Use of population health data and qualitative analysis to guide local planning and implementation of Supplemental Nutrition Assistance Program Education

PURPOSE

To describe how local quantitative and qualitative data were used to assess the progress of the Supplemental Nutrition Assistance Program Education (SNAP-Ed) interventions in Los Angeles County, California.

APPROACH

Data from the California Health Interview Survey informed the geographical concentration of program resources during the planning phase. At the end of the program, semi-structured interviews with stakeholders were conducted to assess factors that facilitated SNAP-Ed implementation.

SETTING

Los Angeles County, California.

PARTICIPANTS

Twenty-four project coordinators were interviewed.

INTERVENTION

From 2016-2020, 24 organizations across Los Angeles County delivered nutrition education, reaching an estimated 2 million people. Two-hundred policy, systems, and environmental change interventions reached an estimated 1.2 million people.

METHOD

Semi-structured interview data were analyzed using a form of both inductive and deductive content analysis. A codebook was developed based on themes identified in these interviews. Each interview was coded by two team members; discrepancies (if they arose) were resolved by a 5-member group.

RESULTS

Two facilitators - support for capacity building from a local health department and presence of community partnerships - were identified as critical factors that contributed to the success of SNAP-Ed implementation.

CONCLUSIONS

A local health department can increase SNAP-Ed intervention reach and uptake by assisting funded partners with further capacity building, helping them to develop feasible work plans, foster evaluation skills, and engage in sustainability planning.

Incidentally Detected SARS-COV-2 Among Hospitalized Patients in Los Angeles County, August to October 2020

We aimed to determine the percentage of COVID-19- associated hospitalizations reported to Los Angeles County (LAC) Public Health that might have been misclassified because of incidentally detected SARS-CoV-2. We retrospectively reviewed medical records from a randomly selected set of hospital discharges reported to LAC Public Health from August to October 2020 for a clinical diagnosis of COVID-19 or a positive SARS-CoV-2 test result. Among the 13,813 discharges from 85 hospitals reported to LAC Public Health as COVID-19-associated hospitalizations from August to October 2020, 346 were randomly selected and reviewed. SARS-CoV-2 detection was incidental to the reason for hospitalization in 12% (95% confidence limit, 9%-16%) of COVID-19 classified hospital discharges. Adjusting COVID-19-associated hospitalization rates to account for incidental SARS-CoV-2 detection could help public health policymakers and emergency preparedness personnel improve resource planning.

Implementing a Healthy Food Distribution Program: A Supply Chain Strategy to Increase Fruit and Vegetable Access in Underserved Areas

Increasing access to fresh produce in small retail venues could improve the diet of people in underserved communities. However, small retailers face barriers to stocking fresh produce. In 2014, an innovative distribution program, Community Markets Purchasing Real and Affordable Foods (COMPRA), was launched in Los Angeles with the aim of making it more convenient and profitable for small retailers to stock fresh produce. Our case study describes the key processes and lessons learned in the first 2 years of implementing COMPRA. Considerable investments in staff capacity and infrastructure were needed to launch COMPRA. Early successes included significant week-to-week increases in the volume of produce distributed. Leveraging partnerships, maintaining a flexible operational and funding structure, and broadly addressing store owners’ needs contributed to initial gains. We describe key challenges and next steps to scaling the program. Lessons learned from implementing COMPRA could inform other jurisdictions considering supply-side approaches to increase access to healthy food.

Preventing re-entry to foster care

Re-entry to foster care generally refers to circumstances in which children who have been discharged from foster care to be reunified with their family of origin, adopted, or provided kinship guardianship are returned to foster care. In the context of the federal performance measurement system, re-entry refers specifically to a return to foster care following an unsuccessful reunification. The federal Children and Family Services Review measures re-entry to foster care with a single indicator, called the permanency of reunification indicator, one of four indicators comprising the reunification composite measure. This review focuses on research related to the re-entry indicator, including the characteristics of children, caregivers and families, as well as case and child welfare services that are associated with a higher or lower risk of re-entry to foster care. Promising post-reunification services designed to prevent re-entry to foster care are described.

Preventing the recurrence of maltreatment

In the context of the federal child welfare performance measurement system, recurrence of maltreatment refers to circumstances in which children that have previously been substantiated as victims of abuse or neglect experience another incident of substantiated maltreatment. Multiple episodes of maltreatment can lead to: (1) more serious short and long term negative consequences, (2) entry into the juvenile justice system, and (3) juvenile delinquency. In this literature review the authors summarize the research on child, family, and systemic factors related to maltreatment recurrence and promising practices for improving performance. Promising practices aimed at preventing recurrence of maltreatment include interventions at multiple levels (e.g., the child, caregiver, family, and agency) and include a range of service modalities.