Approximately 15 million children under age 6 are in childcare settings, offering childcare providers an opportunity to influence children’s dietary intake. Childcare settings vary in organizational structure – childcare centers (CCCs) vs. family childcare homes (FCCHs) – and in geographical location – urban vs. rural. Research on the nutrition-related best practices across these childcare settings is scarce. The objective of this study is to compare nutrition-related best practices of CCCs and FCCHs that participate in the Child and Adult Care Food Program (CACFP) in rural and urban Nebraska. Nebraska providers (urban n = 591; rural n = 579) reported implementation level, implementation difficulty and barriers to implementing evidence-informed food served and mealtime practices. Chi-square tests comparing CCCs and FCCHs in urban Nebraska and CCCs and FCCHs in rural Nebraska showed sub-optimal implementation for some practices across all groups, including limiting fried meats and high sugar/ high fat foods, using healthier foods or non-food treats for celebrations and serving meals family style. Significant differences (p < .05) between CCCs and FCCHs also emerged, especially with regard to perceived barriers to implementing best practices. For example, CCCs reported not having enough money to cover the cost of meals for providers, lack of control over foods served and storage problems, whereas FCCHs reported lack of time to prepare healthier foods and sit with children during mealtimes. Findings suggest that policy and public health interventions may need to be targeted to address the unique challenges of implementing evidence-informed practices within different organizational structures and geographic locations.

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Background Ecological Approach To (EAT) Family Style is a 16-week responsive feeding Early Care and Education (ECE) intervention, utilizing a multilevel improvement system of 4 implementation strategies: (a) provision of a 7-lesson, on-line professional development training for administrators and teachers (b) administrative support; (c) performance monitoring, feedback, and assistance through follow-up coaching; and (d) use of incentives. The 7 lessons cover role modeling, peer modeling, sensory exploration, self-regulation, children serve themselves, praise and rewards, and family engagement, each relying on goal setting. The evidence-based practices and implementation system was delivered to ECE administrators and teachers completing one online lesson/week followed by a coaching session with a trained coach. EAT Family Style is guided by the self-determination theory. The objective of this study was to evaluate the EAT Family Style intervention through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.Methods Center-based ECE administrators (n=8) and teachers (n=17) caring for preschool (3-5 years) children and coaches (n=9) who participated in the EAT Family Style intervention were recruited. Semi-structured interviews were conducted, transcribed verbatim, and coded deductively by 3 coders using RE-AIM dimensions as a priori codes and placed into themes and sub-themes using thematic analysis. Results All participants perceived that EAT Family Style improved children’s nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches and administrators reported EAT Family Style aligned with their professional goals and beliefs. Coaches found professional development incentives important, whereas administrators/teachers specifically valued in-service training credit hours (Adoption). Teachers reported successful implementation of EAT Family Style practices in the classroom. Administrators and coaches supported the teachers through administrative and coaching strategies (Implementation). All participants reported they intended to continue using the intervention. Administrators and teachers discussed incorporating EAT Family Style practices into handbook/school policy (Maintenance).Conclusion(s) EAT Family Style was viewed as feasible by participants. Its 4-pronged implementation strategy has the potential to improve the uptake of evidence-informed feeding practices in ECEs.

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