1. The Proof Is In The Pudding Health and Education for student / community success A case study of Roy Clark Elementary – Union Public Schools Tulsa, Oklahoma John M. Gaudet, MPH, BS, ADN Theresa Kiger, M.Ed.

2. The Proof Is In The Pudding Presentation Overview Presentation Overview –The state of health in Tulsa, Oklahoma –Review of the medical home concept for the medically marginalized within a designated community school –OU-TACH’s school based clinic description –Why Roy Clark  Healthcare finding  Correlation of Data from health records to school report cards –Discussion of Preliminary Findings  Data Analysis  Summary of key findings

3. The Reason for a Health Clinic at school … “You can’t educate a child who isn’t healthy, and you can’t keep a child healthy who isn’t educated.” former U.S. Surgeon General Joycelyn Elders:

4. Oklahoma A State of Health? “We are the ONLY state where our age- adjusted death rates became WORSE through the 1990s and into this century.” “If we had the same adjusted death rate as the nation, we would have about 3,700 fewer people dying each year.” Oklahoma State Board of Health “2006 State of the State’s Health” Graphic: University of Oklahoma College of Public Health. Data Source: U.S. Centers for Disease Control and Prevention AGE ADJUSTED DEATH RATE U.S OK

5. Oklahoma Economic Class As It Relates to Health Care Poverty Class Poverty Class –Poor health status – die 14 years earlier –Limited access to care – 4% of doctors near homes Middle Class Middle Class –Low healthcare quality –High cost health care Wealth Class Wealth Class –Low health care quality and high cost –High cost of charity care

6. Access to Health Care Varies Dramatically By Zip Code: For every 1 physician in north, east and west Tulsa, there are 26 in mid- town and south Tulsa

7. The Medical Home Concept The American Academy of Pediatrics Policy Statement Accessible, continuous comprehensive, family centered, coordinated, and compassionate Accessible, continuous comprehensive, family centered, coordinated, and compassionate Manage or facilitate essentially all aspects of pediatric care Manage or facilitate essentially all aspects of pediatric care The physician should be known to the child and family and should be able to develop a relationship of mutual responsibility and trust with them. The physician should be known to the child and family and should be able to develop a relationship of mutual responsibility and trust with them. Source: DuPlessis, Helen, M., Cora-Bramble, Denice. (2005). American academy of pediatrics policy statement: providing care for immigrant, homeless, and immigrant children. Pediatrics, Vol. 115 (4), 1095-1100 immigrant children. Pediatrics, Vol. 115 (4), 1095-1100

9. BREAKING THE CYCLE OF POVERTY  Children in poor health miss more school days and have lower cognitive development  Lower educational attainment contributes to lower wages and lower labor force participation  Thus increasing the likelihood of not being insured as an adult and increasing the odds of continued poor health KAISER COMMISSION on Medicaid and the Uninsured, 2002 KAISER COMMISSION on Medicaid and the Uninsured, 2002

10. New Concepts in Health & Disease Allostatic load Allostatic load –Additive burden of psychosocial stresses produces physiological damage Weathering Phenomenon Weathering Phenomenon –Stressed people age faster Physiological Capital Physiological Capital –Genes – environment – behavior  Neighborhoods (community schools)  Education to change behavioral norms

13. Healing Restoring a whole person to a state of right relationships with… –Biological – “milieu interior” –Psychological – self-identity in human dignity –Social – family and community –Spiritual - transcendent Sulmasy D. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. 2006 The Georgetown University Press, Washington, DC.

14. OU Tulsa Alliance for Community Health School Based Healthcare  School based health centers are designed to serve students, their family members, extended family and the community regardless of their ability to pay.  No school program is exactly the same except for

15. OU Tulsa Alliance for Community Health  Comprehensive Primary Care  Acute care  Mental and Behavioral Health Care  Health Promotion  Education  Oral Health screenings and Education  Social Services  Outreach  Home Visits

16. Why A Health Clinic As Part of The Community School Concept Students, families, schools & community partners working together… Children learning Children learning Families succeeding Families succeeding Neighborhoods engaging Neighborhoods engaging Communities thriving Communities thriving Source: Community Service Council of Greater Tulsa

17. Why Roy Clark Elementary Designated as a Community School Designated as a Community School 90% of students qualify for the free lunch program 90% of students qualify for the free lunch program 84% are minority (high % Hispanic students) 84% are minority (high % Hispanic students) Evidence of improved API scores in last 3 years Evidence of improved API scores in last 3 years An estimated 80% of Clark students demonstrate conditions associated with stress and poverty: slowed learning, impassivity, quick tempers and problems defining personal space An estimated 80% of Clark students demonstrate conditions associated with stress and poverty: slowed learning, impassivity, quick tempers and problems defining personal space Source: Theresa Kiger, Roy Clark Elementary School Principal 2008

18. Why Roy Clark Elementary? School Year 2006-2007

19. The Roy Clark Clinic

20. Key Findings CLINIC FINDINGS Underutilization of clinic by African American students/families Underutilization of clinic by African American students/families Major use of clinic by Hispanic families Compared to the other established clinics, Major use of clinic by Hispanic families Compared to the other established clinics, Roy Clark has the highest percentage of preventative visits Roy Clark has the highest percentage of preventative visits

21. Patient Demographics Among African Americans, there is almost a 15% difference between the clinic users and student population

22. % Preventative Visits 2005-07

23. Top 5 Diagnosis Per Visit Diagnosis200520062007 1Routine Infant 2Acute Upper Respiratory Acute Upper Respiratory Childhood Immunizations 3Childhood Immunizations Allergic Rhinitis Acute Upper Respiratory 4Pharyngitis Ear Infection 5GastroenteritisEar InfectionAllergic Rhinitis

24. Key Findings SCHOOL RELATED FINDINGS API scores have increase over last 3 years API scores have increase over last 3 years Attendance rate has increased over last 3 years Attendance rate has increased over last 3 years Mobility decreased from 2005-06 Mobility decreased from 2005-06

25. Federal Free/Reduce Lunch Program

26. Academics-API Academic Performance Index

27. Media

28. Attendance Rates 2005-2007

29. Communication

30. Student Character

31. Data Teams Collaboration built into daily schedule Collaboration built into daily schedule Focused Instruction Focused Instruction Analyzing Analyzing Assessments Assessments Accountability Accountability Title One Funds Title One Funds Data Days Data Days

32. Questions?