757755HPPXXX10.1177/1524839918757755Health Promotion PracticeHeinert et?al. / StudEntS AS HEALtH AdVocAtES research-article2018 Agency and Equity in Health Promotion Partnerships The CHAMPIONS NETWork: Training Chicago High School Students as Health Advocates to Improve Health Equity Sara Heinert, MPH1 Marina Del Rios, MD, MSc1 Arjun Arya, MSc1 Ramin Amirsoltani, MPH1 Nasseef Quasim, BS1 Lisa Gehm, MD1 Natalia Suarez, MA1 Terry Vanden Hoek, MD1 In Chicago, major disparities exist across ethnic groups, Keywords: youth empowerment; health promotion; income levels, and education levels for common chronic chronic disease; health education; health conditions and access to care. Concurrently, many of advocacy; community health Chicago?s youth are unemployed, and the number of minorities pursuing health professions is low. In an effort to eliminate this health equity gap, the University >>IntroductIon of Illinois at Chicago convened a community?univer- sity?hospital partnership to implement the CHAMPIONS Chicago is simultaneously one of the most diverse NETWork (Community Health And eMPowerment and most segregated cities in the United States (Silver, through Integration Of Neighborhood-specific Strategies 2015). This segregation is associated with major health using a Novel Education & Technology-leveraged disparities across ethnic groups, income levels, and Workforce). This innovative workforce training program educational background for common conditions such is a ?High School to Career Training Academy? to as cardiovascular disease and cancer. Compared with empower underserved youth to improve population Whites, coronary heart disease and cancer mortality health in their communities, expose them to careers in rates are higher for Blacks by 10% and 50%, respec- the health sciences, and provide resources for them to tively. Similarly, diabetes mortality rates are also dis- become community and school advocates for healthy proportionate with a rate of 20% for Whites, 31% for lifestyles. This program differs from other traditional Hispanics, and 38% for Blacks (Chicago Department of pipeline programs because it gives its students a paid Public Health, 2012). The most significant barriers to experience, extends beyond the summer, and broadens staying healthy in Chicago are tied to economic hard- the focus to population health with patient contact. The ship: unemployment, lack of insurance, and affordability CHAMPIONS NETWork creates a new type of health workforce that is both sustainable and replicable 1University of Illinois at Chicago, Chicago, IL, USA throughout the United States. Authors? Note: This work was supported by the University of Illinois Hospital and Health Sciences System, the Pritzker Health Promotion Practice Traubert Family Foundation, and the Baxter International January 2019 Vol. 20, No. (1) 57 ?66 Foundation (grant number 19176). Address correspondence to DOI: 10.1177/1524839918757755 Sara Heinert, Department of Emergency Medicine, University of Article reuse guidelines: sagepub.com/journals-permissions Illinois at Chicago, 808 South Wood Street, M/C 724, Chicago, IL ? 2018 Society for Public Health Education 60612, USA; e-mail: sheinert@uic.edu. 57 issues including the cost of care (Chicago Department convened a partnership to build, implement, and of Public Health, 2012). From 2000 to 2009, the number evaluate a ?CHAMPIONS NETWork? (Community Health of Chicagoans who ?avoided the doctor due to cost? And eMPowerment through Integration Of Neighborhood- increased by 100%, and the highest increases were specific Strategies using a Novel Education & Technology- among Hispanics and people without college degrees leveraged Workforce) model. This innovative workforce (Chicago Department of Public Health, 2012). training program empowers underserved youth to A diverse and culturally aware workforce is a criti- champion healthy lifestyles and exposes them to career cal element in the delivery of quality health care pathways in health care. (Nivet, 2011). Diverse health care professionals can This article describes a model curriculum that can provide care that is mindful of various belief systems be easily scaled and replicated in partnership with and cultural biases, which can be more effective for health care systems to simultaneously improve com- patients from a wide range of backgrounds (Cohen, munity health and address youth unemployment. Gabriel, & Terrell, 2002). Greater cultural competency can improve the quality of care due to better provider? >>MEtHod patient communication (Kington, Tisnado, & Carlisle, 2001). Physicians from minority backgrounds are sig- Program Overview nificantly more likely to practice primary care and The CHAMPIONS NETWork aims to advance practice in medically underserved areas than White health equity by empowering high school students physicians (Association of American Medical Colleges, from underserved communities to become health 2014), which can increase access to high-quality health advocates for an at-risk population who might other- services for the underserved (Cohen et? al., 2002; wise ?fall through the cracks? of the health care sys- Kington et?al., 2001). tem. Students are an enthusiastic group who may Yet the proportion of minority health professionals better inform patients and community members is well below what would be expected based on their about their health than professionals who may live population share. Only 9% of physicians identified as outside their community. The overarching goals of Black, American Indian or Alaska Native, or Hispanic the program are to empower youth, improve popula- (Association of American Medical Colleges, 2014), tion health, and create a future after high school? although these groups represented 32% of the United specifically, geared toward health care careers?one States population in 2015 (U.S. Census Bureau, n.d.). of the fastest-growing segments of the U.S. economy Approximately 11% of registered nurses, 3% of den- (Torpey, 2015). tists, and 6% of pharmacists are Black. Similarly, only The CHAMPIONS NETWork builds on lessons 5% of registered nurses, 6% of dentists, and 4% of learned from the Illinois Heart Rescue (ILHR) program, pharmacists are Hispanic (National Center for Health a statewide collaborative that has engaged hospitals, Workforce Analysis, 2015). community-based organizations, and schools through- Of special concern are the high youth unemploy- out Illinois to teach cardiopulmonary resuscitation ment rates in Chicago, especially for minority groups. (CPR) to improve cardiac arrest survival. By focusing Among 16- to 19-year-olds, 12.5% of Blacks and 7.8% CPR training efforts in underserved ?hotspot? neigh- of Hispanics were out of work and out of school com- borhoods with high cardiac arrest burden and low pared with 5.6% of Whites. Among 20- to 24-year-olds, bystander CPR rates (Del Rios et? al., 2014; Del Rios, 39.5% of Blacks and 18.2% of Hispanics were out of Kotini-Shah et?al., 2015; Del Rios, Sasson et?al., 2015), work and out of school compared with 6.3% of Whites ILHR has more than tripled survival in some neighbor- (Cordova, Wilson, & Morsey, 2016). In 2016, the Mayor hoods (Campbell & Del Rios, 2017). School-based pro- of Chicago specifically issued a call to improve safety grams within ILHR highlight the power of high school and security through increased opportunities for student engagement. ILHR created a school-centered Chicago?s youth to stay on track to graduate high school ?pay-it-forward? educational intervention to increase and go to college (Office of the Mayor City of Chicago, bystander-initiated resuscitation by training 9th and 2016). 10th graders on compression-only CPR and AED (auto- It has been suggested that addressing disparities at mated external defibrillator) use. Students were then the precollege level, through partnerships between hos- given CPR kits to bring home to teach friends and fam- pitals, health professional schools, and local schools, is ily. Seventy-one students trained 347 people?a 500% part of the solution to medicine?s diversity gap (Cohen increase in reach. This program has been adopted by et? al., 2002). In an effort to address the gaps in care multiple Chicago schools with similar results, proving capacity, the University of Illinois at Chicago (UIC) that high school students can be highly effective community 58 HEALTH PROMOTION PRACTICE / January 2019 tAbLE 1 demographic characteristics of cHAMPIonS nEtWork First cohort Schools School Type % Whitea % Blacka % Hispanica % Free/Reduced Lunchb 1. Public/neighborhood 2.5 27.2 68.9 95.2 2. Public/neighborhood 0.7 11.9 87.1 97.1 3. Public/neighborhood 9.9 27.8 42.8 82.8 4. Charter 0.8 3.9 95.2 97.5 5. Charter 2.0 25.7 66.4 85.7 District average 9.6 38.9 45.9 80.7 NOTE: CHAMPIONS NETWork = Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies using a Novel Education & Technology-leveraged Workforce. aData from Chicago Public Schools (Chicago Public Schools, n.d.-b). bData from Chicago Public Schools (Chicago Public Schools, n.d.-a). health advocates (Del Rios et? al., 2014). The patient population consisting of 35% Hispanic, 35% CHAMPIONS NETWork expands this model to include African American, and 20% non-Hispanic Caucasian. additional health topics and provides a more compre- hensive training program for students. Recruitment and Eligibility Components of the CHAMPIONS NETWork?high school student participation in intensive health cur- In Spring 2016, the CHAMPIONS NETWork riculum, mentorship, and exposure to health careers? recruited students from three public and two charter have been validated as beneficial to students in previous schools in Chicago. The schools were purposefully programs (Crump, Ned, & Winkleby, 2015; Rashied- selected because they were either located in primarily Henry et? al., 2012; Sasson, Haukoos, Eigel, Magid, & low-income neighborhoods, or their enrolled students Shah, 2014; Wallace, Perry, Ferguson, & Jackson, 2015; came from low-income neighborhoods. Table 1 shows Winkleby, Ned, & Crump, 2015). The CHAMPIONS characteristics of the schools by race/ethnicity and NETWork goes beyond the traditional pipeline program financial need (via free or reduced lunch; Chicago to take a more health promotion focus. Unique compo- Public Schools, n.d.-a; Chicago Public Schools, n.d.-b). nents of the program include a didactic and hands-on In addition to socioeconomic criteria, we selected curriculum, real-life experience in an emergency our inaugural schools based on the guidance of two department (ED) setting, and holding students account- programmatic partners?Gaining Early Awareness and able for dissemination of health knowledge. Students Readiness for Undergraduate Programs (GearUp) and interact with patients in a clinical setting to facilitate Mikva Challenge. GearUp is a program funded by the primary care follow-up. By engaging students to become U.S. Department of Education designed to increase the part of the health care team, the CHAMPIONS NETWork number of low-income students who are prepared to can improve the health of Chicago?s most underserved enter and succeed in postsecondary education (U.S. communities while empowering students in a novel Department of Education, 2017). Mikva Challenge way and building a pathway that equips them to join engages youth in action civics to develop them to be the health care workforce. informed and active citizens and community leaders (Mikva Challenge, n.d.). One or both programs had a Program Site Characteristics preexisting relationship with each selected school, and the three public schools had GearUp offices within The 6-week summer program began in June 2016 them. Our partnership with GearUp facilitated a stream- and took place at UIC and UI Hospital, both located in lined recruitment process for school-based staff to Chicago, Illinois. The university hosts seven health sci- inform students about the program and how to apply. ences schools: medicine, dentistry, nursing, pharmacy, The two charter schools had extracurricular program- public health, social work, and applied health sciences. ming liaisons that were instrumental in aiding in the Shadowing opportunities and the clinical internship recruitment process at their school. Through our part- took place at UI Hospital. The ED at UI Hospital is a nership with Mikva Challenge, we learned best prac- Level II trauma center with an annual census of 47,000 tices of the recruitment process and guidance on some visits serving a predominantly low-income, minority programmatic components. Heinert et?al. / STUDENTS AS HEALTH ADVOCATES 59 Forty five students applied for 28 spots in the 2016 The bulk of the curriculum was delivered by four summer program. The program application require- program coordinators: one medical student, one master ments were (1) application form with parent or guard- of public health student, and two premedical recent ian signature, (2) school transcript, (3) vaccination college graduates. The coordinators taught program records, (4) two short essay questions, and (5) recom- sessions, provided administrative oversight, and served mendation forms from two adults, with at least one as mentors for the students. They were supervised by a from a teacher. Students were eligible to participate if core team of emergency medicine faculty, public health they were rising juniors or seniors and were at least 16 researchers, and representatives from partner organiza- years old by the start of the program. While transcripts tions. The executive director of the program was the were required as part of the application package, there Chair of the Department of Emergency Medicine. were no grade point average (GPA) requirements for The program was divided into two sections; in the acceptance into the program. Attendance records and first 4 weeks, the students were trained to become recommendation forms were important considerations health advocates, and in the last 2 weeks students com- for students who had lower GPAs. All students who pleted a clinical internship where they used their train- submitted a complete application were offered a brief, ing to screen and educate patients. 15-minute in-person interview by program staff. Weeks 1 to 4: Didactic and Enrichment Curriculum. Stu- Participant Characteristics dents were trained as health advocates, using didactic and enrichment curriculum. The didactic curriculum We enrolled 28 students in the first year of the pro- was taught in a classroom by the four program coordi- gram. One student left in the first week because of nators and faculty in health-related departments concerns that travel time from her home was too long, throughout the University. All didactic modules were leaving 27 students who completed the 6-week summer adapted specifically for the CHAMPIONS NETWork program. The demographic makeup of the first-year program from a preexisting interactive health curricu- cohort was 52% Hispanic, 33% Black, 4% White, and lum by UIC College Preparatory High School that was 11% Other. Seventy-eight percent were female and created for use with high school students. The enrich- 78% were rising seniors. Fifty-six percent of students ment curriculum included more hands-on activities, would be the first generation of their family to go to outside of the classroom. Table 3 lists a sample of cur- college and 12% contributed to their family?s income. riculum topic and activities. A third of students (33.3%) spoke only Spanish at home. The students lived in 14 (out of 77), mostly low- income minority and immigrant, Chicago community Weeks 5 and 6: Clinical Internship. During their clinical areas with historically poor health outcomes. Table 2 internship, the role of the students was similar to that of shows health outcomes and socioeconomic factors a community health worker (CHW). CHWs have recently across these community areas (Chicago Department of emerged as a workforce that can be used as a cost-effec- Public Health, n.d.; University of Illinois at Chicago tive strategy to provide health care to the underserved. Great Cities Institute, 2017). They are lay members of local communities who usually share ethnicity, language, and socioeconomic status with the community members they serve. CHWs can provide Program Organization and Delivery culturally appropriate health promotion and health edu- The hospital?s volunteer office facilitated screening cation and assist in accessing medical services (U.S. requirements to attend shadowing experiences and the Health Resources and Services Administration, 2007). clinical internship in the hospital, including an orienta- After training and teach-back, students put the train- tion on Health Insurance Portability and Accountability ing they received during the first 4 weeks into action by Act and patient privacy, background check, and health interacting with patients as health screeners and educa- screening. It was vital to begin the clearance process tors in the ED and the clinical decision unit of the very early in the program so that clinical components University hospital. They specifically focused on car- were not delayed. diovascular disease, cancer, and healthy eating and Each day was divided into a morning (9:00 a.m. to exercise, while also connecting patients to primary care 11:30 a.m.) and afternoon session (12:30 p.m. to 3:00 resources. The students were supervised by one or two p.m.) with a 1-hour lunch (11:30 a.m. to 12:30 p.m.). The program coordinators. They wore business casual attire program took place 6 hours a day, 4 days a week, and with a provided CHAMPIONS NETWork polo shirt, as students received a $1,000 stipend, public transportation well as their hospital ID badge. The students were passes, and lunch every day for the first 4 weeks. assigned participation in four 5-hour shifts per week. 60 HEALTH PROMOTION PRACTICE / January 2019 Heinert et?al. / STUDENTS AS HEALTH ADVOCATES 61 tAbLE 2 Health outcome and Socioeconomic Factors for chicago community Areas Where cHAMPIonS nEtWork Students Live Mortality Out of Hospital Mortality Rate?Stroke % % No % Out of Work Cardiac Arrest % Mortality Rate? (Cerebro- Below High and Out of Rate (per Bystander Rate?Cancer Diabetes vascular Poverty School % School?16 to Community Area 100,000)a CPRa (All Sites)b Relatedb Disease)b Levelb Diplomab Unemploymentb 24 Years Oldc,d Chicago Lawn 163.8 16.5 179.3 73.0 61.7 22.2 31.6 11.9 31.1 East Garfield Park 406.5 4.8 236.8 97.3 47.5 39.7 26.2 16.4 30.1 Edgewater 145.8 15.0 162.0 48.8 31.5 16.6 9.0 9.0 10.1 Gage Park 74.7 6.7 171.0 65.0 51.2 20.8 54.1 14.0 19.6 Humboldt Park 208.0 18.2 211.1 94.1 53.5 32.6 36.8 12.3 30.1 Logan Square 111.5 30.0 148.7 75.7 31.9 17.2 18.5 7.5 11.7 Lower West Side 116.2 15.0 141.3 61.9 39.2 27.2 44.3 13.0 7.0 McKinley Park 140.8 8.7 148.4 61.4 51.7 16.1 31.8 11.9 17.3 Rogers Park 104.8 22.8 176.9 77.1 33.7 22.7 18.1 7.5 10.1 South Chicago 291.9 17.1 227.3 86.9 50.6 28.0 28.2 17.7 21.2 South Lawndale 117.9 9.8 127.4 65.0 37.3 28.1 58.7 11.5 30.1 Uptown 130.4 19.7 183.3 80.0 41.7 22.7 13.6 7.7 10.1 West Ridge 177.3 21.9 155.9 60.5 34.7 15.1 19.6 7.9 12.6 West Town 94.8 20.3 139.6 107.0 33.3 15.7 13.4 6.0 7.0 Chicago average 190.4 15.5 194.3 71.9 46.5 20.3 21.6 13.3 17.0 NOTE: CHAMPIONS NETWork = Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies using a Novel Education & Technology-leveraged Workforce. aData from Chicago Cardiac Arrest Registry to Enhance Survival Data?2013-2016. bData from Chicago Department of Public Health (2005-2011) (Chicago Department of Public Health, n.d.). cData from University of Illinois at Chicago Great Cities Institute (2015) (University of Illinois at Chicago Great Cities Institute, 2017). dData calculated at the Public Use Microdata Area (PUMA) level (2015), which combines multiple (2-5) community areas into each PUMA. This is the smallest geographic united used by the Census for tabulating this data (University of Illinois at Chicago Great Cities Institute, 2017). Therefore, areas in the same PUMA share the same value for this rate. tAbLE 3 Sample of cHAMPIonS nEtWork curriculum topics and Activities Didactic Enrichment Health modules: Hands-on learning opportunities: ? ?Determinants of health? ? CPR certification ? ?Health disparities? paired with ? Simulation lab?suturing, ultrasound relevant documentary and debrief ? Anatomy lab with animal organs ? ?What is a community?? ? Cadaver lab?emphasis on physiology of cardiovascular disease ? ?Access to health care? Mentorship from health professionals: ? ?Rights and responsibilities? ? Lunch and learn ? ?What?s in a drink?? ? Leadership caf? (speed networking) ? Career panel ? Clinical shadowing Life skills and cultural modules: Expert speakers with accompanying discussion on topic: ? Resume workshop ? Cureviolence/ceasefire (neighborhood violence) ? Health career survival skills ? Lead poisoning ? Cultural competency ? Oral health ? Professional communication ? Asset mapping of community resources ? Leadership styles Homework assignments: ? College life ? Train family CPR at home ? Scholarship opportunities NOTE: NOTE: CHAMPIONS NETWork = Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies using a Novel Education & Technology-leveraged Workforce; CPR = cardiopulmonary resuscitation. Students were responsible for conducting cardiovas- the health care system and see if they needed further cular and cancer risk assessments with patients, as well assistance in obtaining a primary care appointment. as assessment of healthy living such as exercise and The program builds on the health impact pyramid nutrition in the ED. The students then reviewed with framework (Frieden, 2010) where students partook in the patient a one-page health information fact sheet counseling and education with patients, as well as pro- related to the information asked in the screening form. vided clinical interventions through referrals to primary The sheet included statistics and suggestions for care. Although these two types of interventions are at the healthy living based on topic-specific health advocacy top of the health impact pyramid, suggesting smaller organizations, such as the American Heart Association population impact and larger individual effort needed and American Cancer Society. Being sensitive to liter- compared with broader changes at the bottom of the acy issues, all information was verbally read to the pyramid, the interventions were within the reasonable patient and was presented at no greater than an eighth- scope of the students? capabilities. Additionally, as the grade reading level, and patients were able to take the students were educating patients on cancer and cardio- information sheet home with them. In addition to vascular conditions and primary care, they were simulta- English, materials were available to share with patients neously increasing their own knowledge on these topics. in Spanish. A sample of questions from the risk assess- ments and health information sheet statements can be Mentorship. Mentorship was an important element of found in Table 4. our program. Events included lunch and learn sessions, Our university is unique in that we have a federally a leadership caf?, a career panel, and clinical shadow- qualified health center (FQHC) within the health sys- ing. In lunch and learn sessions, health care profession- tem. This relationship made it feasible to have students als shared their career path and answered student assist with referrals to this FQHC. The students made questions in a relaxed setting over lunch. Modeling appointments for patients who did not have a primary after our partner Mikva Challenge, students partici- care provider or wanted a new one. Students also made pated in a speed networking event with 16 mentors follow-up phone calls to patients who had been from various health fields. In the career panel, students screened in order to keep those patients engaged with had the opportunity to hear from and ask questions to a 62 HEALTH PROMOTION PRACTICE / January 2019 tAbLE 4 Sample Questions From Patient risk Assessment and Sample Statements From Health Education Sheet Question Type Sample Risk Assessment Questions Sample Health Information Sheet Statement Cancer For women in their 40s or older: The American Cancer Society says that women 45 to 54 When was your last mammogram? years old should get mammograms every year. Women 55 and older can switch to once every 2 years or once a year as desired. Talk to your doctor to know what is best for you. Cardiovascular Do you have diabetes? People who have diabetes are at higher risk of getting heart disease disease. If you have diabetes, it is important to talk to your doctor about your heart health. Access to Do you have a primary care doctor? High blood pressure is symptomless which means you can primary care For any reason, would you like walk around feeling completely healthy but still have high help getting an appointment with blood pressure. This is why regular check-ups are so a primary care doctor so you can important. discuss your health with them? Exercise Over the past 7 days, how many What you can do TODAY to lower your cancer and times did you engage in moderate cardiovascular disease risk: to strenuous activity? ? Get at least 2 hours of moderate activity a week such as gardening or walking. ? Eat at least 2.5 cups of fruits/vegetables a day and lower your salt/sodium intake. diverse group of health professionals, including a staff?a program manager and evaluation manager?and FQHC chief medical officer, a community health worker will cover other programmatic expenses including stu- supervisor, a family medicine physician, a paramedic, dent stipends and transportation costs. We anticipate and an emergency medicine resident. Additionally, stu- annual costs to be approximately $250,000, which dents participated in 2 days of shadowing health pro- includes school year continuation of the program. fessionals throughout the hospital including physicians in multiple medical subspecialties, medical techni- Program Evaluation cians, dentists, pharmacists, social workers, and nurses. During these experiences, students were paired with a As an outcomes-oriented health program, our long- health professional, witnessed them ?in action,? and term goal is to develop an effective pathway for support- were encouraged to ask questions. ing students to graduate from high school and college and become health professionals, while simultaneously Program Funding improving the health of their communities. Using the five dimensions underlying the RE-AIM framework? Initial start-up funds were provided internally by the Reach, Effectiveness, Adoption, Implementation, and University of Illinois Hospital & Health Sciences System. Maintenance?we will estimate the potential public The first year of the summer program cost approxi- health impact of the CHAMPIONS NETWork (Klesges, mately $50,000. During this time, the program did not Estabrooks, Dzewaltowski, Bull, & Glasgow, 2005). In have any full-time staff but engaged more than 80 health addition to measuring the success of the program, out- professionals from the hospital and university who vol- come data can be used to improve and enhance the unteered their time for program oversight, shadowing program in future years by identifying programmatic opportunities, to teach, and mentor students. As we elements with the greatest effects on students. Elements prepare to expand to 50 students in Year 2, the program that were less impactful can be further developed and has received competitive funding from two foundations. improved for future cohorts of students. Our evaluation The grant money was invested in two full-time program metrics follow the three goals of the program. Heinert et?al. / STUDENTS AS HEALTH ADVOCATES 63 Goal 1. Empower Youth to Become Health Champions patients for continued follow-up. They have returned in Their Own Community. Pre- and postprogram to their communities and participated in screening and assessments are used to measure changes in students? education activities such as school health fairs, hands- absences and tardies, grades, self-efficacy, and knowl- only CPR trainings, and neighborhood asset mapping edge of health conditions, including cardiovascular of health resources. Students have engaged their class- disease and cancer. Long-term evaluation includes mates and friends to participate in our afterschool cur- tracking the progress of all students within the CHAM- riculum, broadening our program?s reach. The first PIONS NETWork over time through a dedicated web- CHAMPIONS NETWork class will be recruiters for the site and follow-ups with students, school counselors, next class and exemplary program graduates will have and advisors. the opportunity to participate in the next year?s pro- gram as student leaders. All students are also exposed Goal 2. Address Health Disparities and Improve Popu- to scholarship opportunities during the school year lation Health. Students are trained to become commu- including the UIC CHAMPIONS NETWork Scholarship nity health advocates in order to build a culture of good for UIC-bound high school graduates. health in underserved communities. In addition to baseline screening data, students conduct 3-month fol- >>dIScuSSIon low-up telephone interviews on individuals who agreed to share their contact information. Outcomes of The CHAMPIONS NETWork fosters career develop- interest include percent who followed up with primary ment and student engagement at the grassroots level care, change in blood pressure, change in body mass with a huge impact on improving population health by index, change in smoking through use of smoking ces- creating a new type of health workforce that could be sation services, and change in self-reported healthy sustainable throughout the United States. This commu- behaviors (e.g., increased fruit and vegetable intake, nity?university?hospital partnership engages youth to increased physical activity). become active members of the health care system by empowering them with knowledge and communica- Goal 3. Create a Future After High School Through Col- tion tools to become health advocates for themselves, lege and Health Career Pathways. Pre- and postpro- their families, and their communities. Previous youth gram assessments measure high school graduation engagement programs have demonstrated dramatic rates, interest in college, awareness of and interest in effects on both the teenage participants and the com- pursuing health careers. Longer term evaluation munities in which they live. Urban summer employ- includes tracking high school graduation rates; rates of ment programs for teens have shown that participating entrance, persistence, and graduation from college; and teens have fewer violent-crime arrests (Heller, 2014), pursuit of health care careers. less probability of incarceration (Gelber, Isen, & Kessler, 2014), and increased academic outcomes (Schwartz, Daily Feedback From Students. Each day, students Leos-Urbel, & Wiswall, 2015) compared with students completed brief, anonymous, written evaluations to not in the program. Health career pipeline programs for share their preferences of program content and sugges- youth have shown that participation has increased tions for improvement. Students rated their experience motivation and interest in health care careers (Crump on a 5-point Likert-type scale from Very Poor to Very et?al., 2015; Rashied-Henry et?al., 2012), and most low- Good. After review of the evaluations, we learned that income participants attend college and receive their the students most preferred dynamic instructors and degrees (Winkleby, 2007). Additionally, a teen outreach hands-on activities. The enrichment curriculum was program that promoted healthy behaviors and life skills most popular, but the didactic curriculum was also resulted in decreased teen pregnancy, school suspen- well-received when the instructor worked to engage the sion, and dropout compared with students who did not students. participate (Allen, Philliber, Herrling, & Kuperminc, 1997). CHAMPIONS NETWork brings together several School-Year Program Continuation components of these successful programs, so we expect similar profound effects on the underserved students On completion of the 6-week summer program, stu- and communities engaged. dents were offered the option to continue the program The CHAMPIONS NETWork mission, programming, into the school year to act as health advocates with and curriculum clearly align with all six components their peers and their communities. Students continue of the social determinants of health framework (Heiman to screen and educate patients in the ED and call & Artiga, 2015). We target economic stability through 64 HEALTH PROMOTION PRACTICE / January 2019 health workforce development, neighborhood and Chicago Public Schools. (n.d.-a). School data: Limited English physical environment by teaching about health dispari- proficiency (Special ed.), low income, IEP (2015-2016). Retrieved ties and participating in community engagement from http://cps.edu/SchoolData/Pages/SchoolData.aspx events. Education is targeted through health career Chicago Public Schools. (n.d.-b). School data: Racial/ethnic pipeline programming with local schools, and food by report (2015-2016). Retrieved from http://cps.edu/SchoolData/ Pages/SchoolData.aspx teaching the students about healthy eating for which they then educate their communities. The community Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The case for diver- sity in the health care workforce. Health Affairs, 21, 90-102. and social context aspect is addressed by having the doi:10.1377/hlthaff.21.5.90 students act as health advocates in their communities, Cordova, T. L., Wilson, M. D., & Morsey, J. C. (2016). Lost: The and we target the health care system through students? crisis of jobless and out of school teens and young adults in screening and education of patients and students? Chicago, Illinois and the U.S. Retrieved from https://greatcities. clinical skills development. Initiatives that incorporate uic.edu/wp-content/uploads/2016/02/ASN-Report-v5.1.pdf these determinants can ultimately contribute to Crump, C., Ned, J., & Winkleby, M. (2015). The Stanford medical improved health outcomes and greater health equity. youth science program: Educational and science-related out- comes. Advances in Health Sciences Education, 20, 457-466. doi:10.1007/s10459-014-9540-6 >>concLuSIonS Del Rios, M., Han, J., Demertsidis, E., Llerena, M., McGuire, L., & Considering that there are 130.4 million ED visits Vanden Hoek, T. (2014). Pay it forward: A school-centered educa- annually in the United States (Rui, Kang, & Albert, tional intervention to increase bystander-initiated resuscitation in neighborhoods. Circulation, 130, A266. n.d.), the CHAMPIONS NETWork can be disseminated and translated for implementation in a city-wide, state- Del Rios, M., Kotini-Shah, P., Heinert, S., Foster, E., Campbell, T., Johnsen, C., & VandenHoek, T. (2015). Association of neighbor- wide, and eventually national model portable for use in hood characteristics with incidence and survival from out of other EDs. As models such as accountable care organi- hospital cardiac arrest in Chicago. Academic Emergency Medicine, zations emerge, sustainability is expected due to the 22(Suppl.1), S140. value of the program to health systems through the Del Rios, M., Sasson, C., Han, J., McGuire, L., Junco, A., Panchal, resultant cost savings incurred from keeping their A., & Waxler, J. (2015). Chicago HANDDS program: A targeted patient population healthy (Centers for Medicaid and community-based clinical trial. Academic Emergency Medicine, Medicare, 2015). Additionally, the CHAMPIONS 22(Suppl.1), S198-S199. 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