Developing Meaningful Partnerships within your School Community

1. Developing Meaningful Partnerships within your School Community Advancing Access to Quality Health Care for Youth 2154 NE Broadway, Suite 100, Portland, OR 97232 www.osbhcn.org 503.595.8423

2. Find an Appointment! 12:00 9:00 3:00 6:00

3. Kids bring their whole life to school with them… and it doesn’t fit in a locker. • Every student faces life challenges that impact his or her ability to learn. • Supporting kids and addressing health issues such as hunger, stress, harassment, substance use and unintended pregnancy can greatly improve their ability to learn.

4. There is a research-based link between students’ physical, social and emotional health and their ability to learn…

6. Building Bridges Between SBHCs and Schools

7. Why Partner? SBHCs And Other Health Professionals Partnering With Schools • “Our world and our nation have changed; so too have our schools. Today, more than ever, school health programs could become one of the most efficient means available to improve the health of our children and their educational achievement” (Kolbe,2005 p.226) Schools Partnering With SBHCs • “The best of teaching cannot always compete successfully with the challenges many students face outside of school” (Lee-Bayha & Harrison, 2002 p.1)

8. What We Know: The health-academic outcomes connection SBHCs Graduation GPA Standardized test scores Health Risk Behaviors Educational Outcomes Substance use Mental health Poor diet Intentional injuries Physical illness Self-esteem Sexual behaviors Attendance Dropout Rates Behavioral Problems Educational Behaviors

9. Stressors to Child Health and Learning Readiness • In 2005, 9% of U.S. children had no health insurance • 5% of U.S. children had no usual place of health care • 6.5 million children have diagnosed asthma • One in five children have a diagnosable mental disorder • 35% of uninsured children had no dental contact in two years • 7% of children had ADHD • Children with fair or poor health status were six times as likely to have learning disability and be absent 11 or more days from school • Over 4 million children (7%) has a learning disability • In 2005, 19% of 4th graders and 20% of 8th graders missed three or more days of school the previous month • 14% total school enrollment receive IDEA services (Federal Interagency Forum on Child and Family Statistics, 2007; National Center for Children in Poverty, 2007; U.S. Department of Education - National Center for Education Statistics, 2006)

10. The Terri Story… Asthma Terri has asthma. It is not under control and she misses many days of school because of it. She doesn’t really know what triggers her asthma, but she hardly ever participates in physical activity. Her grades are getting worse because of her absenteeism. Physical Health Implicationson Learning Emotional Health Social Health

11. Connecting Professional Communities For Children Childhood Asthma Nearly 73,000 Oregon children 18 and under currently have asthma. Asthma prevalence in Oregon continues to rise and is higher than the U.S. average. _______ County’s asthma prevalence rate is __%, compared to Oregon’s rate of 9.9% and the US rate of 7.9% Learning Implications Health Implications • About 14% of 8th graders and 9% of 11th graders with asthma reported missing at least one day of school because of asthma in the past month (Oregon) • Children in fair or poor health such as those with uncontrolled asthma were six times more likely to have a learning disability and be absent 11 or more days from school (Nationally) • Disrupted sleep caused by asthma contributes to poor school performance (Nationally) • Asthmatic children have higher rates of grade failure than non-asthmatics (Nationally) • Asthma is more common in low-income and minority populations. These groups are also at risk for higher rates of fatalities, hospital admissions and emergency room visits. (Oregon) • Oregon children were hospitalized for asthma more than 550 times in 2006.Children ages 0-5 have the highest rate of asthma hospitalizations. (Oregon) (Diette et.al, 2000; Fowler, Davenport & Garg, 2001; Halterman,et. al, 2001; Oregon Asthma Surveillance Report (2007)

12. Coordinated School Health Web Activity

13. The Coordinated School Health Model

14. Policies as Partnership Possibilities

15. School Health Programs and SBHCs Grab a post-it… Individually, write down what comes to mind when you hear the words… School Health Programs AND School-Based Health Centers

16. Oregon Educational Governance Governor Quality Education Commission (11 appointed members confirmed by the Senate) Legislature State Board of Education (7 appointed members confirmed by the Senate) Superintendent of Public Instruction (elected) School Districts Superintendents

17. No Child Left Behind : A Synopsis

18. NCLB Criteria Title I – Part C Education of Migratory Children Title I – Part D Prevention and Intervention Programs for Children and Youth who areNeglected, Delinquent, or At-Risk Title IV – 21st Century Schools IDEA Criteria Least Restrictive Environment SBHC Contribution Immunizations, and health records of migrant children served are required to be supplied to the national database. As SBHCs treat clients data could be provided to the schools to input. Prevention & intervention services, information, screening, and treatment of affected students could be performed at SBHC sites. Drug and alcohol prevention education, testing, screening, counseling and treatment options might already being provided in SBHCs Health-related services for students with physiological needs can be supplied on site

19. Local Wellness Policy RequirementsChild Nutrition ReauthorizationPUBLIC LAW 108-265-JUNE 30, 2004 • Goals for nutrition education, physical activity and other school-based activities designed to promote student wellness • Nutrition guidelines selected by the local educational agency • Guidelines for reimbursable school meals • A plan for measuring implementation of the local wellness policy • Community involvement • Oregon Link: http://www.ode.state.or.us/search/results/?id=270 • http://www..fns.usda.gov/tn/Healthy/wellness_policyrequirements.html

20. Other School Health Requirements • State Content Standards and Benchmarks (what a student should know and be able to do) • Law/Policies related to health and physical education • Assessments, Tests • CIM Endorsements • Oregon Healthy Teens

21. Health Education State Content Standards • Concepts(Alcohol, Tobacco, and Other Drug Prevention, Prevention and Control of Diseases, Promotion of Environmental Health, Promotion of Healthy Eating, Promotion of Mental, Social and Emotional Health, Promotion of Physical Activity, Promotion of Sexual Health, Unintentional Injury Prevention, Violence and Suicide Prevention) • Accessing Information • Self Management • Analyzing Influences • Interpersonal Communication • Decision Making • Goal Setting • Advocacy

22. Oregon Laws Related to Health Education Instruction A K-12 Plan of Instruction Based on the Common Curriculum Goals OAR 581-022-1210 AOD Prevention Annually OAR 581-22-413 and ORS 336.222 Human Sexuality Education, HIV/STD, Hepatitis B/C Prevention Education OAR 581-022-1440 and ORS 336.455-475 Emergency Drills and Instruction ORS 336.071 Anabolic Steroids and Performance-enhancing Substances SB 517 Child Abuse Reporting and Training SB 379

23. Oregon Laws RelatedTo School Health and Safety Harassment, Bullying and Intimidation ORS 339.351 to 364 Tobacco Free Schools OAR 581-021-0110 Emergency Plans & Safety ProgramsOAR 581-022-1420 Physical EducationHB 3141

24. SBHC Certification Standards • Centers are certified biannually by the State SBHC Program Office within DHS • Two levels of certification: Core and Expanded • Certification is voluntary, however only certified centers receive State funding • Included in certification standards are guidelines for: facilities, operations/staffing, laboratory and clinical services, data collection and reporting, quality assurance activities and administrative procedures for certification.

25. SBHC Funding • While the SBHC model of care is consistent, funding streams, medical sponsorship and management differ from site to site. • The funding is fragile and resources are scarce. Sources of revenue for SBHCs under FQHCs (23 centers) • Billing & fees 43% • County/city government 26% • Federal funding 13% • State funding 7% • Grants 5% • In-kind donations 3% • Other 2% • Fundraising 1% Sources of revenue for SBHCs NOT under FQHCs (19 centers) • Other 45% • State funding 25% • Grants 12% • In-kind donations 7% • Billing & fees 5% • County/city government 5% • Fundraising 1% Data: Department of Human Services/Office of Family Health/Adolescent Health/SBHC

26. Visioning Activity

27. Education stakeholders ask: • Do school health programs detract from, or complement the academic and social mission of schools? • Advocates of school-related health programs ask: • If our programs are unable to demonstrate their educational value, will they be able to sustain and expand their current place in the health care safety net?

28. Oregon’s Children In Oregon, 12% or over 110,000 children are uninsured. 68% of SBHC clients reported that they would not have received health care without their SBHC School-based health centers are staffed by licensed health professionals, and do not replace the important work of school nurses.

29. A Snapshot of Oregon’s Children • 42.6% of public school students are eligible for free/reduced price lunches • 24% of Oregon children ages 6 – 8 have untreated tooth decay • 13 out of 1000 children are victims of abuse or neglect • Last year, 27% of 9 - 12th graders were overweight or at risk for overweight. • In 2006 18% of Oregon’s children live in poverty, 40% are low-income • In 2005, 13% of Oregon children ages 0 - 17 had been diagnosed with asthma • 21% of students changed school districts in school year 2005 – 2006 (OHT 2007, BRFSS 2005, Children First for Oregon County Data Book 2006)

30. Lake Research Partners Oregon Results • The majority of voters consider all tested services with the exception of prescribing medication important. • Health education around eating right and exercising, and counseling for kids with obesity and other eating problems, and mental health services, including grief therapy, peer pressure, bullying, and suicide prevention. • Support also based on the belief that SBHCs would provide care to uninsured and underinsured children who would otherwise not receive services • Support for mental health services is also high, with 80 percent of voters saying these are important services to provide • Voters look with roughly equal numbers for stable funding from the federal government, insurance companies, and paying more in federal taxes to pay for these centers. • Strongest messages “Provide Care”, “Smart Investment”, “Studies”, and “Disaster Support”

31. How can SBHCs aid in creating a continuum of care for Oregon’s youth? • Provide a solution to access barriers such as transportation, distance, and clinic hours inconvenient to parents • Bring community resources to the student • Support students, teachers, parents, administrators, and other health professionals by keeping children healthy and in school • Aid in identifying health issues early in a safe environment

32. Resources

33. Team Action Planning

34. Closure and Evaluation

35. Contact Information Jess Bogli, Jessica Bogli Consulting jess@jessicabogli.com, 503.784.2932 www.jessicabogli.com Dr. Jeanita Richardson, Turpeau Consulting Group, LLC richardsonjw1@aol.com, 804.674.1976 Maesie Speer, Oregon School-Based Health Care Network maesie@osbhcn.org, 503.595.8423 www.osbhcn.org

36. Selected References Diette, G. B., Markson, L., Skinner, E. A., Nguyen, T. T., Algatt-Bergstrom, P., & Wu, A. W. (2000). Nocturnal Asthma in children affects school attendance, school performance, and parents' work attendance. Archives of Pediatrics & Adolescent Medicine, 154(9), 923-928. Federal Interagency Forum on Child and Family Statistics. (2007). America's Children: Key National Indicators of Well-Being 2007. In Federal Interagency Forum on Child and Family Statistics (Ed.). Washington, D.C.: U.S. Government Printing Office. Fowler, M. G., Davenport, M. G., & Garg, R. (1992). School Functioning of US Children With Asthma. Pediatrics, 90(6), 939-944. Geierstanger, S. P., Amaral, G., Mansour, M., & Walters, S. R. (2004). School-based Health Centers and Academic Performance: Research, Challenges, and Recommendations. The Journal of School Health, 74(9), 347-353. Halterman, J. S., Montes, G., Aligne, A., Kaczorowski, J. M., Hightower, A. D., & Szilagyi, P. G. (2001). School Readiness Among Urban Children With Asthma. Ambulatory Pediatrics, 1(4), 201-205. Kolbe, L. J. (2005). A Framework for School Health Programs in the 21st Century. The Journal of School Health, 75(6), 226. Lee-Bayha, J., & Harrison, T. (2002). Using school-community partnerships to bolster student learning (Policy Brief). San Francisco: WestEd. National Center for Children in Poverty. (2006). Children's Mental Health: Facts for Policymakers. New York: Columbia University Mailman School of Public Health. Richardson, J. W. (2006a). Public K-12 Federal Educational Policy: Battlecreek: The W.K. Kellogg Foundation. Richardson, J. W. (2006b). SBHC Policy Program: Public K-12 Grantee State Educational Policy: Battlecreek: The W. K. Kellogg Foundation. Richardson, J. W. (2007). Building Bridges Between School-Based Health Clinics and Schools. Journal of School Health, 77(7), 337-343. U.S. Department of Education - National Center for Education Statistics. (2006). The Condition of Education 2006 (Vol. NCES 2006-071). Washington, D.C.: U.S. Government Printing Office.