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

Whole Child

Diane Allensworth, PhDProfessor Emeritus, Kent State University

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

Student Health Indicators: The Good

• Dramatic decreases in infectious disease rates and childhood

mortality in 20th century

• Dramatic decline in blood lead levels

• Gradual decline in child injury mortality since 1980

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.

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.

Children in Poor Families by Race/Ethnicity

Children living in poor families:• 29% White• 32% Asian• 57% Native

American• 62% Black• 63% Hispanic

Social Determinants of Health for Children & Youth

Inequitable Education

Food Insecurity Pove

rty

Poor Early Development

Unhealthy Environment

Race & Ethnicity

Lack of Health

Service

s

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

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

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

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.

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

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

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

Health Problems & Inequities in Schooling Limit Education As A

SolutionLeading to 7200 students dropping out of school

every school day –

More than 1.3 million every year – perpetuating the cycle of poverty

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

Education and Health Are Interconnected

School BasedInterventions

Academic Performance

Educational Attainment

Adult HealthStatus

Child HealthStatus

Nancy Murray, et al. Code Red, Education and Health: A Review and Assessment, Appendix E. http://www.coderedtexas.org/files/Appendix_E.pdf

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

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.

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

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

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.PDFwww.casbhc.org/.../Benefits%20of%20School-Based%20Health

%20Centers.pdf

Percentage of WV Schools Engaging Parents & Community Members To

Implement Programs and/or Policies

Topic % Families % CommunityTobacco Prevention 28 36Physical Activity 30 32Nutrition/Healthy Eating 36 40HIV/STD/Teen Pregnancy 11 21Asthma 17 19

Solution #2: High Quality Early Child Care (Head Start)

High achievers in 1st graders72% 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

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.

Positive Effects of Participation in Early Childhood Development Programs

Such 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

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!

Solution #3 Quality Coordinated School Health Program

Healthy and Safe School

Environment

HealthPromotion

for Staff

Physical EducationHealth

Education

Health Services

Counseling, Psychological,

and Social Services

NutritionServices

Family & Community Involvement

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

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.

What Has Been Recommended to Close Achievement Gap by Education

Researchers? Five Essential Supports That Influence Student

Learning When Organizing Schools for Improvement

1. School Leadership2. Parent & Community Ties3. School Learning Climate (Order and Safety)4. Professional Capacity5. Instructional Guidance

Bryk, AS et al. Organizing Schools for Improvement. Chicago, IL: The University of Chicago Press. 2010

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/

Learning Compact for Children: Logic Model

Factors AffectingHealth & Learning

Health Sector’sGuide- lines

Ed.Sector’sGuide- lines

The LearningCompact:

HealthySafe EngagedSupportedChallenged

Students Ready to Learn

Adopting healthierbehaviors

H.S. Grads

Available at: http://www.cdc.gov/pcd/issues/2011/Mar/10_0014.htm

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

Challenge: Quality School Health for All Children Far From Universal

Healthy and Safe School

Environment

HealthPromotion

for Staff

Physical EducationHealth

Education

Health Services

Counseling, Psychological,

and Social Services

NutritionServices

Family & Community Involvement

Challenge: Improve CSHP Policies to Reduce Obesity

Policy for P.E. % of Schools & Physical Activity With Policy

Daily PE for 3rd grade students 20Student fitness measured annually 34Fitness results sent to parents 38Advisory Group making PE/PA & nutrition recommendations (district & school) 16

(Students complete individualized improvement plan)

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

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

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

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

• 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…

…and better health outcomesAdolescents 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

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.

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

Challenge: Health Education K-12: Less Instruction Than You Think

• The Joint Committee on National Health Standards (2007) recommends students receive:– Pre-K -2 a minimum of 40 hours instruction/year – Grades 3 to 12 - 80 hours/year

• Actual percentage 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)

Lack of Health Instruction Yields Health Illiterate Students Who Will Become Health

Illiterate AdultsEducational 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

Literacy: Two Prong Approach

• General literacy – requires skills such as reading, writing, basic math, speech andcomprehension.

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.

School Health System

Goals

Healthy, SuccessfulAchieving Students

8 Components

Priority Health Outcomes

State Actions

Local Actions

District/School

Priority Actions

•http://www.cdc.gov/HealthyYouth/CSHP/schools.htm

1. Secure Administrator Support & Commitment• Principal/ Superintendent• School Board

www.thesociety.org/pdf/connections.pdf

2. Establish a School Health Council/School Health Team

Establish a School Health Council or Team District Level = Council School Level = Team

2. Establish a School Health Council/ School Health Team, Continued…..

http://www.cdc.gov/HealthyYouth/keystrategies

3. Identify a School Health Leader

School Health Coordinator/Leader District level = Coordinator School level = Leader

3. Identify a School Health Leader Continued…

National School Health Coordinator Leadership Institute –

American Cancer Society

Goal: 50% of school districts will have trained school health coordinators

4. Develop a Plan for Improvement

Develop an action plan: Strategic Reviewed annually Focused on continuous improvement Part of School Improvement Plan

Uses CSHP to assess:

• Physical activity

• Nutrition

• Tobacco-use prevention

• Safety

• Asthma

4. Develop a Plan for Improvement

5. Implement Multiple Strategies

Instruction Policies Environmental Change Direct Intervention (Screening through

Follow-up) Social Support Media Advocacy

6. Address Health Risk and Protective Factors

Health Risk Factors Behaviors Social and environmental factors Adverse childhood events

Health Protective Factors Supportive, respectful climate Safety, discipline plus continuum of supports for

at risk students Involvement of family, peers and school staff

7. Engage Students

Peer education Peer advocacy Cross-age mentoring Service learning Youth leadership councils Youth advisory councils

8. Engage School Staff Workshops, conferences & seminars Coaching & mentoring Professional networks Learning communities Professional development for teachers Worksite wellness programming Integrated health lessons across curriculum Supplemental physical activity in classrooms

Addressing the Social Determinants

• Is a health issue, • Is a civil rights issue, • Is an economic issue

Children & Youth: 25% of the Population - All of our Future

Questions? Comments?Contact: dimaster@gmail.com