Community Health Initiative with Youth in Del Valle and Montopolis, UT School of Public Health and Austin Public Health — original pdf

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Youth-led Community Health Learning Initiative in Partnership with the Del Valle & MontopolisCommunitiesANDREW SPRINGER, DRPH& ALLISON MARSHALL, MSSW, MPHUNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH-AUSTINHISPANIC/LATINO QUALITY OF LIFE RESOURCE COMMISSION MACC, AUSTIN, TX -TUESDAY, OCTOBER 22, 2019Youth-led Community Health Learning InitiativeAims1.) Identify health needs and assetsto inform health planning efforts for the Del Valle and Montopolis communities.2.) Build skills and capacity of young people in implementing comm. health assessment of health issues identified by youthCore ComponentsComm. Health Indicator AnalysisYouth-led Community Health Asses.•Del Valle High School (n=19) (Spring 2019)•SAFE-Montopolis (n=12) (Summer 2019)Funder:Austin Public Health (2018-19)Community Health Advisory Committee•Austin Parks & Rec•Austin Public Health•Children’s Optimal Health•Del Valle High School•Dell Medical School•SAFE Expect Respect•Travis County HHS•UTHealthSPHMeeting place: Central Health SEHWC, MontopolisSocio-Economic Context…Del Valle & MontopolisHigh social vulnerability (lower SES, housing, transportation)Low median income:•DV: $44,153•Montopolis: $30,244High % poverty•DV: 24%•Montopolis: 35%% Employed: 95-96% (!)…Multiple AssetsSocial capital:family, friends, teachers and ‘community’ Educational: e.g., high school graduation rates; Del Valle ISD as resource & ‘center’ for communityCommunity/natural: libraries, community rec center (Mont.), comm. health centers, farmer’s markets, parks and trailsCultural:opportunities to build from and inform health promotion efforts via residents’ rich cultural backgrounds/practices. Comparison with Austin AdultsFares Better No DifferenceFares WorseHEALTH BEHAVIORSmoking*MontopolisNo Leisure PABinge DrinkingSleep < 7hrs*MontopolisHEALTH OUTCOMESObesityDiagnosed Diabetes*MontopolisPoor MentHealth DaysHEALTHSERVICESLackHealth InsuranceVisitsto Doctor Clinic Prev. Serv.(female)Selected Health Indicators (of 28 indicators)Del Valle & Montopolis vs. AustinDel Valle•Fared Worse: 17/28•No Differen.: 9/28•Fared Better: 2/28 Montopolis•Fared Worse: 11/28•No Differen.: 10/28•Fared Better: 7/28 Youth-led Comm. Health Learning InitiativeMethods•Participatory Learning & Action (PLA) (in-class)•Participatory Mapping•Data Walks•Dotmocracy(topic prioritization)•PhotoVoice! (primary method)Data Walks & DotmocracyParticipatory MappingPLA: Exploring StrengthsDel Valle •Healthy eating•Physical activity•Access to health services•Mental HealthMontopolis •ACEs•Sexual Health•Mental HealthFigure 7."Healthy eating -NOT" (local convenience store). YLCHLI Youth Co-Investigators, Del Valle, Spring 2019Figure 8. "Healthy eating -NOT" (healthy eating at home)YLCHLI Youth Co-Investigators, Del Valle, Spring 2019.PhotoVoice“Health Eating –NOT”Framing Questions•Why is (health topic)a problem inyour community?•What in your community couldprevent (health topic)?•What are ways we can promote(health topic)in your community?•What are resources/strengths in yourcomm. that can help teens makehealthy choices for (health topic)?Analysis: SHOWeDmethodS -What do you SEE? What is the first thing you notice? H –What is really HAPPENING?O -How does this relate to OURlives? Make it personal.W –WHY does this condition EXIST? WHERE did this issue come from? D -What are some things we can DOabout it? Healthy Eating What are resources/strengths in your community that can help teens make healthy choices around healthy eating?A way to help them make the choice of healthy eating is by not having much junk foods close to them, and givingthem more options of healthy items. Having more fruits & veggies in small containers for them to grab instead of a bag of chips, you can spice up fruits-it's better to have a fruit than a bag of chips. Physical Activity/Inactivity“In Del Valle, there aren’t much resources for us to actually get out and do things that are active. Although we do have a lot of open land, that isn’t always a reason for us to go outside. Most of us don’t have time due to having jobs or not enough time in the day; another reason being that there’s not much we can do with what we have around us.” –YLCHLI Youth Co-Investigators, Del Valle, Spring 2019. “This picture shows a dog running outside. This picture relates to our life because the majority of us have a pet. I took this picture because I think if we could have a dog park with animal activities, this can promote physical activity by people getting their exercise and moving around with their pet.” –YLCHLI Youth Co-Investigators, Del Valle“…In this picture it shows how obtaining health care is far away from our community (distance). The stethoscope isn't focused due to people as well not focusing on their own health as they should. Health is at times also put to the side for the same reason, that people decide to ignore their health issues because they don't think it's as important or it's nothing serious. The open space in the picture also shows how our community does have plenty of space for a healthcare facility to take place, but issue is there's no change being done.” –YLCHLI Youth Co-Investigators, Del ValleAccess to Health ServicesMental Health (Del Valle)“This picture was taken on Friday at Coliseo, a club that a lot of people from the community go to. For me this represents a way for people to get rid of the stress they have and enjoy the things available to them, which are limited. A lot of people relate to music and that is the way they just relax and forget about everything. All thestressfrom work or school is all let out at things available to us in our community. Adding affordable activities related to art, physical activities (not sports), things similar to a main event [a recreational space in nearby Austin with different activities], COTA [Circuit of the Americas] having a discount for the Del Valle Community, in order to attend the events held. All these things will improve the quality of life in the community.”–YLCHLI Youth Co-Investigators, Del Valle“This picture has colorful things and light toward the inside representing your future, with darkness on the outside. To me, this represents mental health issues like stress and everything negative that makes everything look dark. As it closes up, you can’t see your dreams or your future and you feel like you can’t do anything. All the negativity makes you close up and then you can’t see your dreams or a future for yourself. ” –YLCHLI Co-Investigators, Del Valle.Sexual & Reproductive Health“This picture shows a Planned Parenthood [clinic] that is hidden. The connection is that talking about sex is hidden, and sex is a thing that happens naturally when people are ready. Teens should know the resources if they should choose to have sex. If some of our resources are hidden, how are we going to know what we want to do safely if we don’t have them available to us.” –YLCHLI Youth Co-Investigators, MontopolisCommunity showcase presentation-Del Valle High School, May 1, 2019 (YLCHLI, 2019)YLCHLI Co-Investigators presenting findings at Children’s Optimal Health Board Meeting-St. David’s Foundation, Austin, May 10, 2019 with YLCHLI Facilitators Randy Randolph (far left), Allison Marshall (far right), and Del Valle High School Teacher Miguel Delgado-Ochoa (center) (YLCHLI, 2019)Community Sharing of Findings!•Community Showcase Event-Del Valle High School, Del Valle, TX, May 1, 2019•Presentation at Children’s Optimal Health Board of Directors Meeting, St. David’s Foundation, Austin, TX, May 10, 2019•Presentation to Austin/Travis County Community Health improvement Steering Committee, Austin, TX, May 31, 2019•Community Showcase Event –SAFE Alliance, Montopolis-Austin, Texas, July 2, 2019•StoryMap! Thank you COH!•Aetna Foundation Youth Exchange: YWCA in CT (12/2019)StoryMap! https://arcg.is/jrmKnSummary•Multiple strengths of Del Valle and Montopoliscommunities: positive social relationships and sense of community as well as a range of community assets.•Challenging socioeconomic context for residents of Del Valle and Montopolis: one in four and one and in three residents, respectively, living below the poverty line (yet ~95% employed).•Range of disparities in community health indicators for Del Valle and Montopolis adults (≥18 years) •Youth-led assessment: identification of barriers to healthy living and mental health and health services, including: lack of access (PA, healthy eating, health services), transportation, stress and limited time for healthy living, safety concerns, cost of services –as well as opportunities for improvementLooking Forward & Opportunities…1)Youth Voice & Action for CHA/CHIP !Via schools?OST programs?Advisory board?2)CHA/CHIP for Youth Development!CHW certification? CHES training?Enhancement of Health Science Curricula Standards (social determinants)3)Del Valle & MontopolisLiving Wage!?: How do we improve?Wages for Travis County lag behind same-rate employees from Bexar and Harris counties (KXAN 2019)Further activation of leisure-timespaces and activities (provision of,transportation to…)Further activation of access to healthy eating (stores/markets)Increase access to health servicesOpportunities for additional youth-led asset assessment/specific issueCHIP for Del Valle/Montopolis… (?)Community Advisory Committee•Davin Bjornaas (Austin Parks & Rec)•Amanda Cortez (Del Valle High School)•Leigh Ann Ganzar (UTHealthSchool of Public Health [SPH])•Jill Habegger-Cain (Austin Parks & Rec)•Ashley Levulett (Children’s Optimal Health) (COH)•Allison Marshall (UTHealthSPH)•Susan Millea (COH)•Rochelle Olivares (Travis County Health & Human Services)•Edna Parra (Dell Medical School)•Randy Randolph (SAFE Expect Respect)•Barri Rosenbluth (SAFE Expect Respect)•Elena Smart (Austin Public Health)•Andrew Springer (UTHealthSPH)•Ross Stephens (Travis County HHS)•Anna Wilkinson (UTHealthSPH)Thank you! & AcknowledgementsPartner Communities & Youth Co-Investigators•Ms. Cortez & Mr. Delgado-Ochoa’s Del Valle High School students•SAFE Alliance Expect Respect Program Summer Youth LeadersFunder•Austin Public Health(Thank you, Michelle Friedman, Elena Smart & Laura LaFuente!)Recommendations (Del Valle youth co-investigators)TopicRecommendationsHealthy Eating/Unhealthy Eating1)Increase access to healthy food outlets/grocery stores: Del Valle2)Provide nutrition education & cooking classes 3)Make fruit and vegetables easily accessible for snacking by providing ‘grab-and-go’ cut-up fruit and vegetables in containers, with option to add spices such as chili pepper.4)Increase health communication about healthy eating via colorful and eye-catching posters and other communication channels. Physical Activity/Physical Inactivity1)Improve maintenance of parks and trails within Del Valle2)Increase access to parks and trails, including public transportation opportunities to connect residents with parks and trails as well as shared use policies for parks that are currently used only be private clubs3)Increase access to indoor fitness facilities with culturally relevant activities such as Zumba4)Increase access to physical activity that engages parents and children in a safe environment, which may include increased safety efforts at parks, providing street lighting for people to walk at night, and providing sidewalks5)Create innovative spaces that can promote positive social interaction and physical activity, such as dog parksRecommendations (Del Valle youth co-investigators)TopicRecommendationsMental Health/Mental Illness1)Increase access to mental health professionals within the community2)Increase access and visibility of mental health professionals/counselors within the school setting, with lower work/caseloads to allow for greater student support3)Increase access to healthy and safe leisure-time spaces and places within Del Valle for young people.Access to Health Services1)Increase availability of health services, clinics, and pharmacies within Del Valle, including youth friendly services2)Increase access of health services, clinics, and pharmacies within Del Valle, including hours of operation and public transportation optionsRecommendations (Montopolis-based youth co-investigators)TopicRecommendationsAdverse Childhood Experiences1)Increase access to support for mental health, substance use, and violence prevention, including availability of safe people with whom young people can talk about problems 2)Increase access and availability of safe places to go, such as libraries or recreation centers Mental Health1)Enhance awareness of the role of stress in individual and community health within and outside the school2)Increase communication efforts to destigmatize mental illness, including creation of opportunities to have open conversations about mental health and stress3)Increase access to mental health professionals within the community4)Increase access and visibility of mental health professionals/counselors within the school setting, with lower work/caseloads to allow for greater student supportSexual Health1)Increase access and visibility of resources for sexual health education for teens 2)Increase positive and ‘transparent’ communication about sexual health with adolescents 3)Increase access to contraceptives and safe sex resources for teens, including considerations of transportation to access resources.TopicRecommendationsSocioeconomic Context (& Social Vulnerability) 1)Examine further the role of the socioeconomic context in shaping the disparities in health behaviors, outcomes and access to health care and preventive services among Del Valle & Montopolisresidents as noted below. 2)Identify further the causes for the one-fourth to one-third of Del Valle and Montopolisresidents living below the poverty line –despite high employment rates, and develop plan of action to address socio-economic disparities. 3)Develop emergency response planning for natural disasters and other types of emergencies for Del Valle and Montopolisthat takes into account high levels of social vulnerability based on the CDC Social Vulnerability Index. Health Behaviors1)Prioritize community health improvement planning efforts directed at key drivers of chronic disease, including smoking and other substance use, physical inactivity, and infrequency of sleep-given significant disparities found for Del Valle residents and smoking for Montopolisresidents in comparison with Austin and Healthy People 2020 goals.2)Increase health service seeking behaviors in order to address key disparities found for preventive services across indicators for Del Valle and Montopolisresidents in comparison with Austin, Texas and Healthy People 2020. In doing so, address key social determinants (health insurance, transportation to clinics, time off work that allows medical visits).Health Outcomes1)Develop concerted plan of action to address disparities in chronic disease outcomes for Del Valle and Montopolisresidents given majority of indicators (Del Valle) and selected indicators (Montopolis) that fare worse compared to Austin and Healthy People 2020 goals. 2)Prioritize interventions aimed at improving mental health support for Del Valle and Montopolisresidents given disparities found in good mental health days compared to Austin residents.Access to and Use of Health Care and Preventive Services1)Increase coverage of health insurance for Del Valle and Montopolisresidents to address the roughly one-third of residents currently lacking health insurance.2)Continue to explore strategies to increase availability and access to health care and preventive services given disparities across indicators for Del Valle and Montopolisresidents in comparison with Austin, state of Texas, and Healthy People 2020 goals. Recommendations (Comm. Health Indicator Analysis)Accomplishments & Successes!•Establishment of an awesome community advisory committee and partnerships (!)•Support of and contributions to youth leadership•Creation of YLCHLI curriculum•Development of StoryMap•Implementation of 4 community sharing sessions•Provision of insights regarding a range of community health indicators•Urban Institute newsletter spotlight•Ongoing discussions/partnership with YWCA in Connecticut and Aetna