School Health Assessment, Planning, and Evaluation Project -- New York City

The School Health Assessment, Planning, and Evaluation (SHAPE) project, a survey of the health status of New York City school-aged children, was conducted during October 1983 and November 1983. Over 4,500 children in grades kindergarten, 1, 3, 7, and 10 were examined by the staff of the New York City Department of Health. They were selected from 12 different schools to represent high, middle, and low socioeconomic areas of the city from a total of 1,000,000 students and over 1,000 schools.

The examination consisted of standardized height and weight measurements, visual and hearing acuity, dental and physical examinations, laboratory determinations of hematocrit and blood lead levels (in the elementary grades), and a nurse-administered history and/or record review. In addition, students in the seventh and 10th grades were given self-administered questionnaires to ascertain frequency of health-risk-associated behavior and to evaluate nutritional intake.

Based on preestablished criteria, the health status of each child was determined. If objective or historic findings indicated a need for additional health evaluation, this was enumerated as a "referrable condition." These criteria were purposefully conservative; for example, a child with visual acuity corrected by glasses to 20/20 but without written evidence of a professional eye examination within the past year was deemed "referrable." The referrable conditions found included: vision--22.9% of students examined; hearing--7.0%; asthma--4.0%; cardiac--3.1%; orthopedic--2.3%; strabismus--2.0%; other--3.6%.

Analyzing the frequency of risk-taking behavior documented the expected increase between the seventh and 10th grades (Table 1). The interpretation of the questionnaire responses must be guarded, since there probably were frivolous responses and some misinterpretation; however, the relative differences between grades is undoubtedly real, and the magnitude of the positive responses is considered meaningful. The increase between the seventh and 10th grades in risk-taking behaviors that contribute to health problems has led to two major changes in health-promotion activities: (1) the reintroduction of a required physical examination on entry to the seventh grade (state law mandates a physical examination at school entrance, fourth, seventh, and 10th grades, but New York City has had a waiver of this requirement) and (2) the development of a new health professional, the Health Resource Coordinator (HRC).

Concurrent with the SHAPE study, there was an increase in the resources available for health services in the school system. Educators believed there should be a nurse in every school daily, and services should be primarily targeted to the elementary schools. The beliefs of administrators, both in the health programs and educational system, would have lead to widespread employment of aides to perform first aid and keep records. Fiscal realities and the SHAPE results, however, were used to allocate the new resources into areas that addressed needs identified in the SHAPE study.

To deal with the high prevalence of visual and acoustic problems, specialized teams of paraprofessionals are being trained to perform hearing and vision testing in grades kindergarten, 1, 3, 7, and 10. This approach lends itself to quality-control mechanisms, which should prevent overreferrals. Screening had previously been the responsibility of classroom teachers or aides with very little training.

The SHAPE questionnaire for students in the higher grades inquired about students' desires for additional services. Students indicated a need for counseling in addition to classroom education. To meet this need, the HRC position has been established by the Department of Health to concentrate further on behavioral risk factors. An HRC will be assigned to each junior high school over the next 2 years. During the first year, priority will be given to schools in areas designated at highest risk for health problems. The HRCs' duties will be to link young people to needed services in the community and to improve the health of the adolescents by encouraging voluntary behavior change. HRCs will concentrate on improving the students' knowledge on obtaining health information, interpreting such information, identifying options for health decisions, and asking for assistance. Nutrition, substance abuse, sexuality, and stress management will be the areas of primary concern.

Additional pediatric nurse-practitioners, physicians, public health nurses, and public health assistants are to be deployed in the schools to assure a regularly scheduled health department service in all the schools. The initial goal is to have a nurse in each elementary school weekly on the same day of the week.

This new initiative in school health by the New York City Department of Health complements the expansion of the health education curriculum in New York City. Reported by DJ Sencer, MD, Commissioner of Health, O Pitkin, MD, J Lee, Office of Biostatistics, P Clarke, MPH, Bureau of Health Education, New York City Dept of Health, New York; Div of Health Education, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: It has long been recognized that the required years of schooling present unique opportunities for early detection, referral, and correction of pupil health problems. Thus, for many years, health agencies have very actively supported pupil health appraisal and follow-through in community schools, disease prevention, and environmental protection measures. With fiscal and personnel public health resources becoming even more strained, it is becoming even more important that priorities germane to improved educability of youth and consistent with efficient public health practice be identified and implemented.

The health-education curricula being implemented by New York City's Board of Education were originally developed by CDC and the Public Health Service. They are generally known as The Primary Grades Health Curriculum Project (grades kindergarten through 3) (1) and The School Health Curriculum Project (grades 4-7) (2). They are now used by 17,000 teachers in 3,200 schools in 43 states.

References

1. Lynch BS. The primary grades health curriculum project. Atlanta, Georgia: Center for Disease Control, 1980; DHEW publication no. (CDC) 80-8382.

2. CDC. The school health curriculum project. Atlanta, Georgia: Center for Disease Control, 1980; HHS publication no. (CDC) 80-8359.

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