Exploring Opportunities for Collaboration Between Health and Education to Improve Population Health Workshop Summary (2015) / Chapter Skim
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3 How Can the Health Sector Support Education Sector Efforts at the Level of Students, Families, and Schools?
3 How Can the Health Sector Support Education Sector Efforts at the Level of Students, Families, and Schools?
Pages 25-40
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From page 25... ...
Allison Gertel-Rosenberg, the director of national prevention and practice at Nemours, and David Nichols, program manager for Nemours Health and Prevention Services, then discussed ways of leveraging relationships between health and education sectors to improve health. A discussion moderated by Jeffrey Levi, the executive director of Trust for America's Health and a Roundtable member, followed the presentations.
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From page 26... ...
-- that warrant consideration." He further emphasized that mental and emotional health must be addressed thematically because it is a cause or consequence, or both, of the other problems. The precise makeup of this list can be debated, Basch acknowledged, but the central idea is that "there are multiple health problems that influence academic achievement and that all of these problems are highly prevalent and disproportionately affect low-income kids." Vision problems, for example, affect low-income children more than others and black and Hispanic children more than white children (see Figure 3-1)
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1 or more days of school in the past month because they were afraid to be at school or to travel to or from school (see Figure 3-4) .3 3 The most recent Youth Risk Behavior Survey (2013)
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Although these statistics tell an old story, what is new is research that has been carried out over the past 10 to 15 years showing how and why these health problems affect academic achievement and educational attainment. Basch said that his research has identified at least five causal pathways: cognition, sensory perceptions, school connectedness and engagement, absenteeism, and temporarily or permanently dropping out of school.
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Basch noted, for example, that in New York City, vision screening of kindergarten children in the 60 lowest-performing elementary schools showed that 25 percent of the children failed the vision screen but, worse yet, that 60 percent of those children, or 15 percent overall, failed the vision test a second time when rescreened in first grade, indicating that they never got the care they needed for their eyes. "Imagine trying to learn how to read when you have hyperopia," he said.
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She and her colleagues at Nemours realized early on that no sector was going to be effective at addressing the health of children without taking a comprehensive approach that considered societal health issues and incorporated the child's entire family. They know that when the health and education sectors work together and cross-reference each other, they can generate synergies that produce positive outcomes.
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Nemours also concluded in its planning activities that social marketing would be important for creating and accelerating the social policy and behavioral changes that would be required in order to have a truly transformative impact on health at the population level. To illustrate how Nemours is turning these ideas into action, G ertel-Rosenberg discussed two programs, one focused on early literacy, the other on healthy eating and physical activity.
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Three-quarters of the children enrolled at these early childhood education centers are preschoolers, ages 37 to 59 months. Two out of five of the centers participate in the Quality Rating and Improvement System, and two out of three participate in the Child and Adult Care Food Program.
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By the end of the U.S. Department of Education grant, Nemours had partnered with 13 out of 15 school districts in Delaware that have elementary grades and had gotten 74 public elementary schools to incorporate 150 minutes of physical activity into the school week.
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Recognizing this problem, a multidisciplinary team was formed to develop a way to facilitate the exchange of medical and educational information among school nurses, primary and specialty clinicians, and families with the goals of improving communication between school nurses and Nemours clinicians and enhancing nurses' access to students' health information and medical records. Through this effort, 100 percent of Delaware's public school districts, 64 percent of its charter schools, 24 percent of its private schools, and 48 percent of its diocese schools have completed partner and user agreements with Nemours.
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Going forward, the main focus of this program will be to ensure that all school nurses in Delaware have the opportunity to participate and also to use quality improvement measures to improve health outcomes for all students and improve health communications betwen the families and health care providers. Nichols and his team are currently fielding a pre–post survey with parents and guardians to measure perceived changes in health-related quality of life, parent opinions about the program and their child's health, and days of work missed due to children's illnesses.
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In addition, this collaboration with New York City public elementary schools will work to educate teachers about the need for their students to use their eyeglasses and work with parents and guardians to encourage children's use of eyeglasses at home. This project is also going to focus on identifying children with poorly controlled asthma, connecting them to a medical home and helping them receive the medications necessary to get their asthma under control.
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Levi said that having the data be bidirectional so that health care providers know what is happening academically with the children under their care will be an important challenge to address. Basch replied that there is also work under way to get pediatricians to start asking questions relevant to school performance, such as whether parents are reading to their children and if their children are happy at school.
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Basch answered that when he speaks with education leaders, he emphasizes that if they do not address these health barriers to learning, they will jeopardize the educational benefits of all the other investments they are making. "They seem to understand that more and more," Basch said, adding that there is increasing recognition of the educational significance of health barriers to learning throughout the education community, from the secretary of education to the state superintendent to principals, teachers, and parents.
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Pittman also asked how school nurses were funded. Nichols said that in Delaware school nurses are part of regular school funding.
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