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Utilizing School Health Services to Improve Educational Capacity and Provide a More Effective Public Health Response

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Utilizing School Health Services to Improve Educational Capacity and Provide a More Effective Public Health Response Utilizing School Health Services To Improve Educational Capacity and Provide a More Effective Public Health Response By Linda J. Hoff Presented to the Public Administration Faculty at the University of Michigan-Flint in partial fulfillment of the requirements for the Master of Public Administration April 28, 2009 First Reader: Albert C. Price Second Reader: Jim Mikulski Hoff, Linda -Thesis p2 “To promote student achievement and preparation for global competitiveness by fostering educational excellence and ensuring equal access” The U.S. Department of Education’s current mission statement (FY 2007 Performance and Accountability Report, 9) “A child must be physically and emotionally healthy in order to learn, and a child and the child's family must be educated in order to stay healthy.” Former Surgeon General, Dr. Antonia Novello (Healthy Children Ready to Learn, 3) Hoff. Linda -Thesis p3 Abstract Public schools throughout the United States and its territories are under pressure to meet the mandates of No Child Left Behind legislation. The education of children is influenced by a variety of factors, many of which are not in the control of the very people whose responsibility it is to educate, i.e. accessibility to health care, socio-economic status, or home environment. This paper will look at the dimension of school health response: what is required, what is needed, and how a coordinated response between schools and health providers can yield positive results for everyone involved, including society as a whole. There is widespread acknowledgement that good health is a cornerstone to effective learning, yet the state and local education response to the health needs of students is as diverse as the students themselves. This paper explores the history and purpose of public education, legislation and public programs aimed at improving the condition of at-risk individuals, the relationship between health and the ability of students to learn, and the societal costs associated with education failure. Also addressed are several examples of responses some schools have chosen to make in order to better serve their students. Ultimately, this paper will introduce a concept that presents a paradigm shift in the education and health fields: that decisions regarding an appropriate school-related health response, and the actual school health response, should be shared by parents, (public) health professionals and school representatives, allowing each to make contributions in their own area of specialization. Hoff, Linda -Thesis p4 Executive Summary There is no debate, in either the education or health care communities, that children need to be healthy in order to learn, yet many school districts do not employ interventions to adequately address health-related concerns while children are in school. Coordinated school health programs (CSHP) are a proven means with which to provide health services to children. These programs operate in diverse forms, but each is aimed at ensuring the health of children so that they can improve the likelihood of educational success. In addition to operating in a manner that addresses the daily needs of children, CSHPs, especially through school-based health centers (SBHC), can address urgent need situations that arise due to illness or injury as well as address generalized health concerns related to the school environment. A major benefit of coordinated programs is that they can address the education-related health response that is mandated under current education and civil rights laws. A dominant protection, offered through Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act, is that schools must adequately address the needs of a student that might otherwise inhibit them in fully participating in their education. Unfortunately, while the IDEA emphasizes the requirement for schools to provide health-related service, they leave it up to the school to determine what qualifies an individual to perform that function; for many students, this is a major flaw in the legislation and one that prevents them from benefiting from adequate care. Hoff. Linda -Thesis p5 Schools are not entirely to blame when they do not adequately address health needs of students. The specialization of schools is to educate, therefore their decision making would favor education over health care, especially when faced with the realities of budget limitations. Congress showed great insight when they put the requirement for a health response appropriate to education squarely in the province of schools, but they missed a critical aspect by not including the public health department as a health advocate in the process. Public health departments have the expertise that makes them an appropriate choice for determining necessary health responses, budgeting resources and providing health-related services in schools. For many state and local education agencies, the stipulations put forth in laws do not necessarily translate into seamless integration at the service delivery level. In an attempt to demonstrate the viability and necessity of a dramatic paradigm shift in how public services are offered, this paper will examine education legislations, various public health concerns, and how the concerns affect different agencies. Current education-related health responses are as diverse as the students themselves; some state and local agencies are currently addressing the health needs of students with full service clinics while others rely on minimally trained laypersons to address the health-related needs of students with chronic conditions, such as catheterizations and tracheotomy maintenance. Meshing educational and health responses weaves a societal fabric that lessens the likelihood of childhood needs going unmet and threatening the ability of a child to learn. This logical connection provides lifelong benefits to children, Hoff. Linda -Thesis p6 families, and communities alike. Likewise, a lack of adequately addressing the health needs of students puts children at risk of educational failure and schools at risk of failing to meet their progress goals under No Child Left Behind (NCLB). The cycle does not end there; it extends to society through dropouts and individuals that do not achieve their full educational ability. Ultimately, education failure produces detrimental stress to the public health response, the justice response, and the economic security of the country. Congress, and agencies charged with meeting the needs of at-risk students, need to view the scope of the problem from a lens outside of their own area of concern and address the problem through an interagency approach that best utilizes limited resources in an effort to build the public capacity to serve the long-term interest of society. Hoff. Linda -Thesis p7 List of Acronyms AYP Annual Yearly Progress CMS Centers for Medicare and Medicaid Services CSHCN Children with Special Health Care Needs EEOC Equal Employment Opportunity Commission ESEA Elementary and Secondary Education Act FAPE Free and Appropriate Education HHS US Department of Health and Human Services IDEA Individuals with Disabilities Education Act IEP Individualized Education Plan LEP/ELL Limited English Proficiency/English Language Learner MCHB Maternal and Child Health Bureau NASN National Association of School Nurses NCES National Center for Education Statistics NCLB No Child Left Behind NSKC National Safe Kids Campaign OESA Office of Elementary and Secondary Education OSERS Office of Special Education & Rehabilitative Services (OSERS) PCI Per Capita Income SASA Student Achievement and School Accountability SCHIP State Child Health Insurance Program SES Supplemental Educational Services SSI Supplemental Security Income TTR Total Taxable Revenue YRBSS Youth Risk Behavior Surveillance System Hoff, Linda -Thesis p8 Table of Contents Abstract.................................................................................................................................................... 3 Executive Summary...............................................................................................................................4 List of Acronyms.................................................................................................................................... 7 Introduction............................................................................................................................................13 The Federal Role in Education.......................................................................................................... 15 Public Schools to Serve the Public Interest.........................................................................................15 Transformation of Schools through Federal Influence .................................................................. 17 Federalism: Balance between Federal and State Governments ................................................ 18 Federal Legislation.............................................................................................................................. 20 The No Child Left Behind Act (NCLB) .................................................................................................. 20 Annual Yearly Progress (AYP) .........................................................................................................21 Federal Legislation Protecting Students with Disabilities..................................................................24 The Individuals
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