Award of Excellence - 2015

The 2015 Nutrition Education for the Public Award of Excellence has been awarded to Maggie Meehan, MA, MPH, RDN for her program, Well Seasoned. This program contributes to both New York City and City Harvest’s goals of helping low-income seniors attain self-sufficiency and living independently. The program works to increase participant awareness of how they think about food, food purchasing, budgeting and exercise to reinforce pursuit of a healthy lifestyle and aging in place.

Maggie Meehan, MA, MPH, RDN

 

Background

For more than 30 years, City Harvest, Inc. (www.cityharvest.org) has been working to alleviate hunger in New York City. As the world’s first food rescue organization, City Harvest has rescued over 500 million pounds of food throughout the five boroughs of New York City since its founding. New York City residents above the age of 65 constitute, perhaps, the most vulnerable of the populations City Harvest serves. They utilize soup kitchens and food pantries, but, as a whole, underutilize these services, just as they underutilize SNAP. Most cannot work anymore. In many cases, they are coping with physical problems  nd have to fend for themselves using continually-dwindling resources—money they need to stretch to last an unpredictable amount of time. Well Seasoned is designed to educate seniors about nutrition, cooking, physical activity, and financial management to decrease their vulnerability to food insecurity, while promoting social integration and a wide range of other services aligned to their needs.

Supporting these observations, in a study of hunger among the elderly in New York City conducted by CSCS (now LiveOn: www.cscs-ny.org), 40% of respondents reported that “the food they bought didn’t last and they didn’t have money to buy more.” The quality of their diet was also limited, as 37% said they sometimes or often “could not afford to eat balanced meals.” Approximately 32% of seniors eligible for food stamps actually receive them. And, those who do receive food stamps report that they are used up, generally, 2.6 weeks into each month. Program development focused on designated senior centers in New York City Housing Authority (NYCHA) complexes. Since finalization of program development in 2012, we continue to provide Well Seasoned at some of these sites as well as other senior centers and CBOs in City Harvest’s neighborhoods of focus.

 

Assessment of Need

Well Seasoned contributes to both the City’s and City Harvest’s goals of helping low-income seniors attain self-sufficiency and continue to live independently. The program works to increase participant awareness of how they think about food, food purchasing, budgeting, and exercise to reinforce pursuit of a healthy lifestyle and continue aging.

Many of the participants in our adult nutrition and cooking classes are seniors. However, the course we were offering when development of Well Seasoned began was targeted to adults of all ages. It had become clear seniors would benefit from a curriculum addressing their different nutritional and psychological needs. Similarly, the financial management curriculum we then offered was designed for younger people since seniors’ financial circumstances are very different. Finally, much that had been learned from our disease-specific cooking clubs, including the positive impact of hands-on socialization activities, would be incorporated into the seniors’ course.

The senior centers targeted during program development were located in neighborhoods, such as the South Bronx, where high poverty rates and other stressors make healthy eating an essential need but a secondary concern. As a result, these communities, including the elderly, have high rates of diabetes, heart disease,  hypertension, and nutrition-related illnesses. Obesity has also been on the rise among seniors. According to New York City’s Department of Health and Mental Hygiene, low-income   communities, such as the Bushwick and Bedford-Stuyvesant neighborhoods of Brooklyn, experience higher rates of obesity (34%) among those 65 and older than among seniors in New York City overall (25%).

 

Project Outline

Well Seasoned was developed over a four-year period with the first three years supported in part by a HUD grant, and final development and expansion occurring in the 4th year as described below.

Year 1 (2008-2009): Offered 12 courses in six senior centers, serving approximately 180 seniors. Activities included focus groups, evaluation tool design, training of volunteers about special needs of seniors and to implement curriculum, pilot curriculum, development of self-run cooking clubs, and assessment of pilot.

Year 2 (2009-2010): Re-evaluated and further refined the curriculum, provided 18 courses at the original six sites and four new sites, serving 270 seniors. Activities included additional focus groups, update and implementation of revised curriculum, continued cooking clubs, refinement of evaluation tools and assessment of success.

Year 3 (2010-2011): Completed the New York City Housing Authority (NYCHA)-based program development, with two courses serving 30 seniors. Activities included final review of the curriculum, train the trainer protocol and training sessions, finalization of evaluation tools, and final evaluation of pilot.

Year 4 (2010-2012): Prepared curriculum manuscript for publication and wider use. Activities included final editing and formatting of curriculum, final review of Spanish translation, and implementation beyond original pilot sites.

 

Course Structure and Content

Well Seasoned is an eight-week program that meets for two hours each week, providing hands-on culinary skills practice, in-depth nutrition education, finance and budgeting activities, and physical activities designed to support activities of daily living. Sessions are led by a chef, a nutrition educator, and a class manager. Seniors’ specific nutrition topics include managing side effects of medications and eating for one. Discussion is rooted in participants’ life experience. For example, the week focusing on managing side effects of medications begins with recollection of foods eaten when sick as a child.

 

Evaluation

With oversight from the program manager, an evaluation consultant developed, tested, and revised instruments for assessing the impact of the project. Focus groups and participant surveys served as the primary tools. Focus groups were held with staff and members of each of the ten senior centers prior to

the start of classes to ascertain the nutrition needs and medical issues of the seniors in those communities as well as reliability of the survey questions. Surveys were administered at the beginning and end of each eight-session series to assess the impact of the program on participants’ nutrition, meal

preparation, and budgetary practices. The surveys gathered information on how often the participant prepares his/her own meals, how often he/she runs out of money for food, the kinds of meals he/she prepares, and whether proper safety measures are being used, among other data.

 

Results

Data from the 104 seniors included in the Year 3 analysis indicate participants made changes in all five of the target behavior areas: buying healthy foods, cooking healthy meals, eating healthy foods, maintaining a budget, and being more physically active. Additionally, our evaluation indicates that the program impacts specific sub-groups of participants differently.

Data analysis for six sub-groups indicate positive, though different, changes for each. Some highlights:

• Seniors participating in the course with a goal setting component experienced significant changes in budgeting for and cooking healthy foods and reported shopping more often at farmer’s markets

• Seniors new to Well Seasoned showed positive changes related to budgeting and shopping as well as to where they access food

• Seniors who lived with one or more people were more likely to cook healthfully than those who lived alone

• Male participants showed improvement in cooking healthfully

• Seniors with hypertension showed significant behavior change related to cooking healthy food

• Spanish-reading seniors reported improved eating and physical activity behaviors

Our most recent annual evaluation (pre- and post-survey for each course implemented) indicates an increase from 62% to 73% of participants who agree with the statement, “I almost always/ most of the time eat two cups of fruit a day.” There was also an increase from 65% to 77% of participants who

agree with the statement, “I almost always/most of the time eat two or more cups of vegetables a day.”

 

Sustainability

Since the completion of program development, City Harvest continues to provide Well Seasoned at senior centers and CBOs in our neighborhoods of focus. Over the last several years, the program has been implemented in partnership with the Together on Diabetes initiative, which focuses on seniors with diabetes living in the Washington Heights/Inwood section of Manhattan.

In addition, City Harvest has developed a Memorandum of Understanding and in-depth implementation guidelines so that organizations beyond the scope of our neighborhoods of focus—within and beyond the boundaries of New York City—can deliver Well Seasoned to their clients and constituents. The complete set of materials is available for download once the Memorandum of Understanding has been signed.