How Do We Inspire Healthy Change in our Target Population?

1. How Do We Inspire Healthy Change in our Target Population? Network for a Healthy California County of Riverside Department of Public Health Nutrition Services

2. Our Goal • Increase the number of Certified Eligible Food Stamp recipients who receive nutrition and physical activity education in Riverside County. • Increase the number of Likely Eligible Food Stamp who receive nutrition and physical activity education in Riverside County.

3. GoalsSupplemental Nutrition Assistance Program Education and Guidance (SNAP)andNetwork for a Healthy California The goal of SNAP is to improve the likelihood that persons eligible for SNAP will make healthy food choices within a limited budget and choose physically active lifestyles consistent with the current Dietary Guidelines for Americans and MyPyramid.

4. Start-Up Challenges • Who is our target population? • Where could we access our target population? • Which county programs allow access/partnering? • What information would be appropriate? • How much time would be available? • How would our program benefit the organization? • How to market the program to decision-makers? • How would work be distributed among staff? • Can we show a change in knowledge or actions?

5. Who is Our Eligible Population?County of Riverside • Riverside County was created in 1893 from parts of San Diego and San Bernardino Counties • Known as the Inland Empire (with San Bernardino County) • Width extends from Orange County and ends at the state of Arizona • Borders San Diego, San Bernardino, Orange and Imperial Counties • Mostly desert • Much of the growth is due to • Los Angeles County residents looking for affordable housing • Added growth from San Diego residents moving to Murrieta and Temecula

6. Who is Our Eligible Population?County of Riverside California, Food Policy Advocates, 2008 Population • Total Population: 2,026,803 • Total Population in Poverty: 229,043 (12%) • Children in poverty: 92,584 (18.9%) • Poverty = Family of 4 = $21,200 • 130% FPL = $27,560 and 185% FPL = $39,220 Food Stamps • Eligible for Food Stamps: 194,766 • Receiving Food Stamps: 89,592 • Eligible, Not Participating: 105,174 (54%)

7. Who is Our Eligible Population?Cities With Lower Median Incomes

8. The Three Categories of SNAP Recipients Categories are prioritized according to the likelihood that FSNE recipients will be FSP eligibles. • *Category 1: Certified Eligibles • *Category 2: Likely Eligibles • Category 3: Potentially Eligible by Site/Location

9. Category 1: Certified EligiblesCertain to Benefit SNAP Participants

10. Category 2: Likely EligiblesVery Likely to Benefit SNAP Eligibles

11. Category 2: Likely EligiblesVery Likely to Benefit SNAP Eligibles

12. Category 3: Potentially EligiblesFair Likelihood to Benefit SNAP Eligibles • Category 3: Potentially Eligible by Site/Location consists of persons at other venues primarily frequented by low-income audiences. • SNAP activities delivered to this audience provide a fair likelihood of benefiting SNAP eligibles. • As a portion of this audience may be ineligible for the SNAP, States shall request an exclusivity waiver (7CFR 272.3) (Appendix C, Section A.3) for projects delivered to Category 3 audiences. • States should consider delivering SNAP to Category 3 audiences only after making a clear effort to provide SNAP to Category 1 and 2 audiences. • Generally, this audience may receive SNAP when it is not possible or practical to separate out Program eligibles and/or identify Program eligibility.

13. Category 3: Potentially EligiblesFair Likelihood to Benefit SNAP Eligibles

14. Organizational Structure for TANFTemporary Assistance for Needy Families • U.S. Department of Health and Human Services • Administration for Children & Families • Office of Family Assistance • Temporary Assistance for Needy Families Program (TANF)

15. TANF (U.S.) • TANF is the name for the federal program that changed welfare guidelines under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 law which requires work in exchange for a limited cash-aid. • It became effective July 1, 1997 and was reauthorized February 2006. • In California, it is called CalWORKS and replaced Aid for Families with Dependent Children (AFDC) and other programs. • States, territories, and tribal agencies receive a block grant to design and operate their TANF programs. • States are allowed great flexibility in designing their programs.

16. Goals of TANF Goals: • assisting needy families so that children can be cared for in their own homes • *reducing the dependency of needy parents by promoting job preparation, work and marriage • preventing out-of-wedlock pregnancies • encouraging the formation and maintenance of two-parent families.

17. TANF Names Vary in States • Arizona (EMPOWER, Employing and Moving People Off Welfare and Encouraging Responsibility) • Arkansas (TEA, Transitional Employment Assistance) • California (CALWORKS, California Work Opportunity and Responsibility to Kids) • Colorado (Colorado Works) • Connecticut (JOBS FIRST) • Delaware ABC (A Better Chance) • Dist. of Columbia (TANF) • Florida (Welfare Transition Program) • Hawaii, Washington DC, Georgia, Nevada, Mississippi, Illinois, Indiana, Guam and others (TANF) • Idaho Temporary Assistance for Families in Idaho • Maryland FIP (Family Investment Program) • Michigan FIP (Family Independence Program) • Minnesota MFIP (Minnesota Family Investment Program) • New York FA (Family Assistance Program)

18. CalWORKS(California) • CalWORKS = California Work Opportunity and Responsibility to Kids Program • California's Welfare to Work (WTW) program is designed to assist welfare recipients to obtain or prepare for employment. • The welfare to work program serves all 58 counties in the state and is operated locally by each county welfare department or its contractors: • Names for CalWORKS Programs can vary in different counties.

19. CalWORKS/GAINCounty of Riverside • GAIN = Greater Avenues for Independence • GAIN is a large-scale welfare-to-work initiative that has operated throughout the state of California in all 58 counties and Riverside County GAIN started in 1987. • GAIN is administered by the Department of Public Social Services • In 1996, Congress enacted the Federal Welfare Reform legislation and states were required to cut their welfare caseloads by 25% in 1997 and 50% in 2002. • In 1998, GAIN became the CalWORKS/GAIN Program .

20. CalWORKS/GAIN County of Riverside • Secures client participation • Promotes the GAIN program • Benefits of participation • Clients family responsibility to family • Monitors client progress • Aggressively involved in locating job vacancies and recruiting employers for GAIN clients • Promotes retention of employment • Promotes self-sufficiency

21. Requirements for ParticipationCalWORKS • Anyone receiving Cash Aid (welfare) must take the GAIN Program. • SNAP: • The majority of GAIN participants also receive SNAP. • SNAP clients are not required to take the GAIN Program. In fact, many clients receiving SNAP already have jobs. • MediCAL patients are not required to take the GAIN Program • 5 years is the maximum time a family can qualify to receive GAIN/CalWORKS in California counties. (The state will continue to pay benefits for children up to 18 years.)

22. Work Activities Include… CalWORKS/GAIN • Activities that count towards a State's participation rates are: • unsubsidized or subsidized employment* • on-the-job training • work experience* • community service* • job search • vocational training • job skills training related to work • education directly related to work* • satisfactory secondary school attendance • providing child care services to individuals who are participating in community service

23. Cost SavingsCalWORKS/GAIN Riverside County The program cost approximately $3,988 per participant in 2006 and these costs were more than offset by savings to the government.

24. Morongo Tribal TANF, Banning, CA • The Morongo Tribal TANF program provides eligible parents and/or caretakers with job preparation, work, education and supportive services to enable them to become self-sufficient. • Services: Career Development (Job Readiness/Job Club and basic skills development), Transportation, Child Care, Employment or Educational Expenses, and Incentives (academic and clothing incentives)

25. Torres Martinez Tribal TANFThermal, Hemet, Cahuilla (Anza)Los Angeles, Commerce, Gardena, Lancaster Goals Include: • To end dependence of needy parents by developing and promoting program services, assistance and activities that will support their efforts with: job preparation; work opportunities; personal growth; wellness; and stable, healthy marriages and families.  • To reduce and prevent welfare dependency of future generations of Indian people by working with TANF and other eligible American Indian Youth to: ... promote healthy choices… as incentives for regular participation and achievement in educational and work/career readiness activities.

26. California Tribal TANFCalWORKS The California Tribal TANF Partnership (CTTP) is associated with 35 tribes and other organizations that operate tribal TANF programs for Native American people. CTTP was established on July 8, 2003 and remains operational under the governing body Robinson Rancheria of Pomo Indians as lead administrators.Our goal and purpose is to provide educational training, career and employment opportunities toward self-sufficiency; through various supported services and programs with temporary financial assistance.

27. The Foundation for California Community CollegesTANF Child Development Careers Program, SacramentoCalWORKS • TANF Child Development Careers Program (TANF-CDC) is designed to recruit California Community College students who receive cash aid and wish to pursue a career in the field of Early Care and Education (ECE).  • The objective is to increase the number of qualified child development teachers and to assist TANF recipients and their families in becoming economically self-sufficient.  • During 2005-06, 49 of the 96 eligible California Community Colleges were funded to provide additional coordination, case management, support services, mentoring, and teacher permit processing services to over 1,000 TANF participants.

28. Benefits of Working with CalWORKS/GAIN • Mandatory program • County program • Represented the cities we targeted • Maintained a regular class schedule • Worked with our target audience

29. “Work Philosophy” CalWORKS/GAIN Riverside County • “Get people into jobs as quickly as possible, and then work with them to stay on the job,” Gerry Martin, GAIN Supervisor. • “Work First” and “Self-Sufficiency” through employment.” • Encourage clients to get better jobs to support self-sufficiency. • Work has value over and above the obvious one of income. “Work provides dignity, satisfaction and self respect,” Marilyn Kuhlman, GAIN program manager. Historically, the CalWORKS/GAIN Program in Riverside has received national recognition for accomplishments of their program.

30. How We Started(First Steps) • In 2002 -2003, the Network for a Healthy California _County of Riverside wanted to reach Food Stamp recipients in the CalWORKS/GAIN Program with Network messages. • We talked to managers in the program, but were unable to be included in the schedule for years. Our topic was not considered essential to their program. • We were able to provide literature displays to both Food Stamp and CalWORKS/GAIN offices. • We were contacted by their Cathedral City office in November 2003 for health information and/or incentives for their first annual “Fit for Work” conference. • Conducted a staff training in Cathedral City.

31. How We Started(Next Steps) • Next we brainstormed the needs of our programs: • Reviewed the objectives of Network for a Healthy California_County of Riverside • Reviewed the objectives of CalWORKS/GAIN_Riverside County • Found a common interest among our programs which was mutually beneficial • Planned a strategy to introduce the program to other CalWORKS/GAIN staff and clients • Schedule classes at sites per request • Educate at staff trainings • Educate/Support conferences and employment expo • Provide educational information for office displays

32. How We Started(Recent Steps) • In December 2003 the Indio office contacted us to be a part of their first “Fit For Work” Conference in 2004. We conducted a workshop and trained all CalWORKS/GAIN staff in the county and about 80 clients who attended. • We began to do nutrition trainings in the Cathedral City office. • Other offices began to contact us throughout the county and we added trainings at their sites for clients. • We now serve eleven offices throughout the county. We have added classes in Spanish. • We are an integral part of the training clients receive while they are searching for jobs and we provide information for them and their families to eat healthy and be physically active.

33. “Fit For Work” ConferenceCalWORKS/GAIN • Client recognition and support • Skill-building workshops • Motivational speakers • Healthy food and snacks • Fashion show

34. Palm Springs Annual Employment ExpoPalm Springs Convention Center • Public/private partnership of over 200 businesses and agencies promoting employment every September • Sponsored and organized (in part) by CalWORKS/GAIN • Over 1,000 people in attendance every year • 2006 – 2008 Nutrition and Physical Activity Promotion by Network for a Healthy California_County of Riverside • Highlights: • Promoted eating out healthy and reached over 350 people with nutrition and physical activity information in 2008 • Personal story of a man who lost 50 pounds and “no more diabetes” in 2007 after coming to the booth in 2006 • Helped Katrina family get clothes and other basic needs in 2006

35. Palm Springs Annual Employment ExpoPalm Springs Convention Center

36. CalWORKS/GAINJob Club/Job Search • Job Club: (1 week) • teaches the benefits of working • how to find and land a job • how to sell them selves • how to use Job Search skills in the future • Job Search: (3 weeks) (repeat as needed) • Applies work learned in Job Club • Helps clients land the job

37. “Job Club” • 15-20 people • 30 to 60 minutes • Open style format • Audiovisual equipment: • overhead • visual aids • handouts • Questions/comments allowed • Supervisors often attend the class

38. Job Club: Employment Skills • Case Manager assigned • Skill Sets to Learned include: • Work • School • Interviewing • Dress • Barriers/Challenges • Goal Setting: Life Goals, Career Goals • Also available, Counseling for : Substance Abuse and Self-Esteem Building

39. Nutrition/Physical Activity Classes • Classes • Quality information required • Interactive style • Variety of subjects • Visual Aids • Incentives • Maintain relationship with supervisory staff • Maintain the schedule/remind as needed • Expand classes as needed • Be flexible • Emphasize Worksite Wellness goals: importance of health when getting work, maintaining work, and/or maintaining a healthy family. • Provide referrals as needed.

40. Sample Classes • Get the Facts • MyPyramid • What’s In It for You? Whole Grains • Keep Things Moving With Fiber • Get Your Calcium • Stretch Your Food Dollar* • Portion Distortion • Label Reading • Cut the Fat for Better Health • 100% Fad Free

41. CalWORKS/GAIN Classes

42. Sample of Client Questions • How to feed fussy children? • Healthy recipes family or spouse will eat? • Healthy cooking methods? • How to buy healthy food at grocery stores? • How to control the menu at home? • How to eat healthy when eating out? • Which fast foods are healthy?

43. Client Perceptions Healthy Eating and Physical Activity • It costs more to eat healthy. • It takes more time to eat healthy. • Eating healthy doesn’t taste good. • The family won’t eat the healthy food. • There’s no time for physical activity. • I’m already physically active. • Other Concerns: Child care, Transportation, Financial, and Health

44. Benefits of Nutrition & Physical Activity Education • Health and Employment • Healthier clients may do better passing physical exams • Retention of Employment/Employment Support • Healthier employees have better attendance • Health information helps children stay healthy which means fewer lost days from work due to a sick child at home • Improved nutrition (fewer vending machine purchases, less soda when lunch bags were given and many clients starting bringing their lunch to classes) • Potential for increased performance with more physical activity • Worker’s Comp claims can be lowered with healthy, physically active people • Reinforced employment tips • Served as an employment role model for clients

45. Benefits of Nutrition & Physical Activity Education (cont’d) • Nutrition and Wellness information • Provided tips to save money (take lunch, cook at home, shopping tips, saved gas) • Provided tips to save time (healthy crock pot meals, meal planning and Network recipes are encouraged.) • Healthier society costs fewer health care dollars • Physical Activity • Encouraged family activities which supports good parenting skills for mothers and fathers • Program • CalWORKS/GAIN in Riverside met health requirement

46. Challenges • The number of attendees can fluctuate at some clinics due to getting jobs, kids sick, or other reasons • Taste testing is a challenge because the number of attendees can fluctuate at some clinics • 30 minutes minimum is needed, but 45-60 minutes is desirable to provide information and answer questions • “Crowd control” or handling the questions/concerns. • Getting to all of the locations since some sites are farther away than others so other tasks are scheduled for the same day in those areas. • Staffing changes require renewal of support to the program. • Other organizations that we match for funding require our time as well.

47. Classroom Tips • Don’t be rushed when doing classes since many times questions are asked at the end of the session during the break. • Clients often feel the information is valuable and they may take notes so provide quality information. • Provide a handout with the information covered or a copy of your talk. • Provide referrals for health care, WIC, dietitian counseling, and medical resources for conditions like diabetes and overweight. • Clients may be reluctant to see their physicians for health care services. Be sure to reinforce the quality of public health services since they may be reluctant to obtain health care. • Provide incentives at the end of the class. • Provide resources for additional information. • Have the supervisor schedule a break after this training when possible since clients may have personal questions or concerns.

48. Personal Skills Needed • Must know how to work well managers and the target population. • Must be able to control the class when needed. • Must be able to (skillfully) re-direct questions and experiences. • Ex: long stories, health nuts, be able to discuss abusive behaviors intelligently • Must be able to incorporate stretching, exercise and/or dance. • Must be persistent. • Must be responsible.

49. Quick Guide to Program Planning (Basic Needs) • Be able to state the benefits of your program for CalWORKS. • Design a plan to promote your program. Include your CalWORKS Supervisor(s). • Provide the very best staff training to interested sites and/or to the CalWORKS Supervisors. • Schedule client classes with a variety of structured educational, interactive lessons that provide key information in a short period of time of 30 to 60 minutes. Have 3 or more lessons available to start. • Include a physical activity for fun to reinforce learning. • Provide food for sampling to reinforce health messages. • Have a variety of visual aids. • Have educational materials required for learning. • Keep your schedule, but be flexible and modify your program as needed. • Participate in other CalWORKS events as available.

50. Go the Extra Mile • Have well educated professionals. • Provide support to your staff as needed. • Train staff with selling techniques to promote the program. • Find a partner who is supportive and believes in your goals. • Always provide excellent customer service.