the state of school health in baltimore city
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The State of School Health in Baltimore City . Judith F. DeBose, MD, FAAP Medical Director Bureau of School Health Baltimore City Health Department. Disclosures. I do not intend to reference unlabeled or unapproved uses of drugs or products during this presentation. Objectives. - PowerPoint PPT PresentationTRANSCRIPT
The State of School Health in Baltimore City
Judith F. DeBose, MD, FAAPMedical Director
Bureau of School HealthBaltimore City Health Department
Disclosures
I do not intend to reference unlabeled or unapproved uses of drugs or products during this presentation
ObjectivesBaltimore City Health Department Bureau of
School Health and services providedBaltimore City Health Department’s “Healthy
Baltimore 2015” health policy agenda and the role of the School Health Services program
New Initiatives in the Bureau of School HealthBest Practice Guidelines for School Based Health
CentersChallenges in providing school health services
Who We Serve: Baltimore City Public School System (BCPSS)
2011-12 Student Enrollment: 84,212 total 43,520 students in grades pre-k–5 16,986 students in grades 6–8 23,706 students in grades 9–12
Who We Serve: Baltimore City Public School System
Total exceeds 100% due to rounding and mixed race reporting
Who We Serve: Baltimore City Public School System
84 percent low income (based on eligibility for Free or Reduced Price Meals)
3.1 percent English language learner
In short, the majority of who we serve are “urban minority youth”.
Who We Serve: Urban Minority Youth
Urban minority youth are disproportionately affected by both educational and health disparities.
School programs and policies can favorably influence educationally relevant health disparities affecting youth.“Healthier Students are Better Learners”
Basch C. Healthier students are better learners: A Missing link in Efforts to Close the Achievement Gap. Equity Matters Research Review no.6 March 2010
Baltimore City Health Department’s “Healthy Baltimore 2015”
1. Promote Access to Quality Health Care for All2. Be Tobacco Free3. Redesign Communities to Prevent Obesity4. Promote Heart Health5. Stop the Spread of HIV and other Sexually
Transmitted Infections6. Recognize and Treat Mental Health Needs7. Reduce Drug Use and Alcohol Abuse8. Encourage Early Detection of Cancer9. Promote Healthy Children and Adolescents10. Create Health Promoting Neighborhoods
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Hospitalization Rate for Asthma, by Race, Baltimore City, 2010Age Specific Rate, per 100,000 population
All Black White
Less than 5 years 53.9 67.5 15.05-17 years 78.1 97.3 21.118-44 years 90.0 135.1 23.7
45-64 years 144.6 192.2 52.4
65+ 52.5 63.1 34.0
Total 419.12 555.2 146.2
HSCRC, 2010, Primary diagnosis only; CDC Wonder 2009 population estimates
Promote Access to Quality Health Care For All
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Rate of emergency department discharge for asthma by race, Baltimore City, 2010
Age-Specific Rate (per 100,000 population)
All Black White
Less than 5 years 4934.0 6580.3 1225.35-17 years 2936.1 3776.8 494.818-44 years 1615.4 2409.6 428.7
45-64 years 1359.6 1884.8 306.5
65+ 261.7 374.1 62.7
Total 1866.0 2582.0 422.8
HSCRC, 2010, Primary diagnosis only; CDC Wonder 2009 population estimates
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Decrease rate of emergency department visits forambulatory care sensitive indicators by 10%
Baseline: 1866.0 per 100,000 populationTarget: 1679.4 per 100,000 population
Decrease hospitalization rate for ambulatory care sensitive indicators by 15%
Baseline: 419.2 per 100,000 populationTarget: 356.3 per 100,000 population
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Be Tobacco Free
Decrease percent of teens who currently smoke by 20%
Baseline: 11.7%Target: 9.4%
Decrease rate of births to women who report smoking during pregnancy by 15% Baseline: 92.1 per 1,000 live births Target: 98.3 per 1,000 live births
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Rate of Youth with Gonorrhea and Chlamydia 10-19 by race, Baltimore City 2009
Age-specific rate (per 100,000 population)
All Black White
Gonorrhea 1234.3 1329.8 141.5
Chlamydia 4778.9 5589.1 449.9
Stop the Spread of HIV and other Sexually Transmitted Infections
Source: BCHD Morbidity reports for # of case; 2009 CDC Wonder for Census population data
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Stop the Spread of HIV and other Sexually Transmitted InfectionsDecrease rates of Gonorrhea and chlamydia in adolescents by 25%Baseline: 1234.3 per 100,00 populationTarget: 925.7 per 100,000 population
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Recognize and Treat Mental Health NeedsDecrease percent of adolescents expressing feelings of sadness or hopelessness by 20%Baseline: 27.7%Target: 22.2%
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Reduce Drug Use and Alcohol AbuseDecrease percent of high school students reporting alcohol and/or drug use in the last 30 days by 20%
Baseline for Alcohol Use: 10.8%Target: 8.6%Baseline for Marijuana Use: 21.4%Target: 17.1%
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Promote Healthy Children and AdolescentsTeen Birth Rate (15-19) by Race, Baltimore City, 2009
Age specific Teen Birth Rate (per 1,000)
All Black White
All (15-19) 64.4 79.3 28.4
15-17 42.4 49.0 19.5
18-19 87.2 116.5 34.7
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Promote Healthy Children and AdolescentsDecrease teen birth rate by 20%
Baseline: 64.4 per 1,000 teenage girlsTarget: 51.5 per 1,000 teenage girls
Decrease rate of infant mortality by 10%Baseline: 13.4 per 1,000 live birthsTarget: 12.1 per 1,000 live births
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Promote Healthy Children and AdolescentsDecrease rate of juvenile homicide and non-fatal shooting victims by 30%
Baseline for Homicide: 11.2 per 100,000 population
Target: 7.8 per 100,000 population
Baseline for Nonfatal shootings: 39.2 per 100,000 populationTarget: 27.4 per 100,000 population
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Promote Healthy Children and AdolescentsIncrease rate of school readiness by 15%
Baseline: 67% (SY 2010-2011)Target: 77.1%
Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health
Through collaborative and strategic efforts between the Bureau of School Health and other BCHD programs, a significant impact can be made on each one of these health indicators.
Collaboration: Baltimore City School System and Baltimore City Health Department
Since 1991, COMAR 13A.05.05.05 - .15 mandated health coverage in schools by a school health services professional.
Local school systems, with the assistance of local health departments, are responsible for providing school health services to all public schools.
Collaboration: Baltimore City School System and the Baltimore City Health Department
Office of Student Support and Safety School Health Program Home and Hospital Program
• Home Instruction• Hospital Instruction • Infant and Toddler Services• Traumatic Head Injury Program (THIP)• Chronic Health Impaired Program (CHIP):
Baltimore City Health Department provides school health services in all Baltimore City Public Schools
Two Models of Service Delivery Traditional School Health Suite School-Based Health Center
Bureau of School Health
Traditional School Health Suite
Located in most schoolsProvides basic school health servicesStaffing Model:
School Health Aide (5 days a week) School Health Nurse (1 to 3 days a week)
Bureau of School Health
Traditional School Health Suite Health Services
Provided: First Aid and CPR Emergency Response Communicable
Disease Surveillance and management
Assistance with Immunization Compliance
Medication Administration
Health Appraisals and Referrals for Medical Evaluation
Health Screenings (Hearing and Vision)
Health education and skills training
Participation in Individualized Education Program and 504 process for special needs students
Bureau of School Health
Bureau of School Health Traditional Health Suite
Health Services Provided• Nursing care plans for
special needs students• Provision and/or
coordination of advanced nursing skills for technology dependent students
• Reproductive Health Education (Middle/High Schools)
• Crisis Intervention and Counseling
• Student and parent advocacy
Located on 17 School Campuses (11 operated
by BCHD)Provide comprehensive primary care services
as well as basic school health servicesStaffing Model:
Nurse Practitioner Physician (part-time) School Health Nurse Mental Health Provider
Medical Office Assistant Substance Abuse Counselor
Bureau of School Health
School-Based Health Center (SBHC)
Bureau of School Health School-Based Health Center (SBHC)
Services Provided: Primary and Preventive Health Care Health Risk Assessments Care for Acute Illnesses and Injuries Management of Chronic Health Problems Reproductive Health Services Basic Laboratory Tests Prescription Medications Mental Health Services Substance Abuse Services
* Operated by Provider Other Than Baltimore City Health Department
Pre-K to 8th Grade Carter G. Woodson City Springs Collington Square* Harford Heights/William C
March * KIPP Harmony/Ujima Tench Tilghman *
Middle/Middle High Baltimore Freedom Academy Baltimore Talent/Augusta
Fells Savage Friendship Academy *
High Schools Digital Harbor Dunbar Heritage/REACH Maritime/Vanguard* Northwestern* Patterson Southside/New Era
Academies
Specialty Schools William S. Baer
School-Based Health Centers
Bureau of School HealthStudent Utilization (SY 2010-2011)
Over 382,000 visits to School Health SuitesOver 72,000 doses of prescription
medication administeredOver 43,000 State mandated health screens
(hearing and vision) performedImmunization compliance rate > 98.6%Over 18,750 visits to School Based Health
Centers
Student Health Needs
Percentage of Students Returned to Class Following School Based Health Center or Health Suite Visits SY 2010-2011
Bureau of School Health New and Special Initiatives
Oral Health Program Asthma – Breathmobile Asthma Friendly Schools Audiology Program Vision Screening and
Follow-Up Maryland Children’s Health
Program (MCHP)
SBIRT Pilot– Screening, Brief Intervention and Referral to Treatment
Expanded School Mental Health
Electronic Health Record
Bureau of School HealthOn the Horizon…
“Know What U Want/ U Choose” to be used in all health suites located in middle and high schools to aid in counseling and referral for family planning services
Nurse-Family Partnership program as a resource for first time mothers
STI School-Wide Screening Pilot Program“Cluster Model” Pilot for SBHCs
Bureau of School HealthOn the Horizon…
Collaboration between Gay, Lesbian and Straight Education Network (GLSEN) and BCPSS to provide professional development sessions geared towards creating a safe environment for LGBTQ youth in City Schools
Improving collaboration between the Athletic Department and School Health program, regarding medical needs of athletes
School Based Health Centers: Guidelines for Best PracticesPerform a community needs assessmentCoordinate care with the medical
community, hospitals and public health providers
Document the effect of SBHC services on students’ health and educational outcomes
Establish a business plan to generate grants, contracts and billings to match SBHC expenses.
Challenges: School Health Services
Lack of funding to provide full-time registered nurses in all schools, and lower student-to-nurse ratios
Integration of the school health staff into the “culture” of the school
Limited/inadequate facilities and infrastructure in which to provide school health services
Challenges: School Based Health Centers
Public and private insurance programs that do not reimburse all services provided in a school based setting, or pay less than the costs to SBHCs or providing services
Lack of permanent source of financial support for SBHCs
ConclusionsImproving the health of students is an
important and worthy goal for elementary and secondary education, and an important investment in our community
Conclusions
With new changes in the health care system, and the increase of chronic and complex medical conditions encountered in schools, school health programs are becoming increasingly vital points of access for primary health care. However, funding for these programs continues to remain a challenge.
Conclusions
Addressing educationally relevant health disparities that impede motivation and ability to learn is a key component to ensuring the success of any educational program: “Healthier Children are Better Learners
Conclusions
We must continue to work more collaboratively in order to use already existing resources more strategically to obtain the best outcomes for our youth
Bureau of School Health
QUESTIONS?
“School Health - Improving Tomorrow for Today’s Kids”