Justice on the Move

by Emily Piltch

Need inspiration to integrate your Friedman experience into the greater Boston community? See how Dan Hatfield and Alison Brown, both Food Policy and Applied Nutrition (FPAN) doctoral students, are humbly contributing their expertise to fitness programs in underserved neighborhoods.

Each month, the Friedman Justice League (FJL) writes a piece for the Friedman Sprout touching on the theme of the month with an eye towards FJL’s mission: seeking to make our community more diverse and finding ways to allow the Friedman community to better address issues of discrimination and oppression in its teachings, research, and programs.

Photo: Courtesy of the East Boston Neighborhood Center

It seemed like a perfect opportunity to highlight the powerful work that two Food Policy and Applied Nutrition (FPAN) doctoral students have been engaged in, striking a delicate balance between academic life and community work. Dan Hatfield, MS N11, New Balance Childhood Nutrition Fellow, has been working for four years at the East Boston Neighborhood Health Center. Alison Brown, MS, USDA Doctoral Fellow in Obesity, spent this past year engaging with Healthworks Community Fitness in Dorchester.

Dan and Alison completed Albert Schweitzer Fellowships and continue to carry out its mission: “Improving Health, Developing Leaders and Creating Change.” They both started community work in Boston with great humility. Dan was a high school teacher and running coach for six years prior to joining the Friedman School. When he contacted the East Boston Neighborhood Health Center with an interest in working with youth, he jumped at the opportunity to develop a walking/running club for 6th grade boys who were referred by their pediatricians based on overweight or obesity. This program is one of several chronic disease prevention initiatives implemented at the Center, including food access initiatives, a community garden, farmers market, and programs for parents. While Dan didn’t go in with a specific program in mind, it evolved as he learned about the community.

Dan grew up in a safe, suburban town where his dad coached his teams, and resources were readily available for youth sports. He had a parallel experience when he taught and coached in well-resourced private schools.

“I went in with a lens that was informed by my own experiences,” Dan shared about his initial work in East Boston. But he quickly learned how little is needed to establish an impactful program. “When I started there, I basically had a corridor and a cement parking lot to work with in terms of facilities. At first, I had this narrow view that to really have an impact I’d need to bring in new and better resources,” Dan said. But even without access to these resources, Dan saw large changes in fitness and activity levels among the participants, with substantial benefits on short and long-term health.

“I’m interested in how we can design programs that meet kids where they are,” says Dan. “Traditional sports and exercise programs often assume participants have a certain foundation in terms of fitness or skills that, in reality, many kids never had the chance to build. There’s a lot of room to do better in terms of designing programs that elicit high levels of activity while also building kids’ skills and confidence, making physical activity fun, and motivating, sustainable changes in behavior.”

Dan’s role at the East Boston Neighborhood Health Center evolved to standardizing a curriculum the Center could use in summer and after-school programs across sites, serving over 200 at-risk kids each year. About 90% of the participants are Hispanic, mostly first-generation born in the U.S. with about three-quarters living in households below the federal poverty line.

Program evaluation is often one of the last components to be considered during program planning. Through a partnership that also supported his dissertation research, Dan worked with the health center to upgrade their evaluation protocol to consider dimensions beyond simply changes in body mass index (BMI). The goal was to generate evidence that could test research questions while also providing the program with a fuller understanding of how it was impacting kids across multiple dimensions, including physical activity, fitness, and dietary behaviors. Research questions included: What factors predict how active kids are? And what happens to their fitness levels when they participate in community programs? If BMI doesn’t change, what about aerobic fitness, muscular strength, dietary and physical activity behaviors? One key consideration was ensuring that those protocols were rigorous but also feasible for the program to continue to use after the research was completed.

Dan seems to thrive on putting the pieces together. He started with assessing resources of the organization and then helped identify what is feasible and impactful in terms of both programming and evaluation. One summative outcome was to generate practice-based evidence that advances understanding of how things play out in real-world settings.

“Randomized control trials are really important and provide us with specific types of knowledge about the efficacy of interventions in controlled settings. But it’s equally important, I think, to take the time to bridge that evidence to practice environments and evaluate effectiveness in uncontrolled settings.” Dan said. “It has been amazing to be here at Tufts with world-class researchers who really care about communities while also being really close to the ground and attuned to what is feasible and usable in a resource-constrained environment.” Moreover, rigorously designed evaluations can make a much stronger case for policy, programmatic or fundraising decisions, he said. “There is a lot of low hanging fruit, if people who understand research and evaluation are willing to help these community organizations think through these questions.”

One of the challenges of Dan’s work is to consider how change is or is not facilitated outside of settings like the Health Center. Dan acknowledged, “environmental determinants in under-resourced communities can be a huge barrier. Even if you get kids motivated, if they or their parents are afraid for their safety in their neighborhood, it could be really difficult for kids to translate that motivation into behavior.” This is certainly a social justice issue that some might take for granted. Dan continued, “if we want to support change over the long term, we really need to think about how these neighborhoods are set up, not just creating parks and other spaces but also accounting for things like lighting that makes those spaces feel safe or programs that make them accessible for kids of a variety of abilities.” Dan can be proud of the contributions he’s made to supporting long-term change in East Boston.

“The program continues to use the curriculum and the evaluation methods that I helped to develop,” he said. “At this point they could really sustain all those things without me.”

Photo: courtesy of the Albert Schweitzer Fellowship

Photo: Courtesy of the Albert Schweitzer Fellowship

Like Dan’s trajectory into community-based work, Alison Brown had a similarly humbling experience. When she moved to Boston to start the doctoral program, she also sought volunteer opportunities, particularly in underserved communities of color. Having lived in numerous parts of the country—from Atlanta and the Washington DC area to New York and Philadelphia—the stark racial and ethnic segregation between neighborhoods and limited access to resources in the communities of color in Boston became clear. Alison began to volunteer at the Healthworks Community Fitness in Dorchester, where her background in personal training, wellness coaching, exercise physiology, and nutrition made her well-suited to improving community fitness.

During her initial conversations with women who came to the center, Alison realized that the minimal, individual nutrition counseling offered was not enough.

“I would come in each Wednesday and instead of finding the nutrition coach engaged with members, he or she would be preoccupied and sitting behind a desk,” explained Alison. This helped prompt her to apply for a Schweitzer Fellowship, which she received and used to develop a group-based nutrition program for the center.

Screen Shot 2014-10-30 at 11.25.50 AMCoupling her guidance in a summer health literacy course with prior experience developing a nutrition education program in New York City and workshops at an urban farm in Washington DC, Alison initiated the Keeping It “Real”: Better Food for Better Health nutrition intervention. The intervention included 12 sessions over 6 weeks and was designed for intergenerational, healthy dietary change focusing on common myths about food and encouraging the consumption of more ‘real,’ less processed foods. Alison offered three cycles of the program. A total of 21 women and 15 children participated, with about three-quarters of the women who began the program attending all sessions.

 I am so grateful for changing my perspective on what we eat and how,” one participant explained. “Ever since the workshop started, I am amazed at myself…I can also see its impact on my body already…and I feel very energetic.” Among those women who completed both pre and post surveys, 60% decreased their frequency of eating out, 50% increased their frequency of dinner preparation, and 40% decreased their sugary beverage consumption.

Alison encourages students interested in volunteering in the community to take matters into their own hands and start by using a simple Google search to identify organizations doing what they’re interested in.

“Take the leap of faith and reach out to an organization and start off by asking about the needs of the agency.” Alison’s journey took her from simply cleaning floors at the Center to developing a successful workshop series, to initiating a Saturday morning walking group in Franklin Park. When asked what inspired her to get so involved in community work in Boston, Alison’s response was both optimistic and motivating.

“Going to class can be draining,” she said. “Talking to the membership (at the gym) was soul filling, if you will; uplifting for me, mentally…At certain points, looking at STATA output and the racial/ethnic disparities got disheartening. Putting a face on what I was reading about reinvigorated me and makes the work worthwhile. It’s easy to lose connection with why you do the work in the first place—it’s not just numbers, it’s people and families we’re talking about.”

Emily Piltch is an AFE PhD student. When she’s not thinking about infant feeding practices and the cultural and social underpinnings of dietary-decision making on the Zuni Pueblo in New Mexico (her dissertation), she’s dodging traffic on her bike and perfecting vegan, apple, butternut squash muffins.

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