AISD serves over 2000 homeless students and 61% 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.
For the last two years AISD has seen a decrease in students enrolled, reversing a decades-long growth trend. The proportion of economically disadvantaged students is beginning to decline, as is the proportion of English language learners. Similarly, the proportion of African American and Hispanic students in AISD are declining. These findings are consistent with evidence that housing costs are driving families with children to outlying school districts, contributing to the ‘suburbanization of poverty’. The Austin area has led the country in the rapid pace of this phenomenon. The proportion of AISD students defined by Texas Education Agency as At Risk is increasing.
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 over 80% more 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 2013-14, there were 34 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. In SY 2013-14 service was expanded from 27 to 34 AISD campuses, with 9250 students in need being offered treatment. Of students screened in SY 2013-14, 30% were identified with untreated decay, a reduction from 45% the prior year. Nearly all students identified with a dental need and parent consent received treatment at no cost to their families, an effort valued at $2.9 million by St. David’s Foundation.
The dramatic increase in students receiving preventive sealants, comlemented by decreasese among those receiving restorative care only (such as fillings) reflects a change in clinical practice beginning in SY 2012-13. The change in the clinical model was augmented by enhancing staff capacity by having all dental assistants now ‘sealant certified’, and expanding by grade level the number of students screened for sealants. In SY 2013-14 the St. David’s Foundation Dental program screened 83% of its targeted economically disadvantaged students, significantly exceeding a Healthy People 2020 guideline that 28% of children be screened. Over time, it is anticipated that the change in clinical practice will reduce the proportion of students screened who have untreated decay.
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. From January-June, 2014 CHE provided 595 medical encounters and 477 outreach contacts. Of the patients served, 75% are uninsured and 40% are not insurable.
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 2013-14, sports physicals were provided to 857 students, up from 668 students the prior year. These students had self-identified as having limited access to health care. Student athletes served by the program include those participating in Special Olympics.