HealthyCal.org

Theresa Winkler says her one-room apartment at a Skid Row Housing Trust facility in Los Angeles gave her the stability she needed to recover from 30 years of drug addiction, prostitution and homelessness.

By Chris Richard

California’s unprecedented Medicaid expansion in advance of national health care reform is a crucial opportunity to improve care for the homeless, advocates say.

The $10 billion program, called California’s Bridge to Reform, includes increases in health care subsidies for the indigent, including the state’s estimated 134,000 homeless.

In July, when enrollment began, Los Angeles-based St. John’s Well Child and Family Center signed up more than 500 people for Healthy Way LA, the county program charged with overseeing medical coverage as part of the Bridge to Reform, said Jim Mangia, St. John’s president and chief executive officer.

About a third of St. John’s clients are homeless, and Mangia hopes to sign at least 1,500 of them each quarter to Healthy Way LA. Each new enrolee will be assigned a “medical home,” centered on a treating physician and with specialists in issues ranging from housing to nutrition.

“We understand a holistic person with many different needs and many different things that effect their health. Poverty effects people’s health. So how do you help alleviate some of the conditions of poverty?” Mangia said.

Kathy Proctor, a clinic administrator for the homeless division of nonprofit Northeast Valley Health Corp., hopes these new federal subsidies will mean her clients get better access to specialty care.

“That would be great, because the county is so overwhelmed that somebody can wait several months for orthopedic or cardiology,” she said.

Others hope the Bridge to Reform will help them offer shelter.

One model for such an approach currently being studied by the state Assembly Select Committee on Homelessness is the Los Angeles-based Skid Row Housing Trust. At its model facility, the Trust places homeless people in one-room apartments. The Trust offers medical, mental health, substance abuse and case management services in the same complex.

Residents pay as little as $56 per month in rent, said Molly Rysman, the Trust’s external affairs director. It costs the Trust from $5,000 to $7,000 per person annually to provide comprehensive on-site services. Currently, Medi-Cal reimburses the Trust for medical and psychiatric services, but not for nursing or case management, and finding other funding sources can be very difficult, Rysman said.

More funding could mean increasing services, Rysman said. The Trust operates 22 facilities, but can only afford to provide the full range of on-site care to about 450 of its 1,500 residents, she said. Elsewhere, services are limited to case management, she said.

Even in the locations with restricted care, the Trust’s 22-year history shows that starting with stable shelter works, Rysman said. Eighty percent of the Trust’s residents stay for more than a year, and half of those who leave move on to permanent housing, she said. Just 10 percent leave because they can’t live under the Trust’s residency rules, Rysman said.

“We use home as the focal point to work around,” she said. “At a certain point, residents recognize, ‘I will not be able to keep this home if I spend all my money on drugs and don’t pay my rent’ or ‘I will not be able to keep this home if I keep ending up in the hospital for my mental health. I need to get on a regular treatment regimen so I can keep my home.’ Most people really want to keep their homes.”

One resident of the full-service facility, Theresa Winkler, said she ran away from home at age 12 and spent the next 30 years on the streets as a drug addict and prostitute.

“This place builds your self esteem and it gives you a little bit of ‘I could do this!’ Maybe,” she said.

“And ‘mights’ and ‘maybes’ defeat you sometimes if you don’t have the right people around you,” Winkler said. “Their staff and counselors are the right people. They’re the ones who pull you in the office and say ‘Hey, what’s up? I see you’re kind of down. Do you need to talk?’”

Paul Mitchell, who lives in limited service housing nearby, said his manic-depressive disorder led to years on the streets. Whether he was living in a park or taking refuge in noisy, overcrowded shelters, Mitchell could never get a good night’s sleep, he said. Just being able to close the door to his own room and lie down has made it easier to manage his condition, Mitchell said.

Sharon Rapport, associate director of the California Policy Corporation for Supportive Housing, estimated that about a quarter of California’s 134,000 homeless residents need the sort of comprehensive services places like the Skid Row Housing Trust can offer. While there’s no authoritative tally of such facilities, Rapport estimated available beds at just 15,000. That’s half the beds needed.

Susan Partovi, medical director at Homeless Health Care Los Angeles, said even for homeless people requiring less care, the best option is stable shelter. Research around the world has shown that housing the homeless cuts mortality rates by up to 500 percent, Partovi said. One Boston study set the average age at mortality among the homeless at 47.

“The number one thing we can do to help the homeless is to house them,” she said.

Apart from humanitarian considerations, getting the long-term homeless into stable shelter makes economic sense, Rapport said. Most of these people have illnesses that could be regulated through medication. But life on the streets undermines any systematic treatment, and medical ailments are neglected until they grow into crises that must be dealt with in emergency rooms and through lengthy and expensive hospital stays. Likewise, the homeless mentally ill often are repeatedly incarcerated, which also costs taxpayers, Rapport said.

National statistics show that homeless people in stable shelter cost taxpayers 85 percent less than their counterparts on the streets, she said.

Homeless health care advocates and officials alike said government agencies need to make access to shelter – as well as routine outpatient care that is supposed to be funded by the Bridge to Reform – more accessible.

Health care providers say immigration restrictions included in national health care reform are inadvertently complicating the application process. Under federal law, undocumented immigrants are barred from federal programs such as Medicaid. Legally documented immigrants who have been in the country less than five years also are locked out. So the quest for coverage under California’s Medicaid expansion starts with proof of legal residency.

At Northeast Valley Health, Proctor said that can be a daunting challenge for her homeless clients.

“You need a birth certificate to get an ID, you need an ID to get a birth certificate, and you need money to get both,” she said.

Proctor said her organization is seeking funding to help residents born in other states obtain the documents they need.

Testifying at an Aug. 3 hearing of the state Assembly Select Committee on Homelessness, Libby Boyce, Los Angeles County’s homeless services coordinator, also expressed frustration at delays.

“In order to enroll our homeless, we need to have quick access to identification,” she said. “It can be very, very cumbersome and take months to get that.”

In an interview, Boyce said she’s been meeting with county Health Services representatives to address the issue.

By Heather Tirado Gilligan

“This is just going to be a quick prick,” outreach worker Yves Gibbons said. He squeezed the index finger of a woman in her thirties and took a fast jab with a tiny needle – the first HIV test of the evening.

Gibbons and his client sat in the back of a van on a hot July evening as people started crowding the streets for downtown Oakland’s popular First Friday event.

The mobile HIV testing and counseling site is a joint project of the Berkeley Free Clinic and UC Berkeley’s University Health Services. The van, which travels throughout the East Bay, offers rapid response tests. The pinprick of blood, smeared on a test strip, will show a positive or negative result in about 20 minutes. While people wait for their test results, they are counseled about sexual health and any other concerns that come up.

The testing and the counseling are available to anyone, though the joint program, called Berkeley Builds Capacity, is aimed at 18 to 24 year olds in the African American, Latino and Asian Pacific Islander communities. In the van, as in the Berkeley clinic, all healthcare services are free – not even a sliding scale is charged.

“Healthcare is a right, not a privilege,” said Marie Palo, the liaison between UHS and the Clinic. “We try to make healthcare as accessible as possible.”

The Berkeley Free Clinic van helps connect people who don’t have cars to an easily accessible testing site, Palo said. Other clients, she added, don’t want to be seen getting an HIV test in their own neighborhood, and can seek out the van when it’s parked in a location far away from their homes.

The van offered services in front of Feelmore 510, an adult novelty shop in downtown Oakland, during the First Friday event in July. Shop owner Nenna Joiner helped to get the van parked outside of her store for the evening.

Joiner wants to use her store, a sex-positive shop in the tradition of San Francisco’s Good Vibrations, as a place to “turn sex from a humorous subject into a practical one.” People are often uncomfortable talking about sex, Joiner said. Nearby services encourage the conversation to continue outside of the sex store.

HIV also remains a stigmatized disease, Palo said, making conversations about prevention difficult. Young people, she added, often aren’t aware of the importance of getting tested.

The counseling for first-time testers is aimed at making sure that clients leave the van educated about HIV transmission, Palo said. Counselors will explain, for instance, that anal sex carries a higher risk of transmission than vaginal sex, as well as help clients think of strategies for approaching sex safely.

Most people get good news when their test results are ready at the end of the counseling session. Only two people, Palo said, have had a positive result since the van started testing in March of this year. Checking in about available support is the first step with those clients, Palo added, and they are also given “Day One,” the Project Inform guide to living with HIV.

The van tests anywhere from 5-20 people during outreach events, Palo said.

A table outside of the van, loaded with condoms and lube, prompts people to stop on the busy street. People usually leave with about five condoms, outreach coordinator Savannah O’Neill said, along with the offer of a free HIV test if they want it.

The van offers testing regularly in the East Bay, including stops at the RYSE Youth Center in Richmond every other Wednesday and Club 21 in Oakland the second Friday and third Saturday of each month. Palo and the rest of the Berkeley Builds Capacity team will also return to Feelmore 510 for August’s First Friday event in downtown Oakland.

June Choi of UC Davis designed a street market that would be located at the Pacific Plaza on Stockton Blvd in South Sacramento.

By Jenn Walker

A UC Davis professor is pushing the field of architecture in a new direction. Instead of designing new structures, Michael Rios asks his students to try re-imagining structures that already exist. The designs they have responded with range from converting the underbelly of a freeway in a run-down neighborhood into a shadow garden to designing affordable housing out of freight containers in a mobile park.

Rios is trying to show that there is a place for social entrepreneurship in architecture: designing with a focus on social capital and human capital, rather than focusing on capital itself.

Early this year, Rios, a UC Davis associate professor, led a project that explores what such designs might look like in the economically disadvantaged region of South Sacramento, a region which also happens to be one of the most ethnically-diverse in the country.

The project, entitled ‘The Citizen’s Guide to South Sacramento’, was taken on by students from the UC Davis landscape architecture program. They spent ten intensive weeks of the spring quarter creating these design proposals in Rios’ landscape architecture studio.

Rios emphasized that the students act as observers within the community, watching closely how people use a space in their everyday lives before making their proposals to alter it.

“We need to build on what’s already there instead of [creating] proposals that show radical transformation to people’s lives,” Rios said.

While crafting these proposals, students also spent considerable time visiting and observing African American, Latino, Chinese and Southeast Asian communities within South Sacramento, interviewing members of various neighborhoods. They researched the history of the communities as well, sifting through demographic data and archives dated from when the first immigrants settled into the area.

This research ultimately helped to define their proposals.

The interviews were a crucial part of the process, undergraduate student Touyer Lee said. “That’s where the real story comes from.”

During interviews members of the South Sacramento Hmong community described to Lee the hardships they encountered before settling there, relocating from city to city before ending up in Sacramento. Sacramento has become very attractive to Hmong immigrants because of its growing Hmong population, he said.

Yet through his research, Lee discovered how much Hmong history has been lost over the years. He responded by designing a Hmong community center.

The work produced by Lee and his peers will be synthesized into a 50-page document, the Citizen’s Guide to South Sacramento, which will be available to local organizations this fall.

It will also be included in the Sacramento Diaspora’s Project, a larger endeavor headed by Rios, which is an ongoing study aimed at understanding how immigrants and refugees are adapting to and integrating into Sacramento.

Though these design proposals are not necessarily expected to materialize into actual project sites in South Sacramento, they are the beginning of a continuous discussion on how architecture could offer solutions to some of the problems faced within these communities.

Some students were told during interviews with community members that their neighborhoods needed sites for social events or recreation, so students reacted by designing outdoor parks with benches and fountains, a baseball field, a social center or open-air markets.

Student Weijing Marx created a site proposal for a park with a community garden near a neighborhood known as Lemon Hill. The city had mentioned that there was a drainage problem there, so her proposal included a temporary pond that would act as a retention basin for water.

Student Janelle Imaoka spent time observing a parking lot in front of a recycling business which attracts cars only because of the taco truck parked there. She proposed furnishing the parking lot with tables, umbrellas and a fruit stand, and occupying the surrounding spaces with other useful businesses like a Check Cashing store in order to spur economic activity within that space.

Informal businesses such as taco stands or street markets are often a vital part of low income neighborhoods, Rios said, and are what make South Sacramento unique from other parts of the city.

A proposal like Imaoka’s is ideal because it is designed around the activities already existing within that space, preserving what is there rather than replacing it.

The goal, Rios said, is that “rather than trying to in a sense beautify everything [and] make everything look like a middle class environment, to really engage these more uncanny aspects of what you find in South Sacramento, not as a deficit but as an asset, as something to build on.”

The students presented their findings and proposals to a room full of peers, professors and local community organizations at the Stockton Boulevard Partnership in South Sacramento in early June.

Constance Slider, program director of the nonprofit organization Coalition on Regional Equity, or CORE, was seated in the audience.

She said that the students had imagined beautiful designs. She also emphasized how important it is for the students, as future planners, to keep in mind other factors such as funding during the design process.

City council dollars go elsewhere because “low income means low investment,” she said, and maintaining the parks and facilities already in place in South Sacramento is a challenge in itself.

But for Rios, this project is just the beginning of using design as a critique of existing policy barriers.

Rather than design with the traditional mindset that considers the constraints of building codes, policies and planning, the focus of this project was to reimagine space in such a way that it best fits the social, health and environmental needs of its occupants.

Then, by working backwards from the finished design, a critique is formed based on the barriers that would prevent that design from being created.

Ultimately, the Citizen’s Guide to South Sacramento is not ‘the solution’, Rios said, but it offers solutions that will hopefully benefit the efforts of local organizations like CORE in making South Sacramento a more enabling environment for the people that live there.

Donna Taylor, director of the Fresno County Department of Behavioral Health

By Shellie Branco

One county drops a service and another county picks up the slack. It’s happening between Fresno and Kern counties when it comes to care for mentally ill patients in crisis.

Two years ago, Fresno County shut down its mental health crisis stabilization unit, blaming high operating costs. Patients released after the closure ended up back in the hospital – this time in the ER under an involuntary medical hold. Fresno emergency rooms were ill-equipped to handle mental health issues, and hospitals shipped them off to Kern County for psychiatric crisis treatment.

That arrangement doesn’t sit well with Kern County officials, who say the eagerness of Good Samaritan, a Bakersfield hospital, to gain business from Fresno resulted in a drain on county funds because of court hearing costs.

“If (another county) wants to hospitalize someone here, then, in my opinion, they need to bring the person here, participate in treatment planning, pick up the person and have an appointment available for them when they get back,” said Jim Waterman, director of Kern County Mental Health.

The Kern County Board of Supervisors responded in May by removing Good Samaritan Hospital’s ability to take adult patients on involuntary holds. Now the hospital has come under scrutiny for allegations of poor reporting procedures and patients’ rights violations.

Inundated with involuntary holds

Police and certain medical professionals can place an individual on an involuntary hold of up to 72 hours when he or she is considered suicidal or a danger to others. The term 5150 refers to the corresponding citation for the hold in the state welfare and institutions code.

Donna Taylor, director of the Fresno County Department of Behavioral Health, said the decision to close the crisis unit in July 2009 relied on figures that did not accurately reflect the volume of 5150 patients. Patients have continued to inundate Fresno County emergency rooms in high numbers, some 500 to 600 per month, Taylor said.

Fresno County is on track to reopen a crisis stabilization unit in November or December. Taylor is confident the unit will be ready on time, despite the economic downturn, and at a pricetag near $4 million. The privately operated center will provide 12 beds, with a focus on timely stabilization and links to support services. Although it won’t resolve the problem entirely, Taylor said, it will provide relief to local emergency departments.

“If we don’t have good follow-up care, it doesn’t matter what we do in crisis,” she said. “They will continue to come.”

Stressed in the ER

Emergency departments often don’t have the time, resources or mental health staff to handle high volumes of psychiatric patients. Police sometimes add to the problem by applying 5150 holds in less dangerous cases. For example, a threatening comment by a person under the influence of drugs or alcohol might result in a 5150, but that comment could have been an idle threat. Taylor says her department is educating law enforcement on making more informed decisions about detainment.

Before July 2009, the emergency department at Saint Agnes Medical Center in Fresno saw about 30 involuntary hold patients per month. That number jumped to between 120 and 130 patients monthly after the county’s crisis unit closed, said Dr. Richard Winters, hospital president and emergency department chairman. Each patient remained in the department around 16 hours before leaving the hospital.

Those numbers haven’t changed much. On any given day, the Saint Agnes emergency department still sees four or five involuntary hold patients, Winters said. And the expenses of hiring security guards, a social worker, adding nursing shifts, and similar needs add up.

When a 5150 patient comes to the hospital’s emergency department, the individual is placed in an isolated area with a security guard. Physical injuries are treated, and medical staff and a social worker evaluate the patient to determine if he or she poses a safety threat. If the hold stays in place, the patient is sent by ambulance to the nearest psychiatric unit.

The biggest obstacle is finding room for patients in psychiatric treatment centers. That 16-hour wait time for a psychiatric patient in the emergency department delays treatment for people suffering from pneumonia, fractures and lesser traumatic emergencies.

“The average patient, we’re able to take care of in four hours, some are less than that,” Winters said. “So every psychiatric patient we’re holding, there are four patients we could be seeing in that amount of time. And there’s a shortage of beds in emergency departments in the Valley in general.”

The loss of Good Samaritan’s services hasn’t resulted in a noticeable increase in patients at Saint Agnes, Winters said.

“On the other hand, I know that the closure of Good Sam to our 5150 patients is certainly going to hurt us, just as the closure of a trauma center would hurt outlying counties,” he added.

Saint Agnes doesn’t have a psychiatrist in the emergency department, but the problem has led the hospital to add a social worker for 5150 patients. It’s become a personnel safety issue, so the hospital has hired security guards. In the last three months, three Saint Agnes emergency department employees were kicked and punched by 5150 patients, Winters said. They suffered minor injuries.

“It’s a risk of the job now,” he added.

Who foots the bill?

Kern County entered into the contract with Good Samaritan to serve adult involuntary patients in 2007. The hospital continues to serve minors and voluntary adults. Kern County has paid for costs associated with required court hearings to determine if these out-of-county patients should remain committed. The county pays for hearing officers, patients’ rights advocates, county counsel, and public defenders, said county mental health director Waterman.

He noticed the change after Fresno’s crisis unit shut down. Last year, from January to August, 52 percent of clients at Good Samaritan were from Fresno County, compared to 22 percent from Kern County.

Waterman and Taylor have discussed potential solutions. Waterman wants to create an inter-county agreement so that other counties pay for the services their residents use. Taylor has reservations. Her department foots the bill for the smaller counties of Kings and Madera. They rely on Fresno County’s psychiatric resources, she added, although their patient volumes are small and conservatorship costs are borne by the patient’s home county.

“Part of me says, ‘Are we going to set precedent that we’re going to start billing every county for all these other things?’” Taylor added.

Taylor also said she has no control over where emergency rooms send their patients.

“We’ve always told the emergency rooms, our preference is to stay local,” Taylor said. “However, I do understand that from an emergency department (perspective), this client is sitting there eating resources and they need to move them, and if the facilities locally will not respond quickly, they will do whatever to move them where they need to be.”

Quality of care

Kern County officials also want intensive monitoring of safety issues at Good Samaritan and an agreement that the hospital will take only clients from counties that have an inter-county agreement. Waterman said it will be months before plans between Kern and Fresno counties take hold.

Both county mental health directors are concerned about Good Samaritan’s quality of care. Waterman said the hospital does not properly self-report to the county and hasn’t worked with the county to address problems. Kern County patients’ rights advocates reported the hospital had inadequate discharge plans for patients to receive appropriate support back home. And the county claims hospital officials were poorly prepared and provided inadequate information at court hearings.

According to the advocates’ reports, in July 2010, a man was discharged and placed on a Greyhound bus rather than a hospital vehicle. He held the bus hostage at gunpoint in Tulare County and was arrested. And in September 2009, a Fresno County man released at midnight with no discharge plan was assaulted shortly after release, re-hospitalized and placed on a mental health conservatorship – one of the county’s most expensive services – at a cost of $65,000.

Acharya of Good Samaritan wouldn’t comment directly on allegations, but he said the hospital is accredited and in compliance with state licensing. He added that the hospital takes initiative to correct problems and has a peer review process that handles allegations against physicians. The hospital is also working on improving self-reporting with Kern County, although it already reports to the state. Discharge plans are formulated from the time a patient walks in the door, including housing and transportation arrangements, he added.

Waterman said it’s more cost-effective to provide patients strong outpatient care with regular check-ups that keep them stable.

“What if we were getting 90 diabetics a month coming down to go to an intensive care unit in Kern County?” Waterman added. “Then when they were stable again, (we) put them in a van and took them back to Fresno and released them on the street until they had another diabetic crisis and went to intensive care in Kern County? Taxpayers would go ballistic.”

Saint Agnes previously sent patients to Good Samaritan, and continues to send them to Community Behavioral Health Center in Fresno, plus Kaweah Delta Health Care District in Visalia, among others. Winters said his first priority is to send patients to Fresno County psychiatric facilities.

Hospitals have trained emergency department staff on how to handle 5150 patients, Winters added. Beds in Fresno County substance abuse detoxification units have been made available in recent months, providing some relief. And Fresno County hospitals want to create a shared database that would track 5150 patients and flag repeat visitors. The goal is to help health care workers create more comprehensive, coordinated treatment plans for patients who cycle in and out of the system and drain resources.

Children enjoy a lively game of Red Light, Green Light as part of the Healthy Habits summer program offered by Cedars-Sinai in underserved communities. (Photo by Lisa Hollis.)

For some, summer camp brings to mind canoeing on a mountain lake, hiking and roasting hotdogs and marshmallows over an open fire.

Today for many children in cities such as Los Angeles, summer camp provides a different experience, as kids fill school classrooms and playgrounds during the months when school’s out. Activities typically include arts and crafts, field trips, games and for some urban campers, learning about healthy eating choices.

As part of a wide-ranging strategic effort to combat childhood obesity, Cedars-Sinai Medical Center has partnered with Koreatown Youth & Community Center (KYCC), LA’s Best, and other organizations, to get children excited about nutritious food and physical activity. Healthy Habits summer program is offered by Cedars-Sinai at six locations in underserved areas of Los Angeles.

“We’re delighted to have Cedars-Sinai’s Healthy Habits program as part of the summer camp curriculum,” said Janet Lee, curriculum developer and KYCC staff member. “It’s important to have nutrition as part of our summer program due to the magnitude of the obesity problem.”

Obesity prevention is the goal. Throughout the school year, the Healthy Habits program is taught by health educators to second-, third- and fourth-graders in disadvantaged neighborhoods. The approach is similar to learning a foreign language; the earlier you start, the better.

This summer at KYCC’s summer camp at Los Angeles’ Wilshire Park Elementary, two health educators from Cedars-Sinai, Janeth Bravo and Bethy Woubeshet are team teaching a series of six weekly sessions for children in grades first through fifth.

“First-graders, their minds are like sponges, soaking up all the information about healthy eating,” said Bravo. “Kids love the nutritious snacks we make, and the physical activity games. But what’s most important is we’re teaching them to think about the food they’re eating. What’s healthy? What’s not? It’s amazing how quickly they learn.”

On a recent afternoon at KYCC Woubeshet started a session by asking the class of 17 first graders, “What did we talk about last week?” The students shout in unison, “Food!” Next she asks, “What did we make?” Students recall a healthy snack of apple slices with a yogurt, honey and cinnamon dip. Several share their experiences recreating the treat at home.

The lesson on this day is about red, green and yellow light foods, focusing on food choices that are unhealthy (red light), healthy (green light), and those okay in small amounts (yellow). A class discussion, with colorful pictures of food examples, is followed by a lively fitness game of Red Light/Green Light outside to drive the lesson home.

“Which is a green light food,” Woubeshet asks the class, “white bread or whole grain wheat bread?” In chorus, the children answer, “Whole grain wheat bread!”

“Now, who can give me an example of a red light food?”
The first graders’ responses include: Sugary gummy worms, ice cream and cupcakes.

Taking the approach to the next level, Bravo explains how one food, such as milk, could fall into all three categories, with whole milk, two percent and one percent low fat versions; and chicken depending on the preparation. She shows a picture of a chicken drumstick and a student can’t resist shouting out the name of a popular fast food chain, demonstrating seven-year-olds can instantly make the leap to practical associations in their daily lives.

Outside on the playground, what they have learned is put to the test. Students stand in a horizontal line approximately 30 feet from the teacher. She holds up a picture of a food, and says the name of the food. Students must quickly discern if this is a green, red or yellow light food. Similar to Mother May I, they can take three hops for a green light food, two hops for a yellow food, and must not move for a red light food. Bravo cautions, “If you get caught moving when we show a red light food, you must go back to the beginning.”

The game is afoot.
Grilled chicken breast!
The children laugh and all take three hops forward.
Fried chicken.
A few kids are sent back to the start.
Carrots!
An easy one. Everyone proceeds with three hops.
French fries!
Surprisingly, no one moves a muscle.

Back inside the classroom, it’s time to help make a healthy snack: a yogurt parfait with blueberries, fat-free vanilla yogurt, topped with a whole grain cereal. One student holds up his parfait and asks, “Who wants a cheer?” All those sitting nearby exuberantly clink plastic cups with him and laugh before devouring their treats.

Bravo asks them to suggest other fruits they might use to make this snack at home. Enthusiastic answers include: banana, guava, orange, apples, grapes and dragon fruit!

With that, an hour has flown by, and it’s time for the health educators to move on to the next classroom. Next week, the first graders will discover how much sugar is in some popular snacks and beverages, and they’ll learn how to make a healthy, fruity and fizzy pineapple pop, as an alternative to a sugary soda.

“And one of the best things, we’ve discovered, is that most of the kids talk to their parents about what they’ve learned each week, and what healthy snack they’ve made, taking the message home,” said Bravo. “The whole family benefits.”

The Koreatown Youth & Community Center is a nonprofit, community-based organization that has been serving the Korean American Community since 1975. KYCC’s programs and services are specifically directed towards recently-immigrated, economically-disadvantaged youth and their families.

For more than a century, Cedars-Sinai, the largest nonprofit medical center in the Western United States, has been committed to meeting the health needs of the wider community as part of its core mission. The Healthy Habits program is one of hundreds of community service programs provided at local public schools, homeless shelters, and community centers.

Carolyn Buenaflor is the Program Administrator, Healthy Habits for Kids at Cedars-Sinai Medical Center in Los Angeles.