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.

1. Bringing
Food
Prescription
Programs
to
Detroit:
CHASS
Health
Rx
–
Year
1
CHASS
Center
February
12,
2014

2. Welcome
Denise
Pike,
Development
Director,
CHASS

3. Introductions
Kathryn
Savoie,
Detroit
Community
Health
Director,
Ecology
Center

4. 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

5. 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

6. 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

7. campaigns
Advances
special
projects
and
promising
approaches
-­‐
• Offers
introductory
assistance
• Offers
guidance
on
procuring
local
and
sustainable
foods
• Educates
and
activates
health
professionals
• Promotes
&
disseminates
educational
opportunities,
tools,
resources
and
campaigns
• Advances
special
projects
and
promising
approaches

8. 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

9. Healthy
Food
in
Health
Care
–
New
Projects
Health
Leaders
Fellowship
q Leadership
development,
training
&
field
experience
q
Climate
and
energy,
environmental
health,
healthy
food
systems,
civic
engagement
q Health
professionals
of
all
types,
at
any
stage
of
their
career
Application
Deadline:
February
14,
2014

10.
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.

11. Healthy
Food
in
Health
Care
Principles
Food
supply
can
be
met
in
a
variety
of
ways
which
have
consequences
in
terms
of
nutrition,
disease
risk,
public
health,
environmental
health,
social
and
economic
well
being.
Healthy
food
comes
from
a
food
system
that
is
ecologically
sound
economically
viable,
and
socially
responsible.

12.
Key
health
concerns
in
our
industrialized
food
system
• Widespread
exposure
to
toxic
chemicals
• Antibiotic
resistance
• Food-­‐borne
illness
• Environmental
degradation
• High
levels
of
nutritionally-­‐deplete
foods
Confined Animal Feeding
Operations
Overuse of Antibiotics
Overuse of Antibiotics
Chemicals
Chemicals

13. Making
Change
Locally
Institute of Medicine, 2009
“[P]arents and other adult caregivers play a
fundamental role in teaching children about healthy
behaviors…. But those positive efforts can be
undermined by local environments that are poorly
suited to supporting healthy behaviors.”
Strategy 3: Community Food Access
Promote efforts to provide fruits and
vegetables in a variety of settings, such as
farmers’ markets, farm stands, mobile
markets, community gardens, and youth
focused gardens.

14. Factors
that
affect
health
Smallest
Impact
Examples
Counseling
&
Educa1on
Clinical
Interven1ons
Long-­‐las1ng
Protec1ve
Interven1ons
Changing
the
Context
to
make
individuals’
default
decisions
healthy
Largest
Largest
Impact
Impact
Socioeconomic
Factors
www.cdc.gov/about/grand-rounds/archives/2010/download/GR-021810.pdf
Eat
healthy,
be
physically
ac1ve
Rx
for
high
cholesterol,
diabetes.
Vitamin/Mineral
supplements
Immuniza1ons,
exercise,
colonoscopy
Strategic
Food/Bev
Pricing,
HFHC
Pledge,
Farmers
Markets,
CSA
Poverty,
educa1on
level,
inequality

15. Changing
your
thinking:
A
systems
perspective
Farm & Food Policy
Healthier Eating Environments
Behavior Change
Story M, Hamm MW, Wallinga D, eds. Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier
Communities (suppl) Journal of Hunger & Environmental Nutrition, Volume 4, Issues 3 & 4. December 2009 (in press)

16. Health
care
grows
good
food
access
Hospital
Supported
Farmer’s
Markets
Community
Supported
Agriculture
Hospital
Supported
Farms/Gardens
“Our greatest 2010 success was getting staff, patients and visitors to appreciate
what locally produced food is like versus food produced on industrial farms
hundreds or thousands of miles away.”
—Mike Bersani, Manager Clinical Nutrition Services, Catering and Dining Services, MidMichigan Medical Center, Clare, Michigan
Resource: Health Care Without Harm 2011 National Survey

17. Through
farm
stands
or
markets

18. Community
Supported
Agriculture
(CSA)
drop-­‐offs
at
health
care
sites
Henry
Ford
Health
System
Fresh
Food
Share
Delivery
Sites:
1
Ford
Place
Detroit,
MI
48202
New
Center
One
:
Contact
Center
(3rd
Floor)
New
Center
One
:
Clinics
(7th
&
8th
Floors)
John
Muir
Medical
Center,
Concord,
CA

19. Health
care
farming…
Henry
Ford
Hospital
West
Bloomfield
Organic
Hydroponic
Greenhouse
The
Farm
at
St.
Joe’s
Ann
Arbor

20. 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

21. 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

22. CHASS
Health
Rx
Pilot
2013
Program
Overview

23. 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

24. CHASS
Center

25. 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

26. 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

27. How
did
it
work?

28.
Program
Evaluation
and
Outcomes

29. Program Evaluation
and Outcomes

30. 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

31. 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

33. 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

34. Outcome
Evaluation
Plan
To
document
attainment
of
outcomes,
service
learning
goals
To
capture
participant
perspective,
including
attainment
of
unexpected
outcomes

35. Participant
Demographics
The
median
age
was
47.2
Self-­‐reported
Race
9
49%
La1no/Hispanic
Self-­‐reported
gender
33%9
African
American
Men
13%
13%9
Caucasian/White
Women
87%
Two
or
more
ethnici1es
4%9

36.
Expected
outcome:
Increased
knowledge
of
how
to
select,
prepare
and
store
fresh
produce
I
know
how
to
store
fresh
fruits
and
vegetables
to
increase
their
shelf
life.
Strongly
Agree
Agree
Neutral
Disagree
Strongly
Disagree
3.1%
4.4%
Post-­‐survey
24.4%
Pre-­‐survey
Post-­‐survey
Pre-­‐survey
Post-­‐survey
Pre-­‐survey
Pre-­‐survey
12.5%
28.9%
21.9%
17.8%
22.2%
62.5%
Post-­‐survey
(N=32)
Pre-­‐survey
(N=45)

37.
Expected
outcome:
Increased
servings
per
day
of
fruits
and
vegetables
3.23
cups
Post-­‐survey
(N=32)
Pre-­‐survey(N=45)
3.02
cups
2.9
2.95
3
3.05
3.1
3.15
3.2
3.25

38. Expected
outcome:
Consider
CHASS
Mercado
as
a
viable
grocery
option
I
would
shop
at
the
CHASS
Mercado
again
next
summer
Strongly
Agree
37.5%
Agree
Neutral
53.1%
6.3%

39. 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.”

40. Evaluation
Lessons
Learned
• Unique
identifiers
for
participants
• Token
redemption
data
• Market
currency

41. Year
Two
Evaluation

42. CHASS
Health
Rx
Plans
for
2014
–
Year
2

43. 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

44. Bringing
Food
Prescriptions
to
Detroit
Next
Steps
&
Vision

45. 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

46. 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

47. Questions?

48. 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