The L.A. Trust hosts first Youth Mental Health Collaborative

The L.A. Trust, L.A. Unified, healthcare providers and student representatives are uniting to address youth mental health concerns.

Representatives from L.A. Unified School Mental Health, Student Health and Human Services, Wellness Center operators and other concerned organizations met at the first-ever Youth Mental Health Collaborative hosted March 25 by The Los Angeles Trust for Children’s Health.  

Marsha Ellis, director of programs for The L.A. Trust, said, “The Youth Mental Health Collaborative has two objectives — to improve student mental health access and services, and incorporate youth voice into improving the system.” The collaborative is funded by the Ballmer Group and is part of The L.A. Trust Student Mental Health Initiative, launched last fall.  

Maryjane Puffer, executive director of The L.A. Trust, framed the work, outlining how training, engagement and referral systems will work together in a single strategy encompassing awareness, prevention and intervention, and healthcare access.  

Puffer said members of The L.A. Trust Student Advisory Boards and after-school providers have already begun training in Youth Mental Health First Aid. Members of The L.A. Trust staff completed the training last year. Members of the Woodcraft Rangers attended the training March. Students will also participate in Question, Persuade, Refer (QPR), a suicide prevention program, and will continue to conduct student awareness campaigns on social media and on–campus, when classroom teaching resumes.  

Survey finds challenges 

Ellis presented survey results about the challenges encountered with remote counseling. The top issue reported was technology, followed by difficulty obtaining consent forms, distractions, lack of privacy, inadequate follow–through and complicated telehealth platforms. 

Kim Griffin Esperon, a clinical social worker and administrative coordinator of LAUSD School Mental Health, provided an update on school mental health referrals, which have declined during the pandemic.  

Esperon said providers can receive referral requests through several channels. LAUSD has an online “Mail Me” portal that can be used to send and receive parental consent forms. Another consent option is Zoom remote control and signature forms. Parents can also drop off and pick up paper consent forms at schools. 

Jaime Ducreux, LAUSD organization facilitator, gave an update on the status of agreements between LAUSD and school-based mental health providers (MOUs). He said it has not been determined when outside providers will be allowed back on campus. 

Tanya Mercado, a LAUSD social worker and attendance counselor, and  Francisco Dussan of School Mental Health, Innovative Funding for Mental Health, spoke about funding models needed to expand and improve school-based mental health services. Research is still being conducted to investigate funding streams, develop deeper partnerships and recommend policy, practices and legislative changes needed to increase funding and support, they reported. 

The one-hour collaborative concluded with a discussion on future bimonthly Youth Mental Health Collaboratives and establishing subcommittees to act as working groups. 

Dental disease starts young, so should oral healthcare

Brushter, Gumster and Toothster are the spokes-characters of L.A. County’s “Love Your Baby’s Teeth” campaign, which launched on multiple media outlets last month.

Oral health advocates from public agencies, private foundations, community groups and L.A. Unified explored how to improve children’s dental care starting at an early age at The L.A. Trust’s quarterly Oral Health Advisory Board meeting March 16.

Dr. Abrey Daniel of the Los Angeles County Department of Public Health introduced the county’s extensive new Love Your Baby’s Teeth education campaign, launched during Children’s Dental Health Month in February. The campaign features TV, radio, PR and social media.

Daniel said one-quarter of L.A. children age 2 to 4 have tooth decay, and 55% of all lower-income children have dental disease, which is more prevalent in Black and Latinx communities.

“Families where Spanish is (mainly) spoken are at the greatest risk” in L.A. County, Daniel said.

The county’s multilingual campaign includes heavy use of Spanish-language media, and features such elements as dental office posters, bus shelter ads, exam table paper with campaign messages, and giveaway mirror clings to remind kids to floss and brush. The campaign has already reached hundreds of thousands.

Smile, California

Dr. Puja Shah, Medi-Cal outreach consultant, reviewed the California Department of Health Care Services’ “Smile, California” campaign, designed to build awareness and use of the benefits available from Medi-Cal Dental.

The tagline of the campaign is “Medi-Cal Has Dental Covered.” Key messages include getting a child’s first check up by their first birthday; seal today to prevent decay; and Medi-Cal covers dental during pregnancy. The comprehensive outreach includes robust websites in Spanish and English connecting patients and providers, a partner program enlisting community groups and a toolkit with materials for children and family members.

 Shah also noted that the agency was improving its online complaint system so patients can report providers who refuse them care.

More outreach and updates

Cynthia Cervantes, Oral Health Collaborative Consortium liaison from the UCLA School of Dentistry, gave an update on the consortium, which is funded the California Department of Public Health’s Office of Oral Health.

Cervantes stated that the mission of the OHCC is to “support and facilitate the implementation of the L.A. County Community Oral Health Strategic Plan (COHIP) throughout L.A. County through community outreach and leadership in each of four Mega Service Planning Areas. She gave examples of outreach at faith-based organizations, Los Angeles Public Library branches, medical clinics and daycare centers. The consortium will host Oral Health Summits in 2021 and 2022.

Susan Flores, senior policy coordinator from the California Pan-Ethnic Health Network, updated OHAB members on Medi-Cal dental appointments during the pandemic. The decreases in monthly appointments ranged from 437,898 in April 2020 to 129,114 last August, the most recent numbers available.

Flores also urged support for two California Assembly bills under consideration. AB526 would allow dentists to vaccinate for Covid and flu, potentially increasing healthcare equity.  AB733 would help expand access to oral healthcare for children and those pregnant enrolled in Medi-Cal by allowing registered dental hygienists to partner with medical professionals to provide fluoride treatments and oral health education and coordinate dental care. It is similar to a bill signed last year (AB890) that allowed physician assistants to perform more oral healthcare.

Gloria Velasquez, organization facilitator for L.A. Unified’s Student Health and Human Services, gave a briefing on school re-openings, including health and testing protocols and the hybrid teaching model.

Maryjane Puffer, executive director of The L.A. Trust, sounded an optimistic note at the close of the meeting. “The important thing is that nobody stopped working.” She pointed to expanded outreach on social media, TV and video, and events like The L.A. Trust’s ongoing Operation Tooth Fairy, which has distributed more than 58,000 toothbrushes to date. The next meeting of The L.A. Trust’s Oral Health Advisory Board will be held in person or online June 15 in accordance with health directives.

Wellness Centers eagerly prepare for school re-openings

Dr. Kevin Fang of CHLA spoke about healthcare inequities at The L.A. Trust Learning Collaborative.

The word of the day was “hopeful” as L.A. Unified representatives, Wellness Center operators and staff from The L.A. Trust prepared for school re-openings at the fourth pandemic-period Wellness Network Learning Collaborative, March 10 on Zoom.

Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, conducted a roll call of representatives from the 17 LAUSD Wellness Centers, noting The L.A. Trust has been hosting the collaboratives for more than a decade.

Health equals success

Guest speaker Dr. Kevin Fang addressed healthcare inequities, saying, “Zip Codes are better determinants of health outcomes than genetic codes.” Children of parents without a high school diploma are more likely to live in an environment with health barriers, Fang said, noting the direct correlation between education and life expectancy, income and smoking.

Fang said chronic absenteeism was a strong predictor of poor academic achievement. COVID-19 has exacerbated an already high chronic absenteeism rate among California public schools, he said, noting it has risen 89%. Proven solutions include school nurses and other forms of school-based health, physical education and individual education plans. Fang suggested ways to increase collaboration between schools and the medical community, including ACES (adverse childhood experiences) training for pediatricians and Wellness Center clinicians and in-class visits by doctors and medical students.

Fang is an attending physician and an assistant program director for the Pediatric Residency Program at CHLA. The former high school biology teacher is also Fellowship Director for the General Academic Pediatrics Fellowship in Health Equity and assistant clinical professor of pediatrics at USC’s Keck School of Medicine.

Report card

Victor Luna, organization facilitator for LAUSD Student Health and Human Services,  provided a 2020 report card for the Wellness Network.

Visits to the Wellness Centers were down dramatically due the pandemic and facility closures. Visits varied widely — some clinics never closed and some remained closed for most of the year. Organization Facilitator Gloria Velasquez observed that 2020 was not a good year to determine trend lines in the network.

The two-hour collaborative concluded with a group discussion among the clinicians, educators, Student Advisory Board Adult Allies and The L.A. Trust staff. Topics included telehealth, getting students to make and keep medical appointments, and sexual and reproductive health services.

Appointments for STI prevention and birth control have been most impacted by the pandemic. Without outreach and the confidential setting of the school Wellness Center, students may be reluctant to reach out or use telehealth from home. LAUSD Organization Facilitator Ana Griffin said Wellness Centers and students were countering this through outreach campaigns. “We emphasize to students (who have sexual health questions) that the Wellness Center is a no-judgment zone.”

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.”

COVID testing key to L.A. Unified’s return-to-school strategy

L.A. Unified return-to-school plan encompasses testing and tracing for nearly 800,000 students and employees.

The Los Angeles Unified School District has begun an unprecedented coronavirus testing program, part of its developing return-to-school plan for nearly 800,000 students and employees 

Los Angeles Unified Superintendent Austin Beutner said, “Health practices are in place. Classrooms and facilities have been electrostatically cleaned top to bottom, air-conditioning systems have been upgraded with the equivalent of N-95 filters, personal protective equipment is provided to all individuals on campus, and classrooms and facilities have been reconfigured to keep all at a school a safer distance apart.  

“When students do return to schools, they’ll be kept in small cohorts to reduce the risk of spreading the virus. And as we learn of other ways to enhance health practices, we’ll incorporate them as quickly as possible.”

‘Taking the lead’ 

“Once again, LAUSD is taking the lead nationwide in protecting our students, teachers, staff and community members,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health. “It is essential that we open our schools as soon as it is safe to do so.” 

Beutner added, “While unprecedented, the virus testing, community engagement and contact-tracing program is necessary and appropriate as we must do everything we can to protect the health and safety of all in the school community.”  

Among those collaborating on the program are UCLA, Stanford University, Johns Hopkins University, Microsoft, Anthem Blue Cross, Cedars-Sinai Medical Center and Health Net.

School-based health conference focuses on multiple threats

California State Superintendent of Public Instruction Tony Thurmond addressed nearly 1,000 registered guests at this year’s CSHA statewide School-Based Health Conference.  

Nearly 1,000 student health advocates addressed the multiple pandemics facing California’s kids, teens and communities at “School Health on the Frontlines: Navigating Pandemics & Building Equity,” the California School-Based Health Alliance’s first-ever virtual School-Based Health Conference October 6-8. 

Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health and board vice president of CSHA, opened the conference by stating, “School-based health centers have always been on the frontlines of healthcare by serving students and communities with the most challenges and least access to our healthcare. This year has been a real test of that system.” 

She pointed to the COVID-19 pandemic, which “has brought families to the brink,” and to “the unending racial injustices faced by Black, Indigenous and People of Color.” She said, “Our youth are resilient, but they are under incredible strain.”  

She noted that not one of the state’s one thousand local education entities has the recommended number of mental health professionals and only 4% of California school children have access to school–based health centers. 

“The ultimate equity issue” 

Dr. Tony Thurmond, California State Superintendent of Public Instruction said, “These are some of the toughest challenges we’ll see in our lifetimes.” He called “healthcare the ultimate equity issue” and said school-based health was “a top priority.”  

The opening keynote speaker was Dr. Elisha Smith Arrillaga, executive director of The Education Trust–West, a research and advocacy organization focused on educational justice and supporting the high achievement of all California students. She said, “I want my son to say in the face of this epidemic that we stood by him. We must do much better, much faster. We must be co-conspirators for justice.” 

The closing keynote was given by Dr. Tichianaa Armah, medical director of Behavioral Health at the Community Health Center Inc., one of Connecticut’s top school-based health center providers, and assistant clinical professor at the Yale School of Medicine. Armah outlined the impact of racism on the health and mental health of BIPOC students and communities. She shared compelling evidence of how stress of racial injustice has real health consequences, from stress and negative emotions to low-grade inflammation and chronic disease. 

The CSHA Convention included three days of sessions on topics ranging from sexual and reproductive health to school mental health. The L.A. Trust’s Program Manager Robert Renteria headed a panel on “Implementing SBIRT in SBHCs” and three staff members from The L.A. Trust served as room hosts. Sixty attendees registered for the conference as guests of The L.A. Trust. 

Kaiser grants $500,000 to The L.A. Trust for new solutions

The Los Angeles Trust for Children’s Health has announced a two-year, $500,000 grant from Kaiser Permanente to provide healthcare programs, foster healthy habits and generate insights to improve student health in Los Angeles public schools.

A portion of the grant will underwrite an innovative new Data xChange initiative that will link healthcare and educational performance data to find ways to improve healthcare strategies and educational outcomes. 

“This major grant will not only help us deliver on our promise of improving the health of the LAUSD communities we serve, it will give us the insights we need to design programs and services that connect better healthcare to improved educational performance,” said Maryjane Puffer, executive director of The L.A. Trust.

Kaiser fully committed

Will Grice

“At Kaiser Permanente we are committed to helping everyone in our communities achieve total health,” said Will Grice, senior vice president and area manager, Kaiser Permanente Los Angeles Medical Center.“That is why, through this grant, we’re proud to support The L.A. Trust in their efforts to increase access to oral health education, screenings and referrals for LAUSD students and their families, integrate healthy eating, active living programs into schools, and implement a system that measures the impact of health services on academic performance and attendance,” Grice said. “Together, we can work to reduce the disparity in access to quality health care in our communities.”

The mission of The Los Angeles Trust for Children’s Health is “to improve student health and increase readiness to learn through health care access, advocacy, and programs.” The independent 501c3 nonprofit organization supports 15 district-wide Wellness Centers and a variety of programs focused on preventative care, oral screenings and referrals, healthy living habits, mental health services and more. 

Wellness Center leaders collaborate on student health

School-based managers and clinicians from Los Angeles school-based Wellness Centers learned best practices for student health at The L.A. Trust for Children’s Health Fall Learning Collaborative, October 19, 2019, at LAUSD headquarters. The semi-annual event focused on innovative approaches to HPV prevention, contraception awareness, and other urgent student health issues.

The meeting featured a detailed update on The L.A. Trust’s new Data xChange, an initiative that will link real-world clinical data with student performance data to gain insights and find new ways to improve outcomes.

Maryjane Puffer, executive director of The L.A. Trust, said new insights are needed to drive student healthcare in Los Angeles to the next level.

The ambitious initiative has finished its initial phase (gathering clinical data) and laid the groundwork for Phase 2, linking clinical data to student performance data. Rigorous privacy protocols for the data have been established.

Wellness Center leaders poured over reports from their Wellness Centers, including stats on unique patient visits, services provided and demographics. Dr. Ron Tanimura, director of Student Medical Services for L.A. Unified, and Dr. Sang Leng Trieu of The L.A. Trust, led the discussion on Wellness Center metrics and discussed the history and future of the network.

Sexual health

Dr. Kathleen Tebb of the University of San Francisco released results from “Health-E You/Salud iTu,” a computer-based, patient–centered contraception awareness program focused on Latina youth. The awareness program, deployed in partnership with The L.A. Trust, resulted in a substantial increase in clinical visits and a 117% increase in the use of Long-Acting Reversible Contraceptives among the target group. Version 2.0 of the program will switch genders and focus on young Latino males.

Heather Kun from the nonprofit “Fu*k Cancer,” unveiled the group’s HPV vaccination campaign, “Take Your Shot.” Kun noted than HPV causes 43,000 cancer deaths per year in the U.S., and all are preventable with the vaccine. The group is enrolling students to take the lead in an on-campus peer-to-peer campaign to get students vaccinated and save lives.

 Engaging students

 Two Wellness Center leaders shared how they involve students in their operations. Stephan Salazar, manager of adolescent education for Valley Community Healthcare, serving James Monroe High School in North Hills, discussed how his Student Advisory Board members intern at the clinic and provide advice for the operation and an informal support group for each other. Cassie Angus, Adult Ally at Fremont High School and program associate for its UMMA Community Clinic, also encourages student initiative, observing that “the best way to lead kids is to let kids lead themselves.”

The half-day conference included a briefing on school health integration by Dr. Rebecca Dudovitz of the David Geffen School of Medicine at UCLA, and an update on upcoming School Well-Being Centers presented by Frances Valdez and Gloria Velasquez, organization facilitators for Student Medical Services at Los Angeles Unified.