I had the pleasure of interview Kristen Avera from Open Hand Atlanta to learn more about her program addressing food insecurity with women living with gestational diabetes. The interview recording can be found here: https://youtu.be/9_V04RqDUak or you can read the transcript below!
Tell us about yourself.
I'm Kristen Avera. I am a registered dietitian. I've been a dietitian for about 10 years. Certified Diabetes Care and Education Specialist for about four years and then in my current organization with Open Hand for about four years as well. So, currently serving as our Nutrition Services manager, we have an awesome group of dietitians throughout our organization, so I get the privilege of managing three of them. But working alongside all of the rest of them in various ways, doing communication with our education and nutrition, we focus a lot with books of diabetes, so I'm really excited to share this particular program. But give you all a little more sense of the work that we do as a whole as well.
What is Open Hand Atlanta?
So, we are nonprofit organization. We provide what's called medically tailored meals alongside nutrition education to the community. So, Chelsea, when you were mentioning food security, you talked about nutritious meals, right? Not just about feeding folks, but that that underlying component of OK are the foods nutritionally balanced and adequate. And so that's where medically tailored meals come in. And so, we actually began back in 1988. It was just a very small organization or not even an organization at that point, it was literally just a man that was seeing his community affected by HIV and AIDS, and folks that were struggling with this, dying of this condition and just started lending a helping hand and cooking some meals and it has grown since then. So, we have expanded the populations that we work with. We are providing these medically tailored meals mean that we have our dietitians working to balance the foods, and we're able to provide those throughout not just the metro Atlanta, but we are reaching across the state of Georgia and beyond, we're continuing to grow and grow and grow. So, we're able to provide those home delivered meals and then bring in our dietitians not just for the food aspect, but also with the education. So, we have dietitians that are doing one on one education, doing group classes, we're doing in person and virtually. So really trying to just meet people where they're at as much as possible and come overcome some of those barriers as well with getting the food out and getting the education out as well.
What inspired the creation of the gestational diabetes program and what need does it address in the community?
So, with the gestational diabetes program, this was a pilot program that we did. Like I said, we've been providing these medically tailored meals for quite some time now, and we've had the nutrition education, but we know that gestational diabetes is a common condition affecting up to 10% of pregnancies in the United States. We see even higher percentages here in the state of Georgia and we also see that folks that are food insecure are more likely to be diagnosed with gestational diabetes. So, seeing these needs, we thought, hey, we've got the education, we've got the meals. Let's target it in on this population. We also know that making lifestyle changes and modifying your diet can be really, really tricky when you are facing food insecurity. When you are facing the growing of your family and bringing that new life in. We know that stress is something that can be very common in pregnancy and in the food insecure population, and we know that that impacts blood sugars, right? So, what are things we can do to really help to provide not just that food security, but also a little bit of stress relief and those sorts of things? And then we also know that this intervention with providing education and providing meals for women that are diagnosed with gestational diabetes is not just going to help them during their pregnancy, but also can potentially help them with reducing their risk for Type 2. Because we do see that. We know that when you have gestational diabetes, you are at a heightened risk of developing type 2 diabetes. So, with this program, we really wanted to take some of the interventions that we already know that are working. And focus on a population that we haven't really focused on before, but we knew that there was a great need and we knew that could be a really, really big impact for as well long term not just for that specific management of that condition, but hopefully, more long term, throughout the individual's, lifespan.
What are the main features or specific services that were offered by the program?
So, I can break down the program for you, so you can really get a sense of what was going on.
So, we had a partnership with CareSource and what they would do is they would refer folks to us that were just recently diagnosed with gestational diabetes that were in more of that food insecure population. They would send them to us and then we were able to enroll participants in a 2-hour virtual education class, a group class. I actually was able to lead those classes and bring in that dietitian, but also the CDCES credential to really help those folks. And so we had the virtual class, which was really, really helpful because we were able. To reach people in more rural Georgia. We were able to connect people that wouldn't necessarily connect otherwise, right? They didn't have to figure out transportation. We just would send them a link and they were able to join. Often times we would call them and we would have them scheduled within the week for the class. Just because the virtual made it so much easier. So that was a really great way to get this going because with gestational diabetes you're on the clock, right? you have to get that intervention started quickly. And so the virtual. Option was really helpful for that.
And then alongside that, they would attend the class and then we would immediately start them in in our home delivered meals so they would receive a total of 16 weeks. And each week they would receive 14 meals. So, like a lunch and a dinner meal. And so ideally the thought was that they would get meals throughout their pregnancy, and then for about a month postpartum with this population. Of course we know. Sometimes babies come a little bit earlier, so some were getting some of those meals further into after their delivery. Things of that nature. But that was the framework that we were working with. So, this is really helpful because it's going to assist those without food security, it's going to provide those meals to help with blood sugar management.
So, with our meals, we're looking at things like the carbohydrate grams, the fiber, using a lot of whole grains and things of that nature, balancing the protein, all of those things and also sodium, right saturated fat, looking at all of those things. Not just for the blood sugar management but for heart health and just general health and wellness. So, we do have standards that we follow from American Diabetes Association, American Heart Association, all those sorts of things when we are looking at the meals themselves. They were shipped directly to the door each week and one of the secondary goals of this was also thinking about the stress related to food access and food preparation. If you already are struggling to access healthy foods and all of a sudden you're told you have to eat a certain way to impact your health and baby's health. I mean, I just can't imagine, right? The stress levels are just going to be through the roof, so we really hopeful that, and we saw in the data afterwards, that providing these meals just did so much more than just helping with those blood sugar levels, right. Which is really, really cool to see.
And then in addition to that, because like I said, we provide the two meals a day. So, we're also able to throw in a weekly gift card to a grocery store and so we helped with thinking like what are your snack options? What are your breakfast options? What are some of the meals that we're not providing a lot of these folks have families and what not that they were shopping for? So just trying to fill in some of the gaps there with those grocery store gift cards.
And then the last little feature that I'll highlight is our virtual support. After they attended the group class, everyone was funneled into a larger group chat. This was for all of the participants that were in the program and it was really fun because they could share ideas with each other., "I'm sick of drinking water. What are you all drinking? That's not spiking your blood sugars and those sorts of things." They could ask me questions, as their provider. But I think the most fun of the group chat was after, these participants actually had their babies. They started sharing baby pictures. So, I would get to log in and see all these sweet little healthy babies and it just gives you that connection with someone in a time that could otherwise be very isolating. So those are the big features of the program and some of the fun benefits that that they brought as well.
You've already touched on inclusivity and accessibility through providing virtual classes. Were there any additional things you want to add regarding inclusivity and accessibility?
Yes. So definitely the virtual aspect of it was really, really helpful because like I said, it helped to keep that intervention prompt and not worry about things like transportation and whatnot. But then we also did a few things, like for example with the gift cards we were, we were fortunate to be able to talk to the participants and see where do you actually shop and can we get you a gift card for where you're actually going? To be able to utilize it right? On the gift cards that we used, we also talked with some of the participants about using the delivery, so a lot of grocery stores now they have delivery options. However, a lot of folks don't even look into that because of the higher cost. Well, now you have a gift card that you can put towards covering the cost. So that might be able an option to help you to use that benefit that maybe you weren't thinking about before? Then with the meals, home delivered. So, they weren't having to go out and pick up their meals. We would deliver those straight to the door or ship them, depending on how far away the participant lived from our locations. So yeah, being able to have that.
Our delivery team and our client services team were checking in with these participants so they had access to my myself as the as the dietitian and as the diabetes educator. They had access to other. Class participants for that support. But then we also had our client services that would reach out each week. "Hey, how was your delivery? Everything. Did you get what you need? Do you want to make any updates, right?" Because we have a big variety of meals that we send, but we know that not everybody likes everything, right? And especially when you're pregnant, right? You might have certain things that maybe you used to like but are not really working for you now, or whatever the case might be. So, we were able to update those menus and if there was a meal that wasn't there. Let's just take it off the menu. We want to give you things that we know that you're going to eat., food is only healthy for you if you eat it, right. So, we want to make sure that we're able to provide those meals. So being able to swap things out and let people know what options that they have so that it can be the most effective intervention. And again, they are getting a variety, but they're not having to worry about going grocery shopping, meal planning, doing all the dishes, all that stuff. So, really able to help them focus on other things that might be more important at that time.
Are there future goals for the program or how can people get involved and support?
So, our big picture goal and this is something that we're doing, throughout our organization because, like I said, we've been providing these medically tailored meals for different populations for a long time. We know that education and programs like the diabetes self-management program and working with the dietitian for medical nutrition therapy. These are things that we know are effective and getting good help outcomes.
And so with this gestational diabetes, what we're really trying to show is, hey, these interventions that we're using in other ways are effective for this population and can have really lasting impacts for the mom, for the baby, for the family. So, we are trying to collect more and more data. Particularly health outcomes for mother and baby, right? So that's something that we want to see more of that we weren't able to get as much with this particular pilot.
We do have plans and we're working with partners to do that in the future so we can prove that effectiveness. With that sufficient data we're able to talk to healthcare providers and talk to insurance companies and say hey, let's make this a covered benefit for those that are diagnosed with gestational diabetes It's very common practice right now for someone to be diagnosed with gestational diabetes and to be referred to a diabetes educator or to get some education right to get the ball rolling. But as we mentioned, if I'm speaking with diabetes educator, but I'm food insecure, I don't have reliable transportation, I might agree and be very open to making the changes that that are being suggested as far. As what to do with my diet and exercise and my hydration, all these things. But I just might not have the ability to make it happen.
It's saying, OK, can we take it a step further and actually add in some of the assistance of providing those meals and the meals themselves can be a learning opportunity. , I've had many folks that will actually look at our meals and they say. "Oh, OK. This is what you mean by balance, because we still have carbohydrates in our meals, right?" We know that you still can incorporate those. It's not a thing to eliminate. But how much of the plate involves those right? And what types of carbohydrates are we choosing? And so even the meals. Themselves can be a little bit of a learning tool. So that person says, oh, this is the portions I need to be looking at when I'm making my own, I can try to replicate that. And so getting the word out, getting folks excited about medically tailored meals, getting people more aware of things like the food is medicine coalition, if you're not familiar with that, I recommend looking into it. It's a governing body of which we work under for our medically tailored meals and there's a lot of advocacy work that's happening right now to say, OK, let's get this intervention in front of the folks with the money, right? Because we know that food is a lot less expensive than some of our other. Interventions that we do in the medical community and so we're trying to just share that information.
So talking with legislators, getting involved at the local level as well, I know anyone that’s, in the Atlanta or Georgia definitely come check out our website open handatlanta.org. If you're around in Atlanta, come volunteer with us. Come deliver some of our meals. Come, package them. We'd love to see it. We definitely rely on our volunteers as well, but it's just getting the word out and getting excited and continuing to find opportunities. We are always looking for other options as far as funding to continue to provide this intervention so that we can collect more of that data, serve that population and continue to prove. Its effectiveness to to get this to be more of a a standard of care versus a pilot.
If anybody has any questions for you, what would be the best way to get in contact?
So, I would recommend www.openhandatlanta.org. Our phone number and e-mail is on there. You can always ask for me specifically. Kristen Avera. We're a big but small organization, so they can always direct you directly to me. Or if you're interested in learning more about our organization, some of our programs, we publish a lot of our research and what not on the website as well, you can volunteer. You can donate all sorts of things.
I'll do one more little plug if you are interested in supporting openhand and you live in the state of Georgia or the Metro Atlanta area, check out goodmeasuremeals.com. It's our social enterprise and it's where folks can actually purchase our meals. And for every two meals that are purchased through good measure, one meal is funded through Open Hand. So, it's a really cool way for those that maybe do have the means to, pay for some of these delicious and nutritious meals can also get the wonderful health benefits and the value there by supporting you and also be able to support their community. So that's always a really cool. I know I always have a couple of good measure meals in my freezer. For a nice healthy option as well. So just another little extra resource for you today.