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CHOICE: Creating Healthy Opportunities In Child Care Environments

California Department of Public Health


The CHOICE intervention provides tools to assess and develop nutrition and physical activity policies in child care settings. The CHOICE team developed the Self-Assessment Questionnaire (SAQ) and the Best Practices Manual to help childcare centers develop comprehensive written nutrition and physical activity policies. The SAQ is a list of 35 best practices for childcare nutrition and physical activity environments. The four sections of the SAQ address nutrition, child feeding practices, foods served, physical activity, and staff and parent training.

Target Behavior: Breastfeeding, Healthy Eating, Physical Activity

Intervention Type: PSE Change

Intervention Reach and Adoption

CHOICE helps early childcare centers evaluate and implement best practices for childcare nutrition and physical activity. CHOICE provides a manual for self-assessment and policy development. This manual is publicly available and can be used by rural and urban childcare centers throughout the United States.

Setting: Early Childcare Centers

Target Audience: Preschool (<5 years old)

Race/Ethnicity: All

Intervention Components

The CHOICE intervention consists of a manual that helps childcare centers or childcare homes implement comprehensive nutrition and physical activity policies. The four-section manual consists of a 35-question Self-Assessment Questionnaire (SAQ) and a Best Practices Manual that address the following topics:

  • Nutrition
  • Child feeding practices
  • Food served
  • Physical activity
  • Staff and parenting training

Intervention Materials

The manual is the main component of this intervention. It consists of best practices, resources for policy development and implementation, tracking tools, and a self-assessment questionnaire.

The link to the English manual is:

Please note: due to funding, this program manual has been unable to undergo a proper update. Nonetheless, you can find updated links referenced on pages 37-40 here.


Intervention Costs

Materials available at no cost.

Evidence Summary

None available.

Classification: Emerging

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Environmental Settings ST5, ST6, ST7 MT5, MT6 LT5, LT6, LT7, LT8, LT9, LT10, LT11
Sectors of Influence

Evaluation Materials

Evaluation materials are included in the manual.

The link to the English manual is:

The link to the Spanish manual is:

Additional Information

Website: The CHOICE website ( includes a manual with self-assessment questionnaire, best practices for child care nutrition and physical activity environments.

Contact Person(s):
Kitty Lenhart

Grant Projects Coordinator



*Updated as of September 26, 2023