The Nutrition and
Physical Activity Self-Assessment for Child Care (NAP SACC) is a provider-based
program that is implemented in child care centers. This program is designed to
promote healthy weight development in preschool children by improving the
nutritional quality of food served, amount and quality of physical activity,
staff-child interactions, facility nutrition and physical activity policies and
practices, and related environmental characteristics. NAP SACC includes a
5-step intervention to help facilitate gradual change and promote continuous
controlled study using a sample of child care health consultants and child care
centers yielded non-significant results.
DESCRIPTION OF PROGRAM
population:Preschool Children (ages 2 – 5 years) attending Child
Centers and their Health
NAP SACC is a provider-based program
designed to promote healthy weight development in preschool children. The NAP
SACC intervention consists of five steps: (1) self assessment, (2) action
planning, (3) continuing education workshops, (4) technical assistance, and (5)
re-assessment. This intervention is facilitated by trained child care health
consultants. The consultants are required to complete three in-person training
sessions that are three hours in length or web-based training which is
approximately 124 minutes in length. During the self-assessment period, an
assessment of the child care facility’s strengths and
limitations with regard to 14 areas of nutrition and physical activity policy
The program costs are low. It includes the cost of hiring
one health professional to work as a health consultant .0375 FTE (approximately
1 hour and 20 minutes per week) for 6 months. Each toolkit costs about $38 to
create. Finally, funding must be allocated to: a) printing and copying costs;
b) incentives for child care facilities such as gift cards for classroom
supplies, books, balls, etc.; and (c) mileage reimbursement for travel to child
EVALUATION(S) OF PROGRAM
S., Benjamin, Sara E., Ammerman, Alice S., Ball,
Sarah C., Neelon, Brian H, Bangdiwala,
I. (2008). Nutrition and Physical
Activity in Child Care: Results from an Environmental Intervention. American
Journal of Preventive Medicine,35(4), 352-356.
population: The sample consisted of 84 child care centers.
child care health consultants were randomized into intervention (n= 19) and
control (n=10) groups. Approximately three child care centers were recruited
from consultants’ existing caseloads, yielding 84 eligible childcare centers
(58 intervention, 26 control). During the
intervention, two centers assigned to the intervention closed and were excluded
from the study centers. In order to be eligible for the study the child care
centers must have between 20-150 children enrolled at the time of the study,
not be restricted to a special population, and have no open cases of abuse or
neglect. The intervention centers had a slightly higher percentage of nonwhite
children (40%) that the control centers (35%). Other than child race/ethnicity
no other significant differences between intervention and control centers were
and Policy Assessment and Observation (EPAO) instrument was used to measure the
primary outcome for this study (nutrition and physical activity scores). This
instrument consists of a one day observation and review of center documents.
From this instrument, 75 items were selected to evaluate. The item responses
were converted to a three point scale (0, 1, and 2) and averaged within a
subscale to represent nutrition and physical activity scores. Following this
assessment, a child care health consultant worked with center staff to set
goals and develop plans for follow-up actions to improve practice. The EPAO was
administered by trained field observers before and immediately after
implementation of the NAP SACC intervention (in the Fall
of 2005 and the Spring of 2006).
evaluation study did not account for the fact that children were nested within
child care centers. Thus, the findings should be interpreted with caution.
centers demonstrated an 11% increase in average physical activity scores from
pretest to posttest; however, this change was only marginally significant. No
significant differences in children’s
nutrition was observed. Although the study did not yield significant
results, positive change was noted for the intervention group compared with a
negative change for the intervention group. In addition, the inclusion of
non-participating centers in the intervention group (resulting from the ITT
evaluation approach) may have diluted program impacts.
SOURCES FOR MORE INFORMATION
PDF describing various costs of NAP SACC:
Ammerman, Alice S., Ward, Dianne S., Benjamin, Sara E.,
Ball, Sarah C., Sommers, Janice K., Molloy,
Meg, and Dodds, Janice M. (2007). An Intervention to
Promote Healthy Weight: Nutrition and Physical Activity Self-Assessment for
Child Care (NAP SACC) Theory and Design. Preventing
Chronic Disease, 4(3), 1-12.
E., Neelon, Brian, Ball, Sarah C., Bangdiwala, Shrikant I., Ammerman, Alice S., and Ward, Dianne S. (2007). Reliability and Validity of a Nutrition and Physical Activity
Environmental Self-Assessment for Child Care. International Journal
of Behavioral Nutrition and Physical Activity,4(29), PAGE NUMBERS?.
(2008). Nutrition and Physical Activity Self-Assessment for Child
Care (NAP SACC). UNCCenterfor
Health Promotion and Disease Prevention. 1-8.
Ward, Dianne S.,
Benjamin, Sara E., Ammerman, Alice S., Ball, Sarah
C., Neelon, Brian H, Bangdiwala,
I. (2008). Nutrition and Physical Activity
in Child Care: Results from an Environmental Intervention. American Journal
of Preventive Medicine,35(4), 352-356.
KEYWORDS: Physical Health, Nutrition, Early Childhood, Toddlers, Children
(0-5), Co-ed, Child Care, Provider-Based or Miscellaneous, Provider Information is Available, Manual is Available.
Program information last updated on
November 24, 2008.