East Harlem Bikes, Runs, and Walks Its Way to Better Health

Even though he’s only five years old, Moa is an expert on the happenings on Randall’s Island, having explored every corner of the park during visits with his parents, Nicole and Sandy.

The family bikes to Randall’s Island up to several times a week via a vehicle-free pathway that connects their East Harlem neighborhood to the park. “On the bike path to the park, there’s a white board with daily activities and events listed,” said Nicole. “Moa loves to stop and find out about what’s going on for the day. He gets very excited about everything he sees and learns over there.”

Like Moa, many community members of East Harlem have limited access to outdoor physical activity in their neighborhood. With less than half the amount of open space as recommended by New Yorkers for Parks, East Harlem has higher rates of obesity and diabetes as compared with other New York State communities.

NYHealth is supporting a range of efforts to expand and improve access to healthy food and physical activity, build demand for public spaces, and get residents engaged in healthy behaviors throughout East Harlem—one of six communities in New York State where NYHealth is working with grantee partners to transform through its Building Healthy Communities priority area.

For Moa and his parents, the ability to access Randall’s Island for fresh air and physical activity has been a boon. “It means we spend more time outdoors exercising by riding to the park,” says Nicole. “It’s beautiful once you’re there and a safe space to walk, ride, or play.”

NYHealth grants to Randall’s Island Park Alliance (RIPA) and the New York Restoration Project are helping to make Randall’s Island an accessible resource to Moa’s family and other East Harlem residents, where they can participate in free community programming and events related to health and wellness. These projects also are targeting residents of the South Bronx in partnership with the New York Community Trust through a complementary initiative. Also in East Harlem, NYC Bike Share is growing and promoting Citi Bike (the citywide bike-sharing program) and its discount program for low-income residents. The Fund for Public Health in New York is supporting the East Harlem Neighborhood Health Action Center in engaging residents to use walking trails throughout the neighborhood.

Physical Activity and Nutrition Education on Randall’s Island

Connecting people to the 330 acres of park space on Randall’s Island will greatly benefit families in East Harlem. Conveniently located adjacent to the East Harlem neighborhood, the island offers year-round health and wellness programming for all ages, including free weekly running, yoga, dance exercise, and gardening classes. For youth ages 8–14,  the Jesse Owens Track & Field Club offers an introduction to cross-country distance running, proper running techniques, and nutrition habits.

Despite the close proximity, many East Harlem residents are unaware of the health and wellness activities or even how to access Randall’s Island. Residents also have had safety concerns about getting to Randall’s Island using the walking paths or bike lanes. RIPA is working to overcome these perceived barriers and get residents engaged in the wide array of activities offered—some of which people are experiencing for the first time, such as the island’s urban farm.

“The children were able to taste almost every plant, mint, catnip, and other herbs,” said Lisa Schaffner, a teacher at Central Park East 2, of a spring 2017 trip with her kindergarten class to the urban farm, a 40,000-square-foot environmentally sustainable garden and outdoor classroom on the island. Urban farm employees took the children on a tour of the vegetable beds and greenhouse, engaging them in how to identify the different plants by color or leaf shape and how to pick and taste the herbs and vegetables. “It was a hands-on, multisensory experience,” said Ms. Schaffner. “We all were able to eat a small piece of the asparagus that was so delicious, the teachers and children remembered it when we were back at school.”

Through regularly scheduled school trips and periodic special events open to the public, the urban farm gives both children and adults an opportunity to experience and learn about sustainable gardening in an urban setting, including hands-on classes to help them better understand how food choices affect their health, the environment, and their communities.

On some of his trips to Randall’s Island, Moa likes to bring his grandmothers when they visit from out of town. On one occasion, as he guided one of his grandmothers around the urban farm, staff members overheard Moa teaching her everything he had learned during his previous trips. “Chickens are always a highlight, and he likes to taste and see all of the things that grow,” says Nicole, Moa’s mother. “His favorite is basil and he’ll eat okra right off the plants.”

To help facilitate pedestrian access to the island, New York Restoration Project is partnering with neighborhood organizations to increase signage for Randall’s Island in East Harlem and the South Bronx. New York Restoration Project also is working to raise awareness of the physical activity and nutrition education opportunities among schools and community groups that could benefit from these underused resources.

Cycling and Walking Trails

Citi Bike and the East Harlem Neighborhood Health Action Center are encouraging residents to bike and walk around their neighborhood, as well as use the pedestrian and bike trails that connect East Harlem to Randall’s Island.

To help promote its discounted membership for low-income residents, Citi Bike is partnering with local organizations to organize and offer free community rides. It is also working with Bike New York to provide bicycling classes for kids, as well as regularly attending community events to share information about discounts and employment opportunities for East Harlem residents.

East Harlem Neighborhood Health Action Center worked with community partners to help develop the Community Walking Trail, a 3.5-mile pathway along sidewalks that run east and west by way of 106th and 115th Streets in East Harlem. It holds regularly occurring community walking groups on the trail. The walking trail has an added benefit of promoting or passing by public art installations, museums, community gardens, and cultural centers throughout the neighborhood. Through these coordinated group walks, residents are not only improving their physical activity but also learning more about their community’s assets. Additionally, the walking trail connects the neighborhood to Randall’s Island through a walkway at 103rd Street—providing residents with a safe, convenient way to access the island from East Harlem.

Through these collective efforts by NYHealth grantees and their partners, residents of East Harlem and the South Bronx—communities with historically limited opportunity for physical activity—are engaging more in biking, walking, and other activities that improve the health and wellbeing of themselves and their families.

Grantee Spotlight: Connecting Undocumented New Yorkers to Coverage

With NYHealth support, the New York City Mayor’s Office of Immigrant Affairs (MOIA) embarked on a public education campaign in 2016—the largest effort in the United States of its kind—to raise awareness among the tens of thousands of Medicaid-eligible immigrants living in New York City and connect them to health insurance.

In this Grantee Spotlight Q&A, NYHealth Program Officer Amy Shefrin and MOIA Deputy Director of Policy Sam Solomon discuss the campaign and its impact, the benefits in having more immigrants covered under health insurance, and the anxiety and uncertainty surrounding DACA’s future.

The Deferred Action for Childhood Arrivals (DACA) program has given hundreds of thousands of young, undocumented immigrants living in the United States an opportunity to legally work and study without fear of deportation. Established by an executive action in 2012, DACA provides employment authorization, temporary protection from deportation, and a Social Security number to work and pay taxes for undocumented immigrants who were brought to the United States before the age of 16 years and who have been in the country for at least five years. New York State is one of the few states that also provides a pathway to health insurance for DACA recipients by allowing those who are income-eligible to qualify for Medicaid. However, many DACA recipients and potential DACA applicants have been unaware of this option and have gone uninsured.

MOIA’s public education campaign increased awareness of Medicaid eligiblity and enrollment, reaching thousands of immigrants in New York City. Watch the following Q&A segments to learn more:

Do immigrants have access to Obamacare and health insurance coverage?

What is DACA, and how is it a path for health insurance in New York?

What was the campaign to reach immigrant youth in New York City?

How has the campaign been sustained?

What is the impact on our health care system when immigrants do not have health insurance?

What effect has the uncertainty over the future of DACA had in New York?

What are some opportunities to support this work in the future?

Women and Young People Benefiting from Better Reproductive Health Care

Improving Quality of Services…

Ana*, 19 years old, and her boyfriend knew they weren’t ready to start a family—both were enrolled in school and didn’t want to have a baby at this stage of their lives. Ana was apprehensive, however, because she had heard that birth control could harm her body and ability to have children.

Seeking advice, the couple met with a counselor at a federally qualified health center (FQHC) in Corona, Queens, to discuss options. The counselor addressed Ana’s misinformation and reassured her that, although birth control may cause certain side effects, it would not cause harm to her health or affect her long-term fertility. After discussing several effective methods, Ana decided on a birth control shot, receiving her first injection that day at the clinic. Three months later, Ana and boyfriend returned for her next shot, meeting again with the counselor and telling her they were happy with the method and planned to continue using it.

The health center where Ana received care is one of four FQHCs that improved contraceptive services through the Family Planning Capacity Building Program, an initiative of Public Health Solutions (PHS) funded in part by NYHealth.

FQHCs provide comprehensive primary and preventive care regardless of a patient’s insurance status or ability to pay. Although FQHCs are required to provide family planning services, many do not receive funding through the U.S. Department of Health and Human Services’ Title X Family Planning Program to do so—leaving them inadequately equipped or improperly trained to provide the same scope of services as their funded counterparts. However, in light of the new guidelines issued by the Centers for Disease Control and Prevention and U.S. Office of Population Affairs on providing quality family planning, FQHCs are expected to find ways to meet patients’ family planning needs.

The family planning program developed by PHS is a quality improvement collaborative pilot project that ultimately aims to prevent unintended pregnancies. The program works to increase the uptake of effective contraceptive methods among women who receive primary care at non-Title X-funded FQHCs and are not seeking to become pregnant. Four New York City FQHCs participated in the collaborative: William F. Ryan Community Health Center, Urban Health Plan, Bedford-Stuyvesant Family Health Center, and Project Renewal.

An initial assessment of the clinics conducted by PHS found that all four sites had limited capacity to provide contraceptive services. Barriers to offering these services included a lack of provider and staff knowledge of best practices, as well as inadequate data reporting systems.

Over the two-year pilot, PHS educated and trained health center staff on integrating evidence-informed best practices in contraceptive care at their clinics. It worked with quality improvement teams at each site to help identify areas for improvement, including contraceptive counseling and prescribing practices, method availability, and data collection and reporting. PHS then provided the teams with the appropriate coaching and technical assistance to test, adapt, and implement practice changes that would lead to improvements.

Incorporating a contraceptive counselor at each of the sites was also essential to the program’s success. After receiving training from PHS, the counselors helped patients determine pregnancy intention and in selecting, initiating, and continuing to use effective contraceptive methods.

The four FQHCs saw major improvements in contraceptive service provision at their sites after implementing the needed changes they identified during the pilot program. Between May 2014 and August 2015, pregnancy intention screening for patients increased from 3% to 84% across all participating sites. Among women seeking to prevent pregnancy, those who left a clinic visit starting or continuing an effective contraceptive method increased from 2% to 61%.

As a culminating product of the initiative, PHS is developing a comprehensive toolkit that provides guidance and tools for practitioners seeking to improve the quality of contraceptive care in primary care settings.

“We know FQHCs that lack Title X funding are eager and motivated to provide quality contraceptive services, despite their prior limited capacity to do,” said Lisa David, PHS President and CEO. “The Family Planning Capacity Building Program gives health centers the tools and training they desire and need to make successful improvements to contraceptive care, ensuring that the women seeking care at these health centers have access to a full range of effective methods.”

And Expanding Access to Care….

Many young people—especially those from low-income families—lack access to health care services, including reliable family planning and reproductive health services such as contraceptive counseling and services; reproductive education; and sexually transmitted infection (STI) screening, counseling, and testing. Young people on Staten Island in particular had faced challenges in accessing reproductive health care because of a dearth of such services in the community. With NYHealth funding, Planned Parenthood of New York City (PPNYC), in partnership with Community Health Action of Staten Island, established a new health center on Staten Island to provide safe, affordable family planning and reproductive health services for young people, especially those living in low-income neighborhoods of the borough.

PPNYC opened its only existing permanent Staten Island health center in October 2011. The center provides comprehensive family planning services, including contraceptive counseling and provision; gynecological exams; cancer screening; HIV/STI screening, counseling, and testing; and male services, which typically include STI and testicular cancer screenings.

The Staten Island health center also offers on-site health insurance screening and enrollment services, with staff members helping eligible patients enroll in Medicaid and other publicly funded programs, as well as through NY State of Health Marketplace. Health insurance enrollment ensured better access to sexual and reproductive health services and other types of health care as needed from PPNYC and other health care providers. For those without insurance, the health center offers sliding-scale fees so all patients are able to afford services and get the care they need.

NYHealth’s investment in the Staten Island health center allowed PPNYC to expand its operating hours beginning in spring 2015, improving access for those patients who visit the center after school or work. The health center has had a significant impact on the community, with 3,000 patient visits in 2015. As one Staten Island patient shared, “Planned Parenthood helped me when I had a large ovarian cyst. They caught it before it ruptured and caused damage. But if I hadn’t been able to go to Planned Parenthood, I would have waited it out because I couldn’t afford to go to another doctor.”

*Name changed to protect privacy

Getting Parents Information on Environmental Health Hazards in New York City Public Schools

In early 2011, several students at Bronx elementary school P.S. 51 started reporting to the school nurse that they had headaches.

Some P.S. 51 parents had noticed many assorted illnesses among children at the school over the years, including stomach pain and coughing, but no one knew what to make of the trend. In addition, construction had recently started to build 10 new high-rise condominiums on the same block, and some parents and teachers found the noise and dust were making classrooms unusable or causing breathing problems. Parents and teachers questioned whether the school would be relocated so that students and staff would not have to come to this unsafe school environment every day.

The school building’s lease was scheduled to expire that same year, and the renewal process required an assessment of toxins on the property. The Department of Education (DOE) began to perform air tests at the school after hours, starting in January of 2011. The testing revealed dangerous levels of toxins, well in excess of State standards, which were likely left over from chemicals used in the school building’s past as a lamp factory. The factory had left behind trichloroethene, or TCE, a chemical which can cause cancer and other long-term health effects. The DOE had not tested the air when it first leased the building 20 years earlier, exposing students and school staff to these toxins daily for years.

The DOE did not tell the school principal, teachers, or parents about the ongoing environmental testing or its results for six months, while school remained in session. By the time the community learned about the air testing and toxicity, it was summer, when the DOE chose a new site for the school and released a report about the environmental hazards in the original building. The reports were too technical for community members to understand, and parents were left confused, fearing for their kids’ health and safety.

Marisol Carrero’s son, Brandon, attended P.S. 51 before and after the school was relocated. “In October, we were still trying to figure out what the environmental reports meant” about P.S. 51, says Ms. Carrero. “The DOE didn’t explain to us what the reports were saying or what they meant for us—what the toxin was, or what the health concerns would be for our kids.”

“DOE was under no obligation to inform the school community about being in the process of doing environmental testing, so they didn’t,” says Allison Manuel, Lead Community Organizer at Northwest Bronx Community and Clergy Coalition (NWBCCC), a community group that many P.S. 51 parents joined. “You don’t want to do multiple tests as if you can test the problem away before you inform the people who are directly impacted by these toxins.”

While the P.S. 51 community struggled to get information and understand how to protect their kids’ health, New York City’s School Construction Authority was implementing an aggressive plan to relieve overcrowding in public schools by establishing 56 new school buildings over 5 years. Because of the scarcity of affordable, clean land in New York City, schools are often sited on property likely to be contaminated with toxins, like the former lamp factory that became P.S. 51. Because of these past uses, the school sites could be contaminated with toxins such as lead, arsenic, and a range of carcinogenic compounds.

Communities across New York City continue to face difficulties establishing safe and healthy school environments, including issues with expansion, relocation, construction, and toxic lighting. For the previous five years, New York Lawyers for the Public Interest (NYLPI) had been working with community boards at a number of New York City schools to empower parents, community members, and elected officials to get information and ensure school buildings are safe, healthy learning environments. However, the scale of the problem meant there was more work to be done, and NYLPI had reached only a fraction of the contaminated sites proposed to become schools.

With support from NYHealth, NYLPI expanded its work on healthy schools and reached more districts where new school sites were being considered, including P.S. 51, to provide assistance and helpful materials. NYLPI instituted ongoing trainings for community boards, parents, teachers, elected officials, and other school community members to help them learn to navigate the complex school siting system and advocate for the information they need. To reach more schools, NYLPI also developed and distributed a series of practical tool kits that explain how community members can get involved in safe and healthy school siting, construction, and renovation practices.

NYLPI staff met with Ms. Carrero, NWBCCC, and other P.S. 51 parents and community members to help them advocate for a healthy school environment and identify ways to get involved in the school siting and environmental testing processes. NYLPI provided the P.S. 51 community with educational materials, including the tool kits, and helped decode the environmental reports so that community members could better understand what toxins were in the air at P.S. 51 and what the health implications could be for students and teachers.

“This [original location] was not a building that should have ever been used as a school,” says Mark Ladov, Staff Attorney at NYLPI. “We wanted to help provide parents with a realistic sense of the level of health risks.”

New York City Council members subsequently reached out to NYLPI for recommendations on best practices for healthy school siting, construction, and renovation. NYLPI provided Council members with the educational materials it had developed under its NYHealth-funded project, including the tool kits designed to enable community involvement. In early 2015, the Council passed new legislation, signed into law by Mayor Bill de Blasio, designed to prevent future situations like P.S. 51. The law requires the DOE to inform parents and school employees within seven days of any environmental test results that show potential health threats in public schools or proposed sites. It also requires the DOE to publish all environmental inspections to its website, and to publish biannual reports for the City Council and the public summarizing the test results of every environmental inspection and site assessment, as well as plans to mitigate risks.

“I’ve spoken to so many parents, and I can’t tell you how relieved they are that something like this law exists out there,” says Ms. Carrero.

“With such a lack of transparent information, it left room for fear to fill the vacuum,” says Mr. Ladov. “Parents were rightfully concerned. An important part of our role [at NYLPI] was to be on their side, and take this energy and frustration to help the next set of parents down the line.”

New Yorkers Involved with the Criminal Justice System Get Needed Mental Health Care

Having spent the majority of her adolescence on the streets and involved in the criminal justice system, Teisha battled depression and a growing sense of hopelessness at the age of 18.

In an effort to establish some stability and support in her life, she rushed into a marriage with a man she met at a homeless shelter. The relationship soon turned abusive, however—forcing Teisha back onto the streets and into renewed encounters with the justice system. After one particular arrest, Teisha was mandated to the Center for Alternative Sentencing and Employment Services (CASES), an innovative alternative sentencing program in New York City.

Although vivacious and remarkably resilient, Teisha struggled with undiagnosed mental illness. CASES staff identified symptoms in Teisha and referred her to the Nathaniel Clinic for treatment. The first of its kind in New York State, the Nathaniel Clinic is uniquely designed to serve youth and adults who have mental illness and are involved with the criminal justice system. Operated by CASES, this State-licensed clinic, located in Central Harlem, began offering services in September 2014 with support from an NYHealth grant.

Prior to visiting the Nathaniel Clinic, Teisha had never received any mental health treatment. Once at the clinic, she underwent a comprehensive clinical screening and began attending regular therapy sessions to help work through the feelings of hopelessness and anxiety she had developed through years of uncertain, transient living. The Nathaniel Clinic staff also helped Teisha pursue one of her long-time dreams: going to college. A year later, Teisha—now age 20—is a student at the Borough of Manhattan Community College, where she is working toward an associate degree in science.

The Nathaniel Clinic provides services—typically unavailable at traditional clinics—that specifically address the risks faced by and needs of people involved with the criminal justice system. The clinic developed a treatment model that integrates mental health, substance use, and physical health treatment with criminal justice-related coordination and rehabilitation services to improve health outcomes and reduce recidivism. It accepts clients ages 13 years old and up from all five New York City boroughs and provides a range of services, including individual and group counseling/therapy; psychiatric evaluations; medication management; health physicals and monitoring; integrated treatment for substance use; and crisis intervention.

Despite experiencing significantly higher rates of medical, behavioral health, and substance use problems than the general population, most people involved with the criminal justice system have had extremely limited access to effective mental health treatment in the community. For many years, New York City and State officials have grappled with how to address the intersection between mental illness and criminal justice involvement.

While CASES’ primary focus is on alternatives to incarceration, it is ramping up efforts to provide its participants with greater access to evidence-based behavioral health services—a measure strongly endorsed by policymakers in both the health care and criminal justice fields.

“We have seen such a great need for mental health services every day since opening the clinic,” says Ann-Marie Louison, director of adult behavioral health programs, CASES. “The youth and adults we are treating have experienced many difficulties and present with complex histories. Many have been long disconnected from school or work and reside in neighborhoods disproportionately impacted by poverty and violence. Many also have difficult family backgrounds, struggle with substance use, and have significant past experiences of trauma—including the trauma that comes with being incarcerated,” says Ms. Louison. “Our approach to treatment not only helps clients recover, but also allows them to learn different responses when faced with challenges so as to help them avoid new crimes and other poor outcomes.”

Since opening its doors, Nathaniel Clinic has seen a growing demand for services—in its first six months of operation, the clinic has served more than 160 clients, including more than 50 young people ages 13–24. As it reaches capacity, the clinic expects to serve 400 clients annually, offering a much-needed resource for Teisha and others as they work to regain their emotional and physical health and reconnect with the community.

New Yorkers Who Got Covered Under Obamacare

Why Getting Health Insurance Matters.

Ben’s Story: Composed and Covered

Ben is a composer who currently works at an Off-Broadway show. Under the Affordable Care Act (ACA), Ben was allowed to stay on his parents’ insurance until he turned 26 this past July. Ben did a lot of research on his own to see what his insurance options were, but he still had a lot of questions. Then a friend referred him to free assistance at the Callen-Lorde Community Health Center, where a counselor was able to answer all his questions and help him choose a plan. Now, Ben has coverage that’s helping to pay for his medications, and he plans to keep going to Callen-Lorde for primary care.

Jerome’s Story: Coverage for the Future

Between his part-time job at a retail pharmacy and his job as an after-school teacher, Jerome works every day of the week. Uninsured for years, he couldn’t afford to miss a day of work if he got sick or wanted to go to the doctor, even when it was necessary. With help from the Center for Frontline Retail, Jerome found out he was newly eligible for Medicaid under health reform in New York. Jerome is now covered so he can see a doctor when he needs to, stay healthy, and work toward becoming a full-time teacher.

Luis & Carmen’s Story: Covered for Their Health

Luis worked at The Plaza Hotel for 40 years; then he had a heart attack and had to leave his job to go on disability. When Luis’ employer-based coverage ended in September, he didn’t know how he would afford health care for himself and his wife, Carmen. He went to the Health and Welfare Council of Long Island for help with finding a new plan. Now, his new health insurance will allow Luis to get care for all his health conditions, including his neuropathy, diabetes, and heart problems.

Read more stories about New Yorkers who got health coverage with the help of the Enrollment Network.

About this Initiative

In the second year of open enrollment under the ACA, there is still a high need for direct assistance and face-to-face support to help individuals enroll in health insurance. To engage uninsured New Yorkers and help them enroll in coverage, the New York Health Foundation (NYHealth) is funding community-based organizations that serve as trusted messengers to their communities for outreach and enrollment activities. An October 2014 poll by NYHealth found that 92% of New Yorkers who became newly insured under health reform are completely or somewhat satisfied with their health insurance, but some respondents report encountering barriers to care and using their insurance. Learn more about NYHealth’s range of outreach and enrollment efforts, including the Enrollment Network, which has helped Jerome, Ben, Luis, and thousands of other uninsured New Yorkers across the State enroll in health insurance.