Access to quality education is a major driver of financial opportunity and while it exists outside of traditional care delivery, education is a core social determinant of health (SDOH). Research demonstrates that simply having a bachelor's degree increases weekly earnings by 29% above the median, but also that higher education access remains deeply divided across racial lines: Black and Hispanic students are underrepresented at selective post-secondary institutions.
The field guide for defining providers' role in addressing social determinants of health
Moreover, there is compelling evidence that access to quality early childhood education improves cognitive and emotional development, yet less than 50% of the country's children living in the poorest 25% of families enroll. This disadvantaged access to education coupled with financial instability manifests in serious health effects. Impoverished American adults live seven to eight years less than others who earn more than four times the federal poverty line.
Last year, ProMedica partnered with the Kadens Family Foundation to begin an initiative to improve educational opportunity in the Old West End Toledo, Ohio neighborhood. The initiative, HOPE Toledo Promise, guarantees post-secondary tuition for local Scott High School graduates who gain admission to an Ohio institution. Today, there are 105 HOPE Scholars being served through the program, with 66 currently attending post-secondary school. And with HOPE Toledo footing the bill, those students get access to post-secondary education without the financial burden. What is unique to the program is the two generational approach, in which one parent or legal guardian gains access to post-secondary school as well. These "Parent Scholars" represent 22 of the 105 total participants. The HOPE Toledo Promise is already demonstrating a sustainable impact as it recently expanded its tuition offer to Scott High School 2021 graduates, and their parents or legal guardians.
"If we don't have a basis for solid education, it's difficult for folks in our communities to eventually get a job with a living wage and access health care and housing," John C. Jones, HOPE Toledo Promise President and ProMedica Community Liaison, said. "Education is bedrock to the success that we want to see in our communities.”
Jones developed the Promise with three steps that other health system leaders should follow:
Health systems cannot address the SDOH alone, particularly in areas like education, where health leaders tend to have less experience. The question is how to identify the right community partner, as each offers distinct abilities to advance strategy. In launching the HOPE Toledo Promise, the organization engaged different types of community partners: one that already launched a similar program, those in need of the most support, and those with specific characteristics community members find desirable.
Identify partners that launched similar programs and have valuable experience
With the goal of education in mind, ProMedica and the Kadens Family Foundation collaborated to identify an obvious early partner. The nearby Kalamazoo Promise has been broadening post-secondary access to Kalamazoo Public School District students with partial or full scholarships since 2005. As the nation's first "place-based” scholarship, Kalamazoo Promise could bring 15 years' experience in engaging the local community and local officials with the goal of growing educational opportunities. Kalamazoo Promise's success made it a particularly attractive partner and source of information, as research demonstrated its students attempted 6.5 more credits in four years at a post-secondary institution and earned any credential at a rate 10.2 percentage points higher in six years than the average.
Identify partners embedded with community segments that have significant need
After identifying a partner to help design the program, ProMedica and the Kadens Family Foundation's next step was to seek out a partner education system. Because ProMedica was focused on maximizing impact, they focused their efforts on the local urban flight around Scott High School, a traditional institution for the Black community.
Identify partners with characteristics the local community desires
With a partner high school in place, the final piece of the puzzle was to identify partnering high education systems. Ultimately, the Promise identified four primary institutions for the majority of its financial coverage; Central State University, a historically black college, nearby private Lourdes University, the University of Toledo, and Owens Community College. These four institutions constitute nearly 70% of the student's enrollment.
Holistic goals grow as programs evolve, and after establishing a framework for post-secondary education, the HOPE Toledo Promise set its sights on establishing a "cradle to career” vision. Accordingly, the organization works to assess and bolster local pre-kindergarten preparedness. Together with the post-secondary program, ProMedica aims to address the bookends of education from pre-K through college graduation.
In addition, guaranteeing enrollment with covered tuition isn't enough to ensure students make it to graduation. HOPE Toledo develops relationships with each institutions' counselors to ensure students have ample access to guidance resources to refine skills, including time management and study habits.
HOPE Toledo also negotiated memorandums of understanding with its higher education partners to strive for a 75% graduation rate for Promise participants, 15 whole percentage points above average. Together, HOPE Toledo and the universities created shared expectations. HOPE Toledo provides the funding and the universities provide the longitudinal support. Together the partnering organizations reinforce their ultimate goals: persistence through enrollment and ultimately graduation.
Early on, the system established an infrastructure to track the Promise's effects. ProMedica collects data on HOPE Scholars, combined with its screens of 14 SDOH domains, to evaluate the program's long-term effects. ProMedica's data-collection is key to its goals in guaranteeing funding and advocacy to broaden impact.
HOPE Toledo has already measured results: 64% more students graduated from Scott in 2020 as compared to 2019. As Jones describes it, "We expect that if kids have hope, it changes their trajectory. We want to see what impact this announcement has in offering a road of opportunity to a healthy life with gainful employment."
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