Bringing Fruit & Vegetable Prescription Programs to Detroit

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Information about Bringing Fruit & Vegetable Prescription Programs to Detroit
Health & Medicine

Published on February 25, 2014

Author: nicolaliz



Fruit and vegetable prescription programs have become innovative partnerships between healthcare and community food providers – connecting patients to fresh, healthy, locally-grown produce while providing direct economic benefits to small & midsize farmers and the community. Learn about the first ever pilot program in Detroit, Michigan. Visit to learn more.

Bringing  Food  Prescription   Programs  to  Detroit:     CHASS  Health  Rx  –  Year  1     CHASS  Center   February  12,  2014  

Welcome   Denise  Pike,  Development  Director,  CHASS    

Introductions   Kathryn  Savoie,  Detroit  Community  Health   Director,   Ecology  Center    

Welcome  &  Introductions   §  Nicki  Milgrom   §  Healthy  Food  in  Health  Care   Organizer,  Ecology  Center   §  Allison  Sponseller   §  Evaluator   §  Curtis  Center  Program   Evaluation  Group  at  the   University  of  Michigan   § Attendees     §  Name   §  Affiliation    

Agenda   v Welcome  &  Introduction  to  CHASS  –  Denise  Pike   v Introduction  to  Ecology  Center/Healthy  Food  in  Health  Care                                           -­‐  Kathryn  Savoie   v CHASS  Health  Rx  –  Year  1,  Denise  Pike   v Evaluation  &  Outcomes  –  Allison  Sponseller,  University  of  Michigan   Curtis  Center   v Health  Rx  2014  –  Denise  Pike,  CHASS  Center   v Bringing  Food  Prescriptions  to  Detroit:  Next  Steps  &  Vision                                                 –  Kathryn  Savoie   v Questions  &  Answer/Discussion  

Ecology  Center   •  Michigan-­‐based   environmental  organization   •  Safe  and  healthy   environment  where  people   live,  work  and  play   •  Toxics/Environmental   Health,  Climate  and   Energy,  Healthy  Food  in   Health  Care  

campaigns     Advances  special  projects  and  promising   approaches  -­‐   •  Offers  introductory  assistance     •  Offers  guidance  on  procuring  local   and  sustainable  foods   •  Educates  and  activates  health   professionals       •  Promotes  &  disseminates   educational  opportunities,   tools,  resources  and   campaigns     •  Advances  special  projects  and   promising  approaches    

Healthy  Food  in  Health  Care  –  New  Projects   First  Food,  Good  Food   •  Creating  a  “baby-­‐friendly”  food   system   •  Understanding  breast  &  formula   feeding  as  part  of  our  food   system   •  Helping  breastfeeding   advocates/maternal  and  child   health  providers  understand  the   environmental  and  health   impacts  of  our  food  system   •  Increasing  healthy  food  access   for  pregnant  and  breastfeeding   mothers  

Healthy  Food  in  Health  Care  –  New  Projects   Health  Leaders  Fellowship   q Leadership  development,   training  &  field  experience     q   Climate  and  energy,   environmental  health,   healthy  food  systems,  civic   engagement   q Health  professionals  of  all   types,  at  any  stage  of  their   career   Application  Deadline:   February  14,  2014  

    Founding  member  of     Health  Care  Without  Harm   v Over  436  organizations   in  42  states  and  52   countries.     v Attracted  the  attention   of  major  health  care   systems,  regulatory   bodies  and  industry   leaders  throughout  the   United  States.  

Healthy  Food  in  Health  Care  Principles   Food  supply  can  be  met  in  a  variety  of  ways  which  have  consequences  in   terms  of  nutrition,  disease  risk,  public  health,  environmental  health,  social   and  economic  well  being.     Healthy  food     comes  from  a  food  system  that  is   ecologically  sound   economically  viable,  and   socially  responsible.    

      Key  health  concerns  in  our  industrialized  food  system   •  Widespread  exposure  to   toxic  chemicals   •  Antibiotic  resistance   •  Food-­‐borne  illness   •  Environmental   degradation   •  High  levels  of   nutritionally-­‐deplete   foods   Confined Animal Feeding Operations Overuse of Antibiotics Overuse of Antibiotics Chemicals Chemicals

Making  Change  Locally   Institute of Medicine, 2009 “[P]arents and other adult caregivers play a fundamental role in teaching children about healthy behaviors…. But those positive efforts can be undermined by local environments that are poorly suited to supporting healthy behaviors.” Strategy 3: Community Food Access Promote efforts to provide fruits and vegetables in a variety of settings, such as farmers’ markets, farm stands, mobile markets, community gardens, and youth focused gardens.

Factors  that     affect  health   Smallest   Impact   Examples   Counseling     &  Educa1on   Clinical   Interven1ons   Long-­‐las1ng     Protec1ve  Interven1ons   Changing  the  Context   to  make  individuals’  default  decisions  healthy   Largest   Largest   Impact   Impact     Socioeconomic  Factors Eat  healthy,     be  physically  ac1ve   Rx  for  high  cholesterol,  diabetes.   Vitamin/Mineral  supplements   Immuniza1ons,  exercise,     colonoscopy   Strategic  Food/Bev  Pricing,   HFHC  Pledge,    Farmers  Markets,   CSA   Poverty,  educa1on  level,   inequality  

Changing  your  thinking:     A  systems  perspective     Farm & Food Policy Healthier Eating Environments Behavior Change Story M, Hamm MW, Wallinga D, eds. Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier Communities (suppl) Journal of Hunger & Environmental Nutrition, Volume 4, Issues 3 & 4. December 2009 (in press)

Health  care  grows  good  food  access   Hospital  Supported   Farmer’s  Markets   Community  Supported   Agriculture   Hospital  Supported   Farms/Gardens   “Our greatest 2010 success was getting staff, patients and visitors to appreciate what locally produced food is like versus food produced on industrial farms hundreds or thousands of miles away.” —Mike Bersani, Manager Clinical Nutrition Services, Catering and Dining Services, MidMichigan Medical Center, Clare, Michigan Resource: Health Care Without Harm 2011 National Survey

Through  farm  stands  or  markets  

Community  Supported  Agriculture  (CSA)     drop-­‐offs  at  health  care  sites     Henry  Ford  Health  System   Fresh  Food  Share  Delivery  Sites:       1  Ford  Place  Detroit,  MI  48202   New  Center  One  :  Contact  Center  (3rd  Floor)   New  Center  One  :  Clinics  (7th  &  8th  Floors) John  Muir  Medical   Center,  Concord,  CA  

Health  care  farming…     Henry  Ford  Hospital  West  Bloomfield   Organic  Hydroponic  Greenhouse     The  Farm  at  St.  Joe’s   Ann  Arbor  

Healthy  Food  in  Health  Care  –  Detroit     v Innovative   partnerships  that   engage  health  care   providers  in  support  of   sustainable  local  food   systems   v Educational   opportunities  for   health  care  providers   to  increase  awareness   of  environmental  and   health  impacts  of  food   production   Farm  Stand  at  Henry  Ford  Hospital,  2012  

Food  Prescription  Programs     q  Innovative  model     q  Connects  health  care  and   food  systems   q  Improves  patients’  healthy   food  knowledge,  skills,   behaviors   q  Positive  health  outcomes   q  Helps  create  a  healthy   local  food  system   q  Transform  traditional   medical  model  of  health   care    

CHASS  Health  Rx  Pilot   2013  Program  Overview  

Health  Rx  Partnership   Leadership:   q CHASS  Center   q Ecology  Center   Model:   q Washtenaw  County  Public  Health   “Prescription  for  Health”   Resources:   q W.K.  Kellogg  Foundation  grants  to   CHASS  and  Ecology  Center   q GE  Foundation  support  for  CHASS     Key  Program/Planning   Partners:   q Eastern  Market  Corporation   q Fair  Food  Network   q Gleaners  Community  Food  Bank   q Detroit  Wayne  County  Health   Authority   q Henry  Ford  Health  System   q American  Indian  Health  &   Family  Services  

CHASS  Center  

Health  Rx  -­‐  Program  Overview   •  Health  Rx  was  launched  at  the   Community  Health  and  Social   Services  (CHASS)  Center  in  Detroit   in  July  2013.     •  Help  patients  connect  what  they  eat   to  how  they  feel   •  Improve  eating  habits     •  Improve  health  outcomes   •  Connect  healthcare  system  and  the   food  system  in  Detroit  to  support   healthier  local  food  system  

Health  Rx  -­‐  Program  Overview   v Target  Population:   –  Low  income  chronic  disease   patients   –  caregivers  of  children  age   0-­‐5,  and  pregnant  women   v Referred  to  the  Health  Rx   program  by  their  primary  care   physician.   v Program  ran  12  weeks,  July  16-­‐ October  3    

How  did  it  work?  

        Program  Evaluation     and  Outcomes  

Program Evaluation and Outcomes

Evaluation  Methods   •  Observations  of  orientation  and  markets   •  Surveys   •  Participant  pre  surveys  (n=45)  and  post  surveys  (n=32)   •  Participant  raffle  survey  (n=15)   •  Provider  survey  (n=6)   •  Vendor  survey  (n=8)   •  Focus  group  with  participants  (n=12)   •  Market  sales  data   •  Key  Informant  Interviews  with  CHASS  staff,  community  partners   (n=7)   Source:  

Logic  Modeling   Program  blueprint,  theory  of  change     Program  informant  responds  to  a  series  of  questions   resulting  in  a  schematic     Specifies  inputs,  planned  services,  output  and  expected   participant  outcomes     Provides  the  foundation  for  the  evaluation      

Process  Evaluation  Plan   To  document  the  implementation,  including  participant   information,  program  challenges  and  facilitating  factors     To  determine  adherence  to  the  model     To  gather  the  participant  perspective  

Outcome  Evaluation  Plan   To  document  attainment  of  outcomes,  service  learning  goals     To  capture  participant  perspective,  including  attainment  of   unexpected  outcomes    

Participant  Demographics   The  median  age   was  47.2     Self-­‐reported  Race   9   49% La1no/Hispanic   Self-­‐reported   gender   33%9   African  American   Men  13%   13%9   Caucasian/White   Women  87%   Two  or  more  ethnici1es   4%9  

  Expected  outcome:   Increased  knowledge  of  how  to  select,  prepare     and  store  fresh  produce   I  know  how  to  store  fresh  fruits  and  vegetables  to  increase  their  shelf  life.     Strongly  Agree   Agree   Neutral   Disagree   Strongly  Disagree   3.1%   4.4%   Post-­‐survey   24.4%   Pre-­‐survey   Post-­‐survey   Pre-­‐survey   Post-­‐survey   Pre-­‐survey   Pre-­‐survey   12.5%   28.9%   21.9%   17.8%   22.2%   62.5%   Post-­‐survey  (N=32)   Pre-­‐survey  (N=45)  

  Expected  outcome:    Increased  servings  per  day  of  fruits  and   vegetables     3.23  cups   Post-­‐survey  (N=32)   Pre-­‐survey(N=45)   3.02  cups   2.9   2.95   3   3.05   3.1   3.15   3.2   3.25  

Expected  outcome:   Consider  CHASS  Mercado  as  a  viable  grocery  option       I  would  shop  at  the  CHASS  Mercado  again  next  summer   Strongly  Agree   37.5%   Agree   Neutral   53.1%   6.3%  

Participant  Experiences   •  “I  am  in  better  shape  because  of  the  program  and  change  in  my  diet.  My  health  has   drastically  changed…”     •  “  [I]  learned  things  I  didn’t  know  about,  I  was  eating  things  that  were  unhealthy   [and]  didn’t  even  know!  I  changed  what  I  was  eating  because  of  this  [program]”     •  “[The  staff]  taught  us  to  look  at  better  food  selections.  Even  when  going  out  to   dinner  I  look  at  the  menu  differently  and  make  better  choices.”     •  “I  liked  the  cooking  demonstrations,  and  learning  to  try  new  stuff  I  hadn’t  tried   before.”   •  “I  would  like  a  different  variety  of  fruits  and  vegetables.”    

Evaluation  Lessons  Learned   •  Unique  identifiers  for  participants   •  Token  redemption  data     •  Market  currency      

Year  Two  Evaluation  

CHASS  Health  Rx     Plans  for  2014  –  Year  2  

Health  Rx  –  Year  2  Plans   •  Successful  first  year  pilot   •  CHASS  will  run  the   program  again  in  2014     •  Working  to  clarifying  goals   •  Refine  and  standardize   process   •  Double  number  of   participants   •  Adding  additional   educational  events  related   to  chronic  illness   •  Strengthening  peer  support   •  Outreach  to  new  market   vendors  

Bringing  Food   Prescriptions  to  Detroit   Next  Steps  &  Vision  

Food  Prescriptions  in  Detroit     v Continue  to  partner  with   CHASS  for  Health  Rx  in  2014   v American  Indian  Health  &   Family  Services   §  Fresh  Food  Share  box   v Henry  Ford  Health  System        

Food  Prescriptions  in  Detroit   Vision:     A  city-­‐wide  network  of  participating  clinics  and  markets     q      A  community  of  practice    on  food  prescription  programs   q      Detroit  Food  and  Fitness  Collaborative:   proposed  Health  Care  Work  Group   q      Explore  sustainability/funding  for  food  prescription  work  


Closing   Kathryn  Savoie   Detroit  Community  Health  Director   Ecology  Center       (313)733-­‐0039­‐food         Denise  Pike   Development  Director   CHASS  Center   (313)849-­‐3920  x5021  

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