DC Action's Testimony at the Public Roundtable on the School Health Services Program
Yesterday we submitted written testifimony to the Committee on Education for the public roundtable on the new school health services program. We higlighted our analysis on the current school health services asking the critical question: Is the current school health services meeting the health needs of the students? You may find our full remarks below.
Testimony of HyeSook Chung, Executive Director
DC Action for Children
Public Roundtable on the
School Health Services Program
Before the Committee on Education
Council of the District of Columbia
October 24, 2016
Good afternoon Councilmember Grosso and members of the Committee on Education. Thank you for the opportunity to address the Council and participate in this discussion about proposed changes to school health services in the District. My name is HyeSook Chung, and I am the executive director of DC Action for Children and proud parent of two DCPS students.
DC Action for Children (DC Action) provides data-based analysis and policy leadership on critical issues facing DC children and youth, to promote policies and actions that optimize child and family well-being.
DC Action is the home of DC KIDS COUNT, which tracks key indicators of child well-being in the DC neighborhoods where children live, learn and grow. We work closely with city agencies, the school system and service providers to share the most accurate and timely data, along with clear and accessible analysis. Our advocacy agenda is based on these data.
Earlier this year, DC Action completed the School Health Needs Assessment on behalf of the Department of Health. Our research analysis included utilization data from both school nursing records and school-based health centers, interviews with DC agencies, school-based health center personnel and school leaders and focus groups with students, parents and school nurses. We learned a tremendous amount of information, and the full report can be found on our website (www.dcactionforchildren.org). However, I would like to take this opportunity to briefly discuss what we learned through our research as well as our proposed recommendations to the Department of Health and other District agencies to improve school health services.
What did we learn through the 2016 School Health Needs Assessment?
DC Action learned a great deal about the health needs of students through this project as well as the current school health services programs’ ability to meet those needs. While the District of Columbia has done a tremendous job to increase access to health personnel in schools, there are some persistent challenges and inefficiencies that must be addressed.
Enrollment in the District’s public education system continues to grow. As of the 2014-15 school year, the District of Columbia public education system served 85,403 children and youth between ages 3 and 18+ across two public education sectors: District of Columbia Public Schools (DCPS) and District of Columbia Public Charter Schools (DC PCS). 47,548 students attended a school within DCPS and 37,684 attended a charter school. Across public school students District-wide, 70.8% are black, 9.1% are non-Hispanic white and 16.5% are Hispanic.[i] In addition, 44% are eligible for the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF), a proxy measure of student poverty.[ii] These students must navigate a variety of challenges associated with living in poverty.
Data on child and youth health in the District of Columbia illustrate the serious magnitude and range of student health needs. According to the most recent data available from the 2012 National Survey on Children’s Health, 19% of DC children and youth reported they were not in excellent or very good health, an increase from 17% in 2003.[iii] Based on data and reports from students, parents, school leaders and school health providers, the most common health needs affecting students include a mixture of mild, acute conditions like cuts, headaches and stomachaches and complex chronic conditions including asthma and diabetes. Furthermore, older students expressed concerns about the need for more resources focused on mental health and sexual/reproductive health.
Over 28,000 (or 33%) of DC students have at least one chronic health condition. Almost six thousand students require some form of regular health services at school; 88% of these students have multiple health problems. While the vast majority of schools have full-time nurse coverage, a single individual cannot attend to the complex student needs outlined above.
Although limited, there is some data that indicates that providing full-time nursing does not necessarily lead to increased services for children. Our complete analysis is in the report.
Given the breadth and depth of the various student health needs, the participants in the interviews and focus groups indicated that the current school health delivery system is not designed to improve health outcomes for students. We heard this from across the spectrum—from students, parents, school leaders, school nurses and school-based health center personnel.
What are some recommended next steps to improve outcomes for children?
With a vast body of research demonstrating the value of school health services, public health and education experts acknowledge that health intersects with learning and academic performance. However, in order to move toward models that are more responsive to the needs of students, we must move away from one-size-fits-all approached like standard students-to-nurse ratios. National experts at The Centers for Disease Control and Prevention (CDC), in conjunction with the Association for Supervision and Curriculum Development (ASCD), developed a new approach to child well-being designed to improve health and learning in schools
The Whole School, Whole Community, Whole Child (WSCC) model is a child-centered approach to support student well-being.[iv] The WSCC model emphasizes the importance of collaboration among stakeholders in health and education to match local resources with the particular health needs in each school community. At the center of this collaboration, schools function as hubs that connect children to the resources they need to succeed and thrive.
In order to move toward the goal of a holistic approach, our report outlines the following recommended steps for DOH to consider:
- Establish a shared vision for children’s health in the District.
By creating a new model for children’s health based on the WSCC model, DOH can fit school health into a broader system of care that is child-centered and emphasizes improving health outcomes. This new vision must be shared with stakeholders across the District in order to increase collaboration among the agencies, schools, parents and providers. By establishing a shared vision and garnering support among stakeholders, all parties could work more effectively together.
- Improve data collection and systems for school health services.
Multiple parties highlighted the need for improved data collection and sharing. DOH, OSSE, DCPS and PCSB should work together to identify opportunities and methods to improve data collection and sharing. Currently, health data is not linked with education data, but there is an opportunity through the OSSE Statewide Longitudinal Education Database (SLED) to maintain relevant health data by unique student identifier. Data could include data from the universal health certificate as well as utilization of school health services. This will allow both health and education agencies to monitor attendance, assess impact of health services on students and evaluate improvements in academic outcomes over time. Student-level data will provide opportunities for rigorous analysis and should be part of a long-term evaluation strategy for implementation of comprehensive services, including school health.
- Create and distribute process documents and training materials that clearly define the roles and responsibilities of school health providers.
The interviews and focus groups revealed that various parties are unclear about the roles and responsibilities of school health providers, especially the school nurse. In order to clarify and ensure understanding of the responsibilities of school health provides, DOH could provide both written documentation and summer training materials for school leaders and teachers that clarify the role and functions of the school nurse in the school community based on federal and local laws and regulations and the vendor’s grant or contractual agreements. Additionally, marketing materials for students and parents could raise awareness about the availability of school health services and help to set expectations and norms about those services and the appropriate use of those services
- Form a school health collaborative or advisory body.
In order to improve coordination and to create a forum for vetting new ideas and addressing grievances, DOH could form a school health advisory body that brings together agencies and school leaders to ensure on-going communication and collaboration. This group could provide substantive feedback around key processes like collecting student health information, establishing memoranda of agreement for data sharing, and identifying opportunities for linkages to services in the community.
- Implement a more robust evaluation and quality assurance process.
In order to strengthen the program, DOH could collect feedback from school leaders, students and parents about their experiences and satisfaction with services and providers. This feedback can be used to inform quality improvement efforts by identifying areas where more training or targeted professional development for school health providers could be beneficial, ideas for marketing or raising awareness about services, and identifying potential gaps in services.
We believe these steps are critical for removing silos and ensuring that the District provides quality health services in schools. While we are still learning more about the proposed model for January 2017, we feel strongly that a new model should increase effectiveness and efficiency in our school health service delivery system. School health personnel in these new health teams should work to the top of their licenses: registered nurses should provide key services and education according to their training instead of spending time doing something that could be effectively and efficiently done by someone else. Other allied health personnel and community health navigators should provide vital supports, training and care coordination necessary to make demonstrable improvements in children’s health.
Thank you for the opportunity to testify today. We are happy to serve as resource to the Committee on Education in a way that we can.
 As of school year 2015-2016, there are 116 DCPS schools and 62 charter school local education agencies operating 115 schools.
[i] Data from OSSE
[ii] Office of the State Superintendent of Education (2015). SY2014-15 enrollment audit. Retrieved from, http://osse.dc.gov/sites/default/files/dc/sites/osse/publication/attachments/Enrollment%20Audit_updated_2015_7_31.xlsx
[iii] Data via National KIDS COUNT. Accessed at: http://datacenter.kidscount.org/data/tables/8824-children-who-are-not-in-excellent-or-very-good-health?loc=10&loct=3#detailed/3…