School Interventions

1. School Interventions Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health and National Adolescent Health Information Center, Department of Pediatrics & Institute for Health Policy Studies,University of California, San Francisco

2. Presentation Overview • Importance of schools • Creating a healthy environment • School connectedness • What schools can do • Responses • Coordinated School Health Program • School-based health centers • Summary & Resources

3. Importance of Schools • Why are schools important settings for improving adolescent health? • Place to reach young people, as well as their families. • 48 million youth enrolled in elementary and secondary schools; 17 million young people enrolled in colleges/universities. • 98% of 7-13 year-olds, 96% of 14-17 year-olds, and 64% of 18-19 year-olds enrolled in school. • Structure already exists to provide adolescents with health education, services, and referrals. Sources: CDC, 2005; NCES, 2006; CHHCS, 2006

4. Importance of Schools • Schools are an appropriate setting to provide: • Environment that fosters healthy development; • Health education to reduce risky behaviors and promote healthy behaviors; • Links to health care services or referrals; • Training for school staff to aid in health education for adolescents and their families; and • Policies to help implement school health programs/guidelines. Source: CDC-HRSA-NAHIC, 2004

5. Creating a Healthy Environment • Research has shown a strong association between adolescent connections to schools and the prevention of risky behavior. • Higher school connectedness--the interaction of the student with the school environment--is linked to lower substance use, less emotional distress, less violent behavior and lower pregnancy rates. • Source: Resnick, et al.,1997

6. Students who Feel Connected to School are Less Likely to Use Substances Level of Substance Use (SD Units) Levels of Connectedness • Source: Resnick, et al.,1997

7. Students who Feel Connected to School Experience Less Emotional Distress Level of Emotional Distress (SD Units) Levels of Connectedness • Source: Resnick, et al.,1997

8. Students who Feel Connected to School Engage In Less Violent or Deviant Behavior Level of Violence or Deviant Behavior (SD Units) Levels of Connectedness • Source: Resnick, et al.,1997

9. Students who Feel Connected to School are Less Likely to Become Pregnant Percent ever Pregnant Levels of Connectedness • Source: Resnick, et al.,1997

10. CDC Division of Adolescent & School HealthCoordinated School Health Program • Rationale for school health programs: • Schools by themselves cannot, and should not be expected to, address the nation’s most serious health and social problems. • Families, health care workers, the media, religious organizations, community organizations that serve youth, and young people themselves also must be systematically involved. • However, schools could provide a critical facility in which many agencies might work together to maintain the well-being of young people. Source: CDC, 2005

11. CDC Division of Adolescent & School HealthCoordinated School Health Program Source: CDC, 2005

12. What Schools Can DoExample: Suicide Prevention • Schools are a good setting for suicide prevention efforts as they can provide: • Education for students to increase awareness and teach themselves/other peers how to get help; • Mental Health Screening to assess risk for suicide; • Gatekeeper training to teach school staff to identify students at risk for suicide and give appropriate referrals; • Support for adolescents and parents. Source: Weiss & Cunningham, 2006

13. What Schools Can Do Example: Obesity Prevention • Promotion of physical activity and nutrition can be incorporated at schools: • Physical Activity - provide high quality physical education classes and sports teams • Nutrition - reduce access to non-nutritious foods and drinks (e.g., vending machines, fast-food in cafeteria) • School Nurses can identify students at risk for being overweight and follow up with those not seeing a provider on a regular basis. Sources: Wechsler et al, 2004; CHHCS, 2006

14. School-Based Health Centers • Health centers are located within or near a school and can provide a range of health care services for young people. Features often include: • Parents sign consents for their children to enroll; • Advisory board (parents, young people, community and family organizations) plans health center activities; • School health center staff often includes nurses, social workers, physicians and other health care professionals; and • School staff work cooperatively with health center staff to integrate the center into school life. Source: CHHCS, 2006

15. School-Based Health Centers • School-based health centers -- 1,500 nation-wide; School nurses, 30,000 estimated; School counselors, 81,000; School psychologists, 20,000-22,000; School social workers, 12,000. • Services may include: • immunizations, • diagnosing and treating acute illness and injury, • managing and monitoring chronic diseases, • dispensing medications, and • offering preventive and primary dental care. Source: CHHCS, 2006

16. Evaluation: CDC School Health Policies and Programs Study • National survey that assesses school health policies and programs at the state, district, school and classroom levels for elementary, middle and high schools. • Reviews health program components: health education & services, physical activity, mental health & social services, school policy & environment, food service, faculty & staff health promotion, and family & community involvement. Source: CDC, 2006

17. Evaluation: CDC School Health Policies and Programs Study • Results show that many schools are addressing health issues for adolescents, thereby improving the health of this population: • Most schools (89%) are required to teach health education; • Over three fourths (77%) of schools have a school nurse to provide health services; • Almost all (99%) of middle/high schools have interscholastic sports programs and half (49%) of all schools have physical activity clubs or intramural activities; • A guidance counselor is available in 77% of schools and 63% of schools have a student assistance program; and • Over half of all schools (60%) gave families of students information about the school health program. Source: CDC, 2006

18. Schools are valuable settings in which to address and improve the health of adolescents: Can reach adolescents and their families to provide health education and services; Can help identify and reduce health problems through different programs; and Can provide a safe environment for healthy development. Multiple sectors (families, communities, etc.) are naturally integrated into school health programs. Summary

19. Resources • For more information about the 21 Critical Health Objectives and the National Initiative to Improve Adolescent & Young Adult Health, visit: http://nahic.ucsf.edu/nationalinitiative/ or http://www.cdc.gov/HealthyYouth/AdolescentHealth/NationalInitiative/ • For more information on School Interventions, visit: • Partner Resources Database http://nahic.ucsf.edu/index.php/partner_resources/

20. References • Centers for Disease Control and Prevention. (2005). Coordinated School Health Program. Available at: http://www.cdc.gov/HealthyYouth/CSHP/ • Centers for Disease Control and Prevention. (2006). School Health Policies and Programs Study, 2006. Available at: http://www.cdc.gov/HealthyYouth/shpps/overview/index.htm • Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health; Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Adolescent Health; National Adolescent Health Information Center, University of California, San Francisco. (2004). Improving the Health of Adolescents & Young Adults: A Guide for States and Communities. Atlanta, GA: Authors. Available at: http://nahic.ucsf.edu/2010guide/ • National Center for Education Statistics. (2006). Digest of Education Statistics Tables and Figures, 2005. Available at: http://nces.ed.gov/programs/digest/d05/lt1.asp#1 • Resnick, M.D., Bearman, P.S., Blum, R.W., Bauman, K.E., Harris, K.M., Jones, J., et al. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278(10), 823-32.

21. References • The Center for Health and Health Care in Schools. (2005). Childhood Obesity: What the Research Tells Us. Available at: http://www.healthinschools.org/sh/obesityfacts.asp • The Center for Health and Health Care in Schools. (2006). School-Based Health Centers: A Background. Available at: http://www.healthinschools.org/sbhcs/sbhc.asp • Wechsler, H., McKenna, M.L., Lee, S.M., Dietz, W.H. (2004). The Role of Schools in Preventing Childhood Obesity. Alexandria, VA: The State Education Standard, National Association of State Boards of Education. Available at: http://www.nasbe.org/Standard/17_Dec2004/Wechsler2.pdf • Weiss, C.L.A., Cunningham, D.L. (2006). Suicide Prevention in the Schools.Baltimore, MD: Center for School Mental Health Analysis and Action, Department of Psychiatry, University of Maryland School of Medicine. Available at: http://csmha.umaryland.edu/resources.html/suicide%20prevention%20brief.pdf

22. National Adolescent Health Information Center and Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health WEB SITES: http://nahic.ucsf.edu/ http://policy.ucsf.edu/ EMAIL: nahic@ucsf.edu policycenter@ucsf.edu PHONE:(415) 502-4856