Student Well-Being

The Road to Wellness

By Jessica Portner — May 06, 1998 17 min read
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School districts are stepping beyond the traditional boundaries of employee health care.

Salinas, Calif.

In a dimly lighted room in a hospital basement, two teachers tuck their legs beneath them and arch their backs into a “lion’s roar” posture as yoga instructor Stephen Cade prods the class to “push out those emotional toxins!”

For an hour and a half, accompanied by soft, syncopated music, the 20 students detoxify. They fold themselves into tents, twist into pretzels, and curl into fetal positions.

Barbara Baldwin, who teaches special education at a nearby school, says her yoga sessions are a welcome refuge from daily hassles. “Now I focus better on children, and I take things a little more lightly,” says the 54-year-old Baldwin, uncoiling on a pink carpet. She also likes the discount she gets.

While this six-week yoga course costs $7.50 a class, Baldwin pays only $3, a perk provided courtesy of her health plan. Baldwin’s insurance also covers other less conventional services, such as acupuncture and nutritional assessments.

The added benefits are a nice bonus, but it’s a smart strategy too, says Baldwin, who believes a regular yoga regimen ameliorates her arthritis by aligning her spine. “The district saves money if they have healthy people,” she says.

Like a growing number of major corporations across the country, public school systems like the 72,000-student Monterey County schools here along California’s central coast have set up wellness programs for their staffs. Such programs go beyond standard health care in that they aim to promote employees’ general health and well-being. Traditionally, such programs teach about good nutrition, pay for smoking-cessation courses, run health fairs, and create on-site exercise areas for school workers.

And just as corporations such as IBM, AT&T, and Coors Brewing Co. have for years been building in-house gyms and assisting employees with finding day care, some health-conscious school districts see wellness programs as a way to spur recruitment and earn the loyalty of their workers. About 20 percent of school systems have some kind of wellness program, says Joanne Owens-Nauslar, the director of professional development for the American School Health Association, an organization based in Kent, Ohio, that promotes health and physical education in schools nationwide.

And in addition to traditional programs, some school systems from New York to Oregon also subsidize unconventional therapies--whether through health plans or employee-assistance programs, which typically provide such services as mental-health and drug-rehabilitation benefits.

Those services include acupuncture, massage, or even laughter therapy. One Sacramento County district hired a consultant to teach a stress-management class in which she read employees’ “auras.”

In general, more health-maintenance organizations now cover alternative medical techniques in response to consumer interest.

In general, more health-maintenance organizations now cover alternative medical techniques in response to consumer interest, says Donald White, a spokesman for the American Association of Health Plans, based in Washington. One-third of Americans have used unconventional medical treatments ranging from homeopathy to hypnosis at some point in their lives, according to a 1993 study by Dr. David Eisenberg, an assistant professor of medicine at Harvard Medical School. Consumers spend $14 billion a year on nontraditional medical care, and three-quarters of those expenses are not covered by insurance, Eisenberg writes in the report published in the New England Journal of Medicine.

About 20 percent of health-insurance companies in the United States offer supplemental benefits that cover nontraditional care, according to Gary Frazier, a health-care analyst for Bear Stearns, a New York City brokerage firm. And the AAHP reports that 45 percent of managed-care plans now reimburse members for chiropractic care.

“We as a society are starting to find out that there is a mixture of physical and psychological elements in most medical conditions, and that the most effective treatments often address both,” White says.

Here in the Monterey County schools, wellness programs grew out of widespread interest in alternative approaches to health care.In the early 1980s, as health-care costs were increasing nationwide, the Monterey County board of education found its employees pinched by medical costs and without a local health-maintenance organization to bring medical expenditures into check. So in 1982, 21 of the county’s 24 districts, from the poorest rural farming districts to the wealthiest coastal school systems, chose to pool their buying power and form the Monterey County Schools Insurance Group to provide 4,100 teachers, custodians, cafeteria workers, and bus drivers better rates in an expensive medical market.

MCSIG members were able to leverage lower payments at doctors’ offices and hospitals and could set their own premiums for service, says Arthur F. McLoughlin Jr., a regional representative for the California Teachers Association who helped broker the deal. “We were no longer at the mercy of the insurance companies, who need a profit,” he says.

But while the MCSIG health plan offered coverage equivalent to or better than some leading medical plans, many school leaders felt the program’s prevention services were weak.

Gene Martin, the superintendent of the 2,000-student Soledad school district, was among the first to seek a wellness program from the MCSIG. In 1991, Martin says, the district had employees who wanted to quit smoking but had little money to pay for nicotine patches. He thought smoking-cessation kits ought to be free. “You can detect problems early and nip it in the bud instead of waiting for illness to advance, when it’ll be costly to treat,” he says.

The prevailing health consciousness of this coastal California area also greatly helped the wellness cause. Healthful living is almost a religion in this 400,000-resident county that extends from the white sands of Pebble Beach to the Carmel hills blanketed by cypress trees, to the green fields of Salinas Valley, an area known as “America’s salad bowl.” Masseurs, health spas, and homeopathic healers are as common as health-food stores.

But turning this regional sensibility into a personal health ethic for school employees was another matter.

So the MCSIG board formed a wellness committee composed of school leaders and union and staff members from across the 3,300-square-mile county region. The committee reviewed cost-benefit analyses conducted by other health plans and reviewed literature on acupuncture and chiropractic.

On average, districts in Monterey County spend about 20 percent of their budgets on employee health care.

Many school workers were attracted by the equity of the plan, which was designed to provide wellness services to employees regardless of individual district wealth. After reviewing the options, the MCSIG board adopted the wellness program in 1994.

The plan allows members to see an acupuncturist up to 18 times a year at no cost or go to 20 chiropractic appointments for $10 a visit. As part of the wellness plan, the MCSIG offers annual flu shots for employees for $2 each and conducts health fairs where school workers can get free massage demonstrations, cholesterol and blood pressure screenings, computerized cancer assessments, and healthful cooking demonstrations.

It also provides cut rates on tai chi classes, discounts at fitness clubs, and nutrition-oriented supermarket tours conducted by a registered nurse. The health plan also reimburses employees for 80 percent of the cost of nicotine-replacement aids. And though the plan offers a base of services, which are covered by collective bargaining agreements reached with school employees’ unions, each district can subsidize additional benefits if it chooses. The district pays for the insurance, and most single employees have a $150 deductible per year and are responsible for any copayments for medical services. But the plan sets a $650 ceiling on individual employees’ out-of-pocket expenses for medical care each year. The maximum out-of-pocket expense for a family is $1,300 a year, according to the MCSIG.

On average, districts in Monterey County spend about 20 percent of their budgets on employee health care.

While district leaders sometimes fret about the cost to school budgets and worry that not enough employees are using the wealth of services to justify the expense, many Monterey County school workers who indulge in the plan’s various offerings rave about the plan.

The MCSIG’s health package is less expensive and offers more services than did many previous insurance plans, county education officials say. Previously, health insurers would frequently raise premiums, but now the districts and employees can collectively set their own premiums because they sit on the MCSIG board.

In an examining room decorated with charts of the human spinal column, Suzanne du Verrier leans back on a padded table as her chiropractor manipulates her neck and back muscles. Doctors prescribed medication to treat her chronic back and shoulder problems, but du Verrier, the food-service manager for Salinas’ Alisal Union school district, decided to come to Kenneth Oikawa for treatment instead.

“I don’t want to be taking pills,” says du Verrier, as the chiropractor makes an adjustment that ripples through her spine. “This is a way of taking care of my body,” she says. And without the side effects of medications, du Verrier says she is better able to manage 36 cafeteria workers in eight kitchens and pick food menus for the multitudes of hungry students the district serves every day.

“If you’re not in pain or uncomfortable, you are productive,” she says.

Du Verrier is pleased with the wellness program from a manager’s standpoint as well. Apart from the health plan, the countywide incentive program that rewards county workers for reducing the rate of on-the-job injuries has kept many cafeteria workers on the job.

“Congratulations for having no injuries this month. It’s fantastic!” says Donovan J. Brown Jr., greeting four elementary school cafeteria workers as they slip pink sugar cookies into wax paper bags one recent morning.

On top of the workers’ compensation program and health plan, districts have invested money in preventing on-the-job injuries.

Brown, the workers’ compensation loss-control manager for 23 Monterey County districts, hands each surprised staff member a $10 coupon for the Red Lobster restaurant and takes a moment to review safety procedures--ways of avoiding burns and understanding the “body mechanics” of lifting.

“This is a pat on the back. People don’t get enough of that,” says Brown, who notes that the 5,700-student Alisal district has dramatically reduced its injury claims since the incentive program began. Before periodic safety checks were instituted four years ago, the district averaged eight injury claims a year; in the years after, there have been two or three claims each year, and so far this year there have been two.

Brown estimates the savings to the district at up to $20,000.

On top of the workers’ compensation program and the health plan, districts have invested money in preventing on-the-job injuries.

Because so many staff members were filing carpal-tunnel-syndrome, back, neck, and other work-related injury claims, the 10,300-student Salinas Union High district set aside $50,000 in this year’s budget to make ergonomic improvements across the district.

Shelley Mier, who runs the front office at Alisal High School in the Salinas district, taps the keys of her new ergonomic keyboard beneath her computer screen.

“I’m on this keyboard 75 percent of the day, doing budgets, payroll, teacher records, memos,” Mier says. “I had a constant hot knife in my back before, and now it’s disappeared.”

John Torres, the principal at the 1,650-student high school, says safety measures don’t always have to be costly. He often gives gentle reminders to custodians to wear their supportive belts when lifting heavy equipment.

“The principal tells us not to lean over to pick things up or we’ll put our back out of whack,” Frisco Edu, one of the school’s custodians, says as he dumps paper plates, plastic cups, and ketchup packs into a box in the school’s courtyard. “Our boss doesn’t want us to get hurt,” Edu, 42, says.

Besides attending to physical stresses and strains, the Monterey County schools also sponsor events to address employees’ psychological and social ills. While the benefit is more difficult to measure in dollars and cents, such assistance tends to promote loyalty and a general sense of well-being among employees.

“You should be having a good time while you’re working,” says Sam Bozzo, the ebullient personnel director for the county office of education. Bozzo, who says he’s aptly named, believes that levity is a crucial ingredient of any well-functioning workplace.

So, heeding his employees’ wishes, Bozzo hired a laughter expert for a staff-development workshop last month. Bozzo says his employees preferred to cackle for an hour instead of learning the latest management technique. In previous years, Bozzo has conducted personality assessments that divide people into different character types. “The idea is if you know a person’s style, you know how to work with them better,” he says.

Perhaps the most critical piece in the grab bag of wellness offerings here, Bozzo says, is the Employee Assistance Program. The EAP, which is funded separately from the MCSIG, helps employees who require more than a comedian to raise their spirits.

Some districts and individual staff members have expanded the activities available for staff members beyond the county’s wellness offerings.

Last year, for example, a secretary at an alternative education center in Salinas came to work a wreck. A strained marriage and a failing import business made Max want to quit his school job. “I came in one morning and was feeling very stressed and unable to focus,” recalls Max, who preferred not to use his last name. But instead of accepting Max’s resignation, Bozzo dialed a local psychiatrist’s office and scheduled a visit for the employee that morning.

While most corporations and most school districts offer mental-health benefits to their workers, not every boss is so personally involved in seeing that services are delivered, Max says. “The cooperation and follow-through make this benefit a success. Other companies might not go the extra mile,” he says.

Some districts and individual staff members have expanded the activities available for staff members beyond the county’s wellness offerings. In 1991, when the 930-student Washington Union district in Carmel won a bond to build a $1.6 million gymnasium at an elementary school, the superintendent set aside a small workout space for employees and community members to use. Rather than trek to the local gym for a discount membership, bus drivers now work out on stair-stepping machines and treadmills between morning and afternoon runs.

Two cafeteria workers at Frank Paul Elementary School in Salinas have found a low-cost way to keep fit. One afternoon last month, a crew of food-service workers set out on their regular four-mile walk through a meadow strewn with orange poppies that abuts the school.

Pat McBride, on her first outing with the group, said she was relieved to exercise after a day of lifting heavy trays of food. “It’s definitely good to have this release, or else something inside’s going to break,” she says.

Anecdotal endorsements aside, MCSIG leaders and school managers say there are signs that the county’s overall focus on a healthy lifestyle has had some measurable financial benefits.

Since the flu-shot program started in 1993, there’s been a 60 percent reduction in pulmonary-related ailments, according to Neil Hertsch, the MCSIG’s health-promotion coordinator.

While there are no data on countywide absenteeism, McLoughlin of the California Teachers Association, a National Education Association affiliate, says he has noticed that teachers who participate in the wellness program have had fewer illnesses.

“Classrooms are very unhealthy places to be, as kids carry germs and teachers are as susceptible as other students,” he says. “If teachers get in top condition, they are going to be better at warding off diseases that constantly creep into the classrooms.”

David Barrett, the executive director of the MCSIG, says there have been fewer serious illnesses since the annual health fairs began. “What we have seen is not the spiraling cost of cancers and heart disease that we had before,” Barrett says. “We were exceeding national trends slightly. Now we’re not.”

In addition, with the smoking-cessation program in place, one Monterey County schools staff member says he used to have 20 co-workers who smoked, and now that number has dwindled to three.

Despite this enthusiasm, many school leaders here are disappointed that only 15 percent to 25 percent of those eligible for benefits actually take advantage of them. National wellness experts who consult with corporations consider that participation level to be above average, but school wellness leaders are discouraged by the numbers.

State education leaders are also quick to caution districts not to shortchange their educational goals in order to offer esoteric health services.

“Trying to boost participation is the hardest thing,” Hertsch said last month at a planning meeting to organize the next health fair. Despite the newsletters, posters, and assorted promotional efforts, many employees don’t know that certain services are offered.

Hertsch speculates that another obstacle to involvement is the fact that the clientele is so farflung.

“This isn’t IBM. We have a multisite health promotion with 110 buildings,” over hundreds of miles, he notes.

Michelle Freelander, who takes a low-impact-aerobics class taught by a YMCA volunteer in a bungalow classroom adjacent to the county office of education, where she works as a teacher trainer, says she would not come if it required a commute.

“I hadn’t exercised in four years until this class, and now I’ve been coming twice a week,” says Freelander, 31. “‘If it weren’t here, I wouldn’t do it.”

Besides the traveling, some activities creep into prime family time, many school workers say.

Several district administrators also say the wellness activities are costly and set up a competition between funding educational and health needs.

“People want you to spend money on textbooks, pencils, computers and for good reason,” says Catherine Gallegos, the superintendent of the Washington Union district, which has 930 students and 98 employees. For a teacher making $30,000 a year, Gallegos says, the district expects to spend about $10,000 next year to cover full-family health benefits through the MCSIG. “It’s a big expense, but it’s worth it. I would like to see the state of California fund districts [more] so they could afford health care like this,” she says.

Some states are augmenting the health-care costs of schools or at least providing technical assistance on ways to spur low-cost initiatives, such as walking groups for staff members.

But state education leaders are also quick to caution districts not to shortchange their educational goals in order to offer esoteric health services to staff members.

“A lot of districts are facing teacher shortages, and you have to make sure you attract high-quality staff, and that means benefits of this kind,” says David Kysilko, a spokesman for the National Association of State Boards of Education in Alexandria, Va. “But you want to make sure that as long as you have [these health benefits] you’re keeping art classes and band and other things,” he says.

Wellness experts like Owens-Nauslar say that many local educators often require proof in the form research data to convince budget-conscious school boards of the need to spend money on what is still to many a foreign concept.

The research on holistic techniques is trickling out.

But this year, the National Institutes of Health endorsed acupuncture as a useful tool to treat headaches. Also, a three-year study of chiropractic care in Britain released in 1990 found that such treatment was more effective than hospital outpatient management for patients with severe back pain.

One of the best assessments documenting the health benefits of a district’s wellness program was conducted by the Dallas public schools in the 1980s. Dallas’ well-regarded program included smoking-cessation and nutrition education classes, a low-calorie menu, walking groups, and health fairs. After the first year, the district found that the district saved about $450,000 in health costs and teacher-substitute pay because people who participated in the program took less sick leave.

“Good health is more than good medicine, " says Owens-Nauslar. “There is evidence to say that good health is good business.”

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A version of this article appeared in the May 06, 1998 edition of Education Week as The Road to Wellness

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