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Similaire à School-Based Health Centers 101
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School-Based Health Centers 101
- 1. School-Based Health Centers (SBHCs) 101: An Overview and Framework for Building Programs
- 9. Why School-Based Health Centers?
- 20. The Health-Academic Outcomes Connection SBHCs Health Risk Behaviors Educational Outcomes Educational Behaviors Substance use Mental health Poor diet Intentional injuries Physical illness Self-esteem Sexual behaviors Attendance Dropout Rates Behavioral Problems Graduation GPA Standardized test scores Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.
- 24. National Data and Trends Census 2007-08
- 25. SBHCs by State (n=1910) State Total # of Open SBHCs State Total # of Open SBHCs Alabama 5 Nebraska 1 Alaska 3 Nevada 6 Arizona 81 New Hampshire 1 Arkansas 2 New Jersey 40 California 160 New Mexico 79 Colorado 45 New York 206 Connecticut 79 North Carolina 49 Delaware 28 Ohio 20 District of Columbia 4 Oklahoma 11 Florida 245 Oregon 51 Georgia 3 Pennsylvania 28 Illinois 60 Puerto Rico 2 Indiana 87 Rhode Island 2 Iowa 16 Saskatchewan 1 Kansas 2 South Carolina 7 Kentucky 20 South Dakota 6 Louisiana 64 Tennessee 21 Maine 26 Texas 70 Maryland 71 Utah 5 Massachusetts 59 Vermont 5 Michigan 90 Virginia 19 Minnesota 16 Washington 20 Mississippi 31 West Virginia 50 Missouri 3 Wisconsin 8
- 26. SBHCs by Location (n=1226) In school building 95.7 percent On school property 2.9 percent Mobile 1.4 percent
- 27. SBHCs by Types of School (n=1096)
- 28. SBHCs by Community Characteristic (n=1235)
- 29. SBHCs Users by Race/Ethnicity (n=1096)
- 30. SBHCs by Population Served (n=1096 )
- 31. SBHCs by Sponsoring Agency (n=1096)
- 32. Services Offered by SBHCs
- 33. Primary Care Services Provided by SBHCs (N=1046-1075)
- 34. Reproductive Health Services Offered by SBHCs to Adolescents On Site (n= 1030-1068)
- 35. Oral Health Services Offered by SBHCs (n= 1010-1046)
- 36. Contraception Prohibition at SBHCs (N=1095)
- 37. Mental Health Services Offered by SBHCs With (n=878) and Without (n=348) Mental Health Providers
Notes de l'éditeur
- By the end of our time together today, you will be able to: 1. define what a school-based health center is; 2. explain why school-based health centers are better than sliced bread and the best way to deliver health care for children and adolescents; 3. talk about the big picture of school-based health centers including where they are at in the US and where they are located in your community; (You will be able to tell me What a SBHC is Why have a SBHC Where are they and how many)
- The following six slides represent the most common pieces or components that frame and define what a school-based health center is. Unlike most other health care centers, partnerships are key for SBHCs. Schools and community health organizations come together to provide health services (medical, mental health, oral health) that promote the health and educational success of our children and adolescents. Typically, a health agency is one of the key partners and is the sponsoring agency of the SBHC.
- Collaboration is key to making a local decision concerning the range and types of services found in a school-based health center. And the providers within the SBHC work closely with their educational partners such as the school nurse, and their community partners and other service providers to provide the best care to the students.
- Each SBHC will develop and implement a policy and procedure on parental consent. We will touch more on this later in the presentation. And typically, a SBHC is open every school day and has a staff providing , comprehensive services that is supported by an interdisciplinary team which means there are providers from different disciplines such as primary care, mental health, alcohol and other drug prevention and intervention, health education, and oral health.
- Since SBHCs are open during the school day and mostly the school hours, SBHCs need to make provisions for care beyond their typical operating hours, and for needs that are beyond their scope of service. Unique to SBHCs, since they are in the school, the providers have opportunities that your typical medical provider does not have: access access access and the ability to work long term with the students emphasizing prevention and early intervention.
- SBHCs provide services that are age appropriate and focus on the key indicators that influence the health needs of children and youth. This influences what kind of provider you hire and determines your resource needs. And we have talked a bit about the types of services and they are listed more fully here. The services are determined by the needs of the community, the local decision making process, provider type, and availability of resources.
- SBHCs are supported financially by a combination of sources such as grants, foundations, donations, co-pays, billing and reimbursement for services, and fund raisers. Money comes from many levels and from various partners including health and educational partners. Students are most often seen regardless of their ability to pay. So in wrap up, key to remember, that as a health provider, SBHCs are unique. They are where the kids are for most of the day; They focus on what influences positive health outcomes; They work with and within the educational and community partners in the provision of services and follow-up care; They take the time provide health promotion and guidance; and they impact not only the health of our children and youth, they also provide a positive effect on the learning environment and the success of students academically. And this is all done through collaboration and partnerships, with the voice of the local community key in the planning and start up of a SBHC.
- So, we have talked a little about WHAT is a SBHC. We know that SBHCs are a unique way to provide health care to students. So what? Why have a SBHC?
- We want to hear from you. We are going to do an activity now. -I want you to imagine a student in need of a SBHC. I want you to actually picture someone at a specific age. You can do this in a variety of ways: You can go back in time to when you were a school-aged child or adolescent and pick an age and remember what it was like. Or you can think of your own child or adolescent. Or think of family members, neighbors, etc as a student. However you do this, picture the person you have selected; what is their age? Now here is the challenge and the fun part. Using the first letter of your first or last name (or draw an alphabet card from the center of the table/bucket) come up with a ‘Why” SBHCs. Here is an example: I am picturing my daughter who is a senior in high school so she is 18. I am going to use my “A” (first letter of my last name). Why a SBHC for her? Anxiety! A SBHC would be able to help her with her medications, provide support and mental health counseling, be a safe haven for her, and help her develop coping skills through 1:1 or small groups. Any questions? You have a couple of minutes to prepare, then we will share. OK, tell me who the student is, their age, and your letter you are using. Now answer the question: Why? (write up the answers to why on flip chart)
- Comment on the exercise and link throughout the next few slides. SBHCs are critical to providing care to the uninsured. Access to health care is simplified by being in the school so the geographic barriers to care are diminished or gone. Adolescents, without age appropriate health guidance, early identification and support, can be seriously affected with poor health outcomes during their youth and can be set up for longer term health and mental health problems SBHCs are able to connect and often be the hub of the system of care that is typically oriented to specialist and silos. If a student has health or mental health problems, they are at risk for not meeting their educational potential.
- Dr. Phillip Porter, and early architect of the SBHC movement, recognized that students, especially adolescents, need health care where they spend the majority of their time.
- Since the early days of SBHCs, the movement has worked to provide evidence beyond the anecdotal evidence provided by the providers and the students and their families that SBHCs do make a difference. Through many years of research projects, national and state data collection including surveys and census, the leaders in the SBHC field can make compelling reasons for SBHCs. In addition, there have been many initiatives that have blossomed from the needs of the field. The National Assembly on School-Based Health Care (NASBHC) has been very instrumental in developing cutting edge tools, resources, and Collaboratives that support the work of the centers. With the SBHC being a unique model of care, the traditional trainings and resources for other providers just didn’t meet the needs of the young and growing field.
- What do we know? From the research, we can talk about the relationship between a SBHC and Emergency Room use: Having a SBHC can reduce the inappropriate ER use. (a student can’t get to their doc, doesn’t have insurance, etc and has a really bad sore throat. It gets so bad, they finally go to the ER to get treatment-one example) We also know that by getting the help sooner and treating conditions in the early stages, there were fewer hospitalizations. And through age appropriate preventive care in a SBHC, students did not go to the ER for their concerns that could be addressed in the SBHC. SBHCs create timely and trusted access, and provide care earlier in the development of a condition or disease, resulting in less use of an ER as a primary care facility.
- How about asthma? Students enrolled in SBHC significantly reduced their ER visits for asthma in a NY study. With growing rates of asthma and increasing severity of asthma attacks, it is critical to address asthma before it reaches the point of calling the ambulance. The SBHC is able to provide timely care, often help the students obtain their medications, provide quick access to nebulizer treatments and preventing a full blown asthma attack, and help the student recognize some of the triggers to asthma attacks and what to do prevent them.
- In regards to SBHCs and mental health, we know that they serve harder to reach populations and do a better job meeting their mental health needs than a more traditional primary care provider. And not surprising, adolescents report that they were 10-21 times more likely to seek mental health care at a SBHC than a community provider.
- As mentioned earlier, SBHCs have a positive impact in the education arena. We know that by having a center in a school, the center is contributing to the overall milieu, helping students get care earlier and decreasing some potential classroom problems, and keeping kids well. It is hard to teach kids who are sick or at higher risk for poor outcomes.
- Academic performance is negatively affected by: read the list or some of it Conversely, academic performance is positively affected by: Resiliency, development assets, and school connectedness. SBHCs can partner with education to support these indicators.
- Encourage educators to accept that there is a link between health and academics…and instead focus on health-related results and indicators Medical and mental health status impacts academic outcomes SBHCs impact medical and mental health status So…SBHCs can contribute, at least indirectly, to improved academic outcomes
- What else do we know from the research about SBHCs in relation to health care? Many of the students who use the SBHC use the center as their medical home, and do not have a medical home elsewhere.
- SBHCs save parents and employers time, and keep kids in the classroom as they don’t have to leave school for health care visits. SBHCs can send for a student to do follow up care very easily. SBHCs develop relationships with students, often do annual risk assessments, and identify problems earlier SBHCs provide care access to services that allows students to get timely and appropriate care, keeping them out of the ER for their primary care needs.
- Census 2004-05 identified 1709 school-connected programs nationwide. This number includes school-based, mobile and linked programs. 1335 or 78% of known programs responded to the survey. These data on practices and operations during the 2004-05 school year were collected from October 2005 through October 2006. Efforts were made to confirm that non respondents were open during the 2004-05 school year. This presentation describes the 1235 sites providing a minimum of primary care service, defined as having a staffing profile with a nurse practitioner, physician assistant or physician on school grounds. The programs not providing primary care services on school grounds are not presented here.
- Settings for school-based health centers (SBHCs) are as varied as the types of schools in the United States. As schools nationwide re-design for students’ academic success, SBHCs adapt to meet the age-appropriate needs of the students they are serving . 80% of the programs report serving at least one grade of adolescents. 41% are designated as Title One schools. 6% of SBHCs are in alternative schools. 41% of SBHCs in schools with more than 1000 students.
- COMMUNITY SBHCs are located in geographically diverse communities, with the majority (59%) in urban communities. Nearly one in three health centers is in rural schools. Sponsorship of SBHCs is most typically by a local health care organization, such as a hospital (29%), community health center (22%), and health department (17%) , Other community partners include nonprofit organizations, universities and mental health agencies. Only 14% are sponsored by the school system.
- STUDENTS Students in schools with SBHCs are predominantly minority and ethnic populations that have historically experienced health care access disparities. 69% of SBHCs report that more than half of their student population is eligible for free and reduced lunch – a marker for underserved students.
- Although the school population is the school-based health center’s primary target, many (55%) provide services to patients other than enrolled students: students from other schools in the community (33%); family members of students (29%); faculty and school personnel (19%); out-of-school youth (16%); and other community members (12%).
- The majority of SBHCs provide the basic tools of primary preventive care. The most common components in the SBHC scope of service are comprehensive health assessments, anticipatory guidance, vision and hearing screenings, immunizations, treatment of acute illness, laboratory services, and prescription services.
- Health centers serving middle and high school aged students (n= 977) who responded to these questions ( from 897 to 931) were more likely to offer abstinence counseling (76%) and provide on-site treatment for sexually transmitted diseases (62%), HIV/AIDS counseling (64%), and diagnostic services such as pregnancy testing (78%) than contraceptive services (30%). Family planning services most often encompassed birth control counseling (65%) and follow up (48%). A minority of health centers neither provided on-site nor referred to an off-site provider for any reproductive health services.
- Health centers serving middle and high school aged students (n= 977) who responded to these questions ( from 897 to 931) were more likely to offer abstinence counseling (76%) and provide on-site treatment for sexually transmitted diseases (62%), HIV/AIDS counseling (64%), and diagnostic services such as pregnancy testing (78%) than contraceptive services (30%). Family planning services most often encompassed birth control counseling (65%) and follow up (48%). A minority of health centers neither provided on-site nor referred to an off-site provider for any reproductive health services.
- More than two-thirds of school-based health centers are prohibited from dispensing contraception – a policy whose source is most often the school district.
- Mental health services are often delivered by school-based health center primary care staff. School-based health centers offer a variety of on-site mental health and counseling services through several modalities, including individual, one-on-one counseling, student group counseling, family therapy, consultation and case management. These services are more likely to be provided when mental health professionals are included as center staff. Those services most frequently reported as provided by centers without mental health professionals on staff include referrals (63%), mental health diagnosis ( 63%) and screening (62%).