Download - School-Based Health Centers 101

School-Based Health CentersSchool-Based Health Centers(SBHCs) 101:(SBHCs) 101:

An Overview and Framework for An Overview and Framework for Building ProgramsBuilding Programs

ObjectivesObjectives Participants will be able : Define school-based health center (SBHC) Explain why SBHCs are an effective health

care delivery system for children and adolescents

Describe characteristics of SBHCs

SBHC: National DefinitionSBHC: National Definition

Partnerships created by schools and community health organizations to provide on-site medical, mental health, and/or oral health services that promote the health and educational success of school-aged children and adolescents.

One of the partners, usually a health agency (community health center, local health department, hospital, mental health agency, or 501 C3 agency), or a school system, becomes the sponsoring agency.


Services provided by the school-based health care team are determined locally through a collaborative process that includes families and students, communities, school districts, and individual and agency health care providers.

The school-based health care team works in collaboration with school nurses and other service providers in the school and community.


SBHCs have a policy on parental consent.

Although the model may vary based on availability of resources and community needs, SBHCs are typically open every school day, and staffed by an interdisciplinary team of medical and mental health professionals that provide comprehensive medical, mental health and health education services.


SBHCs make provisions for care beyond the centers’ operating hours or scope of service.

Because of the unique vantage point and access to students, the health center team is able to reach out to students to emphasize prevention and early intervention.

7


Services typically offered in SBHCs are age appropriate and address the most important health needs of children and youth.

These services may include but are not limited to: – primary care for acute and chronic health conditions– mental health services– substance abuse services– case management– dental health services– reproductive health care– nutrition education– health education and health promotion.

8


SBHCs are supported by local, state, and federal public health and primary care grants, community foundations, students and families, and reimbursement from public and private health insurance.

Why School-Based Health Centers?Why School-Based Health Centers?

Group ActivityGroup Activity

Why School-Based Health Centers?– Think of yourself as a school aged child, pick

your age, or– Think of your own child or adolescent, or– Think of family members, neighbors as a school

aged child– Using the first letter of your first or last name, or

draw an alphabet card, come up with a reason for having a SBHC in your community

Why SBHCs?Why SBHCs? Uninsurance among children, especially

adolescents

Geographic and financial barriers to health, mental health, and oral health

Dangerous health outcomes associated with adolescents

Nonexistent/fragmented/singular discipline systems of care

Decreased educational attainment

“Health services need to be where students can trip over them. Adolescents do not carry appointment books, and school is the only place where they are required to spend time.”

Philip J. Porter, M.D.

Early architect of the SBHC movement

The Evidence Base for SBHCsThe Evidence Base for SBHCs Research published in professional literature

National and state data

– National State Initiative Survey– NASBHC Triennial census– White papers

Training and technical assistance in the field

– Results of beta testing tools and resources– Collaboratives

Pre and post assessments, chart reviews, progress reports, storyboards, consultation calls

What the Literature Tell Us About What the Literature Tell Us About Emergency Room Use and SBHCsEmergency Room Use and SBHCs

Reduced inappropriate emergency room use, Increased use of primary care, and Fewer hospitalizationsSantelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19:267-275

Prevention-oriented care in SBHCs results in decreased utilization of emergency departments

Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: 30;273

What the Literature Tell Us About What the Literature Tell Us About Asthma and SBHCsAsthma and SBHCs

Greater than 50% reduction in asthma-related emergency room visits for students enrolled in SBHCs in New York City

Webber MP et al. Archives of Pediatric and Adolescent Medicine. 2003; 157: 125-129

$3 million savings in asthma-related hospitalization costs for students enrolled in SBHCs in New York City

Analysis by the Empire Health Group for the NY Coalition of School-Based Primary Care, 2005

What the Literature Tell Us About What the Literature Tell Us About Mental Health and SBHCsMental Health and SBHCs SBHCs attract harder-to-reach populations,

especially minorities and males and do a better job at getting them crucial services such as mental health care and high risk screens.

Adolescents were 10-21 times more likely to come to a SBHC for mental health services than a community health center network or HMO.

Juszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health 2003; 32S:108-118.Kaplan D, et al. Archives of Pediatric and Adolescent Medicine. 1998

Jan;152(1):25-33.

What Science Tell Us About Education What Science Tell Us About Education and SBHCs and SBHCs

Health has both direct and indirect effects on school failure

Good education predicts good health Inequities in health and education are closely

linked: young people who experience inequities in educational

achievement also experience inequities in health care access

Public health and education are linked toward a common cause: student success

What We Know IntuitivelyWhat We Know Intuitively

Healthy students make better learners

You cannot teach a child who is not healthy

A child who succeeds in school is more likely to enjoy lifelong health

What Science Tells Us About What Science Tells Us About Education Education

Academic performance is negatively affected by:– Alcohol, tobacco, and other drug use – Emotional problems – Poor diet – Intentional injuries – Physical illness – Low self-esteem– Risky sexual behavior– Lack of access to health care– Unstable home environment

Academic performance is positively affected by:– High levels of resiliency, developmental assets, and school

connectedness.

SBHCs

Health RiskBehaviors

EducationalOutcomes

EducationalBehaviors

Substance use

Mental health

Poor diet

Intentional injuries

Physical illness

Self-esteem

Sexual behaviors

Attendance

Dropout Rates

Behavioral Problems

Graduation

GPA

Standardized test scores

Geierstanger, S. P., & Amaral, G. (2004). Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White PaperPerformance: What is the Intersection? April 2004 Meeting Proceedings. White Paper . . Washington, D.C.: National Assembly on School-Based Health Care.Washington, D.C.: National Assembly on School-Based Health Care.

The Health-Academic Outcomes ConnectionThe Health-Academic Outcomes Connection

SBHC Outcomes and TacticsSBHC Outcomes and TacticsReduce barriers

to learningIncrease

attendance Improve

student health

Meet government regulations

• Identify students at-risk for health and behavioral problems

• Assist in IEP development

• Provide mental health services

• Treat acute conditions

• Manage chronic conditions

• Provide preventive health services


• Administer medication to students with chronic conditions

• Enroll students in health insurance


• Refer students to services not provided in the SBHC

• Provide preventive health services


• Manage chronic conditions

• Conduct sports physicals


• Immunize students

• Participate in community initiatives on public health such as obesity and emergency planning

• Maintain health records for migratory students

The Medical HomeThe Medical Home

Half of SBHCs estimate more than 30% of their enrollees use the center as their medical home

40% of SBHCs estimate 50% or more of their enrollees use the center as their medical home

Efficiencies in SBHCsEfficiencies in SBHCs

Parents do not need to take time off

Follow-up is less labor intensive

Ability to identifying problems earlier

Costly emergency room visits reduced

National Data and TrendsNational Data and Trends

Census 2007-08

SBHCs by State SBHCs by State (n=1910)(n=1910)

State Total # of Open SBHCs State Total # of Open SBHCs

Alabama 5 Nebraska 1

Alaska 3 Nevada 6

Arizona 81 New Hampshire 1

Arkansas 2 New Jersey 40

California 160 New Mexico 79

Colorado 45 New York 206

Connecticut 79 North Carolina 49

Delaware 28 Ohio 20

District of Columbia 4 Oklahoma 11

Florida 245 Oregon 51

Georgia 3 Pennsylvania 28

Illinois 60 Puerto Rico 2

Indiana 87 Rhode Island 2

Iowa 16 Saskatchewan 1

Kansas 2 South Carolina 7

Kentucky 20 South Dakota 6

Louisiana 64 Tennessee 21

Maine 26 Texas 70

Maryland 71 Utah 5

Massachusetts 59 Vermont 5

Michigan 90 Virginia 19

Minnesota 16 Washington 20

Mississippi 31 West Virginia 50

Missouri 3 Wisconsin 8

SBHCs by Location SBHCs by Location (n=1226)(n=1226)

In school building 95.7 percent

On school property 2.9 percent

Mobile 1.4 percent

SBHCs by Types of School SBHCs by Types of School (n=1096)(n=1096)

SBHCs by Community Characteristic SBHCs by Community Characteristic (n=1235)(n=1235)

SBHCs Users by Race/EthnicitySBHCs Users by Race/Ethnicity(n=1096)(n=1096)

SBHCsSBHCs by Population Served by Population Served (n=1096(n=1096))

SBHCs by Sponsoring Agency SBHCs by Sponsoring Agency (n=1096)(n=1096)

Services Offered by SBHCsServices Offered by SBHCs

Primary Care Services Provided by SBHCsPrimary Care Services Provided by SBHCs(N=1046-1075)(N=1046-1075)

Reproductive Health Services Offered by Reproductive Health Services Offered by SBHCs to Adolescents On SiteSBHCs to Adolescents On Site (n= 1030-1068)(n= 1030-1068)

Oral Health Services Offered by SBHCs Oral Health Services Offered by SBHCs (n= (n=

1010-1046)1010-1046)

Contraception Prohibition at SBHCs Contraception Prohibition at SBHCs (N=1095)(N=1095)

Mental Health Services Offered by SBHCs With Mental Health Services Offered by SBHCs With (n=878) and Without (n=348) Mental Health Providers (n=878) and Without (n=348) Mental Health Providers

Download - School-Based Health Centers 101

Top Related