Sbh Cs & Academic Outcomes


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  • Sbh Cs & Academic Outcomes

    1. 1. SBHCs & Academic Outcomes: Are We Asking the Right Questions? Gorette Amaral Mona E. Mansour Sara Ann Peterson Susan Russell Walters National Assembly on School Based Health Care June 2003
    2. 2. <ul><li>Why we decided to explore this research road…. </li></ul>
    3. 3. First, What Does the Literature Say?
    4. 4. Literature Review <ul><li>To see how academics are impacted by SBHCs, we searched for… </li></ul><ul><ul><li>Peer-reviewed journal articles, evaluation studies and reports </li></ul></ul><ul><ul><li>Written by private and public research and government organizations </li></ul></ul><ul><ul><li>In health, education, and psychology fields </li></ul></ul>
    5. 5. The Impact of SBHCs on Academics + = Positive impact of intervention on indicator. o = No statistically significant impact on indicator. (Blank) = The study did not measure this particular indicator.
    6. 6. Studies found a Positive Impact from SBHCs on… <ul><li>Absences 4 (of 7) </li></ul><ul><li>Promotion to the next grade 2 (of 2 ) </li></ul><ul><li>Withdrawal/drop out rates 2 (of 2) </li></ul><ul><li>Disciplinary problems 2 (of 3) </li></ul><ul><li>Failing grade 1 (of 2) </li></ul><ul><li>Tardiness 1 (of 1) </li></ul>
    7. 7. Limitations of Studies on SBHC’s Impact on Academics <ul><li>3 had no comparison group </li></ul><ul><li>No “cookie cutter” SBHC model </li></ul><ul><ul><li>4 examined interventions beyond the scope of typical SBHCs </li></ul></ul><ul><li>One used anecdotal evidence </li></ul>
    8. 8. Improved Academic Performance SBHC Services Educational Factors Environmental Factors Multiple Influences on Academic Performance Student Health Factors Social Factors
    9. 9. Summary of Findings Regarding Relationships Between Health Status/Risk Behaviors and Academic Achievement Factors that an SBHC might impact + = Positive association found between intervention and academic indicator O = No association found between intervention and academic indicator (Blank) = The study did not measure this particular indicator.
    10. 10. Studies that found a Positive Relationship Between Health Status/Risk Behaviors and Academics <ul><li>AODT use 5 (of 5) </li></ul><ul><li>Mental health problems 3 (of 3) </li></ul><ul><li>Poor diet 2 (of 2) </li></ul><ul><li>Intentional injuries 2 (of 2) </li></ul><ul><li>Physical illness 2 (of 2) </li></ul><ul><li>Low self-esteem and resiliency 2 (of 2) </li></ul><ul><li>Risky sexual behaviors 1 (of 2) </li></ul><ul><li>Health care utilization 1 (of 2) </li></ul>These are issues that SBHC can impact!
    11. 11. Summary of Findings Regarding Relationships Between Health Status/Risk Behaviors and Academic Achievement Factors beyond the direct influence of an SBHC + = Positive relationship between indicator and academic performance. 0 = No statistically significant relationship between indicator and academic performance. (Blank) = The study did not measure this particular indicator.
    12. 12. Studies that found a Positive Relationship Between Other Factors and Academics <ul><li>Educational factors (3 of 3) </li></ul><ul><li>Household/family characteristics (2 of 3) </li></ul><ul><li>Demographics (2 of 2) </li></ul><ul><li>School safety (2 of 2) </li></ul><ul><li>Eating breakfast (1 of 1) </li></ul>
    13. 13. Conclusions from the Literature <ul><li>Insufficient evidence to prove a direct link between SBHCs and academic outcomes. </li></ul><ul><li>Evidence of impact of medical and mental health status on academic outcomes. </li></ul><ul><li>Important role of SBHCs in improving student health can contribute, at least indirectly, to improved academic outcomes. </li></ul>
    14. 14. What are Important Methodological Issues?
    15. 15. Methodological Issues <ul><li>Possible Outcome Measures </li></ul><ul><li>Individual Student Data </li></ul><ul><li>Aggregate Data </li></ul><ul><li>Access to Data </li></ul><ul><li>Student or Parent Survey </li></ul><ul><li>Computerized Records </li></ul><ul><li>Data Quality & Linking </li></ul><ul><li>Variable Definitions </li></ul>
    16. 16. 1. Possible Outcome Measures <ul><li>Graduation rate </li></ul><ul><li>Grade promotion </li></ul><ul><li>GPA/grades-failing grades </li></ul><ul><li>Credit accumulation </li></ul><ul><li>Standardized test scores </li></ul><ul><li>Academic Performance Index </li></ul><ul><li>Attendance/absence </li></ul><ul><li>Cutting class </li></ul><ul><li>Withdrawal/drop-out rates </li></ul><ul><li>Suspension rates </li></ul><ul><li>Disciplinary referrals </li></ul><ul><li>Educational aspirations </li></ul>
    17. 17. 2. Individual Student Data <ul><li>Advantage of individual student data: </li></ul><ul><ul><li>More power to determine differences between your control and intervention groups </li></ul></ul><ul><li>If individual student data is used, however, researchers may need… </li></ul><ul><ul><li>To obtain active parental and/or student consent </li></ul></ul><ul><ul><ul><li>Could get consent along with consent for SBHC use </li></ul></ul></ul><ul><ul><li>To comply with HIPPA issues if research study affiliated with academic institution </li></ul></ul><ul><ul><li>To establish data agreements with school districts </li></ul></ul><ul><ul><li>To deal with “Privacy tag issues” </li></ul></ul>
    18. 18. 3. Aggregate Data <ul><li>Aggregate data may include students </li></ul><ul><ul><li>At the school or district level </li></ul></ul><ul><ul><li>Who did or did not use SBHC services, and/or </li></ul></ul><ul><ul><li>Who were or were not enrolled in the school for the majority of the school year </li></ul></ul><ul><li>Advantage of aggregate data is avoidance of consent issues </li></ul>
    19. 19. 4. Access to Data <ul><li>Methods of Obtaining Data </li></ul><ul><ul><li>Computerized or paper school records </li></ul></ul><ul><ul><li>Parent/child/teacher report or survey </li></ul></ul><ul><li>Relationship with school information services/technology division critical </li></ul><ul><ul><li>Determines priority of providing data needed </li></ul></ul><ul><ul><li>Level of comfort with sharing data </li></ul></ul><ul><ul><li>Whether data is obtainable at all </li></ul></ul><ul><ul><ul><li>This is easier if SBHC run by school district </li></ul></ul></ul>
    20. 20. 5. Student or Parent Surveys <ul><li>Limitations of surveys </li></ul><ul><ul><li>Recall bias </li></ul></ul><ul><ul><li>How questions are phrased </li></ul></ul><ul><ul><li>Low response rates </li></ul></ul><ul><ul><li>Non-representative sample </li></ul></ul>
    21. 21. 6. Computerized Records <ul><ul><li>May be more accurate than surveys, but still some issues </li></ul></ul><ul><ul><ul><li>Where student mobility is high, absences in particular may be inaccurate- absences may be high due to lack of knowledge that student has moved and has not officially withdrawn </li></ul></ul></ul><ul><ul><ul><li>Difficulty with decentralized school districts </li></ul></ul></ul><ul><ul><ul><li>May not be designed to collect all variables of interest </li></ul></ul></ul>
    22. 22. 7. Data Quality & Linking <ul><li>Data Quality </li></ul><ul><ul><li>Limits on how data can be verified </li></ul></ul><ul><ul><ul><li>Limited by cost </li></ul></ul></ul><ul><ul><ul><li>Limited by how data provided </li></ul></ul></ul><ul><li>Data Linking </li></ul><ul><ul><li>Different sources, different challenges </li></ul></ul><ul><ul><li>If multiple sources, how will data be linked </li></ul></ul><ul><ul><ul><li>Consent issues </li></ul></ul></ul><ul><ul><ul><li>Use of unique identifiers </li></ul></ul></ul><ul><ul><ul><li>Making data non-identifiable before link </li></ul></ul></ul><ul><ul><ul><li>Data agreements that allow links by certain personnel </li></ul></ul></ul>
    23. 23. 8. Variable Definitions <ul><li>Caution to make sure there are uniform definitions for variables being measured </li></ul><ul><ul><li>Districts using different criteria for determining and coding whether a child is exempt from academic testing </li></ul></ul><ul><ul><li>Schools within a district using different criteria to determine whether an absence is excused/unexcused or what constitutes being absent ( full day/half day) </li></ul></ul>
    24. 24. Given what we know, what are the next questions to ask about the relationship between SBHCs and academic outcomes?
    25. 25. Keep in mind…. <ul><li>We know: </li></ul><ul><ul><li>SBHCs improve access to health care </li></ul></ul><ul><ul><li>Medical and mental health status of students impacts their academic success </li></ul></ul><ul><li>And: </li></ul><ul><ul><li>All SBHCs are not exactly the same but are defined by their common elements </li></ul></ul><ul><ul><li>SBHCs are a part of a variety of services offered in schools </li></ul></ul>
    26. 26. However… <ul><li>The relationships between SBHCs and academic outcomes that we postulate as research and evaluation questions MAY be direct or indirect. </li></ul>
    27. 27. And this relationship should be… <ul><li>Possible (SBHC actually provides the intervention that is expected to influence academic outcome) </li></ul><ul><li>Realistic (takes into account multiple interventions that may occur simultaneously or that may all impact academic outcome) </li></ul><ul><li>Logical (model linking the intervention with the outcome can be described) </li></ul><ul><li>Demonstrable (data for the intervention and outcome or adequate proxies can be reasonably obtained) </li></ul>
    28. 28. Where should we go next? <ul><li>Consider the various levels at which the intervention can be defined. Is it… </li></ul><ul><ul><li>The SBHC as a whole or </li></ul></ul><ul><ul><li>A specified array of services delivered in the SBHC context or </li></ul></ul><ul><ul><li>An intervention delivered to a specific sub-population in the SBHC? </li></ul></ul>
    29. 29. And… <ul><ul><li>Examine the findings when each of these definitions are used. More focused interventions may yield clearer links to academic outcomes. </li></ul></ul><ul><ul><li>Consider how SBHCs contribute to the Coordinated School Health program model as well as youth development and student support programs. </li></ul></ul>
    30. 30. Finally!! <ul><ul><li>Consider that the highest likelihood of improving student achievement may come from the synergy of interventions including SBHCs, other health and social programs, youth development opportunities, and educational program improvements. </li></ul></ul><ul><ul><li>Develop a variety of algorithms or models that describe the relationships that we think occur based on our prior research and empirical observations. </li></ul></ul>
    31. 31. Health & Academic Risk Health Risk Behaviors Educational Outcomes Educational Behaviors AODT use Mental health Poor diet Intentional injuries Physical illness Self-esteem Sexual behaviors Attendance Dropout Rates Behavioral Problems Graduation GPA Standardized test scores