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Community context matters: The role of local health departments in leading an integrated approach to SNAP-Ed

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)

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Community context matters: The role of local health departments in leading an integrated approach to SNAP-Ed

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  1. 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

  2. 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?

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

  4. 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

  5. CDPH Snap-Ed Funds, 2007-2015 (projected)

  6. Previous Network Funding Modelfor Local Assistance

  7. 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.

  8. 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

  9. What does change for California look like?

  10. Three years of Transition

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

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

  13. 1) Funds based on the target population

  14. 2) Designated Local Lead Agencies (Local Health Departments)

  15. Advantages of the LHD Model

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

  17. 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

  18. 5) Establish Statewide Objectives Healthy foods, mostly fruits and vegetables Healthy beverages and water Physical activity Community supports

  19. What is the role of the LHDs?

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

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

  22. 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

  23. FFY 2015 State-wide mass media campaignMulticultural

  24. 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

  25. 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

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

  27. Putting the LHD model into action

  28. 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

  29. Looking at the Layers PG: 20

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

  31. Asset Mapping: Individual Local Implementing Agency Activity 11:05–12:00 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 Populating our County Map • Draw your county map on a flip chart—fill the page • 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 eachof your activities on the post-it note intervention that it most supports • Include the name of the program, location, and target population • Put your programinitials at the bottom right hand corner of each post it • Place your post it notes on the map to indicate it’s location in the county Healthy Choices Videos – Kern County Elderly Population Countywide AAS PG: 8

  32. 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

  33. Core RE-AIM Indicators Integrated with WRO SNAP-ED Evaluation Framework http://snap.nal.usda.gov/snap/WesternRegionEvaluationFramework.pdf

  34. 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

  35. 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

  36. Implementation • # and % of settings, organizations, communities that put into place activities with fidelity • Was the intervention delivered as intended? • Example: Change 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

  37. 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

  38. 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

  39. Integrated Work Plan Timeline

  40. Thank you! Caroline Kurtz, PhD Nutrition Education and Obesity Prevention Branch Caroline.Kurtz@cdph.ca.gov 916-552-9908

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