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Published on: August 21, 2015
"It Has a Lot to Do With the Cumbersome Paperwork": Barriers and Facilitators of Center-Based Early Care and
Bethany Jana1, Kaitlyn Loefstedt1, Maihan Vu2
1Department of Applied Health Science, Indiana University Bloomington, Bloomington, Indiana.
Insights
Barriers like complex paperwork and low reimbursements hinder participation in the Child and Adult Care Food Program (CACFP). Policy and system changes, including streamlined processes and better support, are recommended to increase enrollment in this vital nutrition program for children.
Area of Science:
- Child Nutrition Programs
- Early Care and Education Policy
- Public Health Interventions
Background:
- The Child and Adult Care Food Program (CACFP) is a federal program supporting nutritious meals in early care and education (ECE) settings for low-income children.
- CACFP participation is voluntary, with significant state-level variations, impacting program reach and effectiveness.
Purpose of the Study:
- To assess barriers and facilitators influencing center-based ECE program participation in CACFP.
- To identify strategies for promoting CACFP participation among eligible ECE programs.
Main Methods:
- A multimethod descriptive study involving interviews, surveys, and document reviews.
- Participants included national/state agency stakeholders, sponsor organizations, and ECE program directors across four states.
Main Results:
- Key barriers identified: cumbersome paperwork, strict eligibility and meal requirements, low reimbursements, and inadequate staff support.
- Facilitators included stakeholder/sponsor outreach, technical assistance, and nutrition education.
- Recommended strategies involve policy changes (streamlining, modified eligibility) and systems-level improvements (enhanced outreach/support).
Conclusions:
- Policy changes at national and state levels are crucial to address CACFP participation barriers.
- System-level changes and consistent practices among stakeholders, sponsors, and ECE programs are needed to improve CACFP implementation.
Background:
The Child and Adult Care Food Program (CACFP) is a federally regulated feeding program that reimburses early care and education (ECE) programs for providing nutritious meals to low-income children. Participation in CACFP is voluntary and varies widely across states.
Objective:
This study assessed barriers and facilitators of center-based ECE program participation in CACFP and identified potential strategies to promote the participation of eligible programs.
Design:
This was a multimethod (eg, interviews, surveys, and document reviews) descriptive study.
Participants/Setting:
Participants included stakeholders from 22 national and state agencies that work with ECE programs to promote CACFP, nutrition, and quality care; representatives of 17 sponsor organizations; and 140 center-based ECE program directors from Arizona, North Carolina, New York, and Texas.
Statistical Analyses Performed:
Barriers, facilitators, and recommended strategies to promote CACFP that emerged from interviews were summarized with relevant illustrative quotes. Survey data were analyzed descriptively using frequencies and percentages.
Results:
Key barriers to center-based ECE program participation in CACFP shared by participants included the cumbersome CACFP paperwork, difficulty meeting eligibility requirements, strict meal patterns, difficulties with meal counts, penalties for noncompliance, low reimbursements, inadequate ECE staff to assist with paperwork, and limited trainings. Facilitators to participation included supports provided by stakeholders and sponsors through outreach, technical assistance, and nutrition education. Potential strategies recommended to promote CACFP participation would require policy change (eg, streamlining paperwork, modifying eligibility requirements, and leniency toward noncompliance) and systems-level change (eg, more outreach and technical assistance) by stakeholders and sponsor organizations.
Conclusions:
Stakeholder agencies recognized the need to prioritize CACFP participation and highlighted ongoing efforts. Policy changes are needed at the national and state levels to address barriers and ensure consistent CACFP practices among stakeholders, sponsors, and ECE programs.
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