Progress 09/15/23 to 09/14/24
Outputs
Target Audience:The priority populationreached by our efforts during this reporting period is described as follows: Patients of, or people living the service area of, Riverwood Healthcare (Aitkin, MN) and Sanford Worthington Clinic (Worthington, MN) who are: 1. Over 18 2. Eligible for SNAP benefits, enrolled in SNAP or enrolled in medical assistance 3. A member of a low-income household that suffers from, or is at risk of developing, a diet-related health condition. This priority population was selected based on the requirements of the GusNIP grant and the mission of both Riverwood Healthcare and Sanford Worthington Clinic to serve patients who screen positive for food insecurity through the GusNIP grant program. Changes/Problems:During this reporting period there have been no new major changes, delays or problems. As we shared in our previous annual report,Sanford Health experienced delays in launching their program due to a delay in the IRB approval process as well as staffing capacity. They received IRB approval at the end of 2023, and then were able to move ahead with their planning, however, had to restructure their plans for program delivery, which delayed their program launch. Shortly after the launch they experienced staffing capacity challenges due to turnover in their Community Health Worker (CHW) position and a parental leave for one of the dietitians supporting the project. While it didn't change any major changes to the program delivery, Riverwood had a staffing change with their lead program planner. The person who launched the PPR at Riverwood took a new position, and a new lead was hired right away. MDH is working with both sites to track their budgets and will submit a budget adjustment request to the USDA in the event that we need to make any adjustments prior to the end of the grant cycle. What opportunities for training and professional development has the project provided?Through this project Minnesota Department of Health (MDH) program staff and partners (Riverwood Healthcare and Sanford Health) staff had the opportunity to participate in the required Collaborative Institutional Training Initiative (CITI Program) training as part of the NTAE's evaluation requirements. TheMDH evaluator attendedthe USDA Program Director meeting in December 2023. How have the results been disseminated to communities of interest?This research project is still ongoing and therefore results have not yet been disseminated. MDH staff did share the GusNIP Year 4Impact Findings report with program partners and our wider local public health partners in Minnesota. What do you plan to do during the next reporting period to accomplish the goals?Plans for the next reporting period (9/15/2024 - 9/14/2025) include: Planning with each partner to complete the final year of the PPR program at each site including Continuing enrollment and baseline survey collection at each site into March 2025 Delivery of the PPR for a minimum of 6 months to all enrolled participants, ending no later than the end date of the grant. Working with each partner to assess interest and capacity for sustainability beyond the end of this GusNIP funding cycle and supporting their sustainability efforts as needed. MDH staff will continue to participate in state-level conversations around using Medicaid policy tools to support Produce Prescriptions and other "food as medicine" interventions for long-term sustainability. Develop a student intern project to code meeting notes from partner meetings according to barriers and facilitators of the development, implementation, and sustainment of PPRs MDH will continue to submit required metrics and data to the NTAE MDH will continue to submit reports to the USDA as required
Impacts
What was accomplished under these goals?
The goal of our GusNIP project is to design, implement and evaluate Produce Prescription Programs (PPRs) in two rural communities in Minnesota to address food insecurity and improve dietary health. We have three main objectives to help meet this goal. During this reporting period (9/15/2023 - 9/14/2024) the major activities that were completed included: IRB approval for the Sanford Worthington Clinic (Obj 1) Established PPR redemption system between Hy-Vee grocery store and Sanford Worthington Clinic (Obj 1) Sustained the delivery of the PPR at Riverwood Healthcare through year 1 and started a 2nd year of delivering produce prescriptions (Obj 1) Developed relationship with local grocery store to supplement the PPR program during the winter months when the local Food Hub is not able to supply enough produce to meet demand (due to MN's growing season) for Riverwood Health (Obj 1) Launched the PPR and enrolled27 participants at the Sanford Worthington Clinic (Obj 2) Reached, and maintainedprogram capacity of 100 participants at Riverwood Healthcare (Obj 2) Redeemed over $2,500 worth of Produce Prescriptions at Hy-Vee Grocery Store via in-store vouchers in Worthington, MN (Obj 2) Completed baseline surveys with 100% of enrolled participants at both sites (Sanford Worthington Clinic and Riverwood Healthcare) (Obj 3) Met (and exceeded)goal of 100 baselinesurveys for newly enrolled participants at Riverwood Healthcare (Obj 3) Completed 62 six-month and 18 twelve-month surveys for participant who were enrolled in the PPR at Riverwood healthcare for that length of time (Obj 3). These activities and accomplishments support the goal of designing, developing, and evaluating produce prescription programs in two rural counties. It has been very interesting to see how these two programs have developed in very different ways over the course of the GusNIP funding cycle. Although they are both in rural communities, they have very different patient populations, food system resources, and healthcare delivery systems, all of which affect how the programs have been developed and delivered. The activities completed under this grant support patients at both sites who screen positive for food insecurity, are over age 18 and aremembers of low-income households that sufferfrom, or areat risk of developing, a diet-related health condition. In addition to the enrollment number and survey data, both programs have received very positive comments and feedback from participants, who see the value of the PPR and how it impacts their health. Some of the comments received include: "Thank you for sticking with me from the beginning. I was not in a very good place when I started and appreciate you sticking with me. I have quick smoking, drinking pop, and started eating more vegetables" "My husband and I pick up the boxes together and use this time as a mini date. It has helped not only with providing more foods to stretch the budget but, time together that we were missing from one another and didn't even know it." "I have enjoyed the recipes and enjoyed sautéing my carrot top greens. I would have never tried it before and really like it." And this from one of the program dietitians: A patient started coming to see the registered dietitianfor [another health reason]. When educating her regarding a healthy plate and ways to improve her diet, she mentioned she couldn't afford to buy many fruits and vegetables. She was getting SNAP already. Enrolled her [in the PPR program] at that appointment. She continues to see the dietitian every few weeks. Usual diet has improved greatly- eating more fresh produce- fiber intake has improved and has decreased excess carbs. Every visit she thanks the RD for the vouchers- she is EXTREMELY grateful.
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:As a matter of background and reference for this report, note that during this reporting period Riverwood Healthcare built and launched their PPR. During the reporting period Sanford Health had not yet launched their program. The priority population* reached by our efforts during this reporting period is described as follows: Patients of, or people living the service area of, Riverwood Healthcare (Aitkin, MN) who are: Over 18 Eligible for SNAP benefits, enrolled in SNAP or enrolled in medical assistance A member of a low-income household that suffers from, or is at risk of developing, a diet-related health condition. This priority population was selected based on the requirements of the GusNIP grant and Riverwood Healthcare's mission to serve patients who screen positive for food insecurity through the GusNIP grant program. *Note that MN Department of Health is moving from the use of the term "target" to the use of the term "priority" regarding the people and communities we work with, due to the aggressive and militaristic connotation of the word "target" (https://medium.com/wehearthealthliteracy/missing-the-mark-with-target-audience-63f295b540b4#:~:text=The%20bottom%20line:%20Ditch%20%E2%80%9Ctarget,%E2%80%9D%20or%20%E2%80%9Cprimary%E2%80%9D%20instead). Changes/Problems:Major changes include: Sanford Health has experienced delays in launching their program. This is due to a variety of factors including staff capacity and working with their internal research office on IRB submission. This has the potential to impact the rate of expenditure. Sanford is planning to launch their PPR early in the second reporting period. At that time, MDH will review the budget and implications for the expenditure of grant funds Riverwood Healthcare is also experiencing limited staff capacity around the PPR delivery. While they anticipate meeting the requirements for number of participants and surveys as required by the NTAE, they may not be able to deliver the PPR in a way to fully expend their budget. As they move into year 2, Riverwood Healthcare plans to expand their program to year-round delivery and they are looking at options for increasing staff capacity. MDH will continue to evaluate the budget and expenditure rate through year 2. There have been minor changes in staffing roles at both partner sites that do not affect the budget. These changes were submitted to the USDA national program office via Program Change Justification Letters. What opportunities for training and professional development has the project provided?Through this project MDH program staff and partners (Riverwood Healthcare and Sanford Health) staff had the opportunity to participate in the required Collaborative Institutional Training Initiative (CITI Program) training as part of the NTAE's evaluation requirements. MDH staff have provided training to partners on Community Participatory Research methods. MDH program staff were able to attend the GusNIP 2023 National Convening in Arlington, VA, although USDA funds were not used to support their attendance. How have the results been disseminated to communities of interest?This research project is still ongoing and therefore results have not yet been disseminated. MDH staff did share the GusNIP Year 3 Impact Findings report with program partners and our wider local public health partners in Minnesota. What do you plan to do during the next reporting period to accomplish the goals?Plans for the next reporting period (9/15/2023 - 9/14/2024) include: PPR launch for Sanford Health in Worthington, MN, in partnership with the local Hy-Vee grocery store using a voucher based system. Sanford Health staff will recruit participants and complete the consent process, pre-surveys and post-surveys with participants. MDH will provide training to partners regarding Theory of Change and co-develop this with each partner Code meeting notes from partner meetings according to barriers and facilitators of the development, implementation and sustainment of PPRs Riverwood Healthcare will move to a year-round recruitment and PPR delivery model to continue their program MDH will continue to submit required metrics and data to the NTAE MDH will continue to submit reports to the USDA as required MDH staff are working with partners at the MN Department of Human Services regarding applying for an 1115 Medicaid demonstration waiver related to Food as Medicine, including Food Prescription Program.
Impacts
What was accomplished under these goals?
Accomplishments in the first program year included Contracts established between the MN Department of Health (MDH) and both clinic partners (Riverwood Healthcare and Sanford Health) Bi-monthly virtual meetings held between MDH staff and clinic partner staff and key personnel as needed On-site meetings held at each health care partner facility with MDH and clinic staff Regular meetings held with NTAE Program Advisor and MDH grant staff IRB for Riverwood project submitted and approved by MN Department of Health IRB IRB for Sanford project submitted and under review by Sanford Healthcare IRB Produce Prescription Program (PPR) launched at Riverwood Healthcare in Aitkin, MN. 63 patients were screened for participation in the program. 50 patients completed the consent and pre-survey for this research project Relationships developed with food systems partners in both communities to support PPR fulfillment
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