  • University of Houston-Clear Lake: Local academic institution with an early childhood education degree program. More information at https://www.uhcl.edu/.
  • San Jacinto College: Local academic institution with a child development degree program and a child development lab school. More information at https://www.sanjac.edu/.
  • Gulf Coast Chapter of the Texas Association for the Education of Young Children: Professional association that seeks to improve teaching and learning by building the early childhood profession and promoting awareness of issues affecting children and their families. More information at http://www.texasaeyc.org/.
  • University of Houston: Local academic institution with a public health degree program and conducting research in areas of child health and nutrition. More information at http://www.uh.edu/.
  • Children at Risk: Research and advocacy organization working to improve the health, safety and economic indicators impacting children, and educating public policy makers about their importance in improving the lives of children. More information at http://childrenatrisk.org/.
  • Education Service Center – Region 4: Regional education service center tasked with helping school districts and charter schools improve student performance, operate more efficiently, and implement state initiatives. Region 4 Child and Nutrition Services provides technical assistance and training to assist CACFP contracting entities.

All the work of the Action Team is directed by the HLM Executive Committee and coordinated by a Public Health Analyst from HCPH. The Executive Committee is a committee made up of Senior and Executive Leaders across multiple sectors – Public Health, Education, Healthcare, Non-Profit/Youth, and the Built Environment. HLM Co-Directors are on this Committee and serve on Harris County Public Health's Executive team.

The goals and objectives as determined by the HLM-ECOS Action Plan are:

Goal 1:  To engage more ECE professionals around obesity prevention.

Objectives:

1. Create an obesity prevention coalition made up of ECE stakeholders.

To meet this objective HCPH had to identify ECE professionals that have a stake in child health and invite them to be a part of the HLM-ECOS Action Team. This Action Team has grown since it was created in 2016 and on a regular basis the group discusses any gaps we may have in representation. To date the group has met 31 times. 

2. Participate in at least one local ECE coalition and one state coalition.

As a result of work of our local coalition, HCPH was invited to sit on the Early Matters coalition, a broad-based coalition of business, civic, education, philanthropic and nonprofit organizations, working together to raise awareness about the importance of high quality early education and to make a strong case for increased investment in this critical, high return on investment area. HCPH was also invited to sit on the Advisory Committee for the Child Development Department at San Jacinto College and on the Advisory Committee for Gulf Coast Community Service Association (a local Head Start grantee).

On a state-level, HCPH was asked to sit on the Texas Department of State Health Service's Early Care Obesity Prevention Committee and the OLE! Texas Leadership Team. HCPH was also asked to serve on the Texas Early Childhood Professional Development System.

3. Share obesity prevention resources with at least 500 ECE professionals.

One of the first strategies that the HLM-ECOS Action Team came up with was to develop an ECE Obesity Prevention Resource Guide and a monthly newsletter. A Resource Guide was soon developed and to date, there have been 24 newsletter issues sent out.  At this time the newsletter has 556 subscribers, but it is also sent out to all area ECE facilities by way of our Child Care Licensing representative.

To meet these objectives we relied heavily on the connections that our HLM-ECOS Action Team members have. We also presented our work at various meetings and conferences and made sure to bring a newsletter sign-up sheet everywhere we presented.

Goal 2: Increase the number of professional development opportunities related to obesity prevention.

Objectives:

1. Provide at least one obesity prevention session at local ECE conferences.

On a yearly basis, the HLM-ECOS Action Team identifies the large ECE conferences in Harris County and Texas. A calendar is developed and shared with the group, including deadlines for proposal submissions. HCPH staff commits to submitting proposals for any conference taking place in Harris County and the top attended statewide conferences (Texas Association for the Education of Young Children, Texas Licensed Child Care Association, Texas Professional Home Child Care Association, Texas Head Start Association, Texas School Ready Summer Institute, and Texas Early Learning Summit). In addition, as a result of their participation in the HLM-ECOS Action Team, the Gulf Coast Chapter of the Texas Association for the Education of Young Children had committed to making their yearly conference completely health-focused. In the last two years, HCPH has been a planning partner and presented on our efforts to all attendees during the lunch gathering.

2. Provide at least one capacity building opportunity to ECE stakeholders.

Every year there is an Action Based Learning conference in Houston. Two years ago, the HLM-ECOS Action Team decided that it would be beneficial to have more ECE professionals trained in Action Based Learning. HCPH was able to sponsor 4 registration spots for ECE professionals on a yearly basis. Those who won were required to provide a training to our HLM-ECOS Action Team and encouraged to present this topic at local ECE conferences. They were also invited to join the HLM-ECOS Action Team.

3. Train at least 25 local professionals to become Child Care Health Consultants.

The Texas Department of State Health Services (DSHS) in partnership with the Texas Association for the Education of Young Children (TX AEYC) oversee the Texas Child Care Health Consultant (CCHC) program. In Harris County there are very few CCHC and the HLM-ECOS Action Team saw that as a barrier to accessing health-related training and technical assistance. This year HCPH partnered with DSHS and TX AEYC to host a CCHC workshop in Harris County. There were 30 individuals in attendance and HCPH provided scholarships for 10 of those – 5 HLM-ECOS Action Team members and 5 HCPH employees. In addition, the state coordinators have agreed to continue to host a yearly workshop in Harris County in partnership with HCPH.

To meet these objectives HCPH made sure to connect with all ECE conference organizers and asked them to commit to offering sessions related to obesity prevention. The conference organizers made sure to keep HCPH informed of call for proposal opportunities and encouraged us to share within our public health networks. The workshop partnership opportunities were made possible because of connections made while participating in the statewide ECE coalitions.

Goal 3: Increase investments and opportunities to add visibility, value, and validation to the ECE sector.

1. Establish partnerships that can lead to ECE investments at the local level.

The HLM-ECOS Action Team committed to seeking out grants and partners that are interested in supporting the ECE sector as it relates to health. At the state-level, the Texas DSHS approached the HLM-ECOS Action Team to see if there was interest in expanding the OLE! Texas project in Harris County and having HCPH become the Regional Coordinator. This project aims to enhance Outdoor Learning Environments (OLE) in ECE settings so that young children are more connected to nature and have more opportunities to be active. In 2017 HCPH became the regional coordinator for this initiative and was tasked with identifying an implementation site and recruiting local landscape architects to be trained in designing spaces for young children. Since becoming the Regional Coordinator, HCPH has partnered locally with MD Anderson Cancer Center, Memorial Hermann Health System, and Cities Connecting Children to Nature-Houston to financially support the development of these outdoor spaces.

2. Pilot the OLE! Texas project in Harris County.

As a result of the partnership with MD Anderson Cancer Center we have 3 OLE! Texas pilot sites in in Pasadena, TX and will be recruiting 3 more in Baytown, TX. Each of the current sites are at different levels of implementation, but are all committed to making environmental changes based on the best practice indicators established by the Natural Learning Initiative out of North Carolina State University. To learn more about the Best Practice Indicators, visit https://media-openideo-rwd.oiengine.com/attachments/c7d2ea86-5e0d-4524-a2e3-7355089ce8c6.pdf.

3. Develop/support a healthy child care recognition program.

Since its inception in 2017, HCPH has been a member of the Texas Early Care Obesity Prevention Committee. This committee decided to create a healthy child care recognition program for the state of Texas. In 2018, DSHS obtained funding to do so and is working with HCPH to pilot the program in Harris County in 2019.

To meet these objectives HCPH made sure to connect with partners who were investing in local communities and make the case for early childhood investments. HCPH was also intentional in attending state-level meetings where obesity prevention in ECE was being discussed. These meetings helped establish the connections with the Obesity Prevention Program staff at the Texas Department of State Health Services.

Some additional strategies that the HLM-ECOS Action Team focuses on are:

  • Promoting and encouraging participation in the Child and Adult Care Food Program.
  • Identifying and connecting ECE professionals and families to nutrition education programs.
  • Connecting families to WIC and Summer Meals programs.
  • Supporting neighborhood improvements that can facilitate active transportation and safe play.
  • Identifying and connecting ECE professionals and families with parks, trails, and other shared use facilities for physical activity.

Practice Costs

The following provides a summary of the costs for each component on a yearly basis:

  • Monthly HLM-ECOS Action Team Meetings
    • Refreshments for monthly meetings - $250
    • Copies for monthly meetings - $150
    • Meeting space – in kind
    • Audio-visuals for meeting – in-kind (provided with the space)
    • Intern support - $0
  • Presentations at conferences
    • Copies for presentations - $1,000
    • Travel - $2,500
  • Participation at state meetings
    • Travel -  $1,500
  • Communication
    • Constant Contact subscription for newsletter - $1,200
  • Evaluation
    • Survey Monkey account for post-training evaluations - $1,200
  • Capacity Building Support
    • Sponsorship of Action Based Learning registration - $1,600
    • Sponsorship of Child Care Health Consultant workshop registration - $750
    • Sponsorship of Gulf Coast AEYC conference - $1,500

The work of HLM is supported through a grant provided by the Houston Endowment, a local philanthropic agency. This funding will continue into 2010, and there are plans to reapply for extended funds. However, HCPH is dedicated to provide funds and resources to continue this work in the future.

During the development of the goals and objectives, and as they are revised each year, the Action Team is asked to answer how the activities support policy, system and environmental change strategies and how the activities engage and serve the interests of the priority populations. The first question is answered by using the HLM policy priories as a guide and those activities that do not support these policies, are not considered. The second question is answered through the help of our Action Team members who represent the ECE profession. HCPH is fortunate to have 6 ECE Center Directors on the Action Team who represent different areas of Harris County.

All of the HLM Action Teams are required to provide quarterly data reports that are compiled into yearly reports. These reports serve as the primary data source for evaluating progress and capturing data.  Other evaluation data is obtained from stakeholders formally via surveys or key informant interviews.  HCPH staff periodically use meeting time to obtain evaluative feedback from Action Team members and/or stakeholders and will continue to do this as a less formal data collection method of evaluation.

As far as the HLM-ECOS goals and objectives, there are both process and outcome evaluation components. Some evaluation efforts are pending as the work is still in the planning phase. More details are included below per objective.

Goal 1:  To engage more ECE professionals around obesity prevention.

Our goal was to grow our numbers as it relates to engagement. In year 1 we started from 0, so any increase was considered a success. After the first year of implementation we decided to add metrics and each year set a goal for engagement.

Objectives:

1. Create an obesity prevention coalition made up of at least 20 ECE stakeholders.

In 2018, HCPH convened ~20 individuals at each monthly HLM-ECOS Action Team meeting and added 4 new members.

2. Participate in at least one local ECE coalition and one state coalition.

At this time HCPH is an active participant in 3 local ECE coalitions and 3 state-level coalitions, attending a total of 15 coalition meetings in 2018. Through our participation we have been able to influence some key decisions related to obesity prevention in ECE and are bringing resources and opportunities to our local community.

3. Share obesity prevention resources with at least 500 ECE professionals.

We obtained a commitment from our Child Care Licensing representative to share our newsletter with all the ECE facilities in our region. However, we proactively sought out subscribers in case the day came where it was no longer shared. During our conference presentations and meetings, we made sure to ask attendees to sign up for the newsletter and have kept track of this number by using the metrics provided to us by Constant Contact. At this time we have 556 newsletter subscribers and an average 22% open rate.

Goal 2: Increase the number of professional development opportunities related to obesity prevention.

When we began this practice we had no baseline number but knew that even if we are able to provide one new professional development opportunity and equip one new trainer, then that would be a success.

Objectives:

1. Provide at least one obesity prevention session at local ECE conferences.

There are 5 well-attended local ECE conferences (Gulf Coast Chapter of the Association for the Education of Young Children Conference, Houston Chapter of the AEYC Conference, Harris County AgriLife Extension Conference, R.T. Garcia Winter Conference, and Weekday Ministries Conference) and  6 statewide conferences (Texas Association for the Education of Young Children, Texas Licensed Child Care Association, Texas Professional Home Child Care Association, Texas Head Start Association, Texas School Ready Summer Institute, and Texas Early Learning Summit). Our goal each year is to try to increase the number of obesity prevention-related sessions at each of these conferences. This year we started keeping track of the number of sessions related to healthy eating or physical activity, the number of conferences where HCPH presented on this topic, and the number of attendees in our session. In 2018:

  • 7 of the 15 monitored conferences offered sessions related to obesity prevention (ranging from 1 session to 10 sessions)
  • HCPH presented at 8 conferences (2 local and 6 state) and trained 274 individuals. After each session an electronic survey is sent to the participants to assess their knowledge gain and their opinions on the session. Survey participation tends to be low, but the feedback is always positive. Our goal for 2019 will be to institute paper evaluation forms that will be collected after the session. Will also work with the HLM-ECOS Action Team to develop a pre- and post-test to assess knowledge gain.


2. Provide at least one capacity building opportunity to ECE stakeholders.

  • By stakeholders, we primarily mean the HLM-ECOS Action Team members. We understand that their commitment is valuable and we want to provide them with as many opportunities to gain knowledge and skills that can help them in their role and in supporting our cause.

    At each HLM-ECOS Action Team meeting HCPH invites guest speakers to present on a topic related to obesity prevention. These presentations help the group better understand the topic and help connect them to available resources. Each year the HLM-ECOS Action Team comes up with a list of topics or speakers they want to invite for the following year. Starting in 2019 the group will be asked to rate the presentations and whether it's had an impact on their knowledge of the topic. In 2018 there were 14 guest speaker presentations and topics included:

  • Community Health Improvement Planning for Harris County
  • Bright Beginnings, a United Way of Greater Houston quality ECE initiative
  • Child and Adult Care Food Program
  • Summer Meals
  • Texas Trainer Registry
  • Common Threads: Nutrition Education Program
  • AgriLife Extension services for ECE professionals
  • Growing Up WILD: nature-based play curriculum
  • Kids' Meals: Meal delivery service for children ages 0-5
  • Women, Infants, and Children (WIC) program
  • Action-Based Learning
  • Bayou City Play: pop-up play initiative for children
  • Revolution Foods: food service provider offering healthy food options
  • 2019 Legislative Session

In addition to the guest speaker presentations, HCPH has provided members of the HLM-ECOS Action Team and others in the field with opportunities to gain new skills related to obesity prevention. In 2017 HCPH sponsored 2 ECE stakeholders to attend the Action Based Learning Summit and commit to provide training in this area. Both winners were invited to become involved in the HLM-ECOS Action Team and both are now active members. In 2018 HCPH sponsored 4 new individuals, one of which committed to be a member of the HLM-ECOS Action Team. In 2019 we will develop a system to track the trainings they present in this topic.


3. Train at least 25 local professionals to become Child Care Health Consultants.

In 2018 HCPH partnered with the coordinating agencies to provide a Child Care Health Consultant (CCHC) workshop in Harris County as there had not been a training in Harris County in over 10 years. The intent was to a) bring more trainings to Harris County; b) provide a capacity building opportunity for the HLM-ECOS Action Team members; and c) train more public health professionals to work with the ECE sector. HCPH sponsored 10 spots (5 HLM-ECOS Action Team members and 5 HCPH staff). In total 30 individuals completed the workshop. There are other components they will need to complete before receiving their Child Care Health Consultant certification, including applying to become listed on the Texas Trainer Registry (TTR). This will allow them to be more visible to any ECE director looking for qualified trainers. The requirement of those who were sponsored is that they list obesity-prevention topics on the TTR. Once these individuals officially become CCHC they will be asked to report back to HCPH about the number of obesity prevention-related sessions they present.


Goal 3: Increase investments and opportunities to add visibility, value, and validation to the ECE sector.

1. Establish partnerships that can lead to ECE investments at the local level.

Because of the work of the HLM-ECOS Action Team, HCPH has been approached by state and local organizations for consultation and/or partnership opportunities. At this time, HCPH has established contractual partnerships with two state organizations (Texas Department of State Health Services and Texas Parks and Wildlife Department) and one local organization (MD Anderson Cancer Center) for the purposes of supporting local ECE facilities on obesity prevention efforts. Each of these partnerships come with direct investments to the ECE facilities. Amounts include:

  • $150,000 from MD Anderson to support the OLE! Texas expansion in Pasadena and Baytown ($25,000 for each facility)
  • $21,000 from Texas Department of State Health Services (DSHS) and Texas Parks & Wildlife Department (TPW) to support OLE! Texas expansion in Harris County

Through our involvement in the Early Matters coalition, HCPH was able to gain partners for the screening of The Raising of America documentary. HCPH hosted 3 screenings (with plans to provide 2 more), obtaining in-kind support from partner agencies. As a result of these screenings, HCPH entered into a partnership with Child Health Policy at the Baker Institute for Public Policy at Rice University. Through this partnership the Child Health Policy offers training on Serve and Return to families being served by the HCPH WIC program.

2. Pilot the OLE! Texas project in Harris County.

As a requirement of the above-mentioned partnership with DSHS and TPW, HCPH was tasked with recruiting at least one implementation site for OLE! Texas in Harris County. HCPH was able to recruit a facility in Pasadena, TX and DSHS/TPW funded the development of the new design for that facility. Our subsequent partnership with MD Anderson Cancer Center has allowed us to fund the environmental changes included on the design and extend the opportunity to 2 additional facilities in Pasadena and 3 upcoming facilities in Baytown. Criteria for the implementation sites was established by the HLM-ECOS Action Team and includes:

- located in Harris County

- serves a large number of children

- serves mostly children who are low income

ECE facilities were asked to complete an application form and sign an agreement form and all must compete the NAP SACC self-assessment tool on a yearly basis. At this time we have only conducted the pre-assessment for each site. These scores will be compared with the annual assessments as they are conducted.


3. Develop/support a healthy child care recognition program.

The Texas Healthy Child Care Recognitions program is currently in development and will be piloted next year in Harris County. The Go NAP SACC self-assessment tool will be used to track the changes in behavior and environment.

HCPH is committed to preventing childhood obesity through county-wide commitment to policy, systems, and environmental change across multiple sectors, including ECE. Regardless of funding, critical steps for this will include:

  1. Maintaining the HLM Executive Committee as high-level representatives, spokespersons, and brokers acting on behalf of HLM as a whole to provide strategic long-term guidance on achieving the mission, to extend the partnership base across various systems, to leverage resources throughout the county, and to expand the capacity of the Backbone Support structure and other conditions for Collective Impact from a cross-sector point of view.
  2. Continuing engagement with project stakeholders by way of quarterly HLM Collaborative meetings, monthly Action Team meetings, joint work plan development and implementation across partners, monthly e-newsletters, and daily social media posts.
  3. Continuing engagement with community members by way of regular participation by HLM in community forums, health fairs, and meetings where community members are active participants.
  4. Continuing presentations at local and state conferences where information about childhood obesity and the HLM CAP policy priorities can be presented to large groups of stakeholders.

Identifying and participating in local and state coalitions specific to the sectors we wish to engage.

Awareness, understanding, and commitment to the issue is characteristic of HLM itself; therefore, the collective body, along with its extended partner network, is critical to the success of this practive. There are also specific organizations and individuals (external to the Backbone Support Organization, HCPHES) that have a more central role in HLM's success. The HLM Executive Committee provides strategic positioning support and provides expedited decision-making on behalf of the Collaborative, particularly in regards to interaction with elected officials and the media. They are also often called upon as HLM spokespeople for community and stakeholder engagement efforts. In addition, several organizations are committed to leadership roles in the implementation efforts described in this application, and are in a unique position of leadership, recognition, and expertise to advance HLM policy priorities within their organizations and fields as well as at the state and county levels. 

HCPHES attributes the success of HLM to-date to the participatory nature of its planning and early implementation activities.  This has fostered community ownership of the issue of childhood obesity and a desire to tackle it in impactful ways across stakeholders and residents alike, regardless of whether or not HLM is directly involved. Strategic partner development is key in seeing this practice being sustained, as Harris County is being sought as the implementation community for new obesity-prevention efforts that are being rolled out by the state.

In addition to the work of the HLM-ECOS Action Team, HCPH has dedicated significant time and effort engaging the early childhood sector around other areas of health and development. Examples include the work HCPH has been doing since October 2016 to promote The Raising of America documentary. HCPH has hosted various screenings where the health considerations of public policy around young children and their families are discussed and policy recommendations are presented. HCPH also sits on various early childhood/child wellbeing coalitions, such as the Harris County ACE Coalition, Early Matters, and the Harris County Child Fatality Review Team. These networks will also play a key role in developing new partnerships and sustaining our efforts to support the ECE sector.

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