Progress 09/01/24 to 08/31/25

Outputs
Target Audience: The target group for the Food for Healing GusNIP project are Native adults living in rural Lake County, CA, affected by interrupted traditional food pathways, decreasing access to affordable healthy foods andhigher levels of chronic conditions, such as diabetes/pre-diabetes, hypertension, cardio-vascular disease, and/or obesity. The grant was awarded September 1, 2024; however, participant enrollment began in June 2025 after further project planning was completed, IRB approvals were received, the produce supplier and Tribal distribution locations were developed, and data collection and management processes had been established. Eligibility for the GusNIP program is determined through an interview process, and those deemed eligible are adult patients of LCTHC having at least one chronic disease, self-reporting food insecurity, and/or indicating eligibility for Medicaid, SNAP or Commodities. At the end of August 2025, 14 participants were enrolled from the target group. Data from the 14 completed intake forms and pre-assessments indicated participants were: 100% Native or a member of a Native family; 64% from Robinson Rancheria and 36% from Habematolel Pomo of Upper Lake (HPUL); 29% Male and 71% Female; Average aged 63.6 years old, with oldest at 82 years old and youngest at 25 years old; 50% living alone, 43% living in household with 2-4 people; and 7% living in a household with 5 or more people; 57% self-reported in good health, 21% Fair, 14% poor and 7% had no response.; 79% with at least one diet-related chronic condition; and 57% food insecure with 29% enrolled in SNAP. In addition, responses to the pre-assessments indicated 64% eat fruit at least weekly with 7% who eat fruit daily, 50% eat leafy greens at least weekly with none eating leafy greens daily, and 43% eat other vegetables weekly with none eating vegetables daily. Changes/Problems:We did not make major changes this past year, such as those indicated above, in our GusNIP Food for Healing project. However, we had originally proposed that participants for the PPR would receive a financial incentive (originally proposed at $100/month) to purchase fruits and vegetables at a local grocery store; instead, Food for Healing participants receive a twice monthly Community Supported Agriculture (CSA) bag of fresh produce sourced by the LCTHC PPR program through purchases from local farmers, Farmer's Markets and/or local distributors (currently North Coast Opportunities). We received original IRB approval in January 2025, and this was updated to reflect this change in approach in April 2025. The focus on Native eligibility for participants, value of the incentive provided per participant, and plans to meet the grant requirement of 30 pre/post-assessments based on the current core metrics have remained unchanged, with the study to analyze changes in consumption, food security, health care usage and clinical outcomes as previously proposed. We made this change in incentive distribution approach based on the limited number of grocery stores in Lake County with the technology to use the FreshConnect debit card; and after further researching the food sovereignty and security programs being offered to Tribal members by the local six federally recognized tribes. We found that four of the six tribes were already offering financial support monthly or quarterly to their members for food purchases. As a result, the PPR Food for Healing project has been working closely with the tribes to supplement their food programs by distributing fresh produce and providing recipes, offering produce tastings, and implementing nutrition education workshops. Through the PPR, fresh produce is currently being distributed at two tribal specific locations on an agreed-upon schedule for those participating in the program. This helps to alleviate issues around transportation for some participants. In addition, we have arranged with the participating tribes to support and assist as needed with distribution to their tribal members who are unable to pick up their CSA bag themselves at these locations and need additional support either because of scheduling, transportation or mobility issues. What opportunities for training and professional development has the project provided?The Food for Healing Project Director (Gemalli Austin) attended the National Convening for GusNIP in Minneapolis on May 20-22, 2025. Staff were trained in What Can I Eat (WCIE) nutrition curriculum on December 2-3, 2024 held onsite at LCTHC. WCIE training increased project staff's nutrition knowledge and provides the basis for the nutrition education workshops offered for project participants on distribution days at the Tribal Rancherias. In addition, each LCTHC staff member is required to complete 15 hours per year of Continuing Education to maintain the Diabetes program's ADA accreditation. Staff attend Indian Health Services (IHS) Continuing Education online, including training on food insecurity, social drivers of health and diabetes, Tribal data sovereignty, motivational interviewing, exploring the GI System, health coaching, managing blood sugars, and diabetes prevention and management. How have the results been disseminated to communities of interest?The Project Team presented at the GusNIP Nutrition Incentitive Hub Community of Practice on April 28, 2025, and have agreed to present at the PPR Community of Practice to be held in November 2025. Meetings of the Hinth'el Wellness Council (HWC) and other community partners have included information about and announcements of upcoming nutrition and other health education workshops needed to establish eligibility for Food for Healing, and updates on the project's status and next steps during the past year. HWC is a community advisory board with representatives from the six federally recognized tribes served at LCTHC. HWC provides cultural, traditional and community knowledge and ensures our public health programming respects indigenous values and reflects the needs of each unique community. This LCTHC Tribal Advisory group now meets quarterly to review and advise on LCTHC Diabetes and Tobacco programs and activities, including Food for Healing. The LCTHC Board Leadership is the governmental advisory board with representatives from the six federally recognized tribes. It provides governmental guidance on behalf of the six federally recognized tribes and ensures that public health programming is driven by the health needs of these tribes. Written Board reports on Food for Healing are provided monthly. The Project Coordinator recently met with the LCTHC Medical Department staff to discuss the Food for Healing program goals and objectives, patient activities and services provided, and processes to encourage patient referrals. There was a lot of interest among the Medical Team; the PPR team will continue to connect with the Diabetes Educator in Medical to receive patient referrals. What do you plan to do during the next reporting period to accomplish the goals? In the next reporting period, the Food for Healing Project Team plans to: Work to expand enrollment among the local Tribal community, adding at least two additional distribution sites to the current two Tribal locations operating as of September 2025. Continue to expand the ages of adult participants, including more participants under age 60. The average age of participants is currently 63.6 years old. Add a new supplier of produce during the winter season, with a continuing focus on access to local produce. Have participantswho have completed their first 6 months of enrollment complete the post-assessments and work to re-enroll these participants for another 6-month period. Continue to track consumption levels of fruits and vegetables, changes in food insecurity, and use of health careamong participants.

Impacts
What was accomplished under these goals? Objective #1: 10 AIAN adults living in Lake County were enrolled in the Food for Healing project between June-August 2025 and received produce distribution; four additional participants were enrolled at the end of August but began distribution in September. Eight (57%) of the 14 participants had taken diabetes or chronic disease self-management workshops (DSME/CDSME) or CookItUp! CalFresh Nutrition classes prior to enrollment; the other 6 participants are receiving What Can I Eat (WCIE) nutrition workshops on distribution days. As a measure of engagement, of the 10 participants receiving produce distribution as of the end of August, on average, 70% (7of 10)attended the WCIE nutrition education sessions consistently between June-August. All 14 participants enrolled as of the end of August were food insecure, at risk for or managing at least one diet-related chronic disease and/or eligible for or enrolled in Medicaid (MediCal) or Supplemental Nutrition Assistance Program (SNAP). Of these 14 participants, 8 (57%) indicated their family experiences food insecurity; and 11 (79%) were dealing with at least one diet-related chronic disease (pre-diabetes, diabetes, obesity, cardiovascular disease, or hypertension). Objective #2: The Food for Healing Project in Lake County has developed and implemented: Activities: 14 participants were interviewed and enrolled from June-August 2025 and each completed the GusNIP PPR interview questionnaire, informed consents and pre-assessment. Events: A total of 6 nutrition workshops were held at one Rancheria (Robinson) for the 10 enrolled Tribal participants from two of the six local tribes (Robinson and Habematolel Pomo of Upper Lake) on produce distribution days every two weeks during June-August 2025. Four additional participants were enrolled at the end of August and started nutrition workshops and distribution in September. Services: Participants were provided with a tasting of specific fruits/vegetables at each distribution day to encourage consumption. Tastings were prepared from recipes using highlighted vegetables and fruits from the distribution bag. From June-August 2025, our Food for Healing program has created a collection of simple, and affordable recipes. Out of more than 30 recipes provided to participants during this reporting period, we highlighted 12 in our presentations and provided tasting samples of these vegetables to participants. These included veggie-forward soups, sautéed greens, roasted squash, fruit-infused waters, and quick skillet meals using produce from the program. Each recipe was intentionally modified to support chronic disease management by reducing added sugars, lowering sodium, and replacing processed ingredients with fresh vegetables, herbs, and healthy fats. Many dishes surprised participants in the best way--for example, our eggplant-pizza bites became an unexpected favorite, even among those who previously had mixed views of eggplant. The broccoli and apple salad was also a major hit, with several participants going back for second servings. And our peach-tofu skewers turned into one of the most delightful recipes we've introduced, inspiring participants to adopt it for their summer BBQ gatherings. Together, these recipes--paired with one-pan methods and culturally aligned flavors--help participants to build confidence in cooking, explore new produce, and make healthy eating realistic. Products: The Food for Healing program works in partnership with the six federally recognized tribes in Lake County. Distribution sites are currently on the tribal land of 2 of the 6 tribes. These tribal partnerships were strengthened during this period with the Elder Coordinator at each of the tribes encouraging enrollment and assisting in distribution. The LCTHC Food for Healing staffcreated a series of PowerPoint presentations used on each of the produce distribution days. The presentations include a focus on a vegetable or fruit to be included in the distribution that day, cultural history and/or traditional Tribal connections to the produce being provided, nutrition information about that highlighted vegetable or fruit, recipes including the range of fruits/vegetables included in the produce bag, and colorful attractive pictures intended to encourage the participants to try the fruits/vegetables being provided. The participants are encouraged to send back a photo of dishes they have prepared at home with the fruits/vegetables included. These are shared with the group on the next distribution day. We do not have post-assessment data to be able to analyze changes in food insecurity or consumption of fruits and vegetables. We have not completed the GusNIP post-assessments using the core metrics as yet since none of the participants have completed their first 6 months of enrollment. The first 10 participants to complete 6 months will be from the cohort receiving produce at the Robinson Rancheria distribution location and we will be working with them to complete their post-assessments in November/December. We anticipate that this group will also re-enroll in the program for another 6-month period. Preliminary data collected in check-ins with participants indicate an increase in consumption in the first couple months of their participation, but a return to consumption levels like those at the start of the project after about 3-4 months of participation. This may have been an effect of the limited variety of produce available at the end of the growing season. We are exploring reasons for this consumption pattern with participants. All 10 participants indicated they were very satisfied or satisfied with the program after three months of participation. Objective #3: Of the 10 participants with check-in data, 60% (6) have utilized health care to manage their diet-related or other chronic conditions. Self-reported utilization of health care by the 10 participants during the initial months of enrollment included: 4 primary doctor visits for regular check-ups for their chronic condition(s); 2 Registered Dietitian visits; 1 Podiatrist visit; 4 visits with cardiovascular specialists; 1 Pain management visit; and 1 Emergency room visit for a fall and head trauma. We will continue to collect data on ER visits, and primary doctor, RD and other doctor visits in check-ins every two months with participants.

Publications