Transcripts For CSPAN3 Bipartisan Policy Center Discussion On Education Health 20240714

Pennsylvania education secretary pedro rivera appear Healthy Schools campaign ceo Rochelle Davis in this discussion. Well, good morning, everyone want to welcome all the title is education and health twin pillars for driving students. Good to see all of you. For those of you new to bpc the mission is to actively seek and take the best ideas from both parties to health, security as well as opportunity for all americans. We try principles and politically viable old policy solution through the power of analysis, negotiation and advocacy. Todays event focuses on the bidirectional impact of education and health. It is part of a project bpc is involved in health and all policies. The idea that policies outside the healthcare have a profound impact on health and therefore Health Impact should be a consideration for policymaking in these areas. To this and it is understood that education is important for health outcomes. In addition, it is a that facilitates learning and is the Education Sector is equally interested in promoting Healthy Learning environment. Just last week the Early Childhood initiative hosted an event on physically safe the children can thrive. We are pleased this afternoon to have an extraordinary set of speakers to discuss the topic as part of a Panel Discussion. To start us off i would like to introduce Rochelle Davis. Rochelle is president and ceo of the healthy campaign. She will be providing remarks for all of us. The campaign is a cosponsor today and it has played a tremendous role nationally and effective on the Ground Program influencing policy. She has long been an advocate for Childrens Health from Environmental Health early in her career to school the last few decades. Following her remarks will invite our panels to pay for a discussion which will be followed by audience question and answer. As a reminder this event is being streamed live online and a recording will be available next week. We also think viewers watching today. Was that i would like to ask her to come to the podium and you can take away. To hotel thank you and the Bipartisan Policy Center for partnering with us and thank you to all of you for been here in person, through the webcast and on c span for this important conversation. Healthy Schools Campaign our work is focused on the simple and common sense notion that healthy students are better learners. Since 2002 we have worked in chicago and across the country to advocate for policies practices that ensure that all children no matter their race, ethnicity or Family Income can attend healthy, safe and Supportive Schools Healthy Schools can provide positively impact students all around will be build a Solid Foundation for learning and help address the health and educational disparities impacting our most vulnerable children. This work is more important than ever. Over the past few decades the problems of chronic conditions that in students ability to be in school and ready to learn such as asthma, diabetes in obese he has double from one in a to one in four children. More and more children suffer from a range of Mental Health issues like anxiety, depression, Substance Abuse and adhd. One in five children has diagnosable Mental Health problem and nearly 2 3 of them get little or no help these conditions disproportionately impact low incomehis children disproportionately suffer from a lack of access to healthcare and attend schools with less access to physical activity, higher exposure to environmental toxins in the air and water and fewer School Based Health services. Compact these challenges many of the same children also live in areas that are less likely to have space for safe outdoor play and many students come to school suffering the impact of Food Insecurity or trauma. The impact of poor child had health compounded by disparities and access to healthcare and Supportive School environment liberates throughout a childs life. A student who is malnourished or living with an unmanaged physical or Mental Health condition will have more problems concentrating in class and miss more school days than help the student. Children who are chronically absent as early as preschool, kindergarten or first grade are much less likely to be reading at grade level by third grade. Students who cannot read at grade level by the end of third grade are four times more likely to drop out of heist. Research increasingly supports the link between educational success and longterm health outcome. In other words, investing in education is essential for supporting a healthy population and an educated and healthy population is essential to a vibrant and strong america. So lets, for a moment, imagine what it would look like if every student in this country attended a school that supports Student Health and wellness as a foundation for learning. In a healthy schoolteachers are given the resources and training to support students overall wellbeing and build a safe and Supportive School climate. Parents are welcomed into the School Community and they are knowledge and leadership is valued. The School Students access to healthy food, physical activity and clean air and water and these are not things we can take for granted. School actively teaches students to make healthy choices and allow them to thrive and physical and Mental Behavioral Health care is available and in a healthy School Students learn through lessons and examples to value their own health. Healthy Schools Campaign has worked in chicago and nationally to make this vision a reality. In chicago engaged parent leaders teachers and principals and help them advocate at the district level for help your school food and the return of physical education and recess to the school day and we have helped transform paved over schoolyards into vibrant green spaces for play and learning. We have seen many many amazing initiatives and programs in chicago and across the country. We applauded the school staff, families and partners who have made these changes happen. The challenge is making these changes scalable and sustainable. To do that, we need systems level change including ensuring that schools especially those serving students with the greatest needs have Adequate Funding including the resources necessary to support Healthy Learning. Providing schools with the knowledge and tools to understand the helpmate of their students, implement appropriate policies and programs and build the partnerships they need and incorporating health and wellness education metrics accountability system so it is prioritized and funded. Fortunately, we are at a moment that offers several opportunities to overcome some long standing level barriers. The new education law, the every student succeed act has given states more opportunity to address Student Health and school wellness, for example, under essa all report cards must include chronic absences which can be a powerful measure of Student Health and school wellness. In addition 36 states have included chronic absent rates as part of the educational accountability system. States and School Districts are leveraging these new opportunities for one example since i only have a few more minutes, a School District it was hard to pick which one. A School District in tennessee is using funding essa to support School Nurses effort to track why students are absent. This allows the district to get a more complete picture of a problem and identify ways to address it. The Education Sector increasingly have a powerful helper which recognizes that health is driven by more than what happens at a doctors office. Recently Trinity Health announces they will require all of the hospitals to include chronic absence in their Community Health needs assessment. Also this year the American Academy of pediatrics released a policy statement highlighting the role that pediatricians can play in addressing chronic absence. With the education and Health Sectors both integrating chronic absenteeism into their metrics and data systems we have really created a new opportunity for alignment and partnership. Another opportunity to address a longstanding barrier that schools have faith his recent changes in medicaid. States have the opportunity to allow School Districts to be reimbursed for a much wider range of services needing a 15 state collaborative so the schools will be able to access the medicaid dollars to pay for School Nurses, counselors, social workers and other crucial services. States are beginning to take advantage of this opportunity. It is important to recognize these are opportunities not mandates. There is much work still to be done at the federal and state level to support schools and communities to create the conditions that will allow all children to thrive. That is why the leadership of our panelists on these issues and efforts of all of you who have joined us today are so important. This event provides an important chance for us to explore how to be successful in building healthy and Supportive School environments so all children can learn and thrive. Think you. Thank you for those opening remarks and i think that sets the stage beautifully for the Panel Discussion today. I want to take may be the first couple of minutes and provide a brief biography sketch of our three panelists i think most of you know them as Public Servants but just so you understand their perspective. Bill is a heart and Lung Transplant surgeon and former u. S. Senate majority leader and senator fritz represented tennessee for 12 years and was elected majority leader in 2003. His service helped committee responsible for all federal education policy later inspired him to found score to propel tennessee to prominence through k12 education. He is currently chairman of tennessee as you are thank you for coping here. John king junior is the president and ceo secretary king served in president obama is cabinet is the 10th the secretary of education. He joined the Department Following his tenure as the first africanamerican to serve as new york state education commissioner. He began his career in education at the High School Social studies teacher in puerto rico and came as a medical middle School Principal. Currently secretary rivera serves as president of the board of directors for the council of state officers and it is a Nonpartisan Organization public official who had state departments of elementary and secondary education. Prior to his appointment he served as superintendent of the School District at lancaster additionally he was a classroom teacher, assistant principal, principal and director for the state. Thank you for all three of you being here and if you heard from rochelle how important this impact is for might be helpful based on your experiences why is this so important and where do you see signs of progress across the country western mark thank you and rochelle, thank you you set the stage beautifully. 12 years ago i was in the senate and after a period of 12 years i had the opportunity to be involved in no child left behind and i came back a couple of things. If somebody has a College Degree or four years of continuing education after secondary school that they will live 5. 3 years longer than someone who doesnt graduate from high. I knew at the time that if someone spent additional years of any kind of education after secondary School Education that they would have less Heart Disease that they would have less diabetes that if they would live longer the five years coming after that and they would have and we have developed the Science Behind and gather the evidence and when you look at health and healthcare and how long someone lives or burden of disease, whatever it is that it is not the doctrine me or the doctrine you that determines whatever that measure is the outcome of health, but twice or three times more important are the social determinants and what we have learned is that education is a primary social determinants for health. We have healthcare over here and what we are talking about is the nexus of the two. This is how i initially got involved. Take it to the simplest level of the student. I was a middle School Principal i had a student who had chronic asthma and he would miss a lot of school as a result of the asthma and the school was in a building that was shared with the nursing home so when we got a nebulizer set up for him in the nursing home that he could access he went from missing a lot of school to being in school regularly and his grades went up and he was a happier student and his family was happier by just having access to quality healthcare made the difference for his educational outcome. The thing im encouraged by his there is a growing Awareness Among states and School Districts that as an educator we have to be thoughtful about how we connect kids and families to quality healthcare. Three quick examples. A partnership between Childrens Defense Fund and Superintendent Association to use the School Enrollment process as an opportunity to talk with families about their enrollment and healthcare whether it is medicaid or chip or one of the Healthcare Options on the exchange for personal health insurance. Making sure that families are attentive for their children having access to healthcare. Two, we see and we heard about this in the discussion we have states paying attention to chronic absenteeism and they are noticing that data points and using that to translate into action whether that is connecting families with Healthcare Providers or addressing homelessness or insecurity or addressing Food Insecurity that a family might be experiencing or helping them strategize transportation. Third example is around food. One of the key things that has made a positive difference all over the country is the free and reduced price lunch. Many kids that is the best meal of the day. Many schools dont have a universal breakfast program. Many schools and communities are working hard to access food in the summer. Less than 20 during the school year access meals during the summer, but we can do better. Some communities do food trucks in the community so that kids have easy access to food. There is also a Pilot Project at the department of agriculture putting additional dollars on the electronic interface card so that families can access meals over the summer and we know that program is working well and increase the likelihood that kids have access. There is a lot of evidence that people are paying more attention. We need to get some of the policy barriers out of their way and also as michelle talked about work to scale some of the solutions. Doing a great job taking off identifying the social determinants. One of the things the government to do well is setting commissions for success reduce the conditions by which neighbors and institutions i understood that if i really wanted to help others improving the quality and building we couldnt focus on the traditional learning without deal with issues of homelessness and have physical health needs. Somewhere the most with quality supports around those needs. A teacher at a smallscale something as simple as providing laundry cards or meals in the classroom or tokens for public transportation. For better support and i have started to become committed and focusing on those areas so as a School Administrator and ultimately as a district administrator and a secretary continue to look at opportunities to expand that and more importantly solicit other partners that can help better serve our students. Now i secretary the secretary of agriculture at the state level and department of corrections or labor and industry. I know we will get a little deeper, understanding that we have the responsibility and the opportunity to set conditions for practitioners every day by working together to ensure we have a direct narrative around why we exist, how we should be best serving our communities, focusing the collective impact in terms of mission and to better serve those communities and being unapologetic and for the sake of the rest of our conversation what we have done and we have defined equity by making those Resources Available to communities and making those resources that they need to be successful in the manner which they need them and that goes from everything from Educational Opportunities to health and Human Services. Education is a powerful determining of health. A lot of literature there and improve gpa and we got right to your point about barriers. In terms of collaborating. Is a data or culture what are the most important barriers as to why these know that it is important and i will take the stand of reflecting the health part of the health and education because i think you just saw we can get programs in there but how do you get them to stay and that will be in alignment around common goals and i will let my colleague talk about the Pure Education and on the health part of it we have two problems. On one side at the state level most of the education is not federal at the state level, state budgets it is for security and safety and it is education. You have to balance your budget. It used to be 10 years ago president obama began to put together value based healthcare to reimburse not just for healthcare and more health and wellbeing the outcome is well being and we are moving again with leadership over the past administration and being supported by the current administration. If you look at value and care and outcome and wellbeing then you look at not to the people that service and you go to reimbursing and we will probably talk a little bit about medicaid and if you want better Health Wellbeing not Just Healthcare you go to value and a major determinant statistically is the education itself. Medicare is beginning to reimburse and we are talking about food and School Nurses coming in from the Delivery System and beginning to reimburse in washington and medicare is not medicaid things like food and transportation and housing. That has to come up to the level and they will be looking for science and it is the common alignment of the well being that will drive it. One last thing the budgeting is education and your focus on education and you have to balance the budget and not until we bring those committees together at the state level and federal level around these common goals and the end way you do that is that the local community level. Agree with everything he said. I think we have political will challenge and a culture challenge. These days that ive done medicaid extensions see Better Health outcomes for their children. The Politics Around that is complicated and the senator knows more about that than probably anyone else in the room. At the end of the day we know that increasing medicaid will link learn go toward better for kids. Even if the kids would otherwise be eligible through chp or other programs they are more likely to participate if their parents can access medicaid through medicaid expansion. If you are going to the doctor and taking care of your healthcare you are more likely to make your kids are getting access. That is a political will problem. The administrative problem we put out a joint toolkit between the Education Department and health and Human Services during the Obama Administration to help School Districts think about schoolbased Health Service and particularly trying to figure out how to leverage medicaid dollars to support schoolbased Health Services in schools that are serving large number of students. It is a hassle, bureaucratic and many states the rules are complicated and the result is that people dont follow through in creating the opportunity and it is a lost opportunity for kids and families. We know people are more likely to Access Healthcare if it is immediately available at the school. The cultural problem, i will give you one example is Johns Hopkins did this study in baltimore, fascinating study, it looked at kids and reading outcomes and they found shockingly that if you can see the board or read the book you do worse in school. I know it is shocking. Similarly shocking if you provide appropriate Vision Services you can see the board and read the book wait for it, you actually do better in school. I make light of the study it is an important study and what is frustrating is the result wasnt that every rule started making sure every kid had vision screening. Their heads who were being held back they were being told they are not good they cant read because of something so simple just untreated vision care. That is cultural problem. Speaking from the state perspective and putting into context what i have noticed over the past few years and observing some of that in local government right now is far too often we have used policy to influence practice as opposed to practice to really inform good policy and over the course of the year we have engaged thousands of stakeholders for the School Improvement and the opportunity and what we have realized is in many instances there could be minor tweaks to language that would allow a classroom practitioner a district leader to utilize resources or time even relationships differently to build in healthcare into School System is happened over the course some rigid policy language being created it is been interpreted in ways that people thought they could not focus where weve been trying to take into account the holistic nudes news to reprogram or deprogram the misnomer is. It always is assumed around the language of law and policy to allow them to think about the kid or client first. That was one of the areas that was most surprising to me. We think specifically around medicare and medicaid and federal dollars being utilized for health and Mental Health support. The biggest barrier between agencies they told us that we couldnt do it that way and then you ask who is they and no one knows who they is. Im waiting to meet someone who says i am a. The other is misrepresentation of law and language of law and it is interesting, i have defaulted you always ask first before moving any further, show me and looking at it and asking why we interpreted this way and can we think differently around the system to better support the community and fulfill our mission. I will share with you one of the things weve been able to do in pennsylvania. I meet monthly with my colleagues in the office of Human Services and the office of labor and industry, secretary of agriculture and secretary of the department of corrections and we take in our let them have the time to discuss breaking some of the barriers we spend as much time discussing around opportunity moving forward and as a result thinking about nuanced changes in language that would allow for better Mental Health providers. We are working with department of human Health Services and it goes into a homeless shelter and we can access that information to collect them connect them to the other services and whether it is something as simple Something Like a kiosk for grab and go programs for breakfast and schools were able to utilize that federal funding because they didnt have the tools to utilize that. Department of corrections building within for Resource Centers and they are womens prisons so when a family comes in to visit a mother that happens to be incarcerated they have that same access to information around services that you would if you were to visit the school for enrollment and by working together you can better focus on what the Community Needs as opposed to trying to understand the law or policy. Another barrier not to the wise looking at some solutions and right now the Foundation Reports regularly that only 25 in the country have access to a school nurse not accent not just in the school but access and as a we have seen it has gotten more complex. If weve seen changes like more diabetes and disorders and an increase in the reported chronic disease and disability area within schools today and that asking too much for teachers and principals when a quarter of the population has a chronic disease, we mentioned asthma and allergy the whole range of diseases or disabilities not to have access to a Trained Health some sort and within the structure of the school, good news because there is progress made and it has been part of the coordinated School Program since the last 15 years were the only state in the country that every district has implemented that program and with that we have seen a dramatic increase over time of our schools themselves having access to Health Personnel. Dramatic as well as increase in activity dramatically change that over time. Still a long way to go, but when you look at Outcome Measures whether it is the increase in activity for it is in education in terms of a math test or science test or cognitive reasoning and to be able to access that for when you need them as that of having to leave school. That is a structural impediment today that looks from the health angle instead of dumping it on the school we have to merge those two together. If we share the science culture continue to invest in education and health. That will come back and help with one of the three. If we can focus specific barriers we talk about the opportunities we Start Talking about it sounds like it provides an opportunity part of essa funds can be used to support School Nurses and there is a focus on chronic absences which is critical for health as rachelle mentioned and medicaid another opportunity. Do you think most important opportunities that bring these sectors together they at the local level, statelevel, federal level . Is that the Public Sector the private sector probably all of the above and talk about some of the most important opportunities today to get to where you all are articulating where we need to go from a policy perspective, where do we need to take the lead if you talk about pockets and replicate anyone can stop there. What are the most important policy opportunities . In my opinion having experience my role as secretary and how i was fortunate enough to land here. I think we have to start local and engage local stakeholders because the policies we inform are usually implemented to improve the quality of life for local community and especially now that the communities are coming better informed and engaged they hate when we do things to them. Even if it is perceived positive intent and doing for all the right reasons. If we dont involve them there will be pushback and as we have been able to inform as much policy as we have those are where we have been most successful is when we have engaged the local community. It is when we articulated their needs and their thoughts through their lands receive the most traction. At the state level one of the other challenges are counterparts dont have and if we get to do this for to terms we are lucky. We have this in front of our constituents as quickly and aggressively as possible. I will share that i think the importance of the relationship between public and private sector create a sandbox to try and create if i spend a dollar on a failed project i think where the partnership through our private sector partners we can better articulate moving forward and create the opportunity to experiment and use what we learn through that experimentation and those resources to better inform the practice. I build on that there is a tremendous leadership here for governors and legislators because health and education are the most dominant things they spend money and they have the opportunity to realize the financial benefit of smart and longterm investment. We know that having a nurse visit, new parents early on improves longterm educational outcomes and health outcomes. It is a long lead time that you need to realize those and if its. For a governor thinking about of course they like tennessee what is best for tennessee not this year or this term, but for the next 20 or 30 years and you start to say yes we should start to make sure we have less than 20 of kids taking advantage of free and reduced lunch and what could we do as a state to radicallyi would love to see them stepping up to take leadership on these issues we need to help them by the long term taking and not focusing all of the elected officials attention on what happens tomorrow. I will build and at the federal level i love the committee and the senate and i love the majority leader and it was great. I think we covered the no child left behind expectations raised gaps addressed, with no direct mention of health. A Natural Evolution under obama was a door open. It has to be reflected even further and comes back to the culture statement instead of the 400 billion and medicaid only 3 1 2 or four is going to help the data is dramatic in terms of jobs and fulfillment contribution to gdp over time. We have to have the federal level. The state level is where the activity is and every job is in education. It has to start at the top. President and first lady and that is really important. It only goes so far because it does matter the culture. What is that culture and we put a large amount of emphasis on it and everyone says, what is it really . It is aligning this intersection where we know intersection incomes and values depends on basic access. Ultimately comes down to the local level because that is who alexi congress and few elects the governor because demanding the accountability, demanding the execution when we start the score 10 years ago and tennessee was at the bottom and we are sort of halfway where we need to be, but the one thing i learned and only thing ive learned and i had the idea to started and stepped on the way. The reason we have been successful is changing the culture at the local level and the implementation of the policies and execution and you do that by only building a Grassroots Movement of alignment and this is what will happen if you do and that is why you have to think longer than just beyond the next election. That thing is it does work. The newness of it is taking healthcare over here which is 3,000,000,000,000. 18 Unlimited Money to education over here whether it is compensation for materials for teachers and leadership we are expecting so much, but by marrying these two together with a clearcut alignment of the data then we can build the support and get appropriate access. Today the technology is there and you dont necessarily have to have a nurse in every school. You start thinking creatively and outofthebox when you can take these good programs. You have to be able to change the culture. Now we have the evidence and the data to do that. I dont mean to advertise, but a year and a half ago scor brought together 500 people and that is why cspan was important. Better help and better learning and at scor political advocacy and the other partner without was Nashville Health which was an independent group and you have the wellbeing of a community of health and well being is what its all about between you take the hospital they are looking at assessments of their community. They have to do it because the policy. The good thing about it when they go into the community, a hospital and they look at what is working they said it makes sense. Our hospital should get more than the community our hospital should adopt schools, our hospital should go to Blue Cross Blue Shield where they put money into education. It looks at the activity and 100 million because of that grant of physical activity the teachers use free five minute videos. All of a sudden that is where the intersection goes if you it at the heart of it. A lot of momentum, leadership and i want to ask all of you to put your Public Sector hat back on. How difficult is it to promote these partnerships. You talked about when you are education secretary and you are able to do schoolbased Health Service and you talked about having monthly meetings with many of your counterparts and i am curious these examples are more the norm for exception and how difficult is it to get people who are interested in health and education to actually help them understand how their policy impacts the other sector. What is some advice you have for current and how they come together and work to elevate these and this is for extra credit how do you deal with things likeyou talked about the National Breakfast program, 30 million kids on the School Lunch Program and the jurisdiction over those programs are usda. Sometimes you are dealing with departments that go well beyond just health and education. Talk to us a little bit, what is the advice you have to ensure and promote classic departmental partnerships that really integrate these two . I think trust and collaborative habit are big challenge and sometimes you can get people organized around one particular initiative and they move on to something else. You have to have a regular partnership driven by common goals. If you think we are going to electively make sure set across agriculture and you have to do that at the federal and date and the level. With those who run local and Community Based organization and faith based and collectively, we know chronic absenteeism is that 20 and we want to reduce that by 20 a year over the next five years how do that and start the ongoing collaboration and trust building and there are things policymakers can do. We can make data sharing easier which is a big obstacle. And what his had had on young people and their health. We can do training better and data sharing better and we can break down some of the silos and i will first reference this. There are these around budget and people feel like those are my dollars. I am happy to collaborate but dont come for any of my money. There are Committee Oversight silos within legislators and we have work to do to break down some of those silos so that people have a sense of shared responsibility first and foremost it is recognizing the fact that when collaborating and being transparent and trying to be clear in terms of hoping to accomplish there is a great deal of vulnerability and i often equate this job been center with been a superintendent in the middle of a snowstorm and deciding whether or not to close schools and you know you hate them when they choose to school close schools so we have to make a decision around big decisions. I think, if there is any advice the advice is we have to be explicit around what need we are looking to address and what goal we are hoping to accomplish and when we were looking at it one of the obstacles was for it to be congregant feeding and we needed to bring the population together to use some federal funding to provide the summer feeding option and we had to bring partners together from both the community and cross agencies some of the most vulnerable and full modes of transportation to serve as a congregant feeding location. We utilize libraries to provide those services and we work with featured partners to provide those services and by not bringing everyone together we wouldve never been able to tackle that issue. Now when interpretative the need and the fix and really reviewing language, some of those, many of the conversations were extremely passionate and everyone had an opinion and everyone understood their role and it would be sometimes as rigid as possible. By not addressing the home abilities and focusing on working through us we wouldve never found a way i think it is at every level of federal, state and local level and what we need and it comes back to leadership whether it is governor, president or first lady says this is a priority. It is always been a priority and no data to show why it is such an important already. The food issue talk about. Programs have shown people do better on tests and they show up on time and when you see the data and you put it out to whether it is a federal official it is clearcut overall. There are other things, processed foods out lunches today that are killing our kids and at the federal level sugar and sugary beverages and vending machines and those are battles that have to be fought, but food is only what goes into your body that gives us health and wellbeing. Is hard because government at the policy level can create problems and not intentionally, but the idea that 30th in the world of education and you need more science and math i was a part of that and looked at the gaps and translated down to the end of their that i will solely be judged on the scores and expectations in terms of scores that means i will sacrifice when i have to punish or discipline a student i will take away with a love and it is counterproductive if we are aligned for the health and well being. The movie aspect of it and i use an example not just at recess and and with the ipads and iphones and electronics that usually means lucid loosening up you put that together and from a positive standpoint one thing i would like to leave people with his education is not funded well in this country. Throwing money at just education doesnt work. The greater construct we have the data for and we need to execute that and implement on that. 18 of our economy is in healthcare. It is very clear that the hospital is under the community and see what is dragging people down overall in terms of health is basic access to education and the movement and food aspect and for me getting that healthcare involved in the community as they increasingly are is a very positive way both of you who spend all your time in education can work to that as persistent over time getting the culture right and the federal policy making it good to get the barriers out of the way and ultimately it will take this momentum to change the direction so execution can happen. I want to offer you all to make final comments. Lets move on we have roaming microphones on both sides. Raise your hand and introduce yourself. Thank you very much. I realize, of course i was an International Economist and an educator as well so i can see a lot of things here on what you are saying as being very important. I realize that you havent mentioned an important stakeholder in this is system and it is not just the people at the local level and the state level, about big pharma and actually you will talk about this better than i can, for example, what im thinking of as far as the education and healthcare our children who have dyslexia, they are in normal classroom and they have a lot of problems and the problems are not just in the school, but also at home with the parents who dont know how to treat them. One of the big problems, of course, is big pharma that does not provide for anything that really helps those students without making them gaga in the classroom and, of course, our teachers are not prepared to deal with the brightness of those students who need to have a different kind of educational system. Can you talk a little bit about how big pharma can be involved in this type of thing and the proper medication, but also can they make these medications less expensive . I love your question. Im not going to be able to answer it. I turned to my colleagues. You bring up the point that the huge stakeholders, you brought up when i did not richard, that are outside of the normal purview of the true experts. In education. And that was the time to open up and reach out and educate them and maybe put political pressure and expose them in certain ways. I mentioned sugary beverages, sugar, thats the kind of thinking, i have no idea how to get pharma involved. But i think its a wonderful idea. I do think we need people in the schools or by telemedicine accessible to people so it is not the teachers, and the principles it falls upon. And that is something, when you talk about telemedicine and Virtual Health and hospitals reaching out to doctors reaching out, and pharma, also be a part of that equation. And pharma such a big issue. Im not an expert in it. If anyone wants to comment on that. The dyslexia point, we do have a real training gap around the science of reading. And Elementary School educators, theres a gap in access to reading specialists also. In high need schools. We are identifying kids, we are not, who have dyslexia. And we are not necessarily providing as a country the kind of instructional so words that students need. The problem at times, they are misdiagnosed and prescribed medication. When what they actually needed was good reading instruction in the first place. That is a real problem. There are who are working hard on improving screening for dyslexia and training of teachers and administrators around dyslexia. If i can share quickly, we are one of the states that just now is completing the dyslexia project where we have tracked a number of identified classrooms and students and have been comparing the reading levels and attainment levels. Both understanding and decoding. Which shows levels of growth. On the talent of that, that study, we can support the efficacy of some of those programs. Im going to be honest, there are two hats i wear, the first is if it works its great, maybe i cant forecast what the study will show. But then, i have to put on my financial administrator had to say how are we going to pay for it . Many of those programs are extremely robust, the work that we have to find the funding. Which is why its important to can can you investing in education. There is a question here. And one of the middle. My name is anna brenton im with the national schoolbased health alliance. Within the last month we released a census study of all the schoolbased Health Centers across the country. I wanted to give a quick number, 6. 3 Million Students currently have access to School Based Healthcare nationwide. And one of the trends we have seen over the last five or six years is the emergence of telehealth. In rural areas and medically underserved areas. How do you will see telehealth coupling with education in coming years . Again, i will let my expert colleagues in education, i am very involved with the largest Telemedicine Company in the world. Within eight minutes we can reach 3 Million People every year. At a very low cost, 40 to talk to one physician. Not to advertise tele. But to show the reach, we have the infrastructure and the knowhow, our federal legislature effective january has broken down the barriers. When i started telemedicine, telehealth, we would not be reimbursed, states, when i started. Now that it is, a huge impact that technology is simple, it is inexpensive. I will take it from there. In terms of access, we are not going to be able to put a nurse every school. We need a nurse or a Health Personnel with that expertise when 25 of the population has some basic health need everyday they come to class. Telemedicine to me, heres why im optimistic, it is a huge opportunity, barriers at state level have been broken down, and at the federal level. Telemedicine has been used in east tennessee, the foundation has used not telemedicine but teledelivery of health into schools with huge success. Again its an area that now ecosystem has lowered the barriers, i think it can expand greatly. Most of you probably have experience with that. The thing i would say is, as a way to address some needs, but cant address all needs. We need to have a greater sense of urgency around eating, meeting the healthcare needs of rural kids. Not just about access to nurses and doctors but access to dental care. To go back to the point about medicaid expansion, we have seen in the states that have pursued medicaid expansion, youve had a strengthening of rural healthcare and the survival of rural hospitals present states that have not extent banded Medicaid Company of those hospitals are closing. There is a real urgency around directing resources to address moral health needs. For us, our department of Human Services and education have been convening superintendents in rural areas to inform what the practice can look like and does look like not only for Traditional Medicine but Mental Health services as well. And working with our superintendent, and their teams, but understanding what their needs are, how they have been most successful, and how we have been able to utilize some type of hybrid model so we are not leaning too heavily in one area versus another. And they have been informing both our policy recommendations, but also what some of the nuance in contract language. Our counties, deliver much of that funding and sometimes, the way it is viewed as a line item budget as opposed to a Mission Driven budget, is one of the areas we are trying to change right now. We have one final question. My name is jr denson im with the nova health systems. I am curious, what if anything you are working on or would like to see happen in order to address issues with hipaa, and actually making it appropriately more portable for organizations and Cross Cultural cross sector collaborations to be able to complete research and help in this area. And the Obama Administration, we put our guidance, especially for our neighborhood communities, promise neighborhood communities where they were trying to connect across sectors, we put up guidance for them explaining the rules more clearly, and showing people the degree to which data sharing is possible under the current law. Secretary rivera made this point, people over interpret imitations and hepa and for band as a result, choose not to share data that could be shared. For the benefit of kissing communities. Hipaa. Now is an advocate one of the things i worry about is how do we balance the desire for good information sharing by Service Providers with parents legitimate concerns, with privacy. And helping to construct good rules that allow the right people have access to the right information in a secure way. We do see in a lot of states many parents, when they turn on the tv and they see news reports, about data breaches, or about companies exploiting their data, they are rightly concerned. Some states, legislators will propose bills that are overly broad. And would make it harder for educators and Healthcare Providers to serve kids well. As advocates we are trying to strike that balance. I will say, the access, its a balancing act. Especially, in the area of social services, nonmedical express of health data plus what you say, the health data, is a challenge. 1998 when we wrote hipaa per se, it is still the standing law but that was before any iphones, the relation of data today. It is an area we do have to come back to, not to dictate to washington but set guide rails in terms of this explosion in data which has huge power. And here with the large systems, they have the money to access more healthcare and socially determinate data than anybody. I think your question really is a challenge to all of us, and especially to those in washington, of the people in this room who are listening today, to come back and struggle with that balance that john looked at. I will say, or personalize healthcare telemedicine, the technologies were not available five years ago. The data was not available five years ago. Again, starting with the Obama Administration and the chief technology officer, said, this is a big deal. We have to be careful that we need to release this data, in an it was the right first step. I think it is incumbent upon all policymakers to take that next step so that people like you who are doing the health data, getting involved in the community, looking at assessments and schools and getting involved, can do it inappropriate, ethical, moral, ethnically sensitive ways. I think its a fantastic question. A couple more questions. Maybe you can catch the speakers on their way out. Senator, secretary, secretary, any final parting words for the audience . I think we have to take the best of organizations, help advocacy, and the best of the education advocacy, and collide them together. And with that good things will happen. Secretary . Two things. One sobering and one more positive. The sobering note is, we did not come up with much. We have to stop doing bad things. Folks saw the Washington Post article the last couple of days about school infrastructure. When teachers are cleaning rodent droppings off of the rug, that is bad for kids education and bad for the health. When you schools in baltimore where the water fountains are covered over with plastic bags because of lead, and the water, and kids are Drinking Water during the day, thats bad for kids education and bad for their health and it sends a message to kids about how much the society does or does not value them and their educations. In addition to all the good things we talked about, and we have to stop doing some of the bad things we are doing by under investing in Public Education including infrastructure of our schools. On a more positive note, thank you for the opportunity to be here, it is inspiring to share a stage. With secretary rivera and secretary king. To see what is possible in a bipartisan collaboration a commitment to kids first. What the senator has accomplished, with tennessee score and the degree to which scor tennessee as a state across sectors, committed to educational improvement and it made so much progress over the last decade. It is inspiring. And secretary rivera, things in collaboration first, and working across agencies, and makes me hopeful about the future of our country. Thank you. I appreciate the opportunity be here and share. Probably most importantly, to listen. Every time i look over at my colleague, all of your great ideas, im going to steal them so you may be reading about them i met i give you credit for it so i apologize in advance for more importantly, the opportunity here for us to share and realize an important fact, that is been brought up over and over. There are many good people, good organizations and community members, doing Amazing Things for our communities and students, the issue is everyone is doing them in silence. At the end of the day you have some very fortunate individuals who can utilize them but there are many more individuals who are not using or utilizing any of the services because they dont have access, they dont have the stamina, to access many of these opportunities. Or the system is just not set up to serve the most vulnerable communities. As much as we can, Work Together to break the barriers so that we can Work Together to the same end, do what we do well. Well serving our population in a holistic way. That is how everyone, in our schools, everyone in our community, every one of her students, will benefit. And can continue to learn in an environment that they are deserving. Being here today and being able to hear but more importantly being able to hit home with a message that should continue to do what we do but Work Together to maximize our impact on almost all of the communities. Thank you for your leadership and for being here. Thank you for rochelle. Thanks everybody for being here. [ applause ] how do i look forward to running against him. Took tuesday President Donald Trump hold a rally in orlando florida, officially launching his run for a second term. Watch live at 8 pm eastern on more road to the white house coverage with 2020 professional, at 10 ] he spoke at the New Hampshire institute of politics and new england counsel politics and eggs breakfast. Good morning everyone