Progress 09/15/23 to 09/14/24
Outputs
Target Audience:The NY North Country Produce Prescription Program addresses rural community food access across the six northernmost counties of New York State: Jefferson, Lewis, St. Lawrence, Franklin, Clinton, and Essex. Our target audience this past year remained under-resourced individuals and households across this rural, low-access area. Residents in this region typically live in neighborhoods with no grocery stores and who may be relying on food pantries to supplement their nutritional needs, not met by corner stores or gas stations. They include families with children who rely on WIC, school food nutrition programs, or other government assistance. They may already be experiencing risk factors for diet-related chronic disease and struggling to feed their families adequate and consistently nutritious meals throughout the month. This audience is identified by the following criteria: adults eligible for SNAP or other food benefit programs and/or those individuals who receive Medicaid, Medicare, or some other form of government insurance. To qualify for a referral, individuals in the program this year were screened by a healthcare provider for risk of food insecurity and/or diet-related chronic disease. One of our healthcare partners, the St. Regis Mohawk Health Clinic, serves the Saint Regis Mohawk Tribe of the Saint Regis Mohawk Reservation at Akwesasne, NY, just south of the border dividing the United States and Canada. This past program year we expanded our reach to include military personnel, military households, and veteran retirees with the addition of partnerships with Fort Drum MEDDAC at Guthrie Ambulatory Medical Clinic, the Fort Drum Commissary, and the Watertown Veterans Affairs Health Clinic. We also served more low-income senior citizens facing challenges managing their health, through a partnership with Jefferson County Office for the Aging, whereby their staff Registered Dietician was able to make referrals when collecting vitals on seniors in public housing. Following this, CCE's nutrition educators were able to deliver nutrition workshops and distribute produce vouchers right where these seniors live. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?As stated above, all new partners receive training for their staff on how the program operates, what is expected as outlined in their letter of agreement, and how referrals can be made. This spring several trainings were held on Fort Drum Fort Drum at the Guthrie Ambulatory Clinic with PCMs, dieticians, and nursing staff as we launched a new partnership with MEDDAC staff to deliver nutrition workshops and free produce vouchers on post. Subsequent trainings were also held at the Armed Forces Wellness Center, Connor Troop Medical Clinic, and the Fort Drum Commissary. An in-person meeting with the Fort Drum Community Information Exchange, including the Fort Drum IMCOM Garrison Commander allowed for information sharing with PCMs, Chaplains, the Garrison Commander, and other Community-Based Organizations. Other trainings included an in-person staff training at the Watertown VA Clinic this summer and a virtual new partner training with Lewis County Public Health and Lewis County Office for the Aging this fall. In addition to trainings provided to our partners, staff involved in this project have had many opportunities for their own training and professional development. Our Local Food and Nutrition Educator, who serves as Project Partnership Coordinator, attended the New to GusNIP Mini-Conveningin New York Cityin June.As Project Director, April Bennett was able to attend the Rural Grocery Summit in Montgomery, Alabama in May and the Gus NIP Food, Land, and Culture Mini-Convening in Hawaii in August. Internally, we've held trainings for all new staff on how this program operates. Those involved in data collection, including a summer intern, received additional training on the proper handling of data and IRB protocols when working with human subjects. Since our initial onboarding meeting, we havereceived ongoing support from the Gus NIP NTAE Center's Consultant Program Advisor, Paige Williams, along withother survey, reporting, and technical assistance advisors through the Nutrition Information Hub. Program staff have also had access to resources specifically designed for grantees housed on the NTAE Center's Nutrition Incentive Hub website and through USDA-hosted webinars providing grantees with technical support. Additionally, monthly one-on-one check-ins allow for more specific support and collaboration. How have the results been disseminated to communities of interest?This year we requested and received a budget modification to implement a comprehensive marketing plan. Marketing efforts in this region reached between 54,000-60,000 dependent on the media outlet.Of those, approximately 18,000 were military households.This plan included: Paid advertisements in all three Local Food Guides throughout the region. A new Fort Drum rack card for our military audience that was distributed to all three clinic sites on Fort Drum as well as to staff at the Soldier and Family Readiness Division, Army Emergency Relief, The Financial Readiness Program, The Family Advocacy Program, The Relocation Readiness Program, and The Employment Readiness Program. A new Fort Drum Commissary brochure was created and displayed at all six registers at the PX Commissary on Fort Drum. A Press Release that went out to all media outlets in May 2024 announcing the new partnership with Fort Drum MEDDAC and the Fort Drum Commissary. Four billboards in the Watertown and Fort Drum area were erected in August and September 2024 to promote NC FVRx. A TV commercial was produced and ran on WWNY TV Channel 7 from July-September 2024. Boosted social media posts through CCE Jefferson promoted NC FVRx to our followers. Fort Drum shared print and digital materials on post to help promote NC FVRx to the military community. In-person tabling at Community events including: Spring Mountain Meetup at Fort Drum, March 2024 Anchor Recovery Center Wellness Fair, May 2024 Watertown Farm and Craft Market (weekly tabling), May - September 2024 River Fest in Alexandria Bay, NY, June 2024 Mountain Fest at Fort Drum, June 2024 Watertown Vet Center hosting Resource Fair and Mobile Canteen Wellness Expo at ARC, June 2024 Carthage Back to School Bash Open House, August 2024 Fall Mountain Meetup at Fort Drum, September 2024 Jefferson Community College Veterans Resource Fair, September 2024 Other strategies used to reach the target audience: Fort Drum Food Insecurity Working Group monthly meetings Distributed marketing materials (rack cards, brochures, and posters) to providers' offices, grocer/producers' stores, and farm stands Attended resource-sharing meetings and events with other COB's What do you plan to do during the next reporting period to accomplish the goals?Three big issues continue to plague this program: The number of referrals, the ability of referred patients to attend workshops and redeem vouchers, and staffing capacity. Here is what we plan to do about these issues during the next reporting period: Increasing Referrals: To increase the number of referrals we receive regularly, we are planning to do two things. The first is a strategy we've already begun which is to circle back to all our current referring partners to 1). Make sure they still know about the program and are aware of their ability to make referrals. This is typically a conversation with an on-site administrator who can influence other staff from the top down. This is also an opportunity for us to deliver new marketing materials and ensure they are prominently displayed; 2). Identify a site champion. If we notice that most referrals are coming from one provider, we connect with that provider to thank them for referring patients, request their feedback on how we might encourage more participation from others at that location, and ask them to help connect us so that we can gain more direct access to the other staff: 3). Whether there's been a lot of staff turnover, or this initiative fell off the radar due to other conflicting priorities, we will offer to provide another staff training to get everyone back on board. This also allows us a chance to share outcomes and success stories with providers so that they can see the impact of the program and feel more bought into the process. As a part of the above strategy, we are rolling out a project modification in this next program year that will allow us to receive referrals from other community-based organizations that serve our target population. We've learned that the time and effort it takes for a prospective participant to get a referral from their provider is creating an unnecessary barrier to accessing this program. Instead, we are reaching out to places like food pantries, DSS, and other human services agencies, nutritionists, and other non-traditional/alternative healthcare providers to screen and make referrals. Healthcare partners will still be our primary source of referrals but adding these additional partners who also work with low-income individuals at risk of food insecurity and chronic disease will help us reach more people. The rest of the project model will remain the same. We will still request that all referred individuals sign a release of medical information (ROI) after their 4thlesson (we are currently doing this) to ensure we still get the healthcare outcomes data weneed. No matter who is providing the referral, we've learned that creating demand from the bottom up and empowering interested individuals to advocate for themselves to be referred to the program, has been a powerful way to elicit more referrals. We will continue to spread community awareness for this program by visiting food pantries during food/meal distribution hours, continuing to reach out to organizations with programs that attract a similar target audience and asking to speak at staff meetings and events, and visiting senior centers where prospective participants with fewer scheduling constraints (retired, no children at home) may be interested in learning more about this program. Increasing Access to Workshops: To make the nutrition workshops more accessible to referred participants, we are looking at new workshop locations at or near year-round redemption sites. This model worked very well during the summer when many workshops were held at or near farmers markets where participating local producers sold their fruits and vegetables. While we still continue to offer virtual workshops to those who cannot make it to in-person workshops, we know that there is still a barrier to ensuring that they can redeem their mailed produce incentive vouchers in person. We've identified some new workshop sites that will make it easier for participants to receive the vouchers at the workshops and then immediately go shopping for their produce to redeem their vouchers. While securing medical transportation has been difficult since our workshops typically do not take place at a medical building (even though they should technically qualify because they are through a healthcare provider referral), there is also volunteer transportation available in some of our areas for low-income individuals to get their groceries. If we can make it so they can use this resource to both attend workshops and get their groceries, we believe we will see higher participation and voucher redemption rates. Staffing Capacity: There is a limited number of staff, even counting those not funded under Gus-NIP who are working on this project, and who have been active in this program this year. Here in Jefferson County, there was an open position for the Local Food and Nutrition Educator/Partner Coordinator for a little over 2 months from mid-December to the end of February. Nutrition workshops for NC FVRx are primarily led by SNAP-Ed staff and there have been numerous vacancies across the region that have caused programming to shut down temporarily or be minimized. We attempted to fill gaps where we could with trained interns and volunteers but there is no doubt this impacted the number of workshops we were able to offer, thus limiting availability for participants. While we had a little easier time in the western part of our region shuffling staff to keep programming going, the eastern half of the region already has fewer staff, so staff turnover has a greater impact. We lost both a SNAP-Ed Educator to run workshops in Franklin, Clinton, and Essex Counties and the Farm to School/Local Food Educator we were subcontracting with to coordinate partnerships for this part of the region changed roles and we have not had a new person in that capacity for most of this past program year. While we remain hopeful that we will continue to attract new staff, especially as we can increase pay rates, we are also looking at other strategies to boost capacity. We found that collaborating with partners who are already providing nutrition education is an excellent way to maximize our time and efforts. This has worked well on Fort Drum where staff dieticians through Guthrie can provide the nutrition workshops and we can provide the vouchers to maximize resources for both programs, which has worked very well. We are now spreading this model to Lewis County where public health staff are leading nutrition workshops through Diabetes and Chronic Disease Prevention and Maintenance Programs. This is allowing us to finally bring this initiative to Lewis County residents and allow the participants to reap the benefits of the combined resources from both entities. We will continue to seek out these opportunities throughout this new program year.
Impacts
What was accomplished under these goals?
In our efforts to improve rural nutrition security and food access across the six-county North Country region of NY State, we continue to expand our reach to a variety of community partners in all six counties. Of our now 111 total partnerships who have signed partner agreements, 62 remain active in helping us achieve our goals, up from 24 the previous year. These active partners consist of 32 healthcare providers, 22 local producers, and 8 brick-and-mortar grocers/food retail stores. The partners have all been trained to make referrals to the program, accept and track the produce vouchers, and turn in monthly invoices and vouchers for reimbursement. This year we received 320 referrals, held 162 workshops, distributed $16,310 worth of free produce vouchers, and reimbursed our local producers and grocers $6,720 in redeemed vouchers that were mailed to us with their monthly invoices. While we have been collecting some knowledge and behavioral data through our SNAP-Ed programming atworkshops all along, this year we collected 57 surveys for the NTAE from participants who completed the NC FVRx program between 2023 and 2024. The results revealed that after attending at least 4-6 weekly workshops, graduates reported a 12.66% increase in those who felt their health was "Good" or better. Additionally, there was a 15.63% increase in participants who consumed fruit three or more times per week in the past month and a 17.52% increase in those who ate vegetables three or more times per week during the same period. Participants had this to say about their experiences with the program: In November 2023 After graduating from the program, a FVRx participant expressed how thankful they were for having participated in the program and that they have been encouraging their friends to inquire about the program with their providers. They went on to say how approachable the lessons were for learning how to make healthy choices and were glad to have participated in the program. This participant struggled to attend workshops when they were first referred, but once they joined went on to say, "I really liked the information covered in each of the workshops and I was surprised at how approachable the lessons were" ... "I am really glad that I was able to attend these classes since I could attend the workshops immediately and I am happy my schedule was able to align with the workshops. I have even told several friends about the workshop!" In April 2024, we connected Allison Andrews, the Program Director for the Greater Watertown Chamber of Commerce with Jake Kowal, the NY State Program Manager forDoubleUpFoodBucksout of Buffalo, NY. The Watertown Chamber runs The Watertown Farm and Craft Market, the only farmers market in Jefferson County that accepts EBT and distributes tokens. We also connected Jake with Delta and Tom Keeney of Windswept Meadows Farm, a local producer couple who run a farmstand and a CSA that delivers to several locations throughout Jefferson County. By spring, Windswept Meadows was enrolled in Double Up Food Bucks, becoming the only local producer in the county to accept this important food benefit resource. At the beginning of the summer, a new FVRx webpage was created to better highlight the program and provide more up-to-date information to current and prospective participants and partners. This webpage, https://ccejefferson.org/nutrition/north-country-fruit-vegetable-prescription-program, highlights what the program is, how it works, who is eligible, where participants can get referred, where they can redeem their vouchers, and where to go for more information throughout the region.
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:The NY North Country Produce Prescription Program addresses rural community food access through a six-county regional project to reduce nutrition insecurity and access barriers while improving healthy food preparation knowledge and health equity for low-income individuals and families in rural Northern NY. The burden of household nutrition insecurity is not distributed equally, but disproportionately high in rural low-access areas. This program expands on a small but successful pilot that began in 2021 to ensure healthy foods get into the homes and onto the plates of those who need them most. While consuming enough produce to meet recommended daily allowances, preventing and managing diet-related chronic diseases, and budgeting to ensure there is enough food to adequately feed a household have all become universal challenges throughout our community, this project intends to provide more health equity to those who need it most, primarily by serving adults eligible for SNAP or other food benefit programs, low-income senior citizens facing challenges managing their chronic diseases, those who live in neighborhoods with no grocery stores and who may be relying on food pantries to supplement their nutritional needs, not met by corner stores or gas stations, veterans and military families struggling to get by, and families with children who rely on WIC, school food nutrition programs, or other government assistance and who are already experiencing risk factors for diet-related chronic disease and who struggle to feed their families adequate and consistently nutritious meals throughout the month. Additionally, this program intends to offer healthcare providers a tangible resource that they can share with patients when they identify these risk factors (like overweight and obesity, elevated blood glucose levels or blood pressure, or concerns with managing a healthy diet) so that patients can start to address these concerns through preventative measures before they need to go on medication or before there are more serious health implications like type II diabetes, heart disease, and cancer. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?In addition to the partner training explained above, staff involved in this project have had many opportunities for their own training and professional development. Before getting started implementing the project, staff had to complete an online course in human subjects research training as well as participate in a data protocol webinar to ensure proper and ethical handling of participant-level data. Our Local Food and Nutrition Educator, who served as Project Coordinator, attended the two-day online workshop"Advancing Health Equity Through Culture-Centered Dietary Interventions to Address Chronic Diseases" led bythe National Institutes of Health.To connect with potential healthcare partners engaged in addressing health disparities, as Project Director, I attended the Lewis County Bridges to Health Training, a compliment to the Bridges Out of Poverty program, and aimed at collaborating to identify new solutions for improving access and services for people in poverty to improve health outcomes.Since our initial onboarding meeting, we havereceived ongoing support from the Gus NIP NTAE Center's Consultant Program Advisor, Paige Williams, along withother survey, reporting, and technical assistance advisors through the Gretchen Swanson Center for Nutrition. Program staff have also had access to resources specifically designed for grantees housed on the NTAE Center's Nutrition Incentive Hub website and through USDA-hosted webinars providing grantees with technical support. Additionally, regular one-on-one and group cohort check-ins allow for more specific support and collaboration. Two national conveningswere held this year, the Gus NIP Nutrition Incentive Hub's National Conveningin Arlington, Virginia June 6-8, 2023, and the USDANationalInstitute of Food and Agriculture'sCommunity Nutrition Project Directors' MeetingDecember 4-6, 2023, held in New Orleans, Louisiana. Both events provided more insight into how individual programs fit together to address food insecurity and chronic disease prevention in a variety of individualized ways whilecollecting similar data, across the country in 48 states, DC, and Puerto Rico. The Listening Sessions highlighted a variety of grantee success stories while Project Pitch Networking Sessions allowed Project Directors working across all three community foods grants to come together in small groups to discuss their grant projects and share insights, best practices, and lessons learned. How have the results been disseminated to communities of interest?Program staff have created a variety of materials to promote this initiative. These include posters and flyers at health clinics, community sites, and redemption sites that the intended audience may frequent. Colorful presentations have also been created and shared with prospective partners as well as others involved in similar work such as SNAP-Ed, WIC, County Public Health Offices, DSS, and local food pantries. A brochure listing all the redemption sites has been distributed at local farmers markets and community events and is also updated and accessible through an online webpage. Regular updates to this project are provided to CCE's nutrition advisories and board members and to help reach an even wider audience, press releases have shared exciting updates to the project, resulting in media coverage on local television, radio, news publications, and social media. We are currently in the process of developing tailored 1-pagers for program partners to keep them abreast of program progress. What do you plan to do during the next reporting period to accomplish the goals?A major focus of this next reporting period is expanding services to our two special populations - The Mohawk Tribal Community in Akwesasne and our military and veteran households here at Fort Drum. We have a signed partner agreement with Saint Regis Mohawk Health Services in Akwesasne but have not yet received any referrals. We've reached out to contacts at the VA Syracuse Healthcare System's clinic in Watertown, NY, and Guthrie Medical Center on Fort Drum and there was a lot of enthusiasm about providing these resources, but we still have some work to do to get approval from the administrative authorities of both clinics. The biggest challenge to this project so far has been getting enough referrals to meet our goals for overall community impact. To do that, we need to engage even more healthcare professionals and ensure that all their providers are well-versed in the program and motivated to make referrals. We have several irons in the fire such as Hudson Headwaters, Carthage Area Hospital, the Fort Drum Medical Department Activity (MEDDAC), the VA Syracuse Healthcare System, and the St. Lawrence Health System. Additionally, we are hoping to add behavioral health providers since we know that many people who are most impacted by nutrition insecurity and health disparities may not regularly see a primary care provider but may be in some form of behavioral health treatment where they could be referred. We also plan to revisit our current partnerships and share updates and outcomes with them in hopes that they will send more referrals our way. Because we know that staff turnover is high everywhere, we will offer to hold new overview trainings with any new providers who may not yet be familiar with the program. To encourage new partners to join the program and increase visibility to potential patient referrals,we also plan to scale up our marketing.Targeted digital ads, boosted social media posts, and more local media coverage will helpensurethat everyone who may qualify for this program is aware of it and knows how to access this resource. New promotional materials with quantitative and qualitative outcomes data from year one can be sharedwith current and prospective partners. With more widespread partnerships across the region and hopefully more referrals in turn, we plan to launch workshops in all six counties and collect baseline data on a sample of 100 participants through surveys administered through Qualtrics and incentivized by $10 e-gift cards. With more workshops and more vouchers being distributed, we also plan to add more redemption sitesconvenient for our participants. Because we cover a vast rural area, we know that it will take a combination of local businesses and larger corporate chains to reach all the participants who receive produce vouchers. To engage larger-scale grocers we plan to follow up with the National Grocers Association Foundation for assistance connecting with potential national retailers. We will also continue to prioritize partnerships with redemption sites that accept SNAP/EBT and other food benefit resources and work to help those who don't, become certified. As stated above, the biggest barrier to our success has been scalability. Securing healthcare partners, essential to the foundation of this project, has proven much more challenging than we anticipated. While many providers are excited about this program and eager to share this resource with patients, decision-making administrators in healthcare networks have been less enthusiastic about a partnership that involves data and evaluation as they fear the ramifications of data sharing, or they have been advised against the partnership by legal and compliance departments. Although we have remained confident that our approach poses no risk to the healthcare partners, articulating that to the necessary decision-making power has been difficult and time-consuming. We recently revised our partner agreement to omit language that may have set off red flags in terms of the potential of violating patient confidentiality and so we now focus more on establishing the partnership so we may enroll patients and continue to seek consent for data collection directly with the patient. As always, no patients are turned away if they choose not to participate in the surveys. We have recently encountered similar challenges with our prospective partners on Fort Drum. USA MEDDAC Staff at Guthrie Medical Center were eager to partner to bring more opportunities on base, such as this produce prescription program, that make it easier for military householdsto access food resources. They have recently launcheda Food Insecurity Working Groupas part of a Joint Commission requirement to address health disparitiesamong the military population. The vision was that USA MEDDAC Staff at Guthrie would determine eligibility and their dieticians, in partnership with our nutrition staff, wouldprovide them with nutrition education workshops and distribute vouchers accordingly. We plannedto coordinate with the Commissary Director, to ensure patients coulduse the vouchers at the Commissary as well asoff-base locations. Although the initial legal review to gain approval to sign a partner agreement in October 2023 concluded that there was nolegal objection to MEDDAC implementing the program,when it came time to decide who had the authority to sign the partner agreement, theBrigade Judge Advocate issued a revisedLegal Review of the agreement between CCEand the Fort Drum MEDDAC stating it violates the Joint Ethics Regulation (JER) by improperly endorsing a non-Federal entity (NFE) and providingsupport beyond what is permitted in the JER, meaning that the command may not sign a partner agreement, provide patient referrals, or distribute marketingmaterials or vouchers. Because CCE has anIntergovernmental Support Agreement in place which allows us to provide programming and resources on Fort Drum and for Fort Drum households and becausethe fruit and vegetable prescription program we are requesting referrals for is a federal program funded through the USDA and the Gus Schumacher Nutrition Incentive Program in partnership with SNAP-Ed, we are requesting further conversation to resolve this matter. The second largest barrier so far has been transportation. Although our communities are small, our referred patients often live quite a distance from one another and do not have reliable transportation. There is not adequate or reliable public transportation for them. There is no county-wide public transportation throughout much of our region. While we do offer virtual workshops for those who cannot get to them in person, there is still the matter of how they will get to the redemption sites to use their produce vouchers. We have gone to such great lengths as having an educator transport participants in our extension office's work vehicle, but this is certainly not a sustainable fix, particularly as these efforts ramp up. Again, with more referrals, we could provide more workshops, and situate them in multiple locations as well as days and times that might accommodate different groups, but until such time, we are not able to offer as much choice as we might like. In the meantime, we will continue to approach other organizations such as Volunteer Transportation Services which may be able to assist with some transportation as well as contact local foundations that may be willing to fund travel vouchers to allow patients without transportation to access these resources.
Impacts
What was accomplished under these goals?
Over the first year of implementing the NC FVRx program, we reached out to a variety of community partners in all six counties. We now have 67 total partnerships: 31 local producers (28 are active), 16 brick-and-mortar food retail stores (13 of which are currently active), and 20 healthcare partners (14 are active).These partners all received training either in person or by virtual meeting on how to screen patients and make referrals either using the referral form we provided or through their internal mechanism. Once referred, each participant was called by a Cornell Cooperative Extension (CCE) staff member to explain the program and schedule them for the next available cohort of workshops. All CCE staff involved in this initiative received training on participant communication and consent, effectively leading nutrition workshops using evidence-based curricula, and proper protocols for data collection. Once enrolled, participants received $25 worth of produce vouchers at every workshop they attended, up to $150 for all six workshops. Workshops also included food demonstrations and tastings, food resource management information, recipes, and other helpful resources to ensure they felt comfortable preparing fresh produce items at home. They even received kitchen incentive items like vegetable choppers, storage containers, and produce peelers. They were given tours of redemption sites like farmers markets and local grocery stores where they could redeem their vouchers for fresh fruits and vegetables whenever possible. Each redemption site also received training on how to redeem, track, and invoice the produce incentivevouchers monthly for reimbursement. This year these farmers and grocers have received over $3,000 in voucher reimbursements. While most of our redemption partners already accept SNAP/EBT, we initially set a goal of increasing SNAP/EBT acceptance by 25%. To achieve this, CCE staff approached and offered technical support to assist any farmers or markets with becoming EBT certified to accept benefits. For some farmers, this program has not been a good fit either because they already participate in a farmers market that accepts SNAP/EBT in exchange for tokens as a whole, because they don't have the administrative capacity to track the necessary paperwork needed to apply and receive reimbursements, because they participate in other food benefit programs such as WIC, FreshConnect, or FMNP that seem to be a better fit for them, or because they are not comfortable using the technology required to run EBT transactions and record sales. Before beginning this produce prescription project, CCE staff were already focused on increasing SNAP/EBT access with local producers, grocers, and farmers markets as part of a larger local food systems capacity-building project. Since 2020, we have been able to assist the following local producers with EBT certification and/or technical assistance in Jefferson County:The Chaumont Country Store,Cogumelo Mushrooms,The Adams Cheese Shop, Bush Gardens,Northrop Farms,Country Cousins,Chicory Hill Farm,Tickle-the-Earth Farm, Forty Roots Farm Stand, Simmons Farm, Northern Lights Nursery,Northrop Farm, and Wind Swept Meadows Farm. This is an increase in the number of local producers accepting SNAP/EBT payments of 59% over the last three years. In St. Lawrence County similar efforts have taken place with the assistance of partner agency, GardenShare. Through their mission to promote alocal food systemthat ensuresfood security for all St. Lawrence County residents, GardenShare has worked with a variety of local farms and farmers markets to become certified to accept SNAP/EBT. Many farmers can "accept" EBT and provide produce for customers needing financial assistance through GardenShare's Farmer's Market token system (GardenShare has the machine, EBT members swipe and receive tokens, farmers accept the tokens for their produce, and farmers get reimbursed the cash amount from GardenShare). For those running their own farm stand or otherwise not connected to a market, GardenShare has assisted in setting them up with EBT machine services. Additionally, GardenShare has worked with a variety of farmers markets including AkwesasneFarmers Market, Farm to Community Canton, and Farm to Community Ogdensburg to accept SNAP/EBT through the market token system. They developed print materials to share with local agencies, provided farmers withtoken system education, and promoted these efforts through consistent social media posts duringmarket season. As a result, before 2020 18 local farms were participating in the farmers market token system, and now there are 32 to date. While we have collected some knowledge and behavioral data through our SNAP-Ed programming atworkshops, we are now beginning to collect more information through GusNIP baseline surveys and post-workshop surveys captured in Qualtrics. One year later we plan to follow up with these surveyed individuals to see if they have been able to sustainthe healthy habits they learned and if there have been any improvements to their health as a result. This information will be shared with all stakeholders so that they can see the positive outcomes associated with this program and the potential cost savings in healthcare when a preventative approach combined with resources such as this is implemented. From the datacollected so far through SNAP-Ed's intent-to-change and knowledge and behavior change surveys, and focus groups with workshop participants, we have discovered the following changes: 66% of participants reportedeating more fruitthan before the program. 50% of participants reportedeating more Whole Grainsthan before the program. 66% of participants reportedcomparing prices more oftenthan before the program. 66% of participants reportedplanning and cooking more meals at home nowthan before the program. 66% of participants reportedhaving more healthy foods nowthan they did before the program. Participants had this to say about their experiences with the program: "This is a nice educational program that is not intimidating... you can speak freely with educators and ask questions without judgment." "[I liked] tasting new foods and learning to make new recipes." "We liked the farmers market tour... it was great to talk with vendors and learn how knowledgeable they are in what they sell and helping you understand how to use their food". "My professor [at a local community college] asked our class to bring in a peeler for our vegetarian recipe and I brought mine that I received from this program! I was excited to bring the kitchen tool I received here, and I have really enjoyed using it at home with the recipes I have been making." "I enjoyed how approachable the lessons were. I felt like anyone could come in and receive the same quality of education without judgment... The vouchers were very helpful in lessening the cost barriers to buying produce [and] Save-A-Lot and vendors at the market were extremely helpful in assisting us with getting the most out of our vouchers." A Fruit and Vegetable Prescription (FVRx) participant in Ogdensburg was skeptical about trying plain, low-fat Greek yogurt. Using the Cooking Matters in Your Community curriculum, the participant was able to learn the importance of eating different colors of fruits and vegetables in different forms. They could also try a "Crunchy Berry Parfait" using low-fat plain Greek yogurt, granola, and craisins. They were unsure if they would like the Greek yogurt as it was not flavored. To make the yogurt more enjoyable, an educator showed the participant how to add vanilla extract and cinnamon to a plain-low-fat yogurt to get a sweet flavor, without the added sugar. With the yogurt and granola, the participant even enjoyed the dried fruit that was in the parfait. They left saying they would make a Crunchy Berry Parfait at home like the one demonstrated at the workshop.
Publications
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