Building bridges between school-based health clinics and schools

BACKGROUND: The 2 institutions that hold great promise in mitigating the negative cyclical relationship between poor health and educational readiness are schools and school-based health care facilities (SBHCs). In partnership with schools, SBHCs could have a profound effect on learning outcomes, which include, but are not limited to, poor concentration in school, attendance, and disturbances of normal sequential development. This article provides an overview of the role of federal, state, and local governmental agencies in the development and implementation of public educational policy and funding in an effort to provide SBHCs the foundation for building a bridge between the health and the educational lexicon. METHODS: This article reviews literature from a wide variety of sources to develop a better understanding of the complexities associated with public K-12 education and provides suggestions for initiating meaningful interactions between SBHC supporters and educational decision makers. RESULTS: Strategic reasoning between supporters of SBHCs and educational policy makers is critical because of the limitations of time and money for those delivering educational services. Additional projects (eg, SBHCs) no matter how well conceived will be difficult to promote unless officials can be convinced that collaboration in school-based health care actually enhances compliance with the No Child Left Behind Act. CONCLUSIONS: Though SBHCs and schools are both committed to enhancing the lives of children, these institutions speak different languages and are accountable to very different types of public and private bodies.     

Hospital schools: a primer on management models and policy implications

This three-part article, a primer on hospital schools for hospital administrators, discusses laws, student constituencies, epidemiologic trends, and hospital school services; describes hospital school organizational models; and discusses policy implications.     

Evaluating healthy schools: perceptions of impact among school-based respondents

Schools are important settings in which to promote children's and young people's physical and emotional health. An evaluation of the National Healthy School Standard in England showed that education and health professionals have implemented a range of projects and activities to improve pupils' health. Although these were generally well received by parents and pupils, they were not uncritical of them. Perceptions of the value of health-related work were influenced by the contextual characteristics of schools--whether primary or secondary, the quality of social relationships, the quality of teaching, and the extent of pupil and parental involvement in the life of the school. With local responsibilities for children's services in England being reorganized in response to the Green Paper, Every Child Matters: Next Steps, there are new opportunities to develop a coherent set of outcome measures that pay due regard to pupils' and parents' views, and which inform collaborative reviews of healthy school programmes, in particular, and local services, more generally.     

Integrating service learning into a curriculum to reduce health risks at alternative high schools

Service learning has been identified as a promising approach to reduce sexual risk behavior, among other outcomes. This study used qualitative data analysis to offer suggestions for optimally integrating service learning into a program to reduce sexual risks among alternative school students. Data were collected from student participants in the All4You! Project using classroom materials, focus groups, and individual interviews. Project educators and project staff also provided data through summary forms and field notes. Qualitative data analysis revealed 5 strategies for creating positive service experiences for alternative school students: (1) find appropriate service-learning sites, (2) create staff support, (3) maintain appropriate student participation and behavior; (4) enhance student reflection on service-learning experiences, and (5) address students' self-images.     

A look at management roles and operating environments of medical schools

In order to reach a better understanding of the many complexities involved in the management of schools of medicine, in 1980-81 a survey was taken of deans of medicine and department chairs of medicine, surgery, and family practice at US medical schools. The major attributes of the managerial work environment are identified and provide a foundation for further inquiry into the overall operating effectiveness of schools of medicine.     

国内外医学院校科技管理模式比较与思考

科技管理是高校科技工作的重要组成部分。通过比较国内外高等医学院校的科技管理模式，探讨了相关国家医学院校科技管理中的利弊。在借鉴国外科技管理模式中先进经验的基础上，提出了我国医学院校在科技管理模式中可以改革的一些建议，为高校科技管理者提供参考。     

Outcomes for a comprehensive school-based asthma management program

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.     

Integrating case management and psychiatric hospitalization

Although case management programs attempt to reduce the use of psychiatric hospitalization for clients with long-term mental illness, inpatient treatment still is required for many individuals in even the best community support systems. Even when formal mechanisms for hospital-community liaison exist, there often is little effective collaboration between hospital and community treatment staffs. Depleted from struggling with relapsing patients, case managers often discontinue their efforts during hospitalization. At the same time, hospital staff often demonstrate little interest in community caregivers until discharge planning begins in earnest. Hospital staff and case managers have common barriers to effective collaboration, but they can work together toward the goal of achieving maximum benefit from hospitalization within the context of a long-term community plan.     

Integrating approximate single factor graphical models

In the analysis of complex and high-dimensional data, graphical models have been commonly adopted to describe associations among variables. When common factors exist which make the associations dense, the single factor graphical model has been proposed, which first extracts the common factor and then conducts graphical modeling. Under other simpler contexts, it has been recognized that results generated from analyzing a single dataset are often unsatisfactory, and integrating multiple datasets can effectively improve variable selection and estimation. In graphical modeling, the increased number of parameters makes the “lack of information” problem more severe. In this article, we integrate multiple datasets and conduct the approximate single factor graphical model analysis. A novel penalization approach is developed for the identification and estimation of important loadings and edges. An effective computational algorithm is developed. A wide spectrum of simulations and the analysis of breast cancer gene expression datasets demonstrate the competitive performance of the proposed approach. Overall, this study provides an effective new venue for taking advantage of multiple datasets and improving graphical model analysis.     

A school-based asthma intervention program in the Buffalo, New York, schools

This project investigated the feasibility and effectiveness of a school asthma program in reducing asthma exacerbations among school children. In 1997-1998, two schools were selected for a case control pilot study. The intervention required that students with asthma, who needed medication daily at school, must present a written plan from the health care provider. Students with asthma were identified through parent/guardian or school reports. The pilot program was expanded into five schools in 1998-1999. All schools kept records of rescue treatments for asthma episodes. The pilot intervention resulted in an 80% decrease in rescue treatments from 1996-1997 to 1997-1998. In the additional five schools, an overall decrease of 17% occurred in rescue treatments during 1998-2000. Overall, 65% of physicians provided requested Asthma Care Plans (ACP). In two schools, the number of asthma care plans that required anti-inflammatory medications tripled. Preliminary results indicate this school asthma program proved feasible and effective in reducing the frequency of asthma exacerbations at school.     

Integrating MRI facility design and risk management

Magnetic Resonance Imaging (MRI) has become a valuable diagnostic tool but the high‐strength electromagnets that enable cutting‐edge clinical images also present significant hazards to patients, staff and equipment. Managing these hazards has fallen almost exclusively under the domain of the clinical staff since the inception of MRI, yet accidents in the MRI suite continue to occur. New strategies for building safety into the design and construction of the MRI suite will further minimize the hazards to patients, staff and health care institutions.     

Effectiveness of the school-based prevention program TOPP on factors influencing adiposity in Thuringian schools

The onset of puberty is considered a critical period for the development of overweight and obesity. For prevention purposes, we developed the school-based intervention program TOPP (Teenage Obesity Prevention Program), especially for boys. In order to test the effectiveness, we conducted a controlled study using a pre?Cpost design. A total of 84?schools in Thuringian, Germany, with 1,199?boys participated in the study. Program effectiveness was analyzed with mostly standardized questionnaires referring to body-related self esteem, eating behavior, physical activity, teasing, and knowledge. The program was performed during the course of a school project within at least 3?weeks or during the regular school lessons for more than 6?weeks. After 9×90-minute, manual-based lessons, including interactive exercises and poster-based group discussions, significant improvement was only reached for nutritional knowledge. As a main outcome, it could be demonstrated how an area-wide prevention program with low costs could be successfully implemented. The school environment enables us to create a universal, socially equitable, and low-threshold access.     

Asthma outcomes at an inner-city school-based health center

Childhood asthma has reached near-epidemic levels in the US cities. Innovative strategies to identify children with asthma and prevent asthma morbidity are needed. This study measured asthma outcomes after initiation of an inner-city elementary school health center with a schoolwide focus on asthma detection and treatment. The site was an inner-city elementary school in Minneapolis, Minn. The study design incorporated a pre and post comparison with a longitudinal cohort of children (n = 67) and a cross-sectional cohort of children before (n = 156) and after (n = 114) the intervention. Hospitalization rates for asthma decreased 75% to 80% over the study period. Outpatient visits for care in the absence of asthma symptoms doubled (p < .01), and the percentage of students seeing a specialist for asthma increased (p < .01). Use of peak flow meters, use of asthma care plans, and use of inhalers also improved (p < .01). While no change occurred in school absenteeism, parents reported that their children had less awakening with asthma and that asthma was less disruptive to family plans. This schoolwide intervention that included identification of children with asthma, education, family support, and clinical care using an elementary school health center was effective in improving asthma outcomes for children.     

Hospital middle management experience and peer interpersonal conflict

Each manager brings a unique decision style to the problem-solving process. This decision style may be quite different from the decision style of other managers and a potential source of interpersonal conflict. A study was undertaken to determine which decision styles were potential sources of interpersonal conflict for hospital middle managers and to determine whether years of management experience had any bearing on the sources of conflict. Study results reported interpersonal conflict with decision styles that were impersonal, logical, and factual. Results were consistent regardless of years of management experience.     

Diffusion of innovations in schools: a study of adoption and implementation of school-based tobacco prevention curricula

PURPOSE. The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process. DESIGN. The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions. SETTING. The study was conducted in North Carolina. SUBJECTS. All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample. INTERVENTION. An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted. MEASURES. Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%. RESULTS. Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation. CONCLUSIONS. While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.