1. Washington State Department of Health
Healthy Communities
State Plan Analysis
School-Based Health Clinics
Practicing
Transformation
Supports

2. Presentation by Jim Harvey 2
Department of Health Healthy Communities
State Plan Analysis
All
Washingtonians

3. Presentation by Jim Harvey 3
Department of Health Healthy Communities
State Plan Analysis
Difference Between
School-Based Health Care Services and
School-based Health Clinics

4. Department of Health Healthy Communities
State Plan Analysis
Presentation by Jim Harvey 4
• Screening, Referral and Follow-up
Current goal: Promote and provide support to build capacity
and availability of healthcare, education, resources and
services.
• Social and Emotional Wellness
Current goal: Improve the knowledge and ability of healthcare
professionals to deliver comprehensive evidence-based
services including integrated mental health and chemical
dependency screening and interventions from
preconception to end of life.
• Quality Clinical and Preventive Treatment Services
Current goal: Support linkage to clinical community prevention
efforts to mobilize services, resources and self-
management program from prevention to intervention.
Goals That
Can Be
Strengthened

5. Increasing school-based health screenings has to be more than
making referrals and ordering follow-up procedures and other
activities.
Why?
•Washington State’s school districts are faced with limited resources.
Potential solution could be:
•Districts, hospitals and other health agencies could pursue
reimbursement through Medicaid Administrative Claiming (MAC)
and/or through Medicaid administrative activities.
Reason to Expand the State Plan Around SBHC
Presentation by Jim Harvey 5
Department of Health Healthy Communities
State Plan Analysis

6. Presentation by Jim Harvey 6
Reason to Expand the State Plan Around SBHC
In Washington, there continues to be consistent need for community
healthy services and educating families to thrive.
Why?
The overarching evidence in the state plan did not reflect:
•Evidence of SBHC potential impact toward improved health status
affecting learning outcomes, potential educational successes, and
affects of lifelong health outcomes; and
•Evidence of SBHC services supporting prevention of both health and
educational disparities that can follow similar patterns.
Department of Health Healthy Communities
State Plan Analysis

7. Presentation by Jim Harvey 7
Reason to Expand the State Plan Around SBHC
The state plan reads:
SBHC current goal focuses on increasing mental health and sexual
health services. This area of the plan needs to include more types of
healthcare services.
Why?
•SBHC services need to be accessible to all students and families who
have challenges in:
o Finances
o Transportation
o Social pressures
o Access to healthcare
Department of Health Healthy Communities
State Plan Analysis

8. Presentation by Jim Harvey 8
Department of Health Healthy Communities
State Plan Analysis
Essential Elements for Establishing SBHC

9. Presentation by Jim Harvey 9
Department of Health Healthy Communities
State Plan Analysis
Essential Elements for Establishing SBHC
Families
and Students

10. The percentage of students demonstrating kindergarten
readiness in October 2015 was 39.4%, falling short of the
44.8% target indicating a clear need for improvement.
What does the national data say about SBHC?
In 2011, the number of SBHCs across the United States
had grown to 1930 locations except in the states of Idaho,
Montana and North Dakota.
Presentation by Jim Harvey 10
What Does
Washington
State Data
Results
Show?
Department of Health Healthy Communities
State Plan Analysis
How can we support our public schools?
Early learning and healthcare providers in public
schools need access to more meaningful ways to
support student success.

11. Presentation by Jim Harvey 11
Department of Health Healthy Communities
State Plan Analysis
What Does
Washington
State Data
Results
Show?
In Washington State, the state as a whole is doing better
than the national average (17.3%) and continues to make
significant strides through Affordable Care Act (ACA)-
related activities.
What is the challenge?
There remain many improvements to be made before
2020. This is being achieved through:
1. Targeted Medicaid enrollment activities to the most
needy citizens and students; and
2. Aligning communications and outreach strategies
consistently with the Health Care Authority (HCA) and
the Health Benefit Exchange (HBE) to promote
coverage across all income spectrums.

12. Presentation by Jim Harvey 12
Department of Health Healthy Communities
State Plan Analysis
What Does
Other
National Data
Results
Show?
According to the American Journal of Public Health (2010),
SBHCs appear to have a significant ability to:
•Reduce health care access disparities among African
American students.
•Reduce health care access disparities among disabled
students.
•Reduce or eliminate access barriers to care and reduce
health care disparities for other vulnerable populations.
•Sustain needed resources for heard to reach healthcare
sectors including potential cost-savings for hospitalization.

13. Presentation by Jim Harvey 13
Department of Health Healthy Communities
State Plan Analysis
Vision SBHC 2020
SBHC interventions are not just an opportunity to improve the
physical wellbeing of students, but an opportunity to increase
their ability to learn and succeed.
How can this be achieved?

14. Presentation by Jim Harvey 14
Department of Health Healthy Communities
State Plan Analysis
Suggested Revisions to Support SBHC Expansion

15. Presentation by Jim Harvey 15
Department of Health Healthy Communities
State Plan Analysis
Suggested Revisions to Support SBHC Expansion
Why is this important?
Partnering with other agencies statewide, focusing on ways to
access Medicaid funding to improve people's "access" and
"coordination" of health information and their capacity to use it
effectively, would contribute to improving health care services
and empowering underserved communities and public schools
in Washington.

16. Presentation by Jim Harvey 16
Department of Health Healthy Communities
State Plan Analysis
Why Are Policy Changes Necessary?
According to the National School-based Health Alliance, the
data reflects:
•80.8% of adolescents are willing to provide feedback to healthcare
professionals.
•54.7% of adolescents participate in organizing center-sponsored
health education events.
•49.9% of adolescents participate in health center committees.
•40.7% of adolescents participate in an advocacy role.
•36.4% of adolescents are peer mentoring, counseling or educating
other adolescents.
•27.0% of adolescents participate in the design and delivery of health
services.

17. Presentation by Jim Harvey 17
Department of Health Healthy Communities
State Plan Analysis
Why Are Policy Changes Necessary?
As the State of Washington strives to create healthy
communities, successful partnerships between healthcare
providers and school districts are critical. A key component of
collaboration is Washington’s ability to provide healthcare
services to all students in a school setting.

18. Presentation by Jim Harvey 18
Department of Health Healthy Communities
State Plan Analysis
Why Are Policy Changes Necessary?
• Students who start school confident capable and ready to learn,
are more likely to succeed.
• The Legislature's goal is to fund full-day kindergarten for all
students by the 2017-18 school years.
• The
Washington Kindergarten Inventory of Developing Skills (WaKIDS)
looks at the "whole child," giving kindergarten teachers
information about the social, emotional, physical, cognitive and
linguistic development to meet the individual needs of each
student.

19. Presentation by Jim Harvey 19
Department of Health Healthy Communities
State Plan Analysis
Why Are Policy Changes Necessary?
• The process connects families and early learning providers in
the transition from early learning settings to the classroom.
• To increase awareness among healthcare professionals in
both the community and school settings.
• To establish opportunities for early interventions for healthy
behaviors during childhood.
• To increase social and physical involvement in communities,
worksites, schools, and early care educational settings to
promote and reinforce healthier behaviors.
• To establish community-clinical linkages across SBHC, PCPs,
advance clinical practitioners and schools supporting access
to quality community programs and resources.

20. Presentation by Jim Harvey 20
Department of Health Healthy Communities
State Plan Analysis
1
There has to be a partnership developed and maintained, to
support schools in making difficult choices between funding their
academic mission and funding school healthcare services
despite the evidence that healthcare is fundamental to learning.
Why Are Policy Changes Necessary?
Footnote
1
The second decade of life (10-19 years of age) is a critical period when patterns of health-
promoting (for example, adopting physical activity habits or learning ways to cope with
stress) or potentially health damaging behaviors (for example, whether or not to try cigarette
smoking, or to experiment with illicit drugs) are established, and that these behaviors may
have a substantial influence on health status (Summary of The Second Decade Summit,
U.S. Department of Health and Human Services, Office of the Assistant Secretary for
Health, Seattle, 2012).

21. Presentation by Jim Harvey 21
Department of Health Healthy Communities
State Plan Analysis
Financial Viability is Necessary for a
Healthier Washington
In order for SBHC and the expansion of an multidisciplinary
treatment approach, there must be identified sources of funding.
Why Are Policy Changes Necessary?

22. Presentation by Jim Harvey 22
Department of Health Healthy Communities
State Plan Analysis
Funding the expansions of SBHC must come from a variety of
sources, examples could be:
•Healthcare providers within the SBHC could bill Medicaid
directly and/or the families’ private health insurance. The funds
would then be reinvested in service expansion.
•Collaborating with HCA to expand Medicaid payment options
for services provided.
•Increasing Medicaid provider eligibility through easier access
to CORE Provider Agreements through HCA would strengthen
financial resources.
•Sponsoring agencies, hospitals and hosting ESDs providing in-
kind services to SBHC.

23. Presentation by Jim Harvey 23
Department of Health Healthy Communities
State Plan Analysis
•ESDs around Washington to sponsor “in-kind support” in the
form of a health aides or school aides who already work within
the districts.
•Healthy Schools and Healthy Communities grants
administered by the Department of Health and Human Services’
(HHS) Bureau of Primary Health Care, which is the largest
source of federal funding for SBHC to this date.
•State funding being the last resource to support SBHC, the
funding would include: Washington State general funds,
possible tobacco tax and tobacco settlement dollars, and
funding from the ESDs.

24. Presentation by Jim Harvey 24
Department of Health Healthy Communities
State Plan Analysis
Monitoring the efficiency and effectiveness of policies is an important
part of the policy management and planning process. This process
would need to involve:
Tracking Strategies and Effectiveness
1. Monitoring on a monthly basis that the objectives identified by the
key partners are being met.
2. Building on other agencies' policy and plan monitoring efforts.
3. Sharing ideas and allowing room for state-wide training to occur.
4. Recording the information from monitoring and evaluations.

25. Presentation by Jim Harvey 25
Department of Health Healthy Communities
State Plan Analysis
Monitoring the efficiency and effectiveness of policies is an important
part of the policy management and planning process. This process
would need to involve:
Tracking Strategies and Effectiveness
5. Analysing the monitoring and evaluation results, interpreting what
they mean, and summarizing the outcomes.
6. Determining where changes are required to the policies and plans as
a result of the monitoring and evaluations.
7. Reporting on the results from monitoring, evaluation and the
effectiveness.
8. Ensuring the entire process is well documented.

26. Presentation by Jim Harvey 26
Department of Health Healthy Communities
State Plan Analysis
Tracking Strategies and Effectiveness
Post-project implementation reporting would need to capture
requirements of all elements to include:
1.A brief description of SBHC statewide and the work accomplished.
2.Lessons and barriers learned during the expansion process.
3.Recommendations for implementation of future SBHC.
4.Quality assurance activities.
5.Monitoring of reimbursed claims.
Note: Monitoring would need to be based on identified strategies. Project leads would need to be responsible for
monitoring the assigned strategies, identifying key performance indicators (KPI), milestones to be met, and the key
partners (i.e., subject matter experts). Expansion of SBHC would fall short unless community members,
stakeholders, and public schools are informed and involved in the planning process.

27. Presentation by Jim Harvey 27
Department of Health Healthy Communities
State Plan Analysis
Tracking Strategies and Effectiveness
Determining whether SBHC activities were taking place, supported
the state plan, evaluations long-term would must include:
1.Determining what key partners worked collaboratively to address
chronic health conditions utilizing the SBHC model;
2.Determining what efforts were used to encourage self-
management, family planning, behavioral and health outcomes; and
3.What lessons were learned regarding the advantages of SBHCs.
Note: Monitoring would need to be based on identified strategies. Project leads would need to be responsible for
monitoring the assigned strategies, identifying key performance indicators (KPI), milestones to be met, and the key
partners (i.e., subject matter experts). Expansion of SBHC would fall short unless community members,
stakeholders, and public schools are informed and involved in the planning process.

28. Presentation by Jim Harvey 28
Department of Health Healthy Communities
State Plan Analysis
SBHC Needs to be Expanded in the Plan
It is not enough to give out information. For SBHC Vision 2020 to be
successful local policy makers must solicit information from the public
they serve and use that information to improve services.
The endeavors would include:

29. Presentation by Jim Harvey 29
SBHC Needs to be Expanded in the Plan
Department of Health Healthy Communities
State Plan Analysis

30. Presentation by Jim Harvey 30
Department of Health Healthy Communities
State Plan Analysis
Building community partnerships can help SBHC,
public schools and communities by:
•Improving academic outcomes, attendance and behavior.
•Reducing exposure to adverse childhood experiences.
•Improving health literacy starting at an early age.
•Reducing chances of negative childhood behaviors between
ages 10 and 20 that could impact the course of their lives.
•Improving health outcomes for students including mental and
behavioral health.

31. Presentation by Jim Harvey 31
Department of Health Healthy Communities
State Plan Analysis
Building community partnerships can help SBHC,
public schools and communities by:
•Reducing the number of students identified as needing special
education services.
•Reducing the number of students expelled or suspended.
•Improved healthcare services and care coordination for all
students.
•Increasing and improve outreach services.

32. Presentation by Jim Harvey 32
Building community partnerships can help SBHC,
public schools and communities by:
•Reducing the utilization of emergent medical services in the
community.
•Controlling costs in the larger healthcare system through
improved outreach activities, delivery, and care coordination in
the districts.
•Streamlining services would prevent the duplication of
healthcare services.
•Engaging in other efforts to meet students academic goals.
Department of Health Healthy Communities
State Plan Analysis

33. Presentation by Jim Harvey 33
Department of Health Healthy Communities
State Plan Analysis
Healthy Communities Need Healthy Schools
A Shared Vision Among Washingtonians
Schools are key members of a healthy community and play a critical
role by promoting health and safety thus establishing lifelong healthy
behavior patterns.
Providing healthcare services within a school district will increase
access to care, improve student healthcare outcomes through care
coordination, result in improved academic performance and
graduation rates.
All of these elements lead to healthier Washingtonians!
What are policy changes necessary?

34. Presentation by Jim Harvey 34
Department of Health Healthy Communities
State Plan Analysis
Proposal: Vision SBHC 2020
Vision SBHC 2020 would rely on elevating population health
improvement activities and direct access to health care services.
This can happen starting with:
1.Partnerships developed uniformly, consistently and ongoing
statewide; and
2.Collaboration between state agencies focused on improving
healthcare, educational outcomes, and consistent efficient
activities statewide. (e.g., student committees, advocacy, health
education events)

35. Presentation by Jim Harvey 35
Department of Health Healthy Communities
State Plan Analysis
Questions from the Audience.

36. Presentation by Jim Harvey 36
Department of Health Healthy Communities
State Plan Analysis
References
Dilley, J. (2009). Research Review: School-based Health Interventions and Academic
Achievement. Healthy Students, Successful Students Partnership Committee. Retrieved from
http://www.doh.wa.gov.
Guo, J. J., Wade, T. J., Pan, W., & Keller, K. N. (2010). School-Based Health Centers: Cost–
Benefit Analysis and Impact on Health Care Disparities. American Journal of Public Health,
100(9), 1617–1623. http://doi.org/10.2105/AJPH.2009.185181
Johnson, V. (2006). Hutcherson V. A. Study of the utilization patterns of an elementary school-
based health clinic over a 5-year period. Journal of School Health, 2006; 76: 373–378.
Result Washington. (2015). Early Learning: Kindergarten Ready. Increase from
https://data.results.wa.gov/en/stat/goals/ci2z-79bv/ar4i-hyez/w79d-quiu.
School-Based Health Alliance. (2011). School-based Health Alliance. Redefining Health for
Kids and Teens. 2010-2011 Census Report of School-Based Health Centers. Retrieved from
http://www.sbh4all.org.