Brief Description of LHD:

Tri-County Health Department (TCHD), Colorado’s largest local health department, is located in the Denver metro area serving Adams, Arapahoe and Douglas counties, which includes 26 municipalities and 1.5 million residents. In Adams County, with a population of 511,469, 49.4% identify as White Non-Hispanic, 40.4% identify as Hispanic, 3.1% identify as African-American and 3.6% identify as Asian. Prevalent health risk issues includes 28.6% of adults and 11.7% of youth are obese, 21.6% of adults and 47.9% of youth do not get physical activity and 13.9% of adults and 34.0% of youth reported poor mental health.^[1]

Public Health Issue:

Oftentimes, fresh, healthy foods may not be nearby or affordable, making shoppers choose less nutritious options to feed their families. According to the USDA, food insecurity is the lack of consistent access to enough food for an active, healthy life.^[2] In Adams County, 36.0% of children ages 1-14, 17.0% of high school students, 7.7% of pregnant women and 14.3% of adults over 60 years old are currently experiencing food insecurity.^[3] Food security disproportionately affects those who are lower income and has negative consequences on the well-being of individuals across the lifespan. According to impact reports from Hunger Free Colorado, 63% of the low-income population in Adams County receives SNAP, with 45,413 individuals receiving program benefits and 26,625 individuals eligible, but not enrolled.^[4] Even with federal nutrition assistance programs, accessing healthy food can continue to be a barrier for many individuals dependent upon their built environment and socioeconomic status.

Goals and Objectives:

            The TCHD Nutrition Division piloted a Healthy Farmer’s Market (“the Markets”) with local partners, to serve community members of Adams County that are unable to access healthy food resources via a grocery store, farm stand or local market. Amidst the COVID-19 pandemic, objectives changed in order to establish a socially distant and safe environment, as well as to integrate collection mechanisms to track the dollars spent from various funding streams. 

How Practice was Implemented/Activities:

TCHD joined forces with the City of Thornton, community members, Anythink Libraries, the American Heart Association (AHA) and Lulu’s Farm to establish community connections to form a Steering Committee. This grew out of a coalition created with a CDC/National WIC Association (NWA) 2016 grant. TCHD identified a funding opportunity from AHA and led monthly Steering Committee meetings, as the partners worked together to seek additional funding, develop marketing materials, build out social media platforms, approve site plans, identify and engage relevant vendors that fit the model, manage volunteers, and ultimately execute the Markets each summer.

Results/Outcomes:

            Three years of dedication to Thornton residents, our reach in the community and accessibility attribute to the success of the Markets. Outcomes of the Markets from expanding to a second location in 2019 include the following:

●     The two markets in 2019 reached 4,700 people, while the single market in 2018 reached 1,800 people; this is a 161% increase in participation because of expansion

●     SNAP and Double Up Food Bucks transactions reached a 440% increase as there were 38 transactions in 2019 and only seven of these transactions in 2018

●     Between the two markets in 2019, 209 WIC coupons were redeemed, which is 809% more than the previous season, which had 32 WIC coupons redeemed

●     Cooking Matters had a 300% participation increase with 40 participants in 2019 receiving $10 vouchers to purchase fresh produce compared to the 10 in 2018.

●     Public transportation vouchers were provided to those who used it to and from the markets and 22 were dispersed this past season

With accommodations necessary for COVID-19 compliancy, outcomes of the Markets from 2020 include the following:

●      3,617 participants

●      $54,991.20 worth of $25 produce vouchers were handed out

●      2,701 produce vouchers were handed out to the following target populations:

○      1,962 older adults over the age of 55

○      325 WIC recipients

○      251 SNAP recipients

○      163 receive both WIC and SNAP

●      80 public transportation vouchers given to those who used public transportation to attend the Markets

Integration of ArcGIS survey tracking was able to collect these data measures in order to monitor where clients were coming to us from geographically, as well as the amount of dollars spent from COVID CARES funds from the City of Thornton and other grant funding.

Objectives Met:

COVID-19 changed how we were able to provide the service of a farmers market, but the model of the program was able to remain consistent, as fresh food access is a pillar of the Markets success. The primary objective was to be a food resource for the community, while meeting core objectives in order to continue to serve our community.

What specific factors led to the success of this practice:

The implementation of the Markets would not have been possible without the recognition of the importance of food security as a health issue, accessibility of locations and successful collaboration of local partners. All partners possessed a desire and level of readiness to address increasing food security issues that coincided with, and are exacerbated by, the COVID-19 pandemic. 

Public Health impact of practice:

The public health impact of the Markets is the capacity to promote health and wellness leading to a decrease in chronic diseases, by engaging its participants to take preventative measures in order to achieve positive health outcomes across generations. The implementation of GIS tracking aids in public health practice, by evaluating program reach in order to identify new community partners for program replicability and sustainability. GIS technology was able to extend program capacity to provide produce boxes in an identified community of need based on spatial analysis data from the Markets participant survey collection. The Markets have improved the knowledge of available resources in an inclusive, community driven, and diverse environment seeking to establish health equity.

Website for your program, or LHD: 

https://www.anythinklibraries.org/farmers-markets

https://www.tchd.org/801/Healthy-Farmers-Markets

^[1] Source: TCHD Adams County Fact Sheet https://data.tchd.org/reports/Adams_CountyFactsheet_JAN2020_Final.pdf

^[2] Source:https://hungerandhealth.feedingamerica.org/understand-food-insecurity/

^[3] Source: TCHD Adams County Fact Sheet https://data.tchd.org/reports/Adams_CountyFactsheet_JAN2020_Final.pdf

^[4] Source: https://www.dropbox.com/sh/yl0zsluc9c30gd7/AAD5YjwTlENXsgjZuZGlRdUka/Large%20Counties?dl=0&preview=Adams+County+-+2019+SNAP+Impact+Rep.pdf&subfolder_nav_tracking=1

Public Health Issue:

The public health issue targeted by this intervention pertains to the social determinants of health and the barriers coinciding with access to healthy food. Individuals living in low-income and low access areas experience disproportional positive health outcomes simply because of their zip code. In Adams County, the City of Thornton is an underserved community with increased lack of access to healthy foods and fresh produce. The population of Thornton estimates at 132,310. The major racial and ethnic groups present identify as:

●            Non-Hispanic White (57.6%)

●            Hispanic or Latino (33.5%)

●            African American (1.8%) 

●            Asian (4.85%)

Of the population, 8.48% are living below 100% of the federal poverty level and 25.36% are living below 200% of the federal poverty level.^[5] The limited access to basic resources has significantly affected the health outcomes of this community’s residents. With the presence of food deserts in Thornton, 25.81% of people have limited access to food, which is a higher percentage than the surrounding Adams County and State of Colorado.

Prior to implementation of the Markets, there was only one farmers market in Thornton, which ran once a year for three days during the Fall Harvest Days and did not accept SNAP. The Markets are a unique approach developed to address broader social determinants of health through a whole person health lens. The Markets are combatting the stigmas surrounding the social determinants by utilizing data and resources that are committed to targeting a population that encounters significant barriers around health and well-being. The Markets strive to position these resources in locations that are accessible, safe and highlight community connection.

Social stigmas around farmers markets have a history of being less culturally relevant in that they are more prevalent in affluent communities. The Markets Steering Committee wanted to create an inclusive space for all residents no matter their age, health or socioeconomic status by connecting with other local organizations committed to health equity. The success of market expansion from one to two markets is due to the implementation of a Collective Impact Strategy, the process of creating impactful change based on the commitment of groups of partners to agree on a common agenda for solving a specific problem.^[6] By supporting equitable access to food systems through implementation of federal nutrition assistance programs, farmers markets can work towards abolishing the stigma around food insecurity.

Target Population:

The target population for the Markets are those relying on federal nutrition programs, SNAP and/or WIC, for nutrition assistance as well as older adults and children. Federal nutrition benefits oftentimes still do not provide enough support for most families, so providing opportunities for leveraging these benefits with funding for produce voucher incentives, provides and immense amount of support for individuals and the households they are feeding. Colorado has one of the highest eligible but not enrolled rates for WIC and SNAP in the U.S, only further exacerbating the food insecurity issue. Among Adams County community residents, only about half of qualifying individuals receive benefits for these programs due to various barriers, including fear of providing personal information required for enrollment and lack of education involved with receiving these services. With Thornton’s high rates of individuals living below the federal poverty level, some families in high need are on these programs, with many more being vulnerable to figuring out where to spend their limited incomes.

What percentage did you reach?

The Markets founding partners recognized these health needs and met to establish a course of action towards combating the disparities around food access and connections to additional useful health resources in their community. An exact percentage from program participation as it relates to the total population is not calculated, but participants from target audiences continue to grow every year. Since inception, the Markets have served a total of 784 WIC clients and 343 SNAP clients showing the increased opportunity of residents to use their benefits. The inclusion of vendors that assist residents with WIC and SNAP applications and providing a farmer that accepts both WIC and SNAP/Double Up Food Bucks benefits, is a significant aspect of the Markets that is not typically found within farmers markets throughout the Denver-metro area.

What has been done in the past to address the problem? 

For TCHD and our partners, the common practice for individuals experiencing food insecurity has been referral to federal nutrition programs (WIC, SNAP, and Summer Food Service Program), local food banks and community gardens. There are 27 active food banks in Adams County and four are located in Thornton. Additionally, TCHD runs two community gardens with one located in Thornton. Prior to this partnership, partners including TCHD have referred to and co-located certain services such as a WIC collaboration with the food banks, schools, and community gardens. 

Why is the current/proposed practice better?

The Markets are not your typical farmers market. The Markets stand out from other markets because our goal is to be an integrated health hub within underserved communities, serving as a gathering place for residents to access affordable, culturally relevant and healthy food, food and health education, and preventative health services all in one location. The current practice is a model of innovation through partnership, ongoing discovery, health equity, and measurable capacity. The cross-sector partnership makes this model particularly effective as each partner brings resources and their unique perspectives to serve the residents of Thornton and surrounding areas. 

Is current practice innovative? How so/explain? 

By building a foundation as a community hub, this innovative approach has enhanced the traditional farmers market to be responsive to community needs around health and health equity. The vision of the current practice is to inspire, nurture and support healthy communities with a mission of building a marketplace that offers affordable, fresh food and a variety of health resources. In its first year, the Market took place at the Anythink Huron Street Library to target specific communities in Adams County distressed by low living wage, limited access to healthy foods and higher rates of chronic disease. Once a week, the Market provided fresh produce; health education screenings, dental screenings and resources; federally funded Supplemental Nutrition Assistance Program (SNAP) including Double-Up Food Bucks and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits; literary resources and local transportation vouchers in a farmer’s market environment. The program was replicated in its second year by expanding to a second location, with both Markets occurring in the 2020 season.

The presence of COVID-19 did require further innovation to the Markets model as there were a number of guidelines for hosting an outdoor community event that needed to be implemented. Hosting a socially distant farmers market required creative planning and organizing. In order to keep our participants and our staff safe, we utilized the parking lot space of the libraries to encourage social distancing between vendors. The layout of the Markets was one loop that required participants to enter through a starting point and flow through the market in one direction. The check-in point is where participants completed a survey in order to learn if they qualified to receive a program benefit to purchase fresh produce. There were also masks, gloves and hand sanitizer available to all participants in order to be compliant with state regulations. 

Is it new to the field of public health?

While health issues related to food access are not new to the field of public health, the larger breadth of addressing social determinants of health is still a new challenge when helping under-resourced families make decisions about which health issues to address first. Food insecure children are at higher risk of experiencing developmental delays and long term chronic disease outcomes, while older adults over age 60 are also at much greater risk of poor health outcomes, such as increased risk of heart disease, when they are food insecure.^[7] This year marks the completion of a third season of the Healthy Farmer’s Markets. By offering a farmers market during the week from 9am - 1pm, we have seen increased participation for older adults and parents of young children who need additional access to fresh food and additional health resources. 

Is it a creative use of existing tool or practice?

Food insecure geographic data from Community Commons drove the strategy behind selecting the City of Thornton as the location of the Markets. Enhancing the concept of a farmers market to additionally meet other health-related needs, such as medical screening, dental screening, grocery shopping skills and a wide variety of health related resources, is how the Markets go above and beyond to establish healthy opportunities for the communities we serve. With COVID-19 restrictions, instead of offering health resources directly on site, the Steering Committee had a webpage created for the Markets. This webpage linked our market participants to healthy eating and healthy living resources throughout the community, by displaying posters with a QR code for the web page at the Markets check-in tent in order to limit social gathering. 

What tool or practice did you use in an original way to create your practice?

The Community Commons vulnerable population’s footprint is a mapping tool that is able to identify the location of needs within a community, in order for an agency to intervene with strategic action towards reducing health disparities. The high prevalence of chronic disease and low living wages is how we identified the City of Thornton as the hosting grounds for the Markets in order to provide fresh produce that was not available before in a predominantly low-income area. Through use of the vulnerable population’s footprint, TCHD has been able to view the social determinants of health as a synergistic framework for the Markets in order to address economic stability, education, health services, built environment and social and community context.

GIS mapping capabilities has been another tool to enhance the effectiveness of the practice. This season, the Markets were able to track participation and collect real-time data in order to measure capacity and the reach of marketing strategies. In addition, GIS kept track of dollars spent for the two different funding mechanisms that provided produce vouchers to Thornton and non-Thornton residents at both market locations. The data collected were presented in real-time throughout the market season through use of an interactive data dashboard. Markets staff were able to measure impact each week, but could also break down the collected data by market location and even further by attendees' age.  This data dashboard also helped us to track dollars spent as well as dollars remaining each week to utilize all funding available for fresh produce for participants. Dollars from each funding category, WIC, SNAP and older adults, had to be tracked separately for reporting purposes as each category had an allotted subtotal. 

Link to data dashboard: https://tchdgis.maps.arcgis.com/apps/opsdashboard/index.html#/4d111f70071a48b7a3a35ff0ceb1a8f1

Is the current practice evidence-based?

While the current practice is not evidence-based, it is evidence-informed, particularly regarding the use of the Collective Impact Model of partnership to align efforts to meet the common goal of addressing an important social determinant of health. This year, the Markets incorporated GIS tracking technology in order to track participant information in real-time. By collecting these data points, we were able to see the reach of our communications strategies to shape those throughout the season to target different audiences as well as track the different funding streams. Each week, we were able to learn about our participant audience, where they were traveling to us from and how they were hearing about the markets. These data help facilitate a formal evaluation for the program in order to improve our Markets each year and establish an evidence-supported, replicable model through the development of a Healthy Farmer’s Markets toolkit.

Goals and objectives:

The Markets stand out from other markets because our goal is to be an integrated community health hub within underserved communities, serving as a gathering place for residents to access affordable and healthy food, food and health education, and preventative health services all in one location. The Markets also provide TCHD supported health related resources for all ages in an easy to access format.

Objectives of the Markets are:

1) To increase food access via healthy, culturally relevant foods and health education

2) To increase access to health related services by collaborating with local health and wellness vendors

3) To create economic opportunities for new, local entrepreneurs to create and/or further develop their businesses as vendors and sell their products

In 2019, TCHD established a second location to increase food access and enhance the model of the Markets to diminish the barriers corresponding to healthy food access. The Markets promote a cross-sector program for community members to access the assistance necessary to improve their health outcomes and wellbeing. Increased success of the Markets are attributed to newly implemented efforts resulting from the expansion of program capacity. Our partners create opportunities for food insecure and lower-income community members to learn more about their health, connect to and build trust with health care professionals in their community, and ultimately live healthier lives.

Steps taken to implement the program:

A particularly unique accomplishment of this partnership is the ability to combine efforts to address food insecurity in combination with health literacy, resources, and access to services that support health. Deliberate steps were taken to include a diverse network of health related resources by screening vendors that would provide links to better health. The library locations promote education and health literacy that allow the Markets to stand out from a traditional farmer’s market. As the Markets grow and expand, this partnership is able to highlight community offerings, incentives and programs that apply to all of the social determinants of health. In the first two years, funding permitted the addition of interactive classes and educational vendors such as Cooking Matters, the Learning Source, Hunger Free Colorado and Growing Home. Cooking Matters provides nutrition education through cooking demonstrations utilizing produce from the market and offers budget-friendly recipes to enhance family knowledge on how to feel more confident as they shop for groceries and prepare meals. The Learning Source supports future achievements for adults and families looking to advance their English skills, GED competencies, and learn English as a second language. Hunger Free Colorado provides SNAP application assistance and referrals to other community food resources such as food pantries. Growing Home provides further education and referrals to families on the health and wellness resources available to them and promotes equitable opportunities to improve social determinants of health through local partnerships. In 2020, COVID CARES funds and local grants secured funding for increasing food access in this area. These funds were able to provide produce vouchers for community members over the age of 55, and for those who receive federal nutrition assistance (WIC and/or SNAP). 

What was the timeframe for the practice? Were other stakeholders involved?

 In prior years, the practice timeframe is 13-weeks as it is a seasonal project running from early July through early October. This year, the Markets ran for 10-weeks, as there were delays in the libraries re-opening after the shutdown from COVID-19. The partners responsible for implementing this practice are TCHD, AHA, City of Thornton, Lulu’s Farm and the Anythink Libraries. For members of this Steering Committee, this project is ongoing and requires monthly meetings to analyze and foster new ideas in order to sustain Market success. 

What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders?

The reach of TCHD and the 1.5 million people we serve, creates more opportunity for engagement due to a widespread agency mission of diminishing health inequities. What makes TCHD unique is our ability to collaborate internally across multiple programs with community partners and local government agencies, to continue to innovate new structures that promote equitable opportunities. TCHD is able to provide expertise integrating public health practice for the creation and implementation of community programs. Inter-agency support creates linkages to internal programming, specifically with our health planners and epidemiologists and their abilities to review and create real time data collection methods and GIS capabilities. TCHD has been fostering collaboration with community stakeholders for three years working to build a coalition in order to diminish food insecurity throughout the City of Thornton. The Markets have been a foundation to build on food security with the help of community members, local businesses, partners and all those committed to addressing hunger throughout Colorado. The Markets bring together local community vendors for market participants to support small business and craft artisans.

The first partnership was with the Anythink libraries, who pride themselves on being a community hub of local resources within their municipality. They believe that the Markets fit their mission and vision to be the catalyst for innovation in Adams County by being the hosting locations of the Markets. By using an established community organization, the location of the Markets are able to provide access, support and education for children, families and our aging population. Participants of the Markets can engage in other library offerings, which include, Preschool Story Time, Baby Bounce and signing up for library cards. Preschool Story Time is for ages 3-5, while Baby Bounce is appropriate for age’s birth-23 months and their caregivers. Anythink is hoping to incorporate some adult programming in future seasons that can relate to the Markets. The first Market in 2018 ran at the Anythink Huron Street library from July through October. TCHD led the Steering Committee of partners to meet each month between the market seasons to discuss lessons learned and explore ways to improve for the 2019 season. In 2019, the Steering Committee felt confident in expanding to a second location, the Anythink Wright Farms Library, and both Markets were sustained through 2020. Providing two locations within the City of Thornton, established more opportunities for families and residents to partake in Market offerings that fit in with their everyday schedules. The Markets have been able to draw attention to Anythink’s interest in meeting both literacy and health needs of the community. 

Second, the City of Thornton became the connector, the link between the idea and the action. Due to the City of Thornton’s desire for a consistent farmers market, the city did not charge a fee for the temporary use permit and was able to provide the capacity to recruit community members and local vendors. Their staff has been able to inform action strategies in market infrastructure pertinent to how the Markets can be most effective to what their community needs are and how to achieve those needs. In addition, the City of Thornton has been able to provide and incorporate bilingual support throughout the Markets through their presence and with marketing materials. Marketing in and promoting the availability of Spanish speaking staff has provided a level of comfort for non-English speakers who may have felt more intimidated at an event such as this and reduces a communication barrier.

Next, Lulu’s Farm, the primary farmer of the Markets, exemplifies a bright spot of community engagement and outreach in this partnership. Indicated by their slogan Not Your Ordinary Produce Market, Lulu’s Farm goes beyond and has received all qualifying certifications necessary to accept SNAP, including Double Up Food Bucks. Their partnership creates an opportunity for healthy foods to be available at a low cost and builds strength throughout the community to end hunger. Providing access for eligible WIC and SNAP beneficiaries is a part of the Markets’ original objectives. Adams County WIC clients have experienced frequent access problems including not having enough money to buy fruits and vegetables, getting to a farmer’s market when it was open, and finding farmers markets in nearby locations. In the Markets first two years, through the partnership with TCHD and Lulu’s Farm, qualifying individuals presented their WIC eligibility card and received a $5 coupon for each member of the family receiving WIC benefits to spend at the Markets each week. WIC coupons were implemented in the Markets in order to incentivize Market offerings and target food insecurities. These coupons were provided in addition to an individual’s WIC food benefits already received. With COVID CARES funds, this year, Lulu’s Farm accepted $25 produce vouchers from qualifying individuals to purchase market produce. Qualifying individuals included WIC beneficiaries, SNAP beneficiaries and older adults over the age of 55. By advocating for these programs, our Markets keep money within the local economy and sustain local, healthy food resources.

Finally, AHA was a recommended key partnership due to their ability to provide a funder necessary to subsidize the farmer and provide marketing strategy and materials. Their reach throughout the nation has been able to connect TCHD to resources on a larger scale in order to continue the efforts of the Markets sustainable funding opportunities and seek out sponsorships that can aim to replicate this market format in communities throughout Colorado and beyond.

In addition to TCHD’s partners and collaborators, the presence of health service providers as vendors is another hallmark of the Markets. Yahweh Health Care (YHC) Clinic is a local, non-profit organization whose mission is to promote the physical, emotional, and spiritual health of all those who need our care. This organization provided free health screenings and check-ups with local medical provider volunteers at the Markets. YHC also provided information and guidance on how to connect residents to additional community resources for a variety of health related needs. Having local providers who serve as volunteers also created an opportunity for community members to get to know a local doctor, build trust with them, and be seen for any future needs in that clinic if they did not already have a primary medical home facility. Other health service vendors offered dental screenings, diabetes education classes, and breastfeeding education with lactation consultants. Residents also had the opportunity to learn more about sugar sweetened beverages, the Diabetes Prevention Program and Journey to Wellness, which are both health related classes, and our aging population received information on a Matter of Balance program, which focuses on reducing the risk of falls. The Steering Committee’s resource table also provided education on a variety of assistance and education programs from the community, our partners, and TCHD including water conservation, vaping, sexual health, US Census jobs, and food pantry locations and times.

The continuation of networking based on these previous partnerships will further the internal and external collaboration to promote community-based and TCHD’s agency-wide program offerings. The planning, coordination and implementation of the Markets with these community stakeholders builds a foundation upon which to continue and expand the Markets footprint not only within Thornton and Adams County, but also throughout all of the counties served by TCHD.

Any start up or in-kind costs and funding services associated with this practice?

AHA has been the primary fiduciary sponsor of the Markets. An initial grant of $10,000 in 2018, provided by an anonymous donor, has subsidized farmers, provided marketing materials and aided in market expansion and replication. This funding is what made the Markets possible, as TCHD did not have enough grant funding to be an independent funding source for project implementation. In-kind costs include TCHD, Anythink Libraries, City of Thornton and community members’ time, printing costs of flyers and community resources, and volunteer hours. In addition, the 13 Steering Committee members have dedicated 1375 hours during the Market season and 425 hours outside of the Market season; an equivalent of .86 FTE. Exploration of sustainable funding opportunities for the Markets include exploring sponsorship opportunities as well as charging low-cost vendor fees to subsidize operational costs.

What did you find out?

As a collaborative effort of partners and resources, the Markets combat health inequities to make a difference in population health. The Markets’ Steering Committee has standardized its qualitative and quantitative data collection methods from Market attendees and vendors. The availability of SNAP/Double Up Food Bucks and produce vouchers was able to enhance the efforts of increasing food access. Customers of the Markets relied on these vouchers and were a consistent incentive that brought members of this eligible population back to the Markets. This highlights the community need for affordable, healthy food that we were able to meet.  The ability to replicate the Markets with Anythink’s reach within the City of Thornton enhanced food access, access to health services and economic opportunities for local entrepreneurs. We learned that some vendors wanted to attend both markets but did not have the resources or capacity to do so. While the Market model is replicable, we found that each of the Markets looked different from one another with not all of the same resources and vendors being consistently available. For further implementation, the Steering Committee is exploring how to incentivize vendors to be a consistent Market participant at an established location in order to enhance dependability during the season. We believe that Market success will only increase as we define accountability for everyone involved.

Did you evaluate your practice?

Evaluation is an ongoing component of the Markets to gain real-time feedback and analyze the overall strengths and weaknesses of the program as it develops and expands. By tracking performance measures, we are able to tailor our marketing throughout the season to bring in more individuals from our target audiences. In the 2020 season, the Markets incorporated a GIS tracking tool that gathered information about our participants. The survey collected the following information: market location, date and time of participant entry, participant zip code, if the participant was accompanied by guests, whether or not they had attended the market before, how they heard about us, what mode of transportation they used to get to the market, whether the participant received WIC, SNAP or both federal nutrition programs, and whether or not they were over the age of 55. Qualifying individuals, those who receive WIC, SNAP or both or who are over the age of 55, were given a $25 voucher to purchase produce at our farm stand. The purpose of tracking these primary data sources ensures that the Markets are reaching the target population and that attendees are aware and taking advantage of the benefits available to them that will reduce the economic burden associated with food access. We also categorized voucher recipients by whether or not they were a resident of Thornton to track different funding streams and amount of funding that continued to be available market after market. The data from 2020 confirmed the following:

                                       Huron Street                  Wright Farms                                        Total

Total Participants^[1]                   1,826                              1,791                                          3,617

Dollars Spent                            $27,353.98                     $27,637.22                        $54,991.20

Vouchers Given                         1,357                             1,344                                          2,701

Older Adult Vouchers                 995                                967                                             1,962

WIC Vouchers                            160                                165                                                325

SNAP Vouchers                         144                                107                                                251

Receives WIC and SNAP           82                                  81                                                 163

Thornton Vouchers                     1,099                             1,080                                          2,179

Non-Thornton Vouchers             258                                264                                                522

Non-voucher Participants           97                                  94                                                  191

Total Guest Count                      372                                353                                                 725

^[1] Total participants were calculated by total vouchers + total guest + total participants who did not receive vouchers

Out of the 2,892 participants that completed the program survey:

●   26.7% heard from a friend/family member

●   13.3% heard from their WIC clinic

●   12.5% were coming to the library anyway and saw us

●   10.8% drove by us and decided to stop

●   6.8% heard from a partner organization in the area

●   6.1% saw communications on Facebook

●   3.8% read about us in the City of Thornton newsletter

●  10.8% were “other” sources. Common entries for other was faith-based organizations, summer community activities and older adult community organizations

With these data, we were also able to create spatial analysis and heat map content to highlight the reach within the community from zip code data. By tracking zip codes, we can further evaluate our reach as we seek to expand and replicate this farmers market model into other communities. The ESRI platform affiliated with ArcGIS was able to populate heat tracking maps highlighting the Markets location as it compares to where survey participants said they lived. With these data, the Anythink York Street Library is a potential market location, as many participants traveled from that area to attend the Huron Street market. 

Link to heat tracking maps: https://tchdgis.maps.arcgis.com/apps/presentation/index.html?webmap=b0615075010d4110ba4cea79f7b91d6a

Secondary data sources include the stories and feedback from community members, volunteers and program staff. COVID-19 has changed the operations for a number of community programs and has created more barriers within the population to access food. 

Personally, it was the seniors. It's always been instilled in me to take care of the elders of our family. At the same time, I know how blessed I am with the ability to have my family close and able to assist them when they need help. But the market made me realize how many seniors are on their own and have limited/no access to family assistance. Especially with this pandemic we are in, it was awe-inspiring to see excited seniors coming out but also feeling safe at the farmers market when they got their produce. We had many awesome neighbors bring their senior neighbors who didn't have access or couldn't drive down to the market so they can have fresh produce as well. Since the pandemic and market, it has made me more aware of checking in with my senior neighbors to see if they need anything as well.

~ Carin Marie Christoffersen - Lulu’s Farm Roadside Market

Mike and I both feel blessed to have an opportunity to serve residents of our community. To see the smiles and hope this program afforded families, seniors and individuals was amazing. Judy from TriCounty did a wonderful  job as well as Lulu’s employees, Library staff and other volunteers.

~ Rosemary - Volunteer that received vouchers, and then decided to volunteer with their husband Mik

What an amazing resource for our community, not only to have access to free or affordable fresh produce, but to get to have some sense of community and normalcy during this time. It was fun to recognize the folks who came every single week, and see their excitement at how much produce they could take home using that $25 voucher. Thank you for offering such a worthwhile and meaningful resource to our community!

~ Maria Mayo | Adult Guide - Anythink Wright Farms

Evaluation of the practice has allowed an understanding of the impact of the Markets on health outcomes. The collected data provides further insight on the crucial strategies for further implementation of the Markets within Adams County. Review of this statistical data highlights our community impact by increasing access to food and promoting an affordable farmers market experience.

Limitations:

As with most data collection, there are limitations to the findings that need to be considered. First, we cannot assume that every guest of the market was accounted for if they did not participate in the survey collection. Although we did have a line for entering the farmers market, some participants may have been able to stop in and were not able to be accounted for. All of the data is based on who was able to and participated in the survey. Second, human error must also be considered. The survey data that was captured has some discrepancies in the form of typos or not actually selecting a value. Smart phones were used to conduct data collection, so there may have also been inconsistencies with the technology depending on the day and abilities of the user. Third, there was a variety of people who were implementing data, so there were times when data trackers may not have known how to record some of the participants data and therefore, tracked a component differently than recommended. Fourth, a participant that received both SNAP and WIC had to be categorized as one or the other when physically receiving a voucher. The funds were grouped separately, so these individuals are accounted for as SNAP recipients in the final numbers. Finally, due to COVID response of the organization, the epidemiologists assigned to the project were not able to update the final dollars spent, after market staff verified the final numbers and documentation with the farmer. 

Lessons learned in relation to practice:

The Markets were recognized as a NACCHO Promising Practice in 2020. From this, we wanted to focus the 2020 market season on integrating data tracking technology and conductive analysis of target audience and program reach within our community. Like many farmers markets, there were many concerns on the capacity and ability to run this year, but with strategic planning and preparation, the Steering Committee was able to provide this service in a unique way. We took each week by week and remained flexible to how we had to adapt in order to continue our services, as we know how this pandemic has exacerbated the food insecurity issues across the nation. This season has shown the resiliency in our efforts and has allowed us opportunities to learn from our data, the experiences of our participants and our collective impact across Adams County, so that we can continue to be a pillar of food access for our residents.

When considering lessons learned, the overall focus in how to increase program sustainability across all core areas of program operations. The Markets Steering Committee members are exploring strategies necessary for maintaining vendor continuity at each location. Currently, market vendors do not pay vendor fees and are only required to have a verbal commitment to market participation. The philosophy behind this method was to provide support and encourage new and existing local entrepreneurs to participate while having access to a free space to promote their products. For many of these vendors, this was their first opportunity to display their crafts since booth fees were too high at other farmers markets throughout the Denver metro area. The current discussion is focused on incentivizing consistent vendor participation without taking away the support of buying local products or having too burdensome of cost to new entrepreneurs.

An additional hurdle of the Markets are the presence of farmers and their cost-benefit ratio on market participation. Being a WIC and SNAP certified vendor has many requirements. The process can be long and many farmers do not want to take the risk without the immediate reward. Unfortunately, even a farm with a WIC certified storefront, may not be able to bring that service to a farmers market setting due to various technology point of sale restrictions. The WIC coupons were established by the Markets Steering Committee to invoice these transactions to AHA for reimbursement at the end of the Market season. Additionally, the funding from AHA pays a stipend to the farmer each month to cover any losses due to lower income areas and provide secure income in the case of lower attendance in new locations. Providing the stipend has ensured the farmer’s regular participation. We also work with Lulu’s Farm to ensure accountability on program incentives and have an established agreement with them that they receive reimbursement for accepting the produce vouchers that are offered each season. The tracking of the $25 produce vouchers had to be characterized by Thornton versus non-Thornton residents so that the correct funds were distributed to the correct organization. COVID CARES dollars from the City of Thornton were specifically provided to the Markets under the agreement that they would only go to Thornton residents. That funding was reimbursed to Lulu’s Farm through Tri-County Health Department MOU with the City of Thornton. In order to match the value of this voucher incentive and knowing that we do not only serve residents of Thornton, AHA provided the funds to provide vouchers to non-Thornton residents. Lulu’s Farm invoiced AHA directly in order to be reimbursed for that category of vouchers. We work very diligently with Lulu’s Farm to offer incentives for our target populations, as this is a key highlight of the program’s mission towards food security.

Furthermore, a farmers market even of a smaller scale requires a significant amount of capacity and resources. In 2020, the Steering Committee members spent an estimated 1375 hours and 300 hours of volunteers to staff the market, coordinate vendors, and address needs of partners during the Market season. An additional 425 hours were spent by the Steering Committee in the off-season for strategic planning, developing marketing materials, evaluation and more.  Additionally, TCHD utilizes two additional staff members to dedicate additional time to support the Markets infrastructure by providing facilitation of the Steering Committee to plan meetings, lead them through strategic planning and manage volunteer recruitment and expansion. TCHD was matched with a CDC Public Health Associate who will be dedicated to this work and support the team for the upcoming 2021 season. Some of the tasks will also include volunteer coordination, increased partnership recruitment and improved processes for expansion.

Lessons learned in relation to partner collaboration:

Establishing a community collaborative requires a strong emphasis on communication. The Markets have a significant amount of moving pieces that require strict orchestration and accountability. Being a collaborative project, the Steering Committee is always working on ways to evaluate program strategies and effectiveness. In the Markets’ second year, the Steering Committee realized that roles of each member needed to be more clearly defined. The Steering Committee established a working agreement as a platform that lays a concise foundation for the roles and responsibilities of all participating parties. After reviewing the 2019 season, the Steering Committee wanted to emphasize the need for active participation amongst all partners as it was found that each partner organization was contributing unequal levels of work. Strategizing for the 2020 season included the implementation of working groups within the Steering Committee. The lift of this project requires many moving parts, so in order to distribute the workload, the project was divided into 5 workgroups: market experience and community resources, vendors, communications, funding and financials and logistics/internal tools and resources. These workgroups permit members of the opportunity to invest in one component of the work so that there is a commitment to one focus area rather than working on one part of all areas of the project. This has created equal distribution of the work and the chance for all committee members to actively participate in an area that highlights their strengths and interests. 

Did you do a cost/benefit analysis?

A formal cost/benefit analysis has yet to be conducted for this practice.

Is there sufficient stakeholder commitment to sustain the practice?

The collaborative efforts of the Markets were already able to replicate and expand the Markets to reach further into the communities of the City of Thornton in just one year; two market seasons. One way TCHD will support and sustain the Markets is through the five-year TCHD Public Health Improvement Plan (PHIP), which has identified food security as a priority area. One of the objectives includes providing access to fresh produce through healthy retail, including farmer’s markets. The PHIP establishes the commitment of the agency and key community stakeholder’s through core strategies in improving the health outcomes of community members. The Health and Food workgroup is committed to a strategic planning model to achieve sustainable action and movement towards food security and promotion of food security through messaging, education, advocacy and policy development. TCHD’s PHIP aligns closely with the statewide Colorado Blueprint to End Hunger. The goals of this blueprint are to increase public understanding and awareness of hunger; increase access to affordable and nutritious foods in their communities; increase access to food assistance and nutritious foods through community-based organizations, increase WIC and SNAP eligible beneficiaries to bring Colorado to the forefront of federal nutrition program enrollment; and maximize participation in federal child nutrition programs. The outreach and education that the Blueprint provides encourages a call to action approach for local health organizations, policy makers, stakeholders and all individuals throughout the state of Colorado.

Additionally, the Colorado Department of Public Health WIC program was recently approved for the WIC Farmers’ Market Nutrition Program (FMNP) in the upcoming 2021 growing season, which is a source of additional fresh produce dollars for designated WIC participants. Congress established the FMNP in July 1992, to provide fresh, nutritious, unprepared, locally grown fruits, vegetables, and herbs through farmers’ markets and roadside stands to WIC participants, and to expand the awareness, use of, and sales at, farmers’ markets and roadside stands. Eligible WIC participants are issued checks or coupons in addition to their regular WIC benefits. These checks or coupons are used to buy eligible foods from farmers at farmers’ markets and/or roadside stands that have been authorized by the State agency to accept FMNP coupons.

 The Markets partners have expressed a high commitment to this work and their dedication has fueled the sustainability of the Market model. This dedication is solidified in the working agreements being developed for the 2021 season amongst partners. To sustain the Markets, the Steering Committee is sourcing funding from a variety of organizations through grants and seeking potential sponsorships. Future funding to continue this development falls into three focus areas, which includes marketing, farmer subsidy and technology.

● Marketing will always be a crucial component to the success of the Markets to increase awareness surrounding the unique resources that are provided. The Steering Committee has planned to highlight services that are provided in real-time in 2020 so attendees of the Markets are making the most of their trips.

● Technology is necessary to provide on-site, direct WIC payment. Incorporating the necessary machinery (still in development by the State) that remotely accepts WIC dollars at the Markets, would eliminate the need of using grant dollars to provide WIC coupons because participants would have direct access to their WIC benefits.

● Funding in each of these areas will increase awareness of the Markets to increase participation and profit for the vendors. This would also reduce or eliminate the need to subsidize the farmer in future years as the Steering Committee could guarantee higher participation.

These developments will support the long-term goal of the Markets to be self-sustaining by reducing reliance on grant dollars for funding. The high stakeholder commitment and plans for sustainability for the Markets is part of this partnership’s greater vision to support families, children and seniors who are impacted by hunger. TCHD views food security as a basic human right. It is our goal to improve access to food resources for our communities through a system of collaborative efforts, which establish the foundations of what it means for an individual to achieve optimal health in a productive population. TCHD can create a system that changes the environment that the members of our communities are exposed to, to decrease the prevalence of chronic disease through the Market model. Until no longer needed, the Markets will continue to expand resources, grow capacity for food security and promote health education. The stakeholder commitment and collaborative partners’ efforts ensure a variety of resources available to those partaking in the Markets, and that the success of the Markets contributes to establishing a marketplace that simplifies access to health resources for individuals of all ages throughout the community.

Link to TCHD Public Health Improvement Plan (PHIP): https://www.tchd.org/DocumentCenter/View/1805/tchd_phip_2019-2024?bidId=