Transcript Improving Children’s Health: Making the Community

Improving Children’s Health:
Making Community-School
Partnerships Work
Center for Health Care Strategies, Inc.
Improving Asthma Care for Children Conference
June 27, 2003
Julia Graham Lear, PhD, Director, Center for Health and
Health Care in Schools, School of Public Health and Health
Services, The George Washington University
The Center for
Health and Health Care in Schools
Children’s Health: Making CommunitySchool Partnerships Work
• Introduction: Why school partnerships
matter to children’s health programs
• The importance of infrastructure -- Models
of health services in school
• New directions that will strengthen school
health programs
• Partnering with parents
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Why Community-School
Partnerships Matter
Access: 53 million children and youth between ages 5
and 17 attend school; 90% attend public schools. A
school “base” enables providers to overcome access
barriers for most children.
Targeting: Perversely, economic and racial segregation
in schools enables targeting services and programs on
those populations with greatest unmet need.
Improved clinical outcomes. Some evidence
suggesting that health services in schools may improve
outcomes in treating certain chronic conditions.
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Making Partnerships Work:
A History of School Health
1890s: Boston & NYC: Physicians and nurses hired to
examine children in school & exclude the potentially
contagious.
Theme: Protect the school environment.
Early 1900s: School health services spread. Educators
launch first full-service schools. Early opposition from
immigrant parents and institutions affiliated with them.
Theme: Multiple possibilities; protect the students.
Post 1910: Conflict between public health & private
medicine. AMA opposition to all publicly-funded
treatment services in schools.
Theme: School health content fixed by external issues.
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Making Partnerships Work:
A History of School Health
• 1920s to1950s: School health = health education,
immunization documentation, screenings, treatment for
minor injuries, referrals for diagnosis & treatment. The
Astoria plan.
Theme: School health contained.
• 1960s & 1970s: New provider types: nurse practitioners,
school-based health centers. New emphasis on getting
care to poor children. Federal law mandates healthrelated services for students with disabilities.
Theme: Increased focus on individual student health,
incorporation of mandated services.
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Making Partnerships Work:
A History of School Health
• 1980s and 1990s:
- school-based health centers;
- 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 for shaping school health.
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The Importance of Infrastructure:
Health Services in School
•
•
•
•
•
•
School nurses -- 30,000 estimated.
School health assistants or UAPs -- N/A
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 reserved for health services
81.1%
Separate medicine cabinet with lock
65.4%
Refrigerator reserved for health services
57.3%
Peak flow meter
27.2%
Glucose meter, not just for an individual’s use
17.8%
Nebulizer, not just for a specific individual’s
use
Source: CDC, School Health Policy &
Programs Study (SHPPS, 2001.
13.0%
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The Importance of Infrastructure:
Models of School Health Services
• Traditional approaches:
- School system funds & staffs school nurse program
- School system funds; health department staffs school
nurse program
• Newer approaches
- School system funds; private provider manages School system funds with federal participation via
Medicaid; various providers
- School system plus local and state dollars support
expanded health services, especially for underserved
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The Importance of
Infrastructure: Things to Note
• Health resources are not spread evenly
across school districts or among schools
within a district
• Schools’ primary focus is academic;
resources directed to activities associated
with classroom learning
• Most school health professionals are
involved in direct care not in planning
services, organizing new initiatives, or “doing
politics” to assure adequate funding and
institutional support.
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What is Important to
Remember
What we have before us are some
breathtaking opportunities disguised
as insoluble problems.
John W. Gardner, 1965
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New Directions With Potential to
Strengthen Service Capacity
• New providers: school-based health
centers
• CDC Coordinated School Health Programs
• Community school model
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State Survey of SBHC Initiatives
12
0
44
27
0
4 5
19
0
0
1
0
35
2
135
97
41
45
30
21
18
0
14
37
57
5
23
33
63
33
67
7
68
27 16
26
10
31
9
6
49
53
6
1
170
5
3
53
0
1
Data from the 2002 State Survey of School-based Health Center Initiatives
sponsored by the Center for Health and Health Care in Schools
89
Map reports number of centers by
state for school year 2001-2002.
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Growth of School-Based Health
Centers
Number of Centers
1600
1200
800
400
0
1994
1996
1998
2000
2002
Year
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Location of School-Based Health
Centers
Suburban
12%
Rural
27%
Data from the 2002 State Survey of School-Based Health Center Initiatives sponsored by the Center
for Health and Health Care in Schools
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2002 State Survey: Types of Schools
Housing School-Based Health Centers
K-12
5%
AlternativeOther
1%
4%
High School
36%
Elementary
38%
Middle
18%
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CDC Coordinated School
Health Program
• CDC Division of Adolescent & School Health
(DASH) -- Focus: documenting adolescent health
problems; strengthening school health
• 8-Point Coordinated School Health Program
- Health education
- Physical education
- Health services
- Nutrition services
- Health promotion
- Counseling
- Environment
Family/community
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Community Schools
• Definition: Set of partnerships to among community
agencies that use the school as a locus to create a network
of youth-supporting education, after-school, health,
recreational and social service programs
• History: A model that emerged over past 20 years with
roots in the Progressive Era of the early 1900s.
- Most commonly found in individual schools or cluster
of schools.
New development: school districts considering regional or
district-wide transformation of existing schools using this
model.
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PARENTS: A New Focus for Building
Effective School Health Programs
• Parents typically uninformed about school’s
health & safety arrangements
• Providers can help educate and motivate
parents to act
• Two CHHCS parent initiatives
– CHHCS Parent Poll, Spring 2003
– Parents’ Resource Center
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CHHCS Poll: Parents Speak Out
on Health in Schools
• In the field, end of February through early March
• Responders: parents, with oversampling by income
• Sample questions (not exact wording):
– In general do you support or oppose providing health care
in schools? (Strongly support to strongly oppose)
– What services to you think it is important to be provided to
kids in school?
– Do you think it is important to educate kids about health?
eg. issues like eating right and exercising?
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Parent Poll Results
Figure One:
Do Y ou Support or Oppose Prov iding
56%
Health Care in Schools?
26%
Support
Strongly
Support
Somewhat
6%
5%
6%
Oppos e
Somewhat
Oppos e
Strongly
Don't Know
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Parent Poll Results
Services
Somewhat support
Providing immediate care in
case of emergencies
Strongly support
88%
8%
Prevention & education about
drugs & alcohol
83%
13%
Caring for children with chronic
problems such as asthma,
diabetes
Providing age-appropriate sex
ed.
70%
20%
56%
28%
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Emotions &
Behaviors
Health,
General
Nutrition &
Fitness
Safety
Getting Things
Done At School
Keeping
Children Safe
Helping
Children Stay
Healthy
The Center for
Health and Health Care in Schools
Asthma is the most
common
chronic disorder in
children
and is a leading
cause of
disability.
Click here to learn
more
Opportunities to Strengthen Children’s
Health through In-School Programs
• Challenges: State budgets, uncertain politics,
unsteady partnerships between health &
education
• Opportunities:
– Web initiatives
• Build an information base for parents and school staff
• Create and/or support state standards for
effective
programs
– Building of parent support
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Contact Information
The Center for Health and Health Care in Schools
1350 Connecticut Avenue, NW Suite 505
Washington, DC 20036
202-466-3396
202-466-3467 fax
www.healthinschools.org
The Center for
Health and Health Care in Schools