Performing Department
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Non Technical Summary
Lake County Tribal Health Consortium's Produce Prescription Program (LCTHC PPR) aims toadvance the health and well-being of American Indian and Alaska Native (AIAN) adults livingin Lake County, CA, by addressing food insecurity, dietary habits, and optimizing healthcareutilization. Over the three-year grant period, our objective is to cultivate a community whereAIAN individuals have equitable access to fresh fruits and vegetables; experience improved foodsecurity; and engage proactively with primary care and dietitian services to increase healthliteracy, effectively manage diet-related chronic diseases, and reduce severe diseasecomplications and unnecessary emergency use of healthcare services. Our methods will includethe collaboration of community organizations, the development of an eligibility and enrollmentprocess, the implementation of culturally-tailored skill-building nutrition and cooking educationsessions, coaching on effective budgeting and shopping, and the provision of $100 per month forsix months of fresh fruit and vegetable vouchers through FreshConnect. Through these methods,LCTHC PPR aims to enroll and empower 300 eligible AIAN adults who are food insecure andmanaging at least one diet-related chronic disease. The collaborative ground-up efforts ofLCTHC's PPR will create sustainable and positive impacts on the health and resilience of therural and under-resourced AIAN communities in Lake County, CA, laying the foundation forlong-term health equity, longevity, and holistic wellness.
Animal Health Component
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Research Effort Categories
Basic
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Applied
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Developmental
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Goals / Objectives
LCTHC PPR aims to advance countywide health and wellbeing of AIAN adults by addressing food insecurity, dietary habits and optimizing healthcare utilization. The vision is to cultivate a community where AIAN individuals have equitable access to nutritious foods, improved food security and engage proactively with primary care and Registered Dietitian Nutritionist (RDN)services to effectively manage diet-related chronic diseases. Our three objectives and corresponding outcomes are:Objective 1: Develop a PPR eligibility and enrollment process (which includes four-weeks required nutrition education) to enable enrollment of a total of 300 AIAN adults living in Lake County who are food insecure, at risk for or managing at least one diet-related chronic disease and are eligible for or enrolled in Medicaid (MediCal) or Supplemental Nutrition Assistance Program (SNAP).Objective 2: For AIAN adult PPR participants living in Lake County, decrease levels of food insecurity by 10% and increase consumption of fresh fruits and vegetables by10% through the distribution of food vouchers.o additional resources. At the end of the six-month program period, 70% of PPR participants will enroll into additional food assistance programs to sustain continued procurement of fresh fruits and vegetables.Objective 3: Decrease emergency room use and associated costs by 10% and promote positive utilization by increasing primary care visits and use of other health services, including registered dietitians, behavioral health, physical therapy, chiropractic care, and acupuncture, etc.
Project Methods
The goals of LCTHC's PPR are to (1) decrease levels of food insecurity for participating LCTHC AIAN adult patients, (2) increase the consumption of fruits and vegetables for LCTHC AIAN adult patients, and (3) increase AIAN adult patients' positive utilization of LCTHC clinic services to prevent serious chronic disease complications and decrease emergency use.This proposal represents our preliminary methodsfor this program. LCTHC agrees to cooperate with the NTAE center on: (1) supporting implementation of their evaluation requirements, (2) meeting periodically with staff from NIFA, FNS, NTAE, and other GusNIP grantees to review project plans, evaluation objectives and methods, data collection, analysis, and reporting requirements, (3) facilitating access to or providing documentation of project implementation, operations, costs and outcomes, and (4) facilitating site visits and interviews with project staff, partners and program participants as requested or required.The target population for the PPR will be adult AIAN patients diagnosed with at least one diet-related chronic disease, who are food insecure and enrolled in or eligible for MediCal or SNAP benefits. An enrollment of 300 eligible AIAN adults is estimated over the course of the LCTHC PPR three-year grant time period. The PPR intervention is to recruit eligible AIAN adult participants from a handful of LCTHC workshops/programs: completers of at least four classes of What Can I Eat, the Diabetes Prevention Program, Diabetes Self-Managment Program, and/or Chronic Disease Self-Managment Programor seen by the RDN on 1:1 visits at the LCTHC clinic or through participation in a nutrition related education class at Tribal locations around the county. Patients are referred to these classes through their primary care provider or the LCTHC Registered Dietitian Nutritionist (RDN). The evaluation specialist will utilize established pre- and post-survey tools with each curriculum to ensure participants are showing an increase in nutrition knowledge and self-efficacy in cooking and/or improvement in chronic disease self-management skills. Those patients who fit the PPR eligibility requirements indicated above will then be referred to the Food Farmacist Care Coordinator(FFCC)/RDNfor screening, eligibility, completing signed informed consents and enrollment documentation. This process will include questions about use of medical care, insurance status, chronic disease diagnosis and food security status. Participants will complete a pre-survey including the core metrics required for the GusNIP reporting. Enrollment will be tracked to review progress toward the target of 300 total AIAN patients over the three-year PPR.During PPR participation, patients will sign-up for the FreshConnect debit card and receive $100 monthly for six months to purchase fresh fruits and vegetables. The local grocery store that accepts FreshConnect is Safeway, but PPR staff expect to work with local Farmer's Markets as well. Coaching on budgeting, grocery shopping habits, types of produce to purchase, easy recipes to follow and other food resources available to supplement the $100/month will be provided by the FFCC. Fresh Connect provides the technology to streamline the food voucher process, but staff at the PPR will be responsible for ensuring AIAN participants are getting their questions answered about where to shop, local transportation options available, and further build on established and trusted partnerships with the tribes in Lake County. Program will access the FreshConnect utilization data to track places where participants are shopping and how much they are spending from the monthly voucher money. Individual redemption of PPR vouchers through FreshConnect utilization tracking data will be documented with monthly check-ins by the FFCC on participant's consumption of fruits and vegetables, self-reported health status, health care visits, use of supplemental food resources, and satisfaction with the program. At completion of their six months of participation, a post-survey will be completed including the core metrics required for the GusNIP reporting including the US Adult Food Security Survey module and Dietary Screener Questionnaire (DSQ). In addition, LCTHC PPR will utilize patient self-report on use of emergency care visits and work with NTAE to estimate changes in associated costs based on the Nutrition Incentive HUB Healthcare use and healthcare cost estimates guidance.The evaluation specialist will track the development of the infrastructure needed to implement and maintain the PPR, along with collaboration with Tribal partners among the six federally-recognized Tribes in Lake County. The internal evaluation will detail the efforts to include traditional foods in the PPR. These efforts will be described in progress check-in calls with the PPR key personnel, documented in monthly progress notes, and data will be tracked utilizing the on-line database, Caspio, currently used by LCTHC for its Public Health program offerings. Required core metric data reporting to NTAE will utilize Qualtrics.We will secure IRB approval and seek expert evaluation guidance through the University of Colorado, as we have long standing, grant-funded project relationships with faculty at that institution.Descriptive quantitative statistics such as percentages, frequencies and means will be used to analyze findings on food insecurity, consumption of fruits and vegetables, and use of healthcare. Electronic Health Record data on A1C, blood pressure and weight will be analyzed for change over time, comparing six months prior to participation to end of six-month completion. Qualitative analysis will be conducted on documentation and notes from periodic community group discussions (including discussion at monthly HWC Advisory meetings) for themes on food sovereignty and security, establishment of community gardens, inclusion of traditional foods, rotation of locations for education and methods of participant recruitment and retention.