Progress 06/15/22 to 06/14/23
Outputs
Target Audience:Kentucky consistently ranks in the bottom ten states nationally for diet-related health outcomes and is 45th in the nation for overall health. With around 22% of Kentucky's children living in poverty, and more than 17% of Kentuckians living beneath the poverty line (45th in the country) - many of Kentucky's households struggle to afford a nutritionally adequate diet. The average adult Kentuckian consumes only 1.9 and 1.3 servings of vegetables and fruit respectively, per day. These dietary factors significantly contribute to Kentucky's poor health outcomes and many health conditions can be positively impacted by a diet high in fruit and vegetable consumption. However, low-income individuals are often unable to locate affordable, healthy foods. With over 500,000 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to increase access to fresh produce while supporting Kentucky farmers and stimulating economic development. The COVID-19 pandemic has dramatically increased the number of Kentuckians experiencing food insecurity, especially in rural eastern Kentucky. Kentucky ranks in the top ten nationally for rates of highest projected overall food insecurity in 2021, with a projected rate of 15.1%. Paired with this, Kentucky ranks in the top ten for rates of highest projected overall very low food security (VLFS) - a more severe level of food insecurity that includes reduced food intake and disrupted eating patterns. Kentucky counties make up 40% of the top ten VLFS counties nationally. Many Kentuckians experienced food insecurity prior to the pandemic, but COVID-19 exacerbated an already dire situation. The project served low-income, expecting mothers on Medicaid in rural and urban communities across the state. Changes/Problems:Despite the success of the program in 2023, CFA has been met with numerous challenges in implementation of the 2023 FRx program as outlined below: Identifying qualified referrals and successfully engaging those referrals to actively participate in the program is another significant challenge. In several cases, referrals were given to qualified program candidates, but the candidates did not come to the market to participate in the program. Markets consistently struggle with connecting with clients in a way that encourages them to participate. This is not due to a lack of training or effort. Additionally, teams have worked with supportive organizations who, at program introduction and onset, indicate an interest in assisting with gathering referrals, but fail to send referrals to the program. This can be due to a number of reasons. In summary, it seems that getting the word out about the program does not necessarily result in getting people to the markets to participate. Moving forward, CFA will continue to strengthen the referral process through more targeted outreach to markets and referring partners, and intentional partnerships with local MCOs Passport and Wellcare, with a goal of utilizing the resources of these MCOs to refer eligible participants. Additionally, CFA has once again experienced significant staff turnover associated with this program. The previous FRx Coordinator (hired in 2022) left her position in June of 2023, and a new FRx Coordinator was brought on in June 2023. This project has experienced fairly consistent staff turnover during the past few years, which has provided a unique set of challenges for program implementation. What opportunities for training and professional development has the project provided?Together with Community Farm Alliance, this project's Fresh Rx Coordinator, developed outreach materials including educational, marketing, and recruitment pamphlets and fliers, hosted workshops, and conducted various other outreach activities. The Coordinator developed, designed, and implemented Zoom meetings for all participating markets. Additionally, the FRx Coordinator created outreach materials for each market manager or Fresh Rx administrator to utilize when establishing referral sites for the program. The FRx program guide was updated this period to provide a complete resource of training and program implementation. The Coordinator provided presentations to Family Resource Youth Service Centers, Health Departments and HANDS staff, and the University of Kentucky's SNAP Nutrition Education Program to provide background on the program so that these groups can successfully conduct program outreach and recruitment with their clients. Additionally, the FRx Coordinator participated in a training with the GusNIP PPR Community of Practice, and was introduced to the idea of pulling together an Advisory Group of participating markets, to help to guide implementation of the program. In response, there are plans to launch an Advisory Group in the coming months that will provide space for representatives from program outlets to convene and share program successes, discuss common challenges, and collectively brainstorm ideas for solutions. How have the results been disseminated to communities of interest?At this time, results have not been disseminated to communities of interest. Results will likely be shared during the next reporting period. What do you plan to do during the next reporting period to accomplish the goals?As the narrative indicates, CFA has experienced significant challenges in the successful implementation of the 2023 FRx Program. The team expects to see improvement in the final year of this grant as a result of implementation of the Advisory Group, increased focus on helping to facilitate necessary relationship building between FRx outlets and their local community organizations, and building intentional partnerships with local MCOs Passport and Wellcare to assist with the referral of eligible participants. Moving forward, markets will be trained to share the unique successes noted at each market in an effort in increase program marketing through various media outlets. The meal kit and CSA models have shown great success, and during the final year the team will evaluate if additional CSA models can be piloted. These are just a few of multiple strategies suggested and CFA intends to further develop these practices at additional markets as appropriate. The team will continue to guide the evolution of the program in response to challenges and successes identified at the end of each season.
Impacts
What was accomplished under these goals?
Goal 1 During this progress period, CFA launched FRx for MOMs at five locations, three of which are piloting innovative methods for getting produce prescriptions to participants, primarily through delivery of preselected food boxes or CSAs. This is a model that the project team tested during the last reporting period, and it showed great success, so the project team expanded these efforts during this reporting period. The Fresh Rx for MOMs program successfully launched in the summer of 2023 at two farmers markets (Bounty of the Barrens Farmers Market located in Western Kentucky and Phoenix Hill NuLu Farmers Market located in Central Kentucky, Louisville Metropolitan) and three CSA or food box style outlets located across the state (additional details on these outlets follows). The program attempted to launch at four additional locations, primarily in rural Eastern Kentucky and urban areas in Louisville and Lexington. However, these locations experienced challenges that ultimately prevented the successful launch of the program. Specifically, the market located in eastern Kentucky is still experiencing significant challenges related to the catastrophic flooding of June 2022. Further, this location only has one referring partner, and has experienced challenges with referring and recruiting eligible participants. The outlets located in urban areas experienced similar challenges, primarily centered around building relationships with community partners, and their successful referral and recruitment of eligible participants. Consistently markets report that they are not receiving referrals. Throughout implementation of this program, it has been clear that transportation is one of the major limiting factors for consistent program participation. In response to this, CFA and project partner, Michelle Howell, developed a food box program to pilot under GusCRR, that delivers "meal kit" boxes directly to the homes of participants. The meal kit includes the weekly prescription of fresh fruits and vegetables, paired with seasonal recipes. This model showed 100% redemption during 2022, and is poised to show 100% redemption during the 2023 season as well. This model makes the program more accessible for participants, by removing the barrier of regular transportation. Additionally, this model facilitates the development of a direct relationship between the farmers and the participants. Further, this model provides an exemplary example of the power of successful community partnerships, with multiple partners that are committed to not only promoting the program but also committed to recruiting eligible participants for the program. Because of this, this model has consistently experienced 100% participation. This model has also piloted relationship building activities amongst participants, dividing participating moms into three groups, and setting up weekly email and text threads among all participants. Each group utilizes these channels to share recipes and other information within their group, creating a community of moms. During this reporting period, CFA also piloted a CSA model, that provides participants with a customizable CSA share each week that is paired with seasonal recipes and tips for processing and cooking the produce in the share, which served Central and Eastern Kentucky, providing delivery to centralized locations in five communities in this region, specifically the communities of Berea, Richmond, Lexington, Lancaster, and Danville. A second similar CSA model is set to participate in the fall of 2023, which will serve the north central community of Glendale. Currently there are 133 individuals participating in the FRx program that have redeemed $54,449 in Kentucky-grown produce under the GusCRR during this period. Totals are lower than those related to actual participation for the 2023 season, as a result of a reporting period that only illustrates a small portion of the farmers market season. Goal 2 CFA's evaluation partner, the University of Kentucky's Community and Economic Development Institute of Kentucky (CEDIK) developed a series of surveys to capture participant experiences, changes in shopping and eating habits, and health outcomes. Previously, participants were given surveys to complete at intake, midpoint, and after program completion. During this reporting period, in response to consistently low numbers of completion of the post-season survey, CEDIK restructured the survey incentive and survey process to increase the survey incentive per survey and eliminate the mid-season survey in hopes of increasing the completion of the post-participation survey. This approach seems to have worked, as 23 individuals have completed the pre- and post-surveys so far. With 23 individuals completing the pre- and post-surveys, we are approaching a number where more complex statistical analyses can be attempted. The first five questions on the surveys are focused on food security. The general trend emerging is that once enrolled in the Fresh Rx for MOMs program, fewer respondents answer that they are experiencing situations where they feel they don't have enough money to eat regular, healthy meals. With more individuals completing the follow-up survey, the CEDIK evaluators can start analyzing these changes within individuals. The results currently represent group means. Health perceptions of the Fresh Rx are more complicated. Many participants felt as though they were starting at good or excellent health conditions when enrolling in the program. Consequently, the percentage of respondents answering 'average' by the final survey actually increased. However, CEDIK evaluators have not yet determined whether individual participants are changing their responses from pre- to post-survey for the question since we still need a few more responses to do meaningful pairwise analysis. Nevertheless, the Fresh Rx for MOMs program seems to have a positive impact when individuals are asked directly, even if they are in a good health condition when they start the program. Respondents indicated that they increased their consumption of healthy food either by a little bit (30%) or a lot (50%). The same percentage of respondents felt that the Fresh Rx program impacted their overall health positively. Only 17% of respondents were involved in nutrition or consumer food education programs while participating in Fresh Rx, which is a decrease from the last report. This is one area where more participation may help improve health outcomes. In response, CFA has intentionally began deepening relationships with nutrition education providers in the state. The Fresh Rx program looks as though it is positively impacting participant health. Fruit juice consumption per week was relatively unchanged, but fruit consumption nearly doubled. Vegetable consumption increased slightly, and fried potato consumption decreased over the course of the program. These are all patterns that one would associate with better health. However, without more responses from the final surveys, it is difficult to make a definitive statement about the program's impact because we cannot compare individual participant's changes in a statistically valid manner. Goal 3 One of the objectives of the Fresh Rx for MOMs program is to sustain and expand the market for Kentucky-grown fruits and vegetables. Surveys distributed to participants at participating Fresh Rx sites are collecting information on their self-reported spending at farmers markets after the duration of the program, though this data is not available yet.
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Progress 06/15/21 to 06/14/22
Outputs
Target Audience:Kentucky consistently ranks in the bottom ten states nationally for diet-related health outcomes and is 45th in the nation for overall health. With around 22% of Kentucky's children living in poverty, and more than 17% of Kentuckians living beneath the poverty line (45th in the country) - many of Kentucky's households struggle to afford a nutritionally adequate diet. The average adult Kentuckian consumes only 1.9 and 1.3 servings of vegetables and fruit respectively, per day. These dietary factors significantly contribute to Kentucky's poor health outcomes and many health conditions can be positively impacted by a diet high in fruit and vegetable consumption. However, low-income individuals are often unable to locate affordable, healthy foods. With over 500,000 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to increase access to fresh produce while supporting Kentucky farmers and stimulating economic development. The COVID-19 pandemic has dramatically increased the number of Kentuckians experiencing food insecurity, especially in rural eastern Kentucky. Kentucky ranks in the top ten nationally for rates of highest projected overall food insecurity in 2021, with a projected rate of 15.1%. Paired with this, Kentucky ranks in the top ten for rates of highest projected overall very low food security (VLFS) - a more severe level of food insecurity that includes reduced food intake and disrupted eating patterns. Kentucky counties make up 40% of the top ten VLFS counties nationally. Many Kentuckians experienced food insecurity prior to the pandemic, but COVID-19 exacerbated an already dire situation. The project served low-income, expecting mothers on Medicaid in rural and urban communities across the state. Changes/Problems:Response: Despite 2022 program successes, CFA has been met with numerous challenges in implementation of the 2022 Fresh Rx program, as outlined below. The most dire challenges during this reporting period have been weather related. These experiences have affected farmers markets and communities in a significant way, which in turn has affected the Fresh Rx program. In late 2021 and early 2022, Western Kentucky experienced consecutively extreme tornadic weather incidents. These incidents resulted in vast destruction across 200+ miles of Western KY. As noted above, two of our GUSCRR markets are in Western KY. In early August 2022, Eastern KY experienced massive and catastrohpic flooding. The flooding destroyed entire cities, neighborhoods, and communities. One of the markets offering Fresh Rx was forced to close, due to safety and biohazard concerns resulting from fruits and vegetables produced in flood conditions. Both weather events were declared national emergencies and FEMA, National Guard and other related emergency management services were and are still deployed, particularly in Eastern Kentucky. CFA is actively working with our partnering agencies in the Eastern Kentucky region in an effort to support the food system and communities during this time. There are notable trends in challenges across each of the markets. The next few paragraphs detail these concerns within a full program context. Markets have experienced consistent issues with distributing correct survey links to participants, with multiple participants completing the incorrect version of the survey. From a market with substantial refugee participation, there are ongoing issues related to the client ID, which is based on the participant's initials and phone numbers. Challenges have been experienced because multiple participants have reported the same initials and phone numbers, resulting in duplicate client IDs. This issue seems to occur as a result of refugees receiving new phone numbers after establishing original records that may have used the phone number for the community's immigrant services. Because the Client ID is linked to the participant's initials and portions of their phone number, the survey client IDs are not matching up. The Fresh Rx Coordinator and CEDIK are investigating these issues. Moving forward, the team will implement a new framework for developing participant ids, that leaves little room for repeating this error. Identifying qualified referrals and successfully engaging those referrals to actively participate in the program is another significant challenge. In several cases, referrals were given to qualified program candidates, but the candidates did not come to the market to participate in the program. Markets are struggling to connect with clients in a way that encourages them to participate. This is not due to lack of training or effort. Additionally, teams have worked with supportive organizations who, at program introduction and onset, indicate an interest in assisting with gathering referrals, but fail to send referrals to the program. This can be due to any number of reasons. In summary, it seems that getting the word out about the program does not necessarily result in getting people to the markets to participate. Moving forward, CFA will continue to strengthen the referral process through more targeted outreach to markets and referring partners. Additionally, CFA has experienced significant rotation in the personnel associated with this project. The Healthy Communities Director, who was leading this program's day-to-day management and implementation, resigned from CFA in July 2022. This coincided with the FRx Coordinator being out on family leave for eight weeks during the summer launch of the program. The FRx Coordinator is back now and fully engaged in the program, but there remain significant challenges to overcome in the periods leading up to her return to work. Additionally, CFA's Grant Manager left the organization in December 2021 and was not replaced until July 2022. In the months preceding the appointment of the new Grants Manager, team members pulled double duty to keep grant reporting afloat and are currently training the new grants manager to take over grant reporting related to this award. What opportunities for training and professional development has the project provided?Together with Community Farm Alliance, this project's Fresh RX Coordinator, developed outreach materials including educational, marketing, and recruitment pamphlets and fliers, hosted workshops, and conducted various other outreach activities. The coordinator developed, designed, and implemented Zoom Meetings for all seven GUSCRR participating markets. Additionally, the FRx Coordinator created outreach materials for each market manager or Fresh Rx dietician to utilize when establishing referral sites for the program. Informational materials included maps to each market and Fresh Rx Program Information. A complete Fresh Rx program guide was created as a resource for training and program implementation. How have the results been disseminated to communities of interest?At this time, results have not been disseminated to communities of interest. It is ourintent to resolve program challenges and gather additional data before presenting results. What do you plan to do during the next reporting period to accomplish the goals?As the narrative indicates, CFA has experienced significant challenges in the successful implementation of the 2022 Fresh Rx Program. The team continues to view the program as a worthwhile investment for both CFA and USDA and is earnestly and quickly developing new program protocols to improve 2023 outcomes. The Fresh Rx Team expects to see noted improvement in 2023 due in part to: extended investment in SmartSheet reporting enhancements, additional program development to include referral and supporting organization participation training, and an intense commitment to the recovery of the Eastern Kentucky Farmers Markets. The project team has learned from participating markets this year and will work to implement suggestions and successful models with participating markets in the final year of this grant. For example, Fresh Rx market Phoenix Hill NULU engaged in three media events during the market season. Moving forward, markets will be trained to share the unique successes noted at each market in an effort to increase program marketing through various media markets. The meal kit pilot met great success when incorporating phone interviews to decrease participant burden when completing surveys. The team will continue to build partnerships withmanaged care organizations. The evaluation team will explore incorporating phone interviews with other markets in hopes of getting more surveys completed. These are just a few of multiple strategies suggested and CFA intends to further develop these practices at additional markets as appropriate. The team will continue to guide the evolution of the program in response to challenges and successes identified at the end of the season.
Impacts
What was accomplished under these goals?
Output Response #1: During this progress period, CFA launched the Fresh Rx for MOMs program with six new markets, two of which piloted innovative methods for getting produce prescriptions to participants. Despite barriers presented by the ongoing pandemic and extreme catastrophic weather, the program is growing and resulting in the formation of relationships with farmers markets, healthcare providers, and community members - a key component to successful program implementation. The Fresh Rx for MOMs program successfully launched in the summer of 2022 at 5 outlets, including the Bounty of the Barrens farmers market (Western Kentucky), the Menifee County farmers market (Central Kentucky), the Phoenix Hill NULU farmers market (Central Kentucky, Louisville Metropolitan), the Black Soil CSA Pilot (Central Kentucky, Lexington Metropolitan), and Need More Acres Meal Kit pilot (Western Kentucky). Fresh Rx for MOMsattempted to launchat the Whitesburg farmers market (Eastern Kentucky) and Covington farmers market(Northern Kentucky). Unfortunately, both Whitesburg and Covington were unable to successfully implement the program this year. The Whitesburg Farmers Market (and several other farmers markets in Eastern Kentucky) was forced to shut down the season early due to safety concerns and life-threatening damage resulting from the nationally recognized flooding that occurred in Eastern Kentucky in August 2022. Substantial areas of Eastern Kentucky are still declared national emergency zones with involvement from FEMA, National Guard, etc.Due to insufficient management capacity, the Covington farmers market was unable to launch. However, the Covington farmers market has indicated that they may attempt to launch the program between September and November 2022. Upon review of previous years' implementation and consistent reevaluation of COVID impacts on Fresh Rx, it is clear that transportation is a major limiting factor to consistent program participation- especially in rural communities (majority of participating communities). In response, CFA and project partner, Michelle Howell, developed a food box program to pilot under the GusCRR, that delivers "meal kit" boxes directly to the homes of participants. The meal kits include the weekly prescription of fresh fruits and vegetables, paired with seasonal recipes. This model also provided participants with cooking kits that included a skillet, mixing bowl, chef knife, vegetable peeler, sheet tray, cutting board, and measuring cups and spoons. The cooking kits have proven to be not only popular, but a necessity for enabling participants to fully utilize their weekly prescriptions, as many of the participants reported not having their own cooking supplies. The meal kit pilot has shown great success so far. Rural participants appreciate the convenience of home delivery. CFA introduced a second Fresh RX pilot project through an equity focused farmers market in central Kentucky, Black Soil. The pilot program focuses on black farmers (1.4% of Kentucky farmers) and generated significant interest with 180 visits and 15 survey participants. Black Soil market team members prepared the Fresh Rx produce shares (boxes) upon the mom's arrival. Pick up includedthe provision of educational materials (recipe cards, community event flyers) as applicable to their needs. Participants enjoyed the process and provided consistently positive weekly feedback to the team. Not having enough room to accept additional moms was a chief concern. Anextreme need for food access exacerbated by COVID19 financial hardships, mounting inflation, and a looming recession resulted in a high volume of registrations but limited open spots. The team reports they could have hosted another 30-40 families. Currently, there are 59individuals participating in the Fresh RX program that have redeemed $12,164 in Kentucky-grown produce under GusCRR. Totals are lower than those related to actual participation for the 2022 season, as a result of the reporting period. Output Response #2: CFA's evaluation partner, the University of Kentucky's Community and Economic Development Institute of Kentucky (CEDIK) developed a series of surveys to capture participant experiences, changes in shopping and eating habits, and health outcomes. Participants are given surveys at intake, midpoint, and after program completion. Many participants have not yet completed yearly prescriptions, so we do not have any completed post-surveys at this time. The project team has consistently experienced difficulties in obtaining survey information across time. Many participants readily complete intake surveys but fail to complete the midpoint or final survey. Beginning this season, the evaluation team restructured the survey incentive, providing higher levels of incentives for subsequent survey completion, in hopes of making the last two surveys more appealing for participants to complete. Nevertheless, as expectant mothers approach their due date, it isunderstandable that completing the third survey decreases in priority. CFA is aware of the serious implications of this challenge, has identified chief concerns, and is actively implementing changes to achieve stronger results in the final program year. Because most participants have not yet completed their prescription or filled out their final surveys, CEDIK is presently unable to evaluate the impacts of Fresh Rx for MOMs on participant food security, health perception, food consumption patterns, or economic impact. Once the participants have completed the survey, CEDIK will be better able to evaluate how Fresh Rx impacts participants. However, CEDIK made the following observations from the intake survey results: Food Security At intake, participants indicated that the food they had was inadequate in quantity (81%) and nutritional quality (70%) due to financial constraints. Participants noted that they experienced hunger (26%), ate less than they felt they should (29%), or cut/skipped meals (48%) at some point during the past year. As end point surveys are completed, we hope to see these percentages decreasing due to increased access to vegetables. Health Impacts Many participants (84%) felt they were in at least 'good' health at the start of the program. This is typical in most healthy food incentive programs - those who feel they are already in good health are invested in continuing habits that maintain health. Recruitment of those who start from a lower health condition is both a priority and a challenge. Nevertheless, we expect the Fresh Rx program will have a positive impact on health perception, even if they are in a good health condition when they start the program. Food Consumption Participants had an average of 3.5 combined servings of fruit and vegetables per day at the start of the program. We are most interested in whether they increase their consumption level of vegetables, fruits, and salads and whether they decrease their consumption of processed and fried items. The evaluation team plans to work alongside the MCO WellCare and other healthcare providers to collect and analyze quantitative dietary health outcomes and healthcare use data. This evaluation will occur at the end of the grant period. Output Response #3 The Fresh Rx program aims to sustain and expand the market for Kentucky-grown fruits and vegetables. Participant surveys are collecting information on their self-reported spending at farmers market after their duration in the program, though this data is not available yet. Anecdotally, market staff have reported that some program participants have become regular customers at their farmers markets even after their produce prescription has ended. Because of the milder climate, Kentucky markets are still active for another two months (CFA will report on those sales in 2023) with one GUSCRR Fresh Rx program location continuing sales into November, and two locations continuing through the end of the year
Publications
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