Donna jennings 2015 ga partnership meeting telemedicine roi & quality outcomes
Veda johnson
1. Health,Education & School
Based Health Centers
Veda Johnson, MD
Associate Professor of Pediatrics
Emory University School of Medicine
November 9, 2012
7. Educational Achievement –
Nationally
National Center for Education Statistics
Table 11.1. Percentage distribution of students at National Assessment of Educational Progress
Table 11.1. (NAEP) reading achievement levels, by race/ethnicity and grade: 2005 and 2007
Grade, year, and American Indian/Alaska
achievement level Total1 White Black Hispanic Asian/Pacific Islander Native
4th grade, 2007
Below Basic 33 22 54 50 23 51
At Basic 34 35 32 32 32 30
At or above Proficient 33 43 14 17 46 18
At Advanced 8 11 2 3 15 4
8th grade, 2007
Below Basic 26 16 45 42 20 44
At Basic 43 43 42 43 39 38
At or above Proficient 31 40 13 15 41 18
At Advanced 3 4 # 1 5 2!
12th grade, 2005
Below Basic 27 21 46 40 26 33 !
At Basic 37 36 38 40 38 41
At or above Proficient 35 43 16 20 36 26 !
At Advanced 5 6 1! 2! 5 ‡
# Rounds to zero.
! Interpret data with caution.
‡ Reporting standards not met.
1
Total includes other race/ethnicity categories not separately shown.
NOTE: Achievement levels are performance standards showing what students should know and be able to do. Basic denotes partial mastery of knowledge and skills that are fundamental for proficient work at a given grade.
(Below Basic, therefore, denotes less than this level of achievement.) Proficient represents solid academic performance. Students reaching this level have demonstrated competency over challenging subject matter. Advanced
signifies superior performance. NAEP reports data on student race/ethnicity based on information obtained from school rosters. Race categories exclude persons of Hispanic ethnicity. The NAEP assessment was not administered
to grade 12 in 2007. Detail may not sum to totals because of rounding.
SOURCE: U.S. Department of Education, National Center for Education Statistics, National Assessment of Educational Progress (NAEP), 2005 and 2007 Reading Assessment, NAEP Data Explorer.
8. Percentage distribution of 4th-grade students at
National Assessment of Educational Progress (NAEP)
reading achievement levels, by race/ethnicity: 2007
9. Percentage distribution of 8th-grade students at
National Assessment of Educational Progress (NAEP)
reading achievement levels, by race/ethnicity: 2007
10. Georgia Reading proficiency
4th graders (2009)
37% read at below basic
34% read at basic
29% read at proficient or better
18% of Low income and minority students
15% of Black students
44% of Higher income students
8th graders (2009)
33% below basic
40% @ basic
27% @ proficient or better
12. Percentage distribution of 12th-grade students at
National Assessment of Educational Progress (NAEP)
reading achievement levels, by race/ethnicity: 2007
13. Percentage distribution of 4th-grade students at
National Assessment of Educational Progress (NAEP)
mathematical achievement levels, by race/ethnicity:
2009
14. Percentage distribution of 8th-grade students at
National Assessment of Educational Progress (NAEP)
mathematical achievement levels, by race/ethnicity:
2009
15. Percentage distribution of 12th-grade students at
National Assessment of Educational Progress (NAEP)
mathematical achievement levels, by race/ethnicity:
2009
16. Percentage of 8th-graders at or above Basic on the National
Assessment of Educational Progress (NAEP) mathematics
assessment, by race/ethnicity and number of days absent from
school in the past month: 2009
18. Georgia Students
Absent >15days from school
Avg. 8.8%
Range: 1.5%– 19.4%
Kid’s Count 2011
Graduate from School on Time
(beginning in 9th grade)
32% don’t graduate on time (nationally
24%)
Kid’s Count 2008-9
20. Health
Nationally
Approximately 28 million children
nationwide from economically
disadvantaged households are at risk for a
variety of negative outcomes including:
1) increased rates of health problems and
mortality;
2) emotional and behavioral problems.
3) increased risk of academic
underachievement, school drop-out, and
unemployment; and
21. National Survey on Child’s Health 2007-8;
Sponsored by MCH and HRSA – Phone
survey by parents
Number of Chronic Conditions Reported*
Number of conditions Percent of Children
*Of 16 specific health conditions.
None 77.7
1 13.6
2 3.9
3 or more 4.8
22. National Survey on Child’s Health
2007-8
Asthma 9.0
Learning Disabilities 7.8
ADD/ADHD 6.4
Speech Problems 3.7
ODD or Conduct Disorder 3.3
Developmental Delay 3.2
Anxiety Problems 2.9
Bone, Joint, or Muscle Problems 2.2
Depression 2.0
Hearing Problems 1.4
Vision Problems* 1.3
Autism Spectrum Disorder 1.1
Epilepsy or Seizure Disorder 0.6
Diabetes 0.4
Brain Injury or Concussion 0.3
Tourette Syndrome
23. Dental Care
More than 16 million children still lack
access to basic dental care despite
efforts by states to improve their
dental health policies, according to the
2011 50-state report card from Pew.
The State of Children’s Dental Health: Making
Coverage Matter graded states' ability to serve
insured and soon-to-be insured children.
24. Health
Georgia
Adverse outcomes are widespread among
children in the state of Georgia. Georgia
ranks 37th in the nation overall for child
well-being (Kid’s Count 2012).
43rd - child economic well-being
30th – Overall child health ( child &teen deaths,
etc.)
38th - overall education
25. Health…
Georgia
We have the 2nd highest childhood obesity
rate in the country (37% OW/OB)
29% of our adolescents had significant
episodes of depression during the past 12
months.
26% of our children live in poverty and
approx. 300,000 children are uninsured.
37. The Solution
Leveraging health to
improve academic
outcomes.
Leveraging academic
success to improve
health outcomes.
38. Health and Academic Success
How does health
affect the
academic success
of our children?
39. Former Surgeon General
Dr. Antonia Novello
“Health and education go hand in hand: one
cannot exist without the other. To believe any
differently is to hamper progress. Just as our
children have a right to receive the best
education available, they have a right to be
healthy. As parents, legislators, and educators, it
is up to us to see that this becomes a reality.”
Healthy Children Ready to Learn: An Essential
Collaboration Between Health and Education,
1992
40. Health and Education
Association between health and
academic success
Students learn best when they are healthy
Students learn best when they are present
Students learn best when they are
connected to the school emotionally and
socially
Students learn best when there is hope
41. The National Association
of State Boards of Education …
"Health and success in school
are interrelated. Schools cannot achieve their
primary mission of education if students and
staff are not healthy and fit physically,
mentally, and socially.”
— Fit, Healthy, and Ready to Learn: Part 1
–
Physical Activity, Healthy Eating, and
Tobacco Use Prevention, 2000
42. Health
The World Health
Organization defines
health as a “state of
complete physical,
mental, and social well-
being, and not merely
the absence of disease
or infirmity.”
44. Social Determinants of
Health…
Definition of social
determinants of health:
The economic & social
conditions that influence
health …
‘The conditions in which
people are born, grow,
live, work and age.’
Source:www.who.int/social
_determinants/en/
accessed 10-4-11
45. Social Determinants of
Health…
Factors in the social environment that contribute to or
detract from the health of individuals and communities:
Income
Housing
Education
Transportation
Access to services
Physical Environment
Socioeconomic status/position
Discrimination by social grouping
Social or environmental stressors
Source: www.cdc.gov/sdoh accessed on 11-9-07
46. Social Determinants of
Health…
Major social
determinants of
health include:
Social Position
Where you live
Race
Stress
47. Social Determinants of
Health…
Health inequities associated with
socioeconomic status of children
Childhood Development
Asthma
Obesity
Diabetes
Behavioral Health
Oral Health
48. Health and Education…
Poor school performance is linked to health-
related issues such as hunger, physical and
emotional abuse, and chronic illness such as
asthma and obesity.
Poor academic outcomes are linked to risky
health behaviors such as substance use,
violence, and physical inactivity which in turn
affect students' school attendance, grades,
test scores, and ability to pay attention in
class.
49. Health and Education…
High school drop out rates are affected
by:
Forces within the school system
School readiness
Elementary and Middle school underachievement
Student disengagement, behavior issues, absenteeism,
and failing grades in 9th grade
Forces outside of school
Health issues
Psycho- social issues
Caretaking responsibilities
A caring adult.
50. American Cancer Society
“[Children] …who face violence, hunger,
substance abuse, unintended pregnancy, and
despair cannot possibly focus on academic
excellence. There is no curriculum brilliant
enough to compensate for a hungry stomach
or a distracted mind.”
— National Action Plan for Comprehensive
School Health Education. 1992
51. Health and Academic Success
How does
academic success
affect the health
of our children?
52. Health and Education
Education is a direct
predictor of health
Academic
underachievement
contributes significantly
to the health disparities
observed in children from
lower socioeconomic
positions.
53. Health and Education
Education is a direct
predictor of health…
Academic success is a
predictor for adult health
outcomes
Adults with higher
educational achievement
are more likely to be more
knowledgeable, have better
jobs and better
opportunities to achieve
and maintain healthy
54. Health and Education…
In addition – ‘Academic success is an
important indicator for the overall well-
being of students’
According to the
Youth Risk Behavior Surveillance System (YRBSS)
, students with higher grades are less likely to
have participated in risky behaviors such as:
Carrying a weapon
Current cigarette use
Current alcohol use
Being currently sexually active
Watching television 3 or more hours per day
Being physically active at least 60 minutes per day on fewer than 5
55. Percentage of High School Students Who
Carried a Weapon,* by Type of Grades Earned
(Mostly A’s, B’s, C’s or D’s/F’s), 2009**
* For example, a gun, knife, or club on at least 1 day during the 30 days before the survey.
**p<.0001 after controlling for sex, race/ethnicity, and grade level.
United States, Youth Risk Behavior Survey, 2009
56. Percentage of High School Students Who Were
in a Physical Fight,* by Type of Grades Earned
(Mostly A’s, B’s, C’s or D’s/F’s), 2009**
*One or more times during the 12 months before the survey.
**p<.0001 after controlling for sex, race/ethnicity, and grade level.
United States, Youth Risk Behavior Survey, 2009
57. Percentage of High School Students Who Ever
Used Marijuana,* by Type of Grades Earned
(Mostly A’s, B’s, C’s or D’s/F’s), 2009**
*Used marijuana one or more times during their life.
**p<.0001 after controlling for sex, race/ethnicity, and grade level.
United States, Youth Risk Behavior Survey, 2009
58. Percentage of High School Students Who Felt
Sad or Hopeless,* by Type of Grades Earned
(Mostly A’s, B’s, C’s or D’s/F’s), 2009**
*Almost every day for 2 or more weeks in a row so that they stopped doing usual activities during the 12
months before the survey.
**p<.0001 after controlling for sex, race/ethnicity, and grade level.
United States, Youth Risk Behavior Survey, 2009
59. How do we improve the academic
achievement for students by improving
their health?
60. The National Governors’
Association
“Policymakers need to focus on eliminating the
barriers that affect these lower-performing
students’ readiness to learn. Among these
barriers are physical and mental health
conditions that impact students’ school
attendance and their ability to pay attention in
class, control their anger, and restrain self-
destructive impulses.”
Improving Academic Performance by
Meeting Student Health Needs, 2000
61. Health and Education…
What we know…
School health programs and policies can be an
efficient way to prevent or reduce risky health
behaviors and avoid serious health problems
among students.
They may also help close the educational
achievement gap between disparate
socioeconomic groups of students.
62. Coordinated School Health
Program
1995 – Institute of Medicine committee
adopted the term ‘coordinated school health
program’ based on the concept of
‘comprehensive school health’ originated in
the 1980’s by Diane Allensworth and Lloyd
Kolbe.
Kolbe founded the Division of Adolescent and School
Health (DASH) at CDC.
63. Coordinated school health
programs
Recommended by CDC as a strategy to
improve the health and academic
performance of students
It is a coordinated approach to school
health that creates a system of care that
addresses the needs of the whole child by
connecting health with education
Creates a school environment that
promotes and supports healthy lifestyles
for students, teachers and staff
64.
65. Components of a coordinated
school health program
Allensworth and Kolbe, 1987
66. Coordinated school health
programs
Benefits:
Engages parents, teachers,
students, families, and communities
Helps keep students healthy
Supports learning and success
in school
Reinforces positive behaviors
Helps students develop knowledge and
skills to make smart choices
67. Coordinated school health
programs…
School based health centers exemplify the basic
tenets of a coordinated school health program
68. School Based Health Centers
(SBHCs)
Definition:
Comprehensive school based health clinics
are primary care medical centers that blend
medical care with preventive and
psychosocial services as well as organize
broader school-based and community-based
health promotion efforts.
69. SBHCs…
History:
School-based medical services began in
1890s to address contagious diseases in
classroom
School nurses replaced MDs in 1902 (MDs
going off to war)
Comprehensive school-based health
center concept began in the late 60s –Dr.
Philip Porter (Mass)
Developed a ‘system of care’ that Increased
access and coordinated healthcare for poor
70. SBHCs…
Qualities:
Recognized as an effective model of healthcare
that can significantly reduce barriers to medical
services for children living in poor communities
Holistic integrated approach to care that
emphasizes access, quality, and improved
outcomes that reduces health disparities
Provide a savings to the public by reducing
inappropriate emergency room usage among
children and adolescents.
71. SBHC’S…
Common Features of School-Based Health
Centers:
They are located in schools or in close proximity (school-linked).
The health center works cooperatively within the school to
become an integral part of the school.
The health center provides a comprehensive range of services
that meet the specific physical and behavioral health needs of
the young people in the community as well as providing for the
more traditional medical care needs.
A multidisciplinary team of providers care for the students: nurse
practitioners, registered nurses, physician assistants, social
workers, physicians, alcohol and drug counselors, and other
health professionals.
72. SBHC’S…
Common Features…
The clinical services within the health center are provided
through a qualified health provider such as a hospital, health
department, or medical practice.
Parents sign written consents for their children to enroll in the
health center.
The health center has an advisory board consisting of
community representatives, parents, youth and family
organizations, to provide planning and oversight.
73. SBHC’s…
Seven Basic Principles:
Supports the school
Responds to the community
Focuses on the student
Delivers comprehensive care
Advances health promotion
Implements effective systems
Provides leadership in adolescent and child health
74. SBHC’s…
Nationally (National Census – 2007/08)
Over 2200 SBHCs
56.7% in urban settings
27.2% in rural settings
16.1% in suburbs
Georgia
Only 2 SBHCs from 1994 – 2009
Currently 6
75. SBHCs…
Research demonstrates that SBHCs
effectively addresses the needs of the
underserved through:
Increased access to quality healthcare
Improved health outcomes
Decreased healthcare costs
Improved school attendance and academic
performance
76. Decreased health care costs –
Whitefoord Elementary School - Based
Health Clinic
Adams EK, Johnson V. An elementary school-based health
clinic: can it reduce Medicaid costs? Pediatrics. 2000;105(4 pt
1):780–788
Compared Medicaid costs to children enrolled in a
SBHC to those not enrolled in a SBHC
Summary of findings:
Decrease in total Medicaid costs per child over 2 year period
w/SBHC
Significant decrease in In-Patient costs
Significant decrease in prescription drug use costs
Significant decrease in emergency room costs
Decrease more significant across all categories if child used
SBHC as medical home
For children with asthma, decrease in Medicaid cost for total
yearly expenditures with significant decreases in inpatient and
drug costs.
77. Whitefoord Elementary and Sammye
E. Coan Middle School Based Clinics
Pediatric and adolescent
primary care health clinics
providing comprehensive
health services for the
students, their siblings, and
other children within the
community
Initiated by the Dept of
Pediatrics at Emory
University Nov. 1994
Removed the provision of
health care from the
institution and placed it into
the community
78. Whitefoord & Coan….
Goal : Increasing access to
quality health care and
improving the academic
achievement of students
Address the physical, mental
and emotional health of the
child
‘Care for the child in the
context of family, home and
community’
Developed the Whitefoord
Community Program, a
community-based support
program for families of children
enrolled in the clinic
79. Whitefoord Community Program
Created to address the
needs of families as defined
by the community
Mission: …‘working together
with families and the
community to ensure that
every child has what he or
she needs to succeed in
school’.
Components:
School based health clinics
Child Development Program
Family Learning &
Community Development
80. Staffing
Mid-level Providers
(NP/PA)*
Pediatricians/Medical
Director*
RN/Clinic Manager
Medical Assistant*
Dentist and Dental Asst
Social Worker/Mental
Health Providers*
Health Educator
Secretaries
Clerical Assistant
*Core Staff
81. School Based Clinic Services
Management of acute and
chronic illnesses and injuries
Routine and sports physicals
Immunizations
Dental care
Mental Health Assessments
and Counseling
Social services
Psycho-educational Testing
Referral to Sub-specialist
24 hr. coverage
82. Accomplishments
Increased access to
physical, mental and dental
health care
Increased immunization
rates for children and
adolescents
Improved school
attendance/?performance
Every child in school
receives health education
instruction on drug and
substance abuse, violence
prevention, safety, general
83. Accomplishments…
Improved health outcomes
for children with chronic
illnesses (e.g. asthma,
diabetes)
Improved risk factors for
overweight/obese students
Reduced BMI’s
Reduced cholesterol levels
Reduced insulin resistance
Reduced cost to the state’s
Medicaid program
Reduced ER use and
hospitalization of students
with asthma
84. Accomplishments…
Facilitated the recovery of many emotionally troubled
children.
Pre-K program
School aged children and adolescents
Improved the academic achievements for children
with ADHD and Learning Disorders.
Reduced the referrals of children with ADHD into Special
Education programs.
Increased parental involvement
Witnessed several challenged families assume proper
responsibility for their children
85. School Based-Health Centers -
Health and academic
achievements
Increases access to
quality healthcare
Improves health
outcomes
Decreases
healthcare costs
Improves school
attendance and
academic
performance
86. “It is easier to build strong children than
to
repair broken men.”
Frederick Douglass (1817–1895)
87. Contact Information
Veda Johnson, MD
Associate Professor of Pediatrics
Emory University School of Medicine
49 Jesse Hill Jr Dr
Atlanta, GA 30303
Phone: 404-778-1419
Email: vjohn01@emory.edu
88. Urban Health Program
Urban Health Program
at the Department of
Pediatrics, Emory
University School of
Medicine
Vision:
To reduce health
disparities ensuring that
all Georgia children are
more likely to be happy,
healthy and productive
members of society.
89. Urban Health Program…
Goals of UHP:
Increase access to healthcare for
underserved children through expansion of
School Based Health Centers (SBHCs)
throughout the state
Improve the delivery of health care for at-
risk children and adolescents
Improve academic outcomes for
underserved children
Train future pediatricians to address the
Editor's Notes
ASTHO and SSDHPER Former Surgeon General, Dr. Antonia Novello, noted how health and education are interrelated saying, “Health and education go hand in hand: one cannot exist without the other.” She went on to say that children have a right to be healthy and that families, schools, and policy-makers must ensure this becomes a reality.
ASTHO and SSDHPER Many influential voices continue to join us in supporting coordinated school health programs. The National Association of State Boards of Education (NASBE) advocates that “Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.” As the national organization representing state and territorial boards of education, we all benefit from NASBE’s continued support and leadership in educational policy making.
Set of Ten Social Determinants - Economic Security & Financial Resources, Livelihood Security & Employment Opportunity, School Readiness & Educational Attainment, Environmental Quality, Civic Involvement & Political Access, Availability & Utilization of Quality Health Care, Health status, Adequate, Affordable & Safe Housing, Community Safety & Security, Transportation
ASTHO and SSDHPER The American Cancer Society took a leadership role in promoting coordinated school health programs for the nation’s schools. Understanding the important links between health and education, ACS stated, “There is no curriculum brilliant enough to compensate for a hungry stomach or a distracted mind.”
This means that 12% of high school students with mostly A ’s carried a weapon, for example, a gun, knife, or club, and 37% of high school students with mostly D’s/F’s carried a weapon, for example, a gun, knife, or club, on at least 1 day during the 30 days before the survey.
This means that 19% of high school students with mostly A ’s were in a physical fight, and 58% of high school students with mostly D’s/F’s were in a physical fight one or more times during the 12 months before the survey.
This means that 21% of high school students with mostly A ’s used marijuana one or more times, and 66% of high school students with mostly D’s/F’s used marijuana one or more times during their life.
This means that 18% of high school students with mostly A ’s felt sad or hopeless, and 42% of high school students with mostly D’s/F’s felt sad or hopeless, almost every day for 2 or more weeks in a row so that they stopped doing usual activities during the 12 months before the survey.
ASTHO and SSDHPER The National Governors Association (NGA) is, as the name suggests, the organization representing governors of the United States. In a policy brief on coordinated school health programs, NGA recommended to policymakers that they focus on eliminating barriers that affect lower-performing students’ readiness to learn. Specifically, NGA highlights barriers including physical and mental health conditions that impact students’ school attendance and their ability to pay attention in class, control their anger, and restrain self-destructive impulses.
ASTHO and SSDHPER In 1987, Dr. Lloyd Kolbe and Dr. Diane Allensworth first proposed the concept of a coordinated school health program. Complete coordinated school health programs consist of eight separate, but interconnected, components. Many of these components exist in every school, but they are often not formally linked in a coordinated way. Active family and community involvement are critical to the success of any coordinated school health program. Coordinated school health programs involve two curricular areas that require qualified teachers for effective implementation. These are comprehensive school health education and physical education. School health services delivered by qualified health care professionals provides basic health care and enables students to stay healthy and prevents injuries. Counseling, psychological, and social services involve professional counselors, psychologists, and social workers to attend to students’ mental health needs. Nutrition services provides a healthy food environment, including a good breakfast and lunch program. A healthy school environment involves two areas: a physical plant or building that is safe and conducive to learning, and a school climate that ensures that students feel safe, supported, and free from harassment. Finally, school-site health promotion for staff involves programming that includes education for school staff that improves their personal health behaviors and provides positive personal examples that reinforce positive student health behaviors.
ASTHO and SSDHPER Coordinated school health programs, or CSHPs, are a solution. Effective coordinated school health programs actively involve parents, teachers, students, families, and communities in their implementation. They work toward long-term results, and they are designed to promote student success by helping students establish and maintain healthy personal and social behaviors. They also work to improve student knowledge about health and to develop personal and social skills that help them to make smart choices in school and in life. According to the Centers for Disease Control and Prevention, Division of Adolescent and School Health, “Schools by themselves cannot, and should not be expected to, address the nation’s most serious health and social problems. Families, health care workers, the media, religious organizations, community organizations that serve youth, and young people themselves also must be systematically involved. However, schools could provide a critical facility in which many agencies might work together to maintain the well-being of young people....” ( Note to presenter : This statement can be found on the CDC’s website. Go to: http://www.cdc.gov/nccdphp/dash/cshpdef.htm.)
Published paper in Pediatrics this past spring, Can a School-Based Clinic Reduce Medicaid Cost. Less than 10% of children attending clinic are sent home.