Transcript Title

School Health Services:
Emerging Opportunities for CDCDASH
Julia Graham Lear, PhD
The Center for Health & Health Care in Schools
School of Public Health and Health Services
George Washington University Medical Center
May 12, 2005
The Center for
Health and Health Care in Schools
1
Overview
• The Past -- A brief history of school
health services and lessons from the
past
• The P resent -- Current models of
health service delivery at school and
underlying issues
• The Future -- Potential directions for
school health services and
opportunities for CDC-DASH
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The Past: What We Can Learn
Those who cannot remember the
past are condemned to repeat it.
George Santayana, 1905
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A Brief History of School Health:
Important Themes
1890s: Boston & NYC: Physicians and nurses hired to
examine children in school & exclude the potentially
contagious.
Theme: Health professionals conduct surveillance
at school and act to protect school community.
Early 1900s: School health services spread. Progressive
educators launch first full-service schools.
Theme: Early introduction of concept that school
health services had a role in helping poor children.
Post 1910: Conflict between public health & private
medicine. AMA opposition to all publicly-funded
treatment services in schools.
Theme: School health strongly influenced by external
issues.
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School Health Services History:
Important Themes
• 1920s to1950s: School health = health education,
immunization documentation, screenings, care for minor
injuries, referrals for diagnosis & treatment. The Astoria
plan.
Theme: Important role of schools in assuring that children
were immunized. Screening for select problems (vision,
hearing, scoliosis) .
• 1960s & 1970s: New provider types emerge: nurse
practitioners, school-based health centers, school-based
mental health programs. Federal law mandates school
systems assure provision of health-related services to
students with disabilities.
Theme: Increased focus on individual student health
needs, incorporation of federally-mandated services.5
School Health Services History:
Important Themes
1980s and 1990s:
Continued development of
school-based health centers; emergence of
coordinated school health programs , changes in
education (accountability, testing, success for all),
new forces in health care (accountability,
managed care, outcomes focus)
Theme: Importance of external education & health
policies and politics for shaping school health.
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The Present: School Health Services in 2005
What we have before us are some
breathtaking opportunities disguised
as insoluable problems.
John Gardner, 1962
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Current School Health Staff
Available for 95,000 public schools
•
•
•
•
•
•
•
School nurses -- 30,000 estimated.
School health assistants or UAPs -- N/A
School physicians -- unknown
School-based health centers -- 1,500
School counselors -- 81,000
School psychologists -- 20,000-22,000
School social workers -- 12,000
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Facilities and Equipment Available
for Health Services
Type of Facility or Equipment
% of Schools
Portable first aid kit
92.7%
Sick room or nurse’s office or other
area re-served for health services
Separate medicine cabinet with lock
81.1%
Refrigerator reserved for health
services
Peak flow meter
57.3%
Glucose meter, not just for an
individual’s use
Nebulizer, not just for a specific
individual’s use
17.8%
65.4%
27.2%
13.0%
Source: CDC, School Health Policy &
Programs Study (SHPPS, 2001.
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Snapshot of Two City School Districts
and Their School Nursing Programs
School system backgrounds
Austin TX
City population
680,000
No. of schools
103
No. of students
78,000
Limited English Proficiency
22%
Special education
12.3%
Percent of uninsured children
note
Students eligible for free and reducedprice lunch
53%
Students with IHCPs
2.3%
Boston MA
589,141
130
63,024
16%
20%
6.3%*
71%
3.8%
Note: Statewide, Texas children ages 6 - 12 have a 25% uninsured
rate; teens ages 13-18 have an uninsured rate of 37%
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Snapshot of Two City School Districts
and Their School Nursing Programs
School nursing programs
Austin
Program Sponsor
Boston
Children's Hospital
BPS
School health staff
Number of school nurses
Number of health aides
Ratio nurses:students
•
65
52
1:1,200
93.5 FTE
5.0 FTE *
1:630
*These paraprofessionals provide care to special needs students and
do not provide assistance to school nurses
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Student School Health Encounters,
2001-2002
Austin
Boston
#
#
%
%
Episodic
338,489 57.5
416,650 57.8
Medication
187,897 31.9
227,114 31.4
Procedure
Included under
episodic &
medication
44,369
Screening
61,786
36,645
Total
588,172 99.9
10.5
5.7
5.1
721,300 100
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Current Models of School Health
Services
School nursing
– Service provision
School nurses only, eg. Boston, MA, Seattle, WA
School nurse-UAP combinations, eg. Austin, TX
– Sponsorship
School system, eg Seattle
Health department, eg. Montgomery Cty MD;
Community-based organization, eg. Children’s
Hospital in Austin, TX
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Current Models of School Health
Services
• Enhanced school nursing
– Enriched service package
– May involve advanced practice nurses
– Extent of model and numbers of nurses & schools
participating unknown. Eg. CT and MA
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Current Models of School Health
Services
• School-based health centers
– 1500+
– Staffed by NPs, clinical social workers, mix of other
professionals including nurses, nutritionists, dental
hygienists depending on needs and resources
– Sponsored and managed mostly by communitybased organizations, eg. community hospitals,
health centers, and health departments.
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Things to Note
• Health resources are not spread evenly
across school districts or among schools
within a district
• Data systems not in place to document the
resources present in individual school districts
or schools
• When school health professionals are
present, they are involved in direct service
not planning, financing, organizing or
evaluation activities
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Things to Note continued
• While most parents are typically uninformed
about school health & safety arrangements
in their school district or in their children’s
schools, they support health services at
school for their children.
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Parent Poll Results
CHHCS Feb 2003 survey
Austin
Boston
#
#
%
%
Episodic
338,489 57.5
416,650 57.8
Medication
187,897 31.9
227,114 31.4
Procedure
Included under
episodic &
medication
44,369
Screening
61,786 10.5
36,645 5.1
Total
588,172 99.9
721,300 100
5.7
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Parent Poll Results
Strongly
support
Somewhat
support
Strongly or
Somewhat
oppose
88%
8%
4%
Prevention & education about 83%
drugs & alcohol
13%
4%
Caring for children with
chronic problems such as
asthma, diabetes
70%
20%
10%
Providing age-appropriate sex
ed.
56%
28%
16%
Services
Providing immediate care in
case of emergencies
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The Future: Moving School
Health Services Forward
It must be remembered that there is nothing
more doubtful of success, nor more dangerous
to manage than the creation of a new system.
For the initiator has the opposition of all who
would profit by the preservation of the old and
merely lukewarm defenders in those who
would gain by the new one.
Machiavelli, The Prince, 1513
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Moving School Health Services
Forward: Can We Use the CDCDASH Four Strategies?
• Monitoring health behaviors and school
policies and programs related to those
behaviors
• Synthesizing & applying research to improve
school policies and programs
• Enabling constituents to help schools
implement effective policies and programs
• Evaluating programs to improve school health
policies and services
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Can We Use the CDC-DASH Four
Strategies to Strengthen School
Health Services?
• Monitoring function - YRBSS, SP HPPS
have worked well.
• Synthesizing research
• Assisting schools in implementing
effective policies & programs -- may
need more research to action
research
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Contact Information
The Center for Health and Health Care in Schools
2121 K Street, NW Suite 250
Washington, DC 20037
202-466-3396
202-466-3467 fax
www.healthinschools.org
The Center for
Health and Health Care in Schools
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