Published on February 25, 2014
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 www.cdc.gov/about/grand-rounds/archives/2010/download/GR-021810.pdf 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
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: www.emfsafetynetwork.org
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 firstname.lastname@example.org (313)733-‐0039 www.ecocenter.org/healthy-‐food www.healthyfoodinhealthcare.org Denise Pike Development Director CHASS Center email@example.com (313)849-‐3920 x5021
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