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Rural Health Association of Tennessee
Melisa Fuhrmeister – State Director
Middle Tennessee
• Only state in the nation with Coordinated School Health in every school district.
• Research shows strong connection between health and academic achievement (grades, standardized tests, graduation rates, attendance)
• Research shows that healthy students are better learners
• Research shows that academic achievement bears a lifetime of benefits for health
• Research shows that youth risk behaviors, such as physical inactivity, unhealthy dietary behaviors, tobacco use, alcohol use, and other drug use are consistently linked to poor grades and test scores and lower educational attainment
TN Coordinated School Health - Foundation
2
Coordinated School Health
3
• This coordinated approach improves students' health and their
capacity to learn through the support of families, communities and
schools working together.
• The primary mission of the office is to improve student health
outcomes as well as support the connection between good health
practices, academic achievement and lifetime wellness.
What is Coordinated School Health
4
Coordinators ensure evidence-based
interventions are provided that build
and sustain a healthy school
environment for all.
5
Components of CSH
Our Team
6
Mark Bloodworth
Data & Fiscal Analyst
Christine Rockwood
Physical Education/Physical Activity
SpecialistChristie Watson
School Nurse Consultant
Lori Paisley
Executive Director of Healthy
Schools
Melisa Fuhrmeister
State Director of Coordinated
School Health
Wanda Harris
Administrative Assistant
Currently Vacant
State Coordinator of Coordinated
School Health
Healthy Schools
Coordinated School Health (CSH) and School Nutrition
Strengthening the partnership between CSH and School
Nutrition, further supporting the fact that healthy students
are better learners, sustaining health school environments
so students receive the support needed to make healthy
choices.
Brief History of CSH in TN…
8
1998 CDC
CSH Model
2000
Authorization &
funding for CSH
in TN
2001
OCSH established by
TDOE; 10 district pilot
sites across the state
2006
Legislative
mandate for
CSH state-wide
July 2007
All TN public
school districts
have CSH2007-2017
BMI rates
declined from
41.2% to 39.2%
1. Vision 1 in 5 youth have vision problems
2. Asthma Asthma is the most common chronic disease
3. Teen Pregnancy Teen pregnancy will affect 1 in 3 teens
4. Aggression & Violence Aggression and violence affects children at all levels; 28% of students in grades 6-12 experienced bullying
5. Physical Activity 2 out of 3 children don’t get enough physical activity
6. Breakfast 22% of children skip breakfast on any given day
7. ADD/ADHD ADD/ADHD affect 4.6 million school-aged youth
Educationally Relevant Health Disparities
9
• Beginning in the 2017-18 school year, chronic absenteeism became a part of district and school accountability. The measure will be called the Chronically Out-of-School Indicator.
• This indicator is based on what research calls chronic absenteeism, which is defined as a student missing 10 percent or more of the days the student is enrolled-for any reason, including excused absences and out-of-school suspensions.
Chronic Absenteeism
• Student health, including seasonal as well as chronic conditions such as asthma or diabetes, can be a significant factor in student absences.
• Coordinated school health directors and school nurses are an excellent source of data on district and building-level chronic health conditions of students.
• These individuals can be an excellent source of suggestions and practices in reducing health-related absences.
Chronic Absenteeism and Coordinated School Health
• The Coordinated School Health Annual Report provides information on programmatic outcomes and selected student health indicators data.
• The Annual Health Services Report provides information on chronic health conditions and health services provided to students.
• The Youth Risk Behavior Survey (YRBS) collects data on health-risk behaviors among youth.
• The School Health Profiles collect data on local school health policies and practices.
Coordinated School Health Data
12
• Goal 1: Reducing Childhood Obesity
– Four objectives on physical activity, nutrition, comprehensive
health education, and parent outreach/involvement
• Goal 2: Asthma, Vision, Violence/Aggression, Teen Pregnancy
Prevention, ADD/ADHD
• Goal 3: District choice based on needs identified; staff wellness,
chronic absenteeism, etc.
District Action Plans
13
TN Student BMI Rates
2008
41.2
2017
39.2
Physical Activity Law
15
Elementary Schools
Middle & High Schools
130 Minutes Per Week
90 Minutes Per Week
Percentage of TN students who were physical active for a total of at least 60 minutes per day
Physical Activity Highlights Since Statewide Expansion
• Hunger and food insecurity contribute to chronic absenteeism.
• One source of critical support for students who are at-risk is healthy breakfast, lunch and snacks that are free or reduced.
• Healthy food at school is an incentive for students to attend regularly.
• Chronic Tardiness can be improved through alternative breakfast programs.
• Summer feeding programs give students the nutrition they need to learn, play and grow throughout the summer.
Nutrition
18
Nutrition
• Universal breakfast is an additional incentive for parents to ensure their child is in school and on time.
• Breakfast After the Bell models: breakfast in the classroom, grab ‘n’ go, and second chance breakfast ensure that no student is hungry and can focus on learning.
• Free supper program provided to all children ages 2-18 served after academics are completed in the after school program.
Strategies Used in Tennessee Schools
Chronic Health Conditions
• The effects of chronic absenteeism can last a lifetime and can negatively impact education, health, and postsecondary success.
• Research clearly shows that health issues are a primary cause of chronic absenteeism.
• Chronic health conditions are often a barrier to attendance and contribute to chronic absenteeism.
Chronic Health Conditions & Chronic Absenteeism
Strategies Used in Tennessee Schools
• Asthma education packets sent home with every student with an asthma individualized healthcare plans (IHPs) to provide parent and student education and better management of the condition.
• Request health services data, it’s available. For example, identify the number of students with chronic illnesses in each of your schools and ensure they each have a plan in place and the services they need to attend class each day.
• Increase and strengthen communication between school nurses and the attendance office related to students visiting the clinic often and/or going home for illness often.
• In 2016-17, there were 4,031,420 student visits to a school nurse. – 86% of those visits resulted in a student’s ability to return to class instead of being sent
home.
• The school nurse is often the only healthcare provider students see at school and at home.– Schools with a full-time nurse have higher return to class rates than those who don’t as
school nurses have the ability to assess where other school staff do not.
• The school nurse is often the only healthcare provider in a school for both emergencies and daily chronic illness management.– Due to services students receive from the school nurse, they are able to attend school and
succeed. For example, breathing treatments given at school by the school nurse.
• School nurses assist students in learning to manage their chronic health conditions, increasing time in the classroom and decreasing absenteeism.– Nurses educating students to manage their diabetes at a level right for his/her age allows
the student to learn to be independent and reduces out of class time to visit the doctor.
School Nurses and Their Impact
24
• School-based health clinics can provide health care to students in the school who would otherwise be sent home or to a provider outside of the school.
• Rural communities utilize school-based health clinics when there are no medical offices and/or hospitals.
• School-based health clinics decrease the amount of time students and parents would take to visit a doctor’s office.
• School-based health clinics keep parents from missing work.
School-Based Health Clinics
25
• Of the 276 Tennessee schools that provided clinic services in 2016-17, 67% used tele-medicine, 68% provided services to staff as well as students, 25% provided immunization and 8% provided dental services.
• Over the past year, the number of school clinics using tele-medicine increased by 35%.
• Some districts have community partners and/or grants that provide part or all of the funding for equipment.
Tele-medicine in Schools
• With asthma being the leading chronic health condition of Tennessee students, improvements in classroom and school air quality as well as improvements to school climate are closely associated with improvements in attendance. One resource is the EPA’s Tools for Schools.
• Student Health Advisory Councils are successful in giving students a voice in school climate and culture needs through action planning with district staff to improve the overall school environment.
Safe & Healthy School Environment
27
• Mental health is one of the most common issues affecting chronic absenteeism. Depression, anxiety, and oppositional defiant disorder can be related to school avoidance behaviors.– Youth Mental Health First Aid, school climate surveys and trauma
informed practices are available resources.
• Counselors, social workers, psychologists and school nurses provide wrap around services.– The lack of funding is a challenge that can be overcome by partnering
with community agencies who will work with districts to provide services.
Mental Health Services
28
• Biennial survey of adolescent health risk and health protective behaviors conducted with CDC since 1991.
• These behaviors are often established during childhood and early adolescence include:– Behavior that contributes to unintentional injuries & violence
– Alcohol and other drug use
– Tobacco use
– Unhealthy dietary behaviors
– Inadequate physical activity
• Conducted in Tennessee high schools, randomly selected by CDC. Self reported by students.
Youth Risk Behavior Survey (YRBS)
29
• High school students who did not go to school because
they felt unsafe at school or on their way to or from school
increased from 5.0% in 2011to 8.0% in 2013. It continued
to increase to 9.3% in 2015 but declined to 8.1% in 2017.
2017 YRBS Results
30
• High school students who reported being bullied on school
property increased from 21.1% in 2013 to 24.1% in 2015
but decreased to 20.3% in 2017.
• Staff training, Olweus Bullying Prevention Program, Stop!t
app, Above the Line are some of the strategies being used
in Tennessee schools.
2017 YRBS Results
• High school students who felt sad or hopeless increased
from 28.0% in 2015 to 31.1% in 2017.
• Utilizing chronic absenteeism data as well as health
services data can help identify students who may need
more mental health support and/or services.
2017 YRBS Results
Questions and Discussion
33
Excellence | Optimism | Judgment | Courage | Teamwork
Districts and schools in Tennessee will exemplify excellence and equity such that all
students are equipped with the knowledge and skills to successfully embark on their chosen
path in life.