1 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

2 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

3 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.

4 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 4.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. 5.Needs of 21st century economy: Our future will be determined by our capacity to help most children learn.

5 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 age- appropriate, comprehensive health education.

6 School Health Services in Place In approximately 95,000 public elementary and secondary schools, there are 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

7 Estimated expenditures on service providers Health staffNumberCost per unitTotal Cost School nurses56,00040,2012,251,256,000 Sch psychol.30,00065,0001,950,000,000 Sch social workers 14,00044, ,200,000 Sch counselors 99,00052,3035,177,997,000 SBHCs 1,750250, ,500,000 TOTAL $10,436,953,000

8 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.

9 Why Health Care Reformers Have Ignored School Health Controversial issues: Sex Ed, condom distribution, HPV vaccine ADHD & Ritalin Mental health screening in schools Measuring BMIs, cupcakes in school Medicaid & school health

10 A New Day? From Threat to Opportunity Children’s mental health Childhood obesity Bird flu Emergency preparedness

11 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.

12 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?

13 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

14 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 (fax) Additional Resources: Frameworks Institute, Washington, DC, Jane Feinberg, Deputy Director for Field Building, Center on the Developing Child, Harvard University, Jack Shonkoff, MD, Director,