ALL Means ALL

When I first learned about SWIFT and began reading about the organization’s framework and philosophy, I was immediately struck by the word “ALL” being highlighted in caps in their literature.

“SWIFT provides academic and behavioral support to promote the learning and academic achievement of ALL students.”

Then, I read the words “eliminating silos,” and I was hooked. Equity-based health care delivery to ALL students is my mission. It is no wonder that during a recent day of congressional visits on behalf of the SMART Student Health and Wellness model, three separate colleagues—familiar with the work of SWIFT—immediately noted the similarities between the two.

The SMART Student Health and Wellness Model

SMART stands for Strategies that integrate health and education to Maximize and improve Academic success, Reaching all students to ultimately impact the Trajectory of lives.

In the journey to create SMART, my instincts as a businesswoman guided me, not the traditional perspectives in this arena. As I sought to create a functional business model worthy of truly meeting the needs, I asked these important questions—What problem am I trying to solve? What business am I in? What is my capacity to solve that problem? At what cost to whom and benefit to whom? I reimagined the primary goal of school health—to support doing well in school. After all, success in school is the primary determinant of life trajectory that reflects both long-term socioeconomic success and good health as an adult. Once this true purpose was established, it became my “North Star,” the lens through which all subsequent decisions were made.

Today, SMART has achieved strong proof of concept and replication as a school health solution dedicated to supporting academic achievement through the deployment of Active Access to deliver Active Care to EVERY student. Active Care includes integrative physical and behavioral health care that seeks to screen, identify, and mitigate risks to educational attainment and competencies, while ultimately building life-long health literacy, advocacy, and self-care in students. The SMART approach is operationalized through a strong, sustainable business model, with protocols, tactics, and a data-driven approach to ensure successful delivery and achievement of stated outcomes.

SMART and SWIFT likely share a similar history—individuals that sought to see beyond the glaring surface problems and instead view solutions from a root cause level. The SWIFT framework integrates the elements that allow success for all students, including those at risk of low academic performance and/or with behavioral issues, into the entire student culture for care. Similarly, SMART operationalizes these goals, working to identify the often unknown risks in students who were traditionally believed to have no risks, based simply on the lack of significant, externalizing behaviors.

The history of primary and behavioral health care is to react to symptoms or illness and offer a cure. Acknowledging the well-documented connections between a student’s or school community’s wellness—physical, emotional, and spiritual, and the impact those have on a student’s education—SMART proactively works to ensure the wellness of ALL, instead of reacting to the acute needs of the few. By creating a culture where striving for wellness is the expectation, engaging with providers becomes the norm, de-stigmatizing the need for care, because EVERYONE wants to be well. Within weeks of integrating SMART Student Health and Wellness Centers in a school, silos are broken down by focusing on a common goal—the opportunity for each child to live up to their educational potential. In fact, SMART presumes that all need care that ensures wellness. SMART screens ALL students for wellness and provides customized levels of interventions and care, preventive and acute, solutions-oriented and resiliency-informed, normalizing the seeking and securing of care.

The approach of deploying Active Access dramatically increases the likelihood that those with unrecognized needs will have those needs met, creating the culture and conditions that allow students in need to be identified without singling them out. For example, “Hannah,” an honors student, president of her class, and captain of her soccer team, is silently suffering with text anxiety and poor body image. Traditionally, Hannah’s needs would go undetected in a school care setting that only has the capacity to offer care to those students who are easily labeled as “in need of support services” or has obvious externalizing behaviors. However, with the SMART model in place, Hannah, too, receives wellness care via screenings and the answers she provides during her SMART health survey prompts the behavioral health team to schedule follow-up care. Hannah begins two to three brief treatment sessions to focus on relieving her test anxiety, including mindfulness and meditation techniques and simultaneously commences participating, once a week, in group therapy sessions (during an elective course or lunch) that provide support relating to weight, nutrition, and self-esteem. The positive impact on Hannah’s immediate and long-term outcomes will be tremendous.

Environments that seek physical, behavioral, and spiritual wellness and educational achievement for all create a generation that experiences education and health in the most inclusive manner possible for the best outcomes that every child can dream of: a world where ALL means ALL.

- Melanie Ginn

Melanie Ginn, is the President and CEO of Ginn Group Consulting (GGC), the architect of the SMART model, and collaborating partner with CVS Health. In 2013, the two entities led a thought leadership collaborative and public-private partnership with local stakeholders in Chicago, Ill., to save an existing school health clinic from closure. With funding and intellectual support from CVS Health, Ginn designed the SMART model, based at the flagship location at Sullivan High School and Kilmer Elementary School. The SMART clinics delivered significant increases in consent and utilization levels and by Year Two had supported dramatic increases in academic metrics, including attendance increases of 9%, freshman-on-track jumping from 61% to 88%, and the school ranking moving from a Level 3 (failing with intensive support) to a Level 2 plus (good standing with provisional support). By Year Three, the clinic was consistently reaching 85% of the students with continued improvements in every metric. In 2016, SMART opened two rural sites in conjunction with a University of Alabama cohort, with similar, remarkable results in Year One. In May of 2017, the SMART model was presented at a Congressional Briefing in Washington, D.C., featuring a White Paper outlining the initial formative evaluation conducted and written by Liza Cariaga-Lo, Ph.D., Brown University.