1. The Harris County BUILD Partnership’s Food Rx Program

2. What is B.U.I.L.D.?
The BUILD Health Challenge is a national awards program designed to support community collaborations in urban neighborhoods experiencing health disparities that are working to give everyone a fair chance to be healthy.
Bold Upstream Integrated Local Data Driven
The goal of BUILD is to foster and expand meaningful partnerships among health systems, community-based organizations, and local health departments to identify and address the complex, upstream problems that influence the overall health of local residents

3. B.U.I.L.D. Awardees 18 community partnerships in 14 states
11 are planning grants
7 are implementation grants
Our grant is the only one in Texas and it was 1 of the 7 grants awarded for implementation

4. FUNDERS

5. Why North Pasadena? In zip code 77506:
Residents make $24,000 less in household income than the county
34% live in poverty (vs. 23% for the county)
47% have not graduated high school (vs. 21% for the county)
11% do not have a vehicle (vs. 7% for the county)
Focus of a DOJ investigation into voter suppression
The north Pasadena community is experiencing a higher rate of poverty, lower educational attainment, more linguistic isolation, and less access to food than Harris County as a whole. There are 97,550 residents living in north Pasadena (zip codes 77502, 77503, 77506) of which 34% are children under age 18.  
The north Pasadena population is 75% Hispanic
19% of residents in north Pasadena live in food insecure homes, meaning they have limited access to adequate food
20% receive SNAP benefits; and 87% of children are eligible for free or reduced price lunch.
18% percent is linguistically isolated, meaning no one 14 years old or older speaks English "very well” in the home.  
Lastly, 36% of adults are uninsured.

6. Two years ago, fresh produce wasn’t always easy to find or affordable in north Pasadena (and health was suffering).
Today, there are almost 20 new places to access healthy food…and it’s usually free.

7. Partnership FootPrint IN North Pasadena
6 Healthy Corner Stores
6 Food Rx and Food Scholarship sites
3 Healthy Dining Matters locations
3 school-based food co-ops (Brighter Bites)
1 new food pantry (Food FARMacy)
Location and financing for CLARA, a combination greenhouse, vertical farm, and classroom space
Community Located Agriculture Research Area.

8. FOOD RX
Mission: Eliminate the conditions that cause food insecurity in north Pasadena
The BUILD Partnership was develop using the collective impact model meaning, we had an executive committee – hire ups that are able to make comments on the organizations behalf; and a backbone committee which is comprised of our core applicants of our core applicants– HFB, Harris County Health Department, Hospital System and additional stakeholders such as the city of Pasadena and our evaluator- UT School of Public Health
Our project involves a three pronged approach to eliminating the conditions the conditions that causes food insecurity in north Pasadena.
Our approach is as follows:
1) Production- Our project involves a three pronged approach to eliminating the conditions the conditions that causes food insecurity in north Pasadena.
The BUILD Health Challenge grant allowed north Pasadena’s Sustainable Food System to accelerate its efforts toward nutrition equity through:  
Production: providing a local source of fresh produce in Pasadena by opening the area’s first farm
Distribution: developing a local network of healthy food access points through healthy corner stores, healthy dining, and Brighter Bites.
Consumption: launching new programs like food scholarships and the food prescription program (“FRx”) to help community members access food and make healthy choices 
1) Production- Establish a sustainable public source accessible healthy foods in North Pasadena through Community Supported Agriculture- indoor vertical gardening; Green houses; This will create job training programs; repurposing of land properties.
2) Distribution – Develop and expanded local network of innovative healthy food suppliers and distributors through initiatives such as healthy corner stores; healthy dining; and Brighter Bites – free food Co-ops at the elementary schools in Pasadena
3) Consumption- Develop a coordinated system of programs to help residents access food and make healthy choices through Food Rx Program and Food Scholarship Program.

9. Food Rx Process Mapping in Clinic Setting
Eligibility Criteria:
Client as to live in one of the following zip codes
77506
77502
77503
Paper Screener ( FI questions)
We work with four clinics representing three types: 2 School based clinics ( MHK) (MHW) ;1 Bariatric Clinic (MHSE) and 1 federally qualified health center (PHC)
Each clinics’ process flow and available staff to work on the program varied. The BUILD team worked with each clinic to develop process maps unique to their staffing capacity that integrated our program into their current workflow.
The process maps covered:
The names and or the job title of the persons or person that would be playing a role in each part of the client enrollment process for example in our school-based clinics – the Office Assistant screened the client for our eligibility criteria (zip codes and food insecurity questions. The nurse practitioner during the office visit describes the program to eligible clients and enroll them into the Food Rx program. In the Bariatric clinic the dietician did everything.
When client calls to make an appointment- if the client is an existing client- the assigned staff – which varied by clinic – would look to see if the client lives in one of the three target zip codes. If the client did then the file was flagged. Because we know are target population is transient the clinic confirmed the address again when the client comes for appointment.
When clients arrives for appointment - client arrives for appointment- address is confirmed- if it is a new client address is asked
Client enrollment into the Food Rx program
Initial client redemption at the Food Rx designated pantry
Each clinic and their designated staff received training on the process map/ Food Rx client enrollment and accompanying tools for the program two weeks before the launch in August 2016.

10. Food Rx CLINIC SETTING Food Farmacy ( Food Pantry) Setting
MDA Role: Program Development, Staff Training,
CLINIC SETTING
Screener
Participation Form
Program Enrollment
Process Survey
Monitoring, Evaluation, & Partner Meetings
Rx Monitoring
Rx Redemption
If client is zip code eligible they are given a paper screener with two food insecurity questions
If client identifies themselves as being food insecure (paper screener), designated clinic staff tells them about the Food Rx program.
If client decided to participate they are given a Participation Form which outlines what they can expect from the program and what we expect from them ( our expectations for clients was to complete the 12 redemptions and participate in our process survey data collection)
When clients sign the Participation Form they enrolled in our program and were given a Food Rx with a unique identification number.
Clients were able to redeem at Pasadena Community Ministries ( Food Farmacy)
We asked that each enrolled client complete a process survey at the following redemption points : 3, 6, 9, 12 redemption
At each redemption client receives 30lbs of food and 4 additional Food Rx items based off of the Feeding to Encourage framework. Clients were able to redeem every 2 weeks for 6 months ( a total of 12 redemptions) beginning the first time they redeemed at our Food Farmacy or until the end of program ( September 30th, 2017).
12 Redemptions
Food Farmacy ( Food Pantry) Setting

11. Food Rx Program Screener
If clients were eligible and did not want to participate and/or if clients did not live in are designated zip codes but were food insecure the clinic staff was provided with a list of Houston Food Bank pantries in Pasadena and directed clients to the closest pantry for food assistance.

12. Food Rx Program Enrollment

13. Food Rx Program Redemption

14. Food Rx Program Redemption

15. Preliminary Process Evaluation Data
Food Rx Process Data
Preliminary Process Evaluation Data
lbs
The aim of evaluation plan is to assess the feasibility and effectiveness of implementing the Food Rx program. The Evaluation plan will focus on three key areas which include program implementation, program acceptability/usage and sustainability.
Program Implementation
Our team administered surveys to key partners to gain insight on program challenges/success, program execution, leadership engagement of each organization , and feasibility of permanent adoption of the program.
Participants include: Clinic referral sites, Food pantry, and Food Bank staff
Program Acceptability and usage
Process Survey
Program participants are asked to complete a survey at 4 time points (3th, 6th, 9th and 12th redemption)
Data collected will help determine the acceptability and usage of food provided, feasibility of redeeming food, access potential cost saving to participant in regards to grocery expenses, and food insecurity
Food Pantry Checkout Form
The food pantry checkout form is a form used to track the number of redemptions per week, uptake of fruits and vegetables
Sustainability
In addition, we will collect data on the cost of implementation (cost per participant for produce and non-produce items, volunteer hours to run the program)
All data collected are key indicators of a sustainability plan
265 out 400 = 66
178 out of 265 = 67
71% Rx have been issued to north Pasadena residents (Sept.)
67% Rx have been redeemed by north Pasadena residents (Sept.)
63,518 lbs of produce delivered to the Food Farmacy (April)

16. Food Rx Program Evaluation highlights
A major consideration for the Food Rx program moving forward is participant retention. The redemption rate decreased consistently from visit 1 to visit 12.  This could be due to several reasons related to program delivery including, program length, lack of follow-up to encourage retention, or just the inconvenience of the pantry location/hours which was a deviation from the original on-site pantry plan. This needs to be explored further, including ongoing contact with participants, communication between the clinic, pantry and food bank, and ongoing tracking of these data.
Overall, weekly produce provisions were consistent and as expected with high variety and consistency across sites.
Participants reported that their food insecurity dropped dramatically by visit 3, with a consistent decline through the end of the program.

17. Food Rx Program Evaluation highlights
Participants reported a high degree of helpfulness of the produce, with a cost savings to their weekly food budget indicating high acceptability of program components among participants.
Nutrition education in the form of booklets was given to most participants, and used by two-thirds.  More meaningful ways to engage this population of food insecure in North Pasadena should be explored further.
Most clinic providers thought the program was successful and were satisfied; they felt it educated them on the food insecurity in the population they serve. Opportunities exist to connect clinics to communities and agencies outside of their own.

18. Thank you! RegiNald Young, MA Director of Food For ChAnge
Marcita S. Galindez, MPA
Program Manager

19. Questions?