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  • 1. Denver School-Based Health Centers: A Model of Integrated Health Care Lisa Abrams MS, PNP Denver Health School-Based Health Centers May 7, 2009 MCH Statewide Meeting
  • 2. Denver School-Based Health Centers (DSBHC)
    • Started in 1988, well established SBHC program with integrated health and mental health services
    • 12 sites  6 middle and 6 high schools
    • SBHCs linked with DH Community Health Center network
    • SBHCs linked with tertiary care facility (hospital services)
    West High School
  • 3. Other Services Provided in Schools
    • Dental Sealant Program:
      • Applies sealant and fluoride varnish to DPS 2 nd graders
      • Staffed by 2 dental hygienists and 1 insurance outreach worker
    • School Health Program:
      • Provides daily on-site school health services in 5 elementary schools
      • Staffed by 1 RN nursing manager, 1 RN case manager and 5 LPNs
  • 4. DSBHC: Partners (2007-08)
    • Denver Health: Community Health Services and Outpatient Behavioral Health Services
    • Denver Public Schools
    • Mental Health Center of Denver
    • Arapahoe House
    • CDPHE
    • Colorado Health Foundation
    • Great West Life
    • The Children’s Hospital
    • St. Anthony Hospital
  • 5. DSBHC: Multi-disciplinary and Multi-agency teams (2007-08) Denver Health (DH); Mental Health Centers of Denver (MHCD); Denver Public Schools (DPS); Arapaho House (AH) DH Health educator DH Insurance outreach worker AH Substance abuse counselor (HS only) DPS School psychologist DPS School social worker DPS School Nurse DH/MHCD Mental Health Therapist DH/DPS School Health Technician/Medical Assistant DH Consulting Physician DH Nurse Practitioner/Physician Assistant
  • 6. DSBHC: Services
    • Focus is integrated Primary Care not episodic urgent care
      • Medical Home provides a full range of primary care services including well child care, minor acute care and chronic disease management
        • On-site pharmaceutical dispensary
        • Waived on-site lab capabilities
        • Full complement of vaccines
      • Mental health therapy
      • Substance abuse counseling (high schools)
      • Reproductive health education
      • Insurance outreach
  • 7. DSBHC: Demographics 2007-08
    • DPS enrollment (12 schools): 12,221
    • SBHC enrollment: 10,179 (83%)
    • SBHC users (medical): 7,801 (76%)
    • SBHC users (mental health): 1,185
  • 8. DSBHC Clinic Users (2007-08) DSBHC Charge Distribution (2007-08)
  • 9. DSBHC: Utilization 2007-08
    • 17,730 Physical health visits (11.8 FTE)
    • 8,811 Mental health visits (11 FTE)
    • 1,755 Substance abuse visits (2.5 FTE)
    • 29,458 Total visits for all services
    • 16,969 Immunizations
    South High School SBHC
  • 10. Most common diagnoses in the DSBHCs
    • Well child care
    • Immunizations
    • Asthma
    • Reproductive health care (high schools)
    Rachel B. Noel SBHC
  • 11.  
  • 12. If you build it, will they come?
    • Critical early decisions depend on needs assessment and resources
      • Medical home providing comprehensive care vs urgent care vs provision of specific services such as immunizations
      • Full-time or part-time provision of services
      • Staffing model
      • Ancillary service provision (lab, pharmacy)
      • Referral patterns
  • 13. Community Engagement It takes a village to identify the need
      • Where are the gaps in children’s health care in the community?
      • What does the community need? (stakeholders and others)
      • What does the community want? (community members)
      • Who are the stakeholders?
      • Are the stakeholders interests the same as the community member’s interests?
      • Where are the funding sources?
      • What is possible with available funding?
  • 14. Community Engagement It takes a village to design a plan
    • Planning committee should include
      • Community members (parents, students and community leaders)
      • Health professionals
      • District and school representation
      • Partners and stakeholders
    • Know your budget and resources
    • Know the vision
  • 15. Community Engagement It takes a village to implement a plan
    • Assign a project manager
      • Responsible for assuring tasks are completed
    • Develop a timeline and stick to it
    • Work closely with the school district to keep lines of communication open
  • 16. Community Engagement It takes a village to sustain a plan
    • Maintain communication with all partners
    • Maintain vision
    • Commitment to continuous process improvement
    • Provide high quality care
    • Each year, plan for the next 5 years (growth and funding sources)
  • 17. The Denver SBHC Collaborative Model
    • Identification of need for a new SBHC
      • Free and reduced lunch
      • School enrollment
      • Request of school community
      • Solid linkage with DH Community Health Centers
    • Design plan for a new SBHC
      • Collaborate with district, partners, and stakeholders
      • Resource development and utilization
    • Implement plan for a new SBHC
      • Operations
      • Clinical processes
      • Education of school community (students, parents, school faculty, greater community)
  • 18. The Denver SBHC Collaborative Model
    • Sustain new SBHC
      • Maintain funding
      • Maintain staffing
      • Provide necessary equipment
      • Integrate SBHC services and staff into school community
      • Maintain support from stakeholders and partners at all levels
  • 19. The Denver SBHC Collaborative Model
    • Provide multiple opportunities for communication
      • Health advisory council in each school (local collaboration)
        • Different composition depending on school culture
      • School-based administrative team (Denver Health)
      • DPS health services council (DPS school district)
      • SBHC management team (mid-level managers carry out strategic decisions collaboratively )
      • Denver School Health Council (program and agency directors make strategic decisions collaboratively)
  • 20. Denver School-Based Health Centers
    • Director: Steve Federico MD
    • Administrator: Abigail Aukema BA
    • Program Manager: Lisa Abrams MS, PNP
    • Mental Health Program Manager: Jennifer Koch LCSW
    • Operations Manager: Audrey Hoener MM
    • [email_address]
    • 303-602-8958
    North High School
  • 21.