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

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