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implementing breastfeeding policies and practices should be explored in future research to better support providers in this area.
• Support in engaging parents to create a healthy child care environment. A lack of parent support was the most frequently cited challenge in healthy practices and routines and in creating written rules or guidelines. In addition, when asked what would help them create a healthy environment, participants selected “materials for parents” as the top choice. Given this consistent trend across multiple questions, parent engagement seems to be a particular challenge. Helping providers engage parents is an ongoing struggle in many programs and is a mandate in some (e.g., Head Start, State Preschool). Perhaps the lessons learned from already existing programs in how to engage parents could be gathered and offered as a resource to providers. In addition, connecting with the other branches of the Choose Health LA program, which includes a parent or family component, might be an area to explore.
• Economic costs in creating healthy changes in child care program. When asked to report on the economic impact of creating healthy practices on their costs, one third of participants indicated that creating healthy practices increased the cost of their program. More information about factors that impact the increase in costs should be explored to support providers in implementing and sustaining healthy practices in their program. Is there an accurate perception of healthy food affordability? What exactly is making costs rise? Knowing this would allow programs to better support providers in implementing and sustaining positive behavior.
• Family child care homes as fertile ground for making positive change in healthy practices and policies. While this evaluation identified differences between center–based care and family child care at baseline on a variety of nutrition and feeding practices such that lower percentages of family child care providers were engaging in positive nutrition policies and practices, the differences did not persist at follow-up suggesting positive change for family child care providers. Amenability to change, coupled with autonomy in setting rules and guidelines in their programs as autonomous business owners - compared to center-based programs, particularly those that have government contracts and are either required to provide healthy practices or are limited in any changes they can make- make family child care homes fertile ground for making positive change regarding health and nutrition. Most importantly, as illustrated in this report, because a large percent of family child care programs are open evenings and /or weekends, they are responsible for serving more meals, including snack and dinner,
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