Progress 01/15/16 to 01/14/17

Outputs
Target Audience:Following the successful completion of the Extension focus groups, a UVM CDAE masters student assisted with the analysis of the on-line focus groups. The results were part of her successfully defended thesis. We asked three basic questions: 1)What health insurance needs has Extension identified as important to agricultural communities? 2) How is Extension programming currently approaching health insurance outreach and education? 3) What specific tools and resources are needed for Extension to respond to these needs? Participants identified two ways in which Extension could improve its ability to assist farmers and ranchers: 1. Boundary span agriculture and health sectors, and 2. Increase professional development and knowledge of applicable resources for Extension professionals. Based on these findings and recommendations our Extension team is developing case studies and educational resources that will be available through webinars and downloadable materials tailored towards these needs. To communicate the results back to the target audience, in this case Extension, members of the team submitted an article to the Journal of Extension. The article was marked as revise and resubmit. As of this reporting date, the article was re-submitted and is back in the review process. To build more substantive links between the health and agricultural communities and across Extension program areas (Family and Consumer Science, Agriculture and Natural Resources and Community Development) a subgroup of the HIREDnAg team applied for a USDA Rural Health and Safety Education grant. While rated highly, the grant was not funded. Farmer interviews Year 1 are being completed in all 10 case study states. Transcription and qualitative data analysis of the interviews is ongoing. Farmers will be contacted again next year for a follow up interview to understand changes over time. The qualitative data has been used to refine the quantitative survey anticipated to launch Winter 2017. The quantitative survey has been approved by UVM IRB. Changes/Problems:In the original proposal we anticipated contracting with USDA-NASS to identify farmers and implement the farmer phone survey in Winter 2017. However, due to staff changes in the NASS and timing issues, we will no longer be working with NASS. We will be purchasing a list of farmer addresses and emails and will be directly surveying the farmers with the University of Vermont taking the lead on implementing the survey, data entry and analysis. The survey is still scheduled to be administered in winter 2017, with an anticipated start date the last week of January. What opportunities for training and professional development has the project provided?Findings from the Key Informant interviews in the 10 case study states were leveraged into additional programing for the agriculture and health sector in Vermont. The PD applied for an internal $7,800 grant from the UVM James Jeffords Fund for Policy Studies to put on the first meeting in the country to bring together the health, agriculture, and tax sectors to discuss health insurance, health, and economic development in the farm sector. The Summit Titled: Health Insurance, Agriculture and Rural Economic Development in Vermont, November 3, 2016. Burlington, VT. 45 participants representing the health, agriculture, tax, government, education and Extension sectors. Participants included: Vermont Dept. of Labor, Vermont Dept. of Health, Vermont Health Connect, Vermont Office of the Governor, Vermont Farm and Forest Viability Program, Vermont Farm Health Task Force, Vermont Coalition of Clinics for the Uninsured, NOFA-VT, AARP Vermont, Public Assets Institute, RAFFL, Vermont Agency of Ag, Blue Cross Blue Shield, VTC, VT Agency of Taxation, Yankee Farm Credit, UVM Extension, the UVM tax school, and several other UVM departments. Interactive sessions designed to develop a statewide effective and coordinated approach to integrate the spheres of health and agriculture to better serve Vermont Farmers. The team took copious notes and documented the process and plan to submit an article to the Journal of Extension or parallel journal to provide a template for other states interested in hosting a similar type of event. The information will also be made available on the project website when it is finalized. Immediate results include the strengthening of and new development of partnerships across the health and agriculture sectors. In addition the VT Agency of Agriculture sent a targeted email to farmers during the open enrollment period with information on how to sign up and useful resources for understanding health insurance options. On the second day of the Jeffords Summit we offered a Professional Development Workshop: Smart Choice and Smart Use Health Insurance for Vermont Farm Families. November 4, 2016. 13 participants including: VT Health Connect, Blue Cross Blue Shield, UVM Extension. Half-day workshop featuring tools and farming scenarios featuring the Smart Choice and Smart Use Health Insurance™ curriculum, enabling health and Extension professionals better serve farmers and rural populations. Workshop taught by B. Braun University of Maryland Extension (HIREDnAg team member) and M. Pippidis, University of Delaware Cooperative Extension. Lead Organizers: S.M. Inwood and K. Morris. The individuals at this meeting were offered a discount rate to particpate in the on-line Smart Choice training, three of the participants took advantage of this opportunity. The Smart Choice materials were well received by Blue Cross Blue Shield and by Vermont Health Connect. Vermont has no formal curriculum comperable to Smart Choice to assist individuals or farmers choose a health insurance plan, thus this curriculum is currently being evaluated and may be adopted. How have the results been disseminated to communities of interest?The team is actively submitting articles to the Journal of Extension and presenting at professional conferences to reach Extension and practioner audiences. The Health Insurance and Rural Economic Development Summit led to an article in Vermont Biz Journal. The particpants at the Summit formed new relationships and are now increasing thier targetted outreach efforts to farmers. The Vermont Agency of Agriculture and the Vermont Farm Health Task Force both sent notices in 12/2016 directing farmers on how to sign up for health insurance, tips for signing up and resources to evaluate plans. NOFA-VT is now organizing a session on health insurance for their members at the Winter 2017 conference. Risk Management teams in Vermont are considering bringing this information to their national and regional conferences. What do you plan to do during the next reporting period to accomplish the goals?Finalize analyzing the qualitative and quantitative data collected through March 2017. Produce research and Extension outputs reflecting the needs identified.

Impacts
What was accomplished under these goals? Following the successful completion of the Extension focus groups, a UVM CDAE masters student assisted with the analysis of the on-line focus groups. The results were part of her successfully defended thesis. We asked three basic questions: 1)What health insurance needs has Extension identified as important to agricultural communities? 2) How is Extension programming currently approaching health insurance outreach and education? 3) What specific tools and resources are needed for Extension to respond to these needs? Participants identified two ways in which Extension could improve its ability to assist farmers and ranchers: 1. Boundary span agriculture and health sectors, and 2. Increase professional development and knowledge of applicable resources for Extension professionals. Based on these findings and recommendations our Extension team is developing case studies and educational resources that will be available through webinars and downloadable materials tailored towards these needs. To communicate the results back to the target audience, in this case Extension, members of the team submitted an article to the Journal of Extension. The article was marked as revise and resubmit. As of this reporting date, the article was re-submitted and is back in the review process. To build more substantive links between the health and agricultural communities and across Extension program areas (Family and Consumer Science, Agriculture and Natural Resources and Community Development) a subgroup of the HIREDnAg team applied for a USDA Rural Health and Safety Education grant. While rated highly, the grant was not funded. Farmer interviews Year 1 are being completed in all 10 case study states. Farmers will be contacted again next year for a follow up interview to understand changes over time. The qualitative data has been used to refine the quantitative survey anticipated to launch Winter 2017. The quantitative survey has been approved by UVM IRB.

Publications

• Type: Other Status: Published Year Published: 2016 Citation: Becot, F., S.M. Inwood, and L. McDermott. 2016. Health Insurance, Rural Economic Development and Agriculture State Case Study Agriculture and Health Insurance Profile Series: 1)VT; 2)MA; 3)PA; 4)MI; 5)KY; 6)MS; 7)NE; 8)UT; 9)WA; 10)CA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Heiss, S. N. (2016). Health boundary spanning in non-healthcare organizations. Paper presented at the annual meeting of the National Communication Association in Philadelphia, PA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Heiss, S. N., & Portman, E. (2016). An analysis of how nutritional professionals navigate messages in a commodification of dietetics. Poster presented at the bi-annual meeting of the Kentucky Conference on Health Communication in Lexington, KY.
• Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Inwood, S., Portman, E., Braun, B., Loveridge, S., Heiss, S., and A. Knudson. In Review. "The Farming Population and Health Insurance: Educational needs and approaches of Extension Professionals" Journal of Extension.

Progress 01/15/15 to 01/14/16

Outputs
Target Audience:Our primary target reached during this reporting period has been nationally with Extension and tax accountants who work with farmers. We have reached each of these group through our interviews and virtual focus groups. Our intention was to have Extension, private consultants, and farmer NGO's on the Technical Assistance Provider virtual focus groups. However, only Extension professionals registred to participate, there were a total of 12 Extension professionals from across the country representing both Consumer and Family Science and Agriculture and Natural Resources. To date 4 tax accountants participated in one focus group, we are following up with individual interviews. National virtual focus groups have been conducted through ADOBE Connect and hosted through the NCRDC Michigan State University. Based on feedback and identified needs we organized two webinars for Extension professionals; one with Extension peers who currently have ACA programing in their outreach efforts (Roberta Riportella, K-State; Barbara O'Neill, Rutgers; Adam Kantrovich, Michigan State). There was a great deal of need for knowledge and interest in programing areas identified by focus group participants. We have also interviewed key informants in each of our 10 case study states to understand the issues and contexts within each state. We have worked with USDA to present a webinar on the Affordable Care Act and Farmers Changes/Problems:The delay in funds being released has delayed our ability to interview farmers in year one. We have shifted our timeline by one year and have begun the process to identify and interview farmers. What opportunities for training and professional development has the project provided?The project has produced two webinars targeting Extension, technical assistant providers, program and policy leaders in the agricultural communities. How have the results been disseminated to communities of interest?National Extension and C-FARE Webinars. What do you plan to do during the next reporting period to accomplish the goals?During the next period we will execute the farmer interviews, and begin to develop the larger farmer household survey. Results will be analyzed from the Extension and tax accountant focus groups which will enable the Extension team to develop appropriate and responsive tools and programming.

Impacts
What was accomplished under these goals? This project is large with multiple institutions and parallel research tracks. A project manager was hired with Inwood's UVM Hatch Funds to assist with record keeping, facilitation and ensure the timeliness of the project. We have had regular conference call with the full team, farmer research team and Exetnsion research team. We have a SmartSheet site to keep track of the project and a drop box site to keep organized. We have organized and conferenced with our stakeholder advisory committee and received support and advice as we move forward. FARMER CASE STUDY RESEARCH: We have identified and finalized our ten study states: VT, MA, PA, MI, NE, MS, KY, CA, UT, WA. To assist with comprehensive understanding of each state, the project has been supplemented with Inwood's UVM Hatch Funds to hire an undergraduate student to assist with constructing a data base for the case study states with information from the Census of Agriculture and Health Insurance Programs and Policy data, primarily from the Kaiser Family Foundation data. These supplemental funds have also been used to hire a graduate student to construct a data base of local news articles from each state tracking health insurance reform and investments in agriculture over the last 5 years. In each state we have completed key informant interviews to understand local agricultural conditions and current health insurance programs and policy. We found key informants were sometimes reluctant to talk due to their own belief they did not have enough knowledge or information about the current topics of inquiry; overall we found those in the agriculture sector know little about health insurance and those who work in health insurance know little about agriculture. Interestingly after our interviews, key informants often feel they have a new perspective on the topic and see increased connections between agriculture and health insurance compared at the start of the interview. However, we were able to meet and in some cases exceed our target of 5 key informants in each state. Efforts are currently underway to recruit farmers for participating in the longitudinal interviews. We are targeting a diversity of farmers ranging from young to old, and a various farm structures. We designed a flyer to assist with recruiting. The questionnaire and closed ended survey have been constructed and are awaiting IRB approval. We have already had farmers who have heard about the study contacting us and interested in participating. EXTENSION RESARCH GOALS The first step in the Extension research goals was to conduct national virtual focus groups with farm technical assistance providers and tax accountants. All virtual focus groups were facilitated by Scott Loveridge at NCRDC, Bonnie Braun, University of Maryland and Shoshanah Inwood using the adobe connect software program. -The technical assistance focus groups were advertised broadly through local and national Extension, Risk Management, non-profit, and food system list serves. We had offered 12 time slots, there were 15 individuals who signed up to participate in the virtual focus groups. We had two in October and a total of eight participate. These individuals were all Extension professionals from the Consumer and Family Science and Agriculture and Natural Resource program areas. The focus groups included both open discussion and closed ended poll questions. The conversations were recorded and transcribed and are currently being analyzed by a Masters Student in CDAE at UVM. The participants uniformly identified a need for more basic information. Almost a third of the participants participated in the focus group primarily to learn more information about the topic. In an effort to respond to this immediate call for assistance, our team organized two webinars. The first webinar targeted Extension, we invited Extension professionals who currently include ACA programing and agriculture in their outreach efforts (Roberta Riportella, K-State; Barbara O'Neill, Rutgers; Adam Kantrovich, Michigan State). The webinar was hosted by the NCRDC through Adobe Connect and we had 30 participants ranging from both Extension and Risk Management Audiences. We have not had any individuals from the non-profit or private consultants participate, we believe it may be because this issue is not currently a major part of their programing or in their realm of concern and with limited staff time and budget these individuals did not participate. The second webinar was an overview of why health insurance is an important issue for the agriculture community and policy makers to consider. This webinar was hosted by CFARE The Council on Food, Agricultural and Resource Economics and included presentations by Mary Ahearn recently retired from USDA-ERS who has conducted research on farmers and health insurance and Shoshanah Inwood. A total of 45 participants were on the CFARE webinar. The focus groups are currently being analyzed by a graduate student in CDAE and will be able to be sent to Journal of Extension for review in June. This analysis will inform additional programing and Extension outputs. -Tax Accountants: We organized and recruited heavily for the tax accountant focus groups which asked similar but more tailored questions for tax accountants. Despite our best efforts, there was four tax accountants who participated in the focus groups. These individuals were enthusiastic and provided a rich set of data. Upon reflection we also recognized this population is more shy and is more reluctant to participate in the focus group format. To address this limitation, we are now going to interview 30 tax accountants who work with farmers and ranchers. NCRDC had access to a comprehensive list of tax accountants in the U.S. and we are currently recruiting from this list. We are waiting till after tax season in May to continue recruitment and conduct the interviews.

Publications

• Type: Websites Status: Published Year Published: 2015 Citation: www.hirednag.net
• Type: Other Status: Published Year Published: 2015 Citation: Project Brochure available at www.hirednag.net