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, 2007-2015 (projected)

FFY 199

7

FFY 199

8

FFY 199

9

FFY 200

0

FFY 200

1

FFY 200

2

FFY 200

3

FFY 200

4

FFY 200

5

FFY 200

6

FFY 200

7

FFY 200

8

FFY 200

9

FFY 201

0

FFY 201

1

FFY 201

2

FFY 201

3

FFY 201

4

FFY 201

5 (p

roje

cted

) $-

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

State Share Federal Share/Grant

Previous Network Funding Modelfor 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.

2013

* 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

Organizations

Local Health Dept. (98)

Schools (40)

Social Services (14)

Universities/UCCE (25)

CBOs(75)

(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 Model LHD ModelAgreement Type Contracts Grants

Boundaries Small, Very defined, eg school

Geographic and generally large encompassing many localities, school districts, etc

Populations Served Generally small, defined, sometimes diverse

Large, diverse

Partners Varies 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,

Influence Generally 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);

1 2100

110

120

130

140

150

160

170

180

190

200

2013 2015Federal Fiscal Year (FFY)

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 campaignMulticultural

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

Looking at the Layers

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

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

http://snap.nal.usda.gov/snap/WesternRegionEvaluationFramework.pdf

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: 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

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 .

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, PhDNutrition Education and Obesity Prevention Branch

Caroline.Kurtz@cdph.ca.gov

916-552-9908