1 NR441442444 Community Health Nursing Required U.docx
ATLANTIC Conference 2013_SBHC presentation
1. Making Sustainability Real: Measuring Indicators and
Implementing Inventions towards Sustainability
2013 Elev8 Fall Learning Institute
Moderator: Kimi Sakashita, MPH, Associate Director
Alameda County Center for Healthy Schools & Communities
Presenters:
Sara Geierstanger, MPH, Senior Evaluator
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco
Erica Snow, MS, MPA, Senior Program Officer
The Colorado Health Foundation
Naomi Shapiro, RN, PhD, CPNP, Clinical Professor
School of Nursing
University of California, San Francisco
2. Presentation Overview
Development and use of an SBHC sustainability indicators
measurement tool, as well as results from administration in
Colorado (Sara)
Motivation for a major foundation to focus on SBHC sustainability,
the tools they developed, and how sustainability assessment
results are guiding interaction with and funding of grantees (Erica)
Mutual benefits of university-school health collaboration and its
contribution to school health center sustainability (Naomi)
Questions and Discussion
3. The Colorado Health Foundation’s
School Based Health Care Initiative
4-year investment in school-based health care
Support the planning and implementation of at least 20 new or
expanded school-based health care programs (SBHC)
Improve the effectiveness of SBHCs at reaching underserved
populations
Identify and address policy barriers
Ensure the financial sustainability of SBHCs
5. SBHC
Implementation Grantees
Rocky Mountain Aurora School
Youth Services/Roaring District/RMYC
Fork School District
Grand River Community Health
Hospital District Services, Inc.
Eagle County Denver Health
School District
Montrose County Summit Community
School District Care Clinic
Sheridan Health
Services
Metro Community
Provider Network
Durango 9-R
School District Cripple Creek
School District
Southwest Open School Pueblo Community
Health Centers
6. Policy Wins
Two provisions in the Patient Protection and Affordable Care
Act
Authorization of a federal SBHC grant program
Creation of an emergency appropriation that has provided
Colorado SBHCs $2.9 million in capital funding
Passage of HB11-1019, which exempts SBHCs from
deductible and co-payment requirement from privately
insured patients
Increase in state general line-item for the SBHC grant
program by approximately $4.3 million
7. SBHC Application Process
Step 1: Complete Readiness Assessment
Step 2: Develop Business Plan
Step 3: Implementation
9. Evaluation
Selected Philip R. Lee Institute for Health Policy Studies at
the University of California, San Francisco to conduct
evaluation
Timeline: January 2010 – January 2014
Purpose: Determine if TCHF’s Initiative process was effective
in driving Colorado SBHCs toward increased self-
sustainability
11. Development of the
Sustainability Self-Assessment Tool
Facility
Staffing
Services
Community
Partnerships
Funding
Strategies
Management
School
Integration
Marketing &
Outreach
Tool developed by our UCSF/PRA evaluation team in 2010.
12. Use of the
Sustainability Self-Assessment Tool
First administered to 16 Alameda County School Health
Centers by UCSF for 2010-11.
Revised and administered to Colorado SBHCs
16 Group 1 grantees for 2010-11
16 Group 1 grantees for 2011-12
24 Group 2 grantees for 2011-12
Administered to XX Elev8 SBHCs for 2011-12 by the School
Based Health Alliance.
Tool is now available on the School Based Health Alliance
web-site and being used by other researchers.
13. Sustainability Scores Summary
4.0
3.9
3.9
3.8
3.7
3.4
3.4
2.9
Facility Indicators
Staffing
Provision of Services
Funding Strategies
Management
Community Partnerships
School Integration
Marketing and Outreach
1=Not in Place 4=Full
Implementation
2=In Planning 3=Partial
Implementation
<2.99
Not in place/planning
3-3.49
Partial implementation
≥3.5
Near/at Full implementation
14. Facility Indicators
Group 1
Baseline (N=16)
Group 1 Change
(N=16)
Group 2
Baseline (N=24)
SBHC includes at least the following functional elements:
Computers/telecommunications 4.00 0 4.00
One exam room. 4.00 0 4.00
Waiting/reception area. 3.81 .13 4.00
Counseling room/private area. 3.88 0 4.00
Privacy, confidentiality, safety 3.75 .06 4.00
Dedicated space only for SBHC 4.00 -.13 4.00
Average Score 3.92 0.01 4.00
15. Staffing Indicators
Group 1
Baseline (N=16)
Group 1 Change
(N=16)
Group 2
Baseline (N=24)
Staff training 3.50 .38 3.96
Organizational chart 3.50 .38 3.92
Culturally appropriate hiring 3.69 .19 3.96
Written job descriptions 3.75 .06 3.92
Average Score 3.61 0.25 3.94
16. Provision of Services
Group 1
Baseline
(N=16)
Group 1
Change
(N=16)
Group 2
Baseline
(N=24)
Needs assessments 3.38 .44 3.29
Address barriers to (safety, transportation, hours) 3.69 .31 3.96
24-hour, 7 days per week coverage 3.06 .25 3.88
Follows clinical practice guidelines 3.56 .13 4.00
Conducts student outreach 3.94 .06 4.00
Has an administrator for overall program management 3.94 .06 4.00
Extends eligibility to all students 4.00 0 4.00
Services are welcoming and respectful of student
diversity
4.00 0 4.00
Complies with federal and state regulations 3.94 0 4.00
Collects student and parent feedback 3.69 0 3.75
Coordination of care among SBHC staff 3.63 -.19 4.00
Average Score 3.71 0.10 3.90
17. Funding Strategies
Group 1
Baseline
(N=16)
Group 1
Change
(N=16)
Group 2
Baseline
(N=24)
Has a sliding fee scale 3.31 .50 3.96
Conducts Medicaid outreach and application assistance 3.81 .19 4.00
Medicaid and third party revenue returned to SBHC 3.44 .13 4.00
Effective and efficient billing system 3.25 .06 3.83
Written billing policies for SBHCs 3.38 -.07 3.96
Average Score 3.44 0.16 3.95
18. Management
Group 1
Baseline
(N=16)
Group 1
Change
(N=16)
Group 2
Baseline
(N=24)
Tracks student health and academic outcomes 2.69 .63 3.96
Evaluates practice management measures 3.31 .31 3.96
Plans for continuous quality improvement 3.50 .25 3.96
Involvement of provider in clinical policies and procedures 3.56 .20 4.00
Written policy on exchange of information with school staff 3.19 .19 4.00
Written record of progress toward selected measures. 3.19 .13 3.96
Annual budget describes funding, including in-kind 3.88 .06 3.96
E.H.R. facilitates the provision of care 3.13 .06 3.96
Obtains consent for sharing SBHC records 4.00 0 4.00
Develops and updates business/strategic plan 3.75 -.06 3.96
Reports revenues and expenses 3.75 -.13 3.96
Works with community advisory council 3.94 -.50 3.88
Solicits youth involvement 2.94 -.56 3.00
Average Score 3.45 0.04 3.89
19. School Integration
Group 1
Baseline
(N=16)
Group 1
Change
(N=16)
Group 2
Baseline
(N=24)
Partners in school-wide programs 2.50 .69 3.21
Advocates for school health programs and policies 1.88 .69 4.00
Joint funding opportunities with the SBHC 3.00 .63 3.00
Active in school-wide committees 3.44 .40 3.50
Policy about roles of SBHC and the school nurse 3.25 .38 3.54
Involved in school health program decision-making 1.94 .20 3.61
Co-locates with the school health staff 2.88 .19 3.63
Provides in-services to school staff/consults teachers 3.69 .13 3.33
Advocates for district health programs and policies 2.44 .13 3.79
Communication and coordination with school health staff 3.75 -.13 4.00
Average school stakeholder support 3.94 -0.11 3.55
Average school stakeholder engagement 2.66 0.02 2.79
Average school health provider collaboration 3.12 0.17 3.52
Average Score 2.96 0.26 3.50
20. Community Partnerships
Group 1
Baseline
(N=16)
Group 1
Change
(N=16)
Group 2
Baseline
(N=24)
Solicits participation from other key community stakeholders. 4.00 0 4.00
Communicates and coordinates with primary care provide 3.75 -.06 3.71
Parent and local community support 3.86 -0.15 3.37
Parent and local community engagement 2.18 0.08 2.22
Lead medical agency/community partner collaboration 3.22 -0.12 3.78
Average Score 3.40 -0.05 3.42
21. Marketing & Outreach
Group 1
Baseline
(N=16)
Group 1
Change
(N=16)
Group 2
Baseline
(N=24)
Strategy for addressing opposition 2.93 .47 2.04
Uses data to promote school health services 3.25 .44 3.26
Uses a variety of marketing and outreach strategies 3.94 -.06 3.00
Crafted messages for different audiences 3.87 -.33 3.04
Has a written marketing plan 2.81 -.69 2.21
Average Score 3.36 -0.15 2.71
22. Recommendations
Continue to support SBHC facility expansion
Continue to focus on funding and management
Encourage SBHC partnerships with school-wide programs
Continue to focus on SBHC marketing strategies
Advocate for government policy/funding for SBHCs
Continue to assess, monitor and improve sustainability factors!
23. Results into Action
Funding
Support State SBHC association and partner with Colorado Dept.
Public Health and Environment in SBHC learning forums
Continue advocacy support for SBHCs
Case study highlighting “Best Practices to Improve Billing”
Case study “Providing services to Uninsured Clients”
Position SBHCs as part of community health networks
Continue to support integration of mental and oral health
24. Results into Action
Marketing and Outreach
Technical assistance to SBHCs via private marketing firm
Kaleidoscope video- Foundation’s storytelling campaign
Community Partnerships
Youth group development at Foundation
Reexamine how to better engage families and students, e.g. focus
groups
School Integration
Healthy Schools Collective Impact project with Community Wealth
Partners
25. Questions and Discussion
Contact Information
Sara Geierstanger: Sara.Geierstanger@ucsf.edu
Erica Snow: esnow@coloradohealth.org
Naomi Shapiro: naomi.schapiro@nursing.ucsf.edu
