Site Recruitment, Screening and Enrollment Preparation

Community Recruitment and Establishing Eligibility

Potential communities with tribally operated ECE programs or nearby IHS or tribal health clinics are identified by programmatic staff as eligible community partners. Many considerations are made during the initial selection process prior to community engagement including, previous ECE program interest in nutrition and physical activity programs, existing relationships between WATCH program staff and community leaders in the ECE and health sectors, geographic proximity of tribal health clinic, as well as locations of ECE and health clinic sites.

Once a community has been identified as being a possible partner, an introductory meeting (Appendix B: Documents for Introductory Kickoff and Meetings is scheduled between the WATCH program staff and the community ECE leaders. Prior to any discussions with the health sector, ECE agreement and confirmation of participation is necessary. During the introductory meeting, the project background, history, and development are elaborated. During this meeting, information such as the number of centers, teachers and an estimate of children attending the ECE are collected. A general intervention overview, timeline, and community partner responsibilities are also discussed. The WATCH team looks to understand the current programs context and opportunities and addresses any community questions. Understanding current programs and activities about nutrition and physical activity offered at the ECE, to families, and more broadly in the community is essential. Any ongoing interactions across education and health sectors are identified. Other key community partners are identified as well. Once each community partner agrees to implementation of the program, more individual meetings and emails are exchanged to collect information on existing activities and structural set up of the ECE programs and health clinics. Meetings are scheduled with each community partner in a small group or individual setting to further discuss WATCH.

The WATCH program aims to build on existing structure and success and further integrate education and health sectors. It does not aim to replace or usurp any existing activities or endeavors. WATCH staff can make adaptations and modifications to integrate WATCH into existing initiatives.

A kickoff meeting (Appendix B: Documents for Introductory Kickoff and Meetings is scheduled with all the health and education center partners to discuss the specific timeline, expectations of community, accountability of WATCH program staff, and to begin to develop relationships across sectors. Again, the global program implementation is shared with the collective group and there is ample opportunity for individuals to ask questions on sector-specific or integrated

components. Discussion on specific requests needed by WATCH program staff is collected and followed by scheduling conversations for the respective sites. At these meetings, a primary point of contact for each center is identified. This group commonly ranges from lead teacher to education manager, site manager or to clinic director. At this time, a Letter of Support (LOS) (Appendix C: Letter of Support is requested from each of the health sectors and a Memorandum of Understanding (MOU) from education centers. Once these documents are complete, they are submitted to OUHSC IRB.

Upon approval of the documents, a plan at each of the community partner locations is set in motion to train staff prior to implementation. To achieve maximum staff attendance, ECEs are asked when and if they have in-service training already established to aid in the scheduling of training. WATCH program staff then plan the collection of preintervention baseline measures. Due to COVID-19, all observations in the ECE have been adapted to self-report EPAO (EPAO-SR). To introduce menu assessments and implementation of best practice menus, an additional meeting is scheduled to discuss with directors, center managers, and cooking staff.

Prior to implementation in ECEs and medical centers, WATCH program staff distribute teacher assessments for baseline measures and will collect the same EPAO-SR after the 16th week and final week of implementation.

General Meetings with Community Partners

A graphic to illustrate the training schedule and timelines was created for general meetings and distributed to all associated partners. This graphic is shared with participating partners to aid in the depiction of program implementation within the context of a school year. Figure 5 is used during Kickoff meetings and is updated to the current community’s timeline.

Intervention Scheduling

After confirming with each partner within the community, we can schedule the following meetings: