Source: Chicago Horticultural Society submitted to
WINDY CITY HARVEST: CONNECTING URBAN FARMERS AND HEALTHCARE PROVIDERS TO IMPROVE COMMUNITY HEALTH
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
NEW
Funding Source
Reporting Frequency
Annual
Accession No.
1015978
Grant No.
2018-70025-28172
Project No.
ILLW-2018-01975
Proposal No.
2018-01975
Multistate No.
(N/A)
Program Code
FIP
Project Start Date
Jun 1, 2018
Project End Date
May 31, 2022
Grant Year
2018
Project Director
Mason, A.
Recipient Organization
Chicago Horticultural Society
1000 Lake Cook Road
Glencoe,IL 60022-1168
Performing Department
(N/A)
Non Technical Summary
The Chicago Botanic Garden will expand its prescription produce initiative for SNAP recipients, known as VeggieRx, to six new Chicago-area locations. The initiative will provide 10,155 low-income individuals with nutrition education and an estimated 122,925 servings of high-quality, local fruits and vegetables. Project activities will build on a previously funded FINI Pilot Project conducted in Chicago's North Lawndale neighborhood in partnership with Lawndale Christian Health Center (LCHC). Over two years, the pilot project provided nutrition education and more than 11,000 pounds of produce to 437 SNAP recipients and their families, impacting a total of 1,748 individuals, and developing an effective, replicable model.This project will deepen the intervention in North Lawndale and expand VeggieRx to six new locations. Sites include LCHC's satellite clinics in Chicago's Archer Heights, Little Village, and East Garfield Park neighborhoods, as well as sites that are part of Proviso Partners for Health (PP4H). These sites include a community clinic in Elmwood Park; Gottlieb Memorial Hospital in Melrose Park, and MacNeal Hospital in Berwyn. Each of these communities faces different diet-related health challenges. Working with three main partners--LCHC, PP4H, and the Chicago Partnership for Health Promotion--the Garden will tailor the program for the unique needs of each community, providing nutrition education and cooking demonstrations in English and Spanish within small group settings. Participants will receive personal attention from the dieticians and trained peer educators that deliver the sessions, as well as regular access to fresh produce.
Animal Health Component
0%
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
70360990001100%
Goals / Objectives
The overarching goal of this project is to increase the purchase and consumption of fresh produce among SNAP clients. Intermediary objectives advancing this overall goal are that:• SNAP recipients gain access to fresh, locally produced, and culturally appropriate fruits and vegetables through a prescription produce box program, subsidized community market sales, and the healthy corner store• Low-income community members gain a greater understanding of the importance of a good diet to overall health through dietary counseling• Doctors gain a greater understanding of dietary health and incorporate nutrition education into their practice• Low-income youth and adults with barriers to employment gain skills and obtain jobs by delivering nutrition education and food preparation demonstrations and maintaining the sustainable urban farms that provide produce for the Food as Medicine project
Project Methods
1) Educate SNAP recipients with diet-related disease about the health benefits of a plant-rich dietNutrition education will begin with an annual orientation for healthcare providers at each site that outlines the program and provides them with tools to discuss nutrition with their patients and advise them about the VeggieRx program and other avenues to obtain fresh produce in the neighborhood. LCHC and PP4H leadership will gather feedback and reinforce provider buy-in through regularly scheduled staff meetings. In turn, clinicians will identify and refer qualifying patients into the VeggieRx program. Patients will be eligible for the program if they have or exhibit risk for the following illnesses, which the World Health Organization indicates can be managed in part through a healthy diet (e.g., obesity, diabetes, cardiovascular disease, multiple forms of cancer, osteoporosis, dental disease.)Patients with a prescription will attend a nutrition education session focused on one of five topics--fats, fiber, added sugar, sodium, and nutrition labels. To encourage the formation of long-term healthy habits, patients will be invited to attend up to ten VeggieRx session annually. A small-group setting will ensure that participants can receive clarification and address questions with program staff. In areas that serve large numbers of Spanish-speakers, sessions will be offered in both English and Spanish. CPHP and PP4H's trained dieticians and peer educators will conduct these sessions at least once per week at each site. During the summer months, WCH's Youth Farm trainees will assist with setup at LCHC. Select students will be trained to provide a short demonstration during the LCHC sessions, for example by creating a "lard burger" with shortening that helps patients visualize the amount of saturated fat in an average fast food meal.2) Increase the purchase and consumption of fresh, locally produced fruits and vegetablesAt the end of each nutrition education session, patients will be provided with an eight-pound VeggieRx box, filled with WCH-grown fruits and vegetables. Toward that same purpose, each prescription produce box will contain $10 in double value coupons for purchase of fruits and vegetables to be redeemed at the Farm on Ogden retail space and community farm stands, which will be conducted weekly at each healthcare provider site concurrent with the nutrition education sessions. WCH, LCHC, and PP4H staff will promote VeggieRx by educating and following through with healthcare providers, and through flyers, posters, and announcements at community partner locations, and by word-of-mouth. The FINI Pilot Project was successful in recruiting its target number of participants through these means.3) Scale the VeggieRx program and adapt it to the health needs of new populationsBeginning in year 1, WCH will work with LCHC to increase referrals into the VeggieRx program by recruiting additional LCHC providers into the program. During the Pilot Project, physician referrals more than doubled in the second year of the program, and WCH believes that support will continue to grow as providers realize the tangible benefit to their patients. WCH and PP4H will collaborate to launch the program at the first PP4H site, a clinic in Elmwood Park. Prominently displayed marketing materials will be utilized to attract patients to the program; regular check-ins with healthcare providers will assess buy-in and provide a forum for troubleshooting. In year 2, WCH and LCHC staff will begin to publicize VeggieRx at the first LCHC satellite clinic, conducting provider orientations, incorporating it into periodic staff meetings, and marketing the program with printed materials. WCH and PP4H staff will work together to evaluate the Elmwood Park clinic launch and make adaptations for its second year. In year 3, WCH and LCHC will assess the program's success reaching satellite clinic patients--making logistical and programmatic adaptations as necessary--and market the program to a second satellite clinic. WCH will work with PP4H to launch the program at Gottlieb Memorial Hospital, anticipating needs based on provider input and community-level data. In year 4, WCH will expand the program to the final LCHC satellite location and to MacNeal Hospital, incorporating relevant feedback from program participants and providers.4) Train participants in WCH education programsParticipants in WCH Youth Farm will also benefit. While learning to deliver the nutrition education sessions, these individuals will be empowered as a resource in their communities and acquire dietary knowledge that is reinforced through the teaching process. Though not funded by the USDA FINI grant, participants and their families will also gain access to produce through donations/reduced-price purchases at community markets.5) Advance replicabilityThe project will model best practices for a partnership between farmers and healthcare providers designed to improve dietary habits and health outcomes in the service population. The program elements, tailored to low-income, urban communities, make VeggieRx stand out among programs of similar capacity and goals. These elements will be continually evaluated and refined, and project results will be shared with the USDA and independent evaluator as described in (f). The project director will also share the program model through a broad network of contacts in agricultural, economic development, museum, healthcare, and environmental institutions.5) Evaluation practicesA process analysis, to be shared with the independent evaluator, will use a variety of tools developed during the FINI Pilot Project to evaluate the impact and success of the project in relation to the intended results and measurements listed under (c) and (e). WCH staff will document the process, challenges, and success of implementation and operation quarterly, making adjustments to the program as needed. WCH has reviewed the minimum core data set, which overlaps significantly with WCH's planned self-assessment (see below). WCH agrees to collect data in each category of the minimum core data set and remit to the independent evaluator as requested.As was the case during the FINI Pilot Project, robust data will be gathered to assess patient responses to the nutrition education and the fruits and vegetables provided through the program. Patient education programs will be tracked through attendance and pre-/post-program surveys related to dietary habits. The surveys will collect demographic data (e.g., race, gender, age, and household size) as well as self-assessment responses (e.g., "I know how to plan and cook a meal using fresh vegetables") with responses along a five-point scale ranging from "strongly agree" to "strongly disagree." At the end of each nutrition education session, patients will be asked to submit a brief questionnaire rating the quality and usefulness of the course content on a Likert scale; subjective feedback will also be gathered. Repeat participants will be asked to rate the quality, familiarity, and utility of the produce supplied in the boxes, and invited to provide subjective feedback as well. Additionally, WCH will track the number of prescription produce boxes delivered to SNAP beneficiaries and the dollar value and percentage of double value coupons redeemed.As in previous years, WCH training components will track application and enrollment numbers, attendance, completion rates, and other metrics. Youth Farm pre- and post-program surveys track improvement in healthy habits, knowledge of agricultural practices, and employability.

Progress 06/01/20 to 05/31/21

Outputs
Target Audience:Through the end of the report period, VeggieRx served 842 Supplemental Nutrition Assistance Program (SNAP) clients. Among attendees surveyed: 51% identified as Black/African American, 45% as Latinx/Hispanic, and 4% as White/Caucasian. Participants were 78% female and 22% male 49.5 was the average participant age In 2020, the USDA granted permission to waive the SNAP balance check requirement for repeat participants whose SNAP enrollment had already been verified due to the limitations of operating during COVID-19 amidst the pandemic. This waiver remained in effect through the end of the report period. All new participants are still required to swipe their LINK card for a balance check at the first produce distribution. Participants were primarily recruited through partnerships with four healthcare institutions: the Lawndale Christian Health Center (LCHC), Loyola University Health System/Proviso Partners for Health (PP4H), PCC Austin Family Health Center (PCC Austin), and PCC Salud Family Health Center (PCC Salud). The partnership with PCC Salud began in July 2020, the result of a successful partnership and positive patient outcomes with PCC Austin in 2019. PCC Salud serves Chicago's Belmont-Cragin neighborhood, an under-resourced community that has consistently had one of the highest rates of COVID-19 throughout the pandemic. During the reporting period, 209 health care providers from these organizations were engaged in educational sessions about the program to encourage them to refer patients into VeggieRx. The project provided produce grown by Windy City Harvest (WCH) trainees at Chicago farm sites, including beginning farm businesses in the incubator program. In 2020, 79% of trainees were economically disadvantaged, in keeping with Windy City Harvest's mission to provide economic uplift through paid jobs training and youth development opportunities, and 81% were people of color. Changes/Problems:During the grant period, WCH completed a major project to design and implement a data management system for the VeggieRx program. To lead this process, WCH hired an applied data fellow, AJ Caughey, from the University of Chicago. Though these activities were not funded by the USDA FINI program, they had a significant positive impact on the VeggieRx program. Once the database was created and tested, Caughey cleaned and uploaded historic program data. Additionally, a new electronic survey was created for participants that integrates seamlessly with the database, saving significant staff time previously spent on data entry. Caughey also worked with project staff to design a reporting dashboard for the VeggieRx program that enables staff to input parameters (e.g., timeframe, VeggieRx location) and instantly obtain key programmatic outcomes and data visualizations. This powerful tool will enable new insights that were cumbersome to produce before, for example exploring outcomes across multiple program years, at different program sites, or before and after COVID-19 modifications. The database has also streamlined aspects of the program's operations, including more efficient program enrollment and a simplified process for changing participants' VeggieRx pickup locations. In addition, staff can provide health center partners accurate and timely information on their patients' participation in the program. Another substantial change was in the protocol for sourcing produce for the program. In 2020, the rapid growth in VeggieRx box distribution (from 2,432 boxes in Year 2 to 6,519 boxes in Year 3) required WCH to supplement the boxes with produce purchased from Midwest Foods, a Chicago-based wholesaler and long-time WCH partner. Midwest Foods is committed to sourcing produce from local and regional farmers, aligned with the project's goal to provide SNAP recipients with high-quality, locally grown fruits and vegetables. At the end of the year, project staff met with Midwest Foods to identify a method for aggregating WCH produce with wholesale produce to pack the VeggieRx boxes. Utilizing the Midwest Foods' shipping and distribution capabilities has been key to sustaining the continued growth of VeggieRx. WCH orders produce boxes one week in advance and Midwest Foods packs the boxes to a $15 wholesale value and delivers them to the Farm on Ogden, WCH's headquarters, where they are stored in coolers until they are needed for distribution. As mentioned previously, WCH has continued to run an adjusted VeggieRx program during the COVID-19 pandemic. These measures include offering socially-distant pickup and contactless delivery of VeggieRx produce, virtual nutrition education and cooking demonstrations, electronic collection of program surveys, and an Facebook group where participants share recipes, experiences, and tips. WCH has continued to operate the program under a procedural waiver obtained from USDA NIFA that provides staff permission to verify SNAP enrollment upon their first visit to the program rather than at each distribution. This adjustment cuts down on in-person contact during produce pickup and/or delivery. What opportunities for training and professional development has the project provided?During the report period, the project has supported the following professional development activities: Eight dietetic interns from Loyola University Chicago and University of Illinois - Chicago were trained in the VeggieRx model, including food safety, protocols, and community-based nutrition education. PCC Salud and Esperanza healthcare providers were engaged in introductory trainings about the VeggieRx model, protocols, and distribution. Three trainings engaged 30 providers In October 2020 and February and March, 2021. Program staff developed and delivered presentations for three professional conferences, as described under "Products." How have the results been disseminated to communities of interest?The Chicago Botanic Garden/Windy City Harvest are committed to sharing the VeggieRx model with a broad audience. Examples include: WCH staff convened a VeggieRx participant feedback session in December 2020 where results and best practices from the 2020 program were shared, and participants were invited to provide feedback on the program. With support from the United States Botanic Garden, WCH published a "train the trainer" toolkit for botanical institutions that provides detailed guidance on how to develop, expand, and adapt urban agriculture programs. The toolkit contains a section on nutrition programs and uses the VeggieRx program as a case study. It is available online here: https://www.chicagobotanic.org/sites/default/files/pdf/wch/Chicago_Botanic_Garden_WCH-Best-Practices-Manual.pdf. The Garden's director of government affairs hosted visits to WCH sites to public officials, including Jerry Costello, Director of the Illinois Department of Agriculture; Israel Rocha, CEO of Cook County Health (the public hospital system in Cook County, Illinois); and Cook County Commissioner Dennis Deer. Written communications about WCH and VeggieRx were sent to federal, state, and local officials. WCH staff delivered presentations at health, agriculture, and food access symposiums. During the report period, these included the Harkin on Wellness Symposium, Carolina Farm Stewardship Association Sustainable Agriculture Conference, and American Hospital Association Accelerating Health Equity Conference. VeggieRx staff were actively involved with food access, health, and community coalitions, including; Illinois Public Health Institute's Alliance for Health Equity Food Access and Security Workgroup North Lawndale Community Coordinating Council's Health and Wellness Working Group Austin Eats, a food and urban agriculture workgroup convened to advance the Quality of Life Plan for Chicago's Austin community. What do you plan to do during the next reporting period to accomplish the goals?Windy City Harvest will continue the program at LCHC, PP4H, PCC Austin, PCC Salud, and Esperanza. Staff have found that partnerships with federally qualified health centers are an ideal fit for the VeggieRx model. Staff will continue to deliver the program with COVID-19 modifications in place and in accordance with public health guidelines. Because the operational changes made during the pandemic broadened participation and distribution of fresh fruits and vegetables in VeggieRx communities, WCH staff will evaluate the impact of those changes and adjust the model should a return to in-person delivery become possible.

Impacts
What was accomplished under these goals? As previously reported, a greater need for fresh food access during the pandemic, along with program modifications implemented by Windy City Harvest, have resulted in significant programmatic growth. That progress during the report period, with COVID-19 adaptations--including virtual nutrition education and cooking demonstrations, a Facebook community for participants, and delivery/contactless pickup options--still in place. The program ran from June - November in 2020, and resumed in February 2021 at four locations: LCHC, PP4H, PCC Austin, and PCC Salud. This May, VeggieRx launched at a fifth site, Esperanza Health Center in the Chicago's Brighton Park community, which has been disproportionately impacted by COVID-19. During the program, healthcare providers from each clinic referred patients with diet-related illnesses, or risk for developing one, into VeggieRx. Participants received weekly free boxes of fresh fruits and vegetables, recipes to help prepare them, and 50% off coupons for purchases of additional produce at farm stands, which are offered at VeggieRx pickup locations. For the first time in 2021, two of the farm stands are being run by farmers the WCH incubator program, which supports urban agriculture business development, particularly for socially disadvantaged farmers. By offering this opportunity to incubator farmers, WCH is providing a consistent weekly market for their produce and an opportunity to diversify their revenue streams. Activities advanced progress on each of the project objectives during the grant's third year. 1) SNAP recipients gain access to fresh, locally produced, and culturally appropriate fruits and vegetables 6,519 produce boxes were redeemed by SNAP-enrolled LCHC, Loyola Maywood, and PCC patients and their families, reaching 842 unique individuals; this provided increased food access to 2,656 people (based on average household size of three people) SNAP participants received and/or purchased an estimated 52,152 pounds of produce (74,500 servings based on USDA estimate of 0.7 pounds per serving) through the prescription produce program and double value coupon redemption. This estimate is based on average box weights of 8 pounds. 94% of repeat participants report consuming more than half of their VeggieRx box 2) Low-income community members gain a greater understanding of the importance of a good diet to overall health through dietary counseling 3,521 participants attended virtual nutrition education/food preparation demonstrations. During the pandemic, the Chicago Partnership for Health Promotion filmed nutrition education and cooking resources and posted them online to the VeggieRx Facebook group. PP4H patients were invited to attend Zoom sessions on these topics. Staff were no longer able to count unique participants in these sessions, instead measuring participation by views of these online resources. Participants reported an 18.51% decline in knowledge of food preparation is a barrier to consuming fresh produce. Overall, this figure represents a small proportion of VeggieRx participants, who report the primary barrier to consuming fruits and vegetables is the cost. Therefore, changes in the perception of food preparation as a barrier to access are calculated on a small sample size, are variable, and are not as significant as the 50% proposed, which was derived from a small sample size baseline from the VeggieRx FINI Pilot Project. VeggieRx participants reported increased knowledge of food preparation, healthy eating habits, and reduced intake of processed/fast foods 75 Youth Farm trainees received nutrition education Participant input was collected through online surveys, an end-of-year convening of partner organizations and participants, and informal interactions. Several participants expressed gratitude for the program's continuation during the pandemic and remarked on the efficacy of COVID-19 adaptations: "VeggieRx has changed my life. I've never made my health/diet so much of a priority before. I can see health changes based on this new way of eating and so can my doctors. And it trickles out to friends and family members, who pay close attention. The local food is top quality. I've really enjoyed learning from the other participants and getting to know them via the VeggieRx Facebook group. It's shocking to me to see how much I've expanded my vegetable choices." "Wednesdays were the highlight of my week because I know I am going to get my veggie box and get to see what's in it. When I was on Facebook it was cool to see everyone posting their meals. People were asking questions and nobody was judgmental...Everybody always had these really tasty suggestions. On Saturday mornings, watching the cooking demos on Facebook live, it was a way to de-stress and get in the groove of planning my meals with what I got in the veggie box. I've shared the veggies with my family and neighbors and they love it." "The staff has been phenomenal. I love how flexible and thoughtful you all have been. Not everyone in my family and neighborhood has the ability to drive. It was wonderful to be able to pick up VeggieRx boxes for my family and neighbors so that can still get their produce too." "What really helped a lot with getting the VeggieRx boxes was the recipes. The recipe[s] always come with the VeggieRx box and then you know what to do with the vegetables that you had. Some of the veggies I have never even seen before, but I followed the recipe and they tasted awesome. I had never tasted spaghetti squash. Then I just followed the VeggieRx recipe, and it tasted so unique and awesome. So now if I don't get spaghetti squash in my VeggieRx box then I will go buy it at the grocery store." "The staff was awesome! We really appreciate you guys. Sometimes we were going through hard times, but just your tone of voice and respecting us and listening to us made such a big difference." "We learned from each other through talking... For example, talking about our how sugar levels and stress are related. A lot of people don't know that stress itself can increase our blood sugar. Talking about it in the VeggieRx support group made me realize maybe that's why my numbers were so high. For example, if I had an argument with my family member and you are feeling really tense maybe that is impacting my blood sugar level, because I know I ate the right foods and I know I didn't add salt to food. Talking with other people with diabetes and listening to their solutions helps a lot." 3) Doctors gain a greater understanding of dietary health and incorporate nutrition education into their practice WCH conducted 7 information sessions with 209 LCHC, PP4H, and PCC providers 4) Train participants in WCH education programs A total of 122 trainees, 79% from economically disadvantaged backgrounds, learned about sustainable urban agriculture while growing produce for VeggieRx. They included: 75 students in the Youth Farm program 19 trainees in the Corps transitional jobs program for formerly incarcerated men and women 21 participants in the nine-month Apprenticeship in sustainable urban agriculture 7 beginning farm business owners in the WCH incubator program

Publications

  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2020 Citation: Calendo, Brittany and James, Ketaurah. "Food Access Innovations for Farmer Training Programs" (Presented online at the Carolina Farm Stewardship Association's Sustainable Agriculture Conference, November 7, 2020).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2021 Citation: Calendo, Brittany and Mora, Mary. "The Power of Partnerships: Moving Ideas to Action to Advance Health Equity" (Presented online at the American Hospital Association Accelerating Health Equity Conference, March 17, 2021).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2021 Citation: Fournier, Eliza. Virtual presentation on the VeggieRx program model to the Harkin on Wellness Symposium, March 8, 2021.


Progress 06/01/19 to 05/31/20

Outputs
Target Audience:Through the end of the report period, VeggieRx served 683 Supplemental Nutrition Assistance Program (SNAP) clients. Each participant attended at least one 30-minute English or Spanish nutrition education session, received a free, eight pound bag of produce and $10 in 50% off coupons redeemable at Windy City Harvest farm stands. Among attendees surveyed: 60% identified as Black/African American, 28% as Latinx/Hispanic, and 8% as White/Caucasian. Participants were 78% female and 21% male; 1% other or did not report 54 was the average participant age SNAP was verified by performing a "balance check" at each free VeggieRx box distribution, as stipulated by USDA FNS. In 2020, the USDA granted permission to waive this requirement for repeat, existing participants due to the limitations of operating during COVID-19 amidst an Illinois stay-at-home order and beyond given contact-free produce distribution. All new participants are still required to swipe their LINK card for a balance check. Participants were primarily recruited through partnerships with three healthcare institutions: the Lawndale Christian Health Center (LCHC), Loyola University Health System/Proviso Partners for Health (PP4H), and PCC Austin Family Health Center (PCC Austin). As was reported last year, VeggieRx was moved from Loyola University Health System's Elmwood Park Health Center to their Maywood clinic (Loyola Maywood), a change made because this Chicago suburb faces far greater food insecurity challenges, linked with greater numbers of SNAP participants. During the reporting period, 112 health care providers from these organizations were engaged in educational sessions about the program to encourage them to refer patients into VeggieRx. The project was supported with produce grown by Windy City Harvest trainees at Chicago farm sites, including emerging farm businesses in the Entrepreneurship Pathway program. Eighty percent of trainees were economically disadvantaged, in keeping with Windy City Harvest's mission to provide economic uplift through paid jobs training and youth development opportunities, and 90% were Black, Indigenous, and people of color. Changes/Problems:NEW ACTIVITY Windy City Harvest will expand VeggieRx to PCC Salud Family Health Center during the current grant period, using the successful diabetes management model piloted at PCC Austin Family Health Center. PCC Salud serves patients from Chicago's Belmont-Cragin community on Chicago's West Side, primarily Latinx, Spanish-speaking patients. Weekly VeggieRx sessions will be offered virtually once a week in English and Spanish. Patients received support from PCC medical providers and care coordinators with biweekly phone consultations to assist with management of their diabetes. This site was selected because of the high rate of diabetes among their patients, and their commitment to addressing this challenge through VeggieRx and strong health impact evaluation protocols. A planning meeting was held with LCHC health care providers and patients to seek feedback on VeggieRx and to identify unmet needs. A recommendation to launch a Family VeggieRx program that involved entire families in hands-on, kid-friendly cooking and nutrition education. While staff had hoped to launch Family VeggieRx in the summer of this year, this initiative became a lower priority as staff focused on shifting to a contactless program delivery model to continue to serve VeggieRx participants during the initial months of the pandemic and reduce on site programming for high-risk participants. VeggieRx staff are receiving consultation on developing a curriculum, based on feedback from the planning meeting, so that it is ready to be implemented when in-person programming can resume in 2021 or beyond. PROGRAMMATIC CHANGES RELATED TO THE IMPACTS OF COVID-19 As stated earlier, all VeggieRx programs werepaused starting the third week in March as staff re-tooled services in light of the Illinois stay-at-home order. LCHC and PCC Austin's VeggieRx programs re-started in early April, while the Loyola Maywood site found outside short-term funding and volunteers to distribute produce bags to area residents. Staff resumed VeggieRx programming at the Maywood site in early June, giving the team time to systematize produce distribution with new rules, regulations, and strategies, and to serve the Maywood site safely. One of the challenges faced was the need for health centers to significantly reduce foot traffic. Currently, at both the Loyola Maywood and PCC Austin sites, VeggieRx bag distribution and produce sales are offered in safe outdoor locations. With nutrition education sessions offered virtually since April, in-person survey data was only collected this year in February and early March. Staff developed and began to use a simplified online evaluation tool this summer; they will resume more extensive evaluations of program impact in 2021 in an online format once a database and collection tools have been developed. With USDA approval for a procedural change, Windy City Harvest is not conducting regular SNAP balance inquiry transactions for weekly produce distribution after the initial swipe. This change enabled low-contact pickup and delivery. In the past, participants shopped after in-person nutrition education/cooking classes with the coupons they received that day for buy one, get one free produce at Windy City Harvest farm markets. Now, participants must visit the farmer's markets to redeem produce, now scheduled on different days than VeggieRx produce bag pick-up to reduce in-person activity at the health clinics and Farm on Ogden. Staff are seeking solutions to this challenge, including expanding Farm on Ogden market sale days, which had been cut back during the Illinois stay-at-home order. What opportunities for training and professional development has the project provided? Physicians, nurse practitioners, dieticians, and others from five health care centers participated in a "Cooking up Health" workshop to gain a deeper understanding of VeggieRx and how to incorporate nutrition education into their health care practices. Windy City Harvest trained students from local universities on the VeggieRx model. This included introducing students from Loyola University's Medical School and Nutrition and Dietetics program to the concepts of community nutrition. They also hosted interns from the University of Illinois at Chicago's nutrition degree programs during their community nutrition and food service rotations. Windy City Harvest and partner organization staff participated in a range of professional development opportunities, such as a training on trauma-informed care and the ServeSafe food handling certification program. They participated in events, including the Chicago Food Policy Summit and the 2019 MOSES Organic Farming Conference. How have the results been disseminated to communities of interest?The Chicago Botanic Garden/Windy City Harvest are committed to sharing the VeggieRx model with a broad audience. Examples include the following: The Alliance for Health Equity, a partnership between theIllinois Public Health Institute, hospitals, health departments, and community organizations across Chicago and Cook County, published a Health Care and Food Partnership case study on the VeggieRx program in January 2020. This document, available online here, highlights the program, partners, lessons learned and adaptations made, and USDA FINI's instrumental role in launching VeggieRx. Windy City Harvest shared the project through farm tours and visits by an estimated 3,800 individuals, elected officials, community leaders, school groups, local residents, and other stakeholders. They included visits with elected officials, including Congressman Brad Schneider, Congressman Jesus Garcia, and Chicago City Clerk Anna Valencia. Staff presented on VeggieRx at Cook County Department of Health's 2019 Food Summit, which included a tour of the garden Windy City Harvest operates at the Loyola Maywood VeggieRx site. They also led a session on VeggieRx adaptations due to COVID-19 for the Alliance for Health Equity's Food Access and Food Security workgroup in April. Botanic/public gardens across the country running urban agriculture programs benefitted from a partnership between the Chicago Botanic Garden and the United States Botanic Garden (USBG) to offer sustainable urban agriculture training sessions. Windy City Harvest piloted a Food, Health, and Jobs: Building Organizational Capacity for Urban Agriculture Programs curriculum, which features VeggieRx prominently in the curriculum. The training was piloted in Chicago last August and was held in New Orleans in early March of this year. Future sessions were put on hold with the pandemic. Staff are now finalizing a train-the-trainer curriculum manual, to include the VeggieRx model, for distribution by USBG. Windy City Harvest revised its website to include information about VeggieRx and PP4H promoted the Loyola Maywood VeggieRx program on its website. VeggieRx received strong media coverage, including: Chicago Tribune, August 2, 2019, "VeggieRX provides free vegetables to low-income people and patients in Chicago food deserts" WGN 9, August 20, 2019, "Urban Farm Growing Opportunities in North Lawndale" FOX 32, June 23, 2019, "Food as Medicine, VeggieRx Program" VeggieRx staff are actively involved with regional coalitions, including; Illinois Public Health Institute's Alliance for Health Equity Food Access and Security Workgroup North Lawndale Community Coordinating Council's Health and Wellness Working Group Austin Garden Collective's Quality of Life Plan Health and Wellness Committee Chicago Food Policy Action Council's Chicago Emergency Food Assistance Group, convened in response to COVID-19 What do you plan to do during the next reporting period to accomplish the goals?Windy City Harvest will continue the program at LCHC, Loyola Maywood, and PCC Austin and expand to PCC Salud Family Health Center. Staff have found that partnerships with federally qualified health centers are an ideal fit for the VeggieRx model; they are exploring potential new opportunities with health centers on Chicago's West Side. The program will continue to operate with contact-free delivery and pick-up, virtual nutrition education lessons, and coupon redemption at Windy City Harvest farm sites, a model that has proven to be effective and even more convenient than in-person programming for many program participants. Safety measures for VeggieRx during COVID-19 are a high priority, as many participants fall into the high risk category for COVID-19 due to underlying health conditions, employment in service jobs, and/or living conditions. Should there be another Illinois stay-at-home order, staff are prepared to once again pivot to a delivery model to ensure program continuity and food access. Given the challenges of working with hard copy participant surveys, particularly at a time when parts of the program have become virtual, staff are planning for the transition to an online platform to better capture and analyze results. Tablets were purchased for this system to transition to a digital format in the grant's third year.

Impacts
What was accomplished under these goals? The growth of VeggieRx in the grant's second year included an expansion to Chicago's Austin community last June through a partnership with PCC Austin Family Health Center. VeggieRx staff worked with PCC Austin to meet their wish to address diabetic management and contributing social determinants of health through the program. They worked together to integrate VeggieRx initiatives with a comprehensive diabetic action plan. PCC care providers set a goal of decreasing diabetic A1c levels (a tool for measuring blood sugar levels) and comorbid depression, while increasing patient perception of self-efficacy in the self-management of their diabetes. The initial 23-week pilot of this program distributed 293 produce bags to 101 individual diabetic patients, coupled with nutrition education and group medical visits, offered in both English and Spanish. PCC tracked a 13% average drop in A1c levels, as well as a reduction in depression and an increased ability to self-manage this chronic disease. Windy City Harvest continued to operate a garden at the clinic (launched in 2015) and sold produce their farm stand, including for coupon redemption. VeggieRx programming began earlier this year, in February rather than June, responding to participant needs for healthy produce and nutrition education year-round, not just during Chicago's limited outdoor growing season. The LCHC and PCC Austin sites kicked off the program in February, while the PP4H plan offered a 10-week "winter VeggieRx" for Loyola Maywood patients followed by a June through November schedule. Windy City Harvest produce was supplemented with regionally grown food obtained through Chicago-based distributors, including Midwest Foods and Local Foods. Right from the start, participation during the winter months signaled strong demand for year-round programming. One of the most significant accomplishments during the second half of the grant period was a swift and effective response to an Illinois shutdown due to COVID-19 and the strict social distancing guidelines that followed, in March of this year. Staff quickly revised the in-person model, which was no longer viable. At a time when food shortages occurred across the region and country, especially in socioeconomically disadvantaged communities like those served through VeggieRx, Windy City Harvest staff pivoted to a delivery-based model. Staff also quickly transitioned the in-person nutrition education and cooking sessions to a virtual format. After closing to the public in late March, VeggieRx implementation was on hold for three weeks as staff re-tooled to safely offer programming again. The Farm on Ogden reopened in early May three days a week with strict social distancing protocols and contact-free pick-up of VeggieRx bags. The delivery option remained popular among certain participants, while others migrated to weekly pick-ups. These changes created greater accessibility for both new and repeat program participants. Activities advanced progress on each of the project objectives during the grant's second year. 1) SNAP recipients gain access to fresh, locally produced, and culturally appropriate fruits and vegetables 2,432 produce bags were redeemed by SNAP-enrolled LCHC, Loyola Maywood, and PCC Austin patients and their families, reaching 683 unique individuals; this provided increased food access to 2,049 people (based on average household size of three people) SNAP participants receive or purchase more than 27,888 pounds of produce (39,840 servings based on USDA estimate of 0.7 pounds per serving) through the prescription produce program and double value coupon redemption 87% of repeat participants report consuming more than half of their VeggieRx bag VeggieRx distributed 674 bags (5,392 produce pounds) from March through May in Chicago communities that were hard-hit by coronavirus and significant food shortages 2) Low-income community members gain a greater understanding of the importance of a good diet to overall health through dietary counseling 683 patients attended nutrition education/food preparation demonstrations Decline in the percentage of VeggieRx participants reporting that knowledge of food preparation is a barrier to consuming fresh produce VeggieRx participants reported increased knowledge of food preparation, healthy eating habits, and reduced intake of processed/fast foods 136 Youth Farm trainees (approximately 40% from families enrolled in SNAP) received nutrition education All VeggieRx participants received at least one 30-minute nutrition education lesson focused on a single topic--including fats, sodium, sugar, fiber, and nutrition label reading. Classes included a cooking lesson that demonstrated how to prepare the produce received and were augmented by support materials, including the day's recipe, a "What's in Your Box?" handout, nutrition information, and storage recommendations. Staff expanded the curriculum with new topics, such as portion size, hydration and rethinking drink options, and understanding phytonutrients and the power of eating fruits and vegetables in a rainbow of colors. The curriculum was also updated to include topics of great concern during the pandemic, such as, "Stretching Your Pantry and Planning Grocery Trips during COVID-19," "Tips for Keeping Produce Fresh and Safe to Eat," and "A Guide to Washing Produce." Examples of VeggieRx participant comments include: "I feel this program is wonderful because it equips us with fresh vegetables that are usually hard to obtain at stores due to high pricing, we do not have produce at our neighborhood stores." "VeggieRx is a positive motivational gradual change of eating, being healthier and living right. Also it is a better way of reaching our fellow neighbors by introducing them to something healthy." "I'm more able to eat produce daily instead of randomly." 3) Doctors gain a greater understanding of dietary health and incorporate nutrition education into their practice WCH conducted four information sessions with 112 LCHC, Loyola University Medical Center, and PCC providers 112 healthcare LCHC, Loyola Maywood, and PCC Austin providers attended VeggieRx orientation sessions and a smaller group participated in regular monthly meetings to gauge program efficacy 4) Train participants in WCH education programs A total of 192 trainees, 80% from socioeconomically disadvantaged backgrounds (varies by program), learned about sustainable urban agriculture while growing produce for VeggieRx. They included: 136 students in the Youth Farm program 31 trainees in the Corps transitional jobs program for formerly incarcerated men and women 15 participants in the nine-month Apprenticeship in sustainable urban agriculture 5 emerging farm businesses (10 farmers) owners The number of trainees in next year's report will be lower as COVID-19 has required staff to reduce the number of participants working onsite at any given time to maintain social distancing requirements. The impact of the pandemic on Windy City Harvest incubator farmers has required businesses to shift their markets at a time when restaurant sales have declined; some have found a steady market distributing produce to VeggieRx, a win-win.

Publications


    Progress 06/01/18 to 05/31/19

    Outputs
    Target Audience:Through the end of the report period, the Chicago Horticultural Society's Food as Medicine initiative directly served 331 Supplemental Nutrition Assistance Program (SNAP) clients. Each participant attended at least one 30-minute VeggieRx session, receiving a free, eight pound bag of produce and $10 in 50% off coupons redeemable at Windy City Harvest farm stands. Demographic data was collected at each attendee's first, fifth, and tenth sessions. Among the 331 first-time attendees, 63% identified as Black/African American, 20% as Latinx/Hispanic, 10% as multiracial, 5% as White/Caucasian, and 1% did not report their race or ethnicity. Participants were 77% female and 21% male; the remaining 2% reported "other gender" or did not report. The mean participant age was 34. Due to the composition of the surrounding communities, VeggieRx nutrition education sessions were offered in both English and Spanish; 84% attended the English language classes while 16% attended sessions in Spanish. All VeggieRx participants were currently enrolled in SNAP, which was verified by performing a "balance check" at each free VeggieRx box distribution, as stipulated by USDA FNS. Another 662 individuals, including 331 children, benefitted from the nutritious meals prepared by family members at home--bringing the program's overall impact to 993 (estimate based on an average household size). Participants were primarily recruited through partnerships with two healthcare institutions: the Lawndale Christian Health Center (LCHC) and Loyola University Health System/Proviso Partners for Health (PP4H). Clinicians from these organizations were engaged in educational sessions about the program to encourage them to refer patients into VeggieRx; 276 providers were engaged in these activities. Additional participants were recruited into the program through advertising and word-of-mouth. Windy City Harvest's North Lawndale headquarters, known as the Farm on Ogden, also proved to be a helpful recruitment tool. Located just two blocks from LCHC's main clinic, the Farm on Ogden is an indoor farm, urban agriculture training center, and year-round farm stand. Windy City Harvest staff notified customers who used Electronic Benefits Transfer (EBT) cards about the program. The project was supported by 196 Windy City Harvest trainees and small farm businesses in its incubator program. Participants were 62% Black/African American, 22% Latinx/Hispanic, 11% white, 5% multiracial; 52% were female, 47% were male, and 1% identified as gender non-binary. Eighty-three percent of trainees were economically disadvantaged, in keeping with Windy City Harvest's mission to provide economic uplift through paid jobs training and youth development opportunities. Changes/Problems:During the report period, the grant project proceeded as proposed. However, after reviewing the first summer of implementation, a few changes were proposed for the remaining years of the grant. The first was that SNAP participation among patients of the PP4H Elmwood Park clinic was lower than anticipated, meaning that demand for the program was also slightly lower than hoped. After reviewing project results, Windy City Harvest and PP4H were able to jointly identify a clinic with a larger SNAP participation rate located in Maywood, Illinois. Food access challenges in Maywood are also comparatively greater in Maywood than in Elmwood Park, so the PP4H portion of the program was relocated to Maywood in Year 2 of the grant. An opportunity arose to launch the program at an additional site, PCC Family Health Center, which is located in the disinvested Austin community on Chicago's West Side. Windy City Harvest has operated a garden at the clinic since 2015, facilitated a farm stand and vegetable box distribution program. PCC staff were interested in adopting the VeggieRx model, which more explicitly connects food and health. In addition to nutrition education and cooking demonstration sessions, the VeggieRx program at PCC is focusing explicitly on patients with diabetes and including a group medical visit as part of each distribution. This change was approved by USDA NIFA in June 2019. What opportunities for training and professional development has the project provided?The project provided professional development opportunities for Windy City Harvest and PP4H staff. Brittany Calendo, an early career professional with a social work background, gained experience working with medical providers to address social determinants of health through the program. Healthcare providers learned how to incorporate VeggieRx into their care plans, emphasizing the role that a plant-based diet can play in preventing and alleviating diet-related illnesses. How have the results been disseminated to communities of interest?Results were through Windy City Harvest and its partners' networks, generating significant interest from the professional community. Dr. Courtney Kimi Suh, a family medicine practitioner affiliated with PP4H, prepared a research proposal on the program titled "An exploration of the social emotional learning outcomes of participants enrolled in VeggieRx." The study will examine the efficacy of VeggieRx in improving health outcomes of patients, as measured by self-reported stress and physical health levels, fasting blood glucose levels, blood pressure, and other measures. The status of these findings will be reported to USDA NIFA in future progress reports on this grant. Windy City Harvest also shared the project with Blue Cross Blue Shield, a medical insurance provider that provides matching support for the FINI grant. Windy City Harvest has received positive feedback on the VeggieRx model, particularly because it provides produce to patients with diet-related illnesses at the site of the nutrition education session--alleviating the need to make an additional trip to the store. For food-insecure communities with few or no grocery stores selling fresh produce, this model creates critical food access that is typically unavailable to program participants. Windy City Harvest also shared the project through farm tours and visits to the Farm on Ogden by elected officials, community leaders, school groups, local residents, and other stakeholders. More than 6,200 individuals were engaged in these activities. Several other methods of dissemination, including widespread outreach to local media outlets, are planned for the next reporting period. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, Windy City Harvest will continue the program at LCHC and PP4H, though it will relocate to a different PP4H site (see "changes/problems"). VeggieRx will also expand delivery to another clinic in Chicago's Austin neighborhood--PCC Austin Family Health Center (PCC). Though not included in the original proposal, this change was approved by the USDA FINI program director in June 2019. To prepare for this expansion, PCC and Windy City Harvest partnered with Common Threads--a Chicago-based nonprofit that provides evidence-based cooking and nutrition education classes--to conduct a provider training in motivational interviewing, cooking, group facilitation and nutrition education. Project dissemination will also continue apace, with broadcast and print media placements completed or planned with several local outlets. Windy City Harvest is revising its website to include information about VeggieRx, and PP4H is adding VeggieRx to its website. The program will also be made available for the first time through NowPow, a database of wrap-around service referrals accessible by medical and social service providers.

    Impacts
    What was accomplished under these goals? In June 2018, Windy City Harvest (WCH) launched the VeggieRx project in partnership with two healthcare institutions--LCHC and PP4H. Each week from June through November, a total of eight VeggieRx sessions, half in Spanish and half in English, were delivered to LCHC patients at the Farm on Ogden. PP4H conducted four sessions weekly at Loyola Center for Health, a clinic in Elmwood Park, a suburb bordering Chicago. PP4H piloted a program to deliver VeggieRx during the winter months. Because the Chicago growing season had largely concluded, offerings of WCH produce were supplemented with regionally grown produce obtained through Chicago-based distributors Midwest Foods and Local Foods. Britt Calendo, an existing member of the WCH staff, was chosen to oversee the program. Calendo was already overseeing a partnership with a healthcare institution: PCC Austin Family Health Center Center on Chicago's West Side. Calendo's experience, as well as her professional preparation in social work, has proven invaluable--in particular for launching the VeggieRx program with PP4H. To coordinate the program, WCH hired Ketaurah James, a graduate of its Youth Farm program and North Lawndale resident. James excels in this role, providing administrative support to the program and connecting with community members. WCH is committed to representing the communities that it serves by hiring program graduates and local residents--in addition to their professional skills, these individuals help ensure that the program is implemented in a culturally relevant manner. Project activities advanced progress on each of the project objectives: 1) SNAP recipients gain access to fresh, locally produced, and culturally appropriate fruits and vegetables At each VeggieRx session, participants received free, locally grown fruits and vegetables to share with their families. Produce was selected primarily for its familiarity and popularity with the local community; a small amount of potentially unfamiliar varieties were incorporated into the boxes to help participants achieve greater variation in their diets. In all, 993 SNAP recipients (including both direct participants and their family members) received 811 VeggieRx boxes. Patients received $10 in 50% off coupons with each box, which were redeemable at WCH farm stands, including those held at each VeggieRx distribution. In all, participants redeemed $1,932 in 50% off coupons, a redemption rate of 25%. This is slightly lower than the 35% proposed; that rate was based on data from WCH's FINI Pilot Project, when coupons were redeemable for free produce rather than a 50% discount on produce. In total, 7,261 pounds (10,373 servings) of produce were provided to SNAP beneficiaries and their families. VeggieRx participants overwhelmingly indicated that they both used and enjoyed the produce received through the program. On average, participants rated the boxes 4.38 for familiarity and 4.54 for likability on a five point scale. Exceeding the proposed target of 65%, 72% of participants reported that they consumed more than half of the produce received. 2) Low-income community members gain a greater understanding of the importance of a good diet to overall health through dietary counseling All VeggieRx participants received at least one 30-minute nutrition education lesson focused on a single topic--including fats, sodium, sugar, fiber, and nutrition label reading. At LCHC, these lessons were delivered by the Chicago Partnership for Health Promotion, the largest SNAP-Ed program in the state of Illinois. Mary Mora, a dietician with expertise in community health education, delivered the PP4H sessions. Each class included a short cooking lesson that demonstrated how to prepare the produce received. Often, recipes included more nutritious twists on familiar dishes--for example, participants learned how to prepare a lower sodium version of collard greens with turkey rather than pork. Each participant received a binder ring with informational cards including the day's recipe; a "What's in Your Box?" handout with photos of the produce, methods of preparation, storage recommendations, and nutrition information; and a summary of the nutrition lesson. Survey data indicate that these lessons succeeded in encouraging behavior change. On average, participants agreed or strongly agreed that they planned to change their eating habits to incorporate the lessons learned (i.e., reduce sodium or increase fiber intake). Participants also reported that food preparation was no longer a substantial barrier to eating fruits and vegetables. At LCHC, 17% of first time attendees reported that they did not know how to cook, compared to 7% who participated in ten or more sessions. Similarly, 16% of first time attendees at the PP4H site reported that cooking was a barrier to healthy eating; that figure dropped to 0% after ten sessions. Participants comments about the program were overwhelmingly positive. Examples of comments include: "I found how good fruits and veggies are for you. How to sauté cabbage and other veggies together and learned that there are fresh veggies in the area." "I'm happy that they have this program available in my neighborhood." "I learned how to roast beets, I never had them before and they are pretty good. I will try to get my kids to eat them now." "I have been adding more veggies because of this market, otherwise I won't be able to afford it." Though not supported directly by FINI funding, 140 students WCH's Youth Farm program supported VeggieRx by growing produce for the program. As they learned to maintain sustainable urban farms, the students benefitted from on-site dieticians who provided nutrition education through weekly workshops and cooking demonstrations, and by setting up nutrition "challenges" between the teens. Interns also worked closely with students to set and track progress toward "Get Healthy Goals." All students set goals and 82% achieved their goal by the end of the program. 3) Doctors gain a greater understanding of dietary health and incorporate nutrition education into their practice Throughout the project period, WCH conducted information sessions with 276 LCHC and PP4H providers. Outreach took place primarily during regularly scheduled provider meetings, conveying the message that VeggieRx is a routine part of patient care, rather than a separate initiative. During the previous FINI Pilot Project, WCH staff learned that garnering buy-in from clinicians at partnering healthcare organizations is the single most important factor in the program's success. Clinicians must understand how the program benefits their patients, how to screen for food insecurity and diet-related illnesses, and how to refer patients into the program. Once VeggieRx is "prescribed" to a patient, the referral becomes part of their electronic medical record (EMR), formalizing the program as part of their care plan. Through the EMR, patients receive automated text message reminders to attend VeggieRx sessions, encouraging repeat attendance. Of the two primary populations that attend VeggieRx (clinician referrals/word-of-mouth), those referred by healthcare providers tend to participate in the program longer--receiving more nutrition education and more fresh produce to take home. 4) Train participants in WCH education programs Trainees in three programs supported VeggieRx by growing local produce on WCH farm sites across the Chicago region. These included 140 students in the Youth Farm youth development program; 26 trainees in the Corps workforce re-entry program for ex-offenders; and 19 participants in the 9-month Apprenticeship in sustainable urban agriculture. WCH recruits participants from marginalized communities--providing opportunities for economic uplift. Eleven small farm business owners in WCH's farm incubator program grew produce that was used in the VeggieRx program.

    Publications

    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2019 Citation: Calendo, Brittany. "VeggieRx Program: Food as Medicine." Presented at the Illinois Public Health Institute Summit, Chicago, IL, April 2019.
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2019 Citation: Calendo, Brittany. "VeggieRx Program: Food as Medicine." Presented at the University of Illinois - Chicago Health Policy and Advocacy Summit, Chicago, IL, February 2019.