 Hello everyone, this is Charlie Severance at LiveWell Colorado. I'll be your moderator today, or at least helping Wendy Peters-Moschetti moderate today's webinar. I have a few housekeeping items to cover before we get started today. First, we will be recording this webinar and sending a link to the webinar video and a PowerPoint presentation via email to everyone who registered. And that webinar will also be posted on the LiveWell Colorado website. Second, we will have some time for Q&A at the end of the webinar. If possible, please let us know who your question is directed to when you ask it and to ask a question, simply type it into the questions tab on your on-screen control panel. And now, I'm going to pass it off to Wendy. Good afternoon everyone. Welcome to Fruit and Veggie Prescriptions in Colorado, How to Build and Sustain Food Access Programs in Healthcare Institutions. That is me. I'm Wendy Peters-Moschetti. I'm director of food systems here at LiveWell Colorado. And we are very excited to showcase this one example today specifically about the many, many connections that we can help make between our hospital and healthcare industries and agriculture. And as one of our speakers we'll be talking about today, there's increasing connections being made across the country between healthcare and the roles that they can play to build healthy and resilient food systems. And as you all are probably aware here at LiveWell Colorado, we are huge fans of prevention and of finding new, unique, innovative ways to increase access to healthy, affordable food and beverages and quite often very specifically access to fruits and vegetables, specifically for lower income and underserved populations. So we're thrilled to have this sort of topic in front of us today and to share with you some really exciting examples of how people are getting this work done across the state. Just so you know, so this is what our agenda, our time together is going to look like today. So we have three presenters with us today that will be speaking about the following topic. So we will, our first speaker will talk about strengthening healthy food systems through healthcare. So we will start with a sort of an overview of what is sort of the landscape. You know, what connections are we seeing being made through healthcare and food systems nationally and across the state of Colorado to kind of just set the stage. And then we're going to move into some very specific examples. So we will hear from the Arkansas Valley Organic Growers Association and from St. Mary Corwin Hospital in Pueblo about some very specific work they are doing around their food and vegetable prescription programs in Pueblo. And then as Charlie mentioned, we will save a little bit of time at the end for Q&A. So before I pass the baton, I wanted to introduce you to our three lovely women here today. The first person you're going to hear from today is Katie Stroh. She is, well, I don't know if there's any Harry Potter fans out there. You know, nearly headless Nick. Well, Katie is nearly an MPH and I'm sure she's very excited to be almost done with her master's degree in public health here in Denver at the School of Public Health, along with being a full-time student. She's also working as a policy coordinator at Jefferson County Public Health and is looking forward to doing a lot more healthy communities work when she's soon to graduate. The second person we're going to hear from today is Becky Guyon. She is a general manager at the Arkansas Valley Organic Growers Association. She is originally from Canyon City, Colorado, moved away for a little while, got a bachelor's of arts and ceramics, so she's very creative and multi-talented. She came back several years ago to start farming with her family and for about 10 years did that, a variety of products. She farmed organic vegetables, grass-fed beef, pastured pork, and poultry. And then a few years ago in 2013 was actually started full-time as a manager of AVOG, the Arkansas Valley Organic Growers Association, excuse me. And then the third speaker you hear from today is Reverend Linda Stetter. She's the director of Mission Integration and Spiritual Care at St. Mary Corwin Medical Center in Pueblo. She's the United Methodist Minister in Chaplain, and she has extensive experience in corporate and academic business management and incredible passion for innovating programs that alleviate the effects of obesity, diabetes, and access to care in southeastern Colorado. So I'm now going to pass it on to our first speaker, Katie. Hi, everyone. My name's Katie, like Wendy said. I am going to talk a little bit today about mostly national initiatives. We're going to go through four examples of some of the things that are happening across the United States and then a brief overview of some of the things that are happening in Colorado. So first I want to look at nonprofit hospital community benefits. So in 2011, nonprofit hospitals got $26 billion to provide community benefit. As you can see on the United States map in front of you, it varies by state how much money that they're receiving, and to keep their tax exempt status, hospitals have to provide community benefit under the New Affordable Care Act. So this is a new and big opportunity that is still being explored and is kind of wishy-washy in the IRS on how those dollars can be used. So they're using a lot of different ways. So community benefit events have been an obligation of nonprofit hospitals for decades, but now they're being leveraged in a different way. You can, when thinking about doing healthy food systems work with hospitals through community benefit, it's advantageous to get in front of the community health needs assessments and the community health improvement plans to collaborate with hospitals in the front end to do their assessment process. You can do like a food access landscape with them. The community benefit dollars can also support programs like fruit and vegetable prescription programs. More on that later, mobile farmers markets, fund local food policy councils, and spend time for exempt employees to volunteer at hospitals to run like farmers markets, and also think about maybe like water costs to run a farm on a hospital campus. Nationally, Mary Dale DeBoer at Fresh Advantage is, she runs this consulting group and works with a lot of hospitals nationwide to find opportunities for healthcare to support healthy food systems, specifically through community benefit. Next slide. The next thing I would like to talk about are food hub collaborations between hospitals. The biggest one that I came across doing my research with Wendy this summer was the Farm Fresh Healthcare Project in the San Francisco Bay Area. It was launched in 2011. The project consists of 10 small to medium-sized farms to produce distributors and six hospitals. These hospitals pull together their purchasing power, selected specific crops for purchase and distribution, change their menus to reflect seasonal changes in produce, and increase supply chain transparency. While there's little data available on the success and setbacks of this collaborative, this is one of the biggest examples of a food hub collaboration. Some of the considerations that they listed in their document that kind of outlines a how-to guide. You can just Google the Farm Fresh Healthcare Project. It will come up pretty easily. Our preparations for the distribution of the food and the commercial kitchen, local procurement is tricky due to pre-slicing, seasonal produce, and changing of menus and the consistency of the product. It's crucial to have enough space and staff to pre-slic certain vegetables and fruits, delivery staff, multiple farms, and alternative methods of procuring fresh foods, thinking about things like preservation. Another example, next slide, is procurement policies and hospital farms. Two of the examples that I came across are the Rodale Farm in Bethlehem, Pennsylvania, and the farm at St. Joe's in Ann Arbor, Michigan. The Rodale Farm collaborated with, what is it called? Oh, it's the Rodale Farm Institute, collaborated with St. Luke's Hospital on the Bethlehem campus and grows organic produce to serve in its cafeteria, and is gradually working to incorporate that produce into patients' meals. They've doubled from 5 to 10 acres. They have 12 types of produce to now 30 types of produce. They're up to about 50,000 pounds of produce per year at this point. And they have incentivized people to eat the salad bar by reducing the price by 25%, and they have weekly farmers markets at each of the campuses. As for the St. Joseph Farm, as you can see, they also have a greenhouse, which is pretty cool. This farm has revamped its menus to incorporate seasonal produce. The most dramatic evidence to their commitment is the 20 acres on the campus that sprawls the property, and they also have an educational farm. And the final example nationally that we're going to look at is the Fruit and Vegetable Prescription programs. They're most widely done by Wholesome Wave right now, and the one that I kind of dug into this summer was DC Greens, which was initially a pilot out of Wholesome Wave in Connecticut. They now funded by multiple farmers and has adapted their program to fit their own community needs. They work with Unity Healthcare, but that's expanding. So it runs for six months, and this model looks different at a lot of different places, and we'll hear more on that later. For this specific program with DC Greens, the Fruit and Vegetable Prescription that they get is $1.50 extra per day for a family member, and they must have Medicaid eligibility. So this is just a bit of a flowchart on this slide that demonstrates how this program can work in a general way. Next slide. And finally, after doing the national scan, we looked at Colorado this summer, and some of the biggest things that are happening in Colorado are food security screening, and that's coming out of Kaiser with Dr. Sandra Stenmark, and she has created a food security screening that's a little bit easier for physicians to use and more adaptable in different settings, and that is lengthy. That's really valuable. Percurement is happening at Valley Roots Food Hub Policy with the Denver Sustainable Food Policy Council that's supported by Denver Health and Fruit and Vegetable Prescription programs, including Valley Food Partnership and St. Mary Corwin Slash Ventura Health. Great. Thanks so much, Katie. So I'm just going to pass it directly over to Becky with the I'm going to say it correctly, or Arkansas Valley Organic Roars. So Becky, take it away. So I first just want to start by giving a brief overview of where we are, what we came from, and where we're kind of going in future. I guess that's not a brief overview, that's the whole thing. So Arkansas Valley Organic Growers officially became a cooperative in 2007. We've been working together as growers since about 2004, and then some of our growers have been working together since the late, the early 2000s. And so basically, we are a group of farmers who got together that needed to provide a distribution system for ourselves. We all have the same goals as far as growing, so we all want to distribute to different institutions, hospitals, and restaurants and colleges. And the best way to do that with our size of farms is to band together. It's easier to get insurance, liability insurance, and it's easier to buy a truck to deliver in and to do all those things. So we banded together and we formed our cooperatives. You can move to the next slide, please. So we recently have come up with our new brand, it's Headwaters Growers Cooperatives. You'll see this a little bit on our items. It's mostly for branding individual products, but the significance of it is we are all situated in the headwaters of Colorado, and it's important to think about the region that our food comes from in relation to where it's delivered to. Next slide, please. So we are located in the Excelsior Farmers Exchange, which is an old middle school located between Pueblo and Fowler, Colorado. We are in the middle of a farm country, so some of our member farms are as little as a mile away. Some of them are as far away as on the western slopes. It's really neat this building. We have 7,000 square feet of at least from the school districts, so we have a great room to expand. Side note that our newest expansion is possibly going to be with the family farmer seed cooperatives to help see some of their packaging, and we're just a good dry seed climate. Next slide, please. So in our facility we've put in walk-ins and freezers, and we have a commercial kitchen that we're almost finished with. As you can see in this picture, we have a wash line, which is the item on the right-hand side there, which allows our growers to move more products. Our growers are small. We have anywhere from one acre to 35 acres as big as our farms are. And so one of the bottlenecks that they have is at the wash stations. So they're able to harvest and bolt, bring in and bin, and we can wash them through our wash line for them. And that just helps keep them on the farm longer and actually growing products over. Next slide, please. Walk-in coolers and freezers. You can move forward, please. It's our kitchen. So, yeah, we are cooperatives. All of our board members, and Julie, who I believe is online here today with the health department in Pueblo, she is one of our board members as well. Our board members also are workers at our facility. So we're all together working to make a difference in this cooperative. Can you move forward, please? So our member farms, we're located kind of all over the state, the mid-state, I'll say. So from the western slope, we have Oceto orchards. And then in Pueblo County, we have Country Roots Farm, Blue Ravens, and Larga Vista Ranch. And then in Buena Vista, Weathervane Farm, Howard is Ringending Farm. And then in Colorado Springs, Fountain Area, Ventuchee Farm and Frost Farm, Family Roots Farm, which is my farm, is located in Canyon City. Can you move forward, please? That's our little buddy there. So we were approached by Julie from the health department, was really kind of the catalyst who got Linda and I hooked up to do this food prescription program. And I really have to give props to Linda and Julie for making it happen. What it does for our end and for our growers is it allows us to do production planning. We can sit down and say, okay, these are the things that they need for their prescription program. And so, you know, who's going to grow this and who's going to make sure that we have enough to fill these orders? Another really nice thing that it does for our growers is that it allows for some flexibility. So Linda orders with us each week, and I'm sure she'll get into that a little bit more, but she places her orders and we fill it to the best we can. And then, you know, if there's something close, if she orders kale and our growers have kale but has charge, you know, we can do some substitution stuff that way. And that makes it really great for our growers because they're still moving the products they have online. So it's really nice to work with her. And she's very flexible and does a really amazing job organizing the program. The other thing it does for our growers is it really, it hits very close to home and the heart. You know, it's hard, passionate work that farmers do. And to see it going into a food prescription that is going to help somebody's health, that makes it all worthwhile as a grower and as, for me, as, you know, the manager of A-Vog. But it's just a really great idea and program and we are really excited to expand it. Like I said, I can't say enough good things about Linda because she's really just done a great job with the program. But in 2016, we're hoping to expand to a couple of the other hospitals, possibly St. Thomas, Warren Canyon City, and then up North in Colorado Springs. And then, my final note, I'm going to talk a little bit about the High Plains Food Cooperative. They're located in Northeastern Colorado, western Kansas. And so they have a cooperative that does a senior program. So it's kind of similar to the prescription program, but they are just getting baskets of food into low income senior housing. And it's a really neat program. So the significance of that is that we have been working together as food hubs to try and do cross docking and get more product from them down here and more product from us up there to expand our product line. And I think that's a really important piece is to, you know, work hub to hub. And I'm interested to look more into the Farm Fresh Health Care Project because that sounds a lot like what we're doing here with the distribution systems and stuff. So it's very important work. And I'm excited to be part of it. And I think that Linda will be able to fill you in very well on what she does on her part. So, oh yeah, here are some pictures of the farm stand for St. Mary Corwin. This was last year's. So. Great. Thanks so much, Becky. And just one quick reminder before I pass the phone over to Linda is if anyone in the audience, you can type in questions as you have them. So just a reminder, just type them, even if we don't answer them right now, feel free to just type in questions or thoughts or comments as they come to you and we will address them at the end. So, Linda, let's pass it to you now. Well, good afternoon. And it's nice to be with everybody here and Live Well Colorado to share some of the lessons that I've learned from building two farm stand seasons for St. Mary Corwin. I just wanted to touch base on one thing that Catherine said about the community benefit. Any of you who are in non-profit hospitals know how important it is to accrue community benefit to offset what we normally would be paying the government in income taxes. And I can tell you that just my time alone for this season of farm stand offset about $7,000 in community benefit. So just one person in one project can accrue a lot of community benefit. And I had to grin when I was looking at the beautiful hospital farms in Pennsylvania because St. Mary Corwin has been around for about 135 years. And I read an article in 1914 where Dr. Corwin, who was the forward-looking doctor there, was talking about how important it was to feed patients exactly what they needed to get well. And, of course, there were no suppliers back then. So he literally had vegetable farms and animal farms to support the dietary needs of the hospital. So exactly 100 years later, by coincidence or whatever, I'm launching the farm stand and going back to what we knew as wisdom is 100 years. So that's just kind of ironic. So I want to spend about... Go ahead and go to the next slide. I want to spend about 12 minutes talking about what I've done and how I've done it, and I'm going to talk very fast. If you have any specific type of questions, please do. So you see the yummy box of fruits and vegetables here in this picture, and it just looks like it's so easy to get there. But like most projects, there is some complexity in getting that little box of veggies to a table for sale. I came to St. Mary Corwin in Pueblo two years ago, or three years ago, and I inherited a very well-written community health needs assessment that I identified obesity and diabetes as two serious health issues in our particular area. And with the help of Julie at the Pueblo City County Health Department, we quickly established that our zip code, 8104, where the hospital is, it's also known as the Bessemer neighborhood. It's a neighborhood of elderly people, poverty, a lot of people who have physical impairments as well. Well, and it's also a targeted neighborhood for some of our community health improvement efforts. It was in fact both a food desert and a food swamp, and I bought a house in that neighborhood, and I found out firsthand that there was no gas station, no grocery store, no pharmacy, no accessible restaurant to most people in that zip code. So it was a really big desert from a lot of perspectives. And so if you'll pardon the horrible pun, I decided to start with the low-hanging fruit, being the kind of energetic person I am. So I said, well, okay, we need fresh produce in this zip code. So I'll just go get myself a farmer's market. So I zoomed away to the farms and asked the farmers to show up at the hospital parking lot on Saturdays to bring their produce. And boom, I met my first brick wall because being new to the community, I didn't realize that the farmers were working with Skeleton crews because they were in the middle of a drought. So they really couldn't do that. And that put the brakes on my grand idea for about a year until summer 2014. But that turned out to be for the best, you know, not to get in such a hurry just to do the first thing that comes to mind. Because over that winter, I learned so much more about the community and its needs. And I refined my goal, which evolved from just getting more access to produce via a farmer's market to a deeper strategy of getting the right produce into my neighborhood. And so the farm's stand concept became the foundation of my food work. Next slide, please. So one of my really big learnings was that I got to develop some great relationships, and that those relationships really did take the time to build but they truly are the foundation of having the outcomes that I hoped for in my project. I would say that the relationship work I needed to do before I ever put that first box of produce on a table was about a year and a half. So I continued meeting farmers and visiting other farm stands and markets of the Pueblo City County Health Department and their mid-level obesity stakeholders group really helped me get well acquainted with the community context. And of course, as you just heard, led me to Becky and the Arkansas Valley Organic Growers. They were the big piece I was missing because this is one tiny project I do amidst all my other work. And I really needed a time-effective, single delivery, single invoice source for my produce. And of course, freshness and quality were extremely important to me because our patients were going to be eating this food and hospitals, as we all know, have to be very careful of food safety and liability. So that led me to my internal relationships. I had to check with regulatory to make sure I wasn't violating any JCO regulations. I had to really schmooze my chef because I needed access to his walk-in storage capacity. I had to get to know the doc supervisor to make sure that the timing of my deliveries wasn't causing her congestion and heartburn. Security and facilities helped me identify a good space for the farm stand. Environmental services, you saw Becky's picture of the tables and the tents. Bless their little hearts. They had to show up every Saturday morning and move that stuff to the parking lot. Volunteer services was crucial because they helped me pack the vegetables. And they also did all of the customer service at the farm stand because our model is not to make money. We want to sell it wholesale, and we just want to make sure we recover our costs to give people the most affordable produce possible. The medical residents at Southern Colorado Family Medicine helped me learn what foods we needed to get into the population in Pueblo and how we needed to time that during the month. And Centurial Legal and the Colorado Department of Agriculture helped me figure out that I really needed to buy a Colorado produce dealer's license in order to do what I wanted to do legally. The infection preventionist at the hospital got in on the act, medical records. Also, the gift shop was critical because that's where our retail manager is in the hospital. I have no way of taking in and dispersing money, so I had to have somebody who could independently account for the incoming and outgoing money. I really appreciated CSU Extension because they formulated easy recipes for us for the things that we had as a produce stand to get people excited about trying new things and getting new ideas. My marketing at the hospital was incredibly important. They made sure we had paid ads, other news articles, radio spots. And this year, two ACOs, Accountable Care Organizations, InnovAge and Integrated Community Health Partners. So the big lesson I learned was not to underestimate the number of people I would need to cooperate with me. And the wonderful part was that they were all just really joyful about stepping up to help because they knew they were doing the right thing. The next slide, please. So some basic operational considerations. Once that produce license came through in June 2014, I had the farm stand up and running in about three weeks, to all of my internal and external partners who knew their parts. So as Becky said, we ordered on Monday mornings for a Friday delivery. And my strategy was to order a combination of fragile produce that I really needed to be able to sell in one session and then other more hearty things that I could buy in greater economy and a little more quantity that would last more than one week. And the doctors told me not to offer beans and corn and really high carb stuff, except at the end of the month when people had less money to spend on food and needed more energy value for the food money they had. And when we packed the food on Friday afternoons, we packed everything in $3.00 increments, which required a little math and some scales. But what we found out is that there's a social justice issue. If everything is the same price on the table, then people who haven't had something in a long time feel like they can afford it again and people will risk trying something new because it's not very expensive. And of course then we stored things overnight in the walk-in refrigerator once they were repackaged. I got up early on Saturday mornings and got there and loaded the stuff on a vehicle and hauled it over to the parking lot. And then my volunteers set up and did the customer service and also gave out recipes and food safety information. Right now we have cash or we have payroll deduction for our hospital people, but I'm working on having SNAP next year because we know we have about 700 families within a six-minute walk to the hospital who need that service. I also did three internal farm stands for the hospital associates and some case pricing on some popular produce from my associates. Next slide. So once the farm stand was up and running, I found out that I could piggyback other programs on top of the basic farm stand thing. And this is where we started our food prescription program. And that was to solve a program that the doctors had at Southern Colorado Family Medicine for their diabetic and obese patients who just couldn't afford the really good food they needed. The doctors were frustrated, the patients were frustrated. So in 2014, our hospital foundation funded 37 scripts for diagnoses of diabetes, obesity, and malnutrition. And what we learned was that $15 a week was the magic amount wholesale because that offered people three servings of healthy fruits and vegetables every day. So that was 21 servings a week that we got into them above and beyond what they were already doing. And it offset the choice people have to make between drug copays and office copays and transportation and food. So one of the unintended consequences was that they really beat a path back to their doctors to get those prescriptions renewed and it solved the 20% no-show rate in our clinic for appointments. So we learned that the docs would write the scripts, that the patients would come and get them filled and that we could track them in the medical record. That was in 2014. And in 2015, we piloted a group with ICHIP and InnovAGE to see if we could get food prescriptions into some of our most medically fragile populations. We increased the farm stand period from 11 to 14 weeks and we increased our sales by 30% this year. And some of the patients were able to get to the farm stand for the InnovAGE people. We packed theirs and actually delivered them to InnovAGE and they went home on the bus with the people. And InnovAGE and ICHIP actually paid up front. They funded the food prescriptions. One was for a diabetic group. One was for an obese group, obesity weight loss group. They had pre, mid, and post farm stand exams and they're crunching the outcomes now because each agency established its own metrics and I'll be really excited to see what that is. Next year, I'm hoping through fundraising to extend it out in Linux to be able to fund hundreds of food prescriptions and I'd really love to fund some at-risk pregnant moms. So if anybody's got money for that out there, I'd sure like to talk to you. Other things that are starting to emerge as a result of this, is the consortium of church gardens and Lois Illek from CSU Extension and Jill Kidd from the public schools are working to help me create classes on food safety practices to help those church gardens alleviate the liability of growing their food and donating it to other organizations. We hope to have some container gardening in homes in Bessemer one of these days. Like I said, I'll have SNAP next year. And I have one church in the north part of town who's interested in being a satellite farm stand provided that my license allows that I've got to research that. So now my big challenge is to provide for some succession planning for sustainability to actually get another human being to assist me and to write an operations manual. And so the lesson I've learned is that if the foundation is solid, other programs will be attracted and can be built on it. Next slide. This is a conclusion to this slide of the castle because we're all trying to get there in different ways. And we've all started in different places. This castle can be gotten to from the road, from the water, from air. And I just want to encourage everybody because no matter where you start, if you understand your assets and you start where your assets are, if we keep sharing ideas and information, we're all going to end up in the same place over time. And if we keep working together, I believe that our population will be much healthier and it'll be much more capable of making better lifestyle choices not only for the current generation but for generations upstream. And that's my story and I'm sticking to it. Thank you, Linda. We hope you do stick to it. And keep on telling your story. So thank you so much, all of you, for the enthusiasm and leadership. We do have plenty of time for questions. We've had a couple of questions come in already. So keep them coming. Before I pass on a couple of questions, I did just want to call out one other really great model that you can jump online and read about. Earlier on, Katie did mention one other fruit and veggie prescription program that we know about that is well established in Colorado. And that is over in Montrose. She mentioned Valley Food Partners. So a collaboration between Valley Food Partners and Live Well Montrose is they have started a local pharmacy program as well. And they're very easy to find. It's a beautiful website. So if this is a model of interest to you, I encourage you also to look them up. Their website is localfarmacyrx.org. And pharmacy is F-A-R-M-A-C-Y. So localfarmacyrx.org. And we can send that out as well when we send out the follow-up slides. But another beautiful example and a beautiful website with lots of great information about how they're actually running another fruit and vegetable prescription program. So we do have a couple of questions that have come in. One that I'm going to pump back to you, Linda, that I think you've already addressed most of. You did mention some work support you got from Colorado Department of Agriculture. Are there any other examples about how CDA does support these types of programs? I'm not totally sure. My needs have been very specific. So they were just incredibly supportive in helping me get the produce dealers licensed and processed in record time. And I know they have part of the SNAP process as well. And when I started asking questions about how our local gardens could create an audit process by which they really knew they were practicing best practices like the big production farmers do so that we could kind of guarantee with some confidence that the donations that come from those farms really are safe and healthy, they were incredibly valuable at furnishing me tons of information on that. So you know what I found out? If you just call them and ask, they'll get you to the right people, and they're really on board with us. They really will bend over backwards because they want us to succeed. Absolutely. So one quick thing, too. For SNAP support, you would actually go through the Colorado Department of Human Services. And then for the Department of Agriculture, can you maybe name names or at least departments so folks on the line know who they could reach out to at CDA? Yeah, actually, gentlemen by the name of Mark Gallegos, who's somewhere in northern Colorado. I've spoken to him on the phone and emailed. He's the guy, the go-to guy for the Colorado Protostealers license. And he's the one who actually got me to the right people in human services for the SNAP process. And he was the person who got me all the information I needed to know on the best farm practice audit system. So he was a great guy. Great. Thank you. So another question. Have you seen any changes at Health Sciences? So I think this question is directed to medical school, primarily, about educating doctors and other health professionals about how to engage in programs like this. Has that come up for you yet, Linda? Actually, it's one fascinating thing. You know, we have a medical residency. So we have 18 medical residents. And I guess there's some really big clearinghouse process by which every medical student who's going to be in a medical residency puts in their top three choices and they all go to this big clearinghouse fair where all of the residencies and all of the applicants come and talk. And I got a call last year from one of our residents who was recruiting for Pueblo and she said that the single best recruitment tools they had for doctors and residents was the fact that we had a farm stand going because the new graduates out of medical school are all seriously interested in nutrition. They are interested in farm fresh food. They are interested in food for healing. So out of the six new residents who came this year, three of them were really recruited because we had some kind of food, pharmacy, food stand program going. How about that? That's fabulous. So another question just came in that you already did address Linda, I think. But the question is about why did you, me, the Colorado producer dealer license? So is there anything else you'd want to add to that? Well, no, but I just really will clarify because instead of asking the farmers to donate and giving the food away, we actually were literally buying the produce and reselling it. And we needed a license to be in business, if you will, to be able to do that, just like grocery stores and other businesses are. Fabulous. Okay. Well, we are way ahead of schedule so if there's any last questions anyone wants to get in, we still have plenty of time to do them so please submit them. But I want to thank you all again for participating. As Charlie mentioned, we will send out a link to the recording of this webinar. Oh, and I'll just keep talking because more questions will roll in, that's great. A new question that just popped in is about the role of local extension offices in supporting these programs. So before I go back to you, Linda, I just want to, I want to do pass it back to Katie and then maybe I'll spec you a little bit as well. And then, Linda, Katie, is that anything that came up when you did your national research about working with Leningrad University's and Extension offices? Of the Extension offices that are predominantly working in this area, I've seen Penn State out of State College, Pennsylvania. One of the studies that we started with for my independent study this summer was came out of the Penn State Department of Agriculture with the Center for Livable Future. John Hopkins? Yeah, it was Ann Palmer and... Mark Winnie? No. But in any event, they work with their Extension office a little bit, but I haven't found anything extensively as it relates to food and healthcare. Yup. Becky, do you have anything to add about support you get from local Extension offices and any of the work we specifically talked about today? Not specifically what we talked about today, but as far as food safety goes, which I guess Linda did touch on, we do get a lot of support from CFU, Colorado State University, so they do a lot of work with gap certification and on-farm food safety stuff. Yup. Linda, do you have anything to add about Extension's role? Yeah, actually, they were really critical. It sounds small for them to have given us recipes, but when I get recipes for them, I know they're easy to prepare. I trust them because they're tested recipes, and I would never have time to figure that part out. And I'm amazed at how much kale I got down people in the first farm stand. They didn't even know what kale was when they showed up, and because those recipes were there, they actually tried it, and they developed a wonderful flyer on how to safely refrigerate a store and clean farm stand produce, and that was an integral part of our plan for mitigating liability. So even though it sounds like a small thing, when my hospital president said to me, so Linda, what happens if somebody eats one of our carrots and dies and soothes us? I had to really think about every little part of the liability, so having that handout actually was a part of our plan to mitigate our liability and educate people at the same time. Absolutely. So I'm going to ask you to keep going along that same vein, Linda, and there's a question about if you offer cooking classes to help recipients learn how to use the healthy food. And so before you answer, I will just flag that the local pharmacy, our expert in Montrose does that, and there's information about it on their website. But do you want to comment on that as well, Linda? Yeah, I'm green with jealousy because I haven't gotten to that yet. I'm getting to know the cooking matters people here. They actually interacted with the Innovage Group at Innovage and made sure that they had recipes and lessons on how to cook the amazing things that we took to them this year. But that is something I truly, truly hope to get going in the future. I think it is awesome and indispensable. So I'm looking forward to that. Great. And then do you, are there any other national examples that pop up in your mind, Katie, where they integrated nutrition education or cooking classes? Yeah, it's better. DC Greens, the example that I talked about earlier, actually does their fruit and vegetable prescription program in a cohort style, where it's a cohort of patients that get to cooking classes. They go through exercise protocol. There's a little bit more extensive, but the cooking classes are weekly, and I know for the pharmacy program and mantras, they're also weekly and pretty extensive. They do them in a few different churches throughout the county there. Great. And then we had a question come in. Great questions, y'all. Keep in common, by the way. A question to anyone who's spoken today. To what extent does your work extend to schools? So, Becky or Linda, do you have examples you want to speak to? We have worked with schools a little bit. One of the things that a lot of the school districts require is a HACCP plan, hazardous analysis, and critical control point, and it's a very detailed plan that we haven't put together as AVOG as a group. Once we get our kids in certified, we might move forward with that, but we've worked with some colleges, but as far as elementary schools and local school districts, we have not a whole lot. Okay. And Linda, I know you briefly mentioned working a bit with Jill Kidd, who's a food service director in Pueblo City Schools there. Can you elaborate a little bit more about what a partnership with Jill is looking like right now? Yeah, the partnership is that I'm actually learning from her because she's had an extensive amount of training in best practices and food safety, and so we're using her as a major resource as we reach out to educate our church gardens. One of the things, and they just have their act together so well this year that they didn't need us exactly because they were doing a wonderful job of introducing fresh local produce into the cafeterias. I think they even had some lifestyle posters of some of the farmers, and every day they would put up which farmer grew a lot so that the kids would have a real personal connection with that. So they've had their own programs that have done very, very well. You know what I forgot to mention, you asked a while ago if there were any other national programs. The program that inspired me to do this whole thing comes from Boston University Hospital in Boston. Boston University Medical Center, they have a half-acre farm on one of their skyscraper buildings at the hospital, and they have a full-time farmer on their hospital payroll. Wouldn't I just love that? And they have a half-time economist and a kitchen, and she trains, you see the little bitty kids who are oncology patients going up to pick their food on the roof and coming down to cook it. She works with people who are going into halfway-house situations. She works with cardiac patients. Anybody who needs special dietary training and food preparation, she works with. And you can go to the Boston University Hospital website, and I can't remember what they're called, but it's in prominent place. They have their recipes. They have pictures, and they are there for the use of anybody who wants to learn from their example. So that's another very rich place to go for a model. And we will find that link and send it out when we follow up on this webinar as well. And we have another great question that I'm going to punt to Becky. Before I read the question into the question, we have a webinar on Thursday on food rescue and redistribution. So I'm just going to float that up there to remind everyone. This coming Thursday, we have another webinar. We just want to jam pack in this week, specifically on issue of food rescue redistribution. Remember, 12th this Thursday, 2.30 to 3.30. We will also send a link out, a registration link out, with that to everyone who participated in this webinar as well. But the question is, to Becky, can you explain the reasoning for buying and selling the produce versus donating and distributing? Do you have thoughts on that, Becky? Yeah, we do some donations, but part of it is trying to... Part of what my job is, is keeping our farmers making a living. And so it would be great if we could donate it all. And I know that you can get right off and all that, but these people are just passionate about what they do and they want it to go somewhere that's meaningful. And so I think a lot of our growers do donate, and they do have field-gleaning and food rescues involved with their projects. So it's happening a little bit. It's important for them to make a living. It really is. Mm-hmm. Linda, do you have anything to add to that? Well, my take on it comes from a very different direction. And that is that we're a faith-based hospital and I'm a faith-based person, and our respective denominations actually have done studies and actually have guidelines for us and suggestions that as a faith-based organization, we support local family farms as best we can. So there's a real imperative there from a faith-based perspective to help small farmers, family farms, in the face of competition from huge farms to stay alive and stay well in our food chain. And so that's part of the reason why we purchase our vegetables and then resell rather than asking for donations. The one thing I forgot to mention in that realm is that if I have something left over that's not going to make it, to the next week we have a zero-waste policy with our farm stand. I will take it to the Pueblo City Soup Kitchen so that they can use it. But the vegetables and fruit that we've gotten from AVOC have been so pristine. I think last year we had about 10 pounds of waste in the whole summer this year. It was a little more because the summer got off to a weird start weather-wise and some of the produce was a little more fragile. But we really try for a zero-waste kind of a situation. Great. So we have another great question that I'm going to pass to Katie here about what research studies can we cite when we're persuading an organization about the benefits of implementing a fruit and vegetable prescription program. So good research to back up what we want to do. Sure, there is not a lot of research right now just to put that up front. The best research article that I have found looking at healthy food initiatives that can also support finding different white papers. Those are like strategy documents from hospitals and the like is healthcare sector support for healthy food initiatives. It was written by Jeffrey O'Hara and Ann Palmer. That's the article that I was trying to talk about earlier. I also know that the program that's being done in Montrose is being done in collaboration with the Colorado Foundation, the Health Foundation. So there will be data coming out on that. As for other academic articles, I have a handful of them that I'm happy to pass along to anybody who wants to email me. During my scan this summer, I came across around 20 articles in white papers. So they're not all specific to fruit and vegetable prescription programs, but they do touch on the benefits of healthcare supporting local food systems. Great. And we can include links to some we think may be most relevant when we do a follow-up after this webinar as well. And also, so we wanted to close down here with all of our contact information. Also, you know, just speaking on behalf of Live Well Colorado, we are hosting this webinar, not just because we want to be one and done. It's because we actually want to understand how we can support and grow and evaluate and learn from these kinds of programs and really help them spread across the state of Colorado. So my email is on, this is Wendy. My email is on there as well. Please do reach out to me if you have ideas about how we can be a partner in really learning from and adapting and growing and spreading this work across Colorado. As we all know right now, this work is grant dependent, which I think gets back to that interesting question before about buying and selling versus donating and distributing. These programs really are very grant dependent, and that's not always the most ideal. We'd love to find ways to make these really sustainable, but I think together we can really learn from and grow some of these programs. So anyway, please do contact me if there's more about this talk about. We will follow up with a lot of resources. And Charlie, is there any last closing logistics? There's not. All right. Thank you so much for your participation. Join us on Thursday again if you want to, and you'll be hearing from us soon. All right everybody, good afternoon.