Early Childcare and Education Site-level Assessment Questionnaire PILOT VERSION FOR FFY 2019 ONLY

Developed by the University of California Nutrition Policy Institute

for the California Department of Public Health

This tool is designed to help you assess how your childcare site progresses over time to support healthy eating and physical activity. This questionnaire can be completed by one or more individuals as needed to ensure that at least one person is familiar with the practices covered in each section of the questionnaire. As a first step, please review the questionnaire to decide who should be involved in completing each section and gather any materials you may need.

It is not expected that all, or even many, of the policies and practices described in the questionnaire will be fully in place at this time. The goal is to measure change and improvements over time, so please do your best to accurately estimate the current situation. Your frank responses are appreciated and will also be the most useful to help you decide where to focus your efforts. You will be asked to update your responses to this questionnaire every year in order to capture the advances that are made at this site.

Keep the following in mind, as you move through the questions:

• Please select the response options that most closely correspond to the current situation.• Use the last section, “Other comments” to let us know if there are other healthy eating and physical

activity practices at your site that are not included here or if none of the listed response options apply tothe current situation at your site.

• The following describes how to interpret the most frequently occurring set of response options in thisquestionnaire:

Response option:

Always/ All (___)

Usually/ Most (___)

Sometimes/ Some (__)

Not Usually/ Few (__)

Never/None/ No (__)

Interpretation: This is true more than 90% of the time

This is true 61-90% of the time

This is true 41-60% of the time

This is true 11-40% of the time

This is true 10% or less of the time

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Gray shading indicates for LHDs to complete. *Site ID: This is the Site ID that is assigned by the PEARS system and can be found here.

Site Information: Site Name: ___________________________________________________ Site ID*: ________

Address: _____________________________________________________ LHD: ___________

Date of current assessment: ____________ Date of last assessment: ____________ q N/A: this is the first year of assessment

Average daily attendance in program: _______ Age range of children enrolled: __________

Positions/titles of those completing this form: 1. ___________________________________ 3. __________________________________

2. ___________________________________ 4. ___________________________________

Sections:

Jump directly to the sections related to your role or expertise at this site. 1. Wellness Policies and Program Participation2. Meal and Snack Foods and Beverages3. Food Environment and Feeding Practices4. Gardens and Nutrition Education5. Physical Activity and Entertainment Screen Time6. Parent/Family Involvement7. Breastfeeding Support8. Other Comments

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Email address for the site to send completed questionnaire:______________________________

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Section 1: Wellness Policies and Program Participation1

1.1. This site has a wellness policy that addresses nutrition and/or physical activity for children attending. ¡ Yes ¡ No à skip to Q1.4

1.2 In the last three years, has has your site assessed the extent to which the site is in compliance withthe wellness policy and/or the progress made in attaining the goals of the wellness policy?

1.3 Have the results of the wellness policy assessment been made available to the public? ¡ Yes ¡ No

1.4 Does this program have a wellness committee? IF SO, how often did it meet during the last 12 months? ¡ No committee ¡ Committee did not meet ¡ 1-2 times ¡ 3-4 times ¡ 5-6 times ¡ 7+ times

1.5 This site participates in the Child and Adult Care Food Program (CACFP)2: ¡ Yes ¡ No

1.6 Does your written wellness policy cover any of the items listed in this section? ¡ Yes ¡ No ¡ N/A: no written wellness policy

Section 2: Meal and Snack Foods and Beverages2

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2.1 Does your site serve meals? ¡ Yes ¡ No à skip to Q2.5 2.2 Meals served meet the Child and Adult Care Food Program (CACFP) guidelines2:

q N/A: Not participating in CACFP¡ ¡ ¡ ¡ ¡

2.3 Fruit (not juice) is offered at meals: ¡ ¡ ¡ ¡ ¡ 2.4 Vegetables are offered at meals: (not including French fries, tater tots, hash browns, dried beans) ¡ ¡ ¡ ¡ ¡ 2.5 Does your site serve snacks? ¡ Yes ¡ No à skip to Q2.9 2.6 Snacks served meet the Child and Adult Care Food Program (CACFP) guidelines2:

q N/A: Not participating in CACFP ¡ ¡ ¡ ¡ ¡

2.7 Fruit (not juice) is offered at snack time: ¡ ¡ ¡ ¡ ¡ 2.8 Vegetables are offered at snack time: (not incl. French fries, tater tots, hash browns, dried beans) ¡ ¡ ¡ ¡ ¡ 2.9 The only beverages available to children during meals and snack time are milk and water: ¡ ¡ ¡ ¡ ¡ 2.10 Milk served to children ages 2 yrs and older is limited to non-flavored and 1% fat or less: ¡ ¡ ¡ ¡ ¡ 2.11 100% fruit juice is offered:

¡ 2 or more times per day ¡ 1 time per day ¡ 3-4 times per week ¡ 2 times per week or less ¡ Never2.12 Sugary drinks (e.g. powdered drink mix, sports drinks, sweet tea, punches, soda) other than 100% juice are offered:

¡ 1 time per day or more ¡ 2-3 times per week ¡ 1 time per week ¡ A few times per month ¡ Never2.13 Drinking water outside is: ¡ Easily visible and self-serve at all times ¡ Easily visible and available on request

¡ Visible, but only available during designated water breaks ¡ Not visible ¡ Not available2.14 Drinking water inside is: ¡ Easily visible and self-serve at all times ¡ Easily visible and available on request

¡ Visible, but only available during designated water breaks ¡ Not visible ¡ Not available2.15 Does your written wellness policy cover any of the items listed in this section?

¡ Yes ¡ No ¡ N/A: no written wellness policy

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¡ Yes ¡ No

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Section 3: Food Environment and Feeding Practices

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3.1 Meals and snacks are prepared from scratch (i.e., from primarily raw ingredients).3

3.2 Staff eat or drink unhealthy foods (i.e., sweets, soda, chips) in front of the children: ¡ ¡ ¡ ¡ ¡ 3.3 When children request seconds, staff ask them if they are still hungry before serving more food: q N/A: Seconds are not allowed ¡ ¡ ¡ ¡ ¡

3.4 Staff require that children sit at the table until they clean their plates: ¡ ¡ ¡ ¡ ¡ 3.5 When children eat less than half of a meal or snack, staff ask them if they are full before removing their plates: ¡ ¡ ¡ ¡ ¡

3.6 Food served during meals/snacks reinforces the nutrition education the children receive about what to eat and what not to eat: q N/A: No nutrition ed. and/or no meals/snacks served

¡ ¡ ¡ ¡ ¡

3.7 Children help prepare their own meals or snacks: q N/A: No meals or snacks served ¡ ¡ ¡ ¡ ¡ Does your site serve meals? ¡ Yes ¡ No à skip to Q3.10 3.8 Meals are served family style (children serve themselves with limited help): ¡ ¡ ¡ ¡ ¡ 3.9 During meals, staff talk with children about trying and enjoying healthy food: ¡ ¡ ¡ ¡ ¡ 3.10 Celebrations and events include mostly healthy foods or non-food treats like stickers: ¡ ¡ ¡ ¡ ¡ 3.11 Fundraising consists of selling only non-food items (like wrapping paper, coupon books or magazines): q N/A: No fundraising ¡ ¡ ¡ ¡ ¡

3.12 Foods or beverages are used to encourage positive behavior or withheld to punish negative behavior: ¡ ¡ ¡ ¡ ¡

3.13 Does your written wellness policy cover any of the items listed in this section? ¡ Yes ¡ No ¡ N/A: no written wellness policy

Section 4: Gardens and Nutrition Education 4.1 There is access to an edible onsite or community garden (select all that apply):

q Onsite garden q Offsite community garden q No garden access à skip to Q4.64.2 Garden is incorporated into nutrition education:4

¡ 1 time per week or more ¡ 2-3 times per month ¡ 1 time per month ¡ Less than 1 time per month ¡ Never4.3 On average, produce from the garden is distributed to families:

¡ 1 time per week or more ¡ 2-3 times per month ¡ 1 time per month ¡ Less than 1 time per month ¡ Never4.4 Children tend the garden:5

¡ 1 time per week or more ¡ 2-3 times per month ¡ 1 time per month ¡ Less than 1 time per month ¡ Never4.5 On average, produce from garden is used in meals or snacks:

4.6 Staff participate in nutrition training opportunities: ¡ More than 1 time per year ¡ 1 time per year ¡ Less than 1 time per year or never

¡ 1 time per week or more ¡ 2-3 times per month ¡ 1 time per month ¡ Less than 1 time per month ¡ Never

¡ ¡ ¡ ¡ ¡

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Section 4: Gardens and Nutrition Education 4.7 Nutrition education is provided to children through an evidence-based curriculum:6

¡ 1 time per week or more ¡ 2-3 times per month ¡ 1 time per month ¡ Less than 1 time per month ¡ Never4.8 Nutrition education includes participatory/hands-on activities such as taste tests, food preparation gardening,

games, etc.: q N/A: No nutrition ed. ¡ All classes ¡ Most classes ¡ Some classes ¡ Few classes ¡ No classes

4.9 Does your written wellness policy cover any of the items listed in this section? ¡ Yes ¡ No ¡ N/A: no written wellness policy

Section 5: Physical Activity and Entertainment Screen Time7

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5.1 Television, videos, or any entertainment screens (personal or group) are on during meal or snack times: ¡ ¡ ¡ ¡ ¡

5.2 When entertainment screen time is offered, active alternatives are provided:8 ¡ ¡ ¡ ¡ ¡ 5.3 Staff participate in active games with the children during free play time: ¡ ¡ ¡ ¡ ¡ 5.4 Staff facilitate (i.e. organize, lead) physical activity during free play time: ¡ ¡ ¡ ¡ ¡ 5.5 Active play time is withheld for children when they misbehave: ¡ ¡ ¡ ¡ ¡ 5.6 When weather prohibits outside play, indoor active play is available to all: ¡ ¡ ¡ ¡ ¡ 5.7 During indoor and outdoor physical activity playtime, children are reminded to drink water: ¡ ¡ ¡ ¡ ¡

5.8 When weather permits, outdoor active play is provided for all: ¡ 2 or more times per day ¡ 1 time per day ¡ 2-4 times per week ¡ 1 time per week or less ¡ Never

5.9 Staff-led, age-appropriate physical activity is offered to all children: ¡ 2 or more times per day ¡ 1 time per day ¡ 2-4 times per week ¡ 1 time per week or less ¡ Never

5.10 Active free play time is provided to all children: ¡ More than 90 minutes per 8-hour day ¡ 46-90 minutes per 8-hour day ¡ Less than 45 minutes per 8-hour day

5.11 Children are seated (excluding meals and snacks) more than 30 minutes at a time: ¡ 1 time per day or more ¡ 2-3 times per week ¡ 1 time per week ¡ Less than 1 time per week ¡ Never

5.12 Television, video, and other entertainment screens (personal or group) are turned on: ¡ More than 30 minutes per after school session ¡ Less than 30 minutes per after school session ¡ Rarely or never5.13 Physical activity education (motor skill development) is provided for children through an evidence-based curriculum:6 ¡ 1 time per day or more ¡ 2-3 times per week ¡ 1 time per week ¡ Less than 1 time per week ¡ Never 5.14 Portable play equipment (wheel toys, balls, hoops, ribbons) consists of:

¡ Wide variety ¡ Some variety ¡ Little to no variety5.15 Fixed play equipment (tunnels, balancing equipment, climbing equipment, overhead ladders, stencils, playground markings) includes: ¡ Wide variety of equipment that accommodates needs of all or most children

¡ Variety of equipment that accommodate needs of some but not most children ¡ No fixed play equipment

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Section 5: Physical Activity and Entertainment Screen Time 5.16 Staff participate in physical activity training opportunities:

¡ More than 1 time per year ¡ 1 time per year ¡ Less than 1 time per year or never5.17 Does your written wellness policy cover any of the items listed in this section?

¡ Yes ¡ No ¡ N/A: no written wellness policy

Section 6: Parent/Family Involvement 6.1 The program involves parents as volunteers in the delivery of nutrition and physical activity education activities and services: ¡ Several times a year ¡ A few times a year ¡ Rarely or never6.2 Program parents/families help develop or implement policies and programs related to wellness:

¡ Always ¡ Usually ¡ Sometimes ¡ Not usually ¡ Never6.3 The program has a system for referring parents and families to nutrition and physical activity services and programs in the community that is:

¡ Comprehensive and well-organized with consistent referrals¡ In place, but needs improvement ¡ No referral system is in place

6.4 Nutrition education (workshops, activities, and take-home materials) is offered to parents: ¡ More than 1 time per year ¡ 1 time per year ¡ Less than 1 time per year or Never

6.5 Physical activity opportunities or promotions (workshops, activities, and take-home materials) are offered to parents: ¡ More than 1 time per year ¡ 1 time per year ¡ Less than 1 time per year or Never6.6 The nutritional content of foods and beverages served to students is made available to families:

¡ 1 time per week or more ¡ 2-3 times per month ¡ 1 time per month ¡ Less than 1 time per month ¡ Never6.7 Families receive guidelines about food and beverages that may be brought into the program by the family members or youth: ¡ Yes ¡ No 6.8 Easy-to-understand information about wellness policies are distributed to all parents at least annually:

¡ Yes ¡ No ¡ N/A: no written wellness policy

6.9 Does your written wellness policy cover any of the items listed in this section? ¡ Yes ¡ No ¡ N/A: no written wellness policy

Section 7: Breastfeeding Support7.1 A welcoming and private space is provided for mothers to breastfeed or express breast milk: ¡ Yes ¡ No

7.2 Refrigerator and/or freezer space is provided to store expressed breast milk: ¡ Yes ¡ No

7.3 Educational materials are provided for families on breastfeeding: ¡ Yes ¡ No

7.4 Staff participate in breastfeeding training opportunities: ¡ More than 1 time per year ¡ 1 time per year ¡ Less than 1 time per year or never

7.5 Does your written wellness policy cover any of the items listed in this section? ¡ Yes ¡ No ¡ N/A: no written wellness policy

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Section 8: Other Comments Section 1: Wellness Polices and Program Participation

Section 2: Meal and Snack Foods and Beverages

Section 3: Food Environment and Feeding Practices

Section 4: Gardens and Nutrition Education

Section 5: Physical Activity and Entertainment Screen Time

Section 6: Parent/Family Involvement

Section 7: Breastfeeding Support

Any other comments:

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Scoring:

Points Received Maximum Possible Points

Percent of Maximum Points Received

Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Total

Each section of this questionnaire has a different number of questions, so the maximum points possible varies by section. To compare how well your site has done in achieving the maximum points possible across sections, you can compare the Percent of Maximum Points Received (scale of 0-100%).

To consider where to focus future efforts you can consider which sections, and which items within the sections, have the most room for improvement.

To see your scores, click the button that says "Calculate" and then send your completed questionnaire to the email address below, unless your local health department contact has specified otherwise.

Email address to send the questionnaire to:

Please check your entries for accuracy and completion before pressing calculate. Once you press calculate, your data will be tabulated, and section and total scores will appear.

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Explanations and Definitions 1. This section refers to policies that relate to child wellness, NOT employee wellness.

2. If you are unsure or need more information about CACFP, ASES, or CCLC guidelines, visit:www.fns.usda.gov/cacfp/meals-and-snacks ORwww.cde.ca.gov/ls/nu/as/afterschoolnutstan.asp

3. Foods prepared primarily with ingredients that are in raw or close-to-raw states.Ingredients can be pre-washed or chopped, but should not be pre-sauced or cooked.Bread, dry pasta, unprocessed cheese, and meat pre-cooked for safety purposes maybe used.

4. Nutrition education refers to formal curriculum-based lessons.

5. "Tend to the garden" includes preparation for planting, weeding, watering, harvesting,etc.

6. Evidence-based curriculum refers to lesson(s) that have been tested and showneffective at improving healthy eating behavior or related factors, such as knowledge,attitudes, or self-efficacy.

7. Do not include educational or active screen time.

8. Entertainment screen time is time spent watching TV or DVDs, using computers, playingvideo or hand-held computer games, or using tablets or smart phones for leisure orrecreation. Does not include time spent using these devices for educational purposes.

Funded by USDA SNAP, an equal opportunity provider and employer.

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