Source: REINVESTMENT PARTNERS submitted to NRP
BULL CITY BUCKS -- MATCHING INCENTIVES TO ENCOURAGE FRUIT AND VEGETABLE CONSUMPTION BY SNAP RECIPIENTS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
1012662
Grant No.
2017-70025-26685
Cumulative Award Amt.
$398,960.00
Proposal No.
2017-01991
Multistate No.
(N/A)
Project Start Date
Sep 1, 2017
Project End Date
Aug 31, 2021
Grant Year
2017
Program Code
[FIP]- FINI Project
Recipient Organization
REINVESTMENT PARTNERS
110 E GEER ST
DURHAM,NC 27701
Performing Department
(N/A)
Non Technical Summary
The Bull City Bucks program provides SNAP recipients in Durham County, North Carolina, with a dollar for dollar match for every SNAP-eligible food purchase, up to a maximum of $40 per month, which can then be used to purchase fruits and vegetables.The Bull City Bucks program will provide "fruits and vegetables prescriptions" to SNAP recipients who visit a health care provider at a Duke community health clinic or participate in a Duke Health community program. This "fruits and veggies" prescription enters the patient's household into the Bull City Bucks incentive program. Bull City Bucks participants receive dollar for dollar matching funds when purchasing SNAP-eligible food at Food Lion, the participating SNAP-authorized retailer. For every dollar of SNAP-eligible food, the participant receives one dollar of Bull City Bucks, up to $40 per month, on their Food Lion loyalty card. The matching funds, or Bull City Bucks, are stored on the loyalty card and can be redeemed for the corresponding amount of FINI qualifying fruits and vegetables at Food Lion.The cost of fruits and vegetables is one of the primary barriers to healthy eating. By offering SNAP recipients up to $40 in matching funds per month that can be used to purchase only fruits and vegetables, the Bull City Bucks program is designed increase the consumption of fruits and vegetables and improve health outcomes.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7046010308040%
7036010302040%
8036099308020%
Knowledge Area
703 - Nutrition Education and Behavior; 803 - Sociological and Technological Change Affecting Individuals, Families, and Communities; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6010 - Individuals; 6099 - People and communities, general/other;

Field Of Science
3020 - Education; 3080 - Sociology;
Goals / Objectives
Increase affordability of fruits and vegetables to increase consumption of fruits and vegetables and establish healthier eating habits.Increase awareness of healthy eating principles and strategies.Increased awareness of barriers to healthy eating.
Project Methods
PlanningIn the planning phase, the Bull City Bucks team will coordinate to ensure successful outreach and implementation of the program. RP will develop marketing materials such as brochures and flyers to be distributed at entry points within the Duke Health system and at the Department of Social Services (DSS). We will also work with the Durham County Department of Public Health (DCoDPH) to develop a marketing strategy to inform their clients about the program.Bull City Bucks intends to use Food Lion's loyalty card for the collection and redemption of Bull City Bucks, which will help make the program replicable to other supermarkets with loyalty cards. Food Lion's loyalty system has the capacity to upload coupons limited to FINI-qualifying fruits and vegetables and to label customers as participants in the Bull City Cool program when the customer scans their loyalty card and EBT card at the point of sale. Food Lion's loyalty card has some technological limitations which need to be addressed before implementing the program. RP and Food Lion have had candid discussions about the limitations of the loyalty card. If Bull City Bucks receives FINI funding, both Food Lion and RP are committed to spending the first six months of the program solving those technological challenges to develop a workable program, upgrading technology, and making program adjustments as necessary. If we cannot solve the technology issues, we will adapt the program.We have also had discussions with Propel, the developers of the Fresh EBT app that allows SNAP benefits to track their benefits using their smart phones. Although the app does not currently have the capacity to accept and redeem incentives, we will encourage Bull City Bucks clients to download the app to use to monitor their benefits and take advantage of additional content including recipes and budgeting materials. In the future, we hope to encourage the development of the Fresh EBT app to allow for broader integration with the program.We will work with DCoDPH, Duke Health, and Food Lion to develop a training program and protocol for their personnel that will be engaged with the program. We will seek to begin training with our partners within the first three months of the grant award. We will also create reimbursement and information sharing protocols with Food Lion, in compliance with SNAP confidentiality requirements.ImplementationWe will partner with the DCoDPH to provide workshop trainings for Duke Health providers, nurses, social workers, and administrative staff at community and school clinics and Duke Health's community programs. In addition, we will conduct training for Food Lion store managers and cashiers in case they encounter questions at point of sale.As potential Bull City Bucks participants enter Duke Health through one of the entry portals, health care providers will screen patients with nutrition related health issues about their access to healthy food. The providers will provide a prescription for fruits and vegetables, inform them about the Bull City Bucks program, and, with the family's permission, enroll them in the program. Food Lion will provide them with an MVP (loyalty) card. If the family buys SNAP eligible food at a participating Food Lion, they will receive a dollar for dollar match up to $40 per month in Bull City Bucks on their loyalty card. The Bull City Bucks can be can then be used at a future time to purchase fresh fruits and vegetables using the Food Lion loyalty card. Food Lion will provide monthly reports to RP and receive reimbursement for Bull City Bucks redeemed.EvaluationRP will track Bull City Buck redemptions based on Food Lion's monthly reports. The monthly reports will provide information on how much is being spent on fresh fruits and vegetables and show how many unique participants are taking part in the program.We will evaluate the program and adapt to better serve participants on an ongoing basis. We may conduct surveys of participants for feedback to better understand the impact of the program and attitudes toward healthy eating. Duke Health and RP will also conduct focus groups to better understand the barriers to healthy eating,

Progress 09/01/17 to 08/31/21

Outputs
Target Audience:Bull City Bucks served SNAP beneficiaries struggling with diet-realted chronic diseases in Durham NC who were patients of participating clinical health providers. Changes/Problems:We learned that using mass messaging is a very effective tool for communicatingwith participants. We also learned to be very thoughtful and methodical in collecting data on participants at the time of enrollment to fully leverage the potential of mass messaging. We expereinced challenges when we first started to use mass messaging for this program because our data collection protocols were not sufficient. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?Yes. We provided summary outputs of this program to all our participating healthcare agencies and Food Lion. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? 1. RP distributed over $325,000 to 1800 participants for fruits and vegetables. 2. Participants received patient wraparound support services through our partnering healthcare agencies. 3. Participants used the nutrition assistance funds and the supportive services to overcome barriers to eating healthy.

Publications


    Progress 09/01/19 to 08/31/20

    Outputs
    Target Audience:Bull City Bucks targets SNAP beneficiaries receiving care for diet related chronic illnesses in Durham County. Changes/Problems:In the fall of 2019, we discovered that our internal projections showed that we were on track to spend down the entire grant budget far in advance of the project timeline. We made the decision to restrict program participation to just one year and began unenrolling participants who had received more than 12 month's worth of program benefit starting in January 2020. This dramatically reduced the number of participants but ensured that our project funds would be sufficient for implementing the program for the duration of the project period. What opportunities for training and professional development has the project provided?We are working with an evaulator at Duke Health to finalize a report on this project. How have the results been disseminated to communities of interest?A final research report will be disseminated in the following program year. What do you plan to do during the next reporting period to accomplish the goals?We plan to continue enrolling participants through January 2021. Once we have reached our enrollment cap we will discontinue new program enrollments and spend down the remaining budget through August 2021. We also plan to release a report about the program.

    Impacts
    What was accomplished under these goals? 1. We enrolled 143 new participants into the Bull City Bucks program between September 2019-August 2020. $85,992 were redeemed for fruits and vegetables by participants. 2. Participants were enrolled by clinical care provieders who provide brief nutrition education at the time of enrollment. 3. Participants are able to put their nutritioneducation into practice by spending the nutrition incentive benefit. This practice increases awareness of the barriers to eating healthy and develops new habits and behaviors for improved health outcomes.

    Publications


      Progress 09/01/18 to 08/31/19

      Outputs
      Target Audience:Bull City Bucks is targeted towards SNAP beneficiaries receiving care at Federally Qualified Health Centers in Durham County, NC. Changes/Problems:We have encountered technical issues with Food Lion's point of sale system which causes disruptions when participants spend incentive funds. The main issues are 1.)transaction receipts display incorrect balances and 2.) discounted produce items aren't always covered by Bull City Bucks. We are working with Food Lion to correct these issues where possible. Where a fix is not possible, we will implement a temporary work-around solution. During the reporting period, we have begun to un-enroll participants who do not load Bull City Bucks for two consecutive months. What opportunities for training and professional development has the project provided?We have become HIPAA compliant as part of this project and have completed HIPAA training. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?We plan to continue improving the point of sale technology to increase utilization efficiency among participants.

      Impacts
      What was accomplished under these goals? 1.) Bull City Bucks distributed $148,480 to 690 participants between September 2018 and May 2019. Of the incentive funds distributed, $118,287.30were spent yielding approximately a 80% utilization rate. The incentive funds increased the affordability of fruits and vegetables for participants. 2.) Every enrolled participant received some amount of nutrition education upon enrollment. 3.) Participants have an increased level of familiarity with healthy eating principles and strategies for efficiently using both the nutrition incentive funds and their SNAP allotment. During the reporting period, participants gained familiarity with the program and established routines for loading and spending incentive funds.

      Publications


        Progress 09/01/17 to 08/31/18

        Outputs
        Target Audience:Our target audience is SNAP beneficiaries receiving care for a diet-related chronic illness at a health clnic or center in Durham County. Our goal is to enroll 1,100 participants per year into our program. Changes/Problems:We planned on launching the progam 6 months after the start of the grant period. However, it took us 8 months to get the program fully up and running. What opportunities for training and professional development has the project provided?Working with health clinics to enroll their patinets has required that we become HIPAA copmliant. We have ungergone training to comply with HIPAA. How have the results been disseminated to communities of interest?We have reported some preliminary data to the enrolling health centers and clinics through regularly scheduled meetings. What do you plan to do during the next reporting period to accomplish the goals?We plan to continue expanding the number of sites that offer enrollment into our program. We will refine our communications about how the program works including hand-out materials and videos. We plan to continue working with Food Lion to improve the participants' experience using our program in the store.

        Impacts
        What was accomplished under these goals? In our first grant year, we have created an online portal that enrolls patients at participating health centers/clinics with the loyalty card program at Food Lion, a major grocery chain in the Southeast. This enrollment process enables the patient to have $40 per month loaded onto their Food Lion customer loyalty card (MVP card) to be spent on FINI eligible fruits and vegetables. This program has been fully implemented at six health centers and twelve Food Lion stores beginning in May 2018. Utilization data is being created that will allow us to track each participants' purchases, the amount of incentive allotted, and where the participant was enrolled. 1. We have currently enrolled 265 food insecure health patients since the program launched in May 2018. These participants can receive $40 per month to spend on fruits and vegetables. Making healthy foods more affordable increases the purchase and consumption of healthy food. Participants in our program spent $2,433 of the nutrition incentive funds on fruits and vegetables of the $4,190 that were issued for an average of a 58% utilization rate over the first 3 months. 2. Each patient is enrolled through a health center or clinic providing nutritional wrap around services. These include nutrition education, peer support, diabetes self-management education, etc. 3. Our program combines incentives and education to increase participants' awareness of healthy eating principles and strategies to help them overcome the barriers to healthy eating. We have engaged patients in an advisory role capacity to help continuously improve the program moving forward. We continue to work closely with health centers and clinics to find effective ways of engaging patients to support healthy eating behaviors.

        Publications