Reading, ‘Riting and Risk: School Health in the Era of MCAS

Reading, ‘Riting and Risk: School Health in the Era of MCAS John Kulig, MD, MPH Associate Professor of Pediatrics Associate Professor of Family Medicine and Community Health Tufts University School of Medicine

The Era of MCAS “Pressed to keep elementary schools on target in English and math to meet new state requirements for graduation, school officials next year plan to reduce by one-third the time allotted to art, music, physical education and health in the early grades.” The Foxboro Reporter 3/29/2001

The Era of MCAS “We realize that a good education has to be a broad education. Competing with that is the fact that there’s now a threshold to get out of high school - that being passing the MCAS test.” Superintendent Kathleen Tyrell Foxboro Public Schools The Foxboro Reporter 3/29/2001

Outcome developmentally based curriculum ¯ standards based curriculum

Scope of the problem “Last year about half of students statewide failed some aspect of the exam and more than one third of all sophomores failed the test in all subjects.” The Sun Chronicle 4/1/2001

Special student populations • students with special needs [603 CMR 28.02] developmental delay intellectual impairment emotional impairment health impairment sensory impairment • vocational education • bilingual students

Scope of the problem “It was just startling to me to have kids come to the dinner table and say, matter of fact, that maybe they’re going to quit school if they don’t pass this test.” Father of a student at Bristol County Agricultural High School, quoted in The Sun Chronicle 4/1/2001

Reading

Mathematics

Science

Completion rate

Dropout rate

Scope of the problem “The correlation between high stakes testing and student dropout rates is worrisome: graduation tests are used in nine of the ten states with the highest dropout rates and are not in use in the ten states with the highest graduation rates.” Center for Mental Health in Schools, Winter 2001

Approaches to school achievement “Somehow, both Republicans and Democrats have become convinced that schools can be immune to social environments. To make poor children academically proficient, we think only to raise standards, create sanctions for failure, and perhaps provide better teachers, smaller classes or more school time.” Richard Rothstein, New York Times, March 2001

Solutions • MCAS ¹ MCAT • recognize the impact of functional domains on academic achievement: individual school family community peer group sociocultural • address barriers to learning

School-based health centers • 1,380 nationwide in 1999/2000 • 20% increase over two years • 7 fold increase over past decade • located in 45 states plus District of Columbia • 33 states provide grant support to SBHCs • 43 states permit SBHCs to bill Medicaid • SBHCs in 22 states are providers in Medicaid managed care networks

Trends in SBHC Settings (n = 755; 151; 130)

Student Health Center at Boston High School • licensed NEMC satellite clinic - founded 1989 • enrollment limited to students attending Boston High School - grades 9 through 12 • consistently enrolls >70% of student population - enrolled 86% in 99-00 • female students predominate • 9th grade students predominate • open only during school hours • 24 hour Adolescent Clinic/NEMC ED backup

Student Health Center at Boston High School: History • second SBHC in Boston (1989) • parental consent required < age 18 except for emancipated minor issues • no contraceptives dispensed on site • no abortion referrals made on site • BHS located in Bay Village/South End neighborhood of Boston • BHS in transition from half-day work-study format to traditional full-day schedule

Student Health Center: Services • Primary health care: episodic and longitudinal • Comprehensive health assessments for school, employment, and sports • Lab testing/screening • Immunizations • Treatment for acute and chronic illness, skin problems, sports injuries, growth disorders, reproductive health concerns • Dental evaluations offered in collaboration with Tufts University School of Dental Medicine • Nutrition counseling • STD/HIV counseling and testing • Psychosocial assessment/crisis intervention • Individual and group mental health services • Expressive therapies

Student Health Center: Services • Classroom based health education • Substance abuse prevention • Sexuality education • Reproductive health counseling and education offered in collaboration with Crittenton Hastings House • Family planning services • Pregnancy options counseling • Case management for pregnant and parenting students • Dating violence education offered in collaboration with Transition House • Classroom-based dating violence prevention education • Individual and group dating violence intervention counseling • Mediation services offered in collaboration with Metropolitan Mediation Services • Peer leadership program

Student Health Center:Registration and Encounters for 1999-2000 • total school enrollment for 99-00 was 776 • 1514 SHC individual encounters • 124 group encounters • 75 peer mediations • 40% of encounters were for mental health services, 27% medical services, 25% case management services

Marijuana use scale: low score is good (results from girls who took all four surveys) 1.25 bhs-trt bhs-con ehs-con 1 0.75 score 0.5 0.25 0 p1:baseline p2: +6-12 p3: +15-18 p4: +25-31 survey

Delivery mechanisms • school-financed student support services • school district mental health unit • formal connections with community mental health services • classroom-based curriculum and special interventions • comprehensive, multifaceted, integrated approaches Center for Mental Health in Schools, Winter 2001

Reading, ‘Riting and Risk: School Health in the Era of MCAS