The recent controversy over who is permitted to administer diabetes injections to children in school underscores a larger issue: Health services for California students with special health care needs vary greatly by school district, are provided by a variety of school staff, operate under a confusing patchwork of regulations, and are often underfunded, according to a new study.

See preliminary findings from the study>>

Researchers from California State University-Sacramento’s School of Nursing analyzed 2011-2012 state education data, interviewed school education experts, and conducted a large-scale survey of certified school nurses who are members of the California School Nurses Association. The research, which will be presented today at the California School Nurses Association conference in Sacramento, was funded by the Lucile Packard Foundation for Children’s Health.

California is home to an estimated 1.4 million children with chronic health issues, ranging from mild to life-threatening. About 16% of 6-to-11 year-olds and 20% of 12-to-17 year-olds have a special health care need that may require additional health services at school to allow for their full participation.

Among the study’s findings:

• 57% of California public school districts report having no school nurse personnel. These districts serve about 1.2 million students, about 20 percent of all public school students in the state.
• School nurse responsibilities have become more complex, including inserting urinary catheters, helping children with their feeding tubes, changing ostomy bags, monitoring oxygen tubes, testing blood sugar, and administering anti-seizure medication.
• Unlicensed school staffers provide sometimes complex medical care in the absence of school nurses. While many staffers are trained by nurses, there is little statewide regulation or monitoring of their training.
• Children with special health care needs aren’t always identified by school staff and may not receive services that could help them stay and succeed in school.

“California has very weak requirements governing school health and provides little data or guidance for school nurses and administrators to manage the care of children with special health care needs,” said the study’s lead author Dian Baker, a pediatric nurse practitioner and associate professor of nursing at CSU-Sacramento. “We can do better.”

See student-to-school nurse ratios by county>>

California has the largest population of children with special health care needs of any state. The federal Education for All Handicapped Children Act (1975), as amended in the Individuals with Disabilities Act (2004), was designed to ensure that children with disabilities have the opportunity to receive a free appropriate public education.

The study’s authors recommend several statewide policies and local practices that could help improve the hidden health system in California schools, not just for children with special health care needs, but for all students.

• Require systematic data collection and reporting systems in school districts to identify and serve children with special health care needs, and to monitor their health and educational outcomes.
• Require that all personnel delivering health services in schools receive mandatory training, including first aid, CPR and procedures needed to serve specific children in each school.
• Require that funds generated through Medi-Cal Administrative Claiming be earmarked to support school health services in the same manner as are Local Education Agency funds.

Posted by Barbara Feder Ostrov

If you missed our February webinar on how to use kidsdata.org after our recent redesign, the recording is now available!

The webinar covers how to find the data you need, tailor the data format for your needs, export data for analysis, and communicate your data in reports, presentations, proposals, social media and more.

Questions? Email us at [email protected]. To sign up for announcements of upcoming webinars, data alerts and other news from kidsdata.org, click here.

Posted by kidsdata.org

The American Academy of Pediatrics’ recently updated policy statement opposing retail clinics for children’s health care drew a surprising amount of attention this week.

While the AAP characterized the clinics as providing fragmented care at odds with the ideals of coordinated care and the medical home, some observers saw the statement as an effort by pediatricians to protect their turf. The AAP has long opposed the rise of retail clinics, which are open late, don’t require appointments and post their prices up front.

In an editorial published in JAMA Pediatrics last year, Dr. Edward Schor, senior vice president of the Lucile Packard Foundation for Children’s Health, urged his fellow pediatricians to embrace some of the customer-focused practices that have made retail clinics so successful.

To improve the care experience for busy families, pediatricians who haven’t already done so should consider expanded office hours and after-hours care, same-day and walk-in appointments, co-location of frequently used services, and transparent pricing, Schor noted.

“Families are sending a clear message to pediatric practices through their use of RBCs (retail-based clinics). Although they appreciate the array of services available from their pediatrician, they value convenience and low cost and see no apparent difference between a pediatric practice and an RBC in quality of care for minor illnesses,” Schor wrote.

Read the editorial.

Related Content

Docs Oppose Retail-Based Clinics For Kids’ Care, USA Today

AAP Principles Concerning Retail-Based Clinics

Medical Home: What’s in a Name?

Toward a “Triple Aim Medical Home” for Children with Special Health Care Needs

Aiming for Change: Achieving Triple Aim Goals in Pediatricians’ Practices

Posted by Barbara Feder Ostrov

As National Children’s Dental Health Month winds down, we’re highlighting a number of developments relating to children’s oral health and access to dental care.

In recent news, Covered California, the state’s health insurance exchange, will require children’s health plans available on the exchange to include pediatric dental coverage starting in 2015. Also, dental coverage for adults, which often has an impact on whether their children receive regular dental care, will be partially restored under Denti-Cal beginning May 1.

The Children’s Dental Health Project and Families USA have just released a new consumer guide for parents trying to evaluate dental coverage on the exchanges in California and nationwide.

And the Lucile Packard Foundation for Children’s Health has published a new issue brief, Dental Care Access for Children in California: Institutionalized Inequality, that examines shortcomings in the state’s social safety net of publicly funded health care services related to dental care.

So how are California children faring when it comes to getting the dental care they need? That all depends on their income, insurance status, race/ethnicity and where they live.

While an estimated 73% of California children ages 2-11 and 78% of youths ages 12-17 had a dental visit in the past six months, approximately 10% of children between the ages of 2-11 had never had a dental visit. Some counties reported that more than one-fifth of children have never been to the dentist by the age of 11, according to 2011-12 data from kidsdata.org.

Tooth decay is the most common chronic disease among children ages 6-18, and cavities among even younger children are on the rise, according to a new report from the American Academy of Pediatric Dentistry. Tooth decay and other oral diseases disproportionately affect low-income children, children of color, and the uninsured; these children are less likely to receive routine dental check-ups. The American Academy of Pediatrics recommends dental visits every six months.

Regular dental care is one of the best forms of prevention available, so it is important that all kids have ready access to high quality, affordable dental care.

For more information about dental care in California, see these measures on kidsdata.org:

Length of Time Since Last Dental Visit

By County

Unmet Needs for Preventive Dental Care Among Children with Special Health Care Needs

More Resources:

Children’s Partnership

National Children’s Dental Health Month

California HealthCare Foundation: Dental Health

Center for Oral Health

Children’s Dental Health Project

Photo credit: Dillweed via flickr

Posted by Amy Lam

A new Field Poll shows that public concerns over the biggest threats to children’s health are shifting to nutrition and exercise, rather than drugs or violence.

The new Poll, which surveyed more than 1,000 California voters in late 2013, found that:

…the proportion of Californians citing unhealthy eating or a lack of physical activity among kids’ top two health risks has grown over the past ten years to 59%, and now far outranks the next highest ranking concern, illegal drug use (43%) by a considerable margin. Next most frequently mentioned is the threat of violence to children cited by 31%.

Their concerns may be well-founded. According to kidsdata.org:

• Only about 25% of California 5^th graders in public schools meet state physical fitness standards for students.

• Just over half of California 5^th graders in public schools are considered to be at a healthy weight or underweight.

• About 41% of children consume one or more sugary drinks (soda, juice) daily

• About 37% of children reportedly eat two or more servings of fast food each week

For more comprehensive information on children’s weight, nutrition and fitness – including how California children are faring and policy implications, check out these links:

Kidsdata.org Topic Summary: Physical Fitness

Kidsdata.org Topic Summary: Nutrition

Kidsdata.org Topic Summary: Weight

Posted by Barbara Feder Ostrov

Approximately 95% of California children have health insurance coverage, most through their parents’ employers or through Medi-Cal, the state’s Medicaid program. As the Affordable Care Act (ACA) is implemented in 2014, some children and families will see changes to their plans and new opportunities for coverage.

Meanwhile, the State is at a crossroads, and must determine if and how to alter existing programs and systems to better serve children. Several questions arise in the wake of ACA implementation: what will be the role of the numerous children’s health programs post ACA, what can be done to ensure adequate coverage of vulnerable populations, including the remaining uninsured, and how can insurance programs be better coordinated for optimum efficiency and accessibility?

A new series of issue briefs, prepared by Insure the Uninsured (ITUP) and funded by the Lucile Packard Foundation for Children’s Health, examines the impact of the ACA on health insurance coverage for children in California, and offers recommendations on how the state might alter existing programs and systems to better serve children.

The briefs include:

Executive Summary
Part I: Inventory of Children’s Health Programs
Part II: Issue Diagnosis – Patient Care Challenges
Part III: Issue Diagnosis – Evolutionary Challenges
Part IV: Policy Options & Recommendations

Posted by kidsdata.org

This guest post is written by Cassandra Joubert, ScD, director of the Central California Children’s Institute at California State University-Fresno.

As we celebrate Dr. Martin Luther King’s birthday and his life’s work to achieve fair and equal treatment for the disenfranchised, we pause to reflect on the persistence of racial and ethnic disparities in child well being, and how we can more intentionally activate his vision today.

Significant racial/ethnic differences persist in children’s access to quality health, dental, and mental health care, proper diagnosis and treatment for conditions such as ADHD and autism, birth outcomes, and access to preschool and quality education.

In the San Joaquin Valley, we are particularly concerned about the impact of race and ethnicity on boys and men of color. The Central California Children’s Institute’s data chart book, Boys and Men of Color: Fresno County, California, documents racial/ethnic disparities in socioeconomic status, health care utilization, safety and educational attainment.

The vision we hold for children of the San Joaquin Valley, as articulated in the 2010 Central California Children’s Agenda, is that “(our) region prioritizes and ensures a healthy and prosperous future for all children and families.” Indeed, as we celebrate Dr. King’s birthday, we realize that in our nation and region, efforts to achieve equity must continue.

In 2014, the Children’s Institute will increasingly apply an equity lens to our work. We will be revamping one of our key publications, “Our Regional Children’s Agenda: Child Well-Being Indicators,” to not only stress racial/ethnic disparities in childhood outcomes, but also call attention to structural barriers to equity. Inequities in access to high quality, culturally appropriate health care; livable, safe neighborhoods and environments; preschool education; and healthy foods produce disparities in child well-being.

Not only will we document racial/ethnic disparities in outcomes (i.e., lower academic achievement, higher juvenile arrest rates, more untreated mental health challenges, etc.), but we also will attempt to secure data that demonstrate structural inequities in opportunity, services and supports that require policy change.

As an example, inequities in preschool availability are a structural barrier, which, if changed, would greatly improve kindergarten readiness and academic achievement for children of color.

According to kidsdata.org, the percent of third-grade students in the eight counties of the San Joaquin Valley who scored proficient on the English Language Arts California Standards Test ranged from 36–44% in 2012, well below the state’s 48%. Further, kidsdata.org shows that with the exception of one county, the availability of child care was below the potential demand in 2012.

By calling attention to the need to expand the availability of affordable, high quality, center-based care, we hope to accelerate academic achievement and prosperity for our entire region. The Children’s Institute is a member of the San Joaquin Valley team of the national Place Matters health equity movement led by the Joint Center on Political and Economic Studies. The Place Matters team is a key partner in this work.

Fifty years ago, Dr. King said: “Now is the time to open the doors of opportunity to all of God’s children” and “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

In Central California, we are sharpening our lens on equity to propel Dr. King’s vision of fairness and democracy for all. For more information about racial equity in child well being outcomes in the San Joaquin Valley, visit www.centralcaliforniachildren.org.

Posted by Guest

As California legislators coming back from their holiday break prepare to consider a controversial “soda tax,” a recent study examines how a statewide penny-an-ounce tax on sugary drinks might affect adults’ and kids’ health in the Golden State.

The study, published in the journal Public Library of Science One (PLOS), estimates that a penny-per-ounce tax could result in a 10-20% decline in statewide consumption of sodas, sports drinks and other sugar-sweetened beverages. As frequent consumption of such drinks has been linked to child obesity, diabetes and heart disease, this decline is projected to result in a drop in new cases of diabetes and heart disease, yielding population health benefits and cost savings in California.

As Santa Cruz Sentinel reporter Jason Hoppin writes:

Researchers pegged the likeliest savings from reduced diabetes cases at $320 million to $620 million in 10 years. In some scenarios, that figure topped $1 billion when coronary heart disease was factored in…

…The impacts were particularly profound within minorities and low-income populations, which have been disproportionately affected by chronic diseases linked to dietary intake. 

The PLOS study doesn’t differentiate between adults and children in terms of health impact, but statewide, an estimated 41% of children ages 2-17 drank one or more sugar-sweetened beverages every day, according to 2011-12 data on kidsdata.org.

More than 70 percent of African American and Latino children and youth ages 12-17 in California reported drinking one or more sugar-sweetened beverages every day, compared to 56 percent of white children in the same age group.

To see California kids’ consumption of sugary drinks at the county and state levels – as well as diabetes-related hospitalizations and figures on healthy weight – check out these indicators on kidsdata.org:

Children Drinking One or More Sugar-Sweetened Beverages Per Day (County Level Data)

By Age (California Only)

By Age and Race/Ethnicity (California Only)

Students Who Are at a Healthy Weight or Underweight, by Grade Level (2011-2012)

by Gender and Grade Level

by Race/Ethnicity and Grade Level

Diabetes-related Hospitalizations, By County

Posted by kidsdata.org

As we mark the 50th anniversary of Lyndon Johnson’s War on Poverty this month, it’s a good time to take stock of the economic status of California children and their families.

While the national poverty rate declined from 26 percent in 1967 to 16 percent in 2012, it has been harder to move the needle on child poverty in California in recent years.

The state’s child poverty rate in 2012 – 22.5 percent – was about the same as it was in 1990, although it dipped to a low of about 16 percent in 2001, according to an analysis by the California Budget Project.

Why does this matter? The national research center ChildTrends highlights the five ways poverty harms children’s health and well being.

Several measures tracked by kidsdata.org show other ways in which California children and their families continue to struggle despite the recovering economy:

• Nearly 30 percent of California children lived in “crowded households” – a marker of poverty and high housing costs – in 2011.
• More than 220,000 children in the state’s public schools were homeless in 2011.
• Nearly 3.5 million public schoolchildren qualified for free or reduced price school meals in 2012.

See more state and county-level data on California child poverty and family income on kidsdata.org:

Children in Poverty (Regions of 65,000 Residents or More)

Children in Poverty – Supplemental Poverty Measure (State & U.S. Only)

Children Living Above and Below the Poverty Level (Regions of 65,000 Residents or More), by Income Level

Student Eligibility to Receive Free or Reduced Price School Meals

Median Family Income (Regions of 65,000 Residents or More)

Self-Sufficiency Standard, by Household Type

Families Living Below the Self-Sufficiency Standard

CalWORKs Recipients

Adequacy of Income to Meet Basic Needs

Households with a High Housing Cost Burden (Regions of 65,000 Residents or More)

Children Living in Crowded Households, by County (65,000 Residents or More)

Related Content:

• A Less-Noticed Consequence of Child Poverty: Poor Health as Adults, Kidsdata.org advisory
• Poverty in the Golden State: Where California Stands 50 Years Since the War on Poverty Began, California Budget Project
• Child Poverty in California, California Public Policy Institute

photo credit from flickr.

Posted by kidsdata.org

Children Now’s 2014 “California Children’s Report Card” was released this week, with grades ranging from B+ to a less impressive D on how the state performs on child health, education and welfare indicators.

While the Oakland-based advocacy group praised recent changes in state education funding, Children Now gave only a C- grade for California’s performance in timely developmental and behavioral screening. The report card notes:

• No more than 30% of developmental disabilities or delays are identified before children enter kindergarten.”
• Within 1 year, 72% or 1.7 million of California’s youngest children did not receive any of the developmental screenings that are recommended by the American Academy of Pediatrics.

Children Now handed out an even worse D+ grade for access to oral health services, noting that more than a quarter of California children have untreated tooth decay. California students miss an estimated 874,000 days of school each year because of dental problems, the group noted.

To see the report card, click here.

To learn more about data on California children with special health care needs, click here.

To learn more about California children’s dental health, click here.

photo credit from flickr.

Posted by Barbara Feder Ostrov