Councilmembers Gail H. Ewing (Chair, Health and Human Services Committee) and Michael Subin (Chair, Education Committee), joined by Board of Education President, Nancy King, today called for increased attention to meeting the health needs of Montgomery County public schoolchildren.
The three elected officials highlighted several findings of a report on School Health Services, prepared by the County Council's Office of Legislative Oversight (OLO), and presented to the County Council today. That report noted the increasing health needs of Montgomery County public schoolchildren, and the fact that both the County Government and Montgomery County Public Schools play significant roles in meeting those needs. According to Councilmember Ewing, "The health problems coming to the health room today are a far cry from the scraped knee many of us remember from our childhood. The amount and complexity of health needs of today's students are daunting challenges that all of us must face."
Summarizing information from a 1997 School Health services survey, the OLO report indicates that the most prevalent reported health conditions of students attending MCPS schools are asthma, allergies, and attention deficit disorders. (See attached Table 2). Similar findings come from the 1997 Health Status Report of the County's Public Health Officer, which identified asthma and other respiratory illnesses as the leading reasons for hospitalizing children under the age of ten. For children ages 10-14, the major causes of hospitalization are psychiatric disorders and substance abuse, as well as injuries. For adolescents ages 15-17, the major causes of hospitalization are also psychiatric disorders/ substance abuse and pregnancy-related hospitalizations.
Also contributing to the health needs of Montgomery County's schoolchildren are the large number of children without health insurance for whom school health personnel may be their only regular health care contact. County officials estimate that there are approximately 26,000 children under the age of 18 without health insurance.
Noting that research shows a relationship between low income and poor health, the OLO report indicates that from 1975-1995, the percentage of students eligible to receive free and reduced-price meals almost quadrupled, from six to 22 percent of total MCPS enrollment. Eligibility for this program is based on poverty guidelines and is used as a measure of the number of low income students in the school system.
The increased number of children with disabilities who receive special education services in their home schools also has contributed to increasing health needs in the schools. In recent years enrollment for students needing the highest level of special education services has increased more than the general education enrollment. Between fiscal year 1997 and fiscal year 1998, the regular MCPS enrollment increased 1.8% while the highest level special education enrollment increased 5.4%. According to MCPS and School Health Services staff, a larger portion of these students are likely to require some type of health-related attention during the day, for example, administering prescription medication or treatments, and/or providing assistance with the activities of daily living.
To meet the school-based health needs of schoolchildren, MCPS and School Health Services staff provide a range of important services including: emergency care, health assessments, communicable disease control, and health education and counseling. In addition, in an initiative begun by Councilmember Subin, the County has established Linkages to Learning, a school-based health and human services program, currently operating at seven County schools. Two of the schools also have school-based health centers that provide primary health care services to their students.
With over 600,000 student visits to health rooms, Montgomery County spends almost $9 million a year or approximately $72 per student for the School Health Services program. Approximately 69 School Community Health Nurses and 182 Health Room Technicians provide health-related services in the schools. All schools except for 29 elementary schools have health room coverage for six hours a day. Those 29 schools have health room coverage from three to five hours a day.
The Executive Summary of the OLO Report is attached. The complete report is available upon request at 301-217-7990.
Attachments:
| Health Condition | Number of Students |
|---|---|
| Asthma | 6,060 |
| Allergies | 4,368 |
| ADHD | 4,225 |
| Other** | 1,062 |
| Vision | 760 |
| Anaphylaxis | 696 |
| Hearing | 603 |
| Cardiac | 603 |
| Headaches | 510 |
| Seizures | 341* |
| Genetic Disorders | 328 |
| Blood Dyscrasias | 287 |
| Gastro-intestinal Disorders | 224 |
| Communicable Disease | 194 |
| Diabetes | 173 |
| Cancer/malignancies 1 | 73 |
| Cerebral Palsy | 62* |
| Cystic Fibrosis | 18 |
* Cerebral palsy and seizures were under-reported in their categories because some were counted in the "other" category.
** Other: amputation, arthritis, bleeding disorder, blindness, blood clotting disorder, cataract, cerebral palsy, collagen vascular disease, depression, detached retina, eating disorders, fibromyalgia, hemiparesis, hydrocephalus, rickets, kidney disease, lactose intolerance, lead toxicity, lupus, lyme disease, malignant hypertension, malnutrition, mental health disorders, neuromuscular weakness, obesity, ostomy, paraplegia, post-polio syndrome, scoliosis, spastic hemiplegia, thyroid disease.
Source: School Health Services' survey of health conditions, November 1997 - 161 of 183 schools responded to survey.
BASED ON REPORTS FROM SCHOOL PRINCIPALS AND RESULTS OF A RESEARCH STUDY BY THE UNIVERSITY OF MARYLAND THE FOLLOWING OUTCOMES ARE SIGNIFICANT:
LINKAGES STAFF:
School Health staff provide an important set of services to the school community, often working in partnership with other County, MCPS, and private sector staff. Factors contributing to the demand for School Health Services include: more students and schools; more students with special health needs; and a significant number of students without health insurance.
Services provided by School Health staff include emergency care, health assessments, communicable disease control, and health education and counseling. For some students, staff also administer medications, perform prescribed treatments, assist with activities of daily living, and facilitate access to health care. School Health staff also participate in some inter-agency programs, including Linkages to Learning and Head Start.
More than 90% of School Health staff are school-based School Community Health Nurses and Health Room Technicians. Between FY 96-98, the ratio of students to technicians remained the same; the ratio of students to school nurses increased 3.5%. This year's budget supports technicians for six hours per day in all schools except for 29 elementary schools.
While it is commonly believed that health and education are inextricably linked, there is little empirical evidence to document the link between health services and educational outcomes. At present, School Health staff manually collect activity data, which track the volume of work, but do not measure the quality of the services performed, the amount of time spent, or the health and educational outcomes. Recognizing this limitation, School Health is in the process of re-designing the program's data collection system.
To improve School Health Service operations and enhance the Council's understanding of the program, OLO recommends: