Community context matters: The role of local health departments in leading an integrated approach...
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Community context matters: The role of local health
departments in leading an integrated approach to SNAP-
Ed
Caroline Kurtz, PhD
Community and School Policy and Training Section; Community Development Unit
Nutrition Education and Obesity Prevention Branch (NEOPB)
California Department of Public Health
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What was the role of the Local Health Department in developing an integrated
work approach to SNAP-Ed?
Why a Local Health Department (LHD) Model?
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United States Department of Agriculture (USDA)
Food & Nutrition Service
$401 million (National)
County Welfare Departments
(CDSS)
California Department of Food and
Agriculture (CDFA)
California Department of Public Health (CDPH)University of California
CalFresh Nutrition Education Program
(UC CalFresh NEP)
California Department of Social Services (CDSS)
CalFresh Branch
SNAP-Ed Oversight Agency
3
Updated: 2/2014
California Department of
Aging (CDA)
59 Local Health
Departments (LHDs)
19 County Welfare
Depts (CWD)+CCC
22 Area Agencies on
Aging (AAA)5 County Fairs
30 County Cooperative
Extension Services
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Change happens…• Projected SNAP-Ed funding declines• Healthy Hunger-Free Kids Act (HHFKA) of
2010• Based on successful on other public health
programs, including the California Tobacco Control model
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CDPH Snap-Ed Funds, 2007-2015 (projected)
FFY 1997
FFY 1998
FFY 1999
FFY 2000
FFY 2001
FFY 2002
FFY 2003
FFY 2004
FFY 2005
FFY 2006
FFY 2007
FFY 2008
FFY 2009
FFY 2010
FFY 2011
FFY 2012
FFY 2013
FFY 2014
FFY 2015
(projec
ted)
$-
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
State Share Federal Share/Grant
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Previous Network Funding Modelfor Local Assistance
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Healthy, Hunger-Free Kids Act of 2010
• Sec. 241: – Replaces 50% match with capped grants;– Allows policy, systems and environmental
supports, with USDA approval of State Plan;
– Bases funds in future years on SNAP participation.
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Change Happens…• Projected SNAP-Ed funding declines• Healthy Hunger-Free Kids Act (HHFKA) of
2010• Based on successful on other public health
programs, including the California Tobacco Control model
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What does change for California look like?
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Three years of Transition
2011
* Planning with internal and
external advisors,
stakeholders;
2012
* LHD Model announced;
* Additional year of funds
allocated to all Network;
* New USDA PO.
2013
* Planned federal funds
reductions;
* Plan implementation
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252 stakeholders provided input to the NEOPB transition
123 participants who are
Current Network contractors
129 participants who are
not currently Network contractors
Organizations
Local Health Dept. (98)
Schools (40)
Social Services (14)
Universities/UCCE (25)
CBOs(75)
(Three-year transition plan) Stakeholder Meeting Demographics
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NEOP Branch Proposed Organizational Chart
Program Sections within NEOPB are Local Support, Information and Communication, Partnerships and Resource Development, Research and Evaluation
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1) Funds based on the target population
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2) Designated Local Lead Agencies (Local Health Departments)
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Network Model LHD ModelAgreement Type Contracts Grants
Boundaries Small, Very defined, eg school
Geographic and generally large encompassing many localities, school districts, etc
Populations Served Generally small, defined, sometimes diverse
Large, diverse
Partners Varies but probably limited
Large groups of diverse partners in all sectors including schools, parks and recs, city governments, healthcare organizations, chambers of commerce, business, utilities,
Influence Generally limited if not in size then in scope
Policy, legal, political.
Advantages of the LHD Model
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3) Require subcontracts with Community-based Organizations
In 2014, 190 contracts in place with Community-based Organizations (up from 175 in 2013);
1 2100110120130140150160170180190200
2013 2015Federal Fiscal Year (FFY)
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4) Implement A Coordinated Blend of Strategies
• Do an assessment of community needs• Collaboratively develop an integrated SNAP-
Ed work plan, • Develop and leverage SNAP-Ed and non
SNAP-Ed funded partnerships that have a cause in common with obesity prevention
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5) Establish Statewide Objectives
1) Healthy foods, mostly fruits and vegetables
2) Healthy beverages and water
3) Physical activity
4) Community supports
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What is the role of the LHDs?
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Almost 200 subcontracting entities: school-based,
community-based and faith-based
200 subcontracting entities: school-based,
community-based and faith-based
59 Local Health Department
Coalitions
Statewide Evaluation
California SNAP-Ed Program
Training Resource
Centers
Statewide Media Campaign
Health Executives and
Officer Associations
Statewide Partnerships
Office of
State
Printing
Technical
Assistance
policy
development
State Agency
Collaboration
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A Powerful Equation
Statewide Media
Community Based Efforts+
=Social Norm Change
Healthier
Communities
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What is the Role of Media?• To be ahead of the wave (public opinion)• To use the energy at the front of the
wave to pull public opinion forward • To support program goals
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FFY 2015 State-wide mass media campaignMulticultural
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Vision for Local Health Departments• Improve the environment with policy,
systems, and environmental (PSE) change strategies that is supported and backed up by direct education
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Why policy, systems, and environmental changes are Important Outcomes
• Creates demand for and reinforces change in individual and group behavior
• Protects health or the environment• Sets expectations• Maximizes resources• Builds the capacity of local communities• Institutionalizes change
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Training Resource Centers
North Coast and Cascades:
California State University, Chico
San Francisco Bay Area:
Public Health Institute
Central Coast:
Monterey County Public Health
Greater Los Angeles:
California Center for Public Health Advocacy
Delta and Gold Country:
Health Education Council
Inland Desert:
University of California
at San Diego School of Medicine
Center for Community Health
Central Valley:
Public Health Institute
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Putting the LHD model into action
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Guiding principles for the local integrated work plan• Work plan responds to community needs
and evaluate the work beyond reporting counts.
• Build synergy with funded and unfunded partners and leverage existing resources
• Be a model for SNAP-Ed delivery by developing strategic partnerships to widen the sphere of influence in the community
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PG: 20
Looking at the Layers
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SNAP-Ed
County Profiles
-Secondary analysis of data
-Used as starting point
-Uniform data for all
jurisdictions
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Populating our County Map
1. Draw your county map on a flip chart—fill the page
2. Each LIA will populate the county map with the activities they provide in each intervention strategy area
• Look at the color key for intervention strategy areas
• Write each of your activities on the post-it note intervention that it most supports
• Include the name of the program, location, and target population
• Put your program initials at the bottom right hand corner of each post it
3. Place your post it notes on the map to indicate it’s location in the county
Asset Mapping: Individual Local Implementing
Agency Activity
PG: 8
11:05–12:00
Healthy Choices Videos – Kern County
Elderly Population Countywide
AAS
a. Nutrition Education – Blue
b. Media, Social Media & PR – Green
c. Community Events – Yellow
d. Coordination & Collaboration – Pink
e. Training & Technical Assistance – Purple
f. Policy, Systems and Environmental Change - Fuchsia
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Policy, Systems, Environmental (PSE) Change Evaluation with RE-AIM framework
A framework for planning and evaluating PSE intervention
• R – Reach • A – Adoption• I – Implementation• E – Effectiveness• M – Maintenance
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Core RE-AIM IndicatorsIntegrated with
WRO SNAP-ED Evaluation
Framework
http://snap.nal.usda.gov/snap/WesternRegionEvaluationFramework.pdf
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REACH• # and % of all people • Did you reach your target audience?
• Example: # of people and % of the target population affected--representative and most at risk– # of people shopping at farmers’ markets in low-
income area
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Adoption• # and % of settings that decided to initiate a
program or policy, systems, or environmental change strategy?
• Did the community decide the PSE was something they wanted to take on?
• Did the community choose to put the PSE into place?
• Example: The # and % of settings participating-- appropriateness of settings (and partners) for reaching/engaging the target population – # of farmers’ markets established
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Implementation• # and % of settings, organizations,
communities that put into place activities with fidelity
• Was the intervention delivered as intended?
• Example: Change is implemented as intended; fidelity – # of farmers participating in farmers’ markets each
week– Quality, price, and variety of fruits and vegetables
sold at farmers market
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Effectiveness (Efficacy)• What was the impact of the intervention
on outcomes (short, medium, or long-term)?
• What worked well? What didn’t work well?
• Example: Short term outcomes--actual environmental changes; intermediate outcomes-- effects on health behaviors – Local sales of fruits and vegetables as reported by
participating farmers
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Maintenance• What is the extent a PSE has been
institutionalized?
• Example: Individual level – individuals continue to exhibit the desired health behavior changes. Setting level – environmental change is maintained. New barriers to use are prevented or mitigated.– # of farmers’ markets that were established yearly, #
that continue to operate; EBT accepted; bonus incentive programs continue
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Integrated Work Plan Timeline
February 27–28, 2014
SNAP-Ed Local Implementing Agency (LIA) Forum
February 28–June 30, 2014
CNAP/Integrated work plan development.
CDSS and State Implementing Agencies (SIAs) to provide technical assistance throughout the
process .
June 2014
Final Date to submit LIAs Budgets to the state (individually).
Budget review process begins by all SIAs; comments will be sent to pre-identified work plan
coordinators.
June 2014
SIAs package and submits individual final work plans, budgets and other needed documents for
CDSS’s review. LIAs submit final work plan and budget (with comments from SIAs incorporated).
CDSS review process continues.
August 1, 2014
FFY 2015 SNAP-Ed State Plan is finalized and ready for submittal to USDA-FNS.
August 15,2014
Official Deadline to submit California’s SNAP-Ed State Plan to USDA-FNS.