It was a year that challenged almost everything

Empty classrooms and full intensive care units created a year of unprecedented challenges for Los Angeles students, educators and healthcare providers.

A pandemic. An uprising. An education crisis. And an economic crash. The year 2020 was one of the most challenging years in our history — and an outsize share of those challenges were borne by the students, educators and healthcare workers we serve. 

“Our friends rallied around us, and we rallied around them during this crisis,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health. “But the problems experienced in 2020 — healthcare and income disparity, racial injustice, distrust of our institutions and inadequate public health facilities — did not start in 2020 and will not disappear in 2021. We have so much work to do.” 

The L.A. Trust adapted quickly to the pandemic and school closures in mid-March, transferring in-person outreach to social media and face-to-face meetings to online platforms like Zoom. 

With schools on lockdown and many Wellness Centers closed, The L.A. Trust redoubled its efforts to address the primary, oral and mental health needs of Los Angeles Unified students: 

Held Wellness Center Learning Collaboratives online in May, October and December to discuss urgent issues related to the pandemic. The three online events were attended by a total of nearly 200 healthcare providers, researchers and L.A. Unified facilitators. 

Provided its stakeholders with information about the unfolding pandemic, interviewing experts like Barbara Ferrer, head of L.A. County Public Health, and Jim Mangia, president and CEO of St. John’s Well Child & Family Center, operator of Wellness Centers at Lincoln, Manual Arts and Washington Prep, which have remained open during COVID. 

June: Distributed more than 50,000 toothbrushes as part of Operation Tooth Fairy, garnering widespread media coverage about the importance of maintaining oral health. 

July/December: Conducted virtual convenings of The L.A. Trust’s Oral Health Advisory board to help providers pivot during COVID crisis. An in-person meeting was held in March, pre-COVID. 

July: Moved its nutrition programs online, reaching nearly 80,000 students and community members with Facebook workshops and professionally produced cooking videos. 

August: Trained student health advocates at our first-ever Summer Academy and supported Student Advisory Board members and their allies throughout the pandemic. 

August: The L.A. Trust launched our Student Mental Health Initiative, funded by a $100,000 grant by Cedars-Sinai and a $50,000 grant by Health Net. The initiative will train students as peer leaders through The L.A. Trust’s Student Advisory Boards, increasing awareness of symptoms like anxiety and depression, and building positive coping mechanisms and self-referrals to care. The initiative will include student-run social media campaigns and online trainings such as “Youth Mental Health First Aid” starting in the fall. 

September: Educated more than 40 state legislators and their staff on the need for school-based healthcare during a first-ever virtual Advocacy Day. 

September: Launched a new website for The L.A. Trust with expanded resources and a new rallying cry, “Putting the care in student healthcare.” 

October: Helped promote and conduct the online California School-Based Health Alliance Conference, attended by nearly 1,000 health advocates from across the state. 

October: Released a Data xChange Report on the impact of L.A. Unified Wellness Centers over the past five years. 

Fall: Partnered with L.A. Unified and KLCS-TV to broadcast The L.A.Trust-produced nutrition and oral health spots reaching an audience of up to 2.3 million students and family members. 

Fall: The L.A. Trust’s program managers, adult allies, director of programs and executive director completed the eight-hour Youth Mental Health First Aid (YMHFA) training and received certification as YMHFA providers. The L.A. Trust’s program manager in turn trained dozens of Student Advisory Board members in the How to H.E.L.P. A Friend curriculum. 

November: Worked with the office of Supervisor Mark Ridley-Thomas and the T.H.E. Clinic to distribute thousands of N95 protective masks to frontline healthcare workers at Los Angeles Unified Wellness Centers. 

December: Created a new Oral Health Toolkit to put resources at dental providers’ fingertips. 

“It has been a devastating year,” Puffer said, “and the effects are far from over. But last year witnessed unimaginable courage, resilience and resourcefulness. We are so proud of our students, educators, healthcare providers and partners in Los Angeles Unified and beyond.”

New tool will help integrate schools and health centers

Dr. Kenny Ferenchak presented “School-Based Health Integration with Schools” at The L.A. Trust’s Learning Collaborative December 2. 

A new tool to measure the integration of school-based health centers with their schools was presented at The L.A. Trust’s Wellness Network Learning Collaborative December 2. More than 50 representatives from Los Angeles Unified, Wellness Center operators and The L.A. Trust attended the online event. 

“The L.A. Trust believes there’s a strong correlation between student health and student achievement, and school-based health centers are key,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, which helped support the research. 

“Integration of health centers with schools adds an extra element,” said Dr. Kenny Ferenchak, underscoring the fact that the whole is greater than the sum of the parts. Dr. Ferenchak, a former UCLA researcher and pediatric resident at Seattle Children’s Hospital, University of Washington, notes that no measure currently exists to quantify the degree of integration for clinics and their partner schools.  

The presentation included remarks by Dr. Rebecca Dudovitz, a board member of The L.A. Trust and associate professor in general pediatrics and vice-chair of the Primary Care College at the UCLA David Geffen School of Medicine. 

“Measuring school health integration can drive practice improvement initiatives among SBHC-school partners, identify SBHC and school characteristics that are associated with better integration, and test whether better integration is associated with better student health and academic outcomes,” they reported. 

Scanning the environment 

The Learning Collaborative included presentations by three organization facilitators with L.A. Unified Student Health and Human Services: Ana Griffin gave an update on Wellness Network performance; Gloria Velasquez conducted a whiteboard exercise on successes in outreach and services; and Victor Luna led a resiliency exercise.  

Robert Renteria, program manager of The L.A. Trust, and Erika Hernandez, project specialist for Children’s Hospital Los Angeles, gave a presentation on Conducting an Environmental ScanPreparing for Implementation of Screening, Brief Intervention, Referral to Treatment (SBIRT) at Your School-Based Health Center. 

School-based health centers are encouraged to use the Environmental Scan to ensure they are providing accessible substance use prevention and treatment services. It reflects lessons learned by Children’s Hospital Los Angeles and The L.A. Trust from a multi-year initiative to integrate SBIRT into five school-based health centers across South Los Angeles. Funding for the project was provided by the California Community Foundation and the Conrad N. Hilton Foundation.

Wellness Centers confer on impact and inclusion

Senior LAUSD Physician Dr. Rosina Franco provided an update on the District’s coronavirus response at The L.A. Trust Wellness Network Learning Collaborative.

Representatives from Los Angeles Unified and its Wellness Centers discussed how to reach and treat students during the COVID-19 pandemic at The L.A. Trust’s online Learning Collaborative October 14.

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Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, welcomed the participants. Noting that inclusion was the theme of the gathering, she quoted Dr. Martin Luther King, Jr., who said, “Injustice anywhere is a threat to justice everywhere.”

Report card

Gloria Velasquez, an organization facilitator for L.A. Unified’s Student Health and Human Services, presented a Wellness Network Report Card for academic year 2019-2020. She reminded the attendees that the purpose of the Wellness Network was to help students and families “where there is a gap in healthcare” and thanked The L.A. Trust Data xChange “for gathering and presenting these metrics so they could be shared in so many different ways.”

Velasquez noted that student patients comprised more than 28% of all patients seen by the Wellness Clinics and they averaged 2.1 visits per year. More female than male students visited the clinics (55.6% vs. 44.4%) and the overwhelming number of student patients were teens 14-19. The top services provided to students were well child exams, overweight and obesity concerns, contraceptive management and vaccinations and pre-exposure prophylaxis (PrEP).

Return plan

Senior LAUSD Physician Dr. Rosina Franco provided an update on the District’s coronavirus response and prospects for school reopening. She noted that Los Angeles County was still in Tier 1, reflecting widespread case and positivity rates, and outlined the state’s requirements for re-opening. As of October 13, Los Angeles County had 9.0 new COVID cases per 100,000 population — the county’s positivity rate was 3.7% and rising.

Franco said L.A. Unified was laying the groundwork for a safe return to in-person instruction. LAUSD is currently testing teachers, staff and children in childcare to establish an initial COVID-19 baseline. The second phase of initial baseline testing will include all staff working from home. The third phase will include all students.

The District will do another return to school baseline test and periodic testing thereafter. Contacts of students and staff who test positive will be notified by the District as part of its robust Community Engagement effort.

Inclusive engagement

Two representatives from the Carson Wellness Center presented ideas on how to engage students and community members and drive visits to Wellness Centers.

Kristie Garrison of Healthy Start and Suzanne Markey of LAUSD School Mental Health offered marketing and communications tactics, including virtual clinic tours media to be shared on classroom Zoom meetings and social media. The team is focused on promoting clinic services to students, especially sexually transmitted infection and HIV prevention education.

Rosario Rico and Robert Renteria of The L.A. Trust gave a brief presentation on inclusive strategies to increase student use of LAUSD Wellness Centers.

They emphasized “location, location, location,” which includes virtual environments like Schoology, Zoom and social media, and more traditional methods like putting printed fliers in places where students are still checking in. They said messaging should include Wellness Center hours, available services, minor consent services and how to make an appointment.

The two-hour event concluded with breakout rooms discussing “How to expand outreach efforts in a more inclusive manner?” Suggestions included involving parents and past student clients as ambassadors; engaging teachers; and utilizing ConnectEd, Schoology and other platforms.

Conference attendees committed to exploring the techniques and increasing clinic visits next semester.

Wellness Centers discuss COVID challenges at virtual collaborative

Pia V. Escudero of LAUSD Student Health and Human Services addressed more than 100 participants at The L.A. Trust’s online Learning Collaborative. 

Wellness Centers online meeting (recording)

Representatives from the Los Angeles student health community met online Thursday, May 7, 2020 at The L.A. Trust’s Wellness Center Learning Collaborative to discuss how to serve students and their families during the COVID-19 health emergency. More than 100 clinicians, educators and healthcare advocates attended.  

The coronavirus is impacting patients — and the clinics that serve them. Nine of the sixteen on-campus Wellness Centers have suspended operations (see list). Fewer students and community members are visiting clinics, putting their long-term health at risk. It also threatens the financial health of some clinics that have been serving high-need communities for years. 

Dr. Yohanna Barth-Rogers, chief medical officer of the UMMA Wellness Center at John C. Fremont High School in South Los Angeles, told the Learning Collaborative that her clinics were moving the majority of patient visits to video conferences and phone calls.  

In-person visits must be approved in advance and be deemed medically essential. Two of the needs deemed essential are vaccinations and contraception. 

One challenge is finding safe spaces to have sensitive conversations with students, she said. “My worry is that we’re missing things, such as violence in the home.” She said the clinic was developing ways to have confidential conversations with students during the coronavirus shut-down. 

Reaching out 

In addition to telehealth, clinic operators have been staying in touch with patients through community networks and social media. “Asian Pacific Healthcare Venture Inc., serving Belmont and John Marshall High Schools, cares about you,” they said in an email to The L.A. Trust. “If you have any health concerns, call us. We’ll make a telephone appointment to talk to a provider or get your medication refilled. We are also open for confidential services. Stay safe!” 

North Hills Wellness Center at James Monroe High School issued a “stay at home challenge” for students: “Eat an apple instead of chips. Get outdoors (with your mask on!). Follow a workout routine on FaceTime or YouTube. Learn a TikTok dance. Be creative and remember that social distancing and face coverings save lives!” 

Dr. Rosina Franco and Student Medical Services reported that while the Hollywood High Wellness Center was closed for safety reasons, “we are currently working on a re-entry plan for when schools, and our clinic, will re-open. In the meantime, please log on to the LAUSD SHHS webpage.”