TAG in Action: Bringing Health and Education Partners Together in East Baton Rouge

TAG in Action: Bringing Health and Education Partners Together in East Baton Rouge


Welcome to the webinar on successful
strategies for improving adolescent health. This is one of a series of webinars highlighting local, state, and national efforts relating to the Office of Adolescent Health national call to action to improve adolescent health and development called Adolescent Health: Think, Act, Grow, or TAG. My name is Evelyn Kappeler. As the Director of the Office of Adolescent Health, I’m very pleased to be with you to talk about TAG and to share information about a successful strategy to
improve adolescent health out in the field. This webinar will highlight an
innovative effort in Louisiana called Health Centers in School, and we’re pleased to
have their CEO with us, Sue Catchings, to share her experience in developing these
health centers in East Baton Rouge Parish Public School. Before I turn it
over to Sue, I’d like to tell you a bit about the Office of Adolescent Health and TAG. The Office of Adolescent Health is located in the United States Department of Health and
Human Services. We were first funded in 2010 and we’re pleased to have just celebrated our
5th anniversary. Congress charged the Office of Adolescent Health with developing a
national plan for improving adolescent health. Using our limited resources and
the input of experts to synthesize what we know about what works and to spur
action in support of adolescent health the TAG call to action is the first
response to that charge. We’re glad to be able to shine a light on an outstanding
example of a program that is working across the health and education fields to improve adolescent health and is a terrific example of TAG in action. TAG builds on the collective
work and insight of many professionals, researchers, and family members who know
what it takes to promote the health and healthy development of America’s 42 million
adolescents. Teens are generally fairly healthy but there are many missed
opportunities to promote adolescent health and to intervene promptly as challenging health issues
emerge in adolescence and young adulthood. TAG is a comprehensive strengths-based
positive youth development approach to adolescent health, rather than a risk-based
approach. TAG is designed to help young people reach their full potential as
healthy productive adults. With TAG we hope to spur action across multiple
groups of professionals and organizations and in communities that all share a common
interest in promoting adolescent health. Stakeholder engagement is a core tenet
that drives all aspects of TAG and reflects our understanding that many
determinants of adolescent health lie outside the health care system. The goals for TAG are the following.
To raise awareness about the importance of adolescent health. To engage
stakeholders, including youth serving organizations and caring adults. To get
adolescent health on the national agenda. And I think most importantly to spur
action at the community level. Long-term, TAG contributes to achieving the Healthy
People 2020 objectives for adolescent health that were developed by the U.S. Department of Health and Human Services, and more details about TAG can be found on
the Office of Adolescent Health’s website. Before we begin, I’d like to point out that the
content and views of the next portion of the webcast do not necessarily represent the
official policies of the Office of Adolescent Health. I’m now pleased to turn
things over to Sue Catchings to learn what some East Baton Rouge Parish Public
Schools and Louisiana have been doing to improve adolescent health through their
school-based health centers. Sue has been the CEO of Health
Centers in School since 1994. In her 10 years, the organization has doubled the
number of school-based health centers health centers for school provides
health care to approximately 45,000 children and youth. Sue?>>Sue Catchings: Thank you so much! It’s great to be here today. So as you’ve heard, we have a very unique program here in Baton Rouge that really does bring
together both the community health system and the school system. And while some
people think that’s an odd match I think it’s a match made in heaven, so if I can
have the next slide. The Regional Medical Center Our Lady of the
Lake is the largest hospital here in Baton Rouge. They have 844 beds. They have about 7,000 team members about 1,000 medical staff. They are one of the biggest
hospitals in this area and they are part of a system called the Franciscan
Missionaries of Our Lady. Next slide. Health centers In Schools, while we are
all employed by the hospital system, we we work totally inside of the East Baton
Rouge Parish Public School system. There are approximately 90 to 97 school campuses and
on 7 of those campuses we have a comprehensive school-based health center
that for us in Louisiana we are regulated by our own office of public
health and those health centers represent the integrated primary care and mental
health including psychiatric services and mobile optometric services. We have 18 stationary nurses that means the nurse goes to one school and stays at that
school all day for the whole school year, and 72 campuses have rotating nurses and also
support staff person to the nurse that we call the school health system. We serve
approximately 45,000 students every year. Next slide. One of the things about East Baton Rouge Parish, the
School System, is that they’ve had a noted performance improvement over the last
six years 87% of those 90+ campuses are academically acceptable and their enrollment ranges between that
42 and 45,000 number. What makes this system unique is that
80% of the students in this school system are on the free lunch program
and actually what that crosswalks to is that these children are all on Medicaid or
Louisiana’s CHIP program. Very few of our students have private
insurance. We do have some however about 10% and there’s still about 10% that
do not have insurance at all. The school system began to contract with Health Centers in Schools for the school nurse program in 2004 that’s when we expanded across the whole
system and not just the school-based health centers. Next slide. Part of why this works with the hospital
system is one of our primary activity is to reduce utilization of the emergency room
by students that are in the school that we serve. We have an inordinately high
number of asthmatic children, many of whom take medication at school, we have an evergrowing population of diabetics. Children with sickle-cell disease, children
who have some type of hypersensitivity either food or insect venom.
So if you push the button again This is our mission. This is what we exist for
We keep students healthy so they can stay in school and learn. One of the
things that I would say to the audience is that you must realize that you put
health services on a school campus you must remember to always be talking in
the world does health care because we’re all health people but we live in an
education world so we have to look at academics also. And pushed the button again. Our goal is to improve the school and
the test scores. One of the ways we do that is we know that 95% of the
time, we send students back to class. They don’t go home unless they’re
absolutely ill and then we want them at home because that’s the best place for them to be. And push the button one more time please. We are actively pursuing many different
endeavors in population health. When we have– And I also believe that because we have so
many students that live at or below the federal poverty level– if you really want to do population
health, you’re going to go to school because this is the one place that these students, the
children and the teenagers, have to be. So if you could give me the next slide. We have strategic partnerships with many
different entities in many different arenas across Baton Rouge. We couldn’t do what
we are doing without all of these people coming to the table and saying, “How can
we help?” Every year, and right now we’re in the middle of it, we do what’s called Give Kids a Smile Day. If I took all the chronic disease in East Baton Rouge
Parish Public School system that I just isolated and looked at oral health, I would tell you that it’s going to
double or triple the percentage of students that have poor oral health. It
is really disturbing to me just see so many children with oral health problems
that are really going to impede their health overall as they age. We work with two optometrist who do
mobile optometr–that means they get a number of consents on a school campus. Those consents allow them to do dilated eye exams, make glasses for students, and bring them back to school. Why would we want to do that? Because
most of the time prior to be invention of mobile optometry less than a third of the students that
we failed in visions framing actually got to an eye exam. I am pleased to tell
you that we have access to a child and adolescent psychiatrist and he is
backing up our clinical social workers and work hands-in-glove with our medical director who’s a board certified adolescent
medicine specialist. Department of Agriculture and Forestry
is the single entity that because they have a huge refrigerated warehouse
here in Baton Rouge that allows us to do the flu project. The Commissioner of Agriculture
and Forestry is a great supporter of what we are and gives us a place to store
all of the vaccines that we give, which is thousands of doses during flu season. We also work hand-in-glove with
Vaccines for Children (VFC) at the Office of Public Health because we tried to make
sure that all of the students, including those 11 year-olds, are up to date with their
immunizations. I have the privilege of serving part of the Lake Physician Group, and what that means is that I get to go to the pediatric residency program and interact with all
of the general pediatrician and the sub-specialists. That is really a part of the
match that has been one of the best and shining examples of what we’re doing. I now
know the physicians that are taking care of many of the children that have chronic disease in Baton Rouge, and they know me. We are working diligently together to make sure that we are coordinating care for those physicians And all physicians–they don’t have to be part
of the Lake Physician Group–their patients that are on our campuses. We
worked with another program that comes from the federal government call the
Nurse Family Partnership. Mostly on our middle and high school campuses, we work
very closely with our area health education centers because they have
resources that can help as we go down the road of teaching young people about
health. We have the fortune of being in a city
that has a dedicated biomedical research renter, mainly
focused on obesity, but they are branching into other areas with Pennington. That has given the opportunity to really
participate in research study that in my hopes and dreams will one day change the
crime at the rate of obesity that we have in this city, in this state, but also in the country. We partnered years ago with the
Greater Baton Rouge food bank and we do the backpack program on a number of
elementary school campuses. One of the things that I would hope that our
country would realize is that many of our children go to bed hungry. They live in
food insecure homes. With the backpack program the schools help coordinate this, but
the backpacks go out on Friday full of food that doesn’t require refrigeration, comes back
empty on Monday, and we do the process throughout the school year so that kids
and their families have some opportunity to have food. We work very closely with the Children’s Coalition of Baton Rouge, which brings together all of the child serving
agencies in this city and it’s a place where we can work together and partner
with each other to take better care of children. And then of course we have a
children’s health project which comes out of New York. Those are mobile buses, there’s a medical and mental health bus that have the capability of moving from school to
school and see students on campuses where we don’t have full-time nurses and
do not have a school-based health center. Next slide. The way that we’ve created more community
impact is we are linking everything together. We are literally
connecting the dots. One of the things that we have put in place that I am most
excited about is our school asthma management program and then the hospital
runs an asthma camp during the summer. These two programs work hand-in-glove with each other with an asthma specialist coming out of
respiratory therapy from the hospital who works across the line and into the
school system so that we can take care of the children that are the most
fragile and experience problems with asthma. We still have problems and
challenges with this particular disease. We haven’t conquered it all, but we are
well on the way of beginning to connect all the dots and create a seamless
program that works with the population of asthmatics in pediatrics. If you press
the next bullet again. As I mentioned before we do the
influenza immunization program. We couldn’t do it without the Department of
Agriculture and Forestry because that is literally where all the vaccine is stored. But we also couldn’t do it without the Lakes Foundation. They purchase all of the non-VFC vaccines that we
use because when the superintendent at the school system said, “I will do the
program. I want to do program, but you have to immunize everybody.” So that
meant we had to not just look at the VFC population but we also had to look at
the non-VFC population and every year come October/November, health centers in
school and all of our community partners come together and we immunize thousands of
children in East Baton Rouge Parish. Next bullet point. We also have the capability with our
buses, our mobile buses, of doing an 11 year-old immunization project. What
I have found here in Baton Rouge is that many of the parents do not still
understand that there are now required 11 year-old immunizations. Now we’re at the
forefront of helping to educate the community about the importance of these
immunizations and to make sure that the children actually get them many times on
the school campus. Next bullet point. We do about 25,000 vision and hearing
screenings anually. This is a very important part for education. If you can’t
see, you’re going to have a hard time learning how to read. And if you can’t hear, you’re not
going to hear the sounds of the letters, and therefore, you’re not going to speak
appropriately. In fact today we are planning or a one site vision clinic
that will be next week where one sight foundation is on the ground here in Baton Rouge,
and together with the school system, the Children’s Hospital Health Centers in Schools,
we are going to do 600 dilated eye exams and make glasses for students that need them in one week. Wish us luck, because we’re going to need it! And then I can’t speak enough about oral
health. This is one–again–on of the most disturbing pieces that I see. We do Give Kids a
Smile Day because it’s the right thing to do. It’s a partnership between the school
system and local dentists. We need to do more. This is a huge problem in this city.
Give Kids a Smile Day, what’s so great about it is that I can contact these
dentists when we run into a child that has a real challenge and we don’t have
the venue to take care of it because we don’t have any dental operatory and they see the
children and take care of the problem because they know that there is a huge
challenge here in Baton Rouge. Next slide. Oh. Obesity management and education. Sorry,
I didn’t realize there was one more bullet point. So, Our Lady of the Lake system has adopted what’s called 5-2-1-0 + 10. 5-2-1-0 is a signature national
program and it’s all about educating the population–the students and their family–
about eating more fruits and vegetables, spending less time on all the
different kinds of screens that we have, making sure that there’s at least an
hour of physical activity every day, and having zero sugary drinks. We added + 10 because that’s the American Academy of Pediatrics’ request or
requirement for sleep with for adolescents. I think that if I could say
anything at all that is where we all as a nation need to look at how schools are
structured, and we need to work toward making sure that adolescents come to
school later in the day as opposed to earlier in the morning. Next slide. Research has shown us that because of what
we are doing we have improved attendance and graduation rates, and we are helping the
students to go out and either go to a two-year college or four-year university
or go into a technical trade. If you’ll go to the next slide. So, if you would click the button. In 2012 what we know is that if the
student comes to school and has to leave is essentially what’s happening is that those
students lose up to six hours of academic time–that is the time
they’re in the classroom learning. When we look at what we do in our health
centers, 22,000 visits means that they would have have lost over 200,000 hours of academic
time. Their unique way to look at this, or what we know is that we are helping them achieve
academically. Next bullet. 2013–click again. We had almost 17,000 visits. Oh, by the way, let me make sure you understand: that’s the year we went into the
electronic health records. So it does slow you down a little bit but we get
that feedback. So we had almost 17,000 visits that year, and we would have lost
100,000 hours of academic time. Next slide. So, examples of our success I can’t tell you enough about are the asthma program and the camp. The camp in the
summer is the weeklong camp run specifically by all the partners that led the Respiratory Therapy Department out of
the hospital. We bring in all the ambulances, we do programs every day, but
what we’re really focused on is helping the children and their parents
understand this disease called asthma. This program alone has reduced emergency room utilization admits by 30% and had a 50% decrease in ICU stays for students who have exacerbations of asthma. We
keep working on this. We’re not finished. We are hoping to be part of the
collaboration that will begin now to look at housing in our city but more
to come on that later. Next slide. You’ll click–just hold here. I want you to meet this child. Her first
name is Elizabeth I want you to look. Elizabeth in this photograph is in
second grade at an elementary school. She participated in Give Kids a Smile Day.
I want you to look at her smile because what I want you to notice is it appears she
has one primary front tooth and then it begins to look a little different with spaces
around her mouth. The dentist who saw this child during Give Kids a Smile Day called me during the program that was actually running and she said, “We have a
problem.” And I said, “What’s that?” “What’s happening to Elizabeth is her
other front tooth is coming in right under, and so all of her teeth are moving trying
to fill up that space.” So if you’ll hit the next bullet. This problem was corrected because that dentist knew the orthodontist
who saw this child and did all the work that needed to be done to correct
her problem. Next. Click again. It has boosted her self-confidence
greatly. She is now in middle school and– Click again. and has also reduced the potential of
her being bullied because the dentist and the orthodontist that worked
with me for this child basically said her face would have been malformed had they not gone in and done work they did.
You’ll click one more time. Meet Elizabeth. Four years later, two front teeth in place and a beautiful
beautiful smile. Next slide. In terms of academic improvement, not only are we worried about
students who are staying in school, but I want to know what the impact of mental
health therapy is on students. This slide shows our tracking of students who participated in mental health therapy with our licensed clinical social workers and
completed that therapy, and what we know is that we are showing a very large
increase in academic improvement, but there’s a smaller–and– we still are studying why don’t they
all improve. We haven’t figured all that out yet. We are working on it. But we do know that we are having a huge
impact because of the mental health therapy that’s going on in the
school-based health centers and if I could make one plea, at a national, regional, and
state level we don’t have enough mental health therapists. We don’t have enough
mental health therapy and we’re not doing prevention. We’re totally just
intervening. Our social workers work predominantly within prevention with
mental health therapy. That is our goal. Not to let them have the total DSM V diagnosis. Next slide. And what’s next? We do have a few more plans. We will
continue to grow our population health programs and those will be only limited
by our own imagination and that of all the sub-specialists. We’ve already done a
quality improvement program with asthma controller meds and show that
60% of the students when we give the controller medication at school missed less days of school, understood
their asthma better, and were in better control of their asthma. Click again. We continue to do ongoing training and
education programs, both for the community, for the students, and for our own team members. We tried to find speakers who can come in and speak to the
challenges that we face and offer a unique opportunity. We trained our staff
for seven days before we ever come back into a full session. Next slide. I mean, sorry, next
bullet. We have gone down the road of the electronic medical record. It’s not as easy as
you think it is but it does give you the opportunity to let providers see what other providers
are doing as long as you’re on the same electronic record. We found that very
helpful because the physician, because they’re also on Epic: they can see
what we’re doing, we can see what they’re doing, and we can better
coordinate care because we’re all on the electronic record. Click again. We are now beginning to go down the road
tele-health in one of our high schools where we have about 1,300 children. What we’ve
done is deployed tele-health equipment where a stationary nurse is at that high
school campus. She has the capability of dialing in to both the sub-specialist, some of the physicians, and also to our school
based health center nurse practitioners. So she is working with us to help us
understand how it needs to look as the pilot site. This is one of the things
that I believe will help us reach more children and teens. Next bullet. And then the final thing that we’re doing is to
do the complete integration of the program. That’s school nursing and
school-based health centers so that we’re all focused on working as a team
across all of the schools here in Baton Rouge. Next slide. And that’s my contact information if
anybody needs to contact me, and I’ll turn it back over to the host. Evelyn: Thanks Sue for such a wonderful
presentation. We’d like to take a few minutes now to ask some questions about
the work that you’ve been doing. So, can you tell us a little bit about your rationale for moving
school nursing into prevention? Sue: Sure. I studied the history of school nursing,
actually, and school nurses came into being in this country in the 1920s, and if you think
back to that time they didn’t have a lot of medication and we didn’t understand a
lot about how disease was spread but nurses were put in schools at that point
to detect student who were ill and to get them away or out of the school. So it’s
it’s always been this reactionary kind of program. The times have changed now and
we are now trying to reach prevention through population health. I don’t think that
we can continue what we’re doing. We have to go down this road because we know
it’s going to be more cost effective. So I believe that not just here in Baton Rouge,
but across the whole United States, I think school nursing programs are moving in
this direction because they’re one more piece of the puzzle that we call an
integrated health system. Evelyn: Thanks Sue. Can you
tell us a little bit about how you manage the navigation between
a school system and a health system? Sue: Carefully. I have been both the teacher in
middle school and high school, and I’ve also been a medical technologist working in
hospital. The advantage that I have is that I understand at a building level the
lingo of each of these two systems. I understand for the most part how they really
work. We were offered the opportunity to basically take over the school nurse
program because the superintendent at that time said
something that I think is very true. He said I’m an educator. I know about
education, I don’t know anything about health care and yet I find myself on all of
our campuses to be dealing with very chronically ill children. I think that we
all need to acknowledge that this is where chronically ill children come to
school in the public sector, and so the thoughts and ideas that I have that
seem to be very relevant today. We have more chronically ill children coming to
school. Sometimes their care represent very
challenging process. I have seen students in disease states that I never thought I’d
see here in Baton Rouge. So I think that what we need to do is work together.
I am so pleased to be an employee of a large health center, and I am equally pleased to
be working in a school system. I do believe these two systems really need
each other and they need to work together. I also believe that this is
beginning to be recognized across the United States and that we will begin to
see more partnerships with health care and school systems coming together. Evelyn: So, Sue. If you are given a dream program, what would it be and why? Sue: I already talked a little bit about if I had the
chance to dream, and I can dream pretty big, I can tell you that, I would like to
bring integrated health and mental health programs to all the schools. I don’t think that we can
take care of students in our society today without having mental
health really right there with us. There is such a huge lack of care, in my opinion, and the way I see it playing out
for particularly adolescents is they get into trouble and oftentimes end up in jail because of something that they’ve
done. I think that if we can ever put all of this together and work we can do not
just the primary preventive care, we can also support the health systems,
the physicians with doing chronic disease care, and I think that we’ll ultimately
end up having oral health care at school– and vision and hearing for students–
where the resources are sitting at school. It only makes sense in a large
school system where you’ve got thousands of children, so I think the urban areas
around our country are moving in this direction and I think it’s only going to
get bigger as time goes by. Evelyn: Great. Thanks Sue. Can you tell us a little bit about why you invested time and dollars in the Student Alliance Council? Sue: I absolutely can. This has been one of the last
pieces that we’ve added. Tele-health will be the next piece that we’re working on. I think that this particular
program of selecting a group of students, and in Baton Rouge we have two or three
students from every public high school in our system. They are part of the
student alliance council but what we are really doing is, we’re learning from them as
much as they are learning from us, And I know that these two things have to be
intertwined–health and education. I think it’s an interesting place for us
to work. I also think it’s going to help the community as a whole in the long run
because we’re really looking at the social determinants of health. Everything in
my opinion about a community goes to what doe the school system look like and
how are they supporting their children. Evelyn: Thank you, Sue.
Thank you for sharing with us today your experiences and your work, which is
so helpful. On behalf of the Office of Adolescent Health, I want to thank you for joining
us to learn about the Office of Adolescent Health and Think, Act, Grow, and
to hear about the wonderful work going on and Louisiana. I especially want to
thank Sue Catchings again for sharing the story of how combining health care
services in school settings can bring about better outcomes for young people.
We’d love for you to get involved and spread the word about Think, Act, Grow
within your own professional networks and there are lots of things you can do.
I encourage you to explore our website, to check out the TAG Playbook, to join
TAG, and get email updates from the Office of Adolescent Health. I help encourage you to notify
your colleagues and grantees about TAG I encourage your organization to use
the TAG action steps and resources. You can blog about TAG, and we have sample
text in our TAG toolkit. I encourage you to ask questions, share ideas, and stay in touch.
I also encourage you to use social media to reach of some of America’s 42 million
adolescents and adults who care about them. I encourage you to stay connected to the
Office of Adolescent Health and our TAG call to action. Here’s the URL for the TAG landing page.
You can email at [email protected] to let us now you’re using TAG and
share your successes and ideas for collaboration. You can follow us on Twitter at
@TeenHealthGov and monitor #TAG42mil to see what’s going on with
TAG. Thank you for joining us today.