Transcript Fruits and Vegetables The Flavor of Life

How Do We Inspire Healthy Change
in our Target Population?
Network for a Healthy California
County of Riverside
Department of Public Health
Nutrition Services
Our Goal
• Increase the number of Certified Eligible
Food Stamp recipients who receive
nutrition and physical activity education
in Riverside County.
• Increase the number of Likely Eligible
Food Stamp who receive nutrition and
physical activity education in Riverside
County.
Goals
Supplemental Nutrition Assistance Program
Education and Guidance (SNAP)
and
Network for a Healthy California
The goal of SNAP is to improve the likelihood that persons
eligible for SNAP will make healthy food choices within a
limited budget and choose physically active lifestyles
consistent with the current Dietary Guidelines for
Americans and MyPyramid.
Start-Up Challenges
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Who is our target population?
Where could we access our target population?
Which county programs allow access/partnering?
What information would be appropriate?
How much time would be available?
How would our program benefit the organization?
How to market the program to decision-makers?
How would work be distributed among staff?
Can we show a change in knowledge or actions?
Who is Our Eligible Population?
County of Riverside
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Riverside County was created in
1893 from parts of San Diego and
San Bernardino Counties
Known as the Inland Empire (with
San Bernardino County)
Width extends from Orange
County and ends at the state of
Arizona
Borders San Diego, San
Bernardino, Orange and Imperial
Counties
Mostly desert
Much of the growth is due to
– Los Angeles County residents
looking for affordable housing
– Added growth from San Diego
residents moving to Murrieta and
Temecula
Who is Our Eligible Population?
County of Riverside
California, Food Policy Advocates, 2008
Population
• Total Population: 2,026,803
• Total Population in Poverty: 229,043 (12%)
• Children in poverty: 92,584 (18.9%)
• Poverty = Family of 4 = $21,200
• 130% FPL = $27,560 and 185% FPL = $39,220
Food Stamps
• Eligible for Food Stamps: 194,766
• Receiving Food Stamps: 89,592
• Eligible, Not Participating: 105,174 (54%)
Who is Our Eligible Population?
Cities With Lower Median Incomes
Cities
Population
Median Income
Beaumont
28,250
$39,553
Coachella
35,207
$33,402
Desert Hot Springs
22,011
$33,263
Hemet
69,544
$31,749
Perris
47,139
$35,338
Riverside*
287,820
$52,023
San Jacinto
31,066
$39,235
The Three Categories of SNAP Recipients
Categories are prioritized according to the likelihood that FSNE
recipients will be FSP eligibles.
• *Category 1: Certified Eligibles
• *Category 2: Likely Eligibles
• Category 3: Potentially Eligible by Site/Location
Category 1: Certified Eligibles
Certain to Benefit SNAP Participants
Audience
Examples
Category 1: Certified Eligibles
includes persons that
participate in the formal SNAP
certification process and are
determined eligible.
•Persons referred by the local SNAP
office
•Persons reached through direct
marketing to SNAP Participants.
•Persons participating in the Food
Distribution Program on Indian
Reservations
As such, SNAP participants,
who consist of over 25 million of • Ineligible parents who receive SNAP
benefits on behalf of their child
the nation’s neediest people,
are at the core of SNAP efforts. •SNAP participants in a SNAP Job
Readiness Training Program
Category 2: Likely Eligibles
Very Likely to Benefit SNAP Eligibles
Audience
Examples
Category 2: Likely Eligibles are
persons that are eligible for the
Program but have not yet
applied.
A. Proxy By Income. Persons
not falling into category 1 above
that have gross incomes at or
below 130% of poverty
guidelines. This criterion does
not include persons typically
ineligible for the SNAP.
• Income
(Example: incarcerated persons,
boarders, college or university students)
eligible persons (130% of
poverty guidelines) referred by WIC,
Medicaid, or Child Nutrition Programs.
• Persons receiving Supplemental
Security Income (SSI) or Temporary
Assistance for Needy Families (TANF)
• Persons participating in TANF Job
Readiness Training Programs.
Category 2: Likely Eligibles
Very Likely to Benefit SNAP Eligibles
Audience
Examples
Category 2: Likely Eligibles are
persons that are eligible for the
Program but have not yet applied.
• Persons
B. Proxy By Location. Persons
receiving SNAP at:
• SNAP/TANF offices
• public housing
• food banks, food pantries, and
soup kitchens in conjunction with
the distribution of foods to needy
persons at these sites
in a TANF office waiting
area or conference room.
• Persons at a public housing
apartment community room or
lobby.
• Persons visiting a food pantry to
obtain food.
• Persons receiving a meal at a
soup kitchen.
Category 3: Potentially Eligibles
Fair Likelihood to Benefit SNAP Eligibles
• Category 3: Potentially Eligible by Site/Location consists of persons at
other venues primarily frequented by low-income audiences.
• SNAP activities delivered to this audience provide a fair likelihood of
benefiting SNAP eligibles.
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As a portion of this audience may be ineligible for the SNAP, States
shall request an exclusivity waiver (7CFR 272.3) (Appendix C, Section
A.3) for projects delivered to Category 3 audiences.
• States should consider delivering SNAP to Category 3 audiences only
after making a clear effort to provide SNAP to Category 1 and 2
audiences.
• Generally, this audience may receive SNAP when it is not possible or
practical to separate out Program eligibles and/or identify Program
eligibility.
Category 3: Potentially Eligibles
Fair Likelihood to Benefit SNAP Eligibles
Audience
Examples
Category 3: Potentially Eligible by
Site/Location consists of persons at
other venues primarily frequented by
low-income audiences.
A. Venues serving low-income
populations and at least 50% of persons
have gross incomes at or below 185% of
poverty guidelines.
B. Persons at stores with average
monthly SNAP redemptions of
$50,000.
C. Stores with lower redemptions that
meet the 50 percent of 185 percent low
income criterion may continue to be used
as SNAP sites with an approved waiver.
•Persons residing in approved
census tracts
•Schools located in approved
census tract
• Children in schools where at
least 50% of children receive
free and reduced priced meals.
• WIC Participants
• Persons shopping in approved
grocery stores (census tract or
redemption criteria met)
Organizational Structure
for TANF
Temporary Assistance for Needy Families
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U.S. Department of Health and Human Services
Administration for Children & Families
Office of Family Assistance
Temporary Assistance for Needy Families
Program (TANF)
TANF (U.S.)
• TANF is the name for the federal program that changed welfare
guidelines under the Personal Responsibility and Work
Opportunity Reconciliation Act (PRWORA) of 1996 law which
requires work in exchange for a limited cash-aid.
• It became effective July 1, 1997 and was reauthorized February
2006.
• In California, it is called CalWORKS and replaced Aid for
Families with Dependent Children (AFDC) and other programs.
• States, territories, and tribal agencies receive a block grant to
design and operate their TANF programs.
• States are allowed great flexibility in designing their programs.
Goals of TANF
Goals:
– assisting needy families so that children
can be cared for in their own homes
– *reducing the dependency of needy parents
by promoting job preparation, work and
marriage
– preventing out-of-wedlock pregnancies
– encouraging the formation and
maintenance of two-parent families.
TANF Names Vary in States
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Arizona (EMPOWER, Employing and Moving People Off Welfare
and Encouraging Responsibility)
Arkansas (TEA, Transitional Employment Assistance)
• California (CALWORKS, California Work
Opportunity and Responsibility to Kids)
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Colorado (Colorado Works)
Connecticut (JOBS FIRST)
Delaware ABC (A Better Chance)
Dist. of Columbia (TANF)
Florida (Welfare Transition Program)
Hawaii, Washington DC, Georgia, Nevada, Mississippi, Illinois,
Indiana, Guam and others (TANF)
Idaho Temporary Assistance for Families in Idaho
Maryland FIP (Family Investment Program)
Michigan FIP (Family Independence Program)
Minnesota MFIP (Minnesota Family Investment Program)
New York FA (Family Assistance Program)
CalWORKS
(California)
• CalWORKS = California Work Opportunity
and Responsibility to Kids Program
• California's Welfare to Work (WTW)
program is designed to assist welfare
recipients to obtain or prepare for
employment.
• The welfare to work program serves all 58
counties in the state and is operated locally
by each county welfare department or its
contractors:
• Names for CalWORKS Programs can vary in
different counties.
CalWORKS/GAIN
County of Riverside
• GAIN = Greater Avenues for Independence
• GAIN is a large-scale welfare-to-work initiative that has
operated throughout the state of California in all 58
counties and Riverside County GAIN started in 1987.
• GAIN is administered by the Department of Public
Social Services
• In 1996, Congress enacted the Federal Welfare Reform
legislation and states were required to cut their welfare
caseloads by 25% in 1997 and 50% in 2002.
• In 1998, GAIN became the CalWORKS/GAIN Program .
CalWORKS/GAIN
County of Riverside
• Secures client participation
• Promotes the GAIN program
– Benefits of participation
– Clients family responsibility to family
– Monitors client progress
• Aggressively involved in locating job vacancies
and recruiting employers for GAIN clients
• Promotes retention of employment
• Promotes self-sufficiency
Requirements for Participation
CalWORKS
• Anyone receiving Cash Aid (welfare)
must take the GAIN Program.
• SNAP:
– The majority of GAIN participants also
receive SNAP.
– SNAP clients are not required to take the
GAIN Program. In fact, many clients
receiving SNAP already have jobs.
• MediCAL patients are not required to
take the GAIN Program
• 5 years is the maximum time a family
can qualify to receive GAIN/CalWORKS
in California counties. (The state will continue
to pay benefits for children up to 18 years.)
Work Activities Include…
CalWORKS/GAIN
• Activities that count towards a State's
participation rates are:
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unsubsidized or subsidized employment*
on-the-job training
work experience*
community service*
job search
vocational training
job skills training related to work
education directly related to work*
satisfactory secondary school attendance
providing child care services to individuals
who are participating in community service
Cost Savings
CalWORKS/GAIN Riverside County
The program cost approximately
$3,988 per participant in 2006 and
these costs were more than offset
by savings to the government.
Morongo Tribal TANF, Banning, CA
• The Morongo Tribal TANF program provides eligible parents
and/or caretakers with job preparation, work, education and
supportive services to enable them to become self-sufficient.
• Services: Career Development (Job Readiness/Job Club and
basic skills development), Transportation, Child Care,
Employment or Educational Expenses, and Incentives
(academic and clothing incentives)
Torres Martinez Tribal TANF
Thermal, Hemet, Cahuilla (Anza)
Los Angeles, Commerce, Gardena, Lancaster
Goals Include:
• To end dependence of needy parents by developing and promoting
program services, assistance and activities that will support their
efforts with: job preparation; work opportunities; personal growth;
wellness; and stable, healthy marriages and families.
• To reduce and prevent welfare dependency of future generations of
Indian people by working with TANF and other eligible American
Indian Youth to: ... promote healthy choices… as incentives for
regular participation and achievement in educational and
work/career readiness activities.
California Tribal TANF
CalWORKS
The California Tribal TANF Partnership (CTTP) is associated with
35 tribes and other organizations that operate tribal TANF
programs for Native American people. CTTP was established
on July 8, 2003 and remains operational under the governing
body Robinson Rancheria of Pomo Indians as lead
administrators.
Our goal and purpose is to provide educational training,
career and employment opportunities toward self-sufficiency;
through various supported services and programs with
temporary financial assistance.
The Foundation for California Community Colleges
TANF Child Development Careers Program, Sacramento
CalWORKS
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TANF Child Development Careers Program (TANF-CDC) is designed
to recruit California Community College students who receive cash aid
and wish to pursue a career in the field of Early Care and Education
(ECE).
The objective is to increase the number of qualified child development
teachers and to assist TANF recipients and their families in becoming
economically self-sufficient.
During 2005-06, 49 of the 96 eligible California Community Colleges
were funded to provide additional coordination, case management,
support services, mentoring, and teacher permit processing services to
over 1,000 TANF participants.
Benefits of Working with
CalWORKS/GAIN
• Mandatory program
• County program
• Represented the
cities we targeted
• Maintained a regular
class schedule
• Worked with our
target audience
“Work Philosophy”
CalWORKS/GAIN Riverside County
• “Get people into jobs as quickly as possible, and
then work with them to stay on the job,” Gerry Martin,
GAIN Supervisor.
• “Work First” and “Self-Sufficiency” through
employment.”
• Encourage clients to get better jobs to support selfsufficiency.
• Work has value over and above the obvious one of
income. “Work provides dignity, satisfaction and self
respect,” Marilyn Kuhlman, GAIN program manager.
How We Started
(First Steps)
• In 2002 -2003, the Network for a Healthy California _County of
Riverside wanted to reach Food Stamp recipients in the
CalWORKS/GAIN Program with Network messages.
• We talked to managers in the program, but were unable to be
included in the schedule for years. Our topic was not considered
essential to their program.
• We were able to provide literature displays to both Food Stamp
and CalWORKS/GAIN offices.
• We were contacted by their Cathedral City office in November
2003 for health information and/or incentives for their first annual
“Fit for Work” conference.
• Conducted a staff training in Cathedral City.
How We Started
(Next Steps)
• Next we brainstormed the needs of our programs:
– Reviewed the objectives of Network for a Healthy
California_County of Riverside
– Reviewed the objectives of CalWORKS/GAIN_Riverside
County
– Found a common interest among our programs which
was mutually beneficial
• Planned a strategy to introduce the program to other
CalWORKS/GAIN staff and clients
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Schedule classes at sites per request
Educate at staff trainings
Educate/Support conferences and employment expo
Provide educational information for office displays
How We Started
(Recent Steps)
• In December 2003 the Indio office contacted us to be a part of
their first “Fit For Work” Conference in 2004. We conducted a
workshop and trained all CalWORKS/GAIN staff in the county and
about 80 clients who attended.
• We began to do nutrition trainings in the Cathedral City office.
• Other offices began to contact us throughout the county and we
added trainings at their sites for clients.
• We now serve eleven offices throughout the county. We have
added classes in Spanish.
• We are an integral part of the training clients receive while they
are searching for jobs and we provide information for them and
their families to eat healthy and be physically active.
“Fit For Work” Conference
CalWORKS/GAIN
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Client recognition and support
Skill-building workshops
Motivational speakers
Healthy food and snacks
Fashion show
Palm Springs Annual Employment Expo
Palm Springs Convention Center
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Public/private partnership of over 200 businesses and agencies
promoting employment every September
Sponsored and organized (in part) by CalWORKS/GAIN
Over 1,000 people in attendance every year
2006 – 2008 Nutrition and Physical Activity Promotion by Network for
a Healthy California_County of Riverside
Highlights:
– Promoted eating out healthy and reached over 350 people with
nutrition and physical activity information in 2008
– Personal story of a man who lost 50 pounds and “no more diabetes”
in 2007 after coming to the booth in 2006
– Helped Katrina family get clothes and other basic needs in 2006
Palm Springs Annual Employment Expo
Palm Springs Convention Center
CalWORKS/GAIN
Job Club/Job Search
• Job Club: (1 week)
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teaches the benefits of working
how to find and land a job
how to sell them selves
how to use Job Search skills in the future
• Job Search: (3 weeks) (repeat as needed)
– Applies work learned in Job Club
– Helps clients land the job
“Job Club”
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15-20 people
30 to 60 minutes
Open style format
Audiovisual equipment:
– overhead
– visual aids
– handouts
• Questions/comments allowed
• Supervisors often attend the class
Job Club: Employment Skills
• Case Manager assigned
• Skill Sets to Learned include:
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Work
School
Interviewing
Dress
Barriers/Challenges
Goal Setting: Life Goals, Career Goals
Also available, Counseling for : Substance Abuse
and Self-Esteem Building
Nutrition/Physical Activity Classes
• Classes
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Quality information required
Interactive style
Variety of subjects
Visual Aids
Incentives
• Maintain relationship with supervisory staff
– Maintain the schedule/remind as needed
– Expand classes as needed
– Be flexible
• Emphasize Worksite Wellness goals: importance of
health when getting work, maintaining work, and/or
maintaining a healthy family.
• Provide referrals as needed.
Sample Classes
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Get the Facts
MyPyramid
What’s In It for You? Whole Grains
Keep Things Moving With Fiber
Get Your Calcium
Stretch Your Food Dollar*
Portion Distortion
Label Reading
Cut the Fat for Better Health
100% Fad Free
CalWORKS/GAIN Classes
DATES
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Classes Clients
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Classes Staff
10/05 – 9/06 88
842
5
204
10/06 – 9/07 61
570
5
225
10/07 – 9/08 120
1622
7
341
Total
3,034
17
770
269
Sample of Client Questions
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How to feed fussy children?
Healthy recipes family or spouse will eat?
Healthy cooking methods?
How to buy healthy food at grocery
stores?
• How to control the menu at home?
• How to eat healthy when eating out?
• Which fast foods are healthy?
Client Perceptions
Healthy Eating and Physical Activity
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It costs more to eat healthy.
It takes more time to eat healthy.
Eating healthy doesn’t taste good.
The family won’t eat the healthy food.
There’s no time for physical activity.
I’m already physically active.
Other Concerns: Child care, Transportation,
Financial, and Health
Benefits of Nutrition &
Physical Activity Education
• Health and Employment
– Healthier clients may do better passing physical exams
• Retention of Employment/Employment Support
– Healthier employees have better attendance
– Health information helps children stay healthy which
means fewer lost days from work due to a sick child at
home
– Improved nutrition (fewer vending machine purchases,
less soda when lunch bags were given and many clients
starting bringing their lunch to classes)
– Potential for increased performance with more physical
activity
– Worker’s Comp claims can be lowered with healthy,
physically active people
– Reinforced employment tips
– Served as an employment role model for clients
Benefits of Nutrition &
Physical Activity Education (cont’d)
• Nutrition and Wellness information
– Provided tips to save money (take lunch, cook at home,
shopping tips, saved gas)
– Provided tips to save time (healthy crock pot meals, meal
planning and Network recipes are encouraged.)
– Healthier society costs fewer health care dollars
• Physical Activity
– Encouraged family activities which supports good parenting
skills for mothers and fathers
• Program
– CalWORKS/GAIN in Riverside met health requirement
Challenges
• The number of attendees can fluctuate at some clinics due to
getting jobs, kids sick, or other reasons
• Taste testing is a challenge because the number of attendees
can fluctuate at some clinics
• 30 minutes minimum is needed, but 45-60 minutes is desirable
to provide information and answer questions
• “Crowd control” or handling the questions/concerns.
• Getting to all of the locations since some sites are farther
away than others so other tasks are scheduled for the same
day in those areas.
• Staffing changes require renewal of support to the program.
• Other organizations that we match for funding require our
time as well.
Classroom Tips
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Don’t be rushed when doing classes since many times
questions are asked at the end of the session during the
break.
Clients often feel the information is valuable and they may
take notes so provide quality information.
Provide a handout with the information covered or a copy of
your talk.
Provide referrals for health care, WIC, dietitian counseling,
and medical resources for conditions like diabetes and
overweight.
Clients may be reluctant to see their physicians for health
care services. Be sure to reinforce the quality of public health
services since they may be reluctant to obtain health care.
Provide incentives at the end of the class.
Provide resources for additional information.
Have the supervisor schedule a break after this training when
possible since clients may have personal questions or
concerns.
Personal Skills Needed
• Must know how to work well managers
and the target population.
• Must be able to control the class when
needed.
• Must be able to (skillfully) re-direct
questions and experiences.
– Ex: long stories, health nuts, be able to discuss
abusive behaviors intelligently
• Must be able to incorporate stretching,
exercise and/or dance.
• Must be persistent.
• Must be responsible.
Quick Guide to Program
Planning
(Basic Needs)
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Be able to state the benefits of your program for CalWORKS.
Design a plan to promote your program. Include your CalWORKS
Supervisor(s).
Provide the very best staff training to interested sites and/or to the
CalWORKS Supervisors.
Schedule client classes with a variety of structured educational,
interactive lessons that provide key information in a short period
of time of 30 to 60 minutes. Have 3 or more lessons available to
start.
Include a physical activity for fun to reinforce learning.
Provide food for sampling to reinforce health messages.
Have a variety of visual aids.
Have educational materials required for learning.
Keep your schedule, but be flexible and modify your program as
needed.
Participate in other CalWORKS events as available.
Go the Extra Mile
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Have well educated professionals.
Provide support to your staff as needed.
Train staff with selling techniques to promote the program.
Find a partner who is supportive and believes in your goals.
Always provide excellent customer service.
Success Stories
CLIENT
STAFF
More clients brought their
lunch
More staff brought their lunch
Clients have rated our classes
as beneficial during their
evaluation
Staff have made lifestyle
changes like not drinking soda
and/or losing weight
Clients who were hired by the
county (as Eligibility
Technicians for Social
Services) tell us they remember
our presentation and want to
see the presentation again.
Staff are supportive; they direct
clients to pay full attention and
they recommend expansion of
our program to other times and
other offices
Physical activity increased
during lunch by walking
Physical activity increased
during lunch by walking
Future Plans
• Increase classes in English/Spanish
• Re-establish the newsletter/mailings
• Evaluate outcomes
Acknowledgements
Special Thanks:
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We continue to be grateful for the support of
the Network for a Healthy California.
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This work would not be possible without the
funding and support of the USDA
Supplemental Nutrition Assistance Program.
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Special thanks to Gerry Martin, Supervisor,
CalWORKS/GAIN for facilitating the start of
nutrition and physical activity education in
the programs for the County of Riverside.
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Special thanks to the CalWORKS/GAIN
Program in Riverside County for allowing us
to educate their clients and for continued
support of our partnership.
Thank You
Diane Wayne, MS, RD
[email protected]