Thursday, September 22, 2016

USDA Tours National Health Foundation's Successful Youth-Led Health Academy Programs

U.S. Department of Agriculture (USDA) Administrator Audrey Rowe met with youth and leadership of the National Health Foundation's (NHF) innovative youth-led Health Academy program to highlight successful implementation of the Supplemental Nutrition Assistance Program –Education (SNAP-Ed) funded Champions for Change grant, administered locally by the Los Angeles County Public Health Department.  The goal of SNAP-Ed is to improve the likelihood that persons eligible for SNAP will make healthy food choices within a limited budget and choose physically active lifestyles.

The Health Academy, a youth-driven nutrition education and obesity prevention program, has been an opportunity for youth at Thomas Jefferson High School in South Los Angeles to create and implement upstream interventions to improve the health of their community. The focus of Rowe's visit will be the following Health Academy successes: The Mini Farm-Stand/Breakfast in the Classroom food waste abatement project, the school cafeteria makeover and the Healthy Marketing and Product placement corner store makeover projects. "We are honored to have been a part of Administrator Rowe's visit to southern California. The youth involved in Health Academy have impacted the health of their community in tangible ways that are rippling out beyond the school's walls. The enthusiasm of the Health Academy students is touching families and friends and creating a veritable shift in consciousness around what constitutes health," shared NHF President and CEO Kelly Bruno.

About the Health Academy Projects  The Mini Farm-Stand project was designed by students to provide classmates access to healthy snacks while curbing food waste. Students placed attractive baskets in pilot classrooms and filled them with the fruit and foods left over from the Breakfast in the Classroom program. Typically, these foods would have been discarded, however, by placing them in the Farm-Stand baskets, students were able to simply take a piece of fruit at any time in the day, as needed. The results of the pilot were remarkable. Food waste was significantly reduced and students greatly appreciated having access to healthy options to the typical snack bar and vending machine fare offered between school meals. The Mini Farm-Stand project has been expanded through two Los Angeles Unified School District (LAUSD) schools and is recognized as a potential model for district-wide implementation.

Students in the Health Academy also tackled the issue of low participation in the school lunch program. The youth polled their fellow students and learned that the layout and appearance of the cafeteria was not conducive to purchasing and consuming a meal in the allotted 30-minute lunch break and that many students were consuming snack foods for lunch rather than tackle the lunch lines. With a few minor tweaks to the layout and a creative point-of-purchase marketing scheme complete with posters touting the value of school lunches, the youth were able to significantly increase participation in the school lunch program.

The Health Academy youth shifted their attention to the community around their school and have begun to offer local merchants 'Store Makeovers'. Recognizing that South Los Angeles, with its high number of fast-food restaurants and liquor stores constitutes a food desert, the students set out to make fresh produce and water available at the corner stores closest to their school. Students worked with Mercado Garibaldi owner, Joel, to increase the visibility of bottled water as an option to sugary beverages, and they worked with La Favorita owner, Carlos, to increase the availability of fresh fruits and vegetables. Both retailers embraced the changes and the energy of the students and plan to continue offering healthy options year-around.                                               

Wednesday, September 7, 2016

School-Based Teen Pregnancy Prevention Program Leads to Longer, Healthier Lives


Designed and facilitated by NHF, Be a STAR girls is a school-based teen pregnancy prevention program for adolescent females at-risk for a first time pregnancy. The program focuses on healthy behaviors, family planning, skill development, communication, and goal oriented behavior to empower teen girls to prevent unplanned pregnancies and improve their overall health, well-being, and success in life.

We recently caught up with one of our Be a STAR graduates, Ty’Kese, before she headed off to college. Ty’kese epitomizes what Be a STAR is all about. She is a Successful Teen Acting Responsibly. Pregnancy and parenthood cause many young, promising teens to drop out of school. And dropping out of school can completely devastate their lives and shut down otherwise bright futures.

High school drop-outs face unemployment, poverty – and shorter lives. Yes, you read that correctly. There is a significant link between education and health. High school graduates live longer than high school dropouts. College graduates have even longer life spans, better access to health care, better dietary and health practices, and overall better health.

Ty’Kese is smart and interested in making a difference in others’ lives. She’s a vegetarian. She wants to study psychology and social work as an undergraduate and then earn her master’s degree. She prides herself on asking questions and being well informed in the classroom and in the world at large.

Ty’Kese was surprised when the social worker at her high school recommended she get involved with NHF’s Be a STAR girls program. Although she’d had a few pregnancy scares, she really didn’t think she was at-risk of becoming pregnant. Plus, helping to take care of her younger brother at home, she felt, gave her a good idea of what it would be like to be a young mother. It didn’t seem like it would be that hard.

The truth is she didn’t want anything to do with Be a STAR girls, but she sat in on one session and was hooked. She loved getting honest, factual information about health and sexuality. She loved being in an atmosphere where she could freely ask questions. She appreciated having the opportunity to learn more about her own body in a safe environment with other girls. And it was eye opening for her to have myths such as, "you can’t become pregnant when you have your period" debunked.

What is shocking is that Ty’Kese had taken several other health and sex education classes and said she learned more in just a couple of Be a STAR sessions than she ever learned before. Be a STAR prepared her for adulthood by giving her full information about her birth control options and helping her set forth her personal goals for the next two, five, and ten years.

The goal setting exercises caught her attention. Yes, she enjoyed helping take care of her little brother, but now she saw how completely different this would be from actually being a young mom. In one exercise, Ty’Kese created a daily schedule of what her life would be like as a parent. This “as if” schedule showed her an unending string of early mornings, grueling days, and the difficulty of getting someone to watch her baby while she went to school. She could see how extremely difficult, if not impossible, it would be to reach her goals in these circumstances.

Ty’Kese is more concerned, careful, and knowledgeable about birth control than she used to be. Her eyes are wide open. She pays attention to her own body and is self-aware. She wishes Be a STAR was required for all girls at her former high school.

She wants to be a mom one day, when she’s ready, perhaps in a decade, after she has completed her education and has a good job as a social worker. For now, Ty’Kese wants to enjoy being a student and focus on her goals for a life that will be filled with achievements and the prospect of long-term health.

Tuesday, August 23, 2016

Teens Bring Mini-Farm Stands to the Classroom, Reduce Food Waste in the Process







Youth engagement provides young people with the opportunity to develop leadership skills and address challenges they face head-on in their own communities. For the past three years, National Health Foundation’s Health Academy has been working alongside youth from Historic South Central Los Angeles to address upstream barriers to healthy weight such as access to healthy food in their community. NHF Health Academy’s “Legion of Health” youth team is one of four teams in the program that engaged in youth participatory action research to identify issues impacting access to healthy food and food waste and develop and implement solutions to tackle those barriers. Here is one example of their success.

In the fall of 2014, Los Angeles Unified School District implemented Breakfast in the Classroom (BIC), a program that enables students to eat breakfast provided by the school in their classrooms rather than before they get to school. This was especially important at Thomas Jefferson High School where the surrounding community is labeled a food desert1 and access to healthy foods is an extreme challenge. Living in a “food desert” means that at least one third of the residents live more than one mile from a grocery store and in a dense urban environment, that is a significant barrier. In addition, those grocery stores serve significantly more people than in areas with better access. A 2010 Community Health Councils report indicated that South Los Angeles’s 60 full-service grocery stores serve approximately 22,156 residents each. In comparison, West LA’s 57 grocery stores each serve approximately half the number of residents. Layer onto this story the fact that 60% of South Los Angeles eateries are fast food restaurants. Clearly, BIC was an essential program providing increased access to fresh, healthy foods and students needed to take greater advantage of this opportunity. Within these statistics, the Legion of Health youth team saw an opportunity to make real impact.

As the Legion of Health team investigated the BIC program, they discovered that one of the unintended consequences was an increase in food waste, specifically the fruit accompanying the breakfast meal. A meeting and tour of the cafeteria with the Cafeteria Manager gave the youth real insight into the actual volume of food waste. The youth team began re-envisioning the BIC program as a way to encourage consumption by recovering the food and offering it as a snack to students throughout the day. This option would reducing food waste and minimize cost of healthy snacks. Legion of Health developed a pilot project to provide healthy snacks throughout the day at no cost to students by saving the surplus of fruit and/or non-perishable food items from the BIC program. Youth placed decorative baskets in classrooms and set uneaten food from BIC into the basket. Legion of Health named their project “Health Academy Mini-Farm Stand” and designed baskets to hold the fruit in classrooms. Legion of Health partnered with several of their high school teachers to implement the pilot project in select classrooms. Youth also developed a tracking system to record the number of students that grabbed a snack. Legion of Health hypothesized that students would consume all the items by the end of each school day.

The project findings proved the Legion of Health’s hypothesis to be correct: all food from the farm stand baskets were consumed by the end of each school day. Legion of Health presented these findings to school administration and advocated for school-wide implementation. School leaders agreed to implement the project school-wide so that every classroom would have a “Health Academy Mini-Farm Stand” basket and students would have access to healthy food anytime of the school day in any classroom on campus. Since school-wide implementation, the Cafeteria Manager is reporting a near complete reduction of food waste from BIC.

Legion of Health recently expanded the “Health Academy Mini-Farm Stand” project to Nava College Prep Academy. Legion of Health presented the benefits of the baskets to students and staff along with delivering baskets to each of the classrooms. This past school year, Legion of Health met with Laura Benavides Co-Director of LAUSD Food Services who applauded the youth’s efforts. In the coming year, Health Academy’s Legion of Health will seek out partnerships at other schools to expand the program in hopes of ultimately meeting with the LAUSD School Board to advocate for district-wide implementation.

[1]Free and Reduced Meal,’ Analysis, Measurement, & Accountability Reporting Division. California Department of Education, 2013; http://www.cdph.ca.gov/programs/cpns/Documents/SNAP-Ed%20FFY%2015%20Att%201%20FRPM%202013%2005%2024.pdf

Tuesday, August 9, 2016

NHF Seeks KaBOOM! Funding to Further their BUILD Health Challenge Efforts



 
Playing is an essential part of development for young children. Its benefits go beyond learning to include better health and improved social skills. However, not every child lives in a community with enough accessible, safe, outdoor space to play.
The national nonprofit KaBOOM! is dedicated to bringing balanced and active play in the daily lives of all children. Their latest “play challenge” will award $1 million in prizes to communities that provide the best ideas to increase the playability of their neighborhood. For this challenge, there is one caveat, the idea to increase playability must be implemented in a nontraditional space, such as a sidewalk, vacant lot, bus stop, or street.
Like KaBOOM!, National Health Foundation (NHF) realizes that in some communities, a nontraditional approach is often necessary. Over the last year, NHF, in partnership with the California Medical Center and the Los Angeles Department of Public Health, has conducted an environmental scan of the Historic South Los Angeles community. Among a wide range of identified health disparities and poor social determinants of health this community faces, lack of safe, open play space is one of community residents’ greatest concerns. After carefully evaluating the needs of the community and receiving input from a team of South LA high school youth leaders, a robust community action plan was created to address this lack of safe, open space in Historic South LA, along with the lack of access to healthy food.
The community action plan will address the lack of safe, open space through a tested method, partnership with the 100 Citizens program, which places kinesiology students from local universities in local communities to facilitate exercise programs. There is demonstrated need for this partnership. Local organizations that offer physical activity programming have long waiting lists and too few resources to meet the demand. Implementation of these partnerships would take place in small pocket parks that currently have no programming. Through this action plan, NHF and its partners will support residents in taking advantage of their parks. 
In July, NHF’s KaBOOM! playability idea was selected as one of the top 200 ideas submitted to the Play Everywhere Challenge. In line with the strategies of the action plan, NHF proposed to, in collaboration with Council District 9 and five youth leaders from a local high school, design a maze that will highlight historic events of South Central on the sidewalk in frontof the Constituent Center located on Central Avenue. Additionally, creative seating will be installed that will be abstract in shape, such as concrete orbs, or cylinders. The project will provide an opportunity to play and learn in a space that is safe and close to community resources, the Council District’s Constituent Resource Center on Central Avenue.  Here there is high pedestrian traffic. As a main corridor of the community, high pedestrian traffic will bring many children through the maze to play. NHF’s KaBOOM! submission is building on the work already underway to enhance the local community’s physical environment and invite children and adults alike to get more physically active.

Tuesday, August 2, 2016

Zip Codes as Indicators ... of Actively Engaged Communities


 

By Danielle Cameron, Chief Strategy Officer for National Health Foundation

Too many times we have heard how zip codes have a greater impact on individuals’ health than their genes; usually in the negative sense. Social determinants of health – conditions in the places where people live, learn, work, and play – can have wide ranging impact on health risks and outcomes.[i] But these zip codes facing troublesome social determinants of health have an opportunity to rise up and tackle these challenges head-on so that these zip codes are no longer synonymous with poor health, but rather signify some of the most willful, engaged communities working together to improve their environment and collective health.

Rather than viewed for their economic policies, environmental circumstances, social norms, or educational experiences that poorly impact health, these zip codes often indicate the presence of a powerful community of organizers, advocates and change agents. They are shifting the tide in terms of population health – in their own neighborhoods. It’s these zip codes where hospitals, health plans and community-based organizations should be looking to establish multi-sector partnership that leverage local resources and ambition to create the most impactful change.

NHF has had just that experience in South Los Angeles.

According to the ‘Mapping LA’ project of the Los Angeles Times, South Los Angeles is a 51 square-mile region encompassing 28 neighborhoods that are home to more than 749,000 residents and some of the most troublesome zip codes in Los Angeles County.

For the past four years, NHF has been working in a handful of these zip codes with a generation of engaged teens, learning to bring about dramatic changes in their community and succeeding! In particular, they are changing the way South Los Angeles residents view their physical environments, personal health practices, the healthy development of their children, as a means of improving their overall health and wellbeing.

Through a series of student-led programs that emphasize information gathering as well as peer and public input, healthy changes are afoot in a zip code that otherwise has many negative associations.

At Jefferson High School, National Health Foundation’sHealth Academy, a student-led, healthy change initiative has, over the past three years, implemented such ground breaking ideas as a hydration station offering fresh water as an alternative to sodas and juices, reconfigured the lunch room so that all students have time to get lunch and eat it, versus having to go to the snack shop to buy sugary treats to replace meals, and have tested and introduced healthy meal options that are now on the lunch menu. Perhaps the biggest victory was the creation of classroom-based mini farm stands where students can help themselves to a piece of fresh fruit when needed. The initiative caught the eye of the Los Angeles Unified School District’s food services director who acknowledged the thoughtful use of fruit left over from breakfast service, the reduction of food waste, and the increase in opportunity for students to snack on healthy fruits. The district is considering expanding the program to other LAUSD school sites.

Through another project, NHF’s BUILD Health Challenge grant in collaboration with California Hospital Medical Center and the LA County Department of Public Health, student ”Community Health Liaisons” spent several months interviewing residents about their perceptions and needs as they relate to their physical environment. Residents voiced concerns ranging from a need for safe, open spaces for play and exercise, to a desire to walk more and have more opportunities to purchase fresh fruits and vegetables. The partnership took the information gathered and formulated a Community-Driven Action Plan for Historic South Central. The purpose of the plan will be to implement upstream, meaning preventative rather than curative, solutions to the health issues faced by the community. By lowering or even eliminating some of the social and environmental barriers to health, the team hopes that the community will defy the current statistics that point to lower life expectancy and a higher than average rate of preventable illnesses.

As part of Mayor Eric Garcetti’s Great Street’s Initiative, another group of inspired students championed the creation of a Walking Corridor along Central Avenue. Through the use of clever wayfinding signage, the community can now see how far the nearest transit, entertainment, shopping and recreational facilities are located on foot. The signage, unveiled during a community event in May, has been met with the resounding approval of the community and visitors alike.

The community is seeing first-hand that change is most meaningful when it comes from within and is possible when it is led by the energy and passion of one of its most valuable assets: its youth. The remarkable success of these empowered and engaged youth is a reflection of a new and brighter outlook in the zip codes of South Los Angeles.


[i] World Health Organization

Thursday, July 7, 2016

A Community of Hospital Safety Champions

 

By Mia Arias, MPA, National Health Foundation Director of Programs
For seven years, Patient Safety First (PSF) has provided hospital staff with an opportunity come together, learn from each other, and share success stories and best practices all in the name of providing safe, quality care to patients that step through the doors of their hospitals. As a statewide collaborative, PSF has provided over 200 in-person meetings, webinars and calls to support hospitals’ improvement efforts.
Many times, the faces you see at these regional meetings change, but there are some that become very familiar. One such face is that of Donna Young. Donna is Director, Performance Improvement at Chino Valley MedicalCenter. Donna has been an RN for sixty years and attests to seeing a lot of changes in healthcare during that time. For the past seven years she has consistently attended PSF meetings in the Southern California region. I had the opportunity to sit down with Donna and ask her a few questions about her experience participating in PSF, what effect it has had on her work and why she makes coming to these meetings a priority.                  
How has PSF supported quality improvement efforts at Chino Hospital? 
“PSF provides us practical tools to drive improvement, it also enables us to have good data to present to our staff and medical board. Our leadership often asks, how does our data compare with local and national hospital programs? PSF provides a credible comparison point.I really appreciate the consistency of the PSF goals and how the program stays relevant to changes in performance improvement measures and requirements. PSF is a very reliable resource.”
What are some of the practices your hospital has undertaken to effect positive patient safety changes?
“We focus on safety at every single staff meeting and understand that building and supporting a culture of safety is paramount to ensuring we provide the highest quality of care to our patients. We use the Agency for Healthcare Research and Quality (AHRQ) survey on patient safety culture to asses where staff are and we’ve seen great results. Chino Valley Medical Center recently received three awards recognizing our successes in safety, including the Truven Top 100 Hospitals, 2015 Women’s Choice Award for Emergency Care and HealthgradesPatient Safety Excellence Award™ Winner 2016. Our involvement with PSF has helped us both achieve and demonstrate our improvement.”
In your experience what has been the single best component of PSF and why?
“I like the peer-to-peer learning aspect. Working at a fast pace in a hospital can sometimes feel isolating. Coming to these meetings and networking with your peers helps take you out of your routine. You find people you can talk to about the same issues you might be experiencing. PSF is a community, so when you are asked to present, you feel comfortable because you are in front of your peers. It is still a challenge, but a good one that expands your competencies.”
As we finished our discussion, Donna told me that she certainly hopes PSF continues for many years. For her, and for many of the hospitals that participate in the free, statewide collaborative the resources and information they receive is just as valuable as the networking and social aspects of the program. PSF truly is a community.
Patient Safety First (PSF) is a groundbreaking partnership between National Health Foundation, California’s Regional Hospital Associations, Anthem Blue Cross and over 160 hospitals across the state. The efforts of Patient Safety First have been recognized by several awards, most notably the esteemed 2013 John M. Eisenberg Patient Safety and Quality Award from the National Quality Forum and The Joint Commission, for the demonstrated Phase 1 accomplishments of its first three years (2010-2012).

Thursday, June 23, 2016

Bridge Housing: Connecting the Homeless to Housing After Hospitalization


The recent 2015 homeless count conducted by the Los Angeles HousingServices Authority showed a staggering 44,359 homeless individuals in LA County, a 12% increase in the last two years. Although partly due to a change in methodology, the count is seen as more accurate than ever before. In addition, LA’s chronic homeless population has grown to 12,536 since 2013, accounting for more than 1/3 of the Nation’s chronically homeless. Many of these individuals are plagued by chronic health issues, frequently sending them to the hospital for care.

At the core of these individuals’ health issues is their lack of housing. Social determinants of health tell us that housing equals health. But to help these individuals make the transition into a home, it takes more than finding a vacancy.

Each year, National Health Foundation (NHF) provides recuperative care to more than 1,000 homeless patients who have been safely discharged from partnering hospitals. Recuperative care provides homeless patients with a safe place to heal while receiving comprehensive care management. Often during their stay in recuperative care, clients experience a disruption in homelessness and, if they were not already, become willing to participate in the process to secure housing. When the client is interested, securing housing is a goal. However, funding for recuperative care rarely last more than 14 days and this is often not enough time to connect a client to needed housing resources, let alone transition them into their new home. If a client is forced to return to the street while waiting to transition, their chances for a successful move diminish.

Through its bridge housing program, NHF is able to provide these individuals with additional or “bridge” time in the recuperative care center. During their lengthened stay, they receive help with applications for birth certificates, identification cards, and applications for state and federal benefit programs. Connections are made to medical homes and referrals are made to substance abuse and/or mental health programs and social support groups. Clients have a safe, clean place to stay while waiting for their home to become available. When the time comes, bridge housing clients receive comprehensive discharge instructions and continued follow-up for six or 12 months post-transition.

Bridge housing makes transitioning into a home more feasible for homeless clients and is more economical for the community. According to the Los Angeles United Way Homeless Cost Study (2011), the total cost of public services for two years on the streets was estimated at $187,288 compared to $107,032 for two years in permanent housing with support services—a savings of $80,256 or almost 43%. But more than that, housing the homeless resolves one of their biggest barriers to a healthy life.

With support from the Conrad N. Hilton Foundation, the Ahmanson Foundation and the Harold Edelstein Foundation, NHF is implementing the bridge housing program with a goal to place 150 clients in permanent or permanent supportive housing over two years.