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School-based health centers (SBHCs) have steadily increased in numbers across the United States over the last 3 decades.

The most recent SBHC census, conducted in 2004 to 2005 by the National Assembly of School Based Health Care, identified more than 1709 SBHC programs in the United States.  This shift in the delivery of health care for children is premised on the assumption that access to health services in school increases access to health care and improves health status among children, especially for those children whose access to care is otherwise limited.  Health status is often measured by health-related quality of life (HRQOL), which attempts to tap the current health perception of individuals.  HRQOL has been demonstrated in both social scientific and clinical research to predict future health status, health care utilization and costs, and even mortality.

For example, a study linking the 1992 Medicare Current Beneficiary Survey with the 1993 Medicare Continuous History Survey found that a person’s response to a selfrated health question accurately predicted that individual’s respective use of health care services over the next year.  Only a few studies, however, have examined the connection between HRQOL and health care utilization and health care cost savings among children.  The link between HRQOL and utilization among Canadian adolescents was examined by Vingilis et al. with a single measure of perceived general health status that asked children to rank their answer on a 5-point scale from excellent to poor.  They found that reductions in perceived health over time were associated with increases in physician services and declines in dental care. This anomaly in usage across service providers may reflect differences between preventive dental care (representing the majority of dental services), which is not covered by publicly funded Canadian Medicare, and insured, curative health services.

Evaluation is a significant part of assessing whether the Montana Asthma Control Program is reaching its goals. This 5 year strategic evaluation plan is a roadmap assessing the direction, feasibility, and significance of the projected projects and associated objectives.  Evaluation results will be used to feed information back into our initiatives about what is and is not working so
that changes can be made to improve outcomes and guide program development. The following plan includes information on specific activities that will be evaluated using the chosen evaluation design and timeline, as well as a communication plan to relay information on evaluation and outcomes of the evaluation. This is a living document that will be enhanced and updated annually to fit the growing needs of the MACP and its partners. As new projects are implemented, individual evaluation plans will be created to assess each major project. All MACP staff will remain involved in producing new individual plans and updating the strategic plan. MACP partners will also play an integral role in designing and implementing individual evaluation plans and updating the strategic plan as needed.

This Environmental Stewardship Guide is published to provide the CMS community information and insights on the CMS environmental footprint.  It includes examples of the district's environmental performance and offers examples of the efforts you can make to foster stewardship action in your own activities at home, school, and work.

The Charlotte-Mecklenburg Board of Education formalized the CMS commitment to environmental stewardship in Board Policy ECF, "Environmental Stewardship" (p. 2).  The Superintendent has furthered this commitment by including environmental stewardship in the internationally recognized ISO 14001 standard and is tailored to have environmental stewardship integrated into the everyday business of the district (p. 4). 

Environmental Stewardship requires the wide-ranging engagement of staff, students and the community.  The district's goals to reduce utility consumption and pollution by 20%, and solid waste by 5% by June 2014 are possible through your input, participation and leadership.  The snapshot below illustrates the magnitude of the district's environmental footprint.