Detailed Information on the
Food and Nutrition Service - Child and Adult Care Food Program Assessment

Develop new long-term measures to assess the nutrient content of meals; piloting a process to collect annual data on compliance with meal pattern requirements.

Continue a management improvement initiative, including new regulations, training, and technical assistance for program sponsors, to address identified weaknesses in program management

Collect annual data on the accuracy of reimbursement rate determinations in family day care homes to determine the program's efficiency in ensuring payments are made properly.

Measure: Percentage of eligible children enrolled in CACFP

Explanation:CACFP's specific purpose is to enable licensed non-residential child and adult care facilities to integrate a non-profit nutritious food service for enrolled participants into their programming. Increasing enrollment in the program improve access to nutritious food for the children who participate, reducing the risk of food insecurity and promoting better diets for these children. This measure tracks the proportion of eligible children up to age 18 receiving CACFP meals. While many participating day-care homes and child care centers focus on serving pre-school children, the program also has an outside-of-school-hours component that reimburses after-school care providers for snacks and suppers provided to low-income school-aged children. Because many of these children do not participate in such care programs, there is a low overall proportion of eligibles served (<5 percent). However, this measure is a useful indicator of change over time in our success in expanding access to the program. USDA has targeted increases of roughly 1.5% annually in the proportion of children served in CACFP. This level reflects expansion by this amount beyond the expected participation growth that results from increases in the eligible population

Measure: Average number of children served by CACFP per day

Explanation:Targets for the number of children to be served annually in CACFP, measured as average daily attendance for March of that year, are based on projected needs estimated for the budget process. The measure makes a concrete link between the budget request and the level of service that is intended to support.. The targets are intended to reflect the outcome of efforts to encourage and support access to CACFP. CACFP is designed to reduce the risk of food insecurity and improve the diets of participating children

Measure: % of CACFP meals served to low-income children or through low-income providers

Explanation:Proportion of meals served to children who were certified as low income or who were cared for in day care homes which were operated in low income areas or by low income providers (i.e., provided to free or at reduced price eligible children in child care centers and Tier II family day care homes, and all those provided in Tier I family day care homes.)

Measure: % of licensed child care providers participating in CACFP

Explanation:Licensed child-care providers are a primary venue through which CACFP is operated. Increasing the proportion of licensed child-care providers that participate in the program expands access to the program for children who receive care from such providers. A steady increase in the proportion of licensed child care providers participating in CACFP is considered to be an important strategy toward improving program access. Success is measured through this metric.

Measure: % of CACFP sponsors making payments accurately

Explanation:The baseline for this measure is derived from a 1999 USDA Inspector General audit of CACFP providers that found significant problems in payment accuracy among CACFP sponsors While program sites (child care centers and family day-care homes) provide the nutrition service, sponsors are organizations that manage the operation of these sites, and keep records and submit claims for reimbursement from the State agencies that administer program funding. While it does not directly measure reductions in erroneous payments in CACFP, it represents an important indicator of the proportion of program operators at risk of making such errors. An increase in the measure reflects reduction in that risk. FNS is targeting ambitious increases in the proportion of CACFP sponsors making payments accurately in line with its aggressive ongoing regulatory, training, and technical assistance activities designed to improve performance in this area.

Measure: % of CACFP sponsors without major administrative problems

Explanation:The baseline for this measure is derived from a 1999 USDA Inspector General audit of CACFP providers that found significant problems in payment accuracy among CACFP sponsors While program sites (child care centers and family day-care homes) provide the nutrition service, sponsors are organizations that manage the operation of these sites, and keep records and submit claims for reimbursement from the State agencies that administer program funding. Examples of major administrative problems found in the audit include failure to maintain adequate financial and operational records, submission of false information to a State agency, a history of administrative or financial mismanagement, and failure to monitor and train child care providers that they sponsor. While it does not directly measure reductions in erroneous payments in CACFP, it represents an important indicator of the proportion of program operators at risk of making such errors. An increase in the measure reflects reduction in that risk. FNS is targeting ambitious increases in the proportion of CACFP sponsors without major administrative problems in line with its aggressive ongoing regulatory, training, and technical assistance activities designed to improve performance in this area.

Is the program purpose clear?

Explanation: Purpose is to provide assistance to States to initiate, maintain, and expand nonprofit food service programs for children and adult participants in nonresidential institutions which provide care, to enable such institutions to integrate a nutritious food service with organized care services for enrolled participants.

Evidence: National School Lunch Act, CACFP program regulations

Does the program address a specific and existing problem, interest, or need?

Explanation: The program fosters improved nutrition through provision of reimbursement for nutritionally balanced, age appropriate meals served to children and adults. A higher level of reimbursement is provided for low income children and adults or children who are in care in facilities which are located in low income areas.

Evidence: CACFP program regulations

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: The program is the only mechanism for providing a subsidy for meals served to children and adults in nonresidential care facilities, in particular for facilities which serve low-income children. It complements the nation's efforts to ensure best health and developmental outcomes for children in early childhood programs. USDA sets national standards consistent with dietary guidelines and ensures that meals meet basic nutritional requirements.

Evidence: CACFP program regulations

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: The program is designed to provide access to nutritious meals, in particular to low income children, while minimizing barriers and administrative costs. The agency is conducting a series of assessments to evaluate the effectiveness of recent changes in regulations and guidance affecting program integrity in the Family Home Day Care segment of the program; initial results show that sponsors are generally operating the program in accordance with the new program requirements.

Evidence: National School Lunch Act, CACFP program regulations

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: CACFP reimburses meals served in child and adult day care centers and homes. Funds are targeted to lower-income children by providing higher reimbursements for meals served to low-income children in centers, and for meals served in homes located in low income areas or operated by low income providers. 45 percent of reimbursements in 1999 were for meals served to low-income children compared to 21 percent in 1995, reflecting changes made in 1996 to better target funds. The tiering policy effectively targets low-income children; about 95 percent of low-income children in homes have their meals reimbursed at the higher rate. However, it is less effective in ensuring that children with incomes above 185 percent of poverty are subsidized at lower rates -- 58 percent of higher income children are subsidized at the higher level. This reflects decisions enacted in 1996 to mitigate administrative burden for some providers by replacing individual means-testing with a geographically-based mechanism. Mechanisms to reduce the number of higher income children receiving tier 1 subsidies would significantly increase administrative burden, reduced the number of participating institutions and disadvantaged low-income program providers.

Evidence: Program administrative data, CACFP program regulations

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: Program partners are generally not asked to report information that supports assessment of outcome goals, except on a periodic basis for studies or surveys. Program goals are clear and all partners work toward them although many are not aware of specific measures.

Evidence:  

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: Independent evaluations on the CACFP tend to be descriptive in nature, focusing on the characteristics of participating institutions, providers, and the children or adults they serve, as well as the nutritional profile of meals offered. Other studies are conducted as needed to evaluate the effectiveness of new regulations or initiatives designed to address specific program issues. The Agency is planning to conduct periodic studies, as resources are available, to assess progress in increasing the consistency of CACFP meals with specific nutrient targets, based on the Dietary Guidelines for Americans. PART guidance requires that plans be in place to conduct comprehensive evaluations at specified intervals. USDAs available evaluation resources are insufficient to make such a plan realistic for CACFP.

Evidence: The Early Childhood and Child Care Study (1997) collected data in 1995 from a nationally representative sample of sponsoring agencies, participating child care sites, and children. Nutrient content of meals and snacks offered and consumed were compared with several nutrient standards. A congressionally mandated study (2001) examined the effects of a new reimbursement structure designed to increase the number of low-income children served in family child care homes. Beginning in 2004, FNS initiated the Child Care Assessment Project, designed to measure the effectiveness of Agency efforts to improve the integrity of CACFP family day care homes. FNS will initiate a study in 2005 to review the proper classification of family day care homes for Tier 1 or Tier 2 program reimbursement.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: Program budget requests routinely estimate the effect of legislation, policy changes, and program participation trends on program costs. Budget requests are tied to the performance goals of the USDA Strategic Plan, as reflected in the Summary of Budget and Performance budget exhibit.

Evidence: FNS FY 2005 and FY 2006 budget submissions. USDA Strategic Goal 4: Improve the Nation's Nutrition and Health, from the Strategic Plan for FY 2002-2007, and its related Objectives (4.1: Improve Access to Nutritious Food, and 4.2: Promote Healthier Eating Habits and Lifestyles) apply to CACFP, as well as all other USDA nutrition assistance programs. (See USDA Strategic Plan 2002-2007, pp. 18-20.)

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: FNS is developing improved long-term measures, and planning supporting evaluation and assessment work, to assess the nutrient content of CACFP meals. In conjunction with a study on CACFP meal nutrient content, USDA will develop and pilot test in one FNS region a process to collect annual data on compliance with meal pattern requirements. This could be used to collect a national sample of meal pattern compliance data, if the study indicates ongoing monitoring is necessary to improve performance.

Evidence: FNS Strategic Plan 2000-2005, pp. 10, 12.

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: CACFP is one of 15 Federal nutrition assistance programs that are designed to work together to reduce hunger and improve diet quality for the children and low-income people that they serve. For this reason, USDA has established measures of the prevalence of food insecurity with hunger, and dietary quality as reflected by USDAs Healthy Eating Index, for children and low-income people. CACFPs specific purpose is to enable licensed non-residential child and adult care facilities to integrate a non-profit nutritious food service for enrolled participants into their programming. The proportion of eligible participants receiving such services  in particular, eligible children, as day care homes and child care centers are the focus of program operations  thus represents a clear, easily understood, measurable outcome of CACFP operations. The relationship between this program outcome and population-wide hunger prevalence and dietary quality cannot be quantified, because of the conceptual difficulty of attributing changes in these complex metrics to specific influences. However, the provision of meals required to meet food-based standards that promote healthy diets logically contributes to reducing the risk of hunger and promoting good diet quality among those served, and thus tends to reduce the overall prevalence of hunger and improve diet quality among program eligibles over the long-term. Consistency of meals with food component requirements and current nutrition guidance is assessed through periodic evaluation work. Because of its responsibility to ensure effective stewardship of Federal funds USDA also considers accurate program payments an important outcome of program operations. The agency has sought funding from Congress to develop a methodology to measure erroneous payments, but has thus far been unsuccessful. In the meantime, USDA uses findings from a Inspector General audit of CACFP as baseline data to target an aggressive program improvement effort, and is collecting data through oversight reviews to measure progress in improving payment accuracy.

Evidence: USDA Strategic Plan 2005-2010; internal planning documents.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: USDA has set ambitious quantitative targets reflecting appropriate program growth over the long-term to support the Agencys cross-cutting nutrition assistance programs outcomes. USDA is seeking to make all CACFP meals consistent with the current Dietary Guidelines for Americans, and continues to gear its program review and technical assistance work to this goal as an important aspect of program management. The most recent available evaluation work, though dated, found that the great majority of CACFP meals conform to meal pattern requirements, and that the nutrient content of CACFP meals compare favorably in many respects to school meals. When this evaluation work is updated, USDA plans to assess the need to support its general long-term nutrition goal with specific nutrient targets. As noted in the response to Question 2.1, USDA uses findings from a Inspector General audit of CACFP as baseline data to target an aggressive program improvement effort, including regulatory changes, training and technical assistance for program operators and sponsors, and increased Federal oversight.

Evidence: Internal planning documents; technical assistance materials to support CACFP providers in improving meals -- Child Care Nutrition Resource System (web-based system), Menu Magic for Children, Making Nutrition Count for Children, Feeding Infants - A Guide for Use in the Child Nutrition Programs, Food Buying Guide for Child Nutrition Programs, Building Blocks for Fun and Healthy Meals menu planner, Keeping Kids Safe - A Guide for Safe Food Handling & Sanitation for Child Care Providers; USDA-Food and Consumer Service, "Early Childhood and Child Care Study: Summary of Findings," 1997; USDA Office of Inspector General, Audit Report No. 27601-7-SF, Presidential Initiative: Operation Kiddie Care ( pp. 91-101 describe CACFP management corrective actions completed or underway)

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: FNS uses five annual performance metrics that link to its long term measures, consistent with the logic of the program: 1) number of children served in CACFP; 2) % meals served to low-income children or through low-income providers; 3) % licensed child care providers in CACFP; 4) % sponsors making payments accurately; and 5) % sponsors without major administrative problems. These discrete, quantifiable, and measurable metrics that are at once logically linked to long-term goals, and focused on common-sense outcomes of program operations  serving the appropriate number of children with budgeted funds, reaching a high proportion of child-care facilities, and targeting low-income children. The stewardship measures, while process-oriented, are also critical to Federal management responsibilities. USDA is also pilot-testing a methodology to collect annual data on the compliance of CACFP meals with program standards. If updated evaluation work on the nutrient content of meals indicates significant problems in this area, USDA will deploy this data collection method in a sample of child care homes and centers across the country.

Evidence: Internal planning documents.

Does the program have baselines and ambitious targets for its annual measures?

Explanation: FNS has set ambitious but reasonable targets for each of its annual CACFP performance measures: * Targets for the number of children to be served annually in CACFP are based on projected needs estimated for the budget process. They will thus reflect a measure of concrete program results linked to the budget request, and the outcome of efforts to encourage and support access to CACFP. * The agency will target modest incremental increases in the proportion of CACFP meals served to low-income children or through low-income providers in support of the goal to focus program benefits on children in greatest need. * The agency will also seek a steady increase in the proportion of licensed child care providers participating in CACFP as an important strategy to improve program access. * FNS is targeting ambitious increases in the proportion of CACFP sponsors making payments accurately, and in the proportion of CACFP sponsors without major administrative problems, reflecting its significant ongoing regulatory, training, and technical assistance activities designed to improve performance in these areas.

Evidence: Internal planning documents.

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: Payments to subgrantees are based on actual performance, delivery of meals. Beyond this, State agencies are overseen through Federal reviews. Program sponsors are reviewed on a regular schedule by State agencies, and through the Federal Child Care Assessment Project, which entails Federal review of a national sample of sponsors to determine operational compliance with program standards. Program operators are reviewed on a regular schedule by State agencies. FNS has an internal operational planning system that includes performance expectations for specific work functions, including the Agency efforts in operating and overseeing CACFP and other Child Nutrition Programs. Agency managers are held responsible for completing CACFP management evaluations to assess and promote compliance with program standards, ensuring that CACFP data reporting is timely, complete, and as accurate as possible, and other work functions that support program and Agency goals. Identified program deficiencies must be addressed through corrective action and payments may be withheld if deficiencies are not corrected.

Evidence: CACFP regulations; internal Agency documents and records.

Are funds (Federal and partners') obligated in a timely manner and spent for the intended purpose?

Explanation: Funds are obligated consistently with the overall program plan. FNS Regional Offices monitor State draw downs from the Treasury. CACFP funds are obligated appropriately and consistently for their intended purpose and within a timely manner and schedule. FNS uses information from periodic Management Evaluations (ME) to confirm that funds are being spent for their intended purposes. In FY 2004, FNS conducted MEs in seven State agencies administering CACFP and is currently analyzing the results of these evaluations. FNS also recently conducted Child Care Assessment Project reviews in each of its region offices to measure the effectiveness of improved regulations and guidance. FNS continues to develop regulations and guidance to address management weaknesses identified by Federal and State reviews and OIG audits.

Evidence: FNS FY 2006 budget submission to OMB. OIG Report 27600-6-At. Federal Register, Vol. 69, No. 169.

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: USDA is collecting annual data on the percentage of sponsor reimbursement rate determinations in CACFP-participating family day care homes made accurately, as a measure of the program's efficiency in targeting benefits appropriately. Improvement in this metric, which will be tracked annually, will reflect a high proportion of program payments reaching intended beneficiaries; to the extent that the errors identified and corrected reflect payments in excess of those permitted by regulations, improvement will lower unit costs of providing benefits. The Agency is also seeking funding to develop a methodology to measure CACFP payment errors. Sub-grantees are required to use applicable competitive sourcing in program procurements. The agency works with State agency program partners to identify, develop, and provide funding where available for IT improvements to increase program efficiency. At the local level, some family day care home program operators are implementing scanning or computer based meal reporting to improve claiming accuracy. Sponsor administrative reimbursements reward efficient administration and innovation.

Evidence: CACFP regulations

Does the program collaborate and coordinate effectively with related programs?

Explanation: The program is designed to operate within existing child care facilities (day care centers, family day care homes) in order to support quality care. Program rules give child care operators flexibility in providing meals consistent with meal patterns and quality/nutrition standards. The Program is credited by many as improving the quality of child care by encouraging licensing. The Program uses faith-based organizations effectively in its delivery.

Evidence: CACFP regulations

Does the program use strong financial management practices?

Explanation: FNS is collecting annual data on the accuracy of sponsor reimbursement rate determinations by participating family day care homes to determine the programs efficiency in targeting benefits. At this time there is no reliable estimate of the level of improper payments in the program, however, funding is requested in the PB to measure payment errors. Financial policies are articulated in Program directives, regulations, and OMB Circulars. FNS administers the CACFP through grants to State agencies. Independent centers and sponsoring organizations enter into agreements with State agencies to assume the administrative and financial responsibilities for local CACFP operations. CACFP institutions are reimbursed for meals served to eligible participants. In response to USDA OIG audits, FNS published a series of Integrity Rules on 9/1/2004 to improve program administrative and financial operations and monitoring.

Evidence: The Food and Nutrition Service which administers this program received an unqualified opinion in its financial statements audit in FYs 1998 through 2000. The Agency has had no reportable conditions in the Departments consolidated financial statements audit in FYs 2001-2004.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: FNS has undertaken a management improvement initiative, including new regulations, training, and technical assistance for CACFP sponsors, to address identified weaknesses in program management. As noted above,a detailed assessment of the program is underway, and initial results show that sponsors are generally operating the program in accordance with the new program requirements.

Evidence: CACFP regulations; description of Child Care Assessment Project (CCAP); Question 1.4.

Does the program have oversight practices that provide sufficient knowledge of grantee activities?

Explanation: Grantee (State agency) activities are assessed biennally through a structured management evaluation process. Sub-grantees (independent and sponsored centers, family day care home sponsors) are reviewed by State agencies on a 2 to 3 year rotation under review requirements established by FNS regulations. However, information is not available for Federal level oversight.

Evidence: CACFP regulations

Does the program collect grantee performance data on an annual basis and make it available to the public in a transparent and meaningful manner?

Explanation: Because reimbursements are driven by meals served, FNS has detailed performance data on participation, meals served, and funds disbursed and this data is available by State by year on the FNS website.

Evidence: FNS Keydata reports

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation:

Evidence:

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: A high proportion of the children reached by the program are low-income children. The percent of total meals served to low-income children is higher in CACFP than is found in the National School Lunch Program. The full complement of meals and snacks offered by most CACFP providers are well-balanced, supplying more than one-half of the RDA for calories and substantially more than two-thirds of the RDA for key nutrients.

Evidence: CSFP Administrative Data; Effects of CACFP Reimbursement Tiering: Major Findings of the Family Child Care Home Legislative Changes Study (2002); Early Childhood and Child Care Study (1997)

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: Analysis of the nutrient profile of CACFP meals found that nearly nine out of ten menus complied with all meal pattern requirements and provided children with healthy, well-balanced meals. With the exception of calories and iron, children in part-day care consume more than one-half of the RDA for other nutrients from CACFP meals and snacks and children in full-day care consume more than two-thirds of the RDA. The mandated evaluation of the effects of tiering found that the legislative change achieved the desired objectives: the number of low-income children served between 1995 and 1999, and the number of meal reimbursements going to low-income children doubled (Hamilton et al., 2001). Moreover, tiering had no adverse effect on either the number or nutritional characteristics of meals offered by Tier II providers. The Agency is planning to conduct periodic studies, as resources are available, to assess progress in increasing the consistency of CACFP meals with specific nutrient targets, based on the Dietary Guidelines for Americans.

Evidence: CSFP Administrative Data; Effects of CACFP Reimbursement Tiering: Major Findings of the Family Child Care Home Legislative Changes Study (2002); Early Childhood and Child Care Study (1997)

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: The latest data indicates that the proportion of eligible children participating in CACFP has increased from 3.9% in 1999 to 4.5% in 2004. Current data is not available on the proportion of CACFP meals consistent with meal pattern requirements. The Agency is planning to conduct periodic studies, as resources are available, to assess progress in increasing the consistency of CACFP meals with the Dietary Guidelines for Americans. Cross-Cutting Measures: Reductions in the rate of food insecurity with hunger were somewhat ahead of target through 2000. Rising unemployment and increased poverty have contributed to an increase in the rate of food insecurity with hunger in subsequent years. There was a small improvement in the HEI between 1996 and 1999-2000.

Evidence: USDA-FNS National Data Bank; Census Bureau population estimates

Does the program (including program partners) achieve its annual performance goals?

Explanation: The most recent data on the CACFP annual performance metrics shows that: * The number of children served in CACFP (measured in March of each year) increased by roughly 30,000 between 2004 and 2005 to reach 3.27 million children per day. * The proportion of CACFP meals served to low-income children or through low-income providers increased from 74.1% in 2003 to 74.6% in 2004 and 2005, representing an improvement in program targeting but falling slightly short of the FY 2005 goal. * The proportion of licensed child care providers in CACFP increased from 49% to 50% between 2003 and 2004. * 2004 data is not yet available on the proportion of sponsors making payments accurately; we expect to have this data ready in mid FY 2006. * 2004 data is not yet available on the proportion of sponsors without major administrative problems; we expect to have this data ready in mid FY 2006.

Evidence: State reported data (in USDA-FNS National Data Bank); study of CACFP tiering accuracy; CCAP reviews

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: 2004 data is not yet available on the proportion of sponsors making payments accurately; we expect to have this data ready in mid FY 2006. Improvements in this rate increase program efficiency by reducing the average reimbursement per meal served made in error.

Evidence: Study of CACFP tiering accuracy (FNS, pending)