Alameda County School Health Services Coalition

2006-07 Coalition Evaluation Highlights

Berkeley High School Health Center

Evaluation Team:

University of California, San FranciscoPhilip R. Lee Institute for Health Policy Studies

Claire Brindis, DrPHSara Geierstanger, MPH

Adrienne FaxioSamira Soleimanpour, MPH

Alameda County School Health Services Coalition

Objectives

Present data highlights that illustrate the:Breadth of services providedProfile of the clients servedImpact of the services on clients

Generate ideas on how this data can be used to improve programming and service delivery at BHS Health Center

Alameda County School Health Services Coalition Sites

UCSF Evaluation Methods

Student Focus GroupsQualitative data

California Healthy Kids Survey(custom health care module)

Comparison data(SBHC client vs. non-client)

Pre and Post Client Survey & Youth Program Post Survey

Self-reported client outcome data

Clinical Fusion database systemService & outcome

Evaluation ToolsType of Data

Coalition Overview and Key Outcomes

Overview of Clients and Services

Key Outcomes: 1. SBHCs Increase Access to Care for the School

Community 2. Mental Health Services Positively Impact Clients3. Female Family Planning Clients Improve Birth

Control Use4. Youth Development Programs Improve Client

Resiliency

Data Source: Pre/Post Client Survey 2006/07

Alameda County School-Based Health Center Coalition

Overview of Clients and Services

Data Source: Clinical Fusion 2001/02 – 2006/07

Increased Coalition-Wide SBHC Services

4,047 5,010 5,577 5,748 6,170 6,624

12,581

18,81820,186 20,975

25,73727,078

FY 01/02 (7 SBHCs)

FY 02/03 (8 SBHCs)

FY 03/04 (10 SBHCs)

FY 04/05 (10 SBHCs)

FY 05/06 (11 SBHCs)

FY 06/07 (11 SBHCs)

Clients ServedClinic Visits

3.1 to 4.1

Visits per Client

64%

Registered Clients

115%

Clinic Visits

Data Source: Clinical Fusion 2001/02 – 2006/07

Increased Berkeley SBHC Services

1387 1445 1563 1469 1433 1621

50995799

6158

5188 5306

6860

FY 01/02 FY 02/03 FY 03/04 FY 04/05 FY 05/06 FY 06/07

Clients ServedClinic Visits

3.7 to 4.2

Visits per Client

17%

Registered Clients

35%

Clinic Visits

Data Source: Clinical Fusion 2006/07

Client EthnicityCOALITION Ethnicity of Students vs. Clients

13%11%16%

25%

35%

3%

16%

28%27%26%

AfricanAmerican

Latino API White Multi/ Other/Unknown

Clients (n=6,624) School Population (n=19,818)

Ethnicity: •A smaller percent of clients than students were Asian/Pacific Islander at all sites.• A larger percent of clients than students were African-American at most sites (Tech, Fremont, San Lorenzo, Berkeley, Chappell Hayes and Youth Uprising).

BERKELEY Ethnicity of Students vs. Clients

15%

25%

6%12%

43%

15%

34%

8%13%

30%

AfricanAmerican

Latino API White Multi/ Other/Unknown

Clients (n=1,621) School Population (n=3,384)


Client GenderBERKELEY Gender (n=1,621 clients)

Female62%

Male38%

Coalition: Since 2001-02, males represent 34-37% of clients.

Berkeley:Since 2001-02, males represent 36-40% of clients.

COALITION Gender (n=6,624 clients)

Female63%

Male37%

Client Insurance Status

COALITION n=6,624 clients

Uninsured35%

Other2%

Unknown21%

Medi-Cal11%

Private23%

Other Govt8%


BERKELEY n=1,621 clients

Uninsured7%

Unknown42%

Medi-Cal11%

Private40%

Data Source: CHKS 2005-06 and 2006-07

SBHCs Serve Students that Face More Difficulties

Difficult Experiences in Past Year

6%2%

10%

17%

16%

19%

38%

70%

3%

11%

7%

13%

32%

60%Trouble w/ schoolwork

Death of someone close

Considered suicide

Serious health problems

In violent fight/ attack

Pregnancy (m/f)

HomelessClients (n=998-1,011)Non-Clients (n=2,027-2,045)

76% of students that did not use the SBHC reported the reason was that they did not need the services.

Visit Types


Berkeley Visit Types (n=6,860)

First Aid49%

Medical20%

Mental Health13%

Health Education

18%

Majority of Clients Screened for RisksCOALITION Medical/Health Education Clients SCREENED for Risk Factors

86% 79% 86% 86%

33%

64% 60% 66% 66%

35%

NutritionalConcerns

Violence Issues Tobacco Use Sexual Activity BMI

Females (n=3,358) Males (n=1,563)


BERKELEY Medical/Health Education Clients SCREENED for Risk Factors

80% 78%90% 88%

10%

54%42%

78%63%

12%

NutritionalConcerns

Violence Issues Tobacco Use Sexual Activity BMI

Females (n=717) Males (n=362)

Data Source: Clinical Fusion 2006/07 and Pre/Post Client Survey 2006/07

Clients Reported a Variety of Risk Factors

19%

5%14%

80%

21%14%

6%14%

66%

22%

NutritionalConcerns

ViolenceIssues

Tobacco Use SexualActivity

Overweight

Females (n=1,095-2,899) Males (n=540-1,029)

The SBHC has helped me to…Eat better and/or exercise more (80%)Use tobacco, alcohol or drugs less (63%)

5% 5%

24%

87%

10%3% 4%

23%

73%

2%

NutritionalConcerns

ViolenceIssues

Tobacco Use SexualActivity

Overweight

Females (n=69-671) Males (n=43-229)

SBHCs Increase Access to Care for the School

Community

Finding 1KEY OUTCOME #1

SBHC Clients Receive Needed Care More Often Than Non-Clients

81% of SBHC clients report that the SBHC helped them to get help sooner than they would have otherwise

66% report the SBHC helped them get services they would not have otherwise received.

Data Source: CHKS 2005-06 and 2006-07

Client vs Non-Clients that "Always" Got Care When They Needed It

53%

34%

22% 19%

Reproductive Health Care Mental Health CareClients (n=658 & 646) Non-Clients (n=913 & 1,090)

Students Like Using the SBHCsClients chose to use the SBHCsbecause of:

Privacy/confidentiality (100%)Convenient location (86%)Free services (71%)Like the staff (68%)Convenient hours (63%)

Most “strongly agree” or “agree” SBHC staff are:

People I can go to for advice or information (95%)Easier to talk to than other doctors or nurses (89%)



Impact of SBHC Services on Access to Care

The SBHC has helped me to…Get information and resources I need (91%)Get help sooner than I would otherwise (90%)Get services I would not get otherwise (77%)

Additional Reach of the SBHCs26% (n=5,217) of students attended health education

presentations provided by SBHC staff or peer health educators which addressed a range of issues from nutrition to reproductive health information.

16% (n=3,258) of the combined student population received referrals to community services such as primary care providers or Medi-Cal enrollment services.

8% (n=1,516) of students dropped in to the SBHC for consultation or advice, to get supplies such as band-aids or sanitary pads, or just to check-in with or say “hi” to SBHC staff.

Data Source: Narrative Quarterly Reports 2006/07 (n=8 SBHCs)

Mental Health Services Positively Impact Clients


Mental Health Encounter Form(Completed by Providers)

Substance Abuse (AOD)

Post Traumatic Stress Disorder (PTSD)

Oppositional/Defiant Behavior

Grief/Loss

Eating Disorder/s

Depression/Sadness

Attention/Learning

Anxiety/Nervousness

Anger Management

Very Much a Problem

A Problem

Somewhat a Problem

Not a Problem

Not Assessed

Based on client’s visit today, does the client have any of the following problems?

Issues Faced by Mental Health Clients

26%

38%

47%

69%

73%

75%

85%

85%

90%

EatingDisorders

SubstanceAbuse

PTSD

OppositionalBehavior

Grief/ Loss

AngerManagement

Attention/Learning

Anxiety/Nervousness

Depression/Sadness


42% improved (p<.04)

Portion of clients that showed statistically significant improvement 3-6 months later




Impact of Mental Health Services

Mental health clients report SBHCs helped them:

Deal better with personal or family issues (83%)Have goals and plans for the future (73%)Do better in school (70%)Use alcohol and drugs less (69%)Use tobacco less (62%)

Data Source: CHKS 2005/06 and 2006/07

Female Family Planning Clients Improve Birth

Control Use

Finding 1KEY FINDING #3

Female Planning Client Birth Control Method Use

70%

29%

8% 6% 2% 3%

59%

29%

5% 1% 1% 5%

Condoms The Pill The Patch Injection Ring Abstinence

Coalition Berkeley

Female Family Planning Clients Reported Improved Birth Control Use

CHKS:

90% of SBHC family planning clients report that the SBHC helped them to use birth control and condoms more often.

Pre/Post Survey:

93% of Pre/Post Survey clients report the SBHC helped them to use birth control and condoms more often

2006-07 (n=120 clients)

13%

33%

Always used birth control (other than condoms), pastmonth (p<.001)

Baseline 3-6 month Follow-Up

Data Source: Clinical Fusion 2006/07 and CHKS 2005/06 and 2006/07 and Pre/Post Client Survey 2006/07, Clients who responded “don’t know/doesn’t apply” were excluded.

Family Planning Clients Reported Little Change in Condom Use

The percent of female family planning clients that reported…

Always using condoms in the past month decreased 3-6 months later, from 34% to 31%, although this was not statistically significant.Always using birth control AND condoms in the past month increased only slightly, from 8% to 11%, although this was not statistically significant.


Youth Development Programs Improve Client Resiliency


Youth Development Programs

In 2006-07, 342 students participated in 26 youth development/empowerment programs at 10 SBHCs

Programs included: Personal and cultural enrichment programs (n=9)Peer-led health education classes (n=8)Youth leadership and advisory boards (n=6) Counseling and conflict mediation programs (n=2)Student research team (n=1)

Data Source: Youth Development Program Inventory Survey 2006/07 (n=10 SBHCs)

Youth Development Programs

Data Source: Youth Development Program Inventory Survey 2006/07 (n=10 SBHCs) and Pre/Post Client Survey 2006/07

Peer Health Educator Program San Lorenzo High Health Center at San Lorenzo High School

Peer Education Condom Project Tiger Clinic at Fremont Federation of Small Schools

Leadership and Resiliency Program (co-ed)

Leadership and Resiliency Program (SOUL -girls)

Leadership and Resiliency Program (boys)

Youth Educating and Advocating for Health (YEAH)

Alameda Family Services SBHC at Alameda and Encinal High Schools

B-Tech Advisory Board

PASSHEN

Youth Advisory Program Berkeley High School Health Center at Berkeley High School

T-High Steppers

Homies United in Solidarity to Teach, Learn, and Survive (HUSTLAS)

Tennyson Health Center at Tennyson High School

Hip Hop Elements Program Logan Health Center at James Logan High School

Male Involvement Program

Peer Health Education Program TechniClinic at Oakland Technical High School

Youth Programs SurveyedSBHC/School

The SBHC has helped me to get involved in leadership programs (60%)

Youth Participants Report Improved Academic and Personal Indicators

Data Source: Youth Development Program Post Survey 2006-07 (n=110-114)

16% 17% 17%

50%46%

34%

Felt Very Satisfied w/SchoolExperience*

Felt Very Connected to Peopleat School*

Never/Rarely Felt Bored AfterSchool**

Before Program After Program

* Statistically significant (P<.0001) ** Statistically significant (P<.004)

Youth Participants Report Improved Academic and Personal IndicatorsThe majority of respondents indicated that participating in the program improved their:

Communication skills (91%), Belief that they have control over their future (83%), Feeling connected to others at school (82%), Presentation and public speaking skills (78%), Feelings about themselves (77%), School attendance (61%), and Grades (57%)

Data Source: Youth Development Program Post Survey 2006-07 (n=110-114)

Conclusion

Conclusions

SBHCs provide valuable services in a safe, accessible environment. Each year, more students are served through SBHCs: 64% increase since 2001-02.SBHCs are a critical source of care: 79% clients report SBHCs helped them get services they would not have otherwise gotten.SBHCs are responsive to student health risksand positively impact student health issues, such as student resiliency and contraceptive use.

For More Information about the Evaluation CONTACT:

University of California, San FranciscoInstitute for Health Policy Studies

Adrienne Faxio, Project Director415-502-4058

[email protected]

Documents

Alameda County School Health Services Coalition