In the final session of the workshop, roundtable members and participants reflected on the workshop presentations and discussions and shared their observations. To start, Magnan shared the main points she took away from the discussions:
- Educational outcomes are health outcomes. The heath sector needs to evolve its mindset to recognize this.
- School health initiatives are not about “fixing” the child. The goal is to meet the needs of children and their families by fixing the systems and, in doing so, realize the desired academic outcomes. Fixing the systems requires that people think beyond their usual roles and responsibilities.
- There is a synergy of interventions that happen within the educational system that helps keep children in school. For example, breakfast in school meets a child’s need for nourishment, but it also makes the child feel connected and cared for, which might help that child perform better and stay in school.
- Speak the language of educators. Colleges in education and health need to develop a common language together to help move collaboration forward.
- Chronic absenteeism affects educational outcomes and is an important metric of child thriving, but it is often overlooked by health care providers.
- It is complicated to interpret the child that presents before you. It is important to think beyond the child and have the humility to realize that the child may be experiencing many issues (e.g., lack of breakfast, bullying in school, parental mental or behavioral health issues).
- Mutual and shared outcomes are essential to the health–education partnership. Health measures that are not specifically related to education can still be important for achieving educational attainment, and vice versa for health care.
- Is the right set of measures in place in both health and education to produce life-ready 18-year-olds?
- Embrace the concept of the Whole School, Whole Community, Whole Child approach. Address the issues facing the entire child.
- People learn through storytelling. Data should accompany stories, and stories should accompany data, and the stories should include the disparities and the need to build toward equity.
- In closing, committed public health lawyers can be valued partners.
Some participants shared observations on the topics of measurement and the social context in schools and drew attention to areas for further discussion.
Some of the metrics that should be used are very clear, Basch suggested, such as the number and rate of elementary and middle school students who need eyeglasses and do not have them. Another needed metric, he continued, is the number and rate of children with uncontrolled asthma, including demographic data to identify and address disparities. There should be a metric focused on changing the rate of non-marital teen births and reducing the disparity between white female teens and African American and Hispanic female teens, he said. The number of children who are missing school because they are afraid to be at or travel to or from school should be measured, he said, as well as the amount of bullying and fighting that goes on in schools throughout the country. Hunger and food insecurity in children should be metrics, and schools should work to increase participation in the school breakfast program, he suggested. Innovative strategies are also needed to help children with attention-deficit/hyperactivity disorder find ways to succeed academically and socially, he said, and children with untreated oral health problems should be identified and cared for.
There are proven or promising approaches to address these issues, Basch said. The challenge is how well they can be put into practice. In seeking to achieve outcomes, it is also important to consider how students feel about going to school and measuring the climate in schools, he concluded.
The Importance of Human Relationships to Learning
Bobby Milstein of ReThink Health drew attention to the role of loneliness and social isolation in health. Conversely, there are benefits from the sense of belonging and civic agency. The workshop presentations demonstrated the power of the school as an institution to make people feel connected and have a sense of belonging. Students can have a meaningful role in shaping that school culture, he said.
Mary Pittman of the Public Health Institute suggested that the issues discussed regarding school success set the stage for the future of the country. If these issues are not addressed, children will not have the opportunities they need to succeed. The country is dependent on the next generation of leaders, she said. Pittman mentioned the FACES for the Future program of the Public Health Institute, which mentors young people who are in disadvantaged situations and helps them build their future. These are students who do not have ideal test scores or grade point averages and are often expected to drop out of school, but there is a 100 percent graduation rate among participants, she said. The majority continue on to obtain higher education, and they also enjoy improved health status. She emphasized the importance of student connections with a caring adult and of a supportive system that helps students see that they can overcome barriers.
Tamayo also mentioned the importance of human relationships to learning. The science of learning development has shown that human relationships are key drivers of positive and healthy development of children. The most recent Gallup Student Poll found that only 39 percent of kindergarten through 12th-grade students surveyed self-reported that they believe most adults in their school care about them. This means, he said, that 61 percent of students in this country believe that most adults in their schools do not care about them. He suggested that the lack of relationships between students and adults, and also among students, is a crisis. He challenged participants to think about how the nature of relationships in schools is measured and how relationships can be built in meaningful ways. Every day, educators are trying to build those relationships, and they need to be equipped with the practical knowledge, research, and tools to do so more effectively, he said.
Other Areas for Further Attention
Early Brain Development
Mylynn Tufte of the State of North Dakota called for educating both health care providers and educators about early brain development. Children’s brains have been impacted long before they start school, whether in utero or in the home, she said. Knowledge in this area is still evolving, but health and education providers should be made aware of it.
The Impact of Alcohol and Marijuana Use
Dillaha expressed the need to better understand the impact of alcohol and marijuana use by students and families. There is a pro-addictive culture in the United States, she said, and there is currently political will for dealing with opioid addiction, but alcohol and marijuana use are far more pervasive. Because alcohol and marijuana have become such a part of our culture, it can be difficult to see the impact.
Community Health Assessments
Sally Kraft of the Dartmouth-Hitchcock Medical Center noted that, in her experience, community health needs assessments do not include survey questions about education in schools as a health issue. From a health system perspective, how can education be incorporated into the community health needs assessment, and how can community benefit dollars be invested wisely to promote the relationship between health and education?
Catherine Baase of the Michigan Health Improvement Alliance recalled the models that illustrated the links between health and education in the larger context (see Figure 2-2). Health and education are not isolated entities that affect only each other, she said. In addition, policies in many areas can affect both health and education (e.g., immigration policy). Gary Gunderson of Wake Forest University emphasized the need to overcome competitive behavior and work together across silos to give the next generation a chance at success. Sharfstein said that there are many dedicated people in the health system who have no idea how the children around them are performing in school. If that gap can be bridged, he stated, it will open up many different pathways to helping children succeed.