a health learning environment - michigan · a health learning environment challenges and...
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A Health Learning Environment
Challenges and Opportunities
HENRY FORD HEALTH SYSTEMELLIOTT ATTISHA, DO FAAP
Are more likely to attend school
Are better able to focus and stay engaged
Are more likely to be ready to learn
Healthy Students…
Health Barriers Related to Learning
Michigan Youth Risk Behavior Survey (2013)
Michigan Detroit
In a physical fight in the last year 21.6% 30.9%
Did not go school because they felt unsafe at school or on their way to or from school
6.8% 10.9%
Experienced symptoms of depression in the last year 27% 29.2%
Attempted suicide 8.9% 12.1%
Have tried marijuana before age of 13 6.1% 11.2%
Ever had intercourse 38.1% 42.2%
Had intercourse before the age of 13 3.2% 10.4%
Did not use any method to prevent pregnancy 8.9 15.3%
Did not eat fruits or 100% fruit juice in the last 7 days 5.7% 11.2%
Were not physically active at least 60 min per day 5 days in the past week
50.3% 75.5%
Low income and minority students are at increased risk of health problems that hinder learning.
These students are also more likely to attend schools with unhealthy learning environments.
Impact of Health Disparities on Learning
Health in Mind – Improving Education through wellness
Reciprocal Causal Relationship
Health Education
Poverty
Healthier Students are Better Learners – Charles Basch, PhD
Students who are chronically absent from school are more likely to:• fall behind academically
• display behavior and discipline problems
• engage in smoking, drug use, and high risk sexual behaviors
• drop out of school
Why is school attendance so important?
Attendance Works
Recommended definition: missing 10% of school year; 18 days
Different from Truancy (unexcused) or average daily attendance (how many students show up each day).
Chronic Absence
Excusedabsences
Unexcusedabsences
SuspensionsChronic Absence
Attendance Works
83% of students
chronically absent
in kindergarten
and 1st grade are
unable to read on-
level by 3rd grade.
Students who
can’t read on-level
in 3rd grade are 4
times more likely
to drop out than
kids who can.
Absences Lead to Dropouts!
Attendance Works
The number of students who missed
18 or more days in the last school year
at “unnamed” Detroit Public School.
66%
• Absences are
only a problem if
they are
unexcused
• Sporadic versus
consecutive
absences aren’t
a problem
• Attendance only
matters in the
older grades
• Lack of access
to health or
dental care
• Poor
transportation
• Trauma
• No safe path to
school
• Homelessness
• Child struggling
academically or
socially
• Bullying
• Ineffective school
discipline
• Parents had
negative school
experience
• Undiagnosed
disability
• Lack of engaging
and relevant
instruction
• No meaningful
relationships with
adults in school
• Vulnerable to
being with peers
out of school vs.
in school
• Poor school
climate
Myths Barriers Aversion Disengagement
Factors Contributing to Chronic Absence
Attendance Works
10,000,000The number of school
days missed each year
because of asthma.
Asthma and Achievement Gap
Asthma can undermine a child’s mental-emotional and physical health
Children with asthma perform worse on test of concentration
Virtually every study examining asthma and absenteeism found a positive association
Poorly controlled chronic diseases can lead to falsely diagnosed behavioral problems Asthma, eczema, vision/hearing problems and
tooth pain can lead to poor sleep, distractibility and discipline issues
Health Issues Manifesting as Behavioral Health
School Role in Asthma
A coordinated approach
Identifying all children in the school with asthma
Ensure every child has an action plan on file and access to rescue medications
A school wide plan be established for asthma emergencies, including staff training
Prevent student contact with allergens or irritants, both indoors and outdoors.
Close tracking of missed school days
Full participation in all activities
Detroit’s sad
reality…
Michigan’s School Health Partners!
Working to overcome the challenges:
Coordinated School Health
School Nursing Services
School Based Health Centers
Michigan School Health Coordinators
• Leadership and guidance around health policies, practices, and program expertise including:
Curriculum
• Instruction
Provide quality primary health care services on, or near, school property, including mental health services.
Models School-Based/Linked Health Centers Alternative School Based Health Centers School Wellness Programs (RN + SW)
Network Sites (Hub & Spoke Model)
All Centers are required to have a ½ time behavioral health provider
Michigan’s Child and Adolescent Health Center Program
Services Provided at Michigan SBHCs
Student Benefit from SBHCs
• Decreased engagement in risk behaviors
• Fewer threats to achievement
• Fewer negative peer influences
• Greater self esteem and satisfaction with health
• Increased physical activity
• Better nutritional choices
• More family involvement
• Improved problem solving and conflict management
• Improved health and health behaviors
CAHC 2014 Dashboard
Recommended School Nurse to Student Ratio is 1:750
Michigan’s Ratio?
1:6607
School Nurses
School Nurses
• Coordinate Care• Outreach• Access to providers• Ensure students feel safe • Provide support • Encourage utilization of reporting
systems• Conduct parent/caregiver and student
classes• Advocate
Barriers to Care Specific to Detroit…
• Roughly 1 in 4 families lack a vehicle
• Health Professional Shortage Areas throughout most Detroit neighborhoods
• 45% Functional Illiteracy Rate
• Similar to the rest of MI, most Detroit schools lack a school nurse
• School system is in disarray
HFHS School-Based & Community Health Program
Bringing health care services directly
to the child at select schools in Detroit
and surrounding communities. • 8 School-Based Health Centers
• 3 School-Wellness Sites (Network)
• 2 Mobile Clinics
• 3 RN sites (Transformation)
HF SBCHP Network Project
Full Service Centralized School-
Based Health Center Western
High School
(Hub)
Earhart
(K-8)
SWP
Munger
(K-8)
SWP
Maybury
(K-5)
SWP
• One of three programs in the State• Hub and Spoke like model
• SBHC at Center and RN + LSW at each surrounding school
• Telemedicine initiative will be launching soon
A sticky
mess…
This is the inside of one of
the school libraries. Books
are limited to those you see
on the shelf. There is no
librarian and no check out
system…
“No matter how well teachers are prepared to teach, not matter what accountability measures are put in place, not matter what governing structures are established for schools, educational progress will be profoundly limited if students are not motivated and able to learn.”
Charles Basch, PhD
We Know What Works
https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Documents/Panel%201%20-%20Shonkoff%20Center%20on%20the%20Developing%20Child%20Presentation.pdf
• Children have the right to a healthy learning environment.
Schools obviously can’t do it alone
Essential roles to be also played by families, communities, health care systems, legislators, foundations and more
As discussions continue around school reform (DPS), student health and current disparities must be a part of the conversation
No Simple Solution
School Health Priorities
• Provide a safe and health place to learn and play• Increase access to evidence based school health
services• Improve collection of health and wellness
information and data• Establish a school health team that regularly
assesses school health needs• Develop accountability measures around school
climate, health programs and policies• Build partnerships that support school health
services
SBHCs School Nurses Health Institutions Community Parents Children School Systems Specialists
Health Plans State and
Government Officials
Foundations Community Health
Workers Volunteers
It Takes a Village
“Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.”
National Association of State Boards of Education
