Source: Chicago Horticultural Society submitted to
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
Funding Source
Reporting Frequency
Accession No.
Grant No.
Project No.
Proposal No.
Multistate No.
Program Code
Project Start Date
May 1, 2016
Project End Date
Dec 31, 2017
Grant Year
Project Director
Mason, A.
Recipient Organization
Chicago Horticultural Society
1000 Lake Cook Road
Glencoe,IL 60022-1168
Performing Department
Non Technical Summary
In support of the USDA's goal to "increase the purchase of fruits and vegetables by low-income consumers participating in the Supplemental Nutrition Assistance Program (SNAP) by providing incentives at the point of purchase," CBG's one-year FINI Pilot Project will provide nutrition education to 30 physicians, who will in turn offer nutrition education and free fruit and vegetable prescription boxes to 240 clients suffering from diet-related illness and their families, reaching a total of 744 unique individuals. To incentivize return visits to the market, each box will contain $15 in coupons for use at the WCH-run North Lawndale farmers' market and healthy corner store, and physicians may prescribe refills for additional produce boxes. In addition to these benefits, WCH's North Lawndale farmers' market and the healthy corner store will offer a 50% discount on all purchases made using SNAP benefits, reaching an estimated 780 individuals. In total, the project will provide an estimated 18,600 servings of fresh, culturally appropriate fruits and vegetables to SNAP beneficiaries from underserved neighborhoods in Chicago. The project will also train and additional 130 low-income participants in WCH's Youth Farm and Corps programs to deliver nutrition education and food preparation sessions to LCHC clients, improving their own health behaviors in the process.
Animal Health Component
Research Effort Categories

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
Goals / Objectives
The Food as Medicine project fulfills FINI grants program objectives toward the overarching goal to "increase the purchase of fruits and vegetables by low-income consumers participating in the Supplemental Nutrition Assistance Program (SNAP) by providing incentives at the point of purchase." The project advances the related USDA Strategic Goal 4.2: Promote Healthy Diet and Physical Activity Behaviors, and concomitantly, NIFA's Strategic Goal 1 (Science) to combat "childhood obesity by ensuring the availability of affordable, nutritious food and providing individuals and families science-based nutritional guidance." In service of these objectives, LCHC patients will gain access to free and reduced-price fruits and vegetables that are produced in their own communities, increasing their purchase and consumption. To engender healthy eating habits, the project will teach LCHC clinicians how to incorporate nutrition education into their practices and to channel patients with diet-related illnesses to WCH produce and nutrition education--exemplifying the direct-to-consumer approach preferred by the USDA. Through the WCH student-delivered food preparation and nutrition education demonstrations, both LCHC patients and low-income participants in WCH training programs--including 100 youth from communities with high rates of childhood obesity--will increase their knowledge of healthy eating habits and food preparation.In addition to improving health behaviors, these programs address the socioeconomic ills that impact health in the underserved North Lawndale community. WCH empowers Youth Farm and Corps participants through job training and individualized goal-setting. These activities have proven impacts on the trainees that reverberate deeply in the community. Despite significant barriers to employment faced by the formerly incarcerated and other hard-to-employ adults, the Corps transitional jobs program is successful in reducing recidivism and maintains a 65% job placement rate. Youth Farm also has a strong track record of success; each year, 100% of the program's seniors graduate high school and at least 90% go on to attend college. These figures are especially powerful when compared to the Chicago Public Schools' average rates of 66% and 29%, respectively.The sum of these activities respond to the USDA's interest in developing and testing an innovative model of how healthcare providers and farmers can work together to strengthen individual communities by producing a replicable, scalable, and sustainable project.
Project Methods
The synergistic effect of the planned activities--carried out using the following methods--will advance the project's overarching goal to help participants make lasting improvements to their dietary habits by achieving the following objectives.1) Increase the purchase and consumption of fresh, locally produced fruits and vegetablesLCHC physicians will write prescriptions for free produce boxes, targeting patients based on health status and/or self-reported dietary habits. Patients will be eligible for the program if they have the following illnesses, which the World Health Organization indicates can be managed in part through a healthy diet: obesity, diabetes, cardiovascular disease, multiple forms of cancer, osteoporosis, and dental disease. Physicians may prescribe "refills" to further encourage patients to build healthy eating habits over the long term. Toward that same purpose, each prescription produce box will contain $15 in coupons for free fruits and vegetables to be redeemed at the food hub healthy corner store or at WCH's North Lawndale farmers' market. Program participants, as well as all other SNAP beneficiaries in the North Lawndale community, will be able to receive a 50% discount on the purchase of fruits and vegetables made using the Illinois Link card at the healthy corner store and North Lawndale community market. Windy City Harvest staff will promote the market throughout the neighborhood through fliers, announcements at community centers, and by word-of-mouth.2) Educate LCHC physicians and clients about the health benefits of a plant-rich dietNutrition education will begin with sessions delivered directly to physicians that provide them with tools to discuss nutrition with their patients and advise them about the produce prescription program and other avenues to obtain fresh, healthy food in the neighborhood. In turn, LCHC physicians will integrate nutrition education into their practice, with emphasis on choosing fruits and vegetables in contrast to highly processed and fast foods so abundantly available in this food desert community. Patients with a prescription will receive a free produce box equipped with simple, culturally appropriate recipes that match the ingredients provided. Additionally, WCH staff, along with Youth Farm and Corps participants, will teach nutrition and food preparation sessions within the food hub twice weekly. The facilities provided by the food hub are central to these activities--kitchen for cooking demonstrations, space for nutrition education workshops and other community education initiatives, refrigeration for produce, and the healthy corner store to serve the greater North Lawndale community. The site is located on the main thoroughfare of Ogden Avenue and is immediately adjacent to multiple bus stops and a subway station and a commuter train, station within walking distance, easing potential barriers to access for those without access to a vehicle.3) Train participants in WCH education programsParticipants in WCH Youth Farm and Corps will learning to deliver nutrition education sessions. These individuals will be empowered as a resource in their communities--an aspect particularly critical when engaging justice-involved participants--and also acquire dietary knowledge that is reinforced through the teaching process. Participants and their families will also gain access to produce through the program through donations/reduced-price purchases at the healthy corner store.4. Advance ReplicabilityThe Food as Medicine project will model best practices for a partnership between farmers and healthcare providers designed to improve dietary habits and health outcomes in the service population. The program elements, tailored to a low-income, urban community, make the Food as Medicine project stand out among programs of similar capacity and goals. These elements will be continually evaluated and refined, and project results will be shared with the USDA and independent evaluator. The project director will also share the program model through a broad network of contacts in agricultural, economic development, museum, and environmental institutions.5. Evaluation PracticesA process analysis, to be shared with the independent evaluator, will use a variety of tools to evaluate the impact and success of the Food as Medicine project in relation to the intended results and measurements. WCH staff will document the process, challenges, and success of implementation and operation quarterly, making adjustments to the program as needed. This evaluation builds on previous experience administering and evaluating the impact of nutrition education programs on WCH training program participants as well as a successful partnership distributing produce boxes and food preparation demonstrations to WIC program participants.LCHC patient education programs will be tracked through attendance and post-program surveys related to dietary habits. The surveys will include self-assessment questions (e.g., "I know how to plan and cook a meal using fresh vegetables") with responses along a five-point scale ranging from "strongly agree" to "strongly disagree." Additionally, WCH will track the number of prescription produce boxes delivered to SNAP beneficiaries, percentage of produce coupons redeemed, and number and amount of discounted produce purchases made with the Illinois Link card. The effectiveness of physician training will be evaluated through attendance, clients referred, prescription redemptions at the farm site, and medical staff feedback on a simple post-program survey.As in previous years, WCH training components will track application and enrollment numbers, attendance, completion rates, and other metrics. Youth Farm pre- and post-program surveys track improvement in healthy habits, knowledge of agricultural practices, and employability. Corps staff conducts screening surveys, develop individualized employment plans, track job performance, and track job placement and retention data through 180 days.

Progress 05/01/16 to 12/31/17

Target Audience:Over the past two growing seasons, the Chicago Horticultural Society's urban agriculture division, known as Windy City Harvest, conducted a "VeggieRx" prescription produce program. VeggieRx exclusively served SNAP (Supplemental Nutrition Assistance Program) clients with nutrition education sessions and distributions of free produce. The program targeted SNAP clients who either had a diagnosed diet-related condition or an identified risk for developing one. Patients were identified by clinicians at the Lawndale Christian Health Center (LCHC) and channeled into the program. Over the course of the program, 437 individuals directly participated in the program, far exceeding the goal of engaging 240 individuals. Services reached an estimated 1,346 individuals (including 804 children) who were members of participants' households (based on reported average household size and composition). The program also reached healthcare providers, with 23 referring patients into the program in Year 1 and 64 referring patients in Year 2, again exceeding the proposed goal of 30 providers. In Year 1, the program served 175 unique participants; 66% were African American, 29% Hispanic, and the remaining 5% were either Caucasian, Native American, Asian, or multi-racial. The number of Hispanic participants was low relative to LCHC's service population, which is 55% Hispanic, and measures were implemented in Year 2 to increase participation among that group (see "changes/problems" for details). In Year 2, the program served 262 unique individuals and succeeded in increasing Hispanic representation. Participants identified as 59% African American and 36% Hispanic, with the remaining group composition similar to Year 1. In both years, females were overrepresented at 78% of the service population, with the remaining 22% identifying as male. This disparity aligns with research demonstrating that men are less likely to seek health assistance than women, but providers will nonetheless focus on increasing male participation in future years of the program. All participants were considered low-income based on their eligibility for SNAP; each direct participant's SNAP status was verified by performing a "balance check" on their Illinois LINK card at each box distribution. Two WCH programs--Youth Farm and Corps--respectively engaged 241 and 51 individuals across both years of the grant. Ninety-five percent of youth participants identified as people of color; 40% are male and 60% female, and 75% are low-income. Demographic information collected from Corps participants indicates that 78% are African American, 5% Hispanic, 9% Caucasian, and the other 8% from other backgrounds; 94% were male and 6% female. All Corps participants were ex-offenders, 31% were under age 25 and not in school or employed, 29% had not completed high school or earned a GED, and 4% were military veterans. Changes/Problems:As previously reported, the most significant challenge was the delayed opening of the Farm on Ogden. The facility (now complete and ramping up operations) was set to host VeggieRx delivery and year-round sales of fresh produce at its indoor farmers' market. VeggieRx was relocated to The Gallery, a space owned by LCHC just one block from the clinic. Produce sales continued at the weekly North Lawndale community market, hosted by LCHC. Though not as convenient as a year-round market, SNAP participation at the community market was still robust, with participants taking home an estimated 2,583 pounds (3,690 servings) of produce at the discounted rate or in exchange for VeggieRx coupons. The only other significant change, also reported last year, was the change in nutrition education delivery. Staff originally planned to have the FINI project intern deliver the sessions with assistance from Windy City Harvest trainees. However, the opportunity to collaborate with the Chicago Partnership for Health Promotion at no cost was appealing, with their considerable experience delivering SNAP-Education programs. Windy City Harvest plans to continue this partnership for expanded VeggieRx delivery at LCHC in 2018. What opportunities for training and professional development has the project provided?The project has provided professional development for Windy City Harvest and LCHC. Windy City Harvest staff advanced their knowledge of planning crops for a community health initiative, as well as knowledge of partnering with a healthcare provider to improve food access to patients. Several dietetic students, including the Year 1 project coordinator and Youth Farm dietetic interns, learned how to communicate about nutrition to low-income youth and adult audiences. LCHC clinicians benefitted from the integration of holistic health interventions into their practice. How have the results been disseminated to communities of interest?Dissemination occurred through multiple channels and reached a broad audience. Neighborhood residents, community leaders, Windy City Harvest donors, and other program stakeholders participated in farm tours and presentations, where they learned about Windy City Harvest's mission to improve community health through food access interventions like VeggieRx. These activities reached a total audience of 8,600 across both years. Additionally, articles in the Garden's Keep Growing member magazine, LCHC's annual report, and the Chicago Tribune communicated the program to the public. Windy City Harvest and LCHC staff communicated the program through their professional networks, discussing VeggieRx with their respective boards, as well as the staff of universities, healthcare institutions, local health departments, local food stakeholders, and others. Project director Mason also presented the program at the Teaching Kitchen Collaborative, a coalition led by the Culinary Institute of America and the Harvard University School of Public Health that is intended to advance holistic health using cooking as a basis for behavior change. The project generated significant interest among local health systems, including Loyola University Health System, which ultimately led to a successful FINI Project proposal to expand VeggieRx to LUHS clinics and hospitals, as well as expanding delivery within LCHC clinics. Planning for the project is underway and the grant project will launch in May as scheduled. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

What was accomplished under these goals? In April 2017, staff interviewed and hired Truly Gannon for the part-time project coordinator position. Gannon replaced Amanda Kritt, who accepted a full-time position with the Illinois Hunger Coalition. Gannon has the advantage of also holding a part-time dietician position at LCHC and proved quite helpful at promoting the program to her fellow healthcare providers during internal staff meetings. Prior to the program's launch, she worked with Windy City Harvest, LCHC, and the Chicago Partnership for Health Promotion (the nutrition education provider) to incorporate clinician and patient feedback from the previous year into the program model. The second season of VeggieRx launched on June 7, 2017 and ran for 25 weeks, concluding on November 21. Over the course of both seasons, VeggieRx was delivered for 45 weeks total. Project activities advanced progress on each of the three project objectives: 1) EDUCATE LCHC PROVIDERS AND CLIENTS ABOUT THE HEALTH BENEFITS OF A PLANT-RICH DIET As in 2016, the FINI project intern organized opportunities to introduce LCHC healthcare providers to the program and to encourage them to incorporate nutrition education into their practice. A breakfast information session held on May 12 engaged 11 providers. Windy City Harvest staff presented about the connection between urban agriculture and health, and a representative from the Chicago Partnership for Health Promotion discussed the nutrition education curriculum. In addition to this, the program was also regularly discussed at medical staff meetings by Gannon and by LCHC's Chief Clinical Officer of Operations, Wayne Detmer, M.D. Gannon also sent VeggieRx updates to LCHC's medical staff at least bi-weekly, often featuring success stories and participant feedback to encourage further buy-in. This additional support greatly increased provider participation, with 64 providers (compared to 23 the previous year) offering 583 referrals into the program in 2017. Flyers in both English and Spanish were posted throughout the clinic, encouraging patients to talk about the program with their healthcare provider. In all, 262 unique patients attended at least one 30-minute nutrition education session in 2017. Sessions covered one of five topics (sodium, fat, fiber, nutrition labels, and sugar) were delivered by dieticians and trained peer educators with the Chicago Partnership for Health Promotion, a SNAP-Education provider. Produce boxes were provided to participants at the end of each session. The nutrition education component succeeded in making food preparation accessible to participants; exit survey data indicates that the share of participants who reported they "don't know how to cook" fell from 22.7% to 12.31%. Participants rated the classes highly, counting them as the second most helpful aspect of the program, with the distributions of free produce rated most helpful. As a result of the courses, individuals intended to change their behavior, with 92% agreeing with the statement "I plan to change my eating habits based on the information I learned today." 2) INCREASE THE PURCHASE AND CONSUMPTION OF FRESH, LOCALLY PRODUCED FRUITS AND VEGETABLES Over the course of both seasons, the VeggieRx program provided 1,098 boxes of produce, exceeding the program's goal of distributing 900 boxes. an estimated 11,583 pounds (16,547 servings) of fresh, locally grown produce to SNAP clients, falling just shy of the 13,020 pounds proposed. Participants exchanged $6,030 in coupons (37% redemption rate) for free fruits and vegetables at Windy City Harvest's North Lawndale community market. Windy City Harvest offered a 50% discount on fresh fruits and vegetables at the North Lawndale community market; the number of customers was smaller than anticipated at 89 (see "changes/problems"). All of the produce was grown by participants in Windy City Harvest's training programs, including at the North Lawndale Youth Farm a mere two blocks from LCHC. Overall, the VeggieRx program was well-received by participants. The program addressed common concerns expressed by participants, including the price and local availability of fresh produce. On the exit survey, which was completed by participants in five or more VeggieRx sessions, the total share of participants who reported eating three or more servings of vegetables per day jumped by 38%, and the vast majority (79%) consumed more than half of the produce received. An indication of its cultural appropriateness, the produce in the box was highly rated (above 4 on a 5-point scale) for overall enjoyment, familiarity, and ease of preparation. Participants were also invited to share subjective feedback on their experience. Several participants reported that they were eating more daily servings of produce because the quality of Windy City Harvest's food was so much higher than the fruits and vegetables available through local retailers. Other common feedback included shocked responses at the amounts of fat, sodium, and/or sugar in common processed foods, which was covered in the nutrition label class and in sessions about the individual nutrients. Other representative comments included: "All of [the information] is useful. I really changed my diet. Thank you for taking the time to teach a better way to eat a meal." "Everything was informative and vegetables are important part of my diet that has been missing because of where I shop and live." "Material was explained in detailed way. Now I know how to prepare a healthy, fiber and full of nutritious veggie plate. I will increase my intake of fiber to improve my glucose levels, promote weight loss and keep my energy." Other comments provided suggestions for future additions to the curriculum. For instance, several participants reported that the shelf life of fresh produce was a limiting factor in their produce consumption. As one participant put it: "I love the demo. I just wish there was a refrigeration or storage demo to for keeping the veggies." 3) TRAIN PARTICIPANTS IN WCH EDUCATION PROGRAMS Across both years, the program engaged 292 participants in the Youth Farm and Corps programs, surpassing the goal of 130. Youth Farm students learned how to manage an urban farm. They planted, tended, and harvested the produce; sold produce at a weekly farm stand; and engaged the community in tours. Students at the North Lawndale Youth Farm supported the program by helping to set up the VeggieRx sessions and by running the weekly farm stand, where they advertised the program and answered customers' questions about the produce. The Corps program engaged 51 individuals in transitional jobs, where they grew, harvested, and packed the produce for the program. Corps members, including some who had never before held a job, learned about common workplace expectations and how to transfer the skills learned on the farm into jobs. They also received referrals to services, including housing, legal, and financial assistance, as well as help applying and interviewing for jobs from Windy City Harvest's licensed social worker. In total, 34 (67%) were placed in jobs. Youth Farm and Corps participants also learned how to improve their diet and health behaviors. Youth Farm students benefitted from a nutrition education curriculum that was woven into daily farm operations and delivered by dietetic interns from the University of Illinois - Chicago's School of Nutrition Education. They learned to set and track their progress toward "Get Healthy Goals," and also benefitted from monthly workshops provided by volunteers from the American Diabetes Association. Participant surveys reveal that 95% of students ate 2-6 daily servings of produce by the end of the program. Corps participants benefitted from a single-day session on nutrition and informal chats with Windy City Harvest staff and peers about health.


    Progress 05/01/16 to 04/30/17

    Target Audience:Through the end of the report period, the Chicago Horticultural Society's Food as Medicine initiative served 725 Supplemental Nutrition Assistance Program (SNAP) clients and their families through a "VeggieRx" prescription produce/nutrition education program and reduced price sales at the North Lawndale community market. Each individual's SNAP enrollment was verified by performing a "balance check" at each free VeggieRx box distribution, as stipulated by USDA FNS. Additionally, 23 healthcare providers at the Lawndale Christian Health Center (LCHC) were engaged in training sessions to support the initiative. In just five months, the VeggieRx program directly served 175 individuals, who shared produce with an average of four family members, bringing the program's overall impact to 700 people. Demographic information collected from the 175 individuals directly served indicates that 66% identify as African American, 29% Hispanic, and the remaining 5% multi-racial, Native American, Asian, or Caucasian. These figures roughly mirror the demographics of the surrounding North Lawndale neighborhood and LCHC's service population. The mean participant age was 44.5 years; 78% were female and 22% male. (Though the disparity aligns with research demonstrating that men are less likely to seek health assistance, LCHC providers are nonetheless working to channel a larger proportion of men into the program.) Reduced price sales to individuals using Illinois LINK cards at the North Lawndale community market reached an additional 25 individuals, which was lower than anticipated due to a delay in the opening of the food hub facility (see "Changes/Problems" for further details). Demographic information was not collected from these individuals. Two WCH programs--Youth Farm and Corps--respectively engaged 103 low-income teens and 26 formerly incarcerated adults. Ninety-six percent of the participating youth identify as people of color, 80% are low income, 59% are female, and 41% are male. Demographics in 2016 showed Corps participants as 88% black, 6% Latino, 3% white, and 3% multi-racial/other. All participants were ex-offenders, approximately 40% were under age 25 and not in school or employed, 25% faced circumstantial barriers to employment (homelessness, substance abuse), 25% had not finished high school or earned a GED, and 3% were veterans. Included in these numbers were two women. Changes/Problems:The most significant challenge was the delayed opening of the Farm on Ogden, which was initially scheduled to open in November 2016. The project was originally conceived as a two-phase process, with the first phase resulting in an open and functional facility on a short timeline. As the project evolved, it became apparent that the majority of components in the two phases were best merged, due to permitting, costs, and logistical concerns. This newly protracted timeline was lengthened further by the need to raise funds for the entire project at once, rather than phase-by-phase. Fundraising was completed in February 2017; construction began this May and is currently underway with an anticipated opening in December 2017. Staff established a workaround plan for project activities that would have taken place there--including VeggieRx delivery, produce sales at the facility's healthy corner store, and year-round aquaponics production--minimizing the impact of this delay. A no-cost extension was requested, extending the project through a second growing season and compensating for the inability to deliver the program through the winter months. Despite the challenge, staff currently anticipates that all deliverables will be achieved, with only the number of healthy corner store purchases lower than anticipated. With the program progressing smoothly, the total number of produce servings (18,600) is likely to be met. VeggieRx delivery was relocated to The Gallery, a community space owned by LCHC that is located one block from the main clinic at 3824 W. Ogden Avenue. Both project staff and patients were pleased with the program delivery in the convenient, light-filled, tidy space. Produce sales continued at the seasonal North Lawndale farm stand, which will run from May through October in both years of the grant. This weekly venue will not reach the number of SNAP customers originally projected to patronize the healthy corner store, which was to be open daily and year-round. However, the improved integration of VeggieRx into LCHC care delivery is educating new audiences about the community market and may increase patronage by SNAP clients. Another change was the delivery of nutrition education sessions. Staff originally planned for the FINI project intern and trained participants in WCH programs to conduct the sessions. WCH had previous experience training Youth Farm students to teach nutrition education and cooking demonstrations for Women, Infants, and Children program participants. However, when the opportunity for a no-cost collaboration with the Chicago Partnership for Health Promotion (CPHP) arose, project staff seized the chance to engage these experienced professionals and trained peer-educators to assist with the project. Tailoring CPHP's effective, research-based curriculum to the VeggieRx program saved WCH staff from "reinventing the wheel." The behavior-change philosophy behind CPHP's work perfectly dovetailed with the VeggieRx mission. Youth Farm students from the North Lawndale site are currently assisting with the daytime VeggieRx sessions by leading a short demonstration at each session. These activities provide valuable community education and public speaking experience for the teens, who deliver the information in a relatable way. What opportunities for training and professional development has the project provided?The Food as Medicine project advanced the professional training of LCHC providers through its emphasis on holistic health. One early career nutritionist (Kritt) gained additional experience in the field of community nutrition education. Though WCH has always maintained an emphasis on health for its trainees, both WCH trainees and staff benefitted from the deepened focus on the topic this year. As indicated by anecdotal and survey data, the trainees (some of whom are enrolled in SNAP themselves) improved their eating habits. Through the planning, administration, and evaluation of the VeggieRx partnership with LCHC, WCH staff gained experience serving a new population--clinic patients with diet-related disease. These activities have garnered the interest of several additional healthcare institutions, opening the door for an expansion of the pilot project (see "dissemination"). How have the results been disseminated to communities of interest?Dissemination reached a broad audience. WCH's primary vehicle for public engagement are farm tours and presentations. These events educated attendees about WCH and VeggieRx, engaging more than 3,700 individuals. The public was also engaged through an article titled "A Prescription for Health in Chicago's North Lawndale," which ran in the winter 2016 edition of the Chicago Horticultural Society's (CHS) member magazine, Keep Growing. The magazine reaches approximately 55,000 member households and other stakeholders. The three-page feature described WCH and LCHC's plans for the food hub facility--now called the Farm on Ogden--and outlined the FINI project's goals and objectives. Communications staff is planning to follow the article with a media release on the program once the pilot is completed. In December 2016, Chicago Tribune included Windy City Harvest the top of its "5 City Farming Efforts to Watch Next Year," citing the VeggieRx program, as well as the enhanced capabilities ushered by the Farm on Ogden. WCH, LCHC, and CHS staff discussed the FINI project's theory of change and progress to-date with relevant professional audiences, including the staff of universities, county health departments, healthcare institutions, food distributors and retailers, and other community partners. WCH shared 2016 evaluation data with the Chicago Partnership for Health Promotion, whose professional staff and peer educators conduct the nutrition education sessions, to assist with their evaluation processes. Already, the project has generated significant interest, resulting in a partnership with the University of Chicago Medical Center. The hospital is hosting a community-supported agriculture program in its lobby for hospital staff and patients. Another potential partner, Loyola University Health System, is exploring the possibility of launching a VeggieRx program. Loyola is currently conducting pilot testing at its healthcare facilities. This strong interest from hospital-based partners provides an expansive new market for WCH and other local farmers, and is a potential basis of a four-year FINI Project proposal. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, staff will continue to deliver the VeggieRx program, community markets, and WCH training programs as proposed. Now in its second year, VeggieRx is proceeding with improvements to the program model suggested after staff analyzed the results of the 2016 pilot. Most significantly, the LCHC and WCH teams revised the FINI project intern position. Truly Gannon, RDN, was hired in May 2017; she holds an existing part-time dietician position at LCHC and splits her time between LCHC and WCH. Gannon's dual role has significantly streamlined VeggieRx delivery and embedded it into LCHC operations. For example, the assistant integrated the produce prescription process into the LCHC electronic medical records system. This level of integration enables patients to schedule VeggieRx classes and produce pickups through their provider, and improves providers' ability to track their patients' participation in the program. The change improves upon the pilot year, which operated with paper prescriptions. To better accommodate patients' diverse schedules, a second VeggieRx pickup time was added; weekly sessions take place from 10 a.m. to noon on Wednesdays, and from 4 to 6 p.m. on Thursdays. Early indications are that offering both a morning and evening session is boosting participation. In just under two months, the 2017 program has provided 214 boxes (1,712 pounds) of produce to LCHC patients (compared to 111 boxes distributed in the same time period last year). Across both years, 51 providers have referred at least one patient into the program.

    What was accomplished under these goals? In May 2016, staff interviewed and hired Amanda Kritt, RDN, to coordinate FINI project activities. Kritt earned her bachelor's degree in nutritional sciences from Cornell University in 2015 and completed a dietetic internship at Loyola University Chicago in 2016. Leveraging her extensive experience with community-based nutrition initiatives, Kritt worked with WCH and LCHC staff to efficiently design the curriculum, educational aids, and protocols and to implement the program. VeggieRx launched on July 14, 2016; the program's combination of nutrition education and produce distribution was delivered weekly through November 22. Once the growing season concluded, project staff compiled and analyzed data and participant feedback and recommended adjustments for the following year (see "changes/problems"). Project activities advanced progress on each of the three project objectives: 1) EDUCATE LCHC PROVIDERS AND CLIENTS ABOUT THE HEALTH BENEFITS OF A PLANT-RICH DIET The FINI project intern worked with LCHC staff to organize an introduction to the VeggieRx program for healthcare providers in June, 2016. The session introduced providers to the goals and objectives of the program and educated them about the need to discuss preventive and holistic health measures with clients. Providers also learned how to refer patients into VeggieRx. On October 4, the intern hosted a provider check-in to gather formal feedback from providers about the program. This feedback and other evaluation data ultimately resulted in the improved process launched in 2017 that fully integrates VeggieRx into LCHC (details in "plans for the next reporting period"). LCHC patients and community members with or at-risk for diet-related disease were recruited into the program by LCHC providers, flyers posted throughout the clinic, and word-of-mouth. The 30-minute nutrition education sessions covered one of five rotating topics--sodium, fat, fiber, nutrition labels, and added sugar--and included a five-minute cooking demonstration using a simple recipe made with seasonal produce. Each session was delivered by healthcare providers and trained peer educators participating in the Chicago Partnership for Health Promotion (see "changes/problems" for details on this new partnership). Produce boxes were distributed at the end of each session and attendees' SNAP enrollment was verified using the method described in "audience served." 2) INCREASE THE PURCHASE AND CONSUMPTION OF FRESH, LOCALLY PRODUCED FRUITS AND VEGETABLES In just five months, the VeggieRx program provided 5,700 pounds (8,144 servings) to SNAP clients. This total included 392 VeggieRx boxes containing 8 pounds of hyper-local fruits and vegetables, and approximately 2,565 pounds of produce distributed in exchange for the $15 coupons included in each box. All produce was grown by students in WCH's suite of urban agriculture training programs (see objective 3) on 12 farm sites in the Chicago area. One farm site, the North Lawndale Youth Farm, is only two blocks from LCHC and is a well-known community asset; several VeggieRx participants expressed delight that the nourishing produce was grown in their own neighborhood. To further encourage local produce consumption among SNAP clients, a 50% discount was offered on fresh fruits and vegetables at the North Lawndale community market. However, given the delay in opening the Farm on Ogden's healthy corner store (see "changes/problems"), the number of customers was small. In total, 25 individuals purchased 248 pounds of produce. Staff believes that figure will rise in the second half of the grant, as improved integration of the VeggieRx program reaches new audiences through the LCHC clinic. The VeggieRx program was very well received. Entrance survey data indicates that VeggieRx was successful in addressing the two most significant barriers to eating vegetables--price (53%) and lack of cooking experience (23%). Accordingly, exit surveys revealed that the box of vegetables and nutrition lesson were perceived to be the most helpful components of the initiative. Data gathered from repeat participants in the program (133 individuals, or 76% of participants) indicate that the majority (79%) consumed more than half of the produce received. The produce in the box was very well rated (above 4 on a 5-point scale) for overall enjoyment, familiarity, and ease of preparation. Qualitative data also indicated participants' satisfaction, particularly with the quality of the produce and the nutrition education sessions. One participant wrote: "I love the program in all aspects. Having a different variety of fresh, local produce offered every week along with coupons inspired me to start cooking again and more consistently. Overall excellent program that was very accessible for me to attend weekly." Another common refrain was that VeggieRx fulfilled a previously unmet need in the community: "This program is amazing. Excellent to connect the community to better food and spread health consciousness." The exit surveys also included a few suggestions for improvement. Two requests were related to the box contents - to include more "conventional" vegetables (e.g., potatoes and peppers that were included in some boxes, but only as available) and fruit. This feedback was incorporated into 2017 crop plans. One comment dealt with accessibility: "Any home delivery available? New mother can't take public transportation with infant." Though delivery is not feasible within the pilot, the comment points to the need to continue expanding access to these valuable services. 3) TRAIN PARTICIPANTS IN WCH EDUCATION PROGRAMS The project engaged 103 predominantly low-income teens of color in urban agriculture-based youth development programs. At four farm sites, students learned all aspects of managing a sustainable urban farm--from growing, tending, and harvesting produce, to marketing weekly farm stands and providing tours. Students gained valuable paid work experience in neighborhoods with soaring rates of youth unemployment and violence. All 17 students at the North Lawndale Youth Farm directly assisted the VeggieRx initiative, helping set up the produce distributions and running the weekly farm stand, where they spread the word about the project, answered questions, and offered free produce in exchange for the $15 VeggieRx coupons. Through this work, Youth Farm students learned about the connection between food access and community health. As one student put it: "[VeggieRx] has changed my interest a bit because not only am I doing something I love, but making the community aware and exposed to good healthy food that they can enjoy." The Corps program addressed social determinants of health by engaging 26 formerly incarcerated individuals in 14-week transitional jobs; trainees grew, harvested, and packed produce for the project. Corps members learned transferable workplace practices, expectations, and sustainable urban agriculture skills. A total of 22 individuals were placed in jobs; 11 retained employment through 90 days. Youth Farm and Corps participants also received nutrition education. A partnership with the American Diabetes Association brought trained educators to the Youth Farm sites, who delivered monthly nutrition education sessions focused on healthy snacking, hydration, and other topics. WCH staff worked with students to set and track progress toward "get healthy goals." Survey data indicate that students' junk food intake declined by 14%, and 94% of students reported eating 1-3 vegetable servings daily by the end of the program. Corps staff held informal nutrition chats with participants, who anecdotally reported improving their diet. In 2017, staff intensified the program's health focus and began collecting formal evaluation data on Corps' participants eating habits. This information will be included in the final report for this project