New York State Food as Medicine (FAM) Program Survey
Time to complete: approximately 10-15 minutes
Please confirm that your program is located in New York State
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Yes, the program is located in NYS.
Are you a member of the NYS Food as Medicine Coalition?
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Yes
No
No, but would like to learn more
Not sure, and would like to learn more
Program Name:
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Type of FAM Program (Defunct as of May 2024)
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Medically Tailored Groceries
Medically Tailored Meals
Produce Prescriptions
Food Farmacy
Pantry Stocking (Healthy Pantry)
Other
Type of FAM Program
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Medically Tailored Groceries
Medically Tailored Meals
Produce Prescriptions
Food Farmacy
Pantry Stocking (Healthy Pantry)
Other
Resource Category
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Food Pantries
Children and Youth Programs
Community Meal/Soup Kitchens
Holiday Meals
Housing, Clothing, Furniture, Misc.
Medical Assistance
Senior Center/Meal Services
Senior Services
Veggie Mobiles
WIC/SNAP Assistance
Other
Organization:
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Service Area (city/county/target population):
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Contact Name:
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Phone Number
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Please enter a valid phone number.
Hours of Operation (days of the week and hours):
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Is there a cost or fee for your services?
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Yes
No
If yes, what payment method(s) do you accept?
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Cash
EBT
Other
Email:
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Address
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Street Address
Street Address Line 2
City
County
Zip Code
Program website or social media platform (URL):
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Funding Source(s):
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Do you have barriers to using NY Produced Food? If so, what are the barriers?
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Do you receive Nourish NY through your food bank or do you have a direct contract?
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Do you have a health professional on staff (RDN, nurse, etc.): Please list how many and what kind.
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How do you get your food?
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How do you get your food to your participants?
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What are your Clinical Care Elements/Outcome Measures?
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Other Program Measures/Metrics:
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Educational Resources used by organization staff:
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What would make your program better/more sustainable?
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What are your research needs for you to advance your Food as Medicine program? Select all that apply.
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FAM Return on Investment
FAM Intervention Dose (Amount of Food)
FAM Intervention Frequency of Service
FAM Intervention Program Duration
Serving the Individual vs. Serving the Whole Household
Nutrition Education Methods (e.g., MNT, Group Classes, etc.)
Program Effectiveness Evaluation Methods
Biometric Outcomes: A1C
Biometric Outcomes: Blood Pressure
Biometric Outcomes: LDL
Biometric Outcomes: Weight/BMI
Biometric Outcomes: Other
Program Model: Medically Tailored Meals
Program Model: Medically Tailored Groceries
Program Model: Medically Supportive Groceries (Pantry Stocking)
Program Model: Produce Prescription Programs
Program Model: Nutritious Food Referrals
Program Model: Food Farmacy
Program Model: Nutrition Incentive Programs
Program Model: Other
Population Category: Medicaid High Utilizer
Population Category: Individuals in Health Homes
Population Category: Pregnant or Postpartum Persons
Population Category: Post-Release Criminal Justice Involved
Population Category: Juvenile justice involved, foster care youth
Population Category: Children under the age of 18 with one or more chronic condition
Population Category: Children under the age of 6
Population Category: Substance Use Disorder
Population Category: Intellectual or Developmental Disability
Population Category: Serious Mental Illness
Population Category: Other
Diagnosis: Obesity
Diagnosis: Cardiovascular/Heart Disease
Diagnosis: Diabetes
Diagnosis: Hypertension
Diagnosis: Kidney Disease
Diagnosis: Cancer
Diagnosis: HIV/AIDS
Diagnosis: Inflammatory Bowel Disease
Diagnosis: Mental and Behavioral Health
Diagnosis: Rheumatoid Arthritis
Other
If "Other" for any of the research categories above, please specify:
Would you like your program information to be added to the publicly accessible NYS Food Connect Map? See the map here: https://map.thefoodpantries.org/
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Yes
No
Need more information
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Section 2: Produce Prescription (PRx) Programs
Please fill out the following additional questions if you run a produce prescription (PRx) program. If you do not run a produce prescription program, you can skip this section and submit your responses.
How many people does your produce prescription program serve annually?
1-10
11-50
51-99
100 or more
Which geographic areas does your produce prescription program serve? Please select all that apply.
Urban
Suburban
Rural
Other
Which primary region(s) does your produce prescription program serve? Please select all that apply.
Western NY
Finger Lakes
Southern Tier
Central NY
Mohawk Valley
Capital Region
Mid-Hudson
North Country
New York City
Long Island
Other
What is the length of your PRx program?
Seasonal
Year-Round
Multi-Year
Other
What are the eligibility requirements for patients to enroll in your PRx program? Please select all that apply.
Low-income status
At risk for and/or diagnosis of diet-related chronic diseases (e.g., diabetes, hypertension, cardiovascular disease)
Medicaid/WIC/SNAP recipient
Pregnant or parenting
Other
How is your PRx program funded? Please select all that apply.
Private Funding: Foundation, Trust, Enterprise or Large-scale Grant Support
Federal Nutrition Incentive Funding (GusNIP/FINI)
State, Municipal, and other Governmental Funding
Private Healthcare Funding
Crowdfunding / Donations
Self-Supported / Organizational Budget
Other
Who are your main program partners and what are their respective roles (healthcare provider(s), farmers/retailers/other produce sources, community outreach organizations, etc.)?
What is your program model? (How do patients enroll? What is the frequency and amount of the voucher/incentive? Do participants pick up produce at the healthcare site or other farmers market/retailer sites in the community?)
What are the gaps or barriers to operating/sustaining your PRx program (What is difficult to pay for? What is needed to make this program more sustainable?) Please be as specific as possible.
What policy initiatives could help improve or expand produce prescription programs across NYS? Please elaborate.
Submit
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