How New York State Implemented a Multi-Component Approach

The New York State Department of Health (DOH) implemented a multiprong approach to address childhood obesity in child care and early education settings.

The opportunities successfully pursued included CACFP, Funding and Finance, Professional Development, and Facility-Level Interventions.

Revising Food Program Practices and Funding

The New York Child and Adult Care Food Program (NY-CACFP), within the New York Department of Health (DOH), developed Healthy Infant and Healthy Child Meal Patterns by revising the federally regulated meal patterns to reflect evidence-based data on food practices associated with a reduced risk of obesity. Required and recommended changes were established to improve menus in ECE facilities and child care home settings.

NY-CACFP received USDA Team Nutrition grants and a Child Care Wellness grant to enhance their obesity prevention efforts. Team Nutrition Training grants allowed CACFP to focus on nutrition and environmental improvements in their menu, mealtime environment, nutrition and physical activity education and policies. This was accomplished in ECE settings through ECE provider training and goal setting. The Child Care Wellness grant, awarded in fiscal year 2011, allowed NY-CACFP to provide an obesity prevention intervention to family child care home providers and the children in their care.

New York used USDA’s Supplemental Nutrition Assistance Program – Education (SNAP-Ed) funds, which were supplemented with state obesity prevention funds to match the federal dollars to support implementation of facility-level interventions.

Provider Training and Facility Interventions

New York worked with the Early Childhood Education and Training Program, sponsored by the Office of Children and Family Services, to produce a 2½-hour statewide videoconference training for ECE providers. Program topics included beverages, menu planning, staff/child feeding interactions and TV viewing and other screen use.

New York also developed several facility-level interventions, including:

1) Eat Well Play Hard in Child Care Settings (EWPHCCS) − Through the end of federal fiscal year 2010, NY-CACFP had implemented EWPHCCS in 757 licensed, low-income ECE facilities. Low-income early care and education (ECE) facilities are defined as those in which 50 percent or more of enrolled children live in households at or below 185 percent of the federal poverty level. This intervention is administered by regional Child Care Aware agencies and by the New York City Department of Health and Mental Hygiene.

2) Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC) − New York supports the use and implementation of the Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC) on a statewide basis. Implementation of NAP SACC intervention is accomplished through a contract with the New York Early Care and Learning Council, and through multiple regional contracts funded by the state’s Creating Healthy Places to Live, Work and Play initiative. The NAP SACC intervention is designed for ECE facilities to improve their nutrition and physical activity environments, policies and practices through self-assessment, action planning, staff training and targeted technical assistance. New York developed an additional NAP SACC media-reduction module to assess and modify the screen-viewing practices of participating centers.

3) Breastfeeding Friendly Child Care Initiative − NY-CACFP developed standards for ECE centers and family day care homes to assist them in providing breastfeeding support to moms. Centers that meet these standards are designated as Breastfeeding Friendly Child Care Sites. New York enacted a Breastfeeding Mothers’ Bill of Rights that details mothers’ rights related to breastfeeding before and after their baby is born and includes hospital rights.

Partnerships and Challenges

To advance policies and practices in support of healthy eating, increased physical activity, reduced screen time and breastfeeding support, the New York Department of Health (DOH) convened a task force of key leaders in early care and education (ECE) to examine opportunities for systemic improvements. The ongoing work of the task force, now known as the Obesity Prevention in Child Care Partnership, was integrated into the workgroup structure of the Early Childhood Advisory Council (ECAC).

Key partners in the task force were the New York Office of Children and Family Services, the CACFP and Obesity Prevention Programs in the Department of Health, the New York Early Care and Learning Council, the New York Council on Children and Families, and the Head Start State Collaboration Project. These partners were essential to focus attention on state-level policy change.

With the benefit of both state and federal funding, the New York DOH implemented several obesity prevention interventions and initiatives focusing on ECE settings, which provided tangible examples of best practice implementation and demonstrated public health’s commitment to work with and invest in the ECE sector.

The formation of the Obesity Prevention in Child Care Partnership was essential to engage early childhood stakeholders, including state agencies and organizations, in addressing early childhood obesity collectively and individually. Engaging key partners in guiding the partnership has already yielded proposed policy changes. Affiliating the Partnership with the Promoting Healthy Development workgroup of the New York Early Care and Learning Council (ECAC) provided ongoing opportunities to integrate nutrition, physical activity, screen time reduction and breastfeeding support in the overall development of the state’s early childhood system.

ECE providers in New York identified several challenges to implementing obesity prevention initiatives that included lack of funding for staffing, training and purchasing of healthy foods; lack of space, equipment and training for physical activity; lack of staff knowledge about how to implement appropriate practices; lack of adult role models among professional caregivers and parents; and a need for greater collaboration between providers and parents.

Lessons Learned

  • Having ECE partners and stakeholders who are engaged in the development and decision-making process is important to the successful implementation of initiatives and advancement of policies.


  • ECE providers need training and consultation on policy development and environmental and practice changes to successfully implement childhood obesity prevention standards and practices related to nutrition, breastfeeding, physical activity and screen time limits.


  • Interventions and initiatives alone are not sufficient to raise the bar on obesity prevention practices in ECE. State-level policies must set the bar for performance. ECE interventions and initiatives targeting nutrition, physical activity, screen time and breastfeeding support can promote and support ECE practice improvements to achieve state policy objectives.