- I'm gonna get started.  Again, my name is Amy Korth, and healthTIDE is something that I am a co-director of healthTIDE, and we're calling it, actually, a movement towards health in Wisconsin, and just to give you a little bit of a background, something that we've found working as specialists, as well as with other colleagues around the state, is that there were a lot of different people doing a lot of wonderful things across the state related to nutrition, physical activity, and making their communities a healthier place to live.  You may have heard the terms PSE, or policy, systems, and environmental changes, and that's kind of where a lot of people have been moving to actually create environments and have their communities actually reflect really healthy and viable communities.  And so, kind of along with that work, there were a number of different people and organizations kinda going all in different directions and there were a number of different people that would apply for the same funding, and so there came this idea of what if, what if it were possible for us to have a united front? And what would that look like, and how could we get the majority of the state or at least a knowledge of what's happening in the state so that we could all be moving towards kind of this overarching goal and what that looked like? And so, as part of a Wisconsin Partnership Program grant that's actually based out of UW Madison here, we started to bring together community leaders as well as government leaders and kind of different people and said, "So, what would this look like? "What would be possible if we did this?" So through a couple of grants through the Wisconsin Partnership Program, we've kind of gotten to our next stage, which is...   To really think about how we can utilize collective impact to actually create some changes in our state.  And some of you may remember, we had a speaker that came last fall, so it was last October of 2014 that we had Liz Weaver come, and she did a joint conference with Conrad and our family living programs, and she really talked about what collective impact is, so I'm not necessarily gonna dive that deep into it, but I will talk to you a little bit about what that actually means, and for us, in my work, in healthTIDE's work, we're really talking about engaging the kind of framework of collective impact, which is really getting coordination and moving towards all of us being on that same page and having a united front, as well as some community organizing techniques, and all that means is we're going out and talking to people.  We're doing one-on-one kind of interviews as well as just chatting with people about what they do in their organization, what that looks like, where their passions are, what resources they have available, and where they see them utilizing those resources into the future.  And so, in the ideal world, we're working towards improved health outcomes for everybody in our state, and really having those changes in behavior, specifically around nutrition, physical activity, and having people just be healthier.   These are the five conditions of collective impact.  Liz Weaver covered these in her talk when she was here a year ago, but this is kind of the essence of what collective impact is, and it's really working towards a common agenda with mutually-reinforcing activities, shared measurement, or evaluation, continuous communication, and then, having a backbone organization or infrastructure. 

 All of these seem really broad, and kind of great, you're coming to a common agenda.  What does that mean? And I think for us, in the work that I'm doing with healthTIDE, we're really honing in on nutrition, physical activity, and getting different priorities set in different setting areas across the state.  For example, we have a early childhood group that really focuses on youth between the ages of zero and five, and really focusing on how are the best ways we can engage that group or those people that really impact that target audience.  That's just one example of something that we have going on.  And we as, I'm support staff for healthTIDE, we are considered the backbone organization for this work.   Some of the kind of key functions of a backbone are these pieces.  So just really supporting collective impact, guiding the vision and strategy.  We say that we facilitate kind of convening people.  So bringing people together to talk at tables.  I know a number of you do this in your own communities as well. 

 We're being ambitious and really trying to do it at a state level.  So, ideally, we'd like to get as many partners as possible engaged in our teams and the different things we have going on.  So all of these six functions are really kind of key to our work and are things that we're kind of moving towards and visioning towards.  So, we've kind of brought together some partners statewide, and this is our mission and vision statement that we've come up with thus far.  It's kind of a draft at this point.  And healthTIDE is a movement committed to creating a wave of real health where everyone has the opportunity to thrive.  And healthTIDE engages in alliance, diverse champions, and partners in realizing better health outcomes for all.  So together we are building real health in the places where people live, learn, work, and play.  And you will notice, or hopefully or all saw that there are notecards on your table.  I put them at the very end of the table. 

 So the reason I did that.  And if you don't have one, please pass them down.  But something that I would really love feedback from you all on is the term real health.  So we've had some positive comments about it, some negative comments about it.  I'm just curious if you had to define what real health was from your own perspective, what is that? You may have heard the term real food before.  That's something that's kind of out in the mass media.  And so we're kind of playing off of that kind of definition of real as well.  We're hoping that it doesn't bring forward this idea of a false health or a fake health or that there is kind of a, there seems to be kind of a backside of the coin when you say real health.  What's the other side of that? And so if you would please take, I'm going to give you 10 seconds, 15 seconds right now just to write down what you believe is the definition from your own perspective about real health because this is really important to our work, and to have your voice here is really important to us as well.  And it kind of helps us ground truth what that means and really have us think about do we want to include it in a vision statement or not. 

 So I'm going to give you a couple seconds to do that.   So, I'm going to go into a little bit more detail about what does it mean to facilitate a common agenda.  So this piece about collective impact and really kind of creating a common agenda, what does that mean? And so right now, like I said, our overall common agenda really is these PSE, policy system and environmental changes that really affect the environments of our communities.  And, also, like I had mentioned, we have priorities that have been set in early childhood, in an early childhood team that we have, a schools team that we have, a food retail team that we have.  Food retail really focuses on restaurants and grocery stores, as well as kind of a built environment active communities team.  So, if you have questions or if you want any more detail about those priorities, you can feel free to connect with me.  I'm not going to go into that detail today.  But just so you know that these things are happening, and if you have interest in any of these teams, please let me know.   Something else that we've really been focusing on is thinking about sectors of involvement.  So, we have also felt like, as far as government nonprofit, so the far right side of that blob here, the circle, we have a lot of partners that represent kind of government and nonprofit and have that really great content expertise. 

 So, what is the evidence base? What does it look like? What are the best programs to move forward with? And so we seem to have that covered really well.  The other side of this circle, the business and community side, tends to be more context focused.  So once it gets down to the real life, real world experience about how you actually implement an evidence-based program, those people really have the kind of understanding of what that means.  And so bringing them to the table is also something we're really interested in furthering what that looks like moving forward.  And knowing that people that are in private business or just living and working in the community, they all have, you know, all kinds of things that they're doing.  So how can we engage them in, you know, one or two pieces that we say, hey, if you're really interested in schools, one of the school priorities is increasing participation in school meals.  Can you tell us or do a survey in your school district that says does your school, do your parents in your school actually think that school meals are healthy? Do they think that they're cost-effective, affordable? Do they feel like they have any voice in kind of what's served in the school meal programs? So that's something, as one example, that we're really hoping to be able to drive and get some community input.  So, some of the key lessons that we've continued to work through, and I'm sure a number of you are with this in your own communities as well, is thinking about kind of turf and territory and how this work, when you're all kind of going in the same direction, that also means that you might have to share some grants or think about how you can write a grant together or have three different organizations or counties or communities work together towards one goal, which can sometimes be a little bit new area of people working together.  So that's something that we've run into in really thinking about how you communicate, and that continuous communication is super important.  We also wanted to continue to diversify voices. 

 So, like I said with a previous slide, that circle in getting people at the table that represent each one of the sectors is really important to us, as well as implementing the priorities and establishing those shared measures.  And shared measures, as you all know, is also really difficult to think about what is one thing that we can all track and think about and make sure it tells our story and that we actually resonate with is something that we've continued to kind of struggle with, and we're still searching for that.  And each one of those teams that I mentioned, they're all kind of moving towards what is our shared kind of measures and what do we want out of that? One other piece that we're moving towards is establishing a leadership council.  So for healthTIDE, we'd really like to have a group of people that really can be a compass for the movement, we're calling it, so that they can tell us if they see something that's bubbling up in their community that they view as something really important and that needs resources to respond to, that's something that we have available.  And we're also launching public communication.  So we have a website that has been, it's actually in a soft launch, we're calling it, right now.  And so it's just healthTIDE.org.  And so we have this web platform we're expecting to fully launch in early 2016 with social media and kind of all those pieces to just continue to get the word out.  And all of the teams that I mentioned and the priorities are all up on that website as well, if you're interested in checking that out.  So this is a structure, kind of, again, in draft form of what we're envisioning the healthTIDE movement to look like. 

 And the movement itself, kind of that big picture, is everybody.  So that's anybody in this room that's interested in nutrition, physical activity, health and wellness, kind of from that broader perspective.  We have partners from the Department of Health Services, our Department of Health agencies at a county level.  We have all kinds of nonprofits and different organizations that view themselves as part of that kind of broader movement towards health and wellness.  And then the circles that are represented, those are the specific teams that I mentioned.  So, schools, early childhood, active communities.  And then myself as part of this kind of backbone at the bottom.  So really thinking about how do we support, as support staff, the entire movement and what does that look like in our state.  So I will say that this is a work in progress, and if this is the first time you're hearing about this, awesome.  We actually changed our name from the Wisconsin Obesity Prevention Network just about about two months ago. 

 And we went away from obesity prevention because it has, we're not really focused on weight.  That's not really our goal.  It's really to think about nutrition, physical activity, environment, the bigger picture.  You know? It's not just the weight.  So we really wanted to get away from using the word obesity.  So that's why we shifted to healthTIDE.  So if you've heard of the Wisconsin Obesity Prevention Network, this is that now.  And so you'll hear more about healthTIDE as we move forward as well.  So, since we got started a little late, I probably will skip this portion.  Something that we do as part of collective impact and just so you are aware, activities that actually build partnerships are really fun. 

 And so I wanted you to kind of pair share with each other, but I'm going to skip this since we have a very packed schedule.  So, my name is Amy Korth again.  My contact information is here.  Amy Meinen is my counterpart.  So if you've heard of her name before, we are both the co-directors of healthTIDE.  So feel free to reach out to either one of us, if you have questions.  And, again, this won't be the last time you'll hear from me either.  So now I'm going to introduce Crawford County Healthy Roots and Jane Schaaf to join me.  And thank you.  (applause)  - I am Jane Schaaf. 

 I am the family living agent in Crawford County.  I have a very important counterpart, which is Sonya Lenzendorf, our WNEP coordinator.  Sonya is going to do the presentation tomorrow.  We just swapped out. I'm doing it today.  But she and I partnered to apply for a grant that was available.  The state of Wisconsin had a grant from AFRI.  We were just trying to get the initials right.  The Agriculture Food Institute, research Institute.  Whatever.  They picked two rural counties in Wisconsin to be a part of this seven-state project. 

  So, it was Crawford County and Iron County.  So they gave me seven minutes, and they have seven minutes.  So, Nancy, can you tell me about when five minutes is up? Okay.  So, what we were doing in Crawford County was we spent the whole first year really putting together our coalition, Healthy Roots of Crawford County.  We had a strong networking group, but it wasn't a coalition.  And we were really striving for that collective impact.  So we spent a whole year doing things like coming up with our name, coming up with our logo.  What is our mission statement going to be?  We worked quite a bit on just what are the messages? So when any of us in the group are talking, how do we want to present Healthy Roots? Our community partners included our 4-H agent, Amy Mitchell.  Then we also had public health.  We had the hospital. 

 We had a couple of community members, parents.  We had human services We were very used to working together, but we weren't used to working as Healthy Roots.  So, not as UW Extension or public health, but as Healthy Roots.  That took a long time.  One thing that helped us was to put together a logic model.  We had several different grants at that time.  We even had it color-coded.  But this led us to collective impact because, while the resources changed depending on the grant, you can see as you move across, we shared the same short-term, medium-term out...   Long-term all wanting to have all Crawford County residents regardless of their age have an equal opportunity to live healthy and active lifestyles.  So we worked very hard toward that. 

  Examples of some of the projects we've done, and I'm happy later to talk to you more about those, but our active school project, we used some of our funding to offer mini grants to schools if they would use them in a way that would encourage students to be more active throughout the day.  We worked and were successful in a couple of schools to get recess before lunch, and you know the research behind that.  We're working still, it's a battle, but the whole healthy concession stands.  The gardening project was we trained childcare providers in doing gardening with children, and then were able to provide them with some garden plots and some raised garden beds.   We're working now, we have a connection with grocery stores.  They were doing our harvest of the month and those recipes and newsletters.  That gave us an in.  Now we're working more with them to make the healthy options the more readily available options.  Crawford County Resource Guide.  So if you're going to be healthy, families need to know where to look for help. 

 All of those things, but what I mostly wanted to share with you today, was a really important lesson to us.  We found that we were way more effective with our strategies if we utilized what we just started calling the connector model.  So this started back with Crawford County on the Move.  Some of you are familiar with that.  It's a nine-week program that we do in eight different communities throughout Crawford County.  Nine-week walk/run program.  And so how it works is every community has their own community leader.  We put together materials, we train those leaders, and then those leaders are the ones who actually implement it in their county.  They're the connector.  We were thinking about how well that works that when we started some of these other projects we decided let's try that. 

 So our active school project, instead of just having, well, Healthy Roots is doing this, it was an individual from Healthy Roots who became that connector.  So when we reached out to the schools, one person from Healthy Roots reached out to that school.  Often it was a person who already had connections.  Their kids went there, they grew up there, whatever.  They just tuned into that relationship.  When we sent an email, it came from that individual on behalf of Healthy Roots.  So when I sent it, I didn't have my whole Extension signature.  I had my Extension email address, but it was signed Jane Schaaf on behalf of Healthy Roots.  What we found was then there was consistency.  It built on existing relationships. 

 There was consistency.  The schools, they knew exactly who they were dealing with.  So the school I was working with was dealing with me.  Seneca schools got Sonya.  Wauzeka schools got Amy Mitchell.  It just, we had that relationship.  It was easy to get evaluation data because when I asked them, well, yeah, they knew me.  I was the one, I was the one who went to the school.  The connector went to the school, shared the research, brought them the resources, helped them put together their plan, took the items out to them.  That one person. 

 We're using that same model now when we're working with the grocery store.  We each have adopted a grocery store we're working with.  But that connector was a way for our work to have way more impact, be way more effective and collective impact.  To prove our collective impact, we went through this really messy, messy diagram here.  But that's a ripple effect mapping exercise.  So we just did this a couple of weeks ago.  And we just started talking about when we were really excited to be a part of Healthy Roots and what were we doing and what's happening.  And you can see, in the messiness of it all, how many different connections there are.  How many different audiences we've reached out.  How many different relationships we've built. 

 So, it really is working.  The last thing I would say before I turn it over to Iron County, the other tip that I would have for you besides this connector model, the thing that really got our coalition going is when almost everyone in our group attended a conference together.  It was a two-day conference.  Attending it together made it so much better.  You know how it is, you come home from a conference, you put it on the pile, and you tell somebody it was really great, but that's all it, it doesn't go any further.  When we attended it together, then when we got back to Crawford County we're like, remember in that one session when they said this? Or, remember that? And we had a shared experience and a shared knowledge base that made it so much easier to go forward.  We're now looking at another conference this next summer that, again, we're hoping the whole group can go.  So that was Crawford County, and I'll turn it over to Iron County now.  - Good afternoon.  My name is Joy Schelble, and at the time of this particular project, I was the WNEP coordinator, and I'm here with Andrea Newby, family living educator and coordinator. 

 Just to expand a little bit on what Jane was saying about the AFRI project, in addition to helping our communities mobilize to prevent childhood obesity, which was the intended outcome, this was actually a five-year research project that hopefully will provide us with some more insight into how coalitions work best together.  So, Iron County and Crawford have a lot of differences.  We're located in the far north.  Very small population.  And another thing is that Crawford County was supported with a community coach.  So that was slightly different.  A few more details about the grant.  This is a five-year project, and it also gave us some funds to work with.  So we had a small pool of money each year to act on some of the things we learned from our coalition and community partners.  So Andrea is going to share with you a little bit about CPCO, Communities Preventing Childhood Obesity. 

 We both use that kind of language, but we didn't really create yet a brand or a localized name for ourselves, and I think we're getting to that point.  So, Andrea.   - It was really interesting to hear Jane's, their work in Crawford County because we've kind of been in the dark until now.  We're reaching the end of our research project.  So we weren't supposed to tell each other what was going on in our communities.  So, it was great to hear what Jane had to say.  We did approach it from a little bit of a different way.  Like Joy mentioned, we didn't have a coach that kind of led us through that coalition work.  So we were left to our own means, which it turned out to be a really, I think we hit the ground running maybe a lot quicker in activities and support and resources in our community.  So we did form a coalition of people from different sectors in the community. 

 Human services, a school, all of our Extension staff was involved, which is, we kind of formed this multidisciplinary work in our office, and this childhood obesity goal became our office mission.  So that was an extra, an add-on for us.  We used the goals of the research project to start a community movement to prevent childhood obesity, and then also to make the healthy choice the easy choice This was a nice little tag line for our community because people caught on to it.  They understood it.  And that meant, for us, helping families access healthy food and opportunities for physical activity.  And we wanted, we looked at the physical environment and assessed what was available and what wasn't available and how could we address that.   So the role of the coalition really played out for us as an advisory committee, and reviewing the data and reviewing, reviewing the data and then prioritizing the activities.  So we were charged with collecting surveys from parents of little children, of toddlers and kindergarten aged children.  And the survey asked them about their access to physical activity opportunities and healthy food.  So our coalition then took the data from those surveys and prioritized them and said what's, where can we have the most impact and what's the priority right now?  And we were able to have a direct response to those surveys within months, really. 

 We were able to say, okay, you know, we live in the far north, we get a lot of snow, it's very cold, so families are looking for activities to do in the wintertime.  They don't get physical activity in the winter.  What can we do right away to address that? And I'll talk some about the physical activity in a little bit, but Joy's going to talk about some of the healthy eating initiatives.  - Well, I have to say, I was taking notes when Jane was talking, and I was like, oh, that was a great idea.  Oh, we'll definitely have to do that.  So it was meaningful to hear you discuss your coalition work.  What's also interesting is, you know, to have individual people assigned to different schools and grocery stores, we did not have a grocery store in Hurley.  The grocery store shut down in the first year of this coalition work.  So it became a huge issue for access to healthy food and access to food at all, which shifted some of where we put, I think, our long-term visioning for how we would support access to healthy food in the community because it leads into things like public transportation to get across a state line to the grocery store that is closest.  So it became really complex. 

 But, as Andrea said, you know, the goal was to respond directly to the information we received from parents and families.  When parents and families say here's the issues we face, here are our barriers, we took that very literally and then created some responses to that.  And pictures are always kind of a fun way to think about programming in communities and what it actually looks like.  So, a few ways in which we responded to the need for healthier food was a farmer's market revitalization project called Garden to Market.  This was also something that Iron County has celebrated and been able to speak about because it is a multidisciplinary program that was housed under a 4-H youth development project looking at young people providing leadership for the community to bring back what was a thriving farmer's market.  Lots of excitement around this project, and it has since lended some energy to the adults in the region, and the farmer's market is in much better shape than it was when we started.  Long-term goals for this, not so long, but would be to integrate things like EBT and other ways to create greater access for food and secure families Next picture is the school garden.  So as part of this coalition, we expanded on a school garden that we constructed with the health department.  And, again, making the healthy choice the easy choice, looking at our school food environment is probably the largest collection of, like, population of our county eating at one time.  And the data around poverty and the number of students utilizing school breakfast and lunch became really insightful as to how we proceeded with healthier food in the places that people eat. 

 The picture below is a human services project.  So these are different players that were at the table.   The coalition framed these projects a little bit differently.  In our community, there were the same people all the time.  You know, it was like the decisionmakers and leadership were the same exact people.  There was a lot of kind of frustration and fatigue around what I call the gerbil wheel phenomena, where we're just kind of talking through these problems and really struggling with how we make sustainable or long-term changes.  So, some of these efforts were really ways to relieve some of that frustration and to continue and expand the dialog.  So that human or the social services or human services project was called the Little Garden Group, and it was our direct connection to human services families, many of whom took our survey and then stayed involved with our coalition.  It was also a good way for us to connect with Head Start families.  And we grew food in those gardens, we invited parents, and the kids took the food home. 

 And the final picture is just a happy little guy who has been a part of out coalition work since the very start and has really come a long way in understanding food and supporting his own family's eating habits.   And that was in the food realm of things.  We also did some pretty exciting work around changes to promote more physical activity, and Andrea can tell you about those.  - Sure.  Yeah, so, really, when we started the coalition, we were looking at, again, changing the physical environment and really modeling some teaching strategies for parents, human services workers, Head Start teachers.   So a lot of the things that we did, staff was involved.  So they took what we modeled and then implemented it into their programming, which was really great.  Some of the money that we received went to purchasing a hundred pairs of toddler sized snowshoes that we housed in our office and then offered to Head Start, schools, and families at no cost.  So we live in a rural community, really low income, families don't have transportation, so we looked at housing this equipment.  We were able to buy some different equipment. 

 So the snowshoes were one of them.  But housing it in an area that families could walk to or that we could bring it to them, and at no cost.  So buying snowshoes for a toddler, not a practical thing because they grow out of it, you know, in a year.  So a lot of the families, that wasn't even on their radar.  But for us to say, here is a pair of snowshoes for you to take your kid out snowshoeing in the park during the whole winter, that made sense.  And so we modeled some snowshoeing activities for Head Start teachers, invited parents to come.  We had a great turnout.  We did about four events with Head Start families and had a great response to the snowshoes.  We checked out, I think, half of them just this winter.   Great response for it. 

 So, again, that was a direct response to the surveys that we got from parents.  The other, the second picture, we wanted to raise some awareness about the importance of bicycling in our community.  You know, that this is a viable physical activity for children.  So we purchased some books called Bikeonomics.  It's actually an adult reading book that we handed out to our county board that said biking is an economic opportunity in our area and we need to start thinking about this.  We were also able to purchase a hundred copies of this little children's book called Zoom, which we handed out to every child in Head Start, every family in Head Start, and in preschool.   And we did an event around the Head Start.  We blew up the pictures of the book and had it around a walking path in our community, invited parents and Head Start kids to do that.  So we did two events with that book.  A great response. 

 Now there's some parents at Head Start that have a little walking group in the summertime and a little snowshoeing group in the wintertime, and we provide the snowshoes for that.  So, again, our modeling that behavior was the way that we changed the environment in our area.  The other, the last picture is the trailhead for a new trail, walking path, that was built in our community that our coalition supported with funds and with letters of support and things like that.  So this was huge for our area to say we value walking and biking, we value physical activity in our community.  And we had some high school students and families involved in painting this beautiful mural that shows healthy eating, healthy lifestyles is important to us.  So, we are beginning this social movement, beginning this physical change to healthy behaviors in our community, and the CPCO coalition is, is becoming more formalized.  We're looking at the region now instead of just Iron County, which is really exciting because we live on the border of Wisconsin and Michigan, the UP, and there's a lot of really exciting things happening in that community as well.  So we realize that we'll have a greater impact doing this more collaborative effort in changing behaviors.   And that's all. - Great.  I think as Andrea and I were talking, you know, this is the next piece for Iron County then, is working with this Roadmaps initiative to get some of that coaching support so we can build, you know, a brand and kind of continue with this work long-term. 

 So, thank you very much.  (applause)  - Good afternoon.  I'm Nancy Crevier.  I'm the Family Living Educator in Marinette County, but I also have the pleasure of being the co-chair for the Family Living Healthy Living Team.  So that's how I'm involved in today's presentation.  We have had, and I don't know how many people know this, but the Healthy Living Team has had, and family living programs too, an ongoing relationship with UW Population Health Institute.  And because of that ongoing relationship, we have had the opportunity to provide Roadmaps to Health trainings and now this community coaching pilot project.  The UW Population Health Institute...   It's a great opportunity for us because they house the Robert Wood Johnson county health rankings and roadmaps within that agency.  So getting to know those people and having them there to provide training to us as Extension educators has been fantastic So it all started back in 2014. 

 We provided three trainings around the state on the Roadmaps to Health Action Center within their website.  And I think we had over about a hundred participants in that.  I don't know how many of you participated, but it was well received.  And participants from all four program areas within Extension were there, and that was really good for us because we like to have that cross-program effort too.   If you have not seen the change model within the Roadmaps to Health Action Center, go and look at it.  It's fantastic, and there are so many resources on this website.  But this is the change model that they abide by and go by.  And you will see that in the middle is where our community members are.  That that's an important part of it, and all the different sectors that are involved in the Roadmaps for Health Action Center.  Working together and communicate are outside of the change model, or outside of the circle, because they're things that we need to be doing all the time. 

 And if you're involved in a coalition, using these resources will be very helpful to you because you can go in and just pluck, you know, if I needed accesses or resources regarding focus on what's important.  How do I decide what we're going to be doing? Hit on that, and you'll be getting lots of information to help you coalition to move forward in that area.  The same is true with every single one of those areas.   So we really wanted to continue that momentum from 2014, and we were able to go back to Laurie Boyce at the time and work with the staff at UW Population Health Institute.  We knew that they had been doing coaching with coalitions, and they were able to collaborate with us to say, yes, we will provide this coaching experience to UW Extension staff and coalitions that you have working in your counties within the state of Wisconsin.   So we found financial support through Laurie for two counties.  There was an application process that happened, and we'll talk more about that in a minute.  The primary contact did need to be a family living educator or colleague.  It could be within family living or WNEP at the time.  And at least one of the partners had to have attended the trainings that we had done the previous year. 

 So we really wanted to continue that Roadmaps to Health emphasis.   We were looking for someone who had either an existing partnership or already a community coalition going.  We wanted them to get involvement from a lot of different community members, especially those who were most affected by the situation that they were going to be working on.  One of the aspects that the Roadmaps people really wanted to include was that there was going to be some commitment to address social and economic factors too.  And I'll show you the actual model in a minute so that you can see that.  And we wanted to have some diversity within the teams, and that there would be an expectation that the teams would be sharing their learning experience just as we are today.  So here's the model that they use.  And you'll see, over on the right-hand side, the different factors, and that social and economic factor, that 40% area, they really wanted to have some emphasis within our two pilot projects on those factors.   So we had the proposal situation that came in, the request for proposal.  We had quite a few applications. 

 The actual proposal process and the review matrix was developed by both UW Extension and Public Health Institute so that both of us were involved in it.  And in the end, we have two counties who are involved in the project right now.  It started about March to April kind of time, and so it will go to March or April of 2016.  And you'll see that Joy and Andrea up in Iron County, this was an opportunity for them to kind of expand the AFRI grant that they've got and go continue now for at least another year getting some coaching from Roadmaps.  And Leah Eckstein, in Adams County, also was the other county, and Leah's going to talk a little bit about the work that she's been doing in Adams County now.   (applause)  - Thank you, Nancy.  So, like Nancy said, I'm the Family Living Educator in Adams County, and we were fortunate enough to receive the grant funding as well as our community coach.  And we started probably about in April with working with our coach.  I'm going to give you a little bit of background and then talk about what we've been doing the last couple months as far as what the coach has been offering us and how we're working to get better outcomes in our community.   So a coalition was formed in 2011. 

 It was called Adams County WECAN, which stood for the Wellness Education Committee on Activity and Nutrition.  And you'll see coming up that we made some changes to that title.  The team identified many priorities, probably over 30 priorities that they were planning on working on.  And they had a number of different parties that were interested in all of the different priorities, but one of the issues was people were vested in a certain priority.  So once they established that work and it was completed as far as they thought it should be, they were no longer interested.  So the coalition had struggles with commitment as well as leadership was lost.  So the coalition disbanded.  However, they didn't lose sight of the fact that it's a need in our community.  Health and wellness, specifically nutrition and physical activity, is a huge need in Adams County.  So we came back together and started to work on coalition building and making sure that we're doing things appropriately to have better outcomes in our community and to have a stronger coalition that's going to withstand changes of leadership, withstand changes of people within the coalition and doing those types of projects. 

 So that's when we applied for our coaching grant, and we were fortunate to receive that.  So within the coaching grant, you needed to make sure you had multiple sectors represented.  So we had our public health officer from Health and Human Services, a community health worker who is similar to a community educator in other counties, our human resource director from the county, a retired schoolteacher, the marketing and community relations manager at our local hospital and clinic, the director of food and nutrition services for our school district, and the executive director of Adams County Chamber of Commerce and Tourism working with myself and then our community coach who is Mary Bennett, and she is out of the University of Wisconsin Population Health Institute.   So like Nancy was saying, they live and breathe the change model.  So the biggest component, like Nancy said, is the work together that's on the outside.  So that was really one of the first projects that we kind of tackled was making sure that we were going to be working together effectively throughout the entirety of the project as well as as long as the coalition lives in our community.   So, how were we going to make sure people were working together? One of the pieces was to have a written commitment from each individual as part of the coaching team.  So making sure they're vested in that project, having that written commitment makes them feel that they're going to be depended on and they're more likely to continue with the project.  We changed the coalition name to Be Healthy Adams County because no one remembered what WECAN stood for, and then we were hearing that people thought it was about food preservation.  We can. 

 So we thought we probably should change that.  We spent a lot of time brainstorming on what we should be called and what's going to resonate with our community members within not only our coalition but then as well as throughout the county.  We identified others to invite to the table.  Our coaching team is a small group of individuals.  They like to keep a coaching team at five or seven people.  That will become our leadership or steering team for a larger coalition in the future.  So we needed to identify who's going to be part of that coalition in the future.   So, on our change model, the next step was assess needs and resources.   We did a number of different activities, and this is where our coach really came in.  There's amazing different tools and resources and anything that you want to know about a coalition and building coalition is on there, the county health rankings website. 

 So really just living on that website, learning what's all there to offer to the community, and working through that.  So we conducted a community assets brainstorm session.  We wanted to make sure we weren't losing sight that we have a lot of assets in our community.  We have great opportunities for physical activity.  We have golf courses, we have many lakes, and the river is right, you know, bordering Adams County.  So we have a great resource right there as far as outdoor activities.  We have walking paths.   So we went through and identified these are our assets, how can we build on those? What can we make changes within those assets and to continue that strong strength in our community? Then we created a community matrix, which basically is a diagram showing who is offering what services.  So the hospital and clinic has yoga and tai chi classes.  We wanted to make sure we didn't lose that. 

 So just going through and figuring out what's being offered so we're not duplicating services.  What's been offered in the past that didn't work so we're not going to continue working on things that we know wasn't a success in our community.  And then we conducted a gap analysis to decide where are the gaps in our community, what are we not meeting as far as physical activity and nutrition, and where can we go from here.   That brings us to what we're working on now, which is focusing on what's important.   This is something that's important in any kind of coalition work.  It's preparing to get your coalition out into the community.  So we're going to have a number of focus groups.  Adams County is a large county geographically.  We want to make sure that we're touching all the communities when we're doing a focus group so we're engaging those different communities.  So we're having a focus group in the north, kind of in the central right where Adams-Friendship is, and then in the south to get a good idea of the different needs of each community because we know that they're going to be very different throughout the county. 

 We're hoping to identify the needs and prioritize our goals and objectives.  One of the issues with the past coalition was they had so many priorities and objectives that it just wasn't feasible for a team to tackle.  So really narrowing those down, making sure that we can do good work around those priorities and goals is important as a coalition.  Making sure that we're choosing evidence-based, policy-supported services and activities so we know that the community will be able to benefit from those.  Our next steps, again, choosing effective policies and programs.  We want to make sure that we're not just doing a bunch of different fun activities that are fun for the community to do and hold and kind of build that comradery, but it doesn't have any lasting impact or lasting resolve within the community.  So making sure we're looking at those types of programs that we know will be effective.  Act on what's important.  Again, not losing track of that gap analysis that we did and what we want to be focusing on within our community.  And then we need to evaluate our actions. 

 Did it do what we wanted it to do? Did it support the community as far as physical activity and nutrition, but also did it increase our economy? Are people using the farmer's market more frequently? Are they using their farmer's market WIC drafts more effectively? Making sure we're making those impacts within the community, the socioeconomic impacts that are important to us all.   So that's our community coach, that's Mary.  What has she done for us specifically? She's really engaged the coalition.  When we started, again, as a coalition, everyone kind of still had their own agendas, and they were Health and Human Services and we were Extension and they were the hospital and they were the schools.  So bringing everyone together, like Jane was talking about, just having our own identity and not each sector of a coalition was really important.  And having Mary kind of work through that process with us to get people to understand that this is important, this is how a coalition should work, and doing that background legwork of doing the maybe not as exciting planning pieces to ensure that your coalition is going to be effective in the future.  She really did a lot of work with explaining why that's necessary.  We can't just jump in with two feet without any plan behind us.  She provided us with tons and tons of information.  Again, that website is just full of resources and toolkits and all the items that you would ever need in order to do any of this work. 

 So really digging into that website was great for us.  And then she supported our team.  Our team went through already a lot of ups and downs.  I was on maternity leave for three months, so they weren't sure there.  Then another team member's son was paralyzed in a car accident.  So another coalition member's mom is going through many different things.  So really supporting the team, and this is how a coalition works.  When one person is not available, the other members of the team pick up, and you don't know that someone's not available, someone's not working on the project.  This is how a coalition is effective and is going to work for us.  So she's been just a great resource for our community, and it's going to be hard for her to go, I think, and it's going to be hard for us to say, okay, we can do this on our own. 

 We appreciate all the work that you've done for us.  - I'm Amber Canto, for those of you who do not know me.  I recently took a position as the State Program Coordinator for the Wisconsin Nutrition Education Program.  But when I was doing this work, though I do continue to support it, I was in a state specialist role as Poverty and Food Security Specialist.  And this was a project, a collaborative effort, with the Wisconsin Community Action Program Agency in which UW Extension served as the academic partner on a community academic program grant through the UW School of Medicine and Public Health.  So I'm going to tell you a little bit about that and how we build it into our work.  So the Safe and Healthy Food Pantries Project's goal is to improve access to an availability of adequate, appropriate, safe, and nutritious food for low income individuals who utilize food pantries.  So when you all think of a food pantry and the type of food at a food pantry, what's one of the first things that comes to mind? - [Woman 1] Baked goods. - Baked goods.  Cookies, what else? - [Woman 2] Ramen noodle. - Ramen noodles.  - [Woman 3] Macaroni and cheese. - Macaroni and cheese. 

 How much of those items would you classify as safe and healthy? Maybe safe because a lot of shelf-stable items in a lot of ways.  Not often falling into what we would normally classify as healthy.  And so when we thought about this conundrum, we said, well, let's think about how we can address some of the diet-related disparities that we do see in this population of individuals who are using food pantries.  And we based our efforts off of the social-ecological model.  You've heard a lot about that already today.  You've seen some of it in the county health rankings.  And we adapted it then for our food pantry effort.  I'm going to go big and go small.  So starting in that outer ring, we took into consideration things like federal food programs and nutrition policy.  So how do programs like the Emergency Food Assistance Program, which delivers commodity foods, impact the availability of safe and healthy products at the food pantry. 

 There's also components of nutrition policy related to federal food program assistance.  So, are individuals income eligible? Do they know about the programs that they're able to provide nutrition and food support and service to? So that's what we see in that bigger, broader social lens.  We then took a look and thought, okay, well, what's the community role in all of this?  There's a huge community supported network of food pantries through donations.  There are people who are volunteering their time to run food banks, to run food pantries, and they have a direct link into supporting this broader healthy food environment not only at the food pantry level but also what we see within the community.  So where is food accessible in the places we live, learn, work, play, and grow? At the organizational level, we specifically were targeting food pantries and food banks in this case.  So what were the distributions policies and guidelines? And before we even distribute food, what are our procurement policies and practices, and how are we encouraging healthier food donations? The interpersonal level, we really wanted to leverage the social support networks.  And at the pantry level this is particularly important when we think about the willingness to change or the ability and willingness to support healthy food choices among volunteers and coordinators of food pantry efforts.  Of course, this then gets carried over at home and our social support networks in the communities and the places we live.  And then, finally, from an individual perspective, could we use the food pantry as a setting to deliver nutrition education and support some of the healthy eating messages and safe eating message we wanted to deliver? So this particular presentation is actually going to break it down in terms of food pantry intervention into two different things.  The first being the Safe and Healthy Food Pantries Project, which is actually a toolkit that you can access online and/or pick up copies that I do not want to take home with me at the end of this conference at the WNEP table out in the hallway. 

 So, please go visit, and take copies for your county.  And then second component of this presentation will be about Healthy Ways, which is a nutrition education curriculum that was developed with food pantries specifically in mind.  So, why? Why this project, and why do we care? One in nine households in the state of Wisconsin are considered food insecure, which means they do not have readily accessible food to live a healthy life.   Two of three low income individuals in our state of Wisconsin are low income and overweight or obese.   And one in nine low income individuals are also diabetic.  So we see pretty significant disparities with regards to diet-related disease and food insecurity in this low income population.  Just to give you guys a sense of trends, overall what you want to take away from this graph is obesity rates in our state have increased over time.  That's demonstrated by the teal green bar, which is all of our population.  And that lime green bar takes a look specifically at income levels of individuals under $25,000 a year.  So you can see not only is obesity rapidly increasing in low income individuals in the state of Wisconsin, low income individuals also have the highest rates of obesity with a pretty significant gap when you compare that to other populations, or income group populations. 

 We see similar trends with diabetes.  Though there is a little bit of up and down with regards to diabetes over time, overall the trend is an increase in diabetes.  And, again, this disparity between the number of individuals are prevalent rates of low income individuals with that income under $25,000 a year compared to higher incomes in who is considered to be diabetic.   So, we put together this toolkit, and I'm going to walk you through it.  It's packaged, we think, in a way to be accessible to not only Extension educators as a train the trainer or coach on the guide type of support, but we also wanted to develop it in a way that it would be accessible and useable to food pantries if they did want to approach it from an individual perspective.  So the way we set it up was this four-step process, and this four-step process is really intended to be cyclical.  And the first piece is starting out with a program assessment.  Where are we at with our existing strategies? The second piece is to take a look at the strategies that support safe and healthy food environments, and then think about what we are in a position to implement and then develop an action plan guided by those strategies and our program assessment efforts.  Moves that into implementation.  And then what we hope is that you'll circle back and take another look at that sort of self-reflective frame and see where are we at again with regards to our program delivery strategy. 

 So, step one, this assessment.  We developed our own self-assessment tool, which is what is this little checklist that you're seeing on the screen, which is an opportunity for pantries to say, okay, yes we have this strategy in place, we have this strategy kind of in place, or no this is something we're not doing with regards to supporting safe and healthy food environments.  And the way we designed this self-assessment checklist rather is to be used or could be used in a pre/post way.  So, at the beginning of the work, we can say this is where we're at, we do some then action planning, some implementation, and then at the end of the process we can revisit this checklist and say, yep, we've made progress on these strategies.  So it's not only an action planning tool and a needs assessment tool but it can also serve in an evaluative capacity as well.  We also outlined a couple of other assessment strategies to get a broader sense of the distribution and procurement strategies that are in the food pantry setting.  So, a food source self-assessment.  What are the primary sources of our food? That's important to know because as we work upstream and we want to make change or leverage some of those various different food channels, we need to know what's coming in and where it's coming from.  We also highlight the community asset map as a tool.  What does our community look like? Where are our assets in place? And what are the assets that we can leverage to support our food pantry community and environment? We used client interviews and surveys in the development of this tool, and that's another great assessment approach that we recommend. 

 And then we also have an inventory assessment, which is a continuous work in progress because every pantry looks very, very different, and so we're continuing to work on a tool that could be applied to many different pantry settings, but this really tries to hone in on what do we have in terms of our existing inventory, recognizing it's cyclical based off of seasons and also donation cycles and also as a tool to support efforts going forward.  We then have people take a look at those strategies and take a deeper dive into what are the evidence-based or research-based and in some cases practice-tested approaches to supporting safe and healthy foods.  So in the case of the food pantry, we have a category that we call putting safe food on the shelf and we highlight the following.  So, establishing a food safety policy educating donors, accepting safe foods and accepting safe produce.   Transportation, handling and storing food properly.  So keeping hot foods hot, keeping cold foods cold in food transportation.  We have a whole set of strategies and guidelines that pantries can follow to make sure that things are handled safely.  And then the classic rule of when in doubt, throw it out.  And that's really just to reinforce if you do have any doubt from the safety perspective of whether this item would be safe to consume, if you're not sure you'd give it to your kid, it's probably better to just throw it out.   And then, finally, supporting clients in handling food safely. 

 So while the pantry does its very best attempt to keep food safe, how do we also support pantry clients in continuing the safe food handling practices when they get home? On the healthy side of things, we start with stocking a healthy food pantry.  So, again, nutrition policy.  So, what are the policies and practices that we want to embody and communicate to our donors and partners with regards to how we operate as a pantry? Education for donors.  And then we really try to hone in on this finding fresh produce.  We acknowledge that a lot of pantries are moving in this direction.  Pantry clients have asked for more fresh produce, and so we highlight some approaches and ways to work with community partners to get that fresh produce.  Encouraging the selection of healthy food choices.  So this really works in adaptation of behavioral economics.  So, nudging people into making healthy choices when they're in front of them.  So, offering flexibility with choices. 

 Incentivizing healthier choices.  So rather than saying, "Oh, we've got a lot of "bakery items and those are going to go to waste, "take as many as you want," could we the same with the produce or could we do the same with, say, whole grain items or other things that the pantry has in store? Provide clients with a shopping list that intentionally highlights or supports the selection of healthy food products.  Make healthy choices more visible.  So our research shows that if you have greater shelf space, for example, in a grocery store dedicated to a healthy product, you're more likely to make a selection of that product.  Could we transfer some of those principles into the food pantry setting and say lots of shelf space for those fruits and vegetables or those lower sodium products and then thereby increase the intention and hopeful selection of those items.   And in the interest of time, I'll move on and just say our final piece is providing nutrition education.  And I won't go into this too deeply because Danielle's going to share more about some of those opportunities.  So, step three then is the development of an action plan and policy.  And this really works off of behavior change theory and the idea that if you set a goal and you write an intention that you're more likely to do it.  And so we've modeled that practice by developing an action plan and strategy template where we can actually carry forward the ideas and strategies from our assessment tool, from the toolkit, directly into this chart and also try to highlight opportunities for evaluation. 

 This is just modeled sample action plan for nutrition.  So we have this in the toolkit as an example of how you might fill this chart out.  We do the same for food safety.  And then we encourage people to go through implementation, and we have a flurry of tools that we've developed to support with the implementation of this project.  One is the coveted food decision table or keep or toss document.  So people are expressed lots of confusion around product dating.  And so our specialist Barb Ingham, in Food Safety, who was a partner on this project, developed a keep or toss sheet and said, all right, here's when this should go out the door or here's when it's still safe to be on the shelf.   I'll just follow up and say that, or conclude with sort of the suggestion of where you all fit in this.  So there's lots of different ways for Extension educators to engage in this project.  We see a role for trainers. 

 So training local food pantries on the use of this tool, coaching food pantries through the use of the tool.  So having a broader conceptual framework for what the tool is and how to use it and assisting through that process.  You could also serve as a connector and a communicator in the community with regards to healthy food donations or connecting food pantries to other assets and individuals within the community that could support the overall approach.  Partner, educator, evaluator, the list goes on and on.  And, on that educator note, we'll turn it over to Danielle to specifically share a little bit more about how you could do some direct education with food pantries in that setting.  Thank you.   - All right.  Okay, so I've been in grad school for the last three years, and for my grad school project last year I needed to develop a nutrition curriculum.   And I wanted to create something that was actually useful.  So I, after having discussions with some of the state specialists, it was decided that I would focus on a food pantry curriculum that consisted of mini lessons because, for those of us that work in WNEP, we've had some changes in the delivery model of how we provide nutrition education in the food pantry setting. 

 So, after looking at the research and policies and audience needs, the priority health issues that were identified were, of course, hunger and obesity, which Amber had shared those statistics with us.  So that's how I came up with the title of Healthy Weighs for Less, and it was just my lame attempt at trying to be clever with a title.  But the title, when you look at it, it should hopefully tell you that this is a curriculum that is designed to hopefully help people maintain or achieve a healthy weight as well as stretch their food dollars.   So the behavioral goals of Healthy Weighs were developed considering that food security is of the utmost importance for our clients.  And also looking at our dietary guidelines we are given behaviors that can help individuals balance their calories and hopefully manage their weight.  So we want to practice, for the behavioral goals, we want to practice food budgeting techniques to improve food security and availability of healthy foods, increase intake of fruits and vegetables, aim to replace half of refined grains with whole grains, and reduce consumption of sugar-sweetened beverages.   So the client component, or what the educator will use to deliver the curriculum, includes a facilitator guide, and in the facilitator guide there are guidelines on how to set up the lessons.  It talks about how to manage that strict timeline that we're under because we only have 10 or 15 minutes to deliver our nutrition education.  So there may be instances where you need to stretch out that time a little bit or, more likely, need to keep it within the 15 minutes, and so there's tips for that in there.  There's also some tips on helping our food pantry clients develop behavior change goals, which is why we do nutrition education in the first place, right? We want people to be able to change their behaviors and have healthy lives. 

 And let's see what else is in there.  It discusses the letter that we have for food pantry, for the food pantry boards.  And...   It talks about the recipes that are available So there are 12 lessons, 15 minutes in length, display and activity cards.  The displays are more activity boards.  So each of the displays are interactive, and if a lesson has an activity board, it's not going to have a set of activity cards.  So I really tried to make the activities within each lesson vary a lot to keep it interesting and have them be hands-on.  There are handouts for each topic with recipes that go with each lesson.  The handouts that I tried to select, most of them come from the 10 tips from ChooseMyPlate.gov.  I tried to find handouts that were one-sided so we could put the recipes on the back of the handouts because, as we know, recipes are very important to our food pantry clients, and they want those recipes. 

 So if you give them the recipe, the nutrition education is going to be on the other side, so they'll be taking that home with them as well.  There's a grid or a chart of recipes.  So there's two or three recipes that are recommended for each lesson that you can choose from, depending on the season.  Maybe that might change or what's available in your food pantry.  And then last, but not least, there are goal sheets to develop action plan.  Each lesson has their own goal sheet.  And the goal sheets are very easy to use.  Most of the goals are written out and all lesson participants have to do is to make a check mark next to a goal, or they can develop their own goal.  And this is a very important part of Healthy Weighs because the curriculum was developed based on the social cognitive theory.  And goal development is a really important part of that particular theory. 

 Also, the social cognitive theory tells us that personal, behavioral, and environmental factors all work together to influence behavior.  So as a part of the curriculum, there is also a food pantry staff component.  So in this letter to food pantry boards, it explains the need as to why they need nutrition education in their food pantry.  And so some of that information are the statistics that Amber had shared with us previously.  It describes what the Healthy Weighs curriculum includes.  And then, as another piece to join the curriculum with the Safe and Healthy Food Pantries toolkit, it promotes the toolkit.  So hopefully that's just another way that they can hear about the Safe and Healthy Pantries toolkit.   And so this is a list of the individual lessons.  If you go back to the slide where we talked about...   What the behavioral goals of the lessons were, there were four behavioral goals. 

 So there are at least two lessons that focus on those particular goals.   And then this is just an example of what the sample, of what a sample lesson plan looks like.  They're all in this grid type format.  I didn't have a choice on what the format of the lessons looked like.  Everyone in my class had to use the same format.  So this is what I had to work with.  So, when educators get ready to do a lesson, you can go to the materials column and just go right down the materials column, collect all of your materials.  It includes the objectives or to why you're doing the content or activity.  And then all of the recipe, or the handouts, excuse me, are hyperlinks.  So when they open up the lesson plan, they can click on the hyperlink just to open up the handouts in English and Spanish for each of the lessons. 

 So I tried to make it as easy as possible.  And then, just as a followup, what the next steps are for the Healthy Weighs for Less curriculum is Gale Coleman has worked really hard in taking each of the lessons and converting them into flip chart format.  So the flip chart that we use for people who aren't familiar is the lesson in a three-ring binder.  So if you're short on space, you can sit down next to a person or a couple of people and go through the lesson.  So those have been completed.  They're going through review right now, and they needed to be translated into Spanish.  So, that's it.  - [Audience Member] What county are you? (applause) - Richland and Sauk.  Richland and Sauk.   - Hi, everyone. 

 I'm JulieAnn Stawicki.  I am a 4-H Youth Development Specialist here with UW Extension.  And, actually, part of my role is working with our Healthy Living Initiative within 4-H Youth Development.  So, 4-H, we work with 47,000 young people across our state.  And what we do is we prepare them for the challenges of the 21st century.  So, the benefit is that we have a framework that we work within called Positive Youth Development, and we prepare young people with education, on academics, healthy relationships, healthy bodies, and ultimately to contribute to the community.  The challenge is that it spans a lot of content.  So, ways that we have approached promoting health and physical wellness has been through partnerships within Extension.  And so I'm going to talk a little bit about our approach to healthy living, and I'm going to be talking about two particular projects that we have in partnership with Family Living colleagues and nutrition education.   So what we do is we build healthy environments for youth. 

 So, much like other presenters have talked about, the social ecological model, we work with directly working with youth.  So we have direct programs that increase learning on health and nutrition, physical activity.   And we work with kids over a long term.  So they're involved in our programs from kindergarten through past graduation and high school and beyond as adults.  We engage with them in behavior change and growth over time.  We work with adults in the community who provide most of our education to our young people.  We have 35,000 adults across the state working with young people in partnerships.  And this actually means we have another audience that we work with, who themselves are learning both about youth development and about the content that we teach.  And, lastly, we work with creating community change.   So these networks of young people are collaborating across county lines, within municipalities. 

 They're working with adults together on projects that impact the health of the community.  And our educators work through helping young people become civically engaged and creating networks of professionals who can work with young people.  So, I'll talk about two specific examples of where we've partnered with our colleagues to promote health within the community.  So the first example, actually, is a grant project that we have within the Menominee County Nation and our colleagues there.  The needs of Menominee County are great.  The community health rankings consistently rank them as one of the lowest on the county health rankings.   This is due to a variety of factors.  The children, percentage of children living in poverty on the reservation is over 50%.   The community spaces and places that people can come together to be healthy aren't existing.  And what Extension's response was a collaborative youth and family program to build skills of children and caregivers to empower them to take action to improve the health of themselves, their families, and their communities. 

  So this is year one of our five-year grant.   And our first step, really, was to engage those caregivers.  So our initial needs assessment that brought us to Menominee County Nation and working with our community partners at the College of Menominee Nation and with the tribal government really identified a lack of programs for young families, specifically children entering into the elementary school age.  And so what we did to reach our ultimate goal of empowering people to change the health of their community is start by designing a program that was designed by the people for whom it's intended.  So we engaged caregivers in a focus group session that was relevant to them.  We did a series of talking circles with people in the community.  We engaged people who were a part of the community resource center, people who were attending school events, and at the health clinics.  And what we learned from those talking circles in working with our caregivers was that one of their highest needs was that families want to find ways to be active together.  So they identified ways that the whole family needed to be together So there was opportunities for youth in sporting events, there was some rec center time that was dedicated to specific age groups of children, and then there was some initiatives for adults within the community, but there was nowhere for everyone to come together and to be active together.   Parents also talked very deeply about the assets that they felt that they had to share with the community but weren't asked about. 

 But they also acknowledged the dreams that they had for their children that they felt like they needed assistance with, and they were struggling to find ways that they could build a community where they could share those assets around health and culture, and be safe and active together.  And, lastly, what we found was that the programs needed to be relevant to their lives and cultures.  So they gave a lot of input in designing of the programs.  So, our program started last February with an initial kickoff family fun day that was done in collaboration with many of the community partners.  They also have a coalition there that is working, I believe, with some coaching efforts in creating some collective impact goals.  And so this project was part of a larger coalition this day, this family fun day, and we had over 60 people attend a day-long event where they had learned healthy recipes to make together as a family and some easy ways to get physically active within the community.   Based on that day, we've designed ongoing programs that have engaged over a hundred children and 56 parents.  They meet twice a month.  I think that's my, they meet twice a month where the parents receive some parenting education, they identify topics that are particularly challenging to the health of their families, and then find ways to build a social support network around that, and, at the same time, the children are doing healthy activities.  So they've built a garden over the summer. 

 They did some harvesting of traditional plants with the cultural center.  And then they have time to come together to prepare a healthy meal and to sort of debrief on what both have learned.  And so the parent shares some of the things that they learned, some ways in engage their kids in some activities, and the kids sort of share out what they've learned about health and nutrition.  This obviously is not an easy thing to do, but it's also not easy to change systems within a community.  So we're looking forward to continuing to grow and build capacity within the young people, the adults, and to start taking leadership over some projects that they're identifying within their neighborhoods.  The last project that I wanted to talk about grants that is a scaled model that we've been working on across the state, and it's called Teens as Teachers.  So in this way we are working with young people who actually have identified that health and nutrition is one of their top goals.  So we have a youth conference every year where young people come together from across the state and have an opportunity to sort of collectively organize about what are the issues that they care about in their communities.  And when I began in my role in 2010, health and healthy living and physical activity was one of those initiatives that the delegates there chose.  So what we've provided is a grant. 

 We've had a series of three grants that have focused on this model.  It's about training youth to work with younger children.  So the older teens are taught both on our positive youth development, so how to facilitate engaging, fun, hands-on activities with young people, and how they can address issues of nutrition and physical activities.  We have adults who work with the teens as mentors, both for content and for supervising and making sure that they're growing as facilitators and models for the young people.  And the teens themselves have come together to collectively identify projects within their community that they want to work on in addition to that.  The teens are mentors for the young people.  And I have to say, the young children love it, which means in turn the teens love it because everybody likes to be appreciated, and what they realize is that they have a real role to play within their community.  And I think the thing that's the most meaningful about this project is the results that we've seen in long-term behavior change.  We are just now starting a third round of communities that we are working with Teens as Teachers.  So we started in 2011. 

 Last year we had six communities participating, and this year we have 19 different counties that have wanted to take on this model.  And what we found from our young people who've participated in this is definitely the post survey evaluation of the education is knowledge, has changed.  People have new ideas.  They feel motivated about working on this, both the teens and the young children.  But, as a result, we have found lasting changes.  So 85% of our teens that are involved as teachers have made healthier food choices themselves, and they've reported spending, 75% have reported spending more time exercising.  - [Audience] The teens that are teaching the classes are telling you that? - Yes, yes.  Who are engaged usually for a year at a time, but multiple, they often come back multiple years.   So, with that, I'll turn it over for questions, or over? (applause)