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The State of School Health in Baltimore City

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.

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The State of School Health in Baltimore City

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  1. The State of School Health in Baltimore City Judith F. DeBose, MD, FAAPMedical Director Bureau of School HealthBaltimore City Health Department

  2. Disclosures • I do not intend to reference unlabeled or unapproved uses of drugs or products during this presentation

  3. 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

  4. 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

  5. Who We Serve: Baltimore City Public School System Total exceeds 100% due to rounding and mixed race reporting

  6. 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”.

  7. 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

  8. Baltimore City Health Department’s “Healthy Baltimore 2015” • 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

  9. 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 HSCRC, 2010, Primary diagnosis only; CDC Wonder 2009 population estimates

  10. Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health HSCRC, 2010, Primary diagnosis only; CDC Wonder 2009 population estimates

  11. 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

  12. 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

  13. 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 Source: BCHD Morbidity reports for # of case; 2009 CDC Wonder for Census population data

  14. 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

  15. 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%

  16. 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%

  17. Baltimore City Health Department’s “Healthy Baltimore 2015” Health Indicators Related to the Pediatric Population and School Health Promote Healthy Children and Adolescents

  18. 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

  19. 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

  20. 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%

  21. 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.

  22. 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.  

  23. 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):

  24. Bureau of School Health • 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

  25. Bureau of School Health Traditional School Health Suite • Located in most schools • Provides basic school health services • Staffing Model: • School Health Aide (5 days a week) • School Health Nurse (1 to 3 days a week)

  26. 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

  27. 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

  28. 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 Physician (part-time) School Health Nurse Mental Health Provider Medical Office Assistant Substance Abuse Counselor

  29. Bureau of School HealthSchool-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

  30. 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 * Operated by Provider Other Than Baltimore City Health Department

  31. Bureau of School HealthStudent 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

  32. Student Health Needs

  33. Percentage of Students Returned to Class Following School Based Health Center or Health Suite Visits SY 2010-2011

  34. 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 New and Special Initiatives

  35. 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

  36. 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

  37. 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.

  38. 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

  39. 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

  40. Conclusions • Improving the health of students is an important and worthy goal for elementary and secondary education, and an important investment in our community

  41. 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.

  42. 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

  43. 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

  44. Bureau of School HealthQUESTIONS? “School Health - Improving Tomorrow for Today’s Kids”

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