PUTTING HEALTH FIRST

• By Janet Katz
• 06/01/03

Students of the Austin Independent School District (AISD) in Austin, Texas, have access to better school health services than they have enjoyed in a decade thanks to a one-of-a-kind collaboration. In 1996, AISD faced losing their entire student health services program. It had been scaled back year after year to where it had little value at the schools. Nurses were spread across so many campuses that they were rarely available when they were most needed. Untrained campus clerks were often the ones left to meet students’ health needs.

AISD serves 78,000 students. Nonanglo ethnic minorities make up 65 percent of the students served. A great number of children in the district lack insurance and access to primary care. Many Austinites realized that the proposed cut would have a negative impact on the community. It was likely to mean the public health hospital would be inundated with nonemergency and preventable visits to the emergency room, all at public expense.

The community, parents, students and members of the health community spoke out to postpone the elimination of services. Working together, they came up with a unique solution. Children's Hospital of Austin, a dedicated pediatric facility that is part of the Seton Healthcare Network, was contracted to manage the student health services provided on more than 100 campuses in AISD. Seton provided cash and in-kind services to make sure student health services remained uninterrupted. This public/private collaboration was the first time in the United States that a public school district had outsourced its student health services to a healthcare organization.

One result of the program was the formation of Student Health Service Teams. Each team consists of one registered nurse (RN) and one unlicensed assistant. The pairs are assigned to an AISD campus based on an assessment of student health care needs, school population and other factors.“It was vital to us to provide each child with more opportunities to learn,” says Judy Frederick, RN, director of Children’s/AISD Student Health Services. Frederick and the teams knew the best way to achieve this goal was to improve student health and increase time in class.

Naturally, student health was closely followed after the program was in place. More than 1,300 students with known health conditions were tracked for two years. The study indicated that 75 percent of students either maintained or improved their attendance in the second year.“Our student health services truly improved across the board,” says AISD Superintendent Dr. Pat Forgione. Improvements were found in the areas of prevention, health education and management of significant/chronic conditions in the school setting.

“We realize that other factors may have contributed to the improvements, but we know it is likely that health system improvements also played a role,” says Frederick. “Since state educational funding is based on student attendance, these numbers proved that there is a definite link between student health and education,” she points out.

Still, AISD and Children’s Hospital wanted to learn more about the benefits this collaboration was providing. Another study was conducted in the 2000-2001 school year to measure the market value of health services being provided in the schools. The study used Medicaid reimbursement rates for school health services to calculate the cost savings to the community. “We were thrilled with what we learned,” says Frederick. “The study proved that the cost savings to the community was 2.5 times the budget for the school health program in a single year.”

“The study was a conservative estimate on many grounds and didn’t even project any potential savings to the community that resulted from the preventive care services,” notes Forgione.

At the end of the 2001-2002 school year, the Children’s/AISD Student Health Services program took a look back at the progress in student health since the collaboration began. Program administrators found:

• implementation of a screening program to identify students at risk for Diabetes Type 2;

• nearly 400 percent increase in preventive screenings from the 1999-2000 school year to the 2001-2002 school year;

• completion care rate of 95 percent for vision referrals, 89 percent for hearing referrals and 80 percent for dental referrals in 2000-2001;

• more than 300 percent increase in RN health teaching from the 1998-1999 school year to the 2001-2002 school year and;

• health room visits for acute illness or injury care resulted in 89 percent return to class.

Overall, the report found that an individualized care plan for students with chronic or severe conditions helped keep them in school. For kids with asthma, studies showed that 83 percent who have an individualized plan in place and experienced breathing difficulty remained in school.

Since the program took off, Children’s/AISD Student Health Services has received a number of inquiries about their program from across the country. School districts want what AISD enjoys now — better student health at a better price. Today, the program offers other school districts what they’re calling Healthy Achievements, a consulting service that can study a district’s student health services and provide recommendations on systems, processes and products that can be delivered in a cost-effective manner. These recommendations are based on individualized assessments of the unique needs of each school district.

“We have a very successful systemic approach. While we have methods to develop the systems, the solutions are based on local resources,” notes Frederick. “School health programs can’t be packaged like products. They need to be individually tailored to each community.”

Following this maxim, Healthy Achievements offers services in the form of training modules. The modules support a wide variety of areas, including:

• environmental health/risk management,

• emergency and ill-child care,

• case management of students with special health care needs,

• medication management,

• staff development and competency assessment and,

• health screenings.

“We know how vital student health is and what it can mean for their education. We’d like to see it remain a priority everywhere,” says Frederick.