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. Dell 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.
Parents of AISD students are asked to indicate the health insurance status of their students each year when they register for school. The information is voluntarily provided. Response rates have increased in recent years from about 50% to 70.5% most recently. Consideration of insurance status by academic level provides a baseline indicator prior to the implementation of the Accountable Care Act in Texas.
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 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; Sally Freeman, SHS Director; Tracy Lunoff, AISD Health Services Assistant Director; Michele Rusnak, AISD Physical Education Supervisor; Pat Werner, AISD Health and PE Specialist; and June Hayman, AISD Food Services Nutritionist 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 2012-13, there were 27 AISD campuses served. Care for AISD students is coordinated through Student Health Services.
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. Since SY 2010-11 service has been provided to 27 campuses, with 9611 students in need being treated in the most recent school year. Of students screened in SY 2012-13, 45.4% were identified with untreated decay. Nearly all students identified with a dental need and parent consent received treatment at no cost to their families, an effort valued at $2.4 million by St. David’s Foundation.
A decrease in students receiving only restorative care, such as fillings, 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 71% of its targeted economically disadvantaged students, significantly exceeding a Healthy People 2020 guideline that 28% of children be screened.
Process improvements have been implemented to help reduce the loss of classroom instruction by reducing the number for dental visits to complete care. Only 11% of patients needed more than two visits to complete care in SY 2012-13, an improvement over the prior year.
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 (CHE). Care is in collaboration with 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 calendar year 2012 CHE provided 1292 medical encounters to 664 children. Of the patients served, 75% are uninsured and 40% are not insurable. An additional 565 children were served at a variety of health fairs targeting high need communities. The CHE is also mobilized to address various unexpected health needs that arise throughout the school year.
In SY 2009-10, CHE received a HRSA grant to serve pregnant/parenting students on targeted AISD campuses in an effort to reduce their out-of-class time for medical reasons, and improve school and health outcomes. Grant funding has concluded, but because the program was successful, CHE has funded the program for an additional year with help from Dell Children’s Medical Center, while sustainability funds are sought.
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 2012-13, sports physicals were provided to 668 students, who had self-identified as having limited access to health care. Student athletes served by the program include those participating in Special Olympics.