California school-based health convention builds bridges

Dr. Janine Jones discussed the “silent struggle” experienced by many students of color at the California School Health Conference November 3. 

Equity was topic one as more than 350 healthcare providers, educators and policymakers met online November 2-4, 2021, at the California School Health Conference hosted by the California School-Based Health Alliance, co-hosted by REL West and sponsored by The L.A. Trust and others.  

Keynotes and workshops focused on the theme “Building Bridges to Healthy and Resilient Communities.” Esther Yepez, program manager for The L.A. Trust, appeared on the “Bite Back” panel, examining oral health challenges and solutions. 

CSHA Board President Sergio Morales opened the virtual event, saying the past months “have tested our resilience” and contributed to a mental health crisis among students. He cited reports showing a 58% decrease in pediatrician visits, a 25% increase in suicidal ideation and the loss of five months of learning by students. 

Morales said school-based healthcare can play a crucial role in building bridges to community, and he thanked healthcare providers and educators for helping children and youth by facilitating vaccinations, mental and oral healthcare, hot meals and PPE during the pandemic. 

Healing communities 

“We are sitting between trauma and transformation,” said opening keynote speaker Dr. Shawn Ginwright, professor of education at San Francisco State. He challenged the concept of PTSD as it is often applied, saying that people of color are experiencing “a persistent traumatic environment”; he said calling it a disorder places the onus on the person rather than the system.  

“People can’t be well if the community is not.” He called for “healing-centered engagement, a nonclinical, strength-based approach that advances a holistic view of healing and recenters culture and identity as a central feature in well-being.” 

Dr. Janine Jones, Wednesday’s keynote speaker, said “culture is key” to understanding Adverse Childhood Experiences (ACEs). Jones, who is professor and associate dean for academic affairs in the College of Education at the University of Washington, said that in addition to the previously recognized Adverse Childhood Experiences, educators and healthcare providers must also be aware of Adverse Community Experiences driven by implicit bias, cultural blind spots and microaggressions. 

She said microaggressions are often subtle and unintentional but “they are like tiny cuts” that make the subject feel powerless. Jones said microaggressions are fueled by stereotypes. “It’s a silent struggle” and students may respond with isolation, avoidance, apathy or anxiety. When they do, they are sending out an SOS that adults should respond by listening to the student and examining unconscious, implicit bias in the environment and the system. 

Community trauma  

Closing keynote speaker Dr. Howard Pinderhughes, professor and chair of the Department of Social and Behavioral Sciences at the University of California San Francisco, recounted his personal experience growing up in the Roxbury section of Boston. 

“Roxbury was a mixed-raced, mixed income neighborhood until the early ’60s,” Pinderhughes said. Real-estate “blockbusting” and racial uprisings in 1967 and 1968 accelerated the exit of white and middle-income residents and “the community became almost entirely poor.” He experienced the trauma of seeing a neighbor’s body in a black plastic bag lying in the street. Later, a young Black girl killed in a nearby park. “It became clear the neighborhood was not safe.” By the early ’90s, Roxbury had become the youth murder capital of the world. 

Similar trauma — defunded infrastructure, capital flight, concentrated poverty and violence — were experienced in neighborhoods across the country. When Pinderhughes moved to the Bay Area, he witnessed community trauma in East and West Oakland, Richmond and the Western Addition of San Francisco. 

The killing of 23-month old Baby Hiram in West Oakland caused the community to be “wracked with despair, worry and trauma,” Pinderhughes said. “I remember thinking about the impact – not just on the family but on the community.” 

He said Black and Hispanic youth have developed rituals to deal with the violent death around them. “As soon as there is a shooting death the altars and the (memorial) T-shirts come out.” Kids wear their prom suits to funerals “because they aren’t sure they’ll live to go to prom.” 

“How did we get here?” 

Pinderhughes listed root causes (poverty, inequality, racism, sexism, oppression and heteronormativity), structural factors (economic, political, social and institutional) and environmental factors (neighborhood, family and peer group).  

Pinderhughes advocated a two-track approach to address and prevent community trauma. He said root causes must be faced, but communities must strengthen resilience at the same time. 

“Let’s change the conditions but let’s be real,” he said. “Let’s develop safer public spaces, reclaim our communities and develop bridge housing during replacement of public housing.” He called for strategies including restorative justice, healing circles, workforce development and strategies that resist the forces of gentrifications, which he called a “form of structural violence.” 

He also said communities should change the narrative about themselves and the place they live: First by organizing regular positive activities and second by giving voice and power to community members in changing structural and environmental factors. He cited one example where a school district enrolled students to help in redesigning and restructuring schools. Another example was building a skate park on Lakota land that not only became a gathering place for youth but a sacred space for the community. The most successful programs were intergenerational and some were multicultural, like a group that brought Black and Hispanic men together. 

State of the Alliance 

Tracy Mendez, executive director of the CSHA, wrapped up the event by thanking the hundreds of attendees from across California and beyond and reviewing key conference takeaways. 

Mendez wore a “Black Lives Matter” tee and said those words could just be a slogan but served to remind her and others that she is accountable. “We need as many reminders as possible.” 

“School-based health centers are a great model of care,” Mendez said. “We should have one in every school” and CSHA is pushing for 500 SBHCs in California by the end of the decade. 

Mendez announced the Student Health Index, California’s first comprehensive statewide analysis to identify the counties, districts and schools where new SBHCs will have the greatest impact on student health and healthcare equity. She also cited the California Student Mental Health Implementation Guide, which CSHA helped develop. 

The L.A. Trust joins allies and providers marking school-based healthcare month

L.A. County leads the state in school-based health centers, providing critical care during the coronavirus crisis.

The Los Angeles Trust for Children’s Health is joining healthcare providers, educators, allies, students and community members in celebrating National School-Based Healthcare Awareness Month in February.

Tracy Mendez, executive director of the California School-Based Health Alliance, stressed the impact of school-based health centers (SBHCs) during COVID-19, as students and communities face pandemic stressors, including isolation and anxiety.

“Our SBHCs and Wellness Centers are more critical than ever,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health. “Supporting these centers has been a core part of our mission since our founding, and it’s important we redouble our efforts during this incredibly challenging time.”

There are 75 SBHCs in Los Angeles County serving schools with more than 83,000 students, more school-based clinics than any other California county. The total includes 17 Wellness Centers, with three more on the way. “Since the first Wellness Center opened in 2012, more than 550,000 patient visits have taken place, a key accomplishment for the consortium of organizations for which The L.A. Trust serves as the backbone,” Puffer said.

Stepping up

“During the pandemic, school-based health centers are stepping up to provide students with behavioral health services via telehealth, and they continue to provide immunizations for students,” Mendez said. “School-based health centers have always provided healthcare access to students who would otherwise go without, but now the need is so much greater.”

There are 17 Wellness Centers serving Los Angeles Unified’s under-resourced communities and dozens of other school-based healthcare facilities operated directly by the district. Wellness Centers serve Belmont High School, Carson High School, Crenshaw High School, Elizabeth Learning Center, Fremont High School, Gage Middle School, Garfield High School, Hollywood High School, Jefferson High School, Jordan High School, Locke Early Education Center, Maclay Middle School, Manual Arts High School, Maywood Center for Enriched Studies, James Monroe High School, Santee Education Complex, and Washington Prep High School. All but Hollywood High are operated by Federally Qualified Health Centers.

Advocacy is key

“School-based health providers have performed heroic work to keep students connected to care during this pandemic,” Mendez said. “This is a month to advocate for the funds, personnel, equipment and vaccines our school-based health clinics need to serve their students and families. We are pleased that the Governor, state legislators, and state departments of health and education are recognizing the critical value of school health services and have endorsed plans to invest much more in them.”

Puffer quoted Dr. Martin Luther King, Jr. who said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.” She said, “School-based health is the path to greater health equality and we cannot let down our kids and teens in the hour of their greatest need.”