school-based health care 101 understanding the basics 1

School-Based Health Care

101Understanding the Basics

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ObjectivesObjectives

Participants will be able to:– Define the term school-based health care– Explain why school-based health centers

(SBHCs) are an effective health care delivery system for children and adolescents

– Answer the question: how many SBHCs are there in the US and where are they located

– Describe who uses SBHCs

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What is a School-Based Health What is a School-Based Health Center (SBHC)?Center (SBHC)?

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School-Based Health Center School-Based Health Center National DefinitionNational Definition

PartnershipsPartnerships created by created by schools and schools and community health organizationscommunity health organizations to to provide provide on-siteon-site medical, mental health, medical, mental health, and/or oral health services that promote the and/or oral health services that promote the health and educational successhealth and educational success of of school-aged children and adolescentsschool-aged children and adolescents

One of the partnersOne of the partners, usually a health , usually a health agency (community health center, local agency (community health center, local health department, hospital, mental health health department, hospital, mental health agency, or 501 C3 agency), or a school agency, or 501 C3 agency), or a school system becomes the system becomes the sponsoring agency sponsoring agency

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Services provided by the school-based Services provided by the school-based health care team are health care team are determined locallydetermined locally through a through a collaborative processcollaborative process that that includes families and students, includes families and students, communities, school districts, and individual communities, school districts, and individual and agency health care providers.and agency health care providers.

The school-based health care team The school-based health care team works works in collaboration with school nurses and in collaboration with school nurses and other service providersother service providers in the school and in the school and community.community.

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SBHCs have a SBHCs have a policypolicy on on parental parental consentconsent..

Although the model may vary based on Although the model may vary based on availability of resources and community availability of resources and community needs, SBHCs are needs, SBHCs are typically open every typically open every school dayschool day, and , and staffed by an staffed by an interdisciplinary team interdisciplinary team of medical and of medical and mental health professionals that mental health professionals that provide provide comprehensive medical, mental health comprehensive medical, mental health and health education servicesand health education services..

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SBHCs make SBHCs make provisions for care beyondprovisions for care beyond the centers’ the centers’ operating hoursoperating hours or or scope of scope of serviceservice

Because ofBecause of the the unique vantage pointunique vantage point and and access to studentsaccess to students, the health center , the health center team is able to reach out to students to team is able to reach out to students to emphasize preventionemphasize prevention and and early early intervention.intervention.

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Services provided by the school-based Services provided by the school-based health care team are health care team are determined locallydetermined locally through a through a collaborative processcollaborative process that that includes includes familiesfamilies and and studentsstudents, , communitiescommunities, , school districtsschool districts, and , and individualindividual and agency health care and agency health care providers.providers.

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ServicesServices typically offered in SBHCs typically offered in SBHCs are age are age appropriateappropriate and and address address tthehe most most important health needs of children and important health needs of children and youthyouth. .

These services may include but are not limited These services may include but are not limited to: to: primary careprimary care for acute and chronic health for acute and chronic health conditions, conditions, mental health servicesmental health services, , substance abuse servicessubstance abuse services, , case case managementmanagement, , dental health servicesdental health services, , reproductive health carereproductive health care, , nutrition nutrition education, health education and health education, health education and health promotionpromotion. .

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SBHCs are SBHCs are supported bysupported by local, state, and local, state, and federal public health and primary care federal public health and primary care grantsgrants, , community foundationscommunity foundations, , students and students and familiesfamilies, and , and reimbursementreimbursement from from public public and private and private health insurancehealth insurance..

Why School-Based Health Why School-Based Health Centers?Centers?

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Why School-Based Health Why School-Based Health Centers?Centers?

Uninsurance among children, especially Uninsurance among children, especially adolescentsadolescents

Geographic and financial barriers to health, Geographic and financial barriers to health, mental health and dental accessmental health and dental access

Dangerous health outcomes associated with Dangerous health outcomes associated with adolescentsadolescents

Nonexistent/fragmented/singular discipline Nonexistent/fragmented/singular discipline systems of caresystems of care

Decreased educational attainmentDecreased educational attainment

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The Evidence Base for School-The Evidence Base for School-Based Health CareBased Health Care

Research Published in Professional LiteratureResearch Published in Professional Literature National and State DataNational and State Data

– National State Initiative SurveyNational State Initiative Survey– NASBHC Biennial censusNASBHC Biennial census– White papers White papers

Training and technical assistance in the fieldTraining and technical assistance in the field

– Results of beta testing tools and resourcesResults of beta testing tools and resources– Collaboratives Collaboratives

Pre and post assessments, chart reviews, Pre and post assessments, chart reviews, progress reports, storyboards, consultation calls progress reports, storyboards, consultation calls

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What Does the Literature Tell Us What Does the Literature Tell Us About About Emergency Room UseEmergency Room Use and and SBHCs?SBHCs?

Reduced inappropriate emergency room use, Reduced inappropriate emergency room use, Increased use of primary care, and Increased use of primary care, and Fewer hospitalizationsFewer hospitalizations

Santelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19:267-275Santelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19:267-275

Prevention-oriented care in SBHCs results in Prevention-oriented care in SBHCs results in decreased utilization of emergency decreased utilization of emergency departmentsdepartments

Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: 30;273 30;273

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What Does the Literature Tell Us What Does the Literature Tell Us About About AsthmaAsthma and SBHCs? and SBHCs?

> 50% reduction in asthma related > 50% reduction in asthma related emergency room visits for students enrolled emergency room visits for students enrolled in SBHCs in New York Cityin SBHCs in New York City

Webber MP et al. Archives of Pediatric and Adolescent Medicine. Webber MP et al. Archives of Pediatric and Adolescent Medicine. 2003; 157: 125-129 2003; 157: 125-129

$3 million savings in asthma-related $3 million savings in asthma-related hospitalization costs for students enrolled in hospitalization costs for students enrolled in SBHCs in New York CitySBHCs in New York City

Analysis by the Empire Health Group for the NY Coalition of School-Analysis by the Empire Health Group for the NY Coalition of School-Based Primary Care, 2005Based Primary Care, 2005

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What Does the Literature Tell Us What Does the Literature Tell Us About About Mental HealthMental Health and SBHCs? and SBHCs?

Attract harder-to-reach populations, especially Attract harder-to-reach populations, especially minorities and males, do a better job at minorities and males, do a better job at getting them crucial services such as mental getting them crucial services such as mental health care and high risk screenshealth care and high risk screens

Adolescents were 10-21 times more likely to Adolescents were 10-21 times more likely to come to a SBHC for mental health services come to a SBHC for mental health services than a community health center network or than a community health center network or HMOHMOJuszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health Juszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health

2003; 2003; 32S:108-118.32S:108-118.Kaplan D, et al. Archives of Pediatric and Adolescent Medicine. 1998 Kaplan D, et al. Archives of Pediatric and Adolescent Medicine. 1998 Jan;152(1):25-33.Jan;152(1):25-33.

What Does Science Tell Us About What Does Science Tell Us About EducationEducation and SBHCs and SBHCs

Health has both direct and indirect effects on Health has both direct and indirect effects on school failureschool failure

Good education predicts good healthGood education predicts good health Inequities in health and education are Inequities in health and education are

closely linked: young people who experience closely linked: young people who experience inequities in educational achievement also inequities in educational achievement also experience inequities in health care access experience inequities in health care access

Public health and education are linked Public health and education are linked toward a common cause: school success toward a common cause: school success

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What Do We Know Intuitively? What Do We Know Intuitively?

Healthy students make better learnersHealthy students make better learners

You can’t teach a child who is not You can’t teach a child who is not healthyhealthy

A child who succeeds in school is more A child who succeeds in school is more likely to enjoy lifelong healthlikely to enjoy lifelong health

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What Else Do We Know about What Else Do We Know about EducationEducation and SBHCs? and SBHCs?

Academic performance is Academic performance is negativelynegatively affected by: affected by:– Alcohol, tobacco, and other drug use Alcohol, tobacco, and other drug use – Emotional problems Emotional problems – Poor diet Poor diet – Intentional injuries Intentional injuries – Physical illness Physical illness – Low self-esteemLow self-esteem– Risky sexual behaviorRisky sexual behavior– Lack of access to health careLack of access to health care– Unstable home environmentUnstable home environment

Academic performance is Academic performance is positivelypositively affected by: affected by:– High levels of resiliency, developmental assets, and school High levels of resiliency, developmental assets, and school

connectedness.connectedness.

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SBHCs

Health RiskBehaviors

EducationalOutcomes

EducationalBehaviors

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.

The Health-Academic Outcomes ConnectionThe Health-Academic Outcomes Connection

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Efficiencies in SBHCsEfficiencies in SBHCs

Parents time offParents time offFollow-up less labor intensiveFollow-up less labor intensive Identifying problems earlierIdentifying problems earlierReduction in more costly emergency Reduction in more costly emergency

room visitsroom visits

National Data and TrendsNational Data and Trends

Census 2004-05Census 2004-05

23N = 1709

Where are SBHCs Located?Where are SBHCs Located?

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Location of Health Center (n=1234)Location of Health Center (n=1234)

In school building 87%In school building 87%On school property 11%On school property 11%Mobile (non-fixed) 2%Mobile (non-fixed) 2%

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Types of Schools with Health Centers Types of Schools with Health Centers

( n=1222)( n=1222)

Middle/High7%

Elementary/Middle14%

K-1214%

High30%

Elementary20%

Middle15%

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SBHCs by Community Characteristic SBHCs by Community Characteristic (N=1235)(N=1235)

Rural27%

Suburban14%

Urban59%

School-Based Health CentersSchool-Based Health Centers

– Keeping kids healthy

– Meeting them where they are

– Supporting the school

– Supporting the families

– Supporting the communities

MAKING A DIFFERENCE 27

school-based health care 101 understanding the basics 1

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