Healthy Way to Grow

American Heart Association and Nemours


The Healthy Way to Grow (HWTG) is a direct education and PSE intervention directed at early childhood education centers (ECE). HWTG is designed to promote the adoption of wellness policies and implementation of best practices at the center level to create cultures of health within child care facilities, which positively impact early childhood providers’ knowledge and skills about healthy eating and physical activity (PA), provide tools and resources for child care facilities to help parents and families increase healthy eating and PA, and expose children to healthy foods and PA at a young age. HWTG helps centers learn how to approach these issues and embed best practices into their ongoing activities to create a culture of health and wellness within their environments.

Target Behavior: Breastfeeding, Healthy Eating, Physical Activity and Reducing Screen Time, Other: staff wellness

Intervention Type: Direct Education, PSE Change

Intervention Reach and Adoption

HWTG targets staff and providers at ECE centers, and the low-income families that utilize their services. The program was implemented across multiple communities and with various ECE providers including Head Start, faith-based, school-based, non-profit and small business. Overall, by the end of its 5th year (2017-2018) HWTG reached 448 centers, 5,661 staff, and approximately 43,000 children. After sites complete their intensive phase of HWTG, they are supported via digital resources, webinars and community support.

Setting: Child care (Learn)

Target Audience: Preschool (<5 years), Pregnant/Breastfeeding Women Parents/Mothers/Fathers

Race/Ethnicity: American Indian or Alaska Native, Asian, Black or African American, White, Hispanic/Latino, Non-Hispanic/Latino

Intervention Components

HWTG includes technical assistance, training, and support to ECE providers to improve and sustain nutrition, PA, screen time, and infant feeding policies and practices in their centers.  This includes: a baseline assessment, wellness policy and action plan development, ongoing training and technical assistance and center recognition. This can be provided on-site at the ECE program or through a combination of trainings paired with individualized technical assistance. HWTG provides training to partnering organizations on the core components including the wellness policy workbook, wellness policy development, technical assistance and evaluation. HWTG can be implemented at anytime throughout the year, although it is most typically implemented to align with the school year with centers recruited in the fall and successfully completely the wellness policy and action planning by the spring.

Intervention Materials

HWTG provides a variety of tools and resources to support implementation partners and ECE programs. These include:

  • Partner Implementation Guide
  • Project Implementation Timelines
  • Wellness Policy Workbook
  • Wellness Policy Posters
  • Action Planning Templates
  • Training Materials
  • Staff and Family Newsletters
  • Activity Calendars
  • Staff Wellness Challenge
  • Family Challenge
  • Center director survey

Some materials are available here and others are available upon request.

Intervention Costs

Limited costs for training and evaluation, depending on the level of support requested. Printing costs for workbooks and wellness policy posters

Evidence Summary

An implementation evaluation was conducted by Child Trends in 2015 to understand facilitators and barriers to successful HWTG implementation. The evaluation findings for the initial communities were positive across all 5 years, showing the benefits of participation in HWTG. After the first year of participating in HWTG, centers were more likely to develop policies, provide education (to children, staff, and families on the four HWTG topical areas), and monitor wellness practices. Centers with higher organizational readiness were more likely to offer education to staff and families. The evaluation also showed positive benefits of HWTG participation even after five years.

Evidence-based Approach: Practice-based

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)
Individual ST1, ST3 MT1, MT3
Environmental Settings ST5, ST6, ST7 MT5, MT6 LT5, LT6, LT7, LT10,
Sectors of Influence
  • ST1: Evaluation measures increases in nutrition education provided to staff, parents and children overall. Additional tools are available to measure individual impact (goals and readiness) of those programs for parents and staff.
  • ST3: Evaluation measures increases in physical activity education/opportunities provided to staff, parents and children overall. Additional tools are available to measure individual impact (goals and readiness) of those programs for parents and staff.
  • MT1: Additional programs implemented as part of HWTG have focused on shopping and cooking skills as a strategy for changing eating behaviors
  • MT3: Additional programs implemented as part of HWTG have focused on increasing physical activity, particularly for staff
  • ST5: HWTG needs assessment identifies center level readiness for change across nutrition & physical activity policy and best practice areas
  • ST6: HWTG workbook includes goal of establishing wellness policy committee with staff, parents and community partners.
  • ST7: HWTG works with center directors to build community partners to support implementation of wellness policy goals, including having community collaborations as part of policy goals.
  • MT5 and MT6: HWTG needs assessment, wellness policy workbook and center director survey all provide center level information on number and proportion of early care and education programs that make at least one change in policy/writing or practice to expand access or improve appeal for healthy eating
  • LT5: HWTG center directory survey can provide number of centers that implement nutrition policy changes, educational programs and parent involvement.
  • LT6: HWTG center directory survey can provide number of centers that implement physical activity policy changes, educational programs and parent involvement.
  • LT7: HWTG provides Gold, Silver and Bronze recognition levels to recognize those early care and education programs achieving wellness policy goals and best practices.
  • LT10: HWTG assessment and wellness policy workbook include annual review and updating of wellness policy goals and focus on monitoring to ensure sustainability. National HWTG infrastructure provides ongoing resources (newsletters and webinars) to all participating providers.

Evaluation Materials

Evaluation tools are provided to assess both outcomes and implementation. To assess outcomes, the Center Director Survey tracks the number of wellness policies in the four HWTG areas; education provided to children, staff, and families on wellness policies; and how the wellness policies were monitored. A recently developed Interview Guide for both Center Directors and implementing partners provides implementation evaluation.

Additional Information

Website: The HWTG website includes information about the program, where it’s been implemented, and intervention materials.

Contact Person:
Jennifer Weber