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Peer-to-Peer Advocacy: Building Capacity for SNAP-Ed Outreach

Posted by CAHNRS.Web Team | January 15, 2019
Over the past four years, the Spokane Regional Health District (SRHD) has successfully increased capacity for SNAP-Ed outreach through the implementation of a public health peer-to-peer, Community Health Worker (CHW) model. In Spokane, this community-based model has secured blended funding, allowing for additional opportunities beyond SNAP-Ed.

What is a Community Health Worker?

Training Curriculum for Community Health Workers logoCommunity Health Workers (CHW) serve as a link between community members and health services. They function to increase access to these services and improve service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency. Activities like outreach, community education, social support and advocacy help achieve these outcomes. CHWs are chosen from within the community, and each CHW completes a free foundational training through SRHD in partnership with the WA State Department of Health before beginning to serve in this role.

Adapting the CHW Model to Meet Spokane SNAP-Ed Needs

Donna Oliver, Program Manager-Health Promotion, developed a CHW approach for Spokane’s SNAP-Ed program and has successfully implemented it within multiple low-income residential settings. The vision was to have peer educators implement and reinforce SNAP-Ed activities, but there were challenges to address. The first was to identify and recruit CHWs, looking for “natural helpers’ within the community, and then make sure they had training and support to carry out SNAP-Ed activities. Secondly, their additional earnings should not exclude them from receiving their public assistance benefits.

  • Community Health Advocate Vs. WorkerGroupd photo of the SRHD volunteers.
    In general, CHWs are recruited to be SRHD volunteers.  In Spokane, the group elected to call themselves ‘advocates’ rather than ‘workers,’ focusing on their role in advocating on their communities’ behalf.
  • SNAP-Ed Training of Public Health Peer Educators
    In addition to the CHW training, SNAP-Ed CHAs receive specific training to implement SNAP-Ed programming, empowerment and mentoring. Meghan Jacobson, SRHD Public Health Educator, is responsible for this training, which covers such topics as civil rights, food banks, food safety, SNAP-Ed curriculum and other health-related topics.  Each CHA receives one hour of training monthly and one hour of mentoring with the lead CHW, Margaret Braun. Margaret is the direct liaison to these advocates Besides mentoring each advocate monthly, she monitors activities and convenes monthly CHA meetings that offer a platform for problem-solving, building social support among the advocates, updates on trainings and changes in programming. A major challenge of her work is to increase CHA self-efficacy. “We reinforce a ‘you can’ attitude to build self-esteem with our advocates,” she says.

What Roles Do CHAs Play?

CHA members in the produce section of the grocery store.
CHAs wear “Ask Me…” t-shirts to promote their walking club and other activities.

Because CHAs are members of the community, a strong trust–built on common experiences–exists between the CHA and community residents . This results in increased participation at peer-led education and PSE activity events. Each CHA implements one one-hour event per month if not teaching a class series. They also coordinate one one-hour community-building event monthly. Such events include food gardening, visits to the farmers markets, physical activity classes, walking clubs or other evening events that bring residents together. They hold weekly “office” hours in open community spaces so residents can access their assistance for resources like print materials, get their blood pressure checked, and help in connecting to healthcare or community organizations. This results in increased dosage or exposure to health information in a personalized setting and leads to behavior change.

Results: Increased Capacity & Outreach

Over the past four years, the number of Community Health Advocates in Spokane rose from 8 to 20, with a very low attrition rate (4%). These advocates serve ten residential sites for low-income families and seniors with disabilities and chronic medical problems. Two of the ten sites include a large Russian-speaking population. This year, CHAs reached 1,068 low-income residents through classroom and community activities. As a result of this “added voice” for their communities, a new food access partnership with Second Harvest Food Bank now offers mobile food pantries that deliver directly to these residential settings. “As public health, we are able to convene and connect partners with identified community needs. This has been very evident in this model where we are able to enhance services based on community/CHA feedback” said Donna Oliver, Program Manager.

What CHA’s Say about Their New Role in the Community

Recent interviews with several CHAs revealed why they are willing to take on this responsibility in their community.Team, Together everyone accomplishes more.

  • I love helping people and cooking for others. It’s like I am a natural helper…it makes me feel good.
  • When teaching the Plan-Shop-Save-Cook series, I had an “ah-ha” moment:
    that a person can have a disability, but not be disabled!
  • At first, I have to admit, I did it for the money. But now, it’s like the money doesn’t matter anymore…. I now have a sense of usefulness or purpose – a sense of success again… I am contributing to society in a meaningful way. I have life with intent…
  • Before this job, I didn’t know anybody here, but now I realize that other residents were friends I just hadn’t met yet!
  • We are able to celebrate a spirit of inclusion for those we live with….Once they get to know and trust you, it becomes a group mindset…. [for example].. we started a mini Bloomsday [race] last year with 2 people….this year we have 17 or more.

What Residents Are Saying about SNAP-Ed Programming

In a talk-and-share session with five residents of the Appleway Housing Unit, it was clear that SNAP-Ed programming delivered through these advocates is making a major impact.

  • Most agreed that the new Nutrition Facts Label was easy to read and use to make healthier choices. Learning about portion size also increased personal awareness of how much they are eating.
  • One senior stated, “The Community Health Advocates really help organize events that are fun. We have Sit and Be Fit classes on Monday and Fridays where we also get to check our blood pressure.”Senior site in chairs exercising in a senior center.
  • Another senior shared, “I have diabetes, so I count carbs….I love the new labels. [And classes have] good recipes like cowboy caviar, tuna with yogurt and baked chips! …My doctor thinks it’s wonderful that I am doing physical activity classes…my A1C went from 6.5 to 5.8 between visits.”
  • “I now make lasagna with zucchini, spaghetti squash and roasted cauliflower.”
  • “I am saving money by using unit pricing…and have noticed [on store shelves] that the nutritious foods are on the top where I can’t reach them; expensive stuff is at eye level; and sale stuff is on the lowest level.”
  • Others added that they are lowering their blood pressure, blood sugar and weight. One individual with lung disease improved her oxygen saturation, to the delight of her primary care physician.

Stakeholder Benefits and SRHD’s Community Health Advocate Model

  • SNAP-Ed Provider
    • Increased outreach to target population in on-going needs assessment
    • Cost-effective programming
    • Measurable results (direct education, PSE interventions)
    • Increased access to the target population, with increased dosage of health messages
    • Promotion of healthy, active lifestyle within the larger community
    • Redemption of Fruit and Vegetable Prescriptions increased by 75% (incentives have tripled). This is higher than the state average.

  • Community Health AdvocatesA trellis with vegetables growing.
    • Receive financial incentive
    • Improved self-efficacy, educational opportunities
    • Increased opportunities for leadership in community
      • One CHA was instrumental in influencing the Housing Board to implement a garden policy. As a result, raised beds were built.
      • Another CHA was asked to speak at forums, and talk at a Governor’s meeting.
    • Contribute to improved sense of purpose and self-efficacy by serving their community

  • Low-Income Housing ResidentsThree people stand on front of raised gardening beds in an apartment complex.
    • Increased exposure to and availability of health information and events from trusted peers
    • Fun learning opportunities with peers; increased active living
    • Increased social support from community
    • Improved healthy environment
    • Improved health literacy Improved health

  • Low Income Housing Management
    • Increased partnership and recognition for resident health and well-being
    • Potential positive impact on resident turnover and crime reduction
    • Ability to address resident issues that housing management cannot

Is the CHA Model Sustainable?

Because the CHA model focuses on health and well-being of the low-income population, it lends itself to blending of other resources. By identifying and training “natural helpers” within the community and mentoring them toward independence, the likelihood that many will continue to help their neighbors and reinforce information is increased. The implementation of policy, systems and environmental changes such as food access system partnerships, community gardens, safe and active spaces, etc. is highly sustainable.

For more information about Spokane’s CHA programming, contact Meghan Jacobson.

View the schedule of CHW training opportunities across the state.

Resources