Field Placement: Los Angeles Unified School District
Location: Los Angeles, CA
Preceptor: Dr. Kimberly Uyeda, MD, MPH
Student Name: Marisela Romero
Year: 2004

The Los Angeles Unified School District (LAUSD) has taken a proactive stance against childhood dental caries and obesity by performing a needs assessment of its existing dental and obesity programs and services. As the second largest district in the nation, LAUSD services a student population of 746,800 students in grades K-12. The District’s Student Health and Human Services division provides integrated health and social services through a unique cadre of providers, including school nurses, physicians, optometrists, social workers and mental health providers. Other unique programs in the District include the Children’s Health Access and Medi-Cal Program (CHAMP), which provides information and assistance to families regarding health insurance enrollment, retention and utilization. Working closely with the District is the Los Angeles Trust for Children’s Health (LA Trust). This non-profit public benefit corporation was established to support school-based health clinics and other health services for LAUSD students. The LA Trust and the District will use the needs assessment to understand the challenges and successes of the existing LAUSD dental and obesity programs, as well as explore other promising practices in the field.

To complete the assessment, a literature review was performed to research school-related dental and obesity issues. This was followed by an in-depth examination of existing programs and services using an informal, semi-structured interview process. The process resulted in three different models of school-based dental programs and three models of obesity prevention and treatment programs. The three dental models included: community-sponsored dental clinics, which are run relatively independent from the district; district partnership dental clinics which require more district involvement in the management and administration of dental services; and mobile dental clinics which involve some level of district participation in either the funding, organization or coordination. The three identified areas of need involved financial gaps, dental provider gaps and coordination gaps. The needs assessment recommends the following options:

1. Support dental service funding through identification of alternative funding opportunities, fundraising and providing direct funding assistance.
2. Developing an integrated community-referral system.
3. Restructuring existing dental services to focus on oral health prevention.

The assessment also identified three models of obesity prevention and treatment programs. The models consisted of a physical activity model, nutrition model and weight management programs. The assessment also revealed four areas of concern with the existing LAUSD programs and services: the prevention-treatment continuum, resource gap, service outcome gap, and cultural competency gap. Accordingly, the assessment suggests the following options:

1. Optimizing opportunities for physical activity at school.
2. Build healthy nutritional environments at schools.
3. Integrate systems of health promotion and obesity prevention.

With these suggestions, the needs assessment will help the District become better equipped to enhance, expand or refocus programs and services to promote healthy lifestyle choices and behaviors.

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