Efforts to prevent childhood obesity have included investing in the settings where children spend much of their time, like early care and education (ECE), schools, and school-aged child care and after-school programs.

The Coronavirus Disease 2019 (COVID-19) pandemic has devastated the ECE system in the United States. The COVID-19 response and recovery efforts in the ECE space are likely to have both short-term and long-term impacts on behavioral, household, societal, and economic influences on population health and well-being, including weight status. In 2020, NCCOR formed a workgroup to begin to understand, the impact of the COVID-19 pandemic and legislation on child care systems and, further downstream, on child well-being.

What is the CARES Act?

The Coronavirus Aid, Relief, and Economic Security Act (CARES), included $3.5 billion in emergency funds for the Child Care and Development Block Grant and $750 million for Head Start programs. CARES also issued guidance that allowed states more flexibility in meeting Child Care and Development Fund (CCDF) requirements to mitigate the effects of COVID-19.1,2

What is the American Rescue Plan?

The American Rescue Plan (ARP), provided $39 billion for the child care industry, including $24 billion for a child care stabilization fund and $15 billion for the CCDF. 3

NCCOR worked with the Gretchen Swanson Center for Nutrition (GSCN) to conduct key informant interviews to explore how the Coronavirus Aid, Relief, and Economic Security Act (CARES) and American Rescue Plan (ARP) investments may affect the ECE landscape and ECE facilities, including how it will impact children aged 0-13 years, the ages designated in the legislation.

GSCN interviewed 17 key informants working in the ECE space who identified as researchers, practitioners, and federal representatives. Interviews covered interviewee expertise and work in childhood nutrition and physical activity, impact of COVID-19 on ECE, after-school, and summer programs, emerging strategies and adjustments during COVID-19, future programmatic, policy, and research needs to facilitate recovery, and strategic implementation of recovery efforts.

Key informants identified the following among impacts of the COVID-19 pandemic on ECE settings: high levels of stress for program staff; increased food insecurity among children, families and ECE staff; greater attention to existing structural inequality within ECE workforce; reduced physical activity and decreased nutritional quality of foods served. The report also identified potential investments to prioritize in child care programming, research, and evaluation.The Coronavirus Aid, Relief, and Economic Security Act (CARES), included $3.5 billion in emergency funds for the Child Care and Development Block Grant and $750 million for Head Start programs. CARES also issued guidance that allowed states more flexibility in meeting Child Care and Development Fund (CCDF) requirements to mitigate the effects of COVID-19.1,2

What can be done or potential solutions and considerations for recovery funds?

For Researchers
  • Evaluate increasing salary and benefits of ECE staff and impact on staff health and wellness.
  • Pilot and evaluate a child care version of USDA’s Fresh Fruit and Vegetable Program (FFVP), that provides free fruit and vegetable snacks.
  • Assess how the COVID-19 recovery funds impact the diet quality and food security of ECE participants.
  • Pilot and evaluate the incorporation of an additional CACFP snack, with an emphasis on a fresh fruit or vegetable snack.
  • Conduct a study among non-CACFP participating ECE programs on barriers to participating in CACFP.
  • Conduct impact assessments and pilot studies on the recovery of ECE and after-school settings focused on issues such as food insecurity and health and wellness, with an emphasis on assessing diet and physical activity behaviors in children and continued ways in which to promote these important behaviors during challenging times.
  • Evaluate if there was equitable funding allocation, and how under-resourced communities utilized the recovery funds, as well as the potential impacts of these funds on health equity.
  • Create a data surveillance system that assesses health equity in ECE settings.
  • Establish and evaluate a community information exchange ecosystem with the goal to decrease burden on families by allowing care coordination and data sharing between social service agencies.
For Federal Agencies
  • Identify the most salient research priorities focused on evaluating COVID-19 recovery efforts in ECE and after-school settings and disseminate these opportunities out to relevant groups (e.g., researchers, evaluators, practitioners, and affected populations such as ECE programs and community partners.)
  • Foster collaboration among these groups by initiating and/or facilitating conversations to identify alignment, capacity, etc. For example, NCCOR could host or support forums, or create guidance to help ensure that the community voices are elevated.
  • Release rapid/time-sensitive research funding opportunity announcements modeled after the Time Sensitive Obesity Policy and Program Evaluation R01, or other similar mechanisms focused on food insecurity and early childhood obesity.
For Early Care and Education Administrators
  • Implement emerging safety strategies: smaller student to teacher ratios, masking, and social distancing.
  • Consider continuation of emerging meal provision strategies to help food insecure families: grab-and-go meals, meal kits, backpack programs, onsite food pantries, and meal transportation.
  • Focus on reestablishing family style dining, taste testing, new recipe development, and creative strategies to reintroduce fruits and vegetables for children returning to child care.
  • Provide physical and mental health and wellness support for staff.
  • Provide resources and training for staff on youth mental health and transitioning families back to child care.
  • Increase staff salaries and strengthen workplace benefits .
  • Use recovery funds to make long-term changes. Examples of sustainable investments related to nutrition and physical activity could include:
    • School gardens
    • Nature tails
    • Food service equipment
    • Nutrition and physical activity training for staff
For State Policy Makers
  • Leverage federal flexibilities to ensure revenue continues to flow to the center: CAFP waivers for targeted meal patterns, nutritional requirements, monitoring requirements, and increased reimbursement rates.
  • Provide physical activity training opportunities to empower ECE providers to be healthy role models.
  • Reexamine licensing requirements in after-school settings by state, which could positively impact physical activity-related policies and practices.
  • Leverage the Child Nutrition Reauthorization (CNR) to increase meal reimbursements for CACFP, especially in family child care settings for more permanent sustainable changes.
  • Maximize increased interest of state and local partners eager to help address structural issues of ECE programs.
  • Provide ECE programs with training and assistance in business operations, with focus on financial stability.
  • For after-school settings, reevaluate training requirements since needs will differ compared to ECE.
  • Increase coordination among federal and state representatives to advocate for sufficient and sustainable funding for ECE programs.
  • Ensure technical assistance and guidance is made available to ECE programs and families impacted the most.
  • Invest in local municipalities and community organizations (e.g. YMCA, parks and recreation departments) to support people who are disproportionately impacted.
  • Conduct equity assessment to help guide spending decisions.
  • Conduct strategic planning and targeted outreach to bring low-income and ethnic minority community members into conversations with local and state officials within their communities.
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