HealthyCal.org

By Nicole Jones
California Health Report

There’s more to consider than just a family’s income when it comes to measuring poverty and its impact on a child’s well-being, a new study finds. The report by Child Trends Center, a non-profit research organization, is the first to examine the impact of geographic variations and cost of living on child outcomes.

“Not only is income important,” said the study’s co-author Nina Chien, “but income in context of where the family lives.”

The current federal poverty guidelines do not consider cost of living variations, assuming that a dollar in San Francisco buys the same goods and services in rural Nebraska. The Child Trends Center study says this gap is hindering poor families’ ability to receive the aid they need, like food stamps, State Children’s Health Insurance and other government assistance programs.

Another study estimated that within a sample of 98 cities, if costs of living were considered, eligibility for Head Start would increase by 227,000 families and eligibility for the National Lunch Program would increase by half a million.

“There may be low-income families living in high-cost areas and are not eligible for aid,” Chien said, “but in fact they may need it because they have little income left over after rent.”

Cost of living varies drastically across the United States. One month of rent for a modest two-bedroom apartment averages $3,000 in San Francisco and $500 in Frontier County, Nebraska. A family of four with an income of $35,000 living in San Francisco has more financial challenges compared to a family in Frontier County.

Living in a high-cost state does not necessarily mean more benefits are available either. California, for example, does not have a state Earned Income Tax Credit, a refundable tax credit for low to medium-income parents. Existing subsidies are also difficult to access. Section 8 public housing programs in many metropolitan areas have wait lists that are several years long or closed. The wait list for Los Angeles County has been closed since 2009. And only about one-third of families eligible for childcare subsidies currently receive them.

The study also found that living in a higher-cost area was related to lower school resources for poor families, but to higher school resources for moderate-income families. This suggests that in higher-cost areas, schools are economically segregated.

Chien said this report demonstrates how cost of living intersects with income in meaningful ways for child well-being and should be considering for measuring poverty and providing much needed aid. “If more assistance can be directed to those resources,” she said, “the playing field would be more level between living in high-cost and low-cost areas.”

By Joy Hepp
California Health Report

Arcenio Lopez hasn’t been a farm worker since 2003, but the Oaxaca, Mexico native still remembers what it feels like to work a full day under the California sun.

“Your boss is telling you to hurry up,” says Lopez, who spent a year picking strawberries near Oxnard. “Second, you have this pressure. You feel if you don’t move faster you won’t make a good check. You hurry a lot. You think if you drink too much water your body is going to be heavy and you won’t be able to [fill] more boxes.”

Lopez, who is now administrative director for Mixteco/Indigena Community Organizing Project in Oxnard (MICOP), says he was not prepared for the dangers associated with working eight hours or more under direct sunlight. Although deaths related to heat illness have decreased dramatically across the state – from 12 in 2005 to four suspected cases pending medical determination in 2012 – the danger for workers is still very real, particularly during heat waves and during a worker’s first week on the job. Even if heat stroke doesn’t lead to death it can shut down and/or damage major organs and it is particularly difficult to diagnose during urgent care.

“When I was a farm worker I never heard about heat illness …or my rights as a worker,” Lopez says.

If Lopez were working in an outdoor industry in California today, he likely would see billboards in Spanish or hear radio ads in his native Mixteco language with slogans like “A wise man looks for shade.” or “If you want to last, don’t forget to drink water.” Or, he may have learned from a co-worker that his employer is required by law to provide adequate protection from the heat.

MICOP is one of more than 100 organizations in a grassroots network across the state that are working with the California Occupational Safety and Health Administration (Cal/OSHA) and the University of California to help educate workers in the agriculture, construction and landscaping industries both about the dangers of heat-related illness and about their rights as workers.

The issue of heat-related illness came to the forefront among California labor activists and officials in 2005 when record-breaking heat led to 12 farm worker deaths. The State of California issued emergency heat regulations, which were made permanent in 2006. The Heat Illness Prevention Standard — developed by Cal/OSHA — was the first of its kind in the United States and has since been adopted by its Federal counterpart; it calls for employee and supervisor training, fresh water provided at work sights, access to adequate shade for rest and recovery periods and written documentation on site that provides information about the regulations.

After the regulations were passed, the next essential task became educating California’s diverse population of outdoor workers and their employers. Despite initial efforts to get the word out, “it became pretty clear the more outreach was done that we weren’t reaching quite as deep into the base,” says Erika Mendoza of California’s Department of Industrial Relations, Cal/OSHA’s parent organization.

When Cal/OSHA received a government mandate to create a targeted outreach campaign regarding heat-related illnesses in 2009 they enlisted the help of UC Berkeley’s Labor Occupational Health Program (LOHP) to create educational materials and a multimedia communication plan including billboards, radio ads and a comprehensive website that was launched in 2010.

Train the Trainer

At the heart of these educational efforts are “Train the Trainer” workshops in which representatives from LOHP along with UCLA’s Labor Occupational Safety and Health Program (LOSH), and UC Davis’ Western Center for Agricultural Health and Safety (WCAHS) train representatives from schools, advocacy organizations, cultural centers, churches and health centers who in turn reached out to thousands outdoor workers in their respective communities.

“They tend to be the trusted resources and the go-to places, so we have done a lot of outreach to engage those organizations in the campaign,” says Erika Monterroza of the Department of Industrial Relations. “One of the goals of the campaign has been to create a community norm that starts to see this as a public health issue.”

Lopez says he’s seen a growing awareness among his clients.

“I’ve been seeing people being more conscious about this,” he says. Workers realize “it’s not a game. It’s something real.”
According to UC Berkeley’s Labor Occupational Health Program, the train the trainer workshops in addition to direct worker outreach reach 6-8,000 workers per year. For a worker who may be on the job site 10-12 hours a day, 6-7 days a week, this type of peer-to-peer education can be a needed lifeline.

“I think people really appreciate the information,” says Norma Ventura, a community worker with California Rural Legal Assistance who has participated in the Train the Trainer education efforts. “They’re not told they have the right to shade, or that the employer is responsible for following a certain procedure. They don’t get that information anywhere else.”

In 2006 Cal/OSHA found only 32 percent of inspected work sites to be in compliance with the new regulations. In 2011 of 753 heat enforcement inspections, 76 percent of employers were found to be compliant. However, Ventura says that many of her clients – who work in seven Central California counties – report that the workplace culture is often slow to change.

“We’re out there telling farm workers what the law says and they tell us how it doesn’t work that well all the time,” she says. Her clients tell her they worry that, “If we’re feeling sick and we say something, then we’re not going to get called back to work the next day or the next season.”

Both Ventura and Lopez report that dangers often arise for clients whose pay is based upon the amount they harvest each day, or on a “per piece” basis. Many of these workers worry that stopping to take a break in the shade or drink a glass of water would only serve to slow them down, thus taking away from their bottom line.

“They don’t really have that freedom to drink water, they just have this pressure,” Ventura says.
LOHP Progam Coordinator Suzanne Terran says one of the goals of the Train the Trainer workshops and employer outreach is to make heat illness prevention the norm in all outdoor workplaces.

“It’s about creating this culture in the workplace where everybody is doing it,” she says. “We’ve heard examples of where the crew leader blows a whistle and everyone takes their quick water break. It should be accessible and that’s been part of what’s been emphasized so they can in fact drink it without it becoming a big task.”

Over the past week the California legislature passed a trio of bills that would affect outdoor workers. AB 1313 calls for overtime wages, AB 2676 would make it a crime punishable by a fine and/or jail time for employers who don’t uphold heat standards, and AB 2346 would allow workers to sue their employers directly if they don’t provide adequate water and shade. When reached for comment, a Cal/OSHA representative said the agency does not comment on pending legislation. However, Cal/OSHA Heat Illness Prevention coordinator William Kreycia says educational outreach efforts will continue no matter the legislative outcome.

“Heat illness prevention will continue through 2012 into 2013 and as long as heat presents a hazard to the workers of the state of California,” he says.

San Diego Sets the Bar for Older Adults

By Matt Perry
California Health Report

Like many senior centers around the country, the downtown San Diego building at 9th and Broadway was dingy, dark, and offered limited social activities like bingo or the occasional dance. Older adults who weren’t depressed before they arrived at the center often left that way.

But when two local philanthropists met with the center’s director as part of a survey of 10 local senior centers – the trio quickly found they shared the same daring vision: a glittering, high-tech wellness center that would pioneer coordinated health and social services for the impoverished elderly.

Two years ago, the Gary and Mary West Senior Wellness Center fulfilled that vision, opening an environmentally-designed building and a program that blankets clients with support ranging from meals to health classes, housing assistance, nursing advice, transportation, social services, mental health support, and a cyber café.

“This is not your grandma’s senior center,” says Paul Downey, president and CEO of Senior Community Centers, a phrase echoed by staff members heralding a new and innovative approach to elder care.

The gleaming new building, a mile from its original site, today assists more than 3,000 clients annually – 86% of them below the poverty level. Attendance doubled in its second year.

New clients to the center are welcomed into the busy and spacious ground floor by a receptionist who assesses their needs and directs them to one or more services, including food, nursing, or social work.

To the left is The Gathering Place, a room dedicated to health classes ranging from exercise to cooking and diabetes prevention. (Mary West herself teaches a monthly cooking class.)

To the right is the common area, where visitors can read, relax, or watch television in a cavernous room infused with natural light.

The Cyber Café offers computer workstations for classes and tutoring. A game room features board games like checkers and backgammon.

Together, the wraparound services – part of either the center’s Lifelong Learning Institute or the Center for Healthy Aging – focus on keeping older adults out of expensive emergency rooms or urgent care centers.

Downey summarizes the wellness center’s mission: “To provide real-time health interventions that will keep people healthy before something cataclysmic occurs.”

This philosophy mirrors a growing sentiment in the world of health: proper medical care is the hub of a much larger wheel that includes housing, nutrition, exercise, community interaction, and sense of belonging.

“We know that if we keep them healthy, we’ll keep them independent. Nobody aspires to be in a skilled nursing facility,” says Downey. “Everybody wins. There are no losers in this scenario.”

Robert Steenson, 72, was a big winner after getting sick while living out of his car.

“One day I got up and had blood in my urine,” he recalls.

Steenson had cancer. To receive surgery, though, he needed a place to live. The West Wellness Center staff not only found him an apartment, but now provides transportation assistance for appointments, helps him manage his diabetes, assists with food preparation, and makes sure he takes his medications.

“Anything they can help you with they’re more than happy to do,” says Steenson.

Key to the center’s focus on wellness is its most high-tech offering. Placed near a window at the edge of the noisy community room, a health kiosk from Solo Health provides patients with instant assessments for vision, blood pressure, weight, body mass index (BMI), and overall health risk.

The kiosk will play a vital role in the center’s future, central to a its “Passport to Health” program, which will require patients to meet with a new Geriatric Care Coordinator and use the kiosk – both twice a month – according to Mary Mazyck, vice president of programs and services,

While 75% of visitors to the Wellness Center come only for meals, the remainder use its wide range of social services.

Mazyck says some older adults come to the wellness center right after being discharged from the hospital.

“There’s a place for them to go and ask questions,” says Mazyck, adding that the top requests are for housing and medical care, “This is where people have fallen through the cracks.”

Although it is not a medical clinic, the center has a staff nurse who sees patients in the morning then travels to the network’s two multi-unit housing facilities.

Staff social workers ensure clients receive treatment for geriatric depression, or qualify for Medi-Cal. Some even receive food for their pets when they can’t afford it.

“We’ve always known that people feel better and live longer because they come here,” says Mazyck.

Dennis Dooley, 71, participates in several wellness activities at the center. He exercises five days a week, uses the Cyber Café, attends ice cream socials, and attends classes to manage his diabetes.

Dooley, who lives by himself, says without the center life would be much harder.

“I’d have to go out and find my happiness and wellbeing in the city of San Diego, possibly by going to 12-step meetings,” he says. “The senior center arranges a lot of my entertainment.”

For Downey, the wellness center refutes ideas that aging adults and technology don’t mix. In particular, he cites the center’s Cyber Café.

“It blows apart the stereotypes that seniors can’t use technology,” says Downey. “That’s a lot of crap. They need to be shown. They need to be taught.”

The building itself received a coveted LEED gold award for energy savings and sustainable design. One unique feature is Solatube lighting, which uses a series of mirrors to pipe natural daylight into rooms, entirely replacing bulbs.

Senior Community Centers operates the 10 senior centers as well as two apartment complexes that offer 350 units of housing. Together, the vast system provided 450,000 meals last fiscal year – about 40% of them served at the West Wellness Center. (The organization expects to serve 100,000 more meals this year.)

The wellness center serves a wide ethnic mix: about half are white; one-quarter are Asian; over 20% are Latino; and more than 10% are African-American. Besides English, the multi-ethnic staff speaks Spanish, Mandarin, and Tagalog.

Critical to the West Wellness Center’s success are the alliances formed with a wide variety of players in the San Diego health system.

The region’s powerful Sharp Community Medical Group donates a full-time psychiatric nurse who assesses whether clients can safely live on their own – saving the center $100,00 annually.

An Elder Law and Advocacy attorney visits twice monthly to offer legal advice.

And both local university systems – the University of California San Diego and San Diego State University – also provide crucial assistance. UCSD sponsors the “Bridge to Recovery” program for mental health and substance abuse, while SDSU sends student nurse practitioners to teach various health classes.

Gary and Mary West are two of San Diego’s leading philanthropists, who in 2009 also founded the West Wireless Health Institute, a research organization devoted to digital health solutions.

“These seniors are ordinary folks who haven’t caught many breaks in life and are now teetering on the edge of survival,” writes Gary West in an email. (The Wests do not give interviews.) “Our philanthropic investment helps the center provide programmatic outcomes that literally change and save lives. From our perspective, there is nothing better than that.”

By Nicole Jones
California Health Report

The Great Recession hit black workers the hardest, according to a recent report by The Urban Institute, a nonprofit, nonpartisan policy research organization.

“Many low-wage unemployed African-American workers are likely suffering more economic hardship than their white counterparts,” the report said, on top of the statistics that African-Americans likely have fewer assets to fall back on.

Although the unemployment rate is higher for blacks than for white or Hispanic workers, the report found that black workers were less likely to receive benefits than whites, 23.8 percent compared to 32.2 percent respectively. This is even after considering other factors that might explain differences like education, the type of job they held and length of employment.

Some of the difference could be attributed to workers’ choice or preferences, the report said, but it could also reflect discrimination in hiring and reported reasons for separation from those jobs, both of which can affect eligibility.

Previous similar studies have shown that unemployment benefits help to keep families out of poverty when a breadwinner loses a job, said Margaret Simms, one of the report’s authors. Having access to these benefits helps families reduce the need to deplete their assets and draw funds from retirement accounts.

The unemployment insurance system is designed to assist workers who lose their jobs through no fault of their own. A number of factors are considered that might be related to “fault,” Simms said. For example, “they were not fired for cause or quit the job voluntarily,” she said, or “they worked long enough in the job to show a commitment to the employer. They aren’t job ‘hoppers.’”

The measures used to determine fault may work against some types of workers seeking benefits. For example, people who leave a job for family reasons are not eligible in for unemployment in all states. People who don’t hold a job for at least a year are typically not eligible for benefits. In some states, people who are only looking for part-time work also may not eligible. Workers in certain industries might not get unemployment because their employers do not pay into the system.

California’s unemployment insurance system is fairly inclusive, allowing workers to leave a job and collect benefits for family reasons, and even if they are only looking for part-time work. Although there is currently no data specific to race and unemployment insurance benefits in California, the state saw fewer workers filing for benefits over the last year. The California Employment Development Department reported that there were 518,605 Californians receiving regular unemployment insurance benefits during July, compared to 566,380 last year. At the same time, new claims for unemployment insurance were 52,336 in July 2012, compared with 57,897 in July of last year.

But as the Urban Institute study reports, these numbers are not a true indicator of how many people are actually unemployed. There could be many more people who simply haven’t applied for benefits or have been denied for various reasons.

The current unemployment insurance benefit system is a combination federal-state system, with the states making up most of the rules on who is eligible and setting the tax rates for employers who contribute to the system.

Simms says eliminating the racial gap in benefit receipt work require greater information dissemination about who qualifies, as well as some changes in state and federal policy.

“The federal government could make it attractive for states to institute reforms that make the program more inclusive,” Simms said. This tactic was tested under the 2009 Unemployment Insurance Modernization Act, which was part of the stimulus package, and was only partially successful in encouraging reforms.

“The federal government could also assume a greater share of the costs on an on-going basis, basically federalizing the system,” Simms said. That might not be very likely, she added, given the current concerns about the federal budget deficit.

Larry Gray on his second day at Pine Grove Youth Conservation Camp. Photo: Callie Shanafelt/California Health Report

By Callie Shanafelt
California Health Report

Driving into the wooded campus of Pine Grove Youth Conservation Camp feels like arriving at a summer camp – until you see the road signs warning that you are entering a correctional facility.

The mint green office, school, kitchen and dorm buildings are relics from their Civilian Conservation Corps days. The only hint that something unique is happening here is the large garage with red and white ambulance-looking vehicles marked CAL FIRE parked inside.

At this camp, about 60 young men aged 18-25 serve the last year of their sentence with the California Division of Juvenile Justice (DJJ) fighting wild land fires and responding to other emergencies on a CAL FIRE crew. There are no fences, the doors are unlocked and wards are regularly left unsupervised.

“We give them opportunities to screw up,” says Camp Superintendent Mike Roots. “We hope they don’t—but sometimes it takes a while.”

The main goal of the camp is to prepare wards to return to their communities with a work ethic and job skills that will help them be productive members of society. But after a decade of juvenile realignment, Roots says that goal is getting harder to achieve.

In the past ten years, the DJJ has gone from more than ten thousand wards to under one thousand. Most low-level offenders are now serving their time in county facilities and those left in state institutions are the highest-level offenders.

In order to qualify to finish their sentences at Pine Grove wards must show signs of rehabilitation, not be a flight risk or have violent tendencies. The number of wards who qualify is getting less and less.

Ten years ago there were six fire camps for juveniles throughout the state. Pine Grove is now the last camp in operation. But Pine Grove is a crucial program for preparing these young men to go back out into the world. Most of them are serving sentences of less than three years.

“A program like Pine Grove is great because it teaches you to practice [life skills] in a pretty safe setting,” says juvenile justice expert Barry Krisberg of the Earl Warren Institute on Law and Social Policy at UC Berkeley.

“If they’re all coming home what’s the process you’d like to see them go through before they come home?” asks Krisberg. “Lock up 21 hours a day is not a good public safety strategy.”

Eighteen-year-old Manuel Lujan has served two years for assault, the result of a fight back in his hometown of Bakersfield. Before coming to Pine Grove, he was incarcerated in the Preston and O.H. Close Youth Correctional Facilities.

“Over there it’s just to do your time—over here it’s to get your mind right.” Lujan said.

In the other institutions he was associated with the Sureños gang. In Pine Grove he’s on a work crew with people from rival Norteños gangs. One day while they were out hiking, he was surprised when he slipped and a Norteño helped him back up.

“I thanked him,” said Lujan.

“Here, a lot of people basically put their gang stuff behind them,” said 21-year-old Jose Nunez “because it’s your life or another person’s life and you got to be able to help them out.”

Roots says wards with gang backgrounds often catch on to the firefighting chain of command quicker than others.

“They have a value system – it’s a messed up one, but they have one,” Roots said. “If their allegiance goes to their crew instead of their gang, they end up doing a great job.”

Many of the wards at Pine Grove are reevaluating their relationships on the outside.

“All this gang banging that’s old news—that was fun when I was young,” said 19-year-old Larry Gray of Inglewood. “Everybody in my hood, they’re my associates—my one true homie understands.”

Many of the wards never worked before they were incarcerated. Now they all have to get up and work every morning whether there is a fire or not. Every night from 6-10 the ones without a high school diploma have to go to school.

“The pace here is ten times what it is in a facility, yet when they leave here it is one hundred times what it is in here,” Superintendent Mike Roots said.

And he points out that at Pine Grove they are provided with a place to live, food to eat and access to a doctor and nurse 24 hours a day, something that is harder to come by on the outside.

Twenty-two-year-old Bryan Griffith of Oakland has been at Pine Grove for about a year. Before that he served four years of his sentence for second degree homicide at the Preston facility. Over the first two months of his time at Pine Grove, his CAL FIRE captains promoted him through fifteen crew positions to first man because he demonstrated strong leadership qualities and work ethic.

That position comes with privileges. The base pay for any ward is one dollar an hour. As first man, Griffith is paid two dollars an hour with an additional dollar added when he is out responding to an emergency. He also eats first and sits at the head of the table in the mess hall.

But even though he’s learned to shoulder extra responsibility, Griffith says sometimes he’s embarrassed to think about how unprepared he is for the outside world. “I don’t know nothing about no ATM machine,” Griffith said. “I never got a chance to drive myself back and forth to work.”

But he says Pine Grove has helped him to take one step closer to his freedom. He’s decided he would rather go home and get a living wage job than make quick money selling drugs.

“Just learning to accept you can’t get everything you want in life,” Griffith said, “and it actually feels good to do the right thing.” When he gets out in December he hopes a family friend will be able to help him enroll in a pipe trades apprenticeship in San Francisco.

When asked if he wants to be a firefighter the answer is a simple “No.” He hopes to start a family and he doesn’t want to spend 2-3 days at work.

Superintendent Mike Roots says about 10 percent of their wards have been determined to keep fighting wild land fires and got work with the forest service.

The CALFire Division Chief Brian Estes says since most of the wards at Pine Grove and adult fire camps have felonies they are disqualified from working for CAL FIRE or local fire departments. The work crews at Pine Grove basically contain wild land fires by using hand tools to clear fire lines around the fire. Currently only inmates are doing this work.

Estes says it is getting harder and harder to build crews of the highest-level firefighters at the fire camps. “I’m concerned for the program and the future in general because of realignment and DJJ in general,” Estes said. “If you look at the history, I’d be crazy to say I’m not concerned.”

Until recently, the camp had four crews of 13-17 young men. They require two crews in order to assemble a strike-team to go to another part of the state for a fire. They recently had to send an entire crew back to institutional facilities because they robbed a house when they were out on a fire.

Superintendent Mike Roots says nothing like that has happened during the seven years he’s been there.

He thinks some aspects of realignment such as the increased rehabilitation programs have been positive, but he’s finding it challenging to cope with others.

Before realignment, wards were paroled to state parole officers with whom Pine Grove caseworkers worked closely to find placements. Sometimes that meant finding them a place to live away from negative associations back home. Now wards are released into the supervision of county probation departments. Roots worries that rehabilitation will be more difficult after realignment because there is no longer the same emphasis on getting wards away from the negative peer influences they had before detention.

Barry Krisberg believes that probation officers are in a better position than parole to integrate these guys back into their communities. But he says the transition from parole to probation was made too quickly and with little planning.

Krisberg is more concerned that no one is tracking the 500 youth who’ve been released from DJJ since the switch. “Why isn’t the legislature demanding to know what is happening to these youth?” asks Krisberg. “Public safety demands we should be doing it.”

Roots will continue to follow-up with his wards twelve months after they’re released and try to adjust his program to set his wards up for success.

Wards like 19-year-old Nathaniel Hawkins will be returning to Los Angeles in nine months. He’s working on his AA through correspondence courses at Coastline Community College and hopes to eventually study business and acting. He returns to a supportive mother who was devastated by his past behavior.

“She’s proud of me now,” Hawkins said. I’m proud of myself, I never thought I’d be here to the point I’m a man like this—but I am.”