Schools and Health Our Nation's Investment (1997) / Chapter Skim
Currently Skimming:
Appendix D
Appendix D
Pages 365-415
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 365... ...
In a few places, school health efforts have been integrated with school reform initiatives to create a completely different kind of community or full-service school that is responsive to the needs of the local population. Both school systems and community agencies are open to making new administrative arrangements that will improve the status of child and family health.
|
From page 366... ...
Broad replication of comprehensive health and social service programs in schools will require many systemic changes in both the educational establishment and community agencies that supply the services. A number of issues must be addressed, such as financing, governance, turf, staffing, controversy, community input, and parent involvement.
|
From page 367... ...
Table D-2 reveals that at least 40 types of personnel enter into schools to provide services; some are employed by the school districts, others by community agencies. Table D3 presents the assortment of organizations that bring services into schools, including local public health departments, voluntary agencies, businesses, and foundations.
|
From page 368... ...
. It also includes a summary of major findings from research and evaluation, and discusses major issues as they apply to organizing comprehensive school health programs.
|
From page 369... ...
Community college Specialized research center Business Labor union Bar association Local foundations State Governors office initiative Legislative initiative Health department Education department Human resources department Special governmental initiatives Center for Substance Abuse Prevention Maternal and Child Health Adolescent Initiative Division of School and Adolescent Chapter 1 Drug Free Schools Foundation initiative "Think tank" research and development organizations
|
From page 370... ...
The major pupil personnel agencies have joined together to form the National Alliance of Pupil Services Organizations (NAPSO) , with a mission of promoting interdisciplinary approaches to their professions and supporting integrated service delivery processes (National Alliance of Pupil Services Organizations, 1992~.
|
From page 371... ...
Health Department, in conjunction with the Austin City School District, has organized a school services team in high-risk elementary schools: the team consists of a nurse, mental health counselor, social worker, and community outreach worker (Maternal and Child Health Bureau, 1993~. The team provides screenings, case management, home visits, and health promotion activities.
|
From page 372... ...
almost a decade ago. This program brings full-time professional counselors (social workers)
|
From page 373... ...
School-Based Health Centers One response to the growing health needs of students has been the development of school-based health centers (SBHC) , most frequently in inner city high schools but increasingly in middle and elementary schools (Lear et al., 1991~.
|
From page 374... ...
The lackson-Hinds Comprehensive Health Center in Jackson, Mississippi, currently operates school-based health services in four high schools, three middle schools, and one elementary school. In 1979, when the program was first initiated at Lanier High School, the staff found many conditions that demonstrated the extensive unmet needs of the students, including urinary tract infections, anemia, heart murmurs, and psychosocial problems.
|
From page 375... ...
Staff members also dispense formal health instruction about such specific issues as compliance with medication protocols or treatment of acne, and conduct informal "rap sessions" on parenting, the reproductive health system, birth control methods, sexual values, STDs, and substance abuse. The counseling and clinic services are closely coordinated.
|
From page 376... ...
Mental Health Centers When school-based clinic providers are asked what the largest unmet need is among their clients, they most frequently mention mental health counseling. Students come to the medical clinics with a litany of complaints about stress and depression, their typical adolescent problems exacerbated seriously by the deteriorating and unsafe social environment in which they live.
|
From page 377... ...
Based on this experience, the project is in the process of developing a guidebook for practitioners who want to follow a mental health model. Howard Adelman and Linda Taylor, directors of the project, believe that the major challenge for school-based mental health centers is to identify and collaborate with programs that are already going on in the school district.
|
From page 378... ...
. It is operated in the high school and five elementary schools by the local Community Mental Health Center of the University of Medicine and Dentistry of New Tersey.
|
From page 379... ...
Family Resource Centers An unknown number of Family Resource Centers (FRCs) are located in school buildings, while other FRCs are community-based.
|
From page 380... ...
The annual budget is $675,000, which is obtained from local government funds, United Way, MCH Sprans grants, and general state funds. Case Management Another variant of school-based health or social services places social workers from community agencies into schools to act as case managers.
|
From page 381... ...
According to director Charles Teagarden, the strategy calls for "a schoolbased, integrated delivery system of networking service providers connecting at-risk youths through diligent case management to targeted prevention programs, then to job and career opportunities created by economic development, all monitored by a data system evaluation." More than 100 different human service providers are brought into the schools to conduct these activities, or referrals are arranged. Family Resource Centers in eight of the schools allow parents to interact and work in support groups.
|
From page 382... ...
Services include family counseling, case management, substance abuse counseling, student assistance, parenting education, before- and after-school activities, youth programs, health screening, and pre-employment skills. The family
|
From page 383... ...
to establish links and partnerships between the schools and the providers of health and human services and to involve parents and teachers in program activities. For example, at San Antonio's three school sites, 11 graduate student interns were providing family, group, and individual therapy and 10 graduate social worker students were providing crisis intervention, home visits, and AFDC (Aid to Families with Dependent Children)
|
From page 384... ...
In a number of communities, alternative schools for teen parents have been organized with funding from foundations and government grants. The model that has been used builds on concepts of comprehensive services, putting together an array of health services, social services, educational remediation, childcare components, and a lot of individual attention.
|
From page 385... ...
Health services are provided on-site by the Minneapolis Children's Medical Center and the Health Department. A fully equipped day care center is located next door and staffed by County Community Services, and a social worker is supported by the Big Brothers/Big Sisters organization.
|
From page 386... ...
Interventions include a half-day preschool and full-day kindergarten, a Family Support Team, an effective reading program, reading tutors, individual academic plans based on frequent assessments, a full-time program facilitator and coordinator, training and support for teachers, and a school advisory committee that meets weekly. The Family Support Team works full-time in each school and consists of social workers, attendance workers, and a parent-liaison worker.
|
From page 387... ...
. What these community schools have in common are restructured academic programs integrated with parent involvement and services for parents; health centers and family resource rooms; after-school activities; cultural and community activities; and around-the-clock operation.
|
From page 388... ...
In the evening, teenagers are welcome to use the sports and arts facilities and to take classes along with adults who come for English, computer work, parenting skills, and other workshops. A Family Resource Center provides parents with social services such as immigration, employment, and housing consultations.
|
From page 389... ...
Advocates for Youth (AFY) reports that in 1993, about two-thirds of the students in respondent schools were enrolled in their school-based health centers and 75 percent of them utilized the program over the reporting year (Hauser-McKinney and Peak, 1995~.
|
From page 390... ...
In this sample, frequent clinic users were more likely to score high on indices of psychological stress. The authors concluded that "an on-campus clinic can attract a significant number of students who otherwise would not have sought out or received such help." Students who report higher rates of high-risk behaviors, such as substance abuse and early initiation of sexual intercourse, appear to be more likely than other students to use school-based clinics .
|
From page 391... ...
In the 1992 follow-up survey, 30 percent of the health center school students reported that their families had no health insurance, 20 percent were covered by Medicaid, 31 percent had private insurance or
|
From page 392... ...
The only significant variable related to use was the higher number of contacts that the students had with the clinic staff (Brindis et al., 1994~. When Florida created a Supplemental School Health Services Program, the legislation mandated evaluation to study how effectively the program met its objectives of pregnancy prevention and the promotion of
|
From page 393... ...
The first evaluation of the California Healthy Start initiative presents data on 40 different grantees, including eight youth service programs, five of which are school-based clinics. The report showed that adolescent clients of programs with the explicit goal of reducing teen pregnancy had significant reductions in the rate of initiation of sexually activity and an increase in the rate of reliable contraceptive use (Wagner et al., 1994~.
|
From page 394... ...
The Student Assistance Program, a school-based substance abuse program, was evaluated by an outside contractor in the early years of the program (Moberg, 1988~. The summary report stated that the program was very effective in preventing nonuser students from taking up alcohol and marijuana use and in reducing or stopping the prevalence among users.
|
From page 395... ...
In a survey of 500 users of school-linked Teen Health Centers in Michigan, 21 percent of the respondents indicated that they would not have received health care if the centers did not exist (Anthony, 1991~. The main reasons given were lack of transportation and lack of a family physician.
|
From page 396... ...
The recent focus on immunization suggests another important role for school-based clinics the ability to respond rapidly to epidemics and crises in the health system. The New York State Department of Health recently created a pilot immunization project involving outreach efforts by three state-funded school health centers in New York City elementary schools (Bosker, 1992~.
|
From page 397... ...
Several of the Success for All elementary schools in Baltimore that included Family Support Teams (social worker, school nurse, facilitator) and Integrated Human Services (on-site health clinic run by the health department or services from family counseling or men
|
From page 398... ...
The Metropolitan Health Department of Nashville, Davidson County, Tennessee, reported that its One Stop Shopping Family Resource Center provided easier access to prenatal care, pediatric services, and school health (Maternal and Child Health Bureau, 1993~. The immunization rate for enrolled 4- to 5-year-olds was 98 percent in 1993, and 150 families were in intensive case management.
|
From page 399... ...
The RW! evaluation attempted to conduct a "dose-response" analysis to determine the effect of "stronger" health centers versus "weaker" ones.
|
From page 400... ...
A cost-benefit analysis of three California school-based clinics compared the costs for the school services with the estimated cost in the absence of the school clinic (Center for Reproductive Health and Policy Research, 1993~. Variables used included reduced emergency room use, pregnancies avoided, early pregnancy detection, and detection and treatment of chlamydia, a prevalent sexually transmitted disease.
|
From page 401... ...
Consensus is building among educators about the importance of bringing support services into schools that will strengthen their efforts at restructuring. Service integration the establishment of linkages between agencies is a "hardy perennial" that reap
|
From page 402... ...
Although the current federal administration has evidenced an interest in adolescent health issues, educational restructuring, and service integration, all that has come through in the way of tangible support for direct services has been a new small grants program in the Bureau of Primary Health Care, along with some new funds for training in the Bureau of Maternal and Child Health. For the first time, about $3 million in grants has been awarded to 27 new school-based clinics around the country.
|
From page 403... ...
One proposal has been to create "school health resource partnerships" between districts, health providers, and other community agencies to address the financial viability of school health service programs in a managed care environment (Brellochs, 1995~. States would require that managed care plans participate as a condition of licensure.
|
From page 404... ...
School districts have created four types of collaborative programs: school site family resource centers, satellite school-linked family service centers, family service coordination teams involving school personnel with project staff, and youth service programs that include school-based clinics. Since 1987, New Tersey's Department of Human Resources has committed more than $6 million annually for its School-Based Youth Services Program.
|
From page 405... ...
Staff turnover, family mobility, fiscal problems, and personality issues were cited as some of the barriers to change. Most school-based health centers are funded by grants made directly from state health departments to local health agencies, which then contract with school systems to provide services.
|
From page 406... ...
, who is allowed to conduct complete physical examinations, prescribe and administer medication, suture wounds, and perform other hands-on activities. However, school social workers, psychologists, and guidance counselors often have similar initial negative responses.
|
From page 407... ...
The school board has no place in this model, obviating the difficult negotiations that can be stressful and time-consuming. Michigan's experience with its 19 teen health centers (11 school based or school linked and 8 in the community)
|
From page 408... ...
In many places, the precedent exists if the destination involves a competitive athletic event. Staffing and Training If programs are already experiencing difficulty hiring nurse practitioners and social workers, where will the staff for 16,000 full-service schools come from?
|
From page 409... ...
Controversy It has been observed that the phrase "school-based clinic" is like a red flag for those waiting to raise community tensions over sexuality issues. The most highly publicized school-based health programs in the early 1980s were heralded as pregnancy prevention programs, leading to attacks from the opposition that schools were opening "sex clinics" and "abortion mills." When later replications of these models were shown to have little effect on pregnancy rates because they did not include family planning services, the attack shifted and the opposition organized against bringing any kind of services into school buildings, even elementary schools.
|
From page 410... ...
Typically, the local health department comes into the school to hand out the condoms, relieving the school system of the responsibility. State initiatives offering grants to communities that develop collaborative projects have engendered some negative responses from local practitioners.
|
From page 411... ...
1991. Mental health facets of the school-based health center movement: Need and opportunity for research and development." Journal of Mental Health Administration 18:272-283.
|
From page 412... ...
1995. Promising approaches for adolescent reproductive health service delivery: The role of school-based health centers in a managed care environment.
|
From page 413... ...
1993. Formative evaluation of the Kentucky Family Resource and Youth Service Centers: A descriptive analysis of program trends.
|
From page 414... ...
1995. Assessing and Evaluating School Health Centers, Volume IV:.
|
From page 415... ...
1992. Health and social services in public schools: historical perspective.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.