Where Health and Community Meet: UCSF MEPN Students Engage in Bayview-Hunters Point
Sonja Ray was nervous when she arrived at FranDelJA Enrichment Center. Aware that most of her colleagues in UCSF School of Nursing’s Master’s Entry Program in Nursing (MEPN) were in traditional clinical placements for their pediatric rotation, Ray couldn’t help wondering what she was doing at this modest, cheery-looking building, set flush against the Double Rock housing projects in San Francisco’s Bayview-Hunters Point neighborhood. What clinical skills could she learn at a combined day care and preschool?
It’s not that Ray wanted to avoid this community, which is among San Francisco’s poorest. One of Ray’s reasons for enrolling in MEPN, after earning her undergraduate degree in molecular biology and working as a National Institutes of Health researcher in tuberculosis, was to reduce health care disparities by pursuing an interest in community and international health. Moreover, she was aware that research has established a link between early childhood health and learning readiness – and that developing good health habits early can affect health later in life.
Nevertheless, it was hard to reconcile her own placement at FranDelJA with where Ray’s colleagues had been placed: UCSF Benioff Children’s Hospital, San Francisco General Hospital, Lucile Packard Children’s Hospital and Kaiser Foundation Hospital, San Francisco. How, exactly, had FranDelJA become part of this group?
On one level, the answer is simple. “There’s a shortage of clinical sites for nursing students in subspecialty areas,” says Marianne Hultgren, who was Ray’s professor for Parent-Child Nursing, the six-week course with which the FranDelJA rotation is associated. “Everybody in prelicensure programs is always looking for creative solutions.”
As was Hultgren. New to UCSF in December 2009, she was scrambling to find the required 100 clinical hours for each of her students.
That’s when Assistant Dean for Academic Services and Diversity Enhancement Shirley Manly-Lampkin entered the picture. She had come into contact with FranDelJA earlier in her career, and what she’d found there was an organization that was building and implementing an ambitious vision of community health.
“FranDelJA is community-based work at its best,” says Manly-Lampkin, who is now on the center’s board. That December, she and Scott Ziehm worked to arrange a rotation there; Ziehm was assistant dean, MEPN, at the time.
And that’s where the explanation for FranDelJA as a clinical rotation gets a bit more involved.
Sandra Young and Gladys Harris, grew up in Bayview-Hunters Point more than 40 years ago. “The city dump was our playground,” laughs Harris.FranDelJA’s founders, sisters
In 2000, after having raised four children as a single mother and spending years working in child care, Young had a vision for a center in Bayview that wouldn’t force young parents to scramble all over the city, dropping one child off at day care and another at preschool.
“When my children were coming up, everyone was scattered,” she says. “I wanted a center that housed everybody. Here. In this neighborhood.”
More than two years later – after Young convinced Harris to leave her job as program director at a senior center to help build the vision; after observing centers all over the city; after surveying local residents; after conferring with Pastor Arelious Walker of True Hope Church of God in Christ, where the sisters are longtime members; after convincing then Mayor Willie Brown to support their efforts; and after converting a shell space inside True Hope Church into a modern child care facility – FranDelJA, named for Young’s four children, opened its doors. The original enrollment was 42 children.
Today, FranDelJA’s 30 staff members serve 76 children, ages 6 months to 5 years, and the center operates on a budget of $1.3 million, with a waiting list a year out. Families come from diverse backgrounds reflecting the ethnic and racial diversity of the neighborhood. They are, however, similar on at least one level: Most are struggling just to make ends meet and are in no position to pay the full freight for daily care.
FranDelJA helps underwrite the costs, thanks to the sisters’ ability to make their case to federal, state and local funders, as well as to the Mimi and Peter Haas Fund, a family foundation with a deep commitment to meeting the needs of low-income children and their families in the Bay Area.
“FranDelJA is one of five model centers we currently support in San Francisco,” says Lynn Merz, executive director of the Mimi and Peter Haas Fund. “There are many reasons we have chosen to work with FranDelJA for the past 10 years, including how well their work fits with our focus, but it’s also that Gladys and Sandra grew up in the community and are a part of the Bayview community, know the families well, and have the commitment and passion to make something happen. It’s amazing what these two women have done.”
The government and philanthropic grants support, first and foremost, a day care and preschool that appear to exemplify best practices for any such center, regardless of the income level of participating families. Teacher-student ratios are small. Most of the diverse staff have early childhood education degrees or are in the process of earning them. The facilities are bright and filled with artwork. There is an on-site kitchen with fresh food, and a cheery playground carved from what was once a vacant lot.
Yet FranDelJA is more than a child care facility – it is an organization driven to prove its commitment to serve the community in ways both formal and informal. “You need to develop trust by demonstrating that you’re here to stay and that there is no excuse for not taking advantage of what we are offering,” says Harris.
So when Harris and Young heard from a young mother that her child had missed a day because she hadn’t been able to wash the child’s clothes, the sisters purchased a larger washer and dryer, so shame would never be an excuse for keeping a child home. When a staff member, who had once been homeless in the neighborhood, needed help returning to school, the sisters sacrificed chunks of their own salary to make it happen. When they hear of a child missing a meal, they make sure extra fruit finds its way into that child’s take-home items.
As trust has been built and FranDelJA has grown, so has the sisters’ vision, which is rooted in the simple belief that healthy children emerge from healthy families and healthy communities. Armed with a survey that found there are about 200 families in the neighborhood that need, but don’t have, child care, Harris is in negotiations with the city to not just expand the day care and preschool, but to also build an adjacent family resource center and a wellness clinic. Perhaps, says Harris, there could be a job training center as well.
“That’s why FranDelJA is exactly where UCSF needs to be,” says Ziehm. “Part of it is that we can help meet the health care needs of these children, but part of it is that FranDelJA puts our students, the next generation of nursing leaders, in a position to deeply understand community health needs and the places where they can play a role that they may never have considered. There is so much we can learn.”
“The physical and emotional needs at FranDelJA are huge,” says Manly-Lampkin. “And the rotation of the MEPN students might be only the beginning of the role we can play here. But just as Sandra and Gladys have done, we need to slowly build trust in the community.”
Which brings us back to the MEPN students and Sonja Ray.
Ray and two other MEPN students arrived at FranDelJA for a five-week rotation, two days per week, in the spring of 2010.
Part of what was expected, says Hultgren, was that the students would spend time with the children and staff and do a needs assessment. “The challenge was to apply their training in how to assess on the fly,” says Hultgren.
“We broke up into different rooms and acted as assistants, getting some real hands-on time with kids,” says Ray.
The MEPN students also met with staff, who identified two very specific needs. One child had seizures, and the staff felt anxious and unsure about what to do, should he have one while at the center. Similarly, there was a child with allergies and an epinephrine (epi) pen, and FranDelJA staff wanted to make sure they knew how to use the pen properly.
Ray tackled the seizure challenge. “I put together a binder of materials, printed out flyers in English and Spanish that walk people step by step through what to do, and created a handout for parents,” she says. “And when I presented to staff, we did a little skit and I had them walk through the process. My classmates did something similar for anaphylactic shock and epi pens.”
“We also have our students teaching the children health habits like hand washing, not sneezing into a hand, and applying sunscreen,” says Hultgren.
The students left a mark. Gonsalo Toscano, a staff member at FranDelJA, wrote Hultgren: “The students were incredible!”
“They added so much,” says Harris.
The feeling is mutual.
“In the end, because of my community health focus, I was really glad for the placement at FranDelJA – they are doing so much for children’s health,” says Ray. “Being there really helped me understand normal growth and development and forced me, as a nurse, to work on how to talk and build a relationship with a young child. The setting is a little different, but the same rules apply.”