Brief Summary of Evidence: Internal subjective evaluations have shown that former Junior Achievement (JA) students feel very strongly about the positive effect JA has had in their life. They believe that JA strengthened their teamwork skills, problem-solving skills and decision-making skills (90%); that JA strengthened their interpersonal and critical thinking skills (80%), that JA prepared them for the world of work (80%); and that JA connected what they learned in the classroom with real life(80%). Assessments of financial literacy showed that teachers and volunteers agreed that students who participated in JA’s elementary programs were more likely than their peers to have confidence in managing their money (80%), and that middle school students who participated in the JA Finance Park curriculum reported more confidence in managing their personal finances (90%). In a 2009 survey of Georgia teachers who participated in JA again showed the dedication to the program with 91 percent rating Junior Achievement as “good” or “excellent” in its relevant to school curriculum; 95 percent rating their students’ experience with Junior Achievement as “good” or “excellent;” and 96 percent agreeing or strongly agreeing that Junior Achievement helps prepare students for the real world. Citations: Executive Summary, Work-readiness Impact of JA Program Participation, Junior Achievement Worldwide, 2009. Executive Summary, Financial Literacy Impact of JA Program Participation, Junior Achievement Worldwide, 2009. Junior Achievement Evaluation Key Findings, Junior Achievement of Georgia, 2009. Junior Achievement USA: A Solution to Increasing Graduation Rates, Junior Achievement Worldwide, April 2011. Health and Wellness: Solutions 4.1-4.14 Solution Number: 4.1 Incorporate Physically Active Lessons in Elementary Classrooms Solution Description: As part of the FC-CIS obesity reduction strategy, faculty at the UGA Department of Kinesiology propose to assist Alps Road Elementary School with implementing daily classroom based, teacher-led, 10-minute movement activities that are linked to gradespecific academic learning objectives in math, reading, language arts, science, social studies, and general health. The TAKE 10!® solution is a research-based program developed to incorporate physical activity into the curriculum that has been disseminated to more than 40,000 U.S. elementary school classes from 1999-2010. Each TAKE 10!® kit contains 35 activity cards with clearly defined physical activities and learning objectives, 50 worksheets to reinforce learning objectives, three tracking posters, stickers to track activities and rewards, teacher resources to enhance
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implementation, student health knowledge assessments, and a teacher implementation questionnaire. Brief Summary of Evidence: The cumulative evidence to date indicates that children participating in the TAKE 10!Ž program experience higher physical activity levels (13% greater), reduced time off-task (20.5%), and improved reading, math, spelling, and composite scores. Risk of obesity may also be reduced by increasing daily energy expenditure (~25-43 kcal per session). Body mass index values were positively impacted over three-years in a longer term trial although the benefits were significantly greater among intervention schools with 75 minutes or more of physical activity per week. Citations: Bartholomew, J.B. & Jowers, E.M. (2011). Physically active academic lessons in elementary children. Prev Med., 52 Suppl 1:S51-4. PMCID: 3116963. Donnelly, J.E., Greene, J.L., Gibson, C.A., Smith, B.K., Washburn, R.A., Sullivan, D.K., DuBose, K., Mayo, M.S., Schmelzle, K.H., Ryan, J.J., Jacobsen, D.J. & Williams, S.L. (2009). Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med., 49(4):336-41. PMCID: 2766439. Kibbe, D.L., Hackett, J., Hurley, M., McFarland A., Schubert K.G., Schultz A. & Harris S. (2011). Ten Years of Takes 10! (R): Integrating physical activity with academic concepts in elementary school classroom. Prev Med., 52 Suppl 1: S43-50. Luepker, R.V., Perry, C.L., McKinlay, S.M., Nader, P.R., Parcel, G.S., Stone, E.J., Webber, L.S., Elder, J.P., Feldman, H.A. & Johnson, C.C. (1996). Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA, 275(10):768-76. Solution Number: 4.2 Active After-School Programs Solution Description: As part of the FC-CIS obesity reduction strategy, the UGA Department of Kinesiology and the St. Mary’s Hospital Wellness Clinic will partner to assist Alps Road Elementary School with increasing physical activity participation among students attending the Afterschool Program (ASP). Cognitively challenging game-based exercise activities will be incorporated into the ASP as part of a comprehensive curriculum to promote health, wellness, and academic achievement. The recommended physical activity program would be similar to the one currently being implemented at another CCSD elementary school. Activities included in the program would meet four criteria: they a) are intrinsically enjoyable and developmentally appropriate; b) focus on mastery and enhanced skill learning; c) are designed for successful experiences and are followed by positive reinforcement; and d) elicit intermittent vigorous physical activity. To maximize 68 Appendix F
effectiveness, the program will be conducted by properly trained instructors who apply principles of pediatric exercise training and who follow theory-based methods of teaching to create environments that promote children’s physical activity. Brief Summary of Evidence: Given the large numbers of children who attend structured after school programs, providing opportunities for moderate and vigorous physical activity during these programs is an attractive and cost-effective public health strategy. The available evidence indicates that after school physical activity programs are effective in increasing children’s activity levels, are well-received by children and parents, and have high attendance rates. The particular program recommended for adoption (described above) is the product of decade-long field testing and evaluation at the Georgia Prevention Institute at the Georgia Health Sciences University which supports the efficacy of the program to favorably alter children’s body fat percentage, metabolic health, and aerobic fitness. Importantly, this program has also been demonstrated to promote children’s mental development, cognitive function, and academic achievement. Citations: Davis, C.L., Tomporowski, P.D., McDowell, J.E., Austin, B.P., Miller, P.H., Yanasak, N.E., Allison, J.D. & Naglieri, J.A. (2011). Exercise improves executive function and achievement and alters brain activation in overweight children: a randomized, controlled trial. Health Psychol., 30(1):91-8. PMCID: 3057917. Gutin, B., Yin, Z., Johnson, M. & Barbeau, P. (2008). Preliminary findings of the effect of a 3-year after-school physical activity intervention on fitness and body fat: the Medical College of Georgia Fitkid Project. Int J Pediatr Obes., 3 Suppl 1:3-9. Pate, R.R. & O'Neill, J.R. (2009). After-school interventions to increase physical activity among youth. Br J Sports Med., 43(1):14-8. Tomporowski, P.D., Davis, C.L., Miller, P.H. & Naglieri, J.A. (2008). Exercise and Children's Intelligence, Cognition, and Academic Achievement. Educ Psychol Rev., 20(2):111-31. PMCID: 2748863. Tomporowski, P.D., Lambourne, K. & Okumura, M.S. (2011). Physical activity interventions and children's mental function: an introduction and overview. Prev Med., 52 Suppl 1:S3-9. Yin, Z., Gutin, B., Johnson, M.H., Hanes, J., Jr., Moore, J.B., Cavnar, M., Thornburg, J., Moore, D. & Barbeau, P. (2005). An environmental approach to obesity prevention in children: Medical College of Georgia FitKid Project year 1 results. Obes Res., 13(12):2153-61. Solution Number: 4.3 Nutrition Education Solution Description: 69 Appendix F
As part of the FC-CIS obesity reduction strategy, the UGA Cooperative Extension will offer six Expanded Food & Nutrition Education Program (EFNEP) educational sessions for low-income parents in the ACC PN with topics including: Your Food, Your Choice; Stress-Free Mealtimes; Color Me Healthy; Winning Ways with Fast Foods; Keep Yourself Well; and Keep Your Health Out of Jeopardy (eat a variety of foods; decrease risk of chronic disease). These sessions will include: pre and post 24-hour diet recall assessment with computerized analysis report given to participants; pre and post food behavior survey/analysis; quick, easy, and healthy cooking demonstrations at each session; educational incentives given at each session; “graduation� certificate of completion given at end of sessions; recipe book with quick, easy and healthy recipes given at end of session. There will also be six educational sessions for children in the ACC PN including focusing on diet and health, cooking activities, practicing of skills which compliment school objectives including reading recipes (reading), measuring ingredients (math), and recognizing the importance of certain nutrients for the human body (science). Walk-A- Weigh sessions that focus on reducing the risk of overweight, obesity, diabetes, high blood pressure and other chronic diseases to lose weight and become more physically fit will also be included. The FC-CIS Nutrition and Exercise Neighborhood Specialist will be responsible for assisting parents and children with implementing their learning in their homes. Brief Summary of Evidence: In 2010 there were 369 low-income participants who enrolled and graduated from the Expanded Food & Nutrition Education Program (EFNEP) in Athens-Clarke County, completing 4,221 hours of training. These parents learned how to plan, shop for and prepare quick and healthy meals for their families on a budget. Pre and post diet assessment showed that 99.4% of the graduates made positive dietary changes. Also, the participants decreased their monthly grocery bill by $24.30 while the nutritional value of their meals increased. Additionally, 901 at-risk youth participated in AthensClarke County EFNEP nutrition sessions through after-school or summer programs in 2010. These children learned how to improve their diet and how to prepare quick and healthy meals and snacks. They also learned skills that complement school objectives such as reading recipes, measuring ingredients, and recognizing the importance of nutrients found in food. Citations: Burney, J. (1998). A cost-benefit analysis of the Tennessee expanded food and nutrition education program. Hibbs, J. (2010). Athens-Clarke county cooperative extension 2010 annual report. Lambur, M., Rajgopal, R., Lewis, E., Cox, R. & Ellerbrock, M. (1996). In Serrano, E. (2009). Applying cost benefit analysis to nutrition education programs: Focus on the Virginia expanded food and nutrition education program.
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Solution Number: 4.4 Increase Access, Availability, and Awareness of Fresh, Local Produce (School/Community Gardens) Solution Description: As part of the FC-CIS obesity reduction strategy, the Athens Land Trust Community Garden Network (supported by a grant from the USDA National Institute for food and Agriculture) will increase access to and awareness of fresh, local, nutritious food in the ACC PN through: establishment of new community gardens and expansion of existing gardens; expansion of existing school gardens and greenhouse programs at Alps Road Elementary School, Clarke Middle School, PLC, and Clarke Central High School; increased awareness through community outreach of the Athens Farmers Market EBT dollar doubling program; educational opportunities, including gardening workshops, nutrition classes, cooking demonstrations and classes, canning and preservation classes, and food tastings in conjunction with community and school gardens and the Athens Farmers Market. Brief Summary of Evidence: Community gardens have proven significant benefits to the communities they serve. They improve the diets of community gardeners and their children by improving access to healthier, more nutrient rich food, while minimizing exposure to chemical fertilizers. This improved access is particularly significant for low-income families and individuals that may otherwise lack the ability to purchase fresh, healthy produce. Gardens can reduce family food budgets and create income opportunities and economic development. Community gardens provide a space for individuals that do not own land the opportunity to grow food and become more self-reliant. Additionally, gardens can provide a space for exercise and encourage an active lifestyle. Citations: Bremer A., Jenkins, K. & Kanter, D. (2003). Community Gardens in Milwaukee: Procedures for their long-term stability and their importance to the city. Milwaukee: University of Wisconsin, Department of Urban Planning. Center for Integrated Agricultural Systems, University of Wisconsin, Madison. “Community Kitchens: key elements of success.� Research brief #54, January 2001. Sherer, P.M. (2006). The benefits of parks: Why American needs more city parks and open space. Solution Number: 4.5 Women, Infant and Children (WIC) satellite office Solution Description: As part of the FC-CIS obesity reduction strategy, the Clarke County Health Department will operate a part-time Women, Infants, and Children (WIC) satellite clinic to provide on-site services to financially eligible children, ages 0-5 in the ACC PN. There is currently only one WIC clinic in Athens, located on the opposite side of the city from the target neighborhood. Neighborhood focus groups identified this as a barrier to service 71 Appendix F
due to lack of transportation and accessibility. WIC provides nutritional support to pregnant women, peer mentoring for breastfeeding women, and education to families on proper nutrition for children ages 0-5. WIC has widespread access to low-income families whose children are among those at greatest risk of being overweight. Reaching parents and children when they are developing eating patterns and relationships can help prevent being overweight and ensure the development of healthy habits. Brief Summary of Evidence: Nutritional support during pregnancy from the WIC program prevents unhealthy births. Research has demonstrated that by improving infants’ health at birth, WIC can generate Medicaid savings within the first few months of a child’s life of more than $3 per dollar invested. WIC decreases the risk of costly health problems and developmental delays for young children. By reducing the risk of developmental delay, WIIC helps children to be ready to learn when they enter school. Children who are eligible for but not receiving WIC are more likely to be underweight, in poor health, and at risk for developmental delays. WIC is especially effective at protecting the health of children younger than 12 months. It is during this period that young children’s brains more than double in size if the nutritional building blocks are provided. Poor nutrition affects children’s physical and intellectual development and may therefore hinder early school success. Citations: Child Nutrition Fact Sheet: WIC (Food Research & Action Center). “Fit WIC: Programs to Prevent Childhood Overweight in Your Community,” Special Nutrition Program Report Series, No. WIC-05-FW, Project Officer: Ed Herzog. U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition, and Evaluation, Alexandria, VA: 2005. Gayman, A., Ettinger de Cuba, S., Cook, J.T., March, E.L. & Coleman, S. (Jan. 2010). WIC Improves Child Health and School Readiness: Children’s HealthWatch Policy Action Brief. Solution Number: 4.6 Healthcare System Navigation/Train Lay Health Educators Solution Description: The Healthcare System Navigation solution is a core component of FC-CIS’s strategy to address family access to medical care. The FC-CIS Health and Wellness Director will manage the Navigation System, which includes a Health Educator (contracted position) who will train and manage 30 Lay Health Educators. These community members (targeted in ACC PN) will help guide families into the healthcare system by assisting with issues related to medical literacy and compliance with healthcare provider instructions, as well as offering medical assistance related to pre-natal care, safety in the home, blood pressure, fever management, etc. (a proposed initial curriculum has been developed) . Two Neighborhood Leader Specialists will serve as half-time Lay Health Educators for the ACC PN. Nurses and other health educators who are involved will assist with enrollment in health insurance programs such as CHIP and Medicaid, 72 Appendix F
help families access other health and social service resources (including medications and equipment), and offer community-based health education. Brief Summary of Evidence: Community Health Workers, also known as Lay Health Educators, are volunteer community members who are paid public health workers and are trusted members of the communities that they serve. They generally share the same ethnicity, socioeconomic status, and life experiences of the community they serve. These trusting relationships enable the workers to facilitate access to and enrollment in services and help improve the quality and cultural competence of service. The Community Health Workers can enhance the provider-patient communication, preventive care, adherence to treatment, follow-up, and referral, disease self-management, and navigation of the healthcare system. The Health Workers also promote and build individual and community capacity by increasing health knowledge and self-sufficiency through outreach, community education, informal counseling, social support, and advocacy among communities such as the Hispanic/Latino community. The Dalton, Georgia Community Health Worker program prevented $2,379,061 worth of medical costs and had a 16:1 return on investment. Community Health Workers can help address insurance, financial and logistical issues (transportation, scheduling, child or elder care) that many minorities or individuals in poverty often deal with. Citations: Department of Health and Human Services (DHHS). (2007). Community health worker national workforce study. Ferrante, J. M., Cohen, D. J. & Crosson, J. C. (2010). Translating the patient navigator approach to meet the needs of primary care. The Journal of the American Board of Family Medicine, 23(6), 736-744. McCooey, R. (2011). Thesis Proposal for AHN for Developing a Lay Health Education Program. UGA College of Public Health. Schwaderer, K. & Itano, J. (2007). Bridging the Healthcare Divide With Patient Navigation: Development of a Research Program to Address Disparities. Clinical Journal of Oncology Nursing, 11(5), 633-639. Weinrich, S.P., Boyd M.D., Greene, F., Reynolds,W.A. & Metlin, C. (1998). Increasing prostate cancer screening in African American men with peer-educator and clientnavigator interventions. Journal of Cancer Education, 13(4), 213-219. Solution Number: 4.7 Provide School-Based Nurses Solution Description: Since many families in the ACC PN lack access to medical care, school-based nurses serve an important role in children’s health care. The CCSD school-based nurses are currently stretched thin with each nurse having a student to nurse ratio of 1080:1. 73 Appendix F
Located in the heart of the ACC PN, the CCSD H.T. Edwards Complex, which includes the Office of Early Learning (serves birth to five years old as well as pregnant and single mothers), Athens Community Career Academy (grades 10-12), and the Performance Learning Center (grades 9-12), is in great need of a dedicated nurse to serve the population of 605 students. FC-CIS proposes this additional nurse be added in 2012; this nurse would also serve pre-K at other school sites as needed (total CCSD pre-K population 679). CCSD currently employs two school-based nurses in the ACC PN and these positions will continue. Brief Summary of Evidence: The most vital and critical period for early intervention is in the first three years of life. A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides evidence that school nurses make a difference in families accessing services for chronic health problems and in receiving follow-up care for vision problems and injuries. The recommended proportion of registered school nurse-to-student ratio is 1:750. Citations: Gutu, M., Engelke, M. & Swanson, M. (2004). Does the school nurse-to-student ratio make a difference? Journal of School Health, 74(1):6-9. Lewis, K. & Bear, B. (2000). Early intervention and school nursing practice. The Journal of School Nursing, 16(5): 16-24. U.S. Department of Health and Human Services (June 30, 2011). Healthy People 2020. Solution Number: 4.8 Dental Services Solution Description: To address the impact of dental health on educational performance, increasing access to preventative services for children in elementary school is necessary. Athens Technical College Dental Clinic offers reduced rates for preventative dental services. FC-CIS proposes the provision of preventive dental care to 50 children in the ACC PN, which would include an exam, panoramic x-ray, fluoride treatment, and sealants. FCCIS would provide transportation to the clinic with the WIT vans. Brief Summary of Evidence: Oral health affects children both physically and psychologically. Dental health influences how they grow, enjoy life, look, speak, chew, taste food, and socialize, as well as their feelings of social well-being. Severe tooth decay detracts from a children’s quality of life; they experience pain, discomfort, disfigurement, acute and chronic infections, and eating and sleeping disruption as well as higher risk of hospitalization, high treatment costs, and loss of school days with the diminished inability to learn. Tooth decay also affects nutrition, growth, and weight gain. Greater use of sealants for students can reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars. If comprehensive tooth decay 74 Appendix F
prevention programs are implemented widely, prevention programs could accomplish national health goals and reduce the need for new care providers and clinics. Citations: Bhuride, J. P., Damiano, P. C., Kuthy, R. A., Flach, S. D., Kanellis, M. J., Heller, K. E., et al. (2005). Natural history of treatment outcomes of permanent first molars: A study of sealant effectiveness.The Journal of the American Dental Association, 136(9), 12651272. Gherunpong, S., Tsakos, G. & Sheiham, A. (2004). The prevalence and severity of oral impacts on daily performances in Thai primary school children. Health and Quality of Life Outcomes 2004, 57 (2). Locker, D. (1997). Concepts of oral health, disease and the quality of life. Measuring oral health and quality of life. Chapel Hill: University of North Carolina, Dental Ecology, 11-23. Niederman, R., Gould, E., Soncini, J., Tavares, M., Osborn, V. & Goodson, J. M. (2008). A model for extending the reach of the traditional dental practice: The ForsythKids program. The Journal of the American Dental Association, 139(8), 1040-1050. Sheiham, A. (2005). Oral health, general health and quality of life. Bulletin of the World Health Organization, 83(9), 644-644. Weintraub, J. A., Stearns, S. C., Rozier, R. G. & Huang, C. (2001). Treatment outcomes and costs of dental sealants among children enrolled in medicaid. American Journal of Public Health, 91(11), 1877-1881. Solution Number: 4.9 Family Counseling Services in Early Learning, Elementary and Middle Schools Solution Description: To increase universal access to psychological services for children with mental health disorders and their parents, including children in daycare centers, preschool (including those with disabilities), Alps Road Elementary School students, and Clarke Middle School students, Family Counseling Service will provide mental health services at a discounted rate at the schools, daycare centers, homes, etc. For the past 45 years, the mission of Family Counseling Service (FCS), a non-profit private mental health services provider, has been to offer professional and affordable counseling services to meet individual, family, and community needs of Athens-Clarke County and surrounding areas. In addition to its core services, FCS operates a number of special programs addressing such community concerns as youth alcohol and drug abuse, family violence, child abuse, adjustment of children to divorce. Agency staff includes social workers, professional counselors, marriage and family therapists, and certified addiction counselors. FCS practitioners often work with the entire family, viewing the family as a unit or system. Goals include: to communicate more effectively and meaningfully with 75 Appendix F
each other, to guide the family through traumatic experiences, to resolve intra-family conflicts, and to create a more positive family environment. Brief Summary of Evidence: Studies support the critical importance of increasing access to mental health services in schools for children with psychological disorders and their parents. Much of the evidence is drawn from comprehensive research reviews that used computerized searches to identify studies of school-based mental health services for children and then narrowed the inquiry to papers that included a control group, standardized outcome measures, and assessed outcomes at baseline and post-intervention. Rones and Hoagwood’s research review of school-based mental health services notes that 20% of children in the United States have a diagnosable mental illness while only a small percentage ever receive intervention or treatment. Atkins, et al., report that a recent analysis of three national surveys showed that nearly 80% of children (age 6-17) who were in need of mental health services did not receive services within the preceding 12 months, and that for uninsured families, the rate approached 90%. In addition, between 5% and 9% of children can be classified as seriously emotionally disturbed and are served in multiple, separate systems that often provide uncoordinated and redundant services. Citations: Adelman, H. & Taylor, L. (1999). Mental health in schools and system restructuring. Clinical Psychology Review, 19[2], 137-163. Atkins, M., Gracyzk, P., Frazier, S. & Abdul-Adil, J. (2003). Toward a new model for promoting urban children’s mental health: accessible, effective, and sustainable schoolbased mental health services. School Psychology Review, 12[4], 503-514. Armbruster, P., Gerstein. & S., Fallon, T. (1997). Bridging the gap between service need and service utilization: a school-based mental health program. Community Mental Health Journal, 33[3], 199-211. Berliner, David C. (2009). Poverty and potential: Out-of-school factors and school success. Boulder and Tempe: Education and the Public Interest Center & Education Policy Research Unit. Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. & Erkanli, A. (1995). Children’s mental health service use across service sectors. Health Affairs, 14, 147-159. 4.10 Expand Mental Health Services in High Schools To increase universal access to psychological services for CCSD Clarke Central High School students, Advantage Behavioral Health Services (ABHS) will provide in-school or neutral site counseling sessions, modeled on its program with Oglethorpe County School District in-school counseling program. Mental health counseling services are currently limited during the school day and these services would be available from 2:3076 Appendix F
7pm for both individual and family counseling. ABHS will also provide age-appropriate scheduled group sessions for students. High school students would have the opportunity to participate in a Dialectical Behavior Therapy (DBT) group (see evidence below). With prior planning, ABHS staff could also be available for substance abuse prevention services. Students who are at-risk of substance abuse or are currently engaging in these behaviors would have a streamlined process for receiving appropriate follow-up services. Brief Summary of Evidence: All methods used by Advantage Behavioral Health Services (ABHS) in its counseling sessions with children, adolescents, and families are based in appropriate evidencebased practices. ABHS uses only properly licensed and certified personnel and is CARF certified, ensuring that its clinical and administrative practices conform to industry standards. Dialectical Behavior Therapy (DBT) combines cognitive behavioral therapy and mindfulness with an emphasis on skills training. DBT was designed to decrease emotional dysregulation and entails one year of weekly individual and group skillstraining sessions, 24/7 skills coaching, and weekly treatment team meetings. DBT has consistently demonstrated decreases in suicidal and self-harm behavior and emotional dysregulation. A number of studies have demonstrated the effectiveness of this method for individuals of all ages. Citations: Bohus, M., Haaf, B., Simms, T., Limberger, M., Schmahl, C., Unckel, C., et al. (2004). Effectiveness of inpatient Dialectical Behavior Therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42, 487-499. Linehan, M. & Dimeff, L. (2001). Dialectical Behavior Therapy in a nutshell. The California Psychologist, 34, 10-13. Holmes, P., Georgescu, S. & Liles, W. (2005). Further delineating the applicability of acceptance and change to private responses: The example of Dialectical Behavior Therapy. The Behavior Analyst Today, 7[3], 301-311. Solution Number: 4.11 Health and Wellness Mindful Awareness Practices Solution Description Mindfulness is one of the tools used to prevent adverse childhood events in parenting and childcare facilities (both formal and informal), and buffers the effects of such events in children and adolescents who have experienced them. There is ample evidence that poor brain development in traumatized children not only has an impact on their education and future success, but also that childhood adverse events are also a strong predictor of future health problems, some beginning early in life. Beginning in 2013, FCCIS proposes that the Mind Body Institute (MBI) will offer the Finding a Place to Rest course to caregivers and health providers to improve stress resilience, social-emotional competence, sense of well-being and to decrease medical symptoms, including anxiety and depression. 77 Appendix F
Brief Summary of Evidence: Programs using mindful awareness practices are conducted throughout the world in medical, clinical, and educational settings. There are currently over 142 clinical trials on mindfulness registered with the National Institute of Health. Of particular interest is a $1.2 million grant awarded to Pennsylvania State University and the Garrison Institute by the United States Department of Education’s Institute for Educational Sciences to study a program using mindful awareness practices to reduce teacher burnout and improve resilience. Recently, the United States Military has put in place a program for pre-deployment training based on mindful awareness practices. Citations: Beauchemin, Hutchins & Patterson (2008). Mindfulness Meditation May Lessen Anxiety, Promote Social Skills, and Improve Academic Performance Among Adolescents With Learning Disabilities. Complementary Health Practice Review, 12[34]. Biegel, G., Brown, K., Shapiro, S. & Schubert, C. (2009). “Mindfulness-Based Stress Reduction for the Treatment of Adolescent Psychiatric Outpatients: A Randomized Clinical Trial.” Journal of Consulting and Clinical Psychology, 77[5], 855–866. Black, D. S., Milam, J. & Sussman, S. (2009). Sitting-Meditation Interventions Among Youth: A Review of Treatment Efficacy. Pediatrics 2009 124: e532-e541. Coatsworth, J.D., Duncan, L., Greenberg, M. & Nix, R. (2010). “Changing Parent’s Mindfulness, Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial.” Journal of Child and Family Studies, 19, 203-217. Solution Number: 4.12 Teen Pregnancy Prevention/Health Educator Solution Description: To address teen pregnancy prevention needs, an additional school-based health educator is needed in the ACC PN. The Clarke County Health Department currently serves Clarke Middle School and Clarke Central High School with one health educator from the Teen Matters health clinic they operate across the street from the high school; it is necessary to have a dedicated teen pregnancy/sexual education professional for each school. Dedicated health educators within the schools allow for the interventions relating to preventing risky sexual behaviors to be easily disseminated as well as provide an on-site resource for additional questions and counseling that may be required. Interventions developed to reduce risky sexual behaviors among adolescents have been shown to have maximum effectiveness if implemented by trained health educators. An additional health educator will also deliver the Birds and the Bees Sexual Education curriculum to parents and teens in the ACC PN. The program is designed to provide parents with the skills and knowledge to effectively communicate with their children about sex. Open and effective parent-child communication is an important 78 Appendix F
aspect of reducing risky sexual behaviors amongst adolescents. By improving communication between adolescents and parents, adolescents will be more likely to engage in less risky sexual behaviors. Two Teen Pregnancy Prevention Neighborhood Leader Specialists will assist with follow-up from Birds and Bees sessions in the neighborhoods, including working with the health educators on other teen pregnancy prevention activities. Brief Summary of Evidence: Teen childbearing costs the US about $9 billion annually. Forty six percent of high school students have had sexual intercourse and of those 12% did not use any method of contraception during last intercourse. Prevention of teen pregnancy requires evidenced-based sex education, support for parents in talking with their children about pregnancy prevention and other aspects of sexual and reproductive health, and ready access to effective and affordable contraception for teens who are sexually active. Interventions implemented within schools have been shown to have some effect on the sexual behaviors of adolescents. Sex education that works starts early, before young people reach puberty and before they have developed established patterns of behavior. Giving young people basic information from an early age provides the foundation on which more complex knowledge is built up over time. Citations: Coyle, K.K., Kirby, D.B., Marin, B.V., Gomez, C.A. & Gregorich, S.E. (2004). Draw the line/respect the line: A randomized trial of a middle school intervention to reduce sexual risk behaviors. American Journal of Public Health, 94[5], 843-851. Pazol, K., Warner, L., Gavin, L., Callaghan, W.M., Spitz, A.M., Anderson, J.E., Barfield, W.D. & Kann, L. (2011). Vital signs: Teen pregnancy --- United States, 1991-2009. Morbidity and Mortality Weekly Report (MMWR), 60[13], 414-420. Mueller, T.E., Gavin, L.E. & Kulkarni, A. (2008). The Association Between Sex Education and Youth’s Engagement in Sexual Intercourse, Age at First Intercourse, and Birth Control Use at First Sex. Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard M et al. (1994). Schoolbased programmes to decrease sexual risk behaviours: a review of effectiveness. Solution Number: 4.13 Children’s Medical Services Asthma Clinic Solution Description: To address the impact of asthma on children’s health and academic performance, the Northeast Georgia Department of Public Health currently operates a Children’s Medical Services Asthma Clinic that is available to the children in the ACC PN. Patients see a pulmonologist and an assessment is done and prescriptions are written or adjusted. Education is a key focus so that families learn about the disease, triggers, and environmental issues that can be controlled. Eligibility is based on medical condition, family income, and age (birth – 21). Patients can have Medicaid, Peachcare and/or 79 Appendix F
insurance and still be eligible and Children’s Medical Services assists with co-pays if necessary. In 2012 FC-CIS proposes to increase awareness of the Asthma Clinic and connect the ACC PN to its services through the Healthcare Navigation System solution (see solution 4.6). Brief Summary of Evidence: Excessive school absence disrupts learning and is a strong predictor of premature school dropout. School-aged children with asthma are absent more often compared to their healthy peers without asthma. School absences due to asthma are usually brief, but this pattern of absence has been shown to be more harmful academically. Asthma is considered the leading cause of school absence among children 7-17. It accounts for an estimated 14 million missed days of school each year. Citations: Moonie, S. A., Sterling, D. A., Figgs, L., & Castro, M. (2006). Asthma Status and Severity Affects Missed School Days. Journal of School Health, 76[1], 18-24. Richards, W. (1986). Allergy, asthma and school problems. Journal of School Health, 56[4], 151-152. Solution 4.14 Substance Abuse Solution Description: Very limited options for adolescent substance abuse treatment exist in ACC. Currently, Advantage Behavioral Health System (ABHS) offers treatment through the Inner Light program, a referral–only model, with all referrals currently made through the Department of Juvenile Justice for probated youth. The cost of the program without insurance is $1200, out of reach of most of those without coverage so the proposed solution will assist with discounted initial screening for youth in the ACC PN, thereby increasing their access to the program; youth in the target area would receive priority for admission to the program. In addition, funding for an additional counselor position for this treatment would increase the availability of the program, which is currently limited to 12 participants for 12 weeks. The program, based on The Seven Challenges Program, consists of 12 weekly group sessions led by one counselor. A long-range solution for possible consideration is the establishment of a Juvenile Drug Treatment Court. Other suggestions include seeking opportunities for more intensive outpatient treatment for youth and a residential treatment component. Summary of Evidence for Solution: The Center for Disease Control and Prevention reported that rates of smoking, drinking, and other illicit drug use among students had increased in the early 1990s and remained alarmingly high. Half of all students reported alcohol use and nearly one-third were binge drinking. More than one-fourth of high school students were marijuana users; 9.5 percent had used cocaine by the end of high school; and 14.6 percent had used inhalants. Because there is strong evidence of an association between alcohol and/or other drug use and delinquent behavior of juveniles, it is not surprising that the 80 Appendix F
number of juvenile drug offense cases processed during 1995 was 145 percent greater than in 1991. The Centers for Disease Control reports that, while illicit drug use has declined among youth, rates of nonmedical use of prescription and over-the-counter (OTC) medication remain high. Prescription medications most commonly abused by youth include pain relievers, tranquilizers, stimulants, and depressants. In 2009, 20% of U.S. high school students had taken a prescription drug, such as Oxycontin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, without a doctor's prescription. Teens also misuse OTC cough and cold medications, containing the cough suppressant dextromethorphan (DXM), to get high. Prescription and OTC medications are widely available, free or inexpensive, and falsely believed to be safer than illicit drugs. Misuse of prescription and OTC medications can cause serious health effects, addiction, and death. Another study reveals that 7 to 10 percent of adolescents are in need of substance abuse treatment, but only a small number—usually those individuals with severe substance use disorders, comorbid psychiatric disorders, or legal problems—receive treatment. This population is underserved in large part because of limited resources, inadequate age-appropriate programs, and lack of a broad consensus on preferred treatment strategies. Citations: Center for Disease Control. Youth Risk Behavior Surveillance—United States, 2009. MMWR 2010; 59(SS-5):1–142. Eaton, D. K., et. al. (2010) Youth Risk Behavior Surveillance—United States, 2009. Morbidity & Mortality Weekly Report 59, 1–142. Kaminer, Y. (2001). Adolescent Substance Abuse Treatment: Where Do We Go From Here? Psychiatric Services, 52[2], 147-49. Latimer, W. W.; Newcomb, M., Winters, K. C.; Stinchfield, R. D. (2000). Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors. Journal of Consulting and Clinical Psychology, 68[4], 684-696. National Institute on Drug Abuse. Research Report Series: Prescription Drugs: Abuse and Addiction. U.S. Department of Health and Human Services, National Institutes of Health. NIH Publication No. 01-4881, Printed 2001. Revised August 2005. Safety: Solutions 5.1-5.11 Solution Number: 5.1 ACC Peer Court Solution Description: To improve neighborhood safety and address juvenile justice issues, the ACC Juvenile Court will organize a peer court for teens arrested in non-violent and first time offences. The goal of FC-CIS and the ACC Juvenile Court is to obtain funding through private sources, such as the Georgia Bar Association, to implement the peer court in 2014. The 81 Appendix F