NewYork-Presbyterian Hospital – Choosing Healthy & Active Lifestyles for Kids (CHALK)
Choosing Healthy & Active Lifestyles for Kids (CHALK) is New York Presbyterian’s (NYP) community-based obesity prevention program in collaboration with Columbia University Medical Center (CUMC) and the community of Northern Manhattan. The goal of CHALK is to reduce the prevalence of childhood and adolescent obesity in Northern Manhattan by creating an environment in which healthy lifestyles are integral to the lives of all families. CHALK aims to address obesity using the socio ecological model as its theoretical framework, focusing on system and environmental changes that produce long lasting improvements around wellness in the targeted community. The program model stems from working within a community-academic framework that is asset-based, implementing a co-design process, where capacity building is central to the success of the partnership.
CHALK’s programming is founded in the 10 healthy habits, adapted from Healthy Directions and its Healthy Children Healthy Futures program and developed by community stakeholders to ensure that the habits are health literate, culturally sensitive and avoid stigmatization. CHALK’s areas of focus are community organizations and programs, early childhood centers, public elementary and high schools, faith based organizations, and NewYork-Presbyterian Hospital’s outpatient pediatric practices.
CHALK partners are equipped with a full-time staff member to help assess and create wellness goals in collaboration with the organization’s leadership and wellness champions. In this process, organizations choose from a “menu of options” ranging from grant writing to partnership building to promoting healthy food to active design. This approach enables an organization to create, implement and feel ownership over their wellness goals and projects. This non-prescriptive approach and fluidity of CHALK makes the program model easily adaptable into a variety of settings while enhancing the wellness environment specific to that organization.
CHALK for elementary school-aged children: Since 2006, our program has partnered with over 15 of the 30 elementary schools in Upper Manhattan in School District 6. In this setting, CHALK is a four-year model that concentrates on sustainable and systemic changes within the school; CHALK staff helps establish a wellness council with different stakeholders representing the school community with the aim to develop wellness policies and projects for parents, staff and students and sustain them over time. Schools are asked to choose from a “menu of options” of wellness projects that best suits their needs. Examples include: staff professional developments around physical activity and nutrition to support staff in meeting federal and state guidelines around nutrition and physical activity; wellness programming for students and parents, such as Just Move, CHALK’s in-class exercise program that uses flash cards to provide short activity breaks; and changes in the built environment (e.g. offering healthier options at the cafeteria, removing chocolate milk and juice, implementing active design projects). To address sustainability, CHALK provides funding beyond the four-year period to graduated school partners and includes graduated schools in bi-annual meetings. In this setting, CHALK reaches approximately 4000 students and their families each year.
CHALK for early childhood (CHALK JR): Since 2017, CHALK JR has partnered with three Early Childhood Centers in Northern Manhattan. Similar to the model offered in elementary school settings, CHALK JR focuses on systemic, sustainable changes in a pre-school setting targeting children, parents and staff. A wellness council is established comprised of key stakeholders through the early childhood center, including parents, staff and community members. The wellness council focuses on developing projects that enhance and promote wellness at the early childhood center. In addition, CHALK staff support the early childhood center to meet the federal and state mandates around nutrition and physical activity. The “menu of options” offered to elementary school partners, has been adapted to the early childhood center setting; for example, Just Move JR was developed to support in-class room physical activity for children ages 3-5 years. In this setting, CHALK JR reaches approximately 500 children and their families per year.
CHALK for high school-aged adolescents: Starting in fall 2018, CHALK began its collaborate with two high school, located on the George Washington Educational Campus in Northern Manhattan, serving 800 students. In addition to establishing sustainable and systemic changes promoting wellness throughout the campus, CHALK aims to implement a Peer Education program, in which students will have the opportunity to work in a healthcare setting and learn professional, leadership, and public speaking skills to facilitate healthy lifestyles education workshops and be NYP ambassadors for their peers.
CHALK for community members: In this setting, CHALK focuses on changing the food environment and on fostering physical activity in Upper Manhattan through several initiatives:
CHALK Minigrants: Each year CHALK selects ten organizations to participate in the minigrant program; community based organizations and initiatives that support healthy lifestyles for children and families in Northern Manhattan are selected through a competitive application process. Mini-grants of $2000 are awarded to fund either new or ongoing initiatives that increase access to and knowledge about healthy foods and eating habits, and/or physical activity. Organizations are eligible to receive a maximum of three consecutive years of funding; during this period, organizations are evaluated on the innovation, progress, sustainability, and impact of the project. CHALK staff serves as a resource to assist with an organization’s sustainability beyond the granting period, providing support around capacity building and partnership building. Since 2012, CHALK has worked with over 20 grantees.
CHALK’s newest community initiative is the Capacity Building Initiative. This initiative targets local grassroots organizations in Northern Manhattan, providing mentorship and resources to help these organizations build capacity and become sustainable. We achieve this by hosting a yearly conference, creating quarterly webinars, offering consulting services, hosting workshops, and creating a network hub where community-based organizations will be able to learn best practices from one another. Webinar and workshops topics include: wellness programming (including nutrition and physical activity), data collection, fundraising, and working with community officials. The first CBO conference took place on September 16th, 2019.
CHALK is also working with local community spaces to improve their built environment. CHALK is currently working with Highbridge Recreation Center on different beautification and active design projects to gain more traction at the recreation center. There are also monthly wellness events for the entire family where community members are able to participate in a fitness class, receive healthy snacks, and learn about available health resources.
CHALK in Faith-based Organizations: Since 2016, CHALK has worked with local churches to promote healthy lifestyles. CHALK staff helps establish a wellness ministry that promotes numerous wellness programming for the church congregants as well as for the surrounding community. Examples include healthy cooking classes, training for Sunday school teachers to lead Just Move physical activity programming for children, farmers market tours, and construction of an edible garden. Allowing wellness ministries to identify their priority needs has led CHALK to support a couple of churches in establishing sources of emergency food assistance. CHALK staff helps with operation and sustainability of a food pantry and a mobile food market. In this setting, CHALK reaches approximately 1000 community members per month.
CHALK in the clinical setting: Several practice-based initiatives to address high rates of food insecurity experienced by patients of Ambulatory Care Network outpatient practices and the resource gap in Northern Manhattan.
CHALK’s Fruit and Vegetable Prescription program is a collaboration between the NYP Ambulatory Care Network’s Nutrition Department, Grow NYC, and NYP’s office of Community and Government affairs. In this program, Registered Dietitians at five outpatient practices in the NYP’s Ambulatory Care Network “prescribe” their patients fruits and vegetables. These prescriptions are redeemable at Grow NYC tents at local green markets for $10 in fruit and vegetable coupons. Rates of redemption are calculated to inform the success of the program. Since 2016, this program has reached approximately 700 patients.
The Food FARMacia is a 6-month project providing families of patients ages 0-5 year and their families with access to food from a mobile pantry at the Washington Heights Family Health Center in collaboration with West Side Campaign Against Hunger. The Food FARMacia connects families that screen positive for food insecurity with an onsite emergency food resource. In addition to receiving pounds of food based on household size, families receive guidance on how to enroll for entitlements such as SNAP and WIC as well as nutrition education. Since May 2019, the program has served an average of 31 families and 135 individuals.
The NYP Youth Market is a paid summer internship program giving youth an opportunity to get involved with local farmers markets and provide education around diabetes and obesity prevention. Under the supervision of CHALK staff, interns work at three markets throughout Washington Heights and Inwood, where they provide access to fresh fruits and vegetables, conduct market tours with NYP patients, and provide nutrition and health education workshops for community members at market. NYP Youth Market interns operate a weekly farm stand in July and August increasing access to fresh fruits and vegetables to the community of Northern Manhattan.
CHALK in Graduate Medical Education training: CHALK staff train all pediatric residents in the 10 healthy habits, how to address obesity prevention in their medical visits with families, and the impact of food insecurity in the community. This activity based training session allows residents to discuss their approach to communicating with their patients about healthy lifestyles, trains them on the use of motivational interviewing, and how to effectively jumpstart a conversation about health.