SPRINGFIELD PRESCRIPTION PRODUCE COLLABORATIVE

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: ACTIVE
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1029496
• Grant No.: 2022-70424-38543
• Cumulative Award Amt.: $500,000.00
• Proposal No.: 2022-07013
• Project Start Date: Sep 15, 2022
• Project End Date: Sep 14, 2025
• Grant Year: 2022
• Program Code: [PPR]- Produce Prescription

Recipient Organization
WELLSPRING COOPERATIVE CORPORATION
121 PINEVALE ST
SPRINGFIELD,MA 01151

Performing Department
(N/A)

Non Technical Summary
PROJECTSUMMARY Wellspring Cooperative Corporation, Baystate Health and the Center for Research on Families at the University of Massachusetts have joined to form the Springfield Prescription Produce Collaborative, to establish a sustainable prescription produce program in Springfield, Massachusetts. The program's goals, which are consistent with GusNIP grant goals, are to increase participant consumption of fruits and vegetables leading to improvements in dietary health, reduction in food insecurity, and reduction in use of emergency health services and healthcare costs. A total of 150 low-income participants will be selected from Baystate's Brightwood, Mason Square and High Street Adult health centers, and they will receive fresh fruits and vegetables delivered weekly by the Go Fresh Mobile Market. Through the Massachusetts Healthy Incentive Program, SNAP recipients automatically receive monthly allocations of funds, which enables families to purchase produce from farmers markets essentially free. Participants will receive produce for eighteen months and visit their doctors for extensive health screenings every six months to observe health improvements in nutrition-related conditions such as obesity, heart disease and diabetes. Greater engagement and reduced food insecurity are expected to also result in less anxiety and greater participation in primary healthcare over emergency care. This is expected to reduce healthcare costs and improve the quality of life for patients. The Collaborative will analyze health data collected through this project and draw lessons from the project process to form the basis for integrating a sustainable prescription produce program into patient care going forward.

Animal Health Component

50%

Research Effort Categories

Basic

50%

Applied

50%

Developmental

0%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	5010	1010	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
5010 - Food;

Field Of Science
1010 - Nutrition and metabolism;

Keywords

prescription produce

food as medicine

social determinants of health

urban health

Goals / Objectives
PROJECT GOALSGoal 1: Increase consumption of fresh fruits and vegetables through a health center referral processObjectives to increase produce consumption include:Provide culturally appropriate foods at each health center site with culinary and nutritional education as determined by focus groupsParticipants access fresh produce 70% of the weeks in the programParticipants increase consumption of produce by 1 or more servings/day as determined by a The Dietary Screener Questionnaire (DSQ).Participants attend at least 4 nutritional education programs during the program.Goal 2: Reduce food insecurity for participants and their families as measured by Hunger Vital Sign(™) scores.Objectives:Ensure all eligible participants are enrolled in SNAP and understand how to use their HIP benefits.Every participant has a convenient delivery site to access fresh produce through the mobile market.Participants are connected to other food programs in the area to ensure that participants and their families meet their food needs.Goal 3: Improve mental health self assessment scoresObjectives: Reduce the impact of food insecurity related stress by providing weekly deliveries of produce for participants and family membersGoal 4: Increase preventative care among program participants and reduce emergency room visits.Objectives: Strengthen the connection between primary care and participants through a produce prescription referral process in conjunction with educational activities at the community health centers.Goal 5: Increase awareness among providers, staff and medical learners at the Baystate community health centers of the importance of food insecurity as a social determinant of health, screening techniques and mitigation strategies.Objectives:Provide a series of educational sessions at each health center for medical providers, staff, as well as learners.Provide interdisciplinary educational opportunities for undergraduate and graduate students in nutrition and medical -related fields.

Project Methods
METHOD AND EVALUATION Process Evaluation Program partners and personnel, advisors and interested patients will participate in an evaluation of the prescription produce grant process to identify strengths and weaknesses as the basis for improving the program in the future. The assessment by each stakeholder group will be documented and reported.Most important are the experiences of the patients for evaluating the effectiveness of the program process. The exit interview will include questions about interactions with program staff, usefulness of materials and information, experiences with the mobile market and produce delivery process, value of the nutrition and produce preparation programs, and benefits of the interactions with the doctors and health professionals. For future planning it will be helpful to know whether the six month health visits were too frequent, and whether the assessments felt invasive or useful. While the sample is small, particular attention will be paid to different experiences by gender, race and culture to identify potential biases in the implementation process.The experiences of health center staff and doctors is also critical to improving the program, and feedback about the process will be solicited during health center meetings and through an evaluation meeting among participants. Key questions will relate to health center staff experiences interacting with patients to meet their food needs, the value of the six month health assessments, interactions with other program staff, and recommendations about best ways to continue the program.Outcome Evaluation Data and interview material from the four assessment visits for each patient will be analyzed to evaluate outcomes from the program. Quantitative results will include documentation of increases in consumption of fresh produce and how this correlates with changes in Hunger Vital Sign scores; changes in health markers for obesity, diabetes, hypertension and other conditions; and any improvements in patient's own health engagement scores (PHE) . The program will also examine correlations between participation in regular health evaluations with health engagement (SCORE) changes, and any improvements in depression and anxiety as measured through GAD7 and PHQ9 assessments. Finally the changes in patient methods for accessing healthcare will be evaluated by comparing numbers of primary care vs. urgent care and emergency visits during the 18 months prior to the study with the 18 months of participating in the study. Financial analysis of these changes will provide a cost-benefit assessment of the value of the program. Patient interviews from the beginning and the end of the program will be used to provide a qualitative analysis of outcomes. Special attention will be paid to any changes in attitude about nutrition and healthy eating, and perceptions about health benefits. Do participants feel better as a result of their improved diets? Are they motivated to continue to eat differently as a result? Are they sharing their knowledge with their families and communities? Are participants more engaged with their own health care? Have attitudes about preventative care versus urgent care changed? The evaluation will also include an assessment of experiences with food insecurity. Have people improved access to food, especially healthy food, through the mobile market and other food programs? How has this impacted their sense of well-being, and overall economic security?Meetings with health center staff, program partners and advisors will include qualitative evaluations of outcomes as well as the program process. Healthcare providers and staff will provide their reflections about changes in participant behavior, attitudes and health as a result of the program. How do they understand variations in outcomes among patients, and assess the implications for ways to improve the effectiveness of the program? Anecdotes about patients with notable experiences will be documented and incorporated anonymously in the final report. By comparing patient outcomes, evaluators will pay attention to any patterns by demographic group to identify possible strategies to adapt the program differently for different groups.

Progress 09/15/23 to 09/14/24

Outputs
Target Audience: The target audience for our outreach efforts has been patients at three Baystate health centers in the Brightwood, Mason Square and High Street neighborhoods of Springfield. Through extensive outreach and recruitment bymedical providers at the three sites, we have identified patients who fit our income guidelines for the grant and who also have been diagnosed with health conditions that could benefit from improved nutrition, specifically diabetes, hypertension or obesity. We recruited 90 participants for the program by the end of August 2024, and have now increased this number to 108 participants by the end of September. Changes/Problems: Our program timeline has been significantly extended beyond what was planned for this grant. Finalizingour IRB from Baystate Health was a year-long process which delayed the start of the program. Recruitment of program participants also proved time-consuming, andwe just reached 100 participants this September. The extensive intake process required for our research study and IRB added to the challenge of recruitment. In addition working with three different health centers meant that there was significant start-up time with each location. One health center is run by resident doctors rather than full-time staff, which made this a particularly challenging site to work with. These delays are requiring us to reconsider the timeone for our intervention with participants. Our grant goal is for 18 months for each participant because we believed that longer participation would be required to producedietary and health changes. As we enter the third year of this grant, some participants who were recently enrolled will not have the full 18 months to participate.We are currently reviewing our program budget to consider whether a no-cost extension is possible to allow for the extended period for all participants. Additional time will be needed to analyze our data as well. Our project has also faced the challenge of adapting as USDA's regulations about utilizing SNAP data changed. Since most or our project participants are utilizing Massachusetts state Healthy Incentive Program (HIP) benefits tied to SNAP to purchase produce, our data analysis had relied on accessing SNAP data. Now that we cannot do that, we have adapted by issuing additional vouchers to all program participants to supplement their HIP benefits as a way to document program participation. In addition we will rely on self-reporting by program participants about produce consumption. What opportunities for training and professional development has the project provided? Our program is in the process of hiring a few ambassadors from the community, who are community members being hired to increase engagement and outreach to program participants. These ambassadors bring language and cultural skills that will assist with communication. Theyare also being hired to build capacity in the community among people who can serve as a resource once grant funding is over. This will contribute to the sustainability of the prescription produce initiative. Training of our first ambassador is already underway. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Plans over the next reporting period between Sept 2024-August 2025 include: * Training of 2 ambassadors to assist with communication and support for program participants. * Completion of our mid-year and final interviews with program participants. Interviews will be used to document participants perceptions of health and nutrition improvements, changes in food security, increases in medical visits and other indicators. * Work with Baystate Health biostatisticians to gather health impact data from the medical records of program participants. * Begin data analysis as program participants complete their 18 months of participation.

Impacts
What was accomplished under these goals? For Goal 1:By August 2024 this project had enrolled 90 participants at three Baystate Health Centers in Springfield. Of these73 are SNAP users accessing fresh produce using their Massachusetts Healty Incentive Program benefits, and 17 receive vouchers funded by this GusNIP grant. Data for SNAP users was originally collected through EBT records, although once USDA indicated that we could not collect this data, the project issued additional grant-funded vouchers to track produce purchases. Of our voucher recipients 24 have use their vouchers by the end of August and 9 of these or 26% have used them consistently every month. These figures require additional analysis because people have been in the program different lengths of time including some who have just signed up this month. The program has also offered a series of nutrtion and dance classes for participants as well as the wider community of patients at the health centers. Brightwood Health Center has also received a grant for a mobile kitchen that will be used to demonstrate produce recipes for program participants. Goals 2-4: Documentation of these goals depends on our mid-project assessment with each program participant. These assessments will be carried out in the next few months. Goals 5: Educational and informational sessions have been held in each of the Baystate health centers to share information about this GusNIP grant and to encouragehealth professionals to refer their patients to this grant. Based on these referrals, project staff are meeting with patients at the health centers. In addition publicity about the Go Fresh Mobile Market is being provided to patients through community health workers at each health center as well as medical providers. The mobile market now stops weekly at Brightwood Health Center, which has raised the profile of nutrtion and food access issues. Additional stops and outreach including at annual health fairs has also increased knowledge hunger and nutrition needs at the other health centers. The prescription produce has also hosted multiple interns from the University of Massachusetts School of Nutrition, who have gained first-hand experience about hunger and nutrition needs in Springfield.

Publications

Progress 09/15/22 to 09/14/23

Outputs
Target Audience: Initiation of our project has been delayed by the IRB approval process. We have received approval from the Univesity of Massachusetts but still working through the approval process at Baystate Health. Some initial outreach has begun at the Brightwood Health Center by providing nutrition and wellness programs open to all patients, that inclues information about the prescription produce program. Patients at the Brightwood Health Center mostly reside in the Brightwood and Memorial Square neighboroodsof Springfield which have a 45% poverty rate and are 85% Latinx. Changes/Problems: Data collection and ensuring inclusive program participation are among the challenges that required additional problem solving for our project. While most of our participants will access fresh produce through their EBT cards and the Massachusetts Healthy Incentive Program, we have always wanedt to ensure that health center patients without EBT cards could still participate in the program. We tried multiple ways to develop our own magentic bar code card that we could issue to these participants, but that proved too complicated and costly. Instead we printed paper coupon booklets which will be distributed to participants who need them, and their produce will be paid for with the GusNIP grant. To access produce consuption data, we also needed to ensure access to EBT reports through our point of sales system. We clariffied with the state that this requires permission from program participants to utilize the last four digits of their 16 digit EBT card number to track purchase data. Participants will be asked for permission to utilize these numbers in our permission form. What opportunities for training and professional development has the project provided? Professional development programs have been provided to medical staff at the three Baystate Health Centers, to resident medical students and to project staff. Programs at the health centers have included eduation about food insecurity and hunger, and planning for program implementation. These forums are laying the groundwork for sustaining the prescription produce program after the pilot phase provided by this NIFA grant. Resident medical students participate in a week-long intensive program about hunger and food insecurity aduring one of their educational rotations. Springfield Prescription Produce staff have also participated in professional development programs through NIFA, through a self-study program leading to IRB certification through Baystate Health, and our own staff training in preparation for project implementation. How have the results been disseminated to communities of interest? Initial community outreach has taken place through a community advisory committee that provides a sounding board about program plans, and a process for input and improvement in the design of the program. Project staff have also had informal discussions with patients at the Brightwood Health Center to gauge their interest in participating in the progrom. Information has been provided to patients across the three health centers about the Go Fresh Mobile Market schedule, with educational materials about the Massachusetts Healthy Incentive Program, which provides SNAP recipients with additional funds to purchase fresh fruits and vegetables. Patients have been encouraged to utilize the mobile market at its current schedule of stops. What do you plan to do during the next reporting period to accomplish the goals? IRB certification is expected in the next few weeks, which will enable us to begin implementing our prescription produce program. Brightwood Health Center will be the first to identify 50 patients to participate in the program, and will begin the initial intake interviews and health screenings. This will be followed by a similar process at the High Street and Mason Square Health Centers. Over the coming year all 150 program participants will be accessing fresh produce through the Go Fresh Mobile Market, and will participate in additional nutrition programs, food demonstrations and wellness events. Project staff will collect data weekly about produce purchases through the mobile market, with a second health provider check-in to review health and medical changes and patient experiences.

Impacts
What was accomplished under these goals? This first year has been dedicated to preparation and revisions to program plans and data collection systems, including developmetns required by theIRB process to ensure patient privacy with data that will be analyzed by research staff at the University of Massachusetts. We have also laid the ground work for launching the program once IRB approval has been achieved Thisinclues hiring key staff, andIRB certification by key program staff. Project co-director Dr. Elizabeth Eagleson has also carried out multiple outreach and education events at each of the Baystate Health Centers to increase understanding about hunger and food insecurity in Springfield and to discuss patient selection and screening protocols.(Goal 5). Resident medical students also participated in educational programs about food insecurity including hands on experiences with the Go Fresh Mobile Market and other community food programs. In addition project staff have reviewed and revised the project budget and workplan in keeping with IRB and data management developments. We have also assembled and convened a community advisory committee to review program plans and to ensure that these are responsive to community needs and priorities. Plans have been developed to provide nutrition, wellness and food preparation programs to program participants. This includes securing a series of interns from the University of Massachusetts School of Nutrition to assist with educational programs and outreach.

Publications