It s Not Nutrition Until It s Served and Eaten. Amanda Gallaher, MPH, RD Association for Child Development

Transcription

1 It s Not Nutrition Until It s Served and Eaten Amanda Gallaher, MPH, RD Association for Child Development CACFP Magical Moments Orlando, FL April 2016

2 ASSOCIATION FOR CHILD DEVELOPMENT Establish healthy eating habits to last a lifetime One of the oldest and largest CACFP sponsors Sponsor ~4,500 homes and centers in Michigan & Illinois Publish Potpourri, a monthly child care magazine Provide CACFP and wellness training opportunities Two Registered Dietitians on staff

3 OBJECTIVES Discuss the theory and practice of behavior change as they apply to nutrition in child care and CACFP Discuss training techniques and activities that encourage active participation, skill building, and behavior change Practice basic nutrition coaching techniques to encourage and motivate child care programs to serve healthier food Review programs and resources that support healthier CACFP menus and behavior change

4 IN THE LAST WEEK, DID YOU Floss your teeth every day? Eat 5 servings of fruits/vegetables every day? Do moderate aerobic exercise for 150 minutes? Cook most meals at home instead of going out?

5 BRIDGING THE GAP Nutrition Education (Knowledge) Motivation Action Environment Healthy Meals (Practice) (Contento, 2008)

6 THE THEORY AND PRACTICE OF CHANGE

7 STAGES OF CHANGE Precontemplation Problem? What problem? I fixed the problem. Maintenance Contemplation There may be a problem. I m fixing the problem. Action Preparation I m preparing to fix the problem. (DiClemente and Prochaska, 1982)

8 SOCIAL ECOLOGICAL MODEL: INFLUENCES ON FOOD CHOICE

9 SOCIAL COGNITIVE THEORY Key concepts: Influence Environment Individuals & Groups Ex. If providers develop a child care nutrition policy, the policy affects the behavior of the provider and parents. Change starts with beliefs, expectations, and attitudes Ex. Believing that serving more foods with fiber will prevent constipation. Teach by example Ex. Watching a trainer prepare a healthy snack. Build confidence in abilities Ex. Building confidence with making healthy food choices. Focus on behaviors and skills, not just knowledge Ex. Understanding what cooking involves and knowing how to do it. Offer reinforcement Ex. If children enjoy a new recipe, providers are more likely to make them.

10 WHAT S THE TAKE AWAY? Stages of Change Meet providers where they re at Offer resources and training addressing varying needs Social Ecological Model Consider the factors influencing behaviors Support healthy habits in different ways Social Cognitive Theory Incorporate key concepts into training and monitoring opportunities

11 TRAINING

12 WHAT S IN YOUR TOOLBOX? 1. Building knowledge 5. Reassessment Follow Up 2. Assessment 4. Technical Assistance Skill building 3. Goal Setting Action Planning

13 BUILDING KNOWLEDGE Discuss the why Review nutrition best practices USDA American Academy of Pediatrics Academy of Nutrition and Dietetics Raise awareness Social media campaign Informational handouts Address beliefs, expectations, and attitudes

14 ASSESSMENT Compare current practices to best practices Written assessment, short quiz, poll questions Verbal feedback

15 GOAL SETTING & ACTION PLANNING Set goals based on the assessment Start with low and no cost changes Make sure changes are within the control of the home or center Provide examples of strong goals and action plans

16 TECHNICAL ASSISTANCE & SKILL BUILDING Focus on behaviors & skills Cooking, meal planning, grocery shopping, reading labels, gardening Teach by example Show one do one, peer modeling, role playing, simulations, case studies Discuss overcoming barriers Provide helpful resources Build confidence (Contento, 2008)

17 REASSESSMENT & FOLLOW UP Post-training evaluation Provides accountability Assesses whether change is maintained Opportunities for reinforcement and continued assistance

18 NUTRITION 101: IMPROVING NUTRITION IN CHILD CARE Amanda Gallaher, MPH, RD Association for Child Development

19 NUTRITION IN CHILD CARE MATTERS Child care is a home away from home for many children. Children eat 50-75% of daily calories in child care Child care nutrition practices and policies have a longterm impact on healthy child development Children who eat healthy foods are more ready to learn Child care is an ideal setting to start supporting healthy habits.

20 WHAT IS A HEALTHY FOOD? Colorful fruits and vegetables Beans and legumes Whole grains Nuts and seeds Lean meats and fish Low-fat dairy products

21 NUTRITION SELF-ASSESSMENT Best Practices Already doing Making progress Planning to do Not planning to do Limit the consumption of fruit juice to no more than one serving per day Make at least one of the two required components of every snack a fruit or a vegetable Avoid or limit the service of fried and pre-fried foods to no more than one serving per week Provide at least one serving each of dark green and red/orange vegetables, and legumes per week Provide at least two servings of whole grain-rich grains per day Serve breakfast cereals that contain no more than 6 grams of sugar per serving Serve only unflavored milk to all participants Serve only lean meats, nuts, and legumes Avoid or limit the service of processed meats to no more than once per week Serve only natural cheeses

22 PLANNING HEALTHY MEALS & SNACKS (3-5 YEAR OLDS) Breakfast Less Healthy Choice Healthy Choice Fruits/Vegetables Pears in heavy syrup Pears in juice Grains/Breads Toast made with white bread 100% whole grain toast Fluid Milk Whole or 2% milk Low-fat (1%) or fat-free (skim) milk Snack Less Healthy Choice Healthy Choice Fruits/Vegetables 100% grape juice Grapes, halved Meat/Meat Alternates Cookies Whole wheat crackers

23 WEEK #1 LUNCH/DINNER (3-5 YO) Lunch/Dinner Monday Tuesday Wednesday Thursday Friday Milk Fruit/ Vegetable Grain/Bread Meat/Meat Alternate 2% or whole milk French fries Mixed-fruit cup Grilled cheese sandwich 2% or whole milk Green beans Peach wedges Roll Chicken nuggets 2% or whole milk Broccoli spears Pears Beef lasagna 2% or whole milk Carrots Applesauce Turkey hot dog and bun Lunch/Dinner Monday Tuesday Wednesday Thursday Friday Milk Fruit/ Vegetable Grain/Bread Meat/Meat Alternate 1% or fat-free milk Tomato soup Mixed-fruit cup in 100% juice Low-fat grilled cheese with whole grain bread 1% or fat-free milk Green beans no sodium Peach wedges fresh or in 100% juice Whole grain roll Baked chicken 1% or fat-free milk Broccoli spears Pears in their own juice Lean beef or turkey lasagna with whole grain noodles 1% or fat-free milk Carrots Unsweetened applesauce Turkey hot dog and whole grain bun 2% or whole milk Cantaloupe Tuna sandwich on white bread with lettuce and tomato 1% or fat-free milk Cantaloupe Tuna fish sandwich on whole wheat bread with spinach and tomato

24 CREATING AN ACTION PLAN Start with low/no cost ideas Set smart goals Specific Measureable Attainable Relevant Time-Bound

25 CREATING AN ACTION PLAN Best Practice: Offer vegetables, other than potatoes, corn or green beans, 1 or more times a day. Specific Steps to Accomplish Review menus to look at what vegetables are currently served Look for new vegetables to serve at the grocery store Begin to introduce new vegetables at meals and snacks through tastings, games, and other activities Resources Needed Time, vegetables, new recipes, activity ideas Target Completion Date May 15, 2016

26 DO YOU HAVE A CHILD CARE NUTRITION GOAL? What will you do to get ready? What obstacles might you face? How could you overcome them? Discussion

27 MONITORING

28 PERSUASION ACTIVITY Break into pairs and choose a speaker and interviewer Speaker: Imagine that you are a child care provider who is thinking about removing chicken nuggets and French fries from your menus. Interviewer: Try as hard as you can to convince the speaker to make the change he/she is considering. 1. Explain why the person should make this change. 2. Give at least 3 benefits that would result from making the change. 3. Tell the person how they could make the change. 4. Emphasize how important it is to make the change. 5. Tell/persuade the person to do it. 6. Repeat the above if you encounter resistance.

29 WHAT IS MOTIVATIONAL INTERVIEWING? Client-center counseling approach Helps people explore and resolve ambivalence towards change Used in many settings to support behavior change Nutrition, exercise, substance use, etc. Adjust based on the stages of change model

30 WHAT S THE DIFFERENCE? The expert is Persuasion Motivational Interviewing Monitor Provider & Monitor Motivation comes from Ideas for change come from Monitor Monitor Provider Provider, sometimes monitor

31 GUIDING PRINCIPLES OF MOTIVATIONAL INTERVIEWING Resist the righting reflex Understand the provider s motives Listen to the provider Empower the provider

32 Return to the same pairs and restart the conversation. Speaker: Imagine you are a child care provider who is thinking about removing chicken nuggets and fries from your menus. Interviewer: A TASTE OF MOTIVATIONAL INTERVIEWING 1. Why would you like to take this step? 2. If you decide to take this step, what would you need to make it work? 3. What are the three best reasons for you to make this change? 4. How important would you say it is to make this change on a scale of 0 to 10, where 0 is not important and 10 is very important? 5. Why are you at a rather than a 0? 6. Give a short summary of the speaker s motivations for change. It sounds like you re saying

33 HELPFUL STRATEGIES Asking Permission Would you be interested in learning more about? Do you mind if we spending a few minutes talking about? Open-ended questions What do you know about? What would you like to see different about? Would you mind explaining how you approach?

34 HELPFUL STRATEGIES Reflective listening It sounds like What I hear you saying Normalizing Many providers find it challenging to Affirmations I appreciate you taking the time to speak with me about I noticed that you are already doing You are already doing so many things to support healthy habits. I seems like you re ready to take the next step.

35 LET S SWITCH! Switch speaker and interviewer roles with your partner. Speaker: Imagine that you are a child care provider who does not serve any whole grains foods. You are aware of the benefits, but are not currently planning on changing menus. Interviewer: 1. Do you mind if we spending a few minutes talking about whole grains? 2. What do you see as the pros and cons of serving more whole grains? 3. On the one hand it sounds like (repeat back cons), but on the other hand (repeat back pros). 4. How interested would you be in serving at least one whole grain food each day on a scale of 0 to 10, where 0 is not interested and 10 is very interested? 5. Why are you at a rather than a 0? 6. I appreciate you taking the time to speak with me about whole grains. Would you be willing to discuss this more during my next visit?

36 OPPORTUNITIES WITH MONITORING Build relationships Think food partner rather than food police Focus on support rather than judgement Do providers want you to come back? Increase communication Learn about what motivates the provider Share helpful resources if there s interest Find ways to help providers talk positively about change instead of pushing against resistance When providers succeed we ALL do

37 PROGRAMS AND RESOURCES Let s Move! Child Care Nutrition and Physical Activity Self-Assessment for Child Care Cooking Matters for Child Care Professionals Guide for Effective Nutrition Interventions and Education (GENIE) SNAP-Ed Interventions Toolkit (Includes child care examples) EdToolkit2016UpdateFeb2.pdf Best Practices in Nutrition Education for Low-Income Audiences Engaging Families Using Motivational Interviewing

38 SUMMING UP Discussed the theory and practice of behavior change as they apply to nutrition in child care and CACFP Discussed training techniques and activities that encourage active participation, skill building, and behavior change Practiced basic nutrition coaching techniques to encourage and motivate child care programs to serve healthier food Reviewed programs and resources that support healthier CACFP menus and behavior change

39 CONNECT WITH ACD Amanda Gallaher, MPH, RD Association for Child Development Visit us on the web: Like us on Facebook: Follow us on

40 THANK YOU!

41 NON-DISCRIMINATION STATEMENT In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD- 3027) found online at: and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C ; (2) fax: (202) ; or (3) program.intake@usda.gov. This institution is an equal opportunity provider.

42 REFERENCES Contento, I. R. (2008). Nutrition education: linking research, theory, and practice. Asia Pac J Clin Nutr, 17(1), Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: theory, research, and practice. John Wiley & Sons. Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: theory, research & practice, 19(3), 276.