Nashville Community Health Needs for Children and Youth, 0-24

1. Nashville Community Health Needs for Children and Youth, 0-24 GOAL 5Children and Youth are Physically Healthy

2. Children and Youth are Physically Healthy means… • Children and youth are reaching their optimal level of physical health. • Children and youth illness or health conditions are dealt with immediately to assure minimal long-range impact. • Children and youth receive regular preventive care (med/oral) and counseling, assuring physical progress and identifying problems needing referral. • Children receive services for special medical and oral health needs as soon as possible and on as regular a basis as needed.

3. There are many current issues that prevent children from being physically healthy. • Many children and youth are without insurance to cover care. Particular groups affected are: • Children who do not have citizenship status. • Youth over 18 years old. • Many children and youth are living in poverty and access is not easy in their neighborhoods. Particular groups affected are: • African-American and Hispanic children and youth. • Families are often not fluent in English. • Medical and oral health services are centrally organized on traditional hours, creating difficult access, long waits and parental hardship.

4. Numbers help tell the story… • At least 10% of children and youth have no insurance – this figure is increasing. • 40.1% of children and youth 21 and under receive TennCare. The percentage and number has fallen from 66,791 and 43.7% in 2001 to 62,357. • Nationally, the largest growing groups of uninsured are children and youth who are not citizens and youth over 18. • LEP growing to 7% of children in schools, from 3,000 to 5,000. • 19.8% of children live below poverty • 41.1% of these children live below 200% of poverty level. • 61% of these children are African American. • Economically Disadvantaged populations in schools are growing, increasing from 45.3% to 60.8%. * Data from various 2005 statistics.

5. Numbers help tell the story… • Half of children on TennCare do not use available services during the year. • 20% of those 0-9 do not receive screening. • 60% of those 10 and up do not receive screening. • This would likely be greater for those without insurance. • 36% of children K-8 have untreated oral disease. • 12.6% of students in Metro Nashville Public Schools (MNPS) have disabilities. • Disparities tell another story: One example • Asthma is the leading chronic condition leading to Emergency Department use, hospitalization and school absence among children. • Prevalence of asthma may be as high as 15%; the percentage is higher among African American and poor children. • 711 children with asthma identified in Metro schools, but number may be as high as 10,000.

6. Currently, a number of programs in the community address these needs. • Metro Nashville Health Department • Mobile Pediatric Assessment Clinic providing health screening and referral serving up to 21 with TennCare. • School-based Oral Disease Prevention Program. • Dental clinic in East Nashville. • School nurse program: 45 nurses in 128 Metro schools. • United Neighborhood Health Services • 5 neighborhood clinics (1 with dental) (3 Se Habla Espanol). • 3 school clinics (2 Se Habla Espanol). • Mobile clinic. • 3 clinics with Saturday hours 1 clinic with extended hours. • Mercy Health Services • Medical & social services for children, particularly special needs children.

7. Currently, a number of programs in the community address these needs. • Vanderbilt Nursing School • School nurse program with 1 nurse covering 2 schools. • Vine Hill Clinic. • Matthew Walker Comprehensive Health Center • Provides medical and dental services at one location . • Se Habla Espanol. • Saturday hours. • St. Thomas Health Clinics • Two locations. • Se Habla Espanol. • Siloam Health Center • International and refugee services. • Many languages. • Faith Family Clinic • Inter-Faith Dental • Non-traditional evening hours. NOTE: This slide provides only a few examples of programs; it is not intended to be a comprehensive list.

8. There are many gaps in today’s programs and services. • There is no MNPS central health plan to coordinate development of school health & dental services. • School health services are not comprehensive or equitably distributed. • All schools don’t receive services. • All schools aren’t served equally. • Some school services are only for TennCare children and do serve uninsured. • Language competency is not present in all school health programs.

9. There are many gaps in today’s programs and services. • Some high need neighborhoods are without a local health center. • Cumberland View, Bordeaux, Buena Vista, Charlotte Park • Many more neighborhoods do not have oral health services. • Many centers do not have non-traditional hours (Saturdays and evenings).

10. In the next 2-5 years a number of changes are expected. • Number of uninsured children without citizenship will grow. • Number of uninsured youth 19-24 will grow. • CoverKids will expand insurance to those children who are citizens and in poverty 0-18. • Public resources for uninsured are not expected to grow.

11. References • Kids Count • Metropolitan Department of Health • Metro Nashville Public Schools • Tennessee Department of Health • CDC: Center for Disease Control • Health Resources Services Administration • BlueCare Insurance • Bureau of TennCare • Health Affairs • Diversitydata.org (Harvard University)