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Start Healthy, Start Now

  • Need: Rural childcare providers have limited resources to learn about mental and physical health promotion and obesity prevention
  • Intervention: A free health promotion training program for rural childcare providers
  • Results: Rural childcare providers are better prepared to impact children's health and well-being.


Childcare providers are in a position to impact the emotional well-being, nutrition, and physical activity of the children they care for. However, rural childcare workers face challenges accessing education and training that can help them better support children's health and well-being.

Start Healthy, Start Now (SHSN) brought free health promotion and child development training, technical assistance, and educational resources to childcare providers in 6 rural eastern Washington counties. SHSN focused on reducing childhood obesity through emphases in nutrition, physical activity, emotional well-being, and mental health.

SHSN was a collaborative venture led by Inland Northwest Health Services (INHS), partnering with the Washington State University Area Health Education Center (WSU AHEC), Spokane Regional Health District (SRHD), and Community Minded Enterprises (CME). Its work was supported by a 2-year Community Transformation Grant from the Centers for Disease Control and Prevention. The project period was from September 2012 through December 2014.

This program was a finalist for the 2014 Kate B. Reynolds Charitable Trust Innovations in Rural Health Award, which recognizes innovative ideas and work from around the United States that have the potential to improve the health of people living in rural communities.

View this video to learn more about the efforts of Start Health, Start Now:

Services offered

During the grant period, SHSN offered the following training to childcare providers in rural communities:

  • 85210 Curriculum in Childcare Settings
    Encourages childcare providers to implement 5 key health habits in their facilities. Adapted from the 5210 program, which has been used in Maine for 7 years. SHSN added a fifth element, encouraging "8" or more hours of sleep each night.
  • Trauma-Informed Care
    A 3-part training program that helps childcare providers understand how trauma impacts emotion and behavior. Offers tools to help providers work effectively with children who've experienced trauma.
  • Traveling Chef and Let's Cook Whole Foods
    Educating childcare directors and cooks on how to provide healthier, nutritious meals to the children at their facilities.
  • Let's Move! Child Care
    Encourages physical activity for children in rural childcare facilities. Based on a nationally recognized program.


SHSN childcare providers have increased knowledge about promoting healthy behavior changes.

Let's Cook Whole Foods participants learned how to prepare and purchase healthy food on a budget.

Trauma-Informed Care training impact:

  • 449 childcare providers were trained in the part one training, 248 in part two, and 110 in the advanced training. A total of 485 providers from 108 centers were trained in at least one of the three Trauma-Informed Care trainings.
  • Participants have better strategies and tools to understand the effects of trauma and now know how to work with children and families towards child development.
  • By the end of the project period, the percentage of surveyed centers that reported that they had established a policy about how to address adverse childhood experiences increased from 22% to 45%.
  • The percentage of surveyed centers reporting that many or some staff practice trauma-informed childcare increased from 24% to 51%.

Let's Move! training impact:

  • In total, 349 providers from 64 centers completed the Let's Move! training program.
  • By the end of the project period, 89% of the centers surveyed reported that their program had established a policy that includes the Let's Move! physical activity recommendations for children.
  • 84% of the centers surveyed reported that their program had established a written or unwritten policy that includes the Let's Move! screen time recommendations for children.
  • 97% of the centers surveyed reported that their program had established a policy about serving healthy food.

Let's Cook Whole Foods training impact:

  • In total, 70 cooks and directors from 57 centers have completed the Let's Cook Whole Foods training program.
  • The YMCA was able to achieve a cost savings of $2,100 over a 5-month period in the attempt to cook 75% of their meals from scratch and with whole foods.
  • By the end of the project period, 74% of the centers surveyed reported that their program had established a policy about purchasing minimally processed foods for cooking.
  • By the end of the project period, 66% of the centers surveyed reported that most of the food their cooks prepared was minimally processed.


One of the greatest barriers that SHSN has faced is in the implementation of 85210 parent nights in childcare centers. Some of the reasons expressed by providers for their lack of interest in parent nights include having to pay staff extra time to watch the children and too little parent attendance.

Additionally, project staff encountered challenges working with the community college and universities in the area. Partnering with higher education systems was considered crucial to sustaining training recommended by project staff and collaborators. Incorporating these ideas into early childhood education courses, preparing childcare teachers and early childhood professionals for the workforce, would help to sustain the knowledge gained and potentially reach many more children, families, and childcare centers. Barriers to this included:

  • Copyright issues in implementing Trauma-Informed Care Training concepts in other curricula, such as higher education courses
  • Difficulty establishing communication and making connections with higher education institutions

The project was ultimately unsuccessful in meeting the goal of working with higher education, which is an area of focus for future training and intervention efforts. If education systems that are training early childhood educators could integrate principles of trauma sensitive care, or physical activity and nutrition, they have the potential to greatly influence the behaviors of the educators being trained in their programs and the countless children they will encounter.

Initially, SHSN anticipated that the cost of purchasing whole foods could be a barrier to the implementation of whole food preparation practices. However, as childcare centers became more efficient in managing their time and food supply, purchasing only what they need for 1 to 2 weeks, acquiring whole foods was not a cost issue. Some centers even saw a decrease in their food costs once they transitioned from purchasing canned vegetables to frozen or fresh vegetables.


The SHSN program has successfully combined several well-known health promotion training programs, targeting them to rural childcare providers.

To learn more about implementing the specific training programs used by SHSN:

Contact Information

Emily Fleury, Director of health training and community wellness
INHS Community Wellness
Start Healthy, Start Now

Child care
Children and youth
Food security and nutrition
Mental health
Wellness, health promotion, and disease prevention

States served

Date added
April 21, 2014

Date updated or reviewed
April 30, 2019

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.