Boys and Girls Clubs of Boston

Health Advocacy Committee Initiative Consultancy Final Report Boys and Girls Clubs of Boston July 2014 – June 2015

Prepared by Kirsten Davison, PhD Department of Social & Behavioral Sciences Department of Nutrition Harvard T.H. Chan School of Public Health kdavison@hsph.harvard.edu Marvin So, MPH Department of Social & Behavioral Sciences Harvard T.H. Chan School of Public Health Marvin.So@mail.harvard.edu

Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Childhood obesity: addressing the issue of our time Obesity is one of the most pressing health issues of our time. In children, obesity is linked with an ever-expanding list of physical health consequences including type 2 diabetes, metabolic syndrome, asthma, sleep apnea and fatty liver disease along with negative psychological and social outcomes such as low self-esteem, discrimination, depression and reduced quality of life.

Even more concerning, obesity and its health consequences mostly affect low-income populations and communities of color and serve to perpetuate health, economic and social disparities.

Spaces in which children and their families live, work, learn, and play have a significant influence on their health long before they enter the doctor’s office. Thus, public health research and practice now focuses on re-shaping these environments, to make the healthy choice the easy choice.

From 2014-2015, the Boys and Girls Clubs of Boston (BGCB) aimed to do just that. BGCB’s mission is to “help young people, especially those who need us most, build strong character and realize their full potential as responsible citizens and leaders”. In order to fulfill this mission, BGCB recognizes the need to foster Clubs that not only offer a haven of opportunity, ongoing relationships with caring adults, and life-enhancing programs – but also fundamentally cultivate health and well-being in all dimensions of a child’s development.

Healthy Clubs, Healthy Lifestyles In 2014, BGCB received a grant from Harvard Pilgrim Health Care (“Healthy Clubs, Healthy Lifestyles”) to create measurable steps towards shaping a healthier environment in all BGCB Clubs for members, families, and staff. Building off of their CATCH initiative in earlier years, BGCB proposed a deeper commitment to health through collaboration with researchers from the from the Harvard T.H. Chan School of Public Health. Kirsten Davison, PhD, and Marvin So, MPH are skilled in the development, implementation, and assessment of interventions to prevent childhood obesity – particularly in low-income communities and in the context of real world settings such as schools, childcare settings, and afterschool programs. The Harvard researchers were engaged to undertake the following: ● Spearhead the development and implementation of Health Advocacy Committees comprised of staff, teen and child members, and member parents at three BGCB Clubs to drive changes in programs and policy. ● Document the Club social and food environment to inform policy recommendations. ● Facilitate and document an iterative policy development process rooted in the work of each of the three Health Advisory Committees. ● Educate BGCB staff about the current state-of-science concerning children’s health and well-being, with special attention to the importance of policy, system, and environmental changes to promote optimal child health.

This report describes the activities of the Harvard-BGCB partnership and offers strategic recommendations based on lesson learned over the past year.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Laying the Groundwork The Harvard research team, the BGCB Executive Director of Strategic Partnerships (Lauren Cook) and the Community Health Specialist (Suzy Spressert), convened several times in early 2015 to identify possible strategies to address BGCB’s broad goals around health. They devised several preliminary ideas such as a youth health ambassador program to give youth a voice in their community’s health, while simultaneously developing themselves professionally in preparation for jobs and/or college.

In September 2014, the Harvard research team presented some of these initial thoughts to BGCB staff and the Senior Management Team. These meetings emphasized the role of a healthy childhood in setting the stage for health and wellness in adulthood along with the need to engage BGCB stakeholders (including staff, members and families) as leaders of the change process. Soon thereafter, the researchers met with Directors of three Clubs to get their perspective on health initiatives previously implemented, the culture of health in their respective clubs and potential opportunities and challenges they foresaw in terms of not only making BGCB healthier – but doing so in concrete, action-oriented ways focused on sustained policies and systems.

The cross-cutting theme of these meetings was that while prior efforts such as CATCH and Triple Play along with collaborations with the Food Bank, the Food Project, and Bikes not Bombs had been helpful, Club Directors did not feel like these efforts “stuck”. They spoke about both the lack of consistency across Clubs as well as the lack of initiatives that were sustained. Many programs were labeled as “pilot programs”. As Blue Hill Executive Director Carl Thompson put it, “We’re great at starting things as an organization, but we’re not good at keeping things alive.”

The Directors highlighted the need to change the Club culture at the organizational level. At the same time, they also acknowledged the gravity and difficulty inherent to that task as a result of the rich and diverse cultures and practices within and between Clubs, personal health struggles of the staff, and the irascible challenge of engaging parents in health efforts. While recognizing these challenges, the Directors also shared the following ideas on how to achieve success: ●

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Incorporate health into what already exists at the Club-specific level (i.e., leveraging existing staff responsibilities and relationships) and BGCB wide (i.e., job descriptions, onboarding processes, staff education and professional development) thereby minimizing the burden of implementing such changes.

Galvanize Clubs to propose organization-wide policies informed by BGCB staff, members, and families who would be most affected by these changes.

Identify specific actions that can be clearly articulated across all levels of BGCB, and move beyond simply saying that health is important. Yawkey Executive Director Andrea Swain put forth this notion effectively, mentioning that “we want something with a clear format, and something that is not intrusive. Health is so big, massive...expansive. We need to be clear, and we need to define it.”

Alongside discussions with the Club Directors, the research team met with 30 additional programmatic and kitchen staff across six Clubs (the three already mentioned, and three Page 2

Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report additional Clubs spanning free-standing and shared space Clubs) to gauge their “readiness to change” or the extent to which they and the Clubs they represented would be responsive to the changes considered. These conversations largely corroborated the suggestions put forth by the Club Directors and emphasized that the proposed changes should recognize that Staff were already stretched-thin.

Launching the Health Advocacy Committees Drawing on what they learned from these early meetings, the research team in collaboration with the Executive Director of Strategic Partnerships (Lauren Cook), the newly hired Community Health Specialist (Suzy Spressert), and later, the Director of Healthy Lifestyles (Grace Lichaa) (collectively referred to as the Health Leadership Team) conceptualized Health Advocacy Committees as a strategy to guide sustainable policy change and create healthier environments in all BGCB Clubs.

Soon thereafter, the Health Leadership Team held discussions with the BGCB Marketing team to put forth the idea of pulling all of BGCB’s health efforts under an umbrella term - Health360. This concept served to highlight the array of health-related initiatives that BGCB as an organization was undertaking during the 2014-2015 year.

The Health Advocacy Committees included representative staff, members and family members from each club who served as the voice for their Club. Committee members collectively defined their Club’s health needs and identified policy and communicationbased strategies to address these needs and Club environment supporting the health of BGCB members, families, and staff. .

Health Advocacy Committees were implemented in three of the 11 BGCB Clubs. Two of these Clubs were free-standing clubs (i.e., Yawkey and Blue Hill) and one of them was a shared space Club (i.e., Franklin Hill), allowing for a snapshot of the experiences of both types of BGCB Clubs.

Three Clubs were initially selected to allow for a greater focus on fewer sites, which could then inform future implementation of the remaining Clubs.

It took several months of planning to define the goals of the overarching wellness initiative, outline the duties and responsibilities of the committees, plot out an implementation timeline for the Health Advocacy Committee effort as a whole, recruit/orient engaged candidates for Leader and Intern positions for each committee, and identify best practices of other Boys and Girls Clubs that have been effective in pursuing health efforts. Moreover, challenges with both the holiday season and Boston’s snowiest winter in history delayed these efforts such that the Committees finally came up and running by January 2015.

Through an application process, three Health Advocacy Leaders were selected to lead their Club’s Health Advocacy Committee. Each leader was a full-time BGCB staff member willing to dedicate extra time to organize a Committee composed of BGCB staff, members (both children and teens), and parents of members for a total of 5-8 Committee members per Club. Teen committee members received a small stipend to act as Health Advocacy Interns and provide additional support to the Leader in recruiting additional members, organizing committee meetings, and

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report facilitating the Committee’s activities (similar to the role originally devised for youth health ambassadors).

The Committees were encouraged to meet at least once a month between January and May 2015.

Despite facing the harshest winter on record and the resulting school- and city-wide closings, the committees met 2-4 times during this period to push forward with their objectives. Attendance was high in 2 of the 3 committees with an average of 7 attendees at each meeting. Appendix A summarizes the meeting dates, the number of attendees and discussion topics for each Club.

The Committees were designed to align with the Out of School Nutrition and Physical Activity (OSNAP) Initiative implemented during the same year by the Boston Public Health Commission, which characterizes potential organizational actions as programmatic, policy, or communicationbased. Thus, the Committees were encouraged to discuss the perceived needs of their Club and identify strategies to address these issues through actions corresponding to the three OSNAP domains, with a strong leaning for policy and communication-based actions.

Health Advocacy Leaders documented their Club’s food environment The research team provided technical support for each Committee including the provision of meeting agendas and supplemental meeting materials, compiling meeting minutes, and developing tools to measure the Club’s environment and training Committee Leaders in how to use such tools (see Appendix B for examples).

Observing the food environment of Clubs. With support from the research team, the Health Advocacy Leaders observed and documented the types of food consumed in Clubs over a two week period. Specifically they recorded (1) what was on the menu each day, (2) what was served to members, (3) what additional foods were consumed by members (inclusive of additional snacks or foods they may have brought in), and (4) what additional foods were consumed by staff (inclusive of snacks or foods they may have brought in). Concurrent with these activities, the research team reviewed the menus provided by the Health Advocacy Leaders to identify obvious areas to target. [It should be noted that some Clubs prepared their own meals while others served meals from an external vendor (e.g., Emily’s, CityFresh)].

Observations by the Health Advocacy Leaders revealed the following: ● Staff typically ate healthy food while in the Clubs, including: salads, fish, fruit, homemade sandwiches, whole-wheat pasta, vegetable stir fry, chicken and rice, turkey wraps, meatballs, baked chicken, turkey sandwiches, cauliflower pasta, turkey chili, guacamole and water. There were few instances in which staff were observed eating foods that could be clearly defined as unhealthy (e.g., donuts, pizza, calzones, tortilla chips, and pastries). ● The food served to members was generally healthy (e.g., BBQ chicken, pasta, steamed vegetables, green beans, peaches, teriyaki stir fry, chicken soup, oranges). ● The food that members brought into clubs was oftentimes unhealthy and included: chicken strips, French fries, pizza, Arizona Iced Tea, Snapple Iced Tea, candy, chips, cookies, ice cream, and oreos.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report These findings were corroborated by discussions that took place during the Committee meetings, describing an environment in which Club food offered is generally healthy, but the food offerings right outside the Club (and frequently brought into the Clubs) were very unhealthy.

Policy Development Process The Health Leadership Team met frequently with the Committee Leaders through in-person meetings, phone meetings, and working lunches to provide guidance and technical assistance on the Committee’s work (see Appendix A). Concurrent with these activities, the research team documented the policy development process including Leader communication within groups, the number of meetings and attendees at each meeting, meeting minutes, and, starting in April 2015, summaries submitted directly by the Leaders to the BGCB Main Office as part of the Club’s bimonthly report. Collectively, these documents served as the basis of an ongoing process evaluation.

Phase 1: Identifying the health needs of each Club. The first few meetings were largely concerned with introducing the Health360 initiative to members, learning about their own perspectives on health, discussing challenges with adopting and maintaining a healthy lifestyle, and ideas on strategies to encourage members and staff to make healthy choices. Guided by support from the Health Leadership Team, and the food environment assessments conducted by the Committee Leaders, the Committees slowly progressed to talking about policy and environmental changes that could influence healthy choices in a more systematic way. The progress of each of these Committees at each Club is detailed in further depth in Appendix C. Phase 2: Selecting policy options to address Club health needs. Following initial brainstorming sessions, the Committees were provided with a menu of policy options developed by the research team. The menu of policy options drew on the goals outlined by OSNAP, the 2015 National Institute on Out-of-School-Time Healthy Eating and Physical Activity (HEPA) standards, and the content of discussions in Committee meetings up to this point. The list of possible strategies was presented to each Club’s Committee as a basis for evidence-based strategies (i.e., approaches that have been assessed in similar out of school time settings to be effective using rigorous scientific techniques) to consider in developing action plans. Each Committee was asked to identify policies, or modifications of policies, that would address their Club’s needs identified during Phase 1 and provide the Health Leadership Team with a summary of their recommendations.

Phase 3: Consolidating and refining policy options. The Health Leadership Team consolidated the policy recommendations from each Club into a single list (Appendix D). This process was guided by two considerations. First, policies had to be applicable to all BGCB clubs. Second, policies should provide Clubs with sufficient flexibility to determine how best to implement them in their unique context.

Through a series in-person and phone meetings, the Health Leadership Team shared the consolidated policy list with: (1) the Health Advocacy Leaders from each of the three Clubs, (2) the Directors of each of the Clubs where the Committees were initiated, (3) the Directors of all 11 BGCB Clubs, and finally (4) the BGCB Senior Management Team, including the BGCB CEO. With Page 5

Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report each party, the group was given the most recent version of the policy list to peruse prior to discussing their thoughts and concerns about how to adjust the language/content of the policies to be useful in their Clubs. By the time the final list was presented to the BGCB Senior Management Team in June 2015, the Committee-driven policy suggestions had been shared and vetted with all of these important stakeholders. This process is depicted in Appendix E. Recommendations for Implementation The yearlong process of community-driven policy development was an iterative, multi-faceted process that sought to create change in ways that were meaningful in the context of individual Clubs as well as BGCB more broadly. To support the successful implementation of the resulting policies, the research team developed a number of recommendations. These recommendations are informed by a Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis which pinpoints internal and external factors that could facilitate and/or hinder the successful implementation of the proposed policies (summarized in Appendix F). Recommendations include: 1. Develop communication strategies and materials to support policy implementation Successful implementation of the policies will depend heavily on the leadership and enthusiasm of the Club Directors along with tangible and intangible support provided by the BGCB main office team. Recent discussions with Club Directors also revealed a need for several resources including talking points, language, and documents to communicate the importance of these efforts to staff, members, and parents. In addition, materials concerning fundraising alternatives, local options for the procurement of healthy foods, and catering options should be developed. Families were uniformly mentioned as a potential challenge to the success of this initiative. Formal mechanisms to engage families and directly address their questions or concerns beyond simple communications (e.g., sending a letter home), such as Q&A sessions, may serve to support successful policy change.

2. Continue to harness the momentum generated by the Health Advocacy Committees.

The success of the Health Advocacy Committees over the past 6 months illustrates their potential to lead BGCB health programming and policy/culture change. We recommend that Health Advocacy Committees continue to be instituted at these three Clubs and eventually expanded to include all 11 Clubs. A designated BGCB staff person (i.e., the Director of Healthy Lifestyles) could guide these efforts through ongoing technical assistance, mentorship of Club Health Advocacy Leaders, and development of a health monitoring/evaluation system. In addition, we recommend that cross-Club meetings of the Committee Leaders are retained to permit the dissemination of best practices and consistent implementation of policies and future health initiatives.

3. Focus future efforts on the unique needs and perspectives of teenage Club members.

The proposed policies were designed to be applicable to BGCB staff and 6-12 year old members.

Given the need to attract and retain teen members, the Club Directors and Health Leadership Team recommend engaging teens separately to create teen-specific policies that carefully balance the need to create a healthy Club environment for all staff and members with the need to promote the autonomy of teen members and create a sense of buy-in. Engaged teens and/or teens seeking ways to build their resume could be invited to formally apply to be part of this effort. Similar youth Page 6

Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report participatory efforts have described these groups as “Youth Advisory Boards”, “Teen Leadership Councils” or “Youth Board of Directors”. Careful consideration will need to be given to the objectives of the Youth Committee, potential gains for teens who participate, and who should supervise the process.

4. Develop and implement a system to monitor and evaluate BGCB health initiatives.

The thrust of this year’s work has been to formally incorporate health into the policies, and culture of BGCB. In order to sustain and continuously expand beyond this year’s efforts, we suggest the development of a system to monitor and evaluate the efficacy of BGCB’s health initiatives. This system could identify which programs and policies are most valuable and highlight areas for improvement or further technical guidance. Ideally, this monitoring and evaluation system should minimize the reporting/data gathering burden placed on BGCB Club staff (e.g., be incorporated into existing documentation or reporting mechanisms) and purposefully gather information that will lead to improved practice at the individual Club-level.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Appendices Appendix A. Health Advocacy Committee Timeline of Progress

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Appendix B. Tools developed for use by Health Advocacy Leaders Health Advocacy Committee Meeting Minutes Template

Health Advocacy Committee Meeting Minutes Template Location Time and Date Attendees Committee Member Updates

Agenda Item 1 Notes

Agenda Item 2 Notes

Action Steps to complete before next meeting

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Recommendations for Writing Minutes:

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1. Include an “action steps” section in the minutes to capture “homework”/follow-up work assigned to meeting participants during the meeting (be sure to review action steps/action step updates at every meeting) 2. During the meeting, try to gather input from everyone Remind your committee their opinion is valuable in helping make BGCB healthier for everyone.

3. Think about the work your committee is doing in terms of the areas below – the goal is to hit all these areas in some way. a. Practical action steps: changes you can make during the dayto-day operations at your site. Examples are including more children in scheduled physical activity, offering water at the table during snack time, or planning a health event. b. Policy action steps: changes you can make to the rules and structure of programs(e.g. scheduling more daily physical activity time or including a ban on outside foods and drinks in the staff and family handbook. c. Communication action steps: ways you can communicate healthy information, practices or policies to families, program partners, and members (e.g. Distributing monthly health newsletters or posting flyers.)

4. Email meeting minutes to Marvin (marvin.so@mail.harvard.edu) within 72 hours of your meeting, and be sure to write good notes so the minutes are thorough.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Staff and Member Food Consumption Behavioral Observation Tools

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report

Health Advocacy Committee Policy Identification Tool

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Appendix C. Club-specific Committee Progress Blue Hill. This Club has a history for being proactive in creating changes around health – their current Executive Director served as the first “Wellness Ambassador” for BGCB during a previous grant with Harvard Pilgrim. As such, this Club was engaged as one of the potential sites for Committee implementation and its Leader – the Director of Operations - was successful in recruiting many stakeholders to join the group. They consistently had the highest attendance of any of the three Clubs involved, including all desired parties at the table.

Blue Hill’s work largely focused, from the beginning, on shifting Club health efforts towards policy – much of this can be owed to the guidance of the Health Advocacy Leader and her facilitation skills. A discussion on members’ perspectives on food underlay each meeting, exposing the challenges of making food for large numbers of kids that are nutritious, appealing in relation to less healthy alternatives just outside the door, and use ingredients largely from the Greater Boston Food Bank. In addition, Committee members talked at length about the role that youth programs such as Torch Club play in maintaining the status quo in that they sell unhealthy, processed food (e.g., chips and candy) to raise funds for their own program.

Franklin Hill. This was the only Shared-Space Club that participated in the Health Advocacy Committee initiative. This Club was chaired by the Club Director and the Senior Team Leader.

While both Leaders were engaged in making the Club a healthier space, several challenges presented themselves including limitations on staffing and the leaving of one of the Leaders midway through the process. This made it challenging for the Director to focus on the programs they did currently have in place, such as “Wellness Wednesdays”, as well as engage and recruit parents and members to participate in Committee meetings.

Another challenge with the Franklin Hill Club was the difficulty in moving the conversation centered on individual health education and programs towards one of systematic policy change.

Throughout, the BGCB main office staff and authors worked with this Club to drive home the importance of policy but also recognizing the need to not lose focus in the domain of programming, where most of the work had been done.

Yawkey. This Club was chaired by two Yawkey staff members – the Teen Education Coordinator and the Athletic Director. Yawkey was perhaps most effective in two streams: (1) planning Clubwide health events including Get Fit Day and Taste Test Night, and (2) engaging teens effectively.

They also had consistently solid attendance including members, teens, and parents.

The Yawkey Committee struck a balance between brainstorming policy ideas and planning for upcoming events and programs. They were also effective in delegating tasks and doing work inbetween meetings which catalyzed the Committee meetings in enabling them to become checkins of progress that had transpired since the past month, and discussions of pros/cons of previous events. For instance, Yawkey teens collaborated with MGH nursing students to develop policies from as early as February, and were instrumental in developing some of the thinking around the teen-specific elements in the overarching policy recommendations.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Appendix D. Final Policy Recommendations and Rationale Exercise Experts recommend children get at least 1 hr. of moderate to vigorous physical activity every day. - U.S. Centers for Disease Control and Prevention (CDC) 1. Clubs provide members with at least one scheduled, structured physical activity block of 30 minutes every day. Structured activities promote moderate to vigorous physical activity for the majority of the time.

When providing feedback on exercise policies, each of the three Clubs indicated a need for inclusive strategies that encourage their members to be active, rather than just those that are athletic or inclined to be active. It is recommended that children participate in at least 60 minutes of structured physical activity every day; it seems reasonable to expect that children will achieve at least half of this during club time, which should be an addition to what children receive during the school-day. Finally, the language was updated to describe the activity “for the majority” of the time in recognition that, depending on the activity, some of the timeslot will constitute forming teams, delivering instructions, etc. which is fine if the majority of the remaining time in the rotation does lend itself to moderate or vigorous exercise. This could also be useful for Shared Space Clubs, where this might not be wholly feasible but should be something to aspire towards for the majority of the time.

2. Clubs offer a variety of physical activity opportunities that cater to members’ preferences and needs in inclusive ways (e.g., designating “girls only” times in the weight room so that girls feel comfortable enough to utilize the room).

This policy emerged from discussions at two of the Clubs that Club staff need to get creative in order to address the barriers to full participation in physical activities. For instance, it was well-known that girls would tend to engage less than boys in team sport situations, often going on to the side of the court to text or hang out in groups. Thus, this policy seeks to encourage individual Clubs to assess the unique situation of their own membership and design programming accordingly. While this was originally developed in thinking about the social aspects of girls participating, later discussions recognized the utility of inclusivity for encompassing disabled members and/or members that may not feel as willing to participate in standard programming. It should also be noted that policy suggestions about weight rooms were incorporated to be covered by this policy (and represented by the example given).

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Screen Time Experts recommend children and teens engage in no more than 1-2 hours total of entertainment screen time per day, and that should be high-quality content. - American Academy of Pediatrics (AAP) 1. Club members and staff keep their phones in their bags during program time (except in case of emergency). Clubs maintain a “phone away” culture.

This policy was lifted and adapted from Blue Hill’s suggestion. While the authors entertained policies that have been used in other settings such as phone-free zones, phone-free timeslots, and/or limiting the time to the 120 minutes per day as recommended, most Club staff and BGCB main office staff agreed that it would be burdensome to implement and enforce time or location-limited screen time policies - thus the rationale for having an organization-wide phone away policy that focused on the development of a “culture”. By culture, we intend to describe a Club environment in which is not wholly normal to have one’s phone out unless if it is for an emergency or when contacting parents for pick-up. This encompasses both members and staff, such that staff should be discouraged from pulling their phones out unless it is for a needed work-related task (e.g., using the stopwatch or calculator function, responding to a BGCB email etc.). In addition, Committee conversations pointed out that Club administrators need to support staff in not making phones necessary as much as possible – for instance, placing clocks in rooms where rotations/programs take place so that they don’t have to glance at their phone to simply check the time.

2. Staff do not use their cell phones in the Club in front of members (except in case of emergency and work-related communication). Teen members do not use their cell phones in the presence of 6-12 year old members.

Very in line with the above policy, this policy also emphasizes the impact that teenagers have on determining what is acceptable or normative for the younger members. The authors and BGCB main office staff determined that we should not seek to include teens – at least for this time – in this policy as teen programming is a relatively new domain for BGCB and they are seeking to shepherd in as many teenagers as possible without placing too many restrictions on them. In keeping with this, the authors recommend that BGCB engages in a separate policy development effort with teenagers in the 2015-2016 schoolyear.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Beverages Experts recommend water is the best source of hydration for afterschool programs. American Academy of Pediatrics (AAP) 1. Only water (flavored seltzers and fruit infused water included) and 1% white milk will be served to all members and staff at meals and for all events. Clubs do not serve sugary drinks to members or staff. Sugary drinks include: sodas (even diet), fruit juices, flavored juice drinks, sports drinks, sweetened tea, coffee drinks like Coolatas/Frappuccinos, energy drinks, and electrolyte replacement drinks like Gatorade.

Several policy suggestions from Club committees described beverage rules that were specific for certain age groups, for certain events, or for certain fundraisers. Research shows that policies are easier to understand and adhere to when they are clear and straightforward (with few special cases or exceptions).

Therefore, we recommend a complete SSB-free zone to eliminate any confusion and set a precedent, inclusive of beverages both served by BGCB and/or brought in by members and families. We were careful in this policy, which was revised several times, to convey that this applies only to beverages served by the Club to both members and staff (including special events). In addition, we specifically detailed what was meant by sugary drinks after suggestions to make it clear what was included such that they could point to this policy for implementation.

2. Staff do not consume sugary drinks in the Club in the presence of members. Teen members do not consume sugary drinks in the presence of 6-12 year old members.

In keeping with rationale described in Screen Time recommendation #2, this policy does not seek to elicit change in teenage members just yet, but recognizes the influence they might have on younger members. This policy also underscores the point that if staff genuinely feel compelled to consume sugary drinks while in the Club, they can do so discretely (e.g., in a separate room, or in an opaque bottle).

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Healthy Foods See Health360 Food Guidelines 1. BGCB serves healthy foods (see Health360 Food Guidelines) at BGCB routinely-scheduled events and meetings, and at food-based fundraisers where homemade goods are emphasized as opposed to store-bought desserts.

A lot of discussion has been raised around fundraising as central to several BGCB programs and specific special events that involve the entire community. Thus, in order to create a culture in which unhealthy foods are routinely served, this policy was developed to address (1) food served to members in Clubs, (2) food served to staff during meetings and events, and (3) food sold by members in various fundraising efforts (e.g., Torch Club). The language around “routinely-scheduled” events gets at the need to maintain flexibility around “special events” such as birthdays and Club-specific special events (e.g., Annual Summer Fish Fry). In addition, this policy also recognizes that many times bake sales will actually be sales in which members purchase processed/packaged baked goods at the local store to sell. Thus, in an attempt to be mindful of bake sales in youth programming, while also emphasizing homemade foods, the second part of the sentence was included.

The Director of Healthy Lifestyles will be critical here in ensuring the success of this policy, which is arguably lighter than original proposals to completely ban unhealthy foods alltogether. Moreover, the Director’s expertise can be leveraged here in guiding those requests towards options that are healthier and ideally similar in cost/convenience.

2. Members/staff are discouraged from bringing unhealthy foods/drinks into the Clubs (see Health360 Food Guidelines). Staff do not consume unhealthy foods/drinks in the presence of members. Teen members do not consume unhealthy foods/drinks in the presence of 6-12 year old members.

This policy pertains to discussion that took place at each Club around how to create a healthy Club environment when (1) there are so many local stores that provide unhealthy fried, processed foods for members and staff to bring in, and (2) many times parents will be supplying these foods for their children. There was a lot of back-and-forth concerning whether or not to outright ban these foods from entering the Clubs or to allow them with restrictions, recognizing the challenges and realities that many BGCB families and staff face in terms of securing healthy food.

This final policy takes these considerations into account, again pointing to the guidelines created by the BGCB Director of Healthy Lifestyles and using the word “discourage” rather than ban. This will hopefully mitigate the potential for pushback but also provide a strong basis upon which to guide members and staff towards being thoughtful about the food they bring it. Again, language around teens was incorporated in regards to the influence they might have on younger members.

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Appendix E. Health Advocacy Committee Policy Development Process

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Boys and Girls Clubs of Boston Health Advocacy Committee Initiative Final Report Appendix F. Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis Strengths 1. Club stakeholders from all levels (Club Directors, Staff/Members/Parents via Health Advocacy Committees, and BGCB Senior Management Staff) were provided with multiple opportunities to provide their insight and feedback during the policy development process.

2. The Advocacy Committees played a central role in formalizing the process by which BGCB community members’ provided their perspectives on policy change and may play an important role in ensuring policy uptake.

3. Holding monthly meetings for Healthy Advocacy Leaders was effective and the Leaders found them helpful.

4. Programming and partnership efforts around health continue to be sustained and strong at individual Clubs, and strengthened by being part of the overarching Health360 effort.

Weaknesses 1. It is clear that staff are resistant to change particularly pertaining to individual choices.

2. Word travels fast. There has been word among staff that things such as birthday cake and fun foods will be banned at all Clubs.

3. It is unclear how to make these policies effective for teens.

4. The policies have been re-shaped extensively due to how they were developed. Much of the language has been pared down in areas (e.g., “discouraged”) such that it may be difficult to enforce some of them.

5. This year’s experience with one shared space Club may not be wholly representative of all shared space Clubs due to extenuating circumstances including large staffing changes.

Opportunities 1. All Club Directors have approved the health policy recommendations and agreed to support implementation of the policies over the upcoming year which includes invigorating and inspiring their staff for policy change.

2. The Director of Healthy Lifestyles is still a relatively new position within BGCB; there is the potential for this role and the associated measures of success to align with implementation of the policies.

3. BGCB’s work with OSNAP over the year, while mixed in its reception, offers an ongoing source of resources including action planning frameworks, and practice/policy assessment tools. OSNAP also provides an Online Learning Community that BGCB/individual Clubs can access given their completion of the year of Learning Collaboratives.

Threats 1. Health Advocacy Committees may not be viable without an ongoing source of funding (e.g., HPHC Grant).

2. Directors largely agree that one of the biggest hurdles to making these changes will be parents and families of members. Thus, resources and strategies need to be developed to directly address this obstacle.

3. In spite of the positive changes made within Clubs, BGCB Clubs still largely serve communities in areas with less access to healthful options.

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