Cooley Dickinson: Community-owned goals for addressing food access

By creating an environment in which people who experienced food insecurity and professionals working to address food access were on equal ground, a committee finds innovative solutions.

• A long-standing relationship between Cooley Dickinson Health Care and Healthy Hampshire, a community-based initiative, led to their collaboration in a food access assessment effort.
• The innovative engagement approach for the Food Access Advisory Committee, designed by Healthy Hampshire and supported by Cooley Dickinson, ensured community residents, who are affected by food access issues, could actively participate in the committee.
• The process led to the development of an action plan, featuring “shared, community-owned goals, to address food access in their community.”

The challenge

Located in the Pioneer Valley region of Western Massachusetts, Cooley Dickinson Health Care serves a mix of urban and rural communities. Its broad service area stands out for including a major university (with a student population of nearly 30,000) and multiple smaller colleges, as well as being a region of significant agricultural production.

Sixty percent of the population served by Cooley Dickinson lives in Amherst, Easthampton, and Northampton, all located in Hampshire County. Racial and ethnic diversity varies across the service area. Approximately 15 percent of the residents in Cooley Dickinson’s service area live in poverty.

Understanding food access needs and opportunities

Cooley Dickinson’s 2016 Community Health Needs Assessment (CHNA) process identified four broad categories of health needs and specific community level needs. Under social and economic determinants of health, food insecurity and inadequate access to healthy food were identified as one of the social, economic, and community-level health needs. High rates of obesity, cardiovascular disease, and diabetes were identified as a priority health need, a continuation from the previous CHNA in 2013.

While Cooley Dickinson was in the midst of the 2016 CHNA process, Healthy Hampshire, a program of a core community partner called the Collaborative for Educational Services, initiated work on a countywide food access assessment to better understand the impact of limited food access on community residents. Cooley Dickinson became involved in the Food Access Advisory Committee, convened as part of Healthy Hampshire’s effort, to support an innovative approach for developing an action plan focused on food access and to inform the implementation strategy emerging from its most recent CHNA.

The solution

The Food Access Advisory Committee (FAAC), convened by Healthy Hampshire, sought to gain in-depth community input to better understand food access issues in Hampshire County and to inform actionable solutions to address those issues. Cooley Dickinson‘s participation was motivated by the alignment of the work with its mission and goals and a confluence of events. Underlying the collaboration is also a history of partnership and mutual support between the hospital and Healthy Hampshire staff and its parent organization, the Collaborative for Educational Services.

A recent Centers for Disease Control and Prevention grant — called State and Local Public Health Actions to Prevent Obesity, Diabetes and Heart Disease and Stroke and known as 1422 grant — to the Massachusetts Department of Public Health supported further partnership between Healthy Hampshire and Cooley Dickinson. This funding aimed to improve the healthfulness of food served at the hospital and to make community-clinical linkages to promote population health measures related to healthy eating and to bolster work being done through Mass in Motion, a statewide initiative that helps communities develop chronic disease prevention strategies, with focused support for healthy eating and active living initiatives. The area served by Healthy Hampshire and Cooley Dickinson includes multiple Mass in Motion communities.

Healthy Hampshire’s food access assessment emerged as a means to delve deeper into food access issues influencing community health and to generate ideas that Cooley Dickinson could support through its Community Health Improvement Plan. The assessment included a combination of surveys, on-site store assessments, and focus groups and interviews.

After completing the initial assessment, Healthy Hampshire convened the FAAC to gather community partners and stakeholders to review the data and to generate shared actions for addressing food access issues. Specifically, project managers sought to gain diverse perspectives on the issue of food access, based on the unique values and experiences of participants.

They further sought to create a process that gave residents who experience food access issues an equal voice in shaping the strategies that resulted from the effort. The process they employed has roots in Collaborating for Equity and Justice Principles that focus on “explicitly address[ing] issues of social and economic injustice and structural racism.” They also used the Dimensions of Success framework from the Interaction Institute for Social Change. Cooley Dickinson valued this approach, recognizing that the residents could play a significant role in helping to achieve sustainable change.

“An important part of the process was hearing all the voices – if you meet with people separately, you might not be aware of commonalities – that piece is really important”
–Food Access Advisory Committee participant 

The committee met a total of five times over the course of five months and produced a list of priority action areas. A sub-group, known as Food Access Organizing Group, which consisted of the eight residents experiencing food insecurity, met an additional five times outside of the main committee.

These group meetings allowed for additional discussion of food access issues and advocacy roles and supported leadership development among the residents. Structuring the process in this way aimed to:

• Create a comfortable space in which residents could talk openly about their food access issues;
• Give dedicated attention to residents’ concerns and ensure they were relayed to the full group, thereby deepening the shared understanding of food access issues in Hampshire County;
• Dedicate time to educating residents on food systems planning and concepts; and
• Help facilitators build trust with residents and for residents to build trust and common bonds among themselves.

The committee devised a list of more than 40 action items. The list reflected new ideas put forth by FAAC members as well as recommendations from existing resources including the Massachusetts Local Food Action Plan and the Pioneer Valley Planning Commission’s toolkit on food access. Facilitators distilled this list down, with input from group discussions, to a list of 17 priority actions.

The action items generated by the FAAC effort are considered “shared, community-owned goals.” Certain actions on the list are already being carried out by Healthy Hampshire while others, such as creating a mobile market, have been added to its work plan. Cooley Dickinson is also using the actions to shape implementation strategies to address food access and insecurity, as called out in its 2016 CHNA. Among the interventions that Cooley Dickinson anticipates supporting is the mobile market, though the planning for that effort is still in its early stages.

The results

Program evaluation and impacts

Healthy Hampshire engaged Fertile Ground, a local community-based organization and farm-to-school initiative, to assist with the evaluation of the FAAC. The evaluation sought to determine if Healthy Hampshire accomplished its intended goals, to collect feedback for the Massachusetts Department of Public Health, and to understand the interests and priorities that motivated participants to become involved in the effort. Fertile Ground, with support from the Collaborative for Educational Services staff, conducted a mixed method evaluation consisting of focus groups (with FAAC participants), individual interviews, and a review of minutes and resources generated by FAAC during the assessment process. The evaluators found the project achieved its goals of developing an agreed upon set of actions, an inclusive process, and of fostering relationships among participants. Moreover, they found that participants shared “the common value that healthy food should be affordable and within reach of everyone,” and that participants valued the process they experienced due to the project design. Evaluators also found, however, participants lacked clarity about next steps, namely how such a collaboration would move forward, what organizations would take the lead on certain actions, and how the residents would continue their work in the absence of continued facilitation.

Lessons learned

Listening and shared respect:

Participants came from very different places. The facilitators wanted residents to share their experience and expertise. At the same time, residents wanted to learn more about food system planning to better understand how they fit into the bigger picture. With careful listening, the different parties gained a better understanding of the perspectives and approaches each brought to the table.

Building leadership:

Residents responded to the leadership training and acted on opportunities to share what they learned with others. Three residents took part in training to learn how to communicate about the Healthy Incentives Program, which enables them to help others access healthy, fresh food at farmers markets. Another participant created a community garden at her housing complex. Two of the residents and the tenant organizer/health advocate are now involved in the mobile market working group. These individuals are working for the group, as community organizers, and are being compensated for their efforts to facilitate outreach and engagement with their communities.

Changing perceptions:

The process focused heavily on building trust and relationships. Healthy Hampshire structured the process to create a foundation for future efforts and to encourage people to see how they are connected beyond the traditional service and provider networks. Having Cooley Dickinson at the table also helped residents see the hospital’s role as a community resource and potential partner, not just a health care provider. This realization led to conversations about how residents and Cooley Dickinson could work together, for instance, on soil testing for a community garden at the public housing complex. The process sheds light on the need for collaborative efforts to address significant community needs. According to one participant, the process laid clear that “so much that gets done hangs from a thread—small organizations doing the work have one staff person, meaning their role might change drastically due to lack of capacity and organizational infrastructure.”

Cultivating relationships:

The relationship between Cooley Dickinson and Healthy Hampshire/ Collaborative for Educational Services has been many years in the making and goes beyond individual projects. Staff members from Healthy Hampshire previously worked for the Center for Healthy Communities, a program of Cooley Dickinson. Cooley Dickinson contracts with the Collaborative for Educational Services to provide evaluation and assessment assistance to grantees of its community benefit funding process. Staff members of the organizations also participate in advisory boards for each other. Hospital staff (Jeff Harness) sit on the Collaborative for Educational Services’ Strategic Planning Initiative for Families and Youth steering committee, and Collaborative for Educational Services staff sit on Cooley Dickinson’s Healthy Communities Committee. The variety of ways in which these organizations and their staff have worked together in the community over time led to strong working relationships that made it easy for them to come together efficiently when an assessment opportunity arose.

For the FAAC process, facilitators dedicated meeting time to fostering relationships between participants. Using icebreakers and less structured conversation time allowed participants to get to know each other on a personal level, which prompted a deeper connection that carried on outside the meetings. Of this aspect of the meetings, one participant said, “These allowed us during lunch, dinner, walking out to the car, to check in, build communication. A big part of this kind of thing is building a common language. Different personal connotations on different words, dialects. We were able to hear out one another. I got close with people in the professional group over common interests. Common language building was important. We can speak together in the community now.”

Next steps

The partners involved in the food access assessment and advisory committee are now working towards implementation of prioritized actions. Among recent efforts are participants advocating for the Healthy Incentive Program, including participation in an advocacy day at the Statehouse and the initiation of a working group, convened by Healthy Hampshire, to advance efforts to create a mobile market.

About Cooley Dickinson Health Care

Cooley Dickinson Hospital is a proud member of Mass General Brigham and an acute care community hospital in Northampton, Massachusetts. In addition to the Hospital, the system includes community-based primary care and specialty practices, and their VNA & Hospice program. They are committed to serving their patients and communities with exceptional, compassionate, and personalized care.