The notion that children suffering from chronic conditions, like asthma or diabetes, are more likely to miss school and lag behind academically is hardly new. But there is now strong evidence showing just how health problems in childhood can also thwart lifelong success well beyond the classroom—an achievement gap that can be made even wider by higher rates of chronic illness in low-income communities.
To address this gap, Johns Hopkins Children's Center pediatricians and the Norman and Ruth Rales Foundation are joining forces with educators to create what they say will be the most comprehensive, fully integrated school-based health program in the country, designed to ensure that Baltimore City students from economically disadvantaged areas achieve their full academic potential.
The $5 million Ruth and Norman Rales Center for the Integration of Health and Education, headquartered at the Johns Hopkins Children's Center, will offer a wraparound, fully integrated model of health and education. The center's signature program, called READY—Rales Educational and Health Advancement of Youth—soft-launched in August in two Baltimore KIPP schools, KIPP Harmony Academy and KIPP Ujima Village Academy. Combined, the two schools serve 1,500 K-8 students, 83 percent of whom come from low-income backgrounds. Under the program, KIPP students will have access to a full-time clinic for acute and primary health care and a range of wellness services.
"Children's physical, mental, and emotional well-being directly affects their ability to learn and develop and can have dramatic consequences not only on school performance but on lifelong achievement as well," says Rales Center co-director Tina Cheng, director of the Division of General Pediatrics and Adolescent Medicine at Johns Hopkins. "Children who have unmet health care needs often miss school and experience learning and academic setbacks that put them at an early disadvantage that may persist throughout life."
Also see: On the Healthy Road to Academic Success (Johns Hopkins Children's Center)
Such gaps, Cheng adds, could be closed, or at least narrowed, by delivering timely primary medical care. That, Cheng says, can in turn boost a child's academic achievement and set kids on a path to lifelong success.
The goals of the READY model are to improve students' access to health care that is tailored to their needs, increase student health education and literacy, improve students' self-management of chronic conditions, and promote healthy behaviors, such as regular exercise, a wholesome diet, and healthy sleep.
"We have known for a long time that healthier students miss fewer school days, can focus and learn better, and as a result fare much better academically," says center co-director Sara Johnson, associate professor of pediatrics at the Johns Hopkins University School of Medicine and a public health expert at the Johns Hopkins Bloomberg School of Public Health. "But we haven't been good at synchronizing health and education to ensure that medical issues do not interfere with a child's progress and development. Our new initiative will align the two to ensure optimal health and learning."
The dangers of chronic health problems in childhood are even greater in economically disadvantaged neighborhoods. Research shows that children growing up in such areas are both more likely to suffer from a range of chronic conditions than their peers from more affluent ZIP codes and to have unmet health care needs.
The long-range objective of the center is to evaluate the case for integrating health centers into schools in a way that fosters the health, growth, and academic achievement of students from low-income communities by instilling healthy behaviors early in life and ensuring common childhood afflictions are prevented or treated promptly before they affect a child's academic progress.
"Many children growing up in Baltimore City and other urban areas have complex health and educational needs that often go unmet because health care services are unavailable or not easily accessible," Johnson adds. "The need for a new school-based comprehensive approach to health is truly acute."
In addition, schools provide the perfect natural setting not only to identify and treat at-risk students who need health care services, Johnson says, but also to foster lifelong healthy behaviors and build students' capacity for long-term education achievement.
The impact and cost-effectiveness of the READY model will be assessed in five years to determine whether the approach has bolstered conditions that could narrow the achievement gap. Specifically, they will measure whether it has contributed to a healthier school climate, successfully reduced absenteeism, minimized asthma flare-ups, reduced obesity and curbed risky behaviors, as well as whether it boosted well-child visits and immunization rates.
The findings will give insights to public health experts and educators about ways to improve the model and refine strategies as needed.
"We're doing this with the intention that it will become a replicable and scalable model that could change population health," Johnson says. "We hope our findings will inform our national discourse on health and education and help reshape existing child health policies."
Insights generated from this effort, she adds, will be disseminated in the peer-reviewed public health literature as well as to child-health advocates and policymakers.
"The goal of the Rales Center is to build a foundation of good physical and mental health for every low-income child, which can, in turn, support sustained academic achievement, educational attainment and healthy behaviors through the transition to adulthood," says Joshua Rales, president and trustee of the Norman and Ruth Rales Foundation. "Beyond that, the center illustrates the power of public-private partnerships as a catalyst to desperately needed innovation."
The READY program being implemented at KIPP Baltimore will be staffed by a pediatrician, a nurse practitioner, a nurse, a dental hygienist, a wellness coordinator and a parent engagement coordinator. By contrast, only 45 percent of public schools in the United States have full-time nurses, and 30 percent of schools share a nurse with another school.
The center will offer:
Acute and well care, immunizations, and management of chronic conditions
Screening and management of vision, hearing and behavioral problems
Dental screening and links to community dentists provided through a partnership with the University of Maryland School of Dentistry
Routine assessments of developmental progress
A parent liaison to help link families to resources they need to support their children's health, such as refilling prescriptions, accessing community resources or healthy cooking classes
Group and individual mental health programs
Increased opportunities for physical activity
A healthy diet program to evaluate the nutritional content of school meals and help make healthy foods more appealing to students
Parenting support and education on health topics
Health topics and skills that are incorporated into classroom activities
Teacher stress reduction and wellness programs
"KIPP Baltimore is the perfect setting for this program because our commitment to providing a strong culture of achievement for lifelong success is seamlessly aligned with the goals of the READY model," says Kate Mehr, executive director of KIPP Baltimore.