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Addressing Childhood Obesity using Continuous Process Improvement

The Cardiovascular Health, Nutrition and Physical Activity Section (MDHHS) is within the Division of Chronic Disease and Injury Control of the Michigan Department of Health & Human Services.  MDHHS currently supports four childhood obesity initiatives: Michigan NAP SACC; Michigan Breastfeeding-Friendly Workplace Project; Blue Cross Blue Shield of Michigan: Building Healthy Communities; and the Physical Activity and Nutrition Before/After School and Summer Program.

Michigan NAP SACC (Nutrition and Physical Activity Self-Assessment for Child Care) is based on a research-tested intervention designed to improve 1) nutritional quality of food served, 2) amount and quality of physical activity, 3) staff-child interactions, and 4) nutrition and physical activity policy.  Child care providers utilize a self-assessment and goal setting approach to achieve best practices.  Participants are provided with opportunities for training and targeted technical assistance.  NAP SACC promotes the use of a continuous process improvement model.

Child Care Network (CCN) is a child care resource referral organization that serves as an implementing agency for the Michigan NAP SACC initiative.  CCN provides free mentoring, technical assistance, and training to providers participating in NAP SACC.  CCN reaches providers through training opportunities, assistance with licensing and access to programming, including connecting with means-tested programming to connect providers and families in need with resources.  Additionally, CCN assists providers seeking licensure and participation in the Great Start to Quality (GSQ), with assistance in navigation of the systems and requirements.  GSQ is Michigan’s Quality Rating and Improvement system which defines quality ratings based on state standards for education systems and programs, including child care.


The MDHHS Cardiovascular Health, Nutrition and Physical Activity Section  was selected as a NOW Bright Spot because of its work across the state to decrease obesity among children through nutrition and physical activity initiatives.  Michigan NAP SACC focuses on improving early care and education settings.  This site has provided insight and lessons for implementing improvement on a large scale and spreading innovation.


MDHHS is using NAP SACC to identify a shared vision of best practices related to nutrition, physical activity, and breastfeeding support among childcare providers.  Multiple stakeholders impact the education, health and wellbeing of young children.  The lack of alignment among requirements and recommendations can lead to confusion and limit improvement efforts at the local and individual level.  The movement from stakeholder collaboration to alignment was noted as a key to scaling improvement and spreading innovation.


Relationships are noted as key at all levels to improve health and wellbeing for all children.

Relationships between state agencies, among regional and local support agencies and between providers are essential.  Additionally, the relationships between the different levels allows for engagement and understanding of needs of children and their families and feedback on support mechanisms.


Data is used at the state level and locally to understand needs and progress in improvement efforts.

Additionally, feedback among providers, NAP SACC Consultants, and the state identify challenges in improvement initiatives and local issues for support


Most of the providers CCN supports are caring for vulnerable children and/or have limited resources themselves.  CCN is providing training and professional development to help providers better meet the needs of their children and families, and themselves.

MDHHS has identified high-need children as the target population for Michigan NAP SACC, adopting the definition from US DOE. High-need children have characteristics such as living in a low-income household, homelessness or American Indian identity.


Lonias Gilmore, MPH, Childhood Obesity Prevention Specialist

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