Measurable Outcomes of School Health Care Initiatives

1. Measurable Outcomes of School Health Care Initiatives School Health Initiatives Midwestern Regional Conference July 23-24, 2008 Terrell W. Zollinger, DrPH, MSPH

2. Why Evaluate? • Zollinger’s Law: You can make better decisions WITH data than WITHOUT data. The better the data, the better the decisions – the worse the data, the worse the decisions • The times, they are a changin’ • P4P is only the tip of the iceberg • Resources are tight everywhere • It’s not that the data show the program is ineffective – it that there is no data…

3. What is Evaluation? • The process of determining the degree to which an objective of a program or intervention or some other action has been completed or met • It is a management tool

4. What Evaluation is NOT • Not a punishment for low performing units • Not a way to justify discontinuing a program • Not a top – down activity – it IS a team activity

5. Measurement Hierarchy Limited Major outcomes Numerous

6. Components OF EVALUATION • Needs Assessment --- part of pre-planning or service revision  GAPS. Are you providing needed services to the right people? • Process Evaluation --- documenting services delivered, clients helped, education delivered. What have you done with the resources? • Satisfaction --- determining the level of acceptance of the services. Are the services valued? • Outcome Evaluation --- measuring changes in behavior, health indicators, performance. So what? • Success Stories --- relating examples of children helped. Does anyone care?

7. Where to start? • Strategic planning – lots of options! • Root cause analysis What is the problem? What is causing the problem? What fits within mission? Do we have (or can we get) resources? Can we have “quick” success? Partners needed?

8. The Learning Well Story • Problem 1:Lack of adequate utilization of integrated, preventative primary health care services. • Problem 2: Lower school attendance due to health care needs

9. Lack of utilization of primary health care services • Lack of Access • Economic issues • Lack of Insurance • Lack of resources for “out of pocket” costs • Distribution/Organization of Resources • Inconvenient location • Inconvenient hours • Lack of Knowledge/Attitude Barriers • Don’t value of preventive care • Don’t understand self care • Unaware of services

10. More antecedents… • Provider issues • Lack of cultural competence/communication • Mental health issues not met • Delayed treatment causes illness to progress, leading to more absence • Children must be taken from school to provider • Parents have to take time off work • Kids stay home without care • Children leave school for minor illness/services

11. Learning Well Goals • Goal I: Address Barriers to Health Care Access • Goal II: Provide Health Care Knowledge • Goal III: Address Attitudinal Barriers • Goal IV: Address Clinic Provider Issues

12. Goal I: Address Barriers to Health Care Access • Address economic barriers • 19.8% of parents indicated they would NOT be able to pay for their child’s medical services if the clinic were not here

13. Goal I, continued • Convenient location for health care services • 100.0% of parents and 95.4% of students agreed • Convenient hours for health care services • 100% of parents and 93.3% of students agreed

14. Goal I, continued • If the clinic were not here, where would parents take their child if he/she had a minor illness before leaving for school:

15. Goal I, continued • If the clinic were not here, where would parents take their child if he/she had a minor illness while in school:

16. Goal II: Provide Health Care Knowledge • Provide awareness of the value of preventive medicine • Parents: 82.9% schedule a regular check up for their child each year • Students:36.3% visit the clinic to get health information even when not sick • Teachers: 57.9% VERY appropriate and 38.2% SOMEWHAT appropriatefor children to miss class to visit the clinic for preventive care

17. Goal II, continued • Provide knowledge of self-care and preventive care • Do the parents and students know how to keep healthy?

18. Goal II, continued • Increase awareness of clinic services • Do the parents and students know what services are available at the clinic?

19. Goal II, continued • Increase awareness of community health resources • Do the parents and students know where to get health services, other than the clinic?

20. Goal III: Address Attitudinal Barriers • Provide a comfortable setting for health care • Parents: 97.4% indicated they were comfortable with their children receiving health care at the clinic • Students:96.9% indicated they were comfortable receiving health care at the clinic

21. Goal III, continued • Address the value of health care • How often is a regular medical check up scheduled, when child is sick/not sick?

22. Goal III, continued • Address the perception of the need for care • Parents: 96.6% were VERY comfortable and 3.4% were SOMEWHAT comfortable deciding when to seek medical care for their child

23. Goal IV: Address Clinic Provider Issues, continued • Are your child’s physical health needs being met at the clinic?

24. Goal IV, continued • Are your child’s mental health needs being met at the clinic?

25. Parting Shots… • Evaluation is a requirement -- Outcome evaluation is critical to success • Evaluation plan is connected to the goals and objectives • Data are needed • Requires thought, effort, knowledge • Outside evaluator – very helpful • Questions???