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Parent to ParentParent to ParentCan parent liaisons increase parental awareness, involvement & use of School-Based & School-Linked
Health Centers?
2
PresentersPresentersDepartment of Pediatrics School-Based & Community
Health ProgramStephanie Kendzierski, MSW, LLMSW
Rachel Pearson, MSW, LMSW
Stacey Ingram
Michigan State University Office of Medical Education
Research & DevelopmentBrian Mavis, PhD
3
Racial Composition of Residents**
11%
5% 2%
84%
African American White Other Tw o or More Races
Detroit, MichiganDetroit, MichiganEconomic & Health Indicators for Children*
Detroit Michigan
Child Population (ages 0-17) 263,709 2,513,714
Percent of total population 29.7& 24.8%
Children under 18 living in poverty 45% 19%
Students receiving free/reduced lunch 71.3% 37.1%
State health insurance participation (ages 0-18)
Healthy Kids (Medicaid) 55.3% 32.1%
MI Child (SCHIP) 0.8% 1.3%
Children ages 1-14 hospitalized for asthma 71.1 24.5
Birth to teens ages 15-19 (per 100,000) 71 34.4
*Kids Count in Michigan, Data Book 2006
**US Census Bureau, 2005 American Community Survey
4
HFHS School-Based & HFHS School-Based & Community Health ProgramCommunity Health Program
• Established in Detroit, Michigan in 1994 as the School-Based Health Initiative
• Initial support from the W. K. Kellogg Foundation in partnership with the Detroit Public Schools
• Current funding: Local, state & private sources Henry Ford Health System
• SBCHP provides services to medically underserved school-age children & their younger siblings and young adults
• Services offered: Primary Care Prevention Family
Planning
Mental Health Health Education Medicaid Outreach
5
HFHS School-Based & HFHS School-Based & Community Health ProgramCommunity Health Program
• Full & part-time centers• Currently 8 programs located in elementary
schools, middle schools, a high school and a community youth center
• Staffing varies by center:• nurse practitioner, physician’s assistant or
registered nurse• medical assistant• social worker• pediatrician
6
Funding RequirementFunding Requirement
• Health Center Advisory Boards• Required for Michigan Department of
Community Health (MDCH) funded SBHCs • Board composition
• Parents (minimum of 33.3% of the board)• School staff• Community members• SBHC staff (maximum of 50% of the board)
• 5 SBCHP programs are funded by MDCH
7
ProblemProblem
• Encouraging parent participation is challenging• Many things compete for parents’ time
• Schools struggle to maintain their parent organizations
• Health Center Advisory Board concept is not widely understood
• SBCHP staff have many duties to fulfill• Establishing advisory boards takes time
• SBCHP has struggled to create & maintain advisory boards
8
Problem SolvingProblem Solving
• Do we need someone with dedicated time to establish an advisory board?
• Who would be in the best
position to recruit parents &
community members?
• What type of work would they do?
9
Possible SolutionPossible Solution
• Parent Liaisons• Connected to the school &
community• Familiar with the issues faced by
parents• Aware of what would motivate parents to participate
• Funding• Proposal submitted to Families and Communities
Together (FACT) at Michigan State University
10
Project GoalsProject Goals
• Increase the clinics’ community & school outreach efforts
• Establish active adult & youth advisory boards
• Encourage parental involvement in the clinic
• Increase the number of signed parent consent forms
• Increase use of the clinics’ services by students and their siblings
11
Pilot ClinicsPilot Clinics
• Webber Health Center• Provides medical & dental services• Located in Webber School
• Pre-K – 8th grade public school
• YouthVille Health Center• Provides medical & mental health services• Located in YouthVille Detroit
• Youth center operated by the Detroit Youth Foundation
• Linked to University Preparatory Academy • Pre-K – 12th grade charter school system
12
Project StaffingProject Staffing
• Project Coordinator• Responsible for overseeing the project and
supervising the parent liaisons• Worked 24 hours per week
• Two parent liaisons (one at each clinic)• Responsible for clinic outreach & advisory
board development• Worked 20 hours per week
13
Staff RecruitmentStaff Recruitment
• Project Coordinator• Professional position• Posted on HFHS careers web site• Posted at the local school of social work
• Parent Liaison• Para-professional position• Principals recommended suitable parents from
each school
14
Project TimelineProject Timeline
Planned Actual
•Spring: Hire Project Coordinator •Spring: Began interviewing for Project Coordinator
•Summer: Project Coordinator develops the parent liaison training program
•Summer: Continued interviewing Project Coordinators, interviewed Parent Liaisons
•Sept.: Hire Parent Liaisons & implement training program
•Sept.: Project Coordinator & Parent Liaisons started work
•Webber liaison resigned
•Oct.: Begin outreach & advisory board development
•Oct.: Webber Parent Liaison Replaced. Ad Hoc training “program” implemented.
15
Parent Liaison PerspectiveParent Liaison Perspective
16
Understanding ofUnderstanding of School-Based/Link Program School-Based/Link Program
• Read all materials received about school-based/linked
• Asked questions regarding school-based/linked
• Visited the other HFHS school-based/linked health centers
• Attended staff meetings
• Worked closely with health center staff / F.A.C.T. Team
17
Gain Knowledge About Gain Knowledge About Parent Liaison RoleParent Liaison Role
• Board development training & research
• Parent & youth engagement training
• After-school program training
18
Developing Advisory BoardDeveloping Advisory Board
• Brainstormed about possible members• Created/distributed flyers• Attended parenting/school events• Solicited T.E.E.N., YouthVille, University
Preparatory Academy parents• Asked YouthVille & University Preparatory
Academy students• Invited community members
19
Increase Consent FormsIncrease Consent Forms
• Visited school and spoke directly to students
• Offered incentive to students / staff
• Prepared packets to be distributed to parents
• Created frequently asked question list
20
Raise Awareness &Raise Awareness & Use of Health Center Use of Health Center
• Informed school staff of health center services
• Distributed flyers about health center
• Presentations within the community
• Utilized advisory board as community outreach
• Attended community events
21
ExpectationsExpectations
• Clearer Roles• Structure &
organization• Understand school-
based health centers• Gain knowledge about
parent liaison role
22
OutcomesOutcomes
• 22 member advisory board• Increased use of health center from within the
community• University Preparatory Academy consent form
count went from 47 to approximately 200• Greater knowledge of school-based and it’s
mission• Attained knowledge of engaging parents &
youth and creating an advisory board• Health Fair
23
SuccessesSuccesses
• Training classes
• Building relationships with students, teachers and administrators
• Committed parents on the Advisory Board
• Chairperson of the Advisory Board
24
ChallengesChallenges
• Hours• Program start date• Time management• Getting the students to give
their parents flyers for upcoming events
• Getting more parents/guardians involved in the school and its activities
• Sharing efforts
25
Reflecting…Reflecting…
• Better management of projects or events
• Numerous contacts• Early recruitment for advisory
boards• 40 hour work load • Incentive / expectations• Following up & following through• Early training
26
Notes from the FieldNotes from the Field
Comments from advisory board members
video production by Patrick Betzold
27
Evaluation of the Pilot ProgramEvaluation of the Pilot Program
• Outcomes• Consent forms• Services provided• Advisory board meetings
• Process• Interviews• Activity logs
28
School-Based Health Centers:School-Based Health Centers:Completed Consent FormsCompleted Consent Forms
0
50
100
150
200
250
300
350
400
450
500
S O N D J F M A M J A S O N D J F M A M
Com
plet
ed F
orm
s (N
) .
Site ASite B
Control
2005 -2006 2006 - 2007
29
School-Based Health Centers:School-Based Health Centers:Number of Clients by QuarterNumber of Clients by Quarter
0
20
40
60
80
100
120
140
160
180
Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Nu
mb
er o
f C
lien
ts
Site A
Site B
2005 2006 2007
30
School-Based Health Centers:School-Based Health Centers:Number of Client Visits by QuarterNumber of Client Visits by Quarter
0
100
200
300
400
500
600
Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Cli
en
ts V
isit
s .
Site A
Site B
2005 2006 2007
31
School-Based Health Centers:School-Based Health Centers:Services Provided by QuarterServices Provided by Quarter
0
100
200
300
400
500
600
700
800
Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Serv
ices P
rovid
ed
.
Site A
Site B
2005 2006 2007
32
Advisory Board MeetingsAdvisory Board Meetings
Youth Adult
• Project Coordinator 4% 8%• Parent Liaison (Site A) 14% 14%• Parent Liaison (Site B) 1% 21%
• Advisory boards were created at both sites• Each has met at least once in past year
33
Time and Activity StudyTime and Activity Study
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
7:30
AM
8:00
AM
8:30
AM
9:00
AM
9:30
AM
10:0
0 A
M
10:3
0 A
M
11:0
0 A
M
11:3
0 A
M
12:0
0 P
M
12:3
0 P
M
1:00
PM
1:30
PM
2:00
PM
2:30
PM
3:00
PM
3:30
PM
4:00
PM
4:30
PM
5:00
PM
5:30
PM
6:00
PM
6:30
PM
7:00
PM
7:30
PM
8:00
PM
- - - - - - - - - - - - - - - - - - - - - - - - - -
7:00
AM
7:31
AM
8:01
AM
8:31
AM
9:01
AM
9:31
AM
10:0
1 A
M
10:3
1 A
M
11:0
1 A
M
11:3
1 A
M
12:0
1 P
M
12:3
1 P
M
1:01
PM
1:31
PM
2:01
PM
2:31
PM
3:01
PM
3:31
PM
4:01
PM
4:31
PM
5:01
PM
5:31
PM
6:01
PM
6:31
PM
7:01
PM
7:31
PM
3837
3635
3433
3231
3029
2827
2625
2423
2221
Meetings with youth for the YV Youth Advisory BoardRecruiting youth for the YV Youth Advisory Board
Meetings with parents in the communityRecruiting parents for the Health Center Advisory BoardMeetings with community membersRecruiting community members for the HC Advisory Board
time
perio
ds
Directions: Use this form to document your activities.This form is divided into half-hour blocks of time. Most of the time you will complete several activities in each half-hour block. For this log, record the activity that took the most amount of time during each half-hour. If you have an activity that is longer than a half hour, mark as many time blocks as you spent in the activity.
Attending HFHS/SBCHP trainingsAttending youth engagement trainingsAttending parent engagement trainingsAttending advisory board development training
Preparing to meet with school staff, students or parentsMeetings with parents at the schoolMeetings with school staffAttending school events Recruiting teachers/staff for the Health Center Advisory BoardRecruiting parents for the Health Center Advisory BoardRecruiting students for the Youth Advisory Board
Preparing to call or meet with community members
Training
School Outreach
Community Outreach
34
Activity Categories:Activity Categories:Project CoordinatorProject Coordinator
• Training• Identifying training needs• Researching training options• Enrolling liaisons in trainings• Attending trainings
• School & Community Outreach• Assist with outreach plans• Help prepare for activities• Attend school events/outreach• Assist recruiting adv boards
• Health Center Advisory Board• Assist in meeting preparation• Attend SBHC advisory brd meetings• Assist in summarizing notes
• Youth Advisory Board Meetings• Assist with meeting prep• Attend youth adv board meetings• Assist summarizing meeting notes
• Incentives• Identifying contributors• Contacting contributors• Picking-up incentives
• Staff Meetings/Supervision• Supervision meetings• Meet with Project Director• Meet with health center/other staff
• Medicaid• Assist Medicaid outreach activities• Report Medicaid outreach activities
• Other• Lunch• Travel• Other paperwork
35
Activity Categories:Activity Categories:Parent LiaisonsParent Liaisons
• Training• SBCHP meetings• Youth/parent engagement• Advisory board development
• School Outreach• Meeting preparations• Meetings with parents, staff• Attend school events• Recruit parents, students, staff
• Community Outreach• Meeting preparations• Meet: parents, community, youth• Recruit parents, community, youth
• Incentives• Identifying contributors• Contacting contributors• Picking-up incentives
• Advisory Board Meetings• Preparing for meetings• Conducting meetings• Summarizing meetings
• Consent Forms• Distributing consent forms• Speaking with parents• Follow-up on incomplete forms
• Staff Meetings/Supervision• Meetings with Project Coordinator• Meetings with Project Director• Meetings with other staff
• Other• Lunch• Invoices• Travel• Other paperwork
36
Time and Activity Study: The DataTime and Activity Study: The Data
• November 2006 through May 2007• Only some activities from Sept-Oct
• 4139 records• 1455 records from Project Coordinator logs• 1207 records from Parent Liaison at Site A• 1477 records from Parent Liaison at Site B
37
Project Coordinator ActivitiesProject Coordinator Activities
6%
23%
5%
17%10%
12%
27%
Parent liaison training
Staff meetings/supervision
Incentives
School outreach
Community outreach
Advisory board
Other
38
Project Coordinator by MonthProject Coordinator by Month
0
10
20
30
40
50
Nov Dec Jan Feb Mar Apr May
Tim
e (%
) .
Parent Liaison Training Activities
0
10
20
30
40
50
Nov Dec Jan Feb Mar Apr May
Tim
e (%
) .
Staff Meetings and Supervision
39
Project Coordinator by MonthProject Coordinator by Month
0
10
20
30
40
50
Nov Dec Jan Feb Mar Apr May
Tim
e (%
) .
School Outreach
0
10
20
30
40
50
Nov Dec Jan Feb Mar Apr May
Tim
e (%
) .
Community Outreach
40
Project Coordinator by MonthProject Coordinator by Month
0
10
20
30
40
50
Nov Dec Jan Feb Mar Apr May
Tim
e (%
) .
Other Activities
0
10
20
30
40
50
Nov Dec Jan Feb Mar Apr May
Tim
e (%
) .
Youth and Parent Advisory Board Recruitment
41
Parent Liaison ActivitiesParent Liaison Activities
4%
17%
14%
14%14%
6%
9%
5%
17% 8%
16%
13%
22%1%
8%
11%
2%
19%
Training School Outreach Community OutreachCenter Advisory Board Student Advisory Board Consent FormsStaff Meetings Incentives Other
Site A Site B
42
Parent Liaison ActivitiesParent Liaison Activities
0
5
10
15
20
25
Training SchoolOutreach
CommunityOutreach
CenterAdvisory
Board
StudentAdvisory
Board
ConsentForms
StaffMeetings
Incentives Other
Tim
e (
%)
.
Site A
Site B
43
Monthly Parent Liaison Monthly Parent Liaison Activities: Consent FormsActivities: Consent Forms
0
5
10
15
20
25
30
Nov Dec Jan Feb Mar Apr May
Tim
e (
%)
.
Site A
Site B
44
Monthly Parent Liaison ActivitiesMonthly Parent Liaison Activities
0
10
20
30
40
50
60
Nov Dec Jan Feb Mar Apr May
Tim
e (
%)
.
Site A
Site B
0
10
20
30
40
50
60
Nov Dec Jan Feb Mar Apr May
Tim
e (
%)
.
Site A
Site B
Student Advisory Board
Health Center Advisory Board
45
Monthly Parent Liaison ActivitiesMonthly Parent Liaison Activities
0
10
20
30
40
50
60
Nov Dec Jan Feb Mar Apr May
Tim
e (
%)
.
Site A
Site B
0
10
20
30
40
50
60
Nov Dec Jan Feb Mar Apr May
Tim
e (
%)
.
Site A
Site B
Community Outreach
School Outreach
46
Monthly Parent Liaison Activities:Monthly Parent Liaison Activities:School OutreachSchool Outreach
0
5
10
15
20
25
30
35
40
45
Preparationsfor schoolmeetings
Meetings withparents
Meetings withschool staff
Attendingschool events
Recruiting stafffor advisory
board
Recruitingparents for
advisory board
Recruitingstudents for
advisory board
Tim
e (
%)
.
Site A (17%)
Site B (14%)
47
Staff InterviewsStaff Interviews
• Telephone interview (10-30 minutes)
• 11 of 12 planned interview completed• Parent liaisons• Supervising social worker• Health center personnel• SBCHP administrative staff
48
Lessons Learned: Staff InterviewsLessons Learned: Staff Interviews
• Importance of training in multiple skill areas
• Basic skills and experience necessary
• Clear expectations of supervisor
• Need for a clear message about programs
• Boundary issues need to be resolved
49
Put the Cart Put the Cart AFTER the HorseAFTER the Horse
• Know what you have, need, and want before you get started
• Know what you are willing to do to make the program a success. • How much time can you devote to:
• Finding the right candidate?
• Orientation?
• Supervision?
• Helping make connections with the school?
50
Supervision SuggestionsSupervision Suggestions
• The provider should plan to meet with the PL for 30 minutes at least twice a week
• The PL should give the provider a daily update (written or verbal)• Keeps provider aware of the direction of the
project and keeps PL accountable
• Provider should be readily available for questions and giving direction
51
Front-End Heavy LiftingFront-End Heavy Lifting
• Give Parent Liaison a knowledge base regarding SBHCs in general and your site in particular
• Make sure the PL has a clear message to share with the community
• Be clear about how your clinic should be represented
• Spend time with the Parent Liaison providing introductions to school staff and administration
• The PL needs to be comfortable and feel empowered to have meetings without clinic staff
• Provide training on relevant topics
52
What Every PL Should KnowWhat Every PL Should Know
• Board Development• Recruiting and retaining board members• Leading a meeting/meeting styles• Creating by-laws• Setting and keeping an agenda• Recording and distributing minutes• Decision making options• Electing officers• Attend a board meeting from another organization
53
What Every PL Should KnowWhat Every PL Should Know
• Professional Development• Dressing professionally• E-mail & phone etiquette• Effective communication• Engagement skills
54
What staffing is really needed?What staffing is really needed?
• If the provider or other clinic staff can dedicate time to supervise the PL, project coordinator not needed
• Choosing the right Parent Liaison is key
55
Necessary QualificationsNecessary Qualifications
• Experience• Some college or 2 years professional work
experience• Interest in or experience with child &
adolescent health care • Experience in community outreach or project
management preferred• Prior experience with serving on a
board/committee preferred
56
Necessary QualificationsNecessary Qualifications• Skills
• Ability to work with minimal supervision• Basic computer knowledge
• E-mail, Microsoft Word and Excel• Excellent communication skills
• Written, verbal and interpersonal• Excellent organizational skills
• Able to prioritize, multi-task and meet deadlines• Works well independently and collaboratively • Easily adapts to change• Creative & innovative perspective• Exceptional time management skills
57
Things to Keep in Mind…Things to Keep in Mind…
• If you are serving in a impoverished area, your parents will likely have additional life stressors that will affect their work• Car troubles, child care issues, sick children
• You will have to be flexible but mindful of the project timeline and goals
• The amount of time it takes to learn and apply new skills and knowledge varies by person
58
Unanswered Questions…Unanswered Questions…
• Can the PL position serve as a welfare to work model?
• Would a stronger project coordinator with a different skill set have made a difference?
• Why were the results at each site different?• School vs. community?• Skill set of parent liaison?• Other factors?
59
Keys to SuccessKeys to Success
• Success will depend on both the provider and the PL.• You have to find the right balance. The PL can’t be
working in a vacuum, but the provider can’t be expected to micro-manage
• The line of communication between the provider and the PL must always be open and clear
• Boundaries about roles and responsibilities have to be very clear
60
Questions, Discussion . . .Questions, Discussion . . .