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Louisiana, US_EiJ Paraconference

Misria

In Louisiana, governing elites have long found it more profitable to deny the connections between health outcomes and the structural inequities of an anti-Black petrostate. Their denial is made possible by the existence of data divergence–that is, inconsistencies between data sets or between a data set and the realities it purports to represent (Encyclopedia of Social Measurement 2005). These inconsistencies range from missing or “undone” (i.e. incomplete or ignored) data (Frickel et al. 2007) to the production of different measures (and the selection of different priorities) by institutional silos. Recognition of the need for public health capacities that address the systems and structures impacting health–especially children’s health–has motivated health equity advocates in Louisiana to fill the data gaps through collaborative datawork, that is, the work of making data meaningful across social and scientific communities. In 2022, a coalition of community organizations, academic researchers, and public health workers led by the Louisiana Center for Health Equity (LCHE), a community-based organization created by a registered nurse, worked together to examine the links between adolescent mental health and disciplinary practices in schools. Ensuring their agendas were informed by community priorities led them to incorporate the contributions of adolescents advocating for better access to physical and mental healthcare resources and the abolishment of discriminatory and punitive disciplinary actions in schools. Their collaborative datawork revealed how data gaps around adolescent mental health are a structuring component of schools’ discriminatory and punitive climates–much as gaps in environmental health data benefit polluting industries. They found that existing figures around adolescent mental health are inaccurate, as many youth are unable to receive an official diagnosis owing to lack of healthcare access. LCHE advocates at a house committee meeting in January 2023 reported that students who exhibit behavioral issues rooted in trauma or mental health more often receive punitive disciplinary actions rather than rehabilitative and restorative services. This work generated the support needed to pass legislation to expand public health infrastructure and access to mental health resources. In June 2023, House Bill 353 authorized the allotment of "mental health days" as an excused absence for students; introduced procedures for schools to connect students to medical treatment and services; and required the Louisiana Department of Education to develop and administer a pilot program for implementing mental health screening, among other changes. By mobilizing advocates and scholars from across the social and institutional silos, LCHE’s collaborative datawork tentatively expanded children’s public health infrastructures. 

Fisher, Margaux. 2023. "Collaborative Datawork and Reframing Adolescent Mental Health in the Deep South." In 4S Paraconference X EiJ: Building a Global Record, curated by Misria Shaik Ali, Kim Fortun, Phillip Baum and Prerna Srigyan. Annual Meeting of the Society of Social Studies of Science. Honolulu, Hawai'i, Nov 8-11.

10.What steps does a user need to take to produce analytically sharp or provocative data visualizations with this data resource?

margauxf

Creators of the Student Health Index recommend using the tool in combination with qualitative data collection and stakeholder/community engagement (e.g. working with school leaders, local community leaders, and healthcare providers).

A full guide to using the dashboard is available here.

 

8. How has this data resource been critiqued or acknowledged to be limited?

margauxf

Data sources utilized by the index are not always the most current due to data collection limitations (e.g. covid-19 has caused disruptions in the collection of CDE data).

The Index is limited in that it does not offer data for schools that were not large enough to warrant the construction of a School-based Health Center. Thus, schools that did not meet specific enrollment targets were excluded from the dashboard. This includes rural schools (designed as such by the USDA) with an enrollment under 500 students, urban schools (without a high school) with less than 500 students, and urban schools (with a high school) with less than 1000 students. California had more than 10,000 active public schools in 2020-21. The final dashboard for the Student Health Index includes 4,821 schools.

The lack of available data on health indicators at a school-level restricted the Student Health Index to using proxies for the health outcomes. Some health indicators are included, but they are not school-specific, instead linked to specific schools geographically through the census tract. However, community-level data does not always accurately reflect the characteristics of a school’s population. As a result, school-level indicators in the Index were weighted more heavily than community-level indicators.

Additionally, race was not included as a measure in the Student Health Index because of California’s Proposition 20, which prohibits the allocation of public resources based on race and ethnicity. However, the dataset does contain measures of non-white students at each school. 

The Index has also been limited as a quantitative measure of need, which may overlook the influence of other factors that might be better illuminated through qualitative evidence (e.g. stakeholder engagement, focus groups, interviews, etc.).

6. What visualizations can be produced with this data resource and what can they be used to demonstrate?

margauxf

The Student Health Index can produce visualizations that represent data on conditions, school characteristics and risk factors that affect education outcomes and could be improved through access to school-based health care. These visualizations can be used to demonstrate need for expanding school-based health care access in California.

In addition to maps, the index can also be used to generate graphs and visual displays of data (e.g. ratio of highest need schools to all schools, by county).

The visualizations can be used to demonstrate the correlations between final need scores and race, the impact of specific indicators in health, and the concentration of need to certain regions of California (hot spot analysis).

5. What can be demonstrated or interpreted with this data set?

margauxf

The Student Health Index enables users to identify where SBHCs will have the most impact for students. The index uses 12 indicators, each of which can be scored from 1 to 4 for any given school. These scores are generated using percentiles and represent relative values. The 12 indicator scores are combined into a Need Score, which is calculated using percentiles along a scale of 1 to 4. Schools with a score of 4 (in the 4th quartile) have the highest Need scores relative to other schools in California.

The index is composed of 12 diverse indicators (percentages, rates, and index values) that have been transformed using percentiles in order to enable comparisons on a common scale. These indicators are divided into 3 categories: health indicators, school-level indicators, and socioeconomic indicators.

 

Health Indicators

  1. Diabetes
  2. Asthma ED admissions
  3. Teen birth
  4. Health Professional Shortage Areas (HPSA)

 

Socioeconomic Indicators

  1. Poverty among individuals under 18
  2. Uninsured among under 19
  3. Healthy Places Index

 

School-Level Indicators

  1. Percent FRPL (students eligible for free or reduced-price meals)
  2. Percent English Learners
  3. Percent Chronically Absent
  4. Percent experiencing homelessness
  5. Suspension rate

 

Other Data

  1. Mental health hospitalization rate
  2. Percent in foster care

 

Indicator selection was guided by CDC estimations on the primary contributing factors that shape health (social determinants of health, medical care, and health behaviors). The indicators included in the index are all either directly associated with the absence of health services that could be provided at a school level, act as proxies for health behaviors, or represent social determinants of health that could be addressed through access to school-based health services.

Indicator selection was influenced by recommendations from the Research Initiative of the Campaign for Educational Equity at Columbia Teachers College, which found that seven health disparities affecting school-aged youth could be addressed through school health programs. These disparities include: (1) vision, (2) asthma, (3) teen pregnancy, (4) aggression and violence (including bullying), (5) physical activity, (6) hunger, and (7) inattention and hyperactivity.

More detailed description of the rationale shaping indicator selection is available here.

 

3. What data is drawn into the data resource and where does it come from?

margauxf

The Student Health Index draws from data that is publicly available and up to date on a statewide level. Sources include the University of California San Francisco Health Atlas, the American Community Survey, the U.S. Census Bureau, the California Department of Education’s Downloadable Data Files site, and the CDC.

 

 

Detailed list of sources:

PLACES Project, CDC (available through the UCSF Health Atlas)

CalEnviroScreen (available through the UCSF Health Atlas)

Opportunity Atlas (available through the UCSF Health Atlas)

Health Resources and Services Administration (available through the UCSF Health Atlas)

American Community Survey (available through the UCSF Health Atlas)

California Department of Education’s Downloadable Data Files site

Kidsdata.org

2. Who makes this data available and what is their mission?

margauxf

The California Student Health Index is made available by the California School-Based Alliance, a statewide organization on a mission to put health care in schools in California, which has lagged behind other states in supporting the establishment of school-based health SBHCs. The alliance aims to increase the number of SBHCs in California to 500 by 2030. There are currently 291 SBHCs in California (and over 10,000 K-12 schools). They are generally implemented by local districts, community organizations, healthcare providers, and school leaders rather than by state officials. Funding also typically follows a grassroots model (placing the burden on local communities), despite the funding California received ($30 million in 2011-2012) from the Affordable Care Act ACA to build and expand SBHCs (out of $200 million nationwide).

According to the California School-Based Alliance, SBHCs offer a step forward towards health and education equity by providing easy and safe access to healthcare, addressing physical, mental, social, and emotional health, and offering integrated healthcare through coordination between schools and community health care providers. The establishment of SBHCs has been recommended by the Center for Disease Control’s Community Preventative Services Task Force based on evidence that they improve educational outcomes for low-income populations and generally promote health equity.

The Student Health Index is intended to support these goals by providing a quantitative analytical tool that supports statewide advocacy to increase and maintain the number of SBHCs, build awareness of the interrelations between health and education, and to provide access to comparative tools for parsing publicly available local data in ways that can help communities and stakeholders identify opportunities to improve health care access in schools.