1. DC Action for Children, Washington, DC, June 3, 2003 Julia Graham Lear, PhD, Director Center for Health & Health Care in Schools, GWU School of Public Health & Health Services The Center for Health and Health Care in Schools Comprehensive School-Based Health Programs: The Impact of School Policies and Programs on Student Health

2. The Center for Health and Health Care in Schools Four Challenges to Building Effective, Sustainable School Health Programs Challenge of implementing organizational change Challenge of solidifying a quality program Challenge of securing adequate funding Challenge of building political support

3. 3 Shared Beliefs About School Health and Safety Children must be safe when attending school. Emergency medical services should be available and urgent services should be provided for persons in the school building. By law, all communities are obligated to provide the care needed to enable children with physical or mental health disabilities to benefit from a free, appropriate public education. Schools should educate children about keeping their bodies safe and healthy.

4. 4 Beyond Basic School Health Filling gaps in care -- within the community-based system, especially for low-income children, those needing mental health services, and for adolescents  Cost-savings & lives’ saving -- through early intervention and treatment  Times have changed -- children's parents may be inaccessible to schools or find it difficult to pick up child during school day

5. 5 Who’s in Charge: Traditional School Health Funding & Management Arrangements Traditional approaches School system funding/management eg. Boston, MA; most New England communities School system funding/health department management, eg. Detroit, MI; Milwaukee, WI Strengths: Institutional understanding of unique characteristics of health programs in schools; community good will; support for individual school nurses Weaknesses: Good managers but leadership not involved; Health must compete with education for education dollars

6. 6 Who’s in Charge: Newer School Health Money and Management Arrangements Newer approaches School system funding/private system managementeg. DCPS/Children’s Medical Ctr, Washington, DC School system funding/federal participation via Medicaid/various management arrangements, eg. Baltimore County PS, Baltimore City School system funding plus local-state dollars for underserved, Medicaid, philanthropy & private provider supporteg. Palm Beach County, Fl; Denver, CO

7. 7 Who’s in Charge: Strengths and Weaknesses of Newer Approaches Strengths Establishes broader funding base and/or political support Changes in program management, accountability structure will strengthen content and outcomes of program Weaknesses Requires on-going collaboration, partnerships Requires major changes in management, accountability measures

8. 8 Characteristics of Effective, Sustainable School Health Programs Data and epidemiologically-driven program design Transparency: Funding, program goals, staffing and service arrangements are clear Accountability: Reports to institutional leaders and to the public describe program performance against program goals CQI: On-going efforts to improve performance and measure the improvement

9. The Center for Health and Health Care in Schools Contact Information The Center for Health and Health Care in Schools 1350 Connecticut Avenue, NW Suite 505 Washington, DC 20036 202-466-3396 202-466-3467 fax www.healthinschools.org