Cover Image

PAPERBACK
$48.00



View/Hide Left Panel

2
The Child and Adult Care Food Program

The Child and Adult Care Food Program (CACFP) has the broadest scope of any of the U.S. Department of Agriculture (USDA) food programs that specifically target vulnerable populations. In particular, it subsidizes nutritious meals and snacks served to infants and children in participating day care facilities, emergency shelters, and at-risk afterschool programs, and to adults who receive day care in participating facilities. Moreover, a majority of the participants (and many of the providers) are from low-income households. This chapter covers a variety of topics important to the development of revised Meal Requirements. After providing an overview of CACFP, this chapter highlights key elements of the history and growth of the program, describes program settings and clientele, summarizes important aspects of the program’s administration and regulations, addresses the program’s role in providing a food and nutrition safety net for vulnerable populations, and ends with a brief summary.

PROGRAM OVERVIEW

The goal of CACFP is to serve nutritious meals and snacks to participating children and adults. Ordinarily, the program serves children no older than 12 years of age. However, there are two exceptions: it may serve (1) migrant children ages 15 years and under and (2) youths up to 18 years of age in afterschool programs and in shelters. Adults in participating day care facilities generally are ages 60 years and older. However, individuals from 18 up to 60 years of age may participate if they require daily supervision because of functional limitations.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 25
2 The Child and Adult Care Food Program The Child and Adult Care Food Program (CACFP) has the broadest scope of any of the U.S. Department of Agriculture (USDA) food programs that specifically target vulnerable populations. In particular, it subsidizes nutritious meals and snacks served to infants and children in participating day care facilities, emergency shelters, and at-risk afterschool programs, and to adults who receive day care in participating facilities. Moreover, a majority of the participants (and many of the providers) are from low- income households. This chapter covers a variety of topics important to the development of revised Meal Requirements. After providing an overview of CACFP, this chapter highlights key elements of the history and growth of the program, describes program settings and clientele, summarizes impor- tant aspects of the program’s administration and regulations, addresses the program’s role in providing a food and nutrition safety net for vulnerable populations, and ends with a brief summary. PROGRAM OVERVIEW The goal of CACFP is to serve nutritious meals and snacks to par- ticipating children and adults. Ordinarily, the program serves children no older than 12 years of age. However, there are two exceptions: it may serve (1) migrant children ages 15 years and under and (2) youths up to 18 years of age in afterschool programs and in shelters. Adults in participating day care facilities generally are ages 60 years and older. However, individuals from 18 up to 60 years of age may participate if they require daily supervi- sion because of functional limitations. 25

OCR for page 25
26 CHILD AND ADULT CARE FOOD PROGRAM TABLE 2-1 General Aspects of Current CACFP Meal Requirements Eating Occasion Current Requirements All Must meet daily pattern, which may differ by age group and setting. The pattern specifies the number of meal components (shown below) and the amount of each. Breakfast 3 meal components Lunch or supper 4 meal components Snacks Any 2 of 4 components Meal Component Fruit/vegetable Any fruit and/or vegetable Grain Enriched or whole grain Meat/alternate None required at breakfast, no restrictions on types Milk No restrictions Food Component Energy No requirement Micronutrients No requirement Fats No restrictions Sodium No restrictions SOURCE: Adapted from USDA/FNS, 2010a. To receive reimbursement for the meals and snacks served, participating programs are required to provide meals and snacks according to require- ments set by USDA. In this report, the term meal component refers to the food groups required in the meals, and the term food component refers to nutrients and other substances contained in food. General aspects of the current CACFP Meal Requirements are shown in Table 2-1. PROGRAM SETTINGS CACFP is administered in three major types of day care settings, whether for children or adults: family or group homes, centers, and inde- pendent centers. The entity responsible for administering the local program depends on the type of setting, as shown in Figure 2-1. Independent centers report directly to the state CACFP agency, whereas other centers and family or group homes must operate under the auspices of a sponsoring organiza- tion. A community action agency is a common example of a sponsoring organization. For further information, see the section “Administration and Regulations, Overview.” Sponsoring organizations and independent centers (see Figure 2-1) enter into agreements with their state administering agency to assume ad- ministrative and financial responsibility for CACFP operations at the local level, and each state CACFP agency administers the program within the

OCR for page 25
27 CHILD AND ADULT CARE FOOD PROGRAM Family or Group Homes USDA, FNS Sponsoring Regional FNS State CACFP Centers Headquarters Organizations Office Agency Independent Centers FIGURE 2-1 CACFP settings as administered through USDA FNS. NOTES: CACFP 5 Child and Adult Care Food Program; FNS 5 Food and Nutri- tion Service; USDA 5 U.S. Department of Agriculture. All day care homes and centers must come into the program under a sponsoring organization, which pro- vides training, technical assistance, and monitoring. State CACFP agencies approve sponsoring organizations and independent centers, monitor the program, provide guidance, and administer CACFP in most states. USDA FNS administers CACFP at the federal level through grants to states. SOURCE: Adapted from USDA/FNS, 2000. FIGURE 2-1 state. Public or private entities that are eligible to participate in CACFP are described below (USDA/FNS, 2010b). Day Care Centers for Children and Adults Child Day Care Public or private nonprofit child care centers, outside school hours care centers, Head Start programs, and other institutions that are licensed or approved to provide day care services are eligible to participate in CACFP, either independently or as sponsored centers. For-profit centers are eligible to participate only if, in addition, either (1) they receive title XX funds for at least 25 percent of enrolled children or licensed capacity (whichever is less), or (2) at least 25 percent of the children in care are eligible for free and reduced-price meals. Meals served to children are reimbursed at rates based upon a child’s eligibility for free, reduced-price, or paid meals. In centers, participants from households with incomes at or below 130 percent of poverty are eligible for free meals, while those with household incomes between 130 and 185 percent of poverty are eligible for meals at a reduced price (USDA/FNS, 2010b).

OCR for page 25
28 CHILD AND ADULT CARE FOOD PROGRAM Adult Day Care Public or private nonprofit adult day care facilities that provide struc- tured, comprehensive services to nonresident adults who are functionally impaired or ages 60 years and older may participate in CACFP as either independent or sponsored centers. For-profit centers may be eligible for CACFP if at least 25 percent of their participants receive benefits under title XIX or title XX. Meals served to adults receiving care are reimbursed at rates based upon a participant’s eligibility for free, reduced-price, or paid meals as defined above (USDA/FNS, 2010b). Family or Group Day Care Homes for Children Family or group day care homes (referred to as “homes”) are private and must be sponsored by an organization that assumes responsibility for ensuring compliance with federal and state regulations and that acts as a conduit for meal reimbursements to family day care providers. Both family and group day care homes must meet state licensing requirements, where these are imposed, or be approved by a federal, state, or local agency. Group day care homes must be licensed or approved to provide day care services. It is each state’s licensing or approval requirements that distinguish a family from a group home. Homes enroll an average of eight children, including a provider’s own children. On average, seven enrolled children are in care in a home on a daily basis. Centers enroll more children than homes. On average, a center that enrolls 60 to 70 children will have 53 to 57 children in attendance daily (USDA/FCS, 1997). Food preparation facilities vary greatly just as kitchens do in homes across the socioeconomic spectrum. Many providers have limited education, but others may have college degrees. In some areas, a substantial number of the providers are not fluent in English. Many pro- viders have incomes at or below the poverty level. The day care home may be a major income source for some providers (USDA/FCS, 1997). “At-Risk” Afterschool Care Programs Community-based programs that offer enrichment activities for at-risk children and youth after the regular school day ends may be eligible to pro- vide snacks through CACFP at no cost to the participants. Programs must be offered in areas where at least 50 percent of the children are eligible for free and reduced-price meals based upon school data. Reimbursable suppers are also available to children in eligible afterschool care programs in Con- necticut, Delaware, Illinois, Maryland, Michigan, Missouri, Nevada, New York, Oregon, Pennsylvania, Vermont, West Virginia, Wisconsin, and the

OCR for page 25
29 CHILD AND ADULT CARE FOOD PROGRAM District of Columbia (USDA/FNS, 2010b). The effective date of the final rule to add suppers was May 3, 2010 (USDA/FNS, 2010c). Emergency Shelters Public or private nonprofit emergency shelters that provide residential and food services to homeless children have been eligible to participate in CACFP since July 1, 1999. Eligible shelters may receive reimbursement for serving up to three meals each day to homeless children, through age 18, who reside there. A shelter does not have to be licensed to provide day care, but it must meet any health and safety codes that are required by state or local law (USDA/FNS, 2010b). CLIENT CHARACTERISTICS Age Groups Section 226.2 of the USDA regulations describes who may receive CACFP meal benefits. Participants must meet the following criteria: • Children ages 12 years and under, or ages 15 years and under who are children of migrant workers; • For emergency shelters, persons ages 18 years and under; • For at-risk afterschool care centers, persons ages 18 years and un- der at the start of the school year; • Persons of any age who have one or more disabilities, as deter- mined by the state, and who are enrolled in an institution or child care facility serving a majority of persons who are ages 18 years and under; • Provider’s own children only in a specific low-income situation called tier I day care homes (see description in the section “Meal Reimburse- ments”) and only when other nonresidential children are enrolled in the day care home and are participating in the meal service; and • Adult participants who are functionally impaired or 60 years of age or older and who remain in the community (USDA/FNS, 2010b). HISTORY AND GROWTH OF THE PROGRAM In 1968, CACFP began as a small 3-year pilot program called the Special Food Service Program for Children. It arose as part of an effort to create an affordable food program for low-income working mothers. Initially, the program provided grants to states to serve meals when schools were not in session. Table 2-2 shows the chronological development and legislative milestones of CACFP. Of special note are (1) the expansion of eligibility, in 1976, to family child care homes that either meet state licensing requirements

OCR for page 25
30 CHILD AND ADULT CARE FOOD PROGRAM TABLE 2-2 Timeline of the Child and Adult Care Food Program Date Legislative Action 1968 Public Law (P.L.) 90-302: established the Special Food Service Program for Children (SFSPFC) as a 3-year pilot program 1972 P.L. 92-433: extended the SFSPFC for another 3 years 1975 P.L. 94-105: separated the Child Care Food Program (CCFP) and the Summer Food Service Program 1978 P.L. 95-627: made CCFP permanent 1981 Omnibus Budget Reconciliation Act of 1981: amended CCFP reimbursement requirements, reduced reimbursement rates, limited reimbursement, and lowered the maximum age of eligibility through 12 years 1987 Older Americans Act of 1987: authorized participation of eligible adult day care centers 1988 Hunger Prevention Act of 1988: allowed for a fourth meal for children in care 8 hours or more per day in child care centers and outside school hours centers only 1989 Child Nutrition and WIC Reauthorization Act of 1989: changed the name of the program to the Child and Adult Care Food Program (CACFP), funded the expansion of family day care homes into low-income or rural areas, permitted snacks for schools participating in CACFP 1994 Healthy Meals for Healthy Americans Act of 1994: extended eligibility for free meals for children participating in Head Start 1996 Personal Responsibility and Work Opportunity Reconciliation Act of 1996: replaced the single reimbursement rate with a two-tier structure (two reimbursement rates that consider the provider’s economic situation), eliminated reimbursement for a fourth meal, required cost-of-living adjustments for meals served in homes and paid meals served in centers 1998 Child Nutrition Reauthorization Act of 1998: authorized CACFP reimbursement for snacks to children through age 18 in afterschool care programs, amended licensing requirements, consolidated benefits for homeless children, reinstated automatic eligibility for free meals for Even Start participants 2000 Agricultural Risk Protection Act of 2000: changed eligibility criteria, expanded the at-risk afterschool care component of CACFP 2000 Consolidated Appropriations Act of 2001: extended eligibility to for-profit centers and outside of school hours care centers serving low-income children 2001 Agriculture, Rural Development, FDA, and Related Agencies Appropriations Act of 2002: authorized supper benefits to some afterschool programs, extended CACFP eligibility to for-profit centers serving low-income children through fiscal year 2002 2004 Child Nutrition and WIC Reauthorization Act of 2004: increased the minimum state administrative expense funding; changed the frequency of tiering determination from 3 to 5 years; for military personnel living in privatized housing, excluded counting the household allowance in the determination of eligibility for free and reduced-price meals NOTE: FDA 5 Food and Drug Administration; WIC 5 Special Supplemental Nutrition Program for Women, Infants, and Children. SOURCE: Adapted from USDA/FNS, 2010d.

OCR for page 25
31 CHILD AND ADULT CARE FOOD PROGRAM or obtain approval from a state or local agency; (2) the provision of finan- cial incentives through P.L. 95-627, in 1978, to expand participation; (3) the change from pilot program status to the permanent Child Care Food Program, also in 1978; and (4) authorization for the adult care component following the enactment of the Older Americans Act of 1987, which resulted in the renaming of the program to the Child and Adult Care Food Program. CACFP has expanded greatly since its inception as a pilot program (USDA/FNS, 2010d), both in terms of the number of participants served and the types of care programs that are eligible. CACFP currently serves more than 3 million children and adults across the United States and two of its territories: Puerto Rico and Guam. Table 2-3 summarizes key infor- mation about program characteristics and program participation and illus- trates the diversity of settings and the broad reach of the program. ADMINISTRATION AND REGULATIONS Overview CACFP is authorized by Section 17 of the National School Lunch Act (42 U.S.C. 1766). Regulations for program administration are issued by USDA under 7 C.F.R. Part 226. The CACFP program is administrated by USDA’s Food and Nutrition Service through grants to states. At the state level, the state education agency is the usual administrator. In a few states, CACFP is administered by an alternate agency, such as the state health or social services department. The child care component and the adult day care component of CACFP may be administered by different agencies within a state at the discretion of the governor. Independent centers and sponsoring organizations enter into agreements with their administering state agencies to assume administrative and financial responsibility for CACFP operations. Day care homes may participate in the CACFP only under the auspices of a sponsoring organization. Several types of organizations, such as community action agencies and nonprofit organizations, are approved by states to serve as sponsors. Sponsoring organizations provide payment to sponsored day care providers for meals and snacks that meet requirements and are allowed nonfood meal services. The following discussions cover requirements for current meal patterns and key aspects of meal reimbursement. Current Meal Patterns CACFP facilities must follow the current meal patterns to receive reim- bursement for the meals. The meal patterns for children and adults make use of up to four meal components: • Fluid milk, • Fruits/vegetables,

OCR for page 25
TABLE 2-3 CACFP Program Characteristics and Participation by Provider Type for Fiscal Year 2008, Listed in 32 Descending Order by Average Number of Participants per Month Number of Participant Reimbursement Number of Participants Provider Type Characteristics Licensure Options Providers Served Child care centers Children ages Licensed or approved 2 meals and 1 snack; or 39,615 1,860,498 12 years and 2 snacks and 1 meal younger Family day care home Children ages Licensed or approveda 2 meals and 1 snack; or 141,549 849,568 12 years and 2 snacks and 1 meal younger At-risk afterschool care Children ages Approved 1 snack; or 1 snack and 6,686 300,008 facility 18 years and 1 mealb younger Outside school hours care Children ages Licensed or approved 2 meals and 1 snack 3,131 125,467 facility 12 years and younger Adult care facility Adults ages 60 Licensed or approvedc 2 meals and 1 snack; or 2,568 108,192 years and over 2 snacks and 1 meal and disabled adults Shelters Children ages None 3 meals; or 2 meals and 398 7,958 18 years and 1 snack younger aEach state has licensing or approval requirements that distinguish family from group homes and establish maximum participation based on the ratio of infants and children to adults. bAt this time, both one snack and one meal are allowed only in 13 states and the District of Columbia. cDependent on state and local rules for adult day care. SOURCE: USDA/FNS, 2009.

OCR for page 25
33 CHILD AND ADULT CARE FOOD PROGRAM • Grain/bread, and • Meat/meat alternates. As described below, the combination of meal components differs for breakfast, lunch/supper, and snacks; the minimum required amounts of the meal components differ by age group and, for children and adults, by eating occasion. Meal Pattern Descriptions Meal patterns for infants differ markedly from those for children and adults, as shown below. Infants The current infant lunch/supper meal patterns appear in Table 2-4. Ranges are given because of the wide variability in infants’ needs based on developmental stage and readiness for foods. Children and adults For children, a general description of the current minimums required in the meal and snack patterns follows. The general meal pattern description for adults is identical to the list given below except that a serving of milk is not required at supper. TABLE 2-4 Current Infant Meal Pattern for Lunch or Supper Birth through Food Components 3 Months 4–7 Months 8–11 Months Formulaa milkb,c or breast (fl oz) 4–6 4–8 6–8 Infant cereala,d (T) 0–3e 2–4 0–3e Fruit or vegetable or both (T) 1–4 Meat or meat alternated Meat, fish, poultry, egg yolk, cooked dry beans or peas (T) 1–4 Cheese (oz) ½–2 Cottage cheese (oz, volume) 1–4 Cheese food or cheese spread (oz, weight) 1–4 NOTE: fl oz 5 fluid ounce; oz 5 ounce; T 5 tablespoon. aInfant formula and dry cereal must be iron-fortified. bBreast milk or formula, or portions of both, may be served; however, breast milk is recom- mended from birth through 11 months. cFor some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount of breast milk may be offered, with additional breast milk offered if the infant is still hungry. dMenu may include infant cereal, a meat/meat alternate, or both. eA serving of this component is required when the infant is developmentally ready to accept it. SOURCE: Adapted from USDA/FNS, 2010a.

OCR for page 25
34 CHILD AND ADULT CARE FOOD PROGRAM • Breakfast: one serving each of milk, fruit or vegetable, and grain or bread (three meal components) • Lunch and Supper: one serving each of milk, grain or bread, meat/ meat alternate, and two different servings of fruit or vegetable or a combination of fruit and vegetable (four meal components) • Snacks: one serving selected from each of two of the four meal components (milk, fruit or vegetable, grain or bread, or meat/meat alternate)—that is, two of the four components. Serving sizes for children and adults differ by age group, as shown in Table 2-5 for breakfast and in Appendix E for all the other meals and snacks by age group. For children over 12 years of age and adults, the pat- tern is the same as for children 6–12 years of age with allowance for larger servings. For example, one serving of bread for children ages 1 through 5 years is one-half slice, whereas it is one full slice for children ages 6 through 12 years and may be more for adults. The patterns shown in Table 2-5 and Appendix E include specifications for the types of foods that make up each meal component and the amount of each type of food that represents one serving. Notably, only adult day care centers currently have the option to use the offer versus serve form of food service. In this form of service, participants may refuse to take one or more of the meal components of- fered to them. By following the breakfast pattern for children 3–5 years of age, a breakfast menu under the current regulations might include one-third cup TABLE 2-5 Current Child Meal Patterns for Breakfast: Select All Three Meal Components for a Reimbursable Meal 6–12 Yearsa Meal Components 1–2 Years 3–5 Years 1 Milk (c) ½ ¾ 1 1 Fruit/vegetable Juice,b fruit, and/or vegetable (c) ¼ ½ ½ 1 Grain/breadc Bread (slice) ½ ½ 1 Cornbread, biscuit, roll, or muffin (svg) ½ ½ 1 Cold dry cereal (c) ¼ 1/ 3 ¾ Hot cooked cereal (c) ¼ ¼ ½ Pasta noodles, or grains (c) ¼ ¼ ½ NOTE: c 5 cup; svg 5 serving. aChildren ages 12 years and older may be served larger portions based on their greater needs. They may not be served less than the minimum quantities listed in this column. bFruit or vegetable juice must be full-strength. cBreads and grains must be made from whole grain or enriched meal or flour. Cereal must be whole grain or enriched or fortified. SOURCE: Adapted from USDA/FNS, 2010a.

OCR for page 25
35 CHILD AND ADULT CARE FOOD PROGRAM corn flakes with one-half cup sliced banana and three-quarters cup of whole milk (part on the cereal and part in a cup). The meal components for CACFP were established when the program began in 1968 as the Special Food Service Program for Children. Changes to the regulations for CACFP governing the required meal components in the meal patterns were established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193). The mandated changes included a reduction in the number of meals eligible to be claimed for reimbursement to a maximum of two meals and one snack or one meal and two snacks, regardless of the length of time a child was in attendance (see Table 2-3, “Reimbursement Options” column). The CACFP regula- tions only provide broad nutrient standards for meals or snacks. Useful benchmarks for assessing nutrient standards for CACFP meals and snacks were examined in the Early Childhood and Child Care Study carried out for USDA (USDA/FCS, 1997). These benchmarks came from the school-based programs (7 C.F.R., Parts 210 and 220), which currently call for breakfast to offer at least one-fourth of the Recommended Dietary Allowance (RDA) and for lunch to provide at least one-third of the RDA for these nutrients. Benchmarks for food energy from total fat, saturated fat, and carbohydrate, as well as the total amounts of cholesterol and sodium in the meals and snacks offered, were derived from recommendations in the 1995 Dietary Guidelines for Americans (HHS/USDA, 1995) and the Diet and Health report (NRC, 1989) (USDA/FCS, 1997). Meal Reimbursements Eligible program providers receive reimbursement for meals and snacks served if the meals and foods meet the requirements specified in the regula- tions (USDA/FNS, 2010a,d,e). The CACFP reimbursement system does not provide partial credit for meals or snacks that meet most of the require- ments; they must meet all requirements specified in the meal patterns (see Chapter 7). Reimbursement Methods Centers Reimbursement for center-based CACFP facilities is computed by claiming percentages, blended per meal rates, or actual meal count by type (breakfast, lunch, supper, or snack) and considering the eligibility cat- egory of participants (free, reduced-price, and paid), which is determined by participant family size and income. As stated above, participants from households with incomes at or below 130 percent of poverty are eligible for free meals. In centers, participants with household incomes between 130 and 185 percent of poverty are eligible for meals at a reduced price (USDA/

OCR for page 25
36 CHILD AND ADULT CARE FOOD PROGRAM FNS, 2010b). The state agency assigns a method of reimbursement for cen- ters, based on meals multiplied by rates, or the lesser of meals multiplied by rates versus actual documented costs. The current reimbursement rates for centers are delineated in Table 2-6; the rates are updated annually. CACFP centers may operate as pricing or nonpricing programs. Non- pricing programs charge a single fee to cover tuition, meals, and all other day care services; pricing programs charge separate fees for meals. Gen- erally, most CACFP centers, including Head Start programs, operate as nonpricing programs. TABLE 2-6 Child and Adult Care Food Program (CACFP) Reimbursement Rates per Meal by Meal Type for Adult and Child Day Care Centers, Homes, and Sponsoring Organizations of Day Care Homes, July 1, 2010, through June 30, 2011 Contiguous States Alaska Hawaii Whole or Fractions of U.S. Dollars Centers Breakfast Paid 0.26 0.39 0.30 Reduced 1.18 2.06 1.42 Free 1.48 2.36 1.72 Lunch and supper Paid 0.26 0.42 0.30 Reduced 2.32 4.01 2.78 Free 2.72 4.41 3.18 Snack Paid 0.06 0.11 0.08 Reduced 0.37 0.60 0.43 Free 0.74 1.21 0.87 Day Care Homes Ia Breakfast Tier 1.19 1.89 1.38 IIb Tier 0.44 0.67 0.50 Ia Lunch and supper Tier 2.22 3.60 2.60 IIb Tier 1.34 2.17 1.57 Ia Snack Tier 0.66 1.07 0.77 IIb Tier 0.18 0.29 0.21 NOTE: These rates do not include the value of commodities (or cash in lieu of commodities) that some facilities receive as additional assistance for each lunch or supper served to partici- pants under CACFP. The national average minimum value of donated food, or cash in lieu thereof, per lunch and supper under CACFP (7 C.F.R. Part 226) will be 20.25 cents for the period July 1, 2010, through June 30, 2011 (USDA/FNS, 2010f). aTier I homes are those located in low-income areas or run by providers with family incomes at or below 185 percent of the federal poverty guideline (USDA/FNS, 1997). bTier II homes are those that do not meet either the location- or provider-income criterion for a tier I home (USDA/FNS, 1997). SOURCE: Adapted from USDA/FNS, 2010e.

OCR for page 25
37 CHILD AND ADULT CARE FOOD PROGRAM Day care homes The Personal Responsibility and Work Opportunity Rec- onciliation Act of 1996 (P.L. 104-193) refocused the family child care com- ponent of CACFP on low-income children by establishing a two-tier system of reimbursement rates for family child care homes. Tier I day care homes are those that are located in low-income areas, or those in which the pro- vider’s household income is at or below 185 percent of the federal income poverty guidelines. Tier II homes are those family day care homes that do not meet either the location- or provider-income criterion for a tier I home. Sponsoring organizations may use elementary school free and reduced- price enrollment data or census block group data to determine which areas are low income. However, the provider in a tier II home may elect to have the sponsoring organization identify income-eligible children. When this is done, the meals served to children who qualify for free and reduced-price meals are reimbursed at the higher tier I rates. Program payments for day care homes are based on the number of approved meals served to enrolled children multiplied by the appropriate reimbursement rate (tier I or tier II; see above) for each breakfast, lunch, supper, or snack. MONITORING THE QUALITY OF CACFP MEALS Current federal regulations require that state agencies annually con- duct monitoring reviews of at least one-third of all CACFP institutions1 and must follow a specific review cycle for sponsors and their sponsored centers and day care homes, with the number of homes monitored based on the home sponsor. The state may conduct additional reviews and/or provide technical assistance for those institutions that need close observa- tion. The purpose of the monitoring is to examine the extent to which the institutions are complying with the CACFP requirements. States monitor the entire CACFP operation, including the ability of child care providers to adequately plan, prepare, and serve a reimbursable meal and to provide nutrition education to its participants. To ensure that the institution meets the CACFP requirements, state monitors also review the institution’s finan- cial viability and financial management systems, internal controls, and other management practices and systems. Indicators of compliance include record keeping; meal counts; menus; licensing and approval; production records, where applicable; meal obser- vation; administrative costs; and, for sponsor organizations, training and monitoring of their sponsored facilities. States provide technical assistance 1 As defined in federal CACFP regulations at 7 C.F.R. 226.2, “institution means a sponsoring organization, child care center, at-risk afterschool care center, outside-school-hours care cen- ter, emergency shelter or adult day care center which enters into an agreement with the State agency to assume final administrative and financial responsibility for Program operations.”

OCR for page 25
38 CHILD AND ADULT CARE FOOD PROGRAM as needed, and many combine the monitoring and technical assistance vis- its. Generally the review covers a specific test month. If further evaluation is warranted, other months may be combined in the review. The state may require the CACFP institutions to develop and submit written corrective action plans to improve and permanently correct any program violations noted during the visit in order to achieve compliance with requirements. If meal deficiencies are observed during the evaluation of the menus (and production records where applicable) and the meal observation, the state may disallow (not reimburse) meals. Because many CACFP institutions have had difficulty completing and maintaining production records that provide enough data to substantiate the validity of the meals produced, several states have eliminated the production record-keeping requirement. In its place, they use receipts and invoices to support the meal reimburse- ment claims. CACFP AS PART OF THE FOOD AND NUTRITION SAFETY NET CACFP is one of 15 nutrition assistance programs administered by the FNS of USDA. These programs provide a safety net for low-income individuals and specific groups that may be vulnerable to social and envi- ronmental factors that place them at increased nutritional risk. Of special note, children who consume meals offered through CACFP may also con- sume food provided through other established nutrition programs such as the Supplemental Nutrition Program for Women, Infants, and Children or through the School Breakfast Program (SBP) and the National School Lunch Program (NSLP). Because these are very large programs that serve millions of the nation’s children, it will be especially useful for the CACFP Meal Requirements to align well with the foods and nutrition education provided by these programs. A new and much smaller program recently introduced by the FNS is the Fresh Fruit and Vegetable Program, which began as a pilot program in 4 states and is now a nation-wide program in selected schools in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands. This program provides fresh fruits and vegetables to low-income children, who may also receive meals through CACFP (USDA/FNS, 2010g). Appendix F contains brief descriptions of most of these programs and identifies websites that provide more detailed information. CACFP serves a key role in the U.S. food and nutrition safety net. As such, CACFP is expected to meet a portion of participants’ nutritional needs and to be in alignment with current nutrition policy and guidance, including the current Dietary Guidelines for Americans (HHS/USDA, 2005) and Dietary Reference Intakes. The following briefly addresses concerns

OCR for page 25
39 CHILD AND ADULT CARE FOOD PROGRAM about food insecurity in today’s environment and summarizes CACFP’s potential contribution to the nutrition of individuals in day care. Concerns About Food Insecurity Food insecurity, the uncertainty of having enough food to meet the ba- sic needs of household members, places children at risk for inadequate food and nutrient intake and for impaired or diminished growth. Among both children and adults, food insecurity increases the risk for behavioral and psychosocial dysfunction (Miller et al., 2008) and poor health outcomes, including infant and toddler development (Biros et al., 2005; Kirkpatrick et al., 2010; Rose-Jacobs et al., 2008; Stuff et al., 2004). The monitoring of food insecurity across the nation by USDA indicates that, as of 2007, the prevalence of food insecurity among children was 8.3 percent and was 11.1 percent for households (USDA/ERS, 2009a). By the end of 2008, the prevalence of household food insecurity had increased to 14.6 percent, the highest prevalence since data collection began in 1995 (USDA/ERS, 2009b). A high proportion of children served by CACFP can be considered vul- nerable to food insecurity because they are from low-income households. However, economic status alone does not predict “hunger” or food inse- curity. Adult participants may be vulnerable to food insecurity for another reason: functional impairments may limit their ability to obtain, store, and prepare enough food to meet their needs. Taken together, the population served by CACFP may be considered at higher risk for food insecurity and its associated outcomes than the general population. Potential Impact of CACFP on Client’s Food and Nutrient Intake Considering the U.S. population as a whole, CACFP makes a much greater contribution to the food and nutrient intakes of the nation’s chil- dren, especially its young children, than it does to its adults. The potential impact of CACFP on individuals in day care settings that participate in the program, whether children or adults, depends on the number of hours spent in day care and thus the amount of food they are served. The discussion below covers participation in day care and the potential contribution of calories from meals served during day care. Child Care Participation Overview The document America’s Children: Key National Indicators of Well-Being estimates that 36 percent of the U.S. child population ages 0–6 years are cared for in center-based programs that include child care centers,

OCR for page 25
40 CHILD AND ADULT CARE FOOD PROGRAM Head Start programs, publicly funded pre-kindergarten, and private child care (Federal Interagency Forum on Child and Family Statistics, 2009). As discussed in Chapter 1, family day care homes and traditional child care centers comprise the majority of CACFP providers (more than 93 percent). Preschool children, the largest age group in full-day care, were reported by the U.S. Census Bureau to spend about 32 hours per week in care of any type. According to the 2006 Survey of Income and Program Participation, the number of children younger than 5 years of age reported in all child care arrangements in the United States was about 12.7 million (U.S. Census Bureau, 2006). Ethnic and socioeconomic considerations Data from the U.S. Census Bu- reau indicate there are substantial ethnic and socioeconomic differences among children enrolled in different types of day care programs. Enrollment data from 2004 by racial and ethnic group showed that about 25 percent of black, Asian, and non-Hispanic white children of working mothers were enrolled in day care. By comparison, only 5 percent of children of Hispanic working mothers were enrolled in day care. Hispanic mothers were twice as likely as non-Hispanic white mothers to rely on relatives, including siblings, for care of their preschool children (19 vs. 7 percent, respectively; U.S. Census Bureau, 2006). Enrollment in day care programs is 10 percent greater for children from families with incomes above the federal poverty level than for children from families in poverty, whose children are more likely to be cared for by a sibling (U.S. Census Bureau, 2006). Meals in day care Child day care homes provided 497.5 million meals in fiscal year (FY) 2010 and child day care centers provided 1.1 billion meals during that same period (USDA/FNS, 2010h, Table 13a). The committee was unable to locate current program-wide data on average meals served to participants per unit of time by age group. To try to provide some per- spective, the very limited available information on CACFP’s contribution to children’s nutrition is summarized below. Analysis of survey data gathered in 1999 from parents or guardians of children served by CACFP family day care homes found that children in tier II homes would likely consume 50 percent of their daily energy requirements from the breakfast-lunch-one-snack-meal combination and two-thirds from the breakfast-lunch-two-snack-combination (USDA/ERS, 2002). Children in afterschool programs, who are typically in care for a mini- mum of 2 hours a day, generally receive only one snack—a small fraction of their daily food needs. These participants, however, may have been provided slightly more than half of their daily food needs through the SBP and the NSLP combined. Those children in the afterschool programs that

OCR for page 25
41 CHILD AND ADULT CARE FOOD PROGRAM are allowed to receive supper in addition to a snack would be expected to receive roughly one-third of their daily calorie requirements from CACFP. Adult Day Care Participation According to the National Adult Day Services Association, 3,500 adult day care facilities across the United States are caring for approximately 150,000 adults daily (Robert Wood Johnson Foundation, 2007). USDA surveys indicate that adult day care centers provided 56 million meals to participants in FY 2010 (USDA/FNS, 2010h, Table 15b). Based on the cur- rent CACFP meal pattern, adults in day care have the opportunity to meet approximately two-thirds of their calorie needs while attending adult day care centers that provide CACFP services. SUMMARY To contribute to the health of persons in day care, the Child and Adult Care Food Program subsidizes the cost of nutritious meals and snacks to participating independent day care centers and, through sponsoring organi- zations, to other centers and day care homes. More than 3 million children and adults are served through CACFP yearly. To receive reimbursement for the foods served, participating sites are required to provide meals and snacks that meet minimum requirements. The current requirements specify which meal components (fruit/vegetables, grains, meat/meat alternates, milk) must be included in the meals and snacks and the minimum amounts of each. Especially for the infants, children, and adults that are in day care for much of the day, CACFP provides a large majority of their daily food and nutrient intake and makes a major contribution to the food and nutrition safety net. REFERENCES Biros, M. H., P. L. Hoffman, and K. Resch. 2005. The prevalence and perceived health conse- quences of hunger in emergency department patient populations. Academic Emergency Medicine 12(4):310–317. Federal Interagency Forum on Child and Family Statistics. 2009. America’s Children: Key Na- tional Indicators of Well-Being, 2009. Washington, DC: U.S. Government Printing Office. http://www.childstats.gov/pdf/ac2009/ac_09.pdf (accessed September 28, 2010). HHS/USDA. 1995. Nutrition and Your Health: Dietary Guidelines for Americans. Wash- ington, DC: U.S. Government Printing Office. http://www.health.gov/DIETARYGUIDE LINES/dga95/default.htm (accessed December 16, 2010). HHS/USDA (U.S. Department of Health and Human Services/U.S. Department of Agriculture). 2005. Dietary Guidelines for Americans, 6th ed. Washington, DC: U.S. Government Printing Office. http://www.health.gov/DietaryGuidelines/dga2005/document/ (accessed July 23, 2008).

OCR for page 25
42 CHILD AND ADULT CARE FOOD PROGRAM Kirkpatrick, S. I., L. McIntyre, and M. L. Potestio. 2010. Child hunger and long-term adverse consequences for health. Archives of Pediatrics and Adolescent Medicine 164(8):754–762. Miller, E., K. M. Wieneke, J. M. Murphy, S. Desmond, A. Schiff, K. M. Canenguez, and R. E. Kleinman. 2008. Child and parental poor health among families at risk for hunger attending a community health center. Journal of Health Care for the Poor and Under- served 19(2):550–561. NRC (National Research Council). 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press. Robert Wood Johnson Foundation. 2007. National Adult Day Services Association Becomes Independent Organization, Expands Outreach through New Materials, Conferences and Member Hotline. http://www.rwjf.org/reports/grr/040623.htm (accessed August 11, 2010). Rose-Jacobs, R., M. M. Black, P. H. Casey, J. T. Cook, D. B. Cutts, M. Chilton, T. Heeren, S. M. Levenson, A. F. Meyers, and D. A. Frank. 2008. Household food insecurity: As- sociations with at-risk infant and toddler development. Pediatrics 121(1):65–72. Stuff, J. E., P. H. Casey, K. L. Szeto, J. M. Gossett, J. M. Robbins, P. M. Simpson, C. Connell, and M. L. Boglet. 2004. Household food insecurity is associated with adult health status. Journal of Nutrition 134(9):2330–2335. U.S. Census Bureau. 2006. Survey of Income and Program Participation. http://www.census. gov/sipp/index.html (accessed July 11, 2010). USDA/ERS (Economic Research Service). 2002. Households with Children in CACFP Child Care Homes—Effects of Meal Reimbursement Tiering: A Report to Congress on the Fam- ily Child Care Homes Legislative Changes Study. Washington, DC: USDA/ERS. http:// www.ers.usda.gov/publications/efan02002/efan02002.pdf (accessed October 11, 2010). USDA/ERS. 2009a. Food Insecurity in Households with Children: Prevalence, Severity, and House- hold Characteristics. Washington, DC: USDA/ERS. http://www.ers.usda.gov/publications/ eib56/eib56.pdf (accessed March 25, 2010). USDA/ERS. 2009b. Household Food Security in the United States, 2008. Washington, DC: USDA/ ERS. http://www.ers.usda.gov/publications/err83/err83.pdf (accessed September 27, 2010). USDA/FCS (Food and Consumer Service). 1997. Early Childhood and Child Care Study: Nutritional Assessment of the CACFP: Final Report, Volume 2. Alexandria, VA: USDA/ FCS. http://www.fns.usda.gov/ora/menu/Published/CNP/cnp-archive.htm (accessed July 9, 2010). USDA/FNS (Food and Nutrition Service). 1997. Child and Adult Care Food Program; Im- proved Targeting of Day Care Home Reimbursements. Federal Register 62(4):889–915. USDA/FNS. 2000. Building for the Future in the Child and Adult Care Food Program (CACFP). http://www.fns.usda.gov/cnd/care/publications/pdf/4Future.pdf (accessed June 29, 2010). USDA/FNS. 2009. Child and Adult Care Food Program: Building for the Future. PowerPoint presentation at the open session of the IOM committee on December 8, Washington, DC. USDA/FNS. 2010a. Child and Adult Care Food Program Meal Patterns. http://www.fns.usda. gov/cnd/care/Program Basics/Meals/Meal_Patterns.htm (accessed March 24, 2010). USDA/FNS. 2010b. Child and Adult Care Food Program. http://www.fns.usda.gov/cnd/care/ cacfp/aboutcacfp.htm (accessed July 9, 2010). USDA/FNS. 2010c. Child and Adult Care Food Program: At-Risk Afterschool Meals in Eli- gible State. Federal Register 75(62):16325–16325. USDA/FNS. 2010d. Child and Adult Care Food Program Legislative History. http://www. fns.usda.gov/cnd/Care/Regs-Policy/Legislation/history.htm (accessed March 24, 2010). USDA/FNS. 2010e. Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2010 Through June 30, 2011. Federal Register 75(137):41793–41795.

OCR for page 25
43 CHILD AND ADULT CARE FOOD PROGRAM USDA/FNS. 2010f. Food Distribution Program: Value of Donated Foods From July 1, 2010 Through June 30, 2011. Federal Register 75(137):41795. USDA/FNS. 2010g. Fresh Fruit and Vegetable Program. http://www.fns.usda.gov/cnd/FFVP/ FFVPdefault.htm (accessed March 24, 2010). USDA/FNS. 2010h. Program Information Report (Key Data) U.S. Summary, FY 2009–FY 2010. http://www.fns.usda.gov/fns/key_data/july-2010.pdf (accessed October 19, 2010).

OCR for page 25