Food Security: Collaboration between University and Community Karen W.R. Lin, MD, MS, FAAFP Assistant Dean, Global Health Family Medicine and Community Health Robert Wood Johnson Medical School 090816 AAFP-GHW Over 55% speak another language besides English at home 31..4% population live below the poverty line (in comparison, 9.9% live below poverty line in NJ state) Feeding America report: 10.8% food insecure in the county

Healthy Garden and Healthy Living A creative intervention to integrate mental health into primary care for those who suffer illness from food insecure, poor diet and inconsistent access. 1/29 1929 4:33 1/31 1976 11:32

Collaboration Partners University partners: Rutgers University Family Medicine and Community Health: faculty and students Landscape Architecture: Community Partners: Elijah’s Promise Clients who are homeless and eat at Soup Kitchen Gardening instructor of Community Garden Coalition & Food Alliance Bee hives instructor Elijah was a Hebrew prophet of 9th century “the Lord is my god”, left this earth in a blazing chariot ascending to heaven. promise is an acronym: Empowering Lives Inviting Justice Alleviating Hunger Food changes Lives

Rutgers University Landscape Architecture Dr. Alomar Landstewardship in Urban underserved community Use of sketching, mapping and garden stories to describe nonprofessional designs

Rutgers Robert Wood Johnson Medical School 14 of 21 members of honor society works at Promise Clinic

Elijah’s Promise Empowering Lives Inviting Justice Alleviating Hunger A passage in the Hebrew bible: The prophet Elijah is called by God to stay with a widow at Zarephath during a severe famine (hunger) Elijah asked the widow for food and water, The widow showed that she has enough food for only one final meal. Elijah promised that she will never lack what she needs if she shared with him. After she fed Elijah, the widow’s jar of flour remains full even amidst a harsh famine. The philosophy is By sharing not only what we have, but also the tools for people to feed themselves, no one in our community needs to go hungry. 1989, 3 local churches 1997 Promise culinary school- professional culinary curriculum 2010, Baking and Pastry program –professional baking 2009 A Better World Café , philosophy of OWEE www.oneworldeverybodyeats.org- helping to end hunger with pay-what-you –can community cafes

Protocol Purpose: Question: Understand the relationship between participation in a community garden and improvement of health outcomes for a population in New Brunswick Promote community-based health, and benefit students’ learning. Question: Will creative learning opportunities foster positive physical, emotional and social health outcomes?

Hypothesis The measureable body height, weight, body mass index, waist circumference, blood pressure and mood will improve with 16 weeks of gardening activities. the sketching is an embodied exercise that improves attitudes, cognition and memory.

Measuring outcomes Pre- participating assessment Post- participating assessment Measurement weight, height, basic body index Waist circumferences blood pressure PHQ-9 (patient health questions for depression) Written /drawing reflections

IRB Institutional Review Board application Protocol Consent form Outreach flyers – recruitment of clients Pre-project assessment Post-project assessment PHQ-9 forms All bilingual documents, English and Spanish. Budget

Outcomes 10 of 13 participants completed project 100 % improvement on PHQ-9 50% showed improvement on blood pressure, BMI and waist circumferences. Improvement was more in the first 8 weeks, than the second 8 weeks. 171 reflections demonstrated therapeutic effect.

Interpretation The project helps to re-discover self-confidence, talent, mutual respect and responsibility. Creative learning and support can impact positively on physical, mental and social health outcomes.

Lesson learned Funding – own backyard, sustainability IRB challenges – timing, process, communication between different IRB offices of schools. University policy and community expectation Fund transfer from grant office to host department to partners Client expectation of Stipend payment Nature of the garden project is limited by weather: – extremely hot in July, very cold in October, Index set up in Sept Cash payment, school will not dispense cash Community partner help out