Empower— an Arizona Program to Promote Healthy Childcare Settings

BACKGROUND:   Empower was developed by the Arizona Department of Health Services (ADHS) and first implemented as a pilot program in January 2010 to promote healthy environments for children in licensed childcare facilities. The program requires facilities to follow standards that focus on nutrition and physical activity, sun safety, smoke free environments, and oral health, in exchange for discounted licensing fees.  Initial study indicated that the program held promise. 

METHODS:   On July 1, 2013 updated Administrative Rules went into effect and a new assessment methodology was implemented to provide more information on key components of each standard and assess childcare employees’ perceptions of their levels of implementation.  Licensing staff incorporated a new monitoring tool into their site reviews.  Analysis of data from this tool will define and distinguish between different levels of compliance with written policies, monitor self-reports of implementation (none, partial, and full), identify barriers to implementation as well as successful strategies and best practices.  

RESULTS:  Preliminary results for the Empower standards among 432 licensed childcare facilities were analyzed for the last quarter of 2013.  At that time, 34% of Empower facilities reviewed had written policies with all ten components of the physical activity standards, although higher percentages of facilities self-reported that they had fully implemented those same components, including providing at least 60 minutes of daily physical activity (87%), limiting sedentary activity to less than 60 minutes at one time (88%), and limiting screen time to three hours or less per week (87%).  34% of Empower facilities had all six components of family-style meals in written policy, but higher proportions reported full implementation of those same components.  Only 25% of Empower facilities had all four components of the breastfeeding standard in written policy. 

CONCLUSIONS: Qualitative information collected during site reviews indicates that there is confusion over to whom breastfeeding policy applies.  Many stated that because they do not have infants in their centers, they did not believe the standards applied to them.  ADHS has identified this as an area for further education and training, as the standard applies to all settings, in order to accommodate staff, or even mothers of infants who enroll their older children in childcare.