School-Based Health Care 101 Understanding the Basics 1

Objectives 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 2

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

4 School-Based Health Center National Definition 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 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 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 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

5 School-Based Health Center National Definition 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. 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. The school-based health care team works in collaboration with school nurses and other service providers in the school and community. The school-based health care team works in collaboration with school nurses and other service providers in the school and community.

6 School-Based Health Center National Definition SBHCs have a policy on parental consent. SBHCs have a policy on parental consent. 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. 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.

7 School-Based Health Center National Definition SBHCs make provisions for care beyond the centers’ operating hours or scope of service SBHCs make provisions for care beyond the centers’ operating hours or scope of service 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. 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.

8 School-Based Health Center National Definition 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. 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.

9 School-Based Health Center National Definition Services typically offered in SBHCs are age appropriate and address the most important health needs of children and youth. Services typically offered in SBHCs are age appropriate and address the most important health needs of children and youth. These services may include but are not limited to: primary care for acute and chronic health conditions, mental health services, substance abuse services, case management, dental health services, reproductive health care, nutrition education, health education and health promotion. These services may include but are not limited to: primary care for acute and chronic health conditions, mental health services, substance abuse services, case management, dental health services, reproductive health care, nutrition education, health education and health promotion.

10 School-Based Health Center National Definition School-Based Health Center National Definition 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. 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.

Why School-Based Health Centers?

12 Why School-Based Health Centers? Uninsurance among children, especially adolescents Uninsurance among children, especially adolescents Geographic and financial barriers to health, mental health and dental access Geographic and financial barriers to health, mental health and dental access Dangerous health outcomes associated with adolescents Dangerous health outcomes associated with adolescents Nonexistent/fragmented/singular discipline systems of care Nonexistent/fragmented/singular discipline systems of care Decreased educational attainment Decreased educational attainment

13 The Evidence Base for School- Based Health Care Research Published in Professional Literature Research Published in Professional Literature National and State Data National and State Data –National State Initiative Survey –NASBHC Biennial census –White papers Training and technical assistance in the field Training and technical assistance in the field –Results of beta testing tools and resources –Collaboratives Pre and post assessments, chart reviews, progress reports, storyboards, consultation calls Pre and post assessments, chart reviews, progress reports, storyboards, consultation calls

14 What Does the Literature Tell Us About Emergency Room Use and SBHCs? Reduced inappropriate emergency room use, Reduced inappropriate emergency room use, Increased use of primary care, and Increased use of primary care, and Fewer hospitalizations Fewer hospitalizations Santelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19: Prevention-oriented care in SBHCs results in decreased utilization of emergency departments Prevention-oriented care in SBHCs results in decreased utilization of emergency departments Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: 30;273

15 What Does the Literature Tell Us About Asthma and SBHCs? > 50% reduction in asthma related emergency room visits for students enrolled in SBHCs in New York City > 50% reduction in asthma related emergency room visits for students enrolled in SBHCs in New York City Webber MP et al. Archives of Pediatric and Adolescent Medicine. 2003; 157: $3 million savings in asthma-related hospitalization costs for students enrolled in SBHCs in New York City $3 million savings in asthma-related hospitalization costs for students enrolled in SBHCs in New York City Analysis by the Empire Health Group for the NY Coalition of School- Based Primary Care, 2005

16 What Does the Literature Tell Us About Mental Health and SBHCs? Attract harder-to-reach populations, especially minorities and males, do a better job at getting them crucial services such as mental health care and high risk screens Attract harder-to-reach populations, especially minorities and males, do a better job at getting them crucial services such as mental health care and high risk screens Adolescents were times more likely to come to a SBHC for mental health services than a community health center network or HMO Adolescents were times more likely to come to a SBHC for mental health services than a community health center network or HMO Juszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health 2003; 32S: Kaplan D, et al. Archives of Pediatric and Adolescent Medicine Jan;152(1):25-33.

What Does Science Tell Us About Education and SBHCs Health has both direct and indirect effects on school failure Health has both direct and indirect effects on school failure Good education predicts good health Good education predicts good health Inequities in health and education are closely linked: young people who experience inequities in educational achievement also experience inequities in health care access Inequities in health and education are closely linked: young people who experience inequities in educational achievement also experience inequities in health care access Public health and education are linked toward a common cause: school success Public health and education are linked toward a common cause: school success 17

What Do We Know Intuitively? Healthy students make better learners Healthy students make better learners You can’t teach a child who is not healthy You can’t teach a child who is not healthy A child who succeeds in school is more likely to enjoy lifelong health A child who succeeds in school is more likely to enjoy lifelong health 18

What Else Do We Know about Education and SBHCs? Academic performance is negatively affected by: Academic performance is negatively affected by: –Alcohol, tobacco, and other drug use –Emotional problems –Poor diet –Intentional injuries –Physical illness –Low self-esteem –Risky sexual behavior –Lack of access to health care –Unstable home environment Academic performance is positively affected by: Academic performance is positively affected by: –High levels of resiliency, developmental assets, and school connectedness. 19

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. The Health-Academic Outcomes Connection 20

21 Efficiencies in SBHCs Parents time off Parents time off Follow-up less labor intensive Follow-up less labor intensive Identifying problems earlier Identifying problems earlier Reduction in more costly emergency room visits Reduction in more costly emergency room visits

National Data and Trends Census

23 N = 1709 Where are SBHCs Located?

24 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%

25 Types of Schools with Health Centers ( n=1222)

26 SBHCs by Community Characteristic (N=1235)

School-Based Health Centers –Keeping kids healthy –Meeting them where they are –Supporting the school –Supporting the families –Supporting the communities MAKING A DIFFERENCE 27