Progress 06/15/23 to 06/14/24
Outputs
Target Audience:This project is based at the Waianae Coast Comprehensive Health Center (WCCHC), the largest Federally Qualified Community Health Center (FQHC) on Oahu and one of the oldest, with over 50 years of service. WCCHC provides high-quality, accessible, and affordable health, social, and community care to medically underserved communities along the Waianae Coast. In 2023, WCCHC served 47,432 patients through 195,823 visits at seven different service sites. Among these patients, 48% were Native Hawaiian, 28% were Asian and Pacific Islanders, and 12% were Caucasian. A significant portion of the patients, 71%, live at or below 100% of the federal poverty level. Additionally, 3% are uninsured and 60% have healthcare coverage through QUEST, Hawaii's Medicaid program. Our target audience includes patients from WCCHC's primary service area (zip codes: 96792, 96797, 96707, 96706) who are existing Medicaid beneficiaries and/or SNAP benefit recipients. Eligibility by participant category includes: Pregnant, low-income WCCHC patient with the following risk factors: Evidence of food insecurity as indicated by 2-item survey and/or; Pre-existing nutrition-related chronic health condition, or newly developed nutrition-related chronic health condition during pregnancy (ex: gestational diabetes). Pediatric WCCHC patient <5 years of age with at least one of the following risk factors: Evidence of food insecurity as indicated by 2-item survey completed by parent/guardian and/or; Weight-for-length (child < 2 years) or body mass index (child 2-5 years) is ≥ 95% age/sex and/or; Parent/guardian has history of obesity, pre-diabetes, diabetes (including gestational diabetes), or other nutrition-related chronic health condition. Teen WCCHC patient 13-17 years of age (parent/guardian-teen dyads) with at least one of the following risk factors: Evidence of food insecurity as indicated by 2-item survey completed by parent/guardian and/or; Parent/guardian or teen has history of obesity, pre-diabetes, diabetes (including gestational), or other nutrition-related chronic health condition. Changes/Problems:Our team observed a lack of program referrals for the Teen 13-17 years (parent/guardian-teen dyad) participant category, despite receiving positive feedback from providers about extending eligibility to this age range. Upon conducting a root cause analysis, we discovered that the requested updates to our program referral template in the EMR had not been implemented. To address this, we have initiated a new service request with our Health IT EMR team. This request aims to complete the necessary updates and enhance the template further by reducing the number of clicks and eliminating free text options, thereby improving the end-user experience for our medical providers. What opportunities for training and professional development has the project provided?During this reporting period, our team members completed two professional training programs and attended several conferences to deepen our collective understanding of the Food is Medicine landscape. 6/29/23 Webinar: Building Partnerships to Advance Nutrition Access & Health: Case Studies from Harvard's CHLPI and California's Medically Supportive Food & Nutrition Steering Committee 5/15/2024 How Effective Leaders Create High-Performing Teams Conferences: 7/25-7/28/2024 Feeding America- Food Security Equity Impact Fund grantee Convening 9/10-9/13/2023 Native American Nutrition Conference 12/4-12/6/2023 Program Director meeting for USDA GUSNIP, FASLP, CFP Grantees 12/14/2023 Hawaii Food Systems Summit 2/12 - 2/15/2024 National Association of Community Health Centers - Policy & Innovation 4/8 - 4/11/2024 33rd Best Practices Forum 5/28-5/29/2024 Hawaii Primary Care Associaton Ho?ola Conference How have the results been disseminated to communities of interest?During this reporting period, our team presented program insights at a number of events geared towards fostering collaborative problem solving, filling knowledge gaps with cross-sector partners, and helping to informpolicy. 7/26/2023 Feeding America: Food Security Equity Impact Fund Grantee Convening 8/18/23 WCCHC Strategic Planning Board Retreat - Food Security, Food Sovereignty and Value-Based Care 8/21/2023 Feeding America - Mark Ford, Director of Native Partnerships 9/6/2023 Stupski Foundation - Aileen Suzara, Director of Food Security 9/19/2023 Office of Hawaiian Affairs 10/26/2023 Hawaii Foodbank - Marielle Terbio, Vice President of Strategy & Programs 11/30/2023 Feed the Hunger - Director of Programs and Lending, Aaron Ellis 12/5/2023 Program Director meeting for USDA GUSNIP, FASLP, CFP Grantees 12/15/2023 Kamehameha Schools - Pia Chock, KS New Ventures Investment Manager and En Young, Director of Sustainable Industry Development 2/12 - 2/15/2024 National Association of Community Health Centers - Policy & Innovation 2/22/2024 Doris Duke Foundation 2/22/2024 Kapolei Chamber of Commerce 2/29/2024 Hawaii Good Food Alliance 3/2/2024 The Association of Asian Pacific Community Health Organizations 3/13/2024 Valley of the Rainbows Girls Conference 3/25/2024 Pacific Island Health Officers Association 4/4/2024 Hui Huliau Foundation 4/8/2024 33rd Best Practices Forum 4/25/2024 USDA NIFA team visit- presentation and tour 5/15/2024 HMSA - Camille Rockett, Director of Community Health & Equity 5/24/2024 - Mayor Rick Blangiardi and Mike Formby, C&C of Honolulu Managing Director 6/6/2024 - Honu?apo Foundation - Kendis Kado, CEO 6/13/2024 - Malama I Ke Ola Community Health Center - Executive Leadership Team 6/18/2024 - Hawaii Food Funder Hui What do you plan to do during the next reporting period to accomplish the goals?In the upcoming reporting period, we plan to invest time in cross-training our program staff to enhance redundancy in referral management and program enrollment. This will help minimize disruptions caused by absences or staffing changes. Additionally, we will broaden program access by introducing a new Tuesday night farmer's market in Kapolei, which will serve as an additional location for voucher distribution and redemption. We will also maintain our commitment to engaging with clinic staff and providers through monthly visits to all service sites. These visits will not only ensure ongoing support but also provide an opportunity to train any new clinic staff and providers.
Impacts
What was accomplished under these goals?
Goal 1: To enhance the dietary health of pregnant participants by increasing F/V consumption: Accomplishments: 110 pregnant women were referred to the WOPRx expansion program. 71 pregnant women were enrolled into the WOPRx Goal 2: To enhance the dietary health of young children (<5 yrs old) and teens (13-17 yrs old; parent/guardian-teen dyads) by empowering parents to purchase and serve more fruits and vegetables. Accomplishments: 146 parents of young children (<5 yrs old) were referred to the WOPRx expansion program. 71 parents of young children (<5 yrs old) enrolled in the program. 4 teens (13-17 yrs old) were referred to the program and all 4 enrolled.
Publications
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Progress 06/15/22 to 06/14/23
Outputs
Target Audience:This project is based at the Waianae Coast Comprehensive Health Center (WCCHC), theoldest, and one of the largest federally-qualified community health centers in Hawaii. WCCHC provides comprehensive health, social, and community services to the medically-underserved communities of the Waianae Coast. WCCHC was founded by the Waianae Coast community, for the community, 50 years ago. In 2022, the Health Center served 35,217 patients through 202,041visits. The majority of patients are Native Hawaiian (47%), followed by Asian & other Pacific Islanders (26%), and Whites (11%). The majority (71%)of patients live at/below 100% of the federal poverty level, 3% are uninsured, and 60% receive coverage under QUEST, the State of Hawaii's Medicaid program. Our target audience includes: Pregnant WCCHC patientswho havethe following risk factors: Food insecurity and/or; Pre-existing nutrition-related condition; or develop nutrition-related conditions during pregnancy (ex: gestational diabetes); Pediatric patients and their parentswho have the following risk factors: Evidence of food insecurity as indicated by 2-item survey completed by parent/guardian; Weight-for-length (child < 2 years) or body mass index (child 2-5 years) is ≥ 95% for age/sex; Parent/guardian has history of diabetes (including gestational diabetes), pre-diabetes, or obesity. In addition to the criteria above, all participants: Have a WCCHC primary care provider Live along the Leeward Coast of Oahu (primary service area for patients utilizing WCCHC services) Have QUEST insurance or is a SNAP Benefit Recipient Changes/Problems:The following arechallenges and corresponding changesduring this reporting period: Slow referrals from providers As a result of the slow number of referrals, program staff set upa table to advertise this program at several community health fairs and events. This helpedincrease the number of referrals slightly. Program staff also set up a table in the Women's Health building to advertise the program, which also contributed to a slightincrease in the number of referrals. In the next reporting period, they efforts will be continued and expanded upon. Program retention among pregnant participants Our team recognized a trend of declining participation among our pregnant members. Upon investigation, it became evident that some participants mistakenly believed their eligibility terminated upon giving birth. We have since revised the enrollment process to emphasize that participants can remain in the program post-childbirth. What opportunities for training and professional development has the project provided?Our program staff had the privilege to participate in the 2023 National Nutrition Convening, which took place from June 6 - 8, 2023. This gathering presented an excellent opportunity to liaise with and gain insights from a diverse group of professionals nationwide. This encompassed teams working on nutrition incentives and produce prescription initiatives, researchers, policymakers, and notable leaders in the field. How have the results been disseminated to communities of interest?We have regularly communicated program updates, challenges, and achievements to our health center providers, administration, support staff, and community. Below are a list of events/meetings and dates at which updates and preliminary results were shared. Waianae Coast Comprehensive Health Center Leadership meetings - monthly Hawaii Good Food Alliance - once every quarter Hawaii Farmers Market Association - once every quarter Hawaii Food Bank Meetings - monthly Stupski Foundation meeting - November 2022 Council for Native Hawaiian Advancement - December 2022 Lunalilo Trust Meeting - April 2022 Office of Hawaiian Affairs Board of Trustees Communtiy Meeting - June 2024 University of Hawaii Lightning Talk- Health Sciences Convening, "Collaborations to Address Healthy Food Access and Food Security" May 4, 2023 As the program is still in the process of enrolling and completing participants, the analysis and dissemination ofprogram results are pending. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting period, the following will be implemented to enhance recruitment efforts: Program staff will regularly set up a table in the Adult Medicine, Women's Health and Pediatric clinics to increase awareness of programs Program Staff will meet again with the Pediatric Clinic Team and Women's Health Team to provide an update and discuss barriers/facilitators to enrollment. Updated program flyers will be sent out to WCCHC providers, WCCHC communications team, the different WCCHC clinic locationsand community organizations.
Impacts
What was accomplished under these goals?
Goal 1: To enhance the dietary health of pregnant participants by increasing F/V consumption: Accomplishments during the reporting period: 43 pregnant women were referred to the WOPRx program 46 pregnant women were enrolled into the WOPRx program Goal 2: To enhance the dietary health of young children by empowering parents to purchase and serve more fruits and vegetables. Accomplishments during the reporting period: 3 total parentsopted in to receive a monthly culturally-tailorededucational Food Activity Bag (FAB)that includes recipes, nutrition lessons and activities, and a cooking tool. 34 total parents with a child 0 - 23 months were referred to the WOPRx program 24 total parents with a child 0 - 23 months were enrolled into the WOPRx program
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2023
Citation:
Shelton, C. (2023). Baseline Characteristics of Adults in a Produce Prescription Program at a Federally Qualified Health Center in Hawaii. Journal of Nutrition Education and Behavior, 55(7S), S62
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Progress 06/15/21 to 06/14/22
Outputs
Target Audience:This project is based at the Waianae Coast Comprehensive Health Center (WCCHC) is Hawaii'slargest federally-qualified community health center and provides comprehensive health, social, and community services to themedically-underserved communities of theWaianae Coast.WCCHC was founded by the Waianae Coast community, for the community 48 years ago and is now the largest, and oldest of the fifteen community health centers in Hawaii. In 2019, the Health Center served 38,699 patients through 219,339 visits. The majority of patients are Native Hawaiian (47%), followed by Asian & other Pacific Islanders (25%), and Caucasians (10%). Over 67% of patients live at/below 100% of the federal poverty level, 8% are uninsured, and56% receiving coverage under QUEST, the State of Hawaii's Medicaid program. Our target audience includes: Pregnant patients: We have begun enrollment of low income pregnant women, who utilize WCCHC for their prenatal services,into the WOPRx Program and have the following risk factors: Food insecurity and/or; Pre-existing nutrition-related condition; or develop nutrition-related conditions during pregnancy (ex: gestational diabetes); Pediatric patients and their parents: We have begun enrollment of low-income children, and their parents, who are at higher risk for nutrition-related chronic conditions. Evidence of food insecurity as indicated by 2-item survey completed by parent/guardian; Weight-for-length (child < 2 years) or body mass index (child 2-5 years) is ≥ 95% for age/sex; Parent/guardian has history of diabetes (including gestational diabetes), pre-diabetes, or obesity. WCCHC healthcare providers:WCCHC providers include those providing primary adult and pediatric care,Dental, Behavioral Health, Substance Abuse Treatment, Tobacco Cessation, Nutrition, Fitness, Pharmacy, and Specialty Care including Cardiology, Endocrinology, Psychiatry. Staff also provide services in comprehensive case management, drug abuse treatment, and community outreach. Changes/Problems:The COVID-19 pandemic severally impacted the initial implementation of this project. 1. The Makeke Farmers Markets: Makeke Market is operated by the Waianae Coast Comprehensive Health Center (WCCHC) and isessentialto the Produce Prescription Program as this where our participants can access local produce byredeeming their prescriptions. Unfortunately, due to the pandemic, the Markets wereclosed for most of 2021 and early 2022. The Markets finally re-opened in March 2022. 2. Online System to Order: We worked with a vendor to try to create an online produce ordering system, however, it was not well received by our participants who found the produce selection too limited. We are now using a new platform called Local Food Market Place that has an easier user interface and is working well for those participants who would rather order online and get produce delivered. 3. Limited In-Person Clinic Visits: WCCHC limited in-person clinic visits through 2021 until March2022. This limited recruitment to the program. Now that clinic volume has increased to near normal levels, we are actively engaging in recruitment. 4. Establishment of Elepaio Social Services:WCCHC created Elepaio Social Services in 2021 to more effectively and efficiently expand and operate the social services, including the food systems programs, for the community served by the health center. This includes moving all the community outreach and food systems personnel, including those for the GusCRR Program to Elepaio. The change in subcontract was recentily discussed with USDA staff. What opportunities for training and professional development has the project provided? Meeting with WCCHC Healthcare Providers: 09/30/2021, 10/06/2021, 09/18/2022 to discussion nutrition-related chronic diseases, nutritional challenges during the pandemic and food insecurity, motivational strategies to addressing diet-nutrition. We also met individually from staff in the Tobacco Control Department, Nutrition Department to discuss strategies in recruitment and how to use the WOPRx Program to motivate patients. How have the results been disseminated to communities of interest?We have provided regular updates to our health center providers, administration, and support staff. However, we have not yet disseminated results to the greater community. We anticipate making the first community report in Year 2. What do you plan to do during the next reporting period to accomplish the goals?-Recruitment: Now that the Makeke Markets are open, and healthcare providers are seeing patients in-person with more regularlity, we are more actively promoting the program and seeing increased recruitment results. -Use of messaging for recruitment and retention: WCCHC will be piloting an app that enables the EMR Department to more easily text patients. We will be pilot testing this app to explore if this strategy can increaserecruitment and retention.
Impacts
What was accomplished under these goals?
Goal 1: To enhance the dietary health of pregnant participants by increasing F/V consumption: Objective 1.1: Enroll at least 220 low-income WCCHC participants who are pregnant and 1) have a pre-existing nutrition-related condition; or 2) develop nutrition-related conditions during pregnancy.Objective 1.2: Retain these participants in the program through the remainder of their pregnancy.Objective 1.3: Promote regular prenatal visits, including measurements of weight, blood pressure, blood sugar, to support with healthy outcomes of pregnant women with nutrition-related conditions. Accomplishments: Electronic templates were created in the WCCHC EMR system which makes it easier for healthcare providers and clinic support staff to refer patients to the program. These templates were pilot tested and revised and are now actively used by providers including those from Women's Health, Adult Medicine, Nutrition, and Tobacco Control. Meeting with WCCHC Healthcare Providers: 09/30/2021, 10/06/2021, 09/18/2022 to discussion nutrition-related chronic diseases, nutritional challenges during the pandemic and food insecurity, motivational strategies to addressing diet-nutrition. We also met individually from staff in the Tobacco Control Department, Nutrition Department to discuss strategies in recruitment and how to use the WOPRx Program to motivate patients. Total pregnant women with nutrition-relatedconditions referred: 6 Total pregnant women withnutrition-relatedconditions enrolled: 1 Goal 2: To enhance the dietary health of young children by empowering parents to purchase and serve more fruits and vegetables. Objective 2.1: Enroll at least 225 low-income WCCHC participants under the age of 5 years, who are at-risk for nutrition-related adverse consequences, and provide their parents/caregivers with prescription produce vouchers. Eligibility criteria: WCCHC patients < 5 years of age and at least one of the following: 1) Evidence of food insecurity as indicated by 2-item survey completed by parent/guardian; 2) Weight-for-length (child < 2 years) or body mass index (child 2-5 years) is ≥ 95% for age/sex; 3) Parent/guardian has history of diabetes (including gestational diabetes), pre-diabetes, or obesity. Objective 2.2: Provide parent/caregivers of young children with information on how to prepare and serve produce to their young children. Objective 2.3: Assess parent strategies to encourage their children to eat more F/V. Accomplishments: Electronic templates were created in the WCCHC EMR system which makes it easier for healthcare providers and clinic support staff to refer patients to the program. These templates were pilot tested and revised and are now actively used by providers including those from Women's Health, Adult Medicine, Nutrition, and Tobacco Control. Total adults who have nutrition-related chronic conditions AND young children referred: 20 Total enrolled: 4
Publications
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