Findings from the 2013-14 Census of School-Based Health ...Census of School-Based Health Centers Core primary care and behavioral health team includes nutrition, health education,

Findings from the 2013-14 Census of School-Based Health Centers

Erin Schelar, MPH, RN, School-Based Health Alliance

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Today’s Presenters

Erin Schelar, MPH, RN

Directions for the future

SBHC awareness

How far we’ve come

Objectives Methods

Growth

Access

Comprehensive Care

Adolescent Care

Health System Partnerships

Sustainability

Accountability

MORE & GREAT Goals

Methodology

2013-14 Census of School-Based Health Centers

Ongoing: Identifying new and closed SBHCs

After census launch: Specific outreach to sites who have not completed

census through May 1, 2015

Census survey given to all SBHCs starting July, 2014

Prior to census: outreach to state offices and

sponsoring organizations for contact information


and in the District of Columbia, Puerto Rico, and the Virgin Islands.

in 49 of 50 states 2,315 SBHCs

Location of SBHCs

(map)


SBHC Growth, 1998-2013

1135

1378

1709

1909 1930

2315

0

500

1000

1500

2000

2500

1998-1999 2001-2002 2004-2005 2007-2008 2010-2011 2013-2014

Nu

mb

er

of

SB

HC

s N

ati

on

all

y

Census School Year

Total number of SBHCs identified


100% of SBHCs in our analysis provide

primary care on-site.

This includes:

• comprehensive health

assessments

• diagnosis

• treatment of minor, acute,

and chronic medical

conditions

• referrals to specialists

• follow-up

ACCESS


SBHC Locations


(n=1,736)

Other, 24.6%

PreK/K through

12th, 27.9%

High School,

23.4%

Elementary

School, 15.3%

Middle School,

8.8%

Grade Levels of Schools Served by SBHCs

(n=1,645)


0% 10% 20% 30% 40% 50% 60% 70%

Parochial/Private School

Charter School

Alternative School

Vocational School

Magnet School

Community School

Traditional Public School

1.1%

2.9%

5.0%

6.0%

6.7%

10.0%

66.6%

Types of Schools Where SBHCs Are Located


(n=1,645)

0%

5%

10%

15%

20%

25%

30%

35%

White Hispanic/Latino

of any Race

Black or African

American

Asian/Pacific

Islander

Two or more

races

American

Natives

31.7% 30.6%

25.7%

3.9% 3.0% 1.9%

Ethnic/Racial Profile of Student Population

at Schools Served by SBHCs


(n=1,736)

Populations eligible for care at SBHCs serving non-students

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Students from other

schools (n= 901)

Family of student users

(n=903)

Out-of-school youth

(n=892)

Faculty/school

personnel (n=897)

Other people in the

community (n=884)

83.6% 65.8% 61.4% 59.9%

35.5%


of SBHCs serve a population other than students enrolled in their school 55.9% (n=1,234)

Population Served

0%

10%

20%

30%

40%

50%

60%

70%

80%

76-100% 51-75% 26-50% 0-25%

48.7%

27.8% 16.3% 7.2%

Percentage of Student Population

Eligible for Free/Reduced Lunch Program

at Schools with SBHCs


(n=1,735)

77.6%

Title I School Not Title I School

Title I Status of Schools

With SBHCs


(n=1,385)

51.2%

34.6%

14.2%

0%

10%

20%

30%

40%

50%

60%

70%

1998-99 2001-02 2004-05 2007-08 2010-11 2013-14

Trends in Geographic Location

Urban Rural Suburban


(1,026≤n≤1,731)

Local Story: West Virginia’s Rural SBHCs


0%

10%

20%

30%

40%

50%

60%

10 years or more 5-9 years 2-4 years Less than 2 Years

53.0%

20.9% 16.0% 10.3%

Length of Time SBHC Has Been Open


(n=1,549)

66.5% 21.6% 11.9%

> 31 hours/week 9-30 hours/week <8 hours/week

(n=1,729) (n=1,729) (n=1,729)

SBHC Hours of Operation per Week

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

During school vacations/holiday breaks

During summer months

Before the school day begins

After the school day ends

During school hours

22.0%

40.0%

48.2%

59.0%

97.6%

SBHC Times of Operation


(n=1,701)

78.1%

SBHC Has a Prearranged

Source of After-Hours Care


(n=1,536)


0%

10%

20%

30%

40%

50%

60%

2001-02 2004-05 2007-08 2010-11 2013-14

Percentage of SBHCs with an Expanded Care Team Growth in Percentage of SBHCs with an Expanded Care Team


Core primary care and behavioral health team includes nutrition, health education, social services, oral health, and/or vision care

of SBHCs teams include a primary care provider and a behavioral health provider 67.2%

Staffing

(1,026≤n≤1,737)

0% 20% 40% 60% 80% 100%

Vision Care

Health Educator

Nutrionist/Dietician

Oral Health

Behavioral Health

Clinical Support

Primary Care

Provider Types in SBHCs

On-site provider only Both on-site and telehealth Telehealth provider only


SBHCs Support Physical Health


0% 20% 40% 60% 80%

Attention/concentration/ADD/ADHD

Anxiety/nervousness/phobias

Social skills/relationship issues/conflicts

Depression/sadness

67.7%

71.2%

71.5%

76.1%

SBHCs Screen for Behavioral Health


(n=1,683)


Primary Care Providers Use Preventive Services to Promote Oral Health


4 out of 5 SBHCs serve

adolescents

(81.3%, n=1,381)

0% 10% 20% 30% 40% 50% 60% 70% 80%

Positive Youth Development

Violence Prevention

Suicide Prevention

Dating Violence

Substance Use

71.1%

75.8%

76.0%

76.1%

79.7%

Preventive Activities for Adolescents

Topics frequently covered by SBHC prevention and harm reduction counseling with individual students


(n=1,391)

Peer Groups Support Social and Emotional Health


(n=853)

Healthy Eating and Active Living


(n=1,391)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Prenatal care (n=1,276)

Papanicolaou (Pap) test (n=1,278)

Prescriptive contraceptive services (n=1,280)

HIV testing and counseling (n=1,277)

Counseling for contraceptive services (n=1,279)

Sexual orientation education and counseling (n=1,266)

STD diagnosis and treatment (n=1,280)

Chlamydia testing and treatment (n=1,278)

Relationship violence counseling (n=1,275)

Pregnancy testing (n=1,275)

Abstinence counseling (n=1,257)

12.9%

45.3%

47.0%

55.0%

62.7%

67.3%

69.5%

70.0%

73.2%

80.2%

83.3%

Sexual and Reproductive Health Services


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

State policy (n=347)

State law/regulation (n=342)

Sponsor policy (n=327)

Health center policy (n=322)

School policy (n=333)

School district policy (n=419)

42.1%

44.2%

47.4%

47.8%

68.8%

90.5%

(n=1,236)


Entity Prohibiting Dispensing of Contraceptives in SBHCs

50.2%

Contraception

of SBHCs are prohibited from dispensing contraception

0%

20%

40%

60%

80%

100%

Barrier

methods

(n=504)

Hormonal

methods

(n=503)

Emergency

contraception

(n=500)

Implantable

devices

(n=501)

96.8% 82.9%

73.3%

39.8%

SBHCs that dispense contraceptives on-site provide:



0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2001-02 2004-05 2007-08 2010-11 2013-14

Hospital/medical center Community health center or FQHC or Look-Alike

Local health department School system

Private, nonprofit(1,026≤n≤1,734)


Trends in Sponsor Type


Local Story: Denver Health


0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

State family planning programs (n=1,478)

State programs for the medically indigent (n=1,377)

Patients or families (self-pay) (n=1,664)

Tri-care (military insurance program) (n=1,522)

Private/commercial insurance (n=1,672)

Children's Health Insurance Program (CHIP) (n=1,375)

Medicaid: Managed Care Organization (MCO) (n=1,614)

Medicaid: State agency (n=1,681)

38.2%

42.9%

48.1%

51.6%

69.0%

71.4%

78.1%

89.0%


Percentage of SBHCs that Bill Entities for Reimbursement

0% 10% 20% 30% 40% 50% 60% 70% 80%

Monthly or annual capitated payments for

care coordination (n=1,027)

Supplemental payments for meeting

performance standards (n=1,011)

Monthly or annual capitated payments for

primary care (n=1,081)

Fee for service (n=1,366)

18.8%

26.7%

34.8%

78.3%


Type of Insurance Payment Received by SBHCs

0% 20% 40% 60% 80%

Corporations/businesses (n=1,477)

County/city government (n=1,497)

School/school district (n=1,532)

Private foundations (n=1,501)

Federal government (n=1,500)

State government (1,540)

17.2%

31.7%

33.9%

40.4%

53.6%

70.9%


Funding Sources

0% 10% 20% 30% 40% 50% 60% 70%

19.4%

34.6%

61.0%

Top Sources of Federal Funding


Title X PHSA: Family Planning

(n=607)

Section 330 PHSA: FQHC Funding

(n=583)

SBHC Capital Program (HRSA)

(n=625)


0% 20% 40% 60% 80% 100%

School-Based Health Alliance Mental Health Program

Evaluation Template (n=1,104)

School-Based Health Alliance CQI for SBHC Tool

(n=1,108)

Sponsor-defined tools/measures (n=1,207)

Recommended core set of child health quality

measures (CHIPRA/Medicaid) (n=1,105)

Healthcare Effectiveness Data and Information Set

(HEDIS) measures (n=1,165)

SBHC-developed tools/measures (n=1,244)

State-defined tools/measures (n=1,232)

10.2%

16.7%

54.4%

55.3%

65.3%

67.8%

77.2%

SBHCs Participating in Quality Benchmarks

and Programs


State Certification

43.9%

NCQA 22.2%

Joint Commission

41.1%


SBHC Accreditation by Source

7 in 10 SBHCs are accredited

0%

10%

20%

30%

40%

50%

60%

70%

80%

SBHC is not recognized as

preferred provider, but is

reimbursed for some

services (n=1,183)

SBHC serves as a

PCP/preferred

provider/medical home

(n=1,346)

SBHC serves as a specialty

care provider (n=1,221)

55.5% 50.7%

38.5%

Recognition of SBHC Staff by Managed Care

Companies


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007-08 (n=1,096) 2010-11 (n=1,297) 2013-14 (1,657<n<1,688)

EHR/EMR Electronic Billing System Electronic Prescribing


Health Information Technology (HIT) Use Over Time

7.3%

Yes No

(n=1,737)

SBHCs Using a Telehealth

System



Local Story: Telehealth in Rural North Carolina


Vision for the Future


• School Health Services National Quality Initiative

• RWJF Measures to Mobilize a Culture of Health • Census Planning Grant and Work with RAND • Children’s Health and Education Mapping Tool

#MoreSBHCs

30% Grow the number of

SBHCs by 2018

#GreatSBHCs

50% SBHCs to document

performance measures

Acknowledgements


Acknowledgements


Melina Bersamin

Jill Daniels

John Dougherty

Sarah Knipper

Mona Mansour

Jan Marquard

Margo Quiriconi

Mary Ramos

Samira Soleimanpour

Jennifer Salerno

Michele Strasz

Terri Wright

Census Advisors


Health Resources and Services Administration’s (HRSA)

Bureau of Primary Health Care, Office of Special Populations

Maternal and Child Health Bureau, Office of Adolescent Health

The Atlantic Philanthropies

Funders


Thank you!


Questions? [email protected]

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Findings from the 2013-14 Census of School-Based Health ...Census of School-Based Health Centers Core primary care and behavioral health team includes nutrition, health education,