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2013 Model Practices (Public)

Practice Title
TAKE 10: A Policy Integrating Physical Activity into Classroom Curriculum
Submitting LHD/Agency/Organization
Franklin County Health Department
City
Frankfort
State
KY
Submitting LHD/Agency/Organization Web Address (if applicable)
www.fchd.org

Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:

• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status) 
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.

In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met? 
• What specific factors led to the success of this practice?

The Franklin County Health Department is located in Frankfort, KY and along with its many public health system partners serves a population of 49,285 (US Census Bureau, 2010). Our MAPP (Mobilizing for Action through Planning and Partnerships) health improvement coalition noted a youth obesity rate of 33.2% for KY compared to 27.8% for the U.S. (CDC, 2009) in its Community Health Assessment (2011). Locally collected data (2008) from 4th and 5th grade students also revealed that an alarming 41% were either overweight or obese. Using this assessment data the Frankfort YMCA was awarded a $40,000 Pioneering Healthier Communities (PHC) grant and the Franklin County Health Department was awarded a $7,000 Leadership for Healthy Communities grant to reduce childhood obesity and chronic diseases through policy, systems and environmental change strategies. These coalitions and MAPP developed the objective to increase the number of elementary schools from 0 to 11 that have policies integrating physical activity into the classroom curriculum by Sept. 2012. This objective targeted our kindergarten through fifth grade population, in our 7 Franklin County elementary schools, our 1 Frankfort Independent elementary school and our 3 private elementary schools or a total of approximately 5,000 students. To accomplish this objective and to ultimately help with the goal of reducing the trend of childhood obesity numerous partners, including but not limited to Kentucky State University, the Kentucky Department for Public Health and the Franklin County Parks and Recreation Department, developed sample policy language that was presented to the 5 Boards of Education that represent all 11 of our elementary schools for first and second readings. The Frankfort YMCA utilized approximately $16,000 of its PHC grant award to provide the TAKE 10 curriculum to all kindergarten through fifth grade teachers to assist with policy implementation. The Franklin County Health Department provided staff training to all teachers and coalition partners issued annual electronic teacher evaluations and conducted BMI assessments of all students. From April to July 2011 the entire target audience was reached by the passage of Board of Education policies requiring that at least 10 minutes of physical activity be integrated into the daily classroom curriculum utilizing programs such as TAKE 10. Although no statistically significant changes in BMI were noted during the first 2 years of implementation school nurses have assumed and will continue to monitor BMI status. An additional 50 minutes of physical activity was added to the school week in 10 schools and one private school added 100 minutes of physical to each week by requiring that 20 minutes of physical activity be integrated into the daily classroom curriculum. Policies integrating physical activity into classroom curriculum could easily be replicated by other local health departments with strong support from their community partners and support for their teachers. A neighboring Kentucky community has recently begun to replicate this practice by discussing such policies with their Boards of Health and Education.

Overflow: Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

N/A
You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles, etc.
Describe the public health issue that this practice addresses. (350 word limit)
The childhood obesity epidemic has been largely recognized. The CDC (2012) reported that “childhood obesity has more than tripled in the past 30 years.” The health effects of childhood obesity are both immediate and long-term and include cardiovascular disease, diabetes, bone and joint problems, social and psychological problems, sleep disturbances, stroke and several types of cancer. Of course the monetary costs associated with the obesity epidemic are in the billions. When looking at the childhood obesity rates for Kentucky, the Childhood Obesity Action Network (2009) reported that in 2007 37.1% of children aged 10-17 were overweight or obese exceeding the national rate of 31.6%. Youth Risk Behavior Surveillance (YRBS) data was collected for high school students and showed that 33.2% were overweight or obese in Kentucky compared to 27.8% in the nation (CDC, 2009). Even more alarming is locally collected data (2008) from 4th and 5th grade students (includes county, city and private schools) that revealed a rate of 41%. Closely linked to these obesity rates are sedentary lifestyles. YRBS data indicate no physical activity for 17% of Kentucky and 23.1% of U.S. high school students (CDC, 2009). Out of 120 counties Franklin County received a ranking of 38 in health behaviors on the County Health Rankings (2011). This category was Franklin County’s lowest score.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit)
The Mobilizing for Action through Planning and Partnerships (MAPP) community-wide strategic planning process was used to prioritize relevant public health issues to our community. The Franklin County MAPP coalition, that includes participation from over 60 community partners, conducted four assessments including the National Public Health Performance Standards Program (NPHPSP), a Forces of Change assessment, a Community Themes and Strengths assessment and a Community Health Status assessment. By exploring the combined results of these four assessments MAPP identified strategic issues that represent the prominent cross-cutting findings that need to be addressed to reach our coalition’s vision. One of these strategic issues is, “how do we encourage healthy lifestyles?” Relationship diagrams were created showing how results from each of the assessments led to this strategic issue. For instance, our community identified overweight and obesity as one of our three most serious risk behavior problems on a quality of life survey, environmental forces of change included opportunities for enhancing physical activity, the NPHPSP showed that our lowest scores were for linking people to needed health services and the assessment of community health status showed high adult and childhood obesity rates. Goals and strategies were then formulated using evidence-based practices. The CDC (2011) identified physical activity as one of the winnable battles and a priority area that can significantly impact our nation’s health, which lead to our MAPP goal, encourage physically active lifestyles. After researching model school wellness policies we developed the objective of increasing the number of elementary schools from 0 to 11 that have policies integrating physical activity into the classroom curriculum by Sept. 2012 (National Alliance for Nutrition and Activity, 2007).
How does the practice address the issue? (350 word limit)
To prevent childhood obesity the CDC (2012) recognizes that “Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support health behaviors.” The Socio-Ecological Model provides a theoretical framework describing how behavior change is influenced by (1) social structure, policy, and systems; (2) community; (3) institutional/organizational; (4) interpersonal; and (5) individual (Gregson et al., 2001). There has also been a growing recognition that working with individuals to affect behavior is difficult and resource consuming, while interventions that influence policies and group-level behaviors can in turn affect individual-level behaviors among a much larger group of people and thus be more resource efficient (Stokols et al., 1996). TAKE 10: A Policy Integrating Physical Activity into Classroom Curriculum addresses the issue of childhood obesity through a policy, systems and environmental change approach. While TAKE 10 is an evidence-based program one agency would not be able to sustain it in over 180 classrooms. High level policy changes by the Boards of Education ensure that the program is enforced and sustained. This policy change ultimately increases physical activity by at least 50 minutes during the school week to address the issue of childhood obesity. By integrating physical activity into the standard classroom lessons the barrier of limited classroom time is also overcome.
Does this practice address any of the CDC Winnable Battles? If yes, select from the following
Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support)
TAKE 10: A Policy Integrating Physical Activity into Classroom Curriculum adds up to 50 minutes of physical activity to the school week. Physical inactivity or sedentary lifestyles are closely linked with overweight and obesity, which contributes to many of the leading causes of death in Franklin County, KY and the nation. The CDC (2011) has identified physical activity as one of the winnable battles and a priority area that can significantly impact our nation’s health (http://www.cdc.gov/winnablebattles/). Integrating physical activity into the classroom setting is recommended by the National Alliance for Nutrition and Activity (2007) Model School Wellness policies (http://www.schoolwellnesspolicies.org/). The National Association for Sport and Physical Education also recommends that children spend at least 60 minutes per day in physical activity and states that “Physical activity breaks or energizers can be incorporated into the school day …during each academic class as a way of integrating learning objectives with physical movement.” TAKE 10 is listed as one of the resources for use during school (http://www.aahperd.org/naspe/publications/teachingTools/upload/PA-During-School-Day.pdf). To increase physical fitness and reduce childhood obesity rates the Leadership for Healthy Communities Action Strategies Toolkit (2011) includes policy and program options such as “integrate physical activity throughout the school day” (http://www.leadershipforhealthycommunities.org/index.php/action-strategies-toolkitmenu-122/active-schools-toolkitmenu-130?task=view). Physical activity has also been associated with academic achievement and less disruptive classroom behavior (CDC, 2011). Numerous research studies have evaluated the effectiveness of TAKE 10 to increase academic achievement, decrease childhood obesity, and increase physical activity levels (http://www.take10.net/publications).
Is the practice new to the field of public health? If so, answer the following questions.
Yes

What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review.

An extensive literature review revealed no previous involvement of public health in the passage of Board of Education policies that integrate physical activity into classroom curriculum. This literature review included NACCHO’s Model Practice Database, public health and school health journals as well as an Internet search. As part of our NACCHO Leadership for Healthy Communities grant, Dr. Kenneth Smith, also reported that no other similar policies could be located and has begun to write a case study about the passage of our school policies. Integrating physical activity into the classroom setting and curriculum has been recommended by many sources (LHC, 2011; McKenzie and Kahan, 2008; NANA, 2007; NASPE, 2011) http://dx.doi.org/10.1086/529100, but in examples where schools are using TAKE 10 or similar programs there is not an accompanying policy to require, enforce and sustain its use, nor is there participation from the public health sector in its implementation.
How does this practice differ from other approaches used to address the public health issue?
Many approaches addressing the public health issue of childhood obesity have focused on the school sector. However, most such approaches have focused on programming versus more sustainable policy, systems and environmental changes. Literature reviews, including the NACCHO Model Practices Database have revealed school wellness policies for active recess and joint use agreements, but no policies requiring that physical activity be integrated into the classroom curriculum. Unlike active recess policies, this policy that integrates physical activity into core content and classroom lessons increases the number of minutes devoted to physical activity each school week. This policy approach is more sustainable and has already seen growth and expansion since its implementation with the inclusion of programs other than TAKE 10 and employee wellness challenges.
Is the practice a creative use of an existing tool or practice? If so, answer the following questions.
No
What process was used to determine that the practice is a creative use of an existing tool or practice?  Please provide any supporting evidence you may have, for example, literature review.

What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice?  (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?

How does this practice differ from other approaches used to address the public health issue? 

If this practice is similar to an existing model practice in NACCHO’s Model Practices Database (www.naccho.org/topics/modelpractices/database), how does your practice differ? (if, applicable)
Who were the primary stakeholders in the practice?
The ultimate stakeholders of this policy that adds 50 minutes of physical activity to each school week are approximately 5,000 kindergarten through fifth grade students in Franklin County, KY. The over 180 kindergarten through fifth grade teachers tasked with implementing this policy are also primary stakeholders. These two stakeholder groups both stand to benefit from the health impacts of this policy. The policy makers at the Franklin County, Frankfort Independent, Good Shepherd School, The Frankfort Christian Academy and Capital Day School Boards of Education were extremely important stakeholders in the passage of this policy. The Frankfort Y Pioneering Healthier Communities (PHC) Coalition and the entire Franklin County Mobilizing for Action through Planning and Partnerships (MAPP) Coalition that developed the policy goals and objectives and completed specific tasks to reach and evaluate these goals are also considered stakeholders in this practice. The Y PHC Coalition is comprised of numerous key stakeholders in our community including the Kentucky Department for Public Health, Kentucky State University, Franklin County Parks and Recreation, Frankfort City Commissioner, Franklin County Health Department, Frankfort Independent Schools, Frankfort Regional Medical Center and the Frankfort YMCA.
What is the LHD's role in this practice?
The Franklin County Health Department (FCHD) served as a member of the Frankfort Y Pioneering Healthier Communities (PHC) Coalition that developed the objective of increasing the number of elementary schools in our county that had policies integrating physical activity into the classroom curriculum. FCHD also secured additional funding to cover staff time that was spent researching and developing policy language, contacting and educating Boards of Education, distributing materials and training teaching staff in the implementation of this policy through programs such as TAKE 10, conducting BMI assessments and teacher evaluation surveys. FCHD also widely publicized the efforts of the Y PHC, including these Board of Education policies integrating physical activity into the classroom curriculum, through weekly newspaper articles and monthly local cable television shows. Further support for such policies was gained through FCHD’s facilitation of the larger Franklin County Mobilizing for Action through Planning and Partnerships (MAPP) coalition, which includes the Y PHC coalition as a subcommittee. Resources, such as the equipment to conduct BMI assessments and partnerships with Franklin County Public Schools were located through MAPP.
What is the role of stakeholders/partners in the planning and implementation of the practice?
The Frankfort Y was the lead agency in forming and developing the Pioneering Healthier Communities (PHC) Coalition to address childhood obesity through policy, systems and environmental change strategies. The Frankfort Y secured the start up funding for this coalition and provided the TAKE 10 curriculum to over 180 kindergarten through fifth grade classrooms in Franklin County. All Y PHC members including, the Frankfort Y, the Kentucky Department for Public Health, Frankfort Regional Medical Center, Kentucky State University, Frankfort Independent Schools, Franklin County Health Department, a Frankfort City Commissioner and Franklin County Parks and Recreation were instrumental in the development of the policy objective. All partners solicited support for the policy and many participated in interviews conducted by our local newspaper. In addition, they reviewed and revised the proposed policy language and teacher evaluation surveys before they were presented to Boards of Education. Kentucky State University (KSU) provided the equipment and training to conduct the BMI assessments at selected schools. KSU, Frankfort Y, Franklin County Parks and Recreation and Franklin County Health Department representatives were also present at the school sites assisting with the numerous BMI assessments. The Frankfort Independent Schools representative on the Y PHC Coalition was instrumental in gaining support from our county and private Boards of Education. This included having schools participate in BMI assessments.

What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals.

The Franklin County Health Department (FCHD) has been working to foster collaborations among community shareholders since the formation of the Franklin County Mobilizing for Action through Planning and Partnerships (MAPP) coalition in December 2008. MAPP has been extremely successful in our community at bringing together all existing health coalitions, including the Y Pioneering Healthier Communities (PHC) Coalition, to coordinate activities and share resources. MAPP meets as a whole at least every other month and a typical meeting lasts two hours with the first hour devoted to the entire coalition and the second hour devoted to individual subcommittees such as the Y PHC, Franklin County Diabetes Coalition, etc. Under the facilitation of FCHD our MAPP coalition has conducted and widely shared an extensive Community Health Assessment that led to the development of our Community Health Improvement Plan (CHIP). These assessments and the resulting CHIP have been utilized by several MAPP subcommittees, including the Y PHC, in grant applications that have secured funding to improve the health of our community. FCHD representatives are active members on all MAPP subcommittees as well as other community groups. Through MAPP and the National Public Health Performance Standards Program (NPHPSP) FCHD has solidified relationships with a variety of public health system partners. In the case of this practice, a policy integrating physical activity into classroom curriculum, Franklin County Public Schools (FCPS) was unable to commit to serving on the Y PHC coalition. This did not serve as a barrier since FCPS was easily updated through MAPP. Having this relationship ensured the opportunity for the FCPS Board of Education to hear our proposed policy. MAPP’s larger goal of encouraging physically active lifestyles also led to the participation of Kentucky State University in the BMI assessments involved in this practice.
Describe lessons learned and barriers to developing collaborations.
Collaborations have become more necessary than ever with dwindling human and financial resources. For this practice our community’s history of strong collaborations was vital to the receipt of funding. Through collaborations, such as the Y Pioneering Healthier Communities (PHC) coalition we have been able to educate numerous key public health system partners in evidence-based policy, systems and environmental change strategies. Having all of these partners trained in such strategies has greatly increased support for and participation in community health improvement activities. Having partnerships with key stakeholders has also been vital to decreasing the time required for the passage and implementation of policy, systems and environmental change strategies. Board of Education agendas are often very full and requesting the presentation of new policies for consideration can often be a lengthy process. However, having these partners involved in goal development ensured space on the agenda and negated the need for long presentations explaining the evidence base. With so many competing demands time has always been a large barrier faced when developing collaborations. We have been able to overcome this barrier through our larger Mobilizing for Action through Planning and Partnerships (MAPP) coalition that incorporates numerous coalition, or MAPP subcommittee, meetings under one umbrella.

Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.


Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).

List up to three primary objectives for the practice. For each objective, provide the following information:  (750 word limit per objective)

• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation.  Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback:  List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.


 

1. Increase the number of Franklin County elementary schools that have policies integrating physical activity into the classroom curriculum from 0 to 11. 2. Increase by 50 the number of minutes of physical activity during each school week. 3. Reduce the trend of childhood obesity.

Objective 1:

The first outcome objective of this practice was to increase the number of Franklin County elementary schools that have policies integrating physical activity into the classroom curriculum from 0 to 11. The performance measure being used to evaluate this objective was the policy change and the Y Pioneering Healthier Communities (PHC) Coach and Franklin County Health Department representative collected the new Franklin County, Frankfort Independent and three private Board of Education wellness policies showing that: INTEGRATING PHYSICAL ACTIVITY INTO THE CLASSROOM SETTING For students to receive the nationally-recommended amount of daily physical activity (i.e., at least 60 minutes per day) and for students to fully embrace regular physical activity as a personal behavior, students need opportunities for physical activity beyond physical education class and recess. Toward that end: • classroom education will reinforce the knowledge and self-management skills needed to maintain a physically-active lifestyle and to reduce time spent on sedentary activities, such as watching television; • at least 10 minutes of physical activity per day will be incorporated into other subject lessons (e.g., TAKE 10!®, Active and Healthy Schools™ Classroom Activities Card Sets); and • classroom teachers will provide short physical activity breaks between lessons or classes, as appropriate (not to include physical education classes, recess or transitions between classes). Board of Education meeting minutes documenting the passage of the new physical activity requirement were also collected. This objective was fully achieved due to the collaboration of all Y PHC partners. Using a high level Board of Education policy change approach in this practice streamlined the process that otherwise would have had to be presented at 11 different elementary schools. This policy approach also strengthened the policy and helped in gaining support from teachers. Teachers commented on electronic evaluations that “participation was encouraged by my principal,” and that it helped “student engagement” and to “refocus students.” These evaluation results and this success was shared widely with every elementary school, each Board of Education and the Y PHC and MAPP coalitions. Furthermore the general public was alerted through a weekly newspaper article written by the Franklin County Health Department.

Overflow (Objective 1): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

Objective 2:

Another important objective of this practice was to increase by 50 the number of minutes of physical activity during each school week. The performance measure for this objective was the number of TAKE 10 activities completed by each classroom. To collect this primary data each kindergarten through fifth grade classroom was provided a TAKE 10 tracking poster and stickers. One sticker was placed on the poster after the completion of each 10 minute curriculum based physical activity lesson and on electronic survey evaluations teachers were asked to count the number of activities on their tracking poster. We had a response rate of almost 54% for our teacher evaluations, which showed that on average almost 31 minutes of additional physical activity was added to each school week. There were many comments that a greater variety of activities were needed. Each school and all coalition partners were notified of these results and as suggested in the TAKE 10 curriculum teachers were encouraged through e-mail communication to create their own physical activity lessons that complimented their lesson plans. Schools were also reminded of other such programs with ready made activity cards and in the case of one school the Family Resource Center was able to purchase a second curriculum for use. Yet again including all partners and stakeholders has been vital to our success. We are continuing to work through our partnerships to identify additional ways to assist our teachers with the integration of physical activity into their classroom curriculum.

Overflow (Objective 2): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

Objective 3:
The long term outcome objective of this practice is to reduce the trend of childhood obesity. Y PHC partners conducted BMI assessments for all kindergarten-fifth grade students as a primary data source and performance measure for this objective. These assessments were completed before and after implementing the TAKE 10 policy and showed no statistically significant change in BMI. The Kentucky Department for Education is now requiring all schools to collect primary BMI data, therefore Franklin County Health Department school nurses are continuing monitor this objective. Y PHC and MAPP partners have also committed to completing regular community health assessments that will look at secondary data sources, such as the Youth Risk Behavior Survey. All stakeholders have been kept apprised of the aggregate BMI assessment results and all understand that improvements in long term outcome objectives that include changes in health status will likely take many years and many interventions at the community, policy, system and individual levels. The long term goal of the Y PHC is to reduce the trend of childhood obesity by 2015 and to this end we are also working to improve nutrition and physical activity standards in early learning childcare centers.

Overflow (Objective 3): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

What are the specific tasks taken that achieve each goal and objective of the practice?
In order to achieve the objective of increasing the number of Franklin County elementary schools that have policies integrating physical activity into the classroom curriculum from 0 to 11 there were several specific tasks that had to be achieved. The Y PHC began by identifying and researching the cost of possible programs, such as TAKE 10, that would help with the implementation of such a policy. Coalition members also researched model school wellness policies and developed sample policy language for consideration by Boards of Education. Boards of Education were then approached. Each Board of Education held a first and second reading of the policy before its adoption. While the policies were under consideration evaluation plans were being formulated and possible teacher training dates were being identified. For our objective of increasing by 50 the number of minutes of physical activity during each school week a tracking method had to be developed. The tracking posters and stickers that are standard components of the TAKE 10 program greatly helped with this task. Teachers then had to be trained on the use of this tracking method and an electronic survey was developed to collect this primary data from teachers. The long term outcome objective of this practice, to reduce the trend of childhood obesity, initially included many tasks revolving around BMI assessments. The dates for assessments were coordinated with either classroom or PE teachers. A Kentucky State University Tanita machine that automatically calculates BMI was utilized and trainings for this equipment were scheduled. BMI is now being monitored by school nurses and other secondary data sources.
What was the timeframe for carrying out these tasks?
Boards of Education were originally approached and their interest was determined during June and July 2010. The TAKE 10 materials and teacher training, including the process for tracking the number of activities completed, occurred from August to September 2010. The first BMI assessments also occurred in September 2010. Boards of Education held their first and second readings of the policy and adopted the policy from April to July 2011. In June of 2011 BMIs were reassessed and the first electronic teacher evaluation was issued. BMI assessments were repeated in September 2011 and June 2012. A second teacher evaluation was also issued in June 2012. We had originally expected it take to two complete schools years for all 5 Boards of Education to pass new requirements integrating physical activity into classroom content and had therefore set September 2012 as the goal date for policy passage. This deadline was greatly exceeded due to our partners and the ease with which policies were presented to Boards of Education.
Please provide a succinct outline of some basic steps taken in implementing your practice.
I. Form a coalition from all sectors of the local public health system II. Research and purchase programs to assist teachers with integrating physical activity into classroom curriculum. III. Draft policy language IV. Present policy to Boards of Education for review and passage V. Provide teacher trainings on the policy and methods for implementing the policy (TAKE 10) VI. Evaluate the policy (BMI assessments, teacher surveys, etc.) VII. Provide continued to support to teachers

What were some lessons learned as a part of your program's implementation process?

It was vital to have widespread partnerships that were included at all levels of policy development. Board of Education staff as well as teachers were key stakeholders that allowed for policy passage and implementation. Involving community partners and approaching childhood obesity from the policy rather than program level has ensured that all elementary schools are participating and therefore all kindergarten through fifth grade students will have increased opportunities for physical activity at school. High level policies such as this are more sustainable and easier to enforce although implementation of policies is often more complicated than program implementation.
Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services.
The Y Pioneering Healthier Communities (PHC) coalition utilized approximately $16,000 of its $40,000 Y PHC grant award to purchase the TAKE 10 curriculum for over 180 kindergarten through fifth grade classrooms. In the second year of implementation an additional $3,500 of these grant funds were utilized to replenish tracking posters for all kindergarten through fifth grade classrooms. The Franklin County Health Department (FCHD) also secured a $7,000 NACCHO Leadership for Healthy Communities grant that largely, but not fully, covered staff time devoted to coalition meetings, partnership development, policy research and drafting, conducting BMI assessments and teacher trainings and evaluations. FCHD along with all other Y PHC partners, including the Frankfort Regional Medical Center, Kentucky State University, Franklin County Parks and Recreation, a Frankfort City Commissioner and Frankfort Independent Schools, also provided in-kind staff time for planning and assessments related to this practice.
Is there sufficient stakeholder commitment to sustain the practice?  Describe how this commitment is ensured.
The Franklin County MAPP coalition was formed in December 2008 and continues to meet regularly with one of its health improvement goals being to encourage physically active lifestyles. This practice represents one of the strategies for meeting this goal and over 60 MAPP partners are energized by this policy success and are committed to increasing the use of TAKE 10 and therefore the amount of physical activity that occurs during the school week. To achieve this goal and to address the public health issue of childhood obesity coalition members are continuing to evaluate teacher satisfaction and garner teacher input. Teacher evaluations conducted in 2012 show an increase in the percentage of teachers who are aware of the new policy requirements. Boards of Education are also provided regular updates on this policy implementation and school principals are actively engaged in enforcing this and all school wellness policies.
Describe plans to sustain the practice over time and leverage resources.
Since implementing this policy change the Franklin County MAPP coalition has already received an additional $60,000 in grant funding for the prevention of chronic diseases through policy, systems and environmental change strategies. Coalition members and Franklin County Health Department staff actively seek out grant funding and hope to build upon current successes. Strategies such as this TAKE 10 policy that integrates physical activity into classroom curriculum are sustainable over time as they become integrated into the culture of the school system. The latest 2012 teacher evaluations also show that teachers are creating more of their own physical activity lessons and are implementing TAKE 10 at a greater variety of times throughout the day (before lunch, in the morning, at the end of the day, etc.). Over 50% of responding teachers feel that the TAKE 10 policy motivates students, provides a transition between lessons and promotes health and activity. Slightly less than 50% of teachers feel that academic concepts are reinforced through this TAKE 10 policy. We are confident that this policy will continue to increase the amount of physical activity provided during the school week and that these changes will be continued overtime due to the collaboration of partners that have combined resources.
Practice Category Choice 1:
Chronic Disease (Obesity)
Practice Category Choice 2:
Organizational Practices
Practice Category Choice 3:
Community Assessment
Other?
No

Please Describe: