School-Based Health Centers Improving Access and Strengthening Quality of Care for Adolescents American Public Human Services Association, November 19, 2001 Julia Graham Lear, Director, Center for Health and Health Care in Schools, School of Public Health & Health Services, The George Washington University

Survey of State SBHC Initiatives School Year 1999-2000

Top Ten States with School-Based Health Centers Survey of State SBHC Initiatives. The survey was conducted by the Making the Grade National Program Office in the summer of 2000. In February 2001, Making the Grade became The Center for Health and Health Care in Schools. The Center remains at The George Washington University and is co-sponsored by the School of Public Health and Health Services and the Graduate School of Education and Human Development.

Location of School-Based Health Centers Survey of State SBHC Initiatives. Center for Health & Health Care in Schools.

Types of Schools Housing SBHCs Survey of State SBHC Initiatives. Center for Health & Health Care in Schools.

State Policies to Support SBHCs

State Financial Policies to Support SBHCs

SBHCs and Managed Care

State Dollars Supporting SBHCs *Other includes: Juvenile Justice funds, STD training dollars, Special Education funds, EPSTD, and The Robert Wood Johnson Foundation dollars

Data from the Census of the National Assembly on School-Based Health Care, NASBHC, Washington, DC 2000 Data collected in 1999

How Old Are SBHCs? 41% were established five or more years ago. 59% of SBHCs were established in the last four years.

SBHC Staff Clinical Support Mental Health Primary Care

Physical Health Professionals Onsite % Hrs/wk Physician 50 6 Physician Assistant 12 20 Nurse Practitioner 76 25 Physical Health All 92 27

Mental Health Professionals Onsite % Hrs/wk Clinical social worker 36 30 Mental health (other) 18 23 Psychologist 12 15 Substance abuse 8 15 Psychiatrist 4 6 Mental Health All 57 33

SBHC Staff, Other % Hrs/wk Director 24 22 Health Educ 19 22 Social Srvs 19 32 Nutritionist 14 6 Dentist 6 8 Dental Hyg. 5 10 Other 18 22

SBHC Health Services Comp. health assessment 95% Anticipatory guidance 95% Screenings (vision, hearing) 94% Treatment of acute illness 94% Nutrition counseling 91% Asthma treatment 91% Prescriptions for medication 90% Sports physicals 90% Lab tests 89% Meds administered in SBHC 86% Treatment of chronic illness 84% Psychosocial assessment 73% Medications dispensed 62% Dental screenings 52%

SBHC Characteristics 69% operate more than 30 hrs/week 48% operate summer hours 75% bill Medicaid/third-party 88% use computerized encounter system 31% accredited by JCAHO/other 34% certified by state 96% train health professionals on site

Recent Developments in School-Based Health Centers Focus on quality standards and quality improvement Broadening political base for SBHCs Increased interest in school-based initiatives to provide mental health and dental health services

Quality Standards and Quality Improvement for SBHCs Direction over time Informal to more formal Local to state to national 1980s- no uniform standards, what was done determined by funding and reporting requirements of funding bodies Late 1980s and 1990s - state standards began to be developed 2000 - development of outcomes-focused CQI tool.

SBHC CQI Tool http://www.healthinschools.org/ home.asp The tool Data collection forms Instructions Resources/glossary/directory FAQ’s

Broadened Political Support But Fiscal Uncertainty Looms SBHCs and distributional politics Bipartisan support: CT, DE, LA, NY, RI Fiscal uncertainty: the downside of a state or local funding base

Increasing Mental Health and Dental Health Services in School through SBHCs Surgeon General reports on mental health and oral health Disparities data especially striking in these two areas Increased recognition by public and professionals that more children’s mental health services are essential RWJF grant initiative -- Caring for Kids: Expanding Mental Health and Dental Health Services through SBHCs

Opportunities for Medicaid Partnerships with SBHCs Benefits: Increased access for Medicaid & SCHIP beneficiaries Accountability -- SBHCs receptive to use of CQI measures Cost-effective use of personnel Making the partnership work Collaboration with Family Health or MCH Offices in DOH, other relevant state agencies Commitment of time for mutual education & negotiation