the proof is in the pudding health and education for student / community success a case study of roy...
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The Proof Is In The The Proof Is In The PuddingPudding
Health and Education forHealth and Education for
student / community successstudent / community successA case study of Roy Clark Elementary – Union Public A case study of Roy Clark Elementary – Union Public
SchoolsSchoolsTulsa, Oklahoma Tulsa, Oklahoma
John M. Gaudet, MPH, BS, ADN John M. Gaudet, MPH, BS, ADN
Theresa Kiger, M.Ed.Theresa Kiger, M.Ed.
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The Proof Is In The PuddingThe Proof Is In The Pudding
Presentation OverviewPresentation Overview– The state of health in Tulsa, Oklahoma The state of health in Tulsa, Oklahoma – Review of the medical home concept for the Review of the medical home concept for the
medically marginalized within a designated medically marginalized within a designated community schoolcommunity school
– OU-TACH’s school based clinic descriptionOU-TACH’s school based clinic description– Why Roy Clark Why Roy Clark
Healthcare finding Healthcare finding Correlation of Data from health records to school report Correlation of Data from health records to school report
cardscards
– Discussion of Preliminary FindingsDiscussion of Preliminary Findings Data Analysis Data Analysis Summary of key findingsSummary of key findings
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The Reason for a Health Clinic at The Reason for a Health Clinic at school …school …
““You can’t educate a child who isn’t You can’t educate a child who isn’t healthy, and you can’t keep a child healthy, and you can’t keep a child
healthy who isn’t educated.”healthy who isn’t educated.” former U.S. Surgeon General Joycelyn Elders:former U.S. Surgeon General Joycelyn Elders:
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OklahomaA State of Health?
“We are the ONLY state where our age-adjusted death rates became WORSE through the 1990s and into this century.”
“If we had the same adjusted death rate as the nation, we would have about 3,700 fewer people dying each year.”
Oklahoma State Board of Health “2006 State of the State’s Health” Graphic: University of Oklahoma College of Public Health. Data Source: U.S. Centers for Disease Control and Prevention
AGE ADJUSTED DEATH RATE
U.S
OK
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Oklahoma Economic Class As Oklahoma Economic Class As It Relates to Health CareIt Relates to Health Care
Poverty ClassPoverty Class– Poor health status – die 14 years earlierPoor health status – die 14 years earlier– Limited access to care – 4% of doctors near Limited access to care – 4% of doctors near
homes homes Middle ClassMiddle Class
– Low healthcare qualityLow healthcare quality– High cost health careHigh cost health care
Wealth ClassWealth Class– Low health care quality and high costLow health care quality and high cost– High cost of charity careHigh cost of charity care
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Access to Health Care Varies Dramatically By Zip Code:
For every 1 physician in north, east and west Tulsa, there are 26 in mid-town and south Tulsa
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The Medical Home ConceptThe Medical Home Concept
The American Academy of Pediatrics Policy StatementThe American Academy of Pediatrics Policy Statement
Accessible, continuous comprehensive, family Accessible, continuous comprehensive, family centered, coordinated, and compassionatecentered, coordinated, and compassionate
Manage or facilitate essentially all aspects of Manage or facilitate essentially all aspects of pediatric care pediatric care
The physician should be known to the child and The physician should be known to the child and family and should be able to develop a relationship family and should be able to develop a relationship of mutual responsibility and trust with them. of mutual responsibility and trust with them.
Source: DuPlessis, Helen, M., Cora-Bramble, Denice. (2005). American academy of pediatrics policy statement: providing care for immigrant, Source: DuPlessis, Helen, M., Cora-Bramble, Denice. (2005). American academy of pediatrics policy statement: providing care for immigrant, homeless, andhomeless, and immigrant children. immigrant children. PediatricsPediatrics, Vol. 115 (4), 1095-1100 , Vol. 115 (4), 1095-1100
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BREAKING THE CYCLE BREAKING THE CYCLE OF POVERTYOF POVERTY
Children in poor health miss more school Children in poor health miss more school days and have lower cognitive days and have lower cognitive developmentdevelopment
Lower educational attainment Lower educational attainment contributes to lower wages and lower contributes to lower wages and lower labor force participationlabor force participation
Thus increasing the likelihood of not Thus increasing the likelihood of not being insured as an adult and increasing being insured as an adult and increasing the odds of continued poor healththe odds of continued poor health
KAISER COMMISSION on Medicaid and the Uninsured, 2002KAISER COMMISSION on Medicaid and the Uninsured, 2002
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New Concepts in Health & New Concepts in Health & DiseaseDisease
Allostatic loadAllostatic load– Additive burden of psychosocial stresses Additive burden of psychosocial stresses
produces physiological damageproduces physiological damage Weathering PhenomenonWeathering Phenomenon
– Stressed people age fasterStressed people age faster Physiological CapitalPhysiological Capital
– Genes – environment – behaviorGenes – environment – behavior Neighborhoods (community schools)Neighborhoods (community schools) Education to change behavioral normsEducation to change behavioral norms
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HealingHealing
Restoring a whole person to a state of Restoring a whole person to a state of right relationships with…right relationships with…– Biological – “milieu interior”Biological – “milieu interior”– Psychological – self-identity in human dignityPsychological – self-identity in human dignity– Social – family and communitySocial – family and community– Spiritual - transcendentSpiritual - transcendent
Sulmasy D. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. 2006 The Georgetown University Press, Washington, DC.
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OU Tulsa Alliance for Community Health OU Tulsa Alliance for Community Health
School Based HealthcareSchool Based Healthcare
School based health centers are designed to School based health centers are designed to serve students, their family members, serve students, their family members, extended family and the communityextended family and the community
regardless of their ability to pay.regardless of their ability to pay. No school program is exactly the same except forNo school program is exactly the same except for
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OU Tulsa Alliance for OU Tulsa Alliance for Community Health Community Health
Comprehensive Primary CareComprehensive Primary Care Acute care Acute care Mental and Behavioral Health CareMental and Behavioral Health Care Health Promotion Health Promotion EducationEducation Oral Health screenings Oral Health screenings
and Educationand Education Social ServicesSocial Services Outreach Outreach Home VisitsHome Visits
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Why A Health Clinic As Part of Why A Health Clinic As Part of The Community School ConceptThe Community School Concept
Students, families, schools & community Students, families, schools & community partners working together…partners working together…
Children learningChildren learning Families succeedingFamilies succeeding Neighborhoods engagingNeighborhoods engaging Communities thrivingCommunities thriving
Source: Community Service Council of Greater Tulsa
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Why Roy Clark ElementaryWhy Roy Clark Elementary
Designated as a Community SchoolDesignated as a Community School 90% of students qualify for the free lunch 90% of students qualify for the free lunch
programprogram 84% are minority (high % Hispanic students)84% are minority (high % Hispanic students) Evidence of improved API scores in last 3 Evidence of improved API scores in last 3
yearsyears An estimated 80% of Clark students An estimated 80% of Clark students
demonstrate conditions associated with demonstrate conditions associated with stress and poverty: slowed learning, stress and poverty: slowed learning, impassivity, quick tempers and problems impassivity, quick tempers and problems defining personal space defining personal space Source: Theresa Kiger, Roy Clark Elementary School Principal 2008
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Why Roy Clark Elementary?Why Roy Clark Elementary?
0
500
1000
1500
2000
2500
3000
3500
# of Patients
# of VisitsSchool Year 2006-2007
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The Roy Clark ClinicThe Roy Clark Clinic
TACH Roy Clark School Based Clinic
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500
1000
1500
2000
2500
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3500
2005 2006 2007
School Year
Patient Visits
Total Patients
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Key FindingsKey Findings
CLINIC FINDINGSCLINIC FINDINGS Underutilization of clinic by African Underutilization of clinic by African
American students/familiesAmerican students/families Major use of clinic by Hispanic Major use of clinic by Hispanic
families Compared to the other families Compared to the other established clinics, established clinics,
Roy Clark has the highest percentage Roy Clark has the highest percentage of preventative visitsof preventative visits
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Patient DemographicsPatient Demographics
0
10
20
30
40
50
60
White AfricanAmerican
Hispanic NativeAmerican
Asian
Roy Clark Patient Demographics
SY 2005
SY 2006
SY 2007
05
1015202530354045
Percentage
White AfricanAmerican
Hispanic NativeAmerican
Other
Race
Roy Clark Student Demograhics
SY 2005
SY 2006
SY 2007
Among African Americans, there is almost a 15% difference between the clinic users and student population
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% Preventative Visits 2005-% Preventative Visits 2005-0707
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Top 5 Diagnosis Per VisitTop 5 Diagnosis Per VisitDiagnosis 2005 2006 2007
1 Routine Infant Routine Infant Routine Infant
2 Acute UpperRespiratory
Acute UpperRespiratory
ChildhoodImmunizations
3 ChildhoodImmunizations
Allergic Rhinitis
Acute UpperRespiratory
4 Pharyngitis Pharyngitis Ear Infection
5 Gastroenteritis Ear Infection Allergic Rhinitis
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Key FindingsKey Findings
SCHOOL RELATED FINDINGSSCHOOL RELATED FINDINGS API scores have increase over last 3 API scores have increase over last 3
yearsyears Attendance rate has increased over Attendance rate has increased over
last 3 years last 3 years Mobility decreased from 2005-06Mobility decreased from 2005-06
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Federal Free/Reduce Lunch Federal Free/Reduce Lunch ProgramProgram
78
80
82
84
86
88
90
92
94
2003 2004 2005 2006
Free/ Reduce
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Academics-APIAcademics-APIAcademic Performance IndexAcademic Performance Index
0
200
400
600
800
1000
1200
1400
1600
2003 2004 2005 2006
ReadingMathTotal
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MediaMedia
0
1000
2000
3000
4000
5000
6000
7000
2003 2004 2005 2006
Number ofbooks permonth
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Attendance Rates 2005-Attendance Rates 2005-20072007
560
580
600
620
640
660
680
700
720
2005
2006
2007
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CommunicationCommunication
0102030405060708090
100
2003 2004 2005 2006
Attendance Rate
Parent TeacherConf.
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Student CharacterStudent Character
0%10%
20%
30%
40%50%
60%
70%
80%90%
2003 2004 2005 2006
Good Behavior
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Data TeamsData Teams
Collaboration built into daily scheduleCollaboration built into daily schedule Focused InstructionFocused Instruction AnalyzingAnalyzing AssessmentsAssessments AccountabilityAccountability Title One FundsTitle One Funds Data DaysData Days
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Questions?Questions?