Community Action Network and the Hikone Community Food and Fun After School Program

Molly Hungerford and Miriam Holbrook.

We would like to thank that National Kidney Foundation of Michigan for taking the time to meet with us and discuss the current situation regarding nutritional education in SNAP-ED eligible public housing communities. This is a new direction for the Kidney Foundation and we are honored to be a part of this new program. We are thankful for the opportunity we have had to engage with the Hikone community to understand their needs and to further understand the best way to engage this community in embracing healthy living habits.

***Molly Hungerford and Miriam Holbrook currently work for non-profits whose main goals are to work with vulnerable populations in order to reduce the number of health disparities and health complications in these communities. Molly Hungerford is currently working for the National Kidney Foundation implementing the Food and Fun after school program in the Hikone community. However, Miriam was recruited to help implement an enhanced community engagement plan that better meets the needs of the community.

Executive Summary The National Kidney Foundation of Michigan has served the state for over 58 years. Its mission is to prevent kidney disease and help improve quality of life. Since Kidney disease is mostly preventable, the foundation has partnered with several organizations and communities throughout Michigan, running a variety of programs aimed at fighting the root causes of the disease- diabetes, obesity and hypertension. Most of the people suffering from these conditions live in vulnerable communities, which are usually dependent on food assistance, have less access to a variety of nutritious foods, and fewer opportunities to stay physically active.

The Food and Fun program is currently being implemented in the Hikone Public Housing Community, made up of minority households eligible for SNAP benefits. The program is funded through the Michigan Nutrition Network and involves a partnership between the National Kidney Foundation and the Community Action Network. Food and Fun uses a multi level engagement approach from two social systems theories. Social ecological model considers the individual, community, and societal levels in its prevention strategy. The social systems perspective values the cooperation of all parts of a community toward creating a better whole.

The Food for Fun program considered information from three assessment tools from which to base its engagement plan. The rich map shows the relationships and stakeholders within the organization and community. The SWOT analysis identified strengths and weaknesses, outside threats, and recognized opportunities for possible resources toward sustaining good health in general. The force field analysis was applied more specifically toward the Food and Fun program’s goals for change. The Hikone community is small, making engagement and implementation more simplified; the community garden and fitness trail provide opportunities implementation and sustainability. Availability to fresh produce is limited. The community is made up entirely of poor minorities, while program staff are mostly white, so issues of trust and resentment could hinder engagement and participation.

Recommendations include forming a coalition with the goal of community partnership and working with other food distributers to provide more fresh foods. Forming a strong relationship with the resident council helps to build trust. Staff will use food distribution days to get out into the community, get to know the residents, and ask for their input through open communication and surveys on classes and events. Community Action Network staff is also engaged in changing their own eating habits, so everyone is working toward change together. The program will be evaluated through weekly debriefings, and through seeking community feedback through surveys, assessing whether families have increased their consumption of fruits and vegetables and increased physical activity, Sustainability requires that the program remain flexible, adapting to community input throughout implementation.

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Organizational Background Description of the Organization

The National Kidney Foundation of Michigan’s (NKFM) state office is located in Ann Arbor with branch offices in Flint, Grand Rapids, and Detroit. The mission of the National Kidney Foundation of Michigan is to prevent kidney disease and improve the quality of life for those living with it. Diabetes and high blood pressure are the leading causes of chronic kidney disease, accounting for approximately 75% of all cases. Diabetes and high blood pressure are diseases that can typically be delayed, controlled or prevented by good nutrition and a physically active lifestyle. Therefore, the NKFM is committed to promoting a diet of increased fruit, vegetable, whole grain, and low-fat dairy consumption, and physical activity every day. The NKFM new focus is promoting healthy behavior in low-income public housing by administering after school pogroms focused on teaching healthy eating habits and encouraging sustainable and lasting change.

Target Clientele

Individual Level: The National Kidney Foundation of Michigan is partnering with the Community Action Network (CAN) in the Hikone Public Housing community to deliver nutrition education programming to SNAP eligible children in public housing.

Interpersonal/Environmental Level: The Food and Fun program believes strongly in the role family and community engagement can play in reinforcing positive healthy behavior among children in the after school program. Therefore, it is crucial to target the families and parents. The Food and Fun curriculum engages parents on a regular basis through regular communication, involving parents in the weekly physical activities and taste tests, as well as providing parents with the Food and Fun newsletter and weekly handouts that promote healthy behavior and eating in the home.

Organizational Level: The National Kidney Foundation has created a strong partnership with the Community Action Network and a valuable relationship with the CAN resident council. This relationship will prove resourceful in promoting policy change on the organizational level at the Community Action Network to ensure the consumption of more fruits and vegetables and increased physical activity in the Community Action Network’s after school programs and other meal services.

Theories of Change and Rationale

The National Kidney Foundation promotes a multi-level approach and embraces the social ecological model to ensure sustainable change over time. The ultimate goal of the social ecological model is prevention. This model considers the complex interplay between individual, relationship, community, and societal factors. It allows the NKFM to address the factors that put people at risk for experiencing or perpetuating risky unhealthy behavior.

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Prevention strategies include a continuum of activities that address multiple levels of the model. This approach is more likely to sustain prevention efforts over time than any single intervention (Center for Disease Control, 2013). Utilizing a conceptual framework which serves to refocus attention away from strictly intra-individual factors related to healthy behavior and more towards the interpersonal, community, organizational and environmental determinants of healthy behavior helps to ensure a sustainable system and environment change in the Hikone community.

The implementation of the program also borrows from another systems theory, the social systems perspective, which considers the cooperation of all parts of the community to ensure a greater whole. This theory of change describes five subsystems within the community: the economic or administrative system, the social systems (i.e., family and school), local government, social participation, and support or welfare organizations (Van Wormer, K., Besthorn, F.H., & Keefe, T., 2007). The Kidney Foundation has partnered with several other non-profit organizations. Administration occurs through the Public Housing Commission, CAN staff workers, and the resident council, which also work to enforce rules for the safety of all Hikone residents. The Food for Fun program is implemented as an after school activity, but also requires family participation for successful implementation and sustainability for the entire Hikone community. The school program integrates home and community life to change the daily routines of children and parents, with an opportunity to bring the whole community together around a common goal of better health. Systems theorists maintain that all parts of a system are related; a change in one will affect another. The ultimate goal of the Kidney Foundation is to reduce the chronic kidney disease in vulnerable populations. This program expects that changes in habits affecting health will carry over to and engage all other systems in the community.

Client Description

Community Action Network began its work in the Hikone neighborhood – one of the Ann Arbor Housing Commission public housing communities. Hikone is located in SE Ann Arbor, and houses 29 families. Although it is surrounded by a rather affluent community, Hikone residents are low-income or very low-income. All Hikone families are SNAP eligible. The children participating in the after school program are African American with the exception of one Latino family. While the Hikone community is a vulnerable population they are surrounded by a strong support system. The Community Action Network offers programs for children, teens and adults at the Hikone Community Center, focused on academic support and enrichment, and improving personal, social and work-readiness skills. The Community Action Network also provides an after school program for the children where tutoring and homework helps is offered, as well as dinner served to the children. However, before the Food and Fun program there was no health-centered programming at the Hikone Community Center, and many times the meals served are not the most nutritious. Therefore, due to the high prevalence of health disparities among the African American community, the Hikone community is a prime area to focus the Food and Fun’s efforts to increase healthy behavior. While the children in the Food and Fun nutritional after school program remain one of the target populations, much of the Kidney Foundation’s efforts will go towards engaging the families in establishing environmental change in their homes, as well as organizational change at the Community Action Network to ensure that the Community Action Network is making changes regarding the drinks served in their afterschool programs

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Literature Review and the nutritional content of the meals served. However, creating sustainable change will be impossible without engaging the larger Hikone community and families in participating in the Food and Fun efforts.

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According to Jacobson (2007), successful community engagement should combine coalition building, community organizing and development for sustainability. Food security has taken on new meaning in today’s global food economy, where small family-run farms have been lost to large corporate processing facilities. Fast processed foods are often the only easy options for those living in poverty. Jacobson argues that programs addressing food insecurity need to consider the broader issues regarding economics, the environment and social justice, by understanding the importance of access to healthy, fresh fruits and vegetables. Providing SNAP benefits may only allow access to processed foods and ensure higher risks of obesity, diabetes and cancer. Food drives and other charity models of practice do not address deeper concerns of health and social justice and thus are not sustainable. The community needs to be invested in the change while implementation promotes local food production and processing. The National Kidney Foundation’s Food for Fun program works with the resident council and the Community Action Network to form a support system and utilize existing client resources such as the community garden and promotion of local farmers markets, in order to provide long-term access to more healthy fresh food choices.

A study completed by Michigan State University found that neighborhood bonds and friendships with those in close proximity are positively correlated with participation in wider neighborhood community events. The small cohesive Hikone community is an ideal location for involvement since most of the community members know each other well. The Food and Fun program believes strongly in the role family and community engagement can play in reinforcing positive healthy behavior among children in the after school program. Interpersonal relationships with family members, friends and neighbors are important sources of influence in health related behaviors for individuals (McLeroy, Bibeau, Steckler, & Glanz, 1988). According to researchers at Duke Medicine, kids who parents encourage them to exercise and eat well, and model those healthy behaviors themselves, are more likely to be active and healthy eaters (Duke Medicine News and Communications, 2013). The Food for Fun program provides activities for children but involves their families by providing information and recipes to parents to use at home, strengthening the bond between children and parents. The program will include activities for social involvement at the community level as well. Citizen participation is imperative to maintaining success and continued positive change after the initial implementation has ended (Thomas, Schweitzer, & Darnton, 2004).

The Food and Fun program will rely on community building in order to maintain fidelity. Fabricant and Fisher (2002) explain that community organization must emphasize reciprocity in order to create the trust necessary for complete community engagement. Due to the nature of the public housing setting of the Hikone community and the role of the Community Action Network, organizational change must take place to ensure lasting sustainable environmental and community change. Research has shown with the majority of people spending one third to one half of their life in organizational settings, it is imperative to challenge these structures and processes due to the substantial influence they have on health and health related behaviors (McNelly, Bartholow, Garner, & Nishio, 2009). The Food and Fun program acknowledges this component and aims to establish partnerships with various community organizations that are most influential in the target population. The Hikone Community Action Network will work together with the resident council to change their own behaviors for a healthier life style- with the community. This establishes a vertical relationship, rather than a hierarchical one, creating an equal playing field between staff, administrators and community residents. Another way to ensure fidelity of change is to integrate it into the places where residents already live or frequent (Fabricant & Fisher, 2002). The Hikone community has two playgrounds, a new fitness trail and a community garden, which can all be incorporated into the maintenance of healthy eating habits and a physically active lifestyle.

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Findings In order to understand the best way to engage the larger Hikone community in making healthy lifestyle choices and changes at home, it is imperative to understand the current state of the community. Therefore, acknowledging the community’s ability to not only participate in the Food and Fun program, but also the community’s ability to access healthy resources necessary to adopt a healthy lifestyle is vital. These factors will be important in understanding what needs to be addressed further in the community to promote greater participation in the program and what further community engagement needs to take place to ensure the success of the program in promoting sustainable environmental and organizational change to improve the health of the Hikone Public Housing community.

Current Resident Participation in the Community Action Network Programming

The Community Action Network, where Hikone public housing is located, offers many programs to their residents, such as programs for children, teens and adults focused on academic support and enrichment, and improving personal, social and work-readiness skills. Until recently, the Hikone community was not considered for programs promoting healthy behavior, so the Food and Fun program is a new and exciting opportunity for this vulnerable community. However, like the other programs at the Community Action Network, the focus is more on educating and informing the residents of the resources and services available to them with no feedback from the participants. Currently, the type of citizen participation happening in this particular social system falls along the lines of informing. While informing is an important step towards citizen participation, too frequently the emphasis is placed on a one-way flow of information with no channel to provide feedback. Under these conditions the people of Hikone will have little to no

opportunity to influence the Food and Fun program designed “for their benefit” (Arnstein, 1969).

The National Kidney Foundation of Michigan acknowledges the importance of community engagement in extending the Food and Fun program’s efforts and is working hard to create an equal playing field between staff, administrators and community residents in building a healthier Hikone community. In the initial community engagement moving the Hikone community from “informing” to “consultation” is imperative. By engaging a vulnerable community like the Hikone community, it is necessary to seek input from the Hikone residents through various means such as surveys, neighborhood meetings, and public hearings. While education is important, community input and feedback is valuable in understanding the needs and desires of the community in promoting a comprehensive community engagement plan and increasing citizen participation. However, it is the National Kidney Foundation’s ultimate goal to create a partnership with Hikone residents and the resident council. The hope is that the community will eventually share planning and decision-making responsibilities regarding the Food and Fun program, the environmental changes in the Community Action Network, and in establishing an organized power-base once the NKFM is no longer involved.

Assessment 1: Rich Map

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A rich map is a great tool for community organizers to assess the relationships that exist within an organization. A rich map examines the social structures, organizational stakeholders and community stakeholders that all play a role or provide resources, supervision, money or various other processes involved in an organization’s efforts. A rich map aids organizations in figuring out its best practices in serving its target population. Utilizing a rich map to assess the Food and Fun after school program and the National Kidney Foundation’s role and partners in implementation will allow us to understand the current support and resources available to the Hikone community in adopting healthy behavior and find where further support is needed. This rich map shows us that there is a strong support system for the Food and Fun program and a variety of organizations involved who can provide resources once the NFKM is no longer involved. It also shows us where existing gaps are and where other organizations could be recruited.

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Assessment 2: SWOT Analysis

Developing a full awareness of the Hikone community and the Food and Fun program will help with both the strategic planning and decision-making regarding the community outreach and engagement component of the Food and Fun program. Therefore, the SWOT analysis will offer a simple method of communicating for the National Kidney Foundation’s initiative pertaining to the Food and Fun program. It is also an excellent way to organize information gathered from needs assessments, studies, and surveys.

This strategic tool accounts for the strengths and weakness of the Hikone community in terms of its ability to change on a general level. In this case, the SWOT analysis is not assessing in terms of the specific program implementation; rather, it is considering the opportunities that favor the community and the threats against the community when considering its potential for learning healthier behavior, adopting a healthier lifestyle and accessing resources to maintain that lifestyle (Community Toolbox, 2013). The SWOT analysis provides an understanding of where further support, resources, and engagement will be most needed to ensure success and sustainability of the Food and Fun program. This SWOT shows us that while there are great strengths and opportunities within this community in adopting healthier behaviors, the weaknesses and threats will hinder the community’s ability to do so if they are not addressed, such as the lack of transportation among this low-income community which further impacts the negative effects of living in a food desert.

Strengths

Small community Strong community support Cohesiveness among the Hikone community Community working towards common goal Support of Resident Council Community Action Network staff support in

adopting Food and Fun’s message Community Garden Outdoor physical activity space

Opportunities

Affluent Ann Arbor community surrounding Hikone

Ann Arbor School District Food Gatherers/Food Pantry Access to farmers market in spring that accept

SNAP/EBT One years worth of Food and Fun funding

Weaknesses Low income Several single parent households Dependent on food stamps Lack of transportation High levels of stress Depression Poor nutrition Higher priorities than participating in program

and events

Threats Food Desert Attendance and participation in the program

and events not mandatory Failure to acquire long-term funding to

continue interventions past the length of the grant.

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Assessment 3: Force Field Analysis

The force field analysis will allow us to take the SWOT analysis a step further by applying it more specifically to the Food and Fun program. Here, we consider the forces driving or hindering change. More precisely, we assess the influence and direction of the community's strengths, weaknesses, opportunities, and threats as it applies to program implementation. The force field analysis provides a better understanding of the big picture by analyzing all of the forces impacting the Hikone community’s ability in engaging in the Food and Fun program and its efforts to promote and help maintain a healthier lifestyle. In order to ensure the success toward sustainable environmental change, it is important to properly guarantee participation and engagement in the program from the beginning. The FFA shows that while administering nutritional programming can be difficult, the Hikone community has several positive forces and resources that are beneficial in helping the Hikone community engage in the program. The small community outreach implementation and strong support through the Resident council will be extremely helpful in the success of our community engagement plan. Furthermore, understanding the forces against change will allow us to address these forces in our community engagement plan to ensure the change we are seeking.

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Strengths and Weaknesses of the Client System

As the SWOT analysis shows, the Hikone Public Housing Community is made up of poor, minority and mostly single parent households. All the families in the community are SNAP eligible. Transportation is a problem for many of the households, and since the closest grocery is over a mile away, access to nutritious food can be difficult. The families have common interests and support each other, but motivation seems inconsistent, as they are often busy and have time and availability limitations for participation in new programs. The engagement plan has addressed this by seeking the community’s input on availability and types of events that interest them.

The Hikone community is almost entirely African American; (one Latino family); there are no language barriers. They have a well-established and organized resident council, which helps coordinate neighborhood events and maintain strong community support. The Food for Fun program implementation includes working on community gardening and other changes through the Community Action Network, whose employees are also modeling the practices of Food for Fun to help create lasting and entrenched roots from which to grow after the National Kidney Foundation is no longer involved.

Strengths and Weaknesses of the Social System

The Hikone Public Housing Community is are surrounded by a predominantly white affluent community, which could be perceived as a threat if allowed to remain polarizing. However, as the SWOT and Force Field Analysis demonstrate, the community has several social system strengths and remains amenable to change. The outlying affluent communities can be used as a resource and is currently an opportunity for the children living in public housing since they attend the public schools in those communities, which are very well funded.

The Community Action Network is partnered with WIC and Food Gatherers; each of these organizations help distribute supplemental food supplies and run other programs within the community that can be vital in providing nutritious food and fresh fruits and vegetables to the Hikone community. The National Kidney Foundation of Michigan has provided all the funds necessary for the first year of Food and Fun program implementation. The outreach is fairly simple since we are working in a community with only 29 families. Sustainability is a concern due to the lack of transportation, creating a possible food desert situation. While the Community Action Network is also a target clientele of the National Kidney Foundation, they also act as a necessary strong social support system for the Hikone community. As mentioned above, they are enforcing the Food and Fun messages in their own programs and are working hard to provide the necessary resources and added support for their residents in adopting a healthy lifestyle themselves.

Impacts of Social Justice Issues

There are a variety of social justice issues that impact the Hikone public housing community on a daily basis. The vast majority of Hikone community members are African American, while the larger Ann Arbor community is predominantly White. Living in public housing in the very affluent Ann Arbor community creates an imbalance of power. Prejudice, discrimination and oppression still strongly impact

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the Hikone community and their children. The code of ethics 6.04 Social and Political Action, states that “social workers should act to prevent and eliminate domination of, and discrimination against any person, group, or class on the basis of ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital states or mental or physical disability (NASW, 6.04 d, 1996). The National Kidney Foundation and its stakeholders realize how important this is and fights every day to make this a reality.

Those living in the Hikone public housing are all low income or very low income. Due to the low socioeconomic status of the residents living at Hikone, they are unable to afford many of the resources the city of Ann Arbor has to offer, including nutritional resources and healthy eating options. Healthy and affordable food can be hard to come by for those in public housing. The Kidney Foundation believes that everyone should have access to the same resources and education needed in living healthy lives free from health complications. However, many resident in the Hikone community do not have access to the same resources and education that many others in the Ann Arbor community do. It is our role as social workers to fight against this inequality. All people no matter the color of their skin, socio- economic status or physical location should have equal access to the resources and opportunities required to meet their basic needs and to live a healthy life (NASW, 6.04 a, 1996). Additionally, many of the residents at Hikone are unable to afford health insurance; therefore, the Food and Fun program can help to ensure good health and fewer health complications in this vulnerable community.

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Community Engagement Plan

Recommendation

The Food and Fun program is actively engaging the children of the Hikone community in after school programming, teaching children healthy behavior. The program currently engages parents and families by providing them with a regular educational newsletter and handouts promoting how to make healthy changes at home. However, the ultimate goal of the Food and Fun program is to refocus attention away from strictly intra-individual factors related to healthy behavior and more towards the interpersonal, community, organizational, and environmental determinants of healthy behavior. Furthermore, due to the nature of the public housing setting of the Hikone community and the role of the Community Action Network, organizational change must take place to ensure lasting sustainable environmental and community change. Currently the National Kidney Foundation has reached out to the Hikone Community Resident Council for support and to help promote the integration of the Food and Fun healthy behaviors and policies into the Community Action Network’s programming and meal service. However, once analyzing the SWOT and the force field analysis, it came to our attention that the lack of transportation was a rather large problem in the sustainable environmental change the Food and Fun program is seeking. Additionally, the time and availability limitations of the Hikone community residents can be a hindrance to the success of the Food and Fun program in terms of participation. With the lack of sustainable funding, the National Kidney Foundation is working hard to create environmental change in the Hikone community by involving not only the Hikone residents, but recruiting other organizations that can provide the support and resources needed to sustain a healthy lifestyle once the National Kidney Foundation is no longer involved.

In order to fully engage the Hikone community and their families in adopting long-term healthy behaviors, outreach needs to occur from several different angles to address the challenges. Utilizing the Hikone Food and Fun force field shows the strong forces for change in the Hikone community and acknowledges the forces against the change the Food and Fun program is initiating, which allows us to address these forces in a more comprehensive engagement plan. In order to implement a proper community engagement plan that promotes sustainable and lasting healthy behaviors, the following actions are recommended for the Hikone Food and Fun program:

Create a Food and Fun coalition. There are multiple organizations currently involved in making sure the Food and Fun program efforts are successful. There are also many other community organizations that could be beneficial in promoting the Food and Fun efforts. Forming a coalition inclusive of the National Kidney Foundation, the Community Action Network, the Michigan Nutrition Network, Michigan Department of Community Health, Growing Hope, Food Gatherers, and other prominent stakeholders can prove beneficial in establishing strong support in the community engagement process that outlasts the length of the grant. Meeting on a regular basis would allow these stakeholders to discuss the resources they have to offer the Hikone community and help guarantee constant communication between all the stakeholders, as they exchange resources and ideas, and establish an outreach plan that is regularly assessed for its effectiveness.

** See rich map for current organizations involved either in the Community Action Network for the Food and Fun program

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Create opportunities for educational outreach. The Community Action Network is currently partnered with Food Gatherers who help distribute supplemental food supplies and run other programs within the community that could be vital in providing nutritious food and fresh fruits and vegetables to the Hikone community. It could prove beneficial for the Hikone community if the National Kidney Foundation reached out to Food Gatherers and worked together to find a way for them to supply the Hikone community with more fresh fruits and vegetables and other healthier choices in addition to the supplemental food supplies they currently distribute. Additionally, these weekly food distribution days provide an opportunity to deliver social marketing materials and Food & Fun parent/caregiver resources along with the food distribution. In addition to providing educational and nutritional resources, providing recipes that incorporate many of the foods being distributed with easy tips included will allow busy Hikone residents to cook quick and healthier meals for their families.

Create monthly community events that promote healthy behavior. Providing frequent community events, such as informational sessions and presentations, cooking demonstrations, fitness, and dance classes can further promote the healthy Food and Fun message. Events can also help provide opportunities for skill development and support in learning how to eat healthy and teach fun and easy ways to stay physically active. Monthly community events may also encourage community cohesiveness, community support, and increased accountability, as well as provide Hikone residents with the opportunity to attend demonstrations and physical activity classes they could not otherwise afford outside their community.

Evaluation. Frequent evaluations in the form of surveys should be utilized on the individual, interpersonal, and organizational level in order to provide the National Kidney Foundation with feedback on the Food and Fun program and the community outreach efforts. This will allow the Foundation to alter the Food and Fun program interventions to best suit the needs of the children, as well as to make sure that the educational materials and events are useful to the community. Furthermore, it might prove beneficial to administer surveys to the community inquiring what types of community events they would like to attend and what days and times work best for them. In order to ensure the community engagement plan is successful, it is vital to make the community needs the number one priority. Hosting events that the community is interested in attending will help boost attendance and the educational component of the event.

Additional variables to consider

Utilizing Traditional and Nontraditional Spaces.

Utilizing both traditional and non-traditional spaces are vital in community engagement and offer multiple avenues to increase engagement. The following recommendations utilize both traditional and nontraditional places to engage and support the Hikone community in learning how to adopt healthier living habits. Currently the National Kidney Foundation is utilizing traditional means of engaging the Resident Council board members and meeting with the Community Action Network program coordinator to discuss moving forward with the Food and Fun program and the impact it will have on the entire community. However, it has been established that a formal Food and Fun coalition can have positive effects in promoting environmental change. Holding a formal coalition can be a great use of traditional spaces and time to discuss how to best continue engaging the community and delivering the Food and Fun programs’ important healthy messages. Although in addition to using traditional means

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and meeting spaces, the proposed community engagement plan also recommends multiple uses of non-traditional spaces in engaging the Hikone community.Utilizing the Community Action Network’s food pantry days to distribute educational materials and meet the people of the Hikone community is a great use of non-traditional spaces. This is a good way to engage the Hikone community in their own community and when it is most convenient for them. The fun community events are also a great use of non-traditional spaces that allow the National Kidney Foundation to connect with the residents of the Hikone community and promote the healthy messages of the Food and Fun program in a fun and easy way. Community engagement has the word community in it for a reason; therefore, it is important to understand how utilizing the target population’s community can help to promote participation and true engagement, rather than strictly using traditional means and spaces for engagement

Developing Relationships of Trust and Respect

In order to engage the community, the National Kidney Foundation has been working to create a relationship with the community based on trust and respect. Initially, the Food and Fun program reached out to the resident board, who are known residents who already have a positive reputation throughout the Hikone community. Letters were written to the resident council introducing the Food and Fun program and its objectives in the hopes of gaining the councils support. Gaining the council's support was imperative in acquiring the larger Hikone communities support and trust. In addition to reaching out to the resident board, the National Kidney Foundation’s program coordinators and interns constructed letters to the parents in the Hikone community whose children would be attending the Food and Fun after school program. These letters were intended to extend our gratitude to the Hikone community for welcoming us into their community and to introduce ourselves in order to familiarize parents to the Foundation and to the Food and Fun program. The introduction letters explained the components of the lessons, the hopes of the program staff, and requested input from the community to help plan the lessons and future events. The initial communication established that the new program intends to encourage families and all staff members to apply the healthy-habits to their own lives, so it is clear that there are no derogatory assumptions; the program is intended to work with, not on the community.

In response to the enhanced community engagement recommendations, the National Kidney Foundation Food and Fun program staff members will continue to work to gain the community’s trust by maintaining a presence and familiarity in the community through attending the food distribution days and community events. The hope is that staff can learn from the community while getting to know the residents and their families and also allowing the families to get to know them.

As a part of the new community engagement plan, program staff, working with the National Kidney Foundation, Community Action Network, and other partners, will regularly seek community input. Beginning at the first communication, parents will be asked to complete surveys asking what they would like to get out of the program, what types of events they would participate in, when they are most likely available to participate, and what kinds of recipes and food preferences they have. NKFM staff members will also reach out to community members for suggestions regarding the physical education components of the program, so they can create classes and activities based on community input. Acquiring the community’s input and feedback will further the support and trust in regards to having their needs met on their own terms.

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Issues of Social Bias and Mistrust

Social bias prevents mutually beneficial interaction among people and this would be detrimental to in-group cohesion, intergroup cooperation, and the ultimately the success of the program. The Hikone community residents are entirely African American or Latino, while most of the NKFM program staff are white. Most of the residents live in poverty. Issues of discrimination and prejudice may have played a significant role in their lives, affecting them in different ways from each other, but particularly and more meaningfully sets them apart from those leading the program.

While the goal of the National Kidney Foundation is to promote and achieve better health in poor communities, the minority community may be suspicious and resistant to engagement. It is important to recognize that each of us bring vastly different experiences to the table, which bias us in ways we won’t always see. These differences need to be discussed openly, understanding at all levels of community building that staff and residents may have completely different ideas of planning and education for good health habits.

The National Kidney Foundation and Community Action Network did not begin the program based on assumptions about the community. The partners and program staff worked with the Hikone Resident Co-council to learn about the residents before planning events and implementing the Food and Fun Program. Adequate assessment of the community and their needs is essential before establishing a positive relationship. While expectations include potential challenges along the way, the Food and Fun coalition could involve several familiar partners from which staff will continually learn throughout implementation and beyond the funding period. The proposed engagement plan remains flexible from the onset, allowing for new perspectives and adjustments in order to meet the needs of all members in the community.

Social Justice Issues Addressed

The code of ethics 6.04 Social and Political Action, states that “social workers should act to prevent and eliminate domination of, and discrimination against any person, group, or class on the basis of ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital states or mental or physical disability (NASW, 6.04 d, 1996). The Kidney Foundation believes that everyone should have access to the same resources and education needed in living healthy lives free from health complications. However, many resident in the Hikone community do not have access to the same resources and education that many others in the Ann Arbor community do. The Food and Fun program challenges the imbalance of affordable and available resources between the Ann Arbor community and the Hikone community.

Due to the low socioeconomic status of the Hikone community, lack of transportation is a problem for many residents and continues to perpetuate the food desert the Hikone public housing community is located in. Therefore, our community engagement plan addresses the lack of nutritional food by working with Food Gathers to increase the amount of fresh fruits and vegetables they provide during the weekly food distribution days. Additionally, the proposed community engagement plan recommends that the National Kidney Foundation uses these food distribution days to provide educational resources,

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healthy eating tips, as well as healthy recipes to the Hikone residents. Working with Food Gathers to enhance the quality and nutritional factor of their supplemental food distribution will help relieve the negative effects of living in a food desert and the little access the Hikone community has to healthy resources.

Furthermore, implementing a Food and Fun collation will help increase the support for further service and resource provision for the Hikone community, especially in promoting sustainable environment change once the Kidney Foundation is now longer involved. Additionally, implementing regular community events provide the opportunity for the Hikone residents to attend fitness classes, dance classes, cooking demonstration, and other events they could not otherwise afford.

  Addressing Conflicts and Differences

The Food and Fun staff and partners recognize that conflicts may arise throughout the program between organizations or individuals at all levels. The initial plan focuses on prevention, generally through establishing a working environment encouraging safe and open communication. Food and Fun staff members will debrief each week; the coalition will hold regular meetings, and the organizations within the coalition will hold meetings every month. All stakeholders in the program are committed and will come together whenever the success of the plan depends on it. Open communication will also include reaching out to community members, those involved and those who have been more reserved, explaining concerns and requesting their ideas. The goal again is to bring the community up to partnership level so that all areas of participation are on a level playing field.

The National Kidney Foundation and program staff recognize the sensitivities involved in the differences in social location that might create a challenge for program implementation and community engagement. Food can be a very personal and culturally sensitive subject. It is important to assess the situation on the whole: the predominantly white program staff and young students from the University of Michigan are coming into a community of poor African American families with the intention of teaching the children how and what to eat and telling the parents what they can do at home to help them live a healthier life. In most cases, community members may react with resentment, which is why the program must take issues of social location, race, and privilege into account with a great deal of sensitivity, while openly acknowledging this and reaching out for community input regarding the challenges that come from the situation.

Evaluation

Determining the significance and merit of the Food and Fun program will rely heavily on the environmental changes in the Hikone community as a result of engaging the community in the Food and Fun program. Outcome and process evaluation will be essential in assessing the fidelity and success of the program. Process evaluation will center on the implementation and operation of the Food and Fun coalition and enhanced community engagement plan, while the outcome evaluation will focus on the logical sequence from Food and Fun program actives, to program processes, to program outcomes.

Due the nature of the multilevel programming of the Food and Fun program, it is essential to conduct process and outcome evaluation for each level the program serves: individual, interpersonal and organizational. To ensure that the Food and Fun program and the community engagement has been implemented as intended internal weekly debriefs will be utilized to assess the suitability of each lesson, attendance, engagement of the children, and whether or not the lesson was completed. Midterm

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evaluations will be distributed to the children to gain their feedback on the after school program. Per the community engagement plan, additional surveys will be used to gain feedback from the Hikone community of the events being held. Furthermore, in order to evaluate the Community Action Network’s role in supporting the Food and Fun program, informal meetings and discussions will be held to discuss any barriers and/or matters that need to addressed in implementing environmental change in the Community Action Network and in the Hikone community. Understandings these matters will allow for further contemplation in improving the potential for the Food and Fun program. However, in order to attain funding from the Michigan Nutrition Network certain behavioral objectives must be met using the pre and post assessments proposed below. Utilizing the recommend community engagement plan will help ensure positive outcomes in implementing behavioral and environmental change.

After participating in the 12-week Food & Fun program from January 1, 2014 to September 30, 2014 children will make at least one of the following healthy lifestyle improvements as indicated by pre and post program self assessment:

o 35% will increase their consumption of fruit by at least one serving per day.o 30% will increase their consumption of vegetables by at least one serving per day.

Parents /caregivers whose children participate in the Food & Fun program during January 1, 2013 to September 30, 2014 will make at least one of the following environmental improvements in the home at the conclusion of the 12-week program as indicated by a pre-program Household Assessment and a post-program Household Assessment:

o 25% of Hikone Public Housing families will serve a fruit and/or vegetable at every meal and snack

o 25% of Hikone Public Housing families will provide opportunities for their child to engage in at least 1 hour of physical activity every day

The Community Action Network After School Program will make at least one of the following environmental improvements in the Hikone Community Center at the conclusion of the 12-week program as indicted by a pre-program Organizational Assessment and a post-program Organizational Assessment:

o The CAN After School Program will serve a fruit or vegetable to children everydayo The CAN After School Program will serve water everydayo The CAN After School Program will offer children 30 minutes of physical activity

everyday

Funding

Currently the Food and Fun program is being funded by the Michigan Nutrition Network for a total of 11,000 dollars for the length of seven months, January 1, 2014 to September 30, 2014. The National Kidney Foundation is funded by the Michigan Nutrition Network’s Coaching for Behavior Change pilot project, exploring how coaching skills coupled with SNAP-Ed programming can move participants toward lasting behavior change. It is designed for those who are providing nutrition education and promoting physical activity. While the National Kidney Foundation only received 11,000 dollars to implement the Food and Fun program in the Hikone community, it was not without the opportunity to receive further funding if the program proved successful. The National Kidney Foundation is currently in the process of writing a grant in order to acquire 36,000 dollars to implement the Food and Fun program in all three of the Community Action Network’s public housing sites to further the impact of the Food and Fun program and community outreach can have in attaining and sustaining environmental change in the public housing setting .

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Justification and Final Comments

Justification

The goal of the National Kidney Foundation is to prevent kidney disease and to improve the quality of life of those with kidney disease. Since diabetes and high blood pressure are the leading causes of kidney disease, the Food and Fun program aims to prevent both by promoting good nutrition and a physically active lifestyle. The program targets vulnerable communities with high SNAP eligible residents, as these communities are most impacted by kidney disease. Communities with high poverty are often located in food deserts with little easy access to fresh healthy foods. The Food and Fun program aims to increase fruit, vegetable, whole grain and low-fat food consumption in the Hikone community with increased healthy food distribution through Community Action Network and Food Gatherers, and the use of the community garden. The program also helps create daily routines, which increase regular physical activity for residents and their families.

The impact of the program is both short and long term. It will lower the risk of child obesity, which could lead to chronic diseases in adulthood. For adults, it will help reduce the likelihood of type-two diabetes, obesity and high blood pressure, all of which will result in longer and better quality of life for all residents.

The Food and Fun program will also have several more immediately positive impacts on the Hikone community. Through program implementation, families are brought closer together, as the events and activities encourage family involvement through taste testing and recipe sharing; children and parents work together to change eating habits. Through community events and activities, the program helps families spend more time together and builds a stronger community through participation and engagement.

The stakeholders and partners in the program are dedicated to sustainability and will work with the community to continue healthy food consumption on their own, after the Kidney Foundation is no longer involved, through fresh food distribution and maintaining the community garden. Physical activities are encouraged rather than the passive activities that often distance families. The program helps inspire and build a routine of physical activity for families and community, ensuring the playgrounds and fitness trails will be used, maintained, and further developed by the community.

Conclusion

The National Kidney Foundation, with the partnership of the Community Action Network and other food distribution services, has created an engaging program for poor minority communities. The Food and Fun program aims to improve the quality of life through the prevention of obesity, diabetes, and hypertension, the major causes of kidney disease. The program organizers will work to earn the trust and respect of the Hikone community through the creation of a community partnership involving a more vertical relationship with organizers and residents, as they all work together toward a common goal of increased well being and a healthy active lifestyle.

Implementation of the Food for Fun program at the Hikone public housing community will increase the distribution of fresh produce, increase awareness of establishing a healthy eating habits and physically

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active routines, starting first with the children, reaching into their home, spreading to parents and families through inclusive outreach and events and on to sustainability and the development of a supportive and stronger community.

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