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)
California Department of Social Services (CDSS)
CalFresh Branch
SNAP-Ed Oversight Agency
California Department of Public Health
(CDPH)
59 Local Health
Departments (LHDs)
County Welfare
Departments (CDSS)
19 County Welfare
Depts (CWD)+CCC
California Department of
Aging (CDA)
22 Area Agencies
on Aging (AAA)
California Department of Food
and Agriculture (CDFA)
University of California
CalFresh Nutrition Education
Program
(UC CalFresh NEP)
5 County Fairs
30 County
Cooperative
Extension Services
3
Updated: 2/2014
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)
$250,000,000
$200,000,000
$150,000,000
$100,000,000
$50,000,000
$-
State Share
Federal Share/Grant
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
2012
* Planning with
internal and
* LHD Model
external advisors, announced;
stakeholders;
* Additional year
of funds allocated
to all Network;
* New USDA PO.
2013
* Planned federal
funds reductions;
* Plan
implementation
(Three-year transition plan)
Stakeholder Meeting
Demographics
Organizations
252 stakeholders
provided input to the
NEOPB transition
Local Health Dept. (98)
Schools (40)
123 participants who
are Current Network
contractors
Social Services (14)
Universities/UCCE (25)
129 participants who
are not currently
Network contractors
CBOs(75)
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)
Advantages of the LHD Model
Network Model
LHD Model
Agreement Type
Contracts
Grants
Boundaries
Small, Very defined, eg Geographic and generally large
school
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.
3) Require subcontracts with
Community-based Organizations
In 2014, 190 contracts in
place with Communitybased Organizations (up
from 175 in 2013);
200
190
180
170
160
150
140
130
120
110
100
2013
1
2
Federal Fiscal Year (FFY)
2015
4) Implement A Coordinated
Blend of Strategies
• Do an assessment of community needs
• Collaboratively develop an integrated SNAPEd 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?
California SNAP-Ed Program
Statewide Evaluation
Statewide Media Campaign
Statewide Partnerships
59 Local Health Department
Coalitions
Health Executives and
Training Resource
Almost 200 subcontracting entities: school-based,
Officer Associations
Centers
community-based and faith-based
200 subcontracting entities: school-based,
community-based and faith-based
Office of
State
Printing
policy
development
State Agency
Collaboration
Technical
Assistance
A Powerful Equation
Healthier
Communities
Statewide Media
+
Community Based Efforts
=
Social Norm Change
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
Delta and Gold Country:
Health Education Council
San Francisco Bay Area:
Public Health Institute
Central Coast:
Monterey County Public Health
Greater Los Angeles:
California Center for Public Health Advocacy
Central Valley:
Public Health Institute
Inland Desert:
University of California
at San Diego School of Medicine
Center for Community Health
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
Asset Mapping:
Individual Local Implementing Agency
Activity
11:05–12:00
Populating our County Map
1.
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
2.
•
•
•
•
3.
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
Place your post it notes on the map to
indicate it’s location in the county
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
Healthy Choices Videos – Kern
County
Elderly Population Countywide
AAS
PG: 8
Policy, Systems, Environmental
(PSE) Change Evaluation with REAIM 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 lowincome 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 longterm)?
• 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
June 2014
June 2014
May 2014
Submission of
integrated
work plans by
CNAP/Integrated all
work plan
participating
development.
counties/juris
CDSS and State dictions.
Implementing
Plan review
Agencies (SIAs) process
to provide
begins;
technical
comments will
assistance
be sent to
throughout the pre-identified
process .
work plan
coordinators.
February 28–
June 30, 2014
February
27–28,
2014
SNAP-Ed
Local
Implementi
ng Agency
(LIA) Forum
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.
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 USDAFNS.
Thank you!
Caroline Kurtz, PhD
Nutrition Education and Obesity Prevention Branch
Caroline.Kurtz@cdph.ca.gov
916-552-9908