Program Planning Community Nutrition Assessment 2005 Program Planning

Program Planning: Community Nutrition Assessment 2005

Program Planning Basics • Systematic process • Continual feedback and evaluation • Cyclical: based on increasing understandings of the true nature of the situation and the effectiveness of interventions. • Starts with an assessment of the current situation

Process Evaluation & Adjustment Assessment Prioritize Analyze problem and propose model to address Develop Intervention goals, objectives, implementation plan Outcome evaluation

Why Do Assessment?

Community Nutrition Assessment: • Anchors program/intervention in the reality of the community • Essential part of ongoing process: – Needs assessment – Designing and implementing services – Evaluation – Improving programs and services • Includes community and stakeholders as fully active participants

Community Nutrition Assessment: • Based on assets more than deficits • Helps to integrate nutrition programs into community-based health programs and plans

Successful Community Assessment Includes: • Understanding current conditions of families and individuals • Evaluating local capacities for supporting health and nutrition needs • Building community support for implementing changes

Models and Protocols for Community Assessment • Planned Approaches to Community Health (PATCH) – CDC • Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO (National Association of County Health Officials) • Moving to the Future: Developing Community Based Nutrition Services – ASTPHND (Association of State and Territorial Public Health Nutrition Directors)

Strategic Planning for Initiatives to Address Local Health Efforts • • Community Assessment Organize a community planning group Define community boundaries Gather information – Statistical profile – Qualitative data – Community Resources Agency for Health Care Policy and Research

Strategic Planning, cont. • Analyze Information – Common issues – High risk individuals – Unmet needs – Prioritize • Develop and implement community health plan • Monitor and evaluate community health plan

Steps to Assessment • • Convene a planning group Define community Identify Community Assets Identify Perceived Needs Build Demographic Profile Analyze Community Health Status Analyze Community Nutrition Status Identify Community Resources and Service Utilization • Identify common issues and unmet needs • Prioritize

Community Nutrition Planning Group: Responsibilities • • • Collect data and information Identify health needs and gaps in service Set priorities Develop a plan Help to implement interventions Assist in evaluation – Of assessment, planning, and intervention process – Of impact of intervention

Community Nutrition Planning Group: Potential Members • • Community leaders Consumers Health and Nutrition Service providers Health organizations Schools Political office holders or their staff Fitness professionals Representatives from greater community health planning groups

Define the Parameters • Public Health Nutrition: Assuring conditions in which people can be nutritionally healthy • Community: “A community is any group sharing something in common” Community Tool Box

Community Description • • • Geographic boundaries General history Key people and leaders Demographics Financial & economic information Important issues Morale and involvement levels Key allies and rivals Unspoken rules and norms Attitudes and opinions Strengths and shortcomings

Identify Community Assets • • Physical structure, place, business Concerned citizens History of successful efforts Organizations Individual and group skills Communications systems Relationships

Identify Perceived Needs • WHY? – To understand public opinion – To become aware of needs the planning group doesn’t know about – To gather support & expand group expertise – To make decisions about priorities – To plan programs in ways that will be acceptable to stakeholders

How do we assess perceived needs? • • Listening sessions Public forums Key informant interviews Needs assessment survey or survey of concerns

Demographic Profile • Economic status: income, employment, % below poverty • Education levels • Age and gender • Race & ethnicity • Social factors: homelessness, immigration status, family composition, TANF utilization

Community Health Status • • • Causes of Mortality Hospital discharge data Disease prevalence data Food bourne illness reports Years of potential life lost Infant mortality

Community Nutritional Status • Pregnancy related: – weight gain in pregnancy – Pre-pregnancy weight – Anemia • Disease prevalence: HIV/AIDS, cardiovascular disease, diabetes • Activity levels (BRFSS) • Food intake: fat, fruits & vegetables (BRFSS) • Dental health • Food/dieting related behaviors (YRBS) • Food Security (BRFSS)

Community Resources & Service Utilization • What resources are available? • To what extent are people using them? • Sources of Information: – Citizens – Service providers • Tools – Existing data – Interviews – Surveys

Examples of Community Nutrition Resources • Food assistance programs (WIC, Basic Food, etc. ) • Grocery stores with high quality produce • Food Service with health promoting food options • Educational programs • Media • Profession and non-profit organizations • Nutrition counseling

Criteria for defining/prioritizing community problems • • • Frequency Duration Scope or range Severity Perceptions Root causes (“but why? ”) & ability to impact root causes (effectiveness of interventions) • Barriers to resolutions • Political and financial support

Group Work: Roles • Assign roles within a breakout group: – Mayor who has lead the charge for a comprehensive strategic plan for economic development that includes recreation and attracting active retirees. – County Health Officer: a family practice MD who is a strong advocate for breastfeeding – Bicycle Alliance member – Anti hunger and farmers market advocate – School administrator – Nutritionist from the local health department

Group Work: Develop Problem List • Brainstorm nutrition & physical activity related issues & problems that arise from these data • Choose 5 issues that are of interest to all stakeholders • Prioritize these issues using criteria in these slides • Establish the one issue or problem that all stakeholders will be comfortable working on for the next two weeks

Community Inventory Moses Lake Factors that affect nutrition and physical activity choices June - August 2002

Moses Lake • • Agricultural community Recreation destination Population: 14, 953 in 2000 census Unemployment rate: 8. 5% (2001) 2, 246 cases of food assistance ( MRDA, Oct 2001 ) 33% population increase from 1990 -2000 Workforce: primarily agriculture; Increasing food processing and industrial manufacturing base • 48% school children eligible for free or reduced lunch

Ethnic Distribution White 77% African American 2% Other 21% Hispanic 25%

Interviews with Nutrition and Physical Activity Professionals

Top Health Concerns • • • Obesity Poor nutrition Diabetes Smoking Unplanned pregnancy Poor medical “compliance” among minorities

Perceived Barriers to Accessing Healthy Food and Physical Activity • Healthy food • • Lack of education Lack of recognition/concern for food choices Cultural attitudes TIME- easier to access fast/junk food • PA • • • Lack of awareness/perceived need Difficult to get people interested/time factors Poverty/poor nutrition Language issues Decreased emphasis on PE in school

Readiness for Change and Level of Interest • Level of interest: medium-high interest • Awareness: strongly represented in need to educate through schools, starting early • Infrastructure- Moses Lake/Grant County have strong community health programs • Perceived readiness to change- medium to high • Community level exposure- festivals and summer recreation- based activities may reach large numbers

Solutions/Priorities for Change • Increase nutrition and PE curriculum requirements • Increase staffing to implement programming, especially In schools and existing food programs • Increase access for all members of community through “riverwalks”, lengthier bike paths, schools indoor walking programs (inclement weather) • Promote active lifestyles for families; “Free exercise” • Coordinate community resources to “make healthy lifestyle changes happen” (= coalition-building!) • Promote positive media campaigns

Interviews with Community Leaders

Is obesity a problem? • 5/10 reported that it was a visible problem – Not perceived as unique to ML – Due to sedentary lifestyle and fast foods – Concern because see in children in schools

Perceived Levels of Physical Activity • 9/10 believe that lack of physical activity is a problem in Moses Lake – Don’t see people exercising (but I do) – Fairly active community – Poor community & people don’t know that there are free opportunities for recreation here – There is a general lack of facilities in rural towns in general – Same as nation as a whole

Perceived Problems due to Poor Diet • 9/10 thing that poor diet is a problem in Moses Lake – Heavy use of fast foods (5) – Rushed lifestyle (3) – Poverty – People don’t know how to cook

Awareness of Nutrition and Physical Activity Programs in Community • 7/10 were aware of some – Private health clubs and weight loss programs – Hospital classes – School classes – City Parks and Recreation, skate park, pool, skating rink – Programs for Seniors

Community Inventory Goals • Assess factors which affect nutrition & physical activity choices in Moses Lake • Assist AC members to determine what project(s) are appropriate for the community

Healthy Communities, Healthy Living Planning Document Based on State Plan for Nutrition and Physical Activity • Enhanced opportunities for recreation & physical education • Increased access to healthy foods • Assurance that transportation, urban planning, & public safety systems support active lifestyles

Key Community Documents • City of Moses Lake: Planning Commission Recommended Comprehensive Plan • Parks, Recreation, & Open Space Plan • Community Streets & Utility Standards • Municipal Code for Major Subdivisions • “Just Data” Grant County Health District Community Assessment Data • Draft VISION 2020 Strategic Plan • A Description of Grant County: Population -The Changing Face of Grant County -August 2001

Community Resources • • • Police Department: http: //www. moses-lake. com/police/ Parks and Recreation: http: //www. mlrec. com/ School district: http: //www. moseslakeschools. org/ Chamber of Commerce: http: //www. moseslakechamber. org/ Moses Lake Information: http: //www. moses-lake. com/ Grant County Economic Development Council: http: //www. grantedc. com/ Samaritan Healthcare: http: //www. samaritanhealthcare. com/ Moses Lake Community Health: http: //www. mlchc. org/ Moses Lake Clinic: http: //www. wvclinic. com/locations/MLC. asp Port of Moses Lake: http: //www. portofmoseslake. com/ Columbia Basin Herald: http: //www. columbiabasinherald. com/ Aging and Adult Care of Central Washington: http: //www. aaccw. org

CI Committee Members • • • Anne Henning Becky Meyer Bev Shuford Brenda Teals Caren Jacobson Dave Helms Debe Nuss Diana Mc. Kinsey Emily Dufault Fernando Alvarez Jane Kim • • • Judi Ellis Laure Grammer Lori Barlow Lori Moholt Mary Falconer Mary Talcott Ryan Hopkins Spencer Grigg Teri Carpentier Tracy Fisher Tim Varney

Methods Community Action Info / Training Development Pre-work Recruitment Sample audit • Walkability • Map of physical environment • Non-section specific research

Methods Community Action Info / Training Development Pre-work Sample audit Recruitment • Sample audit presented at 1 st AC meeting • Call for volunteers to assist in finishing the section -specific audit • Follow-up recruitment post 1 st AC meeting via phone / email

Methods Community Action Info / Training Development Pre-work Sample audit Recruitment • • Forms and instructions for assessment Segmentation of ML Technology for summarizing results Information and training

Methods Community Action Info / Training Development Pre-work Sample audit Recruitment • • Roll call Segmentation of ML Process overview ‘Size’ of task

• Sections • Data collection • Continued follow-up / cheerleading by email • Trouble-shooting • Evaluation Methods Community Action Info / Training Development Pre-work Sample audit Recruitment

1. Recreation & physical education

1. Recreation & physical education Schools • School district has a written policy requiring P. E. K-12 • P. E. per week – Elementary: 60 minutes – Middle: 250 minutes – High school: 450 minutes • School district has started to implement the Health & Fitness EALRs

1. Recreation & physical education Facilities • Community Schools serves to interface with the public regarding public use of buildings, community improvement classes, & schoolrelated volunteer activities • All school with indoor rec facilities are available based on priority areas: – 1 st: School activities – 2 nd: Parks ‘n Rec – 3 rd: Other programs • All schools with outdoor rec facilities available to

1. Recreation & physical education Programming • • • • Organized athletics Aquatic Center Cal Ripken Yoga City of Moses Lake Walking Program Walk Across Washington Spring Festival Kayaking Kickboxing Karate Thai Chi Special Olympics Physical activity & strengthening Dancing Parks & Recreation Facilities The Learning Center Moses Lake – City Hall Moses Lake Parks & Recreation Facilities Marital Arts Academy Parks & Recreation Facilities Hospital Senior Center Parks & Recreation Facilities

2. Access to healthy foods

2. Access to healthy foods Breastfeeding • Samaritan Hospital is not considered a ‘Baby Friendly Hospital’ by BFHI standards supported by WHO / UNICEF • ML does not have an official ‘Breastfeeding Friendly’ program for workplaces & business, but. . . – – Moses Lake Clinic Community Health Hospital ASMI • Mothers breastfeeding in ML – Early postpartum 90% – At 2 months 50% – At 6 months 20%

2. Access to healthy foods Farmers market & CSA • Columbia Basin Farmers Market – Saturday AM – mid-June through late October – Wednesday PM – mid-July through mid. September • ML & Grant County farmers represented • 1 farmer sells apples & resells oranges to MLSD • 5 -A-Day message promoted • Food bank receives inkind donations from local processing plants & houses the

2. Access to healthy foods Food Security • Poverty status in Grant County, 1999 – 13% of families – 17% of individuals • Food assistance – Food Bank – Free & reduced breakfast & lunch – WIC – Congregate & home-delivered meals

2. Access to healthy foods Food Security: Seniors June Meals Congrega 1142 te Home 1194 delivered July Seniors Meals Seniors 251 1088 237 58 1215 55 60+ population for county was 11, 220

2. Access to healthy foods Food Security: Schools Free Reduced Enrollme nt % receiving ES 1398 369 3072 57. 5% MS 618 186 1525 52. 7% HS 511 167 1798 37. 7% TOTAL 2527 722 6395 50. 8% 1998 -2001 Grant county 50. 7%; WA State 31. 2%

2. Access to healthy foods Schools: Lunchline * ES no food vending, but Fruitopia; no a la carte

2. Access to healthy foods Schools: Lunchline How congruent are breakfast & lunch programs with Dietary Guidelines for Americans? n Scale: ‘ 1 not well at all’ Rating ES 4. 4 n n MS HS 3. 3 3. 5 n n to ‘ 5 extremely well’ 50% of ES had 5’s! Possible association with low SES 5 star salad bar Nutrition education

2. Access to healthy foods Grocery stores & markets Fruits / veggies? Frank’s Market Grocery Outlet Safeway Super 1 Quality Health Bike promotion facilities 2. 5 (18) 2. 0 (25) 1. 6 (26) Quality scale: “ 1 = poor”; “ 2=good”; “ 3=excellent”

2. Access to healthy foods Eating establishments Number Fast food Sit-down Both ‘Healthy’ label? Average # Bike healthy facilities options 14 5 5. 1 1 13 2 11. 3 0 5 0 7. 4 0 Healthful food and beverage options include low-fat, low-calorie, nutrient-

2. Access to healthy foods Convenience stores 11 stores assessed n 9. 7 healthful food options n 1 store with bicycle facilities n 9 stores n 2 stores n 1 store n ‘ 1 -25’ car parking ‘ 101+’ car parking ‘ 26 -50’ car parking Healthful food and beverage options include low-fat, low-calorie, nutrient-

2. Access to healthy foods Programming • • Diabetes class WIC / MSS Breastfeeding class Food Assistance Hospital Community Health Moses Lake Clinic • • Congregate meals Home delivered meals Weight loss Extension Family Nutrition Education Program (EFNEP) Food Bank / Community Services of Moses Lake Home and Community Services Offices Senior Center TOPS WSU Cooperative Extension Civic Center

3. Infrastructure & built environment

3. Infrastructure & built environm Zoning, permitting, & land use Incorporated land = 6843 acres; Unincorporated land = 13, 361 acres Land use / zoning maps available in the Comp Plan

3. Infrastructure & built environm Land use: housing distribution n Coding encouraging activity-friendly and mixed-use communities are encourages in the City of Moses Lake: Comprehensive Plan

3. Infrastructure & built environm Public works supporting PA • Miles of street: 267 miles • Miles of street with sidewalk on at least 1 side: 97 miles • Proportion of streets with sidewalk on at least 1 side: 36. 3% • Miles of bikepath, separated from roadway 1. 9 miles • Miles of shared path (bikeped) available: 8 -foot: 1. 7 miles 10 -foot: 23. 5 miles Sidewalks of all widths, except for those in the central business district, are available for bikeped transportation

3. Infrastructure & built environment Walkability • • 27 walks taken 16 sections Individual scales ‘ 1 awful’ to ‘ 6 excellent’ Overall scale 26 -30 Celebrate! 21 -25 Celebrate a little. . . 16 -20 Okay, but needs work. 11 -15 Needs a lot of work Crossin Drivers Safety 5 -10 Call out the NG. . . Sidewal ks gs Averag 3. 7 e Score 4. 0 4. 1 rules Pleasan Overall t 4. 1 3. 9 19. 7

3. Infrastructure & built environment Walkability • Sidewalks • Street crossings • Traffic & driver behavior • Safety • Appeal • Overall 26 -30 score Celebrate! • Scale 21 -25 Celebrate a little. . . 16 -20 Okay, but needs work. 11 -15 Needs a lot of work

3. Infrastructure & built environment Walkability • Sidewalks • Street crossings • Traffic & driver behavior • Safety • Appeal • Overall 26 -30 score Celebrate! • Scale 21 -25 Celebrate a little. . . 16 -20 Okay, but needs work. 11 -15 Needs a lot of work

3. Infrastructure & built environment Bikeability • • 23 rides taken 14 sections Individual scales ‘ 1 awful’ to ‘ 6 excellent’ Overall scale 26 -30 Celebrate! Safety Averag 3. 3 e Score 21 -25 Pretty good. . 16 -20 Okay, but not ideal. 11 -15 Poor – call the mayor! 5 -10 Oh dear. . . Surface Inter. Section s Drivers Ease Overall 4. 1 4. 0 19. 3 3. 9

3. Infrastructure & built environment Bikeability • • Safety Surface Intersections Drivers Ease Overall score Scale 26 -30 Celebrate! 21 -25 Pretty good. . 16 -20 Okay, but not ideal. 11 -15 Poor – call the mayor! 5 -10 Oh dear. . .

3. Infrastructure & built environment Bikeability • • Safety Surface Intersections Drivers Ease Overall score Scale 26 -30 Celebrate! 21 -25 Pretty good. . 16 -20 Okay, but not ideal. 11 -15 Poor – call the mayor! 5 -10 Oh dear. . .

3. Infrastructure & built environment Schools & walk / bikeability Schools # students % 1 mile Basin homes Longview 524 36% % walk / bike 15% Larson base North Larson hts CC 322 377 60% 85% 40% 65% Bike facilities 252 23% 4% 86 3% 8% 661 10% Moses Lake end of the year enrollment: 6395 No schools in New fire station, Gillete park, or Cascade valley sections Guffin eccles Discover Midway Frontier

3. Infrastructure & built environment Schools & walk / bikeability Schools # students % 1 mile Knolls vista 369 62% % walk / bike 45% Garden hts HS 461 1672 48% 5% 20% 2% Bike facilities Moses Lake end of the year enrollment: 6395 No schools in Pelican pt, Montlake park, or Westlake sections

3. Infrastructure & built environment Parks & walk / bikeability Parks Bike facilities - Parking Larson base - - - Fire station - - - Gillete park Gillete Cascade valley Cascade ’ 76 -100’ Guffin eccles Mc. Cosh Carl T. Ahlers ‘ 101+’ Basin homes - -

3. Infrastructure & built environment Parks & walk / bikeability Parks Bike facilities - Parking Pelican pt - Knolls vista ‘ 1 -25’ Montlake park Montlake ’ 26 -50’ Garden hts - Westlake ML Community - - ‘ 101+’

3. Infrastructure & built environment Pedestrian / bike safety 2001 Pedestrian Bicycle Collisions 6 5 Injury 1 None 2 Possible 2 Evident 1 Disabling 1 None 2 Possible 2 Evident Vehicle type 5 pickup or panel 4 pickup or panel 1 Lrg truck Violation 5 Driver only 3 Driver only 1 Ped only 2 Ped only Block watch program within city limits – 66 areas are involved. Community oriented policing in county.