& UNITED COMMUNITY CENTER HEALTH CENTER: EL CENTRO DE SALUD ANNUAL PROGRAM REPORT

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1 & UNITED COMMUNITY CENTER HEALTH CENTER: EL CENTRO DE SALUD ANNUAL PROGRAM REPORT JUNE 13, 2009 JUNE 15, 2010 PROGRAM YEAR GLADYS SIMANDL, PhD, RN SAM BASTIAN, MS, RN, FNP-BC

2 TABLE OF CONTENTS 1. Introduction 1 2. El Centro de Salud Client Visits 1 3. Bruce Guadalupe Community School 3 A. Child Health Screening 3 B. Miles of Smiles Dental Program Sponsored by the Harley-Davidson Foundation 4 C. Immunizations 6 D. Physical Examinations 6 E. Developmental Screening 6 F. Mental Health Support Groups 7 G. Individual Mental Health Program 7 H. Head Lice Treatment 7 I. Nurse Camp Health Careers Camp 7 J. Program 8 K. Health Education Funded by MAHEC 8 4. Senior Center & Adult Day Center 9 5. Human Services, Residential & Day Treatment UCC Families, Clients, & Employees 10 A. Flu Vaccines 10 B. Vaccines 10 C. TB Testing Community Collaboration Acknowledgements 12 Appendix A: Health Education Sessions by Grade A1-2

3 1. INTRODUCTION El Centro de Salud is the health center owned and operated by Columbia College of Nursing (CCON), directed and managed by 2 of its nursing faculty, Dr. Gladys Simandl and a board certified family nurse practitioner, Ms. Sam Bastian. It is a collaborative program with the United Community Center (UCC), a community-based organization that serves Hispanics and residents of the near south side of Milwaukee, Wisconsin. El Centro de Salud consists of 5 exam rooms and is housed in the UCC. The health center has provided services to the population for the past 16 years. 2. EL CENTRO DE SALUD CLIENT VISITS In Table 1 are the types of visits and number of clients who received care at El Centro de Salud during the program year. Figure 1 demonstrates the number of services provided to the population subgroups in the UCC. After significant growth in the number and scope of services provided, as delineated in Table 2, the number of client visits has stabilized near 14,000 over the past 3 years. Increase This report includes academic year data, such as the number and type of client visits. Relevant health data about the various UCC programs are reported including: (a) Bruce Guadalupe Community School (BGCS), consisting of grades K3 through 8; (b) Senior Center and Adult Day Center; (c) Human Services out-patient mental health program and 2 in-patient substance abuse programs, Residential Treatment Center (RTC) and Latinas Unidas (LU); and (d) UCC clients and employees. The final section acknowledges community members many contributions to El Centro de Salud. over time is shown in Figure 2. The data in these tables, with some exceptions, do not include other special purpose visits that are detailed in this report, such as vision screening and mental health groups. In addition to the 13,989 visits for individual health, a minimum of 1,000 more visits were made for various special purposes; these do not appear in Table 1. TABLE I FIGURE I CLIENT VISITS TYPE OF VISIT NUMBER CHILD HEALTH VISITS (ALL SCHOOLS) 6,614 MEDICATION VISITS (ALL SCHOOLS) 1,754 DENTAL PROGRAM (ALL SCHOOLS) 1,643 DENVER II TESTS (PRESCHOOL) 247 ADULT WALK INS (ADULT) 2,036 TB TEST VISITS (ADULT) 367 SENIOR CENTER & ADULT DAY CENTER TOTAL 13,989 (ELDERLY) 1,328 1 With the exception of the Miles of Smiles Dental Program, sponsored by the Harley-Davidson Foundation, these data do not include visits made to the health center for various screenings or special purposes. EL CENTRO DE SALUD PAGE 1

4 TABLE 2 NUMBER OF TOTAL BIANNUAL CLIENT VISITS TYPE OF VISIT CHILD HEALTH VISITS (ALL SCHOOLS) 841 2,386 6,884 10,502 10,701 11,299 12,131 13,261 MEDICATION VISITS (ALL SCHOOLS) ,613 1,791 1,981 3,362 3,360 3,282 DENTAL PROGRAM (ALL SCHOOLS) DENVER II TESTS (PRESCHOOL) WALK INS (ADULT) ,967 2,329 2,326 2,723 4,666 4,556 TB TEST VISITS (ADULT) SENIOR & ADULT (ELDERLY) ,062 1,697 1,136 2,562 TOTAL 926 3,418 11,074 15,457 16,711 20,887 24,988 28,196 FIGURE 2 EL CENTRO DE SALUD PAGE 2

5 3. BRUCE GUADALUPE COMMUNITY SCHOOL (PRESCHOOL THROUGH 8TH GRADE) Numerous health services were provided to BGCS (preschool through 8th grade) children. Included were: (a) child health screening, (b) Miles of Smiles Dental Program, (c) immunizations, (d) physical examinations, (e) developmental screening, (f) mental health support groups, (g) individual mental health program, (h) head lice treatment, (i) Nurse Camp Health Careers Camp, (j) nutrition program, and (k) health education. All are described in the sections that follow. Vision, hearing, blood pressure, height, weight, and body mass index screenings were provided by CCON nursing students to all UCC students. In Table 3, the data from the health screenings for all school programs are displayed, including the number of children who were identified with problems and those who received follow-up care from their health care providers. The rate of children seen by their health care providers at the bottom of the table is an important community health index. The numbers of children who did not receive follow-up health care may indicate the need for affordable and accessible community health services. VISION screening was done by the nursing students using the Lea Chart and Welch Allen Sure Sight digital vision screener 1. Screening included testing for myopia (distance vision acuity), stereopsis (depth perception), muscle balance, color, alignment, and peripheral vision. When indicated, children were also tested for hyperopia (near vision). Children who did not pass the screening tests were referred to their health care providers. Ten children received glasses through Vision Service Plan (VSP). This special program helps families with limited resources obtain eye exams, glasses, and lenses free of charge. As indicated by the data, 65% of the referred children obtained care. HEARING screening was done by the nursing students using a pure tone audiometer. Hearing thresholds (the decibel level at which a person can hear sound frequencies) were obtained. Children who failed were rescreened one month 1 Funded by a grant from the Milwaukee Metropolitan Nurse Practitioners A. CHILD HEALTH SCREENING later, allowing ear infections or congestion from colds and flu to resolve. Also, under supervision of the nurse practitioner, children who had ears impacted with earwax had their ears flushed and were then rescreened. Every year, all children in odd numbered grades, newly enrolled students, and children referred by adults for suspected hearing problems are screened. Children under medical care for diagnosed hearing problems were not screened; they were monitored during the year for any untoward problems. Sixty-seven percent of the children referred this year obtained follow-up medical care. BLOOD PRESSURES were taken on all children by the nursing students. Of the 9 children referred, 3 saw their health care providers; the others will be tracked during the coming year. The blood pressure criteria determined by the American Academy of Pediatrics were used as the standards for referral. A BODY MASS INDEX (BMI) was calculated on every child. A BMI is a person s weight in relationship to height. Parents of children with BMIs above the 95 th percentile received a letter and list of healthy foods and activities in accordance with pediatrician recommendations. Those in the 85 th -95 th percentiles for BMIs were observed. All children who qualified were enrolled in a special program of diet and exercise under the supervision of the UCC Health Director. In all, 39% of all children were above the 85 th percentile for BMI, which is consistent with national data on Hispanic health disparities and associated with increased risks for Type II diabetes mellitus and heart disease. EL CENTRO DE SALUD PAGE 3

6 TABLE 3 HEALTH SCREENING BRUCE GUADALUPE COMMUNITY SCHOOL GRADE TOTAL CHILDREN WITH NO VISION HEARING BLOOD PRESSURE BMI 1 PROBLEMS REFER SAW HCP 2 REFER SAW HCP 2 REFER SAW HCP 2 > 85 TH PERCENTILE > 95 TH PERCENTILE K3 K TOTAL % SEEN OF REFERRALS 65% 67% 33% -- 1 BMI = Body Mass Index, an indicator of height in relationship to weight. 2 HCP = Health Care Provider. 3 K3 K5 = data from Bruce Guadalupe Community School preschool children = data from Bruce Guadalupe Community School 1 st through 5 th grade children = data from Bruce Guadalupe Community School 6 th through 8 th grade children. B. MILES OF SMILES DENTAL PROGRAM sponsored by the Harley-Davidson Foundation The MILES OF SMILES DENTAL PROGRAM, funded by the Harley-Davidson Foundation, opened its doors in January of Children who previously had limited or no dental services receive care from both dentists and dental hygienists. This is critically important because of the growing body of evidence supporting the need for preventive dental care to avoid serious acute and chronic physical health problems associated with poor oral health, such as heart disease. With funding, El Centro de Salud has a part-time Registered Dental Hygienist, Belinda Tadych, and a part-time dentist, Dr. Susan Freundl, as part of its staff. The dental hygienist was housed in El Centro de Salud, while the dentist was housed in St. Elizabeth Ann Seton Dental Clinic, approximately one mile from the health center. In addition, the Milwaukee Area Technical College (MATC) Dental Program students and faculty contributed dental sealants and fluoride treatments to the grade school students, as they have in the past. El Centro de Salud plans to continue to work collaboratively with both dental programs. The total response rate from parents who consented for the dental program this year was 83%, similar to the previous year. As shown in Figure 3, only 15% of parents did not wish to participate, which may represent the families who have dental insurance. Only 2% did not respond, the lowest nonresponse rate ever. All children (participating and non-participating) were screened by the dental hygienist for decay detection and referral. The amount of decay identified decreased 15% (Figure 4), with a fairly equal distribution of decay among age groups. All children with decay were referred to either the program or local dentists. This year, a total of 111 visits were made by 53 children to the MILES OF SMILES DENTAL PROGRAM dentist for restorative purposes. Another 149 children visited their private dentists, for an overall dental follow-up rate of 57% (5% increase). Clearly, the dental program has affected the oral health of the children in dental problem prevention, detection, and treatment. Increasing the dental hygiene services to two days per week has resulted in the program goal of providing preventive dental care to all children; all 712 participating children were seen by the dental hygienist for fluoride treatments and teeth cleaning. Of those, 253 children had 735 sealants placed (averaging 3 per child). In addition, parents comments on surveys this year indicated high satisfaction with the program and their gratitude for it during these difficult economic times. EL CENTRO DE SALUD PAGE 4

7 FIGURE 3 FIGURE 4 EL CENTRO DE SALUD PAGE 5

8 C. IMMUNIZATIONS El Centro de Salud is an approved site for the state sponsored Free Vaccines for Kids program. Immunizations are obtained from the State of Wisconsin Immunization Program and are available for all school children who do not have health insurance. El Centro de Salud administers Immunizations according to each child s individual needs. A total of 76 vaccines were administered this year: 6 DtaP (DIPHTHERIA, TETANUS, & ATTENUATED PERTUSSIS < age 7) 42 Tdap (DIPHTHERIA, TETANUS & ATTENUATED PERTUSSIS > age 7) 17 Varicella (CHICKEN POX) 7 MMR (MEASLES, MUMPS, & RUBELLA) 4 Polio Using continuous surveillance, including parent reminders, numerous children received their needed immunizations from their own healthcare providers. Over the years, this program has maintained a 100% compliance rate. D. PHYSICAL EXAMINATIONS A total of 57 physicals were done for children in the following programs: UCC sports, Lake Valley Camp, the BMI program, and the kindergartens. In addition, physicals were provided to UCC staff and school teachers as requested. E. DEVELOPMENTAL SCREENING Children in grades K3 through K5 were screened by the nursing students for their abilities to perform standardized developmental tasks using the DENVER II assessment tool. A total of 247 children were screened. The testing was done in English or Spanish, depending on the child s needs. In Table 4 are the results of the screening; 93% of the children passed (same results as previous year). Examples of the required tasks are provided below the table. Findings were reviewed with teachers who had been assessing the children s developmental abilities throughout the year. All children identified with needs were referred for further services. TABLE 4 DENVER DEVELOPMENTAL SCREENING GRADE CHILDREN CHILDREN CHILDREN NUMBER OF PROBLEMS IDENTIFIED SCREENED PASSED REFERRED SOCIAL 1 FINE MOTOR 2 LANGUAGE 3 GROSS MOTOR 4 K K K TOTAL SOCIAL = social skills, e.g., naming one friend. 2 FINE MOTOR = finger and hand skills, e.g., drawing with a pencil. 3 LANGUAGE = understanding opposites, adjectives, etc. 4 GROSS MOTOR = large muscle control, e.g., hopping, skipping. F. MENTAL HEALTH SUPPORT GROUPS EL CENTRO DE SALUD PAGE 6

9 Children selectively chosen by BGCS administrators, faculty, and parents were referred to El Centro de Salud for mental health supportive care. With parental consent, 24 children participated in weekly group sessions conducted by nursing students under the supervision of the school guidance counselor and nursing faculty. The sessions were focused on helping students perform better in school, cope, and learn effective social skills. Groups were focused on specific topics, such as bullying, kindness, listening to your fears, and hope. A total of 140 half-hour sessions were provided during the year (Table 5). The groups were intentionally small (3-6 per group) to accommodate individual children s needs. The school guidance counselor evaluated and referred for professional therapy those children requiring further care. GRADES TABLE 5 MENTAL HEALTH SUPPORT GROUPS NUMBER OF CHILDREN NUMBER SESSIONS HELD G. INDIVIDUAL MENTAL HEALTH PROGRAM Nursing students worked with 35 individual children in all grades throughout the year. Children who needed focused mental health interventions were selected. The nursing students derived nursing care plans and met with the children repeatedly throughout the year. Issues such as separation anxiety and a need to increase social skills were addressed with the young children, while self-esteem and loneliness were addressed with the older children. A minimum of 175 visits with the children were made this year. H. HEAD LICE TREATMENT All students were screened at the beginning of the school year for head lice. Student nurses screened an additional 429 children for head lice during the year. The incidence of head lice among children at the UCC was consistently less than 10%, representing an endemic (naturally occurring) rate. El Centro de Salud offers a unique head lice program that has decreased loss of school time. With parental permission, student nurses wash children s hair with a safe, effective pediculocide (lice shampoo). To maintain privacy, each child s hair is thoroughly dried before returning to class. Parents are then sent information about the care of people in the home and the home environment to prevent recurrence. I. NURSE CAMP - HEALTH CAREERS CAMP NURSE CAMP - HEALTH CAREERS CAMP, a program to recruit middle school children to nursing and other health professions, was held this year on the CCON and Mt. Mary College (MMC) campuses. Twenty five middle school children (7 males) stayed overnight in the CCON dormitories. They visited the emergency and x-ray departments at Columbia Hospital, performed experiments in the chemistry laboratory at MMC, experienced what it was like to be in a wheelchair, worked with manikins in the nursing laboratory, and toured an ambulance. EL CENTRO DE SALUD PAGE 7

10 J. NUTRITION PROGRAM There is continuing concern regarding the high incidence of diabetes and heart disease in the Hispanic population. Years of data indicate high rates of overweight children (Table 3). As a result, the UCC instituted several changes: (a) adding more fresh fruits and vegetables to the school lunch program, (b) no longer soliciting outside food vendors, and (c) removing soda and snack machines from the building. El Centro de Salud contributed by continuing programs of monitoring children s BMIs, teaching health related issues specific to the Hispanic population in the classrooms, collaborating with the UCC Health Director s diet and exercise family education program by providing physicals to children enrolled in the Healthy Latino Families: A al/exercise Program to Reduce Obesity, in collaboration with the University of Wisconsin-Milwaukee, Institute of Environmental Health. This project incorporates healthy diet, physical activity, and counseling with Hispanic children and their families. K. HEALTH EDUCATION A total of 293 health education sessions were provided to all children s classrooms in BGCS as shown in Table 6. The detailed data by grade are displayed in Appendix A. This year, with funding from the Milwaukee Area Health Education Center (MAHEC), El Centro de Salud focused much of its health education content in three areas: recruitment to nursing and other health professions, health care concerns particular to the Hispanic population (e.g., diabetes, exercise, nutrition, etc.), and mental health concerns. Two other focal areas were health promotion topics (e.g., hygiene, germs, etc.) and physiology (e.g., respiration, digestive system). flu was a particular focus this year; all classrooms received at least one health module on it. In addition, the nursing students wrote a rap song and designed germ T-shirts that they wore as they delivered the rap to all children during lunches and to the remainder of the programs at various times. With approximately 20 students attending each classroom session, the education modules have a high potential to promote healthy life ways and habits in many young children. TABLE 6 HEALTH EDUCATION SESSIONS FOR SCHOOL CHILDREN HEALTH EDUCATION TOPIC NUMBER OF CLASSES % Nursing/ Careers 1 MAHEC 52 18% Hispanic Health Concerns 1 MAHEC 73 25% Emotional Health 1 MAHEC 84 29% Health Promotion 45 15% Physiology 39 13% TOTAL % 1 MAHEC = Milwaukee Area Health Education Center: focused area of teaching with funding from this organization EL EL CENTRO DE DE SALUD SALUD PAGE PAGE 9 8

11 4. SENIOR CENTER & ADULT DAY CENTER Nursing students provided numerous health services to the UCC Senior Center and the Adult Day Center. There were 1,328 individual elderly client visits (see Table 1). A faculty member from CCON provided a focused gerontologic learning experience for nursing students. The services included: (a) monitoring blood pressures, blood glucose levels, prescription medications, and other health concerns; (b) counseling individuals about health; (c) providing information about community resources; and (d) referring and arranging visits to private health care providers. Health education modules were provided to the elderly clients as seen in Table 7. Additional programs and activities accomplished by the nursing students for senior clients, staff, and family members are included in Table 7. TABLE 7 NURSING STUDENT PROGRAMS & ACTIVITIES FOR SENIORS & STAFF PROGRAM SENIOR CENTER ADULT DAY CENTER HEALTH EDUCATION Dementia ADDITIONAL ACTIVITIES PROGRAM STAFF &/OR FAMILY MEMBERS Cholesterol Diabetes Heart disease Blood pressure screening Flu Vaccines Normal aging changes & wound healing Peripheral artery disease Health information/ pamphlet rack Blood glucose checks Blood pressures Cognitive activities 1 Fine motor activities 1 Foot assessments Fotonovela project Group walks/exercise Health survey Ambulation-caregivers Community resources Empathy exercise Free/sliding scale clinics Health assessments Large motor activities 1 Physician referrals TB testing Vital sign screening Weight screening Managing medications Oral care Poster session Preventing falls 1 Cognitive activities included Bingo, singing, and reminiscing. Fine motor activities included baking and decorating cookies, making wreaths, bead work, and painting. Large motor activities included dancing, exercising, and walking. Some activities, such as making applesauce, included cognitive, fine motor, and large motor skills, while triggering memories. EL CENTRO DE SALUD PAGE 9

12 5. HUMAN SERVICES, RESIDENTIAL, & DAY TREATMENT The Residential Treatment Center (RTC) is an inpatient substance abuse health facility for men; Latinas Unidas (LU) is its female counterpart. Day Treatment consists of outpatient mental health services, such as individual and group therapy. New clients from both programs were referred to El Centro de Salud for TB skin tests. A total of 162 TB visits were provided to clients in these programs (Table 8), and visits for other purposes also occurred. 6. UCC FAMILIES, CLIENTS, & EMPLOYEES UCC families, clients, and employees sought health care from El Centro de Salud. Their 2,036 visits are included in the Walk-Ins row of Table I. The unique nature of the program allows for family members to seek health care at El Centro de Salud. For example, parents and UCC employees have received care from the health center. Likewise, high school siblings of BGCS students have received care, in particular for chronic conditions, such as asthma, which often affects more than one family member. Care includes health education to family members about disease processes. Similarly, preschool siblings are brought to the health center when BGCS students are experiencing colds or flu. In this way, El Centro de Salud is increasingly providing care that is family centered. A. FLU VACCINES: A total of 92 seasonal flu injections were provided to the adult UCC population. B. VACCINES: A special program implemented this year was administering vaccines to all ages except the very young. A total of 329 injections and nasal sprays were provided to children and adults in all program areas. C. TB TESTING: Testing for tuberculosis was available to all residential clients, the elderly, and UCC employees. Table 8 demonstrates that there were a total of 367 visits for TB test purposes. The one client with positive results was referred for chest X-rays and follow-up to the City of Milwaukee Health Department. TABLE 8 TUBERCULOSIS TESTING CLIENT VISITS Residential Treatment/Latinas Unidas 162 Adult Day Center Elderly 80 UCC Employees & Adult Walk-In 125 TOTAL 367 EL CENTRO DE SALUD PAGE 10

13 7. COMMUNITY COLLABORATION El Centro de Salud engaged in several collaborative projects. Many were mentioned previously; all are listed in Table 9. Collaboration among disciplines and involving community partners has strengthened El Centro de Salud s programs, affected clients health in positive ways, and enhanced student learning. Many people are served by these collaborative endeavors. TABLE 9 COMMUNITY COLLABORATION AGENCY PROGRAM DESCRIPTION CLIENT Child Proof, Ltd Identification cards BGCS students (K-5) Columbia-St. Mary s (CSM) Foundation Grant collaboration All programs Columbia-St. Mary s (CSM) Hospital Medical/Dental/Eye Clinics Guatemalan Village CSM Community Services, Bill Solberg Dental program consultation UCC students Department of Health Services, WI Clinic Site Community Division of Public Health Response Team Community Family Care TB tests, home visits, medical UCC Seniors follow-up Guadalupe Head Start Sharing information, physicals, BGCS students (K3 & K4) screenings, and hematocrits Lake Valley Camp Physicals BGCS students St. Elizabeth Ann Seton Dental Clinic Dentist visits UCC students/elderly clients Milwaukee Area Technical College Dental sealants/consultation BGCS students (grades 1-2) Dental Program Milwaukee Public Schools Consultation, school nursing UCC students Mount Mary College Joint Bachelor s Degree in Nursing CCON Nursing students National Association of School Nurses Consultation, school nursing UCC students Prevent Blindness Wisconsin, Inc Vision screening UCC seniors UCC Health Director Obesity program BGCS students University of Wisconsin-Milwaukee Institute of Environmental Health Healthy Latino Families: A al/exercise Program to Reduce Obesity BGCS students (5-8) University of Wisconsin-Milwaukee/UCC Hispanic Breast Cancer Survivor Hispanic Community Group Vision Service Plan Free glasses UCC students EL CENTRO DE SALUD PAGE 11

14 8. ACKNOWLEDGEMENTS The amount of health services provided, under the direction of Gladys Simandl and Sam Bastian, would not be possible without the contributions of the 62 students who used El Centro de Salud as an educational site. Their numbers and types are presented in Table 10. Students were accompanied by their faculty members, whose dedication and contributions have strengthened El Centro de Salud s programs over the years. Their contributions are greatly appreciated. Table 10 does not include the time of the nurse managers, receptionist, or the many faculty, professionals, and staff who accompanied their students. TABLE 10 STUDENTS USING EL CENTRO DE SALUD AS AN EDUCATIONAL SITE STUDENT DESCRIPTION NUMBER OF STUDENTS TIME IN HOURS ACTIVITIES CCON Senior Nursing Across all program activities MATC Dental Dental cleaning, fluoride, & sealants TOTALS Columbia College of Nursing gratefully acknowledges the financial or program support of: the Harley-Davidson Foundation the Milwaukee Area Health Education Center (AHEC) and the State of Wisconsin the Madre Angela Dental Clinic the United Community Center the Milwaukee Metropolitan Nurse Practitioners EL CENTRO DE SALUD PAGE 12

15 APPENDIX A: HEALTH EDUCATION SESSIONS BY GRADE (GRADES K3 K5) GR TOPIC TAUGHT GR TOPIC TAUGHT GR TOPIC TAUGHT PRESCHOOL & KINDERGARTEN K3A K3B K3C K3D K3E Digestive System Friendship Good/Not Good Food Hand Washing Bones Eyes Friendship Hand Washing Feelings/Emotions Friendship Hand Washing Cardiac Health I II Feelings/Emotions Friendship Lungs Sharing Lungs Sharing Lungs Sharing Hand Washing Lungs I II Sharing K4A K4B K4C K4D Feelings Friendship Hand Washing Feelings Friendship Hand Washing Feelings Friendship Hand Washing Feelings Friendship Hand Washing Heart System Lungs Safety Lungs Safety Heart System Lungs Safety Lungs Safety K5A K5B K5C K5D Bones Brain Feelings Germs/Hand Washing Bones Brain Feelings Germs/Hand Washing Bones Brain Digestive System Feelings Germs/Hand Washing Bones Brain Digestive System Feelings Feelings/Emotions Germs/Hand Washing EL CENTRO DE SALUD APPENDIX A-1

16 APPENDIX A: HEALTH EDUCATION SESSIONS BY GRADE (GRADES 1 8) GRADE SCHOOL 1A 1B 1C I II Germs I II Germs I II Germs 3A 3B 3C I I I II II II 5A 5B 5C & Exercise & Exercise & Exercise 2A 2B 2C I II Dental I II Dental I II Dental I II I II I II 4A 4B 4C I II Diabetes Emotions & the Brain I II Diabetes Emotions & the Brain I II Diabetes Emotions & the Brain MIDDLE SCHOOL 6A 6B 6C Flu: Seasonal & Flu: Seasonal & Flu: Seasonal & Menstruation Menstruation Menstruation 7A 7B 7C Flu: Seasonal & Flu: Seasonal & Flu: Seasonal & Additional Rap Song was presented to all grades during their lunch hours. Lice Lice Lice 8A 8B 8C Flu: Seasonal & Flu: Seasonal & Flu: Seasonal & EL CENTRO DE SALUD APPENDIX A-2

17 4425 North Port Washington Road Glendale, WI