1. 1 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

2. 2 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 learn.

3. 3 School Health Services & Prevention Programs School Board Superintendent School-Based Health Center - Physical health - Mental health - Nutrition Associate Superintendent Facilities Associate Superintendent Pupil Support Associate Superintendent Special Education Associate Superintendent Academic Affairs School Nurses Health Aides Guidance Counselors Mental health professionals Testing for Special Ed. placement School psychologists Related Services - Mental health - OT/PT - Health Services - Health education - Physical education -Recess Community-based sponsor: - Health system - Community health center - Health department - Hospitals Community Parents Voters Community based providers Policy Program Planning and Management Policy Program Planning & management 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 chhcs@gwu.edu or call 202-466-3396. School mental Health program - Individ. & group counseling - Family counseling - Teacher consultations Community-based sponsor: - Community mh center - City/county mh dept. - Other human services organizations Principals Services & prevention

4. 4 Who Are the Health Professionals at School? ProvidersNumbers School nurses56,000 Counselors99,000 Sch psychologists30,000 Sch social workers14,000 Sch-based health centers 1,725 Dentists, dental hygienists, physicians, SA, HIV/AIDS counselors Unknown

5. 5 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)

6. 6 What Does It Cost? StaffNumberAver Cost per unit Total $ in thousands Sch nurses56,000$ 40,2012,252,256 Sch psych30,000$ 65,0001,950,000 Sch SW14,000$ 44,300 620,200 Sch Couns99,000$ 52,3035,177,997 SBHCs 1,750$250,000 437,500 Total 10,436,953

7. 7 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.

8. 8 Barriers to Expanded School Health Services Who will be in charge? Who will pick up the tab? What are the political costs?

9. 9 Potential Work on Health at School at the Federal Level GAO studies: –An analysis of Federal spending on school- connected 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

10. 10 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

11. 11 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, info@frameworksinstitute.org Center on the Developing Child, Harvard University, Jack Shonkoff, MD, Director, www.developingchild.harvard.edu