1. The Center for Health and Health Care in Schools Improving Children’s Health: Making Community-School Partnerships Work C enter 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

2. 2 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 Children’s Health: Making Community- School Partnerships Work

3. 3 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.

4. 4 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.

5. 5 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 health- related services for students with disabilities. Theme: Increased focus on individual student health, incorporation of mandated services.

6. 6 Making Partnerships Work: A History of School Health 1980s and 1990s: - school-based health centers; - coordinated school healthprograms - 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.

7. 7 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

8. 8 Facilities and Equipment Available for Health Services

9. 9 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

10. 10 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.

11. 11 What is Important to Remember What we have before us are some breathtaking opportunities disguised as insoluble problems. John W. Gardner, 1965

12. 12 New Directions With Potential to Strengthen Service Capacity New providers: school-based health centers CDC Coordinated School Health Programs Community school model

13. 13 State Survey of SBHC Initiatives Map reports number of centers by state for school year 2001-2002. 68 27 5 4 170 26 16 7 67 27 57 14 33 10 3145 53 35 19 6 9 0 5363 1 0 49 97 135 1 2 41 44 12 0 0 0 0 0 1 30 6 33 53 89 23 37 18 21 Data from the 2002 State Survey of School-based Health Center Initiatives sponsored by the Center for Health and Health Care in Schools 5

14. 14 Growth of School-Based Health Centers Year Number of Centers

15. 15 Location of School-Based Health Centers Data from the 2002 State Survey of School-Based Health Center Initiatives sponsored by the Center for Health and Health Care in Schools

16. 16 2002 State Survey: Types of Schools Housing School-Based Health Centers

17. 17 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

18. 18 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.

19. 19 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

20. 20 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?

21. 21 Parent Poll Results

22. 22 Parent Poll Results Services Strongly support Somewhat support

23. The Center for Health and Health Care in Schools  Emotions & Behaviors  Health, General  Nutrition & Fitness  Safety Getting Things Done At School  Keeping Children Safe  Helping Children Stay Healthy Asthma is the most common chronic disorder in children and is a leading cause of disability. Click here to learn more

24. 24 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

25. The Center for Health and Health Care in Schools 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