To an outsider, the room looked chaotic and confusing. Middle school students sat at tables with enlarged aerial maps of their community, brightly colored sticky notes and words posted across the front wall with multiple lines of tape running from one to the other. As they worked their way through an interactive workshop using THRIVE (Tool for Health and Resilience in Vulnerable Environments), 18 youth began connecting the impact of the community environment on health and safety. Jonathan Hernandez, one of the workshop participants, hated being late to school, because that meant detention. He lived just a few blocks away but without sidewalks, crossing lanes or slower speed zones in his neighborhood, he often took his chances when crossing Plainsburg Road, which runs between his house and Cesar E. Chavez Middle School. Until this workshop, he just accepted this dangerous daily challenge.

Created by Prevention Institute (PI) over a decade ago and updated in 2010, THRIVE is a place-based and action-oriented tool and framework that engages community leaders and residents, public health practitioners, and multiple sectors in a process of assessing, identifying, and improving community conditions that can facilitate better health, safety and equity outcomes. PI describes THRIVE as a process and a tool. As a process, it has five steps:

1. Engage and partner
2. Foster shared understanding and commitment
3. Assess
4. Plan and act
5. Measure progress.

When Central California Regional Obesity Prevention Program (CCROPP) staff attended a THRIVE training of trainers, they immediately understood how this tool could help San Joaquin Valley residents link the connection between environment, behavior and health. Since CCROPP's inception in 2006, the Public Health Institute (PHI) has partnered with local health departments, community-based organizations and residents in seven counties to create environmental, policy and systems changes, which improve health outcomes among their low-income, predominantly Latino communities. CCROPP has enhanced local capacity and allowed for tailored approaches focusing on local assets and issues. It has also created a powerful regional approach across the counties they serve.

In 2010, as part of a five-year cooperative agreement, the Department of Health and Human Services Office of Minority Health provided funding to the National Network of Public Health Institutes (NNPHI) and PI to support the implementation of THRIVE by member institutes with community partners. “Pairing the broad reach of our public health institutes throughout the network with the health equity training and tools provided by PI was a valuable community health and empowerment endeavor,” said Vincent Lafronza, NNPHI’s President and CEO. Since starting this effort, additional institutes adopted components of THRIVE in a variety of ways, including broad utilization of the train-the-trainer model. This has enhanced the capacity of communities to develop place-based solutions that address the social determinants of health. Since 2012, NNPHI and PI have trained 57 people associated with 12 member institutes to facilitate local grassroots community led efforts to achieve health equity using THRIVE. This train-the-trainer model helped more people implement THRIVE in their community, and has raised the local capacity to develop placed-based solutions to health inequity issues.

Because of THRIVE, CCROPP staff trained other people, including the residents themselves, the impact the community environment has on their health outcomes. Claudia G. Corchado, the Merced County CCROPP Program Manager said, “The tools we created didn’t go deep into the roots of equity and disparity. So when Prevention Institute trained us on THRIVE, we were excited that we finally had a tool that supported us to dig deeper into the environment and the impact it has on our health.” Discussing local factors in their own environment that affect health (social networks and trust; norms and cultural; what’s sold & how it’s promoted; look, feel & safety; parks & open space; housing; arts & cultural expression; education; and living wages and local wealth), enabled residents and policy makers alike to see a broader range of solutions to long-term, endemic problems.

Partners conducted three community trainings in the San Joaquin Valley, including one they adapted for the Student Education Empowerment Development Squad (SEEDS) in Planada, an unincorporated town of 2,400 people within the croplands nine miles outside of the city of Merced. Claudia intuitively knew that she needed to use the most interactive components of THRIVE to effectively engage the youth. During SEEDS second session, Claudia took the group outside to photograph their community. “We wanted them to see and match up how their natural and built environment really influences their choices.” This project gave the students a new lens from which to see their community. “These connections allowed the participants to both understand the links to poor health due to their environment, and then identify how things could be changed,” Claudia said.

As they shared their photographs, participants reviewed images of gang graffiti, a student’s reflection in a store window covered in bars, an almost unreadable yellow school crossing sign and a boy walking down a busy street carrying a backpack. With the THRIVE tool, these images and ensuing conversations helped the youth identify their community’s health concerns and inequities, determine health priorities, develop a vision and goals; and initiate diverse short and long term action steps. “They [students] had to go clear across the whole wall to connect it [the factors] to a behavior and connect it to injury and connect it to all of the other things,” she said. “So they had this big, messy wall by the time they were done. They had to get up on their chairs. They had to think. They had to partner with other people.” Once the students drew the connection between getting around and injuries, the youth decided to focus on safe routes to school. The students thought that creating a zone in school areas that doubled speeding fines would effectively address driver’s poor choices and increase monies for infrastructure [sidewalks]; both of which would increase the likelihood that they could walk or bike to school more safely.

To build awareness about their ideas, the youth set up an informational table at a local transportation forum where they displayed enlarged versions of their photos with older engineering plans filled with trees and other streetscaping. The juxtaposition of these two sets of images generated dialogue between the students, county planners and a county supervisor. According to Claudia, “The kids didn’t know them from anyone else,” so they simply said this is what we want; to which a supervisor directed the planners to, “do something.” Momentum built.

SEEDS youth wrote opinion pieces, presented to their county board of supervisors, testified before the California Senate Transportation and Housing Committee and worked on a CalTrans Environmental Justice Transportation Planning Grant. With a specific focus on enhancing safety and access near schools and other key routes, the ensuing Planada Pedestrian Improvement Plan provides a five to ten-year framework that will improve pedestrian safety throughout the community.

At 14, Jonathan Hernandez became an activist focused on place-based inequities. The County Board of Supervisors approved the Pedestrian Improvement Plan. The state legislature passed a law increasing the fine for traffic violations in and around school zones, Vetoed by the governor, CCROPP participants re-approached the next legislative session with reworked language. CCROPP continues to incorporate THRIVE into other community-level approaches to improve health outcomes in vulnerable communities. This unique collaborative approach by DHHS-Office of Minority Health, NNPHI, Prevention Institute, the Public Health Institute, CCROPP at United Wayof Merced and diverse community partners fosters an expanding circle of dialogue and action with broad reaching outcomes for Planada’s youth and the broader San Joaquin Valley.