NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016

 
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
NSW HEALTHY
CHILDREN
INITIATIVE
The first five years July 2011 – June 2016
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
ACKNOWLEDGEMENTS

    Childhood obesity affects our whole society and it is only through
     partnerships with many individuals and organisations that change
 can be achieved. We gratefully acknowledge all those who have been
involved in the NSW Healthy Children Initiative (HCI) planning, delivery
 and evaluation over the last five years, particularly our major partners
   including the NSW Department of Education, Office of Sport, Heart
   Foundation and NSW Department of Premier and Cabinet. We also
     acknowledge the contribution from state-wide teams at the NSW
   Ministry of Health and the NSW Office of Preventive Health to each
    of the health promotion teams based in Local Health Districts. We
particularly acknowledge the work of the Program Managers who have
     tirelessly driven each of the HCI programs and other investments.

 We pay our respects to the traditional custodians of the lands across
         NSW, to Elders past and present and to all Aboriginal people.
 We gratefully acknowledge the valuable contributions that Aboriginal
                      Elders, organisations, community members, staff
                                        and families have made to HCI.

                               NSW OFFICE OF PREVENTIVE HEALTH
                              Don Everett Building, Liverpool Hospital
                                             LIVERPOOL BC NSW 1871
                                                    Tel. (02) 8738 6284
                                                    Fax. (02) 8738 6371
                                          www.preventivehealth.net.au

                 This work is copyright. It may be reproduced in whole
                    or in part for study or training purposes subject to
                 the inclusion of an acknowledgement of the source. It
                 may not be reproduced for commercial usage or sale.
                Reproduction for purposes other than those indicated
                      above requires written permission from the NSW
                                                      Ministry of Health.

                                         © NSW Ministry of Health 2017

                                                    SHPN: (CPH) 170514
                                       ISBN: 978-1-76000-725-6 (Print)
                                            978-1-76000-726-3 (Online)

                  Further copies of this document can be downloaded
                     from the NSW Office of Preventive Health website
                                           www.preventivehealth.net.au

                  Suggested citation: Innes-Hughes C, Bravo A, Buffett
                  K, Henderson L, Lockeridge A, Pimenta, N, Radvan D,
              Rissel C (2017) NSW Healthy Children Initiative: The first
              five years July 2011 – June 2016. NSW Ministry of Health.
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
CONTENTS
 EXECUTIVE SUMMARY                                                                                  4

 THE HEALTHY CHILDREN INITIATIVE                                                                    7
 Childhood Obesity in NSW                                                                           7
 HCI Funding and Policy Context                                                                     8
 Framework for HCI Action                                                                           9
 Overview of Current Programs and Other Investments                                                10
 The Innovative HCI Delivery Model                                                                 13
 Implementation and Performance Monitoring                                                         15
 A Commitment to Equity                                                                            17
 Ongoing Quality Improvement                                                                       19
 Future Directions                                                                                 20

 FLAGSHIP PROGRAMS                                                                                 23
 Munch & Move®                                                                                     23
 Live Life Well @ School                                                                           26
 Crunch&Sip   ®
                                                                                                   28
 NSW Healthy School Canteen Strategy                                                               30
 Go4Fun®		                                                                                         32
 Finish with the Right Stuff                                                                       34

 ADDITIONAL INVESTMENTS                                                                            36
 The Healthy Kids Website                                                                          36
 Healthy Supported Playgroups                                                                      37
 Active Travel for Children                                                                        38
 yhunger		                                                                                         39

 REFERENCES                                                                                        40

                                                      The first five years July 2011 – June 2016   03
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
EXECUTIVE SUMMARY
The NSW Healthy Children Initiative (HCI) was established
in 2011 to provide a comprehensive, coordinated approach to
childhood obesity prevention across NSW. HCI is funded by
the NSW Ministry of Health and delivered through the NSW
Office of Preventive Health and Local Health Districts.

HCI delivers evidence-based programs across a range         NSW Ministry of Health, Local Health Districts and key
of settings. The structure and delivery of the initiative   service delivery partners in mutually beneficial ways.
are unique in terms of the scope, population reach,
                                                            This report reflects upon the actions and outcomes of
framework for action and focus on implementation
                                                            the first five years July 2011 – June 2016, and sets
and performance monitoring, notably in response to
                                                            directions for the future to achieve the Premier’s
equity issues. Genuinely reciprocal partnerships
                                                            Priority target of reducing childhood overweight and
across NSW and enhancement of the existing health
                                                            obesity by 5 percent by 2025.
promotion workforce draws upon the strengths of the

04        NSW Healthy Children Initiative
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
FLAGSHIP
                                                                       PROGRAMS

HCI comprises a suite of childhood obesity prevention               Munch & Move® is being
programs delivered in childrens’ settings, including Munch          implemented in over 3,000
& Move, Live Life Well at School, Go4Fun, Finish With The           centre-based early childhood
Right Stuff and yhunger.                                            services across NSW (91% of all
•	Over 2,000 NSW primary schools have introduced a                 services), 92% of which have
   Crunch&Sip® strategy to schedule a daily in-class break          met or exceeded the performance
   for students to eat fruit or vegetables and drink water,         targets related to implementing
   promoting healthy living.                                        health promotion practices.

•	
  The new NSW Healthy School Canteen Strategy is in
  development with the NSW Department of Education
  to reinforce the benefits of healthy eating and provide
  healthier food and drink choices at school.
•	
  Finish with the Right Stuff assists junior community
  sports clubs and associations to promote water as a
  drink of choice and provide healthier food and drink              Live Life Well @ School is being
  options to children, families and spectators.                     implemented in over 2,000
                                                                    primary schools across NSW
•	
  The Healthy Kids Website provides a “one stop shop”               (84% of all primary schools),
  of current and credible information and support                   80% of which have met or
  materials for teachers, parents, carers, coaches, health          exceeded the performance
  professionals, kids and teens.                                    targets related to implementing
•	
  Healthy Supported Playgroups promotes and models                  health promotion practices.
  healthy eating and active play through playgroups that
  will reach disadvantaged children and parents, many
  of whom do not access other HCI settings such as
  childcare.
•    ctive Travel for Children is working across the NSW
    A
    Government and with non-government agencies to
    explore ways to increase walking, cycling, scootering,
    skateboarding or any similar transport where human
    energy is spent to travel, for a range of health, social        Go4Fun® has delivered over
    and environmental benefits.                                     800 programs to over 7,800
                                                                    children and their families,
•   yhunger, a Sydney Local Health District Program,
                                                                    resulting in reduced weight,
     recognises the complex challenges of food access and
                                                                    improved nutrition, increased
     physical activity options for young people aged 12-24
                                                                    physical activity and additional
     years of age who are experiencing or are at risk of
                                                                    benefits including improved
     homelessness, and works with youth workers and
                                                                    fitness and self-esteem.
     services to reach and support this important
     marginalised population.

                                                               The first five years July 2011 – June 2016   05
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
06   NSW Healthy Children Initiative
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
THE HEALTHY
CHILDREN INITIATIVE

Childhood Obesity in NSW
The World Health Organization          Intervention during childhood                    •	Facilitate preventive health
describes childhood obesity            therefore has the potential for                     research and knowledge
prevention as one of the most          both short-and long-term benefits.                  translation into policy and
urgent public health priorities for    There is growing evidence for the                   practice
this century1. The prevalence of       potential of childhood obesity
                                                                                        •	Support the NSW Local Heath
overweight and obesity in NSW          prevention9, 10 including strategies
                                                                                            District (LHD) health promotion
children aged 5 to 16 years was        delivered in settings such as early
                                                                                            workforce to deliver key state-
22% in 20152. This is a cause for      childhood services11, 12 and schools13, 14.
                                                                                            wide preventive health
concern, and the Premier has           To be effective and sustainable, it
                                                                                            programs
accordingly identified it as a top     is important that comprehensive
priority for the NSW Government3, 4.   childhood obesity prevention takes               •	Provide high level evidence-
This cross-government                  a population-wide approach,                          based advice to the NSW
commitment is described in the         includes community-based                             Ministry of Health on matters
NSW Healthy Eating and Active          interventions, and has strong                        relating to delivery of
Living Strategy5 that drives major     leadership, policies, dedicated                      preventive health programs
health promotion investments           funding, monitoring and                              and strategies.
across NSW.                            infrastructure in place to support
                                       health promotion action1. The                    The NSW Healthy Children
Childhood obesity is associated        establishment of the NSW Office                  Initiative (HCI) was established
with compromised health6 and           of Preventive Health (OPH) in July               in July 2011 to provide a
significant reductions in quality of   2012 provided the ideal mechanism                comprehensive, coordinated
life7, 8 . Children above a healthy    for this to be enabled in NSW, with              approach to childhood obesity
weight may develop health              stated OPH objectives being to15:                prevention across NSW. HCI is
problems in childhood, such as                                                          funded by the NSW Ministry of
asthma, sleep problems, hip, knee      •	Manage the planning,                          Health and delivered through the
and ankle problems, and high              implementation, support and                   OPH and LHDs.
cholesterol or blood pressure.            evaluation of priority state-wide
Children who are above a healthy          preventive health programs
weight are also much more likely
                                       •	Report on outcomes of NSW
to become overweight adults
                                          priority-funded preventive
putting them at risk of health
                                          health programs, including
problems like heart disease,
                                          economic analyses
diabetes and cancer1, 9.

                                                                                The first five years July 2011 – June 2016   07
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
HCI Funding and Policy Context
Although numerous childhood obesity prevention            NSW Government Priority
programs and projects were being delivered in NSW
prior to the establishment of HCI, they were not of the   In late 2015 the NSW Premier committed to 12 key
scope, scale nor coordinated intent that is described     personal priorities to make NSW a better place to
herein. Initial funding through the Council of            work and live, including reducing the prevalence of
Australian Governments (COAG) National Partnership        childhood overweight and obesity by 5% in 10 years,
Agreement on Preventive Health made HCI possible16.       which would result in 62,000 more children who are
All jurisdictions in Australia received this funding      a healthy weight in NSW3.
stream for childhood obesity prevention to “help          HCI is an important strategic component of this
assure Australian children of a healthy start to life”    Premier’s Priority, providing coordinated state-wide
(p5) with particular focus on:                            leadership of childhood obesity prevention programs.
•	Building on existing efforts, while adapting them to   HCI is complemented by more than 50 cross
   suit demographic and other factors in play at          government actions, including3:
   various sites                                          •	Enhancing the Make Healthy Normal social
•	Covering physical activity, healthy eating, and            marketing campaign with new messages for
   primary and secondary prevention                           families

•	In settings such as child care centres, pre-schools,   •	Supporting GPs and health professionals to identify
   schools, multi-disciplinary service sites, and             children above a healthy weight and refer them to
   children and family centres                                appropriate programs

•	Including family based interventions, settings         •	Supporting the NSW menu labelling initiative to
   based initiatives, environmental strategies in and        help people make lower-kilojoule choices when
   around schools, and breastfeeding support                 eating out
   interventions.                                         •	Creating guidelines for the planning, design and
When that funding stream ended in July 2014,                 development of healthy built environments.
programs in other jurisdictions were concluded or
scaled back. However the HCI infrastructure in NSW
was sufficiently robust to remain in place as the
central focus of childhood obesity prevention in NSW.
HCI continues to deliver key programs under the
cross-government NSW Healthy Eating and Active
Living Strategy5. Specifically, HCI provides access to
state-wide healthy eating and active living programs
(Strategic Direction 2). The key settings for
implementing these programs include early childhood
education and care services, schools, junior
community sport and the community more broadly.

                                                                    “We’re determined
                                                                 to protect children from
                                                                   the poor health and
                                                                   wellbeing outcomes
                                                                      associated with
                                                                     being overweight
                                                                         or obese.”

                                                                    (Former) NSW Premier Mike Baird3

08       NSW Healthy Children Initiative
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
Framework for HCI Action
Figure 1: HCI Framework for Action

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                       Innovative Delive

                                                                                                                     oing
                                                                                                                      p
                                                                                          Improving the
                                                      Supporting                          environments
                                                     children and                          in which they
                                                       families                              live, learn
                                                                                              and play

                                       H
                                              E                                                       VE
                             T

                                                     HE                                            TI
                                                       AL                                      TI A
                                                         T HY
                                                                               N I NI
                                                                       CHILDRE

                                                        The               Primary            Teenagers
                                                    early years         school age           and youth
                                                     0-5 years           5-12 years          13-18 years

A comprehensive framework for HCI action is
represented in Figure 1. This recognises that:

•	
  The scope of action is broad, focussing not just                              •	
                                                                                  The approach is coordinated and strategic. This
  on children and families but also the settings in                               includes an innovative delivery model that builds
  which they spend time, to create supportive                                     strong reciprocal partnerships between the OPH
  environments and a culture that is more conducive                               and LHDs, implementation and performance
  to healthy eating and active living.                                            monitoring for both insight and accountability,
                                                                                  a strong commitment to equity and ongoing
•	HCI programs and other investments are tailored
                                                                                  investments in innovation and research (see
   to context and needs across a range of ages
                                                                                  more from page 13).
   and stages, including the early years (0-5 years),
   primary school age (5-12 years) and teenagers                                •	This framework for action collectively provides
   and youth (13-18 years).                                                        an opportunity for coordinated state-wide,
                                                                                   population-level program delivery.

                                                                                             The first five years July 2011 – June 2016   09
NSW HEALTHY CHILDREN INITIATIVE - The first five years July 2011 - June 2016
Overview of Current Programs
and Other Investments

HCI was initially built upon a number of existing                               and the following tables provide a snapshot summary
programs which were scaled-up for delivery across                               of each. “Flagship programs” are highlighted as those
NSW. It continues to evolve through further innovation                          with greatest population reach and a substantial focus
and research. Figure 2 provides an overview of current                          and resource allocation.
HCI programs and other investments by age and stage,

Figure 2: HCI programs and other investments by age and stage

                         Age      0      1      2    3    4    5   6   7    8     9    10   11   12   13     14   15   16   17   18

                                             The early years           Primary school age                  Teenagers and youth
                                               0-5 years                   5-12 years                          13-18 years
   FLAGSHIP PROGRAMS

                                                                       NSW Healthy School Canteen Strategy
  investments
   Additional

                                      Healthy supported
                                         playgroups

                                                                            Active Travel for Children

010                    NSW Healthy Children Initiative
Table 1: Snapshot of current flagship programs

        PROGRAM                  TARGET GROUP                 SETTING                      BRIEF DESCRIPTION

                                                                                     Encourages healthy eating,
                              Children aged 0-5 years,                               increased physical activity and
                                                          Early childhood
                              parents/carers, early                                  reduced small screen recreation
                                                          education and
                              childhood educators                                    in children attending early
                                                          care services
                              and staff                                              childhood education and care
                                                                                     services.

                                                                                     Enhances teacher’s knowledge
                                                                                     and skills in teaching nutrition
                              Children aged 5-12
                                                                                     and movement. Supports schools
                              years, parents/carers,      Primary schools
                                                                                     to create environments which
                              teachers, principals
                                                                                     enable children to eat healthily
                                                                                     and be physically active.

                                                                                     Encourages primary schools to
                                                                                     schedule a daily in-class break
                              Children aged 5-12
                                                                                     for students to eat fruit or
                              years, parents/carers,      Primary schools
                                                                                     vegetables and drink water, in
                              teachers, principals
                                                                                     addition to their usual recess and
                                                                                     lunch breaks.

                                                                                     Encourages all primary and
                              Children aged 5-18
                                                                                     secondary schools to provide
  NSW Healthy School          years, parents/carers,      Primary and
                                                                                     a healthy and nutritious food
   Canteen Strategy           canteen staff and           secondary schools
                                                                                     service that is consistent with
                              volunteers, principals
                                                                                     the Australian Dietary Guidelines.

                                                                                     Helps children above a healthy
                                                                                     weight and their parent/
                                                                                     carer(s) to modify family
                                                                                     lifestyles, improve nutrition
                                                                                     and activity levels, promote
                              Children aged 7-13 years,                              weight management and
                                                          Community
                              parents/carers                                         increase wellbeing and self-
                                                                                     esteem. Delivered by trained and
                                                                                     qualified health professionals,
                                                                                     with prioritisation for delivery
                                                                                     within disadvantaged
                                                                                     communities.

                                                                                     Encourages junior sporting clubs
                              Children aged 5-16                                     and associations to provide
                              years, parents/carers,      Sporting clubs             and promote healthier food at
                              sporting clubs and          and associations           club canteens and encourages
                              associations                                           children to drink water before,
                                                                                     during and after the game.

                                                                            The first five years July 2011 – June 2016   011
Table 2: Snapshot of additional HCI investments

           PROGRAM                        TARGET GROUP                SETTING                 BRIEF DESCRIPTION

                                                                                         This website provides a “one
                                      Children and young
                                                                                         stop shop” of current and
                                      people, parents/carers,
                                                                 Online                  credible information and
                                      HCI project partners,
                                                                                         resources about healthy eating
                                      communities
                                                                                         and physical activity.

                                                                                         Provides recommendations
                                                                                         and online information to
                                                                                         create environments and
                                      Children aged 0-5
       Healthy supported                                         Supported               deliver consistent, appropriate
          playgroups                  years, parents/carers,
                                                                 playgroups              messages and learning
                                      playgroup facilitators
                                                                                         experiences that support healthy
                                                                                         eating, active play and oral
                                                                                         health to parents/carers.

                                                                                         Provides an overarching
                                      School aged children,                              strategy on active travel for
          Active Travel
                                      parents/carers, partner    Community               children, in collaboration with
          for Children
                                      organisations                                      key government and non-
                                                                                         government agencies.

                                                                                         Helps disadvantaged youths
                                                                                         to develop healthy eating
                                                                                         and physical activity skills
                                      Young people 12-
                                                                                         by training youth workers to
                                      24 years who are
                                                                 Youth workers           provide healthy, nutritious
                                      experiencing or at risk
                                                                 and services            food and encourage regular
                                      of homelessness. Youth
                                                                                         physical activity. Delivered
                               a      workers and services
                                                                                         through specialist youth health
                                                                                         and homelessness services and
                                                                                         alternate education providers.

a
    yhunger is a Sydney LHD-funded program with HCI contribution towards resource development and evaluation.

012         NSW Healthy Children Initiative
The Innovative HCI Delivery Model
One of the greatest challenges in health promotion is      LHDs implement HCI programs through dedicated,
the concept of scalability – increasing the scale and      funded positions. Resourcing these local positions is a
adoption of health promotion interventions to achieve      central component of the delivery model, to ensure
state-wide, population-level program delivery and          capacity for local intervention delivery. LHD teams
outcomes17, 18 . The innovative delivery model of HCI is   also have the best understanding of their local
central to achieving effective program delivery at         communities and project partners, and can adapt the
scale, notably across our flagship programs.               flagship interventions accordingly, while maintaining
                                                           fidelity, hence value-adding locally. Each LHD has
Traditional, top-down models are often characterised
                                                           worked for many years to establish the vital local
by state-level determination of broad priorities for
                                                           partnerships that are essential to practice, and build
action, with funding provided to local areas for action
                                                           their capacity to promote and support healthy
within the agreed scope. Another common delivery
                                                           lifestyles, particularly in relation to equity investments
approach is central coordination, often through non-
                                                           such as working with Aboriginal organisations and
government organisations without an on-the-ground
                                                           communities. The implementation experiences of
workforce. There is often little further coordination or
                                                           LHDs are shared between one another and fed back
collaboration. In contrast, HCI has seen the
                                                           to inform the central coordination of HCI, completing
establishment of genuinely reciprocal partnerships
                                                           the ongoing quality cycle in a truly collaborative
across NSW with enhancement of the existing health
                                                           manner.
promotion workforce. This draws upon the strengths
of each group in mutually beneficial ways.                 The HCI delivery model can therefore deliver much
                                                           more than the sum of its parts. Each group builds the
OPH is well-placed to conduct centralised planning
                                                           capacity of the others. This has particular benefits for
and coordination. OPH can negotiate within the health
                                                           rural and remote LHDs who might otherwise be
system and build partnerships with other
                                                           working in relative isolation with minimal resources.
organisations at the state level to facilitate HCI
funding, design, delivery, research and evaluation.        This model builds a critical mass that benefits all.
OPH investments in centralised or commissioned             Long-term funding enables OPH and LHDs alike to
research and intervention development can be shared        recruit personnel, and develop and sustain the state-
state-wide, avoiding duplication and improving             wide health promotion workforce as a whole. This
evidence-based practice. Similarly, OPH can support        includes recruiting to identified positions such as the
LHDs by funding a pilot study or evaluation of a           Aboriginal Leaders who deliver programs such as
locally-developed intervention, building the potential     Go4Fun® for Aboriginal families.
for wider adoption across the state. The resulting
improved impact of programs which are delivered
state-wide is also desirable when working with other
state-wide organisations such as the Department of
Education. Finally, centralised implementation
monitoring provides information which is used to
inform program review and quality improvements.
The efficiencies of centralised systems also maximise
the resources that can be directed into local
intervention delivery.

                                                                         The first five years July 2011 – June 2016   013
Examples of the state-wide, population-level reach and impacts achieved across NSW,
July 2011 to June 2016, through the innovative HCI delivery model include the following.

  MUNCH & MOVE®
                                                       3,231 (91%) of centre-based early
                                                  childhood services across NSW participate
  LHD performance target = 70% of
   participating services achieving                     in the Munch & Move® program.
          ≥70% of practices

      This performance target
         has been exceeded,                     95% include         96% include           97% have a
       rising from 36% in 2012                active play time       fruit and           written policy
            to 92% in 2016.                                       vegetables daily        on nutrition

  LIVE LIFE WELL @ SCHOOL
                                               2,050 (84%) of primary schools across NSW
                                             participate in the Live Life Well @ School program.
  LHD performance target = 70% of
   participating services achieving
          ≥70% of practices

      This performance target                92% encourage          89% have a         81% provide
         has been exceeded,                   students to be      fruit, vegetable    nutrition and
                                             physically active       and water       physical activity
       rising from 32% in 2012                 during recess            break          information
            to 80% in 2016.                     and lunch                               to families

  GO4FUN®                 On average, participating children have achieved:

      7,821
   overweight
   and obese
  children and
  their families
                             Reduced            Improved          Increased             Additional
      have                    weight:            nutrition:          physical               benefits:
  participated              BMI reduced        Statistically         activity:             Improved
     in 807                 by 0.5kg/m2         significant        Increase by            fitness and
                                               increases in         3.6 hours             self-esteem
    Go4Fun®
                                              both fruit and        per week
     groups                                  vegetable intake

014    NSW Healthy Children Initiative
Implementation and
Performance Monitoring
The scale of the investment in HCI demands that              An information management system was
comprehensive and systematic monitoring be                   commissioned to report data in real time by LHD staff
undertaken. This is in line with World Health                and is used by the Ministry of Health to report HCI
Organization recommendations that highlight the              data for performance monitoring and by OPH for
importance of information and accountability1.               program monitoring. Known as the Population Health
                                                             Intervention Management System (PHIMS), this
There are two distinct elements of this in HCI:              system comprises multiple components including
•	implementation monitoring by OPH to inform                software to enable data entry, analysis and reporting,
   HCI delivery; and                                         and a tailored user interface for LHDs, the Ministry of
                                                             Health and OPH. PHIMS was developed as a flexible,
•	quality improvement, and performance monitoring           scalable and sustainable information technology
   by the NSW Ministry of Health as part of Service          solution, with due consideration of issues such as
   Level Agreements between the Ministry and                 access and confidentiality. The system has 150 users
   individual LHDs.                                          who account for the monitoring and reporting of over
                                                             6,500 intervention sites.
IMPLEMENTATION MONITORING
                                                             Data on the practices are obtained by health
Effective scaling up requires the systematic use             promotion officers in each LHD as a result of their
of evidence, and it is essential that data from              direct contact with the service or school and are
implementation monitoring are linked to decision-            entered into PHIMS. Data are reported quarterly and
making throughout the scaling up process18 . To that         used to inform quality improvements in the programs.
end, a framework was developed to guide the
monitoring, evaluation and quality review of Munch           In addition to the PHIMS data describing Munch
& Move® and Live Life Well @ School, both of which           & Move® and Live Life Well @ School, Go4Fun®
would be implemented at a large scale19.                     implementation data are also routinely gathered and
                                                             monitored. These data are entered into a service
Program adoption indicators known as practices are           provider data system, Better Health Data, and
a key feature of this monitoring approach. These             analysed and reported as part of a contractual service
program-specific practices relate to organisational          provision. Data describing the number of families
changes in early childhood services and primary              registering, enrolling and completing the Go4Fun®
schools which reflect program adoption to a high             program are reported by LHD and at state level.
standard. Practices relate to healthy eating, physical       Aggregated participant outcome data are also
activity and sedentary behaviours (see full lists later in   reported and include changes in self-esteem, BMI,
this document). Each practice was developed, piloted         consumption of both healthy and unhealthy indicator
and subsequently analysed for sensitivity, then clearly      foods and time spent in physical activity and
defined in a Monitoring Guide to ensure consistent           sedentary behaviours.
determination of achievement across NSW.

                                                                          The first five years July 2011 – June 2016   015
PERFORMANCE MONITORING
Performance monitoring relates to procedures            As the programs have become established over time
between the NSW Ministry of Health and individual       and their achievements have grown, the KPIs too
LHDs. The data used for performance monitoring are      have increased to reflect this, and to drive ongoing
extracted from the PHIMS and Go4Fun® data sources       performance improvement. Having achieved good
described above.                                        program participation or reach, the focus of KPI
                                                        increases has been on program adoption through
Key performance indicators (KPIs) and measures
                                                        achievement of program practices. The targets for
were developed to describe program reach and
                                                        June 2016 were as follows:
adoption for Munch & Move® and Live Life Well @
School. KPIs for Go4Fun® relate to enrolments against
a defined target and completion rates.
                                                            •	Munch & Move®: 80% of all centre-based
KPIs are reported at both the state and LHD level.
                                                                services participate in the program and
Annual LHD targets were established for KPIs. Annual            70% of services achieve 80% of the
incremental targets were set to achieve progress                program practices.
towards the June 2015 targets as follows:

    •	Munch & Move®: 80% of all centre-based              •	Live Life Well @ School: 80% of all
        services participate in the program and                 primary schools participate in the
        60% of services achieve 70% of the                      program and 70% of schools achieve 80%
        program practices.                                      of the program practices.

    •	Live Life Well @ School: 80% of all                 •   Go4Fun ®: an additional 1,694 children
        primary schools participate in the                        enrolled across NSW from July 2015 to
        program and 60% of these schools                          June 2016 with 85% of them completing
        achieve 70% of the program practices.                     the program.

                                                        Key performance indicators were embedded in the
    •   Go4Fun ®: 7,000 children enrolled in the      in the annual Service Level Agreements between
          program across NSW with 85% of them           the NSW Ministry of Health and LHDs20. These
          completing the program.                       Service Agreements comprise the performance and
                                                        service delivery requirements of LHDs19. As part of
                                                        the NSW performance framework, Chief Executives
                                                        of each LHD are required to participate in quarterly
                                                        performance reviews against the annual service
                                                        agreement. Incorporating HCI KPIs in this process
                                                        enables state and local level monitoring of HCI
                                                        program implementation, facilitates LHD
                                                        accountability, and provides feedback to inform
                                                        local HCI program delivery planning. It also
                                                        encourages ongoing investment in child obesity
                                                        prevention at the state level.

                                                        There is always some risk that a systematic and
                                                        centrally directed approach to implementation and
                                                        performance monitoring may act as a barrier to local
                                                        innovation, and even compromise program fidelity19.
                                                        However, within the context of HCI, whilst the
                                                        outcomes and targets are centrally directed, LHD
                                                        implementation to achieve these targets remains
                                                        locally determined. A balance is therefore achieved
                                                        between local innovation and central management.

016       NSW Healthy Children Initiative
A Commitment to Equity
An important function of implementation monitoring
                                                            THE HCI
is to ensure equitable access and participation and
equitable outcomes. These are critical considerations
                                                            PRIORITY
for the fair, universal delivery of HCI programs and
other investments across NSW. Certain groups in our         GROUPS ARE:
communities experience poorer health than the rest of
the NSW population21, 22. The NSW State Health Plan:
Towards 2021 calls upon health services and programs
to make sure that health gains are shared by everyone
and across every community in NSW21.

HCI recognises that the following equity principles are
important to achieve this23:

•	Identify barriers that prevent or limit children from
                                                                                 Children
   priority groups from participating in HCI programs
                                                                                 living in low
•	When necessary, tailor programs to meet the                                   socioeconomic
   needs of priority groups                                                      population
                                                                                 groups
•	Promote the sustainability of equity principles by
   building them into the policies and programs

•	Monitor and evaluate programs in terms of their
   accessibility to and impacts upon priority groups.                            Aboriginal &
                                                                                 Torres Strait
The need for more coherent planning is also                                      Islander
emphasised, as is the importance of strengthening the                            children
infrastructure underpinning program delivery, and the
need to increase partnerships between health and
other government-delivered services. State-wide
stakeholder consultation also determined a need for                              Children from
something more concrete and practical tools to guide                             culturally and
program activity. As a result, The HCI Equity Toolkit23                          linguistically
was developed through a Delphi consensus process.                                diverse (CALD)
The toolkit identifies and describes practical actions                           backgrounds
across three “other platforms for action” relating to
community needs assessment, identifying
opportunities for collaborative action and prioritising
equity and sustainability across all programs.                                   Highly
                                                                                 marginalised
The toolkit has subsequently been enhanced by more                               children and
specific tools and resources such as a checklist for                             youth
considering and incorporating the priorities and needs
of culturally and linguistically diverse communities
when implementing HCI programs and other
investments.

In practice, this commitment to equity is evidenced                              Children from
throughout the ongoing cycle of planning,                                        remote NSW
development, implementation and evaluation –
notably a strong focus on equity in the performance
monitoring of HCI programs and other investments,
to ensure HCI does not widen the health differential
by ensuring that it has broad reach including those
who need it the most (see next page).                                            Children from
                                                                                 single parent
                                                                                 families

                                                           The first five years July 2011 – June 2016   017
Reach and Adoption of HCI Programs
Implementation monitoring tracks the reach and adoption of HCI programs in vulnerable populations, as well as
state-wide, to ensure that equity goals are being met.

       MUNCH & MOVE®

                                                                                               % that participate        % that have achieved the
                        Focus population/setting
                                                                                               in Munch & Move®          practice adoption targets

    Early childhood services in areas of
                                                                                                           94%                     90%
    socioeconomic disadvantagea

    Early childhood services with high
                                                                                                           96%                     88%
    proportions of Aboriginal childrenb

    Early childhood services in outer regional
                                                                                                           75%                     70%
    and remote/very remote locations

    ALL EARLY CHILDHOOD SERVICES ACROSS NSW                                                                91%                     92%

       LIVE LIFE WELL @ SCHOOL

                                                                                              % that participate in      % that have achieved the
                        Focus population/setting
                                                                                            Life Live Well @ School      practice adoption targets

    Primary schools in areas of socioeconomic
                                                                                                           86%                     79%
    disadvantagea

    Primary schools with high proportions
                                                                                                          90%                      79%
    of Aboriginal studentsb

    Primary schools in outer regional and
                                                                                                           77%                     77%
    remote/very remote locations

    ALL PRIMARY SCHOOLS ACROSS NSW                                                                         84%                     80%

       GO4FUN®

       25% of participants                                    54% of                             9% of participating         30% of participants
       to date identify as                                participating                          families identify as       have come from outer
        being from a sole                                mothers hold a                          being Aboriginal or         regional or remote/
          parent family                                  health care card                       Torres Strait Islander      very remote localities

a
    Defined as being in SEIFA quintiles 1 and 2   b
                                                      Defined as being above 10% (greater than population prevalence)

018              NSW Healthy Children Initiative
Ongoing Quality Improvement
The scale and longevity of HCI provides a context in
                                                          Go4Fun® Quality
which quality improvement can be achieved through
                                                          Improvement Case Study
sound, long-term practices and targeted quality
investments.                                              Targeted investments in innovation and
                                                          evaluation build stronger HCI programs.
Evidence-based practice is the cornerstone of health
                                                          For example, since Go4Fun® was launched
promotion, and HCI is built upon a foundation of
                                                          in 2009, there have been ongoing
quality health promotion practice, and is shaped by
                                                          investments to evaluate and improve the
policy and research. For example, health promotion in
                                                          program. The original program model was
schools was the focus of the work of many health
                                                          supported by evidence for efficacy related
promotion professionals across NSW for many years
                                                          to weight and psychosocial outcomes25, 26,
prior to the establishment of OPH and HCI24. Building
                                                          acceptability to parents25, positive long
upon that evidence and experience of the past and
                                                          term outcomes27 and participation by those
the wisdom of current practitioners and partners are
                                                          from disadvantaged and ethnic minority
key to effective health promotion delivery.
                                                          backgrounds28 .
Ongoing reciprocal communication between OPH
                                                          That model included twice-per-week two-
and LHDs occurs through routine contact such as
                                                          hour sessions over 10 weeks. Despite
quarterly networking meetings, as well as purpose-run
                                                          relatively successful implementation, a
forums. Informal consultation and feedback is
                                                          program review in 2012 found that the
continuous. The implementation experiences of LHDs
                                                          twice-per-week attendance requirement
are shared between one another and fed back to
                                                          was a barrier to participation for some
inform the central coordination of HCI, completing the
                                                          families. A program of reduced duration
ongoing quality cycle in a truly collaborative manner.
                                                          could potentially remove this barrier, as
For example, feedback regarding the Live Life Well @
                                                          well as costing less to deliver. But would
School program shaped the delivery of professional
                                                          it still achieve the same results?
development for primary school staff.
                                                          OPH undertook a cluster-randomised
Implementation monitoring provides valuable insight
                                                          controlled trial between July 2013 and
and intelligence to guide HCI delivery, particularly in
                                                          March 2014 to compare the effectiveness
terms of reach. This considers not only the scale of
                                                          of a revised, once-per-week program
that reach but also whether individuals and
                                                          delivery model with the original twice-per-
communities who experience disadvantage and
                                                          week model29. Evaluating outcomes at
inequities in health and wellbeing are accessing and
                                                          program completion and six-month follow-
participating in HCI programs and other investments.
                                                          up, the study concluded that Go4Fun®
                                                          can be delivered once-per-week with no
                                                          compromise to health or behavioural
                                                          outcomes. The standard mode of delivery
                                                          has been once-per-week across NSW since
                                                          October 2014.

                                                          Through this ongoing program
                                                          improvement process, feasibility has been
                                                          improved and cost efficiency achieved with
                                                          no compromises to program outcomes,
                                                          and significant contributions made to the
                                                          evidence base29, 30.

                                                                 The first five years July 2011 – June 2016   019
Future Directions
There are indications that the prevalence of childhood                The NSW government Premier’s Priority to reduce
obesity in NSW has stabilised and may be declining.                   obesity prevalence by 5% by 2025 has provided an
The prevalence of overweight and obesity in children                  opportunity and an imperative to strengthen the
has been relatively stable in NSW since 2007, with the                childhood obesity prevention effort. This will require
2015 prevalence at 22% of 5-16-year-old children                      a strong effort across childhood obesity prevention
(Figure 3). The 2015 NSW School Physical Activity                     programs through HCI, food and physical activity
and Nutrition Survey (SPANS) reports objectively                      environments, the built environment, social marketing
measured height and weight in children from                           and clinical engagement to identify and manage
Kindergarten to Year 12 and trends over time. SPANS                   obesity5.
2015 suggests that obesity prevalence has decreased
at entry into school (Kindergarten) and Year 6, while
prevalence remains high in the adolescent years of
secondary school, (Years 8, 10 and 12).

The high reach of HCI programs targeting early
childhood settings and primary schools is likely to
be a contributing factor to these apparent changes,
but the issue remains a high priority for government
action.

 Figure 3: Overweight and obesity in children aged 5-16 years, NSW 2007-2015

          30
                                                                                                                Target 2025
          25                                                                                                       16.5%
PERCENT

          20

          15

          10

          5

          0          07           09             11   13        15           17      19        21        23         25

                                                                     YEARS

                                                           NSW Childhood Obesity Prevalence

 020           NSW Healthy Children Initiative
To move HCI into the future to achieve these targets,      •	
                                                             Focus on building sustainability, through strategies
OPH will:                                                    including but not limited to:

•	
  Maintain the high population reach of flagship HCI           - Increasing the relevance and thereby
  programs by continuing to deliver flagship                     acceptability, sustainability and system-wide
  programs at scale, notably:                                    reach of HCI strategies, such as ensuring that
                                                                 training delivered to early childhood educators
    - Munch & Move® in early childhood settings
                                                                 and primary school teachers is accredited.
    - Live Life Well @ School in primary school
                                                           •   Identify opportunities to build evidence to direct
       settings.
                                                                future investments, such as:
•	
  Scale up programs where appropriate to improve
                                                               - Interventions for parents of children aged 0-2
  reach and impact.
                                                                 years and 2-6 years
    - With a major new investment to be provided
                                                               - Interventions for adolescents both in the school
       through the NSW Premier’s Priority, Finish with
                                                                 setting and in the community.
       the Right Stuff will be implemented in 300 clubs
       over the next two years.                            •    argeted delivery to improve reach and impact
                                                               T
                                                               on vulnerable groups, such as:
•   Increase the impact of HCI programs through
     strategies including but not limited to:                  -D
                                                                 elivering Go4Fun® to the most vulnerable
                                                                groups within an LHD and the state-wide
    - Increasing the support for less well achieved
                                                                development of adapted programs such as
       practices (such as teaching fundamental
                                                                Go4Fun® for Aboriginal Families, which was
       movement skills in early childhood services
                                                                piloted in 2015.
       and primary schools)
                                                           •	
                                                             Complement the HCI settings based approach
    - Exploring more effective implementation
                                                             with more direct communication to families,
       processes (such as training methods) to achieve
                                                             parents and carers through social marketing and
       greater reach and sustainability.
                                                             development of programs or services which target
•    everage off existing policy imperatives and
    L                                                        this audience directly.
    monitoring systems, such as:

    - Improving healthy food access and availability in
       school canteens and linking this to Department of
       Education monitoring systems

    - Supporting Department of Education to roll out
       and monitor the canteen strategy

    - Supporting early childhood services to meet their
       requirements under the National Quality
       Framework.

•   Invest in ongoing quality improvements in each
     HCI program to ensure programs are delivered
     with fidelity, remain contemporary and are
     relevant for the target groups.

    - The Best Practice Framework that is routinely
       implemented for Go4Fun® incorporates
      professional reflection and continuing
      professional development as well as providing a
      quality check and feedback loop to program
      improvement.

      evelop a quality framework for Munch & Move®
    -D
     and Live Life Well @ School.

                                                                         The first five years July 2011 – June 2016   021
022   NSW Healthy Children Initiative
FLAGSHIP PROGRAMS
Munch & Move®

                                 Centre-based early childhood                       participating in active play have
                                 services including preschool and                   been associated with higher levels
  The Munch & Move®
                                 long day care services are                         of physical activity in preschools39.
  program aims to influence
                                 important settings for childhood                   Healthy eating and physical
  the healthy eating and
                                 obesity prevention11, 12, 31, 32. It has           activity strategies have been able
  physical activity
                                 been recommended that this                         to be sustained beyond one year
  behaviours of young
                                 should target dietary intake                       of intervention40.
  children from birth to five
                                 and activity behaviours
  years who attend NSW                                                              Munch & Move® provides state-
                                 simultaneously33 and policies be
  early childhood education                                                         wide professional development
                                 strengthened to create a healthy
  and care services. The                                                            training by an early childhood
                                 early childhood environment34.
  program offers professional                                                       registered training organisation
  development and support        Evidence shows that educational                    and support by LHDs. The
  across six key health          workshops and training for child                   program also offers:
  promoting messages:            care providers on nutrition,
                                                                                    •	An online refresher module
                                 physical activity and screen-time
  •	Encouraging and                                                                   to further reinforce knowledge
                                 behaviours and regulations have
     supporting                                                                        and skills
                                 increased provider knowledge,
     breastfeeding
                                 improved centre policies and                       •	Practical resources to support
  •	Choosing water as a         reduced body mass index for                           policy and practice
     drink                       children in child care centres in the                 development and
                                 United States35, 36. Within Australia,                implementation
  •	Choosing healthier
                                 preschool-based obesity
     snacks                                                                         •	Fact sheets to communicate
                                 prevention interventions have
                                 produced significant changes in                       with families
  •	Eating more fruit
     and vegetables              children’s food intake, movement                   •	Ongoing implementation
                                 skills and indicators of weight                       support from LHDs.
  •   Getting active every day   status37, reduced the prevalence of
                                 overweight and obesity in early                    The program is strongly aligned to
  •	Turning off the
                                 childhood settings38 and improved                  the National Quality Framework
     television or computer
                                 children’s food intake at                          and it can help services meet the
     and getting active.
                                 preschool39. Written physical                      requirements of the National
                                 activity policy, structured staff-led              Quality Standard and the Early
                                 physical activity and staff                        Years Learning Framework.

                                                                            The first five years July 2011 – June 2016   023
A set of 15 program adoption indicators (also
known as practices) has been developed:                 There has been a steady growth in the
                                                         number and type of early childhood
                                                       services participating in Munch & Move®
                 Service monitors food and drinks         since it began as a pilot in 2008.
  Practice 1     that are in children’s lunchboxes
                 every day

  Practice 2
                 Service menu includes fruit and
                 vegetables at least once per day                            91%
                 Service menu includes only                                  of centre-based early
  Practice 3                                                                 childhood services
                 healthy snack options every day
                                                                             across NSW now
                 Service supplies age appropriate                            participate in Munch &
  Practice 4
                 drinks every day                                            Move® (3,231 services)
                 Service provides structured and
                 specific learning experiences
  Practice 5
                 about healthy eating at least 2                     213,800 children in NSW attend
                 times per week                                      an early childhood service41.
                                                                     Nearly 195,000 children attend
                 Service provides tummy time for                     a participating service.
  Practice 6     babies 0-12 months of age every
                 day
                 Service provides physical activity    There has been a significant increase in
  Practice 7     for 1-5 year olds at least 25% of     the number that have implemented 70%
                 the daily opening hours               or more of the Munch & Move® practices:
                 Service provides fundamental
  Practice 8
                 movement skills for children 3-5
                 years of age every day, to at least   36%                                    92%
                 90% of children                           in 2012                            in 2016
                 Service use of small screen
  Practice 9     recreation by 3-5 year olds is            This increase in program adoption has
                 appropriate                                been seen across all early childhood
                                                           services (preschool, long day care and
                 Service has a written nutrition            occasional care services) and notably
 Practice 10
                 policy                                      by early childhood services that are
                 Service has a written physical              characterised by priority population
  Practice 11                                              groups (high proportion of Aboriginal
                 activity policy
                                                                children attending, services in
                 Service has a written policy                  disadvantaged communities and
 Practice 12     restricting small screen                     services in remote communities).
                 recreation
                                                       The strongest increases in individual
                 Service provided health
                                                       practice improvement have related to:
 Practice 13     information to families within
                 past 12 months                        •	
                                                         Water or age-appropriate drinks
                                                            (Practice 4)
                 Service has at least 50% of
                 primary contact educators             •     ealthy eating learning experiences
                                                            H
 Practice 14                                                at least twice per week (Practice 5)
                 trained in nutrition and at least
                 50% trained in physical activity      •     undamental movement skills ages
                                                            F
                 Service monitors and reports               3-5 years (Practice 8)
                 achievements of healthy eating        •	
                                                         Written physical activity policy
 Practice 15
                 and physical activity objectives           (Practice 11)
                 annually
                                                       •	
                                                         Provision of health information to
                                                            families annually (Practice 13)

024      NSW Healthy Children Initiative
The first five years July 2011 – June 2016   025
Live Life Well @ School

                                          Primary school aged children              NSW. It is built on the outcomes
                                          spend a large proportion of their         and learning of previous state-wide
   Live Life Well @ School is
                                          day at school, which has an               programs and was developed in
   delivered through a
                                          important role in their lives             line with relevant obesity
   partnership between NSW
                                          providing a safe and supportive           prevention guidelines48, 49 and
   Health, the NSW
                                          environment for learning about            Department of Education policies50.
   Department of Education,
                                          and reinforcing healthy eating and
   Catholic and Independent                                                         The program offers professional
                                          physical activity behaviours during
   school sectors. It is                                                            learning for teachers to improve
                                          the formative years13, 42, 43. Research
   delivered in NSW primary                                                         skills and confidence in teaching
                                          suggests that interventions using a
   schools to promote healthy                                                       nutrition, fundamental movement
                                          combination of nutrition and
   eating and physical activity                                                     skills and physical education. LHDs
                                          physical activity interventions are
   to students and their                                                            provide additional support for
                                          effective in achieving weight
   families.                                                                        program implementation at the
                                          reduction in school settings13, 14,
                                                                                    school via school visits, phone
   The program aims to                    44-46
                                                . There is convincing evidence
                                                                                    calls and email follow ups to assist
   enhance teachers’                      that long-running school-based
                                                                                    schools to develop an Action Plan
   knowledge, skills and                  interventions are effective in the
                                                                                    that reflects a whole of school
   confidence in teaching                 short-term in reducing the
                                                                                    approach to nutrition and physical
   nutrition and physical                 prevalence of childhood obesity47
                                                                                    activity, assist in the development
   activity as part of the                and supporting the beneficial
                                                                                    of school community focused
   school curriculum. The                 effects of child obesity prevention
                                                                                    nutrition and physical activity
   program has a “whole of                programs on body mass index,
                                                                                    strategies, and provide access to
   school” approach                       particularly those aimed at primary
                                                                                    information and resources that
   consistent with classroom              school aged children10.
                                                                                    support the teaching and creation
   teaching and school
                                          Live Life Well @ School was first         of a school environment that
   policies, and encourages
                                          implemented in Government                 promotes physical activity and
   links with parents, carers
                                          schools in 2008, and was                  healthy eating. LHDs also target
   and communities.
                                          expanded in 2012 to include               schools that have relatively high
                                          Catholic and Independent schools.         numbers of Aboriginal and Torres
                                          The program provides a                    Strait Islander students, schools
                                          framework to consolidate pre-             located in disadvantaged
                                          existing nutrition and physical           communities and schools that
                                          activity programs, resources and          are geographically remote.
                                          strategies being offered across

026     NSW Healthy Children Initiative
84%
                                                                              of primary schools
Like Munch & Move®, Live Life Well @ School                                   across NSW now
established and promotes a core set of evidence-                              participate in Live
based practices.                                                              Life Well @ School
                                                                              (2,050 schools)

                The school provides curriculum
                learning experiences regarding
  Practice 1                                                     668,685 children in NSW
                healthy eating, physical activity
                and sedentary behaviour                          attend a primary school51.
                                                                 Nearly 562,000 children
                The school explicitly addresses                  attend a participating school.
                fundamental movement skill
  Practice 2
                development as part of the
                PDHPE programs
                The school provides the                          4,617 teachers attended
                opportunity for classes to eat                   workshops between 2008-2014.
  Practice 3
                vegetables and fruit and drink
                water (see also page X)
                The school encourages physical                   7 conferences were held
  Practice 4    activity during recess and/or                    between January 2014 and
                lunch                                            June 2015 with 669 teachers
                                                                 attending from 595 schools.
                The school provides a supportive
                environment for healthy eating
  Practice 5
                (canteens, school activities
                involving food and drink)            There has been a significant increase in
                The school provides information      the number that have implemented 70%
                to families on healthy eating,           or more of the desired practices:
  Practice 6    healthy lunchboxes, physical
                activity and limiting small screen
                recreation                           32%                                           80%
                                                     in 2012                                       in 2016
                Teaching staff are provided
                with professional learning /
  Practice 7    development to promote healthy       The strongest increases in individual
                eating and physical activity to      practice improvement have related to:
                students
                                                     •	Physical activity during recess and/or
                The school has an identified            lunch (Practice 4)
                team / committee with executive
                                                     •	Teacher professional learning /
  Practice 8    membership to support the
                                                        development on healthy eating and
                implementation of LLW@S or
                                                        physical activity (Practice 7)
                similar initiatives
                                                     •	School team/committee with
                School planning processes               executive membership to support the
                (e.g. strategic, annual,                implementation (Practice 8)
  Practice 9
                operational plans) incorporate
                LLW@S strategies                     •	School planning processes
                                                        incorporate practices (Practice 9)
                The school monitors and reports
                annually on the implementation       •	School monitors and reports annually
 Practice 10                                            on Live Life Well @ School strategies
                and outcomes of LLW@S
                strategies                              (Practice 10)

                                                               The first five years July 2011 – June 2016    027
Crunch&Sip®

                                                        The implementation across NSW is supported by
                                                        the Healthy Kids Association and OPH, including:
   Crunch&Sip encourages primary schools to
                ®

   schedule a daily in-class break for students to      •   A school implementation guide
   eat fruit or vegetables and drink water, in
   addition to their usual recess and lunch             •	Food and nutrition focused classroom activities
   breaks. Crunch&Sip® provides extra nutrition,           that fit within the NSW primary schools Personal
   helps to prevent dehydration and normalises             Development, Health and Physical Education
   drinking water, as well as giving children an           curriculum and also meet other cross-curricula
   opportunity to try new vegetables and fruit.            outcomes

                                                        •   Activity ideas based around healthy eating

Crunch&Sip® takes a whole-of-school approach,           •	Background nutrition information and helpful
with the program incorporated into school policy.          resources for teachers.
Originating in Western Australia in 2002, Crunch&Sip®
has been operating in NSW since 2008. A vegetable,
fruit and water break such as Crunch&Sip® is part of
the Live Life Well @ School program, although schools
can participate in Crunch&Sip® separately.

    Crunch&Sip® schools have a positive
    impact on students by:

          Creating an enjoyable daily
          routine that increases fruit and
          vegetable intake
          Promoting a positive attitude
          towards fruit, vegetables and
          water
          Incorporating nutrition education
          into key learning areas of the
          curriculum

                          Crunch&Sip® is currently
                          being implemented
                          across NSW in over

                          78%
                          (2,022) of
                          primary schools

028      NSW Healthy Children Initiative
“We were concerned at the amount
 of processed foods students were
consuming. To encourage healthier
eating habits, the school introduced
 Crunch&Sip®. The outcomes have            “It’s well worth the time
  demonstrated the positive and        it takes to have Crunch&Sip®,
    life-changing influences that            to improve students’
       we, as teachers, can have               concentration for
         upon our students.”                    the remainder of
                                                  the morning.”

 Feedback from teachers and schools

                                               The first five years July 2011 – June 2016   029
NSW Healthy School
Canteen Strategy

                                           The Fresh Tastes @ School NSW         There have been significant
                                           Healthy School Canteen Strategy       developments in this area since
   A key action point of the
                                           was jointly developed in 2004 by      the introduction of the Strategy
   NSW Healthy Eating Active
                                           the NSW Ministry of Health, the       more than ten years ago, most
   Living Strategy5 is
                                           NSW Department of Education,          notably an update of the Australian
   improving the availability
                                           the Catholic Education                Dietary Guidelines57 and
   of healthy food and drink
                                           Commission NSW and the                accompanying Australian Guide to
   in a range of settings, and
                                           Association of Independent            Healthy Eating49, the release of
   implementing the
                                           Schools of NSW. Implementation        National Healthy School Canteen
   Australian Dietary
                                           of the Strategy is a requirement      Guidelines58 and introduction of
   Guidelines within all
                                           for government schools and            the voluntary national Health Star
   nutrition initiatives.
                                           encouraged in Independent and         Rating system on packaged foods
                                           Catholic schools.                     in 2014. In this developing context,
                                                                                 a review of the Fresh Tastes @
School canteens are an important           The Strategy requires that
                                                                                 School NSW Healthy School
setting to target in this context,         nutritious food and drink to be
                                                                                 Canteen Strategy was required to
with evidence that:                        promoted and made readily
                                                                                 ensure consistency with the new
                                           available to NSW school students.
                                                                                 guidelines, improve
•	Around 60% of NSW students              Food and drink with minimal
                                                                                 implementation, and increase
   report purchasing their lunch           nutritional value is to be offered
                                                                                 healthy food and drinks sold in
   from the school canteen at              infrequently and should not be
                                                                                 school canteens. The review was
   least once per week52                   promoted. The NSW Canteen
                                                                                 led by the NSW Department of
                                           Menu Planning Guide 55 outlines the
•	Older students (particularly                                                  Education jointly with the NSW
                                           requirements of the Strategy and
   boys Year 8 and above) are                                                    Ministry of Health and was
                                           is based on the 2003 Australian
   more likely to report purchasing                                              launched in Term 1 2017.
                                           Dietary Guidelines for Children and
   from the canteen more than
                                           Adolescents56. The Menu Planning
   once a week, as are students
                                           Guide uses a traffic light system
   from a low socio-economic
                                           (red, amber and green) to classify
   status background53
                                           the nutritional value of food and
•	On average, Australian school-          drinks.
   age children consume more
   than one-third of their daily
   energy intake at school. This
   includes a combination of foods
   purchased from canteens and
   food brought from home54.

030      NSW Healthy Children Initiative
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