PHC6534- From Farm to Family: A trauma-informed program for healthy meals and healing among low-income women in the Bronx
Overview
Adverse childhood experiences (ACE) have been found to increase the risk for several chronic diseases, including hypertension (Gilbert, et al., 2010). These diseases increase the chance for adverse maternal and neonatal outcomes (Chang, Brown, & Nitzke, 2016). If not managed, gestational hypertension can lead to preeclampsia or eclampsia and an increased risk for developing hypertension and stroke later in life (Tanaka, et al. 2007). It is also one of the leading causes of maternal mortality in the U.S (Singh, et al., 2018).
Consumption of foods identified as protective against hypertension, including fresh fruits and vegetables, has been reported to be lower among low-income women (Treiman, et al., 1996). This is attributed to various factors, including the inaccessibility of produce in low-income neighbourhoods, and unfamiliarity with preparing fruits and vegetables (Sacks, Ni, & Nonas, 2015). Furthermore, a healthy diet is critical for healthy childhood development, and a poor childhood diet is associated with higher levels of chronic diseases, which may also be compounded by intergenerational ACEs (Spence, et al. 2013).
According to Feeding America, the Bronx has a food insecurity rate of 17.5%, which is well above the national average, and has the highest rates of hypertension and severe maternal morbidities in New York City (CDC, n.d-A; New York City Department of Health and Mental Hygiene Bureau of Maternal, 2016). Furthermore, reports show that grocery stores in the Bronx are closing and more convenience stores are opening, thereby making fresh produce more unattainable (Cohen, et al. 2020).
This program will have two activities that will each be conducted once monthly and biweekly physical exams consisting of blood glucose and blood pressure checks and fetal heart rate checks. The first activity will consist of a farmer’s market workshop that has the dual purpose of providing information on how to shop at a farmer’s market and prepare healthy meals. These workshops will be run by a market liaison who is trained in trauma-informed care and a nutritionist specialized in antenatal and maternal health. Every other month, the prepared meal will include specific instructions for how to involve children of different ages in the food preparation, thus teaching the mother avenues for communication with and support for her children. The meals will be produce-centered, easy and cheap, in order to provide convenient meals that can also protect against hypertension in the mothers and their children.
The second activity will be a trip to a farm that sells at the farmer’s market. Women will be encouraged to attend with their children whenever possible in order to establish a network of support and create a sense of community for the women and their children. In addition to physical activity, the outings will also contain a mindfulness and counseling session. This will be led by a social worker and a psychiatrist who will foster constructive dialogue, provide professional support, and lead exercises. As with the cooking classes, mindfulness or physical exercises will include ways to include the child in the exercises, when possible.
Public Health Framework
In accordance with the Trauma-Informed Philanthropy Guide, this program will use a multi-dimensional and multidisciplinary public health framework that aims to address various factors that impact health (Philanthropy Network Greater Philadelphia, 2016). A public health framework recognizes the wider context of health and works to create a “cross-sector, multi-level program and policy change that will be the most effective way to prevent adverse childhood experiences and promote healing” (Philanthropy Network Greater Philadelphia, 2016).
We recognize that health is not a linear process and that wider socio-political, economic, and personal factors can all affect health. As such, this program will employ a collaborative and participatory approach that will include individuals from various occupations, interest groups, and with diverse experiences that can identify and address these various factors.
Furthermore, this program will target the three levels of prevention across two generations in order to reduce hypertension and mitigate health outcomes associated with trauma, screen for trauma and associated health outcomes, and reduce and prevent ACEs and build resilience in future generations.
Levels of Social-Ecological Model
In order to increase the likelihood for an effective and sustainable project, this program will address factors at various levels of the CDC’s Social-Ecological Model, including the individual, relationship, and community levels (CDC, n.d-C). This program acknowledges that behaviours are influenced by a wide variety of factors at different levels and are not only a personal choice.
The program’s focus on health and healing among mothers will address the individual level. Awareness about trauma and its effects on health, and the skills-based aspect to shopping for and preparing healthy meals will aim to improve knowledge and build self-efficacy among the women.
At the relationship level, the program will increase awareness for how trauma can be intergeneration and how parents can create supportive, safe spaces and help build resilience in their children. The practical skills learned in the cooking lessons will also contain a component for how to connect with children through cooking that will promote communication within families. Furthermore, the relationships generated between the women will hopefully also provide comfort and support.
Finally, farmer’s markets were historically not available in low-income neighborhoods like the Bronx, so there may be less community knowledge and awareness for farmer’s markets. As such, at the community level, the program will work to make farmer’s markets and produce-based cooking more accessible to women living in low-income settings.
Trauma-Informed Principles
This program will incorporate all trauma-informed principles outlined by SAMHSA to ensure that activities, staff, and spaces help the participants heal and minimize the risk for re-traumatization (2014).
Safety aims to ensure that all participants feel physically and psychologically safe. As such, all individuals that work directly with the participants will be trauma-informed. Furthermore, and in accordance with trustworthiness and transparency, all activities will be explained beforehand, and participants will have time to ask questions or opt-out of any activities that seem potentially triggering. This is especially important when traveling out of the city, and thus the address for the farm will be shared in advance and the day will adhere to a pre-planned schedule to the highest degree possible. Any participants that wish to leave the farm tour early will be able to do so and will be provided transportation.
Peer support will be upheld through the relationships formed within the participants. Collaboration and mutuality will be integrated as women provide feedback on activities and will be further solidified throughout the program levels as participants join the administrative team.
Empowerment, voice, and choice will be promoted by encouraging women to make choices for themselves. Rather than mandating a healing process or a behavioural change, this program aims to motivate women through skills-based training and strengths-based healing. Mindfulness sessions will incorporate techniques used in motivational interviewing to empower the women and respect their autonomy.
Lastly, working with women from predominantly Hispanic/Latinx neighborhoods means that the participants may be at high risk for discrimination, bias, and several sources of trauma (CDC, n.d-B). Individuals working with participants will also undergo cultural competence and implicit bias training to raise awareness for cultural, historical, and gender issues, and policies will continuously be updated to reflect any changes to the sociopolitical context.
CDC. (n.d.-A). Compare Counties. https://nccd.cdc.gov/PLACES/rd...questForwarding=Form
CDC. (n.d.-B). Preventing Adverse Childhood Experiences |Violence Prevention|Injury Center|CDC. https://www.cdc.gov/violencepr...n/aces/fastfact.html
CDC. (n.d.-C). The Social-Ecological Model: A Framework for Prevention |Violence Prevention|Injury Center|CDC. https://www.cdc.gov/violencepr...ecologicalmodel.html
Chang, M.-W., Brown, R., & Nitzke, S. (2016). Fast Food Intake in Relation to Employment Status, Stress, Depression, and Dietary Behaviors in Low-Income Overweight and Obese Pregnant Women. Maternal and Child Health Journal, 20(7), 1506–1517. https://doi.org/10.1007/s10995-016-1949-5
Feeding America(n.d). Food Insecurity in Bronx County[interactive map]. Accessed December 1, 2020. Available at http://map.feedingamerica.org/...ew-york/county/Bronx
GrowNYC (2020). Food Access 2019 Report [PDF slides]. GrowNYC. https://www.grownyc.org/files/...rojectHighlights.pdf
Gilbert, L. K., Breiding, M. J., Merrick, M. T., Thompson, W. W., Ford, D. C., Dhingra, S. S., & Parks, S. E. (2015). Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010. American journal of preventive medicine, 48(3), 345–349. https://doi.org/10.1016/j.amepre.2014.09.006
New York City Department of Health and Mental Hygiene (2016). Severe Maternal Morbidity in New York City, 2008–2012. New York, NY.
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, and United Way of Greater Philadelphia and Southern New Jersey (2016). Trauma Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley.
Sacks, R., Yi, S. S., & Nonas, C. (2015). Increasing access to fruits and vegetables: perspectives from the New York City experience. American journal of public health, 105(5), e29–e37. https://doi.org/10.2105/AJPH.2015.302587
SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available at https://ncsacw.samhsa.gov/user...es/SAMHSA_Trauma.pdf
Singh, G.K (2010). Maternal mortality in the United States, 1935-2007: Substantial racial/ethnic, socioeconomic, and geographic disparities persist. US Department of Health and Human Services, Health Resources and Services Administration.
Spence, A. C., McNaughton, S. A., Lioret, S., Hesketh, K. D., Crawford, D. A., & Campbell, K. J. (2013). A Health Promotion Intervention Can Affect Diet Quality in Early Childhood. The Journal of Nutrition, 143(10), 1672–1678. https://doi.org/10.3945/jn.113.177931
Tanaka, M., Jaamaa, G., Kaiser, M., Hills, E., Soim, A., Zhu, M., Shcherbatykh, I. Y., Samelson, R., Bell, E., Zdeb, M., & McNutt, L. A. (2007). Racial disparity in hypertensive disorders of pregnancy in New York State: a 10-year longitudinal population-based study. American journal of public health, 97(1), 163–170. https://doi.org/10.2105/AJPH.2005.068577
Treiman, K., Freimuth, V., Damron, D., Lasswell, A., Anliker, J., Havas, S., Langenberg, P., & Feldman, R. (1996). Attitudes and Behaviors Related to Fruits and Vegetables among Low-income Women in the WIC Program. Journal of Nutrition Education, 28(3), 149–156. https://doi.org/10.1016/s0022-3182(96)70050-x
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