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The Culture of Wellness in Preschools, Policy, System and Environment Change Process (COWP PSE Change Process) is a PSE change intervention designed to implement an average of five changes that promote healthy eating and physical activity in early childcare centers. Interdisciplinary wellness teams are comprised of 3-8 early childcare center staff who work together to participate in three key change-making strategies: 1) conducting a strengths and needs assessment related to healthy eating and physical activity practices, 2) prioritizing PSE changes based on importance and feasibility, and 3) developing action steps and planning for implementation and sustainability. Toolkit materials are provided to each site to support the implementation of their selected PSE changes. COWP facilitators help early childcare center staff develop center-specific wellness policies highlighting their adopted PSE changes to ensure sustainability.

Intervention Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time

SNAP-Ed Strategies: PSE Change

Intervention Reach and Adoption

The COWP PSE Change Process targets preschool-age children in early childcare settings. All children and adults at partner sites are reached via the implementation of PSE changes in these settings. The COWP PSE Change Process was piloted in 20 Head Start Centers in 2015-2016. Since then, the COWP PSE Change Process has been implemented in approximately 125 early child care settings across the state of Colorado. By partnering with early childcare settings that serve a SNAP-Ed eligible population, we can ensure the program is reaching the intended audience. Demographics and classroom enrollment are collected at the beginning of each program year to ensure eligibility.

Settings: Pre-K & Childcare

Age/Population Group: Preschool 

Race: All

Ethnicity: All

Intervention Components

The COWP PSE Change Process involves three key change-making components: conducting a strengths and needs assessment; prioritizing changes by importance and feasibility; and developing action plans for implementation and sustainability. These intervention components provide the basis for the implementation of an average of five healthy eating and physical activity changes in early childcare centers. The COWP PSE Change Process must be conducted with an interdisciplinary wellness team, with director participation, to ensure feedback and buy-in from the center community is present. The length and format of the COWP PSE Change Process are modifiable (e.g. the number of meetings, length of meetings, length of the process). Outcome evaluation forms completed by the center director 6 months, 1 year, and 2 years after completion of the PSE Change Process inform the extent of implementation of the changes, as well as the sustainability of PSE changes. The COWP PSE Change Process is an adaptation of Intervention Mapping and is aligned with community-based participatory research principles.

Intervention Materials

Intervention materials are available for download on the COWP website. Materials include:

  • PSE curriculum one-pagers for three key strategies (Strategy 1, Strategy 2, Strategy 3)
  • Healthy Eating- and Physical Activity-related menu of best practices
  • The PSE Change Process conceptual model
  • CDs, garden kits, and visual support materials
  • Nutrition and physical activity lesson plans
  • Parent Wellness Workshop lesson plans
Evidence Summary

Twenty-three focus groups were conducted with teachers to identify needs, barriers and facilitators to program implementation. Focus groups are conducted with wellness teams at the end of the COWP PSE Change Process to inform annual adaptations and improvements. These data are used to inform adaptation of the PSE Change Process for early childcare settings and to improve programming on an annual basis.

As of January 2019, outcome evaluations demonstrate that an average of 5.3 PSE changes were implemented in every participating early childcare center. Approximately half of PSE changes (47%) were focused on nutrition supports (e.g., implementing a school garden) and 53% were focused on physical activity supports (e.g., teachers leading children daily structured play). A center-specific wellness policy poster was developed and displayed at every childcare center highlighting the new PSE changes adopted. Outcome evaluation data collected at 6 months, 1 year, and 2 years after completion of the PSE process demonstrate that PSE changes implemented through COWP are sustainable. After 1 year, 62% of PSE changes were reported fully implemented and after 2 years, 77% of PSE changes were reported fully implemented.

Implementation of policy, system and environment changes in early childhood education settings 

  1. Farewell, C.V., Powers, J., Maiurro, E., Puma, J. (2020). "Sustainability of Health-Promoting Best Practices in Early Childcare Settings." International Journal of Child Care and Education Policy.
  2. Farewell, C.V., Maiurro, E., Powers, J., Puma, J. (2020). "The Healthy Environment Project: Promoting Sustainable Changes in Early Childcare Education Settings." Health Education Journal.
  3. Powers, J., Farewell, C.V., Maiurro, E., Puma, J. (2019). "The Impact of a Workplace Wellness Program on Provider Health in Early Childhood Education Settings." Workplace Health and Safety. 

Evidence Base: Research-tested

Evaluation Indicators

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

 Readiness and Capacity - Short Term (ST)Changes - Medium Term (MT)Effectiveness and Maintenance - Long Term (LT)Population Results (R)
Environmental Settings MT5, MT6LT5, LT6
Sectors of Influence   
  • MT5,6: 657 adopted changes across 125 early childhood education settings (average of 5.3 changes/setting).
  • LT5,6: After 1 year, 62% of the changes selected are fully implemented. After 2 years, 77% of changes selected are fully implemented.
Evaluation Materials

Evaluation materials are available for download on the COWP website. Materials include:

  • Process Tools: Strengths and Needs Assessment using Menu of Practices (assess baseline level of PSE changes)
  • Outcome Tools: Outcome Evaluation Form
Additional Information

Website: The COWP website includes information on COWP, who they serve, resources (nutrition and physical activity direction education lessons, parent wellness workshop lessons, PSE best practices, etc.), and outcomes of the program.

Contact Person:

Deanna LaFlamme

COWP Program Director, Rocky Mountain Prevention Research Center, Colorado School of Public Health, University of Colorado 

Phone: 303-724-4457



*Updated as of August 29, 2023

Resource Type
Age/Population Group
Evaluation Framework Indicators
Intervention Outcome Levels
SNAP-Ed Strategies
Evidence Base