Washington State’s FINI Project Katie Tong Morrow, MS | Washington State Department of Health ASNNA | February 8, 2018

FINI Grant at a Glance Start | End April 1, 2015 | March 31, 2020* Award $5.86M Subawardees 11 – diverse food system stakeholders Incentive Strategies 1. Farmers Market / CSA Match 2. Fruit and Vegetable Prescription 3. Complete Eats Grocery Store Coupons Outlets ~80 Farmers Markets/CSAs ~170 Safeway grocery stores Award for 2015- 2019. Received no-cost extension through March 2020 Over the first half of FINI implementation (April 2015- September 2017), over $850 K of SNAP incentives have been redeemed.

Farmers Market / CSA Match FARMERS MARKET MATCH: similar to Massachusetts and others, we offer a Farmers Market match strategy. This strategy builds on existing match programs in many places, as well as implements new match programs. Incentive amount varies by program. Incentive tokens are for FV only (should anybody ask: this includes fresh F/V, and in some regions frozen and dried fruits and vegetable with no added salts, fats, or sugars).

Fruit and Vegetable Prescription FV Rx: another component of our FINI project is the Fruit and Vegetable Rx program, which is implemented mostly through local hospitals and clinics– many of which are SNAP-Ed agencies. Clinicians, SNAP-Ed educators, and community health workers (SRHD) distribute the Rx to SNAP clients. Incentive amount for this strategy varies by family size, and can be redeemed to purchase fruits and vegetables at participating Farmers Markets and Safeway stores across Washington. Rx coupons have a 1-month expiration date. Looking ahead: We are adding 5 additional healthcare partners in 2018, including FQHCs that serve large Medicaid populations.

Complete Eats Grocery Store Coupon GROCERY COUPON: Complete Eats Catalina Coupon prints out when SNAP clients purchase $10 worth of Fruits and Vegetables. Coupons are worth $5 and can be redeemed at Safeway stores for additional fruits and vegetables.

3 2 Map of FINI incentive strategies – Farmers Market Match and Complete Eats Grocery Store Coupons available in almost all counties.

How SNAP-Ed Supports FINI Strategies Farmers Markets Fruit and Veggie Rx Grocery Coupons Farmers Market Tours Food demos Distribute promotional materials Educate community partners and FM vendors about SNAP programming at farmers markets Increasing the number of SNAP-authorized markets Established regional FM networks focused on increasing SNAP client participation at markets Distribute FV Rx vouchers on- site through SNAP-Ed programming Educate Safeway Store Staff (SRHD!) Grocery Store Tours Distribute Complete Eats materials BACKGROUND: FINI was approached and is managed as a collaborative effort between SNAP-Ed and HEAL at the Washington State Department of Health. SNAP-Ed laid the groundwork for the Farmers Market Match strategy (particularly by building FM networks through Washington SNAP-Ed’s Statewide Farmers Market Initiative). In Washington, SNAP-Ed is working to COLLABORATE with FINI contractors, EDUCATE SNAP clients about FINI resources in Farmers Markets and Grocery Stores, and ENGAGE with Safeway Store staff about the Complete Eats Coupon program. What does this look like? Here are some specific ways we’re supporting each FINI strategy: FARMERS MARKETS: tours, demos, promotion. SNAP-Ed helped lay the groundwork for the Farmers Market Match strategy, particularly by building FM networks through Washington SNAP-Ed’s Statewide Farmers Market Initiative. The initiative continues to support the FINI grant. We’ve scaled up the FM match strategy from 43 markets in 2015 to more than 85 in 2018, something that would not have been possible without help from Washington’s SNAP-Ed FM Initiative. Since the start of the FINI grant (and relatedly the SNAP-Ed Statewide FM initiative), the number of SNAP authorized farmers markets in WA has doubled. FV Rx: Distribute FV Rx on-site through SNAP-Ed programming (8 SNAP-Ed local agencies) and report data to the DOH FINI Eval. SNAP-Ed providers consistently report higher retention in classes where the Rx is made available to SNAP clients. GROCERY STORE: Promotion and outreach – limited FINI funds available for promotion, so this is key! FINI and SNAP-Ed staff at the state level developed a toolkit for local SNAP-Ed agencies to implement this work, using materials and input from Spokane Regional Health District. Shoutout to Spokane Regional Health District, a SNAP-Ed Implementing Agency (IA) and FINI grant sub-awardee!. They partnered with Department of Health and Safeway to test new Complete Eats Fruit and Vegetable Coupons, provided feedback from SNAP shoppers for quality improvement, advocated to increase the number of participating stores in the region, and adapted the MyHealthyLife social marketing campaign/website to promote Complete Eats.

How We’re Measuring FINI Efforts Farmers Markets Fruit and Veggie Rx Grocery Coupons Retrospective data collection POS data Partner surveys Interviews Participant and manager surveys Distribution & redemption information Online patient- level questionnaire Biometric data Interviews Data sharing Issuance data Redemption data Contribute to the Westat-coordinated national evaluation for FINI projects. State-level goals: involve stakeholder input, and represent state activities Farmers Markets: POS data– all FINI markets are utilizing tablets and the Device Magic app to track SNAP transactions. Looking forward: 2018 and 2019: disseminating an online SNAP customer questionnaire (similar to the Rx-patient questionnaire); survey designed to assess knowledge and attitude toward the program, as well as fruit and vegetable consumption in general. 2019: SNAP participant focus groups Fruit and Vegie Rx Collecting distribution and redemption information. Select providers are collecting biometric data (I don’t believe the SNAP-Ed providers are) Looking forward: similar to the FM participant focus groups, we will have Rx patient focus groups in 2019. Complete Eats Grocery Coupons - Redemption rate for the first six months of incentive = 14%. Typical redemption rate for this kind of coupon is between 3-8%. As part of our effort to build sustainable programming around the state, the DOH FINI grant evaluation is diving deeper into the data we’ve been collecting over the past 2.5 years to identify best practices and inform future programming. For example, one item we’re looking at now is what an ideal FM match ratio might be. We’re just starting these deep dives, and look forward to having more to report next year!

Partners and Match We have strong multi-sector partnerships to support FINI work, and partners provide match in different ways: DOH primarily provides staff time and materials or equipment to implement the program Advisory Network agencies support grant-promotion, goods/services Sub-awardees generate match through a combination of in-kind staff/volunteer hours, goods/services, cash to match incentives, and building space Subawardees: Catholic Charities of Spokane City of Seattle’s Office of Sustainability and Environment Kitsap Public Health Department MultiCare Health System’s Center for Healthy Living Safeway/Albertsons Skagit Valley Farmers Market Coalition Spokane Regional Health District UnitedHealthcare Community Plan University of Washington Center for Public Health Nutrition Washington State University Clark County Extension Virginia Mason Memorial Hospital Advisory Network Healthiest Next Generation WSDA WSFMA

How We’re Approaching Sustainability Forging and strengthening partnerships with diverse stakeholders Convening a Sustainability Planning Committee Note: we are also exploring possibility of state funding for this type of work.

Reach out for more information! Katie Tong Morrow, MS Jamie Wells, MPH, CHES Alyssa Auvinen Health Services Consultant Health Services Consultant Healthy Eating Coordinator Katherine.morrow@doh.wa.gov Jamie.wells@doh.wa.gov Alyssa.Auvinen@doh.wa.gov www.doh.wa.gov/CompleteEats | www.doh.wa.gov/FINI