A Case Study for Adaptation in a Pandemic
On Friday, March 13th I received the first of what would become many urgent requests for services from a recently unemployed community member. The concern of community spread of the Coronavirus was mounting and rapidly upending our community. Within 24 hours, I made the weighty decision to suspend all in-person pantry services, and with direct-to-client delivery, implemented innovation, dignity, and economic stimulus to the emergency food distribution system.
A History of Resilience
In 2014 I founded Food Equality Initiative (FEI) as a response to personal need. My children were diagnosed with life-threatening food allergies (FA), and it was difficult to find safe, affordable foods. Although I was enrolled in Supplemental Nutrition Assistance Program (SNAP) and Supplemental Nutrition Program for Women, Infants, and Children (WIC), the foods I needed to make safe and healthy meals were not available. After standing in line at a local food pantry and only finding a jar of salsa and two potatoes, I made a commitment to create a solution for children and families managing FA and experiencing food insecurity. Resilience and lived-experience have guided FEI from the beginning.
FEI opened the nation’s first allergy-friendly and gluten-free food pantry in the Spring of 2015. Our prescription-based pantry provides supplemental nutrition assistance to patients with FA and celiac disease. Clients “shop” our shelves of non-dairy milk, gluten-free flours and mixes, cereal, bread, alternative grains, egg replacers, lean proteins, and fresh produce monthly to adhere to their prescribed diets. All services are by appointment to respect the time and dignity of our clients. Beyond access to safe foods, our clients find peer-to-peer support, recipes, and educational materials to support the management of their condition.
FA is a potentially life-threatening condition, affecting 10.6% of adults and 7.6% of children in the United States. In Kansas City, an estimated 5,000-8,000 individuals are managing FA and food insecurity. Yet, FEI was only consistently serving a client base of 126. Our pantry-within-a pantry model was designed to keep overhead cost low, but it was also keeping our client base low. While there are over 60,000 food pantries across the nation, many operate less than six hours a week. Limited capacity and the stigma associated with food pantries created barriers to services. In early 2019, FEI began working on a new model that prioritized client experience, increased efficiency, and reduced barriers to services.
Pandemic Protocols in Community Food
The physical limitations of social distancing create many challenges for traditional community food programs. While some programs have shuttered their doors due to the lack of staff and volunteer support, others have implemented pandemic protocols. This includes limiting clients’ choices, opting for predetermined boxes, and drive-thru distribution. While this method of distribution allows staff, volunteers, and clients to receive food safely, it does not preserve the dignity of choice and time of the recipients.
Pandemic protocols also make it difficult for families with FA or other special dietary requirements to obtain medically necessary foods. One recent study suggests children with FA living in food-insecure households and relying on nutrition assistance programs are at increased risk of exposure to food allergens and have more frequent life-threatening reactions. Without the ability to select foods, FA families are at increased risk for life-threatening reactions that require emergency care at a time when we want to lessen the burden on healthcare systems. The images of cars lining neighborhood streets for miles as volunteers and staff pack trunks with boxes of food serves as an example of how established, and well-meaning systems can do harm to the clients they serve.
Adapting in Crisis
The transition from a pantry-within-a-pantry distribution model to a no-contact delivery model took 7 days. My team adapted quickly in part because we developed a plan to transition to a delivery model prior to COVID-19. Early on, I recognized the limitations of the pantry and food banking system in our nation and wanted to transition to another model. A model that was client-centered and measured success by the values of our clients. Our delivery model is informed by data from our clients and emerging trends in food retail. After all, food pantries are small food retailers who serve a customer base that needs critical access to safe and healthy foods.
In our new model, clients receive medically necessary foods delivered directly to their doors. In the beginning, we didn’t have a process to allow clients to choose the items available in their box, so we called them to survey their preference to preserve their dignity and reduce food waste. Then my staff curated boxes to meet clients’ prescribed diets and their food preferences. Every box was hand packed with safety and care in mind. Recipes and notes of encouragement were added to connect to our clients.
To track our progress and client satisfaction in real-time, clients receive surveys with delivery notification. Early data shows an overwhelmingly positive response from our clients. Over 92% of clients are satisfied with the quantity and quality of the foods they receive each month in their box. We also query clients on their most needed items and adapt our procurement activities to source the items they want and need. Utilization of our program is up 240% since implementing a no-contact delivery method. Beyond serving more people, our program aligns with the values of our clients. This will only continue to drive our success. One of our clients wrote:
“My son has many food allergies and Eosinophilic Esophagitis (EoE), He gets really sad when he goes to the store or when I bring food home from the store, he can’t have some of it. But now he knows that once a month a box comes to the door just for him and he can eat everything that is in it. It brings him joy and happiness to see the box every month. Thank you for bringing the joy of cooking and eating back to my son.”
Partnerships Make it Possible
To overcome the challenges of supply chain disruption and unexpected costs, I reached out to our partners in Community Health at Blue Cross and Blue Shield of Kansas City (Blue KC). We met with their team on Friday, March 13th to discuss the impact of COVID-19 on our clients and to request emergency funding. Blue KC’s commitment to building a true community and closing the gap on health disparities by integrating social care into health care made them a perfect partner to help us quickly respond to an increased need in our community.
With funds from Blue KC and other local foundations, we were able to create new supply chains by supporting our local, gluten-free bakery to provide fresh bread to clients. Working with the Kansas City Food Hub, we sourced produce to offer nutrient-rich foods to our clients. Our partnership with KNOQ Cares provided no-contact deliveries and allowed a local technology company to keep staff on the payroll during the first few weeks following the COVID-19 pandemic. Although we can’t provide 10 meals with each dollar donated, we strengthened local supply chains and created a ripple in our local economy.
The COVID-19 pandemic brought many challenges to the social sector. Critical social services are needed now as many Americans navigate the social safety net for the first time. Crisis brings an opportunity for us to innovate and reimagine how we deliver services. Like the transition taking hold in healthcare to move from volume-based care to value-based care, the social services sector must place more value on measures that matter to individuals and families