Maximizing Student Health Resources

by HOWARD TARAS
In my 17 years of working with school districts in San Diego County on student health matters, I’ve concluded that public schools sometimes waste good intentions, time and resources on practices that don’t in the end serve the greater good of the student population.

We all understand how a young child’s or adolescent’s poor health frustrates even the best-laid pedagogical plans to educate them. But it’s less defensible that school health interventions themselves also often frustrate school administrators.

Difficulty with launching health programs smoothly and concerns about cutting into precious time and money for instruction of core subjects are familiar feelings to school leaders. Granted, school districts do not see improvement of student health as a primary goal. Most school personnel are trained on methodologies and theories that help achieve educational objectives directly.

Justifiably few receive training on how to indirectly improve achievement through work on health issues (such as dealing with student sleep patterns, immunization rates or compliance with doctor’s prescribed therapies). As such, health program administration in a medical facility may always be a more comfortable fit than it is in a school district.

Basic Guidelines
Nevertheless, implementing health policy and administering health programs in schools stand a better chance of being relatively undemanding and effective if a few basic guidelines are followed. As a pediatrician who has worked with several school districts, I can attest to several common, avoidable pitfalls that complicate school leaders’ tasks. Here are some suggestions:

* Tap underutilized community resources.
Hospitals, managed care plans, medical schools and physician groups are just as interested as you are in preventing student health problems. One school district asked such partners to provide each school site with free asthma management equipment. One HMO paid a school district each time a school-age member of their health plan received health education at school--something the school was doing anyhow.

Refer students with behavior problems early on to their doctors. Be sure doctors receive schools’ written descriptions of the aberrant behavior. You benefit with a better performing student and lower suspension and expulsion rates. And because children with behavioral problems overuse health resources, the health system and the students benefit too.

* Don’t isolate health issues into separate silos.
Funding for health programs is often disease-specific or issue-specific. For example, funding may be designated solely for school-based prevention of drug abuse or for management of attention deficit disorder. But issue-specific funding is often short-lived and then is replaced by funding for the latest hot topics, such as school violence or childhood obesity.

School staff should not be wasting time building issue-specific infrastructure only to let it whittle away while they turn to build another equally temporary program. To avoid this, apply policies and practices you develop for one funded health program to all similar health issues. For example, if you are setting up a physician referral system for students with asthma who are frequently absent, then apply that system for students frequently absent for any reason.

Another example: Because youth violence, drug abuse, teen-age pregnancy and other risk-taking behaviors share similar antecedents, school leaders could redirect funds from a program serving one health problem to strategies that address factors relating to all of them, such as a history of abuse or disengagement from school.

* Get the health expertise you need.
Include a school nurse in the district’s inner administrative circle to help direct limited health education and program funds to the most cost-effective programs.

You don’t want to be taken for a ride by unchallenged health information. On individual education plans and Section 504 plans, districts unwittingly overspend on health-related services prescribed by students’ doctors (such as special transportation or 1:1 nursing ratio). A school nurse (or a school doctor on a voluntary, contracted or hourly arrangement) should interact directly with students’ physicians to establish the best way for schools to meet a special health care need.

Resist the temptation to replace school nurses with health aides. The latter play an essential role in the functioning of a school health program, but only school nurses are trained to converse easily with doctors of ill-faring students and educate students and parents on health problems.

It’s no more expensive to purchase and promote health education curricula that actually change student behaviors than unproven programs. Use health educators, resources from the Centers for Disease Control and local university experts to scrutinize the literature and identify curricula that change student behaviors.

Ask Hard Questions
* Screen your school health requests carefully.
Aside from mandated vision and hearing screens, schools often are recruited to host other health screenings, such as cholesterol levels, drug testing of athletes and undiagnosed asthma and obesity.

Ask these hard questions before committing to host a screening program: Has the screen been proven to identify students likely to have future problems and to clear those who will not? Have schools been proven to be more cost-effective places to perform these screens versus a doctor’s office? Are resources in place to assist all students who “fail” the screen, regardless of health insurance status or parent income? Is the financial interest of a proprietary firm behind the screen’s promotion? Will the screen’s results help you educate students? Are school staff using precious time to elicit parent permission, explain the screen, make the referrals and assure follow up?

Enlist a local public health official to help answer some questions. You may find that cholesterol screening is not recommended for all children. Efficacy of vision therapy is highly controversial. And drug testing excludes alcohol (the most widely abused drug and contributor to sports injury). No research yet demonstrates that school- or grade-wide screening for asthma or obesity improves these children’s eventual outcome.

When you receive requests to advertise a community-based health program in your newsletters or when asked to help celebrate "National Disease ‘X’ Month," ask a health professional on your staff to determine whether this cause fits into your school health priorities. If it does, study how it can be linked specifically to activities that already exist. Finally, turn the tables around and inform those who have made this request on how modifying their services would better fit your schools' needs. This is what the Centers for Disease Control promotes as "coordinated" school health programs.

* Be proactive by developing your own health objectives.
Determine what health problems are most important to your school district. Is it excessive absenteeism for illness? Behavioral problems disrupting the classroom? Overspending on special health procedures? Outdated health policies and procedures? A districtwide health council that includes community representatives, teaching staff and health staff can effectively identify priorities.

Howard Taras, a pediatrician, is a professor of community pediatrics at University of California at San Diego, 2251 San Diego Ave., San Diego, CA 92093. E-mail: htaras@ucsd.edu.