The latest on school-based health: Partnership launches a health center at Normandy High School

By: NANCY CAMBRIA
Communications Manager, For the Sake of All

The choices were not great: attend school sick and not feeling well or spend the entire day getting to the doctor’s office to obtain treatment.

That was a decision often made by many students at Normandy High School, according to surveys, interviews, and focus groups on community health held by For the Sake of All.

With few primary care options in the 23 communities that make up the Normandy Schools Collaborative and a lack of health insurance and transportation, students in the high-need public school district were typically missing a full day of school to visit a doctor’s office or a medical clinic far away. Some students were calling in absent to take sick siblings to the doctor’s office. Or, they were just skipping the doctor altogether, gritting out symptoms at home – or while attending school.

But that is soon to change. A new health center opened on Aug. 10 at Normandy High School with full primary health care and behavioral health services offered by Affinia Healthcare.

No longer will students have to take two bus lines and MetroLink to get to health services in the Central West End as many did. Nor will they find themselves going to a hospital emergency room for routine treatment at more than double the rate of students in wealthier school districts because of a lack of nearby primary care.

“We hope that with a resource like this conveniently located on one of our campuses our families get needed health services, but also eliminate a barrier that can keep some students out of school,” said Normandy Schools Collaborative Superintendent Dr. Charles Pearson. “This collaboration can have a direct, positive impact on the entire community.”

The health center is also a cause for celebration among For the Sake of All and its many partners. Last year, For the Sake of All staff and dozens of community partners identified school-based health centers as a key strategy in tackling health inequities affecting African Americans in the St. Louis region. The Normandy High School health center is the first new health center to open under this initiative.

“School-based health centers provide access to health care and preventive services where young people spend most of their waking hours—in school,” said Dr. Jason Purnell, director of For the Sake of All. “When properly implemented in schools with high needs, they result in better health and better educational outcomes. Thousands of these centers exists across the country, and we’re excited to be part of the expansion of the model here in St. Louis.”

Though there are thousands of school-based health centers in the United States, St. Louis has just a handful. For the past year, For the Sake of All has convened work groups with participants in the health, education, and student development fields to forge partnerships and establish proven steps to sustain the existing health centers and open many more.

The Normandy High School health center was made possible through a partnership formed in January between Normandy Schools Collaborative, Affinia Healthcare, BJC HealthCare, Wyman, and For the Sake of All.

Affinia health practitioners will provide the primary care. BJC will provide equipment and supplies. Wyman will work with the school district’s nurses, counselors, student development providers, and administrators to integrate the health center into the everyday culture and programming of the school. And For the Sake of All will continue to consult with the center to support its sustainability and best practices.

Two more health centers are currently in the planning stages in schools in North St. Louis County, and similar partnerships are forming to ensure those health centers are sustainable and effective. Part of that work includes making Missouri an affiliate of the School-Based Health Alliance which works to expand and sustain high-performing school health centers around the nation. That emerging organization, to be named the SHOW ME School-Based Health Alliance, is in the early planning stage.

For the Sake of All and its partners aim to build infrastructure and support to open a health center in every high-need high school in the St. Louis region.

The centers have many benefits beyond direct healthcare delivery. Research found in our Discussion Guide on healthy schools shows school-based health centers improve attendance and curb school drop-out rates. They enhance learning environments and empower students to take care of themselves. Further research shows the stress of poverty and neighborhood violence can harm child development and trigger poor health in adulthood. So getting accessible health care for students in a highly supportive setting is an important intervention.

Over the course of conversations in the high school this past year For the Sake of All also learned students and parents were having difficulty finding accessible behavioral health support for mental health issues, despite coping with many intense stresses in their homes and neighborhoods. This gap in services was concerning because a quarter of Normandy High School students surveyed by For the Sake of All reported having trouble sleeping at night, feeling sad, or worrying about the future.

Wyman, a student development organization, is working with Affinia Healthcare to ensure the center will be highly sensitive to trauma among its young patients and will work throughout the school district to ensure students are aware of the center and have access to it. In For the Sake of All surveys, more than 85% of Normandy students, teachers, and staff said they would utilize its services.

There’s more to come in the next year in St. Louis on school-based health. Stay tuned. But for now For the Sake of All is excited students, faculty, and staff of Normandy schools have this important resource within steps of their classrooms, sports practices, clubs, and other activities.

WANT TO LEARN MORE? Check out For the Sake of All’s full Report on the health and well-being of African Americans in the St. Louis region and why it matters for everyone. Make sure to follow us on Twitter @4theSakeofAll.


Investing in our children’s futures: hope grows for Child Development Accounts

By: NANCY CAMBRIA
Communications Manager, For the Sake of All

Research from the Center for Social Development at Washington University suggests nine out of ten parents aspire for their children to go to college regardless of their income, their ethnicity, or where they live.

Ask Charlene Jackson of St. Louis. She firmly believes college will one day happen for her two young grandchildren, despite her lower wages.

But that dream often fades and doesn’t become a reality for low income families. Jackson, for example, said that until recently she had no plan for how to get her grandchildren through college, but was just expecting it to all work out someday.

In the City of St. Louis and St. Louis County there are critical racial disparities when it comes to African Americans going to college. Though trends are improving, only a little more than half of African Americans 25 years and older have gone on to take college level courses. That’s compared to nearly three quarters of white residents. Finances certainly are a challenge for African American families overall. More than 30% of African American households live in poverty compared to 9% of white households.

It’s important to empower African American families like the Jacksons with strategies to get their children and grandchildren to college. How can St. Louis push more children on a path to college built on a concrete plan and not just dreams?

One strategy backed intensively by For the Sake of All is the creation of Child Development Accounts that enable families to build assets targeted for children’s higher education. The creation of such accounts is also listed among the Ferguson Commission’s “Calls to Action.” For the Sake of All and its partners believe every child in the City of St. Louis and St. Louis County should be automatically enrolled in these accounts at birth. To get there, a collaborative group of partners is working on a plan to enroll 30,800 children in 20 of the region’s most high-need ZIP Codes into the Missouri MOST 529 College Savings Plan. There’s more work to be done on this venture, but momentum is building.

Research shows the accounts have positive effects for parents and children – even if assets in those accounts seem minimal or don’t approach the full cost of a college tuition. According to the SEED OK experiment conducted by the Center for Social Development, Child Development Accounts made available to a sampling of children throughout Oklahoma were found to help mothers increase expectations of their children’s education, boost mothers’ mental health, and improve children’s social-emotional development.

Several of these accounts are already in place in St. Louis. They include Beyond Housing’s Promise Accounts, which were recently highlighted in the online publication, The 74; The Scholarship Foundation of St. Louis’ Future Forward program; the City of St. Louis Treasurer’s Office College Kids program; and Focus on College!, a program created by Wells Fargo and the United Way of Greater St. Louis featured in the above video. “Having money saved for college is about more than just the dollars in the account, it’s about actually instilling a sense of hope,” says For the Sake of All Director Jason Purnell in the video.

Charlene Jackson can attest to the power of Child Development Accounts. In 2015 Jackson’s grandson and granddaughter were automatically enrolled in savings accounts through the College Kids program. Jackson described the presence of the accounts as “a boost” that’s made her think more clearly about how to get her grandchildren to and through college: “They have given me the push to say, O.K., you can do this.”

WANT TO LEARN MORE? Check out For the Sake of All’s Discussion Guide on creating economic opportunity, or its full Report on the health and well-being of African Americans in the St. Louis region and why it matters for everyone.


Why early childhood programs and supports are essential to healthy brain development

By: Nancy Cambria
Communications Manager, For the Sake of All

In the snap of a finger about one million neural connections are created in the developing brains of individual newborns, infants, and toddlers. Think of each second as adding on to an amazingly intricate web of wiring that helps the brain manage the body and interact with itself and the world outside of it.

At no other time in life does the human brain experience such incredible growth than in these first three years of life. Research highlighted at Harvard University’s Center on the Developing Child  demonstrates this critical brain development does not happen in a vacuum. Positive or negative human interaction shapes this developing brain architecture in profound ways.

Positive nurturing and attachments – holding children in infancy, attending lovingly to their physical and emotional needs, softly reading picture books, guiding children through imaginative play and other nurturing activities – form essential bonds between young children and adults. Those connections influence the wiring of a young child’s brain to enhance communication, learning, and positive social and emotional skills that can set a child on the right track for life.

The research also shows the brains of very young children who lack nurturing and strong adult attachments develop different wiring to deal with stress and basic survival. They may be prone to classic “fight-or-flight” responses in situations that other children find routine. It can be harder for them to focus and learn. It can impair their ability to work through a task or take mental steps to solve a problem. Their brains are wired to be on guard, so it’s just harder to trust others, like teachers and other children.

Think of the wiring of a young brain as a tree trying to branch out. Trees exposed to sunlight with ample water and nutrients without other trees blocking their sunlight develop spectacular crowns of branches and leaves. These trees can live for more than a century. But trees competing to grow in a dense forest adapt by twisting their branches to reach that one bit of sunlight to survive. They show great grit to survive. But being lopsided in shape makes them more prone to falling down in storms.

This is why For the Sake of All developed a Discussion Guide and Action Toolkit on improving early childhood development in St. Louis, particularly for children in neighborhoods and households experiencing high levels of trauma and stress from poverty. Sometimes it’s just harder for families to provide key nurturing for newborns and toddlers if they are dealing with the extreme stresses of everyday survival to sustain housing, food, and transportation.

Quality early childhood programs help develop healthier brains in babies and young children, particularly for children growing up in poverty. A network of strong prenatal care programs, home visiting programs, parenting supports and quality child care and preschool programming are valuable investments in the health of our community’s children.

Even the U.S. Federal Reserve agrees. Investing in early childhood programs for low-income children has the best return on investment in human capital than at any other time in life: $4 to $9 for every dollar spent.

Check out a recent video by The Atlantic on child brain development and stress. It refers to the early 1990s when George H.W. Bush declared “The Decade of the Brain” to prompt investment in early childhood programs. Though there’s been an increasing call for universal pre-kindergarten funding, overall progress on funding a full array of programs has been slow. Though landmark research on child development and neuroscience continues, the policies and programs to support what we know about optimal brain development in young children is still lacking – particularly for children most in need.

To learn more about how toxic stress and trauma are particularly affecting St. Louis children living in poorer, segregated neighborhoods, read the St. Louis Post-Dispatch report, “The Crisis Within: How toxic stress and trauma endanger our children.” The report features solutions and a graphic that explains how early stress can adversely affect child development and health through a lifetime.


On equitable housing: impoverished neighborhoods deeply influence future health, wealth, and happiness

The legacy of America’s long history of housing segregation has resulted in “two divergent Americas, one with money and one without – and the one without is largely black,” according to this VOX report, “Living in a Poor Neighborhood Changes Everything About Your Life.”

Presented through a series of graphics, it’s a concise way to look at the highly disproportionate percentage of African Americans living in impoverished neighborhoods nationwide with slim odds for upward mobility.

The report addresses the adverse effects of long-term poverty on health, IQ, mental well-being, and educational outcomes. It cites research demonstrating low-income families with the opportunity to live in middle class neighborhoods have better outcomes regarding school performance, income, and health.

It’s similar to For the Sake of All’s video, “The Two Lives of Jasmine,” created in partnership with the Nine Network. The video illustrates the trajectory of children living in neighborhoods of opportunity versus those living in places without key resources like quality child care and schools.

Regardless of how it’s illustrated, it’s clear where families live deeply influences their future health, wealth, and sense of well-being.

For the Sake of All has created an important Discussion Guide on investing in quality neighborhoods for all in St. Louis. One of the guide’s recommendations is to develop an action plan to ensure equitable housing for all residents regardless of race or income.

This month, St. Louis experts in affordable and inclusive housing will convene to develop that regional plan. They will assess the impact of housing segregation in St. Louis and work together to facilitate better affordable housing policies and practices that stop isolating families in poverty.

Stay tuned for updates on this dynamic group as their work progresses in 2017.


“It’s dramatic.” Where you live in America could mean a lifespan difference of 20 years

Last week a landmark study in JAMA Internal Medicine analyzed county to county health data in all 50 states over a recent 34-year period. Researchers found average life expectancies varied as much as 20.1 years depending on the county where people live.

“What we found is that the gap is enormous,” one of the study’s lead researchers told NPR.

The data mirrors similar findings reported here in St. Louis through For the Sake of All, where life spans can differ by as much as 18 years in some of the region’s wealthiest and poorest neighborhoods. Read our Discussion Guide on Economic Opportunity.

In the national study, in wealthy regions with highly educated populations, such as Summit County, Colorado and Marin County, California, people lived the longest, about 87 years. In areas of high poverty and low levels of education residents had much shorter lifespans, about 67 years.

The study further suggested lifespan inequality in America is increasing between rich and poor. Between 1980 and 2014 the gap between the highest and lowest life spans increased by about two years. Researchers expect those gaps to continue to widen.

Here are the links to NPR and CNN’s coverage of the study and suspected reasons why.


Two new and notable books on wealth inequality

Evicted: Poverty and Profit in the American City 1st Edition
by Matthew Desmond
available at Amazon.com

WINNER OF THE 2017 PULITZER PRIZE FOR GENERAL NONFICTION

From Amazon.com: In Evicted, Harvard sociologist and MacArthur “Genius” Matthew Desmond follows eight families in Milwaukee as they struggle to keep a roof over their heads. Hailed as “wrenching and revelatory” (The Nation), “vivid and unsettling” (New York Review of Books), Evicted transforms our understanding of poverty and economic exploitation while providing fresh ideas for solving one of 21st-century America’s most devastating problems. Its unforgettable scenes of hope and loss remind us of the centrality of home, without which nothing else is possible.

Dr. Desmond delivered the keynote address at the Metropolitan St. Louis Equal Housing & Opportunity Council’s recent Fair Housing Conference, held on Thursday, April 6, 2016 at the Brown School at Washington University in St. Louis. Learn more about the conference.

 

The Vanishing Middle Class, Prejudice and Power in a Dual Economy
By Peter Temin
available at The MIT Press

From The MIT Press: The United States is becoming a nation of rich and poor, with few families in the middle. In this book, MIT economist Peter Temin offers an illuminating way to look at the vanishing middle class. Temin argues that American history and politics, particularly slavery and its aftermath, play an important part in the widening gap between rich and poor. Temin employs a well-known, simple model of a dual economy to examine the dynamics of the rich/poor divide in America, and outlines ways to work toward greater equality so that America will no longer have one economy for the rich and one for the poor.

Many poorer Americans live in conditions resembling those of a developing country—substandard education, dilapidated housing, and few stable employment opportunities. And although almost half of black Americans are poor, most poor people are not black. Conservative white politicians still appeal to the racism of poor white voters to get support for policies that harm low-income people as a whole, casting recipients of social programs as the Other—black, Latino, not like “us.” Politicians also use mass incarceration as a tool to keep black and Latino Americans from participating fully in society. Money goes to a vast entrenched prison system rather than to education. In the dual justice system, the rich pay fines and the poor go to jail.


SLPD article on STL city-county divide, by Tony Messenger

Tony Messenger’s April 13, 2017 article, Messenger: Redraw the boundaries so that St. Louis can go all in, addresses the divide between the city and county in St. Louis. Messenger references research outlined in the 2014 For the Sake of All report underscoring the gaps in health outcomes and life expectancy between rich and poor and African American and white St. Louisans. According to For the Sake of All Project Director Dr. Jason Purnell, “This is the story of St. Louis. The in group has divided the resources and, more often than not, left little for the out group. That’s our history, on purpose.”

The article discusses the results from the recent April 4 elections in the context of the city-county divide and highlights an event held on the same day in which Dr. Purnell and other panelists encouraged the city and county to come together. Messenger also proposes an approach where the city, county, and state would work together (as they plan to in the NFL lawsuit) or where policy agencies would consolidate to establish agency-wide standards and improve public safety.

According to Messenger, “that sort of thinking would require what Purnell says is necessary for St. Louis to thrive in a new global economy, a ‘redrawing of the boundary of the in group.’

Messenger’s message: “Redraw the boundaries so that the entire region can go all in.”

Read the full article.


Asset Funders Network releases new brief on wealth and health

On February 28, 2017, the Asset Funders Network released a new brief on the relationship between wealth and health, The Health and Wealth Connection: Opportunities for Investment Across the Life Course, with authors Jason Q. Purnell, PhD, MPH and Anjum Hajat, PhD, MPH. This release demonstrates that funders have an opportunity to bridge interests and cross silos to make stronger connections between wealth building, economic security, and prevention and health outcomes.

People’s relationship with money impacts their health. Far beyond health care access and affordability, wealth and numerous social factors related to where people live, work, and play impacts a person’s health. Data indicates assets, income, and health are inexorably linked. On the one hand, good health is associated with higher wealth and income, better employment and education. On the other hand, we know that adults with more financial resources have better health and live longer lives. Throughout one’s course of life, the challenges of health and wealth are connected — but why aren’t the solutions?

A webinar conducted by the authors is now available. Presenters Purnell and Hajat explore how health and wealth are connected and discuss how health impacts are more significant for low-income, vulnerable populations, particularly people of color. They go on to share compelling evidence for investment in strategies and policies that consider both the physical well-being and economic stability of individuals, families, and communities.

Download the brief.
View the webinar.


WashU: Community Partnership Key to Raising Awareness of Health Disparities

from the Association of Schools and Programs of Public Health (ASPPH) Friday Letter, March 14, 2017:

An academic-community partnership in St. Louis has raised awareness of health disparities and shows promise of reducing those disparities, according to a report from the Brown School at Washington University in St. Louis.

For the Sake of All was established in 2013 to use civic education as a strategy for improving developmental and health outcomes in the St. Louis region. In 2014 it issued six major recommendations for reducing health disparities, such as investing in early-childhood development.

Recommendations prompted action, such as the establishment of a program to provide college savings accounts for kindergartners. The project took on increased resonance after the fatal police shooting of Michael Brown in the suburb of Ferguson in August 2014, just months after the report was released. For the Sake of All was a significant source of information for the Ferguson Commission, which was established to address issues that were raised by the shooting and in its aftermath.

The report said the project has succeeded in influencing public understanding of disparities like the 18-year gap in life expectancy between two nearby ZIP codes in the region, which has been widely cited since the project reported it.

“It seems clear that For the Sake of All has raised awareness and encouraged some action in the St. Louis community regarding the social determinants of health and health disparities,” wrote Dr. Jason Purnell, an associate professor at the Brown School, who led the effort and was the lead author of the report. He said the project could help other cities that face similar issues.

“What St. Louis may offer in efforts like For the Sake of All is a blueprint for a way forward,” he concluded.

The report was published in December in a special edition of the journal Urban Education that focused on For the Sake of All.


St. Louis American article on racism and real estate in STL, by Aimee VonBokel

Aimee VonBokel’s February 23, 2017 article, Real estate and racism in St. Louis, reveals the history of housing segregation in St. Louis through the story of one house at 5117 Wells Avenue on St. Louis’s near-north side and the families of two St. Louisans who lived there: Leo, a white man whose family owned and lived in the house from the 1920s to the 1950s, and Claudia, an African American woman who rented the property from the 1950s until 2005.

The article explores the migration of African Americans in the early 1950s from a near-bursting downtown St. Louis to the less populated near-north side and the white flight to the St. Louis suburbs that followed. It describes how developers used race-restrictive covenants to keep neighborhoods racially segregated and how the redlining of racially mixed neighborhoods reduced property values, making it impossible to obtain mortgages. Rent from properties in these neighborhoods was transferred from African American, working-class city residents to white suburban homeowners, leaving our city with the deeply divided metropolitan areas we see today. According to VonBokel, “Racism is not just about individual decisions or hateful feelings. Racism is about financial incentives that are built into policy, and thus, invisible. What remain visible are only the effects.”

Read the full article.

Read the For the Sake of All Discussion Guide and Action Toolkit on how to work toward quality neighborhoods for all in St. Louis.