Presentation Theme The Community Preventive Services Task Force recommends the implementation and maintenance of school-based health centers in low-income communities. School-based health centers are associated with Improved health outcomes: Increased vaccinations and other preventive services Fewer asthma incidents Fewer emergency department and hospital admissions Increased contraceptive use among females Increased prenatal care and birth weight Better health risk behaviors Improved educational outcomes: School performance Grade promotion High school completion 3
22
Center for Surveillance, Epidemiology, and Laboratory Sciences Division of Public Health Information Dissemination Robert A. Hahn, PhD, MPH Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services U.S. Centers for Disease Control and Prevention (CDC) Prepared for Georgia Legislature Study Committee on the Interface between Health and Education and School-Based Health Centers October 27, 2015 A Community Guide Health Equity Review of the Effectiveness of School-based Health Centers for Improving Health and Academic Outcomes Center for Surveillance, Epidemiology, and Laboratory Sciences Division of Public Health Information Dissemination
Transcript
Center for Surveillance, Epidemiology, and Laboratory SciencesDivision of Public Health Information Dissemination
Robert A. Hahn, PhD, MPHDivision of Public Health Information Dissemination
Center for Surveillance, Epidemiology, and Laboratory ServicesU.S. Centers for Disease Control and Prevention (CDC)
Prepared for Georgia Legislature Study Committee on the Interface between Health and Education and School-Based Health Centers
October 27, 2015
A Community Guide Health Equity Review of the Effectiveness of School-based Health Centers for
Improving Health and Academic Outcomes
Center for Surveillance, Epidemiology, and Laboratory SciencesDivision of Public Health Information Dissemination
Disclaimer
The findings and conclusions in this presentation do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The Community Preventive Services Task Force’s evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.
The Centers for Disease Control and Prevention “provides administrative, research, and technical support for the Community Preventive Services Task Force.”[PHS Act §399U[c]
2
Presentation ThemeThe Community Preventive Services Task Force recommends the implementation and maintenance of school-based health centers in low-income communities. School-based health centers are associated with
Improved health outcomes: • Increased vaccinations and other preventive services• Fewer asthma incidents • Fewer emergency department and hospital admissions• Increased contraceptive use among females• Increased prenatal care and birth weight• Better health risk behaviors
Improved educational outcomes: • School performance• Grade promotion• High school completion
3
The Community Guide
Systematic reviews• Evaluate and analyze all available evidence on the effectiveness of
community-based programs, services, and policies in public health• Assess the economic benefit of effective programs, services, policies• Highlight evidence gaps
www.thecommunityguide.org
5
Evidence-based findings and recommendations • About the effectiveness of these
programs, services, and policies• Help inform decision-making • Developed by the Community
Preventive Services Task Force (Task Force)
Community Preventive Services Task Force
• A non-federal, independent, non-partisan panel• Renowned experts in public health research, practice, and
policy• Members are appointed by CDC Director• Serve without compensation for this work• CDC provides administrative, research, and technical support
for the Community Preventive Services Task Force
6
School-Based Health Centers: Definition
School-Based Health Centers (SBHCs) are systems of health services provided to students at centers within K-12 schools (i.e., school-based) or at off-site health facilities linked to the schools (i.e., school-linked). Most SBHCs are targeted to low-income students.• Services must include primary health care. • Services may also include mental health care, social services, dentistry, and health
education. • Minimally, primary care services are provided by a single clinician (e.g., nurse
practitioner, physician assistant, or physician). Comprehensive services may be provided by multi-disciplinary teams.
• Services need not be available during all school hours or days. • Student participation requires parental consent, and services may be limited for
specific forms of care, such as reproductive and mental health. • Services may also be provided to school staff, student family members, and others
in the surrounding community.
6
Research Questions
• How effective are SBHCs in improving health and educational outcomes in student bodies?
• Does the use of SBHCs improve the health and educational outcomes of users?
7
Review Coordination Team
Staff TeamRobert A. HahnJohn KnopfRamona FinnieYinan PengTask Force MembersRobert Johnson (Rutgers New Jersey Medical School)Jonathan Fielding (UCLA Fielding School of Public Health)Task Force Liaison MemberRegina Davis Moss (American Public Health Association)CDC Library Specialist:Onnalee Gomez
CDC PartnersBenedict I. Truman Camara JonesPete HuntMary Vernon-SmileyJoi HudsonIngrid HallGia RutledgeExternal PartnersIrene Dankwa-Mullan (NIH)Carles Muntaner (U Toronto)Jacqueline Buckley (US Dept Education)Mindy Fullilove (Columbia)Steven Barnett (National Institute for Early Education Research)David Williams (Harvard)
8
Health education: • Nutrition• Sexual behavior• Substance abuse• Physical activity• Mental health
Analytic Framework: School-Based Health Centers to Promote Health Equity
Increased access to services (medical, mental health, dental, social)
Improved health of low-income and minority students
Health Equity
Improved school achievement
Increased proportion with medical home
Reduced teen births
Key Effect Modifier- Available community
health care- Parental engagement- School-based/linked- Record Sharing
Patient comfort/ satisfaction
Increased use of recommended preventive services
METHODS
10
In General, a Conclusion on Effectiveness Requires:
A Body of Evidence
More than one studyFewer if high quality More if lower quality
+
Consistency of Effect
Sufficient Magnitude of Effect+
“Most” studies demonstrated an effect in the direction of the intervention
The effect demonstrated across the body of evidence is “meaningful”
A Demonstration of Effectiveness
11
Two Basic Comparison Options
1. Studies of School Student Body: Comparison of settings including both users and non-users, i.e., the student body.
2. Studies of SBHC Users: Comparison of settings including only users, e.g., students in a school with an SBHC who use the SBHC, compared either with students in the SBHC school who do not use the SBHC or with students in a school without an SBHC who use community resources.
Strolin-Goltzman 14, Taylor 83, Webber 03, Zimmer-Gembeck 97
Limited (>4) - -4
Bourne 71, Dallas ISD 06, Jennings 00, Jones 97
13Included studies: 44Excluded studies: 4 * Citations include separate studies with different features
16
**
17
* *
20
* *
Overall Review Assessment• Body of evidence: 44 studies
• 32% greatest suitability of design; 50% fair quality• Impact on recommended preventive services
• Magnitude of effect meaningful? Yes • Consistent across the body of evidence? Yes
• Impact on morbidity• Asthma
o Magnitude of effect meaningful? Yeso Consistent across the body of evidence? Yes
• Physical Health o Magnitude of effect meaningful? Noo Consistent across the body of evidence? Yes
• Mental Healtho Magnitude of effect meaningful? Noo Consistent across the body of evidence? No
17
Overall Review Assessment, Cont’d• Impact on misuse of medical care resources
• Magnitude of effect meaningful? Yes• Consistent across the body of evidence? Yes
• Impact on source of regular health care services• Magnitude of effect meaningful? Yes• Consistent across the body of evidence? Yes
• Impact on reproductive health• Magnitude of effect meaningful? No • Consistent across the body of evidence? No
• Impact on other risk behaviors• Magnitude of effect meaningful? Yes • Consistent across the body of evidence? Unclear
• Impact on educational outcomes• Magnitude of effect meaningful? Yes• Consistent across the body of evidence? Yes
• Team assessment • Sufficient evidence of effectiveness
18
Economic Evidence
For interventions found to be effective, the Community Guide systematically reviews economic evidence.
The only two available studies examined benefit: cost ratios from a societal perspective.• One found benefits were 1.38 times costs.• The other found that benefits were 3.05 times costs.
19
Task Force Finding Statement
The Community Preventive Services Task Force recommends the implementation and maintenance of school-based health centers (SBHCs) in low-income communities, based on sufficient evidence of effectiveness in improving educational and health outcomes. Improved educational outcomes include school performance, grade promotion, and high school completion. Improved health outcomes include the delivery of vaccinations and other recommended preventive services, asthma morbidity, emergency department and hospital admissions, contraceptive use among females, prenatal care and birth weight, and other health risk behaviors.
20
Task Force Finding Statement (Continued)
Most evidence derives from studies of SBHCs in low-income populations. As SBHCs are commonly implemented in low-income communities and communities with high proportions of racial and ethnic minority populations, many of whom are low-income, this source of student health care and health education may be a prominent means of advancing health equity.
