12/12/2012. Agenda PRESENT AND ENGAGED IN THE EARLY GRADES: IMPROVING HEALTH TO INCREASE SCHOOL ATTENDANCE

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1 PRESENT AND ENGAGED IN THE EARLY GRADES: IMPROVING HEALTH TO INCREASE SCHOOL ATTENDANCE WEBINAR #5 HEALTHY READERS DECEMBER 13, Agenda 1:00 pm Welcome ~ Susanne Sparks 1:05 pm Healthy Readers: Supporting Health and Learning ~ Jeanne Jehl 1:10 pm Overview of Attendance Works and Health Contributors to Chronic Absence ~ Hedy Chang 1:15 pm Reducing School Absenteeism and Hospitalizations Due to Asthma ~ Jessica Tovar, MSW, Project Manager, Long Beach Alliance for Children with Asthma 1:30 pm Does Contact by a Family Nurse Practitioner Decrease Early School Absence? ~ Dr. Jill Kerr, DNP, MPH, & FNP C, Family Nurse Practitioner and Researcher, Duke University 1:45 pm Q&A 1:55pm Tools You Can Use 2 1

2 Jeanne Jehl, Team Leader, Healthy Readers, The Campaign for Grade Level Reading 3 Objectives Participants from the Grade Level Reading Communities Network and the Attendance Works Peer Learning Network will: Learn about health issues that contribute to chronic absence. Learn how community health workers can improve school attendance through an asthma management program. Understand how nurses can help reduce absence from school. Be inspired to seek out tools, models and partners for addressing health issues contributing to chronic absence. 4 2

3 The Campaign for Grade Level Reading Grade level reading by the end of third grade is the most important predictor of school success and high school graduation. Academic success of children from low income families requires engaged communities mobilized to remove barriers, expand opportunities, and assist parents in being full partners in their children s success. The Campaign works with Sponsoring Coalitions in 124 localities to support community solutions to the major barriers to third grade reading proficiency school readiness, school attendance and summer learning. Goal: By 2020, a dozen states or more will increase by at least 100 percent the number of children from lowincome families reading proficiently at the end of third grade. 5 Snapshot of Participating Communities: 124 communities, representing 33 states, DC, Puerto Rico, and the Virgin Islands, filed Community Solutions Action Plans (CSAPs) and joined the Grade Level Reading Communities Network To learn more about the Campaign, go to 6 3

4 Healthy Readers in The Campaign for Grade Level Reading The Healthy Readers Initiative within the Campaign helps communities address children s health issues and design community solutions that Strengthen children s health to improve their readiness for school; Reduce the impact of health issues that lead to chronic absence, and Increase opportunities for summer learning that include access to nutritious food and physical activity. This 5 th Webinar in the Healthy Readers series will address health contributors to school absence. 7 Hedy Chang, Director, Attendance Works hedy@attendanceworks.org 8 4

5 Attendance Works Peer Learning Network Now in its third year, the Attendance Works Peer Learning Network includes over 500 members working to reduce chronic absence. Members are from all across the nation and include: Researchers TA Providers Practitioners Funders Participation in the PLN is absolutely FREE! network/peer learning resources/ 9 What is chronic absence? Average Daily Attendance The % of enrolled students who attend school each day. It is often used for allocating funding. Truancy Typically refers only to unexcused absences and is defined by each state and sometimes by school district. It signals the potential need for legal intervention under state compulsory education laws. Chronic Absence Missing 10% or more of school for any reason excused, unexcused, etc. It should be (but is often not) used to trigger early intervention. 10 5

6 Poll Question What are the top health issues in your community you believe make kids chronically absent? Asthma Dental problems Child disability Lack of health care Depression or anxiety 11 Why are students missing so much school? Discretion Aversion Barriers Parents don t know attendance matters Child is struggling academically Lack of access to health care No safe path to school School lacks a strong culture of attendance Child is being bullied Poor transportation Special thanks to Dr. Robert Balfanz, Everyone Graduates Center, Johns Hopkins University, Baltimore, MD for providing this framework. 12 6

7 Health Related Barriers to Good Attendance Nationally: Asthma is the leading health related cause of school absence, leading to 14 million missed school days annually, according to the Asthma and Allergy Foundation of America. It is also the third leading cause of hospitalization for children under 15. Children from low income families are 12 times as likely to have missed school as a result of dental problems than their peers from higher income families. In California: Almost 18% of California adolescents had asthma, which was responsible for an estimated 1.9 million missed days of school in California in 2005 Almost two million children in California come from homes that experience food insecurity (lack of consistent access to adequate, nutritious food) 13 Margaret Dunkle, Healthy Readers Team, The Campaign for Grade Level Reading mdunkle@gwu.edu

8 Long Beach Alliance for Children with Asthma Jessica Tovar, MSW, Project Manager for LBACA Part of Miller Children s Hospital, Long Beach, California Jmartinez6@memorialcare.org (562) LBACA Mission To change the profile of childhood asthma in the most affected areas of the City of Long Beach through improved: healthcare delivery and quality, outreach, education, support systems, living arrangements, and changes in policy at all levels. LBACA Vision Long Beach and its surrounding communities will be a place where residents, families, children and youth, community organizations, decision makers, health care providers, schools, businesses, and community leaders partner to improve the quality of life for children with or at risk of developing asthma. 16 8

9 History of LBACA In 1999, many parents were concerned because they needed to take their children to the emergency department due to asthma attacks. Community members started researching and found that Long Beach was surrounded by many factors that impact air quality. 17 Collaborative Partners Long Beach Department of Health and Human Services The Children s Clinic Miller Children s Hospital Long Beach Unified School District Families in Good Health Cal State Long Beach Asthma Coalition of Los Angeles County Coalition for Clean and Safe Ports St. John s Well Child and Family Center Occidental College Coalition for Clean Air Community Partner s Council South Coast Air Quality Management District LA Care Health Plan UC Irvine/CHOC Residency Program University of California, Irvine/Department of Pediatrics The Impact Project Los Angeles Port Work Group The California Endowment BHC Air Quality Work Group Asthma and Allergy Foundation BREATHE California of Los Angeles County The American Lung Association Cambodian Association of America Long Beach Comprehensive Health Center Coalition for Environmental Health and Justice State Senator Allan Lowenthal USC Keck School of Medicine Regional Asthma Management and Prevention California Asthma Partners Asthma Community Network EPA 18 9

10 Long Beach 19 Air Pollution in Long Beach Long Beach has: 6 oil refineries Two major ports, and Several major freeways, including one that carries an average of 1,100 trucks per hour. The American Lung Association ranks Los Angeles County (which includes Long Beach): First among 25 counties in the nation with high levels of ozone, and Second highest for levels for year-round particle pollution: PM

11 Asthma Prevalence Rate: Nationwide 8%; Long Beach 14.3% Nationwide Long Beach Percent of Population with Asthma 21 Socio Ecological Model of Care Management by Patient Family Involvement Clinical Expertise W ork/school Support Community Awareness, Support & Action Community-W W ide Environmental Control Measures Conducive Policies 22 11

12 LBACA Direct Services Community Outreach Community Health Workers Asthma Classes Physician Asthma Care Education Medical Assistant Trainings 23 Asthma 101 Trainings Free classes teach participants how to: Recognize early asthma symptoms Reduce asthma triggers in the home Work with doctors Take asthma medications correctly And about referrals to the Community Health Worker Program, community resources and more 24 12

13 Community Health Worker Program 1st Home Visit Community Health Worker assesses the home environment and family needs and educates the family and child about asthma control techniques. 2 nd Home Visit CHW establishes the home Action Plan in collaboration with the family. CHW provides education on non-toxic cleaning products and provides additional community resources. 3 rd Encounter CHW assesses the asthma symptoms Final Home Visit during the past 3 months. At 6 months, CHW monitors progress and reinforces asthma education. 25 LBACA s CHW Program Results Nearly 74% of children that missed school at Baseline had not missed school days at the 6-month Follow-up assessment. 92% and 83% of clients reported good control of daytime and nighttime asthma symptoms, respectively, at the Follow-up assessment. 83% of clients who reported using emergency departments for asthma care at Baseline did not report a visit at the 6-month Follow-up assessment

14 LBACA s Results Continued All clients who reported overnight hospitalizations due to asthma symptoms at Baseline did not report a hospitalization at the 6-month assessment. 95% of clients that did not report a wellness visit at Baseline reported one or more visits at Follow-up. Nearly 35% of clients were able to change one or more behaviors to eliminate behavior-based asthma triggers from their home environment 27 LBACA Results Continued In Advocacy work: there is a great awareness of air pollution issues and asthma especially in Long Beach through the Air Quality Work Group. During World Asthma Day LBACA has received a Proclamation from Long Beach City Council and State Senator Alan Lowenthal

15 LBACA Direct Service Funding Sources Medicaid reimbursement for Community Health Worker Program pays up to $25,000 per year for asthma services Other funding comes from mitigation funds: 29 LBACA Advocacy Funding Services Previous funders for advocacy work: Kresge Foundation The California Endowment Community Action to Fight Asthma (CAFA) Current funder for advocacy work: The California Endowment, Building Healthy Communities: Long Beach 30 15

16 31 Dr. Jill Kerr, DNP, MPH, & FNP C, Family Nurse Practitioner and Researcher, Duke University 32 16

17 Does Contact by a Family Nurse Practitioner Decrease Early School Absence? The setting: Chapel Hill, NC Elementary school 1 (K-3) N=249 Elementary school 2 (K-3) N=200 Head Start program (3-5 yrs old) N=130 Total eligible students N= School Demographics Head Start Elementary 1 Elementary 2 White 2 (2%) 105 (42%) 90 (45%) Black 47 (36%) 30 (12%) 42 (21%) Asian 17 (13%) 39 (16%) 24 (12%) Hispanic 61 (47%) 50 (20%) 34 (17%) Multi-Racial 3 (3%) 25 (10%) 10 (5%) 17

18 Intervention: If stated reason is illness or injury and student had over 10% absence Telephone call Scripted Offer home visit Unannounced home visit when 20% absent Offer clinical visit FNP or school nurse office Intervention Group Demographics N=117 A=25 M=8 W=35 B=19 H=

19 Most Calls Happened Over Brief Period of Time: # calls by school day Number of Calls Days 37 FNP had 98 parent encounters 3 clinic visits 63 telephone conversations 13 home visit conversations 19 unintended community encounters (grocery store, mall, parent meetings, school classroom or hallway) 19

20 Parents stated reasons for student s absence 39 Results Program Year 1 Attendance Year 2 Attendance Head Start 92.9% 92.9% -0.0 ns Elementary 95.9% 96.9% -8.9 <.05 z p z-value for test for difference in proportions, p-value for two-tailed tests 20

21 Key Challenges Increase in attendance influenced by multiple variables Head Start attendance data unreliable Resourced school system High risk students not differentiated Implications Illness or injury requires more information to be excused absence Contacts by school nurse/fnp when absence is illness related may significantly improve individual attendance Attendance rate at elementary, grade and school/grade level higher in intervention Year 2 21

22 Discussion Questions for our presenters? 43 Tools You Can Use Growing Healthy Readers: A Starter Kit for Sponsoring Coalitions to Strengthen Health & Learning, Draft, September 2012, download by visiting the Healthy Readers page on the Campaign website: work/healthyreaders November Healthy Readers Webinar: Children Ready at Five Healthy Homes for Healthy Readers: Reducing Asthma and Lead Poisoning: Review the Slide Deck Attendance Works Peer Learning Network: learningnetwork/peer learning resources/ Facts and Figures from the Asthma and Allergy Foundation of America:

23 Tools You Can Use Asthma Management: Long Beach (CA) Alliance for Children with Asthma: Managing Asthma in the School Environment, EPA, 2010: IAQ (Indoor Air Quality) Tools for Schools Action Kit, EPA, 2010: Asthma: (Resource Page for) Schools and Childcare Providers, Centers for Disease Control: State of the Air 2012, American Lung Association: School Nurses: Does Contact by a Family Nurse Practitioner Decrease Early School Absence? content/uploads/2012/10/josn Does Contact By A Family Nurse Practitioner Decrease Early School Absence.pdf Article by Jill Kerr, Marva Price, Jonathan Kotch, Stephanie Willis, Michael Fisher and Susan Silva, The Journal of School Nursing published online 14 September Please Give Us Your Feedback By completing this brief survey: resentandengaged 46 23