HEALTH JUSTICE FOR EASTSIDE STUDENTS

HEALTH JUSTICE FOR EASTSIDE STUDENTS 2013 Report by InnerCity Struggle Strengthening Access to Health and Wellness for Academic Success Building a Movement in the Eastside

Table of Contents 1 Executive Summary 2 Introduction 2 Background and Urgency 4 A Closer Look: The Esteban E. Torres High School Wellness Center 6 Lessons Learned 6 A Call to Action: Health and Wellness Now! 7 Acknowledgments 7 References 8 Addendum: A Snapshot of the Wellness Center Weekly Schedule Building a Movement in the Eastside 124 North Townsend Avenue Los Angeles, CA 90063 Office #: (323) 780-7605 Fax #: (323) 780-7608 Website: www.innercitystruggle.org Facebook: Facebook.com/InnerCity Struggle Twitter: @ICSEastLA YouTube Channel: UnitedStudentsEastla

Executive Summary The idea is simple. Students need to be healthy to achieve their best academic potential, yet many schools in communities of color are anything but places that support health and wellness. Our schools often lack basic services such as full-time school nurses. In low-income districts, schools will often have no other recourse but to cut physical education and extracurricular sports in order to balance their budgets. And the lunchrooms in our schools are often filled with meals high in fat, salt, and sugar and low in nutrition. Too often, the lack of an infrastructure to support health and wellness in the schools mirrors a similar divestment in basic services in their larger communities, like having few grocery stores, health and medical facilities, parks and recreation spaces, etc. To address the lack of health and wellness as a focus of the school environment, in 2010, InnerCity Struggle (ICS) launched a campaign to secure a comprehensive wellness center at Esteban E. Torres High School (ETHS), as part of the Community Schools Campaign, in collaboration with the Los Angeles Education Partnership (LAEP). The effort aimed to establish a student support model based on schoolcommunity partnerships that can be leveraged to provide comprehensive health and human services to students at Torres High School in East Los Angeles. The original intent of the Wellness Center, in addition to supporting academic achievement, was to shift the way in which students, parents, school staff and administration relate to one another and to the school community. Maggie Flores, a 12th grade student at Esteban E. Torres High School and a youth leader with InnerCity Struggle that advocated for the Center stated, seeing the Wellness Center open is great because it came from an idea about how we can help all students succeed and it is about making sure all students feel healthy and safe. There is an opportunity now to ensure that all students attending Esteban E. Torres High School graduate college ready and healthy. In order to do this, the Wellness Center must be expanded and strengthened. In particular, ICS has identified the following solutions in order to improve services at the Center: Securing a full-time Wellness Center Coordinator in order to oversee outreach and awareness efforts of services provided, convening of providers, tracking of data on impact of services and communication with school administration and faculty across all five schools on the campus; Dedicating new organizational services and staffing in order to ensure the model is fully implemented and availability of services is expanded through increased days and times the Center can be opened. School principals identified the need for a Psychiatric Social Worker; Allocating increased School District resources to strengthen awareness and utilization of the Wellness Center services. In particular, resources will allow for more information to be available to students and teachers, which includes easily accessible information on the schedule of services, the types of services, the referral process, updates/highlights on the most critical care needs for students and information on the medical providers. The creation of a tailored website is key; Institutionalizing dental care services. According to a 2010 Los Angeles Unified Board Study, tooth decay is the most common chronic childhood disease and is the leading cause of absence from school. The UCLA Center for Health Policy Research reports that in California, students miss approximately 874,000 school days annually due to oral health problems. These missed days cost school districts money, as funding is calculated based on Average Daily Attendance; Providing students with vision care resources; Increasing health insurance coverage for students, including Medi-Cal enrollment; Increasing availability of the school nurse; and Strengthening communication and collaboration between Wellness Center staff and Torres faculty. The Esteban E. Torres High School Wellness Center can serve as a model for the community to support the goal of health and academic success for all students. This report is a call to action for the entire community of stakeholders to celebrate what has been accomplished and also to continue 1

to push for greater funding and support to implement the proposed recommendations. This is truly a community effort that has to be supported. Introduction InnerCity Struggle s (ICS) mission is to empower youth and families to address issues of educational access and equity in the Eastside of Los Angeles and to promote healthy, safe and non-violent communities. Founded in 1994, ICS has actively worked to improve the quality of life in the Eastside by engaging youth, parents and community residents in developing their leadership skills to voice concerns, raise community awareness and promote solutions focused in the areas of education, health and violence prevention. ICS supports Eastside youth and adults in effectively conveying their platform of A 2010 national study of school-based health centers found that the critical role of partnerships was one of six necessary conditions to build an effective wellness center. The others include strong community support, dynamic leadership, multiple funding sources, starting prevention efforts early and making the link between health and educational success. The Esteban E. Torres High School Wellness Center has made significant progress toward meeting these conditions. There is a continued need at Torres to secure a set of long-term funding sources and strengthen the link between positive health outcomes and educational achievement. positive community change. Focus areas include leadership development and training in organizing, research, policy and communications. ICS also publishes data-based reports that track progress in reaching policy reforms. InnerCity Struggle s organizing and advocacy efforts have resulted in improved opportunities for local youth; victories have included winning the construction of new schools, increased college access opportunities and improved school safety. ICS organized students, parents, community members and educators through petition drives, community meetings, mobilizations and rallies to secure the construction of Esteban E. Torres High School (ETHS) in a near decade-long process, with the school opening in 2010. Because no new school had been built in East Los Angeles in over 80 years, the ICS New School Campaign was a direct response to a growing student population of mostly poor, Latino students that were attending extremely overcrowded high schools with few opportunities for success. The excessive overcrowding was reflective of years of neglect on behalf of the Los Angeles Unified School District (LAUSD) Background and Urgency Esteban E. Torres High School is located in unincorporated East Los Angeles and is a part of the newly established Intensive Support and Innovation Center of LAUSD. The five small 2 theme-based schools that comprise the campus have the autonomy to deliver personalized instruction and focus on preparing all students for college and high-skilled careers. Close to 100% of the Torres students are Latino, and more than one-quarter are identified as English Learners. More than 80% of students are also classified as economically disadvantaged. The student demographics reflect the community demographics. East Los Angeles has long served as an entry portal for immigrants into Los Angeles County and is made up of predominantly working-class immigrant families from Mexico and Central America and others with deep roots that go back for generations. Adult education levels are very low in the community, with only 34% of residents 25 or older having a high school diploma. Recent data demonstrates a need to continue to increase graduation and college-going rates at Torres. In its first documented school year (2011-2012), Torres had an overall graduation rate of 62% and a successful A-G completion rate of 22%. Providing all students with the opportunity for success will require addressing their holistic needs. InnerCity Struggle has led a movement to secure a comprehensive Wellness Center at Esteban E. Torres High School in an effort to meet the needs of students and their families. This effort is part of the Community Schools Campaign, launched three years ago by ICS in collaboration with the Los Angeles Education Partnership (LAEP). The effort aimed to establish a student support model based on schoolcommunity partnerships that can be leveraged to provide comprehensive health and human services to students at Torres High School. ICS s commitment to organizing and advocating for healthcare services on school grounds was informed by thousands of surveys and focus groups that identified lack of access to health services as a priority for youth and families. The Center is now comprised of eight health practitioners (plus one Outreach Coordinator) from three area based nonprofit service organizations that provide primary healthcare, mental health and reproductive services at no cost and regardless of citizenship status to the 2,305 student campus. The intention of the Wellness Center is also to provide dental health care services to ETHS students. It is through relationship building and advocacy efforts that InnerCity Struggle,

in partnership with LAEP, was able to help bring these service providers into the Center to service Torres students. The non-profit c o m m u n i t y - b a s e d organizations currently providing the much needed services are Bienvenidos, Hillsides and CHCADA (California Hispanic Commission on Alcohol and Drug Abuse). In developing the vision for an on-campus wellness center, InnerCity Struggle recognized that prevention mechanisms were critical to improving overall student health leading to improved academic achievement. ICS efforts to address student health included a Food Justice Campaign launched in 2011 that surveyed students and parents about quality and access to healthy school food. The surveys revealed that 62 percent of the school food being consumed by Eastside students was high fat main dishes and 33 percent high sugar snacks and 76 percent of students reported that they ate the school food out of necessity. ICS student and parent members, working with other stakeholders then developed a School Board Resolution that led to the expansion of the School Breakfast Program in classrooms, which, according to research, dramatically improves student achievement. A 2009 brief developed jointly by WestEd and the Philip R. Lee Institute for Health Policy Studies at The University of California, San Francisco shows the critical link between sustained health support and academic achievement, specifically citing the role of schools in closing this gap. In particular, mental and dental health impact young people the most. More than 30 percent of middle and high school students in California have felt so sad or hopeless for two weeks or more in the past 12 months that it interfered with their regular activities. Students who experience high levels of stress or depression tend to do poorly in school. Among California secondary students, as the percentage who reported that they felt sad or hopeless increased, subsequent gains in reading, language, and mathematics test scores declined. Additionally, children with poor oral health and poor general health are 2.3 times more likely to report poorer school performance than those with good oral health. Additionally it is reported that, Latino children have the highest risk for dental health problems in California. Seventy two percent of Latino children surveyed had experienced decay, 30 percent needed treatment, and 26 percent had rampant decay (cavities on seven or more teeth), nearly twice the rate of non-hispanic white children surveyed. While these are staggering numbers, it has been shown that building health supports into the school infrastructure can make a huge difference in the lives of students. Receiving school-based mental health services has been shown to reduce course failures and dropout rates. For example, a study of school-based mental health centers in the Dallas Public Schools found that students served in these centers showed a 32 percent decrease in absences, a 31 percent decrease in failures and a 95 percent decrease in disciplinary referrals. In addition, an analysis of 165 studies of school-based prevention activities that included individual counseling or behavior modification as well as efforts to change the way schools are managed found that school-based prevention practices appear effective for reducing alcohol and drug use, dropout and nonattendance and other conduct problems. Lastly, school connectedness was shown as the single most influential factor of many in protecting students from substance abuse, early sexual initiation and violence. Additionally, policymakers at all levels of government realize the importance of placing health supports within schools. Student health must be on California s education reform agenda if we ever expect to address the achievement gap and dropout rate, said then Assembly-member and now California State Superintendent of Public Instruction, Tom Torlakson. At the federal level, the Senate committee on Health, Education, Labor, and Pensions introduced the Mental Health Awareness and Improvement Act in early April. A key component of the bill is improving school settings by increasing personnel and school-based programs and partnerships. The evidence and political will make a strong case for continuing school-based health support in high poverty, underresourced communities such as East Los Angeles. InnerCity Struggle is working with Esteban E. Torres High School to secure a set of funding sources moving forward to meet these critical wellness needs and maintain the current services offered at the on-campus Mónica García, President of the LAUSD School Board recognizes the importance of the collaborative work achieved by the community during a time of high need by stating, congratulations to all the community partners for bringing a Wellness Center to the Esteban E. Torres High School community, students will now be able to benefit directly from the services provided. 3

Wellness Center. The Los Angeles Trust for Children s Health, The Los Angeles Department of Public Health and the Los Angeles Unified School District partnered in 2008 with foundations and other stakeholders to identify high priority areas for health and wellness centers in Los Angeles schools and brought forth a proposal to the LAUSD School Board to fund centers in 14 district schools. The board has contributed $32 million to date for the construction of these wellness centers, but not for the actual service delivery. ETHS was not one of the 14 sites originally designated for LAUSD funding, but has managed to open and sustain the Center on a very small budget due to strong school-community support. While the Affordable Care Act allocated $200 million from 2010-2013 to build more centers and expand services around Maria Brenes, Executive Director of InnerCity Struggle states that, "The Esteban E. Torres High School Wellness Center must serve as a hub for community health, a place to obtain information and receive services for youth and their families. The Wellness Center must also play a role in prevention, support academic success and inspire replication in other schools serving lowincome students of color. the nation, schools are left looking for funds to operate the centers. School districts around the country are facing a shortage in nursing staff; LAUSD has only 600 nurses for a student population of over 600,000 (or approximately one nurse for every 1,000 students). This makes community partnerships a critical element of establishing and sustaining wellness centers in Los Angeles schools, as well as greater support from LAUSD, Los Angeles County and the philanthropic community. A Closer Look: The Esteban E. Torres High School Wellness Center Primary Healthcare Support The Esteban E. Torres High School Wellness Center helps meet the critical need for accessible, targeted and communityrelevant healthcare supports that allow local Eastside youth to address their overall health needs. Its wrap-around services aim to create a space for students to be supported in a holistic manner and to be prepared to excel academically. Recently, ICS surveyed and interviewed seventy-five students on the role of the Center in their lives. Key points from students include that the Wellness Center has had a positive impact on them and their family because it allows students to get physical exams faster than having to wait for their parents to take them 4 to the doctor as their parents do not always have the time. Additionally, students felt increased information and awareness regarding the type of services offered and availability of those services was crucial to ensuring more students are helped. Primary healthcare services are provided by Bienvenidos and are available Tuesdays and Thursdays before, during and after-school hours. Students are able to make an appointment at the Center during service days and times. METHODOLOGY FOR INFORMATION GATHERED FOR REPORT Direct observations of weekly Wellness Center services Interviews with nine school-site and off-site practitioners and/or providers, seven teachers, five counselors, five principals, including one school support staff Surveys and interviews with seventy-five students Interviews with ten parents Mental Health The Center has also excelled at providing mental health services offered by the three community-based agencies across each of the five schools, which in addition to Bienvenidos, includes Hillsides and CHCADA (California Hispanic Commission on Alcohol and Drug Abuse). Each of the schools guidance counselors plays a critical role in referring students in need to the services and ensuring access. A total of six mental health therapists are available for the five schools on different days and times throughout the week. Student issues addressed range from substance abuse to depression. Additionally, students must be enrolled in Medi- Cal to access this particular service. Parents interviewed report being most familiar with the mental health services offered. R e p r o d u c t i v e Health The Center also effectively provides reproductive health services which include STD/STI testing, pregnancy tests, birth control, Plan B, information for

teens who are pregnant and general information on reproductive health. Students report that they can come to the Center when it is open to get tested, get information and get a pregnancy test, amongst other services. Additionally, students who have partners who do not attend ETHS, can still come in and get tested as well. Similarly to primary healthcare services, reproductive healthcare support is provided by Bienvenidos and is available Tuesdays and Thursdays before, during and after-school hours. Students are able to make an appointment at the Center during service days and times. Surveyed students also identified a need for increased information and awareness of these services to ensure more students access them. Dental and Vision Care At the onset of the Wellness Center s opening, there were dental services provided for students but these services are no longer available. Efforts are currently underway by InnerCity Struggle and LAEP to secure services by the end of 2013 from a new provider. Additionally, students surveyed identified vision care as a need. School-based health centers serve as a growing national model to address student health needs because of a strong correlation between student achievement and health outcomes. Thirty-three percent of Esteban E. Torres High School students surveyed by ICS stated that student wellness was a key support factor for staying in school and graduating. And, it provides an affordable and convenient alternative for students and their families if they do not have health insurance. Some East Los Angeles families report being in dire need of healthcare for preventable ailments to serious, chronic conditions and seek measures that lead to loss of work and school time. 5 School Nurse Although not officially part of the Wellness Center, it is important to acknowledge that there is a school nurse available six days out of the month. The nurse provides a fullrange of services, including administering first aid and CPR if needed and distributing condoms. Students may refer themselves to the nurse or be referred by teachers, counselors and/or parents. The nurse reports that her availability to students is a challenge as she has to share her time with another high school on the same day she is assigned to ETHS. Additionally, she reports frequently addressing cases of diabetes, sports injuries and stress-related ailments with students at the campus. The Role of Teachers and Principals Teachers and principals interviewed all agreed that the services provided at the Wellness Center are critical for student success. They also expressed a need to increase collaboration between faculty and Wellness Center staff to ensure increased student awareness and use of services. Additionally, a recommendation was made for specialized teacher training in regards to ensuring a safe environment for students accessing the wellness supports. The Role of Families Interviews with parents highlighted the need to provide bilingual information in order to increase awareness of services among families. Recommendations were made to utilize existing parent engagement structures to distribute information. Outreach Mechanisms The Esteban E. Torres Wellness Center Outreach Coordinator, who is a staff of Bienvenidos, is available to share information across the campus about the primary healthcare and reproductive health services and serves as a liaison with constituents of the Center. Next Steps The goal of InnerCity Struggle s efforts to collect information regarding the services provided by the Esteban E. Torres High School Wellness Center is to help identify successes and areas to strengthen for the benefit of students. ICS will continue to play a Alejandra Meza, an 11th grade student at Esteban E. Torres High School and a youth leader with InnerCity Struggle that has utilized the Center exclaims that, the Wellness Center is excellent because it gives students a chance to let out any emotions and/or feelings about anything and provides physical and reproductive support. I believe that EVERY student should know about the Wellness Center.

role in engaging partners, allies, students and parents in organizing and advocacy efforts to increase wellness and wrap-around supports at the school. Partner organizations, healthcare providers, teachers, students, families and school administration have demonstrated a commitment to youth and the community. ICS will build from this momentum to help take the Center to the next level through increased community and stakeholder collaboration. Lessons Learned After reviewing key findings in the research conducted (observations, interviews and surveys), InnerCity Struggle identified SEVEN key takeaways regarding the impact of the Wellness Center at Esteban E. Torres High School. These include, 1. Outreach: A need exists to strengthen outreach efforts to increase information and awareness regarding primary healthcare and mental health services and availability of supports. 2. Mental Health Services: A need exists to increase the availability of mental health services for According to the President and CEO of Bienvenidos, Ritchie Geisel, The Wellness Center is seeing positive outcomes due to the provision of mental health, primary healthcare and reproductive support services, but we are still very limited in support. If we can increase services that support healthier outcomes for youth, increased academic achievement will follow. students facing issues such as depression, thoughts of suicide and substance abuse. 3. Referrals: Implementation of a uniform referral process should continue for students to access mental health services across the five schools. 4. School Nurse: A need exists to increase the availability of the school nurse on campus to ensure students obtain adequate support. 5. Data Collection: A need exists for a system to collect data regarding the impact of services on students. 6. Communication across All Stakeholders: Creating vehicles for on-going communication with school staff and families regarding service availability is a need. 7. Health = Academic Success: Strengthening the link between wellness supports and academic success by investing in research and evaluation is also a need. A Call to Action: Health and Wellness Now! The original intent of the Esteban E. Torres High School Wellness Center was to shift the way in which students, parents and school staff and administration relate to one another and to the school community in addition to supporting academic achievement. Maggie Flores, a 12th grade student at Torres High School and a youth leader with InnerCity Struggle that advocated for the Center stated, seeing the Wellness Center open is great because it came from an idea about how we can help all students succeed and it is about making sure all students feel healthy and safe. There is an opportunity now to ensure that all students attending Esteban E. Torres High School graduate college ready and healthy. In order to do this, the Wellness Center must be expanded and strengthened. In particular, ICS has identified the following solutions in order to improve services at the Center: Securing a full-time Wellness Center Coordinator in order to oversee outreach and awareness efforts of services provided, convening of providers, tracking of data on impact of services and communication with school administration and faculty across all five schools; Dedicating new organizational services and staffing in order to ensure the model is fully implemented and availability of services is expanded through increased days and times the Center can be opened. School principals identified the need for a Psychiatric Social Worker; Allocating increased School District resources to strengthen awareness and utilization of the Wellness Center services. In particular, resources will allow for more information to be available to students and teachers, which includes easily accessible information on the schedule of services, the types of services, the referral process, updates/highlights on the most critical care needs for students and information on the medical providers. The creation of a tailored website is key; Institutionalizing dental care services. According to a 2010 Los Angeles Unified Board Study, tooth decay is the most common chronic childhood disease and is the leading cause of absence from school. The UCLA Center for Health Policy Research reports that in California, students miss approximately 874,000 school days annually due to oral health problems. These missed days cost school districts money, as funding is calculated based on Average Daily Attendance; 6

Providing students with vision care resources; Increasing health insurance coverage for students, including Medi-Cal enrollment; Increasing availability of the school nurse; and Strengthening communication and collaboration between Wellness Center staff and Torres faculty The Esteban E. Torres High School Wellness Center can serve as a model for the community to support the goal of health and academic success for all students. This truly is a community effort that has to be supported. Each stakeholder is in this together Join the growing movement for Health Justice in schools! Acknowledgments We would like to acknowledge the individuals and organizations that supported efforts to complete this report. United Students and Familias Unidas student and parent members School Board President Mónica García Esteban E. Torres High School principals, faculty and staff Bienvenidos Hillsides CHACADA (California Hispanic Commission on Alcohol and Drug Abuse) The Praxis Project Communities Creating Healthy Environments (CCHE) The Los Angeles Education Partnership (LAEP) References i http://www.dshs.state.tx.us/schoolhealth/schoolbasedhc/aspereport20120419.doc ii http://www.calendow.org/uploadedfiles/publications/by_topic/access/general/critical%20connection%20between%20student.pdf iii http://www.calendow.org/uploadedfiles/publications/by_topic/access/general/critical%20connection%20between%20student.pdf iv http://www.calendow.org/uploadedfiles/publications/by_topic/access/general/critical%20connection%20between%20student.pdf v http://tcenews.calendow.org/releases/school-health-foundation-consortium vi http://www.help.senate.gov/newsroom/press/release/?id=c55863fd-040c-4ad1-9a12-2d16868bb8e1 vii http://www.huffingtonpost.com/2013/02/09/school-heath-clinics-los-angeles_n_2653119.html 7

A Snapshot of the Wellness Center Weekly Schedule Below is a comprehensive schedule of services provided at the Esteban E. Torres High School Wellness Center. The information was collected and plotted on the chart by InnerCity Struggle. Physical Health Clinic Reproductive Health Clinic Nurse s Office ELAPAA SJLA ETA HAAT ELARA MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Open 1st & 3rd Monday of ea. month 10am 12pm & 2pm 3:30pm 10am - 2pm 7:30am - 4:30pm (Closed 1pm - 2pm for Lunch) 7:30am - 4:30pm (Closed 1pm - 2pm for Lunch) MENTAL HEALTH THERAPISTS for each School 7:30am - 4:30pm (Closed 1pm - 2pm for Lunch) 10am 12pm 2pm 3:30pm 10am - 2pm School Names: ELAPAA: East Los Angeles Performing Arts Academy SJLA: Social Justice Leadership Academy ETA: Engineering and Technology Academy HAAT: Humanitas Academy of Art and Technology ELARA: East Los Angeles Renaissance Academy Building a Movement in the Eastside 8