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Nutrition

Evaluations Report

IV. TITLE III PROGRAM ADMINISTRATION AND SERVICE DELIVERY

G.TARGETING OF PROGRAM SERVICES TO PRIORITY GROUPS

While participation in the Title III program is open to all persons age 60 and older, the OAA requires the program to target its services toward certain groups the Congress has deemed particularly in need of nutrition services--those of greatest economic or social need, with special emphasis on low-income minorities. The degree to which this targeting has been successful, in terms of the characteristics of the ENP client population, was discussed in Chapter III. For virtually all racial and ethnic and low-income subgroups of congregate and home-delivered meal programs, the percentage of priority subgroups in the ENP participant population exceeds their representation in the program-eligible U.S. elderly population. This section examines the targeting objectives of the program as perceived by various levels of program staff and identifies operational procedures that have been set up to achieve this targeting. [ See U.S. Department of Health and Human Services, Administration on Aging, and Office of Inspector General 1993. The study surveyed a sample of 20 states to obtain detailed information on states ' implementation of the targeting requirements of the OAA. ] , [ Note that the tabulations for activities undertaken by SUAs, AAAs, and projects, as well as for major barriers to targeting, contain relatively larger percentages of responses in the "other " category. We are currently backcoding these responses into existing response categories and creating additional categories. The revised tabulations will appear in the revised version of the final report. ]

1. SUA Targeting Activities

Virtually all SUAs (93 percent) indicated that they encourage the targeting of ENP services to particular groups of priority elders (Table IV.47). The two most common groups that SUAs target are racial and ethnic minorities (84 percent) and elders in greatest economic need (84 percent). About one-third of SUAs also mentioned targeting rural elders.

TABLE IV.47

SUA TARGETING PRIORITIES AND ACTIONS TAKEN

TO TARGET ENP PRIORITY GROUPS

(Percentages)


SUAs

Encourage Participation of Special Groups

93

Special Groups Targeteda


Racial and ethnic minorities

84

Populations with greatest economic need

84

Rural populations

35

Severely disabled populations

31

Populations at risk of institutionalization

29

Populations with greatest social need

27

Populations with limited English proficiency

18

Populations with Alzheimer’s or related diseases

11

Other special group

26

Racial and Ethnic Minorities Targeted


African American

80

Hispanic/Latino

70

Asian/Pacific Islander

61

Native American/Alaskan Native

55

Native Hawaiians/Other

28

Actions Taken to Target Special Groupsb


Require or encourage AAAs or nutrition projects to conduct outreach programs

58

Monitor or evaluate AAA or nutrition project targeting efforts

48

Require or encourage meal site placements where groups live

35

Require or encourage AAAs or nutrition projects to provide specialized services to attract these groups

33

Coordinate activities with other organizations

28

Conduct meetings with AAAs, associations, and so forth

24

Provide technical assistance or training to AAAs or nutrition projects

24

Issue policy guidelines

22

Recruit minority nutrition providers

20

Set aside program funds specifically for groups

13

Alter intrastate funding formula

11

No action to target special groups

2

Action with Greatest Impact on Increasing Participation


Require or encourage AAAs or nutrition projects to conduct outreach programs

27

Monitor or evaluate AAA or nutrition project targeting efforts

15

Require or encourage meal site placements where groups live

15

Require or encourage AAAs or nutrition projects to provide specialized services to attract these groups

4

Coordinate activities with other organizations

2

Set aside program funds specifically for groups

2

Major Barriers Inhibiting Targeting Efforts


Lack of funding

51

Lack of training/guidance on effective targeting practices

23

Lack of data to identify/locate populations

21

Negative attitudes toward targeting

21

Lack of staff

19

Other barriers

51

Sample Size

55

Source: Elderly Nutrition Program Evaluation, SUA survey.

a Percentages total more than 100 percent because SUAs may target more than one group.

b Percentages total more than 100 percent because SUAs may engage in multiple activities.

The activities undertaken most frequently by SUAs to achieve their targeting objectives are directed at the AAAs and/or nutrition projects. Fifty-eight percent of SUAs reported encouraging AAAs and/or nutrition projects to conduct outreach programs, and 48 percent reported monitoring AAA and/or nutrition project targeting efforts (for example, reviewing reports, reviewing AAA plans). Thirty-five percent of SUAs mentioned requiring or encouraging AAAs and/or nutrition projects to place congregate sites in areas in which these priority groups live, and about one-third of SUAs also require or encourage AAAs and/or nutrition projects to provide specialized program services to attract targeted groups into the program, such as ethnic meals or other services specifically designed for special populations.

When asked to identify the targeting activities that were the most successful in increasing target populations participation, SUA respondents felt that initiatives involving outreach programs have the greatest impact on targeting (mentioned by 27 percent). Site selection (15 percent) and monitoring and evaluation efforts (15 percent) were mentioned next most often as activities thought to have the most impact in bringing priority groups into the program. Major barriers to targeting as reported by SUAs include lack of funding (51 percent), lack of training on effective targeting practices (23 percent), lack of data to locate and identify the needs of the targeted groups (21 percent), negative attitudes toward targeting (21 percent), and lack of staff (19 percent). A large proportion of SUAs (51 percent), however, mentioned other barriers, such as racial and ethnic divisions, a lack of minority community leaders or staff for outreach, language barriers, cultural differences, or difficulty in acceptance of different groups by program participants. Other reasons mentioned include a lack of transportation for outreach and a sense that the OAA "gives a double message" on targeting (that special groups should be targeted although all groups are eligible for services).

2. AAA Targeting Activities

Virtually all AAAs (96 percent) reported that they take actions to encourage participation of targeted groups of elders (Table IV.48). As at the SUA level, the most frequently targeted groups are racial and ethnic minorities and populations with the greatest economic need (reported by 84 percent of the AAAs). Rural populations were mentioned by about one-quarter of AAAs. Other groups, such as persons with limited English proficiency or persons with Alzheimer’s or related diseases, although still targeted, were mentioned much less often (fewer than 20 percent).

TABLE IV.48

AAA TARGETING PRIORITIES AND ACTIONS TAKEN TO TARGET ENP PRIORITY GROUPS

(Percentages)


AAAs

Encourage Participation of Special Groups

96

Special Groups Targeteda


Racial and ethnic minorities

84

Populations with greatest economic need

84

Rural populations

24

Populations at risk of institutionalization

16

Severely disabled populations

16

Populations with greatest social need

11

Populations with limited English proficiency

7

Populations with Alzheimer’s or related diseases

6

Other special group

24

Racial and Ethnic Minorities Targeted


African American

73

Hispanic/Latino

53

Native American/Alaskan Native

30

Asian/Pacific Islander

24

Native Hawaiians/Other

7

Actions Taken to Target Special Groupsb


Require or encourage nutrition projects to conduct outreach programs

57

Monitor or evaluate nutrition project targeting efforts

33

Require or encourage nutrition projects to provide specialized services to attract these groups

28

Provide technical assistance or training to nutrition projects

16

Recruit minority nutrition providers

14

Other

53

Action with Greatest Impact on Increasing Participation


Require or encourage nutrition projects to conduct outreach programs

33

Require or encourage nutrition projects to place meal sites where groups live

19

Monitor or evaluate nutrition project targeting efforts

7

Require or encourage nutrition projects to provide specialized services to attract these groups

6

Recruit minority nutrition providers

4

Provide technical assistance or training to nutrition projects

3

Other

27

Major Barriers Inhibiting Targeting Efforts


Lack of funding

40

Lack of staff

15

Lack of data to identify/locate populations

12

Negative attitudes toward targeting

11

Lack of training/guidance on effective targeting practices

4

Other barriers

61

Unweighted Sample Size

406

Source: Elderly Nutrition Program Evaluation, AAA survey, weighted tabulations.

a Percentages total more than 100 percent because AAAs may target more than one group.

b Percentages total more than 100 percent because AAAs may engage in multiple activities.

The most commonly used methods to target these groups are encouraging nutrition projects to conduct outreach programs (57 percent), providing technical assistance to projects (33 percent), and providing specialized services (28 percent). Providing outreach programs and encouraging the placement of nutrition projects where target groups live are considered the most effective methods. Lack of funding is the most common barrier to targeting success mentioned by AAA staff. Lack of staff, negative attitudes toward targeting, and difficulty locating the targeted groups were also mentioned.

3. Nutrition Project Targeting Activities

Fifty-five percent of Title III nutrition projects reported that they make efforts to target services to people with certain characteristics or needs (Table IV.49). Nutrition projects tend to focus targeting efforts on racial and ethnic minorities (34 percent) and those with the greatest economic need (43 percent). One-third of all Title III projects target persons with severe disabilities. The most commonly targeted racial and ethnic minorities are African Americans (23 percent), Hispanics/Latinos (17 percent), and Asians/Pacific Islanders (10 percent).

TABLE IV.49

NUTRITION PROJECT TARGETING PRIORITIES AND ACTIONS TAKEN TO TARGET PRIORITY GROUPS

(Percentages)


Title III Nutrition

Projects

Make Special Effort to Target Services

55

Targeting Priorities for All Nutrition Projects


Those with greatest economic need

43

Racial and ethnic minorities

34

Those with severe disability

33

Those at risk of institutionalization

17

Those in greatest social need

17

Those in rural areas

15

Those with Alzheimer’s or related disease

15

Those with limited English proficiency

10

Other

34

Racial and Ethnic Groups Targeted


African American

23

Hispanic/Latino

17

Asian/Pacific Islander

10

Native American/Alaskan Native

7

Native Hawaiian

1

Other

6

Strategies Used to Target Special Groups


Work with other community organization

24

Information and referral

17

Place meal sites where they live

15

Encourage people to tell their friends

15

Serve ethnic meals

10

Canvass neighborhoods where they live

9

Other strategies

33

Difficulties in Enrolling Targeted Groups


Overcoming stigma of assistance program

19

Nonacceptance by other participants

10

Language barriers

9

Generating interest

8

Lack of confidence in going to public places

7

Lack of transportation to meal site

5

Fear of delivery person entering home

2

Other difficulties

24

No difficulties

8

Unweighted Sample Size

242

Source: Elderly Nutrition Program Evaluation, Nutrition Project survey, weighted tabulations.

Many different strategies are used by nutrition projects to target services, and no single method dominated the responses. The most common targeting activities are working with other community organizations, using information and referral, encouraging participants to tell their friends about services, and placing meal sites where the targeted groups live. A substantial proportion of other responses were given, including presentations, fairs and open houses, improvements in the physical structures to aid accessibility for wheelchair users, television or newspaper advertising campaigns, and referrals through individuals in the medical profession.

Respondents to the nutrition project survey indicated the following barriers to effective targeting of priority groups in the ENP: (1) inability to overcome the stigma associated with an assistance program; (2) nonacceptance by other participants; and (3) language barriers. Once again, a substantial number mentioned other reasons, including cultural differences (in attitudes or food preferences, for example), project staff’s fear that target groups live in unsafe neighborhoods, lack of funding, lack of minority and bilingual staff, and lack of transportation for frail elders.


Last Modified: 12/31/1600