Loren Bell Linnea Sallack, MPH, RD Altarum Institute Community Partnerships for Healthy Mothers and Children Evaluation Highlights Loren Bell Linnea Sallack, MPH, RD Altarum Institute

CPHMC Intended Outcomes Increased collaboration between national and community partners Increased community capacity to implement policy systems, and environmental (PSE) improvements Increased messages on the importance of policy, systems, and environmental improvements Increased access to environments with healthy food or beverage options in local communities Increased opportunities for chronic disease prevention and care through community and clinical linkages in local communities

CPHMC Evaluation Capacity: Whether and how local projects achieved increased collaboration across partners and increased community capacity to implement PSE change. Project outcomes: Whether and how local projects achieved objectives to increase access to environments with healthy food or beverage options and increase opportunities for chronic disease prevention and care. Success factors: Describe what contributes---or presents challenges---to achieving objectives and sustaining project efforts.

Evaluation Data Sources

Capacity: Building Coalitions and Partnerships Most Cohort 1 project coordinators reported “little” or “some” prior experience with community engagement--working collaboratively with and through groups to address issues affecting well-being. “I’m our agency’s community outreach coordinator. I attend community partner meetings and health fairs.” “I established a breastfeeding coalition and have collaborated with food pantries.”

Capacity: Building Coalitions and Partnerships Cohort 1: Change in Experience with Community Engagement

Capacity: Building Coalitions and Partnerships About half the project coordinators reported challenges building coalitions early in the project due to: Lack of existing, viable coalitions Availability and time challenges for coalition members Time required to build relationships Delay in project launch

Capacity: Building Coalitions and Partnerships Once the coalitions were in place, most projects reported few barriers to implementing their objectives….and indicated most of the coalitions would continue beyond the project. “The biggest success is the relationship building, bringing people from the community together to talk about what our needs are and how we can move forward as a group.” “I am surprised at the overwhelming support and involvement of our local government, stakeholders and community. Our coalition members are highly engaged and committed.”

Capacity: Building Coalitions and Partnerships All projects indicated that they will continue to engage with some or all of the community partners after the project ended. “Everyone is excited about the changes in our community and we will continue the strategies.” “It’s a bigger picture for the way we’re serving clients…not just the WIC clients but the families, the community…we are more of a team.”

Capacity: Building Coalitions and Partnerships Cohort 1 & 2: Early-Implementation Experience with Community Engagement

Capacity: Policy, Systems and Environmental Change Most Cohort 1 project coordinators reported limited prior experience with policy, systems and environment (PSE) change efforts. “My focus is on programs…providing services and resources vs. PSE work.” “Working with some community groups enabled us to work on policy-level changes such as community/worksite breastfeeding policies.”

Capacity: Policy, Systems and Environmental Change Cohort 1: Change in Experience with PSE Efforts

Capacity: Policy, Systems and Environmental Change Lessons learned “The PSE change thing was huge… .going from individualized care to community engagement and policy change has been a big learning experience .” “The experience helped us in expanding our traditional roles because we have skills and experience to offer to the community.” “We were working on projects that impacted policy, system and environmental changes, but we didn’t call it that or recognize it as being that! We were just improving our community .”

Capacity: PSE Efforts Cohort 1 & 2: Early-Implementation Experience with PSE Efforts

Project Outcomes: Cohort 1 Success in Achieving Objectives

Project Outcomes: Cohort 1 Across all Cohort 1 projects Nearly 40% of the targets for intervention settings were achieved or exceeded. About half (48%) of the targets for population reached were met or exceeded. For targets not achieved, there was significant progress towards meeting the goals.

Project Outcomes: Cohort 1 Most success reported for objectives around: Increasing healthy food options in stores Promoting WIC and enhanced WIC referral systems Developing tools and resources to increase awareness of healthy eating options and preventive care services Increasing businesses that publicly promote/welcome breastfeeding Increasing healthy restaurant menu options Greater access to and utilization of farmers’ markets Increasing donations of fresh produce by farmers to food banks/pantries

Project Outcomes: Cohort 1 Greatest challenges reported for objectives around: Working with schools to increase offerings of drinking water and healthier food options Increasing the number of WIC-authorized retailers Implementing “green prescriptions” for healthy foods and lifestyles Increasing the number of businesses that that develop policies to support breastfeeding What will Cohort 2 experience? .

Sustainability: Cohort 1 All projects reported they would continue to work with the community partners. Most projects reported that coalitions would continue to meet. 75% of projects reported they would seek funds from other sources to continue their activities. Most projects reported activities would continue even if there was no additional funding. “We are just getting started and the community is fully engaged and excited. We want to continue to grow.”

Success Themes: Cohort 1 Ensure community buy-in and facilitate effective community coalitions and partnerships. Foster ongoing communication and exchange of ideas among stakeholders. Leverage expertise of coalition members, partners and WIC staff. Be realistic and focused on the quality and feasibility—not quantity—of project objectives.

More Success Themes: Cohort 1 Plan thoughtfully and recognize that time and resources are limited. Learn/understand the cultural issues and needs of the community. Recognize--and borrow--successful efforts of other groups.

Conclusions: Cohort 1 WIC can play an important role in creating partnerships to implement PSE changes for improving the food environment and promoting linkages for chronic disease prevention and treatment services. Building strong community coalitions leads to successful implementation of interventions and sustainability of these efforts. Some objectives and strategies require longer term commitments—the short CPHMC period limited success. CPHMC projects are an asset for WIC agencies that are interested in community-based work…there are many valuable lessons.

Conclusions: Cohort 1 CPHMC project experience demonstrates WIC’s capacity to improve the community that exists outside of the clinic walls….to help families adopt healthy behaviors, have positive pregnancy outcomes and healthy children.