Academic journal article Journal of School Health

Using the Kindergarten Health Assessment Report as a Health Report Card. (Health Service Applications)

Academic journal article Journal of School Health

Using the Kindergarten Health Assessment Report as a Health Report Card. (Health Service Applications)

Article excerpt

Most people believe beginning school in optimal health is important to a child's academic success. Health problems such as chronic illness, and difficulties in vision, speech, or hearing may prevent a successful start. (1) Knowledge about the epidemiology of health conditions affecting kindergartners, as well as how gender, race, and socioeconomic status (SES) affect the prevalence of these conditions, enables health care and education personnel to plan interventions and preventive services. One potential method for obtaining this information involves using school entry health exams required in a number of states, including North Carolina. This project used data from kindergarten health assessment reports in one North Carolina county in order to describe the type and frequency of health issues that affect kindergarten children, and explore the effect of socioeconomic status on these health issues.


North Carolina state law requires each child entering kindergarten to complete a Kindergarten Health Assessment Report (KHAR). (2) State law mandates the health assessment be completed by a licensed physician, physician's assistant, certified nurse practitioner, or a public health nurse. All forms must be completed within a year of school entry and be sent to the school the child will be attending. Project staff collected and analyzed KHARs for all children that entered kindergarten in the Guilford County (NC) Public School District during the 1999-2000 school year. Guilford County, located in central North Carolina, has a population of approximately 425,000. Some 60 elementary schools in the district include kindergarten classes.

Prior to obtaining the forms, school personnel removed all personal information from the forms. Data were entered and analyzed by using the statistical software SPSS 10.0. (3) The KHAR includes demographic information, results from six screening tests (growth, blood pressure, vision, hearing, development, and anemia), and a list of the health conditions affecting the child. Abnormal values for the screening tests were determined using standard values found in the literature (Table 1). (4-7) The KHAR does not require specific documentation of a child's performance in regard to developmental screening, but only whether the health care provider deems follow-up is necessary. Given this, the standard established for abnormal development was the notation on the KHAR that the child "needs follow-up."

Due to the small number of children from racial groups other than African American or White, children reported as Asian, American Indian, Hispanic, Multiracial, and Other were combined in an "other" group.

Location of a child's place of regular care served as a surrogate measure for a child's SES. In Guilford County, community health centers and health departments (CHCs) provide health care almost exclusively for children on Medicaid (ie, lower SES). A small percentage of children who receive care at private medical offices (PMOs) have Medicaid as their insurance, but most have commercial insurance or are enrolled in an HMO (ie, higher SES).

Raw numbers as well as percentages were calculated for each variable. Chi-square was used to compare differences between children attending CHCs and those attending PMOs. A p-value of < 0.05 was considered statistically significant. The study was approved by the Guilford County public schools and the Moses Cone Health System institutional review board.


Kindergarten Health Assessment Reports were collected for 4,204 (85.8%) of the 4,898 children enrolled in kindergarten in Guilford County public schools during the 1999-2000 school year. Three schools that did not participate in the project accounted for 325 of the 694 missing forms. The other 369 missing forms were distributed among the remaining 57 schools. In addition, 252 forms were excluded because they differed significantly (eg, out of state or outdated form) from the current standardized form, which was last updated in December 1999. …

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