San Jose Unified School District: Putting Health Care Back Into Schools Demonstration Project funded by Lucile Packard Children’s Hospital and Lucile Packard Foundation for Children’s Health

“Putting Healthcare Back Into Schools” 5-(6)year demonstration project that placed full time School Nurses at 4 schools and formally linked these School Nurses to a local school health clinic. Full time Credentialed School Nurse at 2 elementary and 2 middle schools. .9 FTE NP from School Health Clinic Grant evaluator from Stanford University Start: 8/2007 End: 6/2013 2

Project Partners Sponsors Partners Lucile Packard Children’s Hospital at Stanford Lucile Packard Foundation for Children’s Health Partners San Jose Unified School District (SJUSD) School Health Clinics of Santa Clara County (SHCSCC) Stanford University Department of Pediatrics, and Center for Family and Community Medicine

SJUSD Demographics Urban/Suburban 32,000 Students K-12 40 Schools District Grant Schools Urban/Suburban 32,000 Students K-12 40 Schools 27 elementary 6 middles 7 high Schools 4 Project Schools: 82% Hispanic/Latino 45% English Language Learners 82% Free/Reduced Lunch All Demonstration Schools are located in the vicinity of downtown San Jose. All are close to a School Health Clinic. 2 of 4 are within walking distance to the clinic.

A Student’s Health Must Never Define the Boundaries of Their Success Foundational Belief A Student’s Health Must Never Define the Boundaries of Their Success

Goals of the Project Establishment of a medical home for students as defined by the American Academy of Pediatrics (AAP) Students Have Access to Health Care Improved medical management of students with chronic conditions, with a particular focus on students with asthma Students are Healthier and Ready to Learn Develop advocacy plan to improve nurse-to-student ratios in California Share Successes

Key Findings: What Happens When Schools Have Full Time Credentialed School Nurses Linked to Community Health Resources?

Key Finding: Improved Access to Health Care: Fewer Uninsured Students

Key Finding: Students are More Likely to Visit an Appropriate Health Care Provider after Medical Referral from the School Nurse

Key Finding: Fewer Days Absent Due to Illness

Cost Savings Reduction in absenteeism due to illness in the 4 demonstration schools equated to a savings of $48,518.62 in ADA funding during the first 2 years of the project. Cost of parental sick wages: Estimated difference of $70,790 in parental sick wages gained from 2006-07 and 2008-09 due to fewer student absences due to illness.

Key Finding: Elimination of Existing Chronic Health Condition “Opportunity Gap” on CST ELA Among middle school students, results suggested the same trend: in demonstration schools, students with asthma who scored Advanced or Proficient on the CST ELA increased from 23.2% in 2008-09 to 33.1% in 2009-10, while the percent of students who reported no chronic health conditions who scored Advanced or Proficient students started as 30.3% in 2008-09 and moved to 31.2% in 2009-10. These results continued in 2010-11, where 34.6% of both students with asthma and students with no health condition scored Advanced or Proficient. In 2009-10 (Year 3 of the project), the gap between the percentage of students with asthma and students reporting no chronic health condition who scored Advanced or Proficient on the CST ELA was eliminated These results were sustain for 2010-11, where 36.1% of students with asthma and 37% of students with no health condition scored Advanced or Proficient on the CST ELA. Pediatric asthma is the leading cause of school absenteeism and has been found to be associated with reading problems, grade repetition, learning disabilities, and behavior problems (Levy et al, 2006)

Key Finding: Fewer ER Visits for Asthma Pediatric asthma is the leading cause of school absenteeism and has been found to be associated with reading problems, grade repetition, learning disabilities, and behavior problems (Levy et al, 2006)

Cost Savings

Community/School Partnerships Additional benefits Best Practices from Project Schools disseminated to all schools Improved health data collection Preventative health care Best Practices Leveraged increased nurse funding. Based on year 1-3 date 2 additional sites have full time nurses Expanded Project Increased community collaboration and partnerships Improved teacher satisfaction and collaboration with nurses Community/School Partnerships School Health Clinics Breathe California Essiolor foundation Dental society

Challenges Defining effective utilization of the Professional School Nurse. Sustainable Funding Effective Partnerships with Community Health Agencies Utilization Lack of Common Metrics Funding Free care, Nurses complete over 13,00 vision or hearing screenings, along with followup District sees approximately $5 reimbursement for 30 mins LVN catheterization. Districts primary focus not student Health Medicaid reimbursements for IEP/non IEP driven direct services. “Free Care” Non-Profit Community Health Benefits fund scattered nurses, but no common metrics to evaluate effective practices. Professional School Nurse recognition as a health care partner. Communication challenges Lack of a collaborative, intentional plan for improving student health outcomes through community partnerships.

Contact Information Melinda Landau mlandau@sjusd.org “Putting Health Care Back into Schools” webpage http://med.stanford.edu/schoolhealtheval/nurse_demo_project/index.html Thank You Additional Questions?