School-Based Health Care School-Based Health Care (SBHC) 101: Nuts and Bolts(SBHC) 101: Nuts and Bolts
Laura Brey, MSLaura Brey, MSTammy Alexander, M.Ed. Tammy Alexander, M.Ed.
NASBHC Training of TrainersNASBHC Training of TrainersApril 21-23, 2008April 21-23, 2008
2
Participant ExpectationsParticipant Expectations
Complete the index card and Complete the index card and hand it in.hand it in.
3
IntroductionsIntroductions
Presenters: Presenters:
Tammy AlexanderTammy Alexander
Laura BreyLaura Brey
4
Getting to Know ParticipantsGetting to Know Participants
Type of agencyType of agency
Community settingCommunity setting
Role in agencyRole in agency
School population, if School population, if knownknown
5
ObjectivesObjectives
IdentifyIdentify key collaborators and partners key collaborators and partnersNameName the five key components of the five key components of
needs assessment techniques for needs assessment techniques for planning school-based health servicesplanning school-based health services
Identify Identify potential funding sources for potential funding sources for school-based health services: school-based health services: including public, private, and including public, private, and collaborative partnershipscollaborative partnerships
6
ObjectivesObjectives
DescribeDescribe the rationale and the rationale and components of a case statement for a components of a case statement for a new school-based health center new school-based health center
UtilizeUtilize resource materials related to resource materials related to planning, evaluating, financing, and planning, evaluating, financing, and working with the media working with the media
ListList seven principles describing how to seven principles describing how to plan and implement a school-based plan and implement a school-based health centershealth centers
7
Collaboration and PartnershipsCollaboration and Partnerships
Nut and Bolt #1Nut and Bolt #1
Collaborative PartnershipsCollaborative Partnerships
A mutually A mutually beneficial and well-beneficial and well-defined relationship defined relationship among two or more among two or more organizations to organizations to JOINTLY develop JOINTLY develop structure and sharestructure and share
• ResponsibilityResponsibility• ResourcesResources
• AuthorityAuthority• AccountabilityAccountability• RewardsRewards
9
Why have a Collaboration?Why have a Collaboration?
To accomplish a To accomplish a common goal common goal that that none of the units alone can attainnone of the units alone can attain
To help agencies To help agencies shareshare information, information, resources, staff and equipmentresources, staff and equipment
To To createcreate an awareness of needs, an awareness of needs, problems, or opportunitiesproblems, or opportunities
10
Characteristics of Successful Characteristics of Successful CollaborationCollaboration
Develops clear, concrete, achievable Develops clear, concrete, achievable goals.goals.
Operate in a receptive environment Operate in a receptive environment that facilitates its work.that facilitates its work.
Have good leadership.Have good leadership.Understand and respect each Understand and respect each
member for their different role and member for their different role and responsibility.responsibility.
Build cooperative teams.Build cooperative teams.
11
Typical challengesTypical challenges
Differences among collaborators must Differences among collaborators must be understood and acknowledged.be understood and acknowledged.
Mixed loyalty that some members may Mixed loyalty that some members may have to their organization.have to their organization.
Merging of agencies can cause Merging of agencies can cause conflict.conflict.
* Lack of clarity* Lack of clarity* Lack of awareness* Lack of awareness
12
Difficult Issues that Difficult Issues that Undermine CollaborationsUndermine Collaborations
Territorial questionsTerritorial questions
ConfidentialityConfidentiality
Certification/Certification/CredentialingCredentialing
Conflicting Conflicting prioritiespriorities
Political roadblocksPolitical roadblocks
Financial resourcesFinancial resources
13
Strategies to Overcome Strategies to Overcome Resistance in CollaborationResistance in Collaboration
Joining with the host schoolJoining with the host schoolRelay the message that you are there Relay the message that you are there
to support rather than supplantto support rather than supplantEngage in ongoing negotiations with Engage in ongoing negotiations with
key playerskey playersDeveloping common goals and group Developing common goals and group
consensusconsensusSetting BoundariesSetting Boundaries
14
Establish a Planning Group Establish a Planning Group Composition ConsiderationsComposition Considerations
• Local health department Local health department
• Community or rural health Community or rural health centercenter
• Community and/or Community and/or teaching hospital(s) teaching hospital(s)
• Mental health, substance Mental health, substance abuse, and social service abuse, and social service agenciesagencies
• Private physiciansPrivate physicians
• University faculty University faculty
• Elected OfficialsElected Officials
• Business and community Business and community leadersleaders
• Faith community Faith community
• School superintendent, School superintendent, board, or designeeboard, or designee
• School administration and School administration and Faculty (school nurse, Faculty (school nurse, teachers, principals, teachers, principals, guidance counselors, guidance counselors, physical education, physical education, nutrition/food services)nutrition/food services)
• StudentsStudents
• ParentsParents
15
Role Play - Meeting with Role Play - Meeting with Partners / CollaboratorsPartners / Collaborators
16
Conduct the Needs AssessmentConduct the Needs Assessment
Nut and Bolt #2Nut and Bolt #2
17
What is a Community Needs What is a Community Needs Assessment?Assessment?
An accurate appraisal of the current An accurate appraisal of the current situation (strengths, concerns, and general situation (strengths, concerns, and general conditions) of a community’s populationconditions) of a community’s population
A collection of secondary and first hand A collection of secondary and first hand information and data from a wide range of information and data from a wide range of relevant sources and audiencesrelevant sources and audiences
18
What is a Community Needs What is a Community Needs Assessment?Assessment?
A process for:A process for:identifying needs and resources in a identifying needs and resources in a community community determining gaps between what a determining gaps between what a situation is and what it should besituation is and what it should beestablishing prioritiesestablishing priorities
An opportunity to paint a picture of the An opportunity to paint a picture of the conditions in a community and sharpen your conditions in a community and sharpen your perceptions of the critical issues children perceptions of the critical issues children and families faceand families face
19
Why Identify Needs and Why Identify Needs and Resources?Resources?
Better understand the community in which Better understand the community in which you will be workingyou will be working
Become aware of needs and concerns you Become aware of needs and concerns you never knew aboutnever knew about
Locate hidden strengths or underutilized Locate hidden strengths or underutilized resources that could be developedresources that could be developed
Document needDocument need
Make sure future actions are aligned with Make sure future actions are aligned with expressed community needsexpressed community needs
20
Why Identify Needs and Why Identify Needs and Resources?Resources?
Garner greater support and involve more Garner greater support and involve more people in subsequent actionpeople in subsequent action
Give voice to individuals in the community Give voice to individuals in the community who have not traditionally been solicited for who have not traditionally been solicited for commentcomment
Convince outside funders and supportersConvince outside funders and supporters
Make decisions based on priorities and Make decisions based on priorities and documented needsdocumented needs
21
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Step 1:Step 1: Involve stakeholdersInvolve stakeholders
Establish working group to guide the Establish working group to guide the planning and implementation of planning and implementation of Community Needs Assessments Community Needs Assessments
22
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Step 2:Step 2: Determine the Objectives and Determine the Objectives and Outcomes of the AssessmentOutcomes of the Assessment
What are you really interested in knowing? Your What are you really interested in knowing? Your questions will flow from this.questions will flow from this.
What is your vision? How will you use the What is your vision? How will you use the information obtained?information obtained?
Which issues, questions, and behaviors are of Which issues, questions, and behaviors are of particular interest?particular interest?
What don’t you know about these issues? What What don’t you know about these issues? What questions do you need to answer?questions do you need to answer?
23
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Step 3:Step 3: Identify secondary data sourcesIdentify secondary data sources
Find out what outside resources can be used Find out what outside resources can be used
What public reports exist (examples of What public reports exist (examples of sources: census data, vital statistics, CPS sources: census data, vital statistics, CPS reports)reports)
– Have other studies been done?Have other studies been done?
Are there experts in the community who can Are there experts in the community who can help you?help you?
24
Planning and Implementing the Planning and Implementing the Assessment Assessment (cont)(cont)
Step 4: Choose your approach/ Step 4: Choose your approach/ approaches for gathering newapproaches for gathering newinformationinformation
Most common approaches:Most common approaches: Key informant interviewsKey informant interviews
Focus groups Focus groups
Public forumsPublic forums
SurveysSurveys
25
Planning and Implementing the Planning and Implementing the Assessment Assessment
When making your choice of approach, When making your choice of approach, take into account:take into account:
Purpose of the studyPurpose of the study
Amount of time you have and number of people Amount of time you have and number of people assisting youassisting you
Available resourcesAvailable resourcesSize and characteristics of target populationSize and characteristics of target populationRelationship you have with target populationRelationship you have with target population
“The quality of information about a community is only as good as the technique or combination of techniques used. A single technique may be too narrow; using too many techniques may be costly in terms of time and dollars. Different techniques are appropriate for different needs. Analyze the situation and then weigh the advantages and disadvantages. Sometimes a combination of techniques will provide a more reasonable picture.” (Butler and Howe, 1980)
26
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Key Informant InterviewsKey Informant Interviews
PurposePurpose = to collect information from those in = to collect information from those in the community who are in a prime position to the community who are in a prime position to know the needs facing the community know the needs facing the community
How to implementHow to implement = compile a list of = compile a list of participants, create protocol, make participants, create protocol, make appointments (either telephone or in-person), appointments (either telephone or in-person), gather data, identify common themesgather data, identify common themes
27
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Key Informant InterviewsKey Informant Interviews
AdvantagesAdvantages Easy and not expensiveEasy and not expensive Can discuss confidential issues more readilyCan discuss confidential issues more readily Establishes rapport and trust with communityEstablishes rapport and trust with community Permits clarification of issues and ideasPermits clarification of issues and ideas
DisadvantagesDisadvantages May be difficult to schedule May be difficult to schedule May provide a biased perspectiveMay provide a biased perspective Only represents perceptions – not hard dataOnly represents perceptions – not hard data Personal relationships may influence outcomesPersonal relationships may influence outcomes Should be combined with other methods because may not Should be combined with other methods because may not
represent whole communityrepresent whole community
28
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Focus GroupsFocus Groups
PurposePurpose = = to collect information from those in the to collect information from those in the community who are in a prime position to know the community who are in a prime position to know the needs facing the community needs facing the community
How to implementHow to implement = = compile a list of participants, compile a list of participants, decide on location, create protocol, invite participants decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify facilitator and documenter, organize and identify common themescommon themes
29
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Focus GrouFocus GroupspsAdvantagesAdvantages
Easy and not expensiveEasy and not expensive Establishes rapport and trust with community Establishes rapport and trust with community
membersmembers Permits clarification of issues and ideasPermits clarification of issues and ideas Easily combined with other techniques Easily combined with other techniques
DisadvantagesDisadvantages May provide biased perspectivesMay provide biased perspectives Only represents perceptions – not hard dataOnly represents perceptions – not hard data Sharing opinions and views in a group setting may Sharing opinions and views in a group setting may
be inhibitingbe inhibiting Should be combined with other methods because Should be combined with other methods because
may not represent whole communitymay not represent whole community
30
Planning and Implementing the Planning and Implementing the Assessment Assessment
Public forumsPublic forums
Purpose Purpose = elicit information from a wide range = elicit information from a wide range of residents in a series of public meetingsof residents in a series of public meetings
How to implementHow to implement = develop list of invitees, = develop list of invitees, create list of questions, select strategically create list of questions, select strategically located venue (use different sites and hold at located venue (use different sites and hold at different times), publicize, use facilitator and different times), publicize, use facilitator and documenter, identify common themesdocumenter, identify common themes
31
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Public forumsPublic forums
Advantages:Advantages: Get opinions from a wide range of peopleGet opinions from a wide range of people Promotes active involvement, community awareness, Promotes active involvement, community awareness,
and buy-inand buy-in Inexpensive, quick picture of communityInexpensive, quick picture of community
Disadvantages:Disadvantages: Requires good leadershipRequires good leadership Opinions limited to those who attendOpinions limited to those who attend Lots of advance planningLots of advance planning May generate more questions than answersMay generate more questions than answers May create unrealistic expectationsMay create unrealistic expectations
32
Planning and Implementing the Planning and Implementing the AssessmentAssessment
SurveysSurveys
PurposePurpose = = collect information from a wide range of collect information from a wide range of respondentsrespondents
How to implementHow to implement == find or create carefully find or create carefully developed instrument and administer through a developed instrument and administer through a sampling procedure (may be face to face, personal sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, distribution and collection, self-administered in a group, telephone, mailed), analyze resultstelephone, mailed), analyze results
33
Planning and Implementing the Planning and Implementing the AssessmentAssessment
SurveysSurveys
AdvantagesAdvantages Best approach for eliciting attitudes of broad range Best approach for eliciting attitudes of broad range
of individuals of individuals Data usually valid and reliable Data usually valid and reliable
DisadvantagesDisadvantages Costly and requires time and expertiseCostly and requires time and expertise Needs carefully selected tool and sampling Needs carefully selected tool and sampling Subject to misinterpretationSubject to misinterpretation Individuals may hesitate to answer questionsIndividuals may hesitate to answer questions
34
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Planned Approach to Community Action (PATCH)Planned Approach to Community Action (PATCH)– developed by CDCdeveloped by CDC– effective model for planning, conducting, and evaluating effective model for planning, conducting, and evaluating
community health promotion and disease prevention programscommunity health promotion and disease prevention programs– Used by diverse communities in US and other nations to address Used by diverse communities in US and other nations to address
health concerns health concerns – PATCH Guide for local coordinator has sample surveys and data PATCH Guide for local coordinator has sample surveys and data
collection toolscollection tools– Web siteWeb site www.cdc.gov/nccdphp/path/index.htm
35
Planning and Implementing the Planning and Implementing the Assessment Assessment
Step 5: Implement PlanStep 5: Implement Plan
Collect secondary dataCollect secondary data
Collect primary data (conduct interviews, focus Collect primary data (conduct interviews, focus groups, surveys, etc)groups, surveys, etc)
Analyze secondary and primary dataAnalyze secondary and primary data
Summarize findingsSummarize findings
36
Planning and Implementing the Planning and Implementing the AssessmentAssessment
Step 5: Implement PlanStep 5: Implement Plan
Prepare report Prepare report
Share with working group, interpret data and Share with working group, interpret data and develop recommendations together develop recommendations together
Present to external stakeholders as neededPresent to external stakeholders as needed
Create action planCreate action plan
37
Review Anytown’s Needs Review Anytown’s Needs Assessment DocumentAssessment Document
38
Project Work Plan and Design Project Work Plan and Design Example from Chicago SBHCExample from Chicago SBHC
Convened a planning committee of key community Convened a planning committee of key community stakeholders who met regularly to oversee and stakeholders who met regularly to oversee and guide the process guide the process
Gathered existing dataGathered existing dataU. S. Census Bureau (2000)U. S. Census Bureau (2000)Chicago Health and Health Systems Project Chicago Health and Health Systems Project
(CDPH 2006)(CDPH 2006)Healthy Albany Park Assessment (2004)Healthy Albany Park Assessment (2004)Illinois State Report Card (2004 – 2005)Illinois State Report Card (2004 – 2005)CPS School Profile (2004 – 2005CPS School Profile (2004 – 2005))
39
Project Work Plan and DesignProject Work Plan and Design
Collected new dataCollected new data Conducted fifteen stakeholder interviews with Conducted fifteen stakeholder interviews with
school administrators, school personnel, school administrators, school personnel, school nurses, and external partners working school nurses, and external partners working in schoolsin schools
Conducted a focus group with community Conducted a focus group with community providers providers
Analyzed findingsAnalyzed findings
Drafted initial recommendationsDrafted initial recommendations
40
Make RecommendationsMake Recommendations
Based on Needs Assessment Based on Needs Assessment FindingsFindings
41
Select the SchoolSelect the School
ElementaryElementaryMiddle or Junior High Middle or Junior High K-8K-8High SchoolHigh SchoolAlternative School Alternative School Pre-school Pre-school
42
Select the Service Delivery Strategy Select the Service Delivery Strategy and Modeland Model
Service and Staffing OptionsService and Staffing Options Collaborative PartnershipsCollaborative Partnerships The role of the school nurseThe role of the school nurse Policy and ProceduresPolicy and Procedures Referral NetworksReferral Networks Delivery of ServiceDelivery of Service Parental Consent/Parental InvolvementParental Consent/Parental Involvement Integration of the school-based health center with Integration of the school-based health center with
existing school and community resourcesexisting school and community resources Confidentiality IssuesConfidentiality Issues
43
Services to Consider for Services to Consider for All Grade LevelsAll Grade Levels
Primary Care including Primary Care including biennial risk biennial risk assessmentassessment
ImmunizationsImmunizations Health EducationHealth Education Physical ExaminationsPhysical Examinations Mental HealthMental Health Laboratory ServicesLaboratory Services MedicationsMedications
Nutrition CounselingNutrition Counseling Vision, Hearing, and Vision, Hearing, and
Dental ScreeningDental Screening Social Services Social Services Chronic Disease co-Chronic Disease co-
management management Specialty Care Specialty Care
ReferralsReferrals
44
Services at the MS and HS LevelsServices at the MS and HS Levels
Pregnancy testingPregnancy testing
STD testing and treatmentSTD testing and treatment
Reproductive health careReproductive health care
Group counseling to address issues such as Group counseling to address issues such as sexual abuse, depressionsexual abuse, depression
Individual mental health counseling Individual mental health counseling
HIV testing and/or counselingHIV testing and/or counseling
Referral for family planning Referral for family planning
45
The Role of the School NurseThe Role of the School Nurse
Maintain school nurse mandated functions Maintain school nurse mandated functions (vision and hearing screening, (vision and hearing screening, immunizations, special ed, etc.)immunizations, special ed, etc.)
Member of school-based health team Member of school-based health team
– Identify students for school-based health center Identify students for school-based health center servicesservices
– Provide follow-upProvide follow-up
– Reach out to parentsReach out to parents
– Serve as a liaison between the school-based Serve as a liaison between the school-based health center and school staff health center and school staff
46
Parental/Family Consent / Family Parental/Family Consent / Family EngagementEngagement
The majority of SBHCs have a parental/guardian The majority of SBHCs have a parental/guardian consent policy. consent policy.
Consent form should include:Consent form should include:
– Services to be offeredServices to be offered
– Statement about confidentiality /HIPAAStatement about confidentiality /HIPAA
– Billing issuesBilling issues
– Statement about the relationship between the Statement about the relationship between the sponsoring organization and any collaborators sponsoring organization and any collaborators including the school district including the school district
Review state statutes regardingReview state statutes regarding age of consent for age of consent for various health care servicesvarious health care services
47
ConfidentialityConfidentiality
Confidential versus nonconfidential Confidential versus nonconfidential services services
Access to confidential servicesAccess to confidential services
Release of informationRelease of information
Providing follow-up information to school Providing follow-up information to school personnel and outside agenciespersonnel and outside agencies
Informing students of confidentiality Informing students of confidentiality procedures and limits of confidentiality procedures and limits of confidentiality
48
Nut and Bolt #3Nut and Bolt #3Funding for SBHCs Funding for SBHCs
49
Maslow’s Hierarchy of NeedMaslow’s Hierarchy of Need
It’s hard to focus on best practice standards when your needs are rooted in basic survival.
School health clinics fight for lives
Karina BlandThe Arizona RepublicMarch 12, 2001
50
Multiple Funding Sources/ Multiple Funding Sources/ Models for School-Based Health Models for School-Based Health CentersCenters
Federal grantsFederal grants State grantsState grants Local fundingLocal funding Community Community
partnership partnership contributionscontributions
FoundationsFoundations Patient Patient
RevenueRevenue Mixing several Mixing several
or all funding or all funding sourcessources
51
Foundations
Federal Public Grants
Local Funding/Community Partners
State Public Grants
SCHIPMedicaidPrivate insurancePatient fees
Federal entitlement programs administered at the state level MCHB/Title VCDC HIV/AIDS PreventionSAMHSA/Title XIX (substance abuse and mental health screening and early intervention)Title XX/ Soc Services Block Grant (TANF, daycare, child neglect and
abuse) State FundingState General RevenueTobacco Tax/SettlementEducationNCLB /ESEA (Title I improving academic achievement of the disadvantaged and Title IV safe and drug free schools) IDEA (health-related special education services)
BPHC/FQHC (Section 330 of the Public Health Service Act)Title X of the Public Health Service Act: Family Planning
Figure 1 School-Based Health Center Funding Models
Patient revenue
Foundations that commonly supports school-based health careRobert Wood Johnson FoundationKB Reynolds Charitable TrustWKKF Kellogg FoundationWelborn FoundationMcKesson FoundationDuke EndowmentHealth Foundation of Greater CincinnatiVisit the Grantsmanship Center at http://www.tgci.com/ and the Foundation Center at http://fdncenter.org for other foundation funding opportunities
Local FundingPublic and private grants (e.g., universities, United Way)City/county fundsLocal businesses (e.g., banks, insurance companies)
Community PartnersIn-Kind Contributions from schools, hospitals, health departments, community health departments, and community agencies (e.g., staff, facilities, supplies)Examples of PartnersParents’ employersParents’ health insurance agenciesLocal businessesSchool districtsUniversities
52
Federal public grantsFederal public grants
BPHC /FQHC (Section 330 of the Public BPHC /FQHC (Section 330 of the Public Health Services Act)Health Services Act)
Title X of the Public Health Services Act: Title X of the Public Health Services Act: Family PlanningFamily Planning
53
Core Funding ModelsCore Funding ModelsFederalFederal
330 Federally Qualified Health Centers330 Federally Qualified Health Centers
Entirely federally dependentEntirely federally dependentFairly stableFairly stableLimited community Limited community Limited funds for expansionLimited funds for expansion
54
State public grantsState public grants
Federal entitlement programs administered at Federal entitlement programs administered at state levelstate level
– MCHB Title VMCHB Title V
– CDC HIV/ AIDS PreventionCDC HIV/ AIDS Prevention
– SAMHSA/ Title XIX (substance abuse and mental SAMHSA/ Title XIX (substance abuse and mental health screening and early interventionhealth screening and early intervention
– Title XX/ Social Services Block Grant, Temporary Title XX/ Social Services Block Grant, Temporary Aid to Needy Families Programs (TANF) job Aid to Needy Families Programs (TANF) job training, pregnancy prevention, daycare, child training, pregnancy prevention, daycare, child neglect and abuseneglect and abuse
55
State public grantsState public grants
EducationEducation
– NCLB/ESEA (Title I improving NCLB/ESEA (Title I improving academic achievement of the academic achievement of the disadvantaged and Title IV safe disadvantaged and Title IV safe and drug free schools)and drug free schools)
– IDEA (health-related special IDEA (health-related special education services)education services)
56
State public grantsState public grants
State FundingState Funding
– State General RevenueState General Revenue
– Tobacco Tax SettlementTobacco Tax Settlement
– Juvenile Justice FundsJuvenile Justice Funds
57
Core Funding ModelCore Funding ModelState GrantsState Grants
Louisiana – MCHBG; Tobacco Louisiana – MCHBG; Tobacco settlementsettlement
Connecticut – MCHBG, state fundConnecticut – MCHBG, state fund
Delaware – state fundDelaware – state fund
Fairly stableFairly stableLimited growth; targeted fundingLimited growth; targeted fundingRequires legislative/administrative advocacyRequires legislative/administrative advocacy
58
Local FundingLocal Funding
Public and private grantsPublic and private grants (universities, United Way(universities, United Way
City and county fundsCity and county funds
Local businesses Local businesses (banks, insurance (banks, insurance companies)companies)
59
Core Funding ModelsCore Funding ModelsLocal GovernmentLocal Government
Portland/Multnomah County (OR)Portland/Multnomah County (OR)
Seattle/King County (WA)Seattle/King County (WA)
Great community buy inGreat community buy in
Fairly stable incomeFairly stable income
60
Community partnersCommunity partners
In-kind contributionsIn-kind contributions (staff, facilities, (staff, facilities, supplies) from supplies) from
– Schools,Schools,
– Hospitals,Hospitals,
– Health departments, andHealth departments, and
– Community agenciesCommunity agencies
61
Community partnersCommunity partners
Examples of partnersExamples of partners
– Parents’ employersParents’ employers
– Parents’ health insurance agencies,Parents’ health insurance agencies,
– Local businesses,Local businesses,
– School districts, andSchool districts, and
– Universities Universities
62
Core Funding ModelsCore Funding ModelsCommunity PartnershipsCommunity Partnerships
Denver SBHCsDenver SBHCs
Baltimore County Public Schools, MDBaltimore County Public Schools, MD
Healthy Kids, Lexington, KYHealthy Kids, Lexington, KY
Indianapolis CollaborativeIndianapolis Collaborative
Collaboration has inherent difficultiesCollaboration has inherent difficulties
Built over long-termBuilt over long-term
Requires perseverance, leadershipRequires perseverance, leadership
63
FoundationsFoundations
Robert Wood JohnsonRobert Wood Johnson
WK Kellogg FoundationWK Kellogg Foundation
KB Charitable TrustKB Charitable Trust
Health Foundation of Greater Health Foundation of Greater CincinnatiCincinnati
McDonald FoundationMcDonald Foundation
Welborn FoundationWelborn Foundation
64
FoundationsFoundations
For other foundation funding For other foundation funding opportunities visitopportunities visit– The Grantsmanship Center at The Grantsmanship Center at
http://www.tgci.com
andand
– The Foundation Center atThe Foundation Center at
http://fdncenter.org
65
Core Funding ModelsCore Funding ModelsFoundationsFoundations
Indianapolis SBHCsIndianapolis SBHCs
Cincinnati, Ohio SBHCsCincinnati, Ohio SBHCs
North Carolina SBHCsNorth Carolina SBHCs
Miami SBHCsMiami SBHCs
66
Patient RevenuePatient Revenue
SCHIPSCHIPMedicaidMedicaidPrivate insurancePrivate insurancePatient feesPatient fees
67
Core Funding ModelCore Funding ModelPatient RevenuePatient Revenue
West Virginia – FQHC rateWest Virginia – FQHC rate
New York – Medicaid institution rateNew York – Medicaid institution rate
Commitment to specific sponsor typeCommitment to specific sponsor type
Leadership necessary at Medicaid levelLeadership necessary at Medicaid level
68
Mixed Funding SourcesMixed Funding Sources
Denver School-Based Health Centers Denver School-Based Health Centers
Baltimore County School-Based Health Baltimore County School-Based Health CentersCenters
Healthy Kids CentersHealthy Kids Centers
Indianapolis CollaborativeIndianapolis Collaborative
69
Follow the Income StreamsFollow the Income Streams
Education
Mental Hlth/Sub
Abuse
PublicHealth
HealthCare
70
Funding Service Funding Service ComponentsComponents
Medical/nursing servicesMedical/nursing services
Public health/promotionPublic health/promotion
Mental health/behavioral healthMental health/behavioral health
Case management/social services Case management/social services coordinationcoordination
Education supportEducation support
Nut and Bolt #4 Nut and Bolt #4 Principles of School-Based Principles of School-Based
Health Care Health Care
Seven fundamental principlesSeven fundamental principles
Goals, structures, processes and Goals, structures, processes and outcomes outcomes
72
SBHC Fundamental SBHC Fundamental PrinciplesPrinciples
http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2743459/k.9519/NASBHC_Principles_and_Goals_for_SBHCs.htm
73
The School-Based Health The School-Based Health Center:Center:
1.1. Supports the schoolSupports the school2.2. Focuses on the communityFocuses on the community3.3. Focuses on the studentFocuses on the student4.4. Provides comprehensive careProvides comprehensive care5.5. Advances health promotion activitiesAdvances health promotion activities6.6. Implements effective systemsImplements effective systems7.7. Provides leadership in adolescent and Provides leadership in adolescent and
child healthchild health
74
Supports the SchoolSupports the School
The school-based health center is The school-based health center is built upon mutual respect and built upon mutual respect and collaboration between the school collaboration between the school and the health provider to promote and the health provider to promote the health and educational success the health and educational success of school-aged children.of school-aged children.
75
1. 1. Supports the SchoolSupports the School
Principles/ GoalsPrinciples/ Goals StructuresStructures ProcessesProcesses OutcomesOutcomes Understands and respects Understands and respects accountability within the accountability within the educational systemeducational system
Works with the school Works with the school administration to develop and administration to develop and achieve a shared visionachieve a shared vision
Communicates the vision to Communicates the vision to all school constituencies all school constituencies including teachers, support including teachers, support staff, students and parentsstaff, students and parents
Builds collaborative and Builds collaborative and mutually respectful mutually respectful relationships with school relationships with school personnelpersonnel
Identifies community Identifies community resources that provide resources that provide support to students and support to students and promote successful learningpromote successful learning
Serves as a resource in Serves as a resource in times of school crises and times of school crises and community disasterscommunity disasters
Mutually agreed upon Mutually agreed upon vision statement for vision statement for the SBHCthe SBHC
Mutually agreed upon Mutually agreed upon roles and roles and responsibilities of responsibilities of each partyeach party
Mutually agreed upon Mutually agreed upon policies regarding policies regarding appointment appointment scheduling during scheduling during school hours and school hours and information sharing information sharing
Delineated role within Delineated role within the school’s crisis the school’s crisis intervention planintervention plan
Communication with Communication with School Administration, School Administration, School Nurse, Guidance School Nurse, Guidance Counselor, Social Worker, Counselor, Social Worker, School Psychologist and School Psychologist and FacultyFaculty
Attendance of SBHC Attendance of SBHC personnel at school staff personnel at school staff meetingsmeetings
Presence of SBHC Presence of SBHC personnel at appropriate personnel at appropriate school functionsschool functions
Partnership in identifying Partnership in identifying students with issues students with issues influencing educational influencing educational performanceperformance
Training of SBHC staff on Training of SBHC staff on the school’s crisis the school’s crisis intervention plan and intervention plan and community’s emergency community’s emergency preparedness plan and the preparedness plan and the SBHCs expected responseSBHCs expected response
Recognition by school Recognition by school personnel of the value the personnel of the value the SBHC provides in meeting SBHC provides in meeting educational missioneducational mission
High satisfaction of High satisfaction of school personnel with school personnel with SBHC servicesSBHC services
Increased number of Increased number of appropriate referrals by appropriate referrals by school personnel school personnel
Reduced number of Reduced number of students who leave school students who leave school during the day due to during the day due to illnessillness
In the event of a school In the event of a school crisis or community crisis or community disaster, SBHC performs disaster, SBHC performs effectively according to effectively according to planplan
76
Responds to the Responds to the CommunityCommunity
The school-based health center is The school-based health center is developed and operates based on developed and operates based on continual assessment of local continual assessment of local assets and needsassets and needs..
77
2. Responds to the Community2. Responds to the Community Principles/ GoalsPrinciples/ Goals StructuresStructures ProcessesProcesses OutcomesOutcomesAssesses child and Assesses child and adolescent health care adolescent health care needs and available needs and available resources in the resources in the community through formal community through formal evaluation methodsevaluation methods
Informs the community of Informs the community of student health needs and student health needs and trendstrends
Solicits community input Solicits community input to address unmet health to address unmet health needs and support the needs and support the operations of the programoperations of the program
Definition of geographic Definition of geographic service areaservice area
Identification of population to Identification of population to be served including be served including demographic and demographic and socioeconomic characteristicssocioeconomic characteristics
Identification of key health Identification of key health indicatorsindicators
Continuous needs Continuous needs assessmentassessment
System for gathering data on System for gathering data on key indicatorskey indicators
Resource manualResource manual
Advisory Committee with Advisory Committee with appropriate community appropriate community representationrepresentation
Communications planCommunications plan
Program Program development based development based on periodic review of on periodic review of datadata
Advisory Committee Advisory Committee meetingsmeetings
Stakeholder Stakeholder meetingsmeetings
Periodic Periodic communication with communication with the general publicthe general public
Improved access to Improved access to primary care as primary care as measured by increased measured by increased utilization of SBHC utilization of SBHC services services
Recognition by Recognition by community of the value community of the value of SBHC services in of SBHC services in meeting the needs of meeting the needs of students and responding students and responding to community valuesto community values
High parent satisfactionHigh parent satisfaction
Improved utilization of Improved utilization of other community other community resources through resources through referrals and/or inter-referrals and/or inter-program collaborationprogram collaboration
78
Focuses on the StudentFocuses on the Student
Services involve students as Services involve students as responsible participants in their responsible participants in their health care, encourage the role health care, encourage the role of parents and other family of parents and other family members, and are accessible, members, and are accessible, confidential, culturally sensitive, confidential, culturally sensitive, and developmentally appropriate.and developmentally appropriate.
79
3. Focuses on the Student
Principles/Goals Structures Processes Outcomes
Encourages the student’s active, age appropriate participation in decisions regarding health care and prevention activities
Involves the parents or other adult caregivers as supportive participants in the student’s health care whenever appropriate and possible
Ensures confidentiality of information whether transmitted through conversation, billing activity, telemedicine, or release of medical records
Provides services and materials that are culturally sensitive and respectful of family values and diversity
Parental consent and parental notification policies
Confidentiality and minor consent policy
Emancipated minor policy
Child abuse and neglect policy
Non-discrimination policy
Patient rights and responsibilities
Patient education materials in languages other than English, where appropriate
Methodology for identifying children with special health care needs
Methodology for identifying non-users
Provision of services in a manner consistent with established policies
Treatment of students with acute illness or injury
Counseling of students with behavioral issues
Management of students with chronic conditions
Provision of culturally sensitive anticipatory guidance and health and safety education
Student-centered risk assessment and follow-up
Family assessment and follow-up
Outreach to non-users
Increased enrollment for and utilization of SBHC services
High user and parent awareness of SBHC policy regarding access to confidential services
Improved user knowledge of how and when to utilize the health care system
Students with chronic disease or behavioral issues can demonstrate self-care skills
High satisfaction among users.
80
Delivers Comprehensive Delivers Comprehensive CareCare
An interdisciplinary team provides An interdisciplinary team provides access to high quality access to high quality comprehensive physical and comprehensive physical and mental health services mental health services emphasizing prevention and early emphasizing prevention and early interventionintervention..
81
4. Delivers Comprehensive Care
Principles/Goals Structures Processes OutcomesProvides a scope of services that is consistent with identified health care needs
Promotes availability of on-site services whenever the school is open and facilitates after-hours care 24-hour-a-day, seven-days-a-week
Adopts generally accepted guidelines for clinical practice
Promotes the interdisciplinary role and functions of the school-based health care team
Coordinates and integrates efforts with existing systems to optimize complementary programs, improve continuity of care, reduce fragmentation, prevent duplication, and maintain affordable services
Defined scope of services to be provided
Multidisciplinary team of caregivers
Posted hours of operation
Effective 24/7 on-call system
Staffing guidelines
Clinical protocols or practice guidelines consistent with nationally recognized best practices
Referral relationships with other providers in the community (including lab, radiology and pharmacy)
Standards for medical record keeping
Release of information policy
Population-based Screening
Early identification and treatment
Delivery of care consistent with best practices
Patient assessment
Patient education
Patient treatment
Patient referral
Management of chronic conditions
Anticipatory guidance, health promotion and prevention activities
Continuity of care
Quality assurance
Chart review
Patient perception that well-being has improved
Increasing number of students receiving comprehensive well exam including risk assessment
Increasing compliance rates as measured by follow-up visits completed, prescriptions filled, therapy attended, referrals completed.
Reduced number of students with disruptive behavior or discipline problems
82
Advances Health Advances Health Promotion ActivitiesPromotion Activities
The school-based health center The school-based health center takes advantage of its location to takes advantage of its location to advance effective health advance effective health promotion activities to students promotion activities to students and community.and community.
83
5. Advances Health Promotion Activities
Principles/Goals Structures Processes OutcomesServes as a resource to school administration on the selection, development and delivery of health education curricula
Participates in classroom-based and school-wide health promotion activities responsive to the risk factors that are prevalent among students
Promotes parent and community involvement in health promotion activities
Partnership between the school’s health education faculty and SBHC staff
Coordinated risk assessment and health promotion plan
Age appropriate health education materials
Delivery of classroom health education segments
Display and distribution of multilingual health education materials in SBHC (pamphlets, posters, models, videos, etc.)
School-wide health and safety promotional events
Increased student awareness of health threats and risk factors
Reduced high risk behaviors among students
Increased positive health and safety behaviors among students
Increased student understanding of important health and psychosocial issues
Increased student ability to access valid health information and health promoting products and services
Increased student knowledge of health care rights and responsibilities
Increased student ability to communicate about and advocate for improved personal health
Increased participation of parents in heath promotion activities
84
Implements Effective Implements Effective SystemsSystems
Administrative and clinical systems Administrative and clinical systems are designed to support effective are designed to support effective delivery of services incorporating delivery of services incorporating accountability mechanisms and accountability mechanisms and performance improvement performance improvement practicespractices..
85
6. Implements Effective SystemsPrinciples/Goals Structures Processes OutcomesEnsures compliance with all relevant laws and regulations
Develops and measures annual program goals and objectives
Maintains a physical plant which is adequate to deliver high quality services and assure patient comfort and privacy
Develops all necessary policies and procedures, training manuals, and memoranda of agreement or understanding
Develops a human resources system for hiring, credentialing, training and retaining high quality, competent staff
Collects, evaluates and reports health outcomes and utilization data
Establishes quality improvement practices including but not limited to assessment of patient and community satisfaction
Develops strategies and systems to support long-term financial stability
Organizational chart
Mission statement
Goals and objectives
Administrative policy and procedure manual
Clinical policy and procedure manual
Appointment system and scheduling standards
Tracking system for missed appointments, follow-up appointments and lab reports
Incident reports
Staff credentialing
Staff training
Personnel evaluation and salary review
Facility maintenance
Strategic business/ marketing/financial plan
Billing and collection system
Licensing, Certification and/or Accreditation
CLIA compliance
Medicaid EPSDT compliance
Medical record keeping according to accepted standards and demonstrating collaboration and communication among providers
Formal quality assurance monitoring of clinical and administrative functions
Financial audits
Staff knowledge of current laws and regulations affecting delivery of services
Treatment for high volume, high risk problems consistent with current professional knowledge
High SBHC provider and staff satisfaction
Low SBHC provider and staff turnover
Increased provider productivity
High patient and parent satisfaction with ease of appointment-making and waiting time
Operations within budget
Eligibility for reimbursement from public and private third-parties
86
Provides Leadership in Provides Leadership in Adolescent and Child Adolescent and Child HealthHealth
The school-based health center The school-based health center model provides unique opportunities model provides unique opportunities to increase expertise in adolescent to increase expertise in adolescent and child health, and to inform and and child health, and to inform and influence policy and practice.influence policy and practice.
87
7. Provides Leadership in Adolescent and Child HealthPrinciples/Goals Structures Processes Outcomes
Participates in national and local organizations that focus on adolescent and child health
Contributes to the body of knowledge on the health care needs of adolescents and children
Promotes the School-Based Health Center as a training site for health care professionals
Advocates for the resources necessary to increase access to physical, mental and dental health services for adolescents and children
Informs elected officials, policy-makers, health professionals, educators, and the community-at-large regarding the unique value, acceptability, efficiency and convenience of the school-based health center model of health care delivery
Forms partnerships to develop stable, sustainable funding mechanisms for expanded services
Local Conferences
National Conferences
Journal Articles
Annual Reports\
Videotapes
Web sites
Vehicles to communicate with state and local health authorities
Precepting students in the health professions
Research
Outcome evaluation
Process evaluation
Clinical trials
Medical professional training
Curriculum development
Public education and advocacy
Use of student volunteers
Increased public awareness of the health care needs of children and adolescents
Greater number of children and adolescents with a medical home
Improved access to primary care
Increased exposure of health professionals to the SBHC model
Legislation and regulation supportive of the SBHC model
Increased investment in SBHCs by federal, state, local and private funding sources
Increased participation of SBHCs in Medicaid and Child Health Insurance Plans
Appropriate contracts with managed care organizations
88
Nut and Bolt #5Nut and Bolt #5Developing a Case Statement for Developing a Case Statement for
a School-Based Health Centera School-Based Health Center
89
Case Statement ContentCase Statement Content
PurposePurpose
– What you propose to do / what are you What you propose to do / what are you seeking funding forseeking funding for
– Summary of needs assessment findingsSummary of needs assessment findings
– Partners/collaborators and their Partners/collaborators and their contributorscontributors
90
Case Statement Content Case Statement Content Service designService design
– ModelModel
– ServicesServices
– StaffingStaffing
– Hours of operationHours of operation
– Parent, student, and school staff Parent, student, and school staff involvementinvolvement
– Community, collaborator/partner Community, collaborator/partner involvementinvolvement
91
Case Statement ContentCase Statement Content
Current project support /infrastructureCurrent project support /infrastructure
– Sponsoring organizationsSponsoring organizations
– Health center planning group activitiesHealth center planning group activities
– In-kind contributions of In-kind contributions of partners/collaboratorspartners/collaborators
– Implementation grant possibilitiesImplementation grant possibilitiesProposed budgetProposed budget
92
Nut and Bolt #6Nut and Bolt #6 Using the Media to Your AdvantageUsing the Media to Your Advantage
93
What is the “Media”?What is the “Media”?
the various means of mass communicationthe various means of mass communication
considered as a wholeconsidered as a whole
including television, radio, magazines, and including television, radio, magazines, and newspapers, together with the people newspapers, together with the people involved in their productioninvolved in their production
94
Types of MediaTypes of Media
Daily NewspapersDaily Newspapers
Weekly Weekly NewspapersNewspapers
Wire ServicesWire Services
InternetInternet
MagazinesMagazines
TelevisionTelevision
RadioRadio
95
Tips for Dealing with the Tips for Dealing with the MediaMedia
Don’t be afraid to approach the media with Don’t be afraid to approach the media with an issue or a story idea.an issue or a story idea.
Try to keep relationships with the media Try to keep relationships with the media friendly and honest.friendly and honest.
Remember, the media are doing their job—Remember, the media are doing their job—try to make it easier for them.try to make it easier for them.
Access to the media is access to the publicAccess to the media is access to the public..
96
CommunicatingCommunicating with the with the MediaMedia
Be an information resource for the media.Be an information resource for the media.
Have resources and information to help Have resources and information to help reporters in covering stories.reporters in covering stories.
Be familiar with the types of stories each Be familiar with the types of stories each publication or station covers and how they publication or station covers and how they report the news.report the news.
97
Role Play in PairsRole Play in Pairs
Phone Call to the Editorial Phone Call to the Editorial Editor of a Local NewspapeEditor of a Local Newspaperr
98
Technical Assistance Technical Assistance Resources for SBHCsResources for SBHCs
99
National Technical National Technical AssistanceAssistance
National Assembly on School-Based Health National Assembly on School-Based Health Care (NASBHC)Care (NASBHC)
Society for Adolescent Medicine (SAM)Society for Adolescent Medicine (SAM)
National Association of Pediatric Nurse National Association of Pediatric Nurse Practitioners (NAPNP)Practitioners (NAPNP)
National Association of Community Health National Association of Community Health Centers (NACHC)Centers (NACHC)
100
National Technical National Technical AssistanceAssistance
American School Health Association American School Health Association (ASHA)(ASHA)
Center for School Mental Health Center for School Mental Health Analysis and Action (CSMHA)Analysis and Action (CSMHA)
Center for Health and Health Care in Center for Health and Health Care in Schools at GWUSchools at GWU
101
•Figure 2 National Assembly’s Trainings, Tools, and Resources for SBHCS
•Mental Health Intervention
•CQI tool sentinel conditions
•Continuing education
•Quality improvement collaborative
•Center work groups
•Conference call presentations
•Asthma
•Green Zone web-based tool kit
•CQI tool sentinel condition
•Center work group
•New SBHC Expansion
•Peer to peer exchange
•Conference call presentations
•Web-based tools and information
•Practice Management Improvement
•Web-based tools and information
•Continuing education
•Family Engagement
•Web-based tools and information
•Health Education
•Web-based tools and information
•Obesity/Cardio Health
•Conference call presentation
•Continuing Education
•Panel work group
•STDs/HIV Prevention
•CQI tool sentinel condition
•Quality improvement collaborative
•Conference call presentations
• Web-based resources
• Conference call presentations
• Continuing education programs
• Quality improvement collaboratives
•New SBHCs/Expansion
•Peer-to-peer exchange
•Conference call presentations
•Web-based tools and information
•Evaluation Measures
•Academic Outcomes
•Productivity
•SBHC Census
•Mental Health Evaluation Template
102
State Technical AssistanceState Technical Assistance
State Assemblies, Associations, and State Assemblies, Associations, and Coalitions for School-Based Health Coalitions for School-Based Health
State Health Departments that State Health Departments that administer state funding for SBHCsadminister state funding for SBHCs
State Primary Care AssociationsState Primary Care Associations
State Offices of Rural HealthState Offices of Rural Health
103
National Tools and Resources for National Tools and Resources for Getting StartedGetting Started
NASBHC websiteNASBHC website www.nasbhc.org – Basics, – Training and Assistance, – Publications, and – Members Only Sections
National Association of Community Community Health Centers’ (NACHC) CD-Rom, Health Centers’ (NACHC) CD-Rom, How to Start a Successful School-Based Health Center $25 www.nachc.org
104
Questions and Complete Questions and Complete EvaluationsEvaluations