Assessing the impact of a multi-component implementation intervention on early childhood education and care (ECEC) services implementation of indoor-outdoor free play recommendations and the effect on opportunities for child outdoor free play.

Intervention length has been reduced to approximately 6 months and some adaptations made to intervention components to align with new guidelines around outdoor free play. The intervention will target early childhood education and care (ECEC) service Nominated Supervisors (NS), Service Champions (SC) and Educators to support their implementation of indoor-outdoor free play opportunities. Specifically, childcare services will be supported to provide or increase the time available for unrestricted access to outdoor play areas of the service, to allow children the opportunity to engage in outdoor free play. The implementation intervention will seek to provide support to services to increase awareness of continuous free play recommendations, facilitate the process of amending service schedules and environments, and support childcare service educators with implementing changes as required. The intervention is designed to be flexible in delivery to accommodate the needs of the services, and a facilitation style approach will be applied. The research team will train health promotion officers (with qualifications in nutrition, health promotion and physical education) to deliver the following strategies via six key intervention components: a) Identify and prepare champions: Prior to the first intervention contact, ECEC services will be asked via email to nominate a service champion for the initiative. This may be the Service Manager or another existing staff member e.g. Room Leader, who will be responsible for supporting implementation of indoor-outdoor free play at the service. A position description for the champion will be provided outlining the expectations for the role. This includes overseeing the development and implementation of an action plan (see c) and monitoring implementation progress. As part of the audit and feedback process (see #) the nominated champion will be supported by the HPO to reflect on changes to practice, identify positive implementation outcomes for educators and children and share these observations with staff and parents. Throughout the intervention, the champion will also be asked to provide encouragement and recognition and/or further support to overcome indifference or behavioural challenges that may arise in regards to the intervention. b) Educational Outreach visit(s): Initially (week 1) a 30 minute face-to-face or online meeting will be undertaken with the Service Manager and appointed GOGA champion (and/or relevant room leader). The purpose of this meeting will be to orient the service to the implementation intervention (planned schedule of contacts with the service), provide and reinforce information on sector guidelines and provide supporting information on other benefits of increasing outdoor free play, and discussions around how indoor-outdoor free play may complement existing service philosophy and priorities. An action planning workbook (see c) will be provided and the steps to complete the workbook explained. In order to ensure the action plan has “all of service” input, the nominated supervisor and champion will be asked to plan an information session regarding the initiative for educators at the service (prioritising those in the 3-6 year old room) and identify a strategy to receive wider input from relevant staff into the action plan. The service will be asked to complete these activities prior to week 8 of the intervention. To inform staff of the initiative, the HPO will offer to present an information session (approx. 25 mins), for example, at a staff meeting, Alternatively the service may elect to receive a pre-recorded version of information session presentation for staff to watch, at a time of convenient. The Nominated supervisor/ champion will guide what process to take to obtain wider input on the action plan from educators. This could include a brainstorming session approx. 20 mins), facilitated by the HPO at the conclusion of the delivered presentation or the service may conduct this process independently as per their usual service procedures for consulting with staff. c) Develop a formal implementation blueprint: The HPO will provide an Action Plan workbook at the first educational outreach meeting and discuss how it is to be used to guide service development of a plan to implement indoor outdoor free play. The workbook includes: space to identify and document motivations and anticipated benefits of increasing outdoor free play opportunities, guidance around identifying suitable long and short term goals, an environmental checklist, problem solving tips and sample actions. The service champion will be asked to complete the work book and final action plan prior to week 8 of the intervention. d) Provide local technical assistance: The HPO will provide technical assistance at approximately weeks 6-8, week 8-10 and week 18-20. 3-7 weeks after the first educational outreach visit, the HPO will meet with the Nominated supervisor and/ or champion to view and discuss the service action plan. This visit will take approximately 20-30 minutes, and is an opportunity to ensure the action plan contains desired elements and appropriate timeframes for actions. The HPO will also provide positive reinforcement, facilitate reflection and provide problem solving advice and additional resources if required. The HPO will request an electronic copy of the final action plan to use as a reference during subsequent contacts. At approximately week 8-10 and approximately week 18-20, the HPO will undertake a 10- 20 minute phone support call with the GOGA champion which will include reviewing progress with goals and actions, problem solving and setting any new goals or actions if required. This support will be tailored according to the preferences, needs and/or barriers of each service, and as such additional support calls may occur at time points outside of those specified and will be recorded as part of adaptations to the program. e) Distribute educational materials: At the first educational outreach visit, in addition to action plan workbook, the HPO will provide the Service Manager and GOGA champion with an electronic and hard copy information pack including information regarding how the intervention aligns with ECEC accreditation standards and COVID 19 social distancing guidance by the NSW Department of Education for ECEC services. Additionally, case studies and family newsletter snippets communicating changes at the service and the benefits of increasing opportunities for outdoor free play for families will be provided. A GOGA newsletter for all ECEC staff will be provided for distribution on four occasions throughout the intervention period and will include tips on overcoming common barriers to implementation (e.g. adverse weather, outdoor play resources and equipment). f) Performance feedback and review: ECEC services will receive written and verbal feedback on their performance against at approximately week 12 (mid-way through the intervention) via a phone (duration approximately 30 minutes). The HPO will provide the GOGA champion with a hard copy or electronic version of an observation tool to observe, record and reflect on both indoor and outdoor free play opportunities provided over a 5-day period. On completion, the GOGA champion will submit the tool to their HPO. Based on this data, a written feedback report comparing the current provision of opportunities for outdoor free play with service goals and with the provision of outdoor free play at baseline will be provided. Verbal performance feedback and recognition of achievements will also be provided by phone. Over the 6 month intervention period, fidelity to the intervention delivery will be recorded by the HPO in a REDCap monitoring instrument specifically designed to capture timing, duration, and delivery of specific content outlined for each of the above components. Adaptations and/or additional strategies undertaken as a result of applying the flexible facilitation approach will also be classified and recorded in the monitoring instrument. Intervention delivery modality will also adhere to general health requirements during the pandemic regarding appropriate contact with services and other agencies.