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.

Friday, June 17, 2016

Recuperative Care: Healing the Homeless

In 2005 and 2006, Los Angeles’ Skid Row grabbed national headlines after images surfaced of individuals in hospital gowns being dropped off on the street. These images brought immediate and substantial attention to a struggle that continues today, ten years later: safe discharge options for homeless clients after an acute hospital stay.

Public outcry for better treatment of the homeless, steep fines for poor discharge practices, and hospitals’ clear need for safer, healthier discharge options resulted in development and subsequent proliferation of the region’s recuperative care programs. For National Health Foundation (NHF), a multi-year pilot project that began in 2007 to conceptualize and test recuperative care resulted in a strategic shift in our services several years later. Not only did NHF help to develop a self-sustaining program concept that serves both homeless clients and hospital partners in Los Angeles and Orange Counties, but in 2014 it took on the operation of direct service for the first time. Operating these services has provided valuable insight into best practices for delivering compassionate and cost-effective care to the homeless upon discharge from the hospital setting. Perhaps more importantly, the program has demonstrated how a safe and supportive environment in tandem with a concentration of services can create a disruption in homelessness, result in clients’ willingness to move into a permanent home, and ultimately dramatically shift their long-term health outcomes.

Pathway Recuperative Care a program of National Health Foundation in Los Angeles, now in its sixth year of operations, bridges a critical healthcare service gap by providing homeless clients who are transitioning out of an acute care hospital with basic medical oversight in a clean, safe environment. This service allows clients to continue their recovery and receive treatment for any additional minor illnesses, thereby reducing the chances of relapse and costly re-hospitalization. Prior to partnering with recuperative care facilities, hospitals would be forced to keep patients no longer in need of acute care for roughly 4.5 additional days to provide the basic oversight. The differential in cost for one day of hospitalization versus one day of Recuperative Care is in the thousands. . To date it is estimated that this program has helped hospitals avoid $17,924,184.00 in cost. Partnering hospitals have also noted that streamlined referral procedures, diligent communication with the hospitals, data collection and analysis, as well as an innovate ‘pod’ concept (allowing for more service points in large geographic areas) have improved the experience for the partners while maintaining excellent service for the patients.

For NHF, the real measure of success has been the percentage of recuperative care patients who were discharged into housing. Through intensive care management, care managers help clients identify the root causes of their health issues, work to overcome those challenges, facilitate connections within the community that support a clients’ continual improvement, and for many, provide smooth transitions from the hospital to housing. NHF prioritizes the needs and wishes of the client, working to understand their housing and supportive service preferences, and securing housing during their time in recuperative care. In 2015, NHF added a “bridge housing” component to its program, enabling clients to remain in the recuperative care facility past their hospital-provided days, so they did not have to return to the street while waiting for their housing placement to become available. During fiscal year 2015-2016, NHF served 694 clients with recuperative care, 45% having been discharged into permanent or transitional housing. In addition to helping these clients recover from injury and illness, many of these homeless individuals were connected to critical social and healthcare services. NHF has been able to house approximately 30% of these clients within 14 days, in either transitional or permanent housing (7-10% in permanent housing alone).  As a result of NHF’s partnerships, recuperative care is able to address both health and social service needs of the client while connecting patients to a stable home.

Currently, NHF operates two sites in Los Angeles County, one in the Mid-City area of Los Angeles and another in San Gabriel Valley.  Under the current model, NHF offers 40 recuperative care beds to clients from 60 participating Southern California hospitals. This fall, NHF anticipates launching a third site in Ventura County.

Friday, May 27, 2016

Support in School for Pregnant and Parenting Teens in South Los Angeles

On February 9, 2016, National Health Foundation began its eighth year of the Harold Cares About Your Future: Pregnant and Parenting Teen (PPT) program, which was created to empower teen mothers to have healthy pregnancies and parenting experiences. The program serves low-income, predominantly Latina and African American girls in South Los Angeles.
For many of our participants, maintaining a healthy pregnancy is a daily effort that requires what seem like simple, yet are significant changes in behavior. Whether it be eating healthier, taking prenatal vitamins or exercising more, the program provides space for each mom to discuss behaviors she is trying to improve. The program also connects participants with community resources for healthcare, child care and career planning. The combination of small-group education sessions with community partners gives participants access to different forms of support. Ultimately, the goal of the PPT program is to increase rates of high school graduation, and decrease the incidence of low birthweight babies and recidivism.
This year, a group of 22 girls at Thomas Riley High met once a week for 10 weeks to learn about nutrition, fetal development and child development, to share their experiences with labor, delivery and motherhood, and to discuss healthcare, child care and other family services.
Rebecca, an expectant mom and a sophomore at Thomas Riley High, had a few things to share about her experience in the program:
How did you find out about the Pregnant and Parenting Teen (PPT) program?
I found out about the program through my principal, Ms. Roussel. My math teacher, Ms. Vester, encouraged me to attend. She wanted me to get involved in a program for new moms.
What did you think the PPT program was going to be about? Were you surprised by what it really was?
I thought it was going to be a class with tips for pregnancy and parenting. I was surprised with how open the meetings were. Everyone got a chance to share their experiences. Before being in the group, I was scared to go into labor but after hearing the girls’ stories, I’m happy to know that everything will end up okay.
What was one thing that really stuck with you?
I really liked everything we learned. When we talked about fetal development, for example, I learned that a baby can open and close their eye lids starting in week 26, during the second trimester. The topic that stuck with me the most was when we talked about sleeping patterns. I never realized how important sleeping schedules could be, for both the mom and the baby.
Did any of your behaviors change or improve throughout the program?
Yes, I started practicing meditation and relaxation techniques after we learned about how stress can affect a pregnancy. I also started walking more. It was a little hard at first, but I was able to make the changes I needed to have a healthier pregnancy.
How will you use some of the things you learned going forward?
I’m going to keep all the notes we took in class to use in the future, especially the ones about child development because I think that’s really important.
Participants at Thomas Riley High graduated from the program and received their certificate of completion on May 3, 2016. The PPT program is currently in session at McAlister High School. They are set to have their graduation on June 8, 2016.