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2012 Model Practice Application (Public)Application Name: 2012 Model Practice Application (Public) : Alameda County Public Health Department : Alameda County-Food to Families Project (A Kresge Foundation grant) Applicant Name: Ms. Jessica C. Luginbuhl Application Title: Alameda County-Food to Families Project (A Kresge Foundation grant) Please enter email addresses you would like your confirmation to be sent to. jessica.luginbuhl@acgov.org Practice Title Alameda County-Food to Families Project (A Kresge Foundation grant) Submitting LHD/Agency/Organization Alameda County Public Health Head of LHD/Agency/Organization Anita Siegel, RN, MPH Street Address 1000 Broadway, Suite 500 Practice Contact Person Jessica C. Luginbuhl Title Program Specialist-Life Course Initiative jessica.luginbuhl@acgov.org Submitting LHD/Agency/Organization Web Address (if applicable) www.acphd.org Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice Alameda County has a population of 1,510,271. Food to Families Initiative (F2F), funded by the Kresge Foundation, began implementation in January 2011 and will end in December 2013. F2F goals are to transform the food landscape and to provide local economic and employment opportunities for young adult residents of West Oakland (WO) and Ashland-Cherryland (A-C). To accomplish this, we will address the community-expressed need for local access to healthy food and employment and economic opportunities for youth. These needs emerged through our community engagement process and are supported by community data. Recognizing that the lack of stores that sell healthy foods is related to the lack of economic opportunities in the communities, Food to Families (F2F) will implement two components that address these needs. The first is Produce Rx, a clinic-based program to provide pregnant women with produce “prescriptions” that connect them with local food access points and produce consumer trainings that assist them to develop food purchase, preparation and storage skills. The second is Team Fresh, a training program to support young adult-led development and implementation of produce supply businesses. In a 2007 WO youth survey, 79% reported that lack of activities for youth was a major concern and 77% reported that the lack of jobs for young people was also a concern (OYM, 2007). In a community-wide survey conducted in 2007, improved and connected youth services and employment continued to be a top priority for changes that residents wanted for their neighborhood (CAPE, 2007). Our innovative model meets two community-expressed needs, while improving community health and increasing access to healthy food. Existing data confirms that WO and A-C are “food deserts”; each are home to around three dozen liquor and corner stores, and they experience some of the highest rates of overweight, obesity, and weight-related chronic disease in the county. Data indicates that over half of adults in Alameda County are overweight or obese, including 46% of adult females (ACPHD, 2010). Recent reviews of medical charts of pregnant women receiving perinatal services in WO and A-C demonstrate that a high proportion of these women are overweight or obese, with subsequent pregnancies contributing to prenatal weight and postnatal weight retention Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. In 2008-2009, Oakland’s school district tied for third highest in the percentage of students that were overweight (36.4%) and the San Lorenzo school district (serving Ashland-Cherryland) was rated seventh (31.4%) (CDE, 2005-2006). A-C has the third highest rates of diabetes and highest rates of all-cause mortality in the county (ACPHD, 2010). Oakland has the fourth highest diabetes rate and the third highest rate of all-cause mortality, countywide (ACPHD, 2010).
F2F will have a long-term, positive impact on community residents’ access to healthy food. Therefore, the F2F Initiative will not only benefit pregnant women receiving clinical care, but will contribute to the health of their families and the community as a whole by creating new resources and fresh food access points.
Major activities include the following: A minimum of 100 pregnant women at each FQHC in WO and A-C will participate in Produce Rx, which includes a produce prescription and a variety of classes (each with a cooking component); Team Fresh in WO and Team Fresh A-C are recruited, trained and supported to lead a sustainable produce supply business; Building Blocks Partner agencies will support the efforts of F2F through submission of mini-grant proposals.
In regard to funding, F2F is receiving $750,000 over 3 years from Kresge Foundation as well as additional in-kind support from ACPHD.
In regard to objectives, we are only in the first year of implementation. The overall objectives are as follows: 1. Pregnant women and their families will report an increase in their weekly consumption of produce2. Pregnant women and their families will have increased access to fresh produce as a result of participating in Produce Rx. 3. At least eight corner stores will become a food access point for residents as a result of Team Fresh. 4. Young adults in West Oakland and Ashland-Cherryland will increase their leadership and job skills by participating in Team Fresh. Greater detail is provided in the evaluation section.
Successes to date include, strong partnerships between community-based organizations and health centers, enhanced interventions based on focus group responses, family members of pregnant women are participating, and the creation of one model that has been adapted to serve two different communities.
Describe the public health issue that this practice addresses. (350 word limit)
One of the goals of the F2F Initiative is to reduce the risk of overweight and obesity among pregnant women receiving perinatal services at FQHCs through transforming the food and economic landscape in WO and A-C.
Overweight and obesity is a significant public health concern in Alameda County, particularly among women of child-bearing age in low-income neighborhoods. Data confirms that WO and A-C experience the highest levels of obesity and overweight and related morbidity and mortality in Alameda County.
Overweight and obesity during pregnancy carries risks for both mother and child, including later-life obesity, chronic pulmonary disease, cancer, depression, drug abuse and mental health problems, and cardiovascular disease (Shonkoff, 2009). A recent study confirms that the greater a woman’s weight gain during pregnancy, the higher the risk that her child will be overweight by age three and there is evidence that this continues into adolescence and adulthood (Murphy Paul, 2010). Addressing overweight and obesity among pregnant women has the potential to improve health in the immediate and long-term.
Health inequities, like chronic disease rates, are a result of conditions of social, economic and political inequality that result in inequitable distribution of the resources that affect individual and population health (ACPHD, 2008). Therefore, a woman’s risk of overweight or obesity, while associated with her health behaviors, is affected by the context in which she lives.
A-C and WO experience high rates of poverty, unemployment, and resource deficient schools, factors that contribute to and perpetuate disparities. In 2006, in WO over 50% and in A-C 47% of mothers were receiving Medi-Cal, a recognized indicator of poverty. Residents of A-C experience unemployment rates that are persistently higher than that of the county. Only 73% of Ashland residents and 67% of Cherryland residents have a high-school diploma or higher, compared to 86% for the county (ACS, 2006-2008).
As a result of inequities, WO and A-C lack access to healthy food and experience persistent economic underdevelopment, factors related to higher rates of overweight and obesity. A cycle of persistent neighborhood poverty and lack of economic development have resulted in WO and A-C becoming “food deserts.” What process was used to determine the relevancy of the public health issue to the community? (350 word limit) The planning process for Food to Families Initiative (F2F) brought together individuals and organizations that understand the needs of our target neighborhoods and who currently participate in community-based health and social change movements. To ensure that a broad base of voices and perspectives were included at each stage of planning, we received input and guidance from residents in various settings and collaborated with community representatives who work directly with the residents in WO and A-C. Community residents included participants in neighborhood programs, such as youth in the Deputy Sheriff’s Activities League (DSAL) and community health workers in the Improving Pregnancy Outcomes Program, as well as members of civic engagement groups, such as the West Oakland Resident Action Council and the A-C Eden Area Livability Initiative. Also, many of our Building Blocks Collaborative (BBC) partners work in public agencies and community-based organizations in WO and A-C and are community residents themselves. These diverse BBC partners were involved throughout the entire planning and community engagement process and provided valuable insights. In addition, the Alameda County Public Health Department (ACPHD) employs a Resident Advisor from WO who has been an active member of the BBC and F2F planning team, and provided guidance on resident outreach.
Development of our model was informed by meetings with these individuals and organizations and by summaries from recent community surveys and meetings. By consulting multiple sources of expressed community voice, we were able to identify the lack of access to healthy food and lack of youth employment and economic opportunities as the most notable health-related concerns among residents.
Meetings with community residents and representatives then focused on how F2F could address both of these community-expressed needs. After each of these meetings, our planning team analyzed the predominant themes from these conversations, making adjustment to our model prior to meeting with the next group. The result is a model that addresses expressed community need, builds upon existing community initiatives and momentum, and utilizes BBC partner strengths and assets.
How does the practice address the issue? Recognizing that the lack of stores that sell healthy foods is related to the obesity and overweight and the lack of economic opportunities in the communities, F2F will implement two components that address these needs. The first is Produce Rx, a clinic-based program to provide pregnant women with produce “prescriptions” that connect them with local food access points and produce consumer trainings that assist them to develop food purchase, preparation and storage skills. The second is Team Fresh, a training program to support young adult-led development and implementation of produce supply businesses. In a 2007 WO youth survey, 79% reported that lack of activities for youth was a major concern and 77% reported that the lack of jobs for young people was also a concern (OYM, 2007). In a community-wide survey conducted in 2007, improved and connected youth services and employment continued to be a top priority for changes that residents wanted for their neighborhood (CAPE, 2007). This innovative model meets two community-expressed needs, while improving community health and increasing access to healthy food. Is the practice new to the field of public health? If so, answer the following questions. Yes What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. Our application was accepted by the Kresge Foundation because of its focus on health equity and the innovative partnerships between unique stakeholders. F2F innovative is the coupling of environmental, community-level intervention with a behavioral, individual-level intervention in order to successfully improve the health status of a community. Our partners include Mandela Marketplace, Deputy Sheriffs’ Activities League, West Oakland Health Council and Tiburcio Vasquez Health Center. Mandela MarketPlace is a community leadership incubator that provides civic engagement and economic opportunity to low-income residents and minority farmers. They are a pioneer in development, application and assessment of community food systems. Most recently, their Healthy Neighborhood Stores Alliance has begun piloting youth-led food enterprises in West Oakland. The Executive Director, Dana Harvey, was named a 2010 Robert Wood Johnson Foundation Community Health Leader. The Alameda County Deputy Sheriff’s Activities League (DSAL) provides recreational and leadership opportunities for at-risk youth in Ashland-Cherryland, and oversees Dig Deep Farms and Produce, a project to build a sustainable local food economy while also creating entrepreneurial opportunities for youth. Tiburcio Vasquez Health Center and West Oakland Health Council are both Federally Qualified Health Centers (FQHC) and regional leaders in integrated and holistic community health services. How does this practice differ from other approaches used to address the public health issue? F2F expands on both food access intervention models and nutrition education best practices. Currently, nutrition education is part of clinical care for pregnant women in California. Communities in San Francisco, Boston, Baltimore, Los Angeles, and Honolulu (Hoffman et al., 2009; Gittelsohn et al., 2009; Gittelsohn et al., 2010; Azuma et al. 2010) are model programs for efforts to encourage corner stores to sell healthy foods. What makes F2F innovative is the coupling of environmental, community-level intervention with a behavioral, individual-level intervention in order to successfully improve the health status of a community. Furthermore, it will accomplish this by increasing leadership and employment opportunities for young adult community residents through creating fresh produce access points. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?
What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. How does this practice differ from other approaches used to address the public health issue? Who were the primary stakeholders in the practice? Members of the Alameda County Building Blocks Collaborative, Mandela Marketplace, Deputy Sherriffs’ Activities League, West Oakland Health Council and Tiburcio Vasquez Health Center, Alameda County Public Health Department What is the LHD's role in this practice? F2F is led by the Alameda County Public Health Department as part of our county-wide collaborative effort, the Building Blocks Collaborative (BBC). Convened by ACPHD, BBC is a partnership of multi-sector community and governmental organizations. As a collaborative made up of diverse stakeholders, we bring a wide range of expertise and perspectives to the F2F Initiative. The BBC has been in existence since September 2009 and meets monthly to cultivate learning and dialogue around health inequities and plan for continued collaborative action. We recognize that multiple sectors – healthcare, community, physical and economic environment, and education – influence health across the life course.
The ACPHD is a national leader in promoting health equity through community-based programs and policy advocacy, in partnership with community residents and organizations. Our F2F core partners, who are members of BBC, are well poised to work on increasing pregnant women’s access to healthy food. They bring expertise in peri-natal services, community development, local food systems, entrepreneurship and youth employment training, and community organizing. What is the role of stakeholders/partners in the planning and implementation of the practice? The grant was created collaboratively. Four core partners (described above) were integral in the creation of the grant and are implementing F2F. ACPHD employs two staff, namely a project manager and evaluator, to ensure that implementation is progressing, to provide technical assistance to partners, and to evaluate process and outcome indicators. Progress of F2F is reported on at the monthly BBC meeting and to the BBC steering committee. As ACPHD is responsible to the Kresge Foundation on the outcome of the grant, the Director of ACPHD has the ultimate authority to approve or disapprove changes to the grant. What does the LHD do to foster collaboration with community shareholders? Describe the relationship(s) and how it furthers the practice's goals. ACPHD is the convener of both the BBC (described above) and the four F2F partners. ACPHD co-created a project that builds directly on existing community momentum focused on food justice, and youth and local economic development. Describe lessons learned and barriers to developing collaborations There have been some unanticipated collaborative challenges throughout the first year. It took longer than expected to fully roll-out F2F, partially due to the difficulties in collaborating with multiple partners in different neighborhoods. Different levels of the four organization’s leadership were involved in the actual grant creation, not necessarily those that are now implementing the grant. That said, it took time for all the partners to have a mutual understanding of the grant and deliverables. Moreover, the partners in West Oakland and Ashland-Cherryland had not worked together previously and it took time to create trust and to allow them space and time to fully embrace all aspects of the grant. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
The primary outcome objectives for F2F are as follows:
1. Pregnant women and their families will report an increase in their weekly consumption of produce as a result of having increased access to fresh produce
2. Pregnant women and their families will have increased access to fresh produce as a result of participating in Produce Rx.
3. At least eight corner stores will become a food access point for residents as a result of Team Fresh.
4. Young adults in West Oakland and Ashland-Cherryland will increase their leadership and job skills by participating in Team Fresh. • Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Data sources for the evaluation include: focus groups, pre post tests at trainings, first and third trimester Comprehensive Perinatal Services Program (CPSP) nutritional assessments, chart reviews, retrospective youth surveys, neighborhood and store assessments, a matrix to monitor coupon redemption, matrices to monitor on the job training for youth, outreach, training logs, and attendance sheets.
Preliminary Results:
The sites began enrolling pregnant women in August. Tiburcio Vasquez has enrolled 16 women and West Oakland has enrolled 22 women. The women who are enrolled have unofficially reported at trainings that they are experiencing an increase in access and consumption as a result of the Produce Rx coupons as well as the produce consumption classes. In addition, West Oakland Health Council and Mandela Marketplace conducted focus groups with their patients to determine what types of classes to offer. They are offering a myriad of classes including cooking, physical activity, parenting, stress relief and have several local outings planned.
As of now, three corner stores are enrolled and a fourth has been approached in West Oakland. Mandela Marketplace has done several store assessments in order to choose appropriate corner stores to participate. In Ashland-Cherryland, DSAL and DDFP are expanding their reach with a Community Supported Agriculture (CSA) box program, rather than using the corner store model. Presently, DDFP are delivering boxes to 16 pregnant women and their families. They are also making steps to establish local fruit and vegetable stands in several locations and to obtain more land to increase their production of fruits and vegetables. In addition, DSAL and DDFP conducted a community survey to assess community desires and needs regarding fresh produce and are incorporating that into their business plan.
Team Fresh West Oakland and Ashland-Cherryland are currently working with approximately 20 youth, and are increasing their leadership and job skills. In Ashland-Cherryland the farm manager worked diligently to build a strong work ethic among Team Fresh. They developed an employee handbook to clarify roles and responsibilities and the Team shows increasing evidence of personal and professional growth and development. The youth show up on time and work hard. Two youth team members, Dominick and Tommie, have earned raises and increased responsibility due to demonstrated leadership in farming, packing, and entrepreneurship. In West Oakland several Team members have become team leads in order to have increased ability and authority to implement their ideas on how to improve their relationships with the corner stores. In addition, one team member, Jamelah, has taken on the role of chief marketer and has done an exceptional job.
We are also currently collecting data on other common outcomes objectives of the four sites and will be conducting focus groups and qualitative interviews in the coming months.
1. Pregnant women and their families will report an increase in their weekly consumption of produce as a result of having increased access to fresh produce
a. # of pregnant women enrolled in F2F
b. # of pregnant women attending food consumption and preparation courses
c. # of pregnant women that show an increase in knowledge of preparation of fresh fruits and vegetables
d. # of pregnant women that show an increase in knowledge of how to store fruits and vegetables
Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. 2. Pregnant women and their families will have increased access to fresh produce as a result of participating in Produce Rx.
a. # of pregnant women who purchase fresh produce with coupons
b. # of pregnant women who receive boxes with their coupons
c. # of pregnant women who consume fresh produce
Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: 4.Young adults in West Oakland and Ashland-Cherryland will increase their leadership and job skills by participating in Team Fresh.
• # Youth hired in West Oakland
• # Youth hired in Ashland/Cherryland
• # Bi-weekly trainings to develop job, leadership, and business development skills
• # Health trainings
• # Food systems trainings
• # Community development trainings
• # Food assessment guides distributed
• # Food assessment outreach trainings
Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? Activity A: A minimum of 100 pregnant women at each FQHC in WO and A-C will participate in Produce Rx.
Development of Produce Rx:
A.1 Year 1, F2F core partners will collaborate to develop materials and clinical protocols for Produce Rx, which will include a) produce consumer trainings; b) a produce “prescription”, a list of recommended seasonal produce, an easy-to-cook recipe, and a food access resource guide (e.g. corner stores, farmers markets, etc.); and c) the pilot produce coupon program.
Produce Rx Implementation:
YEARS 1-3:
A.2 100 pregnant women will receive a produce “prescription” at each trimester visit during their nutrition assessment.
A.3 60 women will be randomly selected to participate in the pilot produce coupon program.
A.4 100 pregnant women will attend at least one of the bi-monthly produce consumer trainings offered at WIC sites on topics such as shopping for produce on a budget, cooking fast, health meals, or storage of fresh produce.
Produce Rx Evaluation:
A.5 Staff at FQHCs in WO and A-C will conduct nutrition assessments with each pregnant woman during their trimester visits.
A.6 The produce-purchases of the 60 women receiving produce coupons will be tracked during the course of their pregnancy using a coupon tracking system
Activity B: Team Fresh in WO and Team Fresh A-C are recruited, trained and supported to lead a sustainable produce supply business.
Leadership, job and business skills development:
B.1 Year 1-3, Team Fresh in both neighborhoods will receive ongoing, bi-weekly training to develop job, leadership, and business development skills.
Planning, preparation and assessment:
B.1 Year 1, ten young adults ages 16-25 in each neighborhood will be identified to become part of a Team Fresh WO or Team Fresh A-C.
B.2 Year 1, Team Fresh will receive training about health, sustainable food systems, community development, and other topics.
B.3 Year 1, Team Fresh will work in conjunction with the FQHCs to develop and distribute the food resource guide for the Produce Rx.
B.4 Year 1, Team Fresh will conduct a business assessment in their local areas in preparation to enhance local corner stores through their produce supply business.
What was the timeframe for carrying out these tasks? Specific Tasks continued (from above):
B.5 By the end of Year 1, Team Fresh WO will establish and brand their produce supply business model and create a toolkit for replication.
Business development and sustainability:
B.6 Year 1-3, Team Fresh WO will provide technical assistance to Team Fresh A-C in developing and implementing their business model.
Produce supply business activities:
B.7 In WO, Year 1, two corner stores will be identified, trained, and supported to sell fresh produce, with additional stores added in Years 2 and 3.
B.8 In A-C, Year 2, two corner stores will be identified, trained and supported to sell fresh produce, with additional stores added in Year 3.
B.9 Years 1-3, Team Fresh in both neighborhoods will conduct and document weekly delivery, stocking, rotation, and inventory in participating corner stores.
B.10 Years 1-3, participating corner stores in each neighborhood will receive and sell weekly orders of fresh produce for a minimum of a full year.
B.11 Years 1-3, Team Fresh will conduct monthly marketing and outreach activities to increase awareness of the healthy food network and promote produce sales, including produce consumer training sessions and promotional events.
Activity C: Building Blocks Partner agencies will support the efforts of F2F
C.1 Years 1-3, BBC partners will be invited to submit mini-grant proposals for activities to support the F2F Initiative.
Time frame:
The grant itself is for three years. F2F partners have one-year long individualized scopes of work to carry out their specific tasks (listed above).
Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. This project is funded by the Kresge Foundation until December 2013. We have, however, had nascent sustainability discussions. Our partners have noted they have learned to leverage resources between each other’s organizations. For example, CBO partners have gained knowledge on how health centers can access community resources and vice versa. They have stated that this knowledge will have a lasting impact beyond this project. Moreover, F2F has provided an opportunity to build trust between local institutions (CBOs and health centers) in order to build upon existing community assets and social capital. These elements will last beyond the project. Also, F2F as a whole builds on partners’ existing strengths such as community trust and existing project momentum in the food justice and youth development arenas, which points toward sustainability.
Describe plans to sustain the practice over time and leverage resources. The results of F2F will be used to inform county-wide efforts to improve the health of women, children and families. In addition, we are sharing the results of our model with other communities that seek strategies to increase access to healthy food through the Kresge Foundation online learning-community. Moreover, since this is the first BBC demonstration project we continue to share process results of the F2F demonstration project with BBC, which will inform future work of BBC. In addition, they will be shared widely with the community through our website and blog. Through presentations to colleagues in the region and at national conferences, we plan to share our experiences and provide support to other communities working on similar projects. (We have begun sharing the project by presenting at UC-Berkeley and the City MatCH conference). The vast opportunities to share our work will aid F2F to gain local and nation recognition and ideally gain continued funding. Moreover, the CBOs and health centers have forged strong relationships with each other and have pledged to continue working together as much as possible. Practice Category Choice 1: Health Disparities Practice Category Choice 1, Part 2: Maternal and Child Health (Teen pregnancy, Mother to Child transmission of HIV and AIDS) Practice Category Choice 2: Community Involvement Practice Category Choice 2, Part 2: Maternal and Child Health (Teen pregnancy, Mother to Child transmission of HIV and AIDS) Practice Category Choice 3: Access to and/or Equality of Care Practice Category Choice 3, Part 2 Organizational Practices Other (please specify): NACCHO-MCH Site Visit |
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