Health Information Project: Making Kids HIP on Health

Here are the just some of facts:

·         One in five high school girls report being physically and/or sexually abused in a dating relationship it

·         One in four teens  has a sexually transmitted infection. An estimated 750,000 American girls become pregnant every year, 82% unintentionally

·         Anorexia is the third most common illness among adolescents; almost half of those afflicted show signs of clinical depression

·         Obesity rates in adults and children have more than doubled since the 1970s

·         Suicide ranks as the third leading cause of death (after accidents and homicide) for 15-24-year-olds

Mental illness, alcohol and drugs, bullying, and more – the issues threatening the health of American adolescents are daunting.  And, whether kids live in the plushest suburb or deepest inner city, whether they  are rich or poor, smart or not, ignorance about matters affecting their health and wellbeing is pervasive.  Yet, because of budget cuts and an overloaded curriculum, health education disappeared from the Miami-Dade County Public Schools in 2008.

Then Risa Berrin founded the Health Information Project (HIP) and put it back.

 A far cry from old-fashioned health ed classes, where teachers read statistics and quoted scare tactics from outdated textbooks, HIP pervades an entire school with a multi-media program that engages everyone in the school community.  Outside, a huge green and white banner shouts, “Be Hip on Health.”   In the hallways, green and white HIP posters advise, “Get your teeth checked every six months,” and “Do not get into a car with someone who is drunk or high.”  In ninth grade classrooms, trained upper-class peer educators, wearing green and white t-shirts bearing the “Be Hip on Health” slogan, weave local news events – like the neighborhood teen recently arrested for drunk driving – into a structured curriculum incorporating interactive discussion, exercises, games,  and multi-media presentations. Classes cover mental health; reproductive health; relationships; alcohol, tobacco and other drugs; nutrition, exercise and obesity; and healthy lifestyle.  The classroom black box welcomes anonymous questions that students were too embarrassed to ask out loud, and incorporates the answers into the curriculum or posts them on social media or in the HIP blog.  On the internet, behip.org provides reputable, reliable local and national information sites as well as health resources in each school’s specific neighborhood.  Social media carry pithy tidbits, links to health-related news items, and encouragement to seek medical care for preventive and acute needs. 

 

Once in a school, the Health Information Project is everywhere, and its impact is apparent. In a testimonial on behip.org Paris Grant, ninth grader at Miami Palmetto High School, wrote,
“I was at a party and my friend was drinking too much and he passed out on the floor. I knew from HIP to take initiative and I took him to the hospital. I ended up saving my friend’s life.”

A 2006 graduate of the University of Miami law school, Risa founded HIP in 2009.  She combined two proven models: the sustainable faculty-sponsored club, like debate or yearbook, and peer education, as in woman to woman breast cancer counseling, which demonstrates how much the messenger matters.  She conceptualized a structure wherein a faculty advisor selected by the principal trains a group of eleventh and twelfth graders as peer educators and guides them as they conducted eight ninth-grade classroom sessions. The eight sessions interrupt a core subject (English? History?) of the principal’s choosing and take place when that class otherwise meets.  Curriculum, detailed and scripted including frequently asked questions and their answers, is written by HIP staff.  Revised as soon as important new information is published, each module is carefully based on scientific papers in consultation with academic and clinical experts. New research and current news are readily incorporated.  When, for example, the Rutgers student committed suicide, the issue found its way into discussions on bullying and LGBT tolerance.

Except for HIP’s first year in a school, when the faculty advisor chooses 20-25 juniors to be peer educators, the prospective peer educators are chosen by a student board with input by the faculty sponsor.  Focus groups of ninth graders have shaped the image of peers they are likely to listen to, and interested tenth graders, who submit a written application and undergo an interview, are evaluated accordingly.

“If you’re [promiscuous]  and you’re getting up and talking about elements of reproductive health, that message gets diluted. So they’ve been very stressed out about the kind of people they let in. they’ve thankfully had the opportunity to kind of pick from the best,” said Risa,  who continues to serve as HIP executive director.

Those selected make a two year commitment so that the seniors can mentor the juniors.
Early in the fall, the faculty advisor attends a full-day train-the-trainer session and then conducts a full-day training for the peer educators. The week prior to each classroom lesson, the peer educators attend additional training, which is focused on the module to be taught.  Having studied the curriculum script in advance, the educators are tested on content as well as presentation and public speaking skills.

Max Weinberg teaches a class of ninth graders at Miami Beach Senior High School

At the outset of the ninth graders’ classes each year, the peer educators ask the students a series of anonymous questions: Have you ever been bullied?  Have you ever contemplated suicide?  The peer educators tally up the responses and report them to the students, who invariably are astonished by the numbers.  Typically, the kids respond, “Wow, I thought I was the only one going through that,” and with that response a positive tone for learning is set.  By the end of the course, much learning has taken place.  Misconceptions have been dispelled.  The ninth graders have learned, for example, that people who suffer from depression are not crazy, that undocumented residents will not get deported if they go to a clinic, that you can get pregnant even if you’re 14 and having sex for the first time.  And with new learning comes better behavior: less derogatory language, less bullying, more tolerance, more use of the website as a resource for themselves, their friends and their family.

With pre- and post-tests, outcomes of the program are measured using quantitative and qualitative indicators of behavior, health knowledge, knowledge of resources, and access to care.  Through partnerships with the University of Miami and Florida International University, HIP has acquired surveys that get the right information and accurately measure need and impact.

The 2011 post-intervention survey, the last year for which complete data is available, shows that 81% learned new health information, 84% grew more comfortable discussing health topics,  89% said they prefer having upperclassmen lead the health presentations, and 83% became more confident in their health knowledge and decision-making skills after receiving the HIP program. The majority of students report that HIP is their number one provider of health information.

The upper class educators benefit as well.  Joyce Saturno, peer health educator at Miami Beach Senior High, wrote on the HIP website, “There was this freshman. She was talking about how she had many suicide attempts…like two or three. It made me realize that she seemed so happy but we really don’t know what’s going on.”

 Erika Schumacher, peer health educator, HIP intern and HIP president at Miami Palmetto High  School, spoke for many when she said, “I used to be so scared of public speaking.  I used to get so red and stutter.”

Indeed, Valerie Berrin, director of operations,  reported, “We love seeing how, in the beginning of the year, there is that health educator who is really shy, gets up and in the training is very uncomfortable with teaching. And by the end of the year you see them. . .  in the classroom injecting their personality like it’s something they’ve always done.”

Data sells the project, and the principals jump at the opportunity to acquire it. The late Roseann Sidener, formerly principal at Beach High, listened to Risa’s presentation for only two minutes before stating, “I want it.”  She said the kids are in desperate need.

Shawna Hutchinson, HIP faculty sponsor and ninth grade teacher at North Miami Beach High School agrees. Her testimonial on the HIP website states, “We have no health education in our high school and HIP is our answer to all the issues our students are facing.”

Teachers don’t mind giving up the core class time to HIP either.  Randy  Milliken, assistant principal at North Miami Beach High School, put it this way:  “If you don’t address these health issues now, those kids are not in class. We are actually increasing the amount of school time by educating students about these issues.”

When the HIP program began in 2009,  two schools participated in the program.  By 2012, there were twelve, including one private school, where HIP augments the school’s surviving health ed curriculum.  In 2013, there will be 24. With 600-800 ninth graders in each, nearly 16,000 freshmen and 600 peer educators will have the benefit of this extraordinary program in the fall.

On HIP Day, in April,  all peer educators from across the county meet at FIU to talk about the impact of the HIP program

From the left: RoberT Dollinger, MD, Assistant Dean for Student Affairs; Scarlett Aldana-Bosch, MBA , Assistant Director of Panther Communities; Risa Berrin;  Veronica Alvarez, MD Candidate 2015, HIP Practicum Project Co-Leader celebrating HIP day, April 4, 2013

Risa says that the program is ready to grow.  This coming fall they will test their ability to manage the program beyond the HIP’s own geographical backyard.  While Risa expects to place the program in every Miami-Dade High School, she also sees that the need is similar throughout the country, and the model can work in any high school. 

All it takes is money.  The administration of HIP, a 501 (c) (3) not for profit organization, is surprisingly lean: a professional staff of three plus two interns.  Office space is donated, and partnerships with FIU and UM add abundant in-kind support.  While participating private schools pay for the program, for public schools it is free.  And each new school adds $10,000 to HIP’s budget. This covers a stipend for the faculty sponsor, building out the website, securing curriculum and training materials, printing health campaign materials, obtaining t-shirts and collecting data.

Health Information Project, Inc.

4601 Ponce de Leon Blvd.
Suite 300
Coral Gables, Florida 33146
Phone: (786) 592-0311
Email: info@behip.org
www.behip.org

 

 

WINGS: The Transformation of Delinquent Girls

Maybe they’ve been beaten, molested, or witnessed severe violence.   Maybe they’ve suffered abandonment or neglect or seen parents go to prison.  One way or another, they are troubled girls, and they’ve gotten entangled with the law:  drugs, shop lifting, major theft, maybe assault or battery.  One-third have committed felonies. On average, they’ve been arrested eight times, convicted four.  Worse, they’re young – as young as 14 – and they’re all either pregnant or already mothers.    So now they’ve been sent to WINGS, the only Florida juvenile detention facility where girls 14-19 can stay with their babies.

The girls will stay here for an average 9-12 months.   They will go to school, learn life skills and have intensive counseling. They will keep their babies with them after they’re born, learn how to nurture and care for them, and in the process they will break the cycle of crime, violence and poverty they grew up in.  When they leave, they will be transformed.  Eighty-nine percent will leave delinquency behind them to become successful, responsible mothers and citizens.  

“Juvenile justice is starting to get that they’re in the business of treatment, not punishment,” says Karen Marcus, LMHC, CAP, Executive Director of WINGS.  “[The courts] recognize that the girls are not adults and that kids don’t just behave this way because they’re bad.”  

They are girls like Monica*, abandoned by her mother at age 5, then again by her grandmother at age 15.  Between the ages of 15 and 18, Monica lived in 20 different foster homes, ran away repeatedly, smoked a lot of weed to dull her pain, let her grades fall from A’s and B’s to D’s and F’s, and got arrested for burglary, grand theft and criminal mischief.

Like Monica, the girls often suffer from substance abuse, eating disorders, underlying mental illness, and gang affiliations.  They are inept at solving problems and have poor values.  Yet most are resilient and can blossom in a properly constructed environment.  Consequently, their detention focuses on understanding the trauma they experienced and providing the therapy and education they need to change.

The WINGS Campus

The WINGS facility, which looks like anything but a jail, occupies a sprawling landscaped campus in Homestead, FL, that can accommodate 20 girls and 12 babies.  The campus houses a fully licensed daycare center for  children up to age 2, school rooms, counseling and treatment rooms, and two dormitories – one for the girls while they’re pregnant and one for those who have already given birth.    They live two to a room, which they decorate themselves.

Two Girls and Their Babies Share a Room

A typical day at WINGS begins at 6:00 a.m., when the girls get up and dressed, do chores, get baby ready for the day and have breakfast.  They’re in school until 12:30 or 1:00.  After lunch, they go outside for recreation, followed by afternoon activities, which might include Healthy Start, trauma group, a field trip offsite.  By 5:00 they’re back in, showering and getting babies ready for the night. Dinner is at 6:00. Quiet time, maybe phone calls to family, follows.  They’re in bed at 9:00.

Rules are strict and demands restrictive.  Buildings are locked (though rooms within buildings are not), and supervising staff must know where the girls are and what they are doing at all times. The girls must ask permission before entering or exiting a room. Items that could be used as weapons – even everyday objects like pencils --  must be checked out and returned to a central location by a predetermined time.  In concert with the basic principles of behavior modification, everything the girls do is rewarded or punished: the way they speak, the way they relate to each other, the way they perform everyday activities.   There is a complex system of rank, each with a set of requirements that must be met in order to move up, and points, which are earned for meeting or exceeding expectation as they go about their tasks.  As the girls rise in rank and accumulate points, privileges mount. 

While demands are severe, support is consistent and unfaltering.  

“The staff never gave up on me,” said eighteen-year-old Jackie[*], one of two girls looking forward to release in January.  “They just kept reinforcing that I needed to change.  They said, ‘you can do good or you won’t.’ But they never left it alone. Having that kind of support and having all the resources – we had so many groups. It’s like they genuinely cared and they just showed us the right way, and it makes you want to change.”

One secret to WINGS success is this transformative combination of strict and demanding expectation together with unwavering, caring support.  The second is each girl’s personal prescription for growth and development. Every girl begins her stay at WINGS with an individualized plan she must complete before she is released. This plan covers medical care and health education, mental health counseling, academic education, and parenting education.

Beyond attending all medical appointments for herself and her baby, her medical plan might include, learning what to expect from her medical appointments and how to voice her concerns, developing the skill to advocate for herself and her baby with healthcare providers, actively participating in planning for her release by identifying the professionals she will see.

Each girl’s educational plan is based upon her academic level, which could be anywhere from 7^th grade to 12^th. Some have not been in school in years. Others require special education.   In general, the goal is to move everyone up one grade level, or, if they’re in high school, to obtain high school credits or a GED. Focus is on gaining competency in basic skills (English, math, science) as well as life skills (goal setting, life planning, budgeting, check writing), critical thinking and problem solving.

Depending on her history and diagnosis, each girl has specific therapy goals governing anger and other mood management, behavior management, control of anxiety and depression.  Placed in groups according to diagnosis, the girls work to process their history and address such issues as substance abuse or sexual trauma.  Each girl’s plan includes a family component incorporating, if appropriate, baby’s father. 

Group therapy takes place daily. Among other tasks, the girls write the story of their personal past, present and future.  In the process they explore how the trauma they experienced influenced the decisions they make now and the kinds of changes they want to make based on their new understanding. While group therapy takes place daily, individual and family therapy (and/or therapy with baby’s daddy) take place at least once a month, more often if needed.

Parenting education plans take on a more uniform shape. Healthy Start, through the University of Miami, provides a formal curriculum of prenatal care, childbirth and development, breast feeding, basic infant care, infant safety, and the like.  Equally, if not more, important is the role of the infant mental health specialist, who teaches the art of nurturing, which is difficult for all teenage mothers and especially so for this population.

Like most teens, the WINGS girls tend to be egocentric, impulsive, and lacking in sensitivity.  To compound these problems, most have had poor parental role models, little nurturing, and poor nutrition.  The infant mental health specialist helps the girls break this pattern.  While they are pregnant – when they are feeling frightened and vulnerable and are therefore receptive – she helps them see how their own childhood experiences harmed them and how changing the pattern will make life better for both them and their babies. They talk about the importance of eye contact and verbal communication with baby.  The girls learn about child development, appropriate expectation and constructive discipline. What does discipline mean?  Why don’t we hit our children? Why do we talk to our children?  What expectations are appropriate at different ages?

While they are pregnant, the girls must write three baby songs, and read and sing to baby.  Because research shows that teen moms tend to put their babies down and walk away, WINGS moms don’t wheel their babies in a stroller. They carry their babies in a sling or carrier to underscore the importance of holding baby and paying attention to her.  They develop patience by learning that crying is normal (not a reflection of their poor parenting) and how to interpret baby’s cries.   When the girls hold their babies and peer into their eyes, their attachment and communication are palpable.

Mama and baby

The transformation that takes place is best seen through the eyes of the girls completing the program.  Jackie spent eleven months at WINGS following an ugly period on the street and involvement with drugs.  She is sweet, poised and soft-spoken – a far cry from the girl who, by her own acknowledgment, arrived angry and combative.   Initially she resisted the help offered to her and had her time extended twice for bad behavior.  “I had the idea,” she said, “that this would be just like my two previous programs. That I could just do whatever I felt like it and go home, that I wouldn’t have to work on anything too deep, that I could get away with just talking about surface things.  I didn’t expect that I would actually change.”   But she ultimately gave in and focused on herself and her baby.

”I had a hard time with that,” she acknowledges.  “I wasn’t ready to think about everything in my past, but with nothing but time and a therapist who wasn’t going to let me clam up or talk about the weather, I ended up working on issues that, if I hadn’t realized I had, would have slowly led me to my grave.”

While at WINGS, Jackie completed her GED and has been accepted to a community college, where her four-month-old baby will receive free childcare. Jackie plans to become a paralegal and one day a lawyer.

Monica, now out of the program for 2 years, is mature and insightful about her past.  She has nearly completed her AA degree. Her two year old daughter is thriving, and Monica is in a healthy, committed relationship.

Graduation -- A Triuimphant Moment

WINGS,  a 501 (c) (3) not for profit organization, is an affiliate of the not-for-profit AMIKids, Inc., which specializes in rehabilitating troubled youth. WINGS operates with a staff of 31, including two teachers supplied by the Miami-Dade County Public Schools, a pediatrician and two nurses, a mental health staff of 7 (4 full-time), childcare center staff, and direct care staff, who supervise and coach the girls day and night.

Budget is just under $1 million, most of which goes to staff salaries.  Overhead consumes 15-20%.   Under contract with the Florida Department of Juvenile Justice, WINGS receives most of its funding from the State and the Miami-Dade County Public Schools. Because the babies are not in State custody, this funding does not cover the babies’ costs.  The childcare center receives some funding from the Teenage Parent Program (TAPP), which provides childcare financial assistance to students enrolled in Miami-Dade County Public Schools. But, says director Marcus, “There’s no way you could run your childcare on this allocation.”  To supplement government funds, WINGS relies on private foundation grants and tax-deductible donations. One hundred percent of these funds go directly to supporting program.

AMIKids WINGS South Florida

11000 SW 220 St
Miami, Florida 33170
Office: 305-256-6275
Fax: 305-256-6278
www.wingssfl.org

 

 

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[*] Not her real name