Good Food Is What The Doctor Prescribed

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You may have heard the saying: “an apple a day keeps the doctor away,” but what if your doctor actually prescribed fruits and vegetables for what ails you? In Forest Grove, Ore. (23.1% Latino) a health clinic and farmers market teamed up to help prevent obesity and fight disease by providing patients with prescriptions for healthy foods. Fruits and vegetables are what the doctor ordered, as Forest Grove Latino families visit their local healthcare providers to eat their way to healthier futures.

EMERGENCE

Awareness: Kaely Summers, nutrition, and market access coordinator of Adelante Mujeres, a nonprofit that organizes a farmers’ market in Forest Grove, Ore. (23.1%), was well aware of the dietary health issues faced by community residents.

U.S. Latinos tend to have less access to healthy food and spaces for physical activity.

The results—obesity and poor health—were prevalent in the community served by the Forest Grove Farmers Market, which has been managed by Adelante Mujeres since 2005.

“We really needed to address this on a person-by-person basis, and as an organization to say that this is something that we find very important that we need to integrate into our program, some sort of nutrition education, some sort of strategy that will reach families,” Summers said.

Learn: In 2010, Wholesome Wave, a national nonprofit, launched an initiative to get fresh produce into the kitchens of individuals that were dealing with diet-related diseases. Through their Fruit and Vegetable Prescription Program (FVRx) Wholesome Wave would be able to empower healthcare providers to bring nutritious foods to families by providing prescriptions that help provide fresh foods to families with dietary health issues.

Summers, who had partnered in 2011 with Wholesome Wave on a different program, began to learn about the FVRx program.

Frame Issue: Summers decided that a similar “produce prescription” program could help the farmers’ market customers as many Latino families could use financial help accessing and buying fresh healthy foods.

“We wanted to kind of model our program off of what [Wholesome Wave was] doing,” Summers said. “We are very relationship built and we felt like a prescription program could help families that are struggling with obesity or diabetes.”

Summers decided that the organization’s Forest Grove Farmers Market would be a great place to implement the program.

But how would the program work, and what clinic would be a good partner for their tight-knit community?

DEVELOPMENT

Education: After researching other produce prescription programs, Summers, and her team wanted to keep theirs focused on building relationships and connecting people to resources.

According to Summers, the values of building relationships and connecting people locally are what have made past programs be successful and sustainable.

On several occasions, Adelante Mujeres worked with a local clinic, the Cornelius Wellness Center (CWC) in nearby Cornelius, Ore., helping to serve many of the same individuals that their own program helped.

Summers explained that the CWC, which is part of the Virginia Garcia Memorial Health Center, could be a great fit for the prescription produce program as patients would get to see the same healthcare providers and help them build a relationship with the program.

“Anytime [patients] come into the clinic they are seeing the same group of people that are watching out for their health and wellbeing,” Summers said.

Summers and her team were ready to develop a program.

Mobilization: Wholesome Wave set up site visits with Adelante Mujeres and the CWC to envision a new partnership for the prescription program. After they discussed the model of the prescription produce program, Summers realized there was another component needed to be set in place: a nutritionist needed to be employed by CWC.

Debate: At the time, CWC did not have a nutritionist on staff.

If they couldn’t find a solution, the program could not progress further.

ENACTMENT

Activation: In 2012, Summers reached out to the Executive Director of the Virginia Garcia Memorial health Center, Serena Cruz Walsh, to see about possibly starting a program without a nutritionist on staff and changing up the model to directly fit their participants and the clinics needs.

After envisioning and planning out a model, they signed a memorandum of understanding with CWC.

Walsh recommended a doctor from the clinic, Lynn Jacobs, and her patient care team to take the place of a nutritionist. Jacobs, who had her own home garden and believed in the philosophy of using food as medicine, and the Adelante Mujeres team agreed to work together to design the program.

In August 2012, Adelante Mujeres submitted a grant to the Providence Health Foundation to fund the newly envisioned program, called Produce Prescription (PRx).

Reframe policy: The model of their prescription program would allow future participants to access to produce prescriptions through doctor recommendations. The CWC patient care team would recruit and refer participants into the prescription program based on doctor’s recommendations.

They would then administer vouchers that participants can redeem for fresh fruits and vegetables, organize meetings, schedule and offer nutrition and cooking classes, and train farmers at the Forest Grove Farmers Market staff to accept the vouchers.

Vouchers were planned to be given to participants that work like cash, coming in $1 increments so they could be redeemed by any market vendor to be used only for fresh fruits, vegetables, herbs, etc. Monthly allotments were set for by family size.

“It’s not a discount, rather a type of currency redeemable only for fruits and veggies,” Summers said.

For example:

($6/week) x (family of 4) x (16 weeks) = $384 Monthly allotment for a family of 4 = $96

($6/week) x (# of people in the family) x (16 weeks) = Total PRx script allotment per family

Rules were set to make sure participants would stay in the program and not sell, trade or exchange the vouchers, and each participant would have a validation ID mark and tracking number.

“We didn’t just want to hand out vouchers to anybody, it did take a lot of thought in our team to see how we want to structure this,” Summers said.

Change: In fall 2013, Gill Muñoz, from the Providence Community Grant Council, signed off on a grant that awarded Adelante Mujeres funds to pilot the Produce Prescription Program (PRx) in partnership with the CWC clinic for the 2014-15 farmers market season.

IMPLEMENTATION

Implementation: In April 2014, the first patients were officially recruited into the PRx program through the CWC clinic. A month later participants started receiving vouchers from Adelante Mujeres to use when purchasing fresh produce at the local farmers Market.

Mayra Hernandez, the outreach assistant, was hired full time that year to support the Forest Grove Farmers Market PRx program and continue to support other agriculture programs under Adelante Mujeres.

Hernandez assists PRx participants as they visit the information booth at the farmers markets, where they can ask questions on how to redeem their prescriptions.

The participants also get free cooking classes and fresh vegetables.

Summers explained that the PRx program works because the community is not just the participant and the healthcare provider. The whole family takes part in joining cooking classes, meetings, and purchases at the farmers market.

Equity:  Many low-income Latino families that visit the clinic are also part of the Supplemental Nutrition Assistance Program (SNAP), where dollars can be doubled for fruit and vegetable purchases, so PRx vouchers can even further empower affordable fresh produce purchases.

Sustainability: The W.K. Kellogg Foundation awarded funding in spring 2015 to continue funding the PRx program.

Summers has gained interest from various organizations, universities, and research hospitals to discuss each other’s produce prescription programs over the years. Annually, Summers gathers with leaders of similar programs to share future ideas, successful models, and possible collaborations.

She explained that future funding may come from private companies or federal funds as data has been collected on a larger level through SNAP and farmers markets purchases. Also, successful produce programs are being discussed on a national policy level. Summers explained that support ideas for similar programs have been brought up around insurance coding of foods for diet-related diseases.

“There’s a lot of interest in these programs,” Summers explained. “So right now, beyond foundational support for these programs, were still looking to fund the program through grants, but were keeping an eye with what is happening nationally with these programs.”

This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.

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