Learning Contract

Goal #1: Learn which health disparities are influencing obesity and asthma among children and youth in
New Castle County and Kent County and how NHPSs work is addressing it.

Research
Obesity
About 33% of Delaware children who fall between the ages of 10 and 17 were obese,
which is actually not far from the national average of approximately 31% as of 2008 (Delaware State
Fact Sheet,). As of 2011, although not considered statistically significant, this had risen to 40%
(Delaware Survey of Childrens Health, 2011). However what I found most shocking was the fact that
about 50% of Hispanic Delawarean children are obese (Delaware Survey of Childrens Health, 2011).
During my experiences at NHPS, I have heard of the issues surrounding healthful eating, including the
food deserts and physical activity being impeded due to dangerous environments (Angalet, G, personal
communication, August 19, 2014). The statistics for Hispanic children encouraged me that the nutrition
materials I contributed to the Community Dinners Toolkit could be very useful. The organization is doing
an amazing job: of the centers for child care with whom NHPS has worked closely, results showed that
81% have changed their habits significantly when it came to taking on practices reflective of the 5-2-1-
Almost None campaign (A Statewide Strategy, p.3). The Delaware Survey of Childrens Health provided
results from its 2008 distribution that showed a relative plateau in rates of obesity among children (A
Statewide Strategy, p.4). Although this is not a decrease, it is at least aligning with the speed of goals
the organization would like to reach by next year (A Statewide Strategy).
One of the sources of information I was referenced to by my team associates was Kids Count,
which gave some wonderful information, especially on asthma. The handbook for 2014, showed a
picture of the state of Delaware with where there were contaminated geographical areas of the state
(Childhood Asthma, 2014, p.43). There were clumps mainly in areas where the median income was no
more than $54,000, and even bigger in areas where people made no more than $47,000 per year, much
of this in Northern Delaware (Childhood Asthma, 2014, p.43). The information definitely supported
the handbooks statement that children living in poor urban areas are more likely to develop asthma
(Childhood Asthma, 2014, p.42). The text stated this is so because of the common disparities of poor
ventilation, cockroaches and mold in these areas, all of which antagonize asthmatic symptoms
(Childhood Asthma, 2014, p.42).



NHPSs Work
In my research on obesity, I was recommended to Kate Dupont Phillips, who is currently working
on implementing policies in childcare facilities. Along with employees at NHPS as a whole, she is working
on more of a background effort, as opposed to direct work (Phillips, personal communication, August
11, 2014). One of her tasks is implementing employee trainings for ways to utilize their classrooms to
promote obesity-fighting behaviors (Phillips, personal communication, August 11, 2014). She explained
that intervening early in a childs life could help fight against obesity (Phillips, K.D., personal
communication, August 11, 2014). Another way in which she knew obesity could be prevented was for
mothers to breastfeed their babies, thus leading to her second project, which is called the Baby
Friendly Hospital Initiative (Phillips, personal communication, August 11, 2014). This initiative focuses
on making an effort to give more help and encouragement to mothers willing to breastfeed, and so far
has had success in obtaining five of the six hospitals in the state of Delaware to voluntarily take on the
initiative (Phillips, personal communication, August 11, 2014). I was very pleased to hear of the
creativity of these efforts.
Other ways in which they are working to prevent obesity is through implementing physical
activity in schools. Although my career drive in this field has mainly been nutrition, I was very impressed
when learning about the work being done. I spoke with Jia Zhao, one of the evaluators of the school
physical activity project, and she explained that it does what the name implies: works to encourage
types of physical activity in elementary and middle schools (Zhao, J, personal communication, August 19,
2014). She explained that the work began when the department was awarded a grant for the Making
Schools a Moving Experience project (Zhao, J, personal communication, August 19, 2014). This was
done to help schools create plans to carve out time for their students to receive 150 minutes of exercise
each week for 74 of the elementary schools in the state of Delaware (Zhao, J, personal communication,
August 19, 2014). Associates from NHPS acted as trainers to teachers for carrying out the activities in the
classrooms, each one stemming from evidence-based practice (Zhao, J, personal communication, August
19, 2014). They are currently working to make sure these physical activity practices are sustained in the
schools, and this will continue to be there goal, even without funding (Zhao, J, personal communication,
August 19, 2014). Zhao also explained that the evaluation team studies measures success based on
whether the schools follow through with on creating plans for exercise, whether they go through with
the plans, and whether they are able to do this up to 150 minutes per week (Zhao, J, personal
communication, August 19, 2014). Although the work is not done to purposely lower BMI, Zhao did
express that it is done to promote the maintenance of healthy weight, an extremely important goal
(Zhao, J, personal communication, August 19, 2014).

Asthma
I decided to interview Sheelagh to learn about NHPSs work related to asthma since I had heard
great things about her performance from one of my fellow interns. She is a certified asthma educator
who focuses on asthma education and outreach directed under the CMMI award (Stewart, S, personal
communication, August 6, 2014). She did a wonderful job with breaking down the work she does in our
conversation (Stewart, S, personal communication, August 6, 2014). She explained the difference
between raising awareness and true asthma education, the latter of which she stated as being
evidence based program(s) for behavior change (Stewart, S, personal communication, August 6, 2014).
She stated that about 11 to 12 percent of the children in Delaware had asthma when the work
began, a bit higher than the 10 percent national average for children in Delaware (Stewart, S, personal
communication, August 6, 2014). However she also stated that when assessing the 6 to 11 year-old age
group before implementing their work, about 14.6 % of this population had asthma (Stewart, S, personal
communication, August 6, 2014). Despite what most may realize, Delaware has a lot of diversity, which
made it easier to notice that minorities and those of low socioeconomic status (Stewart, S, personal
communication, August 6, 2014). She also noted that the rates of obesity, depressed parents and
adolescents and maternal smoking are all higher among the low-income population, which is can be
correlated to the low-income asthmatic population (Stewart, S, personal communication, August 6,
2014). She explained the purpose of the CMMI award for asthma related work, that work could be done
under the award to decrease the number of asthma-related emergency room visits and thus, costs for
insurance companies (Stewart, S, personal communication, August 6, 2014).

References
A Statewide Strategy to Battle Childhood Obesity in Delaware. Retrieved at:
http://www.nemours.org/content/dam/nemours/www/filebox/service/preventive/nhps/inthen
ews/obesitybattle.pdf

Delaware State Fact Sheet. Data Resource Center for Child and Resource Health. Retrieved at:
http://www.childhealthdata.org/docs/nsch-docs/delaware-pdf.pdf

Childhood Asthma. (2014). Kids Count in Delaware: Families Count in Delaware: Fact Book 2014.
http://www.stallionpublishers.com/publication.aspx?pid=1420&pkey=aetbmmxbs

(2011). Delaware Survey of Childrens Health. Delaware Infographic. Retrieved at:
http://www.nemours.org/about/policy/encouragehealth/delaware-survey.html

Goal # 2: Learn about the work on addressing obesity of Healthy Kids Delaware and Kent Kids.
I had the privilege of interviewing Tricia Jefferson, who is a registered dietitian employed by the
YMCA. The YMCA is widely known for its health mission. She mentioned that challenges for the
organization include having many gaps to service accessibility such as transportation for child
participants (Jefferson, T, personal communication, August 6, 2014). However, the services are usually
received well once they are accessed (Jefferson, T, personal communication, August 6, 2014). Another
challenge consisted of funding for evaluation tools, which could be used to evaluate their effects on
obesity/obesity related factor (Jefferson, T, personal communication, August 6, 2014). She explained
that this is a high cost for which they have received assistance from NHPS in the past, but currently and
independently do not have room in the budget to accommodate (Jefferson, T, personal communication,
August 6, 2014). However, they do indeed value the significance of evidence-based practices (Jefferson,
T, personal communication, August 6, 2014)
Tricia is also a member of Healthy Kids Delaware. She stated that she works as a decision
maker and facilitator of the organization (Jefferson, T, personal communication, August 6, 2014). She
stated that Healthy Kids Delaware spent his first 2 years serving through networking, and now is serious
(Jefferson, T, personal communication, August 6, 2014). On the other hand, they have been purposeful
in working on event planning, mainly through community dinners and gardens in New Castle County,
within the past year (Jefferson, T, personal communication, August 6, 2014). Healthy Kids Delaware
assists other coalitions with starting events but with the purpose of them eventually being self-sufficient
in their project roles, even though they are not there yet (Jefferson, T, personal communication, August
6, 2014). She also mentioned that NHPS has pretty much been their biggest supporter, although it is
only one of the organizations within this coalition (Jefferson, T, personal communication, August 6,
2014).
It was happy to hear about the emphasis on community dinners and gardens because I truly
enjoy and respect both types of events. I also appreciated Tricias feedback, including the idea of having
a toolkit that was broad enough to be applied to any city, county, or employee (Jefferson, T, personal
communication, August 6, 2014). Although there are some aspects that may be specific, I am pleased to
say there are many multiple materials that are transcendent.

Kent Kids
I had the privilege of interviewing Sequoia Rent, who works for the 4-H/UD Cooperative
Extension program. (Rent, S, personal communication, August 12, 2014. She more specifically works
with the young health program in which she is required to implement the use of the IM40 program for
promoting developmental assets in youth (Rent, S, personal communication, August 12,2014). She
stated that she is currently the vice president of Kent Kids, and wanted to join the work of Kent Kids and
4H so they could share different types of resources (Rent, S, personal communication, August 12, 2014).
She was able to bring the efforts of her organization with those of Kent Kids during a food
demonstration for a community garden (a project sponsored by Kent Kids) (Rent, S, personal
communication, August 12, 2014). She did mention it was hard to combine missions because the work
of Kent Kids is indirect, most of the board are volunteering alongside full-time jobs, and membership has
decreased (Rent, S, personal communication, August 7, 2014.). However she also points out that the
organization is young, and has still harbors much potential for success (Rent, S, personal
communication, August 12, 2014).

Goal #3: Develop the skill to build relationships with partner organizations
I was very pleased with the amount of networking I was able to observe directly, and pleased
that I got to see it very early in my internship. I was able to attend a planning meeting within NHPS for
the steering committee meeting and the actual steering committee meeting. However my biggest
surprise was when I had the privilege of attending the planning session for the grand opening of the
Southbridge Community garden. It was especially exciting because I designed an announcement section
for it in the June newsletter based on the flier for the event .I was so honored to be able to help, even
though only a little, plan a significant event and observe the multiple people from different
organizations at the table. This was also one of my first meetings in which I spoke up and made
suggestions, recalling the advice I was given earlier.
Although I love d the Garden Opening meeting, my most influential networking experience came from
my regular attendance at the Kent Community Dinner Meetings. I am honored to say that I have been
able to attend meetings from the beginning of the planning process, and have been allowed to watch
the employees of multiple different organizations make suggestions for people who could be direct or
indirect connections to laces to hold community dinners, cooks, audiences, and many other aspects. I
appreciate being able to do this during every meeting, and taking opportunities to make suggestions.
Although it was difficult to make some suggestions, since I am not familiar with Kent county, let alone
have human service organization connections in the county, sometimes I felt helpless. However as the
details focused more on specific details for the event, I did not feel as insecure.
I have received great advice from two of my project supervisors, Fanilda Shaw and Na-Tasha
Williams on networking. I have found that even if I could not make the same types of suggestions that
others made, making suggestions showed that I care d and I learned and was recognized for being there,
to the point where I feel comfortable taking up the offer to contact those with whom I have worked.
When speaking with Fanilda, she reminded me of the more business-oriented aspect of networking,
which was partnering. She discussed what I have hared throughout my internship here at NHPS, which is
the true significance of being partners with another organization. She informed of the selflessness and
humility it took to partner with another organization, as well as to make clear and somewhat blunt
explanations on what each part wants (Shaw, F, personal communication, July/Aug 2014). She applied
this teaching in our work on surveys that would go to people in the Kent Community Gardens Group,
which included a comment box for suggestions of other interested parties. This was further highlighted
when I had the opportunity to recruit vendors by telephone for the Back to School Bash, (Kent Kids
event). Although the reason for partnership had already been highlighted, I was reminded of my
responsibility to be a good representative of NHPS/Kent Kids and to call them back because I had
contacted them, suggesting this mini partnership. Even though I worried about what demeanor of each
person with whom I spoke would be, I knew that it was important that I get the experience in order to
become less intimidated by beginning relationships. This was also groomed by reaching out to Dr. Datto,
the Director of the Weight Management program at A.I. DuPont Hospital for Children to come speak at
the intern meeting I had to lead. I was surprised I could have someone of such prestige come to speak,
and learned that I need to not be so doubtful.
Na-Tashas advice really delved into the process of building relationships. Her advice was very
straightforward and consisted of highlighting the importance of good bonds and keeping them intact
(Williams, N, personal communication, August 1, 2014). She reminded me that what I observed in
meetings- her immediate suggestions for people who could help with things was a reflection of this
(Williams, N, personal communication, August 1, 2014). I definitely took note of these things while in
meetings, especially of how confidently people suggested some helpers. I was intrigued by the fact that,
in a way, it could be that simple, and that one could know so many people from so many organizations
throughout the county (most likely made simpler by Delaware being more compact). Thus, despite
having phrases such as low-pay, and nave thrown at people in this field, this allowed me to realize
the power people had in the field of human services.

Goal #4: Be active in contributing my ideas during decision-making.
I am so glad to be able to say that I have been able to make suggestions during my meetings. At
the planning meeting for the Southbridge Garden Opening, I made a suggestion for a food to be added
to the menu. When it was politely rejected, I felt a bit cast down, but was reminded that it was okay
because I made a suggestion, and many people have decisions cast down. However I felt uplifted when I
offered to find nutrition materials to provide to give out, and was give the task of finding an example
recipe for fruit kabobs.
Most opportunities to make suggestions came during my community dinners meetings. Initially
it was difficult because I did not have connections like the other members, nor did I have much
experience, and I did not spend any time in Kent County beforehand. However I put in suggestions
where I could for potential partners, and was given the opportunity to create a list of discussion points.
Although the latter was not given immediate integration after doing them, I continued to remind my
project supervisor about them and was able to use them for the toolkit for Healthy Kids Delaware/New
Castle County. However I finally received the opportunity to use create a slideshow on healthy tips and
was so honored and happy to make it. I was so happy that my ability to do it was recognized and that my
co-planners and I liked it.
One of my final most meaningful meetings was the Kent Community Gardens Group Meeting.
After putting together a garden partner profile and summaries of survey responses about the affiliated
gardens, it was nice to put faces to the names I had seen. I was glad that the present members went
around and gave status updates about their affiliated gardens because it was a great introduction, and
information that I did not receive in the surveys was shared such as the garden yield and which types of
produce were growing the best. Although I did not share much (usually due to irrelevance to myself or
my ability to help since I knew I would be leaving NHPS soon), I did ask one member to share what his
garden was doing with the produce since I knew that was an important evaluation factor. All-in-all, I was
thankful to be part of a meeting so connected to my primary project, and look forward to staying in
touch with its progression process.