Early Care And Education Programs Research Articles

High-quality early care and education for low-income families: Toddlers' cognitive and emotional functioning during the COVID-19 pandemic.

High-quality early care and education (ECE) programs are associated with positive outcomes, especially for children from low-income families. During the initial COVID-19 pandemic lockdown many of these families faced an abrupt halt to ECE. Here, we examined how toddlers from economically disadvantaged backgrounds enrolled in high-quality ECE programs in the United States during the 2020 pandemic (n=48) fared on cognitive and socioemotional outcomes compared to a 2019 pre-pandemic cohort (n=94) and a pandemic 2021 cohort (n=132). Toddlers in the 2020 cohort scored significantly lower on executive function compared to toddlers in 2019 and 2021 cohorts. Toddlers in the 2020 cohort had higher ratings self-regulation compared to the pre-pandemic cohort, but not 2021 cohort. There were no differences on attachment ratings between cohorts. Findings suggest that the abrupt halt to ECE programs due to the COVID-19 pandemic impacted US toddlers' cognitive and socioemotional abilities. This underscores the importance of continued high-quality ECE for infants and toddlers from low-income families during disruptive times. Further work is needed to investigate the long-term impacts of experiencing an abrupt halt to ECE due to COVID-19.

Prevalence and predictors of multiple, concurrent public early childhood education utilization among head start children

With growing public investment in early childhood services, families enrolled in Head Start (HS) have increasing opportunities to participate in other public early care and education (ECE) programs. Using integrated administrative data from across Iowa’s service systems, we examined the prevalence and predictors of HS children’s multiple concurrent ECE service utilization the year before entering kindergarten, focusing on state pre-K and child care subsidy (CCS). Results showed that 61 % of children participating in HS additionally utilized other public ECE programs, with 44 % participating in state pre-K, 8.3 % in CCS, and 8.7 % in both. Utilization patterns differed based on child and family characteristics. Children who were Black, living in urban areas, or born to single mothers were more likely to participate in multiple, concurrent services, especially a combination of services that included CCS. Results imply that improving coordination and collaboration across various ECE public programs may support HS families’ needs.

Who calls for help? Assessing the reach of the Ohio preschool expulsion prevention partnership

Early childhood expulsions are a systemic issue in early care and education (ECE) that have negative consequences for children, families, ECE programs, and communities. The Ohio Preschool Expulsion Prevention Partnership (OPEPP) represents one state's attempt to reduce the incidence of early childhood expulsions using infant and early mental health consultation distributed statewide in a hub-and-spoke arrangement. The study merges records from the first four years of OPEPP implementation (N = 569 expulsion prevention referrals) with child care licensing data (N = 3408 ECE programs) and data from the American Community Survey to assess OPEPP's reach in both the hub and spoke regions and identify what program and community characteristics were associated with OPEPP uptake. We found that 16.7 % of center-based ECE programs operating in Ohio between April 2016 and December 2019 participated in OPEPP, but distribution of referrals was uneven, with 36 % of ECE programs in the hub participating but just 10 % of programs outside of the hub doing so. ECE programs with higher quality ratings had greater odds of participating in OPEPP, as did ECE programs outside of the hub area that accepted publicly funded child care reimbursements. The differences in participation rates and predictors of participation between the hub and spoke regions suggest a need to explore how the hub-and-spoke arrangement of OPEPP may need to be adjusted to reach ECE programs outside of the hub region more effectively and have implications for other large-scale early childhood expulsion prevention efforts.

Illuminating Child and Adult Care Food Program Partnerships That Improved Food Access and Waiver Utilization for Feeding Young Children in Early Care and Education Programs During COVID-19: A Qualitative Study

BackgroundLittle is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. ObjectiveThis study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DesignQualitative semi-structured interviews with 24 participants representing 21 states across the United States. Participants/SettingVirtual interviews with CACFP directors from December 2020 through May 2021. AnalysisFollowing the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. ResultsFour themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). ConclusionsThe CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.

"It Has a Lot to Do With the Cumbersome Paperwork": Barriers and Facilitators of Center-Based Early Care and Education Program Participation in the Child and Adult Care Food Program.

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. 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. This was a multimethod (eg, interviews, surveys, and document reviews) descriptive study. 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. 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. 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. 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.

News Media Coverage of Childcare: How U.S. Local TV News Framed the Problem Before and During the Early Stage of the COVID-19 Pandemic

Early care and education (ECE), or the care young children receive before entering formal schooling, can take multiple forms and is delivered in different settings, such as a center, church, or public school. Federal and state governments regularly fund ECE programs and policies through the Child Care and Development Block Grant Act (CCDBG). Many families, however, face significant challenges in access, cost, and quality of ECE programs, and ECE professionals report substantial challenges in the workplace (e.g., inadequate training) and beyond (e.g., low wages). Policies addressing issues related to ECE were proposed in 2021, but stalled on the U.S. federal policy agenda. In this study, we examine the ECE content of local television news coverage both for its representations of and for its potential influences on ECE policy agendas. We use data from local stations affiliated with the major networks (ABC, NBC, CBS, and FOX) in media markets across the U.S., airing before and during the pandemic. We analyze elements of coverage that could affect public recognition of ECE-related issues, including how problems were framed (e.g., news coverage highlighting scandals or adverse events at ECE facilities) and solutions identified (e.g., public policy). We find that during 2018 and 2019, more coverage highlighted scandalous activity than public policy. The reverse was true, however, during the early period of the pandemic (from mid-March through June of 2020). Researchers and health professionals were seldom included in stories in either sample, and very few stories offered context about the benefits of ECE for health and well-being. These coverage patterns have implications for the public’s understanding of ECE policy and the perceived need for reform. Policymakers, advocates, and researchers looking to advance support for ECE should consider ways to use local television news to present health and policy-relevant information to broad segments of the public.

Multi-State Implementation of Go NAPSACC to Support Healthy Practices in the Early Care and Education Setting.

Childhood obesity in the United States is a serious problem that puts children at risk for poor health. Effective state-wide interventions are needed to address childhood obesity risk factors. Embedding evidence-based initiatives into state-level Early Care and Education (ECE) systems has the potential to improve health environments and promote healthy habits for the 12.5 million children attending ECE programs. Go NAPSACC, an online program that was adapted from an earlier paper version of Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC or NAP SACC), provides an evidence-based approach that aligns with national guidance from Caring for Our Children and the Centers for Disease Control and Prevention. This study describes approaches undertaken across 22 states from May 2017 to May 2022 to implement and integrate Go NAPSACC into state-level systems. This study describes challenges encountered, strategies employed, and lessoned learned while implementing Go NAPSACC state-wide. To date, 22 states have successfully trained 1,324 Go NAPSACC consultants, enrolled 7,152 ECE programs, and aimed to impact 344,750 children in care. By implementing evidence-based programs, such as Go NAPSACC, ECE programs state-wide can make changes and monitor progress on meeting healthy best practice standards, increasing opportunities for all children to have a healthy start.

Changes in Meal and Menu Quality at Early Care and Education Programs after Training with Food Service Staff: the FRESH Study

BackgroundPrevalence of obesity in Native American (NA) children is disproportionately high, indicating a higher risk of health disparities. Many children attend early care and education (ECE) programs, presenting an opportune environment to improve meal and menu quality as the intake of healthy foods is associated with lowered risk of childhood obesity. ObjectivesWe aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs. MethodsFood service staff from 9 participating ECE programs attended a 3-h training focused on Child and Adult Care Food Program (CACFP) best practices, and received a tailored, best-practice menu, and healthy recipes. Meals and menus prepared across 1 wk were examined per CACFP serving size assumptions at baseline, 4 mos, 6 mos, and 12 mos for all 9 programs. Healthy Eating Index (HEI), CACFP requirements and best practices achievement, and food substitutions quality (classified into superior, equivalent, and inferior based on the nutritional quality) were calculated. A repeated measures ANOVA model was used to determine the differences across time points. ResultsThe total meal HEI score increased significantly from baseline to 4 mos (71.1 ± 2.1; 78.6 ± 5.0; P = 0.004), but did not differ from baseline to 12 mos. Menu CACFP requirements and best practices achievement did not differ across time points, although achievement with CACFP requirements was already high at baseline. Superior nutrition quality substitutions declined from baseline to 6 mos (32.4 ± 8.9; 19.5 ± 10.9; P = 0.007); however, it did not differ from baseline to 12 mos. Equivalent and inferior quality substitutions did not differ across time points. ConclusionsImplementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed for improving both meals and menus.This trial was registered ClinicalTrials.gov as NCT03251950 (https://clinicaltrials.gov/ct2/show/NCT03251950?cond=food+resource+equity&draw=2&rank=1).

Implementation of an early childhood mental health consultation pilot in Virginia: Critical tensions and implications for scale-up

Early childhood mental health consultation (ECMHC) is a targeted prevention service that aims to build the capacity of early care and education (ECE) professionals and foster supportive environments that promote children’s social–emotional competence and improve mental health and well-being. A key challenge to delivering ECMHC at scale is navigating complex multi-level factors to maximize successful implementation and program benefits at scale. The current study describes the implementation tensions arising during the first year of a pilot ECMHC program conducted in partnership across multiple agencies and a state’s department of education. In the 2021–2022 pilot year, ECMHC was offered as a free service to ECE programs in one large region of Virginia, with the goal of examining feasibility to scale statewide in future years. Consultation was implemented in 45 preschool classrooms across 30 programs. Implementation data were collected using consultation logs and participant surveys, and 20 participants (educators, families, program directors) participated in focus groups. Three implementation tensions are highlighted in this paper: (1) ideal plans versus reality of a new ECMHC roll-out; (2) how to support ECE professionals’ practice as it relates to children’s behavior, without contributing to a deficit view that children need to be “fixed;” and (3) systemic factors in the early childhood field that undermine the implementation and effectiveness of ECMHC. For each tension, we provide context from the larger literature on ECMHC, describe relevant decision points from Virginia’s pilot ECMHC program, and present implementation data to illustrate these tensions in practice. We conclude with reflections on lessons learned that have implications for other ECMHC and SEL intervention scale-up efforts.

Children's absenteeism from pre-K to kindergarten: A focus on children receiving child care subsidies

As many as 48% of children in prekindergarten (pre-K) miss a month or more of the pre-K year (i.e., 10% or more of the school year), and high levels of absenteeism are associated with adverse academic and social-emotional outcomes in pre-K and in K-12. To date, no studies have examined absenteeism specifically among children receiving child care subsidies, a population of children who may be at greater risk for high absenteeism. Moreover, few studies have explored absenteeism in diverse early care and education (ECE) programs beyond public school pre-K or Head Start programs. This study uses administrative data from Massachusetts to address these gaps by (1) documenting absenteeism rates for children receiving subsidies during the pre-K year in both family child care (FCC) and center-based care (CBC) programs and in kindergarten; and (2) testing whether pre-K absenteeism is associated with kindergarten absenteeism in the full sample and by ECE program type. Results show that children enrolled in subsidized care were absent for an average 8.4% of the school year in pre-K and 5.9% of the school year in kindergarten. Absenteeism rates were lower in pre-K but slightly higher in kindergarten among children enrolled in FCCs, compared to those enrolled in CBCs (Pre-K: 7.2 versus 8.7%; Kindergarten: 6.2 vs 5.8%, respectively). Results from multilevel regression analyses showed that the associations between pre-K and kindergarten absenteeism were positive for children enrolled in both CBC and FCC programs. By documenting the prevalence of absenteeism among a sample of children receiving child care subsidies in diverse ECE programs, this study provides implications for ECE and child care subsidy research, policy, and practice.

Changes in Early Care and Education Settings Amid COVID-19: Voices of Parents

ABSTRACT Research Findings: The purpose of this qualitative study is to understand parents’ perceptions of changes in early care and education (ECE) in the early stage of the COVID-19 pandemic in South Korea. Thirty-three parents of young children who attend three different types of ECE programs (i.e. kindergartens, childcare centers, and non-accredited programs) participated in a 30-minute semi-structured interview. Through an applied thematic analysis, three major themes were generated: Structural Changes in ECE Settings, Support from ECE Programs and Teachers, and Changes in Parents’ Perceptions of ECE. Parents reported that they wanted their voices to be heard going through the changes in ECE settings. Some parents expressed concerns about the changes and were not satisfied with support provided by ECE programs. However, when ECE programs maintained regular communications, parents felt grateful, and parent-program relationships remained uninterrupted. Practice or Policy: The findings highlight the importance of recognizing parents as a meaningful part of the ECE community, understanding and addressing parents’ perceptions, and engaging parents in the frequent and open communication. Understanding parents’ perspectives can potentially improve the quality of ECE programs and promote high-quality parent-program relationships. Continuous efforts are needed to further explore parents’ perceptions in ECE research and practice.

Kindergarten through Grade 3 Outcomes Associated with Participation in High-Quality Early Care and Education: A RCT Follow-Up Study

An accepted conclusion is that children at risk for educational failure who participate in high-quality early care and education (ECE) enter kindergarten “more ready”, possessing skills comparable to their more advantaged peers. There is less consensus about longer-term outcomes with some studies finding continuation of early gains, while others report “fade out” by elementary school. This study investigated child outcomes, kindergarten through Grade 3, of 75 children randomly assigned as infants to either participate or not in an enhanced Early Head Start/Head Start program. It was hypothesized that the children who experienced this high-quality ECE would perform better than their control group peers across a range of measures. From kindergarten to Grade 3, children in the treatment group demonstrated higher skills in letter and word identification, vocabulary, oral comprehension, and math than control group children after controlling for child/family characteristics and classroom quality. Results for executive functioning were mixed with children in the treatment group showing higher skills on one of the two measures of executive function. No group differences were found for social-emotional skills. This study contributes to the scant literature of longitudinal studies spanning infancy through to Grade 3. In addition to the findings of a general pattern of continuation of positive child outcomes in early academic skills associated with earlier high-quality ECE attendance, this study also contributes information about the potential size of impacts of contemporary ECE programs starting in infancy.

Experiences pertaining to child nutrition and care provision among early care and education stakeholders, sponsors, and center directors during the COVID-19 pandemic: A multi-method study.

This study used multiple methods (interviews, survey) to assess experiences of stakeholders, sponsors, and center-based early care and education (ECE) program directors pertaining to child nutrition (e.g., provision of nutritious foods, mealtime practices, CACFP administration/use) and the provision of child-care (i.e., day-to-day ECE operations and programming) during the COVID-19 pandemic. Participants included stakeholders from 22 national and state agencies associated with the Child and Adult Care Food Program (CACFP) who also work to promote nutrition and quality child-care, representatives of 17 CACFP sponsor organizations, and 40 center-based ECE program directors who participated in interviews, as well as 100 ECE directors who completed surveys. Data were collected across four states. Thematic analyses of interviews and descriptive methods were used to analyze data collected. Six main themes emerged from stakeholders, sponsors, and ECE program directors' focusing on: experiences during the temporary closure of several ECE programs; additional responsibilities and unanticipated expenses for ECE programs; difficulty in keeping up with constantly changing COVID-19 guidance; encounters during shifts from in-person to virtual training and monitoring; changes to nutrition practices at ECE; and the need to prioritize ECE funding. Findings highlight challenges and supports to ECE programs and could inform future efforts to enhance child-care quality and child nutrition in the U.S. during pandemic situations.

Center-based early care and education programs and quality indicators: A latent class analysis

High quality early educational experiences are essential for young children's academic and social-emotional development. Although there is no one set of quality indicators that exists at a national level to assess center-based early care and education (ECE) program quality, researchers at the National Institute of Early Education Research (NIEER) have developed a set of quality benchmarks for state pre-kindergarten programs. However, patterns in the types of quality indicators ECE programs meet and how program, community, and policy features might be related to which indicators are met is not well understood. In the present study, we conducted a latent class analysis using nationally representative data from the 2012 National Survey of Early Care and Education (NSECE; n = 5,076 ECE centers) to identify subgroups of centers on the basis of the combinations of quality indicators met, which are similar to those developed by NIEER. Descriptive results show the mean number of NIEER benchmarks met was 5.74 out of 9 possible in the NSECE data. Our latent class analysis results reveal five distinct classes: (1) most quality indicators met; (2) smaller classroom ratios, but fewer teacher education and workforce support indicators met; (3) less screening support, but more teacher education and workforce support indicators met; (4) fewest indicators met; and (5) larger classroom ratios. Predictors of class membership were also examined. Findings of this exploratory study reveal heterogeneity in the specific combinations of quality indicators ECE programs meet.

Implementation of Federal Waivers for Feeding Children in Early Care and Education During the COVID-19 Pandemic

ObjectiveTo capture Child and Adult Care Food Program (CACFP) state directors’ experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019. DesignQualitative semistructured interviews. SettingVirtual interviews with state CACFP directors. ParticipantsChild and Adult Care Food Program directors from 21 states from December 2020 to May 2021. Phenomenon of InterestImplementation of state-level waivers. AnalysisQualitative thematic analysis. ResultsState directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE. Conclusions and ImplicationsResults indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

P065 Using Diffusion of Innovations Theory Explore Family Child Care Home Providers Perspectives on Responsive Feeding Practices

<h3>Background</h3> Early Care and Education (ECE) programs offer ideal settings for young children to develop healthy dietary intake. Implementation of responsive feeding evidence-based practices (EBPs) are a promising avenue to promote healthy eating in young children while supporting children's autonomy and self-regulation. However, implementation of responsive feeding EBPs is low, especially in rural family childcare homes (FCCH). Little is known about how organizational structure in FCCH impact implementation of responsive feeding EBPs in this unique setting. <h3>Objective</h3> To determine FCCH providers' perspectives for implementing evidence-based responsive feeding practices using the Diffusion of Innovations Theory's innovation-decision process. <h3>Study Design, Setting, Participants</h3> Six qualitative, semi-structured focus group interviews were conducted with 19 rural FCCH providers. <h3>Measurable Outcome/Analysis</h3> Interviews were analyzed using thematic analysis. <h3>Results</h3> Providers reported having knowledge regarding responsive feeding EBPs and had learned about them through various communication channels such as the Child and Adult Care Food Program, Go Nutrition and Physical Activity Self-Assessment for Child Care, and Step Up to Quality (Knowledge). Providers reported perceived challenges to implementing responsive feeding related to the organizational structure of the FCCH settings, such as the mixed age groups of children and balancing multiple roles such as administrator, cook and teacher during mealtimes (Persuasion and Decision). Additionally, providers who were implementing responsive feeding EBPs provided strategies used to overcome these challenges (Implementation). Finally, providers reported the benefits of using responsive feeding EBPs, such as supporting children's healthful development and more pleasant mealtimes, as reasons for their continued use of responsive feeding EBPs (Confirmation). <h3>Conclusions</h3> Results indicate that organizational structure impacts successful implementation of responsive feeding EBPs in ECE programs. Programming and policy efforts should consider these factors when targeting children's healthful dietary needs. <h3>Funding</h3> USDA

A cluster-randomized controlled trial to assess the impact of a nutrition intervention on dietary behaviors among early care and education providers: The Create Healthy Futures study

Create Healthy Futures is a self-paced, web-based intervention on improving healthy eating behaviors among Early Care and Education (ECE) providers. We examined the impact of web-based Create Healthy Futures on diet quality measured by the Alternative Healthy Eating Index (AHEI) 2010, dietary behaviors, and related psychosocial and environmental factors among ECE providers. A cluster randomized controlled trial (CRCT) was implemented with baseline surveys administered from October 2019-January 2020, intervention implementation from April-May 2020, and post-intervention from May 2020-August 2020. Centered-based ECE programs under the Pennsylvania Head Start Association (n = 12) were recruited and randomized to intervention (n = 5) or comparison (n = 7) groups. A total of 186 ECE providers completed the post-intervention surveys (retention rate: 86.1%). At baseline, 31.5% of ECE providers were food insecure. Pre-to-post intervention demonstrated no significant within-or-between-group changes in the AHEI-2010 diet quality scores. ECE providers in the intervention group reported a significant decrease from baseline to post-intervention in the number of days eating out (aMD = -0.8, CI:-1.6, −0.1, P = 0.03). Process evaluation showed that 89.9% of the intervention group completed all online module, and 82.9% attended all of wellness session groups. Although the Create Healthy Futures intervention did not improve ECE providers’ diet quality and dietary behaviors, it confirmed critical needs to provide health support to ECE providers. Future studies should employ strategies that improve access to healthy foods and nutrition education, and address social determinants of health such as food insecurity to improve diet quality and health in ECE provider population.

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)

ObjectivesThe 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. MethodsA 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. ResultsKey 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. ConclusionsCACFP 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 SourcesHealthy Eating Research, a national program of the Robert Wood Johnson Foundation (RWJF); and the School of Public Health at Indiana University Bloomington.

Challenges, Supports, and Lessons Learned: The Impact of the COVID-19 Pandemic on Efforts to Promote Nutrition and Quality Care at Early Care and Education Programs

ObjectivesThe COVID-19 pandemic has wreaked havoc in many settings, including early care and education (ECE) programs. This study describes challenges, supports, and lessons learned from the impact of COVID-19 on efforts to promote nutrition and quality care at ECE programs. MethodsA mixed-methods study of 4 states was conducted. Stakeholders from 22 organizations associated with the Child and Adult Care Food Program (CACFP), representatives of 17 CACFP sponsor organizations, and 40 center-based ECE program directors were interviewed; 100 ECE directors completed surveys. ResultsKey challenges included difficulty keeping up with continuous changes and inconsistent COVID-19 requirements across federal, state, and local regulatory agencies. ECE directors reported shortages of personal protective equipment, food, and supplies early in the pandemic. To protect their staff, children and families, directors took proactive measures including stopping family-style meals, switching to single use utensils or individually-packaged meals, conducting daily temperature checks, and installing sanitation stations at building entrances. Despite these efforts, many directors reported staff shortages, low enrollment, and center closures due to state mandates and positive cases on-site. Supports highlighted by stakeholders included the emergency relief funds from state agencies (57%), additional funding from other organizations (46%), access to information from state agencies, sponsors, and community organizations about where to find personal protective equipment (30%), and the CACFP waivers from the U.S. Department of Agriculture (16%). Lessons learned included the need to continue to prioritize federal/state funding to support ECE, provide enhanced internet access to rural programs, and make aspects of the CACFP waivers permanent. ConclusionsThe pandemic has challenged the ECE system, but has also drawn attention to the essential role of ECE in child nutrition and education. This study highlights potential opportunities for new policies to enhance efforts to promote child nutrition and quality care at ECE. Funding SourcesHealthy Eating Research, a national program of the Robert Wood Johnson Foundation (RWJF); and the School of Public Health at Indiana University Bloomington.

Access to Early Care and Education in Rural Communities: Implications for Children's School Readiness.

This study links county-level early care and education (ECE) program, economic, and demographic data to child-level data from the Early Childhood Longitudinal Study-Kindergarten Cohort of 2010-2011 to examine geographic variation in ECE program participation and provision. We find that public ECE programs, particularly Head Start, occupy a larger role in nonmetropolitan communities than in metropolitan areas. By contrast, children in rural counties are less likely to attend private center-based ECE, and nonprofit childcare program expenditures in rural areas lag. We also find rural-metropolitan differences in school readiness diminish when geographic characteristics are controlled. Results suggest that county-level context and state-level policy features shape children's early experiences, and that public ECE investments are key in narrowing disparities in ECE attendance and in children's outcomes.