Creating a Healthy Community

On a busy Wednesday morning, several high school teachers are expertly directing a lively group of students gathered around their lockers to the correct places to begin the school day. But even though the hall has lockers and classrooms and school posters, this is not a school building; it is the MetroHealth Main Campus Medical Center, and the high school students are wearing white hospital coats and genuine hospital ID badges.

This is the Cleveland Metropolitan School District’s Lincoln-West School of Science and Health (LWSH). Its partnership with Cleveland’s MetroHealth main hospital is a unique model for experiential learning and career preparation.

In this high school housed in a hospital, students study a biomedical curriculum with a STEM (science, technology, engineering, and mathematics) focus, in addition to more traditional high school courses. They learn firsthand about the variety of careers available in a hospital system and work one-on-one with a mentor who is a healthcare professional. They receive training in advanced healthcare programs such as Stop the Bleed, the American College of Surgeons program that teaches how to stop bleeding in a severely injured person, and Code Red, which is training for an emergency that includes CPR, AED (automated external defibrillator), and first aid certification. Students have access to internships and networking opportunities in the hospital system, which can lead to jobs in the system. Juniors and seniors also have an opportunity to earn state tested nurse aide (STNA) credentialing in an accelerated three-week program in the spring.

“This school—a high school embedded in a hospital—is the only program of its kind in the country,” explained Shari Obrenski, president of the Cleveland Teachers Union (CTU). “The former CEO of Cleveland’s MetroHealth hospital system, Dr. Akram Boutros, had a vision about what a hospital system should be to a community. And it’s far more than just taking care of the physical health of the people. He really was taking a look at the determinants of health and asking, ‘How can our hospital impact those determinants of health?’ And one of the determinants was around education, and how the hospital system could be part of that.”

In 2015, Dr. Boutros and Christine Fowler-Mack, then the school district’s chief portfolio officer, were both part of Leadership Cleveland, a local program for community leaders designed to enhance their collaborative leadership skills and deepen community impact. They wanted to create leadership experiences for students around a hospital setting and designed the high school within the hospital.

Local philanthropic organizations provided start-up funding. With the strong support of Dr. Boutros and the backing of David Quolke and Eric Gordon, then the union and district leaders, the program came together. The Lincoln-West School of Science and Health opened in the fall of 2016, and the first senior class graduated in 2019. “When the top people in the highest roles in the organizations have a deep belief in the program, anything is possible,” said Juliet King, LWSH’s principal.

That level of commitment to and support of the partnership continues under MetroHealth’s current CEO, Dr. Airica Steed. “Our CEO is on board with the partnership and ready to remove barriers to its success,” said Tiffany Short, MetroHealth director of external education and workforce development. “She is always willing to talk to a student and has even asked to be a mentor! Dr. Steed believes in the vision and is committed to the success of our students and the program.”

Preparing for a Healthcare Career

In grades 9–10, students attend regular classes in the Lincoln-West school building, and they also attend regular MetroHealth experiences—presentations, trainings, and activities—at both the school and hospital locations. In December, for example, 10th-graders attended a presentation on nutritional disparities and their relationship to community health. It included information about nutritional resources available in the community, a discussion with a dietitian, a cooking demonstration, and an explanation of the healthy plate model.

In grades 11–12, students take all their classes at the hospital. They have regular high school classes on Monday, Tuesday, Thursday, and Friday. The LWSH wing at the hospital campus has classrooms for core and elective subjects such as English, math, history, psychology, chemistry, Spanish, and various biomedical sciences, with teachers assigned full-time to the site.

Juniors are assigned to mentors based on their interests and meet with them at least once a month. They also attend lectures and presentations by different healthcare professionals, learn about a wide array of career possibilities in the hospital system, and participate in a variety of healthcare experiences. Seniors are engaged in internships on Wednesday mornings. They begin in science teacher Jessica Wardzala’s large state-of-the-art science lab, where they use a QR code to link to a Google document. On the document, they sign in and record any problems or concerns they may have. Wardzala monitors Wednesday attendance, since there are no regular classes in the morning for seniors on that day, and uses the information provided by students to address any issues.

On a drab Wednesday in January, MetroHealth secondary education specialist Salethia McPherson energetically delivered morning announcements to the quiet group of seniors, including opportunities for afterschool activities that could be included on their college applications and important details about applying for the spring STNA certification program. Her comments incorporated an encouraging “pep talk” and some specific instructions before sending the seniors to meet their internship supervisors throughout the hospital.

On Wednesday afternoons, seniors participate in a capstone study experience. This is a regular course in every senior’s weekly schedule, in which they journal about their internship experiences from the morning, recording their observations and assessments. As a culminating activity, students use this information to study problems or situations they observed at the hospital and devise possible solutions. One recent capstone study was about improving the emergency department patient experience. Students discovered that the ED was short-staffed on weekends, one of the busiest times. The students proposed possible solutions, such as compensation incentives for those who work on weekends and expanding and enhancing the ED area to better accommodate patients.

Avriel Chaney, a teacher and CTU chapter chair, said the senior-year capstone observation and intense journaling experience motivates students to notice details and interactions. It allows for self-assessment, challenges some preconceived ideas of the realities of working in the medical field, and gives students a more realistic perspective about those career choices.

For its healthcare-related courses, the school uses a curriculum developed by Project Lead the Way that combines the study of biology with principles of biomedicine. Students engage in case studies with a series of labs, dissections, and other procedures to determine diseases. They learn how to measure blood pressure and what the normal levels for blood pressure and cholesterol are. They study human anatomy and physiology, along with medical interventions and biomedical innovations.

Students also get training from emergency department doctors, ultrasound technicians, and other healthcare professionals. They get hands-on experiences in various departments in the hospital system and see firsthand not only different medical careers but jobs in other areas such as human resources, finance, business, nutrition and culinary services, and information technology.

“We are building a school-to-workforce pipeline,” said Principal King. “We are getting students engaged in STEM, and this model is changing the game in so many ways. We hope this inspires others to see education in a different way.”

Although LWSH is highly regarded and students are thriving, there is one major challenge: space. In grades 11–12, due to space limitations at the hospital, only 50 students can be accepted in each grade. “We are very hopeful now, with the opening of the new MetroHealth Glick Center and additional available space, that more students can continue in the program in grades 11–12,” said Obrenski. “In 9th and 10th grades, we have about 100 students in each grade. But in 11th and 12th grades, the hospital can currently only take 100 students total, 50 in each grade, so the program is losing up to 100 students in grades 11–12. We need to fix that and make sure that we can accommodate all of them—not half of them—in this valuable program.” The need to accommodate more students is especially pressing because of the success LWSH is having. Its graduation rate of 85 percent¹ is 10 points higher than the district’s graduation rate.²

One of those graduates is Khandah Abdullah, the 2023 valedictorian; she now attends Cleveland State University majoring in biology. “I was interested in studying medicine but had limited knowledge about the high school, even though my brother graduated from Lincoln-West two years earlier,” she said. “I didn’t realize how unique the program was and what great opportunities it provided.”

She was planning a career in nursing when she entered the school in the fall of 2019. In her junior year, her mentor was a nurse. “I learned a lot from that experience and from my senior-year internship about the reality of a nurse’s schedule, duties, and expectations.”

Abdullah participated in the white coat ceremony in fall of 2022 and obtained her STNA credentials in the school’s special three-week program in the spring. With her experience and training at MetroHealth, she is now qualified to work as a patient care nursing assistant (PCNA).

“I wouldn’t be able to work at this level, a PCNA, without the experiences I had through the Lincoln-West/MetroHealth program,” she said. “Other college students I meet are surprised because they are just starting to learn those skills now. I learned them in high school.”

The exposure to real career experiences was valuable in other ways, too. She learned what it takes to run a big hospital, all the behind-the-scenes people and departments. “There’s a lot more than doctors and nurses. There are so many specialties and other career opportunities, and they aren’t all in direct patient care. We learned about many different jobs in a hospital system. This program helped me find my passion.”

Responsibility and Relationships

MetroHealth is a unique partner in that it is a community hospital, and addressing the social determinants of health—such as affordable quality housing and education, nutritious food, public transportation, and well-paying jobs—is one of its key goals. Cleveland has some of the best healthcare institutions in the world, but its population also has some of the worst health outcomes. Across two communities just two miles apart, there is a 23-year difference in residents’ average life expectancy.³ This is in large part because the social determinants of health have a huge impact on health and well-being—often far greater than healthcare⁴—and Cleveland is the second-poorest large city in the United States.⁵

Although the LWSH program has open enrollment for students throughout the district, most of its students live in the MetroHealth hospital area. The hospital is located just west of Cleveland’s downtown, in a racially mixed area with a significant Hispanic and Latinx population. While English is the most prevalent language, Spanish is second, with 21 percent of residents speaking it at home. The median annual household income in the area is $32,000.⁶

MetroHealth’s view is that Greater Cleveland’s overall health—the fabric of the community and its quality of life, culture, economy, and future—depends on the health of its residents, and that MetroHealth has a personal and collective responsibility to address these disparities and improve health outcomes for all.

CTU President Obrenski believes this sense of community responsibility was, and is, a crucial factor in the success of the partnership. “In a collaboration like this, you need some level of altruism in the partners. The product of a health system is people, and MetroHealth sees our students as valuable contributors to a healthier community and invests in them. It’s a win for the students, the healthcare system, and the community.”

Gordon echoed her thoughts on MetroHealth as a partner: “The viewpoint that the hospital system should serve the community and be an anchor in the community was key to the partnership. Also, we had principled leadership in all three areas—the hospital system, the school district, and the union—who were willing to work together and be innovative.”

Director Short stressed the importance of buy-in from leadership to the partnership’s success. “Leadership support is essential. For us at MetroHealth, we believe it’s important for students to see different professionals, many who look like them and have had similar life experiences. Our leadership team always shows up for our students.” She told about an emergency room doctor who faced challenges through school; he was not an A student and even considered dropping out. But with resiliency and hard work, he became a doctor. Through his story and experiences, students see that there are all kinds of different paths to a career goal.

McPherson, the education specialist, said that organizations looking to establish partnerships like this one need to understand that it’s more than just the curriculum; building relationships and trust is important, and commitment to the partnership is a service to the students and community. “If you start by building good relationships though, everything else can be worked out.”

“The problem-solving approach worked for us,” explained Quolke. “Shari Obrenski was the CTU vice president representing high schools and special schools and the director of negotiations when LWSH was getting started. She took the lead. CTU’s nurses chapter chair, Pat Forrai-Gunter, was at Lincoln-West and had a great relationship with MetroHealth, having worked closely with them on creating mobile health units in the schools. Christine Fowler-Mack represented the district in the planning process. They worked with all stakeholders to develop a contractual memorandum of understanding (MOU) and any changes to the school’s academic achievement plan.”

Cleveland has a portfolio of innovative schools, and each one has a specific MOU agreed upon by the union and the district. “CTU members don’t give up their rights when they choose to teach in a special school like LWSH,” emphasized Quolke. “Unless something unique to that program is spelled out in the MOU, all language in the collective bargaining agreement is intact. Teachers and staff who wanted to come to this new school had to apply and interview, and they knew ahead of time what the expectations were. Those who were selected were invested in the school and wanted it to succeed.”

Chaney, the CTU representative for LWSH, agreed with the cooperative spirit of the staff. “No plan can anticipate every problem, and the contract and MOU don’t have specific language for every situation we may face—we’re partially housed in a hospital, not a school building! But we try to maneuver gracefully through any issues, to be fair, and to work in the best interests of students and staff.”

Principal King said MetroHealth, the school district, and CTU work together well to deal with issues as they come up. “We all want the same thing, so we work together to work out the kinks as they arise.” A team of teachers meets with the principal, the campus coordinator, and two MetroHealth representatives on a regular basis.

All stakeholders agree communication is key, and they recommend over-communicating. They established a teacher “ambassador” for each grade level, whose main purpose was communicating with other teachers at that grade to make everyone aware of current teaching topics, expectations, and opportunities. For example, when teachers were instructing on the topic of health disparities, including environmental disparities in the community, MetroHealth provided information about lead poisoning with real-life examples. In another instance, students were engaged in a dissection of cow eyes. A physician from the hospital’s ophthalmology department provided a deeper experience for students. Side by side with teachers, the hospital’s medical professionals provide in-depth explorations that go beyond books and classrooms. And best of all, “When a 12th-grade teacher let us know that there were some struggling seniors, our hospital residents helped tutor them,” added Short. “More communication and collaboration can make the difference for students.”

Overcoming Challenges

MetroHealth and LWSH’s shared commitment to students and relationships enables them to be good problem solvers. Their revamping of the STNA certification process offers one example. Originally, it was available to up to 10 interested seniors in weekly afterschool classes held throughout the spring semester at the local community college, Cuyahoga Community College (Tri-C). Tuition for the class was paid for by a grant, and the school district supplied transportation, meals, and scrubs. Stretched out over the semester, with state testing scheduled in the spring right around prom time, students tended to lose focus. The STNA certification passing rate was low, and there was a possibility that the grant would be rescinded.

The school changed the plan. Since LWSH is a year-round school, the STNA program became an intensive, three-week program held entirely during the school’s long spring break between its third and fourth marking periods. Study tables were set up in the morning, and individual support was available. The result? A 100 percent passage rate last spring for LWSH candidates.

Abdullah, the 2023 valedictorian, was one of the students who participated in the STNA program. “I think it was harder, all concentrated in just three weeks,” she said. “But it was finished in just three weeks, and we all passed!”

Being flexible when dealing with challenges is vital to the program’s success. “There is no one size fits all. Every year is different, and our focus and plans and professional development may need to change,” added McPherson. While the overarching objectives are the same, the day-to-day of the program can be different.

The benefits of this partnership continue to grow.

“The partnership between Lincoln-West and MetroHealth began with a very different vision than many specialty schools that accept only certain qualified students,” explained Obrenski. In this school, the original vision was to enroll kids from the nearby community, if they chose to attend, and genuinely involve them in all of the work of the hospital, exposing them to all of the different jobs associated with the hospital, teaching them about health factors, and improving health and economic outcomes for them and their families. The vision has only grown from there.

Students are finding many personal connections to their learning. For example, when AFT President Randi Weingarten visited LWSH, students were engaged in a Stop the Bleed training. They were told that there are many different types of traumatic bleeding that they might encounter and were asked what type they wanted to focus on. Every student chose gunshot wounds because that’s what they too often deal with in their community. They have all been impacted by gun violence in some way, and now they have the knowledge and skill to increase a victim’s odds of survival.

Another example is an LWSH student who learned to identify stroke symptoms. When he recognized that his grandmother was having a stroke, he called an ambulance immediately. His grandmother received timely treatment for the stroke in the ambulance on the way to the hospital, and it greatly improved her outcome. “There are lots of stories like that,” added Obrenski. “Students are working in the hospital, both as interns and in the summer, and graduates of the school are now employed in the hospital. Students and their families and communities are benefiting from their healthcare knowledge and employment opportunities.”

The community-focused aspect of MetroHealth is central to the partnership’s success. People of color face the effects of racism every day, and societal and economic inequities are apparent in their poorer health outcomes.⁷ Adding to the problem, mistrust of the medical field is more common among Black and Latinx people than white people, often as a result of discrimination.⁸ By enrolling and then employing students from the community, the partnership is helping to address some of the inequities and rebuild trust.

“We are trying to create pipelines out of poverty,” said McPherson. “It starts with students from the community having meaningful, hands-on experiences in the healthcare field. That leads to building valuable skills that can be applied to a job or career that can economically sustain a household, and that creates better, healthier communities. That’s the golden ticket, that’s the pipeline, and it starts with kids from within the community.”

Beyond the health-focused curriculum, the partnership provides wraparound services and other components to help every student succeed. “Once you’re here, you are part of the MetroHealth family,” asserted Short. Many of the students will be the first in their family to attend college. Part of the partnership’s goal is to make sure students have an after-graduation plan—and a plan B. The partnership provides them with help, even after graduation, to navigate uncharted territory through mentors who have had similar experiences.

Building relationships and trust with parents and families is another important component. Students have big decisions ahead of them, and the mentoring program and professional development are more successful when families are on board, too. Short shared an example of MetroHealth’s IT Workforce Development Program. Some parents were not tech-savvy and did not understand the possibilities of this program; during COVID-19, they wanted to pull their children out of it. Short explained that students who completed the IT program would graduate with three separate and valuable IT certifications worth 17 college credit hours, giving students a $40,000 annual earning capacity right out of high school. Helping families understand the opportunities the IT program opened up for students was essential.

MetroHealth personnel have attended parent-teacher conferences and helped families access available resources and services, including workforce training classes. “We believe if a student is in a distressed situation at home—food insecurity, parents working several jobs, students providing sibling care—there will be problems in the classroom. There are resources MetroHealth can bring to help these students and families,” said Short.

Those who helped establish and who continue to work with the program are proud of its benefits for students and the community. Chaney, an LWSH teacher, is proud of the way the program is training students from the neighborhood, giving them knowledge, skills, and opportunities to serve and give back in their own community. “The partnership sees services that the community needs and trains students to fill those gaps in healthcare needs, to serve those who look like them and live in their community.” She noted that there are about 20 former and current students working at MetroHealth in certified healthcare positions as well as food services and other departments.

Gordon witnessed a freshman class in a cadaver study analyzing blood to determine how a person died and was impressed by the science and math skills used in the activity. Other students were learning how to take vitals on a fussy robotic patient. “Experiential learning is a great motivator,” he said. “Students were deeply engaged, inspired, and interested in their work. In this program, students are engaged in productive tasks worth their time and struggle, preparing them for careers. And MetroHealth gets the advantage of having young people ready to fill important job openings in a healthcare staff shortage.”

“The thing about MetroHealth that sets it apart is also a challenge in replication because of the mission of the hospital,” said Obrenski. “The hospital is concerned about not just the physical health of the people they serve, but really addressing all of the determinants of health in a more holistic way. That’s what makes this program successful. You can’t replicate this with just any hospital or organization. You need an administration that is committed to the larger mission. That’s a really important component and something that I think gets lost. I’ve heard them talk about the nuts and bolts of the program, but to me, that commitment—that’s where the secret sauce is. And now, with the opening of the new MetroHealth Glick Center, we are hopeful that this important program can be expanded to include more students.”

On a cold Wednesday morning in January, Cleveland’s LWSH juniors were in the hospital’s professional learning center. The presentation was on nursing: the various types of nursing roles and the education requirements for what is currently the highest-demand job in healthcare.

And in the science lab, just before the seniors in white lab coats and hospital badges went to their internships for the morning, McPherson ended the announcements and her spirited pep talk with a request of the students: “I need an affirmation word for today.” A young lady shyly raised her hand and held up a copy of her recent report card. “My word for today,” she said, “is PROUD.”

Pamela Hummer is the editor of Critique, the Cleveland Teachers Union newspaper, and the monthly newsletter of the Northeast Ohio AFT retirees’ chapter. A retired early childhood teacher and former union representative, she enjoys traveling and attending Cleveland cultural and sporting events with her husband, also a retired Cleveland teacher and former union officer. She volunteers weekly in several Cleveland preschool and kindergarten classrooms.

Endnotes

1. Ohio School Report Cards, “Lincoln West School of Science & Health: School at a Glance,” Ohio Department of Education and Workforce, reportcard.education.ohio.gov/school/016429.

2. Ohio School Report Cards, “Cleveland Municipal: District at a Glance,” Ohio Department of Education and Workforce, reportcard.education.ohio.gov/district/043786.

3. K. Warren and J. Ahern, “The Poorer Your Neighborhood, the Shorter Your Life,” Center for Community Solutions, December 4, 2019, communitysolutions.com/research/life-expectancy-race-ohio.

4. J. Phillips, “Achieving Health Equity: The Invaluable Role of Nurses,” AFT Health Care 4, no. 2 (Fall 2023): 30–38, aft.org/hc/fall2023/phillips.

5. E. Campbell, “Cleveland Is Again the Second Poorest City, but There Is Some Good News on Race and Gender,” Center for Community Solutions, September 18, 2023, communitysolutions.com/cleveland-is-again-the-second-poorest-city-but-there-is-some-good-news-on-race-and-gender.

6. 25Connects, “Community Data,” 25connects.com/community-data.

7. Centers for Disease Control and Prevention, “Racism and Health,” US Department of Health and Human Services, September 18, 2023, cdc.gov/minorityhealth/racism-disparities/index.html.

8. J. Lewsley and R. Slater, “What Are the Effects of Racism on Health and Mental Health?,” Medical News Today, May 31, 2023, medicalnewstoday.com/articles/effects-of-racism.

[Photos by Suzannah Hoover]