The Proof Is In The The Proof Is In The PuddingPudding

Health and Education forHealth and Education for

student / community successstudent / community successA case study of Roy Clark Elementary – Union Public A case study of Roy Clark Elementary – Union Public

SchoolsSchoolsTulsa, Oklahoma Tulsa, Oklahoma

John M. Gaudet, MPH, BS, ADN John M. Gaudet, MPH, BS, ADN

Theresa Kiger, M.Ed.Theresa Kiger, M.Ed.

The Proof Is In The PuddingThe Proof Is In The Pudding

Presentation OverviewPresentation Overview– The state of health in Tulsa, Oklahoma The state of health in Tulsa, Oklahoma – Review of the medical home concept for the Review of the medical home concept for the

medically marginalized within a designated medically marginalized within a designated community schoolcommunity school

– OU-TACH’s school based clinic descriptionOU-TACH’s school based clinic description– Why Roy Clark Why Roy Clark

Healthcare finding Healthcare finding Correlation of Data from health records to school report Correlation of Data from health records to school report

cardscards

– Discussion of Preliminary FindingsDiscussion of Preliminary Findings Data Analysis Data Analysis Summary of key findingsSummary of key findings

The Reason for a Health Clinic at The Reason for a Health Clinic at school …school …

““You can’t educate a child who isn’t You can’t educate a child who isn’t healthy, and you can’t keep a child healthy, and you can’t keep a child

healthy who isn’t educated.”healthy who isn’t educated.” former U.S. Surgeon General Joycelyn Elders:former U.S. Surgeon General Joycelyn Elders:

OklahomaA State of Health?

“We are the ONLY state where our age-adjusted death rates became WORSE through the 1990s and into this century.”

“If we had the same adjusted death rate as the nation, we would have about 3,700 fewer people dying each year.”

Oklahoma State Board of Health “2006 State of the State’s Health” Graphic: University of Oklahoma College of Public Health. Data Source: U.S. Centers for Disease Control and Prevention

AGE ADJUSTED DEATH RATE

U.S

OK

Oklahoma Economic Class As Oklahoma Economic Class As It Relates to Health CareIt Relates to Health Care

Poverty ClassPoverty Class– Poor health status – die 14 years earlierPoor health status – die 14 years earlier– Limited access to care – 4% of doctors near Limited access to care – 4% of doctors near

homes homes Middle ClassMiddle Class

– Low healthcare qualityLow healthcare quality– High cost health careHigh cost health care

Wealth ClassWealth Class– Low health care quality and high costLow health care quality and high cost– High cost of charity careHigh cost of charity care

Access to Health Care Varies Dramatically By Zip Code:

For every 1 physician in north, east and west Tulsa, there are 26 in mid-town and south Tulsa

The Medical Home ConceptThe Medical Home Concept

The American Academy of Pediatrics Policy StatementThe American Academy of Pediatrics Policy Statement

Accessible, continuous comprehensive, family Accessible, continuous comprehensive, family centered, coordinated, and compassionatecentered, coordinated, and compassionate

Manage or facilitate essentially all aspects of Manage or facilitate essentially all aspects of pediatric care pediatric care

The physician should be known to the child and The physician should be known to the child and family and should be able to develop a relationship family and should be able to develop a relationship of mutual responsibility and trust with them. of mutual responsibility and trust with them.

Source: DuPlessis, Helen, M., Cora-Bramble, Denice. (2005). American academy of pediatrics policy statement: providing care for immigrant, Source: DuPlessis, Helen, M., Cora-Bramble, Denice. (2005). American academy of pediatrics policy statement: providing care for immigrant, homeless, andhomeless, and immigrant children. immigrant children. PediatricsPediatrics, Vol. 115 (4), 1095-1100 , Vol. 115 (4), 1095-1100

BREAKING THE CYCLE BREAKING THE CYCLE OF POVERTYOF POVERTY

Children in poor health miss more school Children in poor health miss more school days and have lower cognitive days and have lower cognitive developmentdevelopment

Lower educational attainment Lower educational attainment contributes to lower wages and lower contributes to lower wages and lower labor force participationlabor force participation

Thus increasing the likelihood of not Thus increasing the likelihood of not being insured as an adult and increasing being insured as an adult and increasing the odds of continued poor healththe odds of continued poor health

KAISER COMMISSION on Medicaid and the Uninsured, 2002KAISER COMMISSION on Medicaid and the Uninsured, 2002

New Concepts in Health & New Concepts in Health & DiseaseDisease

Allostatic loadAllostatic load– Additive burden of psychosocial stresses Additive burden of psychosocial stresses

produces physiological damageproduces physiological damage Weathering PhenomenonWeathering Phenomenon

– Stressed people age fasterStressed people age faster Physiological CapitalPhysiological Capital

– Genes – environment – behaviorGenes – environment – behavior Neighborhoods (community schools)Neighborhoods (community schools) Education to change behavioral normsEducation to change behavioral norms

HealingHealing

Restoring a whole person to a state of Restoring a whole person to a state of right relationships with…right relationships with…– Biological – “milieu interior”Biological – “milieu interior”– Psychological – self-identity in human dignityPsychological – self-identity in human dignity– Social – family and communitySocial – family and community– Spiritual - transcendentSpiritual - transcendent

Sulmasy D. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. 2006 The Georgetown University Press, Washington, DC.

OU Tulsa Alliance for Community Health OU Tulsa Alliance for Community Health

School Based HealthcareSchool Based Healthcare

School based health centers are designed to School based health centers are designed to serve students, their family members, serve students, their family members, extended family and the communityextended family and the community

regardless of their ability to pay.regardless of their ability to pay. No school program is exactly the same except forNo school program is exactly the same except for

OU Tulsa Alliance for OU Tulsa Alliance for Community Health Community Health

Comprehensive Primary CareComprehensive Primary Care Acute care Acute care Mental and Behavioral Health CareMental and Behavioral Health Care Health Promotion Health Promotion EducationEducation Oral Health screenings Oral Health screenings

and Educationand Education Social ServicesSocial Services Outreach Outreach Home VisitsHome Visits

Why A Health Clinic As Part of Why A Health Clinic As Part of The Community School ConceptThe Community School Concept

Students, families, schools & community Students, families, schools & community partners working together…partners working together…

Children learningChildren learning Families succeedingFamilies succeeding Neighborhoods engagingNeighborhoods engaging Communities thrivingCommunities thriving

Source: Community Service Council of Greater Tulsa

Why Roy Clark ElementaryWhy Roy Clark Elementary

Designated as a Community SchoolDesignated as a Community School 90% of students qualify for the free lunch 90% of students qualify for the free lunch

programprogram 84% are minority (high % Hispanic students)84% are minority (high % Hispanic students) Evidence of improved API scores in last 3 Evidence of improved API scores in last 3

yearsyears An estimated 80% of Clark students An estimated 80% of Clark students

demonstrate conditions associated with demonstrate conditions associated with stress and poverty: slowed learning, stress and poverty: slowed learning, impassivity, quick tempers and problems impassivity, quick tempers and problems defining personal space defining personal space Source: Theresa Kiger, Roy Clark Elementary School Principal 2008

Why Roy Clark Elementary?Why Roy Clark Elementary?

0

500

1000

1500

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3500

# of Patients

# of VisitsSchool Year 2006-2007

The Roy Clark ClinicThe Roy Clark Clinic

TACH Roy Clark School Based Clinic

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1000

1500

2000

2500

3000

3500

2005 2006 2007

School Year

Patient Visits

Total Patients

Key FindingsKey Findings

CLINIC FINDINGSCLINIC FINDINGS Underutilization of clinic by African Underutilization of clinic by African

American students/familiesAmerican students/families Major use of clinic by Hispanic Major use of clinic by Hispanic

families Compared to the other families Compared to the other established clinics, established clinics,

Roy Clark has the highest percentage Roy Clark has the highest percentage of preventative visitsof preventative visits

Patient DemographicsPatient Demographics

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10

20

30

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60

White AfricanAmerican

Hispanic NativeAmerican

Asian

Roy Clark Patient Demographics

SY 2005

SY 2006

SY 2007

05

1015202530354045

Percentage

White AfricanAmerican

Hispanic NativeAmerican

Other

Race

Roy Clark Student Demograhics

SY 2005

SY 2006

SY 2007

Among African Americans, there is almost a 15% difference between the clinic users and student population

% Preventative Visits 2005-% Preventative Visits 2005-0707

Top 5 Diagnosis Per VisitTop 5 Diagnosis Per VisitDiagnosis 2005 2006 2007

1 Routine Infant Routine Infant Routine Infant

2 Acute UpperRespiratory

Acute UpperRespiratory

ChildhoodImmunizations

3 ChildhoodImmunizations

Allergic Rhinitis

Acute UpperRespiratory

4 Pharyngitis Pharyngitis Ear Infection

5 Gastroenteritis Ear Infection Allergic Rhinitis

Key FindingsKey Findings

SCHOOL RELATED FINDINGSSCHOOL RELATED FINDINGS API scores have increase over last 3 API scores have increase over last 3

yearsyears Attendance rate has increased over Attendance rate has increased over

last 3 years last 3 years Mobility decreased from 2005-06Mobility decreased from 2005-06

Federal Free/Reduce Lunch Federal Free/Reduce Lunch ProgramProgram

78

80

82

84

86

88

90

92

94

2003 2004 2005 2006

Free/ Reduce

Academics-APIAcademics-APIAcademic Performance IndexAcademic Performance Index

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200

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600

800

1000

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1400

1600

2003 2004 2005 2006

ReadingMathTotal

MediaMedia

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1000

2000

3000

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5000

6000

7000

2003 2004 2005 2006

Number ofbooks permonth

Attendance Rates 2005-Attendance Rates 2005-20072007

560

580

600

620

640

660

680

700

720

2005

2006

2007

CommunicationCommunication

0102030405060708090

100

2003 2004 2005 2006

Attendance Rate

Parent TeacherConf.

Student CharacterStudent Character

0%10%

20%

30%

40%50%

60%

70%

80%90%

2003 2004 2005 2006

Good Behavior

Data TeamsData Teams

Collaboration built into daily scheduleCollaboration built into daily schedule Focused InstructionFocused Instruction AnalyzingAnalyzing AssessmentsAssessments AccountabilityAccountability Title One FundsTitle One Funds Data DaysData Days

Questions?Questions?