CHNA Will Be Your Partner in Serving Needy Children and Families
David Perrodin, PhD
Note to reader: This article was published in the November, 2016, Sprigeo, Inc. newsletter.
Per the Instructions for IRS Form 990, Schedule H, 2011 and the Patient Protection are Act, the Community Health Needs Assessment (CHNA) is conducted to aid a hospital in better understanding community needs and to develop an effective implementation strategy to address priority needs.
Community needs include school needs. Yet, I’ve found surprisingly, or alarmingly, that few schools are even aware of the CHNA. Those mindful of the CHNA more often than not vastly underestimate the scope of resources available, by the hospital, to students and families. Yes, by the hospital. When is the last time that schools have not been asked to lead an initiative? Schools are the locomotives of social change. They are asked to couple an underpowered, but noble engine to a line of heavy cars that seem to run the length of the track.
Community Health Needs Assessment – This Data is Invaluable to Schools
Federal regulations require that tax-exempt hospitals provide and report community benefits to demonstrate that they merit exemption from taxation. Community benefit activities or programs included: improving access to health services, enhancing public health, advancing increased general knowledge, and relief of a government burden to improve health.
The CHNA considers multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of healthcare access), assessments prepared by other organizations in recent years, and primary data derived from interviews with persons who represent the broad interests of the community, including those with expertise in public health. Some hospitals inform their CHNAs with focus groups. It’s not just harvesting selective forensic data, but total, boots-on-the-ground immersion into the community. You don’t mail someone a survey. Instead, you knock on doors and talk through questions – clarifying and expanding responses. This information is invaluable to schools seeking to best meet the needs of children and families.
Afford me a few sentence bird walk. It is without explanation that CHNA representatives haven’t combed local schools for data on student needs – instead, such data is downloaded from state public data servers – old data detached from contexts and situations. There is little practical value in comparing schools to schools. The most valid data is per the individual school – not inter-school, inter-conference or inter-state. Consider the following actual CHNA findings and how they might inform your school’s practices…
The process of assembling a CHNA results in a prioritization of needs. This is why it is of utmost important to have school staff as members of the CHNA committee. An example of empirically supported key problems include: (1) poverty, (2) employment opportunities (residents not seeking available local jobs), and (3) substance abuse and dependency.
Other key findings from CHNA’s included, but were not limited to:
- Parents relied on assistance to provide enough food for their families. The population of children receiving food stamps was nearly twice the state average. One of three children lived in poverty compared to the state average of one in five children.
- Locations for food assistance and education were limited. A phenomena of “food deserts” existed, or geographic areas characterized by high poverty rates and limited access to grocery stores. The community itself showed little growth beyond smaller convenience-type stores.
- County has a significantly low health ranking in the state.
- County population is increasing, but mainly due to migration.
- There were more single-parent households compared to the state average.
- There was a high rate of volunteerism perceived by community members.
- Over half of county residents commuted to jobs outside of the county.
Coupling with the CHNA
My doctoral research revealed overlapping of objectives between a hospital Community Health Needs Assessment (CHNA) and a school district’s objectives specific to the non-academic aspects of well-being of students and families, such as access to mental health services. This recommendation applies to all school districts. Again, the CHNA is required to include community partners, yet school district personnel are often NOT represented on the committee that gave input to the creation of the plan. Conduct the following Google search: “CHNA” + “hospital” + “(Name of your county)”, + “(Name of your State)”. Click. You will immediately discover the CHNA(s) that encompass every child and family member of your school. It’s a user-friendly document probably 30-40 pages in length. You might be taken aback to read about detailed steps to incorporate your school into a collaborative effort to serve children and families with various social needs. OK, exactly when did anyone ask for my CHNA input?
Claim Your Chair at the Table
The CHNA shapes decision-making by putting more options on the table for the principal. This is a very good thing. My findings indicate promise that the CHNA be expanded, both in terms of representation from the school district and in terms of areas of student and family wellness, including access to mental health services for children, substance abuse abatement, and education on healthy nutrition. As an example, the CHNA report could be modified to include sections specific to the school district, such as data from the Youth Risk Behavior Survey. Better yet, qualitative constructs from student focus groups could offer real-time school specific data! Benefits from evolving the CHNA into a Community/School Health Needs Assessment might include elements such as:
- Medical professionals would work with educators to better understand the contextual and situation flux of the community and further define mental health needs of children. A potential partnership could incorporate screenings or assessments that specifically target youth and are not derived from a subjective tool not designed to measure mental health. Cooperation would bring clarity to what constitutes a mental health need and facilitate common language between schools and hospitals. Joining forces to address mental health needs would be a step toward greater interagency collaboration on other issues impacting the well-being of children and adults.
- Medical and school professionals could collaborate with staff professional development and trainings for youth and families.
- The CHNA report (actual document) counters the loss of legacy knowledge in the school setting due to rampant turnover of administrators. I would further recommend a brief annual update addendum to the CHNA that would record progress toward goals. In addition, the larger CHNA committee would be better positioned to absorb turnover of membership.
- The CHNA report offers a robust contextual backdrop to help situate discussions of race.
- Hospitals and schools could utilize CHNA findings to apply for joint grant funding.
Principal Gary’s Observations of School Needs
Gary shared that the severe behaviors witnessed in today’s schools are rooted in mental health disorders—an area he revealed having little professional development in. He noted that schools can only do so much in serving children with mental health needs. The following statement reveals the challenges to making sense of the deeper neurological functions of children with severe mental health conditions:
“I think generally in schools is we can try to understand the functions of all of these really sometimes odd, aggressive behaviors. But from a neurological explanation, we don’t have a clue. And I think for me, it is something I would, I mean, yeah, I can read about it. And usually, when I read about it, and I go, oh . . .”
Student Violence Solutions Are Evasive
Principals indicated that episodes of student violence were becoming more severe, although not necessarily more frequent. Again, perplexed principals repeatedly shared that they contacted their counterparts for guidance on such matters. These were crucial leadership discussions that affected their capacities for preparing schools that are safe. Perhaps what is warranted is a community discussion in which the school contributes to the discussion versus conducting it. Welcome, hospital- guided CHNA!
We Don’t Need CHNA – A Counter Argument
While most district has clearly-stated initiatives for curbing disciplinary incidences and increasing safety, rationale for such initiatives were largely subjective or else derived from the Youth Risk Behavior Survey (YRBS), which is neither a screener nor an assessment of students’ mental health. Districts have placed substantial trust in the YRBS as a primary needs assessment tool. It is extensively used to create goals to reduce the perception that bullying and harassment are prevalent at the middle and high school levels.
Progressive districts continue to allocate substantial dollars toward evidence-based mental health curriculums, onsite mental health providers, increased social workers and counselors, and social- emotional curriculum. In one district, more than 100 staff and community members completed a four-day training in Youth Mental Health First Aid (YMHFA). Additional staff and community members in that district will receive the YMHFA training, along with plans for training the trainers. Contrarian’s beliefs: (1) cultivate internal expertise, and (2) help isn’t going to arrive from outside sources. So, is the CHNA hype and hope printed on glossy paper or is it an overdue framework for social change?
David Perrodin, PhD, worked twelve years as a Director of Student Services. As an expert in high-stakes decision making in safety situations, Dr. Perrodin has presented on public television, international talk shows, and at conferences and schools. He partnered with Pulitzer Prize winning author and producer David Obst to write and direct a film script involving an intruder in an elementary school setting. Dr. Perrodin is in a contractual agreement with publisher Rowman & Littlefield to write multiple safety-themed books. www.crisisprepconsulting.com
This article was written exclusively for Sprigeo, 2016.