Community context matters: The role of local health departments in leading an integrated approach to SNAP-Ed Caroline Kurtz, PhD Community and School Policy and Training Section; Community Development Unit Nutrition Education and Obesity Prevention Branch (NEOPB) California Department of Public Health

What was the role of the Local Health Department in developing an integrated work approach to SNAP-Ed? Why a Local Health Department (LHD) Model?

United States Department of Agriculture (USDA) Food & Nutrition Service $401 million (National) County Welfare Departments (CDSS) California Department of Food and Agriculture (CDFA) California Department of Public Health (CDPH) University of California CalFresh Nutrition Education Program (UC CalFresh NEP) California Department of Social Services (CDSS) CalFresh Branch SNAP-Ed Oversight Agency 3 Updated: 2/2014 California Department of Aging (CDA) 59 Local Health Departments (LHDs) 19 County Welfare Depts (CWD)+CCC 22 Area Agencies on Aging (AAA) 5 County Fairs 30 County Cooperative Extension Services

Change happens… Projected SNAP-Ed funding declines Healthy Hunger-Free Kids Act (HHFKA) of 2010 Based on successful on other public health programs, including the California Tobacco Control model

CDPH Snap-Ed Funds, (projected)

Previous Network Funding Model for Local Assistance

Healthy, Hunger-Free Kids Act of 2010 Sec. 241: –Replaces 50% match with capped grants; –Allows policy, systems and environmental supports, with USDA approval of State Plan; –Bases funds in future years on SNAP participation.

Change Happens… Projected SNAP-Ed funding declines Healthy Hunger-Free Kids Act (HHFKA) of 2010 Based on successful on other public health programs, including the California Tobacco Control model

What does change for California look like?

Three years of Transition 2011 * Planning with internal and external advisors, stakeholders; 2012 * LHD Model announced; * Additional year of funds allocated to all Network; * New USDA PO * Planned federal funds reductions; * Plan implementation

252 stakeholders provided input to the NEOPB transition 123 participants who are Current Network contractors 129 participants who are not currently Network contractors (Three-year transition plan) Stakeholder Meeting Demographics

NEOP Branch Proposed Organizational Chart Program Sections within NEOPB are Local Support, Information and Communication, Partnerships and Resource Development, Research and Evaluation

1) Funds based on the target population

2) Designated Local Lead Agencies (Local Health Departments)

Network ModelLHD Model Agreement TypeContractsGrants BoundariesSmall, Very defined, eg school Geographic and generally large encompassing many localities, school districts, etc Populations ServedGenerally small, defined, sometimes diverse Large, diverse PartnersVaries but probably limited Large groups of diverse partners in all sectors including schools, parks and recs, city governments, healthcare organizations, chambers of commerce, business, utilities, InfluenceGenerally limited if not in size then in scope Policy, legal, political. Advantages of the LHD Model

3) Require subcontracts with Community-based Organizations In 2014, 190 contracts in place with Community- based Organizations (up from 175 in 2013);

4) Implement A Coordinated Blend of Strategies Do an assessment of community needs Collaboratively develop an integrated SNAP- Ed work plan, Develop and leverage SNAP-Ed and non SNAP-Ed funded partnerships that have a cause in common with obesity prevention

5) Establish Statewide Objectives 1)Healthy foods, mostly fruits and vegetables 2)Healthy beverages and water 3)Physical activity 4)Community supports

What is the role of the LHDs?

Almost 200 subcontracting entities: school-based, community-based and faith-based 200 subcontracting entities: school-based, community-based and faith-based 59 Local Health Department Coalitions Statewide Evaluation California SNAP-Ed Program Training Resource Centers Statewide Media Campaign Health Executives and Officer Associations Statewide Partnerships Office of State Printing Technical Assistance policy development State Agency Collaboration

A Powerful Equation Statewide Media Community Based Efforts + = Social Norm Change Healthier Communities

What is the Role of Media? To be ahead of the wave (public opinion) To use the energy at the front of the wave to pull public opinion forward To support program goals

FFY 2015 State-wide mass media campaign Multicultural

Vision for Local Health Departments Improve the environment with policy, systems, and environmental (PSE) change strategies that is supported and backed up by direct education

Why policy, systems, and environmental changes are Important Outcomes Creates demand for and reinforces change in individual and group behavior Protects health or the environment Sets expectations Maximizes resources Builds the capacity of local communities Institutionalizes change

Training Resource Centers North Coast and Cascades: California State University, Chico San Francisco Bay Area: Public Health Institute Central Coast: Monterey County Public Health Greater Los Angeles: California Center for Public Health Advocacy Delta and Gold Country: Health Education Council Inland Desert: University of California at San Diego School of Medicine Center for Community Health Central Valley: Public Health Institute

Putting the LHD model into action

Guiding principles for the local integrated work plan Work plan responds to community needs and evaluate the work beyond reporting counts. Build synergy with funded and unfunded partners and leverage existing resources Be a model for SNAP-Ed delivery by developing strategic partnerships to widen the sphere of influence in the community

PG: 20

SNAP-Ed County Profiles -Secondary analysis of data -Used as starting point -Uniform data for all jurisdictions

Populating our County Map 1.Draw your county map on a flip chart—fill the page 2.Each LIA will populate the county map with the activities they provide in each intervention strategy area Look at the color key for intervention strategy areas Write each of your activities on the post-it note intervention that it most supports Include the name of the program, location, and target population Put your program initials at the bottom right hand corner of each post it 3.Place your post it notes on the map to indicate it’s location in the county Asset Mapping: Individual Local Implementing Agency Activity PG: 8 11:05–12:00 Healthy Choices Videos – Kern County Elderly Population Countywide AAS Healthy Choices Videos – Kern County Elderly Population Countywide AAS a. Nutrition Education – Blue b. Media, Social Media & PR – Green c. Community Events – Yellow d. Coordination & Collaboration – Pink e. Training & Technical Assistance – Purple f. Policy, Systems and Environmental Change - Fuchsia

Policy, Systems, Environmental (PSE) Change Evaluation with RE- AIM framework A framework for planning and evaluating PSE intervention R – Reach A – Adoption I – Implementation E – Effectiveness M – Maintenance

Core RE-AIM Indicators Integrated with WRO SNAP-ED Evaluation Framework

REACH # and % of all people Did you reach your target audience? Example: # of people and % of the target population affected--representative and most at risk –# of people shopping at farmers’ markets in low- income area

Adoption # and % of settings that decided to initiate a program or policy, systems, or environmental change strategy? Did the community decide the PSE was something they wanted to take on? Did the community choose to put the PSE into place? Example: The # and % of settings participating-- appropriateness of settings (and partners) for reaching/engaging the target population –# of farmers’ markets established

Implementation # and % of settings, organizations, communities that put into place activities with fidelity Was the intervention delivered as intended? Example: C hange is implemented as intended; fidelity –# of farmers participating in farmers’ markets each week –Quality, price, and variety of fruits and vegetables sold at farmers market

Effectiveness (Efficacy) What was the impact of the intervention on outcomes (short, medium, or long- term)? What worked well? What didn’t work well? Example: Short term outcomes--actual environmental changes; intermediate outcomes-- effects on health behaviors –Local sales of fruits and vegetables as reported by participating farmers

Maintenance What is the extent a PSE has been institutionalized? Example: Individual level – individuals continue to exhibit the desired health behavior changes. Setting level – environmental change is maintained. New barriers to use are prevented or mitigated. –# of farmers’ markets that were established yearly, # that continue to operate; EBT accepted; bonus incentive programs continue

Integrated Work Plan Timeline February 27– 28, 2014 SNAP-Ed Local Implementing Agency (LIA) Forum February 28– June 30, 2014 CNAP/Integrated work plan development. CDSS and State Implementing Agencies (SIAs) to provide technical assistance throughout the process. May 2014 Submission of integrated work plans by all participating counties/jurisdictions. Plan review process begins; comments will be sent to pre- identified work plan coordinators. June 2014 Final Date to submit LIAs Budgets to the state (individually). Budget review process begins by all SIAs; comments will be sent to pre-identified work plan coordinators. June 2014 SIAs package and submits individual final work plans, budgets and other needed documents for CDSS’s review. LIAs submit final work plan and budget (with comments from SIAs incorporated). CDSS review process continues. August 1, 2014 FFY 2015 SNAP-Ed State Plan is finalized and ready for submittal to USDA-FNS. August 15,2014 Official Deadline to submit California’s SNAP-Ed State Plan to USDA- FNS.

Thank you! Caroline Kurtz, PhD Nutrition Education and Obesity Prevention Branch