Focus on Wellness

Turner County is widely considered a “lagging” rural county. Jobs are limited, and the county’s unemployment rate is more than double the State and Federal rates. There is no hospital in the county, so residents must travel 30 to 45 minutes (one way) to obtain emergency, outpatient, and inpatient services. Only two fulltime physicians practice in the county.

Because children are hard hit by poverty, the Focus on Wellness project was designed to create a healthier community through a coordinated and comprehensive school health initiative targeting the county’s 2,012 students (prekindergarten through 12th grade). Specifically, the project sought to strengthen existing health education programs, to provide school nurses with the necessary supplies and equipment, and to deliver mental health counseling, substance abuse prevention education, case management, and parent support services.

To maximize staff resources, the Turner County Board of Education provided funding for the assistant superintendent to serve as project director. It also provided the elementary school nurse, school health educators, and school counselors. The Focus on Wellness project provided funding for a coordinator, one full-time and one part-time mental health counselor, and 64 percent of the middle/high school nurse’s salary. (The remaining portion of her salary was funded through tobacco settlement resources.)

The school nurses, school and mental health counselors, and health educators were responsible for making health-related services, both physical and emotional, available to all students in the Turner County School System. The school nurses also provided a range of health screenings, including blood pressure, diabetes, and cholesterol screenings, for school staff, area businesses, and others throughout the community. However, because school nurses were available only a small portion of the school day, a retired nurse manager from the health department assisted in providing health screenings in area businesses and other locations in the community.

Many organizations have a difficult time recruiting qualified staff members to serve in rural areas. The same was true for this project. After two rounds of advertising and interviewing a fulltime coordinator, the project ultimately hired a retired DFCS director in October 2000 to serve as a part-time coordinator.

The project also had trouble recruiting a qualified, licensed mental health counselor who was willing to relocate to a rural area; instead, the project hired a retired school counselor trained in peer mediation as a part-time counselor and a full-time unlicensed mental health counselor who also had extensive experience. Although the project was unable to follow its original hiring plan, these three staff members brought a wealth of experience to the activities.

All network members shared responsibility for ensuring the success of the Focus on Wellness project, and before the grant, each organization already was a member of Turner County Connection, a community collaborative that served as the governing board for the project. Under the Turner County Connection umbrella, a Focus on Wellness Prevention Education Planning Committee was established.

This committee was actively involved in planning and participating in community health fairs, school staff health fairs, and other activities. In addition, the Focus on Wellness Executive Committee, now known as the Turner County Health Network Committee, was expanded to include all local area health providers in addition to the network members. With broader representation from the medical community, the committee has proven to be more effective in identifying community resources and in eliminating barriers to care for Turner County residents.

During the 2000–2001, 2001–2002, and the first 7 months of the 2002–2003 school years, school nurses recorded 38,169 student visits, and the regular school counselors logged 11,716 student sessions. The part-time and full-time mental health counselors conducted 2,587 individual, group (including peer mediation and conflict resolution), and crisis intervention sessions. In addition, the health educators provided a comprehensive school health education and prevention curriculum.

During the 2000–2001 school year, an average of 1,105 students per quarter received the comprehensive school health education curriculum, and an average of 1,132 students per quarter received abstinence and substance abuse education.

Also, an average of 1,736 students per quarter received character education on courtesy and fairness, self-responsibility, respect, and helping others. In the 2001–2002 school year, 834 students in kindergarten through 5th grade and an average of 200 students per quarter in grades 6 through 12 received comprehensive school health education; 267 5th grade students received abstinence and substance abuse education; 1,803 kindergarten through 11th grade students received character education; 835 kindergarten through 5th grade students and an average of 230 students per quarter in grades 6 through 12 received drug and tobacco prevention services; 19 alternative school students received violence prevention services; an average of 28 alternative school students per quarter received criminal and traffic law education; an average of 22 alternative school students per quarter received basic living skills training; and 83 kindergarten through 12th grade students were referred for the peer mediation program.

In the first 7 months of the 2002–2003 school year, an average of 716 students per quarter received the comprehensive school health education curriculum; an average of 824 students per quarter received substance abuse education; an average of 1,791 students per quarter received character education; 670 kindergarten through 5th grade students and an average of 18 alternative school students per quarter received violence prevention education; an average of 22 alternative school students per quarter received basic living skills training; and 149 students were referred for peer mediation.

Although it will be many years before the project will know whether students avoid premature pregnancy or graduate from high school on time, program staff are confident that the seeds planted through this grant, beginning in kindergarten and extending through 12th grade, will make a difference in the lives and health status of the participants.

The most important lesson learned from the project evaluation was the need to refine the evaluation plan as the project developed to ensure detailed and complete data for all service components supported by the project. For example, in the second year of the project, more detailed data were collected on the delivery of the comprehensive health curriculum than during the first year. This additional information was used to modify and expand various aspects of the curriculum, such as adding the violence prevention component and expanding abstinence education in middle schools. Evaluation data also revealed the lack of an adequate disease prevention curriculum in high schools. Evaluation findings such as these can be used to ensure that the project is responsive to the needs of students.

The school board now provides funding for the middle school/high school nurse. The seed money provided by this grant, along with the project evaluation data collected during the grant cycle, has resulted in additional grants to expand the health education curriculum, including a Special Projects of Regional and National Significance grant to provide abstinence education and an Early Learning grant to provide parenting skills training. The Turner County Connection and Health Network Committee continue to seek additional funding to sustain the availability of mental health counseling services in the school system.