October 2002

Grant Results

SUMMARY

From 1999 to 2001, researchers at Kaiser Foundation Hospitals, Kaiser Foundation Research Institute evaluated two projects that were part of the Kaiser Permanente Cares for Kids Demonstration Projects:

  • Healthy Minds, which integrated mental health services for children in low-income and ethnically diverse communities into an existing school health clinic in San Jose, Calif.
  • Hearts in Power, a cardiovascular disease awareness program implemented among sixth-grade students in two middle schools in San Bernardino County, Calif.

Key Findings
Key findings of the Healthy Minds project included:

  • Of the 78 students referred to services, 43, or 55 percent, followed up with at least one recommended service; those 43 students attended 60 of 106 recommended services, at a 57 percent compliance rate for all recommended services.
  • Students aged 6–14 who were seen and who received recommendations from Healthy Minds staff demonstrated significant reductions in psychosocial problems based on their pretest and posttest scores on the Pediatric Symptom Checklist.
  • The majority of parents surveyed reported improvements in their children's behavior and school performance; parents also said they felt more knowledgeable about and capable of handling their children's mental health problems.
  • There was a great need for Spanish-speaking practitioners for this population, as well as flexibility in scheduling for parents' visits.

Key findings of the Hearts in Power project included:

  • Both parents and students increased awareness of cardiovascular disease risk factors.
  • Significantly more students ate a healthy breakfast and drank more milk, and there was measured improvement in the school nutrition program, including adding a healthy lunch line, low-fat sandwiches and lower-priced milk, water and juice.
  • By the end of sixth grade, all smoking-risk attitudes and behaviors had significantly increased among students.
  • While there was little difference in pre- and post-physical activity among students, sedentary time increased significantly, especially for boys who reported spending more than four hours per day watching television and playing computer games.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $49,829.

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THE PROJECT

Researchers from Kaiser Foundation Hospitals, Kaiser Foundation Research Institute evaluated two projects that were part of the Kaiser Permanente Cares for Kids Demonstration Projects. In the demonstration, Kaiser Permanente of California partnered with schools to improve health and health care for children.

Kaiser Permanente is a health maintenance organization connected with Kaiser Foundation Hospitals.

Healthy Minds

The first demonstration project, Healthy Minds, integrated mental health services — for children aged 3–14 in low-income and ethnically diverse communities — into an existing school health clinic in the Franklin-McKinley School District in San Jose, Calif.

Project staff provided screening, early intervention, brief treatment and triage for referrals to school or community services. The project examined both barriers and keys to success by tracking access, outcomes and patient compliance for referred services.

All enrolled students underwent psychological baseline assessments by means of the Global Assessment of Functioning Scale as well as the Pediatric Symptom Checklist. The checklist was administered again to students who completed Healthy Minds counseling sessions three months after completion.

Additionally, project staff conducted two parent satisfaction surveys — one immediately after counseling and another about six weeks later, a teacher survey and a practitioner survey.

The goal of referring and serving 300 students was not achieved; however, the Student Health Clinic referred 109 students to Healthy Minds. Of those, 78 completed the assessment process and were referred to school or community services.

Hearts in Power

The second project, Hearts in Power, was a cardiovascular disease awareness program implemented among sixth-grade students in two middle schools in San Bernardino County, Calif.

The project aimed to improve students' knowledge, attitudes and behaviors regarding cardiovascular health by focusing on three major risk factors for heart disease: tobacco use, physical inactivity and high-fat diets.

Hearts in Power provided a voluntary health risk assessment screening and incorporated various strategies into the program, including in-class prevention education, campus health promotion activities, healthier choices added to food service offerings and media attention.

For the Hearts in Power project, staff evaluated smoking behavior, physical/sedentary activity and nutrition among a sampling of the 638 participating students by using a non-experimental design with pretest (beginning of sixth grade) and posttest (end of sixth grade) measures.

Further evaluation resulted from key informant interviews and focus groups with the project's School Site Health Council composed of project staff, school administrators, parents and students.

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FINDINGS

Key findings of the Healthy Minds project included:

  • Of the 78 students referred to services, 43, or 55 percent, followed up with at least one recommended service; those 43 students attended 60 of 106 recommended services, at a 57 percent compliance rate for all recommended services.
  • Students aged 6–14 who were seen and who received recommendations from Healthy Minds staff demonstrated significant reductions in psychosocial problems based on their pretest and posttest scores on the Pediatric Symptom Checklist.
  • The majority of parents surveyed reported improvements in their children's behavior and school performance; parents also said they felt more knowledgeable about and capable of handling their children's mental health problems.
  • There was a great need for Spanish-speaking practitioners for this population, as well as flexibility in scheduling for parents' visits.

Key findings of the Hearts of Power project included:

  • Both parents and students increased awareness of cardiovascular disease risk factors.
  • Significantly more students ate a healthy breakfast and drank more milk, and there was measured improvement in the school nutrition program, including adding a healthy lunch line, low-fat sandwiches and lower-priced milk, water, and juice.
  • By the end of sixth grade, all smoking-risk attitudes and behaviors had significantly increased among students. However, because there were no posttest comparison site data available, it is not clear whether the negative findings represent a developmental difference in students from the beginning of sixth grade to the end.
  • While there was little difference in pre- and post-physical activity among students, sedentary time increased significantly, especially for boys who reported spending more than four hours per day watching television and playing computer games.
  • Self-administered questionnaires for data collection are difficult for sixth-grade students; furthermore, the evaluation was limited by not having a comparison school.

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LESSONS LEARNED

Project staff reported that the scope of these projects was overly ambitious for the two-year time frame and the demonstration projects' budgets, which amounted to approximately $100,000 each, funded by Kaiser Permanente.

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AFTER THE GRANT

After the Healthy Minds project, the school district integrated mental health services into its school clinic, and the Hearts in Power project schools integrated some of the health-related materials into the regular curriculum. This was the conclusion of both projects.

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GRANT DETAILS & CONTACT INFORMATION

Project

Evaluation of HMO-School Partnerships to Improve Children's Health

Grantee

Kaiser Foundation Hospitals, Kaiser Foundation Research Institute (Portland,  OR)

  • Amount: $ 49,829
    Dates: May 1999 to June 2001
    ID#:  036713

Contact

Annette Aalborg, Dr.P.H.
(510) 450-2369
aea@dor.kaiser.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Survey Instruments

Kaiser Foundation Research Institute, Daily Nutritional Intake Diary. San Bernardino County, Calif., Winter 1999.

Kaiser Foundation Research Institute, Parent Cardiovascular Risk Assessment. San Bernardino County, Calif., Winter 1999.

Kaiser Foundation Research Institute, Self-Administered Physical Activity Checklist. San Bernardino County, Calif., Winter 1999.

Kaiser Foundation Research Institute, Student Cardiovascular Risk Assessment Questionnaire. San Bernardino County, Calif., Winter 1999.

Kaiser Foundation Research Institute, Student Smoking Attitudes, Knowledge and Behavior Survey, San Bernardino County, Calif., Winter 1999.

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Report prepared by: Eric Love
Reviewed by: Janet Spencer King
Reviewed by: Molly McKaughan
Reviewed by: Marian Bass
Program Officer: Pamela Dickson