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  kathryn@ecocenter.org      (313)733-­‐0039    www.ecocenter.org/healthy-­‐food      www.healthyfoodinhealthcare.org        

Denise  Pike  Development  Director  CHASS  Center  dpike@chasscenter.org  (313)849-­‐3920  x5021