Health Care for Special Populations Examining the Role of SBHCs

Health Care for Health Care for

Special Populations Special Populations

Examining the Role of SBHCs Examining the Role of SBHCs

Welcome and IntroductionWelcome and Introduction

Childworks, PLLCChildworks, PLLCBrooke Lehmann, MSW, Esq.Brooke Lehmann, MSW, Esq.Jennifer Leonard, MBA, Esq. Jennifer Leonard, MBA, Esq.

Purpose of Today’s conferencePurpose of Today’s conference

Objectives of Today’s DiscussionObjectives of Today’s Discussion

1.1. Participants will have a better understanding Participants will have a better understanding of the strengths and challenges associated of the strengths and challenges associated with the integration of school-based health with the integration of school-based health centers and school-based programs serving centers and school-based programs serving special populations. special populations.

2.2. Participants will be able to utilize information Participants will be able to utilize information gained through today’s discussion to think gained through today’s discussion to think through opportunities that might exist within through opportunities that might exist within their professional positions for advancing their professional positions for advancing collaborations between these two entities. collaborations between these two entities.

AGENDAAGENDA

Present information on the Summit’s Present information on the Summit’s purpose and execution.purpose and execution.

Discuss in detail the Summit’s findings Discuss in detail the Summit’s findings and recommendations.and recommendations.

Generate a list of new Generate a list of new recommendations from conference recommendations from conference participants.participants.

Questions/Answers/Wrap upQuestions/Answers/Wrap up

Setting the Stage for Summit Discussion: Setting the Stage for Summit Discussion: Common Themes From the FieldCommon Themes From the Field

Role for SBHCs in serving Special Role for SBHCs in serving Special PopulationsPopulations

Communication is criticalCommunication is critical Must have shared resources with Must have shared resources with

clear delineation of rolesclear delineation of roles Funding mandates can drive Funding mandates can drive

collaborationcollaboration Clarified critical mechanismsClarified critical mechanisms

Future TrendsFuture Trends

Increase in the number of uninsured Increase in the number of uninsured children and familieschildren and families

Increase in the rate of referrals to Increase in the rate of referrals to special educationspecial education

Increase in the need for school-based Increase in the need for school-based mental health servicesmental health services

Strengthening systems that support Strengthening systems that support SBHCs resulting in sustainability and SBHCs resulting in sustainability and growthgrowth

Summit Objective #1Summit Objective #1

Build a Common Understanding:Build a Common Understanding: Describe the experience of: (1) Describe the experience of: (1) School-based health centers School-based health centers (SBHCs) in providing services to (SBHCs) in providing services to children and youth with special health children and youth with special health care or education needs (“special care or education needs (“special populations”); and (2) the school-populations”); and (2) the school-system in utilizing SBHCs to serve system in utilizing SBHCs to serve special populations special populations


Identify Opportunities:Identify Opportunities: Identify areas of service delivery with Identify areas of service delivery with the greatest potential to realize the greatest potential to realize benefits from commonalities or benefits from commonalities or synergy between SBHCs and schools synergy between SBHCs and schools in serving special populationsin serving special populations


Explore Impact of Policies & Explore Impact of Policies & Infrastructure: Infrastructure: Explore the key challenges (e.g., Explore the key challenges (e.g., education and health care policies, education and health care policies, finance mechanisms, and finance mechanisms, and infrastructure) in enabling SBHCs and infrastructure) in enabling SBHCs and schools to work together to better schools to work together to better support special needs populationssupport special needs populations


Identify Short-term Priorities:Identify Short-term Priorities:Provide feedback on the top three Provide feedback on the top three areas of service delivery with the most areas of service delivery with the most potential for benefiting SBHCs and potential for benefiting SBHCs and schools in serving special populationsschools in serving special populations

Working Definition: Special Working Definition: Special PopulationsPopulations

Children and Youth with Special Health Care Children and Youth with Special Health Care Needs: Needs: ● Children who have or are at increased risk for a Children who have or are at increased risk for a

chronic physical, developmental, behavioral, or chronic physical, developmental, behavioral, or emotional condition emotional condition

● Who also require health and related services of a Who also require health and related services of a type or amount beyond that required by children type or amount beyond that required by children generallygenerally

(Maternal and Child Health Bureau)(Maternal and Child Health Bureau)

Definitions ContinuedDefinitions Continued

Special Education: Special Education: ● Defined within the Individuals with Defined within the Individuals with

Disabilities Education Act (IDEA) which Disabilities Education Act (IDEA) which mandates that all children, regardless of mandates that all children, regardless of their unique learning needs, will be afforded their unique learning needs, will be afforded an opportunity to experience a an opportunity to experience a free and free and appropriate public educationappropriate public education in the least in the least restrictive environment restrictive environment

● Specifically designed instruction, at no cost Specifically designed instruction, at no cost to parents, to meet the to parents, to meet the unique needs of a unique needs of a child with a disabilitychild with a disability


Special Education: Special Education: ● A child must have a disability A child must have a disability that that

adversely affects educational adversely affects educational performanceperformance to be eligibleto be eligible

● Children eligible for special education Children eligible for special education services under IDEA are also services under IDEA are also protected under Section 504 (but the protected under Section 504 (but the converse is not true). converse is not true).


Section 504: Section 504: ● Civil rights law that protects individuals with Civil rights law that protects individuals with

disabilities from discrimination disabilities from discrimination ● Ensures that children with disabilities have equal Ensures that children with disabilities have equal

accessaccess to an education by requiring that they to an education by requiring that they receive benefits and services comparable to receive benefits and services comparable to those given their non-disabled peersthose given their non-disabled peers

● To be eligible, child must have a physical or To be eligible, child must have a physical or mental impairment that mental impairment that substantially limitssubstantially limits at at least one major life activityleast one major life activity


School-Based Health Center: School-Based Health Center: ● A health center that is located in or near a A health center that is located in or near a

school facilityschool facility● Is organized through school, community, Is organized through school, community,

and health provider relationships and is and health provider relationships and is administered by a sponsoring facility administered by a sponsoring facility

● Provides, at a minimum, comprehensive Provides, at a minimum, comprehensive primary health services during school primary health services during school hours to children and adolescentshours to children and adolescents

Summary of ExercisesSummary of Exercises

Session ASession A: Identify : Identify services with services with commonalities or potential for synergy commonalities or potential for synergy between SBHCs and school systems between SBHCs and school systems in serving special populations in serving special populations

Session BSession B: : Identify the areas of service Identify the areas of service delivery with the greatest potential for delivery with the greatest potential for synergy between SBHCs and schoolssynergy between SBHCs and schools

Summary of Exercises ContinuedSummary of Exercises Continued

Session CSession C: Identify the key challenges : Identify the key challenges (e.g., education and health care policy, (e.g., education and health care policy, finance mechanisms, and infrastructure) in finance mechanisms, and infrastructure) in enabling SBHCs and schools to work enabling SBHCs and schools to work together to better support special needs together to better support special needs populations.populations.

Session DSession D: As a group, agree on the top : As a group, agree on the top three areas of service delivery with the three areas of service delivery with the most potential for benefiting SBHCs and most potential for benefiting SBHCs and schools in serving special populationsschools in serving special populations

Finding #1: Finding #1: Mental Health ServicesMental Health Services

Potential OpportunitiesPotential Opportunities: : why is this a good idea?why is this a good idea?

Proximity to studentsProximity to students Consistent with “top concerns” given recent Consistent with “top concerns” given recent

violent eventsviolent events Improved identificationImproved identification SBHC staff has sensitivity to needs of SBHC staff has sensitivity to needs of

studentsstudents Multi-disciplinary environment & enhanced Multi-disciplinary environment & enhanced

collaborationcollaboration Reduced classroom behavioral disruption; Reduced classroom behavioral disruption;

stabilized support for students in classroomstabilized support for students in classroom De-stigmatization of MH services by co-De-stigmatization of MH services by co-

locating instead of providing services remotelylocating instead of providing services remotely

Finding #1: Finding #1: Mental Health ServicesMental Health Services

Potential Challenges: Potential Challenges: Why might this be Why might this be difficult to implement?difficult to implement?

Lack of qualified workforceLack of qualified workforce Funding issues - Inability to access funding Funding issues - Inability to access funding

resources for MH services provided in resources for MH services provided in schools; categorical funding an issueschools; categorical funding an issue

Threat to school social worker / counselorThreat to school social worker / counselor Medical providers may not understand the Medical providers may not understand the

special ed issuesspecial ed issues Lack of higher authority providing oversight Lack of higher authority providing oversight

and coordinating end goals for alland coordinating end goals for all

Finding #2: Finding #2: Primary Care Health Primary Care Health Assessment / Medical CareAssessment / Medical Care

Potential Opportunities:Potential Opportunities: Augment IEP developmentAugment IEP development Improved absenteeism and truancyImproved absenteeism and truancy PCP able to coordinate and improve access PCP able to coordinate and improve access

to specialiststo specialists Improved coordination with the school, Improved coordination with the school,

parents and other health care providersparents and other health care providers Better positioned to understand child’s Better positioned to understand child’s

special needs in global environment and special needs in global environment and help child’s chances of staying in school and help child’s chances of staying in school and achieving acad. successachieving acad. success

Caring adultCaring adult

Finding #2: Finding #2: Primary Care Health Primary Care Health Assessment / Medical CareAssessment / Medical Care

Potential Challenges:Potential Challenges: Another piece to the pie of places to receive Another piece to the pie of places to receive

primary health careprimary health care Lack of coordination with other providersLack of coordination with other providers SBHC services not valued the same as SBHC services not valued the same as

“outside” providers“outside” providers Limited training or understanding of IDEALimited training or understanding of IDEA Potential for lawsuitsPotential for lawsuits More paperwork and reportingMore paperwork and reporting

Finding #3: Finding #3: IdentificationIdentification

Potential Opportunities:Potential Opportunities:Streamlined coordination of studentsStreamlined coordination of studentsGreater degree of effectivenessGreater degree of effectiveness Improved financial resultsImproved financial results Increased chance of student successIncreased chance of student successBetter position to measure Better position to measure

effectiveness of specialized serviceseffectiveness of specialized services

Finding #3: Finding #3: IdentificationIdentification

Potential Challenges:Potential Challenges:Collaboration between the school and Collaboration between the school and

the SBHCthe SBHCPractitioner lensPractitioner lens

Other RecommendationsOther Recommendations

Build bridges to special ed community Build bridges to special ed community and leadershipand leadership

Advocate for legislation to require Advocate for legislation to require Medicaid to support SBHCsMedicaid to support SBHCs

Consider databases and evaluationsConsider databases and evaluationsAlign SBHC with schools system’s Align SBHC with schools system’s

needsneedsDevelop “Principles” for SBHCs serving Develop “Principles” for SBHCs serving

needs of special populationsneeds of special populations

YOUR RECOMMENDATIONSYOUR RECOMMENDATIONS

What other areas would you suggest for What other areas would you suggest for collaboration?collaboration?

QuestionsQuestions

THANK YOUTHANK YOU

Contact Information:Contact Information:

Brooke Lehmann:Brooke Lehmann: 202-333-2770, 202-333-2770, [email protected]

Jennifer Guste Leonard:Jennifer Guste Leonard: 202-237-6855, 202-237-6855, [email protected]

Documents

Health Care for Special Populations Examining the Role of SBHCs