This document discusses expanding access to mental health care through school-based health centers (SBHCs). It notes that while SBHCs have evolved since the 1900s to address various health needs, more is still needed to fill gaps in access to mental health care for children and teens. Key changes proposed include increasing and stabilizing funding for SBHCs from federal and state governments. This would allow for improved outreach, quality measures, and accountability. The impacts of these changes would be decreased health risks and costs to society by expanding access to mental health services for underserved youth populations.
PCG Human Services White Paper - Cross-System Approaches That Promote Child W...Public Consulting Group
Child welfare agencies can successfully partner with Medicaid and managed care organizations to address the complex health and behavioral needs of children who experience maltreatment. If prevention and intervention efforts are applied early and effectively, these high-risk children and youth may avoid costly health conditions and experience improved health and psychological outcomes.
Child abuse and neglect is an important concern that negatively affects the physical and psychological well-being of a population that is already vulnerable. Increased preventive services to children in high-risk households can help states minimize the cost of health/medical services to deep-end youth, reduce the number of children with chronic medical conditions and can improve general well-being outcomes. Providing targeted prevention programs and interventions to these children of at-risk families have been shown to reduce the cost of providing intensive services to children with poor health outcomes later on.
Children who are investigated for maltreatment or enter the child welfare system have greater health needs. Children investigated by the welfare system have been found to have 1.5 times more chronic health conditions than the general population. After controlling for other risk factors, children with maltreatment reports have a 74-100% higher risk of hospital treatment. Over 28% of children involved with maltreatment investigations are diagnosed with chronic health conditions during the three years following the investigation.
Aetna Presentation Social Determinants of Latino HealthDanny Santibanez
Social Determinants of Hispanic/Latino Health
Daniel Santibanez, MPH, RD, University of North Florida
September 23, 2005 - UNF Hispanic Health Issues Seminars
This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
PCG Human Services White Paper - Cross-System Approaches That Promote Child W...Public Consulting Group
Child welfare agencies can successfully partner with Medicaid and managed care organizations to address the complex health and behavioral needs of children who experience maltreatment. If prevention and intervention efforts are applied early and effectively, these high-risk children and youth may avoid costly health conditions and experience improved health and psychological outcomes.
Child abuse and neglect is an important concern that negatively affects the physical and psychological well-being of a population that is already vulnerable. Increased preventive services to children in high-risk households can help states minimize the cost of health/medical services to deep-end youth, reduce the number of children with chronic medical conditions and can improve general well-being outcomes. Providing targeted prevention programs and interventions to these children of at-risk families have been shown to reduce the cost of providing intensive services to children with poor health outcomes later on.
Children who are investigated for maltreatment or enter the child welfare system have greater health needs. Children investigated by the welfare system have been found to have 1.5 times more chronic health conditions than the general population. After controlling for other risk factors, children with maltreatment reports have a 74-100% higher risk of hospital treatment. Over 28% of children involved with maltreatment investigations are diagnosed with chronic health conditions during the three years following the investigation.
Aetna Presentation Social Determinants of Latino HealthDanny Santibanez
Social Determinants of Hispanic/Latino Health
Daniel Santibanez, MPH, RD, University of North Florida
September 23, 2005 - UNF Hispanic Health Issues Seminars
This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
Improve Outcomes for Children in Foster Care by Reforming Congregate Care Pay...Public Consulting Group
In child welfare, there is growing emphasis on keeping children at home, and when that isn’t possible, placing them with relatives or in other family-like settings. Secure attachments to consistent caregivers are critical for the healthy development of children and youth, especially for very young children.Congregate care placements are also significantly costlier than traditional foster care or kinship care placements.
Addressing health equity & the risk in providing careEvan Osborne
What Is Health Equity & Why Should It Be Addressed?
How Does Health Equity Impact Providers & Payors?
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
How Can Health Equity Be Addressed Through Technology?
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
Sample Report on International Healthcare policy By Global Assignment HelpAmelia Jones
Sample Report on International Healthcare policy By Global Assignment Help.This report is prepared to analyze the formation of healthcare policy in an international context and discussed contemporary issues in International Healthcare policy.
GA House Study Committee on Health, Education, and School-Based Health Centers
Dr. Veda Johnson , Director of Partners for Equity in Child & Adolescent Health, Emory Univ School of Medicine
www.gacommissiononwomen.org
Improve Outcomes for Children in Foster Care by Reforming Congregate Care Pay...Public Consulting Group
In child welfare, there is growing emphasis on keeping children at home, and when that isn’t possible, placing them with relatives or in other family-like settings. Secure attachments to consistent caregivers are critical for the healthy development of children and youth, especially for very young children.Congregate care placements are also significantly costlier than traditional foster care or kinship care placements.
Addressing health equity & the risk in providing careEvan Osborne
What Is Health Equity & Why Should It Be Addressed?
How Does Health Equity Impact Providers & Payors?
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
How Can Health Equity Be Addressed Through Technology?
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
Sample Report on International Healthcare policy By Global Assignment HelpAmelia Jones
Sample Report on International Healthcare policy By Global Assignment Help.This report is prepared to analyze the formation of healthcare policy in an international context and discussed contemporary issues in International Healthcare policy.
GA House Study Committee on Health, Education, and School-Based Health Centers
Dr. Veda Johnson , Director of Partners for Equity in Child & Adolescent Health, Emory Univ School of Medicine
www.gacommissiononwomen.org
Note Compare and contrast public health funding (and resulting im.docxcurwenmichaela
Note: Compare and contrast public health funding (and resulting impacts on service and program delivery) in your area. How does funding impact the quality of public health?
Response one –PHM-03
In healthcare we depend on the physicians to heal us from any type of illness that we may have, and we also depend on our state and local public health departments to be our ambassadors when it comes to preventing diseases and injuries by keeping us healthy and safe. For that to happen we need public health programs which are financed through a variety of state, federal, and local appropriations. On the local level side, the funds come from local taxes, fees, and Medicaid and Medicare reimbursements for services (Salinsky, 2010). This helps to fund California’s local government programs including education, police/fire protection, welfare, transportation, and healthcare. On the other hand, California’s state government programs are funded through federal appropriations including healthcare license inspections to fund healthcare, education, pensions, family health, Alcohol and drugs, and air pollution (Salinsky, 2010).
The current standards that are in place for the way public health service are funded needs to be revamped considering how so many people are losing their job because of underfunding. This is evident as public health budgets have been decreasing in recent years that local health departments have been struggling to keep people on board. To meet the needs of the public you have be able to promote quality while making sound organizational improvements but if you are not able to have enough staff then how you can be able to offer services that will not last due to funding. Another reason they need to revamp the system is because whenever there is a shortage in money the effect is devastating to those in low-income or impoverished areas since they seem to need the programs the most but are always the first to get them cut. It is understandable that money needs to be spread out through out the local and states, but better financial decisions need to be made so this doesn’t happen.
reference
Salinsky, Eileen, Governmental Public Health: An Overview of State and Local Public Health Agencies National Health Policy Forum Background Paper No. 77 8 (2010),
Richardson Jesse, Jr. et al., Is Home Rule The Answer? Clarifying The Influence of Dillon's Rule On Growth Management, Brookings Institute (2003)
Response two PHM-03
There are many public health services that are funded at the state level. New York State has funding for different programs, including: the Assisted Living Program, the Preventive Health/Health Services Block Grant, the New York State Child/Adult Care Food Program, the Infertility Demonstration Program, the Drinking Water State Revolving Fund, and the Sexual Assault Forensic Examiner (SAFE) Program (New York State Department of Health [NYSDOH], 2018). For the Preventive Health and Health Services (PHHS) Block Grant, it p ...
You should respond to at least two of your peers by extending- refutin.docxjosee57
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
Post #1
Jenna Horgan
NUR 420
Professor Roberts
January 12, 2023
Who are the clients in Community Health nursing?
Individuals, families, and groups who live in a specific geographic area and may be at risk for health problems or in need of health services are considered clients in community health nursing. People of all ages, from infants to the elderly, as well as those with physical, mental, or social challenges, may be included. The purpose of community health nursing is to promote the health and well-being of the entire community by addressing the health needs of its individual members (Rector & Stanley, 2021). Community health nurses work with clients to identify and address health risks, provide health and wellness education, and connect clients to suitable health services.
What government resources might they be eligible for?
Individuals and families may be eligible for a variety of government resources depending on their circumstances. Some of these resources are intended specifically for people with low incomes or who are experiencing financial hardship, while others are open to anyone who meets certain criteria. Among the resources available to them are (ISPOR, n.d):
1. Medicaid: It is a federal-state partnership program that provides health insurance to low-income individuals and families. Individuals must meet income and asset limits, as well as other requirements, to be eligible.
2. Children's Health Insurance Program (CHIP): It is a federally funded program that provides health insurance to low-income children that are not eligible for Medicaid but cannot afford private health insurance. It provides coverage for a variety of medical services, such as preventive care, doctor visits, hospital stays, and prescription medications. Eligibility is determined by income and family size.
3. Supplemental Nutrition Assistance Program (SNAP): It is also known as food stamps and it provides financial assistance to low-income individuals and families in order for them to purchase food. Income and assets, as well as other factors, determine SNAP eligibility.
4. Temporary Assistance for Needy Families (TANF): This program helps low-income families with children by providing financial assistance as well as other services such as job training and childcare. Income and assets, as well as other factors, determine TANF eligibility.
5. Low Income Home Energy Assistance Program (LIHEAP): It is program funded by the federal government that provides low-income households with financial assistance to help them pay for home energy costs such as heating and cooling. The Department of Health and Human Services (HHS) administers the program, which is intended to assist households that are struggling to pay their energy bills and may face having their service disconnected. Eligibility is determined by income and family size.
What ag.
Going Where the Kids Are: Starting, Growing, and Expanding School Based Healt...CHC Connecticut
Webinar broadcast on: June 28 | 3 P.M. EST
This webinar will address the benefits, challenges, and strategic advantages of a school based health center program from a clinical, data, quality, operational viewpoint, communications, and community engagement perspective. Experts will share the strategy for integrating oral health and behavioral health to ensure the best outcomes for patients.
Care Coordination in a Medical Home in Post-KatrinaNew OrleaTawnaDelatorrejs
Care Coordination in a Medical Home in Post-Katrina
New Orleans: Lessons Learned
Susan Berry • Eleanor Soltau • Nicole E. Richmond •
R. Lyn Kieltyka • Tri Tran • Arleen Williams
Published online: 14 July 2010
� Springer Science+Business Media, LLC 2010
Abstract This is a prospective study to evaluate ability of a
nurse care coordinator to: (1) improve ability of a pediatric
clinic to meet medical home (MH) objectives and (2)
improve receipt of services for families of children with
special health care needs (CSHCN). A nurse was hired to
provide care coordination for CSHCN in an urban, largely
Medicaid pediatric academic practice. CSHCN were iden-
tified using a CSHCN Screener. Ability to meet MH criteria
was determined using the MH Index (MHI). Receipt of MH
services was measured using the MH Family Index (MHFI).
After baseline surveys were completed, Hurricane Katrina
destroyed the clinic. Care coordination was implemented for
the post-disaster population. Surveys were repeated in the
rebuilt clinic after at least 3 months of care coordination. The
distribution of demographics, diagnoses and percent
CSHCN did not significantly change pre and post Katrina.
Psychosocial needs such as food, housing, mental health and
education were markedly increased. Essential strategies
included developing a new tool for determining complexity
of needs and involvement of the entire practice in care
coordination activities. MHFI showed improvement in
receipt of services post care coordination and post-Katrina
with P \ 0.05 for 13 of 16 questions. MHI demonstrated
improvement in care coordination and community outreach
domains. Average cost was $36.88 per CSHCN per year.
There was significant improvement in the ability of the clinic
to meet care coordination and community outreach MH cri-
teria and in family receipt of services after care coordination,
despite great increase in psychosocial needs. This study pro-
vides practical strategies for implementing care coordination
for families of high risk CSHCN in underserved populations.
Keywords Care coordination � Medical home �
Children with special healthcare needs (CSHCN) �
Title V CSHCN � Hurricane Katrina
Eleanor Soltau has relocated to Atlanta, Georgia, after her
involvement with this research.
S. Berry (&) � N. E. Richmond � A. Williams
Department of Pediatrics, Louisiana State University
Health Sciences Center, 1010 Common Street Suite #610,
New Orleans, LA 70112, USA
e-mail: [email protected]
N. E. Richmond
e-mail: [email protected]
A. Williams
e-mail: [email protected]
E. Soltau
Children’s Hospital Medical Practice Corporation,
New Orleans, LA, USA
e-mail: [email protected]
S. Berry � N. E. Richmond � A. Williams
Louisiana Office of Public Health, Children’s Special Health
Services, New Orleans, LA, USA
R. L. Kieltyka � T. Tran
Department of Pediatrics, Louisiana State University Health
Sciences Center, 1010 Common Street Suite #2710,
New Orleans, LA 7011 ...
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
Wellness and HealthWellness refers to the state of bein.docxhelzerpatrina
Wellness and Health
Wellness refers to the state of being in good health. Wellness is essential for one to work effectively so that the set goals are met. For the goals to be realized, all the seven areas of health are important because they are connected. The first area of health is education. Education is one of the indicators of life outcomes, for instance, social status, employment, and income and can also be used to predict wellbeing and attitude (Anderson, 2015). Other people apply education as a tool that helps them in shaping their social identity and establishing an understanding of their environment. Education shapes the social identity on how people relate with each other in society. A positive social identity is characterized by positive results, such as increased health status, wellbeing, political engagement, and social trust. Currently, a lot of emphases has been placed on education, and therefore those with lower education find it much challenging to positively identify themselves socially hence negatively affecting their self-esteem and wellbeing (Anderson, 2015).
Individuals with higher education levels tend to develop much interest to vie for political positions than those with lower levels of education. These educated individuals also have got more social trust than their uneducated counterparts — several studies confirmed that there are a number of health benefits of education. Baum &Payea (2013) explains that a more educated person has a higher probability of getting a good job with health-promoting packages such as health insurance. On the other hand, those with low education have higher chances of doing risky jobs. Those individuals who are more educated are subjected to more earnings. A Population Survey conducted by the U.S. Department of Labor and the United States Bureau of Labor Statistics in 2012 confirmed that college graduates registered twice as many average earnings than their colleagues who had dropped out of high school and one and a half higher than those who had graduated from high school (Baum &Payea, 2013).
The families that earn more income are in a position to buy healthy food, can get time to perform exercises and can afford to pay for health services and transport cost. Consequently, low level of education brings about job insecurity, poor pay and the vulnerability of these individuals and their families are much higher during hard times leading to poor housing, malnutrition, and inability to afford medical services. Individuals with higher education levels and therefore, have got higher incomes do not suffer from health-related stress that is attached to chronic social and economic hardships (Baum &Payea, 2013). The category of individuals with lower levels of education has limited resources such as social support, a feeling of control over life, and high self-esteem to counter the stress.
Education from school and outside school enables individuals to acquire skills and foster traits that they w ...
Telehealth Impact on Middle School Mental HealthJennaBuggs
This is a literature review that examines House Bill 9 and the impact of the implementation of telehealth to address behavioral and mental health issues in public schools. This literature review examines families and individuals in societal contexts as I discuss the internal dynamics of family and the role that parents and communities can play to support adolescent mental health. I address family resource management and how goal setting can be used to educate and train parents to fulfill their responsibilities. I also address public policy and how House Bill 9 can be used to holistically address community, family, and individual well-being. To address these content areas I utilized competencies such as evaluating programs, corresponding with others, prioritizing community responsibilities, modifying existing policy, developing goals, and collecting information.
Improving the Health Outcomes of Both Patients AND PopulationsCHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 23, 2019 | 2 p.m. EST
In this webinar experts will share their journey in planning, preparing and launching a population health initiative. With the goals of impacting population health outcomes while ensuring cost effectiveness, our experts designed interventions to eliminate gaps in care, particularly among special populations.
1. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 1
Expanding Mental Health Care Access through School Based Health Centers
Leah M. Schreder
Saint Mary's University of Minnesota
Schools of Graduate & Professional Programs
HP 652 Health Policy
Susan Doherty
December 20, 2015
2. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 2
Expanding Mental Health Care Access through School Based Health Centers
Introduction
Access to mental health care for children and teens is an area of need when addressing
healthcare operations. An effective way to address these needs is through School Based
Healthcare Centers (SBHCs). SBHCs are not a new idea and were first introduced in the 1900’s,
initially based on contagious illness containment (Keeton, Soleimanpour, & Brindis, 2012).
According to Keeton, Soleimanpour, and Brindis (2012), the first school nurse was hired and
began treating children using a variety of methods, which decreased the rates of absenteeism by
90%. Since then, SBHCs have evolved to cover projects helping teenage mothers, increasing
access to overall care and immunizations, and to meet the mental health needs of the underserved
population. SBHCs offer a convenient way for those children who are underserved to have
access to mental health treatment plans through proximity. The stigma of mental health care is
decreased since services can be provided without having to go offsite while attending school.
Even with the advancements in mental health care access, much more is needed to fill in
gaps in access. One specific change in policy is to induce an increase in predictable, steady
funding for SBHCs. Besides making funding more predictable and expanding it, more outreach
programs are needed within the school setting based on increasing knowledge of cultural needs
and disparities. Lastly, the evaluation of SBHCs and quality of service should be improved and
specific outcomes and models need to be defined as the number of centers increase.
Justification for Change
Since the Affordable Care Act (ACA) was passed, many cultural groups suffering
disparities in health care access have seen a decrease in inequality, however, children have not
gained additional access to insurance through eligibility levels within Medicaid or Children’s
3. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 3
Health Insurance Program (CHIP) (Estes, Chapman, Dodd, Hollister, & Harrington, 2013).
Approximately 20% of adolescents meet diagnostic criteria for a mental disorder with severe
impairment, however, only about one-third of identified adolescents obtain treatment (Keeton,
Soleimanpour, & Brindis, 2012).
Children’s mental health affects many social and economic areas, in a cyclical
relationship, creating a need for additional change. The American Public Health Association’s
(APHA) Center for School, Health, and Education (2011) reported the strongest predictor of high
school dropout status is mental/emotional dysfunction and substance use. In addition,
educational disparities, or adults with a low level of education, are more likely to develop
cardiovascular disease, cancer, infections, lung disease, and diabetes (APHA Center for School,
Health, and Education, 2011). To infer that the levels of academic achievement and health status
are strongly correlated to good mental health would be deemed appropriate. Therefore,
addressing mental health needs in children will reduce future economic and societal problems.
Overview of Professional Organization, Regulation, and Laws
The most closely linked professional organization related to SBHCs and children’s
mental health is the APHA’s Center for School, Health, and Education. The center is organized
around the premise of preventing school dropouts and improving graduation rates by addressing
learning barriers such as bullying, hunger, and distress (APHA Center for School, Health, and
Education, 2015). APHA’s Center for School, Health, and Education focuses on increasing the
number of SBHCs to meet health care needs in children and adolescents. The Substance Abuse
and Mental Health Services Administration (SAMHSA) (2015, October 13) is also supportive of
the promotion of mental health wellness in schools in order to provide a safe learning
environment for students. SAMHSA (2015, October 13) reported that over the last two decades,
4. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 4
the amount of mental health conditions have continued to increase, which is one reason why
SAMHSA offers grants programs and other resources that promote mental and emotional health
in schools and on campuses.
In 2004, the W.K. Kellogg Foundation developed the School-Based Health Care Policy
Program (SBHCPP), which focused efforts on making SBHCs financially stable, increasing
access to children and families, and supported consumer-centered care (APHA Center for
School, Health, and Education, 2015). At this time, 1709 school-connected programs that had a
difficult time maintaining adequate reliable sources of revenue were identified, serving the most
vulnerable populations, which included uninsured and underinsured children (APHA Center for
School, Health, and Education, 2015). SBHCPP’s design was based on developing infrastructure
needed for SBHCs, strengthening the capacity of the National Assembly of School-Based Health
Care to advocate for policy change to increase sustainability of SBHCs (APHA Center for
School, Health, and Education, 2015). Eventually, the federal recognition of SBHCs as
providers able to obtain reimbursement through Children’s Health Insurance Program
Reauthorization Act (CHIPRA) was accomplished (APHA Center for School, Health, and
Education, 2015).
The National Conference of State Legislatures (October 2011) provided information on
federal provisions, information and conditions for grant money, including states’ roles in
implementing health reform within the area of SBHCs. The ACA set aside $50 million for
grants in each fiscal year between 2010 and 2013 (National Conference of State Legislatures,
October 2011). The money was for basic construction and to support operations of SBHCs.
Some of the federal provisions under section 4101 (a) described eligibility for grants wherein
SBHCs needed to be primarily described as “a health clinic in or near a school, is organized
5. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 5
through school, community, and health provider relationships, is administered by a sponsoring
facility, and provides primary health services to children in accordance with state and local law
through health professionals” (National Conference of State Legislatures, 2011). Additionally,
preferences for grants were made to SBHCs that served higher proportions of children eligible
for Medicaid or CHIP (National Conference of State Legislatures, 2011). The states’ roles in
SBHC regulation have been to provide oversight of SBHCs as well as stand as the primary
funding source.
Stakeholders
Adolescents are especially in need of mental health care due to the fact that they engage
in risky behaviors that can affect their present health and health status in the future (Keeton,
Soleimanpour, & Brindis, 2012). They require additional guidance when it comes to sensitive
needs such as mental health care. SBHCs provide care that is connected to high levels of
satisfaction and studies have shown that students are much more likely to keep appointments
through SBHCs (Keeton, Soleimanpour, & Brindis, 2012). It would be beneficial to provide a
service that is both highly satisfying and increases maintenance of services. Patients are more
likely to continue care and treatment when relationships and services are meeting their personal
needs.
SBHC providers are constantly challenged with the task of providing evidence or data
that their work is improving health and educational outcomes for its patients. There is a
correlation between evaluations and production of increases in access, improved outcomes, and
achieved, high levels of satisfaction. The issue remains that financial resources are limited along
with the narrow range of services while restrictions based on privacy keeps monitoring
challenging, or at the very least extremely laborious. SBHC providers also have a difficult time
6. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 6
finding a steady source of income from year to year. Relying on private donations is difficult to
predict and is problematic when SBHCs provide services to all students with or without
insurance.
Payers for SBHCs are diverse and school based centers finance their operations based on
the types of financial revenue they acquire. Keeton, Soleimanpour, and Brindis (2012) reported
NASBHC’s 2008 national census of SBHCs reported the use of non-patient billing revenue. The
sources used were: state government (76% of SBHCs), private foundations (50%), sponsoring
organizations (49%), school districts (46%), and federal government (39%) (Keeton,
Soleimanpour, & Brindis, 2012). The study also concluded that most SBHCs bill public
insurance programs (Keeton, Soleimanpour, & Brindis, 2012). The sustainability of SBHCs will
be the passage of legislation providing more funding through the state and federal government.
SBHCs survival will also be based on the amount of community support and resources that are
available, which can be difficult, specifically because most SBHCs are already serving a
majority of uninsured or underinsured population where resources are already limited.
Procedure and Practices
SBHCs are health providers that provide services to every student in need. Within their
practice and procedures should be an outreach to patients. Such activities could begin with
surveys or screenings for the intended population. Because services are provided within or near
schools, school personnel should have a clear understanding on procedures of intake in order to
become primary sources of referrals. Providers working within SBHCs should have knowledge
of best practices and be provided trainings on how to interact with the population of students,
including cultural trainings and trainings on the sensitive nature of mental health needs. SBHCs
integrate within the school community, building educational opportunities and healthy
7. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 7
relationships with staff, parents, and students. SBHCs should develop programs to introduce
healthy activities that promote mental health and a sense of community, with positive programs
defining mental health initiatives such as preventing bullying, understanding depression, and
breaking down stereotypes of mental health diagnoses. Case management should be used to
follow and provide services to those with chronic mental health needs, especially monitoring of
medication and frequent documentation based on teacher observations within school. SBHCs
should set regular meetings to discuss changing health needs within the school setting as well as
provide assistance to school staff as to managing their own stress and wellness within the
workplace. Besides day-to-day procedures and practices, SBHCs should be financially stable
putting effort into budget management and expense reimbursement. If needed, depending on the
amount of expenditures and the state in which the center resides, fiscal audits should be included
in the SBHCs practices and procedures also.
Ethical Considerations
Children and teens with mental health care needs have several types of ethical issues
worth considering when discussing a change initiative. Cultural disparities have been discovered
in access to general healthcare itself, although within SBHCs, studies have found that disparities
are very slight with few significant discrepancies. When discussing general health care services,
SBHCs delivered equitable access regardless of demographics or socioeconomic status
(Parasuraman & Shi, 2015). Parasuraman and Shi (2015) also concluded that very few
significant discrepancies were found when considering gender, race/ethnicity, and insurance
status. In contrast, when focusing on adolescents with serious emotional concerns and female
adolescents, differences in unmet needs were found in mental health care (Parasuraman & Shi,
2015). Unmet mental health needs for female and underserved adolescents were observed the
8. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 8
most while these groups were at the highest risk of being undiagnosed or developing mental
health disorders (Parasuraman & Shi, 2015). Ethically, SBHCs will need to address the
inequality of female and adolescents with serious emotional concerns to ensure mental health
care is provided in the most equitable way possible across the board. Other ethical issues that
need to be addressed are use of active consent to provide services versus passive consent.
Passive consent may be helpful to students who desperately need care and parental supervision is
not consistent where consent may be delayed. It would allow some cases to begin treatment
immediately; where as active consent would hinder the immediate response to needed care.
However, passive consent may put organizations at risk for legal issues, depending on the
satisfaction of results or outcomes.
Proposed Changes in Policy, Procedures, and Practices
In order to provide students in need of mental health care the care they need, SBHC
providers need change their procedures to increase the use of quality measures that will identify
areas of organization weakness and areas that need improvement. Those measures should
generally focus on qualities of a strong SBHC operation such as capacity, efficiency, and
sustainability (California School-Based Health Alliance, 2014). The quality of care should also
be measured in terms of access and timelines, as well as, coordination and continuity. Areas
such as general preventive behaviors and management of chronic disease, in terms of mental
health, could be measured to assess areas in need of improvement (California School- Based
Health Alliance, 2014).
Improvements in SBHCs, and changes in practice, include increasing outreach programs.
Likewise, SBHCs need to maintain and build stronger relationships with students, as well as,
parents and guardians. Review of the outreach measures should be set on a regular schedule to
9. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 9
be discussed with a sample group including providers and SBHCs employees, along with school
administration, the school board, and other school staff members. Brochures should be produced
to clearly outline services provided and the unique benefits to having them provided within the
SBHC. SBHCs need to continue open communication with parents by offering “open houses” so
that parents may be able to visit the organization physically and ask questions face-to-face.
Outreach could additionally include activities that are not specifically based on showing the
community what is offered at the care center, but may simply build relationships that would
increase trust, such as hosting family sporting events or partnering with local businesses to
fundraise through banquets or other events such as silent auctions. SBHC employees could
further consider volunteering to improve the community as whole, such as gathering groups to
clean up local parks, beaches, or picking up on a main street in town spreading information about
the center by word of mouth (Mackie, 2014).
Based on funding numbers previously provided, a stabilization and eventual increase of
federal and state funding for SBHCs must be part of a change in policy. Without more federal
and state funding, it’s difficult to predict the expansion of much needed SBHCs. Healthcare
reform focuses on increasing accountability for all healthcare organizations, including SBHCs.
Increasing measures of quality should provide validation of the important role SBHCs have in
providing mental health care, especially to youth. Due to mental health care’s sensitive nature
and the need for immediate care, it should be easy to provide numbers using outcome measures
and data proving the importance of providing increased access for this vulnerable population
within schools.
10. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 10
Impacts of Change
Making changes within the SBHCs mental health funding process will create many
benefits to society as a whole. Keeton, Soleimanpour, and Brindis (2012) report that uninsured
and underinsured children and adolescents are at a high risk for not having healthcare needs met,
such as mental health services. That risk would be decreased and children and adolescents
would have a predictable, sustained follow up on mental health care with more access to
healthcare. When children are not well, either physically or emotionally, parents need to stay
home with them, creating economic hardship for the family. In the research done by Keeton,
Soleimanpour, and Brindis (2012), “adolescents were 10 to 21 times more likely to prefer
visiting an SBHC over CHC for mental health care, and enhanced availability of care was cited
as one of the likely reasons for this preference”. Based on the information, it would be probable
that more children and teens would be reached to provide much needed services.
Because mental health is linked to other health risks such as cardiovascular disease,
diabetes, and other chronic ailments outlined previously, these rate would decrease and affect
that amount of money spent on treating these diseases. In addition, providing more services
would increase the need for more healthcare providers creating more jobs in the healthcare field,
including medical equipment. Creating clinics within schools would increase jobs in other
industries as well, such as construction.
Influencing, Advocating, and Lobbying for Change
Advocating and lobbying for change should be centered mainly on outcome based
measurements. It’s difficult to argue with statistics and actual numbers based on measurements
defining the unique characteristics of SBHCs. Information should be presented in an informative
way focusing on benefits in healthcare but also benefits to society. Specific community numbers
11. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 11
should be included in preparing for advocating SBHCs. Lobbying would include the same types
of information while adding quality measures into the information, toward pushing for an
increase in federal and state funding. Selling SBHCs should be the focus, so that SBHCs can
work on increasing accountability and quality without the worry of extreme financial shortages.
Conclusion
In closing, the amount of access to mental health care and accountability within SBHCs
cannot be duplicated in another setting. The population that is served by these centers, children
and teens, are dependent on others to take necessary steps to provide mental health care.
Outreach for these programs simply need to be where the population maintains their daily routine
to increase access to the care they need provided. SBHCs reduce the amount of transportation
needed to receive services, the time associated with parents needing work leave to provide
services, and increase the likelihood of follow-up services after care. SBHCs should be
recognized as an essential need for children and teens to provide mental health care in the most
sensible, appropriate setting possible and programs for increased revenue should be expanded.
12. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 12
References
American Public Health Association’s Center for School, Health, and Education. (2015).
Retrieved from http://www.schoolbasedhealthcare.org/
American Public Health Association’s Center for School, Health, and Education. (2011). The
dropout crisis: A public health problem and the role of school-based health care.
Retrieved from http://www.schoolbasedhealthcare.org/wp-
content/uploads/2011/09/APHA4_article_DropOut_0914_FINAL3.pdf
California School- Based Health Alliance. (2014). Key performance measures for school-based
health centers. Retrieved from http://www.schoolhealthcenters.org/wp-
content/uploads/2014/10/CSHA-Key-Performance-Measures-for-SBHCs.pdf
Department of Health & Human Services, USA. (2010). Connecting kids to coverage:
Continuing the progress the 2010 CHIPRA annual report. Retrieved from
http://www.insurekidsnow.gov/professionals/reports/chipra/2010_annual.pdf
Estes, C., L., Chapman, S., A., Dodd, C., Hollister, B., & Harrington, C. (2013). Health policy:
Crisis and reform. Burlington, MA: Jones & Bartlett Learning.
Keeton, V., Soleimanpour, S., & Brindis, C. D. (2012). School-Based Health Centers in an Era
of Health Care Reform: Building on History. Current Problems in Pediatric and
Adolescent Health Care, 42(6), 132–158. http://doi.org/10.1016/j.cppeds.2012.03.002
Mackie, D. (2014, September, 30). Why marketing your small business through community
outreach really works. Retrieved from http://blog.fundinggates.com/2014/09/small-
business-marketing-ideas-community-outreach/
Parasuraman, S. R., & Shi, L. (2015). Differences in Access to Care Among Students Using
School-Based Health Centers. The Journal Of School Nursing: The Official Publication
13. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 13
Of The National Association Of School Nurses, 31(4), 291-299.
doi:10.1177/1059840514556180
SBHC Best Practices Checklist. Reteived from http://thelatrust.org/wp-
content/uploads/2012/12/SBHC-Principles-Checklist-July-2014.pdf
Substance Abuse and Mental Health Services Administration. (2015, October, 13). School and
campus health. Retrieved from http://www.samhsa.gov/school-campus-health
14. MENTAL HEALTH IN SCHOOL BASED HEALTH CENTERS 14
Expanding Mental Health Care Access through School Based Health Centers
Mental health care services can be provided to children and teens by increasing the
quality and number of School Based Health Centers (SBHCs). Evidence has shown the need for
mental health care for children and teen continues to increase. In addition, research has shown
that students are highly satisfied with services provided by SBHCs and more likely to keep
appointments. After care and follow up care of SBHC providers is easily attained, being in close
proximity of patients. Although the need is increasing, funding for SBHCs continues to be
unstable and unpredictable.
Approximately 20% of adolescents meet diagnostic criteria for a mental disorder with
severe impairment, however, only about one-third of identified adolescents obtain
treatment (Keeton, Soleimanpour, & Brindis, 2012).
NASBHC’s 2008 national census of SBHCs reported the use of non-patient billing
revenue. The sources used were: state government (76% of SBHCs), private foundations
(50%), sponsoring organizations (49%), school districts (46%), and federal government
(39%) (Keeton, Soleimanpour, & Brindis, 2012).
Adolescents were 10 to 21 times more likely to prefer visiting an SBHC over CHC for
mental health care, and enhanced availability of care was cited as one of the likely
reasons for this preference (Keeton, Soleimanpour, and Brindis, 2012).
A 50% decrease in absenteeism and a 25% decrease in tardiness two months after
receiving school-based mental health counseling (American Public Health
Association’s Center for School, Health, and Education, 2011).
Recommendations for Change:
1.) Increase outreach programs 2.) Increase federal and state funding 3.) Increase quality