How North Carolina Transformed NAP SACC

Since 2005, North Carolina has implemented the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) in Early Care and Education (ECE) facilities in many of the 100 counties in the state.

NAP SACC relies on trained health consultants (i.e., child care health consultants, nurses, health educators, nutritionists and other health professionals) to implement ECE interventions.

Partnerships and Training

The North Carolina Partnership for Children became interested in statewide dissemination of NAP SACC based on pilot test results. The Partnership operates the Smart Start program, North Carolina’s early childhood infrastructure. The Smart Start program is implemented at the local level, and these agencies serve as a statewide system of ECE resources. Through a collaboration including the Partnership, the North Carolina Division of Public Health and University of North Carolina-Chapel Hill, NAP SACC was implemented across much of the state.

NAP SACC relies on trained health consultants (i.e., child care health consultants, nurses, health educators, nutritionists and other health professionals), familiar with ECE facilities, to implement interventions. Consultants complete web-based training on intervention implementation, nutrition, physical activity and healthy weight in young children. Consultants also help recruit ECE centers to participate in the statewide program.

NAP SACC Used in New Statewide Initiative

In 2011, NAP SACC became part of a new state initiative called Shape North Carolina: Healthy Starts for Young Children to help prevent obesity in child care centers. The first cohort of centers began the program in May 2011. Through funding from The Blue Cross and Blue Shield of North Carolina Foundation, the North Carolina Partnership for Children is implementing a comprehensive intervention to create early childhood wellness champions among ECE professionals. The overall goal of Shape North Carolina is to ensure that children attending ECE facilities are served nutritious foods, engage in physical activity, have naturalized outdoor learning environments and have teachers modeling healthy behaviors.

The Shape North Carolina program will be implemented in 20 counties over the three years of the grant. Each county will have an ECE center that receives intensive technical assistance to become a model center and demonstration site for centers in the surrounding area.

Lessons Learned

  • Incentives for ECE facilities in the form of small items that support organizational change (gift cards for classroom supplies, balls or hula hoops, activity or nutrition books for children) can be provided periodically.


  • Some ECE facilities may need lots of support and encouragement, while others may be able to accomplish change on their own, so tailoring technical assistance to the needs of the facility is suggested.


  • Training is highly recommended to increase the skills, knowledge and confidence of the consultants and to promote implementation of the core elements of the intervention.


  • Continuing education credits from the state agency that oversees ECE can provide an additional incentive for participation in the NAP SACC program. Often, ECE providers are required by the state licensing agency to complete continuing education each year. Offering continuing education credits was a significant incentive for providers to participate in the NAP SACC workshops.


  • It is essential to tailor the NAP SACC self-assessment to ensure that responses on the tool are consistent with or even exceed state licensing requirements.