July | August 2017





Working Together for Healthier Students

By Jennifer Ginn, CSG Associate Editor
In 1996, the Austin Independent School District was in a tough spot. Facing a budget deficit, the district decided to eliminate all of its school nurse positions.
“The superintendent at that time had to make some tough decisions and begin cutting programs and services that were not required by state law for the district to provide,” said Tracy Lunoff, assistant director of comprehensive health for the school district. “In Texas, currently and in the past, health services are not required by law. It is not required for nurses to be on campus.”
But for some in the Austin community, that idea didn’t sit well.
“When different people in the community heard about the decision to cut all school nurses, they were concerned because they realized many times, school nurses are a stop gap before families begin to access EDs (emergency departments) for health care ,” said Sally Freeman, director of Children’s/Austin Independent School District Health Services.
The Seton Healthcare Family, which has 13 hospitals in the Austin area, stepped up and contracted with the school district to provide school nurses and school health assistants for the district. It was the first public/private collaboration of its kind.
“At the time, Seton provided the majority of the funding, resources and services, whether it was in capital or in-kind donation, to continue the health services program since the district was in a budget crisis,” said Lunoff. “Throughout the years, the district has really taken on about 95 percent of the financial burden to fund the continuation of the contract.”
Seton still has some significant in-kind pieces, including all of the human resources, liability insurance and staffing benefits.
Lunoff said a registered nurse and school health assistant work together as a team in the schools. The number of nursing and school health assistant hours each of the district’s more than 100 schools receives is based on the number of students enrolled, the number of students case-managed for health conditions, the number of medically fragile students and the overall health status of students at each school.
“In our model, we end up with about one staff member, I believe, to about 1,200 students there,” Lunoff said. “It’s trying to balance out the costs versus what’s safe for the children. … We’d love to meet that 1-to-750 (students) ratio that the National Association of School Nurses recommends, however, the district at this point in time is not able to put forth the extra funding to do that. So let’s find other ways we can maximize our services.”
Freeman said the school district places a priority on the health of its 87,000 students, of which more than 61 percent come from economically disadvantaged homes.
“We focus on the whole child,” she said. “We know the importance of focusing on health as well as academics. Our vision and mission is to optimize the health and well being of students by coordinating education, prevention, primary care, public health services and advocacy. In doing that, we understand that if children are not feeling well or have a chronic medical condition, it can affect their ability to perform well academically or attend school.”
Austin school district officials have been going over next year’s budget and once again, they’re looking at a significant deficit. Freeman believes the district will continue to fund student health services despite the budget situation.
“The district has continually, throughout our bleak budget years, said these are the buckets that are really important to the district to maintain these levels of funding, Freeman said. “One of those buckets has been the health and safety of students.”
Freeman would like policymakers to know that maintaining, or even improving, student health provides lasting benefits.
“I would like to ask them to really think about the whole child and the value of education in our society,” she said. “It probably has shifted from when they were in school. … We have so many social and economic barriers and challenges.
“Using an innovative model such as ours … opens doors for services that help to create healthier children, who can go on to be healthier adults and taxpayers. So it’s not just a benefit to the district. It’s a benefit to the community and our nation as a whole.”



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