Planting Seeds for Food Is Medicine: Pre-Implementation Planning Methods and Formative Evaluation Findings From a Multi-Clinic Initiative in the Midwest.

Food is medicine (FIM) initiatives are an emerging strategy for addressing nutrition-related health disparities increasingly endorsed by providers, payers, and policymakers. However, food insecurity screening protocols and oversight of medically-tailored food assistance programs are novel for many healthcare settings. Here, we describe the pre-implementation planning processes used to successfully engage federally-qualified health centers (FQHCs) across Kansas to develop new FIM initiatives. A Kansas-based philanthropic foundation facilitated pre-implementation planning for FQHCs over 17 months across 3 stages: 1) Community inquiry, 2) FIM learning event with invitation for FQHC attendees to request pre-implementation funding, and 3) Pre-implementation planning workshops and application assignments for FQHC grantees to develop a FIM implementation grant proposal. We evaluated satisfaction and perceived utility of these pre-implementation planning activities via post-workshop surveys and qualitative comparisons of FIM design components from pre-implementation and implementation grant applications. All 7 FQHCs attending the learning event applied for and were awarded pre-implementation planning grants; 6 submitted an implementation grant application following workshop completion. FQHCs rated pre-implementation support activities favorably; however, most clinics cited limited staff as a barrier to effective planning. As compared to pre-implementation planning grant proposals, all FQHCs elected to narrow their priority population to people with pre-diabetes or diabetes with better articulation of evidence-based nutrition prescriptions and intervention models in their final program designs. In the midst of a nationwide FIM groundswell, we recommend that funders, clinic stakeholders, and evaluators work together to devise and financially support appropriate pre-implementation planning activities prior to launching new FIM initiatives.

Assessing School Wellness Policies and Identifying Priorities for Action: Results of a Bi-State Evaluation.

BACKGROUND: Obesity is a complex health problem affecting more than one-third of school-aged youth. The increasing obesity rates in Kansas and Missouri has been particularly concerning, with efforts being made to improve student health through the implementation of school wellness policies (SWPs). The primary purpose of this study was to conduct a rigorous assessment of SWPs in the bi-state region. METHODS: SWPs were collected from 46 school districts. The Wellness School Assessment Tool (WellSAT) was used to assess comprehensiveness and strength. Additionally, focus group discussions and an online survey were conducted with school personnel to identify barriers and supports needed. RESULTS: Assessment of the SWPs indicated that most school districts failed to provide strong and specific language. Due to these deficiencies, districts reported lack of enforcement of policies. Several barriers to implementing the policies were reported by school personnel; supports needed for effective implementation were identified. CONCLUSIONS: To promote a healthful school environment, significant improvements are warranted in the strength and comprehensiveness of the SWPs. The focus group discussions provided insight as to where we need to bridge the gap between the current state of policies and the desired beneficial practices to support a healthy school environment.

The Effects of Physical Activity on Learning Behaviors in Elementary School Children: a Randomized Controlled Trial.

Research in education and developmental psychology indicates that behavioral engagement in learning is a critical predictor of children's academic success. In an effort to improve academic achievement, school administrators are continually in search of methods to increase behavioral engagement. Previous research has indicated that classroom-based physical activity (PA) lessons have a positive impact on academic achievement. However, little research has been done in assessing the impact of such interventions on the behavioral engagement of students with learning behavior difficulties. This study assesses the impact of classroom-based PA on teacher-rated classroom behaviors of students with identified learning behavior difficulties. Two schools (one intervention, one control) participating in a larger, cluster-randomized trial provided scores on a teacher-administered classroom behavior scale. This scale was used to collect information on 15 characteristics identified as being essential to behavioral engagement. Participants included male and female students in second and third grade classrooms who were identified by their classroom teacher and school counselor as having difficulties with learning behaviors. Mixed linear modeling for repeated measures was used to examine the changes over time in the classroom behavior scores. The intervention group showed significant improvement over time in classroom behavior while the control group showed no change or a slight degradation over time (i.e., group × time interaction, F[2132] = 4.52, p = 0.01). Schools must meet the diverse needs of students today, including those who exhibit less than optimal learning behaviors. Combined with the evidence that PA is linked to several health and cognitive-behavior benefits, providing classroom-based PA that is incorporated within the curriculum provides common ground for all students to participate. It is a potential solution to increasing behavioral engagement, and in turn stimulating and enhancing learning.