Issues Related to Implementation of the Reimbursable After-School Snack Service
Alice Jo Rainville, PhD, RD, CHE, SFNS; and Jerry B. Cater, MS

The Child Nutrition Reauthorization Act of 1998 enhanced nutrition benefits for children in after-school care programs by authorizing reimbursement for snacks that are served in such settings. The purpose of this study was to determine issues faced by child nutrition program (CNP) administrators who implemented the National School Lunch Program's reimbursable snack service in their after-school care programs. Three 2-hour focus groups were conducted with CNP administrators from 15 states. There were a total of 7-11 participants in each group.

Administrators were selected from districts of varied sizes that offered the reimbursable after-school snack service. They reported that snack menus were developed based on requirements set forth by the U.S. Department of Agriculture (USDA), as well as minimal preparation time, food cost, and student acceptance. Some of the CNP administrators reported that nutrition education opportunities increased as a result of the snack service. Administrators received positive feedback on the reimbursable after-school snack service from students, parents, teachers, and school administrators. Many administrators stated that the reimbursable after-school snack service played an important role in meeting the daily nutrient needs of children, while providing an opportunity to serve the community

Administrators faced a variety of challenges, which included obtaining accurate records for reimbursement claims, training for the after-school care program providers, providing variety in snack menus, and monitoring the after-school care program sites. Additionally, most CNP administrators wanted more flexibility in the regulations that apply to the reimbursable after-school snack service. Currently, sites located in areas served by a school in which at least 50% of the enrolled children are certified-eligible for free or reduced-price meals are eligible to receive reimbursement at the free rate for snacks served to all children.

Researchers concluded that the reimbursable after-school snack service is important for children's health and nutrition status, but such issues as obtaining accurate records, training and monitoring site staff, and planning menus can pose a challenge.

The Child Nutrition Reauthorization Act of 1998 enhanced nutrition benefits for children in after-school care programs by authorizing reimbursement for snacks served. The reimbursable after-school snack service can be offered under the National School Lunch Program (NSLP) or the Child and Adult Care Food Program. The after-school care program must provide children with regularly scheduled activities in a supervised environment that includes educational or enrichment activities. The reimbursable snack program provides nutrition assistance to children who are enrolled in after-school care programs that, among other things, reduce involvement in juvenile crime. The snack menus are planned using food groups, and to be eligible for reimbursement, each snack must contain two different food items from the following four groups: fluid milk, meat or meat alternate, vegetable or fruit, and whole grain or enriched bread or cereal. Portion size regulations exist for each food group.

The reimbursement rates are based on the "area eligibility" of the after-school care program. If the program is offered at a school or in a school attendance area in which at least 50% of the enrolled children qualify for free or reduced-price meals, all snacks are reimbursed at the free rate, regardless of an individual student's eligibility. If the after-school care program is not "area eligible," then snacks are reimbursed at the free, reduced price, or paid rate based on each child's eligibility. The U.S. Department of Agriculture (USDA) provides the reimbursement for after-school snacks, and because after-school snack service is part of the NSLP, reimbursement is administered at the state level.

Research shows that snacks make an important contribution to children's daily nutrient intake of many nutrients, especially magnesium, calcium, and vitamins A and C (Bigler-Doughten & Jenkins, 1987). Bigler-Doughten and Jenkins (1987) reported that 80% of children 11-18 years of age did eat snacks, and a 1994 study (Cross, Babicz, & Cushman) reported that 99% of 5th- and 6th-graders reported snacking on occasion. Jahns, Siega-Riz, and Popkin (2001) also reported that the prevalence of snacking increased between 1977 and 1996, based on nationally representative data for children ages 2-18. They found that snacks contributed one-fourth of energy intake and one-fifth of many other nutrients. However, the calcium density of snacks has decreased from 1977 to 1996. Harnack, Stang, and Story (1999) used the 1994 CSFII data for children ages 2-18, and reported that soft drinks displaced milk and fruit juice in the diets of children. Children who had the highest level of soft drink consumption had decreased intakes of the primary nutrients in milk and fruit juice. Dwyer et al. (2001) found that 87% of 8th-grade students reported snacking, and 47% of energy in snacks was from simple sugars.

In a 1993 research report that included 1,797 2nd- and 5th-grade students, Wolfe and Campbell found that 62% of snacks were prepared by children, and that snacks prepared by a child or caretaker were less likely to include a dairy food than those prepared by a parent. They also reported that cookies, soda, fruit drinks, chips, candy, milk, apples, and juice were the most commonly consumed snacks after school. Among other findings relating to after-school snacks, those served in restaurants are likely to be higher in fat. Zoumas-Morse, Rock, Sobo, and Neuhouser (2001) found that children ages 7-17 consumed significantly more (p<0.05) energy from fat and saturated fat when eating in a restaurant compared to any other location, including school. Eating that took place at home, a friend's home, school, day care, and work met dietary recommendations for percent kilocalories from fat and carbohydrates, while those in restaurants did not.

These studies of children's snacking patterns indicate that snacking is more prevalent, but there is a trend toward the consumption of less-nutritious snacks. The reimbursable after-school snack service provides guidelines to ensure that children in such programs receive nutritious snacks. Since the release of the 1998 regulations, no published reports exist that describe such operational issues as menu planning, accountability, training for care providers, and monitoring service.

In order to encourage implementation of the after-school snack service, it was important to investigate the experiences of child nutrition program (CNP) administrators who implemented the reimbursable after-school snack service as a part of after-school care programs. The purpose of this study was to determine operational issues faced by CNP administrators who implemented the NSLP's reimbursable after-school snack service in after-school care programs.

Study Design
The focus group method was selected to identify the operational issues that were of most concern to CNP administrators when implementing a reimbursable after-school snack service. The goal of focus group research is to collect qualitative data that are of interest to the researchers, and to compare and contrast data collected from at least three focus groups (Krueger & Casey, 2000). The data and insights produced during group interactions are valuable for exploration of new research areas (Morgan, 1997).

Morgan (1997) recommended that focus groups have homogeneous participants, rely on a structured interview with high moderator involvement, have 6-10 participants per group, and have 3-5 groups per project. Based on these recommendations, the researchers selected three focus group sites, which were strategically located for ease of travel in the western, middle, and eastern regions of the country: Phoenix, AZ; St. Louis, MO; and Philadelphia, PA.

State agency directors from Arizona, Missouri, Pennsylvania and nearby states (Arkansas, California, Delaware, Illinois, Kansas, Kentucky, Maryland, Nevada, New Jersey, New Mexico, Utah, and West Virginia) were asked to provide names, contact information, and the average number of snacks served per day for CNP administrators who were offering the reimbursable after-school snack service under the NSLP. The CNP administrators held position titles as foodservice directors, coordinators, and administrators. CNP administrators from school districts of varied sizes were subsequently selected to participate in a focus group based on number of snacks served, ranging from an average of 22 snacks per day in two schools to an average of 13,300 snacks per day in 33 schools. Administrators were contacted by telephone and asked to participate in a focus group. After they agreed to participate, they were sent confirmation letters.

Focus group questions designed to explore issues related to the implementation of the reimbursable after-school snack service were developed by the researchers and pilot tested in a focus group held in Mississippi (n=5). The questions were validated during the pilot focus group session and refined immediately following. Three regional two-hour focus groups with CNP administrators from districts of varied sizes were convened in Phoenix (n=11), St. Louis (n=9), and Philadelphia (n=7) in Spring 2001. The groups were homogeneous because all participants were CNP administrators.

One individual moderated each of the three focus groups, and an assistant moderator summarized responses and invited participants to verify that the summary comments were an accurate depiction of the discussion. The moderator and assistant moderator had school foodservice experience and were trained in the Krueger and Casey (2000) method of conducting focus groups. The 12 questions asked in each focus group were:

• How do you select snacks for the menu?
  
• Does reimbursement cover food costs?
  
• Where are the snacks served and who serves them?
  
• Have any food safety concerns been raised, since teachers may not have been trained in food handling?
  
• Have you received feedback on the reimbursable after-school snack service from students, parents, teachers, or school administrators?
  
• Has providing the snack service added extra time to your workday?
  
• What is the greatest barrier to having a successful snack service?
  
• If you were asked to make a suggestion to improve the reimbursable after-school snack service, what would be your number one priority?
  
• How would you convince a school foodservice administrator who has not implemented the reimbursable after-school snack service to implement such a program?
  
• Could you share your feelings about the benefits of the reimbursable after-school snack service and whether or not the service is reaching the target population?
  
• Of all the topics we discussed, which one is most important to you?
  
• Is there anything we should have talked about but didn't?
  

Data Analysis
Focus group sessions were audiotaped and transcribed. The "long table" methodology of Krueger and Casey (2000) was used to analyze transcripts of the three focus groups. In this method, the transcripts were color coded by location, cut apart by comment, and arranged by content on large sheets of paper. Comments for each question were summarized.

Comparing the summarized comments from each session revealed a series of issues that occurred throughout all focus group discussions. Issues raised in all three groups were given more weight than issues raised in only one group. Many administrators mentioned regulations. They would like the reimbursable after-school snack regulations to be clearer and would like more guidance from their state agency. Administrators wanted research studies and educational materials that demonstrate the benefits of the reimbursable after-school snack service. Participants suggested the following types of studies:

• Studies of student satisfaction that involve the first year of reimbursable after-school snack implementation compared to the previous year;
  
• Studies of educational performance and good nutrition; and
  
• Surveys of site coordinators.
  

In addition, many administrators would like to see more nutrition education activities as a part of the reimbursable after-school snack service. Additional concerns mentioned included security of foodservice facilities and supervision of children in foodservice facilities.

Implementing a reimbursable after-school snack service requires attention to important operational activities. A variety of challenges faced by CNP administrators include:

• obtaining accurate records for reimbursement claims;
  
• training for the after-school care program providers;
  
• providing variety in snack menus; and
  
• monitoring the after-school care program sites.
  

Most CNP administrators desired universal access or more flexibility in the regulations that apply to the reimbursable after-school snack service. Accountability, obtaining accurate records for reimbursement, and training the after-school care site staff were mentioned most by administrators in all three groups (Table 1). CNP administrators also offered suggestions for encouraging others to implement the program (Table 2).

Obtaining Accurate Records for Reimbursement
Administrators reported that the reimbursable after-school snack service required extra time to obtain accurate counts from sites in order to process claims for reimbursement. Monitoring the reimbursable after-school snack service and visiting the sites were major concerns. Almost all CNP administrators were using a manual system to keep track of snacks served. They expressed a desire for point-of-sale systems that included tracking after-school snacks to assist them in their record-keeping and reimbursement of after-school snack service.

Currently, sites located in areas served by a school in which at least 50% of the enrolled children are certified eligible for free or reduced-price school meals are eligible to receive reimbursement at the free rate for snacks served to all children. Site location was mentioned as an important factor in preparation of claims; CNP administrators reported a dramatic difference in the time required for preparing claims between "area eligible" schools and schools that were under 50% eligibility. Many administrators recommended that the reimbursable after-school snack service should be offered universally free to all students in after-school care programs. Some administrators suggested lowering the "area eligible" threshold from 50% to 30% of the enrolled children certified for free and reduced-price meals in schools. This would reduce some of the necessary record-keeping for sites that were below the 50% threshold.

Training for the After-School Care Program Providers
Additional costs for training site staff and monitoring service were mentioned as challenges in providing the reimbursable after-school snack service. Many CNP administrators mentioned training the after-school care site staff on the reimbursable after-school snack regulations. Administrators felt having school foodservice personnel involved with service of snacks would be ideal due to a better understanding of NSLP regulations regarding reimbursement. The issue of adult snacks for site staff also was discussed because some after-school care site staff consume snacks. CNP administrators in some districts pay for adult snacks.

Providing Variety in Snack Menus
Many administrators mentioned portion size regulations for menu planning as a barrier. In addition, many of the administrators in all three groups mentioned cost and student preferences as important in menu planning. CNP administrators desired additional funding for refrigeration equipment and more fresh fruits for the menus. A few administrators suggested offer vs. serve for menu items and planning the menus based on nutrient composition instead of food groups.

Convenience foods that were individually wrapped were preferred by most to minimize both losses when student counts are lower than forecasted, as well as losses of labor hours. Many CNP administrators mentioned that pre-portioned fruit juices that met the NSLP portion size regulations for reimbursable snack service were difficult to find. Products required to meet reimbursable after-school snack regulations had to be added to bids.

Other Issues and Concerns
The logistics of getting snacks to remote sites and planning for the many different types and varied schedules of after-school care programs offered within the same district were mentioned in two groups. Most CNP administrators reported that snacks were counted by school foodservice personnel and picked up by staff from the remote sites.

Security was mentioned as a problem if the snacks were not locked in a secure location. Also, most CNP administrators stated that while reimbursement does cover food costs, it does not cover the labor costs associated with preparation and service. Many administrators expressed additional concerns about increased food costs that resulted when snacks were ordered but not served. Some administrators charge the organization responsible for the after-school care program for the costs of prepared snacks that were not served.

CNP administrators reported keeping juice and milk in refrigerators until pick-up time. Several administrators reported that milk temperatures were a potential problem if milk was picked up too early. Many expressed a desire for additional refrigeration equipment in the kitchen and/or after-school care program area. Use of wrapped foods was mentioned as a food safety precaution.

Many administrators expressed a need for additional funding for labor so they could have foodservice employees involved in the service of snacks and monitoring. A few administrators found the resources to involve foodservice employees as monitors.

Benefits of the Service
Administrators felt that nutritious snacks were important for children's learning. The reimbursable after-school snack service generated goodwill and improved public relations for the school foodservice department within the school district and community. The reimbursable after-school snack service encouraged community partnerships, and many CNP administrators mentioned programs supported by a combination of grants and community partnerships.

Several of the administrators with an existing non-reimbursed after-school snack service had positive feedback from school administrators regarding the snack reimbursement. Administrators reported the reimbursable after-school snack service increased the opportunities for nutrition education. The CNP administrators mentioned the reimbursable after-school snack service as valuable for keeping children in a supervised setting. Transportation issues, however, limited some children from attending after-school care programs.

Focus group results in this study are most appropriately used to explore and identify topics for a broader assessment of after-school snack service. Participants in the focus group discussions represented a suitable cross-section of CNP administrators characterized by similarities, but with sufficient diversity to allow for contrasting opinions about the challenges of implementing snack service in after-school care programs. Based on the uniformity of responses in the three groups, several conclusions are offered for consideration.

Accountability was a significant concern with respect to accuracy of snack counts, training associated with obtaining accurate counts, and snack service monitoring costs that are not included in the reimbursement formula. A second concern expressed by administrators reflects some difficulties in menu planning due to food safety and portion size requirements. Food manufacturers need to consider providing more variety in prepackaged food items that will meet the portion size requirements of reimbursable after-school snack service. In addition, software manufacturers need to provide point-of-sale technologies and easy-to-use accounting systems that will facilitate record-keeping for the reimbursable after-school snack service.

The reimbursable after-school snack service was beneficial for forming partnerships within communities. The CNP administrators offered ideas for introducing the reimbursable after-school snack service to school administrators. The CNP administrators stated the importance of reimbursable after-school snack service in providing nutritious snacks for children.

Finally, a number of the focus group participants' comments reflected concerns related to federal regulations. Most CNP administrators desired universal access or more flexibility in the regulations that apply to reimbursable after-school snack service. In particular, administrators were concerned about the area eligibility provisions. Currently, sites located in areas served by a school in which at least 50% of the enrolled children are certified eligible for free or reduced-price meals are eligible to receive reimbursement at the free rate for snacks served to all children. Participants perceived that this provision might limit snack availability to eligible students. Since this is a policy and funding issue, it is beyond the scope of this study. However, these concerns can be forwarded to the appropriate agencies for consideration.

More research studies of reimbursable after-school snack service are needed; therefore, cost studies would be beneficial. Training materials for after-school care program staff are needed. The results of this qualitative study provide useful information to CNP administrators, school administrators, and state agency personnel.

The authors wish to thank the school foodservice administrators who were the focus group participants and the state agency personnel who supplied names of those who offered the reimbursable after-school snack service. This research was conducted by the National Food Service Management Institute, Applied Research Division, located at the University of Southern Mississippi, with headquarters at The University of Mississippi. Funding for the Institute has been provided with federal funds from USDA, Food and Nutrition Service, to the University of Mississippi. The contents of this publication do not necessarily reflect the views or policies of The University of Mississippi or USDA, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

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Alice Jo Rainville is associate professor, Human Nutrition Program, Eastern Michigan University, Ypsilanti, MI. Jerry B. Cater is a research scientist, National Food Service Management Institute, Applied Research Division, The University of Southern Mississippi, Hattiesburg, MS.