{"title":"提高加利福尼亚州家庭托儿所提供者的儿童和成人护理食品计划报销率的影响","authors":"","doi":"10.1016/j.jneb.2024.05.074","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The federal Child and Adult Care Food Program (CACFP) serves over 4.2 million U.S. children. Participating family childcare homes (FCCH) receive tiered reimbursements (I/II) to serve healthy foods to children in households with low-income. CACFP participation can improve the quality and affordability of childcare. During the COVID-19 pandemic, federal waivers eliminated tiers and increased reimbursements. Tier-I/II rates were $4.78/$2.29 before July 2021, $5.67/$5.67 July 2021-2023 with the waiver, and $5.21/$2.72 after July 2023 post-waiver.</p></div><div><h3>Objective</h3><p>Assess the impact of pandemic-waiver and perceived impact of post-waiver CACFP reimbursement rates on FCCH financial viability and meal/snack nutritional quality in California FCCHs.</p></div><div><h3>Study Design, Settings, Participants</h3><p>From a random sample of all licensed FCCH in California on CACFP (n=1,000 per tier), n=261 tier-I and n=257 tier-II completed surveys in English (86%) or Spanish (14%) in May-September 2023, and a subset (n=30) were interviewed.</p></div><div><h3>Measurable Outcome/Analysis</h3><p>Binary and Likert-scale responses for benefits of pandemic reimbursement rates and perceived impact upon return to tiers in July 2023 were analyzed, comparing tier results after adjusting for potential confounders using linear and logistic regression. Qualitative data were coded into themes using immersion-crystallization.</p></div><div><h3>Results</h3><p>More tier-II than tier-I FCCH reported the increased pandemic rates resulted in lower out-of-pocket food costs (65% vs 54%, p<0.5), allowed for increased food variety (62% vs 47%, p<0.001), improved food quality (62% vs 47%, p<0.01), and facilitated CACFP best practices for serving lean proteins (p<0.05) and limiting processed meats (p<0.05). FCCH expected decreased food variety (71% somewhat or extremely likely) and increased childcare charges to families (70%), post-waiver. Interviews indicated CACFP ensures nutritious meals/snacks, but inflation impacts costs, and FCCH advocate for increased federal reimbursements and the elimination of tiering.</p></div><div><h3>Conclusions</h3><p>CACFP pandemic reimbursement rates improved FCCH financial viability and meal quality. Post-waiver return to tiers and lower rates may result in decreased food variety and increased childcare charges for families, highlighting the need for sustained support to ensure quality and affordable childcare for households with low-income.</p></div><div><h3>Funding</h3><p>Robert Wood Johnson Foundation</p></div>","PeriodicalId":50107,"journal":{"name":"Journal of Nutrition Education and Behavior","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Increased Child and Adult Care Food Program Reimbursement Rates for Family Child Care Home Providers in California\",\"authors\":\"\",\"doi\":\"10.1016/j.jneb.2024.05.074\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The federal Child and Adult Care Food Program (CACFP) serves over 4.2 million U.S. children. Participating family childcare homes (FCCH) receive tiered reimbursements (I/II) to serve healthy foods to children in households with low-income. CACFP participation can improve the quality and affordability of childcare. During the COVID-19 pandemic, federal waivers eliminated tiers and increased reimbursements. Tier-I/II rates were $4.78/$2.29 before July 2021, $5.67/$5.67 July 2021-2023 with the waiver, and $5.21/$2.72 after July 2023 post-waiver.</p></div><div><h3>Objective</h3><p>Assess the impact of pandemic-waiver and perceived impact of post-waiver CACFP reimbursement rates on FCCH financial viability and meal/snack nutritional quality in California FCCHs.</p></div><div><h3>Study Design, Settings, Participants</h3><p>From a random sample of all licensed FCCH in California on CACFP (n=1,000 per tier), n=261 tier-I and n=257 tier-II completed surveys in English (86%) or Spanish (14%) in May-September 2023, and a subset (n=30) were interviewed.</p></div><div><h3>Measurable Outcome/Analysis</h3><p>Binary and Likert-scale responses for benefits of pandemic reimbursement rates and perceived impact upon return to tiers in July 2023 were analyzed, comparing tier results after adjusting for potential confounders using linear and logistic regression. Qualitative data were coded into themes using immersion-crystallization.</p></div><div><h3>Results</h3><p>More tier-II than tier-I FCCH reported the increased pandemic rates resulted in lower out-of-pocket food costs (65% vs 54%, p<0.5), allowed for increased food variety (62% vs 47%, p<0.001), improved food quality (62% vs 47%, p<0.01), and facilitated CACFP best practices for serving lean proteins (p<0.05) and limiting processed meats (p<0.05). FCCH expected decreased food variety (71% somewhat or extremely likely) and increased childcare charges to families (70%), post-waiver. Interviews indicated CACFP ensures nutritious meals/snacks, but inflation impacts costs, and FCCH advocate for increased federal reimbursements and the elimination of tiering.</p></div><div><h3>Conclusions</h3><p>CACFP pandemic reimbursement rates improved FCCH financial viability and meal quality. Post-waiver return to tiers and lower rates may result in decreased food variety and increased childcare charges for families, highlighting the need for sustained support to ensure quality and affordable childcare for households with low-income.</p></div><div><h3>Funding</h3><p>Robert Wood Johnson Foundation</p></div>\",\"PeriodicalId\":50107,\"journal\":{\"name\":\"Journal of Nutrition Education and Behavior\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Nutrition Education and Behavior\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S149940462400174X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"EDUCATION, SCIENTIFIC DISCIPLINES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Nutrition Education and Behavior","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S149940462400174X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
Impact of Increased Child and Adult Care Food Program Reimbursement Rates for Family Child Care Home Providers in California
Background
The federal Child and Adult Care Food Program (CACFP) serves over 4.2 million U.S. children. Participating family childcare homes (FCCH) receive tiered reimbursements (I/II) to serve healthy foods to children in households with low-income. CACFP participation can improve the quality and affordability of childcare. During the COVID-19 pandemic, federal waivers eliminated tiers and increased reimbursements. Tier-I/II rates were $4.78/$2.29 before July 2021, $5.67/$5.67 July 2021-2023 with the waiver, and $5.21/$2.72 after July 2023 post-waiver.
Objective
Assess the impact of pandemic-waiver and perceived impact of post-waiver CACFP reimbursement rates on FCCH financial viability and meal/snack nutritional quality in California FCCHs.
Study Design, Settings, Participants
From a random sample of all licensed FCCH in California on CACFP (n=1,000 per tier), n=261 tier-I and n=257 tier-II completed surveys in English (86%) or Spanish (14%) in May-September 2023, and a subset (n=30) were interviewed.
Measurable Outcome/Analysis
Binary and Likert-scale responses for benefits of pandemic reimbursement rates and perceived impact upon return to tiers in July 2023 were analyzed, comparing tier results after adjusting for potential confounders using linear and logistic regression. Qualitative data were coded into themes using immersion-crystallization.
Results
More tier-II than tier-I FCCH reported the increased pandemic rates resulted in lower out-of-pocket food costs (65% vs 54%, p<0.5), allowed for increased food variety (62% vs 47%, p<0.001), improved food quality (62% vs 47%, p<0.01), and facilitated CACFP best practices for serving lean proteins (p<0.05) and limiting processed meats (p<0.05). FCCH expected decreased food variety (71% somewhat or extremely likely) and increased childcare charges to families (70%), post-waiver. Interviews indicated CACFP ensures nutritious meals/snacks, but inflation impacts costs, and FCCH advocate for increased federal reimbursements and the elimination of tiering.
Conclusions
CACFP pandemic reimbursement rates improved FCCH financial viability and meal quality. Post-waiver return to tiers and lower rates may result in decreased food variety and increased childcare charges for families, highlighting the need for sustained support to ensure quality and affordable childcare for households with low-income.
期刊介绍:
The Journal of Nutrition Education and Behavior (JNEB), the official journal of the Society for Nutrition Education and Behavior, is a refereed, scientific periodical that serves as a global resource for all professionals with an interest in nutrition education; nutrition and physical activity behavior theories and intervention outcomes; complementary and alternative medicine related to nutrition behaviors; food environment; food, nutrition, and physical activity communication strategies including technology; nutrition-related economics; food safety education; and scholarship of learning related to these areas.
The purpose of JNEB is to document and disseminate original research and emerging issues and practices relevant to these areas worldwide. The Journal of Nutrition Education and Behavior welcomes evidence-based manuscripts that provide new insights and useful findings related to nutrition education research, practice and policy. The content areas of JNEB reflect the diverse interests in nutrition and physical activity related to public health, nutritional sciences, education, behavioral economics, family and consumer sciences, and eHealth, including the interests of community-based nutrition-practitioners. As the Society''s official journal, JNEB also includes policy statements, issue perspectives, position papers, and member communications.