An OPCA Health Equity Committee Interview
As the holiday season approaches, our thoughts turn to the traditions of gathering, sharing stories, and breaking bread with loved ones. Food is not only a source of nourishment but also a means of connection and community. However, it’s essential to remember that not everyone has equal access to this fundamental need.
In the spirit of addressing these challenges, we turn our attention to the roots of the Federally Qualified Health Center (FQHC) movement, which originally aimed to provide essential items, including food, to underserved communities. Today, FQHCs continue to play a crucial role in ensuring food access and promoting health equity in our communities.
This month, we had the privilege of interviewing Juliet Bates and Sylvia Ness, from Multnomah County Community Health Center, to gain insights into how their organization is providing and sustaining vital food access services within their community.
‘Tis the season of potlucks and gatherings, If you were hosting a community potluck, what dish would you bring, and why?
Juliet: Collard Greens, over the years my family has all learned to love eating collards. This is a traditional Southern dish that my mother-in-law would always prepare and when she grew older and lost interest in the kitchen, this was the most missed dish. Many of our CSA participants have seen it in their share and are unclear on how to prepare. I have learned to perfect her recipe and have shared it with others who have also implemented it into their holiday meal traditions.
Sylvia: A hearty winter soup with celeriac and potatoes. I love celebrating what’s in season and what I’m getting in my CSA that week drives what I cook! Soup always feels like a community dish and it’s so fun to gather together around the steaming pot.
Tell us a bit more about yourself and your journey to working in healthcare and with your FQHC?
Juliet: I am a first generation LatinX-American and a first generation American, child of non-English speaking parents. I served as their CHW without knowing that that was the role I took on. We navigated the community together and I learned at a young age that there was a great need for our community members to get support in navigating a complicated medical system.
I have been working at Multnomah County Health for 15 years. I started as an Office Assistant, Though I wholeheartedly enjoyed my role as an Office Assistant. My calling is to support the underserved. With a gentle nudge from my colleague Doris who was always encouraging me to join the tem. I finally left the role that I so loved applied for a CHW position.In 2018, I transitioned into the Community Health Worker role at the Rockwood Health Center. Shortly after starting my new role I learned about the Community Supported Agriculture Program that we were involved in. I instantly knew that this was important work. I adapted the concept of fresh produce/food as medicine.
Sylvia: I served in the Peace Corps in Niger, West Africa and worked in supply chain management for family planning and other health commodities in African and Asian countries for several years after. I’ve been working in the interface between public health/health promotion and clinical care at Multnomah County for over 12 years now. I currently work with our Community Health Worker team; it’s such a privilege to work alongside this team to bring health promoting factors into our medical model to assist clients on their journey to achieve their health goals.
What specific programs or initiatives does your FQHC have in place to address food insecurity and improve food access for your patients and community members?
Our hallmark program is CSA Partnerships for Health (CSAP4H) which is situated in our Community Health Worker program at our Health Center (made up of 8 FQHCs). Through the partnership we are able to get clients with certain health plans (Care Oregon, Trillium, OHSU) access to a weekly CSA share in the summer and winter seasons, paid for by their health plan. Uninsured clients can also participate. Some other ways we address food insecurity are:
- facilitating grocery Store tours to help our clients learn to stretch their dollars when shopping on a budget
- in the past we’ve had vouchers for farmer’s markets to share with clients at some of our FQHC sites
- connecting clients to our SNAP outreach program, who assist them with completing the SNAP application
- providing clients with a list of local food pantries and/or deliver a food box to the clients home
- educating client about doubling their SNAP benefits at Farmers Markets
- refering clients that are eligible to Meals on Wheels
Why is it important for your organization to prioritize this?
Our providers/the care team recommend “eating healthy”, incorporating vegetables into their diets, limiting salt intake, etc. but for some clients what is available in the community near where they live in their price range is a barrier. Lots of grocery stores don’t have affordable produce, most food pantries don’t have fresh produce. In food deserts or areas where people have to travel far to get fresh produce, grocery stores often have higher prices, further limiting purchasing power.
Our health centers are not just places where clients come when they are sick. We’re their medical home, people trust us with themselves and their families’ medical care. It’s also a place where they come to address their whole health, including their social needs such as inadequate access to food or many other barriers that might impede them on their journey to health.
Food truly is medicine, both preventative and curative. We formed and continue to engage in this partnership because we can make a difference for our patients and our community through partnerships centering on food justice. Here our some of CSAP4H’s guiding principles:
What you eat shouldn’t be determined by your income, where you live, or the color of your skin. Community Supported Agriculture (CSA) Partnerships for Health provides a creative, engaging solution to improve food access and reduce disease by turning community health centers into vibrant neighborhood spaces that distribute food from local farms. Patients get a CSA ‘share’ delivered to them each week to pick up fresh vegetables, taste healthy recipes, learn new ways to prepare produce, and build support networks that lead to improved health outcomes and a higher quality of life. The program supports individual health, the prosperity of our local food system, and works with insurers to provide coverage for fresh fruits and vegetables. Project partners are unified by a commitment to addressing the root causes of food access and disease.
Some things I’d emphasize about this intervention is that it is not only clients we reach but their entire family, however they define that. For instance, in 2023 we have 300 clients enrolled; it is estimated that we will reach 1,200 individuals, benefiting the whole family. Also, this is a deep intervention; it can meaningfully change dietary behavior towards healthy eating, incorporating many different vegetables throughout the week and influencing overall positive dietary change, making it not just a food-insecurity intervention (which may provide food but not necessarily healthy food) but also one that we’ve shown through our annual evaluations, demonstrably changes diet related behaviors. Based on these changes clients say they have more positive health outcomes for themselves and their families.
In what ways do you engage with patients and community members to gather feedback and involve them in shaping your food access initiatives?
Our CSAP4H partnership and our CHW team strive to be client/patient centered and meet each of our clients where they are. To obtain information about how we can best serve them, we have held focus groups, administered patient surveys and regularly use motivational interviewing in our conversations with our clients. We’ve also worked with clients to get their testimonials and stories to better understand what motivates them to participate.
Our CHW team- who run this program on the health center side- engage with clients frequently and each exchange is an opportunity to learn more about what’s going well for that client and what barriers they may be facing. All of this information feeds into program improvement.
Example: This season we asked clients if they would prefer to pick up their share at one of our sites or get it delivered to their home. We know clients already have a lot of barriers to accessing this produce; our interest is in making it as accessible as possible, while still engaging them in the program.
How do you collaborate with local organizations, such as food banks or community gardens, to support your efforts in addressing food insecurity?
In order to sustain this work, which we’ve been engaged in since 2014, several partners formed CSAP4H, a broad coalition of farms, community organizations, and health care providers working to bridge the food system and health system. Current partners include our health plans (Care Oregon, OHSU, Trillium), Multnomah County Health Centers, Richmond Family Health Center, OHSU/PSU Evaluation Team, CSAP4H Program Management staff at Zenger Farm and our farmers: Full Cellar, Full Plate (Winter Farm), Happiness Farms, Lomita Farms, Zenger. Each one of these partners brings expertise we don’t have and is essential to the success of this partnership.
What recommendations do you have for other FQHCs, or healthcare organizations looking to improve their food access services and promote health equity in their communities?
Look to the organizations who are already well poised to partner in this work. Don’t try to do it all yourselves. Bring in your public health department or others focusing on health promotion or holistic health solutions. Who is doing this work in your community?
We started out with grant funding. As our evaluations provided compelling evidence, we were able to partner with our local health plans to fund clients they insure to participate in this program. Engaging with health plans (insurance) to partner on payment has been a huge success and a more sustainable strategy than grant funding (although non health plan funding will continue to be necessary for uninsured clients). It may take a while to get health plan funding in place but it’s been so worth it!
Come up with goals and desired outcomes for your food insecurity work. Although we believe this deep level of intervention is what needs to happen for meaningful behavior change, this is not a lightly resourced intervention. It takes a lot of FTE, funding and planning to pull off. Also, consider having roles to specifically coordinate and champion the work and a team to take ownership. For us, we have a CSA Lead to coordinate the program across our 7 participating FQHCs and a Program Supervisor at the leadership level to champion the work. None of this work would happen without our CHW team to engage in program planning and implementation, recruit and play their vital role in ongoing interaction and support to their clients.
Lastly, for fellow FQHC staff or health system partners who are committed to addressing food insecurity and advancing health equity in their communities, what would you encourage them to do start and expand their efforts?
Consider looking beyond food insecurity solely and whether a dietary/behavior change approach will be helpful in your setting. What do your clients want and need?
From an equity perspective, use your client or community level data to better understand which communities are disproportionately diagnosed with certain health conditions or may face additional challenges and barriers. Work with clients from those communities to inform your interventions. We know that our BIPOC communities have less access to healthy foods and we’ve been very intentional about not only recruiting clients from these communities but also recruiting farmers who represent these communities, rooting our solutions around food and social justice.
Relevant resources for FQHCs: