Collaborative Efforts to Reduce Health Disparities
AISD serves over 2000 homeless students and nearly 66% of all students are economically disadvantaged. In SY 2010-11, nearly 16,000 students were school mobile which means that they either changed campuses during the school year or were enrolled for less than 5 of the 6 grading periods. Changing residence is one of the key reasons students change campuses, disrupting their educational experience. Economic stress is a key driver of residential change. Children’s/AISD Student Health Services seeks to reduce health disparities among children and youth in the District by leveraging existing community resources to help assure all children have access to health care. The purpose is to improve health outcomes and reduce non-academic barriers to school success.
The ability to effectively leverage community resources rests on relationships with other community providers who are committed and positioned to help reduce health disparities. Among these partners are St. David’s Foundation’s Mobile Dental program, Dell Children’s Medical Center’s Children’s Health Express Mobile Pediatric Care Van, the Travis County Medical Society’s Sports Physicals program for underserved youth; and insure-a-kid, which helps families obtain insurance coverage through Medicaid or CHIP. Beyond these partners, the SHS Director, Medical Director, Clinical Managers, and Quality Improvement Consultant all participate in various community collaborations and in the School Health Advisory Council of AISD (SHAC), to improve outcomes for children and youth.
A Program of Children’s Health Express: Reducing Barriers to Health Care Access
Dell Children’s Medical Center operates the Children’s Health Express Mobile Pediatric Care Van (CHEX). Care is coordinated through SHS. With recent program changes, mobile pediatric staff can now serve as the primary care provider for students who lack access to a provider. In SY 2011-12 CHEX provided 1,356 medical encounters. An additional 576 children were served at a variety of health fairs targeting high need communities. The CHEX is also mobilized to address various unexpected health needs that arise throughout the school year.
A Program of Children’s Health Express: Pregnant/Parenting Students
A Health Resources and Services Administration (HRSA) grant allows the Children’s Health Express mobile health clinic (CHEX) to provide medical and social work services to pregnant/parenting students at 3 high need high schools. Students and their children are assisted in obtaining well child, pediatric, WIC, Medicaid and related care without needing to travel, reducing out of school time. Goals for the program are to increase the graduation rate among pregnant/parenting students and to increase immunization rates for their infants. The CHEX program provided 223 well care and acute care visits to 30 pregnant/parenting students and 66 of their children during SY 2011-12. 76% of the visits were for the children of AISD students. Of the child visits, 78% were for an ill child. Maternal depression screening is an aspect of the service model, and 59% of mothers were screened, with service referral for those in need. Having access to CHEX reduces the lost school time for parenting students, increasing the likelihood that they will complete high school. The CHEX mobile clinic is the primary provider for 63% of those served in this program.
A Program of AISD: The School Health Advisory Council (SHAC)
Research shows that healthy children do better in school-from attendance and behavior to academics and overall performance. The Austin School Health Advisory Council (SHAC) works with the district to help school communities support good health and academic achievement. The SHAC is a school board-appointed advisory group of individuals who represent different segments of the community. By law, a majority of the members must be persons who are parents of students enrolled in the district and who are not employed by the district. The AISD SHAC is made up of parents, community members, students, and school staff working together to improve the health of all students and families through coordinated school health programs. The components of a coordinated school health program include: Family and Community Involvement, Nutrition Services, Physical Education, Health Education, Counseling, Psychological & Social Services, Health Services, and Health Promotion for School Staff. Dr. Stephen Pont, Medical Director and Sally Freeman, Director, participate on the SHAC board as advisory board members and attend monthly SHAC meetings.
To facilitate access to primary care, campus RNs provide referral services to community providers when students are identified with unmet health needs. In cases where significant barriers to primary care are encountered, RNs work to remove those barriers and provide linkage to care. These efforts are enhanced through the involvement of the Director, Medical Director, and Clinical Managers all of whom have enhanced expertise and experience accessing community resources both within the Seton Healthcare Family and those within the community at large.
A Program of St. David’s Foundation: Dental Van
The St. David’s Foundation funds 6 dental vans, 6 full time dentists and 2 hygienists that serve low income (Title I) campuses in 6 area school districts. In SY 2011-12, there were 27 AISD campuses served. Care for AISD students is coordinated through SHS. In SY 2011-12 a dental health education pilot was initiated on one target campus with classroom teachers using the Health Teacher curriculum provided by Seton Family of Hospitals. Dental health lessons focused on 2nd grade students.
Parental consent is required for students to be screened or treated. Those targeted students who were not screened typically lacked parental consent for the process. In SY 2009-10 services were provided to 5699 students with need based on screening results, across 17 campuses. Service expanded to 27 campuses in SY 2010-11 and SY 2011-12, with 10,063 students with need being treated in the most recent school year. Of students screened in SY 2011-12, 35.0% were identified with untreated decay. All students identified with a dental need and parent consent received treatment at no cost to their families.
A decrease in students receiving only restorative care is complemented by an increase in those who receive sealants, or sealants and restoration. This outcome is the result of several factors, including a change in the clinical model to focus more on prevention, enhancing staff capacity by having all dental assistants now ‘sealant certified’, and expanding by grade level the number of students screened for sealants. The St. David’s Foundation Dental program screens 69% of its targeted economically disadvantaged students, significantly exceeding a Healthy People 2020 guideline that 28% of children be screened.
In addition to the dental van program, 152 students received emergency dental care from volunteer dentists through the Travis County Dental Society. In total, 3426 students received $2.1 million in care at no cost to their families. The value of services provided was placed at more than $2 million.
A Community Collaboration Program: Sports Physicals
Every spring the Children’s/AISD School Nurses partner with Travis County Medical Society, Dell Children’s Medical Center, Austin Independent School District Athletics, and other community partners to provide free sports physicals to students who do not have a medical home. This collaboration takes place over 4 evenings and has the capacity to service approximately 150-200 students per evening.
During SY 2011-12, sports physicals were provided to 633 students, who had self-identified as having limited access to health care. An immunization clinic was offered in conjunction with the sports physicals to ensure students were up to date on state immunization requirements. Thirty-eight students received 96 immunizations. Children’s/AISD School Nurses worked with physicians and identified 2 students with significant health conditions, which prevented the student from playing athletics until cleared by a medical specialist. Another 74 students failed due to conditions such as having asthma and not having an asthma action plan in place. An additional 50 students failed due to not passing the vision screen. SHS nurses worked to link students to medical specialists such as cardiologists or orthopedic physicians. Additionally, nurses worked with students to obtain asthma action plans and prescribed medications needed to play sports. School nurses also coordinated with vision providers in the community to ensure students have a professional medical vision exam and glasses as needed. Students who fail sports physicals and do not have a medical home are also referred to the Children’s Health Express Van, a pediatric mobile unit based out of Dell Children’s Medical Center. Student athletes served by the program include those participating in Special Olympics.