Improving Adolescent Health Outcomes Hayley Lofink Love, PhD Director, Research and Evaluation School-Based Health Alliance

1. Adolescent health challenges 2. Rethinking healthcare 3. School-based health centers as a solution Agenda

Fragmented care Emergency department use Incomplete care current health care system is failing to meet the needs of adolescents Duplicated care

Convenient Accessible Culturally and developmentally appropriate adolescent-centered care CONFIDENTIAL

Long-term threats to health and wellbeing Teen pregnancy Substance use and addiction School failure Violence/trauma Inter-related Costly Preventable

Adverse childhood experiences Early pregnancy risk for obesity, alcoholism, depression School performance Level of school engagement

School failure Death rate Involvement in criminal justice system Health outcomes Lifetime earnings

Product : broaden concept to ameliorate effects of nonclinical determinants (Inadequate food, housing, safety) Place: beyond medical complex in neighborhoods Provider: nontraditional team members (Community outreach workers, heath educators, coaches, resource coordination) Realigning health with care Rebecca Onie, Paul Farmer, & Heidi Behforouz. Realigning Health with Care. Stanford Social Innovation Review

Acute/ infectious disease Reducing deaths Chronic disease Prolonging disability-free life Wellness/ prevention Achieving optimal health for all The evolving health care system Halfon, Wise, Forrest. The Changing Nature Of Children's Health Development: New Challenges Require Major Policy Solutions Health Aff December :

1.Point of entry to primary prevention, risk reduction and care management system 2.Inter-disciplinary team: whole child approach that unifies mind and body 3.Screen/address behavioral health needs often undetected and unmet by mainstream PC system 4.Meets young people where they are (literally) in terms of problems, pain, social and developmental challenges 5.Unprecedented opportunity for population health Schools in the health neighborhood

1.Provide quality, comprehensive health care services that help students succeed in school and in life. 2.Located in or near a school facility and open during school hours. 3.Organized through school, community, and health provider relationships. 4.Staffed by qualified health care professionals. 5.Focused on the prevention, early identification, and treatment of medical and behavioral concerns that can interfere with a student’s learning. School-based health center characteristics

SBHCs: The Evidence Base 1.Increased use of primary care 2.Reduced inappropriate emergency room use Greater than 50% reduction in asthma-related emergency room visits for students enrolled in NYC SBHCs 3.Fewer hospitalizations $3 million savings in asthma-related hospitalization costs for students enrolled in NYC SBHCs 4.Access to harder-to-reach populations - esp minorities and males Adolescents were times more likely to come to a SBHC for mental health services than a CHC or HMO. SBHCs: The Evidence Base

49 of 50 states More than 2000 SBHCs and in DC

AlaskaMarshall Islands Hawaii Puerto Rico & Virgin Islands Locations of SBHCs Nationwide (n=1930)

66.6 % 73.1 % 60.8 % > 31 HOURS/WEEKAFTER SCHOOLBEFORE SCHOOL (n=1285) (n=1295) (n=1284)

Primary Care Mental Health Nursing or Clinical Support Oral Health Health Educator Dietician 85.8 % (n=1185) 15.9 % (n=219) 16.0 % (n=221) 10.7 % (n=148) 100 % (n=1381) 70.8 % (n=978) Provider Types in SBHCs

37.4 % 33.4 % 29.2 % Primary Care & Mental Health Plus Primary Care & Mental Health Primary Care SBHC Staffing Profiles (n=1381)

Vision Screening Mental Health Oral Health Reproductive Health Immunizations Alcohol, Tobacco, and Drug Use Prevention Healthy Eating, Active Living, and Weight Management Injury and Violence Prevention

have a pre-arranged source of after-hours care 70.6% 52.7 % use electronic health or medical records (EHR/EMR)

Revenue Supporting SBHCs (not including in-kind donations) (n=1286) State Government Federal Government Private Foundations School/School District Hospital County/City Govt. MCO/Private Insurer Corps./Businesses SBHA State Network/Assoc. Tribal Government

report billing at least one insurance program (n=1272) 87.9 %

85.9 % 64.0 % 50.0 % Public Sources (n=1273) Private Sources (n=1300) Self-pay (n=1309) Patient Revenue by Source

81.6 % 64.0% 63.0 % State Medicaid Agency (n=1309) Medicaid MCOs (n=1311) CHIP (n=1307) 71.4 %

30 % Grow the number of SBHCs by 2018

50 % SBHCs to document performance standards

Questions?

Contact information: Hayley Lofink Love