Progress 09/15/23 to 09/14/24
Outputs
Target Audience:The goal of the Chicago Horticultural Society's GusNIP project is to sustain and enhance the Society's VeggieRx produce prescription program, delivered by its urban agriculture division, Windy City Harvest (WCH). To maximize program participants served by the grant, in June 2023 WCH's VeggieRx project began serving individuals with current Medicaid benefits in addition to those with Supplemental Nutrition Assistance Program (SNAP) benefits. This resulted in a significant increase in eligible participants benefitting from the project in Year 2. During the reporting period, the VeggieRx program directly served 2,212 unique SNAP and Medicaid clients. SNAP enrollment is verified at VeggieRx distributions by running balance inquiries on participants' Electronic Benefit Transfer (EBT) cards, and receipts are kept in participant enrollment files.For Medicaid, participants' Medicaid numbers are verified in the OneSource medical billing system to ensure they are eligible at the time of distribution. Based on participant survey responses during the reporting period: 28% identified as Black/African American, 66% as Latinx/Hispanic, 1% as White/Caucasian, and 5% multiple/other ethnicities or not reported. Participants were 67% female, 28% male, and 5% not reported. 51 was the average adult participant age and 6 was the average youth participant age. A portion of the produce the project provided was grown at WCH farm sites by its youth and workforce development program trainees, including beginning farm businesses in the WCH Farm Incubator program. In 2024, 80% of these trainees identified as BIPOC (Black, Indigenous, and people of color) and were economically disadvantaged--in keeping with WCH's mission to provide economic uplift through paid jobs training and youth development opportunities. WCH continued to deliver the VeggieRx program throughout the reporting period in three Chicago neighborhoods. In order to reach its target audience and address community-specific challenges, VeggieRx continued to partner with three Federally Qualified Heath Centers (FQHCs) that are deeply rooted assets in each community to identify appropriate patients--with a diagnosed diet-related health condition or risk of developing one--and refer them into the program. These healthcare institutions were: Lawndale Christian Health Center (LCHC), PCC Austin Family Health Center (PCC Austin), and PCC Salud Family Health Center (PCC Salud). Changes/Problems:In February 2024, Chicago Horticultural Society welcomed Carmen Vergara to lead Windy City Harvest as Vice President, Community Partnerships, a newly expanded role reporting directly to President & CEO Jean Franczyk. Carmen brings 20 years of experience as a public health practitioner on Chicago's Southwest Side, most recently as Chief Operating Officer at Esperanza Health Centers, a former VeggieRx partner. She is committed to a holistic definition of individual and community health, recognizing the importance of access to nutritious food, sustainable jobs, and gardens and green space. While just beyond the reporting period and not directly supported by the GusNIP award, on October 1, 2024 WCH began extending the hours of its reduced-price community produce market, adding an additional weekday (Tuesdays) and an additional hour at the end of each day of operations. The market is open to the public and heavily utilized by VeggieRx participants. Extended hours were implemented in response to community feedback and are intended to facilitate access and increase produce purchasing and consumption in the community. What opportunities for training and professional development has the project provided?During the reporting period, VeggieRx has supported the following training and professional development activities: WCH staff participated in the GusNIP NTAE Produce Prescription Community of Practice to share and discuss best practices and knowledge gained among PPR programs nationally. On October 16-19, 2023, WCH hosted a convening of GusNIP PPR grantees from across the country, organized by the GusNIP NTAE Center/Nutrition Incentive Hub. The convening fostered learning, networking, and best practice sharing among nutrition incentive and produce prescription practitioners, with a focus on strengthening partnerships between healthcare and community-based organizations. The project provided professional development opportunities for both WCH and health clinic partner staff. Through the project, WCH staff gained experience working with medical providers to address social determinants of health, and trained clinic partner staff on VeggieRx program operations and administration. Healthcare providers learned how to incorporate VeggieRx into their care plans, providing a concrete and accessible way to connect a nutritious diet with clinical care. In 2023, WCH partnered with the U.S. Botanic Garden and American Public Gardens Association on a separately funded project to provide intensive urban agriculture program training (including on VeggieRx) as a capstone project for staff from seven public gardens from across the country. While not funded through the GusNIP grant, during the reporting period VeggieRx program manager Ketaurah James completed a 9-month Leadership Institute offered by Young Nonprofit Professionals Network focused on program and team management and leadership. How have the results been disseminated to communities of interest?As a recognized leader at the intersection of urban agriculture and community health both locally and nationally, WCH is well-positioned to share the results of its work with a diverse community of practitioners and stakeholders. Participation in the GusNIP NTAE Center's Produce Prescription Community of Practice meetings is one example of this. Locally, WCH staff are actively involved in volunteer leadership roles within food access, health, and community coalitions, and share program results and best practices with agriculture, social service, and healthcare institutions in the region. During the reporting period, these included the Alliance for Health Equity's Food Access and Security Workgroup (run by the Illinois Public Health Institute), the North Lawndale Community Coordinating Council's Health and Wellness Working Group, Advocates for Urban Agriculture, Chicago Food Policy Action Committee, Chicago Community Growers program, and Austin Eats (focused on growth and consumption of nutritious local food in Chicago's Austin community). Through these efforts, demand for produce prescription programs continues to build, and the model has been adapted at hospitals and clinics across the Chicago area. In August 2024, the VeggieRx program was featured in the New England Journal of Medicine as part of a collection of case studies on innovative health equity initiatives across the U.S. that are addressing complex challenges related to social determinants of health. The article brought awareness of the VeggieRx produce prescription model to an international community of medical professionals. During the project period, WCH staff continued to convene quarterly evaluation meetings with healthcare and nutrition education partners, which were established in 2021. The focus of these meetings is sharing best practices and aligning outcome tracking across VeggieRx sites. Facilitated by WCH's robust data management system, VeggieRx works closely with partners to align reporting/evaluation and shared metrics in order to compare the efficacy and impact of interrelated programs across the sector. WCH's urban agriculture and food-as-medicine programs were featured during the reporting period in a cover-page story in the Chicago Sun-Times, a report on NBC5 Chicago News, and an article in Public Garden Magazine on WCH's urban agriculture trainings for public garden staff, described above. The Chicago Horticultural Society's director of government affairs regularly hosts visits to WCH sites by public officials. During the reporting period these included: - A WCH 20th Anniversary celebration on October 3, 2023 was attended by USDA Public Affairs Director Alan Shannon, Illinois Department of Agriculture Policy Advisor Dakarai Howard (a former WCH staff member), Ginny Hotaling from the Office of Illinois Senator Julie Morrison, Cook County Commissioner Frank Aguilar, and Forest Preserves of Cook County General Superintendent Arnold Randall. - On May 5, 2024, WCH hosted around 10 USDA communications staff from across the country, who met to coordinate their work, tour WCH's urban agriculture facilities, and observe the VeggieRx program. - Other visits included Cook County Commissioner Alma Anya (who held a health stakeholders meeting at WCH's Farm on Ogden), Illinois Senator Lakesia Collins, Illinois Representative Yoland Morris, and City of Chicago Alderman Michael Rodriguez. Additional examples of WCH's commitment to sharing the VeggieRx model with a broad audience during the reporting period included: WCH educated the community about VeggieRx through Farm on Ogden tours for community, health care, government, nonprofit, and philanthropic leaders, as well as school groups, local residents, and other stakeholders. Written communications about WCH and VeggieRx were sent to federal, state, and local officials. What do you plan to do during the next reporting period to accomplish the goals?During the no-cost extension of the project WCH will continue the VeggieRx program, working closely with LCHC, PCC Austin, and PCC Salud. WCH will continue to recruit from a broader potential participant base since starting in summer 2023 to accept Medicaid patients in addition to SNAP participants. WCH will also continue to focus program participation on healthcare partner referrals only, finding that patients coming through partnerships with Federally Qualified Health Centers are an ideal fit for the VeggieRx model. WCH will continue to develop and leverage its data management and POS systems, enhancing program delivery, efficiency, and evaluation, and promoting data-driven decision making. VeggieRx will continue working to improve participant experience at VeggieRx distributions and farm markets, and to deepen participant engagement through opportunities for nutrition and cooking education. WCH will also continue to strengthen engagement and coordination with healthcare partners through monthly staff meetings and quarterly evaluation meetings. WCH will also continue to enhance understanding of PPR impacts on health outcomes and healthcare use and costs as a partner on the American Diabetes Association-funded PPPT2D study. WCH will complete post-survey data collection for participants enrolled in the study by the end of 2024, and will collaborate on the PPPT2D study team's analysis and interpretation of results in 2025.
Impacts
What was accomplished under these goals?
WCH successfully delivered the VeggieRx program throughout the reporting period. In early September 2024, Chicago Horticultural Society authorized a no-cost extension of the project, and anticipates meeting or exceeding all project goals during the revised performance period. During weekly VeggieRx distributions, participants were provided with free fruit and vegetable boxes, along with information and recipes in English and Spanish on how to store and prepare the produce. WCH continued to enhance nutrition and cooking education offerings, providing flexible opportunities to meet participant preferences. Twice per month, the Chicago Partnership for Health Promotion (CPHP) provided in-person nutrition/cooking classes at each VeggieRx site in both English and Spanish, using recipes corresponding to the weekly produce box. For participants seeking more in-depth learning, WCH also offered hands-on cooking courses--two in English and two in Spanish--held in six-week cohorts of 7 participants each (24 classes total). Taught by Chicago-based Good Food is Good Medicine, these courses were piloted in 2022 in response to participant feedback. In addition, WCH provided virtual classes: bilingual nutrition/cooking classes taught by CPHP were held weekly on Facebook Live and posted to the VeggieRx Facebook group (currently with 966members) for later viewing. Activities advanced progress on each of the broader project objectives during the reporting period. 1) Increase consumption of fresh, primarily local, culturally appropriate fruits and vegetables in target disinvested Chicago communities. 10,156 produce boxes (approximately 8 pounds per box) were redeemed by SNAP/Medicaid-eligible participants. Total of 18,433 boxes distributed over the project to date, 105% of the 2-year goal of 17,500 boxes. This healthy food reached 2,212 unique individuals and provided increased food access to an additional estimated 4,424 children and adults (based on an average household size of three). Total of 3,080 direct participants over the project to date, 140% of the 2-year goal of 2,200. Participants obtained an estimated 81,248 pounds of produce, equating to 116,069 servings. Total of 182,285 pounds delivered over the project to date, 130% of the 2-year goal of 140,000. 2) Deepen engagement with participants and healthcare partners. In 2024 through September 14, 83.3% of SNAP/Medicaid participants attended 5 or more VeggieRx distributions (goal: 25%), 49.2% attended 10 or more, and 26.8% attended 15 or more. 78 cooking/nutrition education sessions were delivered, expanding participant knowledge of the impact of a nutritious diet on health. A total of 171 sessions have been delivered to date, 428% of the 2-year goal of 40. Classes were offered in English and Spanish--the primary languages of the service population--to ensure language was not a barrier to access and learning. 746 (1,664 total over the project to date) SNAP/Medicaid participants attended in-person nutrition/cooking education sessions, and virtual sessions logged 1,588 views (4,115 over the project to date). 3 participant feedback sessions conducted (5 total over the project to date; goal: 4), providing opportunities for input, collaboration, and connection between participants and project staff. 26 meetings (51 total over the project to date; goal: 20) with healthcare partner care providers, care coordinators, and leadership teams advanced collaboration, coordination, and sharing of project results. VeggieRx meetings with healthcare partners help doctors and clinics incorporate dietary health and nutrition education into their practice. A new point of sale system (POS) for WCH's community produce market was implemented in 2023, achieving a project goal. In addition to improving operational efficiency and customer experience, the POS has helped WCH better understand customer purchasing trends (many of them VeggieRx participants) and make informed inventory and business decisions. For example, trends observed in POS data informed WCH's decision in September 2024 to extend its market hours. Due to a current technical issue syncing participant survey data with the WCH database, the Society is unable to report at this time on the project goal of a 30% decrease in markers of participant food insecurity, based on relevant survey questions. The Society reported on this goal in the Year 1 progress report, and will provide a cumulative number for the final report in 2025. 3) Enhance understanding of how VeggieRx impacts health outcomes and healthcare use and costs through robust data collection and evaluation based on rigorous research design. WCH continued to expand the depth and rigor of outcome evaluation as a partner on a research study led by the NTAE Evaluation Team/Center for Nutrition & Health Impact, funded by the American Diabetes Association (ADA). The study, titled "Pathway for Produce Prescriptions in Diabetes Management" (hereafter PPPT2D), augments WCH collection of core GusNIP evaluation data for diabetic patients, and serves the GusNIP goal of better understanding PPR impact on reducing healthcare use and associated costs. WCH and VeggieRx clinic partner LCHC actively participated in the PPPT2D study during the reporting period. Trainings on data collection workflows and data security took place in February (in-person) and March (virtual) 2024. Study participant recruitment began in April 2024, resulting in 47 VeggieRx participants being enrolled into the study. Pre-survey data collection began in April 2024 and post-survey data collection will continue through the end of the year. Specific PPPT2Dprogress and results during the reporting period include: IRB application for PPPT2D study approved (LCHC) Developed form for process evaluation data collection Completed additional study training session with PPPT2D research team Hosted PPPT2D study team members for additional data collection support Strengthened VeggieRx program team and collaborations with clinic partner through hiring additional staff members to build capacity for study implementation Completed data collection of program cost for economic evaluation study Initiated all recruitment and data collection procedures Completed baseline data collection from VeggieRx participants Met regularly (weekly/monthly) with the PPPT2D study team to provide updates and troubleshoot challenges throughout the year Contributed program information and data for two professional conference presentations led by the PPPT2D study team. Current and past VeggieRx outcome data demonstrate that VeggieRx has the ability to impact participants' food security and health. Aggregated results shared by health partners suggest that VeggieRx patients show improvements in A1c levels, weight loss, hypertension, and depression. LCHC recently completed its own internal study of VeggieRx health impacts on patients compared to standard of care, which has been submitted for publication and indicates positive results. Taken together, these data show that VeggieRx is not only responding to short-term health and food security needs, but is helping participants make long-term behavioral changes regarding health and nutrition. Qualitative feedback shared by VeggieRx participants also reflects impacts on diet and health. 2024 participant comments include: "My diet stabilized with fresh vegetables! A1C IS DOWN FROM 13 TO 7.3!!" "My doctor talked to me about this program. I went to pick up my first box and I loved all the content. It helped me with my weight and nutrition because I started eating more fruits and vegetables. I learned to cook different recipes... I noticed that the fruits are more tasty than the ones at the supermarket so I started shopping at the store on Ogden... I wish that this program never finishes. Thank you to all of you that make it possible!"
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:The Chicago Horticultural Society's GusNIP project formally began on February 6, 2023. The goal of this project is to sustain and enhance the Society's VeggieRx produce prescription program, delivered by its urban agriculture division, Windy City Harvest (WCH). The project builds on program development achieved with the support of USDA FINI and GusCRR grants; work on the GusNIP grant commenced immediately following completion of the GusCRR project. Over the course of these projects, VeggieRx grew dramatically, particularly in response to increased need in communities hard hit by food insecurity during and in the aftermath of the COVID-19 pandemic. The GusNIP VeggieRx project initially served only Supplemental Nutrition Assistance Program (SNAP) participants. To maximize program participation, on June 1, 2023 WCH also began serving individuals with current Medicaid benefits through the grant. During the reporting period, the VeggieRx program directly served 868 unique SNAP and Medicaid clients. SNAP enrollment is verified at VeggieRx distributions by running balance inquiries on participants' Electronic Benefit Transfer (EBT) cards, and receipts are kept in participant enrollment files. For Medicaid, participants' Medicaid numbers are verified in the OneSource medical billing system to ensure they are eligible at the time of distribution. Based on participant survey responses: 30% identified as Black/African American, 65% as Latinx/Hispanic, 1% as White/Caucasian, 2% other/multiple ethnicities, and 2% not reported. Participants were 75% female, 23% male, and 2% other or not reported. 49 was the average adult participant age and 13 was the average youth participant age. A portion of the produce the project provided was grown at WCH farm sites by its youth and workforce development program trainees, including beginning farm businesses in its Farm Incubator program. In 2023, 85% of these trainees identified as BIPOC (Black, Indigenous, and people of color) and were economically disadvantaged--in keeping with WCH's mission to provide economic uplift through paid jobs training and youth development opportunities. WCH delivered the VeggieRx program throughout the reporting period in three Chicago neighborhoods. In order to reach its target audience and address community-specific challenges, VeggieRx partnered closely with three Federally Qualified Heath Centers (FQHCs) that are deeply rooted assets in each community to identify appropriate patients--with a diagnosed diet-related health condition or a risk of developing one--and refer them into the program. These healthcare institutions were: Lawndale Christian Health Center (LCHC), PCC Austin Family Health Center (PCC Austin), and PCC Salud Family Health Center (PCC Salud). Both LCHC and PCC have a long history of partnership with WCH that predates the existence of the VeggieRx program. WCH has run a healthcare garden at PCC Austin since 2015, and LCHC has partnered with WCH on a variety of projects since 2007, including on its youth development programs, the launch of VeggieRx, and the establishment of WCH's headquarters, the Farm on Ogden. A fourth VeggieRx FQHC partner originally proposed--Esperanza Heath Centers (Esperanza)--was an active program partner at their Brighton Park location throughout the 2021 and 2022 program years. In 2023, Esperanza began running its prescription produce program independently of WCH. WCH anticipates that this procedural shift will not impact project delivery goals. WCH is proud to have helped build Esperanza's capacity to deliver produce prescription programs and to meaningfully connect their communities to the local food system. Changes/Problems:As described in the "Target Audience" section above, in order to maximize program participation, in 2023 WCH began serving individuals with current Medicaid benefits. The VeggieRx team worked closely with health center partners to define processes and procedures related to this shift. Another change made in 2023 was to focus on partner health clinic patient referrals only. While extending the program to non-referrals during and in the wake of the pandemic in response to increased community food insecurity, VeggieRx--recognizing that other emergency food sources are available in the community--returned to its core goal of deepening participant engagement over extended periods of time to support participants in managing diet-related illnesses. This approach addresses two primary challenges. For patients, it offers a tangible way to follow up on providers' dietary recommendations, backed by a supportive community to help reinforce their goals. For providers, VeggieRx is a valuable tool that helps bridge the gap between clinical care and social determinants of health, one of which is access to nutritious foods. During the reporting period, WCH continued to refine the use of its data management system (DMS) on the Microsoft Dynamics platform, initially implemented in 2021, which has had a significant positive impact on the VeggieRx program. The DMS provides in-depth insight into program metrics, and reports and visual dashboards of key metrics can be shared in real-time with staff and healthcare partners to demonstrate the growth and impact of the program. The DMS also streamlines operations and improves participant experience; for example, during enrollment, participants now complete electronic surveys on tablets that integrate directly to the DMS, reducing both participant and staff time spent on the process. In addition, in 2023 WCH implemented a new POS system (ECRS CATAPULT) that further improves participant experience and data collection at VeggieRx distributions and farm markets. The POS has further streamlined operations and improved customer experience in the retail store, reducing wait times and checkout process times. It has also improved and created efficiencies in tracking additional metrics, for example additional produce purchases by VeggieRx participants. In an effort to continue enhancing the program's important nutrition education component, in 2023 VeggieRx fully launched new hands-on cooking courses after a successful pilot last year. These courses, developed in response to participant feedback for more intensive cooking education, are offered in 6-week cohorts in English and Spanish. WCH supported and filled four cohorts this year, two in each language. WCH also welcomed students' family members to attend to learn healthy cooking skills and promote homemade cooking as a family activity. What opportunities for training and professional development has the project provided?During the reporting period, VeggieRx has supported the following training and professional development activities: The project provided professional development opportunities for both WCH and health clinic partner staff. Through the project, WCH staff continued to gain experience working with medical providers to address social determinants of health. Healthcare providers continued to learn how to incorporate VeggieRx into their care plans, providing a concrete and accessible way to connect a nutritious diet with clinical care. VeggieRx staff held an introductory training for staff at PCC Community Wellness Center on 2/9/23 on the VeggieRx model and distribution procedures. Trainings are re-offered if there is clinic staff turnover. WCH staff attended the "Empowering Eaters: Access, Affordability, and Healthy Choices in Support of the Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health Summit" on 8/2/23. Staff learned from experts on a range of food and health equity topics and panel discussions. WCH staff participated in the GusNIP NTAE Produce Prescription community of practice to share and discuss best practices and knowledge gained about VeggieRx and other PPR programs. The VeggieRx team hosted a Nutrition Incentive Hub Mini Convening at the Farm on Ogden in October 2023. The convening fostered learning and networking among nutrition incentive and produce prescription practitioners from across the country. Though not supported by USDA GusNIP funds, in 2023 WCH provided intensive training and mentorship for the U.S. Botanic Garden and American Public Gardens Association's Urban Agriculture Resilience Program Capstone Cohort of staff from seven U.S. public gardens. Trainings included information about how botanic gardens can adapt VeggieRx to their locations and partnerships. For details on trainings/mentoring during the reporting period, please see "Other Products" section. How have the results been disseminated to communities of interest?As a recognized leader at the intersection of urban agriculture and community health both locally and nationally, WCH is well-positioned to share the results of its work with a diverse community of practitioners and stakeholders. WCH staff are actively involved in volunteer leadership roles within food access, health, and community coalitions, and share program results and best practices with agriculture, social service, and healthcare institutions in the region. During the reporting period, these include the Illinois Public Health Institute's Alliance for Health Equity Food Access and Security Workgroup, the North Lawndale Community Coordinating Council's Health and Wellness Working Group, Advocates for Urban Agriculture, Chicago Food Policy Action Committee, and Austin Eats, focused on growth and consumption of nutritious local food in Chicago's Austin community. Through these efforts, demand for produce prescription programs continues to build, and the model has been adapted at hospitals and clinics across the Chicago area. In addition, WCH shares VeggieRx best practices and knowledge gained at a national level through the GusNIP NTAE Center's Produce Prescription Community of Practice meetings. During the project period, WCH staff continued to convene quarterly evaluation meetings with healthcare partners, which were established in 2021. The focus of these meetings is sharing best practices and aligning outcome tracking across VeggieRx sites. Facilitated by WCH's new data management system, VeggieRx has begun working more closely with partners to understand the value of reporting/evaluation alignment and shared metrics in order to compare the efficacy and impact of interrelated programs across the sector. The meetings also enable all partners to see themselves as part of a unified produce prescription program, and not operating their programs in isolation. A practice further honed this year that has improved health clinic partnership effectiveness has been monthly meetings with frontline care coordinators (initiated in 2020) and leadership teams (established in 2021). Frontline staff, who play a key role in supporting, communicating, and recruiting for the program, are kept informed of the latest information and updates, and also share feedback from patients and staff. Identified "champions" at each partner site lead communication of VeggieRx information to healthcare providers, and are essential to the program's success. Equally important, the meetings provide a forum for frontline staff to openly and regularly share feedback from patients and their teams, enabling VeggieRx staff to respond quickly and make changes as needed. Leadership team meetings focus on strategic planning and growth, discussing evaluation priorities, and sharing participant feedback. The Chicago Botanic Garden's director of government affairs regularly hosts visits to WCH sites by public officials. During the reporting period these included: - USDA Deputy Assistant SecretaryDr. Penny Brown Reynolds (in Washington, DC) - Will McIntee, Senior Advisor, White House Office of Public Engagement and Kelliann Blazek, Special Assistant to the President for Agriculture and Rural Policy Additional examples of WCH's commitment to sharing the VeggieRx model with a broad audience during the reporting period included: WCH has educated the community about VeggieRx through Farm on Ogden tours for thousands of community leaders, elected officials, funders, school groups, local residents, and other stakeholders. Written communications about WCH and VeggieRx were sent to federal, state, and local officials. WCH was the subject of or was mentioned in several media articles on urban agriculture and food-as-medicine programs. What do you plan to do during the next reporting period to accomplish the goals?During Year 2 of the project, WCH will continue the VeggieRx program working closely with LCHC, PCC Austin, and PCC Salud. WCH will increase participation through its first full year accepting Medicaid patients in addition to SNAP participants. WCH has found that partnerships with Federally Qualified Health Centers are an ideal fit for the VeggieRx model, and WCH will continue next year to focus program participation on healthcare partner referrals only. WCH will continue to develop and leverage its data management and POS systems, enhancing program delivery, efficiency, and evaluation, and promoting data-driven decision making. VeggieRx will continue working to improve participant experience at VeggieRx distributions and farm markets, and deepen participant engagement through expanded opportunities for nutrition and cooking education. WCH will also continue to strengthen engagement and coordination with healthcare partners through monthly staff meetings and quarterly evaluation meetings. WCH will also continue to enhance understanding of PPR impacts on health outcomes and healthcare use and costs as a partner on the American Diabetes Association-funded study. WCH/NTAE will complete final revisions to the IRB and begin baseline data collection in early 2024. Finally, WCH will complete a VeggieRx strategic planning process that began in 2023 with the support of a grant from the Fair Food Network. The planning process includes an audit of the program's delivery model and a cost-benefit analysis, informing the development of a comprehensive plan to ensure the programmatic and fiscal sustainability of VeggieRx.
Impacts
What was accomplished under these goals?
WCH delivered VeggieRx throughout the reporting period, running the program in 2023 for 40 weeks from February through November. Each weekly distribution included the provision of free produce boxes, in-person and virtual nutrition and cooking education, and information on how to store and prepare the fruits and vegetables provided. Beginning in 2022 and continuing in 2023, WCH significantly expanded the depth of nutrition and cooking education. Last year, WCH created a new Culinary Nutrition Coordinator position to oversee and enhance this central component of the program. In-person nutrition/cooking classes returned in 2022 and continued in 2023, bi-monthly at each VeggieRx site, in addition to weekly virtual classes. Both were offered in English and Spanish, provided by staff from Chicago Partnership for Health Promotion, a key WCH partner since the program's inception. Virtual classes were also posted to the VeggieRx Facebook group--initiated during the pandemic and currently with 844 members--for participants who prefer virtual attendance and/or need flexibility in viewing time and location. Lastly, in 2022 VeggieRx piloted new hands-on cooking courses in 6-week cohorts in English and Spanish, in partnership with Chicago-based Good Food is Good Medicine. These courses saw high demand from participants and were continued in 2023, two cohorts in each language. Activities advanced progress on each of the broader project objectives during the reporting period. 1) Increase consumption of fresh, primarily local, culturally appropriate fruits and vegetables in target disinvested Chicago communities. 8,277 produce boxes (approximately eight pounds per box) were redeemed by SNAP/Medicaid-eligible participants and their families (47% of 2-year goal of 17,500 boxes). This healthy food reached 868 unique individuals (40% of 2-year goal of 2,200) and provided increased food access to 2,604 people (based on an average household size of three). Participants obtained an estimated 66,216 pounds of produce (47% of 2-year goal of 140,000), equating to 94,594 servings. 97% of repeat participants reported consuming more than half of their VeggieRx box, and 72% of repeat participants reported consuming all the produce in their box. Using a new database system and electronic surveys, WCH documented improvements in healthy eating habits. For example, during the reporting period, participants reporting no intake of fruits or vegetables per day fell in pre- to post-program surveys from 7% to 0%. 2) Deepen engagement with participants and healthcare partners. 293 SNAP participants (42% of total participants) attended 5 or more VeggieRx distributions (goal: 25%). 178 SNAP participants (25%) attended 10 or more distributions, and 121 (17%) attended 15 or more. Medicaid participants, added mid-program year, will be tracked for this metric in 2024. 14% decrease (goal: 30%) in markers of participant food insecurity, measured by the share of participants reporting that they sometimes or often ran out of food in the past 30 days. 34% of participants reported in a related question that they no longer worry about running out of food before having money to buy more. 93 cooking demonstrations/nutrition education sessions (goal: 40) were delivered, expanding participant knowledge of the impact of a nutritious diet on health. Nutrition/cooking education was offered in both English and Spanish--the primary languages of the service population--to ensure that language was not a barrier to access and learning. 918 SNAP/Medicaid participants attended in-person nutrition and cooking education sessions, and virtual nutrition/cooking sessions logged 2,527 views. 2 participant feedback sessions conducted (2-year goal: 4), providing opportunities for input, collaboration, and connection between participants and project staff. 25 meetings (2-year goal: 20) with healthcare partner care providers, care coordinators, and leadership teams advanced collaboration, coordination, and sharing of project results. VeggieRx meetings with healthcare partners help doctors and clinics incorporate dietary health and nutrition education into their practice. A new point of sale system (POS) was implemented in 2023, achieving a project goal. The POS improves operational efficiencies, participant experience, and robust data collection at VeggieRx distributions. 3) Enhance understanding of how VeggieRx impacts health outcomes and healthcare use and costs through robust data collection and evaluation based on rigorous research design. WCH began expanding the depth and rigor of outcome evaluation as a partner on a research study led by the NTAE Evaluation Team/Gretchen Swanson Center for Nutrition, funded by the American Diabetes Association. The study, titled "Pathway for Produce Prescriptions in Diabetes Management" augments WCH collection of core GusNIP evaluation data for diabetic patients, and serves the GusNIP goal of better understanding PPR impact on reducing healthcare use and associated costs. WCH progress during the reporting period--aligning to Year 1 of the three-year study--includes: Finalized cost worksheet to assess the cost effectiveness of the project. Cost worksheet tracking has been populated by WCH from May-November 2023, and will continue throughout the next project year. Contributed to creation of a two-page summary for key stakeholders interested in learning about the study. Completed site-level protocols for participant survey data collection. Finalized participant survey modifications and semi-structured moderator guides, including Spanish translations. Completed initial training session with research team on 2/28/23. Data Use Agreement and MOUs fully executed with NTAE/Gretchen Swanson Center for Nutrition on 3/6/23. Staff participated in a qualitative interview with the research team on 3/21/23. Submitted IRB application through the University of Nebraska Medical Center for the study on 6/26/23. Revisions were submitted 10/13/23, and NTAE/WCH are currently completing final revisions. Baseline data collection will commence in February 2024; a secondary training session has been scheduled for the week of 2/5/24. Post data collection points will occur within six months of baseline data collection. Current and past VeggieRx outcome data demonstrate that VeggieRx has the ability to impact participants' food security and health, as indicated by the food insecurity metrics under Objective 2 above. Aggregated results shared by health partners suggest that VeggieRx patients show improvements in A1c levels, hypertension, and depression. These results indicate that VeggieRx is not only responding to short-term health and food security needs, but is helping participants make long-term behavioral changes regarding health and nutrition. Qualitative feedback shared by VeggieRx participants also reflects impacts on diet and health. Recent participant comments include: "Back in August I was diagnosed with high triglycerides and since changing my diet, I am happy to report that I am no longer taking medications." "I've lost weight to where I'm no longer considered insulin dependent. So I threw away my meter this week. I lost about 70 lbs." "I'm learning a lot. I'm gaining knowledge. I didn't know how to eat right. Here I am thinking I'm eating ok, but I'm not putting enough vegetables or fruit... I'm understanding a little better how what I eat impacts my blood sugar." "The VeggieRx program helps you lose weight, lower your A1c, and maybe even reverse your diabetes."
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