LEADERS

Nemours took a closer look at programs in these 24 states. Based on reviews of program website and materials, application documents, and communications with state agency staff, we found the following:

• 13 states have voluntary, statewide recognition programs that challenge and encourage ECE programs to meet or exceed certain standards related to healthy eating and physical activity for young children. These programs usually have unique branding, are managed by a state agency or non-profit organization, and issue recognition or designation for a certain period of time (i.e., one to three years).
• 8 of the 24 states reported having a recognition program that used the Healthy Kids, Healthy Future quiz and/or NAP SACC self assessment tools. However, these tools are used by programs to develop an action or improvement plan, as part of QRIS or rating process, and to help providers identify a focus as part of quality improvement. While some states may use the results of these self-assessments to recognize providers through an existing QRIS program, the tools were not usually associated with a standalone recognition program/designation.
• 4 states appeared to have a recognition program at some point or a program linked to a particular intervention for ECE providers. However, upon closer examination the program appeared to be inactive.
  39 states reported having a recognition program, but we found no evidence of a statewide, all-encompassing program active. However, these states did appear to have active Breastfeeding Friendly Child Care recognition programs.

Characteristics of Recognition / Designation Programs

Reviews of programs focused on the 13 states that had an active, statewide, branded recognition program related to nutrition and physical activity – Arizona, California, Florida, Georgia, Louisiana, Missouri, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Utah. Programs in these states issue recognition based on multiple best practices and/or standards in healthy eating and physical activity.

These programs include the following characteristics:

Application and Criteria for Recognition:

• All 13 recognition programs are completely voluntary and include a standardized application process. Applications are downloaded electronically and submitted via e-mail or regular mail to a state agency contact, primarily a Department of Health (11 states) and in one instance, a Department of Education.
• Applicants must be licensed or license-exempt ECE programs. Some programs are only open to licensed ECE centers. Most programs seemed to focus on centers participating in CACFP.
• With the exception of Florida, Ohio, and Oklahoma, family child care homes do not seem to be the main focus for recognition programs.
• The applications varied in depth and intensity with some states requiring completion of a checklist based on standards/recommendations while other states had 10+ page questionnaires.
• All states require the submission of some supporting documentation in addition to the application as evidence of the program implementing wellness policies, healthy menus, or completing staff training on nutrition, physical activity, and/or breastfeeding support. In addition to these documents, some states require programs to complete self-assessments and/or participate in an in-person training on a specific topic such as child nutrition, physical activity or breastfeeding support.
• Four states (Missouri, Utah, South Carolina, Georgia) have an in-person visit (via TA specialist or QRIS visit) and/or verification visit as part of the application process.
• The Missouri and Florida programs required the submission of photos.

Recognition Time Period:

• All states recognized providers for at least one year. A few states allowed ECE programs to keep their recognition status for three years.
• Most recognition programs required ECE programs to submit updated documentation as part of the renewal process. Most states also reported the renewal process tends to be less stringent. However, other recognition programs require ECE programs to achieve the same expectations specified during the original enrollment.

Recognition Formats:

• All states provided different levels of recognition, usually three (e.g., bronze, silver, gold). This method allows for ECE programs to achieve some level of recognition and make progress toward higher levels. For instance, the minimal level of recognition may align with CACFP standards. However, none of the states had any information on programs that moved from one level to the next, e.g. silver to gold.
• All states branded their recognition/designation program so the recognition could be easily marketed and identifiable. Program names include Missouri’s Eat Smart, MOve Smart, California’s Shaping Healthy Impressions through Nutrition and Exercise (SHINE), Ohio’s Healthy Programs, and Tennessee’s Golden Sneaker.
• Nearly all recognition programs showcased recognized facilities on their websites with names and addresses. Those states that don’t have the list currently available online do make it available upon request. However, none of these websites seem to be targeting or attracting families that would be looking for general information on child care centers.
• Many ECE programs also received certificates or stickers which can be placed on the entrance of the facility to let families know the program had been recognized for healthy eating, active play and/or breastfeeding support.
• Some states recognized providers at statewide conference or annual training events.
• A few states provided sample press releases, parent letters, and menu templates with the recognition program logo. These seem to be helpful in promoting the recognition to families and providing tools and resources to centers.

Other Characteristics:

• Regardless of the complexity of the application, all states have a general uptake (e.g., percentage of total ECE centers recognized) of approximately 4-5%. Only Utah had an uptake of 17% but this was due to the overall low number of ECE centers in the state (approximately 300). The other outlier was South Carolina which has fully incorporated health and nutrition standards into their QRIS, in which 60% of licensed programs choose to be rated.
• Some states offer Technical Assistance to help ECE programs complete the application requirements and/or develop an action plan to improve their recognition level. One state offers the opportunity for “additional resources” depending on funding but it was not clear what these resources include.
• All recognition programs indicate the need for a dedicated managing entity to promote the program, receive and review applications, communicate with applicants, issue recognition materials, and, oversee renewal process, if applicable.
• Only three state’s programs (Georgia, Ohio and South Carolina) seemed directly linked to the state’s QRIS.
• Only two state programs (Oklahoma and Louisiana) recognizes other organizations (schools, restaurants, businesses, college/universities, hospitals and worksites) in their recognition program.

Reviews of healthy eating and physical activity recognition programs for ECE programs

Arizona

Program Name: Empower

Description: Part of the SNAP-Ed Strategies and Interventions Toolkit. Arizona Department of Health Services developed the Empower Program in 2010 as a voluntary program to support licensed ECE facilities’ efforts to empower young children to grow up healthy

Criteria for Recognition: All licensed Arizona’s child care centers and child care small group homes who enroll in the Empower program must meet the 10 Empower Standards. If providers meet all 10, they get a reduction on licensing fee. Must be licensed by the Arizona Department of Health Services (ADHS) Bureau of Child Care Licensing (BCCL). ECE providers could voluntarily agree to implement the Empower Standards in exchange for discounted licensing fees of 50 percent.

Recognition Time Period: Revisited every three years when licensing fees are renewed

Number of Programs Recognized: The data is collected by Department of Health Services but not available on their website.

California

Program Name: Shaping Healthy Impressions through Nutrition and Exercise (SHINE)

Description: SHINE is a voluntary nutrition and physical activity recognition program for licensed child care centers and family child care homes in California. The program is designated for child care sites that participate in a federal child nutrition program, such as the Child and Adult Care Food Program (CACFP) or the National School Lunch Program and serve preschool-aged children (ages 2-5). Funded by the California Department of Education ‐ Nutrition Services Division (CDE‐NSD)

Bronze Certified = Four Required Elements + Two Elective Elements of their choice
Silver Certified = Four Required Elements + Four Elective Elements of their choice
Gold Certified = All Ten Elements

Criteria for Recognition: The Preschools SHINE program consists of 10 elements that foster healthy habits during the early years of growth and development.

1. Participation in a Federal Child Nutrition Program (Required)
2. Meal Quality (Elective)
3. Mealtime Environment (Elective)
4. Nutrition Education (Required)
5. Edible Gardening (Elective)
6. Physical Activity (Elective)
7. Professional Development (Required)
8. Wellness Policies (Elective)
9. Partnerships (Elective)
10. Leadership Team (Required)

Recognition Time Period: The site is recognized as a Preschools SHINE site for four years. To reapply, they need to complete 15 additional continuing education units (CEU) related to nutrition, physical activity, and/or wellness education in the past four years and submit another application.

Number of Programs Recognized: List of Certified Sites from California Department of Education ‐ Nutrition Services Division

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Program Name: Healthy Apple in San Francisco

Description: The Healthy Apple Program is available for free to all child care providers in San Francisco. Healthy Apple supports child care providers in implementing research-based best practices in nutrition and physical activity for children from birth to age 5. The program includes (1) a self-assessment of current practices; (2) goal-setting assistance to improve those practices; and (3) resources, workshops and coaching to help meet these goals.

Criteria for Recognition: Once a year, all Healthy Apple Program participants are considered for Bronze, Silver, and Gold Healthy Apple Awards in the areas of Nutrition and/or Physical Activity. Winners are recognized at a public awards ceremony. The first time one participates in a program, one must complete two self-assessments to provide baseline and improvement data. Most child care providers can complete the following steps within six to eight months:

1. Self-Assessment: Providers can choose to take either or both the Nutrition or Physical Activity Assessments at any time. The online versions are currently available in English. Participants are reminded to re-take the-self-assessment by September 30 to qualify for the awards, which are given each Fall.
2. Setting Goals/Action Plan: A Feedback Report, highlighting areas for potential improvement, is immediately available after completing the self-assessment online. Providers choose a few key items to work on and use the online Action Plan to think through what is needed to complete their goals.
3. Utilize Targeted Resources: Online resources specific to goals selected are provided, including tip sheets, curriculum, parent handouts, posters, monthly newsletters, and videos.
4. Attend Workshops: Healthy Apple offers many free workshops on nutrition, physical activity, and policy development annually. Topics are based on recent self-assessment results from all participants to address areas of greatest needs. Workshops are held on weeknights and weekends.
5. Technical Assistance Support: At any time, providers can call, email, or schedule an appointment with Healthy Apple staff to learn more about the program or self-assessment tool, receive technical help, or discuss ways to achieve goals.

Recognition Time Period: Child care providers are encouraged to participate in the Healthy Apple Program annually to continue implementing best practices and improve their award level.

Number of Programs Recognized: Award Winners are listed on the Healthy Apple website

Florida

Program Name: Florida Early Care and Education Award

Description: The Florida Early Care and Education (ECE) Recognition program is open to early care and education centers that are licensed by the Florida Department of Children and Families. Recognized programs will receive a door/window decal and a certificate to be prominently displayed, and will be listed on the Florida ECE Recognition website. The program may also be highlighted in the media and at community events. The Florida ECE Recognition Program works to encourage the promotion of best practices related to:

1. Healthy Child Nutrition
2. Healthy Beverages
3. Support of Infant Feeding Practices
4. Physical Activity
5. Limited Screen Time

Criteria for Recognition: Early care and education (ECE) programs that are licensed/registered are eligible to participate. ECE program staff completes a standard application providing basic information, including the license/registration number of the program(s). The application packet includes the following:

• The application (must be submitted online or mailed)
• Affidavit signed by the program director. Affidavit it a commitment to healthy eating and physical activity best practices in the ECE program.
• Copy of Training certificates to meet the training requirements.
• Copy of selected Benchmark Menus for consideration
• Copies of Policies as indicated by selected benchmark menu items
• Photographs of Benchmark Menu best practices as indicated by selected benchmark item.

Recognition Time Period: Recognition lasts for two years.

Number of Programs Recognized: Available list of recognized programs on website

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Program Name:  Healthy Sarasota County — Child Care (Sarasota County)

Description: Healthy Sarasota County — Child Care helps child care facilities improve the health and wellness of children in their care. Using the 5, 2, 1, 0 message, the program provides consistent guidance to address the policies, practices, and environments that influence healthy lifestyle behaviors. Centers are awarded a designation of Platinum, Silver, or Bronze based on five benchmarks.

Criteria for Recognition:

1. Submit the Healthy Sarasota County Child Care Application & Affidavit
2. Attend a two-day Healthy Sarasota County Child Care Training
3. Create an Action Plan through Healthy Kids, Healthy Future
4. Evaluate site and set goals

Recognition Time Period: All programs must renew their recognition every year.

Number of  Programs Recognized: Available list of designated programs
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Program Name: Healthy Okaloosa 5210 (Okaloosa County)

Description: The Healthy Okaloosa 5210 initiative launched in July 2014 and is designed to reach children in early childhood education. This includes childcare facilities and childcare homes. Healthy Okaloosa Child Care uses a variety of evidence-based practices to help early childhood education providers improve the health of their students, families and staff. Providers are encouraged to implement sustainable policy and environmental strategies that support healthy behaviors in the in the childcare setting. The DOH-Okaloosa Healthy Okaloosa Child Care team provides training, resources, and technical assistance to all partners.

The program promotes the 5-2-1-0 Challenge:

• 5: Eat 5 or more servings of fruits and vegetables daily
• 2: Trim screen time to 2 hours or less a day
• 1: Move More–be active at least 1 hour every day
• 0: Drinks lots of H20 (water) and 0 sugary drinks

Criteria for Recognition: All providers interested in obtaining recognition in the Healthy Okaloosa program must complete the following steps:

1. Create an action plan.
2. Create a policy pertaining to the 5210 message or environmental policy that is sustainable.
3. All programs must perform at least one center activity and one parent engagement activity.

The Healthy Okaloosa program also holds an award ceremony at the end of the year for all programs who participated in the program.

Recognition Time Period: All programs must renew their recognition every two years. However, the renewal process is different. For re-certification, all programs must complete 2 out of 3 online trainings and develop a new policy or environmental policy.

Number of Programs Recognized: List of programs is available upon request

Georgia

Program Name: Growing Fit Kit: Wellness policies in Georgia’s Early Care Providers linked to the state’s QRIS

Description: The Growing Fit Kit is intended to guide providers in the development or improvements to policies around nutrition and physical activity. This tool kit can also help you move toward achievement of Quality Rated standards by helping you meet what the Department of Early Care and Learning (DECAL) refers to as Quality Rated Portfolio Standard 2.1.

Criteria for Recognition: Department of Early Care and Learning’s (DECAL) Quality Rated Recognition
Quality Rated is Georgia’s system to assess, improve, and communicate the level of quality in early education and school-age care programs. Similar to rating systems for hotels or restaurants, Quality Rated assigns a rating (e.g., one star, two star, or three star) to early education and school-age care programs that go above and beyond minimum licensing standards. By participating in Quality Rated, child care programs demonstrate their commitment to continuous quality improvement. Hundreds of providers have accepted the challenge to embark on a path of continuous quality improvement. Improved physical activity and nutrition are a part of achieving Quality Rated.

There are three steps to Quality Rated recognition:

1. Application: Create an account and complete a brief application with demographic information about your program to get started on the path to becoming Quality Rated.
2. Portfolio: Earn points by submitting evidence of the credentials and training of the teaching staff; your program’s commitment to child health and physical activity; the ways you support family engagement; practices around instruction and curriculum; and your classroom ratios and group size. The information in this tool kit can help you achieve some of the requirements for Portfolio Standard #2.
3. Assessment: Earn points based on your support of the development of children’s reasoning skills, social-emotional development, language, and school readiness.

Recognition Time Period: Annual verification

Number of Programs Recognized: Growing Fit has trained 232 educators from 94 centers, reaching 7,785 children.

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Program Name: SHAPE Award

Description: The SHAPE award honors and recognizes early care and education programs that employ exceptional nutrition and physical activity practices that go above and beyond current licensing standards. The award is open to all child care facilities that become Quality Rated through Bright from the Start.

Criteria for Recognition: The Georgia Department of Public Health and Bright from the Start will use information obtained from the Quality Rated Portfolio to determine which centers qualify to receive the SHAPE Award.

• Centers must be Quality Rated.
• Information submitted in Quality Rated Standard Two: Child Health, Nutrition and Physical Activity will be reviewed and scored: programs must have a score of 85% or higher to receive the SHAPE Award.

All programs that qualify for the award will be contacted by the Georgia Department of Public Health to confirm the information from their Quality Rated Portfolio and will agree to be recognized for their achievement in becoming a SHAPE Award recipient.

Recognized child care programs will receive:

• A certificate of achievement signed by the Governor
• Georgia SHAPE decals that can be placed on the entrance(s) of the facility
• Access to the Georgia SHAPE logo onlin
• Inclusion on the Georgia SHAPE list of designated child care facilities

Recognition Time Period: Quality rated star ratings are awarded for a three-year period, however providers must renew their star rating each year.

Number of Programs Recognized: Current list of SHAPE child care facilities

Louisiana

Program Name: Well-Ahead (Child Care Center WellSpots)

Description: A Well-Ahead designation program provides positive publicity for programs. Centers will receive recognition from the Secretary of the Louisiana Department of Health and the Office of Public Health Assistant Secretary. Recognized programs will also be placed in the searchable network of WellSpots, supplied with a sample press release, and be given a window cling and digital graphics they can use to highlight their designation.

Criteria for Recognition: The WellSpot designation process begins with registration and an online assessment. All child care center WellSpots must be designated tobacco-free locations. In addition to being tobacco-free, child care centers may meet additional wellness benchmarks.

Level One:

• Tobacco-free policy
• All benchmarks met

Level Two:

• Tobacco-free policy
• NAP SACC or Healthy Kids, Healthy Future quiz
• Five additional benchmarks of choice

Level Three:

• Tobacco-free policy
• Three additional benchmarks of choice

Recognition Time Period: There is no designated end period. However, there is an option for WellSpots to move up one level.

Number of Programs Recognized: A database of WellSpots is available

Missouri

Programs: Eat Smart, MOveSmart

Description: A suite of recognition programs overseen by the Department of Health and Senior Services (DHSS). The recognition programs focus on child care centers and family child care homes participating in CACFP (for Eat Smart). The criteria for each programs varies slightly.

Successful applicants receive a certificate, window cling, and recognition on the DHSS website.

Criteria for Recognition: The Eat Smart guidelines are divided into three levels: minimum, intermediate, and advanced. The minimum level is the same as CACFP meal pattern requirements and Missouri State Licensing requirements. Programs are required to submit their policies, weekly schedules, equipment checklist, photos, and list of physical activity trainings completed by staff.

Recognition Time Period: Annual with opportunity for renewal

Number of Programs Recognized: MOve Smart Child Care Recognition Awards list

New Mexico

Program Name: Healthy Kids, Healthy Child Care (HKHC)

Description: The Healthy Kids, Healthy Childcare program is a partnership between the New Mexico Department of Health and Healthy Kids New Mexico to create healthy environments and programs to give kids what they need to play well, eat well, learn well, and live healthy and full lives. Simply put, healthy eating and physical activity are two lifestyle choices that prevent obesity and subsequent chronic disease.

The program promotes the 5-2-1-0 Challenge:

• 5: Eat 5 or more servings of fruits and vegetables daily
• 2: Trim screen time to 2 hours or less a day
• 1: Move More–be active at least 1 hour every day
• 0: Drinks lots of H20 (water) and 0 sugary drinks

Healthy Kids Healthy Childcare aims to train childcare providers from licensed childcare centers and home-based daycares about the initiative and encourages completing a self-assessment and action plan for each childcare facility.

Successful programs will receive:

• Silver Certificate Award: Successfully complete and submit Physical Activity and Screen Time Tracker and description of parent engagement component.
• Gold Certificate Award: Must fulfill Silver requirements plus participation in at least two trainings and submission of portfolio on how challenge was implemented (may include photos, monthly calendar, lesson plans, success stories, etc.).
• A recognition award at the CACFP Childcare Center Annual Training or at the Outreach Workers Conference in October as the Statewide HKHC Champion of the Year
• A feature article in the CYFD Visionary Statewide Newsletter

Criteria for Recognition:

1. Commit to increasing physical activity to 120 minutes a day and screen time to 30 minutes or less per week.
2. Attend training and receive technical assistance on how to implement the Healthy Kids Healthy Childcare Challenge.
3. Implement the Challenge for 4 consecutive weeks during childcare hours.
4. Complete the Physical Activity & Screen Time Tracker every day of the Challenge.
5. Implement a parent education component that supports increased physical activity and decreased screen time at home.
6. Submit completed Physical Activity & Screen Time Tracker and required materials

Recognition Time Period: Seems to have operated as a time-limited initiative in 2014-2015 and it is currently being updated per DOH website. The HKHC challenge operated as a 4-week initiative to increase physical activity and decrease/eliminate screen time in child care programs across the state. The challenge is for registered and licensed home childcare providers and licensed center child care teachers with pre-school age children.

Number of Programs Recognized: Based on available information, recognition appeared to be one time.

North Carolina

Program Name: Be Active Kids

Description: This is an interactive health program for children ages birth to five is available to adults working in child care centers, child care homes, and schools across North Carolina. Eligible providers must interact regularly with children birth to five and may include teachers, directors, floaters, nutritional service staff, and recreation coordinators. Providers typically are associated with family child care homes, private child care centers, faith-based child care facilities, Head Start staff, pre-k or kindergarten classroom teachers, before and after school staff, YMCA/YWCA staff, and parks and recreation staff. This program utilizes a developmentally appropriate curriculum kit and various training modules to increase physical activity of both children and adults in early childhood settings. In addition to the curricula, Be Active Kids offers several training modules, based on our 10 components, to assist in the continuing education of early childhood professionals. Training modules vary in length from one to five hours and are intended to be connected together to develop a deeper level of competence while assisting educators in gaining CEUs towards certification

Criteria for Recognition: Childcare providers can become a part of the Be Active Kids network by attending a 3 hour Be Active Kids training provided by one of our many statewide volunteer trainers. Be Active Kids trainers attend a 5 hour training provided by Be Active Kids staff. The recognition for the child care program includes program material (the kit), a training certificate and 3 Contact Hour Credits (CHCs approved by NCaeyc and DCDEE), and school promotional/marketing materials. The certification for the trainers includes the program materials (the kit), a play package, a training certificate and 4.5 CHCs, and trainers guide. Be Active Kids also uses a center wide recognition program (only a few centers are being piloted directly with Be Active Kids but have integrated this into a larger initiative in the state called Shape NC) in which centers must address specific health-related components in order to be a Be Active Center/School of Excellence (Model Early Learning Center/Demonstration Site)

Recognition Time Period: Childcare providers are Be Active Kids “recognized” as long as they continue to use the program. Trainers remain “certified” as long as they conduct either two provider trainings a year or one provider training and community outreach activity. If not, they become inactive and must retake the train-the-trainer in order to be active and able to access provider trainings and free Be Active Kids resources. The centers/schools must continue to provide action plans showing ongoing progress around the health-related components.

Number of Programs Recognized: Not available.

Ohio

Program Name: Ohio Healthy Programs

Description: Ohio Healthy Programs is funded by the Ohio Department of Health and in part by a cooperative agreement with the Centers for Disease Control and Prevention. The project offers early care and education programs the opportunity to earn recognition as an Ohio Healthy Program.

Criteria for Recognition:

Steps toward designation include:

1. Attend an approved professional development which uses the Healthy Children, Healthy Curriculum; and
2. Implement at least one wellness policy, demonstrate improvement in the children’s menu, and achieve at least one healthy family engagement activity.

OCCRRA recognizes programs that meet the OHP requirements. Each program receives an award letter and certificate. As funding allows, programs may receive additional recognition items.

To maintain OHP status, programs need to complete these four steps:

1. Ensure staff is trained in the curriculum
2. Submit current menu that demonstrates adherence to OHP standards
3. Submit at least one new healthy policy
4. Submit at least one new healthy family engagement activity

Recognition Time Period: Programs remain designated as OHP for one calendar year.

Number of programs recognized: Current Ohio Healthy Programs

Oklahoma

Program Name: Certified Healthy Early Childhood Program

Description: Certified Healthy Early Childhood Program recognizes early childhood programs that are working to improve the health of children, families, and staff by providing wellness opportunities and implementing policies that lead to healthier lifestyles. The Oklahoma Turning Point Council and the Oklahoma State Department of Health, Center for the Advancement of Wellness administer the program.

Criteria for Recognition: Early childhood programs of all types and sizes are encouraged to apply to become a Certified Healthy Early Childhood Program. Programs must be at least smoke-free in order to apply. A program must be tobacco-free and submit a copy of their tobacco-free policy. The program must be licensed by OKDHS to be eligible to apply for the Certified Healthy Early Childhood Program or be exempt from licensure.

Exemptions: Care provided in a child’s own home or by relatives, informal arrangements for the occasional care of children, programs in which children attend on a drop-in basis and parents are on the premises and readily accessible, single activity programs, and programs operating for 15 hours or less per week.

Applicants select activities and policies that are currently offered by their early childhood program in each of seven criteria categories:

1. Nutrition
2. Physical Activity
3. Health Promotion
4. Safe and Healthy Environment
5. Community and Family Involvement
6. Professional Development
7. Staff Health

There are 62 total criteria, including some multiple-option criteria (i.e., check all that apply), and a total of seven criteria with a possible “not applicable” (N/A) response, dependent upon the program’s situation.

Early childhood programs are scored according to type of program, and each criterion selected is worth one point. Certification status is assigned according to the percentage of criteria selected by the applicant in each category. A smoke-free policy is required for Basic/Merit, and a tobacco-free policy submitted with the application is required for Excellence.

Recognition Time Period: Certified Healthy Early Childhood Programs are recognized for one year. If an applicant wishes to apply for re-certification, a new application is required.

Number of Programs Recognized: List of Past Winners

South Carolina

Program Name: Grow Healthy and ABC Quality

Description: The ABC Center Standards at all levels now include nutrition and physical activities standards. ABC Quality has partnered with the SC Department of Health and Environmental Control (SC DHEC) for several years to develop these standards as ABC’s response to the growing state and national concern about childhood obesity. Grow Healthy sets forth policies and activities that promote children’s health and well-being through good nutrition and healthy exercise.

The Level A, B, and C Standards include the new Grow Healthy standards for each level. The Grow Healthy standards are highlighted in yellow in the Level B Standards.

Criteria for Recognition: Multiple requirements to meet per Level (i.e., A, B, C)

Recognition Time Period: Annual, with unannounced reviews

Number of Programs Recognized: Approximately 60% of all regulated providers choose to be rated in ABC Quality. There about 1,500 licensed programs in the state.

Tennessee

Program Name: Gold Sneaker Initiative

Description: The Gold Sneaker Initiative was developed to enhance policies related to health and wellness within licensed child care facilities across Tennessee. Recognition as a Gold Sneaker facility includes:

• A certificate of achievement signed by the Governor.
• Two Gold Sneaker stickers which can be placed on entrance(s) to the facility or used in promotional activities for the facility.
• Access to an electronic Gold Sneaker logo to be used in materials produced by the facility
• Recognition on the following Web sites: Department of Health and the Gold Sneaker Web sites.

Criteria for Recognition: Programs desiring “Gold Sneaker” designation must provide to the Department of Health the following documentation annually:

1. A copy of the program’s policies clearly stating Gold Sneaker Policies 1.1-1.9
2. A copy of the feeding plan form in use by the program demonstrating compliance with Gold Sneaker Policy 1.5.
3. Documentation that the director (if center-based program) and teaching staff have completed Gold Sneaker training. If the program is a family or group child care program, the provider must provide documentation of completion of training.

Recognition Time Period: Programs remain recognized for one calendar year.

Number of Programs Recognized: List of recognized Gold Sneaker Facilities

Utah

Program Name: Targeting Obesity in Preschools and Child Care Settings – TOP Star Program

Description: TOP Star – Targeting Obesity in Preschools and Child Care Settings – is a program developed by the Utah Department of Health, local health departments, and other partners to help prevent obesity among children in childcare. The goal of TOP Star is to help childcare providers improve their nutrition and physical activity environments. The TOP Star Program consists of two components:

1. A training course, which is available through local health departments and Care about Childcare agencies.
2. A consultation and technical assistance program, which is available through local health departments.

Criteria for Recognition: Childcare providers electing to complete the full TOP Star program receive in-depth technical assistance with a trained local health department consultant. Upon completion of a process that includes self-assessment, goal setting, and the implementation of an action plan, childcare providers who demonstrate improvement in physical activity and nutrition environments are eligible to receive a TOP Star endorsement.

Recognition Time Period: The endorsement is valid for three years. After three years, endorsed childcare providers are encouraged to reapply for endorsement, which involves completing a new self-assessment.

Number of Programs Recognized: List available of Endorsed Facilities

Reviews of breastfeeding recognition programs

Alabama

Program Name: Alabama’s Baby-Friendly Hospitals

Recognition Program Description: Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive, and retain, a Baby-Friendly designation.

Alaska

Program Name: Breastfeeding Loving Support

Recognition Program Description: The goal of the Loving Support project is to create sample graphics and messages that could be used by WIC agencies and partners to reach participants, eligible participants, and the public. Messages were developed using content from the Loving Support campaign materials and Loving Support peer counseling training.

Arizona

Program Name: Cochise County Breastfeeding Friendly Childcare Recognition Program

Recognition Program Description: Flagship program for county recognition of child care centers that are certified breastfeeding friendly. County certification and database recognizes providers who go above and beyond minimum breastfeeding requirements. Licensed childcare providers are required to have breastfeeding policies.

Arkansas

Program Name: Baby Friendly Arkansas

Recognition Program Description: Baby Friendly Arkansas participating facilities are provided with on-going coaching and technical assistance from program coordinators through monthly coaching calls and webinars. In addition to a Summit and on-going support, Baby Friendly Arkansas hosts a Certified Lactation Counselor (CLC) course where each birthing facility can send representatives to complete a 45-hour educational program providing the competencies and skills required to provide safe, evidence-based counseling for pregnant, lactating, and breastfeeding women.

California

Program Name: California Breastfeeding Coalition

Recognition Program Description: The California Breastfeeding Coalition is committed to helping all 251 birthing hospitals and birth centers in California to achieve Baby-Friendly designation by 2025. Currently, California leads the nation with 102 designated Baby-Friendly hospitals.

• Developing and implementing a written breastfeeding policy;
• Ensuring all staff are aware of their policy; and
• Informing employees about accommodating their breastfeeding needs before and after parental leave.

Colorado

Program Name: Colorado Baby-Friendly Hospital Collaborative

Recognition Program Description: The CDPHE’s Baby-Friendly program outlines policies and standards that improve support for breastfeeding. The program is part of the Colorado Healthy Hospital Compact, an agreement by hospitals that share a mission to protect and promote the health of patients, families, visitors and staff by providing healthier high-quality nutrition. In doing so, hospitals are working to develop a culture of wellness and contributing to the state’s goal of making Colorado the healthiest state.

Connecticut

Program Name: Connecticut Breastfeeding Coalition 

Recognition Program Description: Connecticut state law allows breastfeeding in public and requires employers to make accommodation at the workplace. There is also a Campus Initiative which creates secure and private spaces in various parts of campuses in addition to lactation rooms.

Delaware

Program Name: Delaware Baby-Friendly Hospital Initiative

Recognition Program Description: The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that help parents make an informed choice about infant feeding. The BFHI assists hospitals in giving mothers information, confidence, and skills needed to successfully initiate and continue breastfeeding, and gives special recognition to hospitals that have done so. Four Delaware hospitals — Beebe Healthcare, Milford Memorial Hospital, Kent General Hospital, and Christiana Care Health System — have received the Baby-Friendly Hospital designation. Saint Francis Hospital is working towards designation.

Florida

Program Name: Florida Child Care Food Program — Breastfeeding Friendly Child Care Facility designation

Recognition Program Description: Complete the child care facility self-assessment to find out if your child care facility qualifies. If your facility meets all six standards and has a breastfeeding policy, you may qualify to receive the Florida CCFP Breastfeeding Friendly Child Care Facility designation.

Georgia

Program Name: Georgia 5-STAR Hospital Initiative

Recognition Program Description: Georgia’s 5-STAR Hospital Initiative was developed to recognize hospitals that have taken steps to promote, protect, and support breastfeeding. A five star system has been developed to encourage maternity centers to promote and support breastfeeding one step at a time. Georgia’s 5-STAR will award one star for every two steps implemented of the Ten Steps to Successful Breastfeeding, as defined by the World Health Organization (WHO) and Baby-Friendly® USA.

Hawaii

Program Name: Breastfeeding for Business — Comprehensive Lactation Support Program

Recognition Program Description: Healthy Mothers Healthy Babies Coalition of Hawaii assists businesses in providing support for workplace breastfeeding. Many companies develop comprehensive lactation support programs and provide additional support to their breastfeeding employees.

As of July 1, 2013, all Hawaii employers are required to provide:

• A reasonable break time for an employee to express milk for the employee’s nursing child for one year after the child’s birth, each time the employee has a need to express breast milk.
• A location, other than the restroom, that is shielded from view and free from intrusion from coworkers and the public that may be used by an employee to express breast milk.

Idaho

Program Name: Idaho Baby-Friendly Hospitals

Recognition Program Description: The mission of the Idaho Breastfeeding Coalition is to facilitate a community and statewide landscape that protects, supports, and promotes breastfeeding as the biological norm for a healthier Idaho.

Illinois

Program Name: Kane County Breastfeeding Friendly Workplace Recognition Program

Recognition Program Description: The Breastfeeding Friendly Workplace Recognition is an initiative of the Kane County Breastfeeding Coalition. Employers have been recognized at the Bronze, Silver, and Gold recognition levels. They are listed on the Coalition webpage and will also get a certificate in the mail.

Kansas

Program Name: Kansas Breastfeeding Friendly Child Care Designation

Recognition Program Description: Child Care Aware® of Kansas recognizes child care providers in Kansas who provide support to breastfeeding families and employees through the Breastfeeding Friendly Child Care Designation. To receive the designation, child care providers must meet five criteria that demonstrate a culture of breastfeeding support. Programs receiving the Breastfeeding Friendly Child Care Designation will receive a certificate, a window cling, and be recognized in the Provider Profile information that is distributed through the Child Care Aware® of Kansas Referral Center to families.

Louisiana

Program Name: The Gift (Breastfeeding-Friendly Designation Program)

Recognition Program Description: The Gift is an evidence-based program for Louisiana birthing facilities designed to increase breastfeeding rates and hospital success by improving the quality of their maternity services and enhancing patient-centered care. The Gift is a program of the Louisiana Department of Health, Office of Public Health, and Bureau of Family Health. It has been adapted from the Texas Ten Step Program and the North Carolina Maternity Center Breastfeeding-Friendly Designation Program.

Maine

Program Name: 6 for ME

Recognition Program Description: The 6 for ME initiative provides support to Maine healthcare professionals and birth hospitals to adopt six of the evidence-based Ten Steps to Successful Breastfeeding. Breastfeeding outcomes are dependent on the number of steps a hospital implements. Implementing at least six of the ten steps has the greatest impact on breastfeeding outcomes short of implementing all ten steps. The long-term goal of 6 for ME is to increase breastfeeding duration.

Maryland

Program Name: Breastfeeding-Friendly Workplace Awards

Recognition Program Description: Employees enrolled in a company-provided lactation support program is a win-win situation. Employers benefit through increased rates of retention, employee satisfaction, and morale. The health benefits of breastfeeding for mother and baby equate to decreased health care and insurance costs, and a reduction in sick leave requests to care for an ill child.

Massachusetts

Program Name: Massachusetts Baby-Friendly Designation Program

Recognition Program Description: Using the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breastmilk Substitutes. BFUSA is responsible for coordinating and conducting all activities necessary to confer the Baby-Friendly designation and to ensure the widespread adoption of breastfeeding best practices.

Michigan

Program Name: Michigan Breastfeeding-Friendly Workplace Award

Recognition Program Description: In partnership with Michigan Department of Health and Human Services, the Michigan Breastfeeding Network is working to catalyze a “race to the top” among Michigan employers. These awards recognize businesses that are in compliance with the Break Time for Nursing Mothers Law and celebrate businesses that go beyond the law’s requirements to support working families.

Minnesota

Program Name: Minnesota Breastfeeding Friendly Recognition Program

Recognition Program Description: Minnesota maternity centers, child care providers, workplaces, and health departments are being recognized as Breastfeeding Friendly. The Minnesota Department of Health recognizes family child care homes and child care centers that have taken steps to become breastfeeding friendly.

Mississippi

Program Name: Business Case for Breastfeeding

Recognition Program Description: Business Case for Breastfeeding is a comprehensive program designed to educate employers about the value of supporting breastfeeding employees in the workplace. The program highlights how such support contributes to the success of businesses. The Business Case for Breastfeeding offers tools to help employers provide worksite lactation support and privacy for breastfeeding mothers to express milk.

Missouri

Program Name: Missouri Breastfeeding Friendly Child Care

Recognition Program Description: The Missouri Department of Health and Senior Services (DHSS) would like child care providers to successfully support breastfeeding families. Becoming a Breastfeeding Friendly Child Care is a voluntary recognition program available to Missouri child care facilities. To receive the award, child care providers must meet the below criteria that aim to improve the support for breastfeeding women in the workforce.

1. Has a written policy that reflects their support of breastfeeding
2. Provides a welcoming environment for breastfeeding families
3. Offers breastfeeding resources to parents
4. Feeds infants on demand and communicates with moms about feeding preferences
5. Trains staff to support breastfeeding parents

Montana

Program Name: Healthy Gallatin Breastfeeding Friendly Worksite Award

Recognition Program Description: Healthy Gallatin and the Gallatin Breastfeeding Coalition recognizes employers in Gallatin County that provide worksite breastfeeding support for employees with the Healthy Gallatin Breastfeeding Friendly Worksite Award. In accordance with Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) and the 2010 amendment, employers are evaluated based on criteria for three levels of support: Gold, Silver, and Bronze.

Nebraska

Program Name: Nebraska Breastfeeding Friendly Business

Recognition Program Description: Recognize your business as one of Nebraska’s Breastfeeding-Friendly (BFF) Businesses. Supporting breastfeeding mothers in the work place is not only the law, but is one way for businesses to embrace wellness, impact health care costs, lower absenteeism, and be seen as a family-friendly business for potential and current employees. Businesses of all sizes and types are encouraged to apply to share creative solutions to support breastfeeding mothers and employees.

Award Criteria includes:

• Business offers a welcoming atmosphere that allows breastfeeding mothers to nurse or express milk in a designated location.
• Business provides breastfeeding mothers access to a private room, other than a bathroom, for expressing milk or nursing.
• The room has supportive amenities including, but not limited to: a comfortable chair, a lock on the door, a small table, and an electrical outlet.
• Business provides all breastfeeding employees flexible breaks to express milk or nurse.
• Business has an informal or formal breastfeeding support policy.
• Business educates all staff to the breastfeeding support policy.

Nevada

Program Name: Nevada Breastfeeding Friendly Child Care Designation

Recognition Program Description: Nevada’s Breastfeeding Friendly Child Care Designation has been developed to recognize child care providers who have taken steps to promote, protect, and support breastfeeding in their programs. Child care providers who have met requirements outlined are encouraged to apply for this distinction. Awardees will receive a Certificate of Recognition, a campaign sticker, poster, and inclusion on the campaign website.

New Hampshire

Program Name: New Hampshire Breastfeeding Friendly Child Care Award

Recognition Program Description: The New Hampshire Breastfeeding Task Force aims to promote, protect, and support breastfeeding. All New Hampshire-licensed child care programs are eligible to apply for the Breastfeeding Friendly Child Care Award. Programs that answer “Yes” to all checklist questions and whose enclosed documents support breastfeeding will be awarded a certificate and a “Breastfeeding Welcome Here” window cling, which designates the center as a Breastfeeding Friendly Child Care program and allows others to see your commitment to breastfeeding.

New Jersey

Program Name: New Jersey Breastfeeding-Friendly Worksite Recognition Program

Recognition Program Description: New Jersey Breastfeeding-Friendly Workplaces have made accommodations to support breastfeeding mothers as employees. This can be as simple as allowing employees to have flexible breaks and access to a private room for expressing milk or nursing. The room needs to have a comfortable chair and a lock on the door.

Minimum criteria for receiving this recognition are:

• All lactating employees are allowed reasonable breaks to express milk or nurse their children.
• All lactating employees have access to a private space for expressing milk or nursing. The space is not a bathroom, is lockable and shielded from view, and has an electrical outlet.

New Mexico

Program Name: New Mexico Family Friendly Business Award

Recognition Program Description: The New Mexico Family Friendly Business Award was formed by the Task Force on Work Life Balance to develop an awards program that would both recognize New Mexico employers and businesses that offer family friendly employee benefits and promote increasing the number of businesses with family centered policies and workforce access to them. The purpose of the award is to recognize and support businesses that adopt and implement family friendly policies for their employees. The Task Force can help you develop a breastfeeding friendly policy for your workplace.

Contact Monica Esparza at monica@breastfeedingnm.org or (505) 629-9877. Email contact@breastfeedingnm.org to request a “Breastfeeding Welcome Here” window decal.

New York

Program Name: New York Breastfeeding Friendly Child Care Designation Program

Recognition Program Description: The New York State Department of Health’s Obesity Prevention Program encourages new mothers to breastfeed their infants. The Department’s Child and Adult Care Food Program encourages child care centers and family day care homes to support breastfeeding families and recognizes these providers with Breastfeeding Friendly certificates. Child care center/day care home staff complete an assessment that shows they support breastfeeding families.

North Carolina

Program Name: North Carolina Breastfeeding-Friendly Child Care Designation Program

Recognition Program Description: The North Carolina Breastfeeding-Friendly Child Care Designation (NC BFCCD) program has been made possible through a grant from Kids Eat Smart Move More. The program recognizes child care facilities that have taken steps to promote, protect, and support breastfeeding. A rating system has been developed that awards child care facilities with a gold-starred building block for every two steps achieved in the Ten Steps to Breastfeeding-Friendly Child Care.

North Dakota

Program Name: North Dakota Infant Friendly Designated Businesses

Recognition Program Description: 138 North Dakota business locations are now recognized as “Infant Friendly” by the North Dakota Department of Health, which reaches over 24,000 employees across the state.

Hospital/Birthing Center Award Designation Requirements:

• Complete a minimum of a two-hour staff training for breastfeeding offered by the North Dakota Department of Health or an equivalent program.
• Organize an interdisciplinary team to support and implement the 5 steps and assess lactation services.
• Implement all 5 steps required for North Dakota Breastfeeding-Friendly designation with consideration for social and cultural diversity.
• Complete a program evaluation in coordination with the North Dakota Department of Health to measure implementation of the 5 steps.

Ohio

Program Name: Ohio First Steps for Healthy Babies Breastfeeding Recognition Program

Recognition Program Description: Ohio Hospital Association and the Ohio Department of Health sponsor the Ohio First Steps for Healthy Babies breastfeeding recognition program. The program recognizes maternity centers in Ohio that are taking steps to promote, protect and support breastfeeding in their organizations. The Ohio First Steps for Healthy Babies program recognizes hospitals for implementing the Ten Steps, using a modified application form. Hospitals can earn up to five stars, earning one star to every two steps achieved. Hospitals can choose which steps to implement and in which order. Applications are accepted on a quarterly basis.

Oklahoma

Program Name: Oklahoma Breastfeeding Friendly Worksite Recognition Program

Recognition Program Description: Worksites should meet or exceed the following minimum criteria required for recognition as an Oklahoma Breastfeeding Friendly Worksite:

• Flexible break times for expression of milk
• A comfortable location allowing privacy for pumping, other than a toilet stall
• Access to a nearby clean water source and a sink for washing hands and rinsing out any breast pump equipment.
• Written policy supporting breastfeeding that includes the above minimum requirements and a description of how all staff are informed of this policy

Oregon

Program Name: Oregon Breastfeeding Mother-Friendly Employer Project

Recognition Program Description: The Oregon Department of Human Services (DHS) has an employer recognition program called the Breastfeeding Mother-Friendly Employer Project. Oregon employers who have a worksite policy and a clear plan to communicate that policy to all employees can apply to be recognized.

Pennsylvania

Program Name: Pennsylvania Breastfeeding Friendly Employer Certificate Program

Recognition Program Description: The Pennsylvania Breastfeeding Coalition wants to recognize breastfeeding-friendly employers that support their employees by providing and maintaining high-quality lactation support programs and appropriate onsite environments. There is a selection criteria for businesses serving patrons/customers and one for workplaces.

Rhode Island

Program Name: Rhode Island Breastfeeding Friendly Workplace Award

Recognition Program Description: Recognition as a Breastfeeding-Friendly Workplace is based on the successful establishment of supportive policies, facilities, and resources for breastfeeding employees and clients. Employers may complete and return the award submission questionnaire to be eligible for recognition at the Bronze, Silver, or Gold level. Review of the questionnaire and a follow-up site visit by a Corporate Lactation Specialist will determine the level of award based on the number of demonstrated strategies.

South Carolina

Program Name: South Carolina Breastfeeding Friendly Child Care Designation

Recognition Program Description: The South Carolina Breastfeeding Friendly Child Care Designation recognizes child care facilities that promote, protect, and support breastfeeding. How it works:

1. Review. Read about the Ten Steps to Breastfeeding Friendly Child Care.
2. Implement. Choose which step you would like to start implementing in your child care facility.
3. Apply. Submit your completed “Ten Steps” for review.
4. Get Designated. When your child care program has completed the Ten Steps, it will earn the Breastfeeding Friendly Child Care Designation.

Texas

Program Name: Texas Mother-Friendly Worksites

Recognition Program Description: Mother-Friendly Worksites are businesses that proactively support employees who choose to breastfeed their infants. Creating and implementing a Mother-Friendly policy is both simple and inexpensive. The most basic Mother-Friendly policies need only provide a private space, flexible scheduling for break time, and other basic support so that mothers may express and store breastmilk for their babies.

An employer may be designated as a Texas Mother-Friendly Worksite if they offer a written employee worksite lactation support policy that offers:

• Flexible work schedules including scheduling breaks and work patterns to provide time for expression of milk.
• Access to a private location(s) that is not a bathroom, for the purpose of milk expression.
• Access to a nearby clean and safe water source and a sink for washing hands and rinsing out any breast pump equipment.
• Access to hygienic storage options for mothers to safely store breastmilk

Vermont

Program Name: Vermont Breastfeeding Employer Recognition

Recognition Program Description: In May 2008, Vermont’s labor law was amended to promote breastfeeding practices. A Vermont breastfeeding friendly workplace should:

• Develop policy and determine who oversees the program
• Inform employees of the new policy
• Provide a clean, private place with access to electric outlets and a chair; consider a “walk-through” with employees
• Offer flexible breaks
• Consider insurance coverage for lactation consultants
• Consider corporate lactation program if staff includes significant number of mothers

Washington

Virginia

Program Name: Virginia Maternity Center Breastfeeding-Friendly Designation

Recognition Program Description: The Virginia Maternity Center Breastfeeding-Friendly Designation (VA MCBFD) Program recognizes maternity centers that have taken steps to promote, protect, and support breastfeeding in their organization.

The five star program awards a star for every two steps achieved in the Ten Steps to Successful Breastfeeding as defined by the World Health Organization (WHO) and Baby-Friendly® USA.

Program Name: Breastfeeding Friendly Washington

Recognition Program Description: Breastfeeding Friendly Washington (BFWA) encourages organizations to promote and support breastfeeding through changes in their policies and procedures. BFWA celebrates and recognizes the commitment that organizations are making to ensure our future generations are the healthiest ever. A voluntary recognition program is currently available for hospitals, birth centers, and community health clinics making these changes. BFWA hopes to expand this program to other types of organizations in the future.

Wisconsin

Program Name: Wisconsin Breastfeeding Friendly Child Care

Recognition Program Description: This program recognizes group and family child care providers around the state who have demonstrated their support for breastfeeding moms and babies. Using the 10 Steps to Breastfeeding Friendly Child Care Centers toolkit as a guide, local coalitions and Child Care Resource & Referral agencies work with providers to learn about breastfeeding and to improve their practices, policies, and child care environments to better support nursing moms. Sites undergo assessments, create action plans, and receive technical assistance to make needed improvements. Once they meet the 10 Steps, providers are awarded and recognized as “Breastfeeding Friendly.”

¹ Centers for Disease Control and Prevention (CDC), Early Care and Education State Indicator Report 2016.