As COVID-19 took its toll on the U.S. in 2020, the numbers began to show that not everyone was equally affected by the virus. Data from the CDC and National Center for Health Statistics showed Black and Latinx populations were almost three times more likely to be hospitalized for COVID-19 than white populations, and it was two times more likely that their cases resulted in death.

But COVID-19 only revealed the health disparities that were already rampant in the nation. And, these underlying disparities did not only affect people of color, but also occurred based on other factors such as socioeconomic status, gender, sexual orientation, geography and age.

As the most economically and ethnically diverse university in the nation, the CSU is committed to ensuring all community members are served equally, including access to health care. Here are a few ways campuses are pushing for that access.​

A Little Motivation

The Stanislaus Recovery Center (SRC), which provides addiction recovery treatment for patients on Medicaid or Medi-Cal who are often unemployed or unhoused, is the site of a pilot study led by Shrinidhi Subramaniam, Ph.D., assistant professor of psychology at California State University, Stanislaus.

Working together since 2018, Dr. Subramaniam and the SRC team noticed when patients were transferring from residential to outpatient care, their participation in treatment dropped off. To address the issue, Subramaniam, her students and the SRC launched the project—funded by a Research, Scholarships and Creative Activities grant—to study whether monetary incentives, paid on reloadable credit cards, increased patient participation in outpatient services as well as improved abstinence and treatment outcomes.

“I expect the participants in our study to all be in the category of socioeconomic disadvantage, and hopefully the little bit of money that we can give them with the incentives will also encourage them to access other recovery resources through continuing care,” Subramaniam says.

This pilot study is based off research she conducted during her post-doc at the Johns Hopkins School of Medicine on motivational incentives in health care, including encouraging HIV patients to take their medication and chronically unemployed individuals recovering from substance use disorder to abstain from drug use. Another study also looked at the efficacy of incentivizing patients to do other important tasks like sign up for health insurance, complete job training or acquire identification like a Social Security card or ID.

Subramaniam hopes her work can expand to incentivize patients to use other services at SRC, includin​g its existing resources that link clients to training or local job opportunities—with the ultimate goal of setting up her own “therapeutic workplace” where individuals can receive treatment as well as help securing education, employment and housing.

“We have to deal with a lot of stigmas working with this population; both the stigma of addiction and the stigma that comes along with poverty,” Subramaniam says. “So, one of the major goals of my research program is to figure out what it takes to help people with that combination of addiction, unemployment and poverty to get out of their situation to the best of our ability. Of course, there are structural changes that need to be made to help people in that position, but there are also things psychology can do on an individual basis to help people access resources that are available. And incentives are a great way to help motivate people to do those difficult tasks.”​

The Next Generation

Named in honor of the unsung medical personnel dubbed heroes during the COVID-19 pandemic, the proposed Regional Healthcare Initiative Health Education, Research, and Clinical Outcomes (HEROs) Institute at San Diego State University would seek to improve health care services and reduce disparities in its community by addressing issues in health education.

“We can’t address access to health care if we don’t address access to health care education,” says Harsimran Baweja, Ph.D., associate professor in exercise and nutritional sciences. “Our idea is to make a grassroots-up change to health care delivery, so that these students who go out now, our alumni, will be the changemakers.”

Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.

Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.

“We will be accelerating the delivery [of health care] from bench to bedside or to the community, because the problem in health care access and delivery is the pace at which it’s given,” Dr. Baweja explains. “We need to reduce the burden on the health care system and reduce the burden on the money that is spent. Our trainees who will go out will know how to run the system more efficiently. We really have to create a better and more efficient work system and workflow.”

Spearheaded by Baweja, María Luisa Zúñiga, Ph.D., campus director of the Joint Doctoral Program in Interdisciplinary Research in Substance Abuse, and other faculty in research and innovation, public health and physical therapy, the HEROs Institute will also consolidate efforts currently occurring separately in the colleges. For example, the NIH-funded Addiction Scientists Strengthened Through Education and Training (ASSET) Program aims to increase the number of Black and Latinx scientists in substance abuse addiction and education, while the California Outreach Challenge, which SDSU participates in, has physical therapy programs compete for the most community service hours. Under the institute, similar programs could be implemented that extend across SDSU’s health care disciplines.

Lastly, professors in the participating programs would imbue students with the values, cultural competence and community understanding that would prepare them to drive health care policy changes in the future.

“If we not just prep students to be ready for whatever is coming in the future, but we guide them with the value system that you have to serve your community before they graduate, then the health care system is going to be better prepared for itself than it was in the past 12 months,” Baweja says. “These are going to be the people who are going to be not only informing the workforce, but will be informing the policies in the future.”

The team is currently seeking public, private and industry partnerships to jumpstart the HEROs Institute, which is part of the​ SDSU Big Ideas Initiative​.

A Health Care Transformation

Building on the campus’s Mi Gente, Nuestra Salud (My People, Our Health) effort, California Polytechnic State University, San Luis Obispo is piloting a new institute that facilitates community-led initiatives to address health equity around the cities of Santa Maria and Guadalupe on California’s Central Coast.

“Our solution is a people’s movement for health ownership,” says Suzanne Phelan, Ph.D., professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “The Mi Gente, Nuestra Salud initiative flips our current system upside down, empowering people—and especially those who are currently minoritized in America—to identify and address their most pressing health concerns. We aim to transform health care into health ownership.”

To meet this goal, the Cal Poly Institute for Community Health Training and Research will largely provide resources that enable existing groups to better serve all members of the community with the help of collaborators from all six of the school’s colleges. These resources will include training in health equity principles, data on the community, funding opportunities and strategies for community partnerships, health advocacy and program evaluation.

“We see this effort as collaborative and, ultimately, community-driven,” says Marilyn Tseng, Ph.D., assistant professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “We see the institute as providing resources that will help the process along; we are only one piece in the complex health ecosystem in Santa Maria. If we can help generate ripples that will produce larger beneficial impacts on community mobilization, health ownership and health equity, we will consider the effort to be completely worthwhile.”

To secure support for the project, the team has already forged partnerships with the city of Santa Maria, nonprofits and University of California, Santa Barbara. It also recently received funding from the California Breast Cancer Research Program to study breast cancer risk disparities in the Latinx and immigrant communities of Santa Maria.

These efforts will also be bolstered by Cal Poly San Luis Obispo’s Women and Infants Mobile Health Unit, which, in addition to supporting local health workers and providing free medical care to uninsured women and infants, will serve as a connection point between the institute and the community.

Finally, the team hopes to introduce health advocacy and ambassadorship training into the classroom, preparing Cal Poly San Luis Obispo students to effectively care and advocate for these communities.

Inspiration for these efforts grew out of a program in Jamkhed, India, called the Jamkhed Comprehensive Rural Health Project (CRHP), aimed at empowering people to address health disparities in their communities by first addressing the social, cultural and economic challenges that exacerbate those inequities.

“All of us conduct research and teach courses in which we confront issues of health inequities rooted in systemwide, structural inequities in access to healthy environments, opportunities and resources,” Dr. Tseng says. “The Jamkhed CRHP has been successful and cost-effective in India, but more importantly, its principles resonated with all of us. We felt that health ownership was something we would like to see here given the stark disparities in health, even in our region.”

As discussed in parts one and two, social emotional learning (SEL) skills have become an even greater focus now that students are limited in their opportunities to socialize, collaborate, and communicate with peers in person at school. By the time students reach middle school, the basic foundational skills for social-emotional intelligence are in place. Preteens and teenagers are now ready to face greater obstacles and challenges, especially with regard to peer relationships, stress, and self-motivation. To meet new benchmarks, students in middle and high school must learn to deal with more significant academic struggles, greater peer influences, ever-changing teenage social dynamics, and their own personal growth and development at the same time. Below is our continued list of specific grade-level SEL standards for middle schoolers and high schoolers.

Middle School

Students should begin to recognize circumstances and situations that cause extra or unnecessary stress; they should begin to adopt strategies to help with motivation, stress management, and task completion. Middle schoolers should begin to recognize the benefits of strong self-advocacy skills and how to best utilize the resources and supports that are at their disposal. For instance, if schools offer after–school homework help, students who know that they struggle to complete assignments on their own should take initiative by signing up for the club/program and making a point to attend.

Since learning to set goals in elementary school, middle schoolers should now be equipped to assess the validity of their goals so that they may make more informed, realistic, and specific goals moving forward. They should also be able to determine why they were able to reach success or not, i.e., What helped them to reach their goal? If they didn’t reach it, then why not? What prohibited them from finding success? By middle school, students should not only be able to recognize other people’s emotions, feelings, or perspectives, but they should be able to surmise why they feel or think that way. In this sense, they’re activating the ability to take another’s perspective that they learned in elementary school, then further expanding on that by making inferences.

Preteens not only recognize cultural differences, but they should begin to acknowledge how certain cultural differences can result in some peers being ostracized or bullied. They should then be able to begin to find ways to combat or address the bullying and/or to make others feel included and recognized. Middle schoolers should be well-aware of group dynamics and what it takes to ensure the success of the group. This includes assigning roles, taking responsibility, sharing the workload, cooperating with others, etc.

Students in the middle school grades should be aware of negative peer pressure, what it looks like, sounds like, and feels like. They should also be able to come up with ways to combat negative peer pressure in non– confrontational ways and under various circumstances. Preteens should be considering their decision-making in terms of others. Before making an important decision, they should consider not only how they will benefit from their choice, but how it could impact others as well.

High School

High schoolers should begin to understand how expressing one’s own emotions/feelings can have both positive and negative impacts on others. For example, as young adults, they need to know that positivity begets positivity, especially when emotions are running high. High schoolers will also have developed the ability to multitask by this point. However, more than multitasking, HS students should be able to shift back and forth between various tasks and under wavering conditions or circumstances. For instance, if completing a chapter review for English, a high schooler may need to answer a phone call or walk the dog to then return to the chapter questions later. Perhaps they need to maintain focus on several different homework assignments while working from a bustling coffee shop.

Students in high school should be able to capitalize on their strengths and think creatively when facing a challenge. This ability connects with problem-solving skills and ingenuity. We can’t all be great at everything, but in what way can we use our personal/individual strengths to make challenging tasks easier? This is key for college and career readiness. High schoolers should also be thinking about setting goals for the future after graduation. College is not the “end all be all.” But if college isn’t their plan, then what is? Young adults need to recognize how important it is to find a path, take steps to follow that path, and evaluate their progress, preferences, and goals as they go. If they want to take a gap year, what do they hope to accomplish during that year? If they are going to study abroad, how will they decide on a program and pay for it? What skill set do they plan to use for supplementary income while in or out of college?

High schoolers should be capable of showing respect for those with opposing or differing viewpoints, even if the opposing side is argumentative, dismissive, rude, etc. It is important to maintain a level of self-control even when others are not. Just because someone has a different opinion doesn’t mean they are wrong or right in their convictions. As young adults soon to be out on their own in the adult world, it is critical that high schoolers recognize how we must all be concerned about the well-being of all people; we may all be different races, but we’re all part of the human race. Therefore, we can positively contribute to our communities by advocating for human rights.

High schoolers should be able to assess their ability to actively listen and explain how active listening helps with conflict resolution. They should also be able to demonstrate leadership abilities within group contexts without dominating or overtaking the goal of the group. Young adults should also be prepared to demonstrate knowledge of social norms and appropriate behaviors between and among various cultural groups. They should recognize certain expectations and norms when interacting with authority figures, children, elders, etc.

Thus, we have completed our three-part series on SEL skills by grade level. The following series will serve best as a helpful resource rather than a scare-tactic of sorts. We all develop in our own ways, but it’s important we be mindful of these skills by grade level. If your child or student seems behind on any of these, consider the ways in which you can empower them.

As discussed in part one, social emotional learning (SEL) skills have become an even greater focus now that students are limited in their opportunities to socialize, collaborate, and communicate with peers in person at school. We all know that academics are just one facet of education; the SEL skills that students learn and develop when in school are just as critical. Some might even argue that these “street smarts” are more important or beneficial than the “book smarts” we acquire in school. That said, distance learning and virtual schooling have certainly created various obstacles for students when it comes to developing and growing their SEL skills. Below is our continued list of specific grade-level SEL standards.

Later Elementary Grades (4-5)

Students in 4th and 5th grade should be able to assess a range of feelings and emotions connected to specific scenarios, circumstances, and situations. In other words, they should be able to thoroughly describe how they feel and precisely what made them feel this way. Students should also be able to maintain control of certain behaviors and/or emotions that might interfere with their focus. For example, if they are feeling stressed about their homework, they should choose to turn off the television and put the phone away until they finish their assignments. Students should be able to articulate interests, goals, and the ways in which to develop the necessary skills to achieve those goals.

Students in the later elementary grades should be able to list the necessary steps for goal setting and future achievement while monitoring personal progress throughout the process. In other words, they should be able to take an active role by tracking growth and taking steps to improve along the way. Students should also begin to understand social cues that demonstrate how others are feeling during certain situations. Students should be able to not only recognize others’ perspectives, but specifically describe another’s perspective or stance as well. They should be using phrases like, I understand what you’re feeling and why you’re feeling that way. I might disagree with you, but I appreciate your point of view. That’s not how I interpreted it, but I can see how you may have experienced it differently.

Students should be able to engage in positive interactions with people from different backgrounds and those with different opinions and beliefs. In the late elementary grades, students should begin to understand various cultural differences between groups, i.e., they should acknowledge that not everyone celebrates Christmas. 4th and 5th graders should be able to describe various approaches to meeting new people and maintaining friendships while forging new friendships with peers in different social circles.

Students should begin to demonstrate self-respect and how to show respect to others, even during conflicts or disagreements; they choose their words wisely as to not offend others in the heat of the moment. Elementary schoolers should begin to understand different social cues and behaviors of others and how they might impact one’s decision making. Once reaching the late elementary grades, children should be able to brainstorm various options for solving a problem and anticipating the different outcomes depending on the situation. Finally, 4th and 5th grade students should be able to identify needs in their school/local environment and perform duties to contribute to these communities. For example, if the cafeteria floor is covered in trash, they will take it upon themselves to help clean up after others.

As said in the last piece, if your child or student falls short in any area mentioned above, don’t panic. Consider how you can help and empower them. In our final part of this series, we’ll cover middle school and high school benchmarks.