Start Strong: "Move your feet and eat before school ...

Start Strong: "Move your feet and eat before school ...

Start Strong: Move your feet and eat before school! Program Evaluation Mollie Greves, MD Evaluation Design Using a Theory of Change Model What is a theory of change? An individuals or organizations beliefs about how to positively change conditions or behaviors Why is this process used? Develop a program systematically Communicate program to partners, funders Monitor implementation, inform decisions Develop evaluation to assess implementation and outcomes Components of Theory of Change Contextual analysis (Background/ setting)

Knowledge and understanding of the problems Assumptions about what is needed to solve problems (may be based on theories of behavior change) Strategic Focus (What doing & whyvery specific) Actions/Activities (How program will be implemented) Short-term & Long-term outcomes (Identify changes expected) Pathway Map Visual depiction of how to link strategies, actions and outcomes May be similar to a logic model Contextual analysis/ assumptions Strategic Focus Program Goals Actions/Activities (may list by goal) Short-term outcomes Long-term outcomes

OMG Center for Collaborative Learning Seattle Start Strong Theory of Change Contextual & Problem Analysis Target Population Over 1300 elementary students (ages 4-12) who are primarily low income and from racial/ethnic minorities at high risk of childhood obesity at: Emerson, Graham Hill, Van Asselt, and Wing Luke elementary schools. Assets: Seattle public schools garnered national recognition in 2004 for progressive nutritional policies adopted by the district Strategic Focus Strategic Focus To implement the Start Strong program by providing nutritious breakfasts and walking-to-school incentives while promoting healthy lifestyles for family and community in four Seattle public elementary schools. District policies establish guidelines on the nutrient quality of school meals and acknowledge the importance of a pleasant and relaxed environment in terms of food consumption. Despite budget cuts, the District has made progress in implementing policy goals, including an increase in its use of fresh, local, unprocessed

foods and implementation of culturally diverse foods in its lunch menu. Individual schools are encouraged to supplement district-wide policies with local school-based initiatives. THE IFCK Seattle can draw from extensive resources through its unique partnership with Harborview Medical Center, Childrens Hospital & Regional Medical Center, and Public health Seattle & King County. The Start Strong program also has the resources available from the collaborative effort established between the Injury Free Coalition for Kids Seattle, Feet First, and Seattle Public Schools to combat childhood obesity. Two successful pilot programs at Bailey Gatzert Elementary School (The Walking School Bus Program) and T.T. Minor (Healthy Eating by Design) will serve as models for the Start Strong program at 4 other Seattle public elementary schools. Challenges: Many children, especially low-income children from racial/ethnic minority groups, are overweight or at risk of being overweight because: They are falling short of getting the to 1 hour of recommended daily exercise They are not eating nutritionally sound meals that meet the recommended daily energy requirements. Student participation in school breakfast programs is low at Start Strongs partner schools: Emerson (39%), Graham Hill (14%), Van Asselt (17%), and Wing Luke (30%) School arrival times, bus schedules, and unpalatable/culturally ill-suited food items, are possible factors prohibiting children and families from walking to school and participating in school breakfast programs. There are insufficient promotional activities to increase participation of parents and other family members in breakfast programs. Focus groups revealed that barriers to participation in free school breakfast programs might also be due to lack of time, concerns about nutritional value, and perceived stigma. Program Goals Assumptions

Eating healthful and culturally appropriate breakfasts will contribute to reducing the incidence of obesity among children in participating schools. IFCK Seattle will be able to identify an array of culturally appropriate meals that are also nutritious and cost-effective. 1. Implement Seattle Walks program in four public elementary schools 2. Increase student participation in Seattle Breakfast program at four public elementary schools 3. Increase family and community involvement in Walk-to-School and Healthy Breakfast programs 4. Strengthen and

Coordinate Partnerships (Feet First, SPS, STEPS, COAT, etc.) Culturally appropriate breakfasts prepared by food service staff will be palatable to students and families. Food service staff will be trained easily and efficiently on new menus and cooking methods. The increase in daily level of physical activity from Walk-to School program will contribute to improving physical fitness. Participating in school Healthy breakfast and Walk-to-School programs will change overall eating and exercise habits in children Parents and children will want to get involved as result of greater outreach efforts, education, and increased availability of information regarding Start Strong program. attle Start Strong Theory of Change Short Term Outcomes 18 months Program Activities Goal 1: Implementation of Seattle Walks programs: Goal 1: Implementation of Seattle Walks: Four partner schools will offer Seattle Walks program. Coordinate efforts with Feet First and Seattle Public Schools to:

Identify safe walking routes to school Identify a point person interested in exercise promotion (PTA parents, school nurse, PE teacher and/or other staff member Outreach to family and community members (the elderly especially) to accompany students in Walk-to-School programs. Students acquire positive attitudes about physical fitness Research culturally appropriate breakfast options, test recipes, and offer taste tests in September and October. Research current breakfast choices being offered, conduct nutrition analysis, and identify barriers to current practices regarding whole grains and whole fruit Identify low-cost options to improve healthy food choices Work with district and food service workers to provide nutritious and palatable breakfasts with increased availability of whole grains and fresh fruit. Establish school and school transport policies supportive of breakfast participation Implement promotional activities and present to schools at weekly morning assembly to kick-start the program. Goal 3: Increase Family and Community Involvement in the Seattle Walks and Seattle Breakfasts Programs Recruit volunteers to do outreach with area senior centers to recruit elders willing to serve as walking champions and to promote intergenerational partnerships for pedestrian activity. Prepare and display promotional materials to engage parents in special breakfast events and in walking and neighborhood safety issues: Update the nutrition bulletin regularly with nutrition information on breakfast consumption, healthy eating tips, etc. Send communications home regarding new options to school breakfast Set up coffee carts for parents as incentive to sit with children while they eat breakfast. Present at family night periodically to gain parent support and offer a taste test Organize special breakfast events with students, family, and community members

Goal Goal4: 4:Strengthen Strengthenand andCoordinate CoordinatePartnerships Partnerships(Feet First, School Board President SPS, Nutrition Services Director SPS, Nutrition Education STEPS,monthly COAT, activities Washington State Childrens Alliance, Work withCoordinator Feet First to develop to promote the relationship etc.) between the walking program and the breakfast program Organize monthly Start Strong meetings with key partners (scheduled the last Work with Feet First to develop monthly activities to promote the relationship between Thursday of every month) the walking quarterly program and the breakfast Organize partner meetings program Organize monthly Start Strong meetings with key partners Develop relationships within each school (food service workers, family services Organize quarterly partner meetings coordinators, teachers and staff, PTA president and principal)

Contact Operation Frontline to determine potential of offering a 6-week cooking class and nutrition education for parents. Collaborate with Seattle Nutrition Action Consortium (SNAC) and Mission:Delicious to offer nutrition education and cooking demonstrations in classrooms at partner schools. Partner with SPS Nutrition Services in developing collaborative relationship with Seattle Public Schools Nutrition Services Department. Develop relationships within each school (food service workers, family services coordinators, teachers and staff, PTA president and principal) Intermediate Outcomes 2-5 years Increased physical activity and healthy food consumption for children in the target population. Increased parent and community involvement and leadership in programs. Goal 2: Increase Participation in Seattle Breakfasts: Goal 2: Increase student participation in Seattle breakfast programs OMG Center for Collaborative Learning Plan is developed for replicating best policies and strategies of Start Strong program for future expansion to other schools and districts. 10% increase in student participation at each partner school. Policy changes are in place that allow students to arrive 20 minutes before school begins to eat breakfast at four partner schools. Breakfast choices will contain more fiber, have a higher whole grain content and will offer more whole fruit at all four partner schools. Four partner schools will have increased access to healthy breakfast foods.

Long-term Outcomes 5+ years Increased knowledge of healthy eating habits. Goal 3: Increase Family and Community Involvement Students improve physical fitness habits 10% increase in parent participation in school breakfast and Walk-to-School (?) program at four partner schools. District and state-wide policies are adopted for ensuring culturally appropriate and nutritious choices in school food. Elderly community members are trained in neighborhood safety issues and their participation increases in special breakfast school events and Walk-to-School programs. High level of participation and leadership from parents and community Established network of volunteers to educate and promote Seattle Walks Goal 4: Strengthen and Coordinate Partnerships Partners are clear on their roles and work collaboratively to meet desired outcomes. Funding is secured and sustainability plan is developed to ensure continuation of Start Strong program in existing partner schools. Replication Kit will be disseminated and shared with other

schools and district planners. Students improve eating habits. Improved capacity of IFCK-Seattle and Seattle elementary public schools to work in partnership with likeminded organizations to implement policies and programs that promote healthy school communities. Partnership is institutionalized as a vehicle towards systemic change in childhood obesity, as indicated by acknowledgement by the community that the partnership is an integral part of the effort to reduce childhood obesity and enhance childrens health Changes are sustained and there is institutionalization of successful policies and practices related to healthy eating and exercising habits in all participating schools Start Strongs Project Goals Primary: dual focus on physical activity and nutrition for children in low-income, ethnicallydiverse schools Increase walking to school Increase school breakfast participation Secondary Promote parent participation, improve social

connectedness of school-family community Improve nutrition and palatability of school breakfast offerings Improve partnership between organizations Intervention components School-wide off days walking and breakfast tasting kick- Helping parents/staff establish walking school buses Monthly breakfast taste-testing, breakfast promotion and nutrition activities Additional school activities Classroom lesson plans (e.g. classroom cookbook, climb Mt. Rainier challenge) Assemblies Family nights Translated school newsletters Measurement/Evaluation Pre-intervention focus groups to gather parent

perceptions of beliefs, barriers Quantitativeobjectively measure behaviors Hands-Up classroom surveystime series measurement during school year Breakfast participation from school reportstime series measurement throughout school year Qualitativeassess attitudes/knowledge Pre-post surveys of parents, 5th graders Mid-year key-informant interviews Focus GroupsMethods 6 non-English (2 each in Somali, Vietnamese, Spanish), 1 English 1 trained facilitator, 1 interpreter per language Script, questions developed by project oversight team 9-12 parents/grandparents of school-aged children per group Recruited from community centers, schools, pediatric clinic Focus groups results Walking Supported

walking in general Exercise Quality time with children Being in nature Concern about child & adult obesity since moving to U.S. due to lifestyle changes that include less walking More concern about others than about their own children Barriers to walking to school Lack of time to walk with children Fearful for children walking alone Language barriers, not knowing/trusting others Lack of safe routes, crossing guards Abductions, bullying Distance too farmany children not going to local neighborhood schools Weather How to overcome barriers to walking to school

Help parents meet, develop trust with other parents Help establish adult-child walking groups: led by parents or teachers/staff Identify safe routes Improve safety Crossing guards, safety training, walking paths, pedestrian-friendly street crossings Promote walking activities during school Focus group results School breakfast concerns Lack of quality, variety, and hot foods Lack of culturally-diverse foods (although children eating all types of food at home) Lack of adult supervision to ensure children eat breakfast at school Children play instead of eating School buses late More School breakfast recommendations from parents fresh fruits/vegetables and hot entrees,

less juice and less processed foods Offer taste tests Offer more culturally-relevant foods: tortillas, chicken, ham and cheese (Spanish), noodle soup, rice, Vietnamese sandwiches (Vietnamese), halal meat, injera (Somali) Remind children to go to breakfast Ensure breakfast available when buses are late Hands-up survey Methodology used in pilot study on walking to school Challenge to ensure 5 schools do on the same day Depend on teachers, principals for accurate completion Hands Up Student Breakfast and Transportation Survey Please enter the number of students who raise their hand for each of the following: Ate breakfast both at home and school Car Ate breakfast just at home School

Bus Ate breakfast just at school Walke d with an adult Walked without an adult Ate breakfast somewhere else Bicycl e Did not eat breakfast Other Hands-up Survey Results Transportation to School (intervention schools) Breakfast Locations (intervention schools)

Someplace else 4% No breakfast 9% Both home & school 12% Home 49% School 26% Walked with City adult bus, bike and 7% other trans 1% School bus 40% Walked without adults 6%

Car or carpool 46% Key Informant Interviews Qualitative, in-depth assessment of staff and parent perspectives on Walking to school and school breakfast overall Start Strong program activities Solicit feedback and ideas Inform our program to modify, improve activities and implementation

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