Embed Size (px)
DESCRIPTION
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 http://www.ecocenter.org/healthy-food/fruit-vegetable-prescriptions to learn more.
Citation preview
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
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 -‐
• Promotes & disseminates educational opportunities, tools, resources and campaigns
• Advances special projects and promising approaches
• Offers introductory assistance • Offers guidance on procuring local
and sustainable foods • Educates and activates health
professionals
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
Application Deadline: February 14, 2014
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
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.
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.
Healthy Food in Health Care Principles
• Widespread exposure to toxic chemicals
• Antibiotic resistance • Food-‐borne illness • Environmental degradation
• High levels of nutritionally-‐deplete foods Chemicals
Overuse of Antibiotics
Confined Animal Feeding Operations
Key health concerns in our industrialized food system
Overuse of Antibiotics Chemicals
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.
Making Change Locally
Largest Impact
Examples Eat healthy,
be physically ac1ve
Rx for high cholesterol, diabetes. Vitamin/Mineral supplements
Poverty, educa1on level, inequality
Immuniza1ons, exercise, colonoscopy
Strategic Food/Bev Pricing, HFHC Pledge, Farmers Markets,
CSA
Socioeconomic Factors
Changing the Context to make individuals’ default decisions healthy
Long-‐las1ng Protec1ve Interven1ons
Clinical Interven1ons
Counseling & Educa1on
Smallest Impact
Largest Impact
www.cdc.gov/about/grand-rounds/archives/2010/download/GR-021810.pdf
Factors that affect health
Changing your thinking: A systems perspective
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)
Farm & Food Policy Healthier Eating Environments
Behavior Change
Hospital Supported Farmer’s Markets
Community Supported Agriculture
Hospital Supported Farms/Gardens
Resource: Health Care Without Harm 2011 National Survey
“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
Health care grows good food access
Through farm stands or markets
John Muir Medical Center, Concord, CA
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)
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: 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
The median age was 47.2
Women 87%
Men 13%
Participant Demographics
Two or more ethnici1es
Caucasian/White
African American
La1no/Hispanic
33%9
13%9
4%9
49%9
Self-‐reported Race
Self-‐reported gender
Expected outcome: Increased knowledge of how to select, prepare and store fresh produce
22.2%
17.8%
28.9%
24.4%
4.4%
21.9%
12.5%
62.5%
3.1%
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Post-‐survey (N=32)
Pre-‐survey (N=45)
Post-‐survey
Pre-‐survey
Post-‐survey
Pre-‐survey
Pre-‐survey
Post-‐survey
Pre-‐survey
I know how to store fresh fruits and vegetables to increase their shelf life.
Expected outcome: Increased servings per day of fruits and vegetables
2.9 2.95 3 3.05 3.1 3.15 3.2 3.25
Pre-‐survey(N=45)
Post-‐survey (N=32) 3.23 cups
3.02 cups
Expected outcome: Consider CHASS Mercado as a viable grocery option
6.3%
53.1%
37.5%
Neutral
Agree
Strongly Agree
I would shop at the CHASS Mercado again next summer
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
Questions?
Closing
Kathryn Savoie Detroit Community Health Director Ecology Center [email protected] (313)733-‐0039 www.ecocenter.org/healthy-‐food www.healthyfoodinhealthcare.org
Denise Pike Development Director CHASS Center [email protected] (313)849-‐3920 x5021
