Transcript Expanding Mental Health Services at School:

School Health and Health Care
Reform: Imagine a world…
Leadership in Nursing, Social Work, and Psychology in School-Based Clinics A
Symposium at Regis College, Weston, Massachusetts
November 28, 2007
Julia Graham Lear, PhD
Research Professor, Department of Prevention and Community Health, and
Director, Center for Health and Health Care in Schools, SPHHS, The George
Washington University, Washington, DC
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Where there are no uninsured
children and children’s health
needs are met
• Three true stories
– In Maryland, Diamonte Driver dies and the health care
system failed
– In Seattle, Washington, student almost falls through the
cracks
– In Asheville, North Carolina, A student is helped
We need a better health system for
kids…health care reform may offer a way
forward
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Where the Health System Fails
Children
• Sick care: access barriers, treatment issues
• Preventive care: from immunizations to anticipatory
guidance
• Outcomes: demonstrated in disparities among
groups of children; disparities between US children &
children in other rich countries.
For many children & their families, health care reform
will make some impact on access to care, but the
quality of that care & its appropriateness to children’s
preventive and developmental needs may be
marginal.
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Health Care at School Can Be
Part of the Solution
Top reasons to pay attention to school health:
1.
Big numbers: 53 million children attend school 7 hrs a day,
5 days a week, 9 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 can
support that goal
Neuroscience: Neuroscience research indicates that all
experiences a child has --positive or negative -- impact on
brain circuitry & how well or poorly children learn over time.
4.
5.
Needs of 21st century economy: Our future will be
determined by our capacity to help most children learn.
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School Offers A Unique Opportunity to
Build Better Child Health Programs
• A lot of services are already in place
• A lot of money is already being spent, and
• Many city and state governments policies support
children’s health at school by mandating
immunizations, banning smoking in or near schools,
encouraging physical activity, and requiring ageappropriate, comprehensive health education.
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School Health Services in Place
In approximately 95,000 public elementary
and secondary schools, there are
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56,000 school nurses
99,000 school counselors
30,000 school psychologists
14,000 school social workers
1,800 school-based health centers
Unknown numbers of dentists, dental hygienists,
physicians, substance abuse counselors, family
planning counselors, HIV/AIDS educators, plus
health educators, community-connected health
promotion staff
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Estimated expenditures on service
providers
Health staff
Number
Cost per unit
Total Cost
School nurses
56,000
40,201
2,251,256,000
Sch psychol.
30,000
65,000
1,950,000,000
Sch social
workers
14,000
44,300
620,200,000
Sch
counselors
99,000
52,303
5,177,997,000
1,750
250,000
SBHCs
TOTAL $
437,500,000
10,436,953,000
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State & City School Policies that
Support Child Health
• Most states & school districts have policies that
schools should teach physical education. Nationwide,
78.3% of schools required students to take physical
education.
• Nationwide, 18% of states and 74.1% of school
districts have adopted policies saying that all schools
will offer a breakfast to students.
• 57.4% of school districts required and 25%
recommended that schools restrict the times during
the day that junk food can be sold in any location.
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Why Health Care Reformers
Have Ignored School Health
Controversial issues:
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Sex Ed, condom distribution, HPV vaccine
ADHD & Ritalin
Mental health screening in schools
Measuring BMIs, cupcakes in school
Medicaid & school health
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A New Day?
From Threat to Opportunity
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Children’s mental health
Childhood obesity
Bird flu
Emergency preparedness
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Where to Begin: A Public Health
Perspective
• Primary prevention: enabling healthy behaviors
from hand-washing to healthy eating, to regular
physical exercise; immunizations.
• Secondary prevention: screenings for vision,
hearing & learning disabilities; surveillance for
disease outbreaks
• Tertiary prevention: managing chronic & acute
conditions to prevent poor outcomes, eg. Medication
management.
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What to Do Is Clearer Than How
to Do It and How to Pay For It
• How to define and organize the interface between
community health and school health?
• Who will represent ‘health at school’ in upcoming health
care reform discussions?
• What are the financial implications? For education in
general and specific school districts in particular?
• What are the most viable first steps?
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Implications of Health Care
Reform for School Health
• The goal: standardized services and
stabilized funding
• Achieving the goal:
– Documenting impact of preventive and treatment
services
– Building coalitions that focus on outcomes for
children
– Getting to the table early and staying in the game
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The Center for Health
and Health Care in Schools
School of Public Health and Health Services, The George
Washington University Medical Center
2121 K Street, NW, Suite 250
Washington, DC 20037
202-466-3396
202-466-3467 (fax)
[email protected]
www.healthinschools.org
Additional Resources:
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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