4
Multisector Support for the Middle School Experience1
The afternoon session opened with a video of 13-year-old Alexandra Simonich sharing her essay about being in middle school and being an advocate for the needs of underserved students. Session moderator John Auerbach of Trust for America’s Health then introduced the panel of presenters from various fields working with middle school students: Barbara Ferrer of the County of Los Angeles (LA) Public Health Department and Lisa Warhuus of the Children and Youth Initiatives at Alameda County Health Care Services Agency, representing the public health sector; Tina Cheng of the Rales Center for the Integration of Health and Education and the Johns Hopkins University School of Medicine, representing the health care sector; Maryam Toloui of Oakland Unity Middle School and Evelyn Garcia of Will Rogers Middle School in the Lawndale Elementary School District (LESD), representing the social work sector; and, finally, Erica Louison of the United Way of the National Capital Area and Ta-biti Gibson of Restorative Justice for Oakland Youth (RJOY), representing the community-based organization sector.
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1 This section summarizes information presented by panel session speakers. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
WHAT IT IS LIKE TO BE IN MIDDLE SCHOOL2
Alexandra Simonich was an eighth grader at Wayside: Sci-Tech Middle School in Austin, Texas, a tuition-free college preparatory charter school founded in 2012 (Wayside: Sci-Tech, n.d.). Its curriculum focuses on science and technology. Simonich won first place in the Education Equality for All competition, which was hosted by the Hispanic Bar Association in Austin, Texas, for her essay describing her position as an education advocate.3
Simonich began by stating that she was very fond of her family dogs, adding that they helped with her social anxiety or concerns about how others view her. Simonich said that she wants adults to know that as a middle schooler, she was concerned and stressed about her future. She said she was unsure what options she had for her future as the world continues to undergo rapid changes, particularly related to climate change.
Simonich shared the context that propelled her to write the essay: it was in response to learning about her school’s lack of resources, such as good food, teachers, books, and classroom spaces. She shared her awareness that her school does not have a strong voice because it is not located in a wealthy area. Simonich added that while she believes that all children should have equal opportunity in education, she recognizes that the reality is often very different. She said it is easier to educate children when there is enough money and a lack of language barriers, teacher salaries are high, and children have their basic needs met. Students need to have a voice, Simonich stated, and schools can help them develop as leaders and advocates for change. Students need to “organize for change, be angry, be seen,” she concluded.
MULTISECTOR SUPPORT
Public Health Sector4
John Auberbach of Trust for America’s Health introduced a multisector support panel featuring speakers from the areas of public health, health care, social work, and community-based organizations. First to speak was Barbara Ferrer, director of the Los Angeles County Depart-
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2 This section summarizes information presented by Alexandra Simonich of Wayside: Sci-Tech Middle School. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
3 To watch Simonich’s full video, see https://www.youtube.com/watch?v=Dz8llXFrnYk (accessed December 14, 2020).
4 This section summarizes information presented by Barbara Ferrer of the County of Los Angeles Public Health Department and Lisa Warhuus of the Alameda County Health Care Services Agency. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
ment of Public Health. Ferrer explained that before her career in public health, she had been a high school principal in Boston, Massachusetts. She shared a story about Jerome, an eighth-grade student who was in a summer academy program helping students transition to high school and aspired to become a pediatrician. Ferrer said that many students in this program had low reading and math levels and were not previously given the necessary support to succeed and that the academy program sought to address some of the issues. After Jerome was absent for three consecutive days, Ferrer visited his home, where she found there were no adults, because his mother was working, no electricity, and limited food. Ferrer learned that Jerome was absent because one of his four siblings was ill and he was the acting caretaker. She felt this situation clearly exemplified how poverty affected his academic achievement. As the public health director in LA, Ferrer identified several problems at the root of education and health gaps: racism, homelessness, poverty, exposure to violence, and environmental hazards. Ferrer stated that unless these factors are addressed, students may be at risk for entering the criminal justice system for avoidable behavioral problems. Ferrer mentioned that 12 percent of seventh graders in LA County who responded to the California Healthy Kids Survey said they did not have any adults who cared about them at their school (Austin et al., 2018). The same children, Ferrer added, were at greater risk for a range of high-risk behaviors, including being
three times more likely to have high levels of truancy, five times more likely to use e-cigarettes, four times more likely to be using cannabis, three times more likely to be engaged in fights, four times more likely to have vandalized school property on multiple occasions, three times more likely to have missed school due to the fact that they were bullied, and two times more likely to consider themselves as part of a gang. (Austin et al., 2018)
Ferrer added that the fragmented way in which youth risk behaviors are approached is detrimental; given that these behaviors happen in clusters, addressing one at a time (e.g., preventing tobacco or cannabis use or bullying) falls short of what is needed to be effective. She added that positive youth development is an approach that can allow those in the education and public health system to reduce the need for young people to engage in risk behaviors.
Ferrer mentioned that public health departments could support the education sector in a variety of ways. First, Ferrer stated that community programming can help this age population. She added that these children are too young to be unsupervised but too old to be in day care, so early and after-school care based in the community were essential. Ferrer noted the collaboration between the health department and the parks and
recreation department in LA County and added that they have specific programs for middle-school-aged children called “Our Spot.”5
Second, Ferrer pointed out that middle school students have voices and smart ideas and that spaces and places should be created where it is safe for them to exercise these. A way to do that, she added, was to emphasize social-emotional learning (SEL) not only in the schools but also in the community and also have parents and caregivers learn to manage emotions and relationships. Third, Ferrer added that public health can support teachers and school staff on topics such as trauma-informed strategies (e.g., cooperative discipline), healthy foods, and food security issues. Finally, Ferrer mentioned that public health can support faith-based institutions and other community-based organizations that work closely with families and thereby have a positive impact on these children. Ferrer concluded her remarks with a short video featuring an LA County 10th-grade student testifying before the city council about the need to ban flavored tobacco products. Student organizing and leadership development “makes a huge difference,” stated Ferrer.
Lisa Warhuus described the work of the Center for Healthy Schools and Communities (CHSC). Warhuus explained that the center is embedded within the Alameda County Health Care Services Agency. CHSC collaborates with the 18 school systems in Oakland, California, to improve health and education outcomes. Warhuus noted that CHSC was established on a foundation of action to support the social determinants of health, and specifically education, given that education impacts health outcomes. CHSC has a vision: “a county where all youth to graduate from high school healthy and ready for college and a career.” “Ready,” Warhuus clarified, means that children are physically, socially, and emotionally healthy, have academic success, are in environments and with families that are supportive and supported, and can access education and health systems that are integrated and equitable.
Warhuus explained that CHSC is staffed with 50 individuals who work directly with school districts to build school health initiatives. CHSC primarily builds capacity to promote its goal by acting as a liaison and partnership builder, influencing policy, and funding school health initiatives, which are approaches that link resources for providing safe and effective learning environments. CHSC functions at the district level to maintain uninterrupted health and wellness services for individual schools, even as school administrations change (ACHCSA, 2019). Warhuus noted that CHSC supports 28 full-service school health centers, which provide medical, mental, youth development, and other services.6
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5 See https://parks.lacounty.gov/ourspot (accessed December 14, 2020).
6 See https://achealthyschools.org/site-map (accessed December 14, 2020).
Warhuus noted that in terms of funding, these centers are run by federally qualified health centers in partnership with Alameda County and receive funds from CHSC, which leverages upward of $1 million through various funding streams. Warhuus added that CHSC also funds behavioral support programs in more than 200 schools and at the district level, along with a youth service center in an unincorporated area of Alameda County, and supports family opportunity initiatives. Overall, Warhuus declared that the county investment in CHSC activities amounts to $17 million annually, which CHSC leverages up to $52 million, and all combined investments in school districts equal $67 million.
In terms of evaluation, Warhuus commented, CHSC uses a results-based accountability framework. Warhuus stated that for the 2018–2019 school year, CHSC registered 14,500 students in the school health center, who made 56,762 total visits.
Warhuus noted that “school-based behavioral health is way more about changing adult behavior than it is about youth behavior” and the work in Alameda County includes supporting teachers and administrators in creating environments that support “positive youth experiences.”
CHSC emphasizes a public health approach to mental health by stressing positive school culture and climate. Warhuus added that 84 percent of students who used the school health centers agreed or strongly agreed that the centers helped them “get access to healthy foods when they or their families did not have enough.” Additionally, 41 percent of students who used mental health resources showed improvement in behavioral health (ACHCSA, 2019).
Health Care Sector7
Tina Cheng, director of the Department of Pediatrics at the Johns Hopkins University School of Medicine and co-director of the Rales Center for the Integration of Health and Education, opened by stating that while health and education are intrinsically linked with highly correlated outcomes, the two sectors remain “siloed financially.” Cheng described the bidirectional relationship between health and education: the higher the educational attainment, the better one’s health is throughout the life cycle, and the healthier the student, family, and community are, the higher the educational achievement.
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7 This section summarizes information presented by Tina Cheng of the Rales Center for the Integration of Health and Education and the Johns Hopkins University School of Medicine. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
Cheng introduced the Centers for Disease Control and Prevention Kaiser Adverse Childhood Experiences (ACEs) Study, which looked at the relationship between ACEs and adult chronic conditions (CDC, 2019). This study had two series of data collections between 1995 and 1997 in which health maintenance organization members receiving care in the Kaiser Permanente Southern California network completed surveys about ACEs and current health status and behaviors (CDC, 2019). ACEs included but were not limited to poverty, violence, incarcerated parents, and racism and other forms of discrimination. The study found that there was a dose–response relationship between ACEs and the risk of poor health as an adult (i.e., the more ACEs a child experienced, the more likely they would have poor health). The relationship has been established for various chronic issues, including ischemic heart disease, stroke, chronic obstructive pulmonary disease, sexually transmitted diseases, and poor mental health outcomes, including depression and anxiety (CDC, 2014). Cheng added that the relationship also holds true for social outcomes, such as absenteeism, financial problems, and poor work performance.
Cheng shared that the World Health Organization pinpointed investment in the academic development of youth as one of the most effective ways to improve health and reduce health disparities. Cheng mentioned that the Community Preventive Services Task Force (2016) conducted a review of 44 studies focused on school-based health centers and found that the centers had a positive impact on issues such as asthma, delivery of recommended preventive services, some high-risk behaviors (including smoking and substance abuse), and general academic achievement. The review did not find the centers to have an effect on sexual activity, self-reported physical health, or mental health. In terms of sexual activity, Cheng noted that although there may be upticks in contraception distributed through school-based health centers, it does not necessarily change sexual activity. Cheng added that there is recognition of missing attention to mental health issues in middle-school-aged children. Overall, Cheng mentioned, the review found that educational outcome improved “just from having school-based health centers.”
Cheng said she sees many opportunities to integrate health and education. The Rales Center, for instance, operates health clinics, offers other programming to charter schools in Baltimore, and aims to incorporate health and learning (Rales Center for the Integration of Health and Education, 2020) (see Figure 4-1). The goal of the center is to “weave health into the fabric of learning” by integrating, not merely collocating, health and education. Cheng explained that there is a focus on the school population and wellness and screening programs for hearing, vision, body mass index, and dental concerns as well as nutrition and physical activity programs. In addition to these traditional programs, the center also provides
NOTE: K = kindergarten; KIPP = Knowledge Is Power Program.
SOURCES: Cheng presentation, December 5, 2019; Rales Center for the Integration of Health and Education, 2020.
mindfulness-based stress reduction, violence prevention, and reproductive health education via the school health curriculum. Cheng added that programs for parents and teachers are also under the umbrella of services offered by the center.
Cheng highlighted a few examples of the Rales Center to illustrate how it supports health and learning. First, Cheng shared a story about a student who had difficulty managing his asthma. He missed school three times during the first month of sixth grade; he was out of breath after gym class, and his teacher sent him to the center, which provided screening, treatment, and education on his disease. There was continuity of care, as the center also connected his family to the home-visit-based Baltimore City Community Asthma Program and his pediatrician. He has not suffered any asthma attacks since then because he, along with other 50 students, visits the center every morning to use an inhaler for management. The student has also become part of the Rales Afterschool Exercise Class and took part in the center’s annual 5K Fun Run with his family.
Cheng also discussed the Rales Center’s visual screening program, in which an optometrist is brought to the school to perform eye exams, fit
students for glasses if needed, and provides students with two pairs of glasses, one for school and the other for home.
Lastly, Cheng mentioned the evaluation of the Rales Center’s activities. She said that it had served 1,500 students over 3 years, and not only had chronic absenteeism been reduced, but the rates of children with asthma and attention-deficit/hyperactivity disorder (ADHD) dropped by 49 and 50 percent, respectively. She stated that the center had prevented 212 emergency department visits, increased immunization rates, and screened 90 percent of all students for vision, dental, and body mass index issues. Cheng explained that for every $1.00 invested in the center, there was a $4.20 return in social benefit. Both parents and teachers, she added, responded well to placing health centers in schools because of convenience and health improvements in their children and students.
Social Work Sector8
Maryam Toloui, director of the Holistic Socioemotional Support Unit at Oakland Unity Middle School, and Evelyn Garcia, social worker and field instructor at Will Rogers Middle School in Lawndale, California, shared social work perspectives on middle school health and well-being.
Oakland Unity is a free public charter school in East Oakland serving 180 students in grades six through eight. Toloui mentioned that to attend the schools, parents apply via the General Common Application called “Enroll Oak,” used by the Oakland District and the charter schools, and schools are filled via a lottery system.
Toloui explained that the middle school is located in a converted shopping mall that is now a hub providing a one-stop shop for social services, including the social security office. She said that the area designated as the school has the traditional spaces, including a wellness center, gymnasium, and school cafeteria, although there is no outdoor space for the children.
She stated that the majority of students are Latino/Hispanic (84 percent), while 12.5 percent are African American, 2.5 percent are Asian/Pacific Islander, and 1 percent are White. The vast majority of students (83 percent) qualify for free or reduced-price lunches, almost all are Oakland residents, and 49 percent reside in the school’s zip code. Currently, 39 percent are English language learners and 40 percent were formerly English language learners. In the 2019–2020 sixth-grade class,
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8 This section summarizes information presented by Maryam Toloui of Oakland Unity Middle School and Evelyn Garcia of Will Rogers Middle School in LESD. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
16 percent were proficient in English language arts and only 8 percent were proficient in mathematics. Only half of parents had a high school diploma or higher education.
Toloui noted that students at Oakland Unity were exposed to higher levels of stress due to violence and trauma. She said that a survey conducted by Oakland Unity in 2017 specific to middle school teachers found that 80 percent of them felt burned out by their students’ emotional and social needs, 90 percent said they wanted more support services to become more effective educators, and 80 percent said more support services would increase their job satisfaction.
Toloui said that “it became very clear that the level of need was much more robust than what we had in place” and thus needed “to increase [their] support structures.” The school created the Holistic Socioemotional Support Unit, with a director (Toloui), a social worker, and counseling interns, that renders services in English and Spanish. The interns are enrolled in local graduate programs and practice under Toloui’s supervision.
Toloui stated that all of the students at the schools were facing challenges and ACEs, including poverty and housing problems, such as multiple families in one apartment (one nuclear family per bedroom). She added that there were also were immigration and deportation issues and an increase in the number of unaccompanied minors emigrating from Central America to avoid violence.
Toloui described the three tiers of services rendered via wellness program. The first tier is “universal interventions and supports,” which implements an SEL curriculum in some classes, manages student advocacy groups and wellness clubs, consults with teachers on trauma-informed educational practices, and collaborates with school administrators regarding school policies, such as discipline and suspension, and their effectiveness and practicality. Tier 2, “targeted intervention and supports,” provided students and their families with crisis intervention, group counseling, and peer mediation; acted as a gateway to community resources; and included support unit members consulting with teachers and staff on students who needed more support and collaborating with the Special Education Department. Tier 3 consisted of “intensive interventions and supports,” wherein the support unit worked with students and families during weekly mental health counseling meetings, gave family support and therapy, conducted home visits, and provided transportation assistance. Tier 3 also provided teacher and student mediation and entailed working more intensively with teachers and staff on specific students and families.
Toloui said that due to the extensive needs of students, families, teachers, and staff, the unit developed various community partnerships,
including community mental health agencies, dental and vision care, and resources that provide for basic needs. The school used local, state, and federal per-pupil funding and funding available to Oakland middle schools to spend in one of four areas: safety, foreign language, art, or music. Oakland Unity invested this funding into “safety,” as mental health services fall within this category, and surveyed students and parents. Toloui concluded with some of the survey responses, which showed that a majority of parents responding felt the school was a safe place (95 percent), and 83 and 85 percent of surveyed students felt they were physically or emotionally safe, respectively. Those teachers who felt they were prepared to meet their students’ social-emotional needs increased from 10 to 40 percent.
Evelyn Garcia described the student support services program at LESD, which was established in 2013 and funded via the Local Control Funding Formula. The set of services contains an onsite social worker at each school, eight community liaisons, one Medi-Cal outreach liaison, and one district social worker. The program focuses on academic, social, emotional, and behavioral aspects through the lens of equity, collaboration, and evidence-based practices (LESD, 2018) (see Figure 4-2).
Garcia described Will Rogers as having a diverse student body, with about 74 percent of its students being Latino/Hispanic, African American, Asian, and other. Eighty percent are eligible for free or reduced-price lunches. Garcia noted that the school has identified 26 families who are homeless, and she added that 27 students have recently moved from other countries, 3 are foster youth, and the LGBTQI+ population is significant. She mentioned that major concerns at the school included ACEs, such as trauma and exposure to violence and abuse, which manifest as anxiety, depression, substance abuse, bullying, self-harm, suicidal ideation, and ADHD.
Garcia described how the onsite social workers and interns addressed the wide range of mental and behavioral health issues that students are facing. She said that the onsite licensed social worker trains the interns, provides social-emotional professional development for teachers and staff, and conducts risk assessments and crisis response management. The interns, under her supervision, provide an array of services, which Garcia detailed. About 80 percent of their work is with the general school population, including class lessons, monthly awareness activities, parent workshops, teacher training and support, and Positive Behavioral Interventions and Supports, which is designed to develop positive behavior and school climate.9 She added that the interns focus some of their efforts on at-risk students by providing short-term individual counseling, group
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9 For more information, see https://www.pbis.org (accessed February 25, 2020).
SOURCES: Garcia presentation, December 5, 2019; LESD, 2018.
counseling, and conflict mediation. The interns also tend to high-risk students, who make up 5 percent of the student population, through individual counseling, crisis management, and attendance counseling. Garcia added that professional development topics outside of trauma include implicit bias, responding to challenging behaviors, restorative practices, and self-care.
Garcia closed her presentation by stressing the vital role of partnerships and support from leadership and the need for a collaborative approach to meeting the needs of students, families, and schools. Specifically, Garcia mentioned that support from the superintendent, school directors, and students was crucial. She added that community partners, such as the University of Southern California, Loyola Marymount University, California State University, and California State University,
Dominguez Hills, make it possible for her team to connect students with mental health and counseling services and that services such as those rendered by Vision To Learn10 help students with learning-related needs, including glasses.
Community-Based Organizations Sector11
Erica Louison of the United Way of the National Capital Area (UWNCA) began by introducing the United Way, stating that it was established 45 years ago and serves 11 counties across Maryland, Washington, DC, and Northern Virginia. Its mission, Louison described, is to sustainably improve the lives of those living across 11 counties in Maryland, Washington, DC, and Northern Virginia by focusing on community resources. Louison said that in 2014, UWNCA shifted its focus to education, financial stability, and health and, after engaging in dialogue with stakeholders and evaluating evidence-based best practices, developed a 5-year strategic investment plan to solve the root problems of inequity.
UWNCA has a distinct focus on middle schoolers because, as Louison pointed out, the organization found that this group has traditionally been overlooked; other agencies and funding tend to focus on early childhood education and the transition from high school to college. Louison added that UWNCA currently supports 13 schools and more than 10,000 students and their families. UWNCA expressly uses the Community Schools Strategy to prepare students in Title I schools to transition successfully to high school and graduate. At its core, Louison explained, this strategy requires stakeholder engagement, collaborative efforts, and capacity building informed by an annual needs assessment. It employs various activities, both academic and nonacademic, to expose students to experiential learning, integrate students into health services and basic needs resources, and support family and community engagement (United Way, 2020). Louison stated that UWNCA mobilizes the community via local residents and municipalities, and that donors and volunteers support its overall activities throughout the region. She added that UWNCA has invested about $4.5 million into the community schools programs in the region and that the 5-year commitment aims to serve 12,000 middle school students (it has served 10,000 thus far).
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10 For more information, see https://visiontolearn.org (accessed December 15, 2020).
11 This section summarizes information presented by Erica Louison of the United Way of the National Capital Area and Ta-biti Gibson of Edna Brewer Middle School. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
The middle school success program at UWNCA, Louison added, is engaged in various activities to support its three areas of focus: monitor absenteeism, promote positive prosocial behavior, and promote academic achievement levels, specifically in English language arts and mathematics in middle schoolers, as these are predictors of high school completion. It also provides office hours, data collection and analysis, and technical assistance to teachers and staff. Volunteers for UWNCA participate in various relevant activities, and financial and supplies donations are collected regularly.
Louison then described UWNCA’s evaluation processes. Under the advice of the Urban Institute, UWNCA collects a series of reports from the nonprofit partners in 13 schools each year. Louison explained that the schools provide two preliminary reports based on each school’s needs assessment plan and preliminary goals, needs-assessment results, and annual goals. These and other reports are used to evaluate the program using achievements, challenges, lessons learned, and standardized test scores. Louison shared a few outcomes captured in these various reports: 88 percent of students in the program had no new suspensions, 76 percent improved by one grade level or maintained the same level of C or higher in mathematics, and 75 percent improved by one grade level or maintained the same level of C or higher in English language arts.
Louison mentioned that in addition to the reports, UWNCA conducts two annual site visits for each school where it collects feedback from students, teachers, administrators, and parents. She shared that these individuals “appreciate and support the investment that [UWNCA] has made in community schools.” Louison concluded by reporting that the community sees UWNCA as a leader and expert and invites it to sit in policy councils, steering committees, and school board meetings to help develop and shape policy in the community.
Ta-biti Gibson, coordinator of RJOY at Edna Brewer Middle School, opened by stating that RJOY has the largest peer restorative justice leadership team in the country. Gibson described restorative justice as a theory that focuses on meditation, responsibility, and agreement rather than traditional punishment. Gibson explained that restorative justice aims to collectively identify and address harms and needs for healing.
Gibson explained that there are 94 students at Edna Brewer who have been trained in RJOY’s restorative justice model (see Figure 4-3). The model has three circles; the first contains the first tier of restorative activities for students, which consists of providing social and emotional support and hosting restorative conversations. Tier I includes community building circles, encouraging relationship building. Gibson added that restorative justice activities should place the most emphasis on building relations. The second circle is Tier II activities, which focus on reducing
SOURCE: Gibson presentation, December 5, 2019.
conflict and harm. Gibson added that a strong foundation in Tier I should be there to support the activities in Tier II and that Tier II activities involve alternative modes of disciplinary responses, as opposed to suspensions or detention. Gibson noted that parents are often involved in these circles and there have been positive responses to resolving behavioral concerns this way. Tier III, Gibson explained, facilitates the reentry of students after an absence from school for reasons such as suspension, illness, family dysfunction, or juvenile hall.
Gibson shared that he took 14 of 94 students to Denver, Colorado, to the Restorative Justice International Conference, where, for the first time, middle school students were presenters on women’s equality and transgender rights. He added that the success of the program lies in the fact that the students themselves exercise restorative justice whenever a situation at school calls for it. Gibson added that through restorative justice practice, students know that the “self and silence” are the best teachers.
DISCUSSION
A brief discussion and question-and-answer session with the audience followed the panel’s presentations. Auerbach asked “what are the policy implications for a nationwide policy to expand best practices?” Toloui responded that there is a strong need for various social-emotional
skills to be part of the academic curriculum and to be appropriately funded for implementation. She said these skills must be taught so that they can be learned and practiced, just like reading and math. Cheng added that attention was needed to funding for school nurses and school-based health centers to address mental health concerns and disparities. Gibson answered by stating that social-emotional skills and science, technology, engineering, and mathematics approaches should be similarly emphasized in schools.
A participant observed that while approaches within the various sectors were different, there were also similarities. The participant then asked the panel to reflect on the various funding sources that support the range of services the panel described. Warhuus shared her experiences in Alameda County of leveraging multiple funding streams when possible, including the Our Kids Our Families Program, which has nonprofit mental health care providers who bill Medicaid. These providers are paired with social workers and other mental health professionals who do not bill Medicaid to ensure that any student has access to mental health services regardless of Medicaid status. Ferrer agreed with Warhuus in that sector partnerships have to break down siloes and added that some small changes in policies within organizations may have a larger impact on providing resources and services more fully, such as setting up new budgeting priorities. Ferrer added that there has to be intentionality in “every single thing you do as building … justice and capacity for equity.” Ferrer mentioned contracting, such as the intention to fund organizations that build said capacity. She added that of the $1.3 billion in the budget she manages per year, $500 to $600 million goes to community organizations and she pays attention to funding smaller community-based, women-owned, and LGBTQ organizations. Ferrer added that hiring practices can also be helpful; for example, the LA County Health Department has set up a youth advisory board for the department and hired them as interns, as opposed to having them be unpaid. She said that everything a local health department does can have a positive impact, and thus reviewing internal policies with a justice and equity lens is helpful.
Cheng responded by stating that the shift from volume to value is leading to greater interest in this kind of community-based work from private payers, Medicaid Managed Care, and federally qualified health centers. Auerbach commented on the importance of state policies (e.g., Medicaid waivers) to support payment models that allow for expanding school-based health care and other best practices. He said that Medicaid or health insurer reimbursement is a “somewhat potentially unlimited funding source.” He gave the example that he assumed that restorative justice was not a reimbursable service, but there should be an “[alternative] in those cases.”
Phyllis Meadows of The Kresge Foundation asked the speakers to reflect on assets found in students, teachers, and communities and how to apply an asset-based and prevention mindset to this work. Ferrer said that students have not been part of the decision-making process in their schools and may be excited to take part in student council or another form of governance. Ferrer said this may give students a sense of belonging and power in their learning environment. She gave the example of restorative justice, as it trains students to be both leaders and decision makers. Gibson reflected on his experiences with his students conducting restorative justice circles. He said it was important for teachers and adults to let students use the skills they have gained. Auerbach added that students are resilient so long as the root of their problems is being addressed. He illustrated this with an example from Puerto Rico, where the trauma experienced by students in a small community affected by Hurricane Maria could begin to be resolved only when the underlying housing and employment issues were addressed. Toloui added that middle schoolers are intelligent, creative, generous, and resilient. In response to the issue of prevention in Meadows’s question, Cheng said there are many issues, such as poverty, that we know how to solve but that there needs to be more political will and appropriate funding to fully address them.
