Jay Dardenne



Sample Materials from

State Advocacy Campaigns

State Communication Samples

➢ Illinois “An apple a day is not enough” Action Alert

➢ Connecticut: What you should know about school-based health centers

➢ Louisiana: The Louisiana Assembly on School-Based Health Care Believes

➢ Maine: Case in Point – Real Students, Real Stories

Key SBHC Messages

➢ NASBHC’s four primary messages

➢ Answers to frequently asked questions

➢ Other sample messages

Op-eds

➢ Gordon/McCord/Tayloe articles

Legislative Correspondence

➢ Louisiana Governor/Response

➢ Connecticut State legislator

An apple a day is not enough!

School Health Centers keep kids healthy!

What are School Health Centers (SHCs)?

School health centers provide primary and preventive health care services to students while reducing lost school time, removing barriers to care and promoting family involvement. Services are accessible, affordable and youth-friendly. Providers are available on a 24-hour basis.

School Health Centers in Illinois

The first 6 centers were established between 1982 and 1985. Since then the number of SHC has grown to 42. Half of these serve high schools and the other half serves elementary and middle schools.

School Health Centers WORK!

They contribute to:

➢ Fewer hospitalizations and emergency room visits

➢ Decrease in smoking tobacco and marijuana

➢ Decline in teen pregnancy

➢ Increased knowledge about health among youth

➢ Fewer school absences

➢ Lower school drop-out rates

SHCs Services May Include:

➢ school & sports physicals

➢ immunizations

➢ mental health services

➢ comprehensive health & sexuality education

➢ nutrition education

➢ diagnosis and treatment of illness

➢ laboratory

➢ reproductive health services

➢ vision and hearing screening

➢ first aid for minor injuries

How do SHCs Benefit Children & Adolescents?

A 1994 study conducted in seven Chicago high schools found:

➢ SHCs reach populations that are most likely to drop out of school.

➢ Cigarette and marijuana smoking decreased at schools with SHCs.

➢ Students at SHCs had higher detection rates for STDs, including HIV. (Ounce of Prevention Fund, 1997)

A study of nine SHCs found that providing teens with school-based primary care results in increased use of preventive health services, resulting in fewer hospitalizations and emergency room visits. (Santelli, et al., 1996)

In one study at an alternative school, SHC users were less likely to be absent and more likely to graduate or be promoted than other students not using the SHC. (McCord, et al 1993)

In comparison to schools without SHCs, students in schools with SHCs gain improved health knowledge and increase their use of health care, especially, students with little access to health care or great need for health care. (Kisker & Brown, 1996)

One community reduced its adolescent pregnancy rate from 77 to 37 per 1,000 women ages 14 to 17 through a school- and community-based pregnancy prevention program. This significantly lower rate rose again to 66 per 1,000 after the state prohibited dispensing contraceptives on school grounds. (Koo et al., 1994)

ILLINOIS CHILDREN & YOUTH ADVOCACY DAY

is co-sponsored by: Chicago Public schools, Henry Booth House, Health & Medicine Policy Research Group, Illinois Caucus for Adolescent Health, Illinois Coalition for School Health Centers, Illinois Maternal & Child Health Coalition, Illinois Women's Health Coalition, March of Dimes Birth Defects Foundation, Mercy Dunbar Health Care Center, Ounce of Prevention Fund, Swedish Covenant Hospital Health Center at Roosevelt High School, Voices for Illinois Children

WHAT YOU SHOULD KNOW ABOUT

SCHOOL-BASED HEALTH CENTERS

IN CONNECTICUT

WHY

Today's children and teenagers face serious health risks. Over the last 30 years, adolescents are the only age group whose health status has not improved. They are our nation's - and our state's -most underserved population. Threats to the health of Connecticut youngsters include:

➢ Poverty

36% of the students visiting Connecticut's SBHCs have no regular appropriate source of health care and only 35% have some type of private insurance.

➢ Violence and psycho-social problems

Of the 42, 000 psycho-social services provided in Connecticut in 1993/94, more than 13, 000 involved counseling for violence and family, peer, stress, substance abuse and depression problems.

➢ Substance abuse

In a recent national survey, 25% of eight graders said they had used an illicit drug at least once up from 22.5% last year. The figure rises to 35% when inhalants are included

➢ Pregnancy and sexually-transmitted diseases

Connecticut has the third highest rate of births to single teens in the nation. In Connecticut, 30 % of all sexually transmitted diseases are among teens.

➢ Mental health problems

In a survey of Connecticut high school 1juniors and seniors, taken during the 1993-94 school year, 1 in 10 reported that they had tried to kill themselves.

WHAT

Access to health care is critical for this population at risk. Obstacles such as lack of transportation, money or insurance, and knowledge about preventive care keep young people from obtaining the services they need. School-based health centers are an important element in meeting the health needs of underserved children and adolescents.

Delivering health care at school is not a new idea. What is innovative about school-based health centers is the commitment to comprehensive care, on-site, delivered by a multi-disciplinary team of health care professionals.

HOW

Connecticut's school-based health centers operate under the auspices of a variety of organizations, including local health departments, mental health agencies, community health centers, a school system, and a private, not-for-profit board of directors. Each is designed and based on community capacity and need and operates with a mix of public and private funds including federal, state and city monies, local and national foundations, donations, and community agency contributions.

School-based health centers are staffed by a multidisciplinary team including nurse practitioners, mental health professionals and additional ancillary health personnel as needed. Services include physical exams; diagnosis and treatment of acute and chronic illness; immunizations; nutrition and weight management; health risk prevention education; mental health services; crisis intervention; individual, group and family counseling; education and training. Some centers also offer specialized program components such as dental services, parenting training, substance abuse prevention and family outreach and counseling services.

WHERE

29 school-based health centers, funded by the Connecticut Department of Public Health and Addiction Services (DPHAS) are located in elementary, middle and high schools in communities across the state including Branford, Bridgeport, Danbury, East Hartford, Groton, Hartford, Middletown, New Haven, New London, Norwalk and Stamford. Eleven additional centers will open in March 1995 in Bridgeport, East Hartford, Groton, Hamden, Middletown, New Haven, Norwalk, Stamford, Stratford and Windham. In addition, Ansonia and Meriden are planning for the establishment of school-based health centers.

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Letters to the Editor:

Published in the Raleigh News Observer

I am writing in response to Ann Frazier's misrepresentation of school-based health centers. I speak with 12 years of experience as the physician assistant in a school-based health center.

On any given day, most students come to the center with sports injuries, stomach pain, respiratory symptoms, rashes and headaches. I am there to make sure these complaints do not indicate a serious medical problem. If they don't, I treat the student and most often send the student back to class to continue his or her academic day.

Much less frequently, a student comes in concerned that he or she might have contracted a sexually transmitted infection, and, thank goodness, I am there to diagnose and treat that medical problem as well.

School-based centers do not dispense contraceptives, as Frazier must know. School-based centers do provide immunizations, health education and nutrition services. Staff in school-based centers collaborate with guidance staff, school nurses, teachers and administrators to promote the health and well-being of the students. Many clinicians in school-based centers treat family members of students and school personnel.

In schools with centers, students and families have access to immediate care for problems that would otherwise require a parent to leave work and the student to miss school. Centers support our schools and families by keeping kids in school and parents at work. To accuse these centers of undercutting important family values is a malicious misrepresentation of a service schools and families have come to trust and rely on.

I hope the parents, students, school administrators, community leaders and medical community take Frazier's letter as a rallying call to actively support school-based health centers for what they are: responsible, professional medical services which support the families in the communities they serve.

RIVKA GORDON

N.C. School of Science and Math, Durham

Tuesday, June 13, 2000

I am concerned about a misconception of school-based/school-linked health centers (SB/SLHCs).

Your May 27 editorial "Rigors of youth" stated that "schools need to concentrate on education and not be saddled with what properly is handled in homes and clinics, and by imaginative county health departments." That is the beauty of SB/SLHCs, as they are actually managed and run by advisory boards, completely separate from the school administration.

Children receive accessible and affordable health care with minimal loss of school time and a complete absence of lost work time for parents and guardians. Care is given in a confidential manner and only with full consent of parent or guardian. What better way is there to attack our growing concerns?

This way, there are no missed opportunities to inquire about smoking, weight concerns, exercise habits, eating disorders and a multitude of other health-related topics that our children so desperately need. So, take it directly from an "imaginative county health department" physician, please do not be lost in the misconceptions about SB/SLHCs. Research them. Go visit one. Ask the principals if they feel "saddled" by them. You will be amazed by how a child can learn and grow when given access to all those things they so greatly deserve.

MARCELLA T. McCORD, M.D.

Raleigh

Tuesday, June 5, 2000

OP-ED: Better Health Care for N.C. Students

David Tayloe, Jr.

Approximately 49 percent of babies born in our state are born to mothers on Medicaid. These babies are covered by Medicaid as long as their families' incomes are less than certain age-based eligibility limits. From birth to age 1 year, the upper limit is 185 percent of the Federal Poverty Level; from 1 to 6 years, 133 percent of the poverty level; and, from 6 to 19 years, 100 percent. Therefore, many children are dropped from Medicaid as they age from 1 to 6 years.

This means that many children who start life receiving health services in a primary care physician's office are forced to enter the haphazard, fragmented health care environment of the indigent uninsured.

We know that insured children are healthier than uninsured children. Pediatricians were ecstatic when the General Assembly adopted a very progressive State Child Health Insurance Program, called Health Choice. It offered "no-longer-Medicaid" children state-subsidized health insurance comparable in benefits to Medicaid. We cold provide seamless primary care for all children who are born into Medicaid until they graduate from high school.

The largest number of Health Choice beneficiaries are school-aged children. Many of these children do not come to physicians' offices for health supervision. Many have significant behavioral and emotional problems and need the services of mental health professionals.

Pediatricians are developing partnerships with local schools, hospitals, health departments and mental health agencies to make health services available to school-aged children in their schools. I'm the volunteer medical director for two very busy middle school

health centers. I review all the medical records of the students and supervise the health care delivered by nurses, nurse practitioners, mental health clinical social workers and nutritionists.

I am amazed at the number of students who really need to see a mental health professional. These are the students who are causing our juvenile crime statistics to soar in the wrong direction. We need to help these children at school and as early as possible. However, the General Assembly prohibits school health centers from billing the Health Choice Program for mental and physical health services rendered to eligible children, except for immunizations.

School health centers are not financed by the schools or by the state. Most are established through private grants that cover start-up costs for the first three years. If the centers are to continue, they must generate revenue. Currently, our centers can bill Medicaid and Blue Cross for services. Uninsured children's families are required to pay cash for services according to the same sliding scale that county mental health centers use.

Most of the uninsured children's families are required to pay cash for services according to the same sliding scale that county mental health centers use.

Most of the uninsured children at our schools are eligible for Health Choice. These children will not be able to receive mental and physical health services after our grant funding runs out unless our county agencies convince county commissioners to fund the health centers, or unless the General Assembly amends the Health Choice statutes to allow school health centers to be reimbursed for services.

I understand that the General Assembly created this confusing situation because some citizens asserted that school health centers

promote sexual activity be giving out condoms and by referring pregnant students for abortions. I am very disappointed that the General Assembly believed these ridiculous falsehoods.

The legislature is addressing juvenile crime with a major appropriation that pays for a more punitive program than we have now, while tying the hands of those of us who want to go into the schools and give troubled adolescents access to mental health evaluations and counseling.

Health Choice should address the big picture for eligible adolescent children. The traditional office-based health centers are beginning to do a better job.

I have spent more than 20 years developing a very large pediatric group practice, but our practice, like those of so many pediatricians, is overwhelmed with the demands of babies and preschool children. We have really done very little for adolescents, and our offices are not likely to become user-friendly for adolescents in the near future. We need to make comprehensive health services available to the adolescents where they are – in the schools. Parents want school health centers, and they give their consent for their children to receive services in the centers.

I urge legislators to reconsider the Health Choice statutes and to amend them to encourage the establishment of school-based health centers as a major part of the legislature's effort to do something constructive and preventive about juvenile crime.

David Tayloe Jr., M.D. is chairperson of the Committee on Government Affairs for the North Carolina Pediatric Society/NC Chapter of the American Academy of Pediatrics

PO Box 407

Jena, LA 71342

Dear Governor Foster,

My name is Myrna Ward. I have been a resident of LaSalle Parish and the town of Jena for the past seven years. I am a single mother with 2 boys – Jamie is a Freshman at NSU and CJ is a freshman at Jena High School.

I would like to relate a story to you that I feel is very important to the parents and children of LaSalle Parish and to the state. A few weeks ago, my son CJ was given a physical exam to play basketball at JHS. At Jena High we have a School Based Health Center that is operated by St. Francis Cabrini Hospital. The nurse practitioner at the Health Center administered the physical and while doing so she detected a heart murmur. She had CJ come back in the next day so that Dr. Krahe could listen to the murmur. Dr. Krahe determined that the murmur was aortic. He recommended that I take CJ to see his family doctor to have an EKG, Echocardiogram & Chest X-Ray done. We did so the following day at LaSalle Parish Hospital. The preliminary test results showed a congenital heart defect and we were immediately sent to Friedman Clinic in Alexandria. Dr. Shaw at the Clinic confirmed test results ran more tests and diagnosed congenital heart defect—the aortic value was malformed from birth. This malformation is causing leakage of blood back into the heart and if not corrected can be fatal. CJ will soon undergo valve replacement surgery and hopefully live a long, healthy life.

Due to the quick action of the staff at the Health Center, my son got the medical attention he needed. Words will never express my heartfelt thanks to them for their attention. The staff is a group of caring, compassionate professionals – concerned with keeping children healthy.

Being from small towns all of my life, I know how valuable medical care is. I also know that there are many children in our state who do not receive proper medical care because they’re not insured and cannot afford to see a doctor. I believe that School Based Health Centers can be the beginning of something really great for school-aged children who might not get medical care otherwise.

I don’t know where your administration stands on School-Based Health Centers but it is my hope that you will support these wonderful organizations. You have been a great Governor for our state and I will continue to support you in your endeavor to make LA a wonderful state to live in—our children are our future—we should try to make it the best state possible for them to grow up in.

Thanks for your time!

Sincerely,

Myrna Ward (signed)

November 1, 1999

Myrna Ward

P.0. Box 407

Jena, LA 71342

Dear Ms. Ward:

I have received your letter regarding your son’s experience with your local school based

health center and thank you for writing.

Often times, we only hear of the negative impacts of such programs. It is truly rewarding to

hear a success story. I give my best wishes to your son for a successful operation and a

speedy recovery. I will keep you and your family in my prayers.

Thank you again for taking the time to share this wonderful story with me.

Sincerely,

M.J. "Mike" Foster, Jr.

cs/Cjs

Manchester Memorial Hospital

East Hartford Connecticut

March 4, 1998

Senator Toni Harp

Room 3000

Legislative Office Building

Capitol Avenue

Hartford, CT

Dear Sen. Harp:

I am writing to you requesting your support of our efforts to secure continuation

funding for those School Based Health Centers that were initiated under a grant from

the Graustein Foundation. These sites will lose their funding and be forced to close

by the end of this school year unless the line item for the School Based Health Center

budget is increased by $567,000. The Graustein sites are located in Bridgeport, New

Haven, Stamford and Hartford, and have served the physical and mental health care

needs of children in these areas for the past two years. I ask that you support our

efforts to maintain the continuity of care that these children deserve by voicing your

support to members of the Subcommittee on Hospitals and Health Care of the

Appropriations Committee. Decisions regarding the addition of this money to the

DPH budget will be made on Friday, March 6, 1998. Any attention you could give

this matter would be greatly appreciated, and again, thank you for your past and

continued support of the School Based Health Center Program.

Sincerely,

Deborah Poerio, APRN, MS

Coordinator, East Hartford SBHC Program

-----------------------

ACTION TO TAKE

Increase funding from $2.4 million to $10.4 million. The additional $8.million would support existing SHCs and fund the opening of 10 new health centers in Illinois. It costs the average SHC $400, 000 to operate at full capacity.

Allocate a portion of the Tobacco Settlement Funds for School Health Centers. These funds were awarded in large part because children and youth were being targeted by tobacco companies. Funds should be used to keep them healthy and prevent unhealthy behaviors.

State of Louisiana

OFFICE OF THE GOVERNOR

Baton Rouge

POST OFFICE BOX 94004

(225) 342-7015

M. J. "Mike" FOSTER, JR.

GOVERNOR

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