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WORLD-CLASS
EDUCATION FOR
EVERY CHILD
from issues discussed mtg.
used in afternoon session
Issues concerning School Health and Medicaid for both general and
special needs populations
Purely State Issues
local matching of funds
receipt of revenues
consultant contracts
school district liability
Mixed Federal/State Issues
Billing -- what services can schools bill medicaid for and under
what conditions? Key issues:
unit billing VS. other billing methods (e.g., IEPs as
authorizing documents)
documentation physician signature for speech, OT, PT
quality assurance
service definitions what is school doing that meeds MC ?,
provider certifications/credentials
administrative cost
Administrative Functions -- what administrative functions can be
undertaken to identify eligible students? Key issues include:
eligibility/outreach
information exchange (Medicaid and FERPA restrictions)
Free Care -- when do the free care provisions pose barriers to
school health and what flexibility do states and schools have to
reduce those barriers?
free care restrictions
statutory exceptions related to IDEA and Title V
NEXT STEPS
What must happen at the state level?
What can/should happen at the federal level?
models, policy guidance, technical assistance,
regulations?
AGENDA FOR MEETING ON MEDICAID AND SCHOOL HEALTH
DATE:
Monday, November 14, 1994
TIME:
8:30 a.m. to 4:30 p.m.
LOCATION:
U.S. Department of Education
Room 2413 (Barnard Auditorium)
600 Independence Ave., S.W.
Washington, DC 20202
8:30 - 9:00 a.m. Continental Breakfast
9:00 - 9:30 a.m. Welcome/Introductions/Workgroup Outcomes
9:30 - 10:30 a.m. Interagency Update on Key Issues Concerning
Comprehensive School Health
10:30 - 10:45 a.m. Break
10:45 - 12:30 p.m.
Medicaid and Schools: Issues and
Implications for Financing Comprehensive
School Health Services
Moderator: Connie Garner
A problem solving session where state
Medicaid directors and local superintendents
can discuss issues surrounding the impact of
Medicaid on school health services.
12:30 - 1:30 p.m. Lunch (To be provided)
1:30 - 3:00 p.m. Medicaid: Federal Issues and Answers
Moderator: Connie Garner
A problem solving session where state
Medicaid directors and local superintendents
can discuss the role of the Federal
Government in promoting effective
collaboration between education and Medicaid
programs.
3:00 - 3:15 p.m. Break
3:00 - 4:30 p.m. Summary of the day
A synopsis of the day's events and action
steps to determine where we go from here.
---
Wednesday
---
September 21, 1994
---
Vol. 3
---
No. 247
---
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THE NATIONAL UPDATE ON AMERICA'S EDUCATION GOALS
A service of the National Education Goals Panel
"I KNOW WHY THE CAGED BIRD
SPOTLIGHT
SINGS"
... probably because it is
HEALTH AND INTELLECT
one of the books most
frequently challenged by those
Horace Mann wrote that
wanting to censure certain
"on the broad and firm
books in public schools. (The
foundation of health alone,
author is Maya Angelou). A
can the loftiest and most
People for the American Way
enduring structures of the
report documents 462 attempts
intellect be reared." His
last year to remove books,
quote leads off a U.S. DoEd
films and plays from schools.
publication on innovative
Fewer than half of censorship
comprehensive school health
attempts are successful, notes
education programs. (#1)
the report.
Calif. leads the nation in
Many educators and health
the most censorship attempts,
professionals nationwide
followed by Texas and Fla.
are making the connection
Ark., W.V., and Vt. were free
between health and
of censorship challenges.
learning. A recent study
The books most frequently
conducted by two M.D.s
challenged: Steinbeck's "Of
found a link between
Mice and Men;" Salinger's "The
several common childhood
Catcher in the Rye;" and
health maladies and a
Cormier's "The Chocolate War."
child's repetition of
kindergarten or first
BOOK PURGING, RUSSIAN STYLE
grade. (#5)
Soviet schoolchildren this
year for the first time will
One solution: the
use textbooks purged of
creation of school-based
communist propaganda. That's
health clinics that draw on
good news for teachers who
community support and are
"winced" when teaching about
housed in middle schools as
Leonid Brezhnev (Carpenter, AP/
well as high schools. (#2)
Miami HERALD, 8/31).
QUOTE OF THE DAY
"Teachers have been out there all by themselves for too long.' --
Ann Sheetz, director of the School Health Unit for the Mass.
Department of Public Health, on student health care. (#2)
supported by the National Education Goals Panel
1850 M Street NW; Washington, D.C. 20036; 202/632-0952
The DRC hereby authorizes further reproduction and
distribution with proper acknowledgement.
Publisher: Barbara A. Pape
TABLE OF CONTENTS
HEALTH AND EDUCATION
SCHOOL HEALTH PROGRAMS: A new paradigm. (#1)
SCHOOLS AND HEALTH CARE: Local models. (#2)
HEALTHY EATING: The debate over school lunch. (#3)
SCHOOL AND HEALTH COLLABORATION: DoEd and HHS. (#4)
RESEARCH NOTES
HEALTH PROBLEMS: One reason children repeat grades. (#5)
CHILDRENS' HEALTH: The environmental factor. (#6)
IIIIII
HEALTH AND EDUCATION
=====
*1 SCHOOL HEALTH PROGRAMS: A NEW PARADIGM
Innovative programs, practices and information on
comprehensive school health education programs are featured in a
recent DoEd publication titled "Comprehensive School Health
Education Programs." The report includes four papers
commissioned for a Nov. 1992 Comprehensive School Health
Education Program conference, which focused on strategies and
practices for developing, implementing and evaluating school
health programs. The papers are: "Research Base for Innovative
Practices in School Health Education," by Diane Allensworth,
Ph.D. R.N., Kent State U and American School Health Association;
"Instituting Innovative Practices in Comprehensive School Health
Eduction Programs for Elementary Schools," by Jill English,
Southwest Regional Laboratory; "Developing Comprehensive School
Health Education Standards for Elementary School Programs, by
Lucinda Adams and Betty Holton, Dayton Public Schools; and "A
Community-Based School Health System: Parameters for Developing
a Comprehensive Student Health Promotion Program," by Dr.
Christopher DeGraw, The George Washington U Center for Health
Policy Research.
A "new paradigm" for comprehensive school health education
emerged from the papers and the conference, according to the
publication. For example, shifts in thinking have occurred:
from school-based to school-wide, community-wide programs; from a
focus on providing health information to a focus on changing
health-related attitudes and behaviors; and from a health content
instruction model in the classroom to a health promotion model
that involves numerous strategies and interdisciplinary team
members from the school and community, among others, writes the
report.
The report also notes three themes generated from the
conference and papers: comprehensive school health education
programs should be driven by the needs of the students; CSHEP
should be a coordinated, comprehensive, school- and community-
based system of service delivery; and CSHEP should focus on
identifying and documenting outcomes.
*2 SCHOOLS AND HEALTH CARE: LOCAL MODELS
The March/April 1994 issue of HIGH STRIDES magazine focuses
on health care for students and features several school-based
models in urban middle schools.
All Atlanta public school children have available to them
school-based health clinics, 87 clinics today compared with only
two clinics located in schools four years ago, writes the
magazine (Seline). Noble Maseru is credited with the growth of
the systems school-based health clinics.
He initially tapped the Medicaid program, which "allows poor
families to get an annual or bi-annual check-up for their
children," to initially finance the school health programs,
according to the magazine. But while families availed themselves
of the services when their children were toddlers, they
discontinued using the health program as their children grew.
"Once the children go to school, the interest to go to a private
doctor's office just dropped off,' explained Maseru.
Maseru's solution was to bring health care to where the
children spent most of their time -- school. "We're getting
these students health care and linking the parents, teachers and
nurses, he said. Students receive physical exams, blood tests
to detect anemia and urine analysis. They also undergo "psycho-
social" assessments "to determine how they are interacting with
peers and parents, writes the magazine. Outreach workers make
home visits to discuss the medical exams with parents and monitor
any follow-up treatment.
Student health care in Mass. is part of the state's
Department of Public Health's mission (Lewis). Ann Sheetz,
director of the department's School Health Unit, works with 36
school districts to "develop model school health programs,"
according to the magazine. The prevention of tobacco use is a
primary goal of the program, which is partly financed through a
25-cent tax on cigarette packs. Funds also are used for public
service ads and to upgrade the quality of school health staff.
Sheetz: "I was shocked to walk into schools and find, for
example, only one person trained for CPR in a school of 2,000
students." She added that "teachers have been out there all by
themselves for too long.'
Sheetz also is attempting to reach out to community health
providers, such as HMOs, which "traditionally have stayed away
from schools." And she intends to "inform food service
administrators at state and local levels about the nutrition
needs of students."
Already, 14 school clinics are open and 21 more are
expected, with some in middle schools, according to the magazine.
Mass. also is the lead agency for the federal Model School Health
Information System Project, which will integrate data from
education and health throughout the New England States.
Other school health programs featured in HIGH STRIDES
include: a collaborative effort between the U of Pennsylvania
and Philadelphia's John P. Turner Middle school, which boasts a
model curriculum that calls on students to "teach their peers,
work in hospitals, publish brochures on health topics and lead
community health programs;" and the Community Health Education
Project housed in the Intermediate School 52, located in a
disadvantaged section of Manhattan.
Dr. Aaron Shirley, the first black pediatrician in Miss.,
explained why health programs should begin in the middle schools,
if not sooner. Many problems that become serious for high school
students, such as anemia, poor eyesight, dental problems, obesity
and teen pregnancies, could have been prevented if detected
during the middle school years, he said. But he added that young
adolescents mostly need "a place they trust and adults whom they
can trust," which is why his clinic staff "do a lot of
handholding" because they serve as "surrogate families."
*3 HEALTHY EATING: THE DEBATE OVER SCHOOL LUNCH
Critics of the U.S. Department of Agriculture's reform of
its school lunch program warn that the proposal is "too much to
swallow" and may cause some schools to drop out of child
nutrition programs due to cost (Shogren, L.A. TIMES, 9/8). The
debate centers on the approach taken by the U.S.D.A. to limit the
amount of fat and sodium in school lunches. (See DRC 9-8-93)
The national Parent Teachers Association, American School
Food Service Association and others argue that the U.S.D.A.'s
strategy of requiring schools to "analyze the nutritional content
of their foods and make sure that over a week students get no
more than 30 percent of their calories from fat and no more than
10 percent from saturated fat" is too cumbersome (Greene, The
TIMES-PICAYUNE, 9/8). It will force schools that want to comply
to purchase expensive computers and software to undertake the
nutrient analysis, according to the critics. Instead, the groups
recommend that schools use a "modified version of the existing
plan that would follow the 'food pyramid,' a program based on the
same nutritional guidelines that require cutting fat to 30
percent of calories," writes the paper.
But U.S.D.A. officials maintain that using nutritional data
is the only way to insure guidelines are met. "You have to have
a mechanism," said Ellen Haas, assistant agriculture secretary
for food and consumer services. She added that the department
will provide model menus and other assistance to schools.
Meanwhile, Public Voice for Food and Health Policy recently
released a study profiling 41 school lunch programs nationwide
(multi cites). The advocacy group discovered that these schools
already have begun serving healthier meals, despite a 1998
deadline imposed by the U.S.D.A. to improve school lunch programs
(Herald Wire Services/Miami HERALD, 8/31). "These case studies
show that the creativity, commitment, knowledge and technology to
create healthier lunches already exists from coast to coast,"
said Mark Epstein, the group's director.
Epstein urged the U.S.D.A. to push up the deadline to the
1996-1997 school year. A BALTO. EVENING SUN editorial agreed.
The SUN: "We concur with the group's stance. In fact, this
newspaper expressed the same combination of praise and criticism
months ago when the U.S. Department of Agriculture went public
with its revisions of the school lunch program. We still feel
that the decision to allow school districts to phase in the
changes over four years is a mistake."
*4
SCHOOL AND HEALTH COLLABORATION: DoEd AND HHS
The U.S. Secretaries of Education and Health and Human
Services earlier this year joined forces to confront child health
issues. "We know that children who come to school healthy, who
have gotten their shots and participated in early childhood
programs, are children who are engaged and ready to learn, said
Ed Sec Richard Riley. Donna Shalala, Sec of HHS added that
"good health for America's children must be a national priority.
There is no question that our schools have a key role to play in
helping our children begin a lifetime of good health."
Officials from both agencies intend to establish the
Interagency Committee on School Health, co-chaired by the
assistant secretary for elementary and secondary education and
the assistant secretary for health. Also planned is a National
Coordinating Committee on School Health, that will unite
representatives of major national education and health
organizations.
A press release that announced the joint statement of Riley
and Shalala also noted that President Clinton's proposed Health
Security Act also "would provide major support to children, with
an emphasis on prevention as the key to helping children avoid
health risks and receive care before an illness reaches an
emergency state.' ( 4/7) But health-care reform, which has
devolved into a rancorous debate in Congress, is not expected to
pass this year.
From the Joint Statement on School Health: "Health and
education are joined in fundamental ways with each other and with
the destinies of the Nation's children.
In support of
comprehensive school health programs, we affirm the following:
America's children face many compelling educational and health
and developmental challenges that affect their lives and their
futures
To help children meet these challenges, education
and health must be linked in partnership.
School health
programs support the education process, integrate services for
disadvantaged and disabled children, and improve children's
health prospects
Reforms in health care and in education
offer opportunities to forge the partnerships needed for our
children in the 1990s
Goals 2000 and Healthy People 2000
provide complementary visions that, together, can support our
joint efforts in pursuit of a healthier, better educated Nation
for the next century."
IIII
RESEARCH NOTES
II
*5
HEALTH PROBLEMS: ONE REASON CHILDREN REPEAT GRADES
Researchers detected a link between several common childhood
health problems and the rising number of children required to
repeat kindergarten or first grade (Medical Tribune News
Service/The TENNESSEAN, 3/12). A nationwide study of nearly
10,000 children ages 7 to 17 found that 7.6% repeated
kindergarten or first grade. U of Rochester in New York
researchers revealed that, while a combination of factors
contribute to a child's educational difficulties, bedwetting,
deafness, low birthweight, exposure to household smoking, male
gender and poverty each place children at a higher risk of
repeating an early grade, writes the paper.
They also found a link, albeit weaker, between recurrent
middle-ear infections, black race and having a young mother and a
child's chances of being held back in school. Drs. Robert Byrd
and Michael Weitzman, authors of the study, recommend that
pediatricians be on "the lookout for such problems to help
prevent children from having difficulties in school,' reports the
paper. Their study was published in the March issue of the
journal "Pediatrics."
According to the study, more children are being held back in
the early grades. The proportion of 8-year-olds who were in a
lower grade than would be expected in 1974 was 17.4% of boys and
12.2% of girls. The percentage rose to 28.1% of boys and 21.7%
of girls by 1989, reports the study. An increase in the number
of children living in poverty and exposed to violence and
pressure placed on schools to demonstrate student improvement may
contribute to the escalating number of children held back, write
the reports authors. But the study also pointed to health
problems: deafness doubled the risk of repeating an early grade;
exposure to household smoking increased the risk by 40%; and
frequent ear infections made children 20% more likely to repeat
an early grade, found the report, writes the paper.
Dr. Barbara Starfield, professor of health policy and
pediatrics at Johns Hopkins U School of Medicine in Baltimore,
remarked that the findings are not new, but do "suggest that a
regular source of coordinated primary care might have an impact
on children's education in the early grades," reports THE
TENNESSEAN. Starfield added that if the researchers reviewed the
type of care the children received, they might have discovered
that children with a "more consistent source of care have less
risk for repeating a grade than kids with an erratic source of
care." The study also validates the argument in favor of
improved community health services, noted Starfield.
*6 CHILDRENS' HEALTH: THE ENVIRONMENTAL FACTOR
Scientists must "do more research on the link between the
environment and children's diseases," and lawmaker must "review
proposed legislation and tolerance levels with children in mind"
editorializes USA TODAY (8/22). The editorial came on the heels
of the release of a study by the Children's Environmental Health
Network, which found, among other things, that children are
developing asthma at a faster rate than adults (Manning, USA
TODAY, 8/22)
Children also are exposed to higher pesticide levels than
adults because their diets contain larger proportions of
pesticide-treated produce, according to the study. And the
report noted that 3-4 million preschoolers are reported to have
high levels of lead in their blood.
USA TODAY: "It stretches the imagination to think that the
higher rates of cancer and spina bifida suffered by children
living near toxic-waste sites are just coincidence."
-30-
OF EDICATION
UNITED STATES DEPARTMENT OF EDUCATION
UNITED STATES of AMERICA
GOALS
Goals 2000: Educate America Act
2000
Legislative Summary
Overview
The Goals 2000 Act provides resources to states and
communities to develop and implement comprehensive education
reforms aimed at helping students reach challenging academic
and occupational skill standards.
Legislative Review
On March 23, the House of Representatives approved the final
Goals 2000 bill by a bipartisan vote of 306-121. On March
26, the Senate approved Goals 2000 by a bipartisan vote of
63-22.
The President signed the bill into law March 31, 1994.
(Public Law 103-227)
Timetable and Funding
In 1994, $105 million was appropriated for Goals 2000.
First-year funds became available to the states on July 1,
1994. Congress has appropriated $403 million in 1995.
Funding will be formula-based. For first-year funding,
states have been asked to submit an application that will
describe how a broad-based citizen panel will develop an
action plan to improve their schools. The application will
also describe how subgrants will be made for local education
improvement and better teacher preservice and professional
development programs.
During the first year, states will use at least 60 percent
of their allotted funds to award subgrants to local school
districts for the development or implementation of local and
individual school improvement efforts, and for better
teacher education programs and professional development
activities.
In succeeding years, at least 90 percent of each state's
funds will be used to make subgrants for the implementation
of the state, local and individual school improvement plans
and to support teacher education and professional
development.
During the first year, local districts will use at least 75
percent of the funds they receive to support individual
school improvement initiatives. After the first year,
districts will pass through at least 85 percent of the funds
to schools.
Components of the Goals 2000: Educate America Act
Title I: Setting High Expectations For Our Nation: the National
Education Goals
Formalizes in law the original six National Education Goals.
These goals concern: readiness for school; increased school
graduation rates; student academic achievement and
citizenship; mathematics and science performance; adult
literacy; and safe, disciplined, and drug-free schools. The
Act adds two new goals that encourage parental participation
and better professional development for teachers and
principals.
Title II: Public Accountability for Progress Toward the Goals
and Development of Challenging, Voluntary, Academic Standards
Establishes in law the bipartisan National Education Goals
Panel, which will: report on the nation's progress toward
meeting the goals; build public support for taking actions
to meet the goals; and review the voluntarily-submitted
national standards and the criteria for certification of
these standards developed by the National Education
Standards and Improvement Council.
Creates the National Education Standards and Improvement
Council, made up of a bipartisan, broad base of citizens and
educators, to examine and certify voluntary national and
state standards submitted on a voluntary basis by states and
by organizations working on particular academic subjects.
Authorizes grants to support the development of voluntary
assessment systems aligned to state standards, and for the
development of model opportunity-to-learn standards.
Title III: Supporting Community and State Efforts to Improve
Education
The central purpose of the Goals 2000 Act is to support,
accelerate, and sustain state and local improvement efforts
aimed at helping students reach challenging academic and
occupational standards.
Section 318 of the Act specifically prohibits federal
mandates, direction and control of education.
Broad-Based Citizen Involvement in State Improvement Efforts
The Governor and the Chief State School Officer will each
appoint half the members of a broad-based panel. This panel
will be comprised of teachers, principals, administrators,
parents, representatives of business, labor, and higher
education, and members of the public, as well as the chair
of the state board of education and the chairs of the
appropriate authorizing committees of the state legislature.
2
States that already have a broad-based panel in place that
has made substantial progress in developing a reform plan
may request that the Secretary of Education recognize the
existing panel.
Comprehensive Improvement Plan Geared to High Standards of
Achievement
The State Planning Panel is responsible for developing a
comprehensive reform plan.
States with reform plans already in place that meet the
Act's requirements will not have to develop new plans for
Goals 2000. The U.S. Secretary of Education may approve
plans, or portions of plans, already adopted by the state.
In order to receive Goals 2000 funds after the first year, a
state has to have an approved plan or have made substantial
progress in developing it.
A peer review process will be used to review the state plans
and offer guidance to the State Planning Panel. The U.S.
Department of Education also will offer other
technical
assistance and support by drawing on the expertise of
successful educators and leaders from around the nation.
In general, the plans are to address:
Strategies for the development or adoption of content
standards, student performance standards, student
assessments, and plans for improving teacher training.
Strategies to involve parents and the community in helping
all students meet challenging state standards and to
promote grass-roots, bottom-up involvement in reform.
Strategies for ensuring that all local educational agencies
and schools in the state are involved in developing and
implementing needed improvements.
Strategies for improved management and governance, and for
promoting accountability for results, flexibility, site-
based management, and other principles of high-performance
management.
Strategies for providing all students an opportunity to
learn at higher academic levels.
Strategies for assisting local educational agencies and
schools to meet the needs of school-age students who have
dropped out of school.
Strategies for bringing technology into the classroom to
increase learning.
3
Funds are also available to states to support the development of
a state technology plan, to be integrated with the overall reform
plan.
Broad-Based Involvement in Local Education Improvement Efforts
Each local school districts that applies for Goals 2000
funds will be asked to develop a broad consensus regarding a
local improvement plan.
Local districts will encourage and assist schools in
developing and implementing reforms that best meet the
particular needs of the schools. The local plan would
include strategies for ensuring that students meet higher
academic standards.
Waivers and Flexibility
State educational agencies may apply to the U.S. Secretary
of Education for waivers of certain requirements of
Department of Education programs that impede the
implementation of the state or local plans. States may also
submit waiver requests on behalf of local school districts
and schools.
The Secretary may select up to six states for participation
in an education flexibility demonstration program, which
allows the Secretary to delegate his waiver authority to
State education agencies.
The Act specifies certain statutory and regulatory
programmatic requirements that may not be waived, including
parental involvement and civil rights laws.
Title IV. Support for Increased Parental Involvement
This title creates parental information and resource centers
to increase parents' knowledge and confidence in child-
rearing activities and to strengthen partnerships between
parents and professionals in meeting the educational needs
of children. Parent resource centers will be funded by the
U.S. Department of Education beginning in fiscal year 1995.
Title V. National Skill Standards Board
This title creates a National Skill Standards Board to
stimulate the development and adoption of a voluntary
national system of occupational skill standards and
certification. This Board will serve as a cornerstone of the
national strategy to enhance workforce skills. The Board
will be responsible for identifying broad clusters of major
occupations in the U.S. and facilitating the establishment
of voluntary partnerships to develop skill standards for
each cluster. The Board will endorse those skill standards
4
submitted by the partnerships that meet certain statutorily
prescribed criteria.
Relationship of Goals 2000 to Other Federal Education Programs
State participation in all aspects of the Goals 2000 Act is
voluntary, and is not a precondition for participation in
other Federal programs.
The Goals 2000 Act is a step toward making the Federal
government a better partner a supportive partner in
local and state comprehensive improvement efforts aimed at
helping all children reach higher standards. The
proliferation of many sets of rules and regulations for
different federal education programs has often interfered
with local school, community or state efforts to improve
schools. The Goals 2000 Act is designed to be flexible and
supportive of community-based improvements in education.
Other new and existing education and training programs will
fit within the Goals 2000 framework of challenging academic
and occupational standards, comprehensive reform, and
flexibility at the state and local levels. The aim is to
give schools, communities and states the option of
coordinating, promoting, and building greater coherence
among Federal programs and between Federal programs and
state and local education reforms.
For example, the School-to-Work Opportunities Act will
support state and local efforts to build a school-to-work
transition system that will help youth acquire the
knowledge, skills, abilities, and labor-market information
they need to make a smooth transition from school to career-
oriented work and to further education and training.
Students in these programs could be expected to meet the
same academic standards established in states under Goals
2000 and will earn portable, industry-recognized skill
certificates that are benchmarked to high-quality standards.
Similarly, the reauthorization of the Elementary and
Secondary Education Act (ESEA) allows states that have
developed their own standards and assessments under Goals
2000 to use them for students participating in ESEA
programs, thereby providing one set of standards and
assessments for states and schools to use for their own
reform needs and, at the same time, to meet Federal
requirements.
For more information, contact 1-800-USA-Learn.
5
school
Health
PROFESSIONAL
Volume 1, Number 14
July 27, 1994
Schools, Community Health Centers Urged to Link Up
Two federal departments
working on a plan to meld the
between the approximately
health centers in their states.
are taking steps to implement
Chapter 1 education program
15,000 school districts in this
At the same time, letters are
a joint statement on school
for disadv antaged students
country and the approximately
going to clinic directors and
health issued last April by Edu-
with federally funded commu-
1,500 community health cen-
State Primary Care Associa-
cation Secretary Richard Riley
nity health centers located in
ters currently funded by the
tion executive directors, who
and Secretary of Health and
high poverty areas.
federal government.
may know which school dis-
Human Services Donna
The idea is that both pro-
That makes it hard to
tricts are in their territories.
Shalala (School Health Pro-
grams serve the same disad-
know which schools might be
The letters will extend an
fessional, 4/27/94).
vantaged children, and it seems
able to collaborate with which
invitation to Chapter I schools
Looking for ways to
logical that they should estab-
health centers-a problem the
and BPHC Health Centers to
"model" the kind of collabo-
lish linkages aimed at improv-
feds are trying to solve by send-
coordinate services, explain-
ration they hope to see at the
ing both health care and edu-
ing introductory letters about
ing how schools can save
local level, program special-
cation..
the new initiative to local and
money by tapping into an al-
ists in the Department of Edu-
But that may be easier
state Chapter 1 directors and
ready existing network of
cation and the Bureau of Pri-
said than done. There's no di-
chief state school officers, en-
health services.
mary Health Care in HHS are
rect geographic relationship
closing a list of community
Continued on Page 2
Report Shows Startling Increase in Obesity in U.S.
A report published last week in the Journal of the American
division of endocrinology, diabetes, and nutrition at St. Luke's-
Medical Association found a startling 31 percent increase in adult
Roosevelt Hospital said, "The proportion of the population that is
obesity since 1980. Thirty-three percent of American adults are
obese is incredible. If this was about tuberculosis, it would be
now believed to be obese, which is defined as weighing 20 percent
called an epidemic."
more than is optimal for your height and age.
The rise in percentage of obesity in the adult population is
A companion report on children's weight scheduled for
especially surprising, the AMA Journal said, because of the
release in the next few months is expected to show that at least one-
emphasis given to weight loss and diet in advertising and media
third of American children are seriously overweight, and that lack
messages in this country.
of physical exercise in schools is one of the reasons for their
"The problem with obesity is that once you have it, it is
obesity.
very difficult to treat. What you want to do is prevent it," said
Commenting on the report, Dr. F. Xavier Pi-Sunyer of the
Dr. Pi-Sunyer.
IN THIS ISSUE
In the News
3
Violence in U.S. Schools
4
Findings from Evaluated Programs
6
School Health Issues-Higher Education for Paraprofessionals
7
School Health Briefs
8
AN INDEPENDENT NATIONAL RESOURCE FOR SCHOOL HEALTH PROFESSIONALS
Page 2
SCHOOL HEALTH PROFESSIONAL
July 27, 1994
Schools and Community Centers Urged to Link Up
Continued from Page 1
ample-will probably come
The two agencies also say
cation Program Specialist,
At the same time, the
up at the local level, as well.
they've learned some lessons
U.S. Department of Education,
Bureau of Primary Health Care
New authorizing legislation
they'd like to pass on to locals,
400 Maryland Ave. SW, Wash-
and the Department of Educa-
for Chapter 1 now making its
about collaboration. Don't
ington DC 20202-6132, tele-
tion say they will develop an
way through Congress would
take differences personally,
phone (202)260-0942, FAX
"idea book" describing eight
allow Chapter 1 money to be
they advise; work out the vo-
(202)260-7764.
or nine sites that are already
used for health services, but
cabulary, so you are both talk-
For the Department of Health
collaborating in the way they
only as a last resort. The Bu-
ing about the same things; and
and Human Services-Sarah
have in mind.
reau of Primary Care says com-
try to overcome pride of turf.
Baily, Public Health Analyst,
All of this is "down the
munity health centers have
The persons managing
Public Health Service, 4350
line a way," they say. They
small budgets for development
the collaboration initiative at
East-West Highway, 9th
also concede that some prob-
and expansion. which might
the federal level are:
Floor, Bethesda MD 20814,
lems that have arisen at the
make it possible to set up a
For the Department of Edu-
telephone (301)594-4470,
federal level-money, for ex-
clinic at a school site.
cation-Susan Winingar, Edu-
FAX (301)594-2470.
What Are Chapter 1 and Community Health Centers?
Chapter 1
ing specific periods of the day
Community Health Centers
aid, Medicare, and private in-
Most school health pro-
to receive special instruction
Like Chapter 1, commu-
surance.
fessionals are probably famil-
in math or reading.
nity health centers had their
About a third of commu-
iar with Chapter 1 of the El-
The legislation now be-
origin in President Lyndon
nity health centers have al-
ementary and Secondary Edu-
fore Congress discourages
Johnson's "War on Poverty,"
ready taken the initiative to
cation Act.
such separation and requires
in the mid-1960s. Originally
start either school-based or
Briefly, Chapter 1 was
that Chapter 1 children be
managed under the Economic
school-linked health centers.
enacted in 1965 as Title I of
given opportunity to reach the
Opportunity Act, the neigh-
In addition, the Bureau of
the original Elementary and
same academic standards ex-
borhood health center program
Primary Health Care this year
Secondary Education Act. It
pected of other children.
was transferred to the Public
is implementing a first year of
provides federal funds to
Although Chapter 1
Health Service in the early
a "Healthy Schools, Healthy
states, which distribute it to
money is supposed to go to
1970s.
Communities" program to
school districts on a formula
schools in areas of poverty,
Currently, there are com-
help homeless children and
based on poverty and other
the formula has been tailored
munity health centers in all of
children who are at high risk
factors, to be used to help edu-
over the years in such a way
the 50 states, the District of
for poor health and school fail-
cate children who are a grade
that about 95 percent of school
Columbia, and the federal terri-
ure as a result of poverty. A
or more behind in subjects
districts receive some Chapter
tories. Sixty percent are located
total of $5.75 million dollars
such as reading and arithmetic.
1 money. Efforts by the Clin-
in rural areas and 40 percent in
is available for grants to pro-
The Chapter 1 mantra is
ton administration to focus the
high-poverty urban areas.
vide health services, health
"supplement not supplant,"
funds on high-poverty schools
The Bureau estimates that
education, and staff develop-
which means the federal
have failed so far in this ses-
about 6 million people a year
ment. Under this program,
money is in addition to and
sion of Congress.
receive primary health care
about 12 to 15 new school-
does not replace whatever the
Unlike the other major
through the centers; 60 per-
based health centers will be
school district would have
federal program for children
cent of the patients have in-
established by community-
spent on those children.
in poverty-Head Start-
comes below poverty level.
based health care providers
Generally, Chapter 1
Chapter 1 programs do not
Patients who can afford to pay
who have entered into part-
funds have been used to pro-
usually have a direct link to
are charged on a sliding scale,
nerships with schools and
vide "pull-out" programs in
health or social services,
and centers are also expected
community groups to provide
which eligible children leave
though some programs have
to make maximum use of rev-
comprehensive primary care
their regular classrooms dur-
provided them.
enue sources such as Medic-
to at-risk students.
School Health Professional is published twice monthly, except once in
Publisher: Craig MacKown. The Federal News Services, Inc.,
August and December, by The Federal News Services, Inc.
P.O. Box 13460, Silver Spring MD 20911-3460
© Copyright 1994. ISSN 1072-3722. Annual subscription rate, $107.
Editor: Virginia Robinson, P.O. Box 1961, Alexandria VA 22313
Reproduction only with written approval of the Copyright Clearance
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Accounting Director: Peggy Abrams Circulation Director: Seeber
Implementing Schoolwide Projects: An Idea Book
Summary
Background
For children in high-poverty schools to meet high standards of performance, their entire
instructional program-not just a separate Chapter 1 program-must be substantially improved.
High standards, flexibility, school-based staff development, school-family partnerships, and
clear accountability can help create the conditions necessary for transforming schools,
particularly those that serve high concentrations of poor children. Research demonstrates how
schoolwide approaches can be an effective option for high-poverty schools. When the target
of change is the entire school, not just the poorest performing children, schools serving even
the most disadvantaged can succeed.
Moreover, research has shown that in schools where the majority of students are poor, it
makes little sense to attempt to target the program on individual students, to the exclusion of
many other needy students. The average performance of all students in high-poverty schools
resembles that of Chapter 1 students in low-poverty schools. Where poverty is concentrated,
the poverty level of the school itself is an impediment to the performance of all children in
school.
At the same time, findings from Chapter 1 studies have identified a need for more assistance
in planning, operating, and evaluating schoolwide projects. Many projects initially only
reduced class size without making efforts to fundamentally improve instructional practices in
schools. Some projects began quickly without adequate planning. Others relied on single
measures for evaluation rather than multiple measures of student achievement.
The strategies that successful projects are using--a framework of high standards,
comprehensive planning and continuous professional development, flexibility in drawing upon
resources, extensive parent involvement and clear accountability for results are those our
reauthorization proposal would extend to all Title I (formerly Chapter 1) schoolwide program
schools.
This idea book provides information on how successful schoolwide projects have achieved
results in high-poverty schools, based on in-depth interviews with administrators and teachers
from such projects. The schools represent an array of program options and serve diverse
student populations. Profiles of successful schoolwide projects are included in the idea book as
well.
On Becoming Successful
Successful schoolwide projects start with an inclusive planning process and a plan that
becomes a working document to motivate and guide staff, students and parents towards
common challenging goals. Planning should be based on a comprehensive, school-generated
needs assessment and parents and teachers should be an integral part of developing and
implementing the plan. For example, at Snively Elementary School in Winter Haven, Florida,
faculty, parents, and community representatives met frequently for six months to plan the
schoolwide project. Teachers rewrote the curriculum to support an interdisciplinary, thematic
unit approach and visited parents at home to solicit support for the project.
Schools need to build in adequate time for school staff to learn new roles and to allow time
for members of the community, including parents, to accept and support the plan. School
staff also need to be involved in developing the plan and need ongoing training and technical
support as the school undertakes the changes. Professional development for all staff also needs
to be provided in using technology, teaching new content, working positively with parents, and
using new teaching methods. The idea book highlights successful strategies schools have used
to engage staff and parents.
Successful schoolwide projects reach out to parents and the community in a variety of ways.
At Balderas Elementary School in Fresno, California, school-home communications are
routinely translated into five languages and followed up with calls to those who cannot read in
any language. Two English classes are offered at the school for parents. Each month the
school offers a parent workshop given in the languages spoken by school families.
Approximately 80 percent of the parents attend. At the parents' request, Balderas also has a
monthly open house, during which the school's programs are explained, student guides take
visitors on a tour of the building, and parents eat lunch with their children. Balderas has also
built strong relationships with the business community. Engineers from several large
companies meet with school staff to identify promising technologies and their applications to
teaching, and plan ways to install them at the school.
By incorporating the additional resources into the entire school program, schools can change
the way they offer instruction throughout the school, extend student learning time, adapt
proven program innovations to their school, and provide more focused, intensive staff
development. Establishing smaller classes may or may not be a good starting point but is not
in and of itself sufficient to bring about far-reaching reforms in the schools. It is also critical
that the schoolwide project establish a well-structured, engaging academic program based on
helping many more students achieve higher standards. McNair Elementary in North
Charleston, South Carolina uses a summer enhancement program for students who scored
poorly on district-based tests. The program focuses on the study of energy, space, marine life,
and conservation. Francis Scott Key Elementary in Philadelphia adapted Johns Hopkins
University's Success for All program to offer a rich array of whole language approaches to
teaching. These schools used innovative approaches to improving instruction and learning in
their programs.
Successful schoolwide projects use a variety of assessment tools to focus on students' progress.
They may use a combination of teacher-designed tests, standardized criterion- and norm-
referenced tests, portfolios of students' work, and mastery skills checklists. Teachers also
monitor students' reading, and their capacity to demonstrate in writing their understanding of
the core content areas of math, science and social studies. The attention paid to academic
progress, as well as to monitoring attendance and discipline, provides staff with a fuller picture
of student progress. Effective programs recognize that fundamental improvement takes time.
Despite high standards and strong academics, students' test scores may waver from year to
year and it may take several years to improve the performance of the neediest students.
On Supporting Success
State educational agency staff and school district staff can support the development and
continued success of schoolwide projects through providing strong leadership and resources for
planning, implementing, and evaluating the success of projects. They can identify and share
successful approaches to team building and planning, staff development and technical
assistance resources and encourage the formation of networks of schools using similar
approaches. Some States have developed guidance on planning for a schoolwide project, with
particular attention paid to conducting thorough needs assessments and identifying early on
how districts will support schools in their efforts. States have also suggested types of
instructional reforms schools may wish to undertake.
Districts can assist schools in developing their schoolwide plans, deciding on components most
essential to improving achievement in the school. District staff can also hold training sessions
for school teams interested in developing schoolwide projects and can provide information to
school teams on other sources of technical assistance and professional development. While
providing much more information and assistance on successful schoolwide approaches and
planning processes, States and districts need to also provide greater flexibility and make
certain their auditing, accreditation, and review procedures compliment, not stifle, successful
whole school projects.
Copies of Implementing Schoolwide Projects: An Idea Book are available by writing the
Planning and Evaluation Service, U.S. Department of Education, 600 Independence Ave. SW,
Rm. 4162, Washington, D.C. 20202.