Examining the Effectiveness of a Pilot Intervention to Increase Participation of License-Exempt Home-Based Childcare Providers in the Child and Adult Care Food Program

Background: The federal Child and Adult Care Food Program (CACFP) reimburses the costs of meals and snacks for eligible center- and home-based programs with the aim of supporting nutritional needs of low-income children in childcare settings. In Illinois, licensed-exempt home-based programs (Family, Friends, and Neighbor caregivers, FFN) are only eligible if they are dually enrolled in the childcare subsidy program. Prior research demonstrates that CACFP has financial benefits for center and licensed home-based providers and nutritional benefits for children in care. Yet, participation rates are low for eligible FFN providers – perhaps because of limited awareness of eligibility and burdensome program requirements. There is almost no existing research on CACFP in FFN settings. Drawing from an administrative burden theoretical framework that identifies knowledge, compliance, and psychological costs of program participation (Herd & Moynihan, 2018), this study evaluates the effectiveness of an intervention designed to enhance CACFP participation in FFN settings by reducing provider burden through intensive caseworker support. We ask whether providing enhanced supports improve CACFP program uptake and participation among subsidized FFN providers.

Methods: Through a partnership with a Cook County program that recruits FFN providers and administers CACFP, 103 FFN providers were randomized into treatment and control groups. The “enhanced process” (treatment) group (n=52) received additional caseworker support beyond “standard services” (control, n=51) to reduce administrative burdens related to uptake and participation. Data from administrative records were used to assess program effects related to uptake (completion of introductory caseworker visit; compliance with enrollment requirements) and participation (claim submission, submission errors). Intervention effects were assessed using tests of mean differences and proportions between standard and enhanced groups. Robustness tests were performed with covariate controls using OLS and logistic regression and by including and excluding ten participants with prior CACFP involvement.

Results: Differences between standard and enhanced groups were largely insignificant. Contrary to expectations, the standard group showed slightly better uptake (a greater percentage completed introductory visits and met enrollment requirements), although differences were statistically insignificant. The standard group was also more likely to successfully submit a claim, but they showed more errors than the enhanced group, leading to a greater proportion of their total claim deducted. Lower error rates in enhanced group may indicate benefits of caseworker support, although differences in errors and claim deductions across standard and enhanced groups were statistically insignificant.

Conclusions and Implications: Possible reasons that the enhanced intervention did not increase program uptake or participation of FFN providers in CACFP include unobserved implementation effects, ineffective enhancement services, failure to target key barriers to participation, and the small sample size of the pilot intervention. Follow-up interviews will investigate how participants viewed the administrative burdens of the program. Further research is needed to address the broader challenges facing FFN providers in participating effectively in CACFP, such as low reimbursement rates and administrative burdens. Without reform to federal requirements of CACFP participation to reduce administrative burden, investments in recruitment of the FFN sector may not be warranted given high costs of program administration.