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Executive Summary

GHS Children’s Hospital proposes to align and partner with the UWGC Middle Grades Success

Initiative SIF program through the implementation of School Based Health Clinics (SBHCs) to

support and accomplish the UWGC goal to reduce student chronic absenteeism. School-based

health centers offer an excellent solution to the systemic barriers that impact health outcomes in

vulnerable populations such as those served by the UWGC SIF project. At no other setting is

access as convenient, familiar, or integrated as in a school setting, where daily attendance is

mandatory. By providing in-school access to desperately needed health care and related wellness

education, students/adolescents are able to receive appropriate care in a timely manner.

GHS Children’s Hospital (Children’s Advocacy) proposes to open a School Based Health Clinic

(SBHC) in each of 3 identified middle schools (Berea, Lakeview and Tanglewood) to address

populations of students and families experiencing health care disparities. A fourth location,

Greenville Early College, will be served by program staff, but due to space limitations will not

have an on-site SBHC. These clinics, in addition to providing non-emergent care, basic

prescriptions and medications (via a portable pharmacy kit), and chronic disease management for

asthma, obesity, diabetes, ADHD and others, will also provide referrals to other necessary

services such as mental health and dental care. GHS will promote health development and

decision making among students and their families through a three-pronged approach:

prevention, non-emergent acute care and chronic disease management, and health literacy. We

will do this through the provision of high quality, acute, non-emergent medical and preventive

care to students during the school day. We will be proactive in working with the school nurse

and staff to identify children who are at risk and those who may need a medical home. In

addition, through new and existing community partnerships, GHS Children’s Advocacy will

provide health education to promote health literacy drawing on the knowledge that healthy

children learn better and educated individuals make better healthcare decisions.

The GHS SBHCs will reduce the number of chronically or frequently absent students in the

target population by impacting health related issues such as lack of appropriate vaccinations,

access to primary care, management of chronic medical conditions such as such asthma, and

health education.

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Strategic Alignment

Theory of Change and Alignment:

In its application to the CNCS, UWGC defined the theory of change as matching the right

students to the right interventions at the right time, and noted that the theory translates into an

insulated education pipeline in which the student is at the core. Through the CNCS funding,

UWGC will implement a dropout prevention strategy for middle grades students, utilizing an

Early Warning and Response System (EWRS) together with a coordinated menu of response

interventions.

GHS proposes to align and partner with the UWGC program through the implementation of

School Based Health Clinics (SBHC) to support and accomplish the UWGC goal to reduce

student chronic absenteeism.

The National Assembly on School-Based Health Care defines SBHCs as partnerships created by

schools and community health organizations to provide on-site medical services that promote the

health and educational success of school-aged children and adolescents. The SBHC team works

in collaboration with school nurse and other service providers in the school and community.

Because of the unique vantage point and access to students, the SBHC team is able to reach out

to students to emphasize prevention and early intervention. 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,

nutrition education, health education and health promotion. Potential sources of support for

SBHCs are local, state, and federal public health and primary care grants, community

foundations, students and families, and reimbursement from public and private health insurance.

GHS Children’s Advocacy proposes to open a School Based Health Clinic (SBHC) in each of 3

identified middle schools (Berea, Lakeview and Tanglewood) to address populations of students

and families experiencing health care disparities. A fourth location, Greenville Early College,

will be served by program staff, but due to space limitations will not have an on-site SBHC.

These clinics, in addition to providing non-emergent care, basic prescriptions and medications

(via a portable pharmacy kit), and chronic disease management for asthma, obesity, diabetes,

ADHD and others, will also provide referrals to other necessary services such as mental health

and dental care. GHS will promote health development and decision making among students and

their families through a three-pronged approach: prevention, non-emergent acute care and

chronic disease management, and health literacy. We will do this through the provision of high

quality, acute, non-emergent medical and preventive care to students during the school day. We

will be proactive in working with the school nurse and staff to identify children who are at risk

and those who may need a medical home. In addition, through new and existing community

partnerships, GHS Children’s Advocacy will provide health education to promote health literacy

drawing on the knowledge that healthy children learn better and educated individuals make

better healthcare decisions.

The UWGC SIF RFP notes that the three key indicators for predicting early disengagement

among middle grades students are: (a) attendance; (b) behavior; and (c) course performance. The

proposed GHS SBHC program will primarily impact student attendance – healthy students miss

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less school, and non-emergent situations that can be dealt with in the SBHC means that students

don’t need to miss school to receive appropriate medical care.

The RFP states that “chronic absenteeism occurs when a student misses 18 days or more of

school in a year or 10% of the year, including excused and unexcused absences and suspensions

(Balfanz & Fox, 2011). Low-income students are at the highest risk of becoming chronically

absent. Research shows that low-income, chronically absent students are more likely to have

lower academic achievement, higher dropout rates, and weak college/career readiness. These

students are also more likely to be in the juvenile justice system. Frequent absences that do not

rise to the level of chronic absenteeism matter. If a student is not in school to receive education

and supports, he or she cannot learn in the classroom or participate in available interventions.”

During the last school year, more than a third of White Horse Crescent middle grades students

(39%) were frequently absent, missing nine or more days of school throughout the year, while

12% of students were chronically absent, missing 18 or more days of school. The GHS SBHCs

will reduce the number of chronically or frequently absent students in the target population by

impacting health related issues such as lack of appropriate vaccinations, access to primary care,

management of chronic medical conditions such as asthma, and health education.

Through the UWGC SIF initiative, efforts to improve outcomes and opportunities for youth and

families will be spread across a continuum of partnerships between the school district, agencies,

and community-based organizations. While these entities provide many needed services and

supports within schools, they have largely operated independently in silos limiting their reach to

effectively address the interconnected factors that create barriers to health and success. GHS will

embrace the theory of change through its SBHC, one of the building blocks we believe is

required for students to succeed. The benefits of good health not only

enhance individuals’ quality of life, but also improves workforce productivity, increases the

capacity for learning, and strengthens families and communities.

White Horse Community Knowledge

According to data provided by the UWGC, this Middle Grades Initiative is geographically based

and targets the White Horse Crescent, an area of concentrated disadvantage located along the

western edge of the county. The following data obtained from UWGC demonstrates that the

GHS target population of children attending the target schools meets the RFP’s definition of

“low-income community” - (1) A population of individuals or households being served by a

subgrantee on the basis of having a household income that is 200% or less of the applicable

federal poverty guideline – according to UWGC 60.3% of households in the target community

meet this guideline. (2) A population of individuals or households, or a specific local geographic

area, with specific measurable indicators that correlate to low-income status, such as, but not

exclusive to, K-12 students qualifying for free or reduced lunch, long-term unemployment, risk

of homelessness, low school achievement, persistent hunger, or serious mental illness –

according to UWGC data nearly all middle grades students (92.5%) in the White Horse Crescent

qualified for free or reduced meals, compared to 49% district-wide. Additionally, “educational

attainment for adults in the White Horse Crescent is low--30.7% of adults lack a high school

diploma or its equivalent and 35.3% of adults are high school graduates with no additional

education (U.S. Census Bureau, 2014). Only 5.0% of adults possess an Associate's degree and

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8.4% of adults possess a Bachelor's degree. Throughout the White Horse Crescent, there are

pockets of extreme unemployment, with some rates exceeding 25% at the census tract level

(South Carolina Department of Employment and Workforce, 2014).”

The GHS SBHC program will initially serve students; however, as the program builds credibility

with students and parents, we foresee that we will be able to offer health education and some

medical services (vaccinations, referrals) to families as well.

Experience in White Horse Road area and Understanding of Local Landscape

GHS Children’s Advocacy serves the White Horse Community through the three divisions of

Safe Kids Upstate, School Health and Healthy Child Development. All feeder Title 1 Elementary

Schools in the White Horse Community have been recognized as Safe Kids Safe Schools for

implementing injury prevention programming from Safe Kids Upstate (SKU) and other SKU

Coalition partners into the curriculum. In addition, students from Cherrydale ES, Grove ES,

Hollis Academy, Monaview ES, Thomas E. Kerns ES, Welcome ES, Berea MS, Lakeview MS,

Tanglewood MS, Berea HS, Carolina HS and Southside HS have all received services from the

Children’s Hospital School program while they have been admitted to the GHS Children’s

Hospital. Healthy Child Development offers child development information to various schools

and community sites and works with the Pregnant & Parenting Teens Program at Berea HS. Five

Head Start centers receive training in Childhood Obesity Prevention education by the School

Health division from a program called Choosy. Several agencies such as New Horizon’s, A

Child’s Haven, DHEC, DSS, Greenville First Steps, Nurse Family Partnership and more that

serve residents of the White Horse Road Community are SKU Cribs for Kids Partner agencies,

providing parents of newborns with Safe Sleep education and a crib.

Children’s Hospital, through the Center for Pediatric Medicine, has the largest Medicaid clinic in

the state of SC. With office sites – one on the GHS campus in Cross Creek and one in Travelers

Rest at the North Greenville campus – CH has served the White Horse Road community for

greater than 20 years. Our comprehensive medical services include both inpatient and outpatient

services as well as case management and social work to ensure the best care is given to our

patients. The Center for Pediatric Medicine is a level 3 Patient Centered Medical Home, attesting

to the high level of service we offer to our patients. Recently, our asthma action team was

recognized by the American Hospital Association (one of 5 programs recognized in the country)

for comprehensive and community focused care. Our program offers home and school visits,

case management and asthma education. Through strong community partnerships with the

schools and local communities we have significantly reduced ER utilization and decreased

hospitalizations for the children we see who have asthma.

Linda Brees, Director of Children’s Advocacy, has also been involved with the United Way on

many partnerships over the last 20 years including a collaborative relationship among United

Way, GHS, the Greenville County School District, and Furman University in the design and

implementation of the North West Crescent Project that brought agencies together to benefit the

citizens of the White Horse Community. The project included early childhood services, health

services, Senior Action, as well as other ancillary programs.

Other partnerships serving the White Horse Crescent in which Children’s Advocacy has had an

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active role in development include: A Child’s Haven (ACH) by serving on both the board and as

a community advisor. GHS has also provided 2 nurses to the program to expand health services

to families in the ACH service area. GHS has partnered for eight years with First Steps and has

been a strong partner since the beginning with Nurse Family Partnership, both of whom serve

residents of the White Horse Crescent. GHS has also been a partner with Julie Valentine Center

that is located on White Horse Road and currently provides 2 highly trained physicians that

complete all forensic exams. A Child’s Haven and Julie Valentine Center both serve a high

proportion of residents of the White Horse Crescent.

GHS is uniquely qualified to implement the school based health clinics in the White Horse

Crescent. Under our Total Health and Accountable Communities initiatives, we have identified

many of the gaps that prevent residents of the White Horse Crescent from obtaining adequate

services, including healthcare services. These gaps include lack of transportation, under-insured

or uninsured status (especially for those children not born in the US), poor or no chronic disease

management for conditions such as asthma, obesity and diabetes, language barriers and lack of

knowledge of needed and available services. In order to provide the community with the right

care at the right time at the right place, GHS has embraced the six components of Total Health:

1) Population identification – the students in the White Horse Crescent have medical needs not

addressed by the traditional health care model due to the gaps discussed above. 2) Evidence-

based guidelines – SBHC have shown a moderate level of evidence and incorporate other

evidence-based medicine protocols for an optimal continuum of care. 3) Collaborative practice

models – the SBHC will link with physicians virtually to increase accessibility of information

and treatment collaboration. 4) Patient self-management and education – the SBHC will enable

patients to comply with healthcare and medication requirements by providing information and

support/coaching, as well as access to community resources. 5) Process and outcomes

measurement, evaluation and management – the SBHC program will have established

performance measures and regularly report and manage progress towards goals. 6) Routine

reporting and feedback loop – GHS will monitor the status of the program and apply the

knowledge from its successes and failures to continually improve.

Number of Participants

Our plan is to implement SBHC facilities and/or staffing in the four target middle schools in

Years 1 and 2. During Year 3 and beyond, we plan to continue services to all 4 schools and

explore ways to expand services and build health literacy among students and families. We

anticipate by Year 3 that we will have built relationships with students, identified additional gaps

in services to students and families and will be able to connect them with additional services.

The exact number of participants is unknown, as we do not have the current number of students

visiting the school nurse other than anecdotally. We anticipate an increase in the number

utilizing the SBHC over those currently using the school nurse, as the SBHC employees will

have much more latitude in the services they can offer. Currently school nurses are not permitted

to diagnose, provide prescriptions or dispense over the counter medications without a written

medication plan. This will change with the addition of the SBHC.

Prior Experience in White Horse or Similar Community

Beginning in 2014 GHS has piloted a school based health clinic at Hughes Academy. Children’s

Hospital (CH) currently staffs the clinic 2 days per week with physicians from the Center for

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Pediatric Medicine. During our short time there we have linked at risk youth with medical homes

(particularly among the undocumented Hispanic population) and identified new resources for

under insured or uninsured children to receive an eye exam as well as glasses. While our

numbers are still small, anecdotally we have been able to send most students we have seen back

to class by diagnosing and treating common illnesses. Previously, those students would have

been offered the option to go home, as the school nurse is not allowed to diagnose or prescribe

medication.

Our experience serving the White Horse Crescent with other programs and partnerships is

described above in the section “Experience in White Horse Road area and Understanding of

Local Landscape”.

Milestone Timeline

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Evaluation Experience and Evidence

Level of Evidence

The impact of School-Based Health Clinics/Centers on absenteeism currently shows at least a

moderate level of evidence. A literature review of studies over the past 15 years indicates more

research has been done linking SBHCs to better medical outcomes for students. However, we

can extrapolate from this and from the few studies focusing on absenteeism and school

performance that availability of non-emergent acute care, management of chronic disease and

increased health literacy are all positively impacted by the SBHCs. It stands to reason that

healthier children will miss less school. Below is a summary of studies related to this issue.

Abstracts are quoted directly from the articles.

The first article below discusses the current literature and studies on SBHCs, rather than being a

study itself. It provides important background and support for the overall understanding of

SBHCs. The remaining articles discuss specific analyses and studies on the issues and impact of

SBHCs.

School-Based Health Centers in an Era of Health Care Reform: Building on History

Keeton, Victoria et al. Current Problems in Pediatric and Adolescent Health Care, Volume 42 ,

Issue 6 , 132 - 156

Studies have found that students identified and referred for mental health services by an SBHC

have fewer absences and tardiness rates and increased grade point averages, factors that are

known to contribute to longer-term academic success. Significant increases have also been found

in school attendance for SBHC medical users compared with nonusers. A recent study of 2 urban

high schools (one with an SBHC, one without) in western New York State examined differences

in academic indicators for students who received a combination of SBHC and school nursing

services, as compared with students who received only traditional school nursing services.

Findings noted that early dismissals from school were significantly reduced in schools with

SBHCs, compared with students who received school nursing services alone. Furthermore,

students who were not receiving services from the SBHC lost 3 times as much “seat time” (time

students were available in school to learn) as students enrolled in the SBHC services. Finally, a

recent longitudinal study in an urban district of Seattle, Washington, found that low-to-moderate

use of SBHC services was related to one-third lower likelihood of dropping out of high school;

this association was higher for youth who were at higher risk for dropout. This literature supports

the idea that SBHCs can play an important role in improving the educational success of our

nation’s youth, including critical retention in school attendance.

The Relationship Between School-Based Health Centers, Rates of Early Dismissal From School,

and Loss of Seat Time

Van Cura M. The relationship between school-based health centers, rates of early dismissal from

school, and loss of seat time. J Sch Health. 2010; 80: 371-377.

BACKGROUND: This study sought to understand the relationship between school-based health

centers (SBHCs) and academic outcomes such as early dismissal and loss of seat time (the time

students are available in school to learn or to access support services).

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METHODS: A quasi-experimental research design was used to compare rates of early dismissal

and loss of seat time between students who received SBHC and traditional school nursing

services and students who received only traditional school nursing services. This study was a

secondary data analysis of 764 ‘‘walk-in’’ visits during a 3-week period in 2 urban high schools

in western New York state. Both schools provided school nursing services, and 1 of the 2 offered

the option to enroll in a SBHC.

RESULTS: SBHCs significantly reduced the number of early dismissals from school (p = .013)

in a comparison with students who received school nursing services alone. Students not enrolled

in a SBHC lost 3 times as much seat time as students enrolled in a SBHC. Race, gender, age,

poverty status, and presence of a preexisting illness did not influence these findings.

CONCLUSIONS: These findings suggest that SBHCs have a direct impact on educational

outcomes such as attendance. Recommendations for further research include replication of this

study to increase confidence in its findings and using early dismissal and loss of seat time as

indicators of attendance to measure other health outcomes related to SBHCs and school nursing.

Understanding the Relationship between School- Based Health Center Use, School Connection,

and Academic Performance

Jessica Strolin-Goltzman, Amanda Sisselman, Kelly Melekis, and Charles Auerbach, Health &

Social Work Volume 39, Number 2 May 2014

School-based health centers (SBHCs) benefit the overall health of underserved communities. In

fact, there is an abundance of evidence suggesting the positive effects that SBHCs have on

physical and mental health. However, research related to understanding the relationship of

SBHCs to academic outcomes such as performance and school connectedness is sparse. The

purpose of the current study was to (a) compare differences between elementary, middle, and

high school student SBHC users and nonusers on school connectedness and (b) test the pathways

between SBHC usage and academic performance. A structural equation model was tested and

found significant pathways between SBHCs, school connectedness, and academic performance.

METHOD: Students and parents from three schools (one high school, one middle school, and

one elementary school) completed in-person surveys on SBHC usage, satisfaction with SBHC

usage, and school connectedness. In addition, school databases were accessed to gather

information on participant demographic variables, grades, and attendance, as well as

administrative data.

Parent consent and youth assent were collected from all participants. Participants were 793

students from three schools in a large northeastern urban metropolis. There were 233 participants

from the elementary school, 110 from the middle school, and 450 from the high school.

RESULTS: Academic Performance GPA, grade promotion, tardiness, and attendance were

extracted for each participant through the schools’ administrative databases. SBHC users in the

middle and high schools had GPAs that were 2.5 points higher than those for nonusers. The

difference was statistically significant. On average, the 2.5 points resulted in students receiving a

B- as opposed to a C+. There was a statistically significant difference in the percentage of

students promoted to the next grade level. Specifically, 90 percent of middle and high school

SBHC users were promoted to the next grade, in comparison with 83 percent of nonusers. There

was no significant difference in attendance (days absent) between users and nonusers. However,

there was a statistically significant difference in tardiness among users and nonusers. SBHC

users were late on an average of 9.5 days, whereas nonusers averaged five tardy days.

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Conclusion: School-based health care is an essential resource for improving access to health care

for underserved children and youth. Evidence from this study suggests that SBHCs may play an

important role in increasing a sense of school connectedness for urban school children. SBHCs

not only improve health care, access to health care, and school connectedness but may also

positively affect academic performance. More research must be done to evaluate a larger sample

of SBHCs as well as to learn more about issues of attendance and tardiness, as they relate to

SBHCs and SBHC programming. Furthermore, additional research is needed regarding the

specific role and skills that social workers contribute to enhancing school connectedness.

School-Based Health Centers as Patient-Centered Medical Homes

Pediatrics 2014;134;957; originally published online October 6, 2014;

Karen Albright, Doron Shmueli, Mandy A. Allison and Allison Kempe

Sean T. O'Leary, Michelle Lee, Steve Federico, Juliana Barnard, Steven Lockhart, DOI:

10.1542/peds.2014-0296

OBJECTIVE: School-based health centers (SBHCs) have been suggested as possible patient-

centered medical homes. Our objectives were to determine, in a low-income, urban population,

adolescents’ reasons for visiting SBHCs and the value parents place on SBHC services, and

adolescents’ and parents’ assessment of how well SBHCs fulfill criteria for a medical home as

defined by the American Academy of Pediatrics.

METHODS: A cross-sectional, mailed survey of a random sample of 495 adolescent SBHC

users and 497 parents of SBHC users from 10 SBHCs in Denver, CO from May to October 2012.

Eligible adolescents were registered in a SBHC with $1 visit during the 2011 to 2012 school

year.

RESULTS: Response rates were 40% (198/495) among adolescents and 36% (181/497) among

parents. The top 3 reasons for visits were for illness (78%), vaccines (69%), and sexual health

education (63%). Factors reported as very important by .75% of parents in the decision to enroll

their adolescent in a SBHC included clinic offering sick or injury visits, sports physicals, and

vaccinations. More than 70% of adolescents gave favorable responses (always or usually,

excellent or good) to questions about American Academy of Pediatrics medical home criteria

(accessibility, continuity, comprehensiveness, family-centeredness, coordination, and

compassion). Most parents (83%) reported that they could always or usually trust the SBHC

provider to take good care of their child; 82% were satisfied with provider-to-provider

communication.

CONCLUSIONS: In a low-income urban population, SBHCs met criteria of a medical home

from adolescents’ and parents’ perspectives. Policymakers and communities should recognize

that SBHCs play an important role in the medical community, especially for underserved

adolescents.

School-Based Health Centers: Improving Access and Quality of Care for Low-Income

Adolescents

Mandy A. Allison, Lori A. Crane, Brenda L. Beaty, Arthur J. Davidson, Paul Melinkovich and

Allison Kempe Pediatrics 2007;120;e887; originally published online September 10, 2007; DOI:

10.1542/peds.2006-2314

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ABSTRACT

OBJECTIVES. We sought to compare visit rates, emergency care use, and markers of quality of

care between adolescents who use school-based health centers and those who use other

community centers within a safety-net health care system for low-income and uninsured patients.

PATIENTS AND METHODS. In this retrospective cohort study we used Denver Health

electronic medical chart data, the Denver Health immunization registry, and Denver Public

Schools enrollment data for the period from August 1, 2002, to July 31, 2003. The cohort

included all 14- to 17-year-old Denver Public Schools high school enrollees who were active

Denver Health patients and were either uninsured or insured by Medicaid or the State Children’s

Health Insurance Program. “School-based health center users” were those who had used a

Denver Health school-based health center; “other users” were those who had used a Denver

Health community clinic but not a school-based health center. Markers of quality included

having a health maintenance visit and receipt of an influenza vaccine, tetanus booster, and

hepatitis B vaccine if indicated. Multiple logistic regression analysis that controlled for gender,

race/ethnicity, insurance status, chronic illness, and visit rate was used to compare school-based

health center users to other users.

RESULTS. Although school-based health center users (n _ 790) were less likely than other users

(n _ 925) to be insured (37% vs 73%), they were more likely to have made _3 primary care visits

(52% vs 34%), less likely to have used emergency care (17% vs 34%), and more likely to have

received a health maintenance visit (47% vs 33%), an influenza vaccine (45% vs 18%), a tetanus

booster (33% vs 21%), and a hepatitis B vaccine (46% vs 20%).

CONCLUSIONS. These findings suggest that, within a safety-net system, school-based health

centers augment access to care and quality of care for underserved adolescents compared with

traditional outpatient care sites.

The Impact of School-Based Health Centers on the Health Outcomes of Middle School and High

School Students

Miles A. McNall, PhD, Lauren F. Lichty, PhD, and Brian Mavis, PhD

1610 | The Role and Value of School-Based Health Care | Peer Reviewed | McNall et al.

American Journal of Public Health | September 2010, Vol 100, No. 9

. (Am J Public Health. 2010; 100:1604–1610. doi:10.2105/AJPH.2009.183590)

OBJECTIVES. We studied the direct and indirect effects of school-based health centers

(SBHCs) on the health and health behaviors of middle and high school students.

METHODS. We used a prospective cohort design to measure health outcomes annually over 2

consecutive years by student self-report. Cohorts of middle school and high school students were

recruited from matched schools with and without SBHCs. Data were obtained from 744 students

in both year 1 and year 2 of the study. We used 2-level hierarchical linear models to estimate the

effects of the presence of SBHCs at the school level and of SBHC use at the student level.

RESULTS. At year 2, users of SBHCs experienced greater satisfaction with their health, more

physical activity, and greater consumption of healthy food than did nonusers of SBHCs.

CONCLUSIONS. Students who used SBHCs were more satisfied with their health and engaged

in a greater number of health-promoting behaviors than did students who did not use SBHCs.

These findings indicate that SBHCs are achieving their goal of promoting children’s health

The Relationship Between School-Based Health Centers and the Learning Environment

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Citation: Strolin-Goltzman J. The relationship between school-based health centers and the

learning environment. J Sch Health. 2010; 80: 153-159.

BACKGROUND: School-based health centers (SBHCs) have improved access to primary and

preventive health care for underserved children and youth by bringing comprehensive health

services into the schools while addressing critical health problems that make it difficult for

students to learn. Despite the findings on the positive effects of SBHCs on health outcomes, the

literature investigating the relationship between SBHCs and the learning environment is scant.

This purpose of this study is to add to the literature by investigating the correlation between

SBHCs and perceptions of the overall school learning environment.

METHODS: This study investigates the relationship between SBHCs and the learning

environment utilizing a retrospective quasi-experimental design. Researchers used secondary

data from the 2007 Board of Education Learning Environment Survey (LES) of a large

northeastern city to compare schools with SBHCs and schools without SBHCs.

RESULTS: The findings demonstrate that the presence of a SBHC is associated with greater

satisfaction in 3 out of 4 learning environment domains.

CONCLUSIONS: Perhaps by helping to eliminate the barriers that affect lower-performing

students’ readiness to learn, while improving student and parent engagement, SBHCs can partner

with schools to reach their performance and accountability goals.

Implementation Fidelity

The proposed program for the White Horse Crescent SBHCs is new for GHS. While we do

operate one SBHC at Hughes Academy, the program was a pilot and we did not have the

extensive evaluation criteria in place that will exist under the SIF program. We will measure the

program’s fidelity to the program model and monitor program quality as we adhere to the

requirements of the RFP. The program coordinator will track evaluation measures and ensure

that institutional checks and balances are in place. In addition, through GHS’ research

collaboration with Clemson University, GHS is internally embedding research scientists and

scholars throughout the organization. These embedded scientists are post-doctoral scholars that

work with both a GHS clinical mentor and a Clemson faculty mentor. Through this interaction,

GHS is able to place select Clemson faculty members into research leadership roles in GHS

Clinical departments. These leaders are then positioned to examine systems and process, to

recommend improvements and to facilitate enhanced research opportunities and scholarly

activities for GHS.

Capacity/Infrastructure

GHS, Children’s Hospital and Children’s Advocacy have strong experience with evaluating

program outcomes and performance. We have knowledgeable staff and contacts with our

research partner, Clemson University, that provide us with a wealth of options for evaluation.

For this program, it is not possible to foresee exact evaluation needs prior to the required

partnership with the Riley Institute. Once we have a clear understanding of the tracking and

evaluation criteria set forth by the UWGC and Riley Institute, we will be able to elaborate upon

institutional capabilities for evaluating the SBHCs. We anticipate that within certain patient

privacy guidelines we will be able to collect data from school records, the EWRS, our own

electronic medical records, surveys and other mechanisms. As far as performance management

tracking, the Program Coordinator will be responsible for its oversight. Key findings will be

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shared as allowed under privacy laws with project partners.

Experience

Through GHS’ research collaboration with Clemson University, GHS is internally embedding

research scientists and scholars throughout the organization. These embedded scientists are post-

doctoral scholars that work with both a GHS clinical mentor and a Clemson faculty mentor.

Through this interaction, GHS is able to place select Clemson faculty members into research

leadership roles in GHS Clinical departments. These leaders are then positioned to examine

systems and process, to recommend improvements and to facilitate enhanced research

opportunities and scholarly activities for GHS. Also through the research collaboration, GHS has

secured the assistance of Clemson faculty in a project to develop a fully integrate, customized,

research-based Lean Six Sigma curriculum for application at GHS and to develop an outline for

a training program to implement and use control charts in various aspects at GHS.

The following are some examples of GHS projects that currently engage external evaluation. Dr.

Rachel Mayo of Clemson is assisting with the evaluation on Dr. Jennifer Hudson’s SC DHHS

funded MAIN project “Managing Abstinence in Newborns”. In this Dr. Mayo will coordinate the

evaluation of the palliative care model intervention, planned retrospective and prospective

studies. Dr. Windsor Sherrill will coordinate the evaluation of the health care costs comparison.

This is a three year evaluation project.

Dr. Herman Knopf of USC is performing the evaluation of the Help Me Grow program

expansion funded by the Children’s Trust of South Carolina and MIECHV. Dr. Knopf and his

team act as an independent evaluator by providing consultation in the design and detail of data

collection, participating in training on the data system used in the project, and by receiving and

reviewing data details to be prepared for analysis by statistical software. The team then provides

a comprehensive evaluation report that tracks and analyzes outcomes as well as service gaps and

barriers in order to inform and improve process. This is a yearlong analysis with the opportunity

to continue beyond that as needed.

Dr. Liwei Chen of Clemson University serves as an external evaluator of the SC Centering

Pregnancy (CP) Expansion project for Dr. Amy Picklesimer of GHS. In this, Dr. Chen evaluate

the outcomes and cost savings of the project which serves to implement the new CP group care

model in ten new practices in SC. This is a two year project.

Logic Model or Theory of Change upload

/document/download/filename/1420830736_12237_GHSSBHClogicmodelforSIF.pdf/

Evidence Level Documentation upload

/document/download/filename/1420830736_12238_GHScitedarticlesforlevelofevidenceforSBH

C.pdf/

Other -- Evaluation upload

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Organizational Capacity and Leadership

Background and Expertise

The GHS Children’s Advocacy department, which will manage this program, was started in

1995 under the direction of Linda Brees. Its mission: In order to reduce health inequities and

disparities, we aim to improve the total health of children by providing community outreach,

health literacy, public policy advocacy, prevention and chronic disease management through

building partnerships between the medical community and the upstate of South Carolina. Twenty

years later this program continues to grow by responding to the evolving needs of children in our

community. These needs are met through the following programs: Injury Prevention, Childhood

Obesity Prevention, Healthy Child Development, Child Abuse Prevention Support, Early

Childhood Education and Public Policy/Community Education.

The School Health division was also started in 2012. The Greenville Health System School

Health division serves the Upstate through innovative education, prevention and treatment

initiatives to improve the total health of children ages 0-21 within traditional and non-traditional

school settings. It recently piloted a successful SBHC at Hughes Academy. The Child Abuse

Prevention Program division was added in 2014 and provides multidisciplinary trainings on the

identification and investigations of child abuse cases as well as child abuse prevention programs.

Initiatives within this program focus on mandated reporter training, abusive head trauma

prevention, drug exposed infants and drug endangered children.

GHS possesses both system and department experience in using data to drive decision-making at

all levels of the organization. Children’s Advocacy has its own internal processes, but also has

access to the strengths of the system.

Within Children’s Advocacy, decisions are driven by the following:

• Compile & analyze health data

• Identify gaps in services and geographic location of greatest need

• Engage community partners and conduct focus groups

• Develop strategies for health improvements

• Implement community programs

• Evaluate impact of programs

• Sustain current programming

GHS as a whole is a continuous learning healthcare organization with business intelligence,

quality management and project management departments. Total Quality Management practices

are used to drive both clinical decision-making and process improvement.

The Management Engineering and Project Management Office at GHS is currently staffed with

10 employees and one position ready to be filled. This office’s main function is to lead projects

throughout the system that help to support GHS’ mission to “improve constantly”. It may be

projects such as the Oconee integration or the ICD-10 conversion. It may be projects that require

our industrial engineering skill set and robust problem solving methods such as Lean Six Sigma.

They also train others in the organization on some of these performance improvement methods,

such as Change Acceleration Process and Work-Out. Reporting functions supported by the

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Management Engineering office include performance reporting; labor productivity reporting,

patient satisfaction reporting, and interdepartmental survey reporting.

The Business Intelligence and Decision Support division of GHS is responsible for the

transformation of raw financial and clinical data into meaningful information used for decision

making within the organization. This team analyzes procedure cost and profitability at the patient

level; focuses on development and reporting from the Clinical Data Warehouse (CDW) that

provides profitability by service line, physician performance, etc.; examines population health

analytics; and benchmarks comparative analysis using Premier and UHC to find cost

opportunities. This division is an integral part of the solution to transform the future cost

structure at GHS to support a sustainable financial model under population health.

The GHS Quality Management Dept. supports the GHS mission and vision of “improving

constantly” and “transforming health care” through data collection, analysis and reporting of

clinical data. Ongoing clinical performance monitoring and improvement is focused on patient

outcomes, processes of care, adherence to practice-guidelines, appropriateness of procedures,

and physician/provider competence.

In addition, the department provides oversight of publicly and externally-reported quality data,

submits data to national registries for quality/ accreditation purposes and uses benchmarked

comparative data to drive improvement. High-quality patient care is the goal; clinically-based

quality-improvement teams assess data and use evidence-based guidelines to continuously

improve outcomes.

The department employs approximately 52 individuals, 35 of whom have job functions related

primarily to quality. This includes staff at Laurens and Oconee. Training and expertise of these

individuals include clinical nursing (data abstractors and nurse analysts), quality improvement

professionals and biostatisticians.

Partnerships

GHS Children’s Advocacy has been and is currently a successful convener, facilitator and

participant in multiple partnerships and coalitions. For example:

Communities in Schools (CIS): GHS Children’s Advocacy and CIS work together in schools to

support CIS after school programs through Safe Kids Upstate Safe Schools programming. Injury

Prevention programs are offered to teach students and parents how to prevent unintentional

injury through bike and pedestrian safety, internet safety, and sports safety. Megan Shropshire,

Manager of School Health, also serves on the Board of Directors for CIS and is the incoming

Board Chair.

LiveWell Greenville (LWG): With GHS Children’s Advocacy staff members serving on one or

more LiveWell Greenville workgroups and leadership teams, LWG and GHS Children’s

Advocacy have worked closely to mutually advance each organization’s mission for the past

several years. Children’s Advocacy sponsored LiveWell Greenville’s Park Hop in the summer of

2014. In September 2012, the School Health division was a subgrantee of the Community

Transformation Grant, awarded to LWG by the Department of Health and Human Services. The

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Safe Kids Safe Schools program has also partnered with LWG to promote the Safe Schools

Award and the Healthy Schools Award each spring.

SHARE Head Start: The GHS Choosy Rx program is in every Head Start center in Greenville,

Pickens and Oconee counties. The goal of the Choosy Rx Project is the improvement of

children’s physical activity and nutrition behaviors during the preschool years, when children’s

preferences and habits are first being formed. The Choosy Rx project focuses on delivering

consistent health messages via the significant spheres of influence surrounding the preschool

child, namely the child’s parents, the child care center (specifically Head Start), and the child’s

pediatrician.

GHS is actively involved in the SC Children’s Hospital Collaborative that serves to move the

agenda of children’s health forward in SC. Through this relationship we leverage experience and

expertise from across the state for school based health and telemedicine – in fact we have already

leveraged this relationship with MUSC to implement an SBHC at Hughes Academy. Linda

Brees, Director of Advocacy, has served as a member of the Children’s Hospital Collaborative

for 15 years and influences decisions made concerning the Collaborative Legislative Agenda.

Additionally, the SC chapter of the American Academy of Pediatrics is very active and engaged

with key players in the state – particularly with DHHS and DHEC. Kerry Sease, MD is the

current secretary/treasurer and sits on the executive committee for the SCAPP and is also a

member of the SC DHEC Pediatric Advisory Committee.

CIS and Children’s Advocacy have partnered on projects for many years and would continue to

do so in the 4 targeted middle schools. CIS plans to place Site Coordinators in all 4 schools and

would work with the School Based Health Clinic staff to coordinate the delivery of services,

specifically for those students who need medical attention the most. We know that basic health

and human services are essential for every child and through our partnership we can ensure that

both these needs are met. GHS Children’s Advocacy School Health division will also work with

CIS site coordinators at the 4 targeted middle schools to increase health literacy among CIS

students and families through targeted programs on various, trending health issues.

Injury prevention programming through Safe Kids Upstate, in partnership with Safe Kids

Worldwide, will be used to teach topics such as sports safety to prevent concussions and thereby

increasing health literacy among middle school students. Sports Safety has been a focus of Safe

Kids Worldwide in recent years due to rising occurrences of concussions among students

involved in contact sports. Safe Kids Upstate has been the recipient of Sports Safety grants to

implement sports safety programming in schools in the past and will continue to do so in the 4

targeted middle schools.

Collective Impact Framework

GHS is familiar and experienced in working under a collective impact framework. In September

2012, GHS Children’s Advocacy School Health was named as a subgrantee of the Community

Transformation Grant awarded to LiveWell Greenville through the Department of Health and

Human Services. Children’s Advocacy was one of several local community agencies including

Greenville County School District, Momentum Bike Clubs, numerous afterschool programs,

drug prevention programs, Piedmont Health Foundation, Meals on Wheels and others to receive

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funding aimed at promoting healthy eating and active living among Greenville County youth.

The funding received by the School Health division helped to expand bike and pedestrian

education programs for Kindergarten through 5th graders. A pedestrian safety town called

PedVille was created to teach K-3rd graders how to safely walk to school and around their

neighborhoods. This mobile interactive exhibit visits Greenville County elementary schools

during the school year and community centers during the summer. Also with funding from the

CTG, new bicycle education program was added specifically targeting fourth and fifth grade

students called the Bicycle Skills Clinic. This program offers an adult instructor training, a

bicycle skills and safety education curriculum, and an available “bike trailer” for groups to

reserve for instruction.

Another example of a collative impact is demonstrated by Children’s Advocacy’s leadership

around the dangers of unsafe sleep. Because of a call to action by the state and local coroner’s

offices, Children’s Advocacy leads the state in the establishment of a Cribs for Kids Program

that educated families of the Upstate on the dangers of unsafe sleep, the gathering of more than

60 community partners with signed MOUs , and the distribution of more than 1000 cribs in the

upstate through these partners.

Children’s Hospital, along with United Way created, founded and fueled the highly successful

Institute for Child Success. Linda Brees is the current Vice Chair of the board and has been

involved since its conception. Dr. Desmond Kelly and Dr. William Schmidt are also board

members. The vision of the Institute for Child Success is to foster a system that ensures the

success of young children. The Institute’s three pillars are research, policy, and integration.

Leadership and Staff Qualifications

The key organizational leaders for this grant will be Dr. Desmond Kelly and Mrs. Linda Brees.

Dr. Kelly is Vice Chair for Academic Affairs for the Department of Pediatrics of the Greenville

Health System Children’s Hospital in Greenville South Carolina. He is a Professor of Clinical

Pediatrics at the University of South Carolina School of Medicine Greenville and directs the

subspecialty fellowship program in Developmental-Behavioral Pediatrics. He will spend

approximately 5% of his time as an in-kind contribution from GHS (separate from the required

cash match for SIF). Mrs. Brees is Director of Children’s Advocacy at GHS and is responsible

for all community outreach and partnership development, government relations, and prevention

programs. Her dontation of time to the program is estimated at 10%. Biographical sketches for

both Dr. Kelly and Mrs. Brees are attached.

The SBHC program will be under the guidance of Megan Shropshire. Her 35% of time on the

grant is an in-kind contribution (separate from the required cash match for SIF) from GHS. Ms.

Shropshire is the Manager of School Health, Children’s Advocacy at GHS. She serves as the

liaison between Greenville Hospital System and school systems within the GHS service area.

Ms. Shropshire works closely with the Director of Children's Advocacy to find programs that can

be implemented in schools to improve the total health of children.

The medical direction of the SBHC program will be under the guidance of Dr. Kerry Sease. Dr.

Sease received her medical degree from the University of South Carolina School of Medicine in

1998. She then completed her Pediatric residency at the Greenville Health System in 2001. After

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residency, Dr. Sease completed a General Academic Pediatric Fellowship with the Children’s

Hospital of Pittsburgh, finishing in 2003. Dr. Sease returned to the Greenville Health System as

faculty with the Department of Pediatrics in July 2003. She received the outstanding faculty

teaching award her first year on faculty and served as Associate Program Director for the

Pediatric training program from 2005-2006 until she took over as the program director in 2006.

Dr. Sease’s academic interests include resident education, advocacy and obesity. In 2010 Dr.

Sease received the 2010 Pediatrician of the Year award from Greenville Health System (GHS)

Children's Hospital as well as the 2010 Humanitarian Alumni Award from USC School of

Medicine. In 2014 she was selected as a member of the prestigious Liberty Fellow program class

of 2015.

The staffing model for the SBHC program is described below, and position descriptions or

required qualifications are attached to the grant.

Program Coordinator (to be hired) – this position requires a minimum education level of

Bachelor’s Degree and three years minimum experience in Early Childhood, Elementary,

Middle, High School education, or any combination.

Physician – Dr. Kerry Sease is the physician and medical director of the SBHC program. She is

currently employed by GHS.

Nurse Practitioner (to be hired) – this position requires an NP degree.

RN (to be hired) - this position requires an RN degree.

The Program Coordinator will be responsible for ensuring that necessary data is collected and

evaluated based upon information received from the Riley Institute during the evaluation design

phase of the program. Oversight of the program for performance management and growth will be

under the guidance of Dr. Kerry Sease, Ms. Megan Shropshire and Mrs. Linda Brees.

Experience with Program Growth and Replication

Children’s Advocacy has had success in program expansion and replication in several of its

programs, including Help Me Grow and Safe Kids Upstate. Help Me Grow is based off of a

national model, was implemented in Greenville County, and is now poised to move statewide.

Safe Kids Upstate is one of more than 450 coalitions affiliated with Safe Kids Worldwide®, an

organization whose mission is to prevent accidental childhood injury, a leading killer of children

14 and under. There are 15 Safe Kids coalitions in South Carolina. Safe Kids Upstate Coalition,

led by Greenville Health System Children's Hospital Children’s Advocacy, consists of more than

70 community partners who join together to fight unintentional injuries. These are just two

examples of Children’s Advocacy’s experience with program expansion and replication.

To be successful with expansion of SBHCs, we will need buy in from the principals and school

nurses at target schools. We already have buy in from the district superintendent, Mr. Royster,

and the principals of the four schools to be served by the grant. Barriers to success at any stage of

the program will be with utilization of the clinics – we will need to get buy in from the parents

and also need written consent, which can be hard to get because paperwork is not often sent back

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to the school. We will also need to consider how obstacles such as patient privacy requirements

(HIPPA) will affect data gathering and analysis.

Experience with Federal Grants

GHS has extensive experience in managing federal grants. Our Office of Sponsored Programs is

tasked with management and oversight of all institutional grants. This provides us with a strong,

centralized and experienced department to ensure program fidelity and complete financial

management. A partial listing of federal grants awarded to and managed by GHS and its research

partners is below.

Department of Homeland Security/FEMA: Dr. Scott Sasser; cooperative agreement -Dr. Scott

Sasser will provide critical analytical, technical, and planning support to DHS’ continued

development of national preparedness policy and doctrine.

CDC via SC DHEC – LAB HIV 2011 – 2016 This contract defines an agreement between the

Greenville Health System and the SC Department of Health and Environmental Control to

expand and integrate routine HIV testing into hospital emergency departments.

CDC via UNC SEARCH 2009-2015 Search for Diabetes in Youth 2: South Carolina Center In

this project, GHS proactively identifies incident cases in the upstate area of SC to facilitate

recruitment and retention of these cases for further data collection.

HRSA via Children’s Trust of South Carolina – Health Steps MIECHV 2014-2016 Healthy

Steps is a home visiting and family support model that seeks to serve higher risk Medicaid

recipients not being seen through other programs or that are being served by the medically high

risk nurse practitioner and care management staff.

HRSA via Children’s Trust of South Carolina – Nurse Family Partnership 2009-2016 This

program is supported through MIECHV funds. Nurse Family Partnership is part of a statewide

network that serves low income women pregnant with their first child through partnering with w

registered nurse and regular home visits.

NIH – SC Coast 2013-2018 South Carolina Collaborative Alliance for Stroke Trials (SC-

CoAST) GHS will serve as a collaborating site within the SC CoAST network.

NIH - NCORP 2014-2019 GHS’ Cancer Institute has been awarded by the NIH to conduct

clinical trials and research studies aimed at improving patient outcomes and reducing health

disparities, cancer prevention, cancer control, screening for early cancers, and post-treatment

surveillance, quality of life and understanding the diverse and multi-level factors that affect

access to and quality of care.

CDC – Community Transformation 2013-2015 This grant comes in collaboration with the

YMCA of Greenville and Livewell Greenville. It serves to increase the number of schools

engaging students to walk or bike to school, to provide pedestrian education, and to provide

bicycle education.

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DOT – Medical Conditions 2011-2015 The Effect of Medical Conditions on Driving

Performance grant project investigates the driving performance of aging drivers with different

medical conditions.

NIH via UNC– Progesterone Action 2009-2015 Progesterone Action in the Endometrium of

Women with Endometriosis

NIH via MUSC 2010 – 2015: Biomarkers in Autism of Aripiprazole and Risperidone Treatment

(BAART) This grant proposed a randomized clinical drug trial in narrowly diagnosed patients

with autistic disorder and irritability to prospectively identify biomarkers, clinical characteristics,

and other phenotypic traits. Will provide guidance to clinicians in the choice and monitoring of

drug treatment of AD.

NSF - ART 2011-2014 GHS was awarded a subaward form Clemson University on this project

which examined building a smart, robotic, over-the-bed table to support and enhance people in

domestic environments over the greater part of their lifetime.

Resumes of Key Staff upload

/document/download/filename/1420830736_12240_GHSSBHCresumesandjobdescriptions.pdf/

Letter of Commitment from Executive Director and Board Chair upload

/document/download/filename/1420830736_12241_Dr.Schmidtandboardchairletters.pdf/

Optional -- Letters of Support

/document/download/filename/1420830736_12242_SBHClettersofsupport.pdf/

Optional -- Other upload

Greenville Health System (GHS)

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Financial Soundness

Funding Diversity and Sustainability

GHS as an organization has overall annual revenue and expenditures of $2 billion, encompassing

patient care, research, academics, community health and other areas. However, each department

and division with in the System is responsible for its own budget management. Children’s

Advocacy is part of the GHS Children’s Hospital. The Children’s Advocacy budget is supported

both operationally through Children’s Hospital funding, and through grants, donations, corporate

sponsorships and community partnerships.

GHS programs such as Children’s Advocacy also benefit from the support of The Office of

Philanthropy & Partnership (OPP), the philanthropic arm of GHS. The Office of Philanthropy &

Partnership works to build philanthropic support for programs throughout the hospital system to

create high-quality health care for everyone in the Upstate communities. It is OPP’s

responsibility to seek involvement and encourage funding opportunities for people outside of the

hospital system by:

• Building relationships with interested community philanthropic and partner prospects

• Providing important GHS facts and uplifting victory stories from grateful patients and

caregivers

• Sharing the philanthropic and partner opportunities attracting significant giving

• Enabling philanthropists to partner with GHS for the betterment of the Upstate

• Collaborating with other community organizations that share the GHS mission

GHS is confident of the ability to sustain the SBHC program after grant funding is complete. We

will work to introduce a revenue stream through Medicaid and other reimbursements, as well as

to operationalize key staff positions in the program. Finally, we will continue to seek community

support for the program by promoting the community benefits and successes of the program.

Match Capacity

The SBHC program has received a written commitment of a $100,000 match in unrestricted

funds from the Children’s Hospital via Dr. William Schmidt, Medical Director, Children’s

Hospital and Chairman of Pediatrics. We also have a commitment of $15,000 from the Piedmont

Health Foundation. The Office of Philanthropy and Partnership and Children’s Advocacy have

committed to obtaining the remaining matching funds as required by the grant.

Children’s Hospital, through Dr. Schmidt, has committed to the $100,000 match for three years,

leaving us with the task of raising the additional funds in years 2 and 3 of the grant. We will

begin working on obtaining this match immediately upon confirmation that we have received

funding under the grant. We will solicit personal as well as corporate and foundation support.

Should funding be available in years 4 and 5, GHS commits to aggressively seeking out the

additional matching funds required.

Capacity and Infrastructure

The Office of Sponsored Programs assists with efforts at GHS to seek outside funding for

research, including all pre-award activities and post-award management. The office disseminates

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21 | P a g e

information concerning appropriate funding opportunities, offering guidance on the development

and submission of proposals, and in the negotiation and award of grants and contracts.

In addition, the office provides assistance in managing various administrative issues arising from

extramurally-funded research. Serving as the primary liaison between GHS and outside sponsors,

the Office of Sponsored Programs ensures accountability and adherence to the standards of

external funding entities, and compliance with federal and state guidelines as well as GHS fiscal

policies. It is the central administrative office responsible for submitting proposals and

coordinating the acceptance of awards on behalf of GHS. The GHS Office of Sponsored

Programs is managed through a partnership with the Office of Sponsored Programs at Clemson

University.

GHS implemented the grant activity module of the Lawson accounting system in summer 2014.

An individual account is created for each grant funding stream for accurate tracking of grant

dollars. This system interfaces directly with other GHS systems such as payroll, procurement,

and capital.

The GHS Post Award staff employee has a degree in Finance and a minor in Accounting with 15

years of experience in the financial management of private, State and Federal awards including

NIH, CDC, DOD, Komen Foundation, etc and has previously managed grants for Duke

University and the University of North Carolina at Chapel Hill.

Budget Narrative and Rationale

GHS – United Way SIF Grant

Budget Justification

UNITED WAY REQUESTED FUNDS

Personnel (Salary)

Program Director: Funds are requested to support the Program Director at 2.742% effort. Base

salary is $164,112 with the annual salary requested at $4,500.

Nurse Practitioner: Funds are requested to support 50% of the salary for a full-time Nurse

Practitioner at 100% effort. Base salary is $75,000 with the annual salary requested at $37,500.

The remaining 50% will be paid using matching funds.

Registered Nurse: Funds are requested to support 50% of the salary for a full-time Registered

Nurse at 100% effort. Base salary is $50,000 with annual salary requested at $25,000. The

remaining 50% will be paid using matching funds.

Project Coordinator: Funds are requested to support 80% of the salary for a full-time Project

Coordinator at 100% effort. Base salary is $49,920 with the annual salary requested at $39,936.

The remaining 20% will be paid using matching funds.

Fringe Benefits

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Fringe benefits will be calculated using the GHS pooled rate of 24.82%.

Supplies

Funds are requested to cover the cost of two fully functional Electronic Medical Record (EMR)

laptops for the Nurse Practitioner and Registered Nurse totaling $6,000, as well as a regular

laptop for the Project Coordinator totaling $2,700.

Funds are requested to cover the initial purchase of two phones and the service fee at GHS’

negotiated rate for 12 months for a total of $2,160.

Funds are requested to purchase medical supply kits for each of the three schools, such as tongue

depressors and cotton swabs, totaling $1000.

Other

Funds are requested to pay the lease of a 100-square-foot on-site program space at each of the

three schools at a rate of $20/square-foot for a total of $6,000.

Funds are requested to cover the cost of the CLIA lab at the cost of $150 per site, totaling $450.

A subgrantee evaluation has been included to account for 10% of the total project budget.

MATCHING FUNDS

Personnel (Salary)

Nurse Practitioner: Matching funds will support 50% of the salary for a full-time Nurse

Practitioner at 100% effort. Base salary is $75,000 with the annual salary requested at $37,500.

Registered Nurse: Matching funds will support 50% of the salary for a full-time Registered

Nurse at 100% effort. Base salary is $50,000 with the annual salary requested at $25,000.

Project Coordinator: Matching funds will support 20% of the salary for a full-time Project

Coordinator at 100% effort. Base salary is $49,920 with the annual salary requested at $9,984.

Fringe Benefits

Fringe benefits will be calculated using the GHS pooled rate of 24.82%.

Travel

Matching funds will support travel for program staff to travel to the middle schools totaling

$4,140. The Nurse Practitioner and Registered Nurse will travel 20 miles daily, 5 days a week,

for 36 weeks. Mileage reimbursement rate for GHS is the IRS standard mileage rate of

$0.575/mile.

Matching funds will support travel and accommodations for program staff to attend an annual

school-based health conference totaling $3,000.

Equipment

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Matching funds will be used to cover the cost of three fully integrated telemedicine carts at

$29,000/each, totaling $87,000.

Supplies

Matching funds will cover pharmacy kits including rapid tests, over-the-counter medications and

antibiotics given on-site for each of the three schools totaling $5,000.

Other

All personnel will receive the appropriate background checks, which are required for all

employees at Greenville Health System. Each of the three new employees will receive a SLED

check at the non-profit rate of $8 for a total of $24. All four project personnel will receive a

fingerprint-based FBI check for $38 each as well as a nationwide name-based check of the

National Sex Offender Public Website, provided at no charge by GHS’ third party provider, for a

total of $152.

Match Commitment Documentation upload

/document/download/filename/1420830736_12246_SIFmatchdocumentionforSBHC.pdf/

Year 1 Budget upload

/document/download/filename/1420830736_12247_SIFBudgetGHS-finalSIF2014-2015.pdf/