Denver School-Based Health Centers: A Model of Integrated Health Care Lisa Abrams MS, PNP

Denver Health School-Based Health CentersMay 7, 2009MCH Statewide Meeting

Denver School-Based Health Centers

(DSBHC) Started in 1988, well established SBHC program with integrated health and mental health services

12 sites 6 middle and 6 high schools

SBHCs linked with DH Community Health Center network

SBHCs linked with tertiary care facility (hospital services) West High School

Other Services Provided in Schools

Dental Sealant Program: Applies sealant and fluoride varnish to DPS 2nd

graders Staffed by 2 dental hygienists and 1 insurance

outreach worker School Health Program:

Provides daily on-site school health services in 5 elementary schools

Staffed by 1 RN nursing manager, 1 RN case manager and 5 LPNs

DSBHC: Partners (2007-08)

Denver Health: Community Health Services and Outpatient Behavioral Health Services

Denver Public Schools Mental Health Center of Denver Arapahoe House CDPHE Colorado Health Foundation Great West Life The Children’s Hospital St. Anthony Hospital

DSBHC: Multi-disciplinary and Multi-agency teams (2007-08)Nurse Practitioner/Physician Assistant DH

Consulting Physician DH

School Health Technician/Medical Assistant DH/DPS

Mental Health Therapist DH/MHCD

School Nurse DPS

School social worker DPS

School psychologist DPS

Substance abuse counselor (HS only) AH

Insurance outreach worker DH

Health educator DHDenver Health (DH); Mental Health Centers of Denver (MHCD); Denver Public Schools (DPS); Arapaho House (AH)

DSBHC: Services

Focus is integrated Primary Care not episodic urgent care Medical Home provides a full range of primary care

services including well child care, minor acute care and chronic disease management On-site pharmaceutical dispensary Waived on-site lab capabilities Full complement of vaccines

Mental health therapy Substance abuse counseling (high schools) Reproductive health education Insurance outreach

DSBHC: Demographics 2007-08

DPS enrollment (12 schools): 12,221

SBHC enrollment: 10,179 (83%)

SBHC users (medical): 7,801 (76%)

SBHC users (mental health): 1,185

DSBHC Clinic Users (2007-08)DSBHC Charge Distribution

(2007-08)

Other3%White

9%

African American

11%

Hispanic73%

Unknown4%

Other4%

Commercial 15%

Uninsured50%

Medicaid26%

CHP+5%

DSBHC: Utilization 2007-08

17,730 Physical health visits (11.8 FTE)

8,811 Mental health visits (11 FTE)

1,755 Substance abuse visits (2.5 FTE)

29,458 Total visits for all services

16,969 ImmunizationsSouth High School SBHC

Most common diagnoses in the DSBHCs

Well child care Immunizations Asthma Reproductive health

care (high schools)

Rachel B. Noel SBHC

If you build it, will they come?

Critical early decisions depend on needs assessment and resources Medical home providing

comprehensive care vs urgent care vs provision of specific services such as immunizations

Full-time or part-time provision of services

Staffing model Ancillary service provision (lab,

pharmacy) Referral patterns

Community EngagementIt takes a village to identify the

need Where are the gaps in children’s health care in the community?

What does the community need? (stakeholders and others)

What does the community want? (community members)

Who are the stakeholders? Are the stakeholders interests the same as the

community member’s interests? Where are the funding sources? What is possible with available funding?

Community Engagement It takes a village to design a

plan Planning committee should include Community members (parents, students and

community leaders) Health professionals District and school representation Partners and stakeholders

Know your budget and resources Know the vision

Community Engagement It takes a village to implement

a plan Assign a project manager

Responsible for assuring tasks are completed

Develop a timeline and stick to it

Work closely with the school district to keep lines of communication open

Community Engagement It takes a village to sustain a

plan Maintain communication with all partners Maintain vision Commitment to continuous process

improvement Provide high quality care Each year, plan for the next 5 years (growth

and funding sources)

The Denver SBHC Collaborative Model

Identification of need for a new SBHC Free and reduced lunch School enrollment Request of school community Solid linkage with DH Community Health Centers

Design plan for a new SBHC Collaborate with district, partners, and stakeholders Resource development and utilization

Implement plan for a new SBHC Operations Clinical processes Education of school community (students, parents, school

faculty, greater community)

The Denver SBHC Collaborative Model

Sustain new SBHC Maintain funding Maintain staffing Provide necessary

equipment Integrate SBHC services

and staff into school community

Maintain support from stakeholders and partners at all levels

The Denver SBHC Collaborative Model

Provide multiple opportunities for communication Health advisory council in each school (local collaboration)

Different composition depending on school culture School-based administrative team (Denver Health) DPS health services council (DPS school district) SBHC management team (mid-level managers carry out

strategic decisions collaboratively ) Denver School Health Council (program and agency

directors make strategic decisions collaboratively)

Denver School-Based Health Centers

Director: Steve Federico MD

Administrator: Abigail Aukema BA

Program Manager: Lisa Abrams MS, PNP

Mental Health Program Manager: Jennifer Koch LCSW

Operations Manager: Audrey Hoener MM

Lisa.Abrams@dhha.org

303-602-8958North High School