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School-Based Health CentersSchool-Based Health Centers(SBHCs) 101:(SBHCs) 101:
An Overview and Framework for An Overview and Framework for Building ProgramsBuilding Programs
ObjectivesObjectives Participants will be able : Define school-based health center (SBHC) Explain why SBHCs are an effective health
care delivery system for children and adolescents
Describe characteristics of SBHCs
SBHC: National DefinitionSBHC: National Definition
Partnerships created by schools and community health organizations to provide on-site medical, mental health, and/or oral health services that promote the health and educational success of school-aged children and adolescents.
One of the partners, usually a health agency (community health center, local health department, hospital, mental health agency, or 501 C3 agency), or a school system, becomes the sponsoring agency.
SBHC: National DefinitionSBHC: National Definition
Services provided by the school-based health care team are determined locally through a collaborative process that includes families and students, communities, school districts, and individual and agency health care providers.
The school-based health care team works in collaboration with school nurses and other service providers in the school and community.
SBHC: National DefinitionSBHC: National Definition
SBHCs have a policy on parental consent.
Although the model may vary based on availability of resources and community needs, SBHCs are typically open every school day, and staffed by an interdisciplinary team of medical and mental health professionals that provide comprehensive medical, mental health and health education services.
SBHC: National DefinitionSBHC: National Definition
SBHCs make provisions for care beyond the centers’ operating hours or scope of service.
Because of the unique vantage point and access to students, the health center team is able to reach out to students to emphasize prevention and early intervention.
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SBHC: National DefinitionSBHC: National Definition
Services typically offered in SBHCs are age appropriate and address the most important health needs of children and youth.
These services may include but are not limited to: – primary care for acute and chronic health conditions– mental health services– substance abuse services– case management– dental health services– reproductive health care– nutrition education– health education and health promotion.
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SBHC: National DefinitionSBHC: National Definition
SBHCs are supported by local, state, and federal public health and primary care grants, community foundations, students and families, and reimbursement from public and private health insurance.
Why School-Based Health Centers?Why School-Based Health Centers?
Group ActivityGroup Activity
Why School-Based Health Centers?– Think of yourself as a school aged child, pick
your age, or– Think of your own child or adolescent, or– Think of family members, neighbors as a school
aged child– Using the first letter of your first or last name, or
draw an alphabet card, come up with a reason for having a SBHC in your community
Why SBHCs?Why SBHCs? Uninsurance among children, especially
adolescents
Geographic and financial barriers to health, mental health, and oral health
Dangerous health outcomes associated with adolescents
Nonexistent/fragmented/singular discipline systems of care
Decreased educational attainment
“Health services need to be where students can trip over them. Adolescents do not carry appointment books, and school is the only place where they are required to spend time.”
Philip J. Porter, M.D.
Early architect of the SBHC movement
The Evidence Base for SBHCsThe Evidence Base for SBHCs Research published in professional literature
National and state data
– National State Initiative Survey– NASBHC Triennial census– White papers
Training and technical assistance in the field
– Results of beta testing tools and resources– Collaboratives
Pre and post assessments, chart reviews, progress reports, storyboards, consultation calls
What the Literature Tell Us About What the Literature Tell Us About Emergency Room Use and SBHCsEmergency Room Use and SBHCs
Reduced inappropriate emergency room use, Increased use of primary care, and Fewer hospitalizationsSantelli J, Kouzis A, et al. Journal of Adolescent Health 1996; 19:267-275
Prevention-oriented care in SBHCs results in decreased utilization of emergency departments
Key JD, Washington EC, and Hulsey TC, Journal of Adolescent Health 2002: 30;273
What the Literature Tell Us About What the Literature Tell Us About Asthma and SBHCsAsthma and SBHCs
Greater than 50% reduction in asthma-related emergency room visits for students enrolled in SBHCs in New York City
Webber MP et al. Archives of Pediatric and Adolescent Medicine. 2003; 157: 125-129
$3 million savings in asthma-related hospitalization costs for students enrolled in SBHCs in New York City
Analysis by the Empire Health Group for the NY Coalition of School-Based Primary Care, 2005
What the Literature Tell Us About What the Literature Tell Us About Mental Health and SBHCsMental Health and SBHCs SBHCs attract harder-to-reach populations,
especially minorities and males and do a better job at getting them crucial services such as mental health care and high risk screens.
Adolescents were 10-21 times more likely to come to a SBHC for mental health services than a community health center network or HMO.
Juszczak L, Melinkovich P, Kaplan D. Journal of Adolescent Health 2003; 32S:108-118.Kaplan D, et al. Archives of Pediatric and Adolescent Medicine. 1998
Jan;152(1):25-33.
What Science Tell Us About Education What Science Tell Us About Education and SBHCs and SBHCs
Health has both direct and indirect effects on school failure
Good education predicts good health Inequities in health and education are closely
linked: young people who experience inequities in educational
achievement also experience inequities in health care access
Public health and education are linked toward a common cause: student success
What We Know IntuitivelyWhat We Know Intuitively
Healthy students make better learners
You cannot teach a child who is not healthy
A child who succeeds in school is more likely to enjoy lifelong health
What Science Tells Us About What Science Tells Us About Education Education
Academic performance is negatively affected by:– Alcohol, tobacco, and other drug use – Emotional problems – Poor diet – Intentional injuries – Physical illness – Low self-esteem– Risky sexual behavior– Lack of access to health care– Unstable home environment
Academic performance is positively affected by:– High levels of resiliency, developmental assets, and school
connectedness.
SBHCs
Health RiskBehaviors
EducationalOutcomes
EducationalBehaviors
Substance use
Mental health
Poor diet
Intentional injuries
Physical illness
Self-esteem
Sexual behaviors
Attendance
Dropout Rates
Behavioral Problems
Graduation
GPA
Standardized test scores
Geierstanger, S. P., & Amaral, G. (2004). Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White PaperPerformance: What is the Intersection? April 2004 Meeting Proceedings. White Paper . . Washington, D.C.: National Assembly on School-Based Health Care.Washington, D.C.: National Assembly on School-Based Health Care.
The Health-Academic Outcomes ConnectionThe Health-Academic Outcomes Connection
SBHC Outcomes and TacticsSBHC Outcomes and TacticsReduce barriers
to learningIncrease
attendance Improve
student health
Meet government regulations
• Identify students at-risk for health and behavioral problems
• Assist in IEP development
• Provide mental health services
• Treat acute conditions
• Manage chronic conditions
• Provide preventive health services
• Treat acute conditions
• Administer medication to students with chronic conditions
• Enroll students in health insurance
• Provide mental health services
• Refer students to services not provided in the SBHC
• Provide preventive health services
• Treat acute conditions
• Manage chronic conditions
• Conduct sports physicals
• Provide mental health services
• Immunize students
• Participate in community initiatives on public health such as obesity and emergency planning
• Maintain health records for migratory students
The Medical HomeThe Medical Home
Half of SBHCs estimate more than 30% of their enrollees use the center as their medical home
40% of SBHCs estimate 50% or more of their enrollees use the center as their medical home
Efficiencies in SBHCsEfficiencies in SBHCs
Parents do not need to take time off
Follow-up is less labor intensive
Ability to identifying problems earlier
Costly emergency room visits reduced
National Data and TrendsNational Data and Trends
Census 2007-08
SBHCs by State SBHCs by State (n=1910)(n=1910)
State Total # of Open SBHCs State Total # of Open SBHCs
Alabama 5 Nebraska 1
Alaska 3 Nevada 6
Arizona 81 New Hampshire 1
Arkansas 2 New Jersey 40
California 160 New Mexico 79
Colorado 45 New York 206
Connecticut 79 North Carolina 49
Delaware 28 Ohio 20
District of Columbia 4 Oklahoma 11
Florida 245 Oregon 51
Georgia 3 Pennsylvania 28
Illinois 60 Puerto Rico 2
Indiana 87 Rhode Island 2
Iowa 16 Saskatchewan 1
Kansas 2 South Carolina 7
Kentucky 20 South Dakota 6
Louisiana 64 Tennessee 21
Maine 26 Texas 70
Maryland 71 Utah 5
Massachusetts 59 Vermont 5
Michigan 90 Virginia 19
Minnesota 16 Washington 20
Mississippi 31 West Virginia 50
Missouri 3 Wisconsin 8
SBHCs by Location SBHCs by Location (n=1226)(n=1226)
In school building 95.7 percent
On school property 2.9 percent
Mobile 1.4 percent
SBHCs by Types of School SBHCs by Types of School (n=1096)(n=1096)
SBHCs by Community Characteristic SBHCs by Community Characteristic (n=1235)(n=1235)
SBHCs Users by Race/EthnicitySBHCs Users by Race/Ethnicity(n=1096)(n=1096)
SBHCsSBHCs by Population Served by Population Served (n=1096(n=1096))
SBHCs by Sponsoring Agency SBHCs by Sponsoring Agency (n=1096)(n=1096)
Services Offered by SBHCsServices Offered by SBHCs
Primary Care Services Provided by SBHCsPrimary Care Services Provided by SBHCs(N=1046-1075)(N=1046-1075)
Reproductive Health Services Offered by Reproductive Health Services Offered by SBHCs to Adolescents On SiteSBHCs to Adolescents On Site (n= 1030-1068)(n= 1030-1068)
Oral Health Services Offered by SBHCs Oral Health Services Offered by SBHCs (n= (n=
1010-1046)1010-1046)
Contraception Prohibition at SBHCs Contraception Prohibition at SBHCs (N=1095)(N=1095)
Mental Health Services Offered by SBHCs With Mental Health Services Offered by SBHCs With (n=878) and Without (n=348) Mental Health Providers (n=878) and Without (n=348) Mental Health Providers