Linking Public Health, Health Care and
Education to Address the Needs of the
Whole Child
Diane Allensworth, PhD
Professor Emeritus, Kent State University
Children & Youth: 25% of the Populat
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
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
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
Solution
Leading 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
Academic
Performance
Educational
Attainment
School Based
Interventions
Child Health
Status
Adult Health
Status
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.as
px
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-bc7acee165c701d9%7D/SBHC%20BENEFITS.PDF
www.casbhc.org/.../Benefits%20of%20SchoolBased%20Health%20Centers.pdf
Percentage of WV Schools Engaging
Parents & Community Members To
Implement Programs and/or Policies
Topic
% Families % Community
Tobacco Prevention
28
36
Physical Activity
30
32
Nutrition/Healthy Eating
36
40
HIV/STD/Teen Pregnancy 11
21
Asthma
17
19
Solution #2: High Quality Early Child
Care (Head Start)
High achievers in 1st graders
72% 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 PreSchool 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
Health
Education
Family &
Community
Involvement
Physical Education
Health Services
Health
Promotion
for Staff
Healthy and Safe
School
Environment
Nutrition
Services
Counseling,
Psychological,
and Social
Services
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/SchoolResources/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 Leadership
2. Parent & Community Ties
3. School Learning Climate (Order and Safety)
4. Professional Capacity
5. 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
Affecting
Health &
Learning
Health
Sector’s
Guidelines
Ed.
Sector’s
Guidelines
The
Learning
Compact:
Healthy
Safe
Engaged
Supported
Challenged
Students
Ready to
Learn
H.S.
Grads
Adopting
healthier
behaviors
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
Health
Education
Family &
Community
Involvement
Physical Education
Health Services
Health
Promotion
for Staff
Healthy and Safe
School
Environment
Nutrition
Services
Counseling,
Psychological,
and Social
Services
Challenge: Improve CSHP Policies to
Reduce Obesity
Policy for P.E.
Physical Activity
% of Schools &
With Policy
Daily PE for 3rd grade students
Student fitness measured annually
Fitness results sent to parents
Advisory Group making PE/PA & nutrition
recommendations (district & school)
20
34
38
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 etracurricular 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
Increase caring
relationships with adults
at school:
(Healthy School
Environment)
Adolescents who feel
connected to school
have better academic
outcomes…
• Better school attendance
• Higher academic performance
• Higher school completion rates
…and better health outcomes
Adolescents 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 Adults
Educational 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
• Health literacy • General literacy –
the ability to obtain,
requires skills such
process, and
as reading, writing,
understand basic
basic math, speech and
health information
comprehension.
and services needed
to make appropriate
health decisions.
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;
School Health System
Healthy, Successful
Achieving Students
Goals
Priority Health
Outcomes
District/
School
Priority
Actions
State Actions
Local Actions
8 Components
• 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
4. Develop a Plan for Improvement
Uses CSHP to assess:
• Physical activity
• Nutrition
• Tobacco-use prevention
• Safety
• Asthma
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