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al (McKewen et al., 1998) report a case study of 22 African American inner city children aged 5 to 12years managed twice daily at their school clinic and treated with inhaled anti-inflammatory medications.The program incorporated regular inhaled anti-inflammatory medication and was found to reduce the needfor inhaled bronchodilators, improve peak flow readings and reduce complaints of nocturnal asthmasymptoms. Limitation in the collection and interpretation of absenteeism data precluded findings onabsenteeism in this study (McKewen et al., 1998). Christiansen. et al., (Christiansen et al., 1997) reportthat their five-session bilingual, interactive curriculum teaching about asthma in a school setting didenhance peak flow meter technique and inhaler technique and reduce asthma symptom scores among the27 intervention students compared to the 15 control asthmatics. While the research on school-basedasthma programs is limited by issues of design and sample size, the findings suggest promise formanagement of asthma symptoms and savings in health care utilization.E-19
Table 3. Summary of Research Findings Linking School-Based Interventions and Chronic ConditionsThe effect of school programs on healthConditionsSchool Health ProgramsLevel ofinterventionIntermediate Health IndicatorType ofeffectHealth OutcomeIndicatorType ofeffectProgram and InterventionComponentsOverweight/Obesity"Eat well and keep moving"-Gortmaker et al., 1999Elementary Dietary intake / Television viewing (+/+) 1. physical activity, 2. dietaryintake, 3. television watchingRobinson, 1999 Elementary Television viewing (+) BMI / triceps skinfold/ waist circumference(+/+/+)SPARK Sallis et al., 1993 and1997Elementary Physical activity for both sexes /Fitness for girlsCATCH Luepker et al., 1996 Elementary Fat intake / Physical activity out ofschool / Physical activity in school /Less fat containing food provided byschool cafeteriasCATCH post-interventionNadar et al. 1996 and quasiexperimentalCATCHColeman et al., 2004Planet Health - Gortmaker etal., 1996MSPAN - McKenzie et al.,2004Elementary Fat intake / Physical activity (+/+) Overweight riskreductionMiddle schoolMiddle schoolFruit and vegetable intake / televisionviewing reductionVigorous physical activity during PEclasses(+/+) Indicators ofoverweight(NE) Physical activity(+/+/+/+) Decrease fat, saturated fat andsodium intake. Increase physicalactivity(+/+) Nutrition(+) Physical activity and nutrition(+) 1 Physical activityDiabetes"Bienestar Program" Trevinoet al. 2004Fitness score / dietary fiber intake /mean fasting capillary glucose / dietarysaturated fat intake(+/+/+/NE)Percentage of bodyfat(NE)AsthmaDSCM asthma control schoolprogram - Tinkelman &Schwartz, 2004Elementaryand middleschoolUnscheduled doctorvisits / asthmadaytime symptomsfrequency / nighttimesymptoms frequency(+/+/+) Program incorporated 1. arespiratory nurse care manager, 2.web-based interactive educationaltools, 3. interactive asthma diaryfor student, and 4. telephoniceducational disease managementfor parents.Anderson et al., 2004 2Number ofhospitalizations /emergent visits /follow-up visitsClark et al., 2004 Elementary Daytime andnighttime symptoms/ parent scoring onasthma managementindexMcKewen et al., 1998Need to use inhaledbronchodilators /peak flow readings /nocturnal asthmasymptoms(+/+/+) Comparison of special school forchildren with chronic conditionswith regular schools(+/+) Enable disease managementthrough intervention on students,parents, class mates and schoolpersonnel(+/+/+) Twice daily asthma managementChristiansen et al., 1997Peak flow meter technique / inhalertechnique(+/+) Asthma symptoms (+) Five-session bilingual, interactivecurriculum teaching about asthmaMild emotional Possel et al., 2004disordersMiddle School(8th grade)Depressivesymptoms in theshort term(+) LISA-T program based oncognitive-behavioral therapySpence et al., 2005Middle School(8th grade)Preventing ormanagingdepression at one orfour year follow-up(NE)Problem Solving for Life programdesigned to promote cognitiverestructuring and provide problemsolving skillsGillham et al., 1995Middle School(5th and 6thgrade)Depression at: 12mo/ 2 yr / 3 yr(NE/+/NE)Program designed by authors forstudents in the 5th and 6th gradeto be followed after 12 months, 2years and 3 yearsPhysicalInactivityStudies included in the "overweight/obesity" section aim to reduce the condition through increased physical activity and improved nutrition.UndernourishedNE, no effect, 1 more for boys than for girls, 2 generalizability of this study to regular schools is limited as special schools have highly specialized setting with resources beyond those oftypical school programs.E-20
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Appendix ATask Force Members and St
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Hector Balcazar, Ph.D.Regional Dean
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Charles Haley, M.D., M.S.Medical Di
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Michael McKinney, M.D.Senior Execut
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M. Roy Wilson, M.D.PresidentTexas T
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Appendix BMedicaid and the State Ch
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services. There are two broad types
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Mandatory and Optional Covered Popu
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• Nurse-midwife services;• Fede
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Disproportionate Share Hospital Pro
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March 13, 2001, that limited the am
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year from FFY 2002-2004, $4.05 bill
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Medicaid beneficiaries. Section 191
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started in 2001 and 2002 to curb in
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urban and with fewer than 250,000 p
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Protection Act of 2000 and the Medi
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orientation). Recipients of Supplem
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enrollee is assigned a primary care
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Table 7. Texas Medicaid Policy Chan
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Table 8. Texas SCHIP Policy Changes
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families (through the employer’s
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share of the match must come from t
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Reinstating the Medically Needy Spe
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Endnotes1 Texas Health and Human Se
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35 Powers, Pyles, Sutter, and Vervi
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73 Office of Management and Budget,
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113 TexCare, Children’s Health In
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150 Lyndon B. Johnson School of Pub
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States by Groupings with Current El
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Medicaid and the State Children’s
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Graduate Medical Education ProgramA
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needs, however, there is a shortage
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15 Texas Association of Counties,
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ecording and evaluation; physical e
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Medicaid and the State Children’s
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ReferencesAmerican Academy of Pedia
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downloads/bipa.pdf#search='Medicare
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Texas Health and Human Services Com
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Appendix CAn Analysis of Reform Opt
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Encouraged by these low rates, Cong
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Establishing state-only tax incenti
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New York passed the Health Care Ref
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Hospital Cost Containment — Maryl
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dollar spent. 237 Texas spent almos
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Another option for small businesses
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• Medical equipment and supplies,
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pay the premiums for Medicaid benef
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Medicaid to children born after Sep
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Bill of Rights or “TABOR”; and
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The federal share for CHP+ is 65 pe
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SCHIP: increased eligibility in CHP
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• Medical equipment and supplies
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6. Funds obtained through the recov
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Status ReportMaineCare Program Expa
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the federal poverty level. 404 Sinc
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need their jobs as a source of empl
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Endnotes191 Deborah Chollet, Issue
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225 Ibid.226 Maryland Health Care C
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259 Kaiser Family Foundation, State
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SCHIP&subcategory=Medicaid+Spending
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325 Kaiser Family Foundation, State
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361 State Coverage Initiatives, Sta
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SCHIP&subcategory=SCHIP&topic=Feder
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An Analysis of Reform Options Devel
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ReferencesAdvantage Insurance and F
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Donnell-Kay Foundation. “Amendmen
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Kaiser Family Foundation. Demograph
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State Coverage Initiatives. Profile
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Appendix DLocal Initiatives to Expa
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with more coordinated services that
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FinancingSources of revenue include
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AdministrationThe Health and Hospit
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Until 1993, Denver Health (DH) was
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different benefit plans are offered
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Cost SharingPatient cost-sharing is
Page 154 and 155: management programs. I-Care promote
Page 156 and 157: the county indigent care plan. Bene
Page 158 and 159: Firstplan xxvi,12Moore County, Mich
Page 160 and 161: Benefits and ServicesEnrollees can
Page 162 and 163: EligibilityAs of 2005, enrollment i
Page 164 and 165: etween $23 and $120 per month. Ther
Page 166 and 167: Healthcare Accountability Act xxxvi
Page 168 and 169: Coordination - When health care age
Page 170 and 171: subsidized initiatives offer exposu
Page 172 and 173: arriers, two health plans attempted
Page 174 and 175: xxi Simmons, Sandy Coe, Gionfriddo,
Page 176 and 177: Table 1 (Continued). Local Care Ini
Page 178 and 179: Table 2 (Continued). Local Coverage
Page 180 and 181: Appendix EEducation and Health:A Re
Page 182 and 183: The human capital approach suggests
Page 184 and 185: etween standardized test scores (St
Page 186 and 187: INTRODUCTIONEducation plays a wide
Page 188 and 189: of children with chronic health con
Page 190 and 191: Implications. Given the current pre
Page 192 and 193: DiabetesPrevalence. Diabetes in chi
Page 194 and 195: Limitations. The cross-sectional de
Page 196 and 197: chronic lung disease, cystic fibros
Page 198 and 199: significant differences between tho
Page 200 and 201: Table 1. Prevalence of Selected Chr
Page 202 and 203: findings of lower test scores are b
Page 206 and 207: Section 3. School-Based Interventio
Page 208 and 209: mathematics, science and oral expre
Page 210 and 211: Table 4. Summary of Research Findin
Page 212 and 213: etween SES and health is a dose-res
Page 214 and 215: Self-Rated Health. Evidence accumul
Page 216 and 217: economic hardship. One of the skill
Page 218 and 219: Education also improves the stabili
Page 220 and 221: sex in the expectation of a more pr
Page 222 and 223: TABLE 6. SUMMARY OF EXPLANATIONS FO
Page 224 and 225: According to the Census 2000 data,
Page 226 and 227: Policy Reports Recommendations (Tot
Page 228 and 229: Section 2. Recommendations on Schoo
Page 230 and 231: Childhood ConditionsSchool-based Pr
Page 232 and 233: Childhood ConditionsDiabetes (n=11)
Page 234 and 235: eduction in reading test scores com
Page 236 and 237: Table 10. Estimates of the Cost of
Page 238 and 239: National Asthma Education and Preve
Page 240 and 241: REFERENCESAck, M., Miller, I., & We
Page 242 and 243: Elo, I. T., & Preston, S. H. (1996)
Page 244 and 245: Kaemingk, K. L., Pasvogel, A. E., G
Page 246 and 247: Miller, D. S., & Miller, T. Q. (199
Page 248 and 249: Ross, C. E., & Wu, C. L. (1996). Ed
Page 250 and 251: Williams, D. R. (1990). Socioeconom
Page 252 and 253: SAMPLE, DESIGN, & INTERVENTIONACHIE
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SAMPLE, DESIGN, & INTERVENTIONStudy
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SAMPLE, DESIGN, & INTERVENTIONACHIE
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SICKLE CELL ANEMIAArmstrong(1996)SA
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SAMPLE, DESIGN, & INTERVENTIONSickl
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SAMPLE, DESIGN, & INTERVENTIONhemog
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SAMPLE, DESIGN, & INTERVENTIONStudy
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Curriculum Content: Statute §28.00
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• HEALTH PROMOTING ENVIRONMENTSch
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• COORDINATION/IMPLEMENTATIONCoor
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Education and Health: A Review and
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Appendix FState Regulation of Healt
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coverage they offer. 14 By 2004 onl
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poor health may make coverage more
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account for most, or even much, of
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More active state intervention in t
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Table 3 (GAO Appendix IV) shows whi
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Appendix GEmergency and Trauma Care
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The treatment of shock prior to sur
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the EMS needs in rural areas of the
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Level IV trauma centers should be a
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Table 2. Trends in Trauma Severity,
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the hospitals were on diversion or
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Representative Delisi was successfu
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Mental Health Access ChallengesCare
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fhttp://www.techproservices.net/his
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oohttp://www.saveourers.org/reports
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Appendix HBrief: Consulate ClinicDe
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In addition, the roundtable discuss
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clinic(s) affiliated with medical s
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Appendix ICommon Abbreviations
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HMOHRQOLHRSAICF/MRIHCTAIOMISSLBBLIU
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Appendix JPresentersDate/Location:
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Appendix KProvider Taxes: A Differe
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were previously categorized as char
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