Family Child Care Research Articles

Licensed Family Child Care Providers’ Participation in the Child and Adult Care Food Program (CACFP): Greater Benefits and Fewer Burdens in Highly Urban Areas?

ABSTRACTResearch Findings: Family child care providers widely participate in the Child and Adult Care Food Program (CACFP), yet their participation experiences have not been studied. To fill this gap, we used a mixed methods approach that combined survey data collected from a random sample of 224 CACFP-participating licensed family child care providers and in-depth qualitative interviews (n = 40 survey respondents). Working within a cost-benefit framework, we sampled from Chicago and small cities and towns in central Illinois in order to compare providers’ perceptions of the benefits and burdens of CACFP participation by reimbursement level and urban/rural location. Reimbursement rate was related to providers’ perceptions of the adequacy of the reimbursement and how difficult it was to purchase food that met program requirements. Location was related to providers’ perceptions of how difficult it was to prepare meals that met program requirements. Practice or Policy: Our findings suggest modifications to reduce inequities in who has access to the higher reimbursement rate. How providers qualify for the higher reimbursement rate could be reconsidered to ensure that providers outside of urban areas are not disadvantaged. Sponsoring organizations could expand efforts to provide technical assistance and nutrition education, especially for providers outside of urban areas.

The Rise of Maternal Grandmother Child Care in Urban Chinese Families

AbstractObjective: This study explores the transformation of patrilineality in grandparents' child care in China, which was traditionally oriented almost exclusively toward caring for sons' children.Background: Since China's 1949 revolution, grandparent child care has undergone rapid transformation, shifting from strongly patrilateral to bilateral or even matrilateral, as maternal grandmothers have become far more involved in child care than in previous generations.Method: This study investigates the choices of maternal versus paternal grandmother child care in 77 urban families that are drawn from a larger random sample of a mixed‐method longitudinal study in Nanjing, China. Content analysis is used to analyze semistructured interviews with the parents from these families.Results: The interviews reveal that parents are turning away from the traditional Chinese tendency to favor paternal grandparent child care, instead basing child‐care decisions on availability, caregiving qualifications, and the nature of grandmothers' relationship with adult children and their spouses, all of which encourage a greater child‐care role for maternal grandmothers than in previous generations. Further examination of these considerations suggests that the following three sociocultural changes associated with China's modernization processes may have led to the new norms in grandparent child care: reinterpreted intergenerational relationships, women's empowerment in natal families, and a child‐centered care ideology.Conclusion: These findings suggest that the rise of maternal grandmother child care reflects a weakening of patrilineality in intergenerational resource exchange in favor for a utilitarian strategy of maximizing resources available to urban Chinese families as they adapt to China's rapid socioeconomic transformations.

Building blocks of infant-toddler conversation skills: using the Conversation Compass© to drive innovation in Early Head Start classroom conversations

ABSTRACT We collaborated with Early Head Start (EHS) coaches to qualitatively explore the feasibility delivering a professional development approach designed to enhance the quality of conversations in infant-toddler (I/T) classrooms and family child care homes. First, we reviewed empirical literature about oral language discourse skills in infants and toddlers. Second, we examined the frameworks and evaluation tools EHS practitioners and programmes used to guide conversations, e.g. the Head Start Early Learning Outcomes Framework and the Quality of Caregiver-Child Interaction for Infants and Toddlers (Q-CCIIT) Scale. Third, we adapted the Conversation Compass© approach for ages birth to 24 months. Lessons learned were (1) teachers report that the Conversation Compass approach was user-friendly, (2) due to teachers’ limitations with computer skills the online course was difficult for them to complete independently, and (3) the approach can be used to facilitate and model conversation in mixed-age group settings with infants and toddlers.

Abecedarian: An Early Childhood Education Approach that has a Rich History and a Vibrant Present

The Abecedarian Approach was created in the early 1970s to serve as the ‘educational treatment’ in the Abecedarian Project, a rigorous randomized controlled trial for children of disadvantaged families. The elements of the Abecedarian Approach are Language Priority, Enriched Caregiving, Conversational Reading, and LearningGames®. The Approach spans from birth to school entry and can be delivered through group child care, family child care, playgroups, and home visits. Preschool research findings showed positive effects on cognition as early as 18 months of age. School research showed improvement in reading and math achievement that persisted throughout the entire period of school enrollment. Long-term benefits for this disadvantaged sample included a fourfold improvement in their rate of university graduation. Adult-age follow-up disclosed unexpected benefits in life course variables including better health, more equitable social decision making, and reduced criminal behavior. Research on this classic early childhood approach is continuing today, and the results of two of those contemporary studies are reported in this issue of International Journal of Early Childhood.

One piece of the matrilineal puzzle: the socioecology of maternal uncle investment.

Maternal uncle relationships in which men invest resources (usually in the form of inheritance of material wealth) into their sisters' children are characteristic of matrilineal systems and hypothesized to arise under certain socioecological circumstances, but little research has systematically investigated conditions that are associated with this type of investment. We quantify relationships between household-level socioeconomic variables and different types of maternal uncle investment (direct care and indirect resource investment) within a bilateral, semi-nomadic population. Shodagor people of Bangladesh allow us to consider matrilineal behaviours in an evolutionary framework owing to their flexible social structure in which 39% of families receive some investment from a maternal uncle. Variables associated with direct maternal uncle care reflect the significance of maintaining consistent residence throughout the year and an increased need for childcare in families residing on boats versus those living on the land. Informative predictors of indirect investment indicate that a mother's birth history corresponds with more tangible contributions such as food and clothing. These results identify household-level variables specific to direct versus indirect maternal uncle investment, whereas having more older brothers or being firstborn increased the odds of a mother receiving any investment from brothers at all. Exploring these social and ecological associations in a bilateral, relatively flexible population unveils household circumstances that may lead to the development of female-biased kinship. This article is part of the theme issue 'The evolution of female-biased kinship in humans and other mammals'.

NP25 Nutrition and Physical Activity Practices and Policies of Family Child Care Home Providers in Oklahoma: Baseline Findings From Happy Healthy Homes

Objective Early obesity prevention in key environments where young children spend substantial time, such as early care and education (ECE) is essential. Children are not eating adequate amounts of whole grains, fruits, vegetables, and nutrients, or getting sufficient physical activity in ECE. Family Child Care Homes (FCCH) are licensed home-based ECEs. Few studies have examined nutrition and physical activity (PA) in FCCHs. Objective was to determine the nutrition and PA practices and policies in FCCH. Description Cross-sectional study with self-reported practices and policies conducted in Oklahoma from October 2017 to November 2018. Evaluation Forty-nine providers (44.2 ± 14.2 years, 100% women) participated. FCCH programs supervised 9.7 ± 4.2 children and had been in business for 10.8 ± 9.6 years (range 0.25-40 years). Providers spent 2.8 ± 6.2 hours/week preparing meals. Many (68.8%) providers had a degree in early childhood education or development. The majority prepared meals after children arrive (70%) and before children arrived (54%). Baking (98%) and slow cooker (70%) were the most common food preparation methods. Almost all (91.8%) believed the food program enhanced dietary quality for children. Frequencies of providers meeting all best practices in NAPSACC domains were foods provided (4.3%), beverages provided (2.2%), feeding environment (0%), feeding practices (40%), menus and variety (43.8%), nutrition education and professional development (4.3%), nutrition policy (20.8%), time provided for PA (0%), outdoor play environment (2.4%), daily PA practices (9.8%), PA education and professional development (6.4%), and PA policies (12.8%). Conclusions and Implications Few FCCH providers meet all best practices in nutrition and PA domains. Understanding current practices and procedures is necessary for intervention development and technical assistance training to meet FCCH provider needs and enhance ECE program quality. Funding 2017-68001-26355.

P143 Examining Nutrition Practices Across Early Childhood Education Programs in Two Rural Counties of California

Background Early childhood education (ECE) programs are important partners for childhood obesity prevention efforts. Despite signs of progress, racial and ethnic, socioeconomic, and geographic disparities in obesity rates still persist in California. Current understanding of obesity prevention strategies (e.g. nutrition practices) is limited across ECE programs in Tulare/ Kings counties of California. Objective To characterize nutrition practices of Child Care Centers (CCCs) and Family Child Care Homes (FCCHs). Study Design, Settings, Participants Study design was cross-sectional. Settings included licensed CCCs and FCCHs in Tulare/Kings counties. Participants included CCC Directors (N = 59) and FCCH Providers (N = 58). Measurable Outcome/Analysis Of the 701 nutrition practices surveys administered, 117 were completed and returned. Descriptive and chi-square analysis was conducted using SPSS. Results Results indicated statistically significant differences (P Conclusion Targeting nutrition interventions based on the childcare context (FCCH vs. CCC) is critical to the implementation of nutrition best practices. Overall, FCCH reported higher adherence to best practices as compared to CCC. This could be attributed to a higher participation of FCCHs in CACFP. A focus on nutrition education as well as participation in CACFP in ECE programs may help in obesity prevention efforts. Funding UC ANR.

P148 Parent and Family Childcare Home Provider Feeding Practices and Child Diet Quality at Home and in Childcare

Background Most US children under the age of 6 attend out-of-home care. This has led to a shared feeding responsibility between parents and child care providers, both influencing children's eating habits via feeding practices. However, little is known about caregiver feeding practices and child diet quality among children attending family child care homes (FCCHs). Objective To describe parent/provider (FCCP) feeding practices and child diet quality at home and in the FCCH, and examine associations between caregiver feeding practices and child diet quality. Study Design, Setting, Participants This was a cross-sectional mixed-methods study including 33 FCCPs-parent-child triads (87% and 64% Hispanic, respectively) from two northeastern states. Measurable Outcome/Analysis Caregiver feeding practices were collected via a self-report questionnaire. Child dietary intake at home was collected via telephone interviews, and via direct observation in the FCCH. Healthy Eating Index (HEI-2015) scores were calculated for dietary intake in both settings. Descriptive statistics were calculated for all variables. We used the Mann-Whitney U tests to examine differences between caregiver feeding practices, the Signed Rank Test to examine differences in child HEI-2015 between settings and Spearman correlations to examine associations between feeding practices and child diet quality in both settings. All analyses were conducted using SAS 9.4. Results Compared to FCCPs parents engaged in significantly greater frequency of controlling feeding practices (P Conclusion Findings suggest that the FCCH environment is more supportive of promoting healthy eating habits in preschool-aged children. However, there is a need for improvement in both settings to decrease the frequency of non-responsive feeding practices and increase child diet quality. Funding None.

P17 Participation in the Child and Adult Care Food Program (CACFP) Influences Nutrition-Related Practices of Child Care Settings in Nebraska

Background Federal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children. Objective Determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. Study Design, Settings, Participants Cross-sectional surveys were distributed to 3,014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2-5 years. Measureable Outcome/Analysis Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). Results The sample included 1,345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P Conclusion While participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommending mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding USDA.

P13 Implementation of and Barriers to Nutrition Best Practices in Urban and Rural Nebraska Child Care Settings

Background Nebraska ranks fifth in the US for childhood obesity among children 2-4 years old. Children in rural areas are more likely to be classified as obese than children in urban areas. There is limited research on nutrition-related practices and barriers of childcare across urban and rural areas. Objective To examine the differences in implementation, barriers, and difficulty of nutrition practices including foods served and mealtime practices in childcare settings across urban-rural contexts in Nebraska. Study Design, Settings, Participants An exploratory cross-sectional study in 2017. Data were collected from 1,170 childcare providers (urban = 591; rural = 579) participating in the Child and Adult Care Food Program (CACFP), including 200 childcare centers (CCCs) and 970 family childcare homes (FCCHs) in Nebraska. Measurable Outcome/Analysis Childcare programs completed the self-administered ‘Healthy Children, Healthy State’ questionnaire. Descriptive statistics and chi-square tests were conducted to assess implementation, difficulty, and barriers to nutrition practices across urban-rural CCCs and FCCHs. Results For implementation of nutrition-related practices, CCCs in urban areas were significantly more likely to serve lean and low fat meat ( P P P P P P P Conclusion This study illuminates factors that may influence high rates of obesity in rural childcare settings.Future research should examine rural childcare programs and how local food systems may decrease costs and increase healthy food availability. Funding USDA National Institute of Food and Agriculture.

“Our quality is a little bit different”: How family childcare providers who participate in a Quality Rating and Improvement System and receive childcare subsidy define quality

This research uses focus group methodology to examine how a specific subset of family childcare providers—those participating in a voluntary quality rating and improvement system and serving a high percentage of children receiving childcare subsidy—define quality. The study builds on the limited existing research about family childcare quality, especially research focused on understanding quality from the perspective of the childcare provider. A total of 28 family childcare providers participated in three focus groups where they were asked to define quality and to describe high- and low-quality programs. Qualitative analysis revealed four themes: relationships, supporting children’s learning, the physical and temporal environment, and personal professionalism. These results can inform how quality improvement initiatives and professional development systems support and engage family childcare providers.

Embracing Urbanity: Child Care Arrangements and Motherhood Anxiety in China’s Urban Transition

“Urbanization of places” in China has produced a large group of landless farmers, who have never left their home villages but are compelled to adjust to an urban way of life. Using ethnographic data collected in three transitional communities, this study examines the transformation of child care arrangement patterns in the families of landless farmers during this transition. Generation-based child care arrangements, in which both paternal grandparents become primary caregivers of children, while their parents take up full employment in the city, have replaced the previous gender-based pattern. Although the new arrangements create challenges for the newly urbanized families, they are largely accepted by all family members because they are in line with the “urban” values of efficiency and survival. But these values still conflict with the ideals of urban motherhood, and this contradiction often leaves the mothers of young children feeling guilty and anxious. This study enriches the literature on family child care construction under structural changes and reflects on the meaning of urbanization in China.

Participation in the Child and Adult Care Food Program Influences Nutrition-Related Practices of Child Care Settings in Nebraska (P04-172-19)

ObjectivesFederal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children; the present study will aim to determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. MethodsCross-sectional surveys were distributed to 3014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2–5 years. Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). ResultsThe sample included 1345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P < 0.05 for all). In family childcare homes only, those who participated in the CACFP were more likely to role model eating healthy foods and serve meals family style (P < 0.05 for both). Across both contexts, those who participated in the CACFP were more likely to receive professional development on child nutrition (P < 0.01). ConclusionsWhile participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommend mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding SourcesThis work was supported by the US Department of Agriculture National Institute of Food and Agriculture and the Nebraska Agricultural Experiment Station.

Exploratory Factor Analysis of Observed Feeding Practices Among Family Child Care Home Providers (OR03-01-19)

ObjectivesFamily childcare homes (FCCH) are a commonly used form of childcare in the US, yet little is known about this setting, particularly the practices that Hispanic providers use when feeding children. Therefore, the goal was to examine the validity of the Environmental Policy Assessment Observation Tool (EPAO) to assess provider feeding practices. MethodsData from an ongoing cluster-randomized trial were used. FCCH provider feeding practices were assessed over 2 days using a modified version of the EPAO (adapted for use in FCCH with expanded assessment of feeding practices). The EPAO captures nutrition and physical activity environments in child-care (e.g., provisions, practices, policies); however, only the 44 feeding practices items recorded during meals were used in this study. For each meal and snack occasion, a weighted factor, which accounted for frequency and time spent in each meal for each feeding practice was created and then averaged across the two observation days to obtain a weighted average score. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. ResultsAll FCCH providers were female (n = 119) and the majority (72%) were Hispanic. A final 3-factor solution, which captured 34% of the variance, was examined. Factor 1 appeared to capture autonomy support practices with 14 items (e.g., Enthusiastic role modeling, eating the same foods, talking about foods being served, reasoning with children) with loadings ranging from 0.455-0.875 (eigenvalue = 7.3). Factor 2 appeared to capture coercive control and indulgent feeding practices and emerged with 5 items (e.g., Insisting child eat foods on plate, pressuring child to eat, rushing child to eat) with loadings ranging from 0.410-0.817 (eigenvalue = 3.7). Factor 3 appeared to capture a mix of overt control and negative structure behaviors with 5 items (e.g., Enforcing table manners, encouraging children to sit at the table, removing the plate before child was done) with loadings ranging from 0.37-0.66 (eigenvalue = 3.2). ConclusionsThe emerging autonomy supportive and coercive controlling factors are consistent with recent research conducted with FCCH providers in North Carolina. Future research should continue to refine this model and explore associations with child diet. Funding SourcesNational Heart Lung and Blood Institute, Grant # R01 HL123016.

A Critical Review on the Formation and Practice of Cooperative Child Care and Educational Discourse

본 연구의 목적은 공동육아 회보에 나타난 권두언 글을 통해 공동육아 교육 담론의 형성과 실천 내용을 비판적으로 성찰하고, 공동육아 교육담론의 지향점을 교육적으로 논의하는 것이다. 본 연구 대상은 2001년부터 2017년까지 공동육아 회보(56호~124호)의 권두언 글 총68편이며, 분석방법으로는 페어클 로의 비판적 담론분석 방법을 활용하였다. 연구 결과 공동육아 교육담론의 형성 및 실천 시기를“지역에 기반한 공동육아 교육 대중화 시기(2001-2003)”,“공동육아 교육 성찰의 시기(2004-2007)”,“공동육아 교육 상상의 시기(2008-2010)”,“삶의 방식으로서 공동육아 교육 시기(2011-2017)”의 4가지로 구분하여 기술하고, 그 실천과정을 비판적으로 성찰하였다.In this study, the formation and practice period of the educational discourseof cooperative care and education were divided into four stages. First, the educational discourse emphasized the change from the child-care center community to the village community in the period of popularization of cooperative child care and education discourse (2001-2003).In this period, the quantitative expansion of cooperative childcare center was achieved, but the cooperative childcare education based on community was not popularized. Second, in the period of:Reflection on Cooperative Care and Education for Children (2004-2007), the educational discourse focused on the identity of cooperative care and education and child care for low-income families and emphasized the changing of culture withinSocial Child Care. Nevertheless, during this period, interest and support for the childcare problems of low-income families was not activated due to joint childcare education. Third, educational discourse was emphasized in terms of learning and practicing a new way of life in the time of imagining the cooperative care and education of children (2008-2010).This period was a time of dreaming of co-education for children as a new possibility. Fourth, educational discourse emphasized the way of sharing life centered on villages in the period of cooperative care and education (2011-2017) as a way of life. In addition, it emphasized the professionalism of the teacher, who develops the early childhood curriculums, grows and collaborates with the crisis of changes of overall child care policies, and insists to learn the ability to help the young children through relationships and caring.

Caregivers' emotional competence and behavioral responsiveness as correlates of early childcare workers' relationships with children in their care.

In the current study, we examined associations among early childcare workers' emotional competence, observed responsiveness, comfort with socioemotional teaching practices, and the quality of their relationships with children in their care. The participants were 100 early childcare workers (72 center-based Early Head Start teachers and 28 family childcare providers). Results showed that caregivers' emotion regulation ability was positively associated with caregiver-child relational closeness. Understanding and regulation of emotion were both positively associated with childcare workers' comfort with socioemotional teaching practices. Their observed responsiveness was positively related to relational closeness and negatively related to relational conflict. Findings are consistent with aspects of the prosocial classroom model, which asserts that educators high in emotional and social competence tend to adopt childcare practices that result in supportive relationships with children. Results provide insight into whether childcare workers' responsiveness to young children and their perceived socioemotional teaching practices provide a pathway between emotional competence and the quality of caregiver-child relationships.

Coparentalidade aos três meses de vida do bebê

O objetivo do presente estudo foi investigar a coparentalidade aos três meses de vida do bebê. Participaram 26 famílias nucleares, com filho único. Mãe e pai responderam a entrevistas. A análise de conteúdo qualitativa revelou responsabilidade predominantemente materna nos cuidados do bebê na maioria das famílias. A mãe parecia ocupar uma posição de guardiã da relação pai-bebê, apresentando comportamentos facilitadores ou inibidores do envolvimento paterno. Todos os participantes mencionaram apoio ao papel coparental, embora também tenha sido identificada depreciação materna à contribuição paterna. O envolvimento triádico ocorria principalmente nos cuidados básicos do bebê. Verbalizações dos genitores sugeriram boa qualidade na comunicação familiar, além de bons níveis de acordo sobre os cuidados. Salientam-se aspectos gratificantes e desafiadores da coparentalidade aos três meses de vida do bebê, período em que os genitores estão se adaptando à nova identidade e aos novos papeis, para atender às necessidades do filho.

Preventing unintentional injuries in US early care and education: Are state regulations sufficient?

Unintentional injuries are currently the leading cause of death among US children older than one. As many children spend significant time in non-parental child care, these injuries often occur outside of the home. This study examined US state early care and education (ECE) regulations related to injury prevention. We reviewed ECE regulations for child care centers and family child care homes through August 2018 for all 50 states and DC (“states”). We compared these regulations to six components from two national health and safety standards on injury prevention (“standards”). One state had regulations that met all six standards for both centers and homes; sixteen states had regulations that met at least five for both. Most states required child care providers to be trained in emergency preparedness (42 for centers; 38 for homes) or first aid including CPR (50 for centers; 46 for homes). Additionally, most states required providers in centers and homes to notify parents (47 and 41, respectively) and the state (40 and 41, respectively) when a child was injured; these requirements varied greatly in both the timing and manner of notification. Two-thirds of states required that providers keep copies of a completed injury form on the premises. However, few states (5 for centers, 3 for homes) required providers to take corrective action after an injury. Although most states had some injury prevention regulations, they varied greatly across states. More states should require corrective action after an injury to help prevent future injuries from occurring.

Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the \u2018Healthy Start/Comienzos Sanos\u2019 cluster randomized trial

BackgroundEarly childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children.MethodsThis paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2–5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers’ need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children’s diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included.DiscussionHealthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH.Trial registration(# NCT02452645) ClinicalTrials.gov Trial registered on May 22, 2015.

Emergency Preparedness Plans and Perceptions Among a Sample of United States Childcare Providers.

Children are at increased risk for experiencing negative physical and mental health outcomes as a result of disasters. Millions of children spend their days in childcare centers or in residential family childcare settings. The purpose of this study was to describe childcare providers' perceived levels of preparedness capabilities and to assess differences in levels of perceived preparedness between different types of childcare providers. A national convenience sample of childcare center administrators and residential family childcare administrators completed a brief online survey about their preparedness efforts. Overall, there were few differences in preparedness between childcare centers and residential family childcare providers. However, childcare centers were more likely to report that they had written plans (94.47%) than residential family childcare providers (83.73%) were (χ12=15.62; P<.001). Both types of providers were more likely to report being very prepared/prepared for fires (91.31%) than they were for any other type of emergency (flooding, active shooter, etc.; 45.08% to 79.34%). Future work should assess how childcare providers respond to and recover from emergencies, as well as explore the types of resources childcare providers need in order to feel comfortable caring for children during such emergency situations. (Disaster Med Public Health Preparedness. 2019;13:704-708).