Kershaw County: Youth on Fire to Build a Healthier Today

This story was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Living well starts with good health across the community. This is the premise fueling the LiveWell Kershaw Coalition, an initiative led by the Community Medical Clinic of Kershaw County and is funded through Healthy People, Healthy Carolinas (an initiative of The Duke Endowment) and the Institute for Healthcare Improvement as a SCALE 2.0 community.

LWK was founded by a group of community members interested in using data to guide action aimed at addressing the health issues faced by the residents of Kershaw County. Today, LWK works to foster collaboration between citizens of all ages, working in partnership with public and private sector organizations and schools to increase community awareness of health issues. The goal is to improve access to quality healthcare and encourage the people of Kershaw County to take ownership of the health of the whole county, acting together to reduce chronic disease and obesity among the members of the community.

LWK is moving the needle on population health in Kershaw County through co-designed solutions to improved well-being in high school youth.

Our Journey

The LiveWell Kershaw Coalition examined data from the Community Health Needs Assessment conducted in April 2017 — funded by the Health Services District of Kershaw County — to identify the most pressing health needs of the community. “Healthy Lifestyles for Youth” was deemed the priority with specific prevention focus to diabetes, teenage sexual activity, and tobacco/vaping use among high school students ages 14-18.

Since identifying "Healthy Lifestyles for Youth" as a priority, the Livewell Kershaw Coalition has done the following:

Trained 12 coalition members in facilitation methods
Conducted 12 focus groups with four high schools and four sensemaking sessions
Hosted an action planning event convening all four high schools
Disseminated a Youth Wellbeing Assessment
Trained 4 student Health Ambassadors in CQI and Model for Improvement
Held a Visioning Workshop with key school district employees to solidify two-year success indicators

"The most impactful thing I've learned through the Livewell Kershaw Coalition would be the fact that students really just want to have a voice. They want to have a say in what happens in their school, in what happens in their community, and if you give them the opportunity to give feedback, usually they can figure out the answer." - Rose Montgomery, Assistant Principal, North Central High School

Inspired Action

Students from across Kershaw county have begun taking action towards leading healthy lives while encouraging others to do the same.

In April 2018, LWK hosted Just Imagine It, a one-day workshop for high school students in Kershaw County to come together and create an action plan. During this workshop, students were taught key community solutions skills that can be embraced by students to begin to transform the culture in their schools for healthy living.

“The biggest thing that I'm taking away from this is the inspiration that I see from all the servant leaders around me,” Matthew Rush, a student at Camden Military Academy said. “It's not easy coming up in front of everybody and saying, ‘This is how we need to change,’ not how we're doing good. It's difficult to point out our flaws rather than where we're succeeding. So, you all really inspired me with that."

Before Just Imagine It, LWK held focus groups at each Kershaw County high school. During these meetings, LWK coalition members asked students about their definition of living a healthy life and how they thought their schools could improve. The information from these conversations was summarized and incorporated into the Just Imagine It workshop.

During Just Imagine It, students were challenged to determine one or two realistic actions that can be done by August 2018 to make each school healthier. They also heard presentations from The Honorable James Davis, Chief Magistrate for Kershaw County, Thoyd Warren, Executive Director at Sumter County Disabilities & Special Needs Board, and State Rep. Laurie Slade Funderburk.

Health Ambassadors

Following the Just Imagine It event, four students were selected to be Health Ambassadors for the Livewell Kershaw Coalition as a summer internship. These Health Ambassadors were tasked with:

Creating and implementing a student-led organization within their high schools by September 2018
Creating an action plan to improve school health and wellness policies
Identifying, tracking, and measuring desired outcomes for their school improvement plan through data tracking system, Measure What Matters, and AC-TAP.

Ambassadors are trained in the Model for Improvement, and collect data on a regular basis to use when making decisions. Health Ambassadors were led by coordinator Mary Reames.

Health and Wellness Clubs

As part of their Livewell Kershaw internship, Health Ambassadors created health and wellness clubs in their respective schools.

Affecting Policy Change

"Adults don’t usually ask us what we think. It was really cool to be a part of this process." — Student from North Central High School

Brain Breaks

The Health Ambassadors presented their Brain Breaks program to school administrators and faculty at schools. As a result, both LEHS and CHS are moving forward with implementation. LEHS has made Brain Breaks a required part of the curriculum.

Teachers have been provided with packets of resources, tools, and demonstrations on activities to conduct.

Moving forward, the Health Ambassadors are collecting and tracking data on their implemented strategies to improve the health and well-being of their peers.

Students are very engaged and leading the effort. They are designing their own solutions. Without their lived experience, policy change of brain breaks probably would not have happened.

What is a Brain Break?

Mental break to help students get energized and/or relaxed
Refresh the brain and help students stay focused
3-5 minutes long
Get students moving! Blood flowing!
Keep students engaged.
Lowers stress and helps students relax
Lowers hypertension
Refocus during long class periods

Examples include:

Listening to music - “Playlist for Personal Power”
Stretching - Yoga Poses (ex: Warrior One)
Playing Games - Snap, Crackle, Pop
Mindfulness - Breath work and Meditation

Fruit Cart at North Central High School

Since September 2018, fruit is offered as an after-school snack to students on Tuesdays and Thursdays at North Central High School. This was the result of a $4,000 Blue Cross Blue Shield Wellness Inspired School Environment, or WISE, grant.

NCHS hopes to expand the program.

Partnership and collaboration were key ingredients for implementation. Partners for this project included State Rep Laurie Slade Funderburk, North Central High School staff and Health Ambassador Izzy Baipho.

Data Driven

LWK Driver Diagram

Youth Wellbeing Assessment

LWK disseminated a Youth Wellbeing Assessment to the four high schools in Kershaw County to determine the overall health and wellbeing status of its priority population. Indicators from the survey captured overall well- being, cognitive well-being, meaning and purpose, social well-being, emotional well-being, and physical well-being.

All four high schools completed this survey for a total of 1,229 responses. There are an estimated 3,150 high school students in the county for a survey response rate of 39%. The LWK team has stratified the results by zip code, grade level, race, and gender to provide student leaders with a starting point for targeted interventions addressing baseline results to then measure improvement of indicators over time.

Equity In Our Work

As part of our work in improving the health of Kershaw County, we believe is it vital to understand how to apply an equity lens, as well as recognize and address our own implicit biases. Our friends, Melvin and Dexter, from Southeast Raleigh Promise, another southeastern SCALE community, recommended that members of our team attend Racial Equity Training offered through the Racial Equity Institute. We recognized that we could not begin this work without first grounding ourselves in a foundation of understanding the historical and systemic perpetuation of racism. Around the same time, key leaders from Kershaw County participated in a Welcome Table offered by the South Carolina Collaborative on Race and Reconciliation. Participation in both of these frameworks allowed the team to better understand what would and would not work in Kershaw County regarding discussions around racism and equity. From this spark, a broader team of community leaders is now planning for the Welcome Table as an offering to thirty individuals representing a broad spectrum of sectors where participants will be tasked with calling out systemic racism within their sector.

Additional Results

Intentional engagement of key groups and placement of the LWK team within workgroups throughout Kershaw County has allowed for the transfer of Community of Solutions Skills to occur and has laid the groundwork for a vision of health and wellbeing as a shared value among residents and local leaders. Additionally, conversations led by the LWK team has inspired and sparked changes at both the macro and micro level within systems. Examples of these successes are outlined below.

Mental Health Counselors

Beginning in September 2018, all three KCSD high schools will have mental health counselors available for students during the school day. Students can be referred to these counselors by the school administrators as well as school nurses, teachers, and guidance counselors. The program is led by doctoral students in the University of South Carolina (USC) School of Psychology.

This program was piloted in 2015 at North Central High School. Its success lead to the expansion of the program to all three Kershaw County high schools.

The collaboration is expected to lead to innovation and research that will be instrumental to the health and well-being of teenagers at the three schools and provide models for other community health clinic-school-university partnerships.

For access to additional resources about this counseling partnership, including links to case studies from the mental health program at North Central High School and peer-reviewed articles by USC researchers, contact Bret Kloos, Ph.D. director of the Clinical-Community Psychology Doctoral Training Program at kloos@mailbox.sc.edu.

Adult Wellbeing Assessment

In partnership with local government, the team included several questions from the Adult Wellbeing Assessment into a county-wide online survey gathering feedback on a comprehensive vision plan. To date, 900 residents have participated in the survey.

Participants were asked to indicate on a ladder (10 representing best possible life and 0 representing worst possible life), their current health status. Of the 734 responses, 74.52% feel that they rank at a 7-10, 21.26% feel that they rank at a 4-6, and 4.22% feel they rank at a 0-3.

Participants were also asked to project where they feel their health will stand five years from now. Of the 725 responses, 72.96% feel that they rank at a 7-10, 20.96% feel that they rank at a 4-6, and 6.08% feel they will rank at a 0-3 five years from now.

Looking forward, the team will be including this information along with other data points to guide a Community Health Improvement Plan.

Community Health Improvement Plan

A community health improvement plan is a long-term, systematic effort to address public health problems in a community. It is based on the results of community health assessment activities and is one step in a process to improve community health. Leading for Sustainability is the common thread between involvement in a district wellness committee, as well as completing a CHIP that creates a shared vision for health in Kershaw County.