In recent years US federal, state, and local governments have been increasing focus on developing and refining policies to improve the nutritional health of young children enrolled in child care. Yet little attention has been devoted to understanding the complex ways in which regulatory structures already affect child care food practices. In Washington State policy makers, public health agencies, child care professionals, and other stakeholders are driving discussions about how early childhood care and education (ECE) providers are experiencing and implementing a complicated array of nutritional policies. With Chad P. Hall, we designed the information graphic above to map the layers of federal, state, and local nutrition-related policies that Washington State child care providers must navigate.
Understanding the Problem
Young children establish many dietary behaviors before they reach kindergarten, with taste preferences largely formed by age five. In a report titled Who’s Minding the Kids? Child Care Arrangements, the Census Bureau states that over the past 30 years, early childhood care and education settings have become major, if not primary, learning and eating environments for an estimated 11 million children under age five in the US. A 2011 American Dietetic Association position paper Benchmarks for Nutrition in Child Care estimates that young children enrolled in ECE receive up to two-thirds of their daily nutrition in these environments.
States vary markedly in the ways they regulate nutrition in licensed child care settings. Due to overlapping policy programs, they may inadvertently establish regulations that contradict each other. For example, the federal Child and Adult Care Food Program (CACFP) regulates and reimburses for food served in ECE settings. It is an important policy lever for improving the nutritional quality of food in child care environments, and states often apply enhanced (CACFP) standards or offer incentives for participation in the program. In addition, recently the federal government has also provided states with new Child Care and Development Block Grants, which fund child care subsidies for low-income working families. When states use these block grants, they may require child care providers that receive these funds to adhere to additional nutritional criteria or policies. Often the nutrition standards established through the block grants are inconsistent with CACFP’s. Providers are tasked with sorting through and managing these policies, regulations, and programs.
Those trying to improve ECE nutrition often do not realize how complicated the regulations currently are, how policies overlap, or how the improvement of one policy or standard might affect another. Policy visualizations are needed to illustrate the system’s complexity and enable strategic decision making.
Mapping Policies to Visualize Solutions
A wide array of people and groups have interest in or are affected by ECE nutritional regulations, including public agencies, advocacy groups, professional organizations, parents and families, service providers and educators, healthcare practitioners, and more. The following visualization helps these stakeholders understand and communicate how regulatory complexity affects ECE nutrition. Policy visualizations such as this can serve as centerpieces for discussions among these stakeholders and starting points for considering the system as a whole.
To create this information graphic, we conducted participatory design sessions with child care providers, representatives of local and state public health agencies, and state early learning agencies. In early sessions, participants drew diagrams that illustrated their understanding of the regulatory policies that influence nutrition at ECE centers. These diagrams—which varied widely—were compared with our own research about ECE policies (i.e., the policies themselves; peer-reviewed manuscripts; online federal, state, or local materials; and documents such as white papers or technical reports). We then created several “policy maps” that depicted relationships between agencies, policies, funding, and child care centers and held focus groups where we presented initial drafts to stakeholders. Participants were asked which maps made the most sense, to identify what was wrong or missing in the maps, and to describe with whom or in what ways they might use them. Based on their feedback, we created a refined information graphic, which was then circulated via email back to the stakeholder group for additional comments or edits.
While no doubt incomplete, the visualization that emerged seems to offer the best available picture of the institutions, policies, and resources that influence child care food service. Through our work, it has become clear that no individual or group seems to have a full grasp of all the relevant policies, and that even among experts there is not a single shared understanding. Our hope is that visualizations like this can facilitate dialogue among stakeholders and build capacity for change.