Progress 09/15/23 to 09/14/24
Outputs
Target Audience:The target audience for the Fresh Rx produce prescription program funded by the GusNIP PPR grant during the reporting period has been the patient population who are on MediCal (California's version of Medicaid), have screened positive for food insecurity, and have a diet-related chronic health condition at four healthcare organizations that serve East Salinas and Seaside, California. One clinic partner, Clinica de Salud del Valle de Salinas (CSVS), added the criterion that all patients enrolled in Fresh Rx must be diagnosed with diabetes with a HbA1c level of 9% or greater. Another clinic partner, Monterey County Clinic Services, that manages multiple federally qualified health clinics (FQHCs), including two of the clinics that enrolled patients in the Fresh Rx program, added the criterion that all patients have an abnormal BMI. At least 1000 patients who were on MediCal and were food insecure were screened to be enrolled in the Fresh Rx program. A total of 540 patients participated in Fresh Rx during different 19 week periods between March 10th and October 22nd, entering and exiting the program on different dates depending on when they were initially enrolled. Of the 540 enrolled, 144 of them received Fresh Rx prescriptions that were funded by the GusNIP PPR grant. At the three Salinas-based farmers' markets where the majority of the Fresh Rx produce prescriptions are redeemed, the people served are primarily Hispanic; over 800 families are served by the three farmers' markets, including the Alisal Farmers' Market located outside of the Women, Infants, and Children (WIC) office in East Salinas, and two hospital locations-Natividad Medical Center and Salinas Valley Health. Most shoppers are women aged 20-70 who make the market part of their weekly routines. The Alisal Farmers' Market, where the majority of the GusNIP PPR funded Fresh Rx prescriptions were distributed and redeemed, is located in the Alisal in East Salinas, a neighborhood that includes the most densely populated census tracts in Monterey County, where farmworkers make up the majority of the population, and where 54.2% of residents earn less than 200% of the federal poverty level, a higher percentage than the county and state averages (California Healthy Places Index 2023). Given that the level of food insecurity throughout Monterey County is over 40% and even more acute in low-income families (44% of adults in low-income households, 57% of children, and 66% of farmworkers), the patients in the Fresh Rx program that receive their produce prescriptions at the Alisal market and the other Everyone's Harvest's markets that serve East Salinas and other lower-income neighborhoods are given the opportunity at the markets to learn about and enroll in other nutrition incentive programs such as CalFresh, WIC, and Senior Farmers' Market Nutrition Program coupons to facilitate their continued access to fresh, affordable produce. In Marina, customers are ethnically diverse, including Asian-American, Pacific Islander, Southeast Asian, and Hispanic residents. In addition to local Hispanic and other farmers, Marina's vendors include immigrants from Laos providing Southeast Asian specialty produce to the community. The market serves an average of 480 customers weekly, more than half of whom are families with children. The Pacific Grove market operates in a more affluent community, yet CalFresh usage is on par with Marina. The market includes 15 farmers, including BIPOC, beginning, and women farmers. The newest farmers' market in Seaside, opened in June 2023, serves an ethnically diverse community of over 32,000 where the largest population contingent (45.7%) is Hispanic, the per capita income is $26,200 and there is a 12.3% rate of poverty. The market features produce from BIPOC, beginning, and women farmers and local small businesses and artisans from the community. The North County Certified Farmers' Market, where the remaining Fresh Rx participants were enrolled, serves the unincorporated town of Castroville with 20,623 residents, a 12.7% rate of poverty and where 68% of the population are Hispanic. Everyone's Harvest has focused on serving low-income and historically underserved communities since its inception 22 years ago. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?EcoFarm Conference (January 2024) Small Farms Conference (February 2024) InTents: The Farmers Market Conference (March 2024) Farmers' Market Manager Training sessions throughout 2024 GusNIP PPR Communities of Practice throughout 2024 Medically Supportive Food and Nutrition Knowledge Network (met bimonthly in 2024) Nutrition Incentive Hub PPR Mini-Convening (August 2024) Civil Rights Training (USDA required course, self-paced, online) California Food Handlers Certificate Course (online) How have the results been disseminated to communities of interest?Results are shared in the following publications and media: Annual Report mailed to all donors and partners Individual reports to all grantors Pamphlets listing end of year accomplishments mailed to all donors Pamphlets listing end of year accomplishments displayed at farmers' markets Press releases Email newsletters to newsletter subscribers Individual letters of appreciation to donors On Everyone's Harvest's website What do you plan to do during the next reporting period to accomplish the goals?We will enroll patients earlier in the season during the next reporting period in order to complete all activities before the end of our grant on September 14, 2025. Usually our enrollment period begins in June and operates for 19 weeks after that, but we will enroll patientsfor a shorter time period of 12weeks and enroll 84 more patients in the program so that all patients complete their course of treatment before the end of the grant period. We have chosen the 12 week period because it isequivalent to the number of weeks that Medicaid members with eligible conditionsare allowed to enroll in a similar medically supportive grocery program that the local medical health plan that provides Medicaidis allowing some providers to provide through Medicaid.We are transitioning to become a provider through Medicaid and expect to be an eligible provider by the end of the next reporting period. Since we have been told that we do not need to survey any more patients, we will not conduct baseline and post-surveys of patients during the next reporting period.
Impacts
What was accomplished under these goals?
1. Monterey County, California is home to the Salad Bowl of the World, yet food insecurity in the county is 40.8%, higher than the U.S. average, and diabetes has been identified as the highest priority community health need by residents, 70.4% of whom are overweight (CHNA 2022). For the 63,121 residents living in the historically underserved community of East Salinas, health challenges are exacerbated by the poverty rate, which is more than 1.5 times the state average, and 30% of children live in poverty (U.S. Census Bureau 2022). Everyone's Harvest (EH) has been serving families impacted by nutrition insecurity and diet-related chronic diseases in East Salinas and other low-income Monterey County communities for 22 years. EH operates three farmers' markets in partnership with healthcare providers in Salinas, and three municipal farmers' markets on the Monterey Peninsula in Marina, Seaside, and Pacific Grove. 2. The population we are serving are patients who are on MediCal (California's version of Medicaid), have screened positive for food insecurity, and have a diet-related chronic disease at three healthcare organizations that serve East Salinas, California. As one of our partner healthcare providers, Clinica de Salud del Valle de Salinas (CSVS), serves approximately 3500 patients with diabetes who could benefit from our Fresh Rx program, there is a great need to expand access to Fresh Rx in East Salinas and Monterey County in general. CSVS added the eligibility criterion that all patients enrolled in Fresh Rx through their clinics must be diagnosed with diabetes with an A1c level of 9% or greater. 3. For major goal #1: improving dietary health through increased fruit and vegetable consumption, some participant level health outcomes data from the 2023 Fresh Rx cohort was not shared by firm partners until after the annual report last year, so the outcomes reported here to achieve major goal #1 represent data from 2023 and 2024. In 2023, participant level health outcomes data for a subsample of 39 patients revealed a significant decrease in patients' mean A1c level by 1.69% after participating in the program for 19 weeks (P-value = 0.000028). Body mass index (BMI) collected in 2023 for 57 pediatric patients, as measured by BMI-for-age percentile, also significantly decreased by 4.3% (p = 0.01). Participant level health outcomes data collected in 2024 for 64 participants indicated a significant decrease in A1c (average blood sugar) by 2.04% (P = 6.5 × 10-12) between the beginning and end of the 19 week program. For both 2023 and 2024, the decrease in mean A1c is also clinically significant, since a change of -0.5% is considered a significant decrease in blood sugar level in patients living with diabetes. Patient BMI-for-age percentiles for pediatric patients have not been reported by firm partners yet for 2024. 67 patients in the Fresh Rx program were surveyed prior to enrollment in the program in 2024. 60 of those patients successfully completed the 19 week Fresh Rx program and completed the Post Participant-Level Survey that was provided by the NTAE's Nutrition Incentive Hub. Overall, the average change in the reported frequency of drinking or eating certain kinds of food was not statistically significant. But Fresh Rx patients reported significantly improved general health and positive experiences with the program. Overall, subjects had more positive responses, on average, about their general health condition (p = 0.002). All subjects (100%) in the post survey indicated positive or very positive experiences with Fresh Rx. For major goal #2, reducing food insecurity,the same surveys were used to quantify self-reported food insecurity in 2024. In a sample size of 58 participants, surveys indicated the following significant improvements in self-reported food security between baseline and post-survey responses: Participants who sometimes or often did not have enough food decreased from 64% to 44% (p = 0.002). Subjects who sometimes or often had unbalanced meals decreased from 75% to 38% (p < 0.001). And respondents who ate less decreased from 32% to 17% (p = 0.046). All participants (100%) in the post survey indicated positive or very positive experiences with Fresh Rx. For major goal #3, reducing healthcare use and associated costs, the clinic partners recorded for a subset of 39 patients in 2023, the total number of clinic visits during the 19 week program was 93 and the average number of clinic visits per patient was 2.4. During the same 19 week period, amongst the 40 patients, there were two patients who each made one visit to the emergency department. The average cost of care per patient for clinic visits was $357.69 and the total cost for all patient clinic visits during the time period was $13,950. Clinic visits were estimated to cost $150 per visit. The firm level healthcare use and associated costs for patients in 2024 hasn't been collected yet. For major goal #4, increasing Fresh Rx's long-term efficacy and sustainability, Everyone's Harvest signed a contract on July 1, 2024 with the local medical healthcare plan (MCP) that provides Medicaid insurance for Monterey County. The contract allows Everyone's Harvest to begin transitioning our Fresh Rx produce prescription program to become a covered medical benefit for Medicaid patients through Community Supports Medically Supportive Groceries for Medicaid patients. Fresh Rx continues to be included in a program for patients in Enhanced Care Management (ECM) through the Monterey County Health Department. In addition to these opportunities for Fresh Rx prescriptions to be funded through Medicaid and ECM, Everyone's Harvest has received contracts to provide Fresh Rx prescriptions to undergraduates at the local university. Everyone's Harvest continues to fundraise and seek grant funding to sustain the program in the longterm. 4. Project objectives included 1) expanding enrollment and retention of current Fresh Rx patients from 250 to 300, and the number of Fresh Rx patients enrolled during the project period from September 15, 2023 to September 14, 2024 were 540, including the patients whom we enrolled whose produce prescriptions are funded by sources other than the GusNIP PPR grant, thereby exceeding our expected outcome. We distributed $160,055 in weekly $35 prescriptions over 19 weeks and patients redeemed $152,596 in prescriptions by purchasing fruits and vegetables from farmers at Everyone's Harvest farmers' markets. The second stated project objective was 2) completing baseline and post-program surveys with 144 patients. This objective referred to the number of patients who would be surveyed during the three year grant period, with the specific objective of completing 48 baseline and post-program surveys during each year. During the second project period of the grant from September 15, 2023 to September 15, 2024, 60 patients completed both the baseline and post-program surveys. Therefore, Everyone's Harvest has completed 102 pre- and post-surveys in total. Regarding objective 3) submitting participant-level and firm-level data to the GusNip NTAE Center, we have submitted all of our participant-level and firm-level data on time to the GusNIP NTAE Center, adding two new firms, an additional clinic partner and a farmers' market, to the project during the project period. The fourth objective was providing nutrition education, and the clinics and Everyone's Harvest provided the following nutrition education during the project period: 67 hour long group nutrition education sessions conducted by clinic staff and 22 in-person cooking demonstrations at Everyone's Harvest farmers' markets, and The last objective, 5) establishing the long-term sustainability of Fresh Rx, has been addressed by our successful receipt of a contract with the local MCP, and an additional grant in 2024 to fund Fresh Rx.
Publications
|
Progress 09/15/22 to 09/14/23
Outputs
Target Audience:The target audience for the Fresh Rx produce prescription program funded by the GusNIP PPR grant during the reporting period has been the patient population who are on MediCal (California's version of Medicaid), have screened positive for food insecurity, and have a diet-related chronic health condition at three healthcare organizations that serve East Salinas, California. One clinic partner, Clinica de Salud del Valle de Salinas (CSVS), added the criterion that all patients enrolled in Fresh Rx must be diagnosed with diabetes with a HbA1c level of 9% or greater. At least 565 patients who were on MediCal and were food insecure were screened to be enrolled in the Fresh Rx program. A total of 380 patients participated in Fresh Rx during the 19 week period between June 6th and October 10th, with 144 of them receiving Fresh Rx prescriptions that were funded by the GusNIP PPR grant. At the three Salinas-based farmers' markets where the majority of the Fresh Rx produce prescriptions are redeemed, the people served are primarily Hispanic; over 800 families are served by the three farmers' markets, including the Alisal Farmers' Market located outside of the Women, Infants, and Children (WIC) office in East Salinas, and two hospital locations-Natividad Medical Center and Salinas Valley Health. Most shoppers are women aged 20-70 who make the market part of their weekly routines. The Alisal Farmers' Market, where the majority of the GusNIP PPR funded Fresh Rx prescriptions were distributed and redeemed, is located in the Alisal in East Salinas, a neighborhood that includes the most densely populated census tracts in Monterey County, where farmworkers make up the majority of the population, and where 54.2% of residents earn less than 200% of the federal poverty level, a higher percentage than the county and state averages (California Healthy Places Index 2023). Given that the level of food insecurity throughout Monterey County is over 40% and even more acute in low-income families (44% of adults in low-income households, 57% of children, and 66% of farmworkers), the patients in the Fresh Rx program that receive their produce prescriptions at the Alisal market and the other Everyone's Harvest's markets that serve East Salinas and other lower-income neighborhoods are given the opportunity at the markets to learn about and enroll in other nutrition incentive programs such as CalFresh, WIC, and Senior Farmers' Market Nutrition Program coupons to facilitate their continued access to fresh, affordable produce. In Marina, customers are ethnically diverse, including Asian-American, Pacific Islander, Southeast Asian, and Hispanic residents. In addition to local Hispanic and other farmers, Marina's vendors include immigrants from Laos providing Southeast Asian specialty produce to the community. The market serves an average of 400 customers weekly, more than half of whom are families with children. The Pacific Grove market operates in a more affluent community, yet CalFresh usage is on par with Marina. The market includes 15 farmers, including BIPOC, beginning, and women farmers. The newest farmers' market in Seaside, opened in June 2023, serves an ethnically diverse community where the largest population contingent (45.7%) is Hispanic, the per capita income is $26,200 and 35.5% earn below 200% of the federal poverty level. The market features produce from BIPOC, beginning, and women farmers and local small businesses and artisans from the community. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?EcoFarm Conference (January 2023) Small Farms Conference (February 2023) Farmers' Market Manager Training sessions throughout 2023 GusNIP PPR Communities of Practice throughout 2023 2023 National Convening of the Nutrition Incentive Hub (June 2023) Medically Supportive Food and Nutrition Knowledge Network (met monthly in 2023) Nutrition Incentive Hub PPR Mini-Convening (October 2023) Civil Rights Training (USDA required course, self-paced, online) California Food Handlers Certificate Course (online) How have the results been disseminated to communities of interest?Results are disseminated in the following publications and media: Annual Report mailed to all donors and partners Individual reports to all grantors Pamphlets listing end of year accomplishments mailed to all donors Pamphlets listing end of year accomplishments displayed at farmers' markets Press releases Email newsletters to newsletter subscribers Individual letters of appreciation to donors On Everyone's Harvest's website What do you plan to do during the next reporting period to accomplish the goals?Since the majority of our goals and objectives were accomplished during the first reporting period, we plan to follow a similar plan of implementation in the second reporting period with the following exceptions based on insights we have gained during the past year. The clinics didn't enroll as many patients as they had agreed to enroll before the program started on June 6, 2023, so not all patients were enrolled by the first week. Patients were added in the ensuing weeks until capacity was reached. Patients who didn't respond to enrollment calls or didn't come to the markets were sent warnings and then replaced by patients on a wait list of MediCal members referred by the clinics. In the following year, we will meet with the clinics earlier in the year and remind them monthly until the start of the Fresh Rx program in June 2024 to ensure that they will be prepared and will have enrolled all of their patients before the first day of the program. We will also seek advice from the NTAE technical advisors to simplify the enrollment form that we gave to the clinics. One clinic didn't provide the support during the enrollment process or the nutrition education they had agreed to provide during our pre-season meetings this past reporting period. They sent us many potential referrals who never responded to our calls to enroll them, and the clinic wouldn't respond to our repeated requests for clarification regarding how they changed their process for referring patients and for delivering nutrition education. Since not all patients from that clinic responded to our enrollment calls, the clinic sent additional patients until the enrollment capacity was reached. We will work with the clinic to improve communication and establish an agreed upon workflow for the second Fresh Rx season. The workflow with the other clinics was very successful and they completed all the pre-surveys of patients during the enrollment process. Everyone's Harvest agreed to complete the post-season surveys, and the change in interviewers could possibly be a confounding factor in the results. We will seek to provide more uniformity in survey providers during the following reporting period. Since we didn't meet our goal of 48 baseline and post-surveys completed this past reporting period, we will increase the baseline survey number to 70 to account for attrition of some patients during the season so that we can complete at least 58 baseline and post-season surveys. With 58 completed surveys, we will have 100 surveys completed by the second year of the grant and will be on track to fulfill the minimum requirement of 100 surveys completed. During the third year of the grant, we will attempt to complete as many above 100 as we can to reach between 130 and 144 completed surveys.
Impacts
What was accomplished under these goals?
Monterey County, California is home to the "Salad Bowl of the World," yet food insecurity in the county is 40.8%, higher than the U.S. average of 34.1%, and 67.9% of county residents report eating fewer than five servings of fruit and vegetables daily (CHNA 2022). Diabetes has been identified as the highest priority community health need by residents, 70.4% of whom are overweight (CHNA 2022). For the 60,531 residents living in the historically underserved community of East Salinas, health challenges are exacerbated by the poverty rate, which is more than 1.5 times the state average, and 29% of children live in poverty (U.S. Census 2020, California Healthy Places Index 2023). East Salinas has the highest food insecurity in Monterey County, scoring 85 out of a range from 0 to 100 (from lowest to greatest need) on a 2021 Food Insecurity Index of all U.S. Counties (Conduent Health Communities Institute 2021). Furthermore, fast-food outlets and convenience stores outnumber healthy food sources including supermarkets and farmers' markets nearly six to one in East Salinas. Everyone's Harvest (EH) has been serving families impacted by nutrition insecurity and diet-related chronic diseases in East Salinas and other lower-income Monterey County communities for 21 years. EH operates three municipal farmers' markets on the Monterey Peninsula and three farmers' markets and community programs, specifically the Fresh Rx produce prescription program, in partnership with healthcare providers in Salinas. The population we serve are patients on MediCal (California's version of Medicaid) who have screened positive for food insecurity and have a diet-related chronic health condition at three healthcare organizations that serve East Salinas, California. As one of our partner healthcare providers, Clinica de Salud del Valle de Salinas (CSVS), serves approximately 3500 patients with diabetes who could benefit from our Fresh Rx program, there is a great need to expand access to Fresh Rx in East Salinas and Monterey County in general. CSVS added the eligibility criterion that all patients enrolled in Fresh Rx through their clinics must be diagnosed with diabetes with a HbA1c level of 9% or greater. For goal #1: improving dietary health through increased fruit and vegetable consumption, 50 patients in the Fresh Rx program were surveyed prior to enrollment in the program using the Baseline Participant-Level Survey for Produce Prescription Projects provided by NTAE's Nutrition Incentive Hub. 42 of those patients successfully completed the 19 week Fresh Rx program and completed the Post Participant-Level Survey that was provided by the NTAE's Nutrition Incentive Hub. The results of the survey indicated that the average frequency of eating other kind of potatoes increased by 16.7 times per month (p = 0.002; 95% CI: 5.8 - 27.5) and the average frequency of eating packaged or homemade salsa increased by 13.7 times per month (p = 0.012; 95% CI: 3.7 - 23.7) but all other eating habits did not significantly change between the beginning and end of the 19 week period of the program except an increase by 4.4 times per month of the average consumption of 100% fruit juice was marginally significant (p = 0.099; 95% CI -4.4, 13.2). Additionally, the average rating of general health condition was marginally significant, increasing by 0.2 points in the 5-point Likert scale (p = 0.099; 95% CI: 0.1 - 0.4) so not indicative of a particularly large increase in self-reported general health given that a 1 point increase would represent a change from fair to good or good to very good. One of our healthcare partners administered a different survey to a subset of 47 patients. Based on a preliminary analysis of 25 patients who have completed both the baseline and post-program surveys, The average frequency of fruit and vegetable intake significantly increased (p = 0.029); the average frequency of sugar beverage intake significantly decreased (p = 0.014); and the average rating in response to the question "How confident are you that you have what you need to make healthy lifestyle choices?" significantly increased (p = 0.011). The health outcomes data for the Fresh Rx participants have not been analyzed yet, as the clinics won't be able to share the de-identified health outcomes data from the patients until early 2024. For goal #2, reducing food insecurity,the same surveys were used to quantify self-reported food insecurity but none of the food security-related questions in the survey had significantly different responses between the baseline and post-program surveys. For goal #3, reducing healthcare use and associated costs, the clinic partners will be reporting on healthcare use and associated costs for the patients who participated in the Fresh Rx program from June to October 2023 at the beginning of 2024. For goal #4, increasing Fresh Rx's long-term efficacy and sustainability, we are researching the possibility for Everyone's Harvest's Fresh Rx produce prescription program to become an accepted provider of medically supportive groceries through Community Supports for patients with MediCal in January 2024. We have met twice with the Medical Director of the county's MediCal healthcare provider and will be receiving training for Fresh Rx to be a covered medical benefit.. Fresh Rx has also been newly included in a program for patients in Enhanced Care Management (ECM) through the Monterey County Health Department. In addition to these opportunities for Fresh Rx to be funded through MediCal and ECM, Everyone's Harvest continues to fundraise and seek grant funding to sustain the program in the longterm. Project objectives included 1) expanding enrollment and retention of current Fresh Rx patients from 250 to 300, and the number of Fresh Rx patients enrolled during the project period were 380, thereby exceeding our expected outcome. We distributed $166,050 in weekly $35 prescriptions over 19 weeks and patients redeemed $169,057 in prescriptions by purchasing fruits and vegetables from farmers at Everyone's Harvest farmers' markets. The increase in the amount redeemed may be due to patients saving tokens from previous years and spending them this year or farmers saving tokens from the previous year and redeeming them late. The second stated project objective was 2) completing baseline and post-program surveys with 144 patients. This objective referred to the number of patients who would be surveyed during the three year grant period, with the specific objective of completing 48 baseline and post-program surveys during each year. During the first project period of the grant from September 15, 2022 to September 15, 2023, 42 patients completed both the baseline and post-program surveys. Therefore, Everyone's Harvest is behind by six patients from reaching our yearly goal of 48 pre- and post-surveys completed. Regarding objective 3) submitting participant-level and firm-level data to the GusNip NTAE Center, we have submitted all of our participant-level and firm-level data on time to the GusNIP NTAE Center, adding two new firms, an additional clinic partner and a farmers' market, to the project during the project period. The fourth objective was providing nutrition education, and the clinics and Everyone's Harvest provided the following nutrition education during the project period: 58 hour long group nutrition education sessions conducted by clinic staff and 14 in-person cooking demonstrations at Everyone's Harvest farmers' markets, and The last objective, 5) establishing the long-term sustainability of Fresh Rx, has been addressed by our successful receipt of two additional grants in 2023 to fund Fresh Rx prescriptions and successful fundraising from local donors to subsidize additional Fresh Rx prescriptions after the termination of the current grant. Also see goal #4 above.
Publications
|