Transcript Baltimore City Health Department School Health Programs

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
§ Baltimore City Health Department Bureau of
School Health and services provided
§ Baltimore 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 Health
§ Best Practice Guidelines for School Based Health
Centers
§ Challenges in providing school health services
Who We Serve: Baltimore City
Public School System (BCPSS)
§ 2011-12 Student Enrollment: 84,212 total
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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”
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Promote Access to Quality Health Care for All
Be Tobacco Free
Redesign Communities to Prevent Obesity
Promote Heart Health
Stop the Spread of HIV and other Sexually
Transmitted Infections
Recognize and Treat Mental Health Needs
Reduce Drug Use and Alcohol Abuse
Encourage Early Detection of Cancer
Promote Healthy Children and Adolescents
Create Health Promoting Neighborhoods
Baltimore City Health Department’s “Healthy
Baltimore 2015” Health Indicators Related to the
Pediatric Population and School Health
Promote Access to Quality Health Care
For All
Hospitalization Rate for Asthma, by Race, Baltimore City, 2010
Age Specific Rate, per 100,000 population
All
Black
White
Less than 5 years
53.9
67.5
15.0
5-17 years
78.1
97.3
21.1
18-44 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
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
1225.3
5-17 years
2936.1
3776.8
494.8
18-44 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 for
ambulatory care sensitive indicators by 10%
Baseline: 1866.0 per 100,000 population
Target: 1679.4 per 100,000 population
Decrease hospitalization rate for ambulatory care
sensitive indicators by 15%
Baseline: 419.2 per 100,000 population
Target: 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
Stop the Spread of HIV and other
Sexually Transmitted Infections
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
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 Infections
Decrease rates of Gonorrhea and chlamydia in
adolescents by 25%
Baseline: 1234.3 per 100,00 population
Target: 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 Needs
Decrease 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 Abuse
Decrease 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 Adolescents
Teen 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 Adolescents
Decrease teen birth rate by 20%
Baseline: 64.4 per 1,000 teenage girls
Target: 51.5 per 1,000 teenage girls
Decrease rate of infant mortality by 10%
Baseline: 13.4 per 1,000 live births
Target: 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 Adolescents
Decrease 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
population
Target: 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 Adolescents
Increase 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
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School Health Program
Home and Hospital Program
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Home Instruction
Hospital Instruction
Infant and Toddler Services
Traumatic Head Injury Program (THIP)
Chronic Health Impaired Program (CHIP):
Bureau of School Health
§ Baltimore City Health Department provides school
health services in all Baltimore City Public Schools
§ Two Models of Service Delivery
l Traditional School Health Suite
l School-Based Health Center
Bureau of School Health
Traditional School Health Suite
§ Located in most schools
§ Provides basic school health services
§ Staffing Model:
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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:
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First Aid and CPR
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Emergency Response
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Communicable Disease
Surveillance and
management
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Assistance with
Immunization
Compliance
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Medication
Administration
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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
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
Bureau of School Health
School-Based Health Center (SBHC)
Located on 17 School Campuses (11 operated
by BCHD)
Provide comprehensive primary care services
as well as basic school health services
Staffing Model:
Nurse Practitioner
School Health Nurse
Medical Office Assistant
Physician (part-time)
Mental Health Provider
Substance Abuse Counselor
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
School-Based Health Centers
Pre-K to 8th Grade
High Schools
Carter G. Woodson
City Springs
Collington Square*
Harford Heights/William C
March *
KIPP Harmony/Ujima
Tench Tilghman *
Digital Harbor
Dunbar
Heritage/REACH
Maritime/Vanguard*
Northwestern*
Patterson
Southside/New Era
Academies
Middle/Middle High
Baltimore Freedom Academy
Baltimore Talent/Augusta
Fells Savage
Friendship Academy *
Specialty Schools
William S. Baer
* Operated by Provider Other Than
Baltimore City Health Department
Bureau of School Health
Student Utilization (SY 2010-2011)
Over 382,000 visits to School Health Suites
Over 72,000 doses of prescription
medication administered
Over 43,000 State mandated health screens
(hearing and vision) performed
Immunization 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 Health
On 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 Health
On 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 Practices
Perform a community needs assessment
Coordinate 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
Conclusions
Improving 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”