EAT SMART NEW YORK

EAT SMART NEW YORK Summary Evaluation Report for 2001 EAT SMART NEW YORK Project Evaluation: Summary Report 2001 Prepared for the New York State Office of Temporary and Disability Assistance and ESNY project sites. Kathryn A. Bowen, Ph.D. Professor Jamie Dollahite Professor Donald Tobias Professor William Trochim Evaluation Consultant Cornell University Cornell University Cornell University The New York State Office of Temporary and Disability Assistance and ESNY project sites have contracted the Community and Rural Development Institute of Cornell University, in cooperation with the Department of Policy Analysis and Management and the Division of Nutritional Science to conduct an evaluation of the Eat Smart New York Program. April 1, 2002 The Mission of the Eat Smart New York Program is to increase food security and reduce hunger in partnership with cooperating organizations by providing children, those participating in government feeding programs or who are eligible to participate in a government feeding program, low income and working poor people access to food, a healthy diet and nutrition education in a manner that supports American agriculture and inspires public confidence. The Eat Smart New York Program coordinator, administrators and staff believe that in order for limited-resource individuals to improve their nutritional status, strong, collaborative community partnerships must be established, public policy instituted that enhances nutrition education and strategies implemented that improve access to healthy foods. Emphasis in New York State is placed on coordination of nutrition education and food access within the public sector as well as removing the barriers that prevent access. The Eat Smart New York Program staff understand that many problems limitedresource citizens experience are rooted in a lack of community resources or supports rather than individual failings. This knowledge promotes intentional efforts to enhance capacity in people. This capacity refers specifically to enhancing knowledge and skills so ESNY participants can practice thrifty shopping behaviors for nutritious food, know how and where food is acquired, know how often food should be purchased, and understand the nutritional value of food, proper preparation and storage techniques. The Eat Smart New York Program is an equal opportunity employer and offers employment and program services and/or opportunities and access to all people regardless of race, color, national origin, gender, age or disability. We encourage the public to contact NYS Office of Temporary and Disability Assistance, 40 North Pearl Street-9-D Albany New York 12243 (518) 473-6661 with their questions, concerns, and comments of discrimination and/or special needs. 1 Section I. Overview and Accomplishments Accomplishments: Evaluation Findings The year 2001 was an active and productive year for the Eat Smart New York Program. Major accomplishments included the following: • A standardized quarterly reporting form was institutionalized during the 4th Quarter of 2001. This form decreased in size from 16 pages to 3 and focused on program highlights, indirect contacts, materials distributed and marketing methods utilized. • At least 9,000,000 New Yorkers were exposed to ESNY messages via billboards, movie trailers, newspapers and radio ads. • ESNY reached more families during 2001. From 10,578 in 2000 to 10,768 in 2001. • Out of 454,872 families in New York State who live at or below the poverty level, the Eat Smart New York program enrolled 10,768 in structured nutrition education translating to 27,460 individuals1 . Adding participants of unstructured nutrition education opportunities and youth programming, the total number of New Yorkers exposed to ESNY programming during 2001 was over 152,160. • Significant improvement was observed in the amount of evaluation data collected for program participants. In 2000, of Overview of the ESNY Evaluation The overall intent of this evaluation is to identify program impact, to provide formative information that can be used to strengthen programming and to provide statistical data that fulfills local, State and Federal reporting requirements. This evaluation also seeks to identify if, how and why the ESNY program impacts the behavior of those who participate. During 2001, emphasis was placed upon clarifying and standardizing quarterly reporting requirements. The strength of statistical information was enhanced by encouraging accurate, consistent data entry collected on all individuals participating in structured group and/ or individual educational programs. The Evaluation Reporting System (ERS) was updated so that data related to instruction and impact among unstructured groups was better captured was also emphasized. Further, a cluster evaluation technique was initiated during 2001 that sought to assemble evidence that ESNY program strategies contributed to their desired ends by answering the questions of What Happened During Programming? and Why? for each of the 10 Regions of New York State. 2 6,557 graduates, only 69% had both entry and exit behavior checklist information. In 2001, of 6,593 graduates, over 99% had both entry and exit behavior checklist information. • Program objectives (Food Security, Food Safety, Dietary Quality) were addressed and achieved to a satisfactory level with statistically significant changes observed in the behavior of Program participants between entry and exit (p<.0001). Of the 6,581 ESNY graduates (from 43 counties), one-half improved behaviors related to Food Security, Food Safety and Dietary Quality by 80% or greater and 100% improved behaviors by at least 50%. Statistics revealed that there was a significant correlation (p<.01) between graduates who reported that they most of the time and almost always read nutrition labels at the time of exit and those who reported choosing healthier foods and adding no additional salt when cooking. Program highlights reflected ESNY programming that assisted clients in becoming more self-sufficient, managing food resources more effectively, making important connections with other community resources, enhancing awareness and knowledge related to the nutritional value of foods. Additionally, enhanced knowledge and skills associated with proper food preparation and storage were also reported. During the first 9 months of the program year, the NY Department of Health’s Just Say Yes, Eat Smart New York Program served over 11,224 clients. A sample of these clients revealed that 83% increased consumption of fruits, 83% increased their consumption of vegetables and 76% of food pantry participants reported, after • • • • WIC referred a 35-year old pregnant woman with diabetes to the ESNY program. This participant’s husband had left her with two children to care for and no family support. She had a difficult time with planning meals, preparing economical meals and food budget management, portion size control and consuming a diet high in fat. The NPA met with her for eight lessons spanning a period of six months. Using food models, fat tubes, measuring utensils, nutrition labels, bone models, food shopping lists and other budget management tools, the NPA helped this participant develop skills that enabled her to follow her prescribed diet plan. She acquired skills to manage her food budget, her nutritionist from WIC indicated that the participant was following her diet plan and had appropriate weight gains during pregnancy. She delivered a healthy boy and is currently planning on purchasing a house from Habitat. She states the “ESNY program helped me and my family learn to eat healthy and avoid high-calorie, high-fat foods. Now I eat vegetables and drink low-fat milk. My favorite recipe is chicken and rice with potatoes and carrots. I also make my own low-fat chicken nuggets for my children.” (Schenectady County, 2001) seeing a Just Say Yes Demonstration, that they knew why the fruit or vegetable was a healthy choice. 1 U.S. Bureau of the Census, (1990). Census of Population and Housing, Summary Tape File 3. 3 • When given opportunities to apply knowledge and skills acquired during ESNY programming, nutrition educators observed children and adults transferring ESNY information to practice. Examples of these observations included; reminding others to wash their hands before food preparation, wearing gloves, cleaning utensils thoroughly, separating vegetables from meat during preparation, using thermometers to check temperature of foods, covering and refrigerating cooked and raw foods and putting leftovers away immediately. These observations confirmed that ESNY participants improved their food safety behaviors. Adult participants were observed acquiring additional skills in planning meals based on the Food Guide Pyramid, preparing a grocery list, performing cupboard inventories, purchasing needed food items based on this inventory and using sales flyers and coupons to make purchases. The observed result of these skills included increased food security and dietary quality. Eight-four percent of ESNY participants graduated or are continuing in programming with only 16% terminating their programming prior to graduation. A 3% increase was observed in families enrolled in one or more food assistance programs as a result of ESNY assistance or recommendation during 2001. A significant increase was observed in youth enrollment. In 2000, 14,151 youth participated in ESNY programming, in 2001, 8,236 more youth experienced ESNY programming (n=22,387). Sixtysix percent of these children were between the ages of 6-12 years. More diversity was observed among youth program participants. African American participation rose from 2,044 in 2000 to 3,511 youth in 2001, American 4 Indian participation rose from 232 to 529, Asian or Pacific Islander participation rose from 122 to 235 and Hispanic participation rose from 562 to 907 young people during 2001. • Three new project sites joined Eat Smart New York, Cayuga, Erie and Steuben counties. • • • • • “Fun With Food 2001-From the Inside Out” provided a series of five lessons focused on the importance of overall fitness and good nutrition. Activities that emphasized movement and fun were incorporated into each lesson. Interactive recipe booklets were created highlighting the five snacks that were eaten at the lessons. To help demonstrate the different body systems, each participant created a little figure, which was added to at each session. White pipe cleaners were used to begin the project (skeletal system). Red tissue paper was wound around them to represent muscles. Blue and red yarn became blood vessels and skin colored tissue was applied last. Finally, the figures were dressed in exercise outfits. The figures were a way to help review previous lessons with the participants and were great “take home’ items at the end of the series. Relevant posters, songs or jingles, and trade books were also used at each lesson. In all, 296 children at 14 different sites were reached with this program. (Yates County, 2001) Section II. Program Diversity N utrition education activities are conducted exclusively for the benefit of Food Stamp Program (FSP) applicants and participants. While the nutrition education activities are conducted for the benefit of FSP recipients, they may also benefit others as long as an approved waiver is granted and the primary beneficiaries are FSP clients. During 2001, ESNY provided nutrition education for a significant number of families with young children. According to the Evaluation Reporting System (ERS), a software package that was developed by the USDA to evaluate nutrition education interventions for low-resource populations, 90% of ESNY families had two children or fewer and 40% of these children were age five or under. Fifty-six percent of the families enrolled in ESNY were enrolled in one or more food assistance programs. At least 31% of program participants were over 50 years of age. Thirty-nine percent of program participants were from central cities over 50,000, 10% were from suburbs of cities over 50,000, 26% were from towns and cities 10,000 to 50,000, 23% were from town under 10,000 and rural non-farms and 2% were from farms. As the bar chart below depicts, ESNY demographics closely match the overall demographics of the State where 22% of ESNY participants were African American (16% of the State’s population is African American), 1% were American Indian (.4% of the State’s population is American Indian), 1% were Asian/Pacific Islander (6% of the State’s population is Asian/ Pacific Islander), 16% were Hispanic (16% of the State’s population is Hispanic) and 60% were White (67% of the State’s population is White). These percentages represented a 2% increase in White participants, a 2% decrease in Black participants and the same percentages among Hispanics, Asians, and American Indians when compared to 2000. Participants Demographic Profile 2001(NY State and ESNY)* Dem ographics Total Percent ESNY Participants Com pared w ith NY State ESNY African American 22% 16% 1% 0.40% 1% 6% 15% 15% 60% 68% NY State African American ESNY Am. Indian NY State Am. Indian ESNY Asian NY State Asian ESNY Hispanic NY State Hispanic ESNY White NY State White * These demographics reflect individuals entered into the ERS database providing only a snapshot of the entire program’s actual demographic profile (n=10,768). The comparison State data reflects 2000 Census Data and is based on a population of 18,976,457. 0% 20% 40% 60% 80% 5 While the ESNY projects across the State of New York vary greatly in their levels of creativity, numbers of individuals reached, length and intensity of the education program and innovation in accessing new participants, all projects follow very specific guidelines that channel efforts and activities toward program goal achievement. Every quarter, staff are expected to report program highlights, numbers of clients reached, implementation strategies that are considered “best practices,” impact, and barriers that have interfered with successful goal achievement. This formative approach to program assessment provides coordinators, staff, and administrators with information that serves to strengthen the program overall by tailoring the projects to align with what seems to work best in a given context among a specific target audience. For example, in situations in which participants were mandated to attend sessions such as in drug and alcohol rehabilitation programs, ESNY staff looked to policies that allowed participants to choose sessions of more interest. The result of this strategy was that it provided a level of control among those who had limited control, thereby enhancing the likelihood of learning and skill acquisition. The ESNY staff has tremendous flexibility and choice at the local level in terms of curricula and learning materials. Most sites draw on Cooperative Extension materials, materials that are developed locally and a multitude of other predeveloped materials from nutrition-based 6 sources. This flexibility enables educators to adapt the materials to the needs of the individual or group. Lessons for adult clients are embedded in adult education, which included the participant’s past life experiences and interests while engaging them in interactive, hands-on Sony and Tim have 3 girls and have been receiving services for 13 years (food stamps, WIC, rental assistance). They requested help with budgeting, quick meals, and Tim’s diabetic diet. Tim had a prescribed diet but said he would not follow it because he could not eat good food anymore. The NPA reviewed the Healthy Food Choices pamphlet and serving sizes. They discussed ways to substitute healthy foods for those Tim could not have. They also discussed the importance of eating in the morning. The NPA encouraged him to apply at a local factory and he now works full time. Sonya was anxious that they would lose food stamps. The NPA worked on budgeting and food shopping. Sonya was given information about the Extra Helpings Program, food pantries and the Farmers Market. She also learned some quick meals to make. The NPA worked with the family for 12 sessions. The family is now off all services except WIC and Head Start. Tim continues to work, has lost weight and now eats breakfast. Sony has started working part-time. (Greene County, 2001) activities. Facilitated discussions, role-play, case studies and food preparation sessions with modification of familiar recipes were also used to appeal to the multiple learning styles of program participants. Children’s nutrition programming was colorful, fun, interactive and always included a hands-on component. Clowns and puppets were used successfully in several school and daycare settings. viduals with developmental delays, HIV/AIDS participants, chemically-dependent substance abusers, teenagers in residential group homes, Native Americans and the Hasidic community. An innovative and extremely cost-effective strategy used by many ESNY projects is exposing secondary audiences like volunteers and staff at food pantries and daycare providers to nutrition education, food safety and food resource management instruction. ESNY staff anticipates that, by educating those working closely with families with limited resources, program messages will be shared in casual, informal ways, thus reinforcing ESNY messages more frequently and consistently. Further, that positive attitudes toward good nutritional practices shared by trusted, familiar people will strengthen ESNY messages. Reaching these non-traditional nutrition educators requires institutional structures “Just by showing an interest in the client and even if it was not nutrition related this opens up the doors for an easy and trusting communication.” (Monroe County, 2001) Program goals are broad with specific behavioral objectives assigned to each goal. Most of the behavioral objectives are designed to help program participants select healthful foods on a limited budget, improve their food handling and preparation skills and understand the importance of exercise. ESNY staff realizes that what makes their programming stronger, more helpful and meaningful may not directly relate to nutrition but rather to understanding lifestyle context in which participants are operating and making decisions. They are intentional about investigating what the ESNY participant wants from life, his/her aspirations, what makes him/her feel inadequate or happy and how much control the participant feels he/she has. ESNY program staff believes that the more confidence the participant has the more nutritional practices, food security and food safety behaviors will be influenced. The target audiences for ESNY are extremely diverse, several examples include families with young children, single parents, parents of schoolaged children, school-age children, adolescents, seniors, domestic violence victims, residents of family shelters, users of soup kitchens and food pantries, the homeless, and people with mental and physical disabilities. Examples of new audiences being targeted this year include indi7 A man was willing to listen while his wife received ESNY lessons. His blood sugars were running 500-667 when his wife enrolled in ESNY. He agreed to do the dietary recall and was very surprised to learn that his diet was extremely high in fats, starches and sugars while quite low in vitamins, minerals and fiber. Through the lessons his blood sugars steadily lowered and he noticed a tremendous difference in his energy level and overall feelings of well-being. He had pretty much been confined to home before his wife enrolled in ESNY, but by the time she graduated his blood sugar was down to a range of 110-150. He began to feel better; he found he was able to take short walks too. He revealed at graduation that before ESNY he had given up hope of living much longer but that he was starting now to make plans with his wife for the future. (Chemung County, 2001) and interagency agreements, expanded management systems and collaboration, all of which ESNY actively pursued. Other secondary audiences include food service providers, teachers, school-age children participating in after-school and summer programs, working poor individuals, WIC participants and youth in lowincome rural and urban areas. Spouses and other family members living in the home with an ESNY participant also experience significant gains particularly when meals become more nutritious and balanced, food resources are managed more effectively and food is safely prepared and stored. Further, attitudes about health and nutrition are changed to reflect the nutrition education they have been exposed to in an incidental way. In New York City, multiple levels of diversity present vast opportunities as well as considerable challenges for ESNY staff. ESNY educators encounter multiple languages, cultures, life circumstances and many overwhelming needs among their ESNY participants. Positive personalities, creativity, commitment, cultural sensitivity and a willingness to network and collaborate with numerous service providers, community agencies and foundations is vital for ESNY staff hoping to address the substantial need that exists in the City of New York. The bar chart above demonstrates the diversity evident during the 4th Quarter among participants in New York City. In New York City During the 4th Quarter ESNY reached 483 new program participants by implementing workshops in 42 different community agencies. Sixty-eight percent of program participants were reached at senior centers/congregate meal sites, 19% from Adult Learning Centers (ESL/GED programs, WEP), 7% from Shelters, 4% from Domestic Violence Shelters and 2% from Rehabilitation Centers. Indirect contacts occurred via five supermarkets and eight health fairs. A total of 748 individuals were reached (22% male, 78% female). Another 676 individuals were reached via unstructured groups. The demographics of this diverse group reflected 39% were Hispanic, 35% were African American and 18% were Asian). (NYC, 2001) 8 Section III. Collaboration In New York City, the Human Resources Administration (HRA) provides an extensive capacity to advise the ESNY program with representatives from city-based and public feeding, social service and education programs. The State Department of Health’s “Just Say Yes” ESNY program and the Hunger Prevention and Nutrition Assistance Program (HPNAP) also maintain a symbiotic relationship where strategies are directed toward increasing the quality, quantity, access to and consumption of fruits and vegetables among food pantry users. These collaborative efforts are described as being mutually beneficial to the ESNY project sites as well as those individuals serving on the board, particularly among those having a stake in the health, availability of nutrient dense foods and overall nutritional status of limited-resource individuals. Most ESNY projects demonstrate a high degree of collaborate and coordinate with others in the community. Evidence that reflects this ability includes interagency cooperation, few barriers related to trust and turf issues, and frequent sharing of information, resources and staff in order to meet common goals. ollaboration between Eat Smart New York and the Department of Social Services as well as other communitybased service providers remained robust during 2001. All ESNY project sites have active advisory boards and include representatives from a number of community affiliations such as social services, healthcare, community nutrition, education and the faith community. Agencies represented on ESNY advisory boards are typically eclectic and can include representatives from the county Office for Aging, the Department of Health, the Supplemental Food Program for Women’s Infant and Children Program (WIC), Farmers Markets, United Way, BOCES and/or adolescent parenting and pregnancy prevention, among many others. Networking with other service providers, community leaders and politicians enhances ESNY staff’s awareness and connection with community resources. According to 2001 ERS findings, overall interagency cooperation increased during 2001. There was a 1.3% increase in the number of WIC offices served, an almost 50% increase in the number of Food Stamp Offices served and 19 more community coalitions established across the state. 9 C Because many program participants experience complex problems with multiple interrelated causes and effects, collaboration with others in the community is essential. To adequately recognize needs and mobilize community resources (both human and physical) requires the multiple sources of knowledge and intervention that successful collaboration provides. The ultimate outcomes of this ability to collaborate and coordinate with others are better service provision, education, reinforcement and support for program participants. In the ESNY program, collaboration is an ongoing mechanism for leveraging resources, dealing with scarcities, eliminating duplication, capitalizing on individual strengths and building internal capacities. “This past weekend our 6th 4-H Summer Fair at Muscoot Farm was a great success in a number of ways. Over 5,000 strolled through our exhibits and participated in activities that familiarized them with what we do. Our on-going collaboration with the County and the Department of Parks was tremendously strengthened and appreciated by the staff of the farm and the legislators who are always interested in the work we do. Conversations with people from the Muscoot Board, Muscoot staff, Parks Department and the legislature were positive and provided glowing testimonials to the work the ESNY does in Westchester County.” (Westchester County, 2001) Another excellent example of such a collaborative effort was described in a 4th quarter report from Onondaga County. The Department of Social Services was awarded funds for assisting limited-resource individuals who are transitioning from TANF services. This assistance included supporting people in getting low percentage rate loans for automobiles. Criteria for eligibility for this assistance included receiving education on budgeting. ESNY provided education for these individuals on household/ food budget management. This positive collaboration resulted in better repayment compliance for transitioning individuals who completed ESNY programming. This collaborative effort between the Department of Social Services and an ESNY project assisted people in being successful in paying back their car loans as well as improving their quality of life where several were able to move into less expensive apartments (because they no longer had to rely on public transportation), move to better paying jobs with better hours and less time spent on transportation. Ultimately these positive life changes resulted in more time to plan nutritious meals, shop and prepare food for their families. Fort Drum active duty spouses are an important target audience. It is estimated that onethird of our Army’s infantry division is food stamp eligible. ESNY in Jefferson County has experienced success in establishing the Clayton Community Garden. This community garden is an example of how agency networking, and local need result in improved food resources, strengthened collaboration, education and food and nutrition related skills. ESNY educator and Cornell Cooperative Extension Master Gardener program worked with Fort Drum’s Community Life Program, the YMCA Project Strong Communities, the Town of Clayton and military spouses. A garden plot was identified and participants contributed to the planning and learned basic gardening. NTAs met with some participants in their homes to teach food, nutrition and food preservation skills. A garden with 27 family plots, including 2 raised beds for handicapped participants and a corn and pumpkin plot for the children, was successfully grown and harvested. (Jefferson County, 2001) 10 Section IV. Program Outreach ESNY strives to use social marketing for behavior change at the individual, household and community level as well as at the advocacy/ policy level. ESNY projects are beginning to use mass media in reaching key audiences including families living in rural and peri-urban areas and those not reached through the health system. Trailers at movie theaters and on buses, billboards, posters and commercials on television and radio have served to reinforce ESNY messages across the state. During 2001, at least 27,404 New Yorkers were exposed to ESNY messages during Farmers’ Markets, 151,500 heard ESNY messages via their radios, approximately 1,545,000 watched commercials encouraging fresh produce consumption, and approximately 10,0960,000 New Yorkers saw Shopper Ads sponsored by ESNY. As 106,000 people sat munching popcorn, awaiting the beginning of a movie they were exposed to messages on good nutrition and their local ESNY program on the movie screen. Another 195,708 received newsletters from their local ESNY program and 3,876,336 read about ESNY events and messages in their local newspapers. There were at least 20,144 ESNY posters displayed across the State, 192,918 ESNY publications and 68,783 brochures distributed across the State in 2001. Another 9,162,937 New Yorkers were exposed to ESNY information/messages via billboards, buses, county fairs and health fairs. 11 uring 2001, via intentional social marketing strategies, ESNY continued to be highly visible throughout the State. All ESNY projects, whether implemented by Cornell Cooperative Extension offices, the Department of Health or the Department of Social Services, portray a credible and approachable resource for nutrition education where innovative educational approaches are used in relevant, interactive, and interesting ways. ESNY staff strives to empower participants by assisting them in learning how to make healthy food choices, spend their food dollars wisely and make use of all their available resources. Educators conduct their work within the communities they serve. This work might occur at a WIC clinic, in a daycare or elementary school classroom, during a Food Stamp re-certification appointment, at a congregate feeding site, a senior residence, a drug rehabilitation center or a county fair. The Eat Smart New York program recognizes that in order to impact behavior and stimulate change, steps beyond insular information sharing alone are necessary. ESNY projects have their eye on what it will take to get people to try a new practice and continue it. Examples include going to a structured class on nutrition, resource management and food safety, cooking fresh produce every day for their families, eating more fruit, exercising or enacting a school policy that enforces lower fat milk and healthy, balanced lunches. D Section V. 2001 Barriers and Solutions behavioral change were recognized and addressed both individually and at the community level. The table below outlines examples of how ESNY programs tackled the barriers to successful transfer of knowledge, attitudes and skills from the program setting to day-to-day practice. This evaluation demonstrated that there is no single intervention or strategy that ensures program participants have enough to eat, improves households’ safe handling, preparation and storage of food, and motivates participants to adopt healthy eating and lifestyle behaviors. A broader view was required where obstacles to Examples of Barriers and Solutions* BARRIERS Lack of Transportation SOLUTIONS Seek “Wheels to Work” funding in collaboration with DSS. This funding provides assistance with acquiring a low-interest car loan. ESNY provides education in budgeting which is a primary criteria for eligility. Collaboration with local used car dealerships is also beneficial. Advertise broadly using multiple avenues, newspaper, newsletters, list-serves, radio and community agencies. Continuously assess program graduates, individuals who intern during welfare to work programs, and students for potential “fit” into ESNY positions. Use of demonstration and hands-on activities rather than printed materials. Appropriately trained Educator who has patience and realizes that frequent, clear explanations are needed. Activities should be easy, allowing for lots of repetition and opportunities for success. Special consideration should be given to safety and support from agency staff. Collaboration with military and/or community agencies, decision makers, local legislators and community members. Identify individuals with the power to make decisions and speak to the multiple benefits of such projects. Place emphasis on the positive publicity these projects receive as well as positive relationship building, enhancing food security and community involvement. 12 Difficulty filling staff positions Low Literacy Developmental delays in program participants Accessing target audiences Acquiring land for community gardens BARRIERS W.I.C. families with poor FNCP redemption rates SOLUTIONS Schedule ESNY instruction during all W.I.C. appointments. Become a “fixture” during clinic times. Instruct, handhold and support when necessary. Coordinate with W.I.C. and Farmers’ Markets; encourage synchronous events where Farmers’ Markets occur on the same day, same time and in close approximation to W.I.C. Clinics. Use radio, newspapers, and ESNY presentation at all congregate meal sites as well as other places that senior tend to meet. Collaborate with the Office of Aging. Use persistence when encouraging application and sharing information. Assist with filling out the paperwork, accompany the participant to the Department of Social Services and sit with the participant as they are experiencing their Food Stamp interview. Helping program participants to become more self-sufficient by increasing awareness about their existing strengths and community/ family resources. Validating small steps toward goal accomplishment and working from a strength-based perspective rather than a deficit model. Involve participant in decision-making and control. Promote personal pride and a sense of achievement in learning about good nutrition, managing food resources and practicing food safety. Seniors lack of knowledge related to the Farmers Market Nutrition Program Lack of Knowledge RE: eligibility for the Food Stamp Program and inexperience with the system Feelings of hopelessness Lack of confidence * This list is not exhaustive rather illustrative. 13 Section VI. Program Impact In addition to the reports of observed behavioral change, the Evaluation Reporting System (ERS) provided statistical validation of these observations. Each ESNY participant enrolled in structured nutrition education completed a demographic form as well as a behavioral checklist at the time of entry and upon graduation. Responses to this checklist served a two-fold OBJECTIVE A: FOOD SECURITY AND FOOD RESOURCE MANAGEMENT Statewide Results: These results reflect ESNY clients who paticipated in and completed a structured program. • 48% of participants more often planned meals in advance. • 41% of participants more often compared prices when shopping. • 37% of participants less often ran out of food before the end of the month. • 44% of participants more often used a list for grocery shopping. • 78% of participants showed improvement in one or more food resource management practices (planned meals, compared prices, did not run out of food or used grocery lists). • 52% of participants showed improvement in two or more food resource management practices. • 29% of participants showed improvements in three or more food resource management practices. purpose: 1) data served as a baseline for assessing pre-existing nutrition, food safety and food security behaviors as well as self-reported improvements in these behaviors after completing ESNY programming and 2) as a tool to assess participant need. T-Test procedures performed on these data revealed that the behavioral changes noted below are statistically significant (p=. 0001). OBJECTIVE B: DIETARY QUALITY Statewide Results: These results reflect ESNY clients who participated in and completed a structured program. • 43% of participants more often planned meals in advance. • 36% of participants more often thought about healthy food choices when deciding what to feed their family. • 34% of participants more often prepared foods without adding salt. • 53% of participants more often used the “Nutrition Facts” on food labels to make food choices. • 27% of participants reported that their children ate breakfast more often. • 81% of participants showed improvement in one or more nutrition practices (planned meals, made healthy food choices, prepared foods without adding salt, read nutrition labels or had children eat breakfast). 14 • 58% of participants showed improvement in two or more nutrition practices. • 35% of participants showed improvements in three or more nutrition practices. OBJECTIVE C: FOOD SAFETY Statewide Results: These results reflect ESNY clients who participated in and completed a structured program. • 26% of participants more often followed the recommended practices of not allowing meat and dairy foods to sit out for more than two hours. Furthermore, 22% ALWAYS followed the recommended practice. • 47% of participants more often followed the recommended practice of not thawing foods at room temperatures. Furthermore, 34% ALWAYS followed the recommended practice. • 57% of participants showed improvements in one or more of the food safety practices (thawing and storing foods properly). • 19% of participants showed improvement in both of the food safety practices. Overall, improvements observed in ESNY participants during 2001 exceeded improvements observed during 2000. • Approximately 11,224 Food Pantry clients observed demonstrations provided by the Just Say Yes to Fruits and Vegetables Program of the NY State Department of Health (DOH). DOH statistics revealed that these demonstrations helped clients to: 1) choose healthier foods, 2) keep foods safe and fresh, 3) stretch their food dollar, 4) identify other food resources in the community, and 5) increase the variety and amount of fruits and vegetables eaten. Seventy-six percent of pantry users observing demonstrations knew why fruits and vegetables are good for their health. Comparison of Behavior Checklist Summaries 2000 and 2001 Indicators* 13: Family Mealtime 12: Whole Wheat 11: Lower Fat Milk 10: Breakfast 9: Reads Labels 8: Add No Salt 7: Healthy Foods 6: Thaw Foods Room Temp. 5: Food Sits Out 2 Hours 4: Use Grocery List 3: Out of Food 2: Compare Prices 1: Plans Meals *The indicators as numbered on the right correspond to the red and blue bar chart on the left. The percentages reflect participant reports of behaviors most of the time and almost always. 15 ESNY led Community Gardens is another example of successful impact on the environment that enhanced the availability and accessibility of nutrient dense foods for program participants. Numerous examples were provided that reflect ESNY Educators successfully mobilized school the many ways in which ESNY efforts impacted children, parents, teachers, military spouses, and changes in the systems or the environment that community members in cultivating, seeding, enhanced the availability and accessibility of planting, weeding, watering, harvesting, preparnutrient dense foods for program participants. ing and preserving vegetables. The vegetables These changes also related to nutritious foods at were used directly by those planting and caring a lower cost, community recognition of healthy for the garden or donated to the local food eating, and education in food safety, nutrition and pantry. The ultimate impact was: 1) enhanced food budgeting. food security, 2) enhanced dietary quality, 3) meaningful involvement of youth during the ESNY projects collaborated with a Federal process, 4) relationships developed among program administered by the NY Department of program participants, ESNY Educators and Agriculture and Markets in promoting the Farmcommunity members, and 5) enhanced collaboraers’ Market Coupons. Coupons are given to tion among commulimited-resource nity members, individuals so that participants, decithey can purchase sion makers, and locally grown fresh ESNY educators. fruits and vegetables at Farmers’ Markets. This program benefits local agriculture and promotes more availability of nutrient dense foods for families in need of assistance. ESNY assisted with teaching eligible individuals how to use these coupons, how to buy fresh vegetables and fruits, and how to cook nutritious recipes using the produce. This effort successfully assisted families enrolled in W.I.C. as well as seniors who participated in congregate meal sites. OBJECTIVE D: SYSTEMS CHANGE 16 Section VII. Program Highlights orty-three program highlights were analyzed using a side-by-side matrix that compared the text provided in success stories as well as ERS data that reflected changes in behavior from time of entry into the program until the time that the ESNY participant graduated. Eighty-four percent of program highlights submitted reflected strategies intended to enhance dietary quality, 4% to improve food safety and 5% to improve food security. One hundred percent of the program highlights featuring strategies to enhance dietary quality were substantiated quantitatively by ERS data. When levels of improvement in dietary quality were compared to food security and food safety the greatest level of improvement was observed in dietary quality/nutrition pactices. This impact was significant in that participants demonstrated 30% more improvement in dietary quality behaviors (such as serving more fruits and vegetables, thinking about healthy food choices when deciding what to feed their families and more often preparing foods without adding salt) than improvement in food security behaviors (planning meals, using a grocery list) and Food Safety behaviors (leaving foods out two hours after purchase and thawing at room temperature). This finding in the program high17 F lights positively correlates with overall ERS data as demonstrated in the previous section. Fifty-four percent of ESNY program highlights were based upon effects of programming observed at the individual level. Program delivery methods varied, however among the 43 program highlights shared, 77% used one-on-one lectures, 20% used food demonstrations and/or hands-on activities and 3% used other program delivery methods such as games, workshops, Power-Point presentations, Fight Bac puppet show, “Thermy,” grocery store tours, finger puppets and informal discussions around a dinner table in order to achieve program objectives. Particularly successful strategies shared in ESNY program highlights included the following: • Promote simple, practical habit change in order to change nutrition behavior (e.g., buying lower fat milk, walking more, adapting a familiar recipe by substituting lower-fat ingredients or adding fruits/ vegetables). Family involvement and child/youth participation in food selection and preparation Active learning (hands-on activities) Egalitarian relationships in which clients shared control and decision making power • • • • • • • • Holistic approaches in which educators focused on basic needs first Introduction of nutrition concepts once participant was stabilized Use of modeling and demonstrations with individuals with low literacy or language barriers Repetition and reinforcement of lessons from a number of community sources both while enrolled in the ESNY program and afterward Repetition and clear, simple interactive lessons with limited use of written materials for mentally challenged individuals • • Clear connections made between good nutrition, health, more energy and a better quality of life Collaboration with a wide variety of community resources and service providers • Intense contact with clients and strong relationship development • Ongoing support • Unconditional provision of opportunities to be successful regardless of life circumstances. • Emphasis was placed on interpersonal communication because it has been found by ESNY educators to be the most persuasive and influential means of communication largely because of the intimacy, responsiveness and participant involvement that it allows. CookShop supports children developmentally. One CookShop staff member working at CPE2 observed a young, very shy Spanishspeaking boy who was put in a special education class simply because the school could not find another place for him. The child was extremely withdrawn. As CookShop classes and Integration activities resumed in the classroom, the boy became more assertive and engaged. By the time the class had taken a field trip to a large supermarket, the boy could name several vegetables in English: lettuce, carrots, pepper, onions, apples, oranges and broccoli. As the staff member said, “A few times my head whipped around; I was so impressed. Here was this little boy who could barely say boo to anyone; now he’s calling out names of vegetables, and in English, no less.” (CookShop, New York City, 2001) 18 “When I met K for the first time she weighed 235 lbs. and was a diabetic. We did several lessons on nutrition basics and had several discussions about increased physical activity and fitness. She has moved and now walks 34 times daily. She had said when we met that she wanted to buy things for her kitchen. So far she has saved enough money to buy a microwave and a small grill so she can cook her food in a healthier way, and enjoys this very much. As of 10/9/01, her weight has dropped to 180 and her doctor has taken her off all diabetes medications. She was so motivated by her successes in rising above several obstacles in her life that she has enrolled in college. K is also a mental health patient.” (Albany County, 2001) A 22 year-old female who’s income meets the 185% Poverty Guidelines was assessed with a low intake of protein, iron and calcium before the ESNY lessons began. In addition, her intake of fat was above the recommended levels. The client’s doctor had mentioned that her lipid profile was elevated. This girl had developed eating habits that in the future could cause osteoporosis, anemia and possible heart disease. This was a good opportunity to educate preventive measures to increase awareness of eating healthy to prevent disease. The objective addressed was Dietary Quality. The individual had nine lessons in seven months by home visits. Lessons focused on how to increase calcium, iron and protein through brochures, recipes, cooking activities and a quiz. Fat facts were taught through explanations on what foods contain fat, how to reduce fat in recipes and the benefits of a low-fat diet. The food guide pyramid was discussed and referred to during these lessons. The participant demonstrated behaviors that indicated an increase in dietary intake of protein, calcium and iron with a decrease in total fat. Impact of the program was also observed through the client demonstrating skills by practicing in activities during the lessons. The ESNY program has promoted awareness and behaviors to improve the client’s health. (Wayne County, 2001) Senior male in his mid sixties within normal weight range with elevated cholesterol levels and high blood pressure. Reportedly, the client had been on medication for a year and a half with no significant decrease in cholesterol levels and was feeling very frustrated. The NTA worked intensively with the client for 5 months and a total of 12 lessons. The dietary quality at issue was lowering fat and cholesterol intake. Delivery methods included one-on-one lectures, food demonstrations, and hands-on related activities. Resources to address the issue included Eating Right is Basic, Ingredient Substitutions, Trimming the Fat from Our Diets, Using the Food Guide Pyramid, Label Reading for Better Eating, Comparing Fat and Calories, Vegetables, How to Get 3-5 Servings a Day, Using the Food Guide Pyramid, Nutrient Needs for Adults, Fruits-How to get 2-4 Servings a Day. Food demonstrations were conducted with fat reducing recipe substitutions. The client reported that during the course of lessons his cholesterol levels began to drop, his food choices were leaner and he was making an effort to increase his fruit and vegetable consumption. He also stated that, “I’m now eating oatmeal to help with my cholesterol.” (Clinton County, 2001) 19 After participating in ESNY The Sisters in Health Program, a graduate stated, “I learned to limit the fat, and to read labels more carefully. My cholesterol went down from 266 to 139. I eat more vegetables now than I’ve ever done before. I got my grandkids to eat more vegetables instead of junk food and I shared recipes with my sister.” Another stated, “Before this class, I used to grab anything on the shelf. I read the labels now. I have a diabetic daughter. I can’t believe what I thought was juice had added sugar. The labels help me to know how much sugar, fat and salt are in our food.” (Onondaga County, 2001) The bar chart illustrates the observed impact of ESNY programming on participants behaviors shared in program highlights for 2001. These observations correspond with the primary goals and objectives of the ESNY Program. These qualitative findings corroborate with the quantitative findings in ERS in that the greatest impact observed was among behaviors that related to nutrition practices and dietary quality. Fifty percent of the success stories reflected observa- tions that suggested impact on dietary quality/ nutrition practices as a result of participating in the ESNY Program (e.g., greater vegetable consumption, greater fruit consumption, weight loss, lower cholesterol, and greater control over blood sugar). Broader impact on participant’s quality of life was also reported and included better budgeting, more awareness about the health benefits of eating well, more exercise, greater independence and more goal setting. Program Highlights: ESNY Impact 20 Section VIII. Future Plans for Evaluation his report reflects the results of the ESNY cluster evaluation thus far and addresses the statewide education elements (food security, food safety, dietary quality, food resource management/shopping behaviors, system and environmental changes). This technique was initiated in the fall of 2001 and visits to 4 regions of the state, Western, Finger Lakes, Central, and New York City, have been completed. This technique as well as the previous data sources (ERS, Quarterly Reports and Program Highlights) will be assessed throughout the course of the evaluation. Cluster Evaluation has various forms but it has certain basic characteristics: a) it is holistic, b) it is outcome oriented, c) it seeks generalizable learning, and d) it involves frequent communication and collaboration among the partners. Each region will have opportunities to participate in this process. T Cluster Evaluation has been used extensively by the Kellogg Foundation and is designed for programs with multiple projects in multiple sites. Typically these multiple projects have their own unique context, use their own human resources to carry out their plan, are relatively autonomous with each developing its own strategies to accomplish the program’s overall goals. This technique aligns nicely with the autonomy and diversity of program planning, implementation and evaluation that exists in the Eat Smart New York projects across the state of New York. Cluster Evaluation is a continuous process. It does not seek to establish causation through controlled comparative designs, but instead depends on naturalistic observations of many people to infer and test logical connections. It strives for documentation and logical conclusions that have been tested as fully as possible given resources, time and methodological constraints of the evaluation. It places a premium on utility, feasibility, propriety (respectability/ good behavior) and accuracy2 . 2 Worthen, B. (1997). Program Evaluation, Alternative Approaches and Practical Guidelines. Longman, New York. 21 During 2002, focus will be placed upon quantitative findings/impact data from the Evaluation Recording System, qualitative findings from document review of quarterly reports and the three new areas listed below: • Tracking at least 10% of ESNY graduation in order to assess the longevity of self-reported behavioral changes. Specific evaluation needs of counties that may work with target audiences that are not thoroughly assessed using behavioral checklists and ERS statistics (e.g., seniors, youth and unstructured groups). Program highlights that specifically make connections between program objectives, strategies used to achieve objectives and observed milestones that ultimately lead to behavioral change. • • 22