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Rural Health Information Hub

Childcare Center-Based Programs

Childcare centers, such as daycares and preschools, can provide a safe and supportive environment for young children to grow and learn about positive health behaviors. Childcare centers can implement early childhood education programs that include a focus on children's health and family well-being. Early childhood education programs incorporate health promotion efforts through instruction and health-related screenings and services. The curriculum-based structure of education used widely in the U.S., including in early childhood, provides existing infrastructure to carry out health-related lesson plans or health-promoting activities. Curricula can address:

  • Nutrition
  • Physical activity
  • Mental wellness and resilience
  • Oral health
  • Positive habit development
  • Healthy living behaviors

Head Start, a federally-funded early childhood school preparedness program for children under five from low-income families, is a critical component of child care in rural communities. Head Start is present in nearly 86% of rural counties across the country. However, rural areas continue to experience a lack of childcare options. Fifty-nine percent of rural communities are considered to be childcare deserts, meaning there is an insufficient supply of licensed childcare providers in the area. Factors that impact the availability of center-based child care in rural areas include:

  • Demand for childcare services may be insufficient, or unreliable over time
  • Costs of opening and operating a childcare center, including staffing, training, infrastructure, and equipment
  • Additional expenses such as transportation
  • Providers may not be ready or willing to operate center-based care in rural areas given the unique challenges

Examples of Childcare Center-Based Models

Color Me Healthy is a preschool program for children ages four and five that uses a highly visual and interactive curriculum to teach children about healthy eating and physical activity. The curriculum includes 12 circle time lessons, picture cards, posters, seven original songs, and parent newsletters. The program is highly adaptable to each individual childcare center, allowing for flexibility of implementation. Many states have implemented the curriculum using the train-the-trainer model with childcare providers receiving in-depth training on how to use the curriculum. The English-language kit and the Spanish-language supplement are both available for a fee. Color Me Healthy reaches all 50 U.S. states, Canada, Mexico, the Virgin Islands, and Israel.

Go NAPSACC is an evidence-based program designed to assist childcare providers to improve children's health using program, policy, and environmental changes. Childcare providers learn how to assess, plan, and take action to implement changes related to topics like child nutrition, breastfeeding, child physical activity, outdoor play, screen time, and oral health. The program currently operates in 19 states, providing technical assistance in addition to access to online tools.

Bounce Back seeks to help children recover from trauma and improve their well-being by delivering clinician-led group interventions in an elementary school setting. A close adaptation of the Cognitive Behavioral Intervention for Trauma in Schools for middle- and high-school students, the elementary group activities include coping skills, feelings identification, relaxation exercises, positive activities, social support, and problem solving. Clinicians also hold sessions with parents to review their child's progress and with individual students to address their specific traumas.

Healthy Schools Healthy Communities is an initiative through the Missouri Foundation of Health that helps school districts become hubs to create healthy communities. From 2013 to 2015, the initiative provided outreach to nearly 30,000 students. School wellness committees address school food options, physical activity, health education, and family engagement. School districts create partnerships with community organizations, including early childcare centers, to develop action plans and align efforts to address barriers to healthy eating and active living for children. In 2020, more than 30 childcare centers participated in the initiative.

The Coordinated Approach to Child Health (CATCH) is a community health program that focuses on the education of children at school and at home. The CATCH Early Childhood program is designed to encourage physical activity, introduce classroom-based gardening and nutrition, and encourage healthy eating in children ages 3-5. The program includes games and activities, flexible lesson plans, music to sing and dance along to, curriculum connectors to connect the lessons into other learning areas, and more. The Sun Safety curriculum called Ray and the Sunbeatables®educates children, parents, and teachers about sun protection, specifically for children in pre-K, K, and first grade. The Early Childhood Coordination Guide is a toolkit that helps administrators, managers, directors, teachers and teacher assistants, and parents and families implement the CATCH Early Childhood Program.

The I Am Moving, I Am Learning program championed by the federal Office of Head Start connects physical activity and learning. This program uses a train-the-trainer model that involves a 2.5-day interactive workshop. The educator-taught curriculum integrates physical activity and nutrition into daily routines of early care and education programs.

Choosy Kids provides resources to promote health for young children and their families. The curricula feature the character Choosy, the Health Hero and Role Model, and music to engage children in lessons about nutrition, physical activity, and oral health, and encourage children to choose health-promoting behaviors. Choosy Kids also offers staff development resources, which pair current child development content with adult learning models, to help educators more effectively implement the Choosy Kids curricula. The Choosy Kids online store provides resources for educators and families. The Choosy Kids program is in partnership with the I Am Moving, I Am Learning program as well.

Hip Hop to Health Jr., part of the Evidence-Based SNAP-Ed Interventions, is a healthy eating and exercise curriculum for children aged 3-7. The literacy-based curriculum includes two curriculum books, parent newsletters, food group puppets, and a CD with songs and two 20-minute exercise routines.

Active Early/Healthy Bites are partner guides that help early care and education professionals improve positive health behaviors in the forms of physical activity and nutrition. The Active Early program emphasizes physical activity, and the Healthy Bites program focuses on nutrition and healthy eating.

Program Clearinghouse Examples

Considerations for Implementation

Staffing. Evidence shows that physical activity and nutrition interventions in childcare settings improve nutrition, increase physical activity, and improve weight status. However, preschool and daycare teachers may not have the time or resources for training on how to integrate programs that address healthy behaviors. Early childhood teachers often experience stress related to low salaries, lack of access to healthcare, and stressful work environments. Challenges related to time and resources are important to address when choosing to implement a childcare center-based program. It may be helpful if a program can offer an incentive (for example, continuing education credits for teachers), or if the program can demonstrate how it will help the school meet local or state standards or requirements.

Funding. Many of the programs in this toolkit are free to implement, but there are also programs that require upfront costs to train teachers, purchase the curriculum, or acquire equipment. For more information on the costs and benefits of funding childcare health programs, see Module 4.

Child care availability. More than half of rural areas qualify as childcare deserts. Areas considered childcare deserts often have larger Hispanic/Latino and American Indian populations. Even when child care is available, not everyone has access to this resource. Families may face barriers to enrolling in child care, including high costs, low wages, and transportation challenges. Limited availability of child care means that children not enrolled would not receive the beneficial interventions taking place in center-based programs.

Resources to Learn More

Healthy Kids, Healthy Future
Offers childhood obesity prevention resources for child care and early education providers in a variety of settings including preschool, tribal, military, faith-based, and Early Head Start and Head Start programs. Resources focus on nurturing healthy eating, increasing physical activity, reducing screen time, and supporting breastfeeding.
Organization(s): Healthy Kids, Healthy Future, CDC, Nemours

Wellness in Alaska Child Care: Best Practices
Describes the Wellness in Alaska Child Care (WIACC) project, a grant program designed to offer childcare staff training that will encourage children to adopt positive behaviors related to healthy eating and physical activity. Highlights several WIACC supported programs encouraging childhood wellness throughout rural and urban Alaska.
Organization(s): Alaska Department of Education & Early Development, U.S. Department of Agriculture
Date: 11/2012

Early Care and Education (ECE)
Discusses early childcare and education centers, and their impact on obesity prevention. Highlights the efforts of the CDC to support national obesity prevention initiatives targeting ECE settings, and includes resources and best practices.
Organization(s): Centers for Disease Control and Prevention

Early Childhood Care Obesity Prevention Recommendations: Complete List
Offers recommendations for early childcare providers supporting childhood obesity prevention. Topics covered include early childcare nutrition, infant feeding and mealtime habits, physical activity, screen time, and sleep routines.
Organization(s): Harvard T.H. Chan School of Public Health