Progress 09/01/20 to 08/31/24
Outputs
Target Audience: • All participants are adults (18+ years old). • All participants are current KKV medical patients OR living in a household which has at least one current KKV medical patient with at least one of the following diet-related diagnoses: hypertension, obesity, prediabetes, diabetes or cardiovascular disease. • All participants who are current KKV medical or dental patients receive a referral to the PPR program from their KKV medical or dental provider. • All participants who are not KKV medical patients reside with at least one current KKV medical or dental patient who has received a referral to the PPR program from their KKV medical provider. • All participants are considered low income as designated by household income and the federal poverty line. This will be verified by: a) documentation in KKV's EMD if they are KKV patients and eligible for our sliding fee scale; b) are currently receiving SNAP benefits, or eligible for SNAP benefits by other means-tested mechanisms (e.g., participation in WIC or HeadStart); c) are enrolled under a State plan under title XIX of the Social Security Act; or d) currently living in low-income public housing. • All participants are residents of Kalihi Valley or adjacent zip codes (96701, 96813, 96817, 96818, 96819, 96822) as determined by KKV's Community Health Workers in order to qualify for produce prescription delivery, or residents of any other Oahu zip code to enroll in produce prescription (pick-up only). • All participants have at least one member in their household that can communicate in English. Changes/Problems:During this reporting period, Roots established a new partnership with Farmlink produce delivery service during calendar year 2024, in order to reach more households via contactless produce prescription delivery. Previously, we had been unable to significantly increase enrollment due to insufficient person-power to fulfill all weekly home deliveries. By partnering with a delivery provider, we have been able to reduce the delivery burden on our staff, so that they can focus on other program activities such as screening and enrollment procedures. With Farm Link's cooperation, we have been able to continue enrolling participants under our GusCRR funding source and have spent down the balance of our GusNIP funds, while also supporting Farm Link's desire to reach customers in a lower income bracket. During this reporting period, 140 unique individuals were enrolled under our GusNIP funding source. As mentioned above, on the basis of our experience in operating the GusNIP/GusCRR produce prescription program, beginning in May 2024, Roots launched an insurance-reimburseable healthy food program in partnership with local healthcare provider AlohaCare. Each week, enrolled participants receive not only fresh produce, but also two prepared healthy meals, consultation with our new Roots program dietician, and opportunities for 'aina (land)-based workdays at Ho'oulu 'Aina, KKV's 100 acre nature preserve, to promote physical, mental, social, and spiritual health. Our staff are monitoring program operations and participant perceptions and outcomes in order to continously improve the program. Our prior experience with the GusNIP produce prescription program has proved invaluable for this new effort. What opportunities for training and professional development has the project provided?As described previously, Roots has provided two major professional development and training opportunities in this reporting period. 1. Farm Partner Gathering (3/19/2024) - provided an opportunity for farmersto network, share agricultural knowledge with one another, and to learn more about the successes and impacts of the Roots Produce Prescription Program that their produce enables. 2. Nutrition Incentive Hub 2024 "Food, Land, and Culture" Mini-Convening (8/21 - 8/24/2024) - Roots Market Manager Kaui Tuihalafatai attended both the2023 Produce Prescription Program Mini-Convening in Chicago, IL (10/16 - 10/19/2023) and the2023 USDA Community Nutrition Project Directors Meeting (12/4 - 12/6/2023), where she networked with many other program grantees as well as Fair Food Network staff, and issued many personal invitations to visit the Roots Program and understand our operations and philosophy. With the assistance of Fair Food Network staff, this crystalized into a planned mini-convening for approximately 30 staff members from other grantee organizations from all over the country. Over the three and a half days of the convening, participants: learned about Hawai'i's unique history, which form the context for today's food system, and food system related challenges and opportunities learned about KKV's Pilinaha health framework, based on Indigenous values, and how this framework guides program operations shared some of the Core Dilemas faced by their own programs, and collectively workshopped solutions and alternatives performed site visits to Roots' Food Hub and KKV's Ho'oulu 'Aina Nature Preserve to learn more about KKV's wrap-around care services heard presentations from some of Roots' partner organizations in food system and community health, the Food Basketand Waianae Coast Comprehensive Health Center, to learn more about the tailored interventions they utilize to address the specific context and needs of their own communities, and fromthe Hawai'i Good Food Alliance to learn more about collective, statewide strategies 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?
Nothing Reported
Impacts
What was accomplished under these goals?
1. To Increase the consumption of fruits and vegetables by low-income patients with chronic health conditions; During this reporting period, the produce prescription program has continued to provide service to up to 140 participants simultaneously enrolled under the GusNIP funding source alone. Our prescription program was designed to promote longevity of participation, and we are pleased to report that some of our GusNIP cohort participants have been enrolled for as long as 36 months as of August 2024. Unique Participants (total) -376 over life of program across all funding sources Enrolled Participants (this reporting period) - 234 simultaneously enrolled across all funding sources 2. To Integrate KKV's Clinical care services and the Roots Food Hub; The Roots Food Hub and clinical care services continue to check in regularly about program function and logistics. Over the course of executing this award, our clinical staff, especially our community health workers, have developed a greater understanding of Roots' operations and available food-related services, and how to connect their patients to these services. Likewise, Roots staff have increased knowledge of medical screening procedures, impact and prevalence of diet-related chronic health conditions in our community, and of how medical data is stored, accessed, and utilized at KKV. These new understandings will aid in providing well-integrated and efficient care to our community members in future collaborative interventions with our medical providers, such as a new insurance-reimbursable health meal program launched by the Roots Program in 2024 (described more below). 3. To Provide Deep educational opportunities around nutrition and cultural foods and Broad access to healthier foods; KKV's community health workers provide ongoing, meaningful engagement with program participants during weekly deliveries. KKV staff talk with participants to learn about their perceptions of the produce Rx program, to discuss any issues or questions participants have with the produce they are receiving, and to educate participants on nutrition, cooking techniques, and recipes. 4. To Uplift and Build food agency among patients with chronic conditions and their families; The Rx program continues to operate with remaining GusCRR funds, and Rx program staff continue to prioritize enrollment of multiple eligible people within a single household, to encourage and provide an opportunity for a culture of healthy eating across multiple household members. We believe that this strategy encourages a stronger mutual support network for lasting dietary changes. 5. To Support and sustain local organic farm partners; and During this reporting period, the Roots Food Hub has partnered with 30 local, sustainable farms for provision of healthy produce to our Kalihi community. Across all Roots programming, Roots has purchased approximately 68,900 pounds of produce during this reporting period. Roots also held a gathering for our farm partners on 3/19/2024, providing an opportunity for farmers to network, share agricultural knowledge with one another, and to learn more about the successes and impacts of the Roots Produce Prescription Program that their produce enables. 6. To Develop evaluation protocols and build data with respect to food and health for chronic care patients and their families around social determinants of health. During this reporting period, project staff have initiated a new coding system in our medical records, enabling easier data extraction for purposes of analyzing program impact on enrolled participants. Moreover, project staff have begun learning KKV's second major healthcare data program, utilized by our dentistry department, in order to apply coding to the dental records of enrolled participants as well. Once complete, this will enable staff to begin analyzing program impact on dental health.
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Progress 09/01/22 to 08/31/23
Outputs
Target Audience:The majority of participants are public housing residents in Kalihi Valley, and primarily Asian American or Pacific Islander. Participants conform to the following eligibility criteria: • All participants are adults (18+ years old). • All participants are current KKV medical patients OR living in a household which has at least one current KKV medical patient with at least one of the following diet-related diagnoses: hypertension, obesity, prediabetes, diabetes or cardiovascular disease. • All participants agree to fill out the USDA baseline and post participant survey. • All participants who are current KKV medical or dental patients receive a referral to the PPR program from their KKV medical or dental provider. • All participants who are not KKV medical patients reside with at least one current KKV medical or dental patient who has received a referral to the PPR program from their KKV medical provider. • All participants are considered low income as designated by household income and the federal poverty line. This will be verified by: a) documentation in KKV's EMD if they are KKV patients and eligible for our sliding fee scale; b) are currently receiving SNAP benefits, or eligible for SNAP benefits by other means-tested mechanisms (e.g., participation in WIC or HeadStart); c) are enrolled under a State plan under title XIX of the Social Security Act; or d) currently living in low-income public housing. • All participants are residents of Kalihi Valley or adjacent zip codes (96701, 96813, 96817, 96818, 96819, 96822) as determined by KKV's Community Health Workers in order to qualify for produce prescription delivery, or residents of any other Oahu zip code to enroll in produce prescription (pick-up only). • All participants have at least one member in their household that can communicate in English. Changes/Problems:As previously noted, we intend to partner with Farmlink produce delivery service during calendar year 2024, in order to reach more households via contactless produce prescription delivery. Previously, we have been unable to significantly increase enrollment due to insufficient person-power to fulfill all weekly home deliveries. By partnering with a delivery provider, we will be able to reduce the delivery burden on our staff, so that they can focus on other program activities such as screening and enrollment procedures.? What opportunities for training and professional development has the project provided?KKV's Food Hub staff provide ongoing advisement to local farm producers on what produce items are most in demand in our community, so that they can plant their crops accordingly.? 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?During this reporting period, we requested and received a no cost extension for our GusNIP award. We intend to double overall program enrollment in calendar year 2024 to expend remaining funds and reach the greatest number of program participants. As of November 2023, we have established a partnership with Farmlink produce delivery service to facilitate prescription fulfillment for participating households, while remaining in compliance with our IRB's mandate for contactless delivery as the preferred method of delivery.?
Impacts
What was accomplished under these goals?
1. To Increase the consumption of fruits and vegetables by low-income patients with chronic health conditions; During this reporting period, the produce prescription program has continued to provide service to up to 119 participants enrolled under the GusNIP funding source. Our prescription program was designed to promote longevity of participation, and we are pleased to report that some of our GusNIP cohort participants have been enrolled for as long as 27 months as of November 2023. Participants also completed their 2023 post surveys in June and July 2023. NTAE will receive this data and provide analysis of any increased consumption of fruits and vegetables. 2. To Integrate KKV's Clinical care services and the Roots Food Hub; The Roots Food Hub and clinical care services have continued to strengthen linkages established through implementation of this program, primarily through regular check-in meetings between Hub staff and our KKV community health workers. 3. To Provide Deep educational opportunities around nutrition and cultural foods and Broad access to healthier foods; KKV's community health workers provide ongoing, meaningful engagement with program participants during weekly deliveries. KKV staff talk with participants to learn about their perceptions of the produce Rx program, to discuss any issues or questions participants have with the produce they are receiving, and to educate participants on nutrition, cooking techniques, and recipes. 4. To Uplift and Build food agency among patients with chronic conditions and their families; Rx program staff continue to prioritize enrollment of multiple eligible people within a single household, to encourage and provide an opportunity for a culture of healthy eating across multiple household members. We believe that this strategy encourages a stronger mutual support network for lasting dietary changes. 5. To Support and sustain local organic farm partners; and During this reporting period, the Roots Food Hub has partnered with 33 local, sustainable farms for provision of healthy produce to our Kalihi community. Across all Roots programming, Roots has purchased 63,000 pounds of produce during this reporting period. 6. To Develop evaluation protocols and build data with respect to food and health for chronic care patients and their families around social determinants of health During this reporting period, program staff successfully worked to link data across program and medical databases for a limited cohort of participants, reflecting our first success at examining produce program impact on medical outcomes for KKV patients. We will continue to work towards more efficient data linkage protocols.
Publications
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Progress 09/01/21 to 08/31/22
Outputs
Target Audience:During this reporting period, our project enrolled 170 participants into the GusNIP program. The majority of participants are public housing residents in Kalihi Valley, and primarily Asian American or Pacific Islander. Participants conform to the following eligibility criteria: • All participants are adults (18+ years old). • All participants are current KKV medical patients OR living in a household which has at least one current KKV medical patient with at least one of the following diet-related diagnoses: hypertension, obesity, prediabetes, diabetes or cardiovascular disease. • All participants agree to fill out the USDA baseline and post participant survey. • All participants who are current KKV medical or dental patients receive a referral to the PPR program from their KKV medical or dental provider. • All participants who are not KKV medical patients reside with at least one current KKV medical or dental patient who has received a referral to the PPR program from their KKV medical provider. • All participants are considered low income as designated by household income and the federal poverty line. This will be verified by: a) documentation in KKV's EMD if they are KKV patients and eligible for our sliding fee scale; b) are currently receiving SNAP benefits, or eligible for SNAP benefits by other means-tested mechanisms (e.g., participation in WIC or HeadStart); c) are enrolled under a State plan under title XIX of the Social Security Act; or d) currently living in low-income public housing. • All participants are residents of Kalihi Valley or adjacent zip codes (96701, 96813, 96817, 96818, 96819, 96822) as determined by KKV's Community Health Workers in order to qualify for produce prescription delivery, or residents of any other Oahu zip code to enroll in produce prescription (pick-up only). • All participants have at least one member in their household that can communicate in English. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?KKV's Food Hub staff providing ongoing advisement to local farm producers on what produce items are most in demand in our community, so that they can plant their crops accordingly. 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?Enrollment is continuing. As program enrollment increases, our program is exploring solutions to address logistical challenges, such as staggering delivery days to program participants, and multiple deliveries from our farm partners per week.
Impacts
What was accomplished under these goals?
1. To Increase the consumption of fruits and vegetables by low-income patients with chronic health conditions; During this reporting period, 170 new participants were enrolled under this funding source. Over this one year period, almost 32,500 pounds of produce were delivered to program participants. Participants also completed their post surveys in June and July 2022. NTAE will receive this data and provide analysis of any increased consumption of fruits and vegetables. 2. To Integrate KKV's Clinical care services and the Roots Food Hub; The Roots Food Hub and clinical care services have developed the following new linkages during the course of implementing the produce prescription program: Weekly or monthly Rx program coordination meetings with management staff (clinical and non-clinical) Bi-annual meetings with all Rx program implementation staff to identify challenges, learn from successes, and discuss logistics Presentations to all clinical care providers on the Rx program and other Roots food support availability 3. To Provide Deep educational opportunities around nutrition and cultural foods and Broad access to healthier foods; KKV's community health workers provide ongoing, meaningful engagement with program participants during weekly deliveries. KKV staff talk with participants to learn about their perceptions of the produce Rx program, to discuss any issues or questions participants have with the produce they are receiving, and to educate participants on nutrition, cooking techniques, and recipes. 4. To Uplift and Build food agency among patients with chronic conditions and their families; By design, Rx program staff attempt to enroll multiple eligible people within a single household, so that multiple members of the social unit are addressing their health via improved nutrition. The goal is to foster an environment of group engagement with healthy eating, to provide mutual support and encouragement. We believe this builds a feeling of agency and reciprocal affirmation. 5. To Support and sustain local organic farm partners; and Roots' Food Hub manager is in constant contact with our existing network of farm partners to understand what crops are currently available and what will soon be coming into season; and to provide feedback about what crops our community would prefer, to inform farmers' future crop selection. Moreover, our manager also solicits recommendations from our partner network about other Oahu farms that might like to join our farm network, as our weekly demand for produce grows along with our enrollment numbers. We are currently partnered with 32 local farms. 6. To Develop evaluation protocols and build data with respect to food and health for chronic care patients and their families around social determinants of health Program staff are working to improve database architecture to facilitate easier access to research data for analysis.
Publications
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Progress 09/01/20 to 08/31/21
Outputs
Target Audience:The target audience of this intervention are patients ofKokua Kalihi Valley Comprehensive Services(currently92.97% of whom are Asian American/Pacific Islander)and their families who are low-income asdetermined by means-tested mechanisms and who have or are at risk for diet-related chronic disease. During this reporting period only, we successfully enrolled 5 community members belonging to our target audience. Changes/Problems:Our original proposal anticipated a relatively short planning phase (several months), followed by implementation. However, the IRB approval process significantly delayed our program launch date. Initial enrollments did not occur until August 2021. We have previously submitted and received approval for a budget modification reflecting the lack of incentives expenditure during our first project year. What opportunities for training and professional development has the project provided?KKV's Food Hub staff providing ongoing advisement to local farm producers on what produce items are most in demand in our community, so that they can plant their crops accordingly. 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?Enrollment is ongoing, and logistical challenges are being addressed as they are encountered. KKV is rapidly building out the collaborative framework for program execution.
Impacts
What was accomplished under these goals?
During this reporting period, KKV enrolled 5 participants into the produce prescription program, and fulfilled one week of produce distribution to said participants. Baseline surveys have been completed, but post surveys have not, so we are unable to demonstrate an increase in produce consumption. KKV has developed new protocols between the Roots Program and KKV's clinical care services to refer, screen, enroll, and distribute produce to program participants. New protocols will facilitate broad access to healthier foods for program participants and their households. Deep educational opportunities are being developed. KKV is building food agency for program participants by presenting ongoing opportunities for feedback on produce preferences andtailoring produce prescription boxes to those preferences. Additionally, KKV is uplifting meaningful cultural foodways by priotizing the inclusion of cultural significant and familiar produce, particularly cultural starches that are otherwise prohibitively expensive for many community members. KKV is currently partnered with 30 small local farms for the provision of fresh produce. KKV's survey instruments collect qualitative and quantitative data on the impact of produce prescription program enrollment on program participants. Additionally, KKV is requesting access to the medical records of program participants who are also KKV patients, for later analysis.
Publications
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