Stakeholder, Sponsor, and Child Care Provider Perspectives on Barriers and Facilitators to Child Care Center Participation in the Child and Adult Care Food Program (CACFP)

OBJECTIVES: The Child and Adult Care Food Program (CACFP) is a federally-regulated, state-administered program that reimburses early care and education (ECE) programs for serving nutritional meals to low-income children. CACFP participation is voluntary and varies among states. This study explored barriers and facilitators of ECE participation in CACFP, and identified strategies to promote participation by eligible programs. METHODS: A mixed-methods study of 4 states with varying levels of ECE participation in CACFP. Stakeholders from 22 CACFP-associated agencies, representatives of 17 sponsor organizations, and 40 center-based ECE program directors were interviewed; 100 ECE directors completed surveys. In total, 66% of the ECE programs were in CACFP. RESULTS: Key barriers to CACFP participation included cumbersome enrollment and reimbursement paperwork, strict eligibility requirements, concerns about non-compliance penalties, strict meal patterns, low-reimbursement levels, and lack of on-site cooking facilities. Facilitators identified by participants were the outreach and technical assistance provided by stakeholders and sponsors, paperwork organizational systems established by sponsors, and trainings and nutrition education provided by stakeholders and sponsors. From the surveys, directors reported it was helpful that CACFP covered the cost of food (87%), served healthy meals (78%), provided meals to at-risk children (49%), kept tuition low (38%), and helped them serve a variety of foods (26%). Nearly all directors agreed that CACFP was “very important/important” to their program (94%), and would recommend CACFP to others (94%). Suggested strategies to promote CACFP participation focused on paperwork reduction, modification to eligibility requirements, increased reimbursement rate, leniency with unintentional non-compliance errors, and outreach/provision of additional technical assistance to ECE programs. CONCLUSIONS: CACFP confers critical nutritional benefits, but key barriers can impact program participation. Policy changes are needed at the federal and/or state levels to address these barriers. FUNDING SOURCES: Healthy Eating Research, a national program of the Robert Wood Johnson Foundation (RWJF); and the School of Public Health at Indiana University Bloomington.