School-Based Health Centers (SBHCs) 101: An Overview and Framework for  Building Programs
Objectives   <ul><li>Participants will be able : </li></ul><ul><li>Define school-based health center (SBHC) </li></ul><ul>...
SBHC:  National Definition <ul><li>Partnerships created by schools and community health organizations to provide on-site m...
SBHC:  National Definition <ul><li>Services provided by the school-based health care team are determined locally through a...
SBHC:  National Definition <ul><li>SBHCs have a policy on parental consent.  </li></ul><ul><li>Although the model may vary...
SBHC:  National Definition <ul><li>SBHCs make provisions for care beyond the centers’ operating hours or scope of service....
SBHC:  National Definition <ul><li>Services typically offered in SBHCs are age appropriate and address the most important ...
SBHC:  National Definition <ul><li>SBHCs are supported by local, state, and federal public health and primary care grants,...
Why School-Based Health Centers?
Group Activity <ul><li>Why School-Based Health Centers? </li></ul><ul><ul><li>Think of yourself as a school aged child, pi...
Why SBHCs? <ul><li>Uninsurance among children, especially adolescents </li></ul><ul><li>Geographic and financial barriers ...
<ul><li>“ Health services need to be where students can trip over them.  Adolescents do not carry appointment books, and s...
The Evidence Base for SBHCs <ul><li>Research published in professional literature </li></ul><ul><li>National and state dat...
What the Literature Tell Us About Emergency Room Use and SBHCs <ul><li>Reduced inappropriate emergency room use,  </li></u...
What the Literature Tell Us About Asthma and SBHCs <ul><li>Greater than 50% reduction in asthma-related emergency room vis...
What the Literature Tell Us About  Mental Health and SBHCs <ul><li>SBHCs attract harder-to-reach populations, especially m...
What Science Tell Us About Education and SBHCs  <ul><li>Health has both direct and indirect effects on school failure </li...
What We Know Intuitively <ul><li>Healthy students make better learners </li></ul><ul><li>You cannot teach a child who is n...
What Science Tells Us About Education  <ul><li>Academic performance is  negatively  affected by: </li></ul><ul><ul><li>Alc...
The Health-Academic Outcomes Connection SBHCs Health Risk Behaviors Educational Outcomes Educational Behaviors Substance u...
SBHC Outcomes and Tactics Reduce barriers to learning Increase attendance  Improve student health Meet government regulati...
The Medical Home <ul><li>Half of SBHCs estimate more than 30% of their enrollees use the center as their medical home  </l...
Efficiencies in SBHCs <ul><li>Parents do not need to take time off </li></ul><ul><li>Follow-up is less labor intensive </l...
National Data and Trends Census 2007-08
SBHCs by State  (n=1910) State Total # of Open SBHCs   State Total # of Open SBHCs Alabama 5   Nebraska 1 Alaska 3   Nevad...
SBHCs by Location  (n=1226) In school building 95.7 percent On school property 2.9 percent Mobile 1.4 percent
SBHCs by Types of School  (n=1096)
SBHCs by Community Characteristic  (n=1235)
SBHCs Users by Race/Ethnicity (n=1096)
SBHCs  by Population Served  (n=1096 )
SBHCs by Sponsoring Agency  (n=1096)
Services Offered by SBHCs
Primary Care Services Provided by SBHCs (N=1046-1075)
Reproductive Health Services Offered by SBHCs to Adolescents On Site   (n= 1030-1068)
Oral Health Services Offered by SBHCs  (n= 1010-1046)
Contraception Prohibition at SBHCs  (N=1095)
Mental Health Services Offered by SBHCs With (n=878) and Without (n=348) Mental Health Providers
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School-Based Health Centers 101

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An introduction to how a school-based health center is defined, where they are located, who they serve, and what they provide.

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School-Based Health Centers 101

  1. 1. School-Based Health Centers (SBHCs) 101: An Overview and Framework for Building Programs
  2. 2. Objectives <ul><li>Participants will be able : </li></ul><ul><li>Define school-based health center (SBHC) </li></ul><ul><li>Explain why SBHCs are an effective health care delivery system for children and adolescents </li></ul><ul><li>Describe characteristics of SBHCs </li></ul>
  3. 3. SBHC: National Definition <ul><li>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. </li></ul><ul><li>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. </li></ul>
  4. 4. SBHC: National Definition <ul><li>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. </li></ul><ul><li>The school-based health care team works in collaboration with school nurses and other service providers in the school and community. </li></ul>
  5. 5. SBHC: National Definition <ul><li>SBHCs have a policy on parental consent. </li></ul><ul><li>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. </li></ul>
  6. 6. SBHC: National Definition <ul><li>SBHCs make provisions for care beyond the centers’ operating hours or scope of service. </li></ul><ul><li>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. </li></ul>
  7. 7. SBHC: National Definition <ul><li>Services typically offered in SBHCs are age appropriate and address the most important health needs of children and youth. </li></ul><ul><li>These services may include but are not limited to: </li></ul><ul><ul><li>primary care for acute and chronic health conditions </li></ul></ul><ul><ul><li>mental health services </li></ul></ul><ul><ul><li>substance abuse services </li></ul></ul><ul><ul><li>case management </li></ul></ul><ul><ul><li>dental health services </li></ul></ul><ul><ul><li>reproductive health care </li></ul></ul><ul><ul><li>nutrition education </li></ul></ul><ul><ul><li>health education and health promotion. </li></ul></ul><ul><ul><li></li></ul></ul>
  8. 8. SBHC: National Definition <ul><li>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. </li></ul><ul><ul><li></li></ul></ul>
  9. 9. Why School-Based Health Centers?
  10. 10. Group Activity <ul><li>Why School-Based Health Centers? </li></ul><ul><ul><li>Think of yourself as a school aged child, pick your age, or </li></ul></ul><ul><ul><li>Think of your own child or adolescent, or </li></ul></ul><ul><ul><li>Think of family members, neighbors as a school aged child </li></ul></ul><ul><ul><li>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 </li></ul></ul>
  11. 11. Why SBHCs? <ul><li>Uninsurance among children, especially adolescents </li></ul><ul><li>Geographic and financial barriers to health, mental health, and oral health </li></ul><ul><li>Dangerous health outcomes associated with adolescents </li></ul><ul><li>Nonexistent/fragmented/singular discipline systems of care </li></ul><ul><li>Decreased educational attainment </li></ul>
  12. 12. <ul><li>“ 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.” </li></ul><ul><ul><li>Philip J. Porter, M.D. </li></ul></ul><ul><ul><li>Early architect of the SBHC movement </li></ul></ul>
  13. 13. The Evidence Base for SBHCs <ul><li>Research published in professional literature </li></ul><ul><li>National and state data </li></ul><ul><ul><li>National State Initiative Survey </li></ul></ul><ul><ul><li>NASBHC Triennial census </li></ul></ul><ul><ul><li>White papers </li></ul></ul><ul><li>Training and technical assistance in the field </li></ul><ul><ul><li>Results of beta testing tools and resources </li></ul></ul><ul><ul><li>Collaboratives </li></ul></ul><ul><ul><ul><li>Pre and post assessments, chart reviews, progress reports, storyboards, consultation calls </li></ul></ul></ul>
  14. 14. What the Literature Tell Us About Emergency Room Use and SBHCs <ul><li>Reduced inappropriate emergency room use, </li></ul><ul><li>Increased use of primary care, and </li></ul><ul><li>Fewer hospitalizations </li></ul><ul><li>Santelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19:267-275 </li></ul><ul><li>Prevention-oriented care in SBHCs results in decreased utilization of emergency departments </li></ul><ul><li>Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: 30;273 </li></ul>
  15. 15. What the Literature Tell Us About Asthma and SBHCs <ul><li>Greater than 50% reduction in asthma-related emergency room visits for students enrolled in SBHCs in New York City </li></ul><ul><li>Webber MP et al. Archives of Pediatric and Adolescent Medicine. 2003; 157: 125-129 </li></ul><ul><li>$3 million savings in asthma-related hospitalization costs for students enrolled in SBHCs in New York City </li></ul><ul><li>Analysis by the Empire Health Group for the NY Coalition of School-Based Primary Care, 2005 </li></ul>
  16. 16. What the Literature Tell Us About Mental Health and SBHCs <ul><li>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. </li></ul><ul><li>Adolescents were 10-21 times more likely to come to a SBHC for mental health services than a community health center network or HMO. </li></ul><ul><li>Juszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health 2003; 32S:108-118. </li></ul><ul><li>Kaplan D, et al. Archives of Pediatric and Adolescent Medicine. 1998 </li></ul><ul><ul><li>Jan;152(1):25-33. </li></ul></ul>
  17. 17. What Science Tell Us About Education and SBHCs <ul><li>Health has both direct and indirect effects on school failure </li></ul><ul><li>Good education predicts good health </li></ul><ul><li>Inequities in health and education are closely linked: </li></ul><ul><ul><ul><li>young people who experience inequities in educational achievement also experience inequities in health care access </li></ul></ul></ul><ul><li>Public health and education are linked toward a common cause: student success </li></ul>
  18. 18. What We Know Intuitively <ul><li>Healthy students make better learners </li></ul><ul><li>You cannot teach a child who is not healthy </li></ul><ul><li>A child who succeeds in school is more likely to enjoy lifelong health </li></ul>
  19. 19. What Science Tells Us About Education <ul><li>Academic performance is negatively affected by: </li></ul><ul><ul><li>Alcohol, tobacco, and other drug use </li></ul></ul><ul><ul><li>Emotional problems </li></ul></ul><ul><ul><li>Poor diet </li></ul></ul><ul><ul><li>Intentional injuries </li></ul></ul><ul><ul><li>Physical illness </li></ul></ul><ul><ul><li>Low self-esteem </li></ul></ul><ul><ul><li>Risky sexual behavior </li></ul></ul><ul><ul><li>Lack of access to health care </li></ul></ul><ul><ul><li>Unstable home environment </li></ul></ul><ul><li>Academic performance is positively affected by: </li></ul><ul><ul><li>High levels of resiliency, developmental assets, and school connectedness. </li></ul></ul>
  20. 20. The Health-Academic Outcomes Connection SBHCs Health Risk Behaviors Educational Outcomes Educational Behaviors 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). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.
  21. 21. SBHC Outcomes and Tactics Reduce barriers to learning Increase attendance Improve student health Meet government regulations <ul><li>Identify students at-risk for health and behavioral problems </li></ul><ul><li>Assist in IEP development </li></ul><ul><li>Provide mental health services </li></ul><ul><li>Treat acute conditions </li></ul><ul><li>Manage chronic conditions </li></ul><ul><li>Provide preventive health services </li></ul><ul><li>Treat acute conditions </li></ul><ul><li>Administer medication to students with chronic conditions </li></ul><ul><li>Enroll students in health insurance </li></ul><ul><li>Provide mental health services </li></ul><ul><li>Refer students to services not provided in the SBHC </li></ul><ul><li>Provide preventive health services </li></ul><ul><li>Treat acute conditions </li></ul><ul><li>Manage chronic conditions </li></ul><ul><li>Conduct sports physicals </li></ul><ul><li>Provide mental health services </li></ul><ul><li>Immunize students </li></ul><ul><li>Participate in community initiatives on public health such as obesity and emergency planning </li></ul><ul><li>Maintain health records for migratory students </li></ul>
  22. 22. The Medical Home <ul><li>Half of SBHCs estimate more than 30% of their enrollees use the center as their medical home </li></ul><ul><li>40% of SBHCs estimate 50% or more of their enrollees use the center as their medical home </li></ul>
  23. 23. Efficiencies in SBHCs <ul><li>Parents do not need to take time off </li></ul><ul><li>Follow-up is less labor intensive </li></ul><ul><li>Ability to identifying problems earlier </li></ul><ul><li>Costly emergency room visits reduced </li></ul>
  24. 24. National Data and Trends Census 2007-08
  25. 25. SBHCs by State (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
  26. 26. SBHCs by Location (n=1226) In school building 95.7 percent On school property 2.9 percent Mobile 1.4 percent
  27. 27. SBHCs by Types of School (n=1096)
  28. 28. SBHCs by Community Characteristic (n=1235)
  29. 29. SBHCs Users by Race/Ethnicity (n=1096)
  30. 30. SBHCs by Population Served (n=1096 )
  31. 31. SBHCs by Sponsoring Agency (n=1096)
  32. 32. Services Offered by SBHCs
  33. 33. Primary Care Services Provided by SBHCs (N=1046-1075)
  34. 34. Reproductive Health Services Offered by SBHCs to Adolescents On Site (n= 1030-1068)
  35. 35. Oral Health Services Offered by SBHCs (n= 1010-1046)
  36. 36. Contraception Prohibition at SBHCs (N=1095)
  37. 37. Mental Health Services Offered by SBHCs With (n=878) and Without (n=348) Mental Health Providers

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