B. PROJECT NARRATIVE Letter of Interest (500 words) We are pleased to present our application for a social prescribing program to address childhood obesity in the City of San Pablo. The social prescribing approach to managing chronic medical conditions has been successful in several U.S. locations and has become a staple in healthcare for the U.K. With the proactive approach that COPAG is taking to address pediatric obesity, social prescribing would be an ideal model to pursue in the wake of the covid pandemic and its effects on physical and mental health and social isolation. The social prescribing model recognizes that people’s health and wellbeing are determined by a range of social, economic, and environmental factors and seeks to address a person’s needs holistically. The goal is to create equitable, positive health outcomes that go beyond the traditional approach of linking illness to medical intervention. In clinical practice, primary care physicians and other health professionals identify patients that might benefit from a holistic approach to their health. With the help of Link Workers (or Community Navigators), providers connect patients with appropriate social interventions. In Phase I, we would concentrate on both nature-based and arts-based interventions. Dr. Alan Siegel has extensive experience implementing similar projects. He founded and has led an arts in health program for Contra Costa Health Services for the last ten years and is a founding board member for National Organization for Arts in Health. He was part of a team that implemented the Health Leads Program at West County Health Center and a critical team member in improvement work. In addition, Dr. Siefel has led pediatric obesity groups for several years. His Active Healthy Families Program was the 3rd Annual Childhood Obesity Challenge winner through The American Journal of Preventive Medicine (AJPM). Plus, he championed the Nature Rx programming the team completed during the last funding cycle, in which the two agencies implemented the Walk With A Doc program at the Regional Parks. We want to expand on this work through this funding opportunity by implementing a social prescribing program for San Pablo residents. We appreciate your efforts to address childhood obesity in the City of San Pablo and feel that developing this social prescribing model will benefit the children and families for many years to come. We believe that social prescribing would enable the best progress on COPAG’s Community Action Plan goals. 1. Approach, Management, and Evaluation Plan (500 words) The Regional Parks Foundation was formed in 1969 by visionaries who saw the need for land preservation and conservation in the San Francisco Bay Area. They shared the belief that connections with nature are critical for leading a healthy and balanced life, and that these benefits should be available to everyone. The proposed project reflects the ongoing commitment to the public and complements the growing list of outdoor programs that reach the underserved communities of the East Bay.
It is also an excellent opportunity to partner with Dr. Alan Siegel again, who has extensive experience implementing similar projects. He championed the Nature Rx programming the team completed during the 2018-19 funding cycle, in which the two agencies implemented the Walk With A Doc program at the Regional Parks. The grant funding will cover the cost of hiring a program coordinator/community navigator, ideally from the City of San Pablo as well as relationship building, oversight, and education by Dr. Siegel. The program coordinator will collect and compile program and evaluation related data, and in collaboration with the Regional Parks Foundation’s Grants Specialist develop reports. Project partners will provide qualitative and quantitative evaluation data for the project in accordance with COPAG's requirements. Qualitative information will include relationships developed with community organizations and clinicians reached. Quantitative data will include patient referrals, number of participants, and non-invasive demographics (age group, residence, etc). At the end of the grant term, project partners will debrief to assess what went well, what areas need improvement, and how to apply these lessons learned to future programming. The team will also explore implementing standardized evaluation metrics developed abroad, such as Measures Yourself Concerns and Wellbeing (MYCaW) and the Nature Connectedness Index (NCI). Compliance – San Pablo Economic Opportunity Policy Project partners will attempt to recruit the Project Coordinator/Community Health Worker from San Pablo, and when practicable, contract with local vendors such as bus companies to implement grant activities. 2. Project Experience (500 words) • Walk With A Doc 2018-19 provided a great experience connecting the patients of Contra Costa Health Services (CCHS) to community wellness resources at the health center and five regional parks. Each walk served 40-60 participants and profoundly affected the participating youth and families. Years later, Dr. Siegel continues to receive positive feedback from his patients about how that program ‘changed their lives.’ It also led to developing relationships with CCHS subcontractors and Parks Rx day organizers and sharing best practices about the program at the 2019 Healthy Parks Healthy People: Bay Area Forum and the Nature Champions Panel at the Children and Nature Network Conference. • The Regional Parks Foundation has supported Multicultural Wellness Walks since 2013. The walks are an opportunity to connect with the community, walk together in nature, eat healthy foods, and address health screening. • Groups to address pediatric obesity – Dr. Siegel has extensive experience developing, facilitating, and evaluating pediatric obesity groups for 5-12 year old children. Together with Dr. Napoleon Dargan, they created an arts-based teen pediatric obesity group at the West County Health Center. • Dr. Napoleon Dargan has developed his own arts-based violence prevention program with high-risk elementary school students in two Pittsburg Unified Schools. They asked him to expand this work with both the students and the staff over the summer.
• Dr. Siegel assisted in implementing the Health Leads program at West County, one of the two sites expanding these services to the West. This program has community health workers providing support to address social determinants of health utilizing community resources, • For 20 years, Dr. Siegel has educated Contra Costa Family Medicine residents and individuals about utilizing community resources better. 3. Scope of Services (1500 words) Background In the United Kingdom social prescribing (SP) is a key component of the National Health Service as an integrated part of all primary care clinics. The model recognizes that people's health and wellbeing result from a range of social, economic, and environmental factors. Therefore, the model seeks to address a person's needs holistically. The goal is to create equitable, positive health outcomes that go beyond the traditional approach of linking illness to medical intervention. The practice embodies the tenants of the World Health Constitution, which states that "[h]ealth is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity."1 In clinical practice, Primary Care Providers (PCP) identify patients that might benefit from a holistic approach to their health. With the help of Link Workers, they connect patients with appropriate social interventions such as local community arts, nature, or volunteering experiences to improve mental health and physical wellbeing. For example, a popular intervention is a nature prescription because the mounting body of evidence shows that being in nature is beneficial to a myriad of chronic mental and physical health conditions. A nature prescription, backed up with direct access to community resources, is a low-cost alternative treatment to help prevent and slow the rise in chronic conditions. SP has the potential to change how our culture thinks about health. It is an upstream solution to prevent illness from even happening. Project Scope The proposed project will implement Phase One of a larger SP project envisioned for San Pablo residents. Built for sustainability, the project will capitalize on existing partnerships and develop new partnerships to implement a nature and arts prescription program. The first year will also set the foundation by advancing the comprehensive and long-term vision for the program. During the implementation of Phase One, we will concentrate on engagement with nature and the arts. Later phases will include: • Volunteering opportunities 1 World Health Organization (1946). WHO Constitution. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1 2 Lackey NQ, et al. Mental health benefits of nature-based recreation: a systematic review. Ann Leis Res. 2021 May 27;24(3):379– 93. 3 Fancourt D, Finn S. What is the evidence on the role of the arts in improving health and well-being? A scoping review. Copenhagen: 2019 (WHO Health Evidence Network Synthesis Reports). http://www.ncbi.nlm.nih.gov/books/NBK553773/
• Addressing the social determinants of health (SDOH) • Developing a database for social prescriptions to occur more widely Project components: Phase One – Development of the Community Navigator, Nature Prescriptions, and Wellness Warrior Academy Workshops Community Navigator/Community Health Worker The cornerstone of the SP efforts in the U.K. focuses on the development of the 'link worker'. In the U.S., the best equivalent would be a Community Health Worker or Community Navigator. In this proposed role, the Community Navigator would receive referrals from clinicians, meet with the patients, and together develop a personalized plan for addressing their needs. The options for referrals in the U.K. often include prescriptions to engage with nature or the arts, become a volunteer, and referrals based on SDOH. Research shows that these areas improve mental and physical health.2 3 One commonality among these interventions is that they address loneliness, which is emerging as a major risk factor for many chronic diseases. During Phase One, much of the efforts will involve developing relationships with community programs and building a patient referral network. There will also be significant efforts to meet with Clinicians for education and training to make the referrals. Nature Prescriptions In 2020, Outside magazine called The Nature Cure a "health revolution that could change your life." They recognized the growing trend of PCPs prescribing time outdoors as a possible cure for a long list of ailments. The idea is revolutionary at its core, very simple and free, and an emerging field of study for solving our most pressing public health issues. Building on the relationship between the Regional Parks Foundation and East Bay Regional Park District, providers at CCHS and other regional clinicians will prescribe nature to improve childhood obesity rates. The mounting evidence shows that when youth (and adults) lose contact with the natural environment, they are missing key opportunities for physical activity, stress reduction, attention restoration, and healthy development (Committee on Environmental Health, 2009). In addition, many low-income and minority children are often more cut-off from nature because of their built environment – the housing conditions, a high-volume of traffic, or lack of parks and green space all make it much harder for these young people to play outside (National Environmental Education Foundation, 2015). Because of the link between physical activity and obesity, the partnership will be an excellent opportunity to provide free, safe, and easily accessible recreation opportunities for people in San Pablo that might not otherwise have access to the Parks. The nature prescriptions will take advantage of the Park District's Multicultural Wellness Walks (MCWW), and grant funds will cover the cost of transportation to/from San Pablo to eliminate any transportation-related barriers. The goal of the Wellness walks is to create a communal experience of walking together in the Regional Parks and build bridges of cultural understanding and appreciation across cultures. The Wellness Walks typically range from 2-2.5 hours. A Park naturalist leads the walk to present
the Park's unique history, the wildlife, and natural resources. A health instructor, such as a yoga or laughter yoga teacher, nutritionist, fitness trainer, sound therapist, or performance artist, engages the participants in dynamic movements and activities that create flexibility, build resilience and reduce stress. The walk often concludes with games and heart circles where participants share their experiences in nature with each other and partake in a shared meal of ethnic cuisine. Through the project, families will have the opportunity to participate in five of the MCWWs, including: • August 2022 – Del Valle Regional • October 2022 – Carquinez Strait Regional • April, May, & June 2023 – Locations TBD Participants get a warm introduction to the Regional Parks and the opportunity to explore in a supportive setting. The experience builds their confidence and makes it more likely for them to return on their own with their families or visit a Regional Park near their home. The goal is to recruit 50 participants from San Pablo for each walk (250 total) with a focus on recruiting families. However, if there is demand, the project team will accommodate as many people as feasible. Wellness Warrior Academy Workshops WWAW Our Community Navigators will also provide referrals to art-based interventions and workshops. These will include opportunities available in the community and an arts-based workshop - a planned pilot for referred children. Rooted in the Acceptance and Commitment Therapy framework, the pilot workshops will help participants identify their core values, as expressed through art, and how to live their lives in alignment with these values. Grant funds will allow the project team to plan and pilot two sets of workshops for Spring 2023, with planning over the fall and early winter 2022. Combing the team's collective knowledge, the team will design a more in-depth curriculum for full implementation. Modules will include activities such as: Module 1: Understanding My Superpowers, Values & the Nature of Emotions • Planting Seeds of Value: Reaping What We Sow. • Collaging Your Vision of "The Perfect Day" • Using Music to Explore Our Emotions, Our Powers, and Mother Nature. Painting Paper Mache Mask • Overcoming Demons (Negative Emotions) & the Cost of Avoiding Emotions. Sand Art Monsters Module 2: Connecting to Our Pure Power – Diffusion and Increasing Physical Activity • Overcoming Snakes! Problem-solving 101. Painting Wooden Shake Snake • Events (Red Flags) and Cues to Anger in Nature. Increasing the Connection to Our Needs, Relaxation, and Mother Nature • Defusing MILK and Negative Self Talk • Leaves in a Stream – Letting go of Thoughts, Flying Towards our Dreams/Values Program Overview - 2 Hours:
• 30 Minutes – "Art in Action. Art in Nature". Group Mindfulness. Art, language and skills development/assessment. Program Introduction + goals for session. • 30 Minutes – Walk N' Talk with Dr. Dargan + Dr. Siegel. Mindful Body Movement, gentle stretching, transitioning into walking, paired with psycho-education and discussion on primary topic(s). • 1 Hour – Hands on Art Engagements, Application and Conclusion, Take Home Challenge. The goal is to recruit 25 kids ages 5-17 for the two 8-week pilot programs from our partnering referral practices or through San Pablo schools. Clients Type # of Unduplicated Clients, Total # of Unduplicated Clients, San Pablo residents Projected # of average interactions/client with CHW (avg. 45 min.)/ minutes per patient Projected # of average hours dosage in activities
Brief description
5-11 years old 82 25 50 66 20 40 1.5/67 1.5/67 205 400 300 MCWW (Nature) WWAW (Art) Other Rx (SP) 12-17 years old 55 25 50 44 20 40 1.5/67 1.5/67 137 400 300 MCWW WWAW (Art) Orher Rx (SP) Adults (18+) 112 25 90 20 1.5/67 1.5/67 280 150 MCWW Other Rx (SP) Total 424 340 1.5/67 2,172 Social Prescribing to Address Childhood Obesity 2022 2023 ACTIVITY Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Coordinator Recruitment/Hire Planning (MCWWs & Workshops) MCWW Events Pilot – Workshops/Evaluation Project Wrap-Up Evaluation (ongoing) 4. References • Dr. Rohan Radhakrishna. [email protected]. CDPH Office of Health Equity Deputy Director. • Dr. Andrea Sandler, [email protected] Dept of Family Medicine Chair, Contra Costa Health Services. • Dr. Ori Tzieveli. [email protected]. CCHS Director of Public Health.