Transcript Title

Health at School: Hiding in
Plain Sight?
Julia Graham Lear, PhD
The Center for Health & Health Care in Schools
School of Public Health and Health Services
George Washington University Medical Center
www.healthinschools.org
March 9, 2007
The Center for
Health and Health Care in Schools
1
Health at School: Why Pay
Attention
1.
Big numbers: 53 million children attend school 7 hrs a
day, five days a week, nine months a year
2.
Serious problems: 12% of poor kids and 10.5% of all kids
have asthma, 9% of boys are identified with learning
disabilities, 23% of uninsured kids have unmet dental
needs
3.
Importance of prevention: All children need
opportunities to practice staying healthy and a school
environment that supports that goal
4.
Neuroscience: Neuroscience research confirms that all
experiences a child has --positive or negative -- will
impact brain circuitry & how well or poorly children learn
over time.
5.
Needs of 21st century economy: Our future will be
determined by our capacity to help most children 2learn.
School Health Services & Prevention Programs
School Board
Policy
Community
Superintendent
• Parents
• Voters
• Community
Program
Associate
Superintendent
Facilities
Associate
Superintendent
Special
Education
Associate
Superintendent
Pupil Support
Associate
Superintendent
Academic
Affairs
based
Planning &
management
Principals
providers
School-Based
Health Center
- Physical
health
- Mental
health
- Nutrition
School
Nurses
Health
Aides
Guidance
Counselors
Mental health
professionals
School mental
Health program
- Individ. & group
counseling
- Family
counseling
- Teacher
consultations
Testing for
Special Ed.
placement
School
psychologists
Related Services
- Health
education
- Mental health
- OT/PT
- Health Services
- Physical
education
Services &
prevention
-Recess
Policy
Program
Planning and
Management
Community-based sponsor:
- Health system
- Community health center
- Health department
- Hospitals
The Center for Health and Health Care in Schools
2121 K Street, NW, Suite 250, Washington, DC 20037
www.healthinschools.org
copyright©2005 Send permissions for reprint to [email protected] or call 202-466-3396.
Community-based sponsor:
- Community mh center
- City/county mh dept.
- Other human services
organizations
3
Who Are the Health Professionals
at School?
Providers
Numbers
School nurses
56,000
Counselors
99,000
Sch psychologists
30,000
Sch social workers
14,000
Sch-based health
centers
1,725
Dentists, dental
Unknown
hygienists, physicians,
SA, HIV/AIDS
counselors
4
Who Creates Programs &
Establishes Policy?
• Local school board, local governing
structure (mayor, county council etc)
• State government: legislature, executive
agencies -- education, public health,
Medicaid, regulatory bodies (eg.licensing
boards, insurance commissioners)
• Federal government (CMS-Medicaid, Dept
of Education, HHS (MCH, SAMHSA & CDC)
5
What Does It Cost?
•
Staff
Sch nurses 56,000
Aver Cost
per unit
$ 40,201
Total $ in
thousands
2,252,256
Sch psych 30,000
$ 65,000
1,950,000
Sch SW
14,000
$ 44,300
620,200
Sch Couns 99,000
$ 52,303
5,177,997
SBHCs
$250,000
437,500
Total
Number
1,750
10,436,953
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Who Pays the Bill?
• Local government -- local revenues, special
children’s taxes
• State government -- general revenues (formula
driven allocations to communities,
demonstration grant initiatives) tobacco tax &
tobacco settlement funds dedicated to specific
purposes
• Federal government -- A few discretionary
programs (eg. Safe Schools/Healthy Children,
Garrett Lee Smith program, Safe & Drug Free
Schools). Major funding via Medicaid.
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Barriers to Expanded School
Health Services
• Who will be in charge?
• Who will pick up the tab?
• What are the political costs?
8
Potential Work on Health at School
at the Federal Level
• GAO studies:
– An analysis of Federal spending on schoolconnected health services as well as prevention
programs
– A report on models of successful services with
attention to federal participation in financing
– A report that looks at the degree to which school
health services are eligible to participate in SCHIP
and Medicaid as well as the level & geographic
distribution of participation
9
Potential Work #2
• HHS, Bureau of Health Professions, Division of
Nursing. Studies on school nursing -- training, best
practice, costs
• School-Based Clinic Establishment Act of 2007.
Hearings, consideration.
• SAMHSA - Safe Schools/Healthy Students. A
synthesis of lessons learned from this 8-year old
program that focuses on mental health-related
issues.
• Collaborative efforts spearheaded by CMS
bringing state Medicaid, federal agencies
together to discuss future directions for federal
initiatives
10
Resources
Center for Health & Health Care in Schools, School of Public
Health & Health Services, The George Washington University.
www.healthinschools.org, 202-466-3396
Frameworks Institute, Washington, DC, Jane Feinberg, Deputy
Director for Field Building, [email protected]
Center on the Developing Child, Harvard University, Jack
Shonkoff, MD, Director, www.developingchild.harvard.edu
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