Nuts and Bolts Nuts and Bolts ofof

Oregon School-Based Health CentersOregon School-Based Health Centers

Janet Matthews, MS, FNP, WHCNP

School-Based Health Center Program Manager

Adolescent Health Section

Office of Family Health

Oregon State Public Health Division, DHS

Aisha KrebsAisha KrebsSchool-Based Health CenterSchool-Based Health Center

Program CoordinatorProgram Coordinator

Columbia Health District- Public Health AuthorityColumbia Health District- Public Health Authority

SBHCs provide accessibleSBHCs provide accessible health care to youth health care to youth

Health care access for youth

Supports youth being in class

Prevention messages delivered

AA School Based School Based Health Center….Health Center…. Delivers a core set of primary health care

services (physical, mental, preventive)

To children and youth in an identifiable school space

During regular scheduled times

By qualified health professionals

In a collaborative relationship with the local educational and healthcare community

SBHC Addresses . . .SBHC Addresses . . .

Barriers to access Health care provider

shortage Underserved

populations High proportions of

high risk youth

School Nurse vs. SBHC School Nurse vs. SBHC SCHOOL NURSE

Employed by School Manages student

immunizations program Coordinates screenings Chronic SH case mgmnt Manage chronic

medication delivery during school

Oversees SH programs FERPA regulated

SBHC

Employed by Medical Sponsor

Administers immunizations

Conducts screenings, PEs

Acute care of both acute and chronic needs

Administer and prescribe medications

Counseling, prevention and wellness promotion

HIPPA regulated

StatewideStatewide 2007: 45 Centers in 19 Counties

28 High Schools 5 Middle Schools 9 Elementary Schools 3 Combined Grade Schools

2006-2007 Oregon SBHCs served: 20,831 clients 69,034 visits

 

 OREGON SCHOOL-BASED HEALTH CENTERS 2008

Oregon State Public Health Division, DHS, Office of Family Health, Adolescent Health Section, School-Based Health Center Program, 971-673-0252 As of January 2008

WASHINGTON COUNTYMerlo Station HS*Forest Grove*Tigard HS

MULTNOMAH COUNTYBinnsmead MS Jefferson HS Marshall HSCleveland HS Lane MS Parkrose HSGeorge MS Lincoln Park ES Portsmouth MSGrant HS Madison HS Roosevelt HS

YAMHILL COUNTYWillamina HS

LINCOLN COUNTYNewport HSTaft HSToledo HSWaldport HS

BENTON COUNTYLincoln ESMonroe ES/MS

LANE COUNTYNorth Eugene HSSheldon HSSouth Eugene HSSpringfield HSWinston Churchill HS

DOUGLAS COUNTYRoseburg HS*Douglas HS

JOSEPHINE COUNTYIllinois Valley HSLorna Byrne MS*Evergreen ES

JACKSON COUNTY Ashland HS **Jewett ES*Butte Falls/Prospect Oak Grove ESCrater HS Phoenix ESJackson ES Washington ES

UMATILLA COUNTYPendleton HSSunridge MS

UNION COUNTYLa Grande HS

BAKER COUNTYBaker HS

COLUMBIA COUNTYLewis & Clark ES*Rainier *St. Helens HS*Vernonia

DESCHUTES COUNTY La Pine K-12 Campus*Bend *Redmond

JEFFERSON COUNTY Madras HS

CLACKAMAS COUNTYOregon City HS*Canby HS*New Urban HS

MalheurHarney

Lake

Morrow

Gilliam

Crook

Wallowa

Sherman

Hood RiverClatsop

Tillamook

WHEELER COUNTYMitchell K-12

MARION COUNTYHoover ES

Linn

Counties with Certified SBHCs

Counties with Certified SBHCs andPlanning Phase I Sites

New Counties with Planning Phase I Sites

WASCO COUNTY*The Dalles Wahtonka HS

POLK COUNTY*Falls City

COOS COUNTY Marshfield HS

CURRY COUNTY *Brookings-Harbor

GRANT COUNTY*TBD

KLAMATH COUNTY*Gilchrist School

*Indicates location of Planning Site**Indicates location of Advanced Planning Site

Total number of Certified SBHCs = 45Total number of Planning Phase I Sites = 17

Growth of Oregon SBHCs

45

20

80

10

20

30

40

50

1986-1987 1996-1997 2006-2007

Service Year

Growth in Number of Clients Seen at Oregon's SBHCs

4,108

6,563

20,831

0

4000

8000

12000

16000

20000

24000

1986-1987 1996-1997 2006-2007

Service Year

Number of clients has increased by almost 500% since their inception in 1986

Today, 38,606 students have access to SBHCs at their school

Increased access to health careIncreased access to health care

Number of SBHCs has doubled each decade

Impact: Access to CareImpact: Access to Care

Students Report Likelihood of Receiving Care if their school did not have an SBHC

68%

32%

Likely to receive care (have access and will go)

Unlikely to receive care (won't go, no access or don'tknow if they have access)

Impact: Fewer Classes MissedImpact: Fewer Classes Missed

21%

24%

23%

19%

13%

2.3%

0%

0.2%

44%

53%

0 10 20 30 40 50 60

Don't Know

All Day

3-5 Classes

1-2 Classes

0 Classes

Classes MissedAccessing Care atSBHC

Estimated ClassesMissed if AccessingOther Care

The State of Oregon contributed $1,370,000 to SBHCs

This supported the delivery of over $2,614,000 in health care services including…

Over $1,142,000 in services to uninsured clients

Value of Care 2006-2007Value of Care 2006-2007

Funding of Oregon SBHCsFunding of Oregon SBHCsFunding of Oregon SBHCsFunding of Oregon SBHCs

Public health infrastructure support from State DHS

Based on a formula: per range of total number of certified SBHCs in a county

Additional sources found on local level:County fundsSchool districtsHospitalsCommunity health

providersGrantsLocal fundraising

Political climatePolitical climate

OR Legislature has supported the # of SBHCs doubling each decade

1985-86 Initial Legislative dollars 2004 Expansion dollars for SBHCs into

5 new counties 2007 Expansion dollars for SBHCs into

5 new counties and 7 existing counties

Student ConfidentialityStudent Confidentiality

School Districts request SBHC parental consent along with general registration

Clarify Oregon minor consent laws

Reproductive health - no age restriction Mental Health - 14 yrs and older Physical Health - 15 yrs and older

Columbia CountyPublic Health Need for SBHC

A. Demographics- Economic Indicators 13% of children live in poverty 33% of public school children eligible for free and

reduced lunch

B. Health Disparities (2006 Col.Co. Data)

15% of children were uninsured 21% of children were on Oregon Health Plan

Columbia CountyPublic Health Need for SBHC

Sacagawea Health Center Data 2006-07 20% of patients were on Oregon Health Plan 36% of patients had NO insurance

Of SHC patients who visited the center 3 or more times…….

47% had NO insurance 27% on Oregon Health Plan 13% had Kaiser insurance (no providers in Columbia Co.)

Columbia CountyPublic Health Need for SBHC

Health Risk Indicators - BRFSS Data 2002-05

The percentages of individuals living with these risks are statistically significant when compared to the data from

the entire State of Oregon.

Survey Topic Oregon% Columbia County %

% who have high blood pressure 24.2% 30.9%

% who are obese (body mass index >30 kg/m2)

22.1% 30.9%

% of adults who currently smoke cigarettes

20.4% 25.9%

Columbia CountyPublic Health Need for SBHC

Columbia County 8th Grade Healthy Teens Survey

Risk Factor Percentage of C.C. 8th Graders

No medical/physical care in previous year

48.6%

Drunk alcohol in last month 34.5%Diagnosed with asthma 21.4%High risk of depression 19.3%Seriously considered suicide

16.4%

Smoked cigarettes in last month

10.2%

Columbia CountyPublic Health Need for SBHC

C. Access to Health Care

Columbia County is the most medically underserved County in Oregon

- Oregon Area of Unmet Healthcare Needs Evaluation

Columbia County currently has a Health Professional Shortage Alert

-Federal Government Designation

For more information:For more information:

Aisha Krebs

SBHC Program Coordinator

PH: 503.397.4651 x 206

Fax: 503.397.1424

apoole@chdpublichealth.com