Progress 09/15/23 to 09/14/24
Outputs
Target Audience:The University of Minnesota Landscape ArboretumVeggieRx(UMLA, https://arb.umn.edu/) award activities serve the patient population of selectedhealthcare clinics located inScott and Carver counties, Minnesota. Theseclinics only offer free general outpatient health services tounderinsured community members. This audience is a significantlyunderservedcommunityand is uniquely marginalized in the Twin Cities metro area due to rapidly changing dynamics in our population geography and food system. The UMLA VeggieRX program is a part of the Arboretum's Farm at the Arb Apprenticeship program, a beginning farmer training program for fruit and vegetable growers.Arboretum's Education Programs are rooted in our communities, guided by their needs, and strive to support greater wellbeing for plants, for people, and for the planet. VeggieRx participantsare all socially disadvantaged when defined by lowincome. The majorityare female,and native Spanish speakers. Interpretation and community partnerships were built aspart of the program design with MiC.A.S.A.,a local female-led nonprofit serving the Latino/a/x community, andexisting community liaison staff at each partner health clinic.Transportation was seen as a primary barrier to program outcomes and a main effort was focused on providing the produce prescription bags and programming at the clinic locations. Scott and Carver are collarmetro counties ofMinneapolis and St. Paul. Twoof the fastest-growing in the state, they arestill predominately rural by acreage. Affluent housingdevelopedfrom farmland rises quicklyon the eastern edge near the Twin Cities.This is where ourcommunities live adjacenttoservices, work, and schools. The rest of the countiesarelow-density rural which only affectsour clinic audiencetangentially, butprioritizespublic investmenttomajor roadway and construction projects to meet thehistorical newtax base, and the impact on low-income people is notvisible. Per historic public health assessments, Carver and ScottCountiesareseen as someof the healthiest counties in the state. Whatpublicofficialshave identified more recently with the rapidincrease in population is a possiblemajority shift in the next decade tofirst-generation Americans, with a significant increase in the% of people of color. Currently, these counties show some ofthe largest disparities in utilizationof SNAP and Medicaid benefits by county in Minnesota. For context in the audience and available services, our initial partneringclinic is an independent nonprofit outpatient clinic open 1daya week, by appointment, and serves over 600 people with primary care. Our area's food costs arehigh, asis the general cost of living. Fresh food in MN tends to take additional shipping compared to other metro centers, state taxation is in the top 10, and ouraudiencetends to live in newly appearing low food access islands, noted by the MN Environmental Justice 40 criteria as disadvantaged,surrounded by high food access affluent areas. So familiesand individuals have to drive to high-end grocers to buy food. Food shelvesand our free health clinic partners are seeing higher use. Participants arescreenedfor program eligibility and food insecurity by their healthcare provider. The providerrefers themto be enrolled in the programfor the positive impact on theirhealth issues. Participantsareenrolledduring apre-program enrollment period at the clinicwhere MiC.A.S.A or UMLAstaff confirm eligibility and reviewprogram details, ensuringtheir interest in 16 weeks offarm-direct fruitand vegetable bags and weeklynutrition education. This audience was selected by UMLA staff and Scott/Carver Public Healthforthe USDA GusNIP Produce Prescription Program with support from NTAE.We have notdefinedhealth issuesto address and plan to work with NTAE and the clinics to see where to focus next. With this audience, an increase in well visits isa goal. Generally speaking, we see a diverse range of agency barriers to fruit and vegetable intake. Many participants are accomplished cooks with low access to produce, others may be unfamiliar with the vegetables grown locally and are encouraged by demos,others are novice cooks, ormay not have the time or equipment. This makes the once-a-week, 2-hour distributions at both locations (32 total) worth the effort. We can offer educationdemos, and participants can check inwith the farmers and educators if they are just picking up that day, or each other if they can stay longer Farmers and SNAPed educators thencan continue the conversations each week with returning participants, interested in what peers are doing or what is next in the bags to try. The progress reporting dates Sept. to Sept. span two program years for us which run July to October to mirror the primary local fruit and vegetable growing season in MN. In our first program year (ending Oct 2023) we served both adults and childrento ensure the eligibility of participantsto NIFA GUSNIP criteria. This was cumbersome for evaluation and programming. After year 1 it was seen asunnecessary with support from NTAE for the second program year (started July 2024). The initial concern was clinic patientsmay or may not have beeneligible, and we did not want to enroll family members who were not patients. In year two, the clinicsfound our capacity of eligible adultpatients for us to enroll, and the household and children similarly benefitted from the produce prescription, intended forshared meals. It remains an ongoing issue but will be addressed later in this report without changing our target. The Arboretum's beginning farmer Apprenticeship program sees the interest of the next generation of fruit and vegetable growers in direct marketing to their communities and their valuein community development for higher quality food, health, and jobs. Our produce prescription program reaches our program audience with expert resources from our partner clinics,public health offices, and SNAPed nutrition educators, while connecting farmers and eaters to talk about food and what they like and do not like in a friendly and positive market environment. Our clinics can connect more with their patients, increase well visits, and connect our target audience with more connections to the community and available resources from SNAP. Farmers can learn how to better market to healthcare initiatives and adapt to culturally appropriate foods and preferences. We are excited to host events and trainings for the participants at the Farm at the Arboretum, strengthening this work and our organization as a whole. Changes/Problems:We had to make a change in our evaluation process which thankfully was not a major impact seen by evaluators at UMN Extension,NTAE, and the Gretchen Swanson to include only adults in our program model. Our specific target audience is underserved by our community and we have found alternative funding sources to serve the patient population we have that are noteligible under GUSNIP criteria. Again this not a major change thankfully due to alternative funding, but limits the community impactand research value as those participants cannot be included in the PPR study. Thank you for your review of this report What opportunities for training and professional development has the project provided?32- 15 min demos were given my SNAP ed educators are part of the program, which as part of the event were shared with UMLA staff, MiCASA, Scott County Public Health Family Resource Center, River Valley Health Services, East Creek Family Center, and many more who gain this training indirectly from program participants. I am eating better from hearing the VeggieRx programming again. It is hard to eat well. The Farm at the Arb Apprenticeship program hired, trained and graduated 5 new and 3 returning farmers who grew produce for the VeggieRx program. 2 of whom ran all of the distribution events with Susanne or myself. This experience was built off of the community-supported agriculture models of farmers markets and subscription shares which connect growers to their customers for a stronger sense of community and a more resilient business model with less overhead and outside interests. VeggieRx connects these Apprentices to a whole new market, where healthy communities is the focus. Safe, reliable and nutritious food being grown for the livelihood of a community member has taken the interest of beginning farmers in our programs. We have had two VeggieRx participants look to apply to the farmer program and hope to see more applicants in the future. The two apprentices in 2024, John and Allison, both learned a great deal about growing, marketing and logistics, but also brought professional marketing backgrounds and co-developed some nutrition education materials with the SNAPeD team. They also developed a model farm plan which they presented to the Arboretum in hopes to develop an urban lot in Minneapolis to farm for a VeggieRx program at a children's hospital. The UMN Extension Evaluation team has hosted undergraduate, graduate and Americorps students to participate in the evaluation of the UMLA VeggieRx program. These have been public health students gaining experience in outreach work and learning about the role of partnerships. How have the results been disseminated to communities of interest?Program partners and staff have participated in annual debrief and Ripple Effect Mapping Sessions which have allowed us to share these results in conversation and document for our joint planning processes. Many of these partners are representative of the communities we serve but still we look to more deeply engage program participants in planning and results in future years. UMN Extension and the UMN Landscape Arboretum speak at local, county, statewide, and national audiences about VeggieRx and the value of our program partnerships. We have yet to share results as the model is working but in Minnesota we are just starting to converse with other programs and see what each other are doing and meet. Abby Gold, this program's evaluators has hosted two world cafes last month to connect different Minnesota VeggieRx programs, GUSNIP and not GUSNIP funded to understand how they can connect and learn from each other. We look forward to sharing the results specific to this and the previous program year as we determine our next course of action. What do you plan to do during the next reporting period to accomplish the goals?We will start recruiting for the 2025 program year in March and look to again serve about 100 people, focusing on increasing communication and retention. We are not planning on major program changes but will apply for a no cost extension to continue out the program year through October, putting another GUSNIP PPR proposal in this winter as it is released. We have another clinic we can recruit from in Carver County for 2025 that will pick up at existing locations, but hope to again focus on communication strength and lessons learned from NTAE and conference materials in preparation for significant growth and partnerships in 2026.
Impacts
What was accomplished under these goals?
In the first program year, ending October 2023, we enrolled 94people into the VeggieRx program and issued 1600 produce bags at the clinic sites. We had an average45% monthly redemption rate the first year of participants participating throughout the 16 week program. For the 2024 program year July to October, we enrolled 120 people with a similar average redemption rate. All produce is aggregated,packed, and sorted, at the UMN Landscape Arboretum by our Apprenticeship program. The majority is grown by our Apprentices onsite orsecured from other emerging farmers and farmers of color near the Twin Cities metro through our partner the Good Acre food hub.The number of bags and weeks remained the same, but we increased the number of items and included fruit in every bag. We also sourced some out-of-state produce such as chayote and cilantro when unavailable locally to round out the season. Screening, enrollment, and survey setup and tools were much easier in the second program year as clinic staff were more familiar with the program and PPR objectivesand we asked for more dedicated staff time from our community partner MiC.A.S.A. Our colleagues in Scott County and Carver County Public Health, who support program implementation and planning,greatly streamlined communications between UMLA staff, UMN Extension program evaluators, MiCASA, and staff at eachclinic. Thisimproved enrollment and retention throughout the program. Our program coordinator Susanne DePalma more clearly defined what produce and logistics wereneeded based on participant interests, and prior planning with growers and new educators on the SNAPed team. Program scripts were written and organized and eligibility processes were improved after redirection from adult and child/parent surveys to adult-only surveys. This onboarding process will be improved upon again but helped to improve the initial participant experience and partner communication throughout the program year. Weekly emails went out to all participants and program staff on 'What's in the bag', the distribution activities/speakers, and even updates on the weather backup options for our outdoor site. This is a far cry and sweet relief from our 2022 pre-GUSNIP pilot with some bags under a tent, a hot plate, an amazing bilingual SNAPed Educator, a farmer, and some flyers! The highlight of our program year is the distributions. We regrettably saw our pilot and initial year SNAPed educator Maria Theresa Thorenson retire, who defined what the program experience could be. Her comfort as a native speaker, community engagement specialist and SNAPed Educator tied all of the nutrition education pieces together, MiCASA could welcome and engage with participants with local resources,and the UMLA Farm staff could focus ondistributing and talkingproduce atthe clinic. But thankfully from strong partnerships with UMN Extension through our evaluation and education team, two new bilingual educators were able to join the program. Jonah and Belkiswere excited about designing a bilingualcurriculum and materials specifically for our participants that they could deliver at the onsite distributions. MiCASA increased their staffing which allowed, Liz to take this program year thenext step of engagement as an expert in event engagement. With additional tabling speakers (from food shelves, public transit, county emergency services, financial literacy) rotating at the distributions, new participants, and UMLA training new farmers each year at giving out the bags while the SNAPeD educators are doing demos, flow can be an issue. This could limit the opportunity for participants to connect or see resources but MiCASA and additional clinic staff are making the events more seamless and more engaging. In debrief meetings from program year 1 we heard that these distribution events are very important in our community partner's view as gatherings around health and eating. As our audience has a lot of stress specifically around food access, health, and transportation, a reason to get together and converse is very important to them. We have been looking at ways to increase retention, tried delivery, and are considering one instead of two locations, but are strongly considering the impact and value of this element. Also needing to find out how to document and find value in that for our audience and program design. For this progress report, we did complete the 2023 program Ripple Effect Mapping, Photovoice,and firm/participant survey analysis by our own program evaluator at UMN Extension. This process was also done in November 2024 and will recieve results this winter for the second program year. We have seen significant fruit increase in participants, but not statistically significant across other questions. Ripple Effect Mapping was started based on a Theory of Change model we developed for the program and recorded with the core program team, partners, and the Apprenticeship farmers which will be shared in our final report as it is completed for the award.
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:UMLA VeggieRx award activities serve the patient population of two healthcare clinics located in Scott and Carver counties of Minnesota. These clinics serve underinsured community members with general health services. They are all socially disadvantaged adults and children defined by low income, the majority of whom are people of color. Participants in our activities have been screened positive for food insecurity by their healthcare provider, referred by their provider directly to our activities for thepositive impact on their health, and have an interest in receiving farm direct fruits and vegetables with nutrition education weekly for 16 weeks over the main food growing season. This audience was selected by UMLA staff as relevant to the USDA GusNIP Produce Prescription Program which we started this year. Changes/Problems:We thankfully had a small pilot before this grant period with similar partners. This was essential to the success of the first year as designing a brand new program, while implementing took longer due to various real sensitivities to new partnerships, a new community audience for UMLA, and the reality of hiring timelines for a coordinator, and a novice project director. Contracts and expenditures were delayed due to this, however, program dates and goals were met by staff and partners who were going to make it happen anyway. Changes may be involved in future budget years but mostly will be activated at a slightly different timeline in year 2. This enthusiasm and expert coordination by new staff allowed us to live off of some assumptions and trust validated by the community due to the partners' track record but with little mutual understanding by project staff at different entities. Each active partner had a learning curve implementing new processes and knew what roles, responsibilities, and expectations for communication were important. Challenges specifics include, how to aggregate produce at a new farm, how to train beginning farmers to be food distributors, and what is needed to create education and surveys that make sense to multiple partners. Communication starts and "dry runs" have been a theme for the year, but we have a lot to work with for developing more sustainable systems in the following program year. Expertise and commitment from each partner have been eye-opening and offer a lot to improve with next year. What opportunities for training and professional development has the project provided?In year one we have provided 64 contact hours directly with project team educators, farmers, and community partner health advocates. This had direct benefit to the participants but also allowed an equal amount of professional development to project staff, several interns, and partner staff throught the delivery and preparation of these contact hours. How have the results been disseminated to communities of interest?We have presented informally to participants during a final season event at the University of Minnesota Landscape Arboretum Farm at the Arb fora end of year celebration and meal. UMLA and partners have begun to present the program through a multi-state audience with formal presentations at conferences and retreats at the UMLA Farm at the Arb. This 28 acre agricultural campus show agricultural concepts past, present and future to our 600,000 annual visitors. The Apprentices who grow the food and the food growing spaces themselves have been visited and celebrated by our program participants andour partners. UMLA staff alsocommunicatethe program to partners of the UMN college of Food Ag, and Natural Resources and multistate Extension and land grant colleges who visit the Farm, as well as interest groups from state, federal, and private agribusiness who choose to also support or visit the Farm. Individually MiCASA, SCPH, RVHS, and UMN Extension have shared the program information, need, and basis with their constituents, which we see as a validation of the work, and an opportunity for further program development. What do you plan to do during the next reporting period to accomplish the goals?We have had a successful first year. Within the context of these clinics, farmers, and 100 participants in 2024 we will rethink each element of our design to make it more accessible, easier to manage with better design and protocols, and more successful with increase return rates, impacts, and participation from clinics and educators on what our model can develop as a lasting impact to our community and participants. This will focus on evaluation and communication with all partners, a participant feedback forum, and additional input from our community which may lead to stronger project outcomes. We do rely heavily on staff and resources volunteered or in kind to this project and we hope to activate those resources further to look at program sustainability, and community impact.
Impacts
What was accomplished under these goals?
With program year 1 running July-October 2023, much of resulting data, activities, and expense will show in the following fiscal year progress report. In this year, year one to 9/14/23, we enrolled 94 adult and child participants in the new UMLA VeggieRx program,a weekly farm direct fruit and vegetabledistribution andpop up education event for a 16week program. 1200 market bags were packed by UMLA staff full of fruits and vegetables grown by the UMLA Farm at the Arb Apprenticesand partnering emerging farms. These were distributed to participants who attended distributions and small number of home deliveries weekly for those who could not travel. UMLA staff included NIFA supported project team members, but also 4dedicated farmers who are apart of the UMLA Apprenticeship program, a paid beginning farmer training program being piloted at UMLA. These farmers delivered the produce and connected with each participant to describe this week's bag as they handed them out during a 2 hour distribution window. The participants were all screened and referred by our healthcare partners River Valley Health Services(RVHS) in Chaska, Mn and Scott Co Health Matters/Family Home Visiting clinics(SCHM) in Shakopee, MN. UMLA staff and contracted partner MiC.A.S.A (Comunidad, Apoyo,Solidaridad y Amistad) enrolled participants into the program and completed the NTAE validated participant core pre-surveys which were designed by our evaluators Abby Gold and Kate Welshons from UMN Extension, with Scott CO Public Health SHIP coordinator Casey Stewic, Carver County Public Health SHIP Coordinator Caitlin Huiras (SCPH), and project director and coordinator Tim Wilson and Susanne DePalma (UMLA) Each participant received onsite food demos by UMN Extension SNAPed educator Maria Theresa Thorenson who tailored the demos for the produce provided by UMLA. She provided English and Spanish presentations with handouts each week at both distribution sites. Additional UMN Extension educators and SCPH educatorsalso provided additional community education in financial planning, community food resources, and healthy and active tips in the community. MICASA offered onsite community engagement, translation, and resource sharing as a highly successful Latina/x-founded and operated nonprofit in our community. Participants went through stations at two different distribution locations, in front of RVHS in Chaska, and at the Scott County Family Resource Center in Shakopee which project staff operated Tuesdays and Thursdays each week. Participants mostly visited the same location each week, familiar with their providers or community partners at each site. MICASA staff support RVHS and SCPH clinics to support referrals to become participants, including reminder calls, last-minute home deliveries, and general community support through the variety of services they offer throughout the year. Project coordinator Susanne DePalma, designed the distribution setup and developed protocols for produce distribution, while intergrating partner activities and surveys into each distribution. These collective activities supported a 56% return rate so far of participants which we see as a success with new partners, new program and a long program commitment from a socially disadvantaged population. Those who returned gave us invaluable feedback and support with excitement behind not only their health benefits related to diet, but also social and mental health in the experience as part of these weekly events. UMN Extension evaluator Abby Gold, Kate Welshons, and support from Nikki Johnson and other team members, directed the UMLA staff through a Theory of Change model process, and worked closely with NTAE staff on survey design and objectives for 2023. They have implemented a Ripple Effect Mapping evaluation process to connect with the TOC model we collectively developed, which will give us additional program impact insight once processed and connected to year two data. This will also reference pre and post-surveys, and firm metricswe collect as part of our work with NTAE. We have been very excited to work with these partners and with support from the Nutrition Incentive Hub NTAE who helped us with program design in all aspect, and most specifically in survey implementation.
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