This section of Success Stories highlights states who have established state school health performance measures, which include a focus on physical activity and nutrition, school safety and access to health services.
Two State Performance Measures: (1) Percent increase in the number of adolescents 10 to 20 years old who receive services in School-Based Health Centers (SBHC); and (2) Percent of schools that have used a program to reduce obesity through physical exercise and nutrition education programs.
Connecticut established these two performance measures based on state priority needs identified from the 2004-2005 five-year needs assessment: (1) Improve adolescent health status; and (2) Promote nutrition and exercise to reduce obesity. Connecticut MCH staff discussed the best strategies to monitor progress on these two priority needs through the inclusion of two state-added performance measures to its MCH Block Grant.
These measures were constructed using information that was known to be available and would allow progress to be followed over time. Connecticut funds 72 SBHCs in 20 different communities, with an increasing number each year. School-Based Health Centers in Connecticut build the capacity of schools to provide comprehensive, primary and preventive health and mental health services. In addition, they also conduct a number of health promotion and health education activities directed at youth in order to prevent and reduce high risk behaviors such as tobacco use, poor nutrition, sedentary lifestyle, sexual behaviors that result in HIV and STDs, unintended pregnancy and alcohol and drug use. Monitoring the volume of students receiving services at these clinics would allow MCH staff to indicate whether the desired increase in the volume occurred.
Similarly, to monitor efforts to promote nutrition and exercise to reduce obesity, communication with the Connecticut Department of Education informed MCH staff of the School Nutrition and Physical Activity Practices survey that was first conducted in the spring of 2006. This first year allowed MCH staff to measure the number of schools that implemented policies that promote healthy lifestyles.
State Performance Measure: Percent of all children and adolescents enrolled in public schools in Louisiana that have access to school-based health center services (SBHCs).
In 1990, as policy makers became concerned about the high morbidity and mortality rates of adolescents, the Legislature asked the Office of Public Health (OPH) to determine the feasibility of opening SBHCs. Subsequently, the Adolescent School Health Initiative was enacted in 1991. This Act authorized OPH to facilitate and encourage the development of comprehensive SBHCs in public schools.
The role of the OPH’s Adolescent School Health Program is to provide technical assistance to SBHCs; establish and monitor compliance with standards, policies, and guidelines for school health center operation; provide financial assistance; and encourage collaboration with other agencies and other potential funding sources.
Staffing in the SBHCs include, at a minimum primary care provider (physician), physician assistant or nurse practitioner, medical director, registered nurse master's level, mental health provider, administrator and an office assistant.
School-Based Health Centers in Louisiana offer primary and preventive health care including, comprehensive exams, immunizations, health screenings, acute care for minor illness and injury, and management of chronic diseases, mental health services, health education and prevention programs, case management, dental services, referral to specialty care and also serve as Louisiana Children's Health Insurance Program enrollment centers.
State Performance Measure: The percent of elementary schools that have developed and implemented a comprehensive approach to prevent bullying in collaboration with the Maine Injury Prevention Program.
The goal of the state performance measure is to increase the number of schools in the state that are providing a comprehensive approach to reduce the detrimental effects of peer victimization among elementary school students.
As part of Health Maine Partnerships, 45 school health coordinators (SHC) are hired by school districts throughout the state to coordinate school health activities and implement policy changes. Their primary focus has been physical activity, nutrition and tobacco, with some substance abuse focus added this year. However, the full scope of their work is a comprehensive approach to health in schools. The SHCs have just completed the CDC School Health Index which has some injury questions that they will use as part of their planning process.
Maine also has an anti-bullying initiative, with the Department of Education taking the lead in providing school districts with resources to implementing systemic changes to school climate. Some resources and expertise from the Maine Injury Prevention Program (MIPP) have contributed to this initiative, as reflected in the state performance measure. Schools have a best practices guide to follow, and can receive training through a number of in-state resources, including MIPP's cooperative agreement with the University of Maine. To see the best practices guide, visit http://www.maine.gov/education/bullyingprevention/index.shtml.
State Performance Measure: Percent of Maryland kindergartners entering school ready to learn; and the number of kindergarteners successfully completing the state's measure of school readiness.
On January 20, 2000, the Subcabinet for Children, Youth, and Families submitted a report to the Joint Committee on Children, Youth, and Families outlining strategies to improve services for young children. The plan was to better prepare young children for success in school and Achieving School Readiness: A Five Year Action Agenda was born. Representatives of many child serving public agencies and private organizations worked together to support the goals of the plan and devote continuing efforts to evaluate and develop a comprehensive early childhood plan.
In the Action Agenda for School Readiness, Maryland defines school readiness as “the state of early development that enables an individual child to engage in, and benefit from, primary learning experiences.” For the past seven years, every Maryland kindergarten pupil has taken part in a work sampling system that measures/rates school readiness. This system has been tested for reliability and consistency. School readiness reflects all the conditions and experiences a child has experienced from prenatal to school entry that affect the likelihood of successful school experiences. Utilizing this data helps determine what perinatal and early childhood practices and behaviors work and where gaps still exist.
The kindergarten work sampling from 2007-2008 indicates that the early childhood community and other partners are successfully reaching a larger number of young children and building the skills they need for kindergarten. The effect of their efforts is 68 percent (49 percent in 2001-2002) of children are entering kindergarten fully ready to learn and better prepared to achieve a successful kindergarten experience. Disparities in school readiness still exist. The school readiness scores indicate that more girls than boys enter school ready to learn (74 percent to 63 percent) and that Caucasian and African American disparity in kindergarten readiness is greater than 13 percent. Immigrant children with limited English proficiency have advanced beyond children in special education by 12 percent, but still lag greater than 22 percent behind white children. Children in poverty (as measured by free and reduced meals) still lag far behind their standard income classmates.
There is a strong correlation between the health of young children and their ability to enter school ready to learn. The National Education Goals Panel states that in order to be ready for school all children need to: “experience high quality learning; have enough to eat and the ability to live in safe and stable neighborhoods; be able to see a doctor under any circumstance; have parents who are caring and attentive, armed with the support they need to be strong and capable caregivers; and attend schools prepared to receive children at school age.” Maryland continues its school readiness efforts through the Early Childhood Comprehensive Systems grant and a host of state and public partners who collaborate to ensure that all Maryland children are healthy and ready to enter school. Detailed data on Maryland school readiness can be found at: http://www.marylandpublicschools.org/MSDE/newsroom/publications/school_readiness.htm.
State Performance Measure: Increase the percentage of high school students who participate in physical activity for at least 20 minutes a day, three days a week.
Just this year West Virginia initiated a collaborative across state government to include the Department of Education, Children’s Health Insurance Program (CHIP), and Public Health (including Community Health Centers and Maternal Child and Family Health (MCFH) to screen four and five year olds using Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program (administered by MCFH) protocols and the EPSDT (uniform) screening instrument to enable the state to collect (Body Mass Index) BMI and other information for health and resource planning purposes on all public school kindergarten enterers. Children could be screened at their health home or, if uninsured, the child could be screened by a local pediatrician available at the school site at no charge to the family. Cost of the screening of uninsured children was paid for by CHIP. Using unobligated CHIP monies for this purpose, which required a state plan amendment, application for CHIP/Medicaid could be made at school sites electronically or by hard copy submission. The initiative, called “Kids First: Healthy and Ready to Learn,” will be incrementally expanded to other grades.