Originally published June 11, 2019 in The Lane Report.

A community-driven children’s health initiative that strengthened cross-sector coalitions in seven Kentucky counties also improved student eating habits, increased youth physical activity, trained teachers to support students experiencing trauma, and increased youth resilience, according to a Foundation for a Healthy Kentucky report released today. The six-year $2.4 million initiative also led to the adoption of 38 local ordinances and policies to help sustain the improvements and promote health equity long-term, the report said.

The success of its Investing in Kentucky’s Future (IKF) initiative has prompted the Foundation to expand its work in obesity prevention and childhood trauma interventions. For example, in May the Foundation announced another $200,000 grant in Russell and surrounding counties to address childhood trauma in a rural setting. This grant builds on an urban demonstration program that was part of the IKF initiative.

The initiative supported demonstration programs in seven Kentucky counties and was designed to reduce the risk that school-aged children will develop chronic diseases later in life. The communities contributed another $1.7 million in matching funds under the initiative, which reached nearly 13,000 students in 28 participating schools.

“Health is something that people don’t typically recognize as a community undertaking, and this initiative aimed to transform that thinking and set in motion a series of changes that will lead to healthier, more productive adults throughout each participating Kentucky county,” said Foundation President and CEO Ben Chandler. “Our approach was to engage diverse, local alliances to bring about youth behavior changes, environmental improvements, increased community involvement, and the adoption of new policies. Now we’re sharing what’s been learned so other Kentucky communities can replicate these achievements.”

Six of the Foundation’s IKF grantees — in Breathitt, Clinton, Grant, McLean, McCracken and Perry Counties — selected childhood obesity prevention as the issue they would address through the initiative. The Jefferson County coalition focused on Adverse Childhood Experiences (ACEs) and building resilience in children who have faced trauma. These issues are complex and influenced by a variety of biological, behavioral, social and environmental influences, so they require the cross-sector approach that coalitions can bring, the Foundation said.

The grant “gave us an opportunity to do something big and to really make an impact and we’ve done that,” said Marsha Bach, a member of the Grant County Coalition, Fitness for Life Around Grant County (FFLAG) and a health promotion manager with the Northern Kentucky Health Department, in the obesity prevention video. FFLAG’s final report to the Foundation said, “… the experience has set us up to pursue other large grants and feel confident doing so.”

Unlike most philanthropic grants, the IKF initiative’s community-driven approach allowed the local coalitions to choose the topic on which they wanted to focus and then funded a one-year planning phase during which the Foundation also provided training and technical assistance in the development of a business plan. This made the grant program more accessible to small communities with fewer resources, said Amalia Mendoza, senior program officer at the Foundation, who developed and oversaw the grant. Mendoza also coordinated twice-yearly Coalition member training from national and state experts in areas such as youth engagement, health equity, and developing policies and influencing policymakers.

“Partnerships between Council membership agencies became stronger as the grant progressed,” said the Breathitt County Health Planning Council for Children Coalition final report.

“Each community coalition selected the health issue they found more pressing as it related to the health of children in their communities,” Mendoza said. “Six years later, they have greatly expanded tools to address additional root causes of poor community health.”

“Participants told us that identifying a local champion and engaging the school system were critical to success in each of the counties,” Chandler said. “But by far the most decisive factor was ensuring that the local health coalition includes multiple members from a broad range of community organizations – schools, hospitals, elected officials, youth groups, and businesses. It takes more time to get everyone aligned but the resulting collaboration makes all the difference in creating long-term change to improve health.”

School-based interventions were ideal for both issues, Mendoza said, because kids spend more than 1,000 hours a year and consume up to half their daily calories at school. The Foundation is now working to create a statewide school-based health coalition to share and implement some of the lessons learned in the IKF initiative.

Among the IKF initiative’s successes highlighted in the report:

  • Policy change: A total of 38 local policies were adopted by the communities at the county, city and organizational levels.
  • Policies related to childhood obesity prevention expand physical education in middle school, require future streets to be usable by walkers and cyclers as well as cars, allow school fitness equipment to be used by the community after school, and make healthier foods available in schools and park concession stands.
  • Policies that support resilience in children include requiring trauma-informed training for all Jefferson County Public Schools (JCPS) and ACEs training certification for out-of-school youth care workers and agencies that receive funding from Metro Louisville’s Office of Youth Development.
  • Built Environment: Additions including new parks, fitness equipment, sidewalks and walking paths, playgrounds, filtered drinking water fountains, community trails and standing desks in schools. Many communities leveraged the Foundation grant to secure additional funding. For example:
    • Purchase Area Health Connections-Paducah Chapter secured another $400,000 Rotary Club grant to build a playground at the health park developed with IKF funding, and then another $500,000 donation to build a second phase of the park.
    • Sidewalks to the school that was built in Grant County will be included as part of a 48-mile trail system under development thanks to a follow-up grant from Interact for Health.
  • FFLAG in Grant County also worked with five elementary schools to win another grant to fund additional outdoor play equipment for students.
  • Expanded Engagement by youth, parents and members of the community in health coalitions that develop health events, farmers markets, and school-based clinics. Several coalitions incorporated youth as members or established youth councils. (Additional engagement gains are listed below under the ACEs coalition finding.)
  • Increased Physical Activity and Improved Nutrition for more than 90% of the students in participating elementary and middle schools in the areas addressing obesity prevention. Among the programs and findings:
    • Many schools incorporated classroom movement activities and standing desks.
    • Many communities adopted annual events and activities, such as fun runs and walking and biking programs, and the Annual Nutrition Fair created by the Partnership for a Healthy McLean County.
    • The Clinton County Healthy Hometown Coalition set up a Fitness Buddies program in which high school students worked with 3rd and 4th graders in intense physical activity during the school day.
    • Many school cafeterias eliminated deep fryers in their cafeterias, installed filtered drinking water fountains, and partnered with local farmer’s markets in farm-to-school programs that brought fresh produce to students.
  • All six coalitions began or expanded student food programs over the weekends or the summers.
  • Most students reported that school was their only source for fruits and vegetables; offering produce at snack time “appears to be a successful strategy” to increase consumption, the report found.

Additional gains specific to the trauma resilience-building model program implemented by the Bounce Coalition in Louisville included:

  • A 56 percentage-point improvement — from 30% to 86% — among participating Jefferson County Public Schools teachers and staff who felt they could be effective in supporting students who are experiencing traumatic events in their lives.
  • Improved school climate in all nine areas measured
  • Parent conferences increased 195% from 2014 to 2017.
  • Teacher retention improvement, from 87.8% in 2014 to 90.2% in 2017.

Leveraging the Foundation grant to:

  • Gain support from the Kentucky Department for Public Health for gatherings with community leaders to discuss ACEs and practical strategies for building resilience.
  • Provide training for healthcare providers and other organizations to foster resilience-building practices in several neighboring communities.

First-grade JCPS teacher Christina Carter said the Bounce training and support helped her form stronger relationships with her students so she could better address those issues that made it difficult for them to focus at school.

“This was the most close-knit class I ever had, and I owe it all to the Bounce Program,” she said.

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    Foundation’s six-year, seven-county children’s health initiative a model for entire state
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    Foundation’s six-year, seven-county children’s health initiative a model for entire state
    Six-year, $2.4 million project is already bringing positive changes to schools as they provide more opportunities for students to focus on their wellness.
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