El Sol Neighborhood Educational Center

Setting and background—Describe the location of the program or project and the community’s characteristics, including local health and social conditions. Include community assets, needs, and unique challenges. El Sol Neighborhood Educational Center (El Sol) was founded in 1991 as a grassroots nonprofit organization with the mission to serve the educational needs of low-income, non-English-speaking individuals. The organization serves the Inland Empire in Southern California, which includes the counties of Riverside and San Bernardino. The region is located in the “Third California,” a term used by the Brookings Institute to describe the disparities in economic indicators as well as in social and health outcomes between subregions in the state. El Sol’s target population is 61.7 percent Hispanic/Latino, 19.2 percent White, 12.4 percent African Americans and 4.8 percent Asians/Pacific Islanders. Many neighborhoods served by El Sol have over half of the residents living at or below 200 percent of the federal poverty level. Additionally, 85 percent of children in the San Bernardino City Unified School District receive free or reduced price meals (as compared to 55.9 percent in California as a whole), evidence that a disproportionate number of children live below the poverty level. San Bernardino is ranked 55th out of 56 counties in California in terms of poor quality of the built environment, an indicator that includes access to healthy foods, quality of the environment, and liquor store density. Furthermore, in San Bernardino, almost 1 in 4 adults (24 percent) report having inadequate social and emotional support, compared to the 14 percent national average. This may explain why individuals in San Bernardino have 4.1 “poor mental health days” (in the last 30 days) compared to the national benchmark of 2.3 days. Despite confirmed needs, San Bernardino receives an average $6 per capita in foundation funding compared to $678 in San Francisco or $108 in nearby Los Angeles. This context confirms the pressing and unique needs of this community and urgency of implementing a robust, comprehensive, and culturally sensitive community empowerment model such as the promotores de salud. This important community asset was implemented as a result of the rising need for community-based education and outreach on various health topics.

Parties involved—Describe stakeholders, partner organizations, partnership formation, and the program or project’s intended audience. Provide an overview of the program or project itself. In 2015, El Sol partnered with Loma Linda University and developed an innovative Promotores de Salud Academy. The academy offers structured training of a minimum of 70 hours to equip community leaders to serve as Promotores de Salud. El Sol has ongoing partnerships with a variety of community stakeholders. For example, El Sol’s work has included partnership with private foundations such as the Weingart Foundation, California Women’s Foundation, AstraZeneca Foundation, and Archstone Foundation, among others. El Sol also partners with public and government agencies, such as the Riverside and San Bernardino County Department of Behavioral Health, Riverside and San Bernardino County Public Health Departments, and San Bernardino County Department of Aging and Adult Services. To ensure monitoring and evaluation of programs, El Sol partners with Loma Linda University. The intended audience for the Promotores de Salud Academy are community leaders with a demonstrated passion for community health and empowerment. Through the Promotores de Salud Academy, participants complete a minimum of 70 hours of basic training on topics such as effective communication, adult and informal learning approaches, client counseling, home and family visitations, conflict resolution, ethical practice, and community advocacy, among other topics. Additionally, promotores receive training on children’s needs, mental health, the developmental benefits of play, family dynamics, attachment, parenting skills, the variety of cognitive styles shown by parents, and cultural differences.

Lessons learned—Provide examples of real-world successes and challenges. Include details about the program or project processes, approaches, methods that worked well and those that did not, and how you overcame/ will overcome those challenges. As a learning organization, El Sol is constantly evaluating its program. El Sol has had significant success. For example, in 2014-2015, El Sol documented impacting over 130,000 participants through a variety of community empowerment strategies. Additionally, in one of its innovative projects designed to educate 600 individuals on issues of nutrition and obesity prevention, a pre/post test of participants (n=275) revealed that participants showed significant (p<0.05) increases in 13 out of the 18 knowledge items. Furthermore, the survey results indicated that participants significantly increased their intention to make health behavioral changes in all of the following areas: drinking fewer sugary drinks, eating more fruits and vegetables, being more physically active, inviting family to exercise together, speaking to family about healthy groceries, cooking with less fat, drinking more water, using a grocery list, and serving smaller portions of high-fat/sugar foods. Comparing pre- and post-survey results, participants reported an increase in their capacity to exercise more, decrease sugary drinks, eat more fruits and vegetables, and prepare healthy snacks for their children. These findings are important as they confirm the effectiveness of the promotores de salud model in influencing attitudes and behaviors. Additional program successes are in the areas of prevention and early intervention, structured case management, early childhood development and literacy, parenting education, and mother-infant health home visitation. There are two key lessons:

• Lesson 1: Trust the community in program development. El Sol strives to include the voice of communities in the development of programs and services. This may be through customer surveys or through program advisory committees. At times, one may be tempted to develop a program without consultation with the community. This may be the result of an offer of funding or another perceived need. However, before moving on, it is important to have a mechanism to engage community voices.
• Lesson 2: Promotores training is much more than an academic certificate. Through the Promotores Academy, El Sol provides a structured mechanism for community leaders to continue developing competencies associated with being an effective promotor/a de salud. However, completion of a series of classes or tests should not be the standard to certify promotores de salud. Instead, field-based experience, such as a supervised practicum, may be better suited to identify individuals who are ready to serve as community facilitators. The role of promotores requires empathy, trust, and commitment to community empowerment by creating awareness and “conscientización.”