Funding for the Vital Brooklyn Initiative

Healthcare

Compared to the rest of the state, Central Brooklyn lacks access to primary care doctors and other critical mental health services. Current statistics show that there are only 55 primary care physicians per 100,000 people in Central Brooklyn, while the statewide average doubles that figure. Additionally, there are 497 Emergency Room visits in Central Brooklyn for every 1,000 people, which also eclipses the statewide average.

Communities need access to healthcare facilities that recognize and prioritize people’s unique needs, which is why Vital Brooklyn:

  • Is strengthening local healthcare facilities to close current gaps and increase services;
  • Transforming the healthcare system by increasing access to quality services and preventive care; and
  • Developing a large multi-site ambulatory care network which will include partnerships with existing community-based providers.

In January 2018, One Brooklyn Health received $664 million in funding to support the state's ongoing effort to create a sustainable health care system that expands access and transforms care throughout Central Brooklyn. A total of $36 million will be reserved for future awards under the program, resulting in total awards of $700 million when the program is completed.

Consistent with the recommendations in Northwell Health's "The Brooklyn Study: Reshaping the Future of Healthcare," Brookdale University Hospital Medical Center, Interfaith Medical Center and Kingsbrook Jewish Medical Center have partnered together to create One Brooklyn Health, which will serve as an integrated health care delivery system in Central Brooklyn.

The funds will support the development of an expansive integrated ambulatory care network, significant infrastructure modernization at each of the three hospital facilities, including regionalizing clinical programs and restructuring inpatient services, and the creation of enterprise wide health information technology platform to improve coordination and delivery of care through an efficient, high quality regional health care delivery system.

Specifically, $664 million of funding to One Brooklyn Health will support:

$210 Million to Develop a 32-site Ambulatory Care Network:

The expansive network will include partnerships with existing community-based providers, to increase access to primary and preventative health care services in the highest need areas of Central Brooklyn. These new facilities are expected to add approximately 500,000 new ambulatory care visits a year, which will more than double the number of visits that currently exist in the area. In addition, the new ambulatory care network will:

  • Include partnerships with four Brooklyn Federally Qualified Health Centers (FQHCs)—Bed Stuy Family Health Center, ODA Crown Heights, Brightpoint Health, and the Brownsville Multi-Service Center—to expand primary care capacity of community-based organizations;
  • Build programmatic bridges with SUNY Downstate and support the academic mission and vision of University Hospital;
  • Integrate with new affordable housing developments which will be built surrounding the three One Brooklyn Health hospitals to include on-site wellness amenities such as urgent care, primary care, and specialty practices; and
  • Create 255 net new jobs and help recruit 300 primary care physicians to the Central Brooklyn area, which has some of lowest rates of primary care physicians per capita in the state.

$384 Million for Critical Clinical and Facility Infrastructure Improvements:

  • Brookdale will undergo significant facility improvements to maintain its role in the community as a regional trauma center, including the development of a new Emergency Department, expansion of its community health center to accommodate a new 30-bed Intensive Care Unit, and development of additional patient care units - which are expected to increase Brookdale's capacity by 100 beds.
  • Interfaith will renovate and expand its emergency department, as well develop a Comprehensive Psychiatric Emergency Program Unit supporting the integration of primary and behavioral health care services.
  • Kingsbrook Jewish will evolve into a Medical Village with new and expanded ambulatory primary and specialty care, emergency services, and post-acute care services. Through this transformation, Kingsbrook will re-purpose portions of its campus to address social determinants of health, including the provision of new affordable housing and community space.
  • $142 million of the $384 million will be reserved to provide One Brooklyn Health flexibility in prioritizing its other clinical and facility infrastructure improvement projects submitted in its application.

$70 Million to Create a System-Wide Health Information Technology Platform:

Critical to the funding support for One Brooklyn Health are the investments to develop a community-wide health information technology system, which will enable the development of a single electronic health record system integrated across the three hospitals technology platforms and the provider care network, positioning the health system to thrive in the new world of payment reform and population health. In particular, the new health information technology platform will:

  • Effectively support clinical decision making, improve quality and patient care outcomes;
  • Develop effective care management capabilities and create operating efficiencies; and
  • Enable uniform measurement of medical and social determinants and reporting of a standard set of outcome measures to effectively gauge the success of interventions undertaken by the health system and its community partners is addressing social determinants of healthcare and its impact on community health status.

These awarded capital funds are in addition to $320 Million in ongoing annual operating support that the State is providing to four Central and Eastern Brooklyn Hospitals, including Brookdale University Hospital Medical Center, Kingsbrook Jewish Medical Center, Interfaith Medical Center, and Wyckoff Heights Medical Center.


Affordable Housing

Every family deserves a safe and decent place to call home. Residents of Central Brooklyn pay approximately half of their total household income on rent alone -- compared to 32 percent of household income statewide. Vital Brooklyn is creating new affordable housing opportunities that encourage active lifestyles and increase access to preventive care.

In November 2018, four winning proposals were announced that will collectively create more than 2,700 100-percent affordable homes in central Brooklyn with apartments and supportive services for the developmentally disabled, individuals aging out of foster care, and chronically homeless families. The developments will advance the Vital Brooklyn initiative's $578 million commitment to build 4,000 units of affordable housing. The Governor also announced the release of a second round Vital Brooklyn affordable housing request for proposals to construct homes on seven parcels of land controlled by the State, owned by One Brooklyn Health, and the Health Science Center at Brooklyn Foundation.

Winners of First Affordable Housing RFPs

  • Apex Building Company, L+M Development Partners, RiseBoro Community Partnership and Services for the Underserved (SUS) have been selected to purchase and redevelop the former Brooklyn Developmental Center. The development will provide more than 2,400 units of affordable housing, with 45 percent of those available to households earning up to 50 percent of Area Median Income, including approximately 207 units for formerly homeless individuals and families, approximately 185 units for intellectually and developmentally disabled individuals, approximately 156 units for seniors and a $1.2 billion investment in East New York. None of the units will be available to households earning more than 80 percent of AMI. The development will include workforce development and outreach to place local residents in construction jobs at Jamaica Bay Landing, and seven community partners will provide job training and entrepreneurship programs. The project is based on 'blue zones' planning, modeled after communities worldwide that have the longest lifespans, and includes 11.3 acres of public open space consisting of a retail main street, civic plaza, garden corridor, residential courtyards, a maritime grove fitness loop and productive zones.
  • Longstanding Brooklyn non-profit CAMBA has been selected to develop "Interfaith Broadway: Site C." CAMBA will transform Site C, on grounds owned by One Brooklyn Health, creating 57 apartments affordable to a variety of income levels, and on-site services for seniors and chronically homeless families. The development on Site C will feature a host of amenities including 24-hour security, bicycle storage, community and fitness rooms, Green Building features that promote healthy living and save energy such as rooftop solar panels, covered parking spaces, and more. A Community Facility Annex in a nearby building will provide residents with access to a workforce development training center, Community Supported Agriculture drop-off point for healthy food, and Neighbors Together meal delivery for elderly residents. In addition, CAMBA will develop customized on-site service plans in financial literacy, job-readiness, healthy living, and substance abuse. There will also be opportunities for residents to engage in movie nights, arts & crafts, as well as service provision LGBT Elders.
  • Vital Brookdale, LLC, a joint venture between MDG Design + Construction, Smith & Henzy Advisory Group, and the Foundling Group has been selected to develop "Brookdale Hospital: Site B" on grounds owned by One Brooklyn Health, creating 152 apartments affordable to a variety of income levels, and on-site services for the developmentally disabled and individuals aging out of foster care. Site B is a 40,000 square foot lot, located across from the Brookdale Medical Center. The development will provide supportive services to developmentally disabled residents living in a subset of the 152 apartments and to people aging out of the foster care system living in another subset of the apartments. Services will include meal planning and nutrition, socialization assistance, and computer use training, among other supports. The development will feature a computer room, a theater, a kitchen for cooking classes, and entertainment and community rooms. It will house a variety of commercial and community facility uses which may include Community Supported Agriculture access and a Greenhouse, a Daycare/Pre-K facility, and/or an Education and Job Training Center. There will be a second floor terrace with a central plaza, community garden, outdoor seating, and playground, and a seventh floor rooftop viewing terrace. The entire surface of the rooftop will contain solar panels to generate electricity onsite, providing environmental benefits and cost-savings.
  • Federation of Organizations, a nonprofit community-based social wellness agency that provides health, supportive and housing services on Long Island and in New York City, will create 119 affordable homes on a 21,000 square foot lot across the street from Interfaith Medical Center known as "Interfaith Herkimer: Site A." The development will provide housing for seniors, including a set aside for frail and elderly seniors who will receive on-site supportive services. Space on the ground floor will be used for food assistance programs. Social workers, case managers and nurses will also operate on site. A terrace on the second floor will have seating and offer exercise classes, and another on the seventh floor will feature an urban farm. The building will be constructed to Passive House Standards and will include solar shades and a green roof.

Second Affordable Housing RFP

In consultation and coordination with Community Advisory Councils, New York State Homes and Community Renewal issued a Request for Proposals for seven additional Vital Brooklyn sites in the second round of the central Brooklyn affordable housing initiative, advancing the initiative's $578 million goal to create 4,000 units of affordable housing.

The housing units covered by the RFP will be developed on state-and hospital-controlled sites including six on the grounds of One Brooklyn Health and another on land owned by the SUNY Downstate Medical Center-affiliated Health Science Center at the Brooklyn Foundation. Many locations will host a new ambulatory care center, which are among 32 being advanced through the previously described $664 million healthcare transformation investment by the state.

HCR asked that proposals incorporate other elements that benefit the surrounding community, including retail and/or community facilities, green building practices, and public and health and wellness-oriented amenities such as open space and streetscapes that will help revitalize the area. Proposals for sites E, F, G, H, and I were due by February 28, 2019 and proposals for sites J, K, and L were due by April 30, 2019. Sites I, K, and L are still under review.

Winners of Second Affordable Housing RFPs

Sites E, F, G, and H

Monadnock Development/Construction, CB-Emmanuel Realty, LLC and Brooklyn Community Housing and Services, Inc. have been selected to develop “Kingsbrook Estates: Sites E, F, G, and H.” The team will transform the Kingsbrook Jewish Medical Center North Campus into a 266-unit affordable housing development with health, wellness, employment and support services. As part of the proposal, three existing buildings on the 102,000 square-foot Kingsbrook Jewish Medical Center North Campus will be demolished and replaced with two newly constructed buildings. The Leviton Building, another building on the campus, will be redeveloped from hospital use into housing units. Residents will include older adults and disabled veterans. There will be access to health and wellness classes, vocational training and employment skills development, physical activity programs and integrated care. On-site amenities will include a therapeutic garden, outdoor exercise equipment, walkways, children's play areas, outdoor kitchens and grills as well as an indoor teaching kitchen. One Brooklyn Health System and Kingsbrook Estates will also provide all-inclusive care for the elderly in the development's 7,000 square-foot PACE Center. These services will be available to residents of the development and the surrounding community.

Site J

Xenolith Partners, LLC, Community Preservation Corporation and Community Solutions International, Inc. have been selected to develop The Rise: Site J, to construct 68 affordable and supportive housing apartments on East New York Avenue in Brownsville. The Rise will offer an array of health, wellness, employment and legal services. As part of the winning proposal, OBHS will house administrative offices on the ground floor of the building. The Women's Prison Association and the Osborne Association will also occupy space on the ground floor in order to serve the building's residents as well as eligible members of the community. These services include case management, job-readiness training and job placement, legal assistance and support groups for re-entry transition and the development of social and wellness skills. The development will also include space on the ground floor and lower level to be shared by Man Up! Inc. and Community Capacity Development, Inc., which will provide fitness classes for youth, adults and seniors. On-site amenities will include approximately 10,000 square feet of green space for residents, two lounges, a community room, three laundry rooms, two resident outdoor terraces, and bicycle storage.


Open Space and Recreation

Currently, Central Brooklyn residents have very few opportunities for physical fitness. 84 percent of Central Brooklynites have gone without adequate physical activity in the last month alone, compared to the 53 percent in the rest of the state.

To ensure residents have access to recreational amenities, nature and open space, Vital Brooklyn is creating hundreds of acres of open space and investing in existing recreational facilities:

Partnership with National Park Service and City of New York to Open Newest and Largest State Park in New York City: In his 2018 State of the State address, then Governor Cuomo announced a partnership with the National Park Service and the City of New York to establish a new 407-acre state park on Jamaica Bay in Brooklyn, providing crucial new open space access to one of the most underserved areas of the state. In the first phase, the state will invest up to $15 million to open the property, making available 3.5 miles of waterfront, miles and miles of paths and trails, and a coastal highland, planted with native species. The new state park complements ongoing efforts to build or improve pocket parks, community gardens, playgrounds and recreation centers within a ten-minute walk for every Central Brooklyn resident.

$10.6 Million to Transform 8 Schoolyards into Community Playgrounds and Open Space: The Office of Parks, Recreation and Historic Preservation, in partnership with the Trust for Public Land, is transforming 8 asphalt schoolyards into dynamic playgrounds and community gathering spaces, adding new recreational opportunities throughout Central Brooklyn. To be complete by 2020, the following community playgrounds will be designed through a participatory process engaging the students and families associated with each school. Construction of the first playground located at PS 581 on Winthrop Street is underway and scheduled for completion later this year.

    • PS 315, K152 (2310 Glenwood Rd, NY 11210)
    • PS 145K (100 Noll Street, NY 11206)
    • PS 377K-Bushwick (200 Woodbine St, NY 11221)
    • PS 156 Waverly/ IS 392 (104 Sutter Ave, NY 11212)
    • MS 354 School of Integrated Learning-Crown Heights (1224 Park Place, NY 11213)
    • K598, K581, K589-East Flatbush (905 Winthrop St, NY 11203)
    • PS 115 (1500 East 92nd Street, NY 11236)
    • PS 213 New Lots (580 Hegeman Ave, NY 11207)

$3.1 Million to Transform Nearly Two Dozen Community Gardens: The Office of Parks, Recreation and Historic Preservation, in partnership with the Brooklyn Queens Land Trust and the New York Restoration Project, will award grants to fund important capital improvements, such as on-site water, to 22 community gardens throughout Central Brooklyn so that the gardens can increase capacity and are better equipped to serve their local communities. Improvements to the following gardens will begin spring 2018, and be complete by 2020.

  • 1100 Block Bergen St Block Association Garden
  • Concerned Citizens of Grove St Community Garden
  • Essex St Community Garden, 3030 Fulton Street
  • Garden of Hope, 392 Hancock Street
  • Heaven's Gate Garden, 169-171 Hart Street
  • Heckscher Foundation Children's Garden, 134 Scholes Street
  • Hendrix St Community Garden, 532 Hendrix Street
  • Jane Bailey Community Garden, 327 Greene Avenue
  • Madison St Community Garden, 974 Madison Street
  • Patchen Ave Garden, 49 Patchen Avenue
  • Sheffield Garden, 673 Sheffield Avenue
  • St John's Place Renaissance Garden, 1642 St. John's Place
  • United Herkimer Garden Club, 97 Herkimer Street
  • Westbrook Memorial Garden, 1233 Pacific Street
  • Aberdeen St Community Garden, 91 Aberdeen Street
  • Hull St Community Garden, 145 Hull Street
  • Williams Ave Community Garden, 88 Williams Avenue
  • Bedford-Stuyvesant Community Garden, 95 Malcom X Boulevard
  • Decatur Community Garden, 1052 Decatur Street
  • Greene Acres Community Garden, 322 Franklin Avenue
  • McLeod's Community Garden, 130 Liberty Avenue
  • Target Community Garden, 931 Bedford Avenue

$1 Million to Enhance Recreation Centers: The Office of Parks, Recreation and Historic Preservation will award grants in the next few months to fund physical improvements to the following local recreation centers to better serve their communities: North Brooklyn/Twelve Towns YMCA and Bedford Stuyvesant YMCA.


Resiliency

Central Brooklyn faces the dual challenges of vulnerability to extreme weather and the increasing need for electricity. The New York State Energy Research and Development Authority (NYSERDA) is doing it's part to help make Brooklyn a more environmentally sustainable and resilient community.

$825,000 to Expand Outreach on Clean Energy and Efficiency Programs: NYSERDA awarded the Center for New York City Neighborhoods $825,000 to help build clean energy awareness and connect underserved communities with cost-saving opportunities. Under this contract, the Center's community energy advisors will work with residents, small businesses, and multifamily building owners to enable informed energy decisions and increase local participation in energy efficiency and renewable energy programs and services.

$243,090 to Improve Building Efficiency: NYSERDA will partner with RiseBoro Community Partnership (formerly Ridgewood Bushwick Senior Citizens Council), an affordable housing developer, to invest in training for property managers and building operations and maintenance staff of 130 buildings across Central Brooklyn, including four hyper-efficient Passive House buildings. Partnership includes development of an on-site training lab space and cultivation of in-house trainers.

$1.1 Million to Advance the Clarkson Avenue Microgrid Project: This innovative project will link the Kings County Hospital, SUNY Downstate Medical Center and Kingsboro Psychiatric Center with a resilient source of on-site backup power. It is currently in the design phase of project development, which is expected to be completed before the end of 2018.

$12 Million to Develop 19 Cogeneration Projects: Cogeneration projects, which are small-scale electricity and heat generation units, benefit their hosts by reducing energy costs, lowering emissions, and increasing resiliency by providing back-up power. NYSERDA will be helping develop 19 cogeneration projects by 2020 in Central Brooklyn.

$8.8 Million to Complete Energy Efficiency Upgrades in More Than 7,300 Multi- and Single-Family Residences: NYSERDA is supporting energy efficiency retrofits with technical assistance and project incentives to make multifamily and single family homes in the Vital Brooklyn area more energy efficient. NYSERDA will complete energy cost-saving upgrades to more than 7,300 home and apartments in Central Brooklyn by the end of 2018.

$1.5 Million to Support More Than 460 Solar Projects: Since the launch of the Vital Brooklyn initiative, more than 460 solar projects have been completed at residences, schools, and small business in Central Brooklyn.

Expanding Operation Eco-Quality: The Department of Environmental Conservation is undertaking an Operation Eco-Quality campaign in the Canarsie area to educate approximately 70 small to medium businesses on best management practices for compliance with a spectrum of state environmental laws and regulations to protect and improve public health.


Education and Youth Development

Today, a well-rounded education requires more than in-class learning. In addition to expanding resources for wraparound services tailored to school needs, the New York State Department of Environmental Conservation (DEC) and partners such as the Billion Oyster Project are exposing at-risk youth to hands-on learning on shoreline and habitat restoration efforts in Jamaica Bay and New York Harbor.

Vital Brooklyn is:

$1.2 million to 8 New Community Schools: The Governor's 2018 Enacted Budget provides a $50 million increase for a total of $150 million in community school funding statewide. These funds will be used to transform the following high-needs schools into community schools and provide support services that are unique to each school and address their individual needs. Services may include medical care, dental care, before-and-after school programs, summer learning activities, and other social services.

  • PS 149 Danny Kaye
  • IS 68 Isaac Bildersee
  • PS 135 Sheldon A Brookner
  • PS 241 Emma L Johnston
  • Brooklyn Environmental Exploration School (BEES)
  • Dr. Jacqueline Peek-Davis School
  • PS 290
  • MS 246 Walt Whitman

$200,000 to Build a Community Oyster Reef and Expand the Billion Oyster Project Curriculum: The Department of Environmental Conservation will award $200,000 to the Billion Oyster Project, a NY Harbor Foundation program, to conduct outreach to Vital Brooklyn community schools to recruit new partners in the in-class programming of nature-based science curriculum. With a focus on the history and future of oysters in Jamaica Bay and NY Harbor, participating teachers will be trained in the oyster restoration need and process through the creation and monitoring of an Oyster Restoration Station with their class. The Oyster Restoration Station will be integrated into a Community Oyster Reef that will be developed and installed by the Billion Oyster Program at Paerdegat Basin in Canarsie, creating an additional hands-on learning opportunity and fostering greater ties between the participating students.

$50,000 Investment to Double Jamaica Bay Restoration Corps Summer Youth Employment: The Department of Environmental Conservation has awarded $50,000 to the American Littoral Society to expand Jamaica Bay Restoration Corps to provide more at-risk youth from Vital Brooklyn communities with summer employment opportunities. Paid for their summer work, the R-Corps conduct coastal enhancement and restoration projects, exposing the participants to the potential for jobs in the environmental sector. The state will expand the program this summer, doubling the number of employment spots for interested youth. Recruitment began April 2018.


Violence Prevention

Central Brooklyn has been grappling with violence that has put residents at risk for years. The homicide rate in Central Brooklyn is almost triple the statewide average. To make neighborhoods safer, Vital Brooklyn is expanding violence prevention programs, creating new opportunities for youth engagement, and increasing support for victims with:

$800,000 to Integrate Social and Mental Health Services within Street Outreach Programs: This pilot program will enhance outreach efforts to prevent and respond to gun violence by connecting social workers with existing violence reduction programs, specifically the city's SNUG/Cure Violence sites, to increase access to social and health services for crime victims, especially traumatized youth. These social workers will also provide crucial support to the program staff and their clients in Central Brooklyn who are impacted by the trauma and complex social needs associated with gun-involved violence. This program is positioned to make a difference in lives of those most impacted by gun violence by leveraging the street current outreach network in New York City and making critical referrals to state resources.

$500,000 to Provide Programming for Young People: This funding will be used to connect the existing violence reduction programs with community-based organizations that provide programs outside of school for youth. These programs range from athletics, such as midnight basketball, to academic support, creative arts, and vocational training. These programs will be geared toward young people between the ages of 14 and 24. In a recent study, there were more than 50,000 young people in Brooklyn - or roughly 1 out of every 6 youth who were neither in school or employed - in 2016. Engaging young people as they transition toward adulthood provides meaningful opportunities to develop the knowledge and skills necessary to be successful in future career and education paths.


Job Creation

While many communities throughout New York State have experienced an economic resurgence over the past six years, the recovery has been slower to reach Central Brooklyn with an unemployment rate almost three percentage points higher than the New York City rate. To break this trend and jumpstart growth in this community, Vital Brooklyn is giving residents of all ages the resources they need for economic empowerment, including financial literacy, entrepreneurship and job training and placement programs.

$250,000 in Green Job Training Grants: The Department of Environmental Conservation is launching a competitive grant program to fund green jobs training programs in Central Brooklyn to help prepare residents for emerging job opportunities in the growing clean, green economy. Eligible not-for-profit organizations are encouraged to apply via the New York State Grants Gateway: www.grantsgateway.ny.gov. Submissions are due July 20th by 3pm. A video recording of the Q&A webinar is available to view here.

$600,000 to Continue Unprecedented Unemployment Strikeforce Effort: Central Brooklyn has seen significant progress in connecting the unemployed to jobs since the Governor activated the Unemployment Strikeforce. Upon announcement of the Vital Brooklyn initiative, the Governor set a goal of 7,500 hires in Vital Brooklyn target neighborhoods in Central Brooklyn. Since that commitment was made less than a year ago, results have greatly surpassed the stated goal—more than 30,000 individuals have been placed in target areas. The progress is expected to continue as the Department of Labor deploys ongoing Unemployment Strikeforce resources throughout Central Brooklyn, in response to community feedback. These localized resources will be available through December 2018.


Healthy Food

Today, one in four Central Brooklynites are food insecure -- almost twice the state average -- meaning they lack access to quality and variety in their diet, leading to diabetes, obesity, and other health issues.

Increasing access to nutritious food, Vital Brooklyn is:

$500,000 Mobile Market Grant Program: Mobile food access units are an important means for reaching those who are often most in need of fresh, healthy food. Establishing mobile markets is more flexible and less expensive than constructing and operating full-scale grocery stores or new food pantries, plus they can serve multiple neighborhoods, and better reach people who have limited mobility. The state is launching a competitive grant program to fund additional mobile markets in Central Brooklyn to help ensure that food access improves for all citizens in the area. Eligible not-for-profit organizations are encouraged to apply via the New York State Grants Gateway: www.grantsgateway.ny.gov. Submissions are due June 8th by 4pm.

$325,000 to Open 12 New Youth Run Farmers Markets: Starting in the 2018-2019 school year, in partnership with Grow NYC and United Federation of Teachers, 12 community schools in Central Brooklyn will begin teaching youth how to manage and operate farm stands, empowering students with entrepreneurship skills and encouraging them to take an active role in their local food systems. These new access points for fresh fruits and vegetables will help make healthy food more available in a part of the city where food insecurity is the highest and chronic diet related health problems have persisted.

$300,000 Food Insecurity Screening Pilot Program: This summer, the New York State Department of Agriculture and Markets will fund a Food Insecurity Screening Pilot Program within the local healthcare system as a part of the Vital Brooklyn initiative. This pilot program, called for by members of the community, will integrate food security assessments into the broader health care system by establishing a process where seniors are screened for food insecurity within their regular healthcare visits, referred as needed to dietary and nutritional counseling and supported with additional benefits to make fresh fruits and vegetables more affordable.