Social enterprises offer the promise of financially sustainable organizations that can respond to the world's most pressing problems. Yet for social enterprises to succeed, their leaders must effectively manage conflicting demands that arise from dual commitments to improving social welfare and achieving commercial viability. While existing research highlights distinct skills for enabling social missions or for achieving business outcomes, we draw on paradox research to build theory about the challenges and associated skills for effectively managing the tensions emerging from the juxtaposition of social mission and business outcomes. We then use two exemplary settings for educating social entrepreneurs, one in the classroom and one in the field, to illustrate pedagogical tools for teaching these skills. Integrating these challenges, skills, and pedagogical tools, we propose a paradoxical leadership model for social entrepreneurs.

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Objectives The number of food pantries in the U.S. has grown dramatically over 3 decades, yet food insecurity remains a persistent public health problem, consistently affecting 1 in 8 Americans. The goal of the study was to examine the impact of an intervention called The Food Pharmacy Network, designed to promote food security amongst patients of health clinics. The Food Pharmacy Network is an alliance of food pharmacies, hubs for free fresh produce within health clinics across the nation. The Network includes 15 member clinics from across the United States. While food pantries only provide food, each individual Food Pharmacy included a client-choice pantry, monthly meetings with a nutritionist or dietician to receive motivational interviewing, and targeted referrals to community services. Methods Control group participants went to traditional food pantries where they received bags of food. Using randomized parallel-group study with equal randomization, data were collected from September 2017 to September 2018; a total of 1028 adults were recruited over 1 year from traditional food pantries and randomized to the Food Pharmacy Network intervention (n = 513) or control group (n = 515), with quarterly follow-ups for 12 months. Data analyses were conducted from July 2018 to November 2018. Outcomes were food security, self-sufficiency, and fruit and vegetable consumption. Multivariate regression models were used to predict the three outcomes, controlling for age, gender, household size, income, and presence of children in the household. Results At baseline, half of the sample experienced very low food security. Over 1 year, Food Pharmacy Network patients were less than half as likely to experience very low food security, increased self-sufficiency by 5.2 points, and increased fruits and vegetables by 1.5 servings per day compared to the control group, all outcomes P < 0.01. Conclusions Our research demonstrates that Food Pharmacies are a more effective model to promote food security than short-term assistance through traditional food banks by addressing the underlying causes of poverty. The research provides convincing evidence of increased self-sufficiency and support for growth and scaling of the program to other areas. Funding Sources Rawlings Presidential Research Scholars Program. Public Service Center Scholars Program Clinton Global Initiative University

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