1. Parents Speak Out: Health and Health Care in Schools Findings from a Survey of Parents with School-Aged Children Conducted for the Center for Health and Health Care in Schools by Lake Snell Perry & Associates

2. Parents Speak Out on Health and Health Care in Schools 2Lake Snell Perry & Associates Purposes Basic: Explore parents’ opinions about health and health care in schools. External: Inform policy-makers, the media and parents about issues around health and health care in schools. Internal: Investigate what arguments for and against health and health care in schools resonate with parents.

3. Parents Speak Out on Health and Health Care in Schools 3Lake Snell Perry & Associates Methodology Nationwide telephone poll of 1,101 parents of school-aged children. Conducted February 25 through March 10, 2003. Margin of Error = plus or minus 3 percentage points. Includes oversample of parents in household earning less than $37,000* annually. –For national results these lower -income respondents have been weighted down to their representative incidence. * $37,000 is roughly equivalent to 200% of the federal poverty limit for a family of four.

4. Parents Speak Out on Health and Health Care in Schools 4Lake Snell Perry & Associates Two Types of Questions General questions about support for and feelings about health care in schools. Child-specific questions about what services, if any, are available in their own children’s school and what services they, as parents feel are important.

5. Parents Speak Out on Health and Health Care in Schools 5Lake Snell Perry & Associates Main Findings Parents are strong supporters of in-school health care. Over eight in ten say they support providing health care in schools, including over half who strongly favor providing such services. Parents feel health care in schools can meet many needs, from providing immediate care in case of accident or illness, to providing mental health counseling and educating students about health issues like eating right and exercising, and the dangers of drugs and alcohol. For many parents, support providing health care in schools for altruistic reasons. They recognize that school may be the only source of health care for uninsured children and those children whose parents may not be able to get care for them elsewhere.

6. Parents Speak Out on Health and Health Care in Schools 6Lake Snell Perry & Associates Main Findings continued Three quarters of parents report that health education classes are taught in their child’s school. Six in ten say the school provides general health care. Less than half report that mental health counseling or comprehensive health care services are available. Majorities say having services like these available in their child’s school is important to them as parents. Half of the parents say the cost of health care is a barrier to getting needed care for their children. Low income parents are especially likely to see cost as a barrier.

7. General Questions Lake Snell Perry & Associates

8. Parents Speak Out on Health and Health Care in Schools 8Lake Snell Perry & Associates 83% of parents say they support health care in schools; over half (56%) are strong supporters. Only one on ten (11%) oppose health care in schools. Parents Are Strongly in Favor of Health Care in Schools.

9. Parents Speak Out on Health and Health Care in Schools 9Lake Snell Perry & Associates Support Across Political and Demographic Groups. Differences of degree rather than direction: –Democrats are the most enthusiastic (90% support/ 71% strongly). Independents (83% / 58%) and Republicans (72% / 41%) are also supporters though they are less enthusiastic. –Parents in households with incomes under $37K a year are particularly enthusiastic (91% / 66%). There is also support among those with incomes over $37K (79% / 52%). –African-Americans (91% / 78%); Hispanics (88% / 66%); Whites (81% / 52%). –Mothers (84% / 58%), fathers (81% / 54%). –Northeasterners (83% / 61%), Southerners (83% / 60%), West (83% / 52%), Midwest (82% / 53%)

10. Parents Speak Out on Health and Health Care in Schools 10Lake Snell Perry & Associates Parents See Many Advantages to Providing Health Care in Schools I

11. Parents Speak Out on Health and Health Care in Schools 11Lake Snell Perry & Associates Parents See Many Advantages to Providing Health Care in Schools II All these arguments resonate with all groups, but especially strongly with those who tend to be more supportive of health care in schools including: –Democrats –Those with incomes under $37K –African-Americans and, to a lesser extent, Hispanics –Mothers No magic bullet: –None of these arguments appear to be particularly convincing to opponents.

12. Parents Speak Out on Health and Health Care in Schools 12Lake Snell Perry & Associates Altruism Underlies Support Eight in ten parents (81%) are convinced by the argument that school may be the only source of care for America’s uninsured children. Almost six in ten (56%) find it very convincing. (see slide 8) –Parents whose children are insured (82%/56%) are as moved by this argument as those whose children are uninsured (82%/62%). Parents of publicly insured children are the most enthusiastic (89%/68%). –This argument resonates most strongly with Democrats (88%/68%). Independents (83%/59%) and Republicans (76%/45%) are also convinced but feel less strongly.

13. Parents Speak Out on Health and Health Care in Schools 13Lake Snell Perry & Associates Arguments Against Health Care in Schools I

14. Parents Speak Out on Health and Health Care in Schools 14Lake Snell Perry & Associates Arguments Against Health Care in Schools II Arguments against health care in schools generally get less than majority support. Cost is the most persuasive argument against healthcare in schools, especially when juxtaposed against other educational priorities. 56% find the argument that “money for education is limited and health care would take money away from more important priorities” convincing. Fewer – though still substantial minorities – find other arguments convincing. Fewer than a quarter find any of these arguments very convincing.

15. Parents Speak Out on Health and Health Care in Schools 15Lake Snell Perry & Associates Elementary School Health Care Is the First Priority If forced to choose, parents across the board feel it is most important to offer health care at the elementary school level.

16. Parents Speak Out on Health and Health Care in Schools 16Lake Snell Perry & Associates A Broad Range of Services Survey measured support for a broad range of services including: –“Traditional” In-School Services –Health Education –Expanded services In general widespread support for all three across survey sub-groups.

17. Parents Speak Out on Health and Health Care in Schools 17Lake Snell Perry & Associates Traditional In-School Health Care Services I

18. Parents Speak Out on Health and Health Care in Schools 18Lake Snell Perry & Associates Traditional In-School Health Care Services II There is widespread support for traditional in-school health services. 96% say providing immediate emergency care is important; 88% say very important. –This is the most important service for all survey sub-groups. Other services are also considered important by large majorities of those surveyed: –All these services are considered especially important by those who tend to support health care in schools in general including: Democrats Those with incomes under $37K African-Americans and Hispanics Single parents Mothers

19. Parents Speak Out on Health and Health Care in Schools 19Lake Snell Perry & Associates Health Education Services I

20. Parents Speak Out on Health and Health Care in Schools 20Lake Snell Perry & Associates Health Education II Majorities of eight in ten or higher feel it is important that health education services be provided to children in school. Education about exercise and nutrition, and age-appropriate sex education, are considered especially important by those who tend to be more supportive of health care in schools in general including: –Democrats –Those with incomes under $37K –African-Americans and Hispanics –Mothers Interestingly support for “prevention and education about drug and alcohol abuse” does not vary according among these usual subgroups. Further evidence of support for health education (see slide 10): Nine in ten parents (88%) are convinced by the argument that “teaching kids about how to keep themselves healthy is as important as teaching them about reading, writing and math.” 59% say very convincing.

21. Parents Speak Out on Health and Health Care in Schools 21Lake Snell Perry & Associates Expanded Health Care Services I

22. Parents Speak Out on Health and Health Care in Schools 22Lake Snell Perry & Associates Expanded Health Care Services II Support is somewhat lower – though still quite strong – for expanded health services such as mental health care, help with eating disorders, in-school physicals, and providing immunizations. These services are considered especially important by those who tend to be more supportive of health care in schools in general including: Democrats Those with incomes under $37K African-Americans and Hispanics Single parents Mothers

23. Parents Speak Out on Health and Health Care in Schools 23Lake Snell Perry & Associates More Evidence that Altruism Underlies Support Parents are more supportive of in-school basic care such as check-ups and tests when these services are targeted at children whose parents can not afford health care.

24. Parents Speak Out on Health and Health Care in Schools 24Lake Snell Perry & Associates Parents See a Role for Schools in Promoting Exercise and Healthy Eating Parents see a role for schools in promoting exercise and healthy eating: –96% of parents believe it is very (77%) or somewhat (19%) important for schools to “educate students about health issues like eating right and exercising.” There is also widespread, if slightly more tempered, support for helping fight childhood obesity: –85% of parents support “having programs in schools to help fight childhood obesity;” including 55% who strongly support this idea. –84% of parents believe it is very (50%) or somewhat (35%) important for schools to “help kids with obesity or other eating problems.”

25. Parents Speak Out on Health and Health Care in Schools 25Lake Snell Perry & Associates Parents Own Experiences Shape their Views of Health Care in Schools 71% of parents say there was health care – such as a school nurse – in their school growing up. Half the parents were asked this question at the beginning of the survey and half were asked at the end. Those parents who had health care in school growing up are more likely than those who did not to support health care in schools – but only if they are reminded of this fact first. In fact, simply asking parents if they had health care in their own school growing up makes parents more supportive of the idea of health care in schools. Even those who said they did not have health care growing up are more supportive of health care in schools when they were first asked about their own experience.

26. Child-Specific Questions Lake Snell Perry & Associates

27. Parents Speak Out on Health and Health Care in Schools 27Lake Snell Perry & Associates Target Child Characteristics Each parent was asked child-specific questions about their child –For those with multiple children in age range, target child was randomly selected. Target child characteristics: –94% are insured, 6% uninsured. Among insured: 77% private, 20% public –52% boys, 48% girls –32% 8 or younger, 18% 9 to 11, 27% 12 to 15, 21% 16 to 18

28. Parents Speak Out on Health and Health Care in Schools 28Lake Snell Perry & Associates Children Health Status Parents say their children are relatively healthy; lower income children slightly less so.

29. Parents Speak Out on Health and Health Care in Schools 29Lake Snell Perry & Associates Getting Care for Children Most parents say getting health care for their children is easy. It is slightly harder for lower-income families.

30. Parents Speak Out on Health and Health Care in Schools 30Lake Snell Perry & Associates Barriers to Care I

31. Parents Speak Out on Health and Health Care in Schools 31Lake Snell Perry & Associates Barriers to Care II Cost is considered a barrier by half of those surveyed (51%) and a major barrier by a quarter (25%). Beyond cost, most parents say they do not face significant barriers to getting care for their children. Difficulty finding doctors is more of an issue for the uninsured (46%) than the insured. Still almost three in ten parents with insured children (28%) say they have trouble finding doctors in their plan. 4 in 10 (39%) parents have trouble getting time off from work to take their children to medical appointments.

32. Parents Speak Out on Health and Health Care in Schools 32Lake Snell Perry & Associates Lower-Income and Single Parents Face More Barriers Some parents are more likely than others to face barriers in getting health care for their children: –63% of parents with annual incomes under $37,000 say the cost of health care is a barrier to getting care for their child and 38% say it is a major barrier. By comparison less than half (46%) of those with incomes over $37,000 consider cost a barrier and only 20% consider it a major barrier. –Half of single parents (49%) have trouble getting time off to take their child to medical appointments compared with 37% of parents in two-parent households. –A third of lower-income parents (32%) report transportation problems compared with 14% of parents with incomes over $37,000.

33. Parents Speak Out on Health and Health Care in Schools 33Lake Snell Perry & Associates A Broad Range of Services Parents were asked about whether the following health care services where available/provided at their child’s school: –Health services (general, unspecified) –Health education classes –Mental health counseling –Comprehensive care Parents were also asked how important having these services available in their child’s school is to them as parents.

34. Parents Speak Out on Health and Health Care in Schools 34Lake Snell Perry & Associates Services Provided

35. Parents Speak Out on Health and Health Care in Schools 35Lake Snell Perry & Associates Importance of Services

36. Parents Speak Out on Health and Health Care in Schools 36Lake Snell Perry & Associates More Parents Feel Services are Important than Have them in Their Child’s Own School

37. Parents Speak Out on Health and Health Care in Schools 37Lake Snell Perry & Associates In-School Health Services I 62% of parents report there are health services in their child’s school. 28% report there are not. 10% do not know.

38. Parents Speak Out on Health and Health Care in Schools 38Lake Snell Perry & Associates In-School Health Services II Parents in the Northeast (79%) are more likely to say health services are available at their child’s school than those in the Midwest (61%) West (58%) and South (58%). Suburban parents (68%) are more likely to report health services in school than those in major urban (59%) and rural (59%) areas. Parents with incomes over $37,000 (64%) are slightly more likely to report that health services are available in their child’s school than those with incomes under $37,000 (57%). Those with children age 16 to 18 are more likely to say they do not know if health service are available in their child schools (14%) than those with children under age 12 (7%).

39. Parents Speak Out on Health and Health Care in Schools 39Lake Snell Perry & Associates In-School Health Services III 83% say having health services in their child’s school is important to them. 60% say it is very important.

40. Parents Speak Out on Health and Health Care in Schools 40Lake Snell Perry & Associates In-School Health Services IV Those whose children have care in school are especially likely to say having these services is important; 90% say it is important and 68% say very important. Among those parents whose children’s school do not provide care or are not sure, three quarters (73%) feel care is important and almost half (47%) say very important. Those who tend to be more supportive of health care in schools in general are more likely to feel it is important for their child including: Those with incomes under $37K African-Americans and Hispanics Single parents Mothers Parents with publicly insured children are most likely to say having care in their child’s school is important (93%) followed by those with uninsured children (85%) and privately insured (80%).

41. Parents Speak Out on Health and Health Care in Schools 41Lake Snell Perry & Associates Health Education I Three quarters (75%) of parents surveyed say children at their child’s school take health education classes.

42. Parents Speak Out on Health and Health Care in Schools 42Lake Snell Perry & Associates Health Education II Parents in the Northeast (82%) are more likely to say that students in their child’s school take health education classes than those in the Midwest (73%) West (74%) and South (74%). Parents with incomes over $37,000 (79%) are more likely to report that health services are available in their child’s school than those with incomes under $37,000 (69%). According to their parents, children age 12 and older are the most likely to have health education classes in school (88%), followed by those 9 to 11 (78%) and those 5 to 8 (54%).

43. Parents Speak Out on Health and Health Care in Schools 43Lake Snell Perry & Associates Health Education III Most (92%) say having health education classes is important to them. 67% say it is very important. –African-American (77%) and Hispanic (75%) parents are more likely to consider health education very important than White parents (64%).

44. Parents Speak Out on Health and Health Care in Schools 44Lake Snell Perry & Associates Mental Health Counseling I 43% of parents say mental health counseling is available at their child’s school, 34% say it is not and 23% do not know. –Parents in the Northeast (51%) are more likely to say mental health counseling is available at their child’s school than those in the Midwest (42%) West (42%) and South (42%).

45. Parents Speak Out on Health and Health Care in Schools 45Lake Snell Perry & Associates Mental Health Counseling II The majority (74%) say having health education classes is important to them. About half (48%) say it is very important. –64% of parents with incomes under $37,000 consider this very important compared with 39% of parents with higher incomes.

46. Parents Speak Out on Health and Health Care in Schools 46Lake Snell Perry & Associates Comprehensive Care I A third (32%) of parents say that comprehensive health services are available a their child’s school.

47. Parents Speak Out on Health and Health Care in Schools 47Lake Snell Perry & Associates Comprehensive Care II Hispanic (48%) and African-American (45%) parents are more likely than whites (28%) to report that comprehensive services are available at their child’s school. Those in major urban areas are more likely to report comprehensive care (43%) than those in other areas (30%). Northeastern parents (41%) vs. those from the Midwest (30%), South (32%) and West (29%).

48. Parents Speak Out on Health and Health Care in Schools 48Lake Snell Perry & Associates Comprehensive Care III 69% say “having a doctor or nurse practitioner at their child's school who can give comprehensive physicals, and diagnose and treat medical problems” is important. 48% say very important.

49. Parents Speak Out on Health and Health Care in Schools 49Lake Snell Perry & Associates Comprehensive Care IV Those whose children have comprehensive care in schools are especially likely to say having these services is important; 90% say it is important and 75% say very important. Among those parents whose children’s school do not provide care or are not sure, six in ten (59%) feel having these services important and a third (34%) say very important. 75% African American parents say very important compared with 68% of Hispanics and just 40% of Whites. 66% of those with incomes under $37,000 say very important compared with 39% with higher incomes. 71% of parents with uninsured children say these services are very important compared with 59% of those with publicly-insured children and 42% of those with private insurance.