Linking Public Health, Health Care and Education to Address the Needs of the Whole Child

1. Linking Public Health, Health Care and Education to Address the Needs of the Whole Child Diane Allensworth, PhD Professor Emeritus, Kent State University

2. Children & Youth: 25% of the Population – All of Our Future

3. Student Health Indicators: The Good • Dramatic decreases in infectious disease rates and childhood mortality in 20thcentury • Dramatic decline in blood lead levels • Gradual decline in child injury mortality since 1980

4. Student Health Indicators: The Bad • 19% of high schools students report current cigarette use (Daily 4000 students try a first cigarette) • Dramatic increase in the number of overweight youth, now 16% (4-5% in 1970’s) • 11 .3% of youth have had at least one clinically significant emotional, behavioral, or substance abuse disorder.

5. Student Health Indicators: The Ugly • High number of children living in poverty • 15.3 million/ 21%; (Family of 4 with income below $22,050 ) • Using 200% of Federal Poverty Limit as definition: • 42.2 % of U.S. children lived in "low income" households -31.3 million Poverty linked with multiple negative outcomes for children and youth.

6. Children in Poor Families by Race/Ethnicity Children living in poor families: • 29% White • 32% Asian • 57% Native American • 62% Black • 63% Hispanic

7. Social Determinants of Health for Children & Youth Inequitable Education Lack of Health Services Poverty Food Insecurity Poor Early Development Unhealthy Environment Race & Ethnicity

8. Ugly Health Implications for Children Living in Poverty Poverty is linked with negative health outcomes • Poor children and youth have more health problems • More chronic disease • More infectious disease • More injuries • More developmental delays • More social/emotional behavioral problems • Prognosis is worse with the same condition • Poor receive less and lower-quality medical care

9. Common Health Problems Reducing Achievement • Lack of breakfast • Aggression/Violence • Teen pregnancy • Asthma • Vision • Inattention & Hyperactivity • Lack of physical activity Source: Basch C. http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web03082010.pdf

10. Absenteeism: Another Major Factor Associated With Dropping Out of School Course failure in 9th grade explains H.S. drop out rates • Demographic & economic background characteristics (7% of course failures) • Eighth-grade test scores explain an additional 5% (12% total) • Absences explain an additional 53% (65% total) Source: Allensworth E, Eston, JQ. What Matters for Staying On Track and Graduating in Chicago Public High Schools. Chicago: Consortium on Chicago School Research at the University of Chicago, Research Report, 2007 Source: Allensworth E, Eston, JQ. What Matters for Staying On Track and Graduating in Chicago Public High Schools. Chicago: Consortium on Chicago School Research at the University of Chicago, Research Report, 2007

11. Poor Children and Minority Children Who Are Sick Experience More Academic Difficulties • Fifty-eight percent of students with chronic health conditions miss school more often. • 10% miss more than 25% of the year. • For students in all grades, the lower the family income, the higher the absenteeism rates.

12. Educational Implications for Children Living in Poverty Poor Children Start School Behind • Achievement gap is present in Kindergarten • Achievement gap increases between poor students and more well to do students throughout K-16 • Children from more well to do families are more likely to attain a college degree

13. The Achievement GAP The achievement gap is the difference seen in the academic performance of: • Minority students and their non-minority peers • Poor students and students who are not poor

14. UGLY Educational Implications for Children Living In Poverty Attending High Poverty Schools: • Poor schools/Run down facilities • Lower per–pupil spending • Less curriculum rigor/Less advance placement tests • Less credentialed/experienced teachers • More teacher absenteeism & turnover • Lack of school safety • Less parent participation

15. Health Problems & Inequities in Schooling Limit Education As A Solution Leading to 7200students dropping out of school every school day – More than 1.3 million every year – perpetuating the cycle of poverty

16. Education: A Solution to Reduce Poverty & Health Disparities • Education is the stepping stone/ foundation to the “American Dream” • Education is the factor consistently linked to longer lives • High school graduates have: • Better health • Lower medical costs • Longer lives: 6-9 additional years

17. Education and Health Are Interconnected Academic Performance Educational Attainment School Based Interventions Adult Health Status Child Health Status Nancy Murray, et al. Code Red, Education and Health: A Review and Assessment, Appendix E. http://www.coderedtexas.org/files/Appendix_E.pdf

18. What Has Been Recommended to Close the Achievement Gap? Solution #1: Collaboration between community & school to address student health & education problems • Low birth weight • Specific diseases • Diabetes • Asthma • Mental health problems • Teen pregnancy • Food insecurity & hunger

19. Has the Solution Worked Elsewhere?Community Schools: One Approach Premise: Educators, Families and Community Sharing Responsibility for Student Learning A community school is both a place and a set of partnerships between school and community. It has an integrated focus on academics, youth development, family support, health and social services, and community development.

20. Coalition of Community Schools: Conditions for Learning • Early childhood development • Challenging curriculum with qualified teachers • Students engaged in learning • Physical, social, emotional, and economic needs of young people and their families are met • Mutual respect and effective collaboration among parents and school staff

21. Research Support for Community Schools Improving Achievement Evaluations from 20 different Community School initiatives showed that 75% of schools improved academic achievement • Improved attendance • Reduced discipline problems • Greater completion of assignments • Increased contact with supportive adults Blank, M. J., & Shah, B. P. (2004). Community Schools: Educators and Community Sharing Responsibility for Student Learning. ASCD Infobrief. Available at http://www.ascd.org/publications/newsletters/infobrief/jan04/num36/toc.aspx

22. Has the Solution Worked Elsewhere?School Based/School Linked Clinics: Another Approach • Improves health status, • Reduces absenteeism, • Reduces in hospitalization • Decreasing discipline referrals, • Increasing parental involvement, and improving readiness to learn. http://www.nasbhc.org/atf/cf/%7Bcd9949f2-2761-42fb-bc7a-cee165c701d9%7D/SBHC%20BENEFITS.PDF www.casbhc.org/.../Benefits%20of%20School-Based%20Health%20Centers.pdf

23. Percentage of WV Schools Engaging Parents & Community Members To Implement Programs and/or Policies Topic% Families% Community Tobacco Prevention 28 36 Physical Activity 30 32 Nutrition/Healthy Eating 36 40 HIV/STD/Teen Pregnancy 11 21 Asthma 17 19

24. Solution #2: High Quality Early Child Care (Head Start) • High achievers in 1st graders 72% From higher income families 28% From lower income families The gap due to poverty can be reduced by ensuring that low income children are enrolled in high quality child care. http://www.thecommunityguide.org/index.html

25. Opportunity: Promoting Health Through the Social Environment: Early Childhood Development Programs The Task Force on Community Preventive Services recommends publicly-funded, center-based, comprehensive early childhood development programs for low income children aged 3 to 5 years based on strong evidence of their effectiveness on preventing delay of cognitive development and increasing readiness to learn, as assessed by reductions in grade retention and placement in special education classes.

26. Positive Effects of Participation in Early Childhood Development ProgramsSuch as Head Start • Less likely to be retained in grade and placed in special education • Higher scores on standardized achievement tests • Improved high school graduation rates • Decreased teen pregnancy • Decreased delinquency • Higher rates of employment and home ownership Source: The effectiveness of early child development programs: A systematic review. Am J Prev Med, Vol. 24, No.3S

27. Challenge: Federal Funding Unavailable for Many Qualified Pre-School Students • Nationwide the system only accommodates students from 1 in 7 eligible families • Inadequate funding relegates many needy children to begin K-12 unprepared!

28. Solution #3 Quality Coordinated School Health Program Health Education Physical Education Family & Community Involvement Health Services Health Promotion for Staff Nutrition Services Healthy and Safe School Environment Counseling, Psychological, and Social Services

29. Will the Solution Work? • All eight components of a quality CSHP help achieve education goals • Even educational researchers have acknowledged that several components are critical • Professional educational association, ASCD, has identified the value of addressing health along with other important issues

30. Components of a Quality CSHP Help Achieve Education Goals: 1) Improved achievement, 2) Improved classroom behavior 3) Reduced absenteeism • Collaborative for Academic, Social & Emotional Learning (CASEL) – casel.org/wp-content/uploads/2011/04/academicbrief.pdf • Society for Health and Physical Education (The Society) - http://wg.thesociety.org/home/publications,2003 • Health MPowers- http://www.healthmpowers.org/School-Resources/Linking-Health---Academic-Achievement.aspx.

31. What Has Been Recommended to Close Achievement Gap by Education Researchers? Five Essential Supports That Influence Student Learning When Organizing Schools for Improvement • School Leadership • Parent & Community Ties • School Learning Climate (Order and Safety) • Professional Capacity • Instructional Guidance Bryk, AS et al. Organizing Schools for Improvement. Chicago, IL: The University of Chicago Press. 2010

32. ASCD – 170,000 Members Nationwide Question: What Works In School Reform? ASCD’s Answer: Learning Compact to Address the Needs of the Whole Child • Healthy • Safe • Engaged • Supported • Challenged http://www.wholechildeducation.org/

33. Learning Compact for Children: Logic Model Students Ready to Learn Health Sector’s Guide- lines The Learning Compact: • Healthy • Safe • Engaged • Supported • Challenged Factors Affecting Health & Learning H.S. Grads Ed. Sector’s Guide- lines Adopting healthier behaviors Available at: http://www.cdc.gov/pcd/issues/2011/Mar/10_0014.htm

34. The Learning Compact: Healthy Each child enters school healthy and learns about and practices a healthy life style • All students have a medical & health home • All students who qualify are enrolled with S-CHIP • Promote visits by RN to teen mothers to ensure healthy outcome for infant • Promote surveillance to identify health related absenteeism, health risk behaviors & health protective factors • Promote quality school health program

35. Challenge: Quality School Health for All Children Far From Universal Health Education Physical Education Family & Community Involvement Health Services Health Promotion for Staff Nutrition Services Healthy and Safe School Environment Counseling, Psychological, and Social Services

36. Challenge: Improve CSHP Policies to Reduce Obesity Policy for P.E. % of Schools & Physical Activity With Policy Daily PE for 3rd grade students 20 Student fitness measured annually 34 Fitness results sent to parents 38 Advisory Group making PE/PA & nutrition recommendations (district & school) 16 (Students complete individualized improvement plan)

37. The Learning Compact: Safe Each student learns in an intellectually challenging environment that s physically and emotionally safe for students and adults. • Promote calm and respectful schools • Anti-bullying initiatives • Peaceful Playgrounds • Personal and social skills scope & sequence curriculum K-12 • Establish a healthy physical environment by using the EPA’s Healthy Seat program

38. Evidence about Student & Teacher Safety in Chicago Public Schools School safety is an issue in many Chicago schools. • Students and teachers do feel safe in high poverty & high crime areas if a quality relationships exists between staff and students and between staff and parents. “Indeed, disadvantaged schools with high-quality relationships actually feel safer than advantaged schools with low-quality relationships.” Steinberg, M.P., Allensworth E.M., & Johnson, D.W. (2011). Student and Teacher Safety in Chicago Public Schools. Consortium on Chicago School Research at the University of Chicago, Research Report. Available at: http://ccsr.uchicago.edu/content/publications.php?pub_id=151

39. The Learning Compact: Engaged Each student is actively engaged in learning and is connected to the school and broader community • Service learning opportunities provided by community agencies • Community & schools ensure a variety of etra-curricular activities • Collaboration exists with out of school community programs to ensure access to quality prevention programs • Teacher outreach to parents • Parent involvement in school

40. The Learning Compact: Supported Each student has access to personalized learning and to qualified and caring adults. • School staff engage all students, particularly low income, at risk students every day • Work with community agencies to ensure vulnerable children have access to • Tutors matched to student vulnerabilities • Mentors matched to student vulnerabilities

41. Better school attendance Higher academic performance Higher school completion rates Increase caring relationships with adults at school: (Healthy School Environment) Adolescents who feel connected to school have better academic outcomes…

42. …and better health outcomes Adolescents who feel connected to school are less likely to • Exhibit disruptive or violent behavior • Carry or use a weapon • Engage in early-age sexual intercourse • Consider/attempt suicide • Experiment with illegal substances • Smoke cigarettes • Be emotionally distressed

43. Strategies for Increasing School Connectedness • Provide students with the cognitive, emotional, and social skills necessary to be actively engaged in school. • Provide professional development and support for teachers to enable them to meet the diverse cognitive, emotional, and social needs of children and adolescents. • Use effective classroom management and teaching methods to foster a positive learning environment (e.g. Cooperative learning). • Create trusting and caring relationships among administrators, teachers, staff, students, families, and communities.

44. The Learning Compact: Challenged Each graduate is prepared for success in college or further study and for employment in a global environment. • Students graduate with competency using personal and social skills; • Students graduate committed to a active, physically fit lifestyle • Students graduate not only with literacy and communications skills but also with health literacy skills

45. Challenge: Health Education K-12: Less Instruction Than You Think • The Joint Committee on National Health Standards (2007)recommends studentsreceive: • Pre-K-2 a minimum of 40 hours instruction/year • Grades 3 to 12 - 80 hours/year • Actualpercentage of schools providing recommended cumulative hours • 7.5% Elementary schools (K-5/360 hours) • 10.3% Middle schools (6-8/240 hours) • 6.5% High schools (9-12/320 hours)

46. Lack of Health Instruction Yields Health Illiterate Students Who Will Become Health Illiterate Adults Educational challenge • Nine out of ten adults have problems finding and using health information • Cost to our nation of poor health literacy is estimated to be between $100 and $200 billion a year

47. Literacy: Two Prong Approach • General literacy – requires skills such as reading, writing, basic math, speech and comprehension. Evidence strongly suggests that children of all ages have the potential to understand the practices associated with health as well as how to access health information; • Health literacy - the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

48. School Health System Healthy, Successful Achieving Students Goals Priority Health Outcomes District/ School Priority Actions State Actions Local Actions 8 Components • http://www.cdc.gov/HealthyYouth/CSHP/schools.htm

49. 1. Secure Administrator Support & Commitment • Principal/ Superintendent • School Board www.thesociety.org/pdf/connections.pdf

50. 2. Establish a School Health Council/School Health Team Establish a School Health Council or Team • District Level = Council • School Level = Team