In Search of the Holy Grail: Health Related Evaluation for Food Banks and other Social Service Organizations

holygrailIf you want to be a big celery-waving food bank then it is all about increasing your poundage, or should I say increasing what is the new guise of poundage – numbers of meals. (Even though by current reckoning, meals can be comprised of things like pounds of candy).

Nevertheless, assuming that you are doing your best to distribute pounds of nutrient dense food, surely providing more and more food to the community has to be a good thing right? Absolutely.

But is it also an effective measure of the success of food banks at ending hunger?

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Not necessarily, because this apparent success is also a strong indicator of the continuation (some might say institutionalization) of food insecurity in America. If we’re giving out more and more food, we are not shortening the line of people who need our services and so failing to bring lasting food security.

If times are tight for people and free food is available, then any smart person is going to take as much free food as they can get their hands on, providing that the distribution timing or environment aren’t so difficult as to make it not worth their while. People will then divert the funds they had for food to pay for some other expense for which there is not so much freely available help. It is the smart thing to do, and to be food insecure in America, you have to learn to be smart pretty quickly.

You can end hunger

We like to give food to anyone who says they need it without much in the way of preconditions. And who doesn’t need food? Your stated mission might be to ‘ameliorate hunger’ or ‘end hunger’ or if you are windy Californians like us then you might want to ‘end hunger and transform the health of Santa Barbara County through good nutrition’. Whatever your goal, we need a way of finding out whether we are succeeding at doing more than keeping the nutritional health of millions of Americans tethered to our life support machine.

Which is where evaluation rears its head.

Food banks are still better at demonstrating outputs (pounds, meals, people served) rather than outcomes (individual behavior changes, community change and societal change). Time was we could get on our high horses and proclaim that ‘ensuring a child didn’t go to bed hungry’ was an outcome as far as we were concerned and the most import one – oh, and by the way, how dare you even ask us to justify what we are doing.

A turkey at Christmas might have cut it for Scrooge, but we need a little bit more
A turkey at Christmas might have cut it for Scrooge, but we need a little bit more

Those days are over.

Whether you buy into the whole ‘nutrition bank’ thing or not, you are will still be noticing a gradual shift in how food banks are being perceived by larger foundations. A few years of recession were good for automatic and generous funding. Even now, knocking on the foundation door generally assures us of having our request for operational funding awarded at x dollars, because ‘everyone loves the food bank.’ However, the social service organizations who are winning the award of x plus x dollars are the ones who can successfully evaluate what they are doing and demonstrate impacts in the community. And sorry, that’s typically not the food bank’s grant application.

Gotta like the hat
Gotta like the hat

As a Mr. Potter-like CEO, I don’t like to leave money on the table, and I believe that there is a huge pile of money sitting on the table for food banks that we are currently not able to pick up more than a few scraps of – health dollars.

The Holy Grail for a food bank like ours would be the ability to demonstrate and quantify the contribution of our programs to lowering levels of childhood obesity, diabetes, food-related cancers etc. If we could do this, we would be in a strong position to be better funded with private and federal health dollars.

HolyGrail034

I want those dollars to continue the little nutrition revolution in our service area and I want them for you too, dear reader.

Despite the importance of exercise, it is clear that when it comes to the most effective and cost-effective way of maintaining good health, ‘it’s the food, stupid.’ Food is what food banks have and it offers us the potential to make an incredible contribution to the wellness of this country.

It is my belief that in the food bank network, we are sitting on the most powerful, most cost-effective preventative healthcare machine the country has ever seen. We just need to be able to unleash its power.

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The way to do that is not to collect a few dollars to feed the needy, but to collect serious bucks to keep the nation healthy. By a combination of nourishment, education and empowerment, we can move millions of people – not just out of hunger, but out of hunger and into health.

Now, to kick me off my high-horse and to get us those health dollars, it takes evidence. And that takes evaluation.

Serena Fuller
Serena Fuller

This is where Serena Fuller PhD, the Foodbank of Santa Barbara County’s Health Education and Evaluation Manager comes in. Serena is a Registered Dietician with a background in obesity research (yes, lab mice are her friends) and public health. She has been on staff for about a year and a half now. When she was brought on board, the understanding was that part of her work would be to find this Holy Grail for us and deliver it to the development department so they could ride out and return with the gold.

Good scientist that she is, she had no interest in fudging the figures or finding some woolly way of claiming direct medical benefits from our programs that we cannot really prove.

Damn.

Getting over this disappointment, we moved on to a phase of having her dirty her nice white lab coat with the realities of food bank programs and for her to be involved in the creation of new programs. We also began to consider different evaluation options.

Have we found the Holy Grail? Of course not – it’s all about the quest, dude – but we did find what we believe is an important next step for us, which can also be replicated at other food banks.

It comes down to working with public health evaluation measures as opposed to medical evaluation measures.

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RE-AIM

We are now in the initial stages of piloting an evaluation approach based on the RE-AIM framework championed by Russell Glasgow. RE-AIM is an acronym for Reach, Effectiveness, Adoption, Implementation, and Maintenance and is an evaluation framework for public health type activities.

So why don’t medical measures work for food banks? Let’s get a teenie bit technical for a minute and look at the classic medical measures. (Take your motion discomfort pill if necessary)

childhood-obesity

BMI

Agencies often brag about ‘collecting BMI’ hoping that this covers a multitude of other evaluation sins. BMI is really just an indicator of later health outcomes, not what we are doing over the short term. Currently there is some question about whether BMI really is measuring what it is supposed to measure – total fat mass. It remains in use as a measure because of some clear positives: 1) it’s relatively easy to collect 2) it’s non-invasive and 3) it seems to correlate reasonably well with fat mass. Essentially some scientists have called into question whether it is good at telling whether people are actually healthy or not.

cholesterol-screening

CHOLESTEROL LEVELS

While total cholesterol, LDL and HDL cholesterol are measures for risk of heart disease that doesn’t necessarily equal myocardial infarction i.e. heart attack.  Cholesterol levels have also been critiqued in the literature as not being a sensitive or specific enough measure and thus have a low(ish) predictor value. But, just as with BMI it has positives as regards ease and non-invasiveness and it seems to correlate reasonably well with risk of heart disease.

WHY FOODBANKS SHOULD NOT BE COLLECTING MEDICAL DATA

The measures discussed, especially BMI, don’t change much in the short term, which is when these labor intensive measures are typically collected (expect in instances of multi-million dollar, long term, multi-clinic studies). Based on her experience at the Foodbank, Serena formed the belief that food banks should not be in the business of measuring subject-level ‘medical’ data because of invasiveness, the cost associated with this type of data collection and because of the issues raised above with regard to commonly collected medical measures. All this meant (in her favorite phrase) that ‘the juice was not worth the squeeze.’

The take away from all of this is that food banks can find their own measures of health, that are reasonable to collect, measures that can change in shorter amounts of time and which – just as much as with ‘medical’ measures – correlate reasonably well with the true health outcomes that interest us – long-term decreases in rates of morbidity (disease) and mortality. Being hungry sucks, but being grossly unhealthy or dead really suck.

These measures that we are most interested in are ones that score diet quality and food security scores.

Medical studies typically focus on populations that need to be similar in order for the data to make sense. But food bank populations are incredibly diverse and it would be unethical to exclude clients from the study if they needed food and their diversity doesn’t bode well for showing statistically significant changes in anthropometric, clinical and biochemical measures.

There is certainly the place for a few well-funded food bank research studies at a national level* (Check suggestions for these out at end of the post).

You may remember a post last year on ‘From Hunger to Health’ where I interviewed Dr. Hilary Seligman of UCSF, who was involved in looking at food security and how it can make major improvements in people with diabetes. There is also the Bristol-Myers Squibb project with Feeding America. It was discussions with Hilary which began to move us down the pathway that led to the RE-AIM tool.

RE-AIM

reaim

Because we want to run programs with the goal of improving the health of our community, we needed to find an evaluation framework that could capture changes in health.

RE-AIM has been used nationally to assess a broad range of community health interventions from actions to prevent child abuse through evaluating the efficacy of specific exercise programs for the elderly. A list of documents and links demonstrating some of these is contained at the end of this post.Here is a link to a monograph on using RE-AIM for program evaluation RE-AIM_issue_brief.

RE-AIM is unusual in that it moves beyond the current approach taken by the medical community to assess community-based interventions. In medical terms, the gold-standard is the Randomized Clinical Trial. In this, there is a focus on something called internal validity, which brings with it a tendency to oversimplify issues and their outcomes in order to isolate the impact of the program. Food banks don’t operate in a bubble. In particular, the emphasis on eliminating the potential for confounding factors typically results in samples of very homogeneous, highly motivated, healthy individuals which equates to samples of non-representative people.

RE-AIM hypothesizes that the overall social-change impact of an intervention is a function of all five RE-AIM dimensions not simply the client-based outcomes. The implication is that to have a substantial impact at the population level, an intervention must do reasonably well on all or most RE-AIM dimensions and thus all 5 must be evaluated or measured.

success score

Our Foodbank RE-AIM evaluation allows summary indices which we have termed ‘Success Scores’ which determine the overall impact of individual programs as well as initiative areas. We realize that the process will be iterative as we develop more measures with high reliability (measures the same thing over time) and validity (actually measures what you think you are measuring) and which include more stakeholders.

Our Success Scores have a range of 50 points, so as to be reasonably sensitive to the different activities we are doing right or areas that need improvement. However, we may find over time that 50 points isn’t sensitive enough or is overly sensitive and we so we will change the Success Score. That is the beauty and strength of evaluation over research in a community setting conducting translational work in that it is more flexible and dynamic.

Here is a link to an excel file that shows how we set the RE-AIM measures for a number of our programs.Program Score Card

Looking to the future the E part of RE-AIM (the effect) and the M part (maintenance) allow an organization to measure the ‘medical’ outputs if resources and will permit.

We are focusing initially on diet quality and food security because just like BMI and cholesterol levels they are reasonably well correlated with our outcomes of interest – adverse health events, long-term morbidity (disease) and mortality (death).  Plus if we are improving the food security status of our clients, the idea is that the demand for food bank services, in the traditional sense, will diminish and we will shorten the line.

We utilize well -accepted measurement tools for assessing good diet and food security:

Diet Quality measurement tool: http://appliedresearch.cancer.gov/surveys/chis/fvscreener/chis_fvscreener.pdf

Food Security measurement tool: http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools.aspx

To measure food security means that food banks will need to change their model to a model like our Healthy School Pantry  or similar approach with wrap-round services like Fresh Place. Here are programs where people can get involved, become food literate, get enrolled in benefits, build their social assets i.e. meeting new people at the pantry, grow their own food, learn how to stretch their food dollar. This means we can track people who will still attend but move out of food insecurity.

The benefits of RE-AIM are that it can be customized to each individual food bank, community and stakeholders, is broadly focused with good external validity, assesses system-wide changes as well as individual changes, includes a maintenance component of making the program sustainable, which is vital when you looking at population-based changes in health status and food security.

RE-AIM can be undertaken by food bank staff and volunteers and doesn’t require highly trained individuals to collect the data, depending on what measures for E and M you have decided on.

The negatives are that there is still lots of data to be warehoused and collected, and that it can be cumbersome to gather the community input. The summary indices are only as good as your inputted data, and some sophistication is required in developing your measurement tools.

One example of how RE-AIM can help you monitor and make changes to what you are doing. Say you are running a distribution and conducting health education at the site. This health education is led by a trained volunteer and you collect your survey data from participants and see that you have no effective outcomes, (i.e. no changes in healthy food behaviors, self-efficacy, knowledge etc). If you were not evaluating the implementation you might just scrap the program, but utilizing the RE-AIM tool would help you notice the difference between this site and another site that had a translator. So the impact is really Impact = implementation x effect. The great part of evaluating implementation is you can learn which sites are doing great, learn from those sites and then take what you learned to other lesser performing sites.

We see the next stage as working to improve the measurement tools as well as identifying the best indicators, i.e. the measures the have the best predictive value of health impact, and tapping into the right partners so we that we can strategically collect ‘medical measures’. We want to develop an evidence library that supports food security and diet quality as the best predictors of morbidity (disease) and mortality (death) in light of community constraints, food bank constraints, invasiveness for subjects and related issues.

We believe that food banks could use RE-AIM to collect meaningful data about their impact on the health and wellness of their communities. We are developing the measurement tools, score cards and success scores, plus causal pathways and definitions.

If we all adopt this method I think we can have a large influence on what funders will expect and of what all of our respective communities view as our work.  This is turn can show the true impact of our work.  If we come together to say that diet quality and food insecurity are the right measures, especially when assessed in the context of RE-AIM based framework we will go very far in proving our impact from that of an earlier measure like Pounds Per Person In Poverty.

We need your input your comments on your systems, your criticisms – and yes, your dollars for continued development of a system that can bring considerable evalutory (did I just come up with a Palin-style coinage there?) benefit for the whole network. You can contact Serena at sfuller@foodbanksbc.org with ideas and me at etalkin@foodbanksbc.org with support!

Serena has put together a brief information sheet containing some aspects and definitions for RE-AIM which can be downloaded here.13-02-21 Evaluation Framework Definitions[2]

The quest for the Holy Grail continues, but until then, stay tuned. This won’t be the last time we consider evaluation issues in these pages.

Hold on, Indiana Jones found the Holy Grail, and it didn't turn out too well for his German buddies...
Hold on, Indiana Jones found the Holy Grail, and it didn’t turn out too well for his German buddies…

Useful links;

http://www.childrenshealthwatch.org/upload/resource/AdvNutr_JC_2013.pdf  (food security and adverse effects)

http://www.ajhpcontents.org/doi/abs/10.4278/ajhp.071211129?journalCode=hepr (RE-AIm evaluation of a health promotion intervention at schools)

http://www.biomedcentral.com/content/pdf/1471-2458-12-403.pdf (RE-AIM evaluation of walking intervention for employees)

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1200303 (diet changes health outcomes)

http://www.ncbi.nlm.nih.gov/pubmed/23280227 (all-cause mortality association with BMI)

http://www.ihepsa.ir/files/h1.pdf#page=525 (book – Health Behavior and Health Education Theory, Research and Practice 4th ed Glanz, RImer, Viswanath editors)

* OPPORTUNITY FOR NATIONAL STUDIES – There is certainly the place for a few well-funded food bank research studies which would be at a national level* – looking at BMI, adiposity (via BIA or caliper), HTN, cholesterol levels, long term blood glucose regulation, e.g HBA1C (which is different than evaluation), plus diet quality and changes in food security.

Food Pantries with Case Management build both Measurable Food Security and Self-Sufficiency

Some of the themes that have been bubbling up in recent posts have concerned food banks searching for ways to impact client’s lives for the longer term, and then how we might be able to measure that improved food security and self-sufficiency.

This week I am looking into the success of the Freshplace pantry in Connecticut, a collaboration between three community organizations: Foodshare, the regional food bank, the Chrysalis Center, which is a social service agency, and the Junior League of Harford, a volunteer organization.  The difference between Freshplace and traditional food pantries is that Freshplace members meet with a Project Manager during their first visit, and then monthly, to discuss and set goals for becoming food secure and self-sufficient. Clients come up with their own goals that they want to work on, which are not imposed by the Project Manager. Nutrition education and a Cooking Matters course are also offered to memebers.

This program has benefitted from having an ongoing evaluation from its inception by a team from the University of Connecticut’s, Institute for Clinical and Translational Science headed up by Katie Martin PhD from the Department of Allied Health Sciences. Katie’s research background is in food security, community food security work, and food assistance programs.

Downloads are available here with the top level Freshplace Research Update as well as a Case Management in Food Pantries Research Brief. I spoke with both Katie and later with Foodshare’s CEO, Gloria McAdam to see what practices or ideas we could take from Freshplace.

 
Katie Martin

Katie, tell me how you came to be involved with the Freshplace project

They had been working for a few years on the notion of a food pantry that could address some of the underlying issues of poverty that were creating the need for food. I talked to them about evaluating this program and in 2009 I joined their advisory group, strategic planning group as we were concurrently developing the program and the evaluation.  Freshplace opened in July of 2010, and right from the beginning we’ve been conducting a randomized control trial of Freshplace where we recruit people from regular food pantries because we want to see how this intervention compares to these other traditional pantries. We randomized 100 into each group and have been tracking the same 200+ people for over a year now and will conclude our 18 month data collection in December.

What has the Freshplace group shown versus the control group in terms of effect on improving food security?

We’re in a very poor neighborhood in a poor city (Hartford) and half of all of the people we began the study with were experiencing significant hunger, cutting back the size of their meals or skipping meals because there isn’t enough food.

The bit the Hartford Tourist Board want you to see.

Over the year, Freshplace members were half as likely to remain in that category. We’ve seen increased food security and also increased self-sufficiency, which are both significantly higher than in the control group.

In the area of diet quality we’ve also seen significant improvement in fruit and vegetable consumption.

The one real challenge area is that we haven’t seen real declines in consumption of fat from snack and other unhealthy food. That means we still have some work to do.

How do you measure these areas?

We have been looking at three main outcomes:

FOOD SECURITY – For which we use the USDA food security module with its 18 questions,

SELF-SUFFICIENCY – For which we have been using the Missouri Self-Sufficiency Scale, which measures changes for 10 different indicators including income, employment, education, housing, transportation, physical health, mental health, child care.

QUALITY OF DIET – The consumption of fresh fruits and vegetables, fiber and also fat and snacks. For this, we’re using the Block food frequency questionnaire.

So, tell me a little more about Freshplace in action.

Clients can attend twice a month for food and once a month to meet with a project manager to discuss what areas they are interested in working on. Those goals are then reviewed in a supportive way.

That’s always kind of been an issue in terms of us demonstrating what we’re doing is improving food security because of the limited amount of a person’s total diet that is derived from a pantry’s food. The other unknown has been that we don’t really know how many different sites people are attending.  How did you deal with that in your study?

In our population, people are going chronically to different food pantries on average two to three times per week averaging up to four different pantry providers accessed every month.  I think a key piece that I think you write about beautifully in your blog is the notion of how food banks around the country are now starting to question how much longer they are going to be able to increase poundage and numbers of people served without significantly investing in preventative measures – whether health and nutrition education and empowerment  or the advocacy to change things. I’ve argued for a long time that hunger is about more than just food and that I think the data that we see nationally and we’re seeing at Freshplace is that even when people are going to multiple food pantries multiple times a week and they’re getting food and they know the system of how to engage in it to the best of their abilities, that it is still not enough to increase their food security. This is reflected by our food insecurity rates nationally really remaining untouched.  I think it’s time for a different way of approaching this issue.

What is the specific model of case management that they are using?

It’s based on the Stages of Change approach, coupled with motivational interviewing.

The idea is that we’re not telling folks the changes that they need to make, but working with them to determine what issues are most important in their life and what are the potential barriers that they encounter that are holding them back from reaching those goals. This type of model is used in some other types of work like HIV prevention, in trying to encourage people to have safe sex using that type of motivation and behavior change model.  We actually did a little bit of research through Foodshare of all of the partner agencies that receive food from the food bank to ask them whether they were providing case management in their pantry and what specific other services they provide just to get a handle on how unique or not unique Freshplace might be within the bigger field.  About half of the food pantries that responded said that they did offer some kind of case management, half did not.  But of the half who said they did, very few of them actually meet monthly and do a follow up. Most consider case management as giving a referral or a brochure with some other type of information.  This isn’t enough. A good Project Manager can be empowering when using motivational interviewing and in recognizing that people go through stages in their readiness to make changes in their life.  If we can engage in a relationship with clients where they trust us, we can have a dialogue where they know they’re coming back in a month and we’re going to do a follow-up with them and ask how they’re doing and what their issues are.

Obviously the food is an excellent motivator for people to return for the monthly interview, but how do people reach the point where they’re food secure enough to exit the program, or would anyone want to leave and turn down free food?

We always knew that we didn’t want this program to be another dependency program where people would stay on it for years.  We wanted this to be something that we could help give people a hand up and that they would want to and be able to move on. We spent some time really deciding what graduation from the program really means and giving clearer expectations so that when people come to Freshplace, they know from the beginning that there are expectations that we will offer a lot of support and services and programs, but you need to want this too so we’re going to meet with you and make sure that you’re making changes.  If you’re really just coming for the food, then I think right now we give maybe three to six months of that time to really monitor are they not making any progress towards their goals and if not, if they’re really just coming for the food, then there are other food pantries in the community that offer that.  So they’ll be discharged to allow other people to join the program.

There is currently a lively debate in the broader non-profit world about focusing all our attention on those who are able to improve and change their lives, because they are the ones that can deliver us the metrics of success that funders want. In the food banking arena, this would be ensuring the continued ability to feed all people; those with mental illness or who just can’t provide for themselves.  I think it is key to build in some avenue out for those who can’t or won’t or who are simply not ready to take on this wider change element. They would still be served to the best of our care and ability, but we wouldn’t waste their time and our money on these particular types of intervention resources.

Yes. I think we face a dichotomy in our country about the issue of hunger. When I describe the work that I do, people will often say, “We’ll always have hunger.”  Even though people don’t like the idea of people going hungry, there’s also this kind of acceptance that there will always be people in need. Now there are definitely those who fit into the category you just described, say those facing severe substance abuse, mental health issues, engrained generational poverty who need traditional food bank services.  But I would argue on the other side nationally there are millions of Americans right now who are food insecure and not sure how they are going to feed their family at the end of the week or the end of the month and I feel very uncomfortable with accepting that. I think from the bottom up we need to work with people and empower them and build those relationships so they can be ready to make changes, but from the top down we need to ensure that in our country that if people are trying their best to get a job or are working one or two jobs, they should be able to have a living wage where they should be able to go out and afford enough food for their family.

So this expanded group of Americans who are benefitting from our services, the 1 in 6. Aren’t a lot of this new group added by the recession able to look after themselves and might find the case management approach patronizing and disempowering? They might think that they just need a break or a few more hours work or a few more benefits. Can this group really benefit from the Freshplace approach?

I think they can. Those who have fallen on hard times need more than a bag of food. They need the ongoing support and link to a range of services rather than just short term food security. We can help them build their job skills to get a better job, and they can help us in our advocacy work to press for the policy changes that will help them long term.

With our own programs we’ve initially kept close to schools basically because that’s a place whereby we can tap into deeper more long term relationships with clients and build what we call their food literacy. However we’re now looking more closely at the thinking behind and impact of our more classic types of distribution. I think in the past the philosophy was to find a poor part of town and carpet-bomb the area with cans of food, hoping that this ‘shotgun’ approach would hit the right people and improve their lives. We did serve a bunch of people who really needed the help, and some who really didn’t need the help but weren’t foolish enough to turn down some free food. We certainly did little to change the long term health or prospects of either group. Do you think it is important to transition away from these traditional mass distributions? I mean it’s not like we have as much food available to us as we used to.

I think you’re right that so often we look at low income communities and say there’s so much need, there’s so much poverty, there’s so many problems we kind of throw our hands up and just say, “Well, let’s just provide food.”  I think a different approach is sorely needed, which says that these are communities that have assets and rich human and social capital, which If tapped, can do amazing things. We need to work with folks to find out why they’re struggling so much.  What are the barriers in their lives?  Again, it takes more time than simply giving food. And I think often Americans like the quick fixes.  Programs like Bridges out of Poverty (Watch out for an upcoming post on their work) are enabling people to really self-investigate what are the issues that are holding them back in their lives. But to truly be most successful, this requires the community as a whole to say ‘how do we look at the issue of poverty in our community and how are we all involved?’  That addresses employers and schools and the bigger picture which impacts all of us. Otherwise we will stick to our quick fixes and continue to spin our wheels.

Traditional food banking makes us feel great about charitable giving, but we’re not making an impact on food security or self-sufficiency or diet quality. That’s why Freshplace offers a different model, that if we can analyze it and find out what’s really working and how we can replicate it, then it could provide an avenue for a longer term approach to dealing with hunger. Clearly, this model is not going to be feasible for every food pantry. They might serve 500 people in a week, how could they possibly provide case management for 500 people in a week?  And I would say, you won’t, but I think that you could target a small segment of that group that you feel would be most ready to make these changes or people who would like to get off of that food pantry line. You could work with them and monitor their changes over time, so you would have that longitudinal data and with the expectation that hopefully six months from now they’re no longer in that food pantry line.

Some food banks may have the financial resources to hire a case manager and deal with issues that aren’t necessarily food related.  The challenge for other food banks is, ‘how do I partner with other organizations that have these skills or specialty to really provide a range of services that cover more of the spectrum of issues covered by the Self-Sufficiency screener?’  What kind of models do you think would work for that partnership?

My interest is in translational research, making sure that things are meaningful on the ground. An academic study is not as much use if other people can’t use this information.  One of the things that we did with Freshplace is to partner with the social work program at the University of Connecticut with the idea that many communities that already have food banks often probably will have some university or college setting that would have a social work program and those social work students need hours in the field of working.  They need that expertise and experience so that can be a way.  We’ve had two women who’ve come through the social work program who’ve worked with the paid case manager through Freshplace who are getting their hours towards their degree and I think that’s a model that other communities could use to partner with other existing programs in their area that wouldn’t necessarily require a lot of funding.

I then spoke with Gloria McAdam, CEO of Foodshare.

Gloria J. McAdam

Gloria, the results from Fresh Place are looking very promising. I understand that you are aiming to scale the program – are you just planning on providing your own case managers or cooperating with other nonprofits.

Our original vision with the Freshplace model was to be able to replicate it throughout our service area.  For example, in the City of Hartford, which is only 17 square miles, there are currently around 90 food pantries.  Since most of these pantries give out meager amounts of food and offer no other services, this structure forces clients to go from one pantry to another, just to put food on the table.  We believe that a much smaller number of pantries, probably 10-15, who operate on the larger scale that Freshplace does and provides these additional services, could serve people much more effectively.

We could do a better job of getting people the food they need for sustenance as well as providing additional services and supports that would move those families toward self-sufficiency.  Our next step with this project is a replication manual and to start identifying new partners for expansion.

In addition, we are considering the idea of hiring a case manager on Foodshare’s payroll who would rotate among a few smaller agencies to test whether case management can also work in smaller food pantries.  We are just in the thought phase of this idea – what would it look like, what would it cost, which agencies might be interested and where would the funds come from.

That’s great work Gloria, thanks to you and Katie for sharing and keep us informed as things progress.

Essential New Guide to Nutrition Education Resources from Why Hunger?

It’s great to have a nonprofit’s name in the form of a question. It is a good way of having the conversation with the community already having begun before you open your mouth. In the case of Why Hunger? this conversation has been going on for 35 years, ever since singer and activist Harry Chapin first posed the question and then even better, got together with founding (and current) Executive Director Bill Ayres to do something about it.

The organization is a grassroots support organization that tries to build the movement against hunger and poverty by amplifying the voices of innovators who we think come from the grassroots.

Harry Chapin

At the recent Feeding America national summit, I met with Harry Chapin’s daughter Jen Chapin, who is a wonderful singer-songwriter, who some in the western region may remember from her address and performance at a conference in Tucson last year hosted by the Community Food Bank of Southern Arizona.

Jen Chapin, Board Member of Why Hunger?

I also had a chance to speak with Jessica Powers, director of the National Hunger Clearinghouse at Why Hunger? Below are excerpts of my discussion with her.

Jessica Powers, Director of the National Hunger Clearing House, Why Hunger?

The organization has been working on an essential new resource for those running nutrition programs which has just been made available.

So tell me a little bit about the types of support that Why Hunger? provides.

We do training and technical assistance.  We do capacity building through some small grant programs, and we also use the vehicle of storytelling a lot.  We try and find out about innovative approaches that people are using, and we try to amplify those voices to a wider audience in order to inspire people about things they could try in their own communities.

Can you give me an example of what you are working on?

Sure.  Through our grassroots action network, we currentlyhave 3 food desert projects that we’re working on.  The technical title is ‘building community power to eliminate food deserts’, and we’re working in Southwest Arizona, in the Mississippi Delta, and in Central Coast California.

And what we do is we bring together different stake holders who are working on food systems issues who may not be talking to each other currently, so that might include ranchers, people from public health, people from the school system and food bankers.  And then through a facilitative process, we talk about the history of that area, how they got to the current situation that they’re in and what their vision for the future is.  Our role is really to facilitate moving that forward that we actually think the community should determine for themselves what is the best solution for them, but that our role is to help move that forward by being sort of a consistent presence and helping with any challenges that arise in moving the work forward.

Tell me a little bit about this guide which is now available for people to download from your website. [DOWNLOAD HERE]

The National Hunger Clearinghouse works on capacity building for emergency food providers, and we focus mainly on food pantries and smaller agencies.  Through that program, we had a lot of conversations with people, and they kept saying that there was a lot of innovation happening in food sourcing and nutrition education, and it was really hard to find out what was going on and to find a place which could be a hub for that information.

We did research and created program profiles on a host of organizations that are working on those 2 different issues.  And so we organized them sort of by strengths.  So in the nutrition education guide, we’re looking at programs that maybe are better at working with diverse communities.   Some are better at evaluation.  And the idea is that people can then tailor it to the program that works for them in their area.

(The ‘From Hunger to Health’ blog is also cited in the guide, so let’s hear it for cross-promotion, folks!)

Self-Promotion – Promoting someone you’re committed to spending the rest of your life with.

Has your organization done any work to uncover the roots of hunger, and answer that tricky question, “Why?”

Yes, in many ways, that is our mission. We have a Food Security Learning Center on our website which is an encyclopedia of food system issues. Everything from water to community food assessments to race in the food system, youth in the food system etc. We have a particular lens, which is that we want to see healthy nutritious food available to people.  So the articles are definitely written with that lens.  But I guess the big thing that we do is try to disseminate information and try to share stories with a wider audience.

Damn, I remember my college days when wearing a button could solve the most intractable of human problems. What happened to the world??!!

What do you think food banks could do or be involved in that they are not currently as a whole involved in?

I think that we all acknowledge that the root cause of hunger is poverty, and if we’re not talking about poverty and solutions to that, then we’re spinning our wheels. So I would challenge food banks to do more of that, to talk more about wage disparity, to talk more about living wages and healthcare and things like that, that are forcing people into the position where they need emergency food assistance.

This came up in the speech by Matt Habash, last year’s winner of the John Van Hengel Award (Prestigious food banking award), and he was encouraging people to make that link to poverty.  But in subsequent sessions that I attended, people from other food banks were saying, “Oh my god, I can’t go near that because it’s a political hot potato, and it’s outside our wheelhouse, etc.” Are there other things that they could do?

It is not only a case of the food bank using its own voice. They could be sharing more information and insights with the agencies that they work with, and helping them build their advocacy skill set.  They can also use State Associations as more of the political voice.

I think it is a question of framing.  It has to be about opportunity.  The whole childhood hunger piece, when you talk about children having an equal opportunity to become leaders, to become educated.  I think that’s something most people can agree on regardless of their party politics.  And I don’t think that people talk about that enough.

So are you suggesting that food banks take more of a leadership role in putting together coalitions and becoming the backbone organization for a wider variety of community organizations?

Yes. Increasingly we’re seeing that there is a political movement that wants to privatize charity. That means putting the burden onto the food banks, so I think food banks need to stand up to this.  When you look at the total pie of food distribution, food banks are still a relatively small piece in this country and so they can’t be expected to take on such an increasing burden, and I think they need to be more vocal about that.  I think when we have discussions that are based solely on poundage or distribution or logistics or supply chain, then it sort of takes away from our ability to say, “Hey, wait a minute, this is supposed to be an emergency response, not a long-term solution,” right?

Thanks, Jessica, and thank you for your work in putting together such a great guide.