CA schools face acute shortage of nurses and counselors

Child getting throat exam in school

California public schools are falling woefully short when it comes to student support personnel. The American Academy of Pediatrics recommends a ratio of one school nurse to 750 students. According to the most recent data available on Kidsdata, however, the state’s public schools employed one full-time nurse for 2,784 students in 2015, or nearly four times the recommended ratio. For the 52 counties with available data, none met the recommended ratio. Yuba County had the most impacted ratio by far, at one nurse for nearly 14,000 students.

The state falls behind in other support categories, too. The American School Counselor Association recommends a ratio of one school counselor to 250 students, yet California’s ratio was one to 792 students in 2015, or more than three times the recommended ratio. Rural counties such as Lassen, Calaveras, and Plumas had the most pronounced ratios, at one counselor for more than 1,400 students. In 2014, California ranked 49th in the US (PDF), after Arizona, in its counselor-to-student ratio.

Student support personnel address students’ social, emotional, behavioral, physical, and cognitive needs to help them reach their maximum academic and health potential. Schools that provide students with greater access to nurses and counselors are associated with more positive school climates, which generally lead to better student performance.

Policy options that could improve student access to quality support services include maximizing partnerships and existing funding streams (PDF) to ensure that students have access to school counseling and other mental health services, promoting the delivery of health care services at school by funding school nurses and school-based health centers, and integrating student mental health and health care services into a coordinated and comprehensive system of supports.

Related Data (by State, County & School District)


Helpful Links

National Association of School Nurses

American School Counselor Association

National Association of School Psychologists

California School-Based Health Alliance

The ‘Hidden Health Care System’ in California Schools and Children with Special Health Care Needs, Lucile Packard Foundation for Children’s Health

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CA’s new vaccine law: which counties have yet to achieve herd immunity?

Cartoon Crowd, Shield Ring

Last month, California’s new mandatory child vaccination law, SB 277, took effect. The law helps enforce the Department of Education’s requirement that all California children attending public and private schools receive a series of vaccines, unless they have a medical exemption. Inspired by the 2014 measles outbreak at Disneyland and the state’s 2010 and 2014 whooping cough outbreaks, SB 277 prohibits parents from citing personal beliefs or religion as reasons to not vaccinate their children.

To better understand how SB 277 will affect the health of children in California, Kidsdata has released the newest data available on student immunizations for the 2015-2016 school year. Depending on the effectiveness of the vaccine, and how long immunization will last, California public health officials recommend vaccination rates of between 80-94 percent in order to achieve community immunity (PDF), also known as “herd immunity.” Diseases such as polio, which is less contagious, have a lower threshold, while diseases such as measles, which is highly contagious, require a 94 percent threshold in order to protect those most at risk.

Between 2011 and 2016, the state showed a modest 2 percent rise in the percent of kindergartners who had all required immunizations, reaching 93 percent in 2016. When broken down by county, however, geographic differences become clear. At 100 percent, Sierra County led the 26 counties with immunization rates of 94 percent or higher. Three counties had rates lower than 80 percent: Tuolomne, Nevada, and Trinity.

The Gold Country counties of Sierra, Calaveras, and Mariposa each saw a rise of at least 8 percentage points since 2011, bringing them closer to recommended thresholds. On the other end of the spectrum, Amador, Modoc, and Trinity Counties (one in Gold Country, and two in California’s far north) all saw drops of at least six percentage points, moving their populations further from community immunity.

Immunizations are among the most successful and cost-effective preventive health care interventions, helping millions of children in the U.S. and internationally avoid contracting numerous serious and potentially fatal infectious diseases.


Related Data (by State, County & School District):

Immunization summary

Helpful Links

California Dept. of Public Health, Immunization Branch

California Immunization Coalition

Legislative Challenges to School Immunization Mandates: 2009-2012, JAMA: The Journal of the American Medical Association

Solutions to Reducing Vaccine-Preventable Childhood Diseases, Population Reference Bureau

Vaccines Do Not Cause Autism, Centers for Disease Control and Prevention

Immunization Rates in Child Care and Schools, California Dept. of Public Health, Immunization Branch

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Ever wondered who runs Kidsdata? Kidsdata is a program of the Palo Alto, CA-based Lucile Packard Foundation for Children’s Health, which promotes the health and well being of children in California.

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How safe are black children in California?

“It’s okay, I’m right here with you.” These were the soft-spoken words of four-year-old Dae’Anna Reynolds, just minutes after she and her mother had witnessed the July 6 police shooting death—while sitting in the same car—of Philando Castile in Falcon Heights, Minnesota. The Castile case, along with the police shooting deaths of black children such as Michael Brown and Tamir Rice, are reminders of the disparate levels of violence faced by black children in this country.

To better understand how safe black children are in California, Kidsdata provides a wealth of relevant data, broken down by race. In multiple categories, black children consistently face the worst outcomes when compared to children of other ethnicities: black and multiracial infants under one year old are dying at a high rate and black children and youth over one year old are also dying at a high rate.

The disparity in infant mortality rates is largely attributed to perinatal conditions and sleep-related incidents, but for children over the age of one, additional factors include death from violence committed by parents/caregivers as well as by non-parents/caregivers.

In school, data on Kidsdata show that a high percentage of black students report being bullied because of their race, compared to students of other races; and a high percentage of black students report feeling unsafe at school, compared to students of other races.

Last month, Sacramento County announced a $26 million initiative to address its high rate of black child deaths. Working with the Steering Committee on Reduction of African American Child Deaths, the program’s goal is to organize community groups, engage policymakers, coordinate existing services, and push for data-driven accountability in order to reduce black child mortality by 10-20 percent by 2020.

Related Data:

Helpful Links

Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates, Centers for Disease Control and Prevention

Black Children Die at Alarming Rate in Sacramento County, and Here’s Why, The Sacramento Bee

Steering Committee on Reduction of African American Child Deaths, Sierra Health Foundation

Racial and Ethnic Stereotypes and Bullying Victimization, Youth & Society

First Full Year of NYPD Data Shows Black Students Disproportionately Arrested at School, New York Civil Liberties Union

Kidsdata in the News

A recent Kidsdata advisory that identified high rates of pediatric cancer in Napa and Marin counties has helped lead to a special report investigating the possible causes of these high rates. The report was presented to the Napa County Board of Supervisors in June. The board is now asking for an annual report on the topic.

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Child asthma hospitalizations drop as CA’s air quality improves

The rate of asthma-related child hospitalizations in California dropped by one-third, from 16 to 11 percent, between 2001-2014, according the most recent data now available on Kidsdata. During the same time period, measurements of air quality also improved: the number of days with ozone levels that exceeded regulatory standards in California dropped by 60 percent, and the levels of Particulate Matter Concentration fell by 23 percent.

Five counties, Napa, Ventura, Imperial, Yuba, and Yolo, all saw drops of more than 50 percent in total asthma-related child hospitalizations.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of hospitalizations and absences from school. Environmental factors, including air pollutants, account for an estimated 30 percent of the total childhood asthma burden in California, according to a report by the Public Health Institute.

Children are more vulnerable to pollutants because they breathe more air relative to their size, compared to adults, and thus experience greater proportionate exposure to chemicals. In addition, children are at greater risk of harm from contaminants because their bodies and organs are not fully developed.

According to experts, policies that could influence asthma rates, treatment, and health consequences include ensuring that all children have adequate health care and insurance coverage for prevention and treatment of asthma. Other recommendations call for strengthening and enforcing laws and regulations limiting vehicle emissions, agricultural practices that generate dust and particulates, and industrial practices that generate air pollution.

Related Data (by State and County):

Asthma (summary)

Air Quality (summary)

Helpful Links

Air Resources Board: Asthma and Air Pollution, California Environmental Protection Agency

California Breathing, California Dept. of Public Health, Environmental Health Investigations Branch

California Environmental Health Tracking Program: Asthma

Costs of Environmental Health Conditions in California Children, Public Health Institute, California Environmental Health Tracking Program

Paying for Quality Care: Implications for Racial and Ethnic Health Disparities in Pediatric Asthma, Pediatrics

California County Asthma Profiles, California Breathing

Children’s Environmental Health Network

Creating Healthy Indoor Air Quality in Schools, U.S. Environmental Protection Agency

Health Effects of Air Pollution, California Environmental Protection Agency, Air Resources Board

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California students getting fitter with age?

According to multiple 2015 data sets now available on Kidsdata, California students are showing improved fitness outcomes as they age. First, more students are able to meet physical fitness standards as they rise between 5th, 7th, and 9th grades. In 2015, 26 percent of the state’s 5th graders met all fitness standards, compared to 33 percent of 7th graders and 38 percent of 9th graders. The upward trend was consistent across all races and ethnicities.

Second, younger students showed higher rates of obesity compared to older students. In 2015, 40 percent of 5th graders were overweight or obese, compared to 39 percent of 7th graders and 36 percent of 9th graders.

Overweight and obese children are at higher risk for a range of health problems, including heart disease, stroke, asthma, and some types of cancer; they also are more likely to stay overweight or obese as adults. In addition, children with obesity are at increased risk for joint and bone problems, sleep apnea, and social and emotional difficulties, such as stigmatization and low self-esteem.

The Physical Activity Guidelines for Americans and the American Academy of Pediatrics recommend that children and adolescents participate in moderate-to-vigorous exercise at least 60 minutes every day. However, according to a 2014 report (PDF), only about one quarter of youth nationwide get the recommended amount of exercise.

According to experts, policy options that could improve children’s physical activity include ensuring that all schools meet state physical education requirements, making school recreational facilities available for use outside of school hours, and encouraging child care and after-school programs to incorporate physical activity opportunities. Additional recommendations that would reduce childhood obesity include providing access to affordable healthful foods and beverages, and reducing access to high-calorie and sugar-sweetened drinks and foods.

Related Data (by State, County, and School District):

Physical Fitness (summary)

Weight (summary)

Helpful Links

Action for Healthy Kids

California Project LEAN

Centers for Disease Control and Prevention: Childhood Overweight and Obesity

CDC Healthy Schools, Centers for Disease Control and Prevention Obesity, American Academy of Pediatrics

Let’s Move! America’s Move to Raise a Healthier Generation of Kids

The Whole School, Whole Community, Whole Child Model, Journal of School Health

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Highest concentration of child hunger in CA shifts to northernmost counties

School is out, which means that child hunger is more visible as millions of low-income California children will no longer have easy access to nutritious school-provided meals. To better understand the demand for food assistance programs, Kidsdata has made available the latest food insecurity data, which show that 23 percent of California children, higher than the national average of 21 percent, lived in a food insecure household in 2014.

The geographic disparities are startling. Data show that California’s seven northernmost counties have some of the greatest need. In those counties, 26 to 32 percent of children lived in food insecure households in 2014. Just three years earlier, in 2011, the counties with the highest percentages were primarily located in the Central Valley. On the other end of the spectrum, the San Francisco Bay Area had the lowest percentages in the state, both in 2011 and 2014. In 2014, the nine Bay Area counties were home to 16 to 22 percent of children living in food insecure households.

Public food assistance programs such as the Free or Reduced Price School Meal program, Summer Food Service Program, and CalFresh provide a safety net to help ensure that low-income children get adequate nutrition to improve their physical health, behavior, school performance, and cognitive development.

Many children who are eligible for these programs do not use them. In California public schools, one-third (PDF) of the state’s low-income students miss out on free or reduced price school lunch during the school year, and two-thirds miss out on school breakfast. The numbers drop even more during the summer months. In California, less than 20 percent (PDF) of children in need access the Summer Food Service Program.

According to experts, policies and programs that could improve nutrition assistance participation, and the quality of the meals themselves, include simplifying and de-stigmatizing access to free and reduced price school meals, adopting more effective breakfast service models, and ensuring the availability of nutritious, appealing school meals and snacks without competition from unhealthy foods.

Related Data:

Helpful Links

California Food Policy Advocates

Feeding America

USDA Food and Nutrition Service: School Meals

Hunger Doesn’t Take a Vacation: Summer Nutrition Status Report (PDF), Food Research and Action Center

Promoting Food Security for All Children, American Academy of Pediatrics

The CalFresh Food Assistance Program, Public Policy Institute of California

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Higher-income students 2x more likely to meet standards for CA’s new common core tests

Higher-income California students are more than twice as likely to meet or exceed grade-level standards on California’s new standardized tests compared to their lower-income counterparts, according to the first year of published test results, which are now available to compare and visualize, by county and by district, on Kidsdata.

For the English Language Arts/Literacy (ELA) test, 64 percent of non-economically disadvantaged students met or exceeded test standards, versus 30 percent of economically disadvantaged students. For the mathematics test, 52 percent of non-economically disadvantaged students met or exceeded test standards, versus 21 percent of economically disadvantaged students. Economic disadvantage is determined by whether or not a student is eligible for the state’s free or reduced price lunch program or if neither of the student’s parents graduated from high school.

When broken down by county, the wealthier Bay Area counties tended to show the highest rates of students passing these exams, while inland, central valley and more rural counties had the lowest rates.

The Smarter Balanced ELA and math tests, which are both administered online, replaced the paper-based Standardized Testing and Reporting (STAR) program, which had been the statewide testing system since 1998. Students in grades 3-8 and high school juniors take the Smarter Balanced tests, which assess the Common Core principles of critical thinking and writing as well as real-world application.

Each state is required to test at least 95 percent of its students, both state-wide and district-wide, in order to receive federal funding. In 2015, 97 percent of California students took the Smarter Balanced tests, but 21 school districts failed to meet the threshold due to parental exemptions. In the Palo Alto Unified School District, for example, 50 percent of juniors at both of the city’s high schools opted out of the 2015 tests due to their proximity to the Advanced Placement and SAT exams.

Early intervention is critical for children who are struggling with reading and math. Limited skills in these subjects can have effects into adulthood, too, as proficiency in both reading and math is associated with better employment and income prospects.

According to experts, policy options that could improve reading and math proficiency include: ensuring that all children have access to high-quality preschool or kindergarten readiness programs, supporting strategies to involve families in school, evaluating the state’s new accountability system for effectiveness, and providing equitable student access to Common Core-aligned curricula as well as the technology needed for Smarter Balanced testing.

Related Data:

Helpful Links

Achievement Gap Points to Ineffectiveness of Decades of Reforms, EdSource

Health and Academic Achievement, Centers for Disease Control and Prevention

Student Achievement in California: 2015 California Assessment of Student Performance and Progress (CAASPP) Results, Education Trust–West

The Local Control Funding Formula: An Essential EdSource Guide (PDF), EdSource

The Power of Parents: Research Underscores the Impact of Parent Involvement in Schools, EdSource and New America Media

The Whole School, Whole Community, Whole Child Model, Journal of School Health

Time for Equity: Expanding Access to Learning, Voices in Urban Education

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Nine percent of young CA children have never seen a dentist

On the heels of the Little Hoover Commission’s scathing report on Denti-Cal, the dental health care program for 13 million low-income Californians, Kidsdata now offers the latest data on the Length of Time Since Last Dental Visit for kids in California. The data come from the California Health Interview Survey and are now available to view and visualize on Kidsdata.

The data show that in 2013-2014, nine percent of children ages 2-11 had never had a dental visit. The counties with the highest percent of young children who had never visited a dentist were San Joaquin County at 28 percent, Shasta County at 19 percent, and Fresno County at 18 percent. In over 12 additional counties, at least 10 percent of children hadn’t visited a dentist, including Santa Clara County, Sacramento County, and Los Angeles County.

Tooth decay is the most common chronic disease (PDF) among children ages 6-18. Untreated dental problems, such as cavities and gum disease, can affect a child’s health and quality of life by causing pain, nutritional and sleep problems, impaired concentration, and increased school absences, as well as lost work hours for parents. If dental disease is not treated early, it can result in more serious and expensive intervention later on.

Tooth decay and other oral diseases disproportionately affect low-income children, children of color, and uninsured children. For this reason, the federal government has set a public health goal focused on improving access to preventive dental services for low-income children. The federal Affordable Care Act (ACA) includes dental health care for children in the essential health benefits that must be covered by all qualified health insurance plans, a major step forward in ensuring access to oral health care for children.

According to experts, policy options that could influence children’s dental health include: increasing reimbursement rates for dental providers under public insurance programs, creating incentives for them to treat low-income children; increasing the number of pediatric dentists where Medi-Cal patients live; setting pediatric dental benefits under ACA at affordable rates to allow low-income families to access the services; reinstating state support for children’s dental disease prevention (PDF); and ensuring that all communities have fluoridated drinking water, as evidence suggests that it reduces cavities among children.

Related Data:

Helpful Links

Center for Oral Health

Children’s Dental Health Project

Dental Care Access for Children in California: Institutionalized Inequality, Lucile Packard Foundation for Children’s Health

Oral Health Care in CSHCN: State Medicaid Policy Considerations, Pediatrics

Racial Disparity Trends in Children’s Dental Visits: US National Health Interview Survey, 1964–2010, Pediatrics

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Kidsdata Welcomes Lori Turk-Bicakci!

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The Lucile Packard Foundation for Children’s Health is excited to welcome Lori Turk-Bicakci to the Kidsdata team as our new senior manager of data and research.

Before joining the Foundation, Dr. Turk-Bicakci was a senior researcher and project director at American Institutes for Research. She has extensive experience with project management, data collection, analysis, and reporting for social welfare and education research projects and has a particular interest in examining and diminishing disparity.

Her most recent project was a large-scale, multi-year evaluation of a law change to the California Work Responsibility and Opportunity for Kids (CalWORKs) program intended to promote self-sufficiency among families in poverty. Also, she is a certified project management professional (PMP) and a certified reviewer for What Works Clearinghouse (WWC) to assess quality of research studies.

Before her graduate studies in sociology, Dr. Turk-Bicakci was a middle school social studies teacher.

To contact Lori, you can reach her via email.

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Child Abuse Cases in CA Drop by 1/4 in Last Decade

For Child Abuse Prevention Month, we are happy to report some good news: The rate of substantiated cases of child abuse and neglect in California dropped by 25 percent between 2004-2014, according to the most recent data available on Kidsdata.

More than 80 percent of counties saw a decline in their rates of substantiated child abuse cases during this time period. Merced, Lake, Santa Cruz, and Colusa counties all saw the steepest declines. During the entire 10-year period, higher rates were concentrated in the state’s northern counties.

23 per 1,000 children in both the African American and American Indian communities experienced substantiated cases of abuse in 2014, the highest by far among ethnic groups. Rates for those two groups were also the highest in 2004. Children ages 0-5 make up nearly half of all substantiated abuse cases, but only one-third of the state’s child population. In addition, children with special needs and those in the foster care system are also at higher risk of abuse.

Children who are abused or neglected are more likely to experience cognitive, emotional, and behavioral problems, as well as disruptions in brain and physical development, which increase the risk for health problems in adulthood. Children who are abused or neglected also are more likely to repeat the cycle of violence by entering into violent relationships as teens and adults or by abusing their own children.

Beyond the impact on individuals, child abuse has a significant impact on society; the total lifetime economic cost due to new child maltreatment cases in a single year is estimated at $124 billion in the U.S.

While California has made major strides in these areas in recent years, continued efforts are needed to ensure the safety of all children. According to experts, programs that can help address child abuse/neglect include: continuing to ensure that effective prevention services are in place, including risk assessment and home-visiting services for families with children at risk of abuse; supporting policies that help reduce family stress, promote stable environments for children, and ensure that affordable child care is available; and providing an accessible system of mental health services for parents and children.

Related Data:

Helpful Links

Children and Family Services Division, California Dept. of Social Services

Office of Planning, Research & Evaluation: Abuse, Neglect, Adoption & Foster Care, U.S. Dept. of Health and Human Services, Administration for Children & Families

A Hidden Crisis: Findings on Adverse Childhood Experiences in California, Center for Youth Wellness

Cost of Child Abuse and Neglect Rival Other Major Public Health Problems, National Center for Injury Prevention and Control

Income Inequality and Child Maltreatment in the United States, Pediatrics

Subsequent Maltreatment in Children With Disabilities After an Unsubstantiated Report for Neglect, JAMA: The Journal of the American Medical Association

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