Prescription For Health: How Parks Can Replace Pills

This audio piece first appeared on KALW‘s Crosscurrents

From the smallest banana slug to the tallest redwood, park ranger Katherine Wright loves introducing new visitors to the sights and sounds of San Mateo County’s beautiful outdoor spaces.

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Leafy hiking trails abound at Wunderlich Park. Photo: Liza Ramrayka

As we hike a trail together at Wunderlich County Park in the town of Woodside, she points out a family of deer approaching in the tall grass just a few feet away from us. Loud birdsong resounds from above. Early afternoon sunlight squints through the redwood branches.

Ranger Wright has the enviable job of welcoming people into some of San Mateo County’s 21 parks and open spaces. And, for the past few years, she’s also been part of an initiative to connect a new group of visitors with nature.

San Mateo County is part of an innovative national program where doctors write a “prescription” for park and outdoor time to improve their patient’s physical or mental health and wellbeing.

What you get is similar to a regular prescription slip. But, instead of a list of medicines, there’s a space for your doctor to prescribe how many minutes and how often each week they’d like you to spend outdoors and in nature.

The prescribed activity could be a nature walk, a guided tour, yoga or meditation outdoors. Family activities pre-pandemic included lawn bowling and loteria — a bingo game.

Basically, it’s Mother Nature as medicine.

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Activities at Wunderlich Park include horse riding at the historic Folger Stable. Photo: Liza Ramrayka

Research shows that spending regular time outdoors helps to reduce headaches and mental fatigue, lower stress, and improve mood.

Ranger Wright says that many of the patients she meets may not have ever visited their local park. Or even hiked or biked a trail. Park life might not be part of their routine, tradition, or culture. Often, she sees patients visibly relax and immediately enjoy their new surroundings.

“Like looking at the trees, listening for the bird songs. And just having a nice chance to learn more about the natural environment,” she observes.

We often see people just feel like they visibly relax out here… And just kind of being present in the moment here. Like looking at the trees, listening for the bird songs.

Park Ranger Katherine Wright, San Mateo County

San Mateo County has engaged a range of its residents in the parks program, including Tongan Pacific Islanders and the Latinx community — some of whom are in low income groups. These groups have historically been disproportionately affected by health conditions including high blood pressure, diabetes, and mental health issues.

Gloria Cardenas lives in San Mateo with her husband and two teenage children. She’s just turned 50 and her family has been involved with San Mateo’s healthy lifestyles clinic for more than ten years, and with the parks program since 2019 when it started.

Cardenas’s pediatrician originally prescribed healthy eating and outdoor time to improve her children’s health. But now, she says, the whole family visits parks almost every weekend. And she has loved the social aspect of getting out and about — meeting other families, playing games in the park, and sharing healthy food.

But her favorite thing about the program is walking in the woods, and learning about the animals and plants that live there — even the banana slugs.

Cardenas says her children have become more active as a result of the program. Both have taken up wrestling in high school and her son plays tennis. He’s also developed a passion for cooking.

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Families play outdoor games in Huddart Park. Photo: Gloria Cahuich-Gonzalez/San Mateo County Health

During lockdown, park rangers hosted Zoom meets for families to stay engaged in the program and offered ideas for outdoor activities in their parks that remained open.

As part of the program, health practitioners use an online system, which syncs with the patient’s existing health record to recommend outdoor activities. 

Dr. Rachel Borovina is a pediatrician who works for San Mateo County Health. For years, she’s run a healthy lifestyles clinic. And, over the past few, she’s worked with county health chief Dr. Scott Morrow on the park prescription program.

For every child aged 2 to 18 years coming in for an annual check up, Dr. Borovina and her team ask about time spent in nature or outdoors. Everyone leaves with a prescription to spend one hour twice a week outdoors. And the team puts together what they call “informational prescriptions” which list the addresses of nearby parks, and the health benefits associated with outdoor time.

Last year, San Mateo County’s Park Prescription program issued annual park passes to 800 families who qualify for the CalFresh low-income benefit.

Dr. Borovina’s program is part of a wider nationwide initiative launched in 2013 by the San Francisco-based Institute at the Golden Gate. It now has an estimated 100 programs across the country.

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Yoga and meditation are suggested Park Rx activities. Photo: Gloria Cahuich-Gonzalez/San Mateo County Health

Around three quarters of these programs tackle general wellness. The remainder address specific health goals like managing anxiety and depression, or reducing stress levels. Research into impact shows participation can help reduce blood pressure and feelings of loneliness.

However, Ranger Wright notes that there are barriers, such as transportation: “If it’s not right in your backyard, like it is for some county residents, it can be challenging to get out to some of these more remote park locations,” she says.

Cost is another barrier, she says. “To enter some of the park sites, there’s a vehicle entry fee of $6. And that can be a barrier for certain people. So we were looking into that. At one of our park sites, we’ve taken that vehicle entry fee away so it’s now free to park.” However, she adds that it’s not a permanent solution because the parks need that revenue to support staff and other projects.

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Park Rx families playing loteria at a community day in Huddart Park. Photo: Gloria Cahuich-Gonzalez/San Mateo County Health

But for Gloria Cardenas in San Mateo, the parks program has been a game changer. Tonight, her son wants her to pick up fresh vegetables from the market so he can cook the family dinner. The Cardenas family’s involvement in the Park Prescription program has resulted in better eating, regular exercise, and more quality time together.

And that’s a recipe for good health.

Learning From Lockdown: Supporting Teen Mental Health

Wellness counselors from Jefferson Union High School District offer online support to students

This audio piece first appeared on KALW‘s Crosscurrents

2020 was definitely not the year that recent high school graduate Anna was expecting. She’s 18-years-old and asked to use a pseudonym to protect her privacy. Instead of a senior year on campus with her friends, Anna spent most of it at home. In her bedroom. Logging onto classes on a laptop in her closet.

Anna says she had already experienced anxiety attacks before lockdown. But having to join classes from home introduced a whole set of new challenges. And being cooped up at home with her family was really hard.

She says they fought over the littlest of things “like who finished the peanut butter, who finished the yogurt.”

Anna’s experience is quite common. Emotional and behavioral health challenges in teens were already a growing concern before the pandemic. Shelter-in-place just made these challenges worse. So much so, reported suicide attempts increased almost two fold at some points in 2020, compared to 2019.

Research from last year found that remote learning, isolation and disruption in sleep or eating habits can all contribute to teen stress and anxiety.

Laura Fraser is a San Francisco-based psychotherapist who works in private practice with adolescents and families. She says the isolation and the lack of activity removed a huge source of how people can care for themselves. “Which has only exacerbated already existing anxiety and depression and eating disorders and all kinds of things. Family tensions, too,” says Fraser.

Teenagers are social creatures, she says. Their interactions at this age with friends and other people help them develop relationship skills and navigate emotional closeness and distance.

And social interaction is also essential for another reason. Fraser says it’s common for adolescents to compare themselves with their peers, thinking others have it all figured out.

“And so those fears get loud, and part of the way we find out that those fears are only that — fears — is by all the incidental interactions that take place in a day,” she explains.

Of course, those interactions may not always be positive. But being physically on campus can provide a safe environment for students to express themselves.

Fraser says: “So maybe they’re walking down the hall and somebody gives them a big smile or somebody runs up to them and says, ‘Hey, you know that thing you said? It totally cracked me up in class today!’”

And those things are great, she says, because that provides students with “a store of evidence to fight against the fears that they have about how they are in the world.”

In-person learning has other benefits. Anna’s parents are very strict with her, based on their own family traditions. So school was a sanctuary that allowed her to be herself and have conversations that she’d never have at home.

Anna admits that she became “kind of a loner” when her two friends moved away during lockdown: “I’m not really that much of a sociable person anymore… those were my only two friends.”

Melissa Ambrose is wellness coordinator for Jefferson Union High School District in San Mateo County. She hears stories like Anna’s all the time.

Ambrose says that, over lockdown, overcrowded homes, financial distress and family trauma added to students’ stress about home learning.

“These kids have had a year and a half of building the habit of lying in bed, not being dressed, eating, you know, whatever they’re eating in bed. Scrolling through Instagram, tuning into their class and napping intermittently,” she says.

To counter this, Ambrose and other Jefferson Union wellness counselors joined virtual classrooms and hosted small group chats. They also launched Instagram feeds with wellness tips and information on finding mental health counselling if you don’t have insurance.

And they hosted a suicide prevention night with breakout rooms in several languages to reach as many parents and caregivers as possible.

Other solutions to the loss of in-person time came from the students themselves. Last October, Anna and other teens in the Jefferson Union school district decided to make a podcast, called It’s Always Something. They experimented with different styles and topics. MK Munoz, who often leads the podcast discussions, says a good example of this was when insurrectionists stormed the U.S. capitol on January 6.

“That happened like five hours before our normal meeting. It’s like, yo, the capital is under attack. Y’all want to talk about it?” she says.

Making the shows gave the students a regular day and time to meet. Kind of like the locker chat and lunchtime banter that they lost last year.

Anna’s just started classes at a local community college. But she hopes to continue helping with the podcast if she has time, because she likes how being involved makes her feel.

Many California schools are working on programming for mental health this coming year. In addition to pandemic-related federal funds for K-12 schools, the state budget approved in July provides $4 billion over five years to help school and college students cope with anxiety, depression and stress.

report from a coalition of bipartisan education groups — including the California PTA and the California Teachers Association — has urged schools to use their COVID funding to support mental health programs this year.

The report recommends school districts take six weeks to offer students, families and educators what they call “a restorative restart.”

Recommendations include conducting regular student wellness screenings and providing mental health support.

Given teaching pressures, though, many schools may not take that recommended time.

Ambrose says it takes time for post traumatic stress to set in and become activated. “So I think like around December, January, we’re going to start to see the mental health impact both on the adults and the students,” she says.

Ambrose has enlisted the help of a trauma therapist who has worked with students affected by the Paradise and other California wildfires. A grant from the government’s Mental Health Student Services Act will enable the school district to deliver a Stanford-developed social emotional learning curriculum with weekly classes for ninth and tenth graders.

The district also hired three new mental health staff members. Each of its five high schools now has multiple mental health workers to support students.

Ambrose says it’s important to acknowledge that students lost some significant “connectedness and humanity and well being” over lockdown, and then tackle that. She concludes: “Our job is to recreate connections, recreate humanity, recreate resilience. And love the hell out of them and love the hell out of each other.”

September is National Suicide Prevention Month. For more information about mental health and wellness support, contact:

California Parent & Youth Helpline: 877-427-2736

National Suicide Prevention Lifeline: 1-800-273-8255

Crisis Textline: Text HOME to 741-741

The Trevor Project (for LGBTQ+ youth): 1-866-488-7386 or text START to 678-678

Kids In America Are Missing School Because They Can’t Afford Toothpaste And Tampons

This article first appeared in HuffPost’s Impact section

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The shiny metal cabinet in Sarah Helms’ sixth grade classroom is full of necessary supplies — not paper and pencils, but personal care products. (Credit: Sarah Helms)

The locked metal cabinet doesn’t look amiss in Sarah Helms’ sixth grade classroom, with its bright yellow walls and green plastic stationery caddies. But rather than pencils, pens or binder paper, its shelves hold bottles of shampoo and body wash, soap, deodorant, toothpaste, toothbrushes, cotton swabs, sanitary pads and tampons.

For the past three school years, Helms, an English teacher at Horace Maynard Middle School in Maynardville, Tennessee, has stocked a “hygiene closet” with personal care items donated for students from low-income families by fellow teachers, current and former Horace Maynard parents, and members of the community. Helms uses cash donations to buy supplies at the dollar store. Her parents gave her the cabinet.

“I noticed certain kids being picked on for not being well groomed, and I felt that many children were just too shy to go to an adult and ask for help with the items they needed,” Helms told HuffPost. She could see how it eroded their self-esteem when their classmates commented on their appearance or body odor.

Once a month, Helms pulls toothpaste, tampons and other toiletries — including “random donations,” such as hairbrushes, combs, body spray and lip balm — from the hygiene cabinet and packs them into plastic grocery bags for 14 girls and 17 boys.

“A huge blessing” is how one Horace Maynard parent I contacted described the hygiene closet at her son’s school. Helms reached out to this single mom (she asked to remain anonymous) at the start of the school year to see whether her son would be interested in receiving a hygiene pack. She said yes. Her son’s monthly bag includes shampoo, deodorant, toothpaste, razors and cologne.

Closet program increase highlights poverty gap

Horace Maynard’s hygiene closet is just one of the thousands of similar programs in public elementary, middle and high schools across the U.S., according to data from DonorsChoose.org, an online giving platform where public school teachers can ask for funds for their classroom needs. The site has seen requests for hygiene and personal care products mushroom, from just one in 2002 to 1,789 last year. Nearly two-thirds of requests come from schools in urban areas, and they are particularly common among schools where three-quarters of students or more are from low-income households.

Over a third of pupils at Horace Maynard are eligible to receive a free or reduced-priced lunch, and some benefit from the school district’s donation-supplied food program, which provides students a weekly bag of groceries to take home to their families.

Helms sends her students home with hygiene bags the Friday before the end of the month. “This is usually when items are needed most because those families who are on food stamps are low on money for other things like hygiene items,” she explained.

The government’s Supplemental Nutrition Assistance Program (SNAP) and Women, Infants and Children program (WIC) provide state-level monthly help to low-income households in the form of a pre-loaded card to purchase vegetables, fruit, dairy and pantry items. Recipients cannot, however, use the cards to purchase non-food items, including toiletries and sanitary products.

Lisa Greenig, a teacher at Fairfield Middle School in southeast Iowa, said the idea for her school’s hygiene closet came about after a discussion with fellow teachers about SNAP restrictions. “Hygiene items can be expensive. Considering 50% of our students live under federal poverty guidelines, I decided to go public with the idea,” she said. “The community embraced the idea and has been very generous to help stock the closet,” which the school started in January.

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The hygiene closet at Iowa’s Fairfield Middle School, where half of the students live below the poverty line. (Credit: Lisa Greenig)

So far, about 24 families have signed up ― parents and guardians of students just have to complete a registration form to receive items from the hygiene closet. “We did not want to risk offending anyone by offering a bag of products without them submitting a request,” Greenig said. “At no time do we want families to feel embarrassed about using the closet.”

Greenig hopes more families, often reluctant to ask for help, will access the program once they realize how private distribution is. “Re-orders typically come through email directly to me. I pack a bag and quietly place the items in the student’s locker. Refills fit in student backpacks so they can be carried home.” With support from local businesses, such at the Hy-Vee grocery store, and backing from school Superintendent Laurie Noll and school board member Jennifer Anderson, Greenig says the district has plans to expand the program to the high school and two elementary schools.

School attendance and self esteem at risk

Other programs are a direct response to changing family circumstances, such as homelessness. “We’ve had an increase in families losing their housing, doubled or even tripled up in a household,” said Stephanie Martinez, program director of student services for the Jefferson Elementary School District in California’s Bay Area. “It’s been pretty drastic and very challenging [for students] if they’ve lost their housing or have a long commute into school.” Martinez is planning a hygiene pack program for the new school year to help students from the 100-plus families in the district living in transitional housing or shelters.

Lack of access to hygiene products can have a negative effect on the lives of children and teens, said Aleta Angelosante, a child psychologist at the Child Study Center at New York University’s Langone Health: “If you are outwardly having difficulties with hygiene, it can certainly lead to at best being more neglected or ignored, at worst being pointed out and bullied in some way.”

North Carolina nonprofit BackPack Beginnings set up a personal care pantry in its Greensboro headquarters about 18 months ago to help schools in Guilford County provide products to students.“We have heard stories concerning the way it impacts self-esteem and the fact that some are skipping school because they are embarrassed by their own hygiene,” said BPB Executive Director Parker White.

Nearly 1 in 5 girls in the U.S., for example, have either left school early or missed school entirely because they did not have access to sanitary products. “Many have heard of teachers buying food for their students, but fewer people hear about them buying hygiene products. Our teachers are underpaid as is, and we want to take this burden off their plate.”

According to a survey of teachers who use DonorsChoose.org to make funding requests, 84% in the highest poverty schools have purchased essentials such as hygiene products for their students. Of those, 63% report spending more than $100 per year on these items.

Parker said about two dozen schools currently access the BPB pantry program, helping hundreds of students across the district.

Fighting for hygiene equity in schools

While programs led and funded by nonprofits and teachers are to be celebrated, hygiene equity campaigners say this issue calls for state intervention. Most hygiene items are taxed under state laws; some, such as dandruff shampoo and chapstick, are not. Some progress has been made around access to sanitary products and several states, including Nevada and Florida, have removed the so-called “tampon tax.” California’s Gov. Gavin Newsom is unveiling a budget plan this week that would drop sales taxes on menstrual products.

But as long as government programs such as SNAP continue to put toothpaste and tampons on the same list of prohibited purchases as tobacco and beer, teachers, parents and local communities will likely still provide such items for low-income students.

Helms said the hygiene closet program had show her just how much of a lifeline this and other assistance schemes are for many students in her community. As the Horace Maynard mother I spoke to told me, “The closet at my son’s school has helped us tremendously. The products that are sent home are used by all my kids. It’s really a very thoughtful thing to do to help make sure the kids feel loved. I would tell everyone that has donated thank you. A million times over, thank you.”