Transcript Slide 1

Coming Home
John Schlitt
National Assembly
on School-Based Health Care
SBHC Beginnings
• West Dallas Youth Center at
Pinkston High School, Dallas, TX
A movement is born
My objectives
• Reflect on where we’ve been
• Where we are today
• NASBHC’s vision for where we’re going.
SBHCs: The Early Years
• First SBHC Census, Center for Population
Options, 1987
• 110 SBHCs in 28 states
• TEXAS:
– West Dallas Youth Clinic
– Urban Affairs Corporation, Houston
• New Mexico (1988)
– Albuquerque (8)
– Pecos
The Good Ole Days
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Predominantly grant funded
Predominantly adolescents
No billing: what was the point?
Accountability was to ourselves and the
youth we served
The Good Ole Days
• HIPAA, ICD codes, practice
management, managed care,
prior authorization, medically
necessary, productivity, quality
assurance, Medicaid 1500
forms, explanation of benefits.
Support Center for SBCs
“As the movement approaches its adolescence,
we find ourselves in the role of proponent and
defender, responding to more and more
vociferous critics…
“Will a fear of controversy move us to inaction? At
a time when so many teens are in need it would
be tragic if a few critics succeeded in stopping
this movement that has developed through
committed efforts of so many communities.
– Sharon R. Lovick (Houston, TX), 1987
SBHCs Today
2004-05 Census
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2100+ SBHCs opened since West Dallas
~1600 in operation today
44 states
Texas SBHC Database
– 110 SBHCs in 46 communities
– 34 sites closed doors (1 in 3)
– 76 open today
– ????
State SBHC Investments
60
Millions
50
40
30
20
10
0
1992
1994
1996
MCHBG
1998
2000
2002
State Gen Rev/Other
2004
Enormous Challenges in face of
Incredible Growth
• Insurance expansion
• Role in Managed Care
– Accommodating multiple access points
• Billing/collecting
– Juice worth the squeeze?
• Managing Outcome Expectations
– Academic achievement
– Cost-savings/efficiencies
Closing Doors
• 540 SBHCs closed across US
• 34 in Texas
• What’s behind the closures?
– Inadequate funding?
– Lack of need/poor utilization?
– No public will?
• Who’s next?
What’s the State
of the Field in Texas?
National Assembly on
School-Based Health Care
NASBHC Strategic Planning
Winter 2005 – strategic planning survey of
membership and stakeholders conducted
April 2005 – Board meets to review strategic
planning data, re-affirm mission and vision, and
identify critical issues
June 2005 – Board reviews staff progress, informs
development of strategic plan
October 2005 – Board evaluates goals and
objectives
November 2005 – Staff completes strategic plan
VISION
WE ENVISION schools and
communities working
together to ensure that all
children and adolescents
have access to health care.
WE BELIEVE…
schools are an excellent and time-proven place to
provide health care.
WE REPRESENT…
those who support, receive and provide health care
in schools and school-connected programs.
WE ADVOCATE…
for national and state policies, programs and funding
that sustain, grow and integrate school-based health
care into our nation’s health care and education
systems.
WE PROVIDE…
leadership, resources and technical assistance to
enable school-based health centers to deliver high
quality services, become financially stable, and play an
active role in public policy.
WE SUPPORT…
the growth of state and regional school-based health
care organizations and networks.
GOAL ONE
•
Build Capacity of National, State and
Local SBHC Community to Influence
Public Policy
– Capacity Building of State and Local SBHC
Organizations to Implement Direct Action
Campaigns
– Youth/Parent Engagement In Advocacy
– SBHC Finance Policy Knowledge
– SBHC Campaign Tactics To Secure Federal
Authorization
GOAL TWO
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Set National Benchmarks for SBHC
Assessment
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Measuring Productivity in SBHCs
National Census of SBHCs
Measuring Cost in SBHCs
Measuring Quality Improvement in SBHCs
Evaluating Mental Health Programs in
SBHCs
– Telling the Story of School-Based Health
Care through Qualitative Data Collection
GOAL THREE
•
Improve/Strengthen SBHC Practice
– Improving Practice Management in SchoolBased Health Centers
– Implementing Evidence-Based Behavioral
Health Interventions in School-Based Health
Care
– Strengthening HIV/AIDS Prevention and
Testing in School-Based Health Centers
– Resources and training for SBHC Practice
GOAL FOUR
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Develop structure to support NASBHC’s
growth, make effective/efficient use of
staff & Board, and assure accountability
across all levels
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Staff Development, Planning and Management
Finance, Data and Technology Management
Board and Leadership Development
Advisory Panel Support and Development
State and Regional Organization Relations
GOAL FIVE
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Build Political and Public Support for
NASBHC and its Mission
– NASBHC Positions and Policies that Affect
SBHC Practice
– Advocacy for Federal Policies and Funding that
Grow and Sustain SBHCs
– Fund Development Plan to Diversify NASBHC's
Revenue
– Marketing Campaign to Raise Visibility of
NASBHC Mission/Goals
National Policy Initiative
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WKKF Funded
National, State (9) and Local Partners (~50)
Establish Champions for SBHCs
Influence policies/funding to sustain and
grow SBHCs across country
• Involve SBHC consumers, families and
supporters in advocacy
Accomplishments to Date
• NASBHC public affairs/field development
• 200+ meetings with Members of Congress
and SBHC advocates
• Federal appropriations campaign
– 65 House sponsors; 24 Senators
• Federal authorization campaign
Congressional Interest by Party
Affiliation
Level of
Interest
Democrat
Republican
Total
Unsupportive
0 (0%)
2 (4%)
2 (1%)
Neutral
6 (6%)
23 (48%)
29 (20%)
Supporter
76 (80%)
23 (48%)
99 (69%)
Champion
13 (14%)
0 (0%)
14 (10%)
95
48
144
TOTAL
National Campaign for
Federal SBHC Program
Principles for Federal Legislation
• Purpose: fund the development and
operation of SBHCs to provide
comprehensive primary public health
services to underinsured and at-risk
children, adolescents and their families
• Priorities: communities that demonstrate
highest need among school age
population
Principles for Federal Legislation
• Medicaid/SCHIP: recognize & reimburse
SBHCs for services to enrollees at 100%
cost of providing services.
• Federal grants: used to expand existing
school health center networks or establish
a new program where none exists.
• Allow scope of service to be determined
by community and reflect accepted
standards of practice for pediatric care.
Importance of Texas Advocates
• Congressman Joe Barton
– Chair, House Energy & Commerce Committee
• Congresswoman Kay Granger
– Member, House Appropriations Committee
State/Local Successes
• New York – campaigning to increase the state’s
investment to $15M
• New Mexico – Governor campaigned to double
the number of SBHCs
• California – campaigning to establish first ever
state program
• Michigan – doubled SBHCs through Medicaid
rule making
• Maine – partnering with state’s commercial
insurers
• New Orleans – leaders pledging to put SBHC in
every new school they open
Determining our Message
Focus Groups/Polling:
Conservative Voters
ARGUMENTS AGAINST SBHCs
Children should not be getting care or treatment without their parents’
consent and involvement.
3.58
Teenagers should not be getting care or treatment without their
parents’ consent, especially family planning services. Schools should
not be handing out condoms or the morning after pill, nor should they
be educating teens about safe sex. This is a role parents should play.
3.35
SBHCs would take money/attention away from more important
education priorities. Schools are already having enough trouble
educating our children, let’s not give them even more to do.
3.10
Parents are responsible for their children’s health care and well-being.
This is not a role that schools, or the government, should play.
2.63
Many services provided by schools are of poor quality. SBHCs are
likely to provide poor quality care too, may end up doing more harm
than good.
1.60
* Participants scored argument on a 0 to 4 scale on which 0 meant not at all convincing and 4 meant
very convincing.
ARGUMENTS FOR SBHCs (high)
SBHCs provide easy access to health care for millions of
children who are uninsured or underinsured. Children should
not go without health care just because their parents are not
in a position to provide the health care they need.
2.95
SBHC provide on-going care for children with chronic diseases
like asthma and diabetes, comprehensive on site care in case
of accidents, sudden illnesses, outbreaks of infectious disease
or other crises.
2.64
Healthy children learn better. By helping children stay
healthy, SBHCs give all kids an equal chance to succeed in
school.
2.53
SBHCs can teach children about nutrition and help prevent
and treat obesity-related conditions among children such as
diabetes and high blood pressure.
2.36
* Participants scored argument on a 0 to 4 scale on which 0 meant not at all convincing and 4 meant very
convincing.
ARGUMENTS FOR SBHCs (low)
SBHCs aren’t just for low-income children. All students
need medical care from time to time. SBHCs work
together with children’s regular doctors to give them the
best care in school and outside of school.
1.99
Families today are busier than ever. SBHCs provide a
convenient way for children and adolescents to get the
comprehensive, high quality health care they need.
Parents do not need to miss work and students do not
need miss school. SBHCs help families and students
stay healthy, without spending hours in the doctor’s
waiting room.
1.87
* Participants scored argument on a 0 to 4 scale on which 0 meant not at all convincing and 4 meant very
convincing.
Early Findings
• Few really know about SBHCs
• Fewer still know that there are so many in
existence
• There are two kinds of parents:
responsible and irresponsible
• Children of responsible parents don’t need
SBHCs
Take Home Messages
• Important that policymakers know SBHCs are not an
untried concept, but a working, established reality
• Less is more: vagueness about extent of services
provided at SBHCs might work to our advantage; seems
to be a point beyond which participants decide it is "too
much."
• In communicating about SBHCs it is necessary to remind
audiences about the extent of uninsurance and its
negative economic and human consequences.
• At the very least, most of the conservatives agree that
many children are doing without health care and that this
is a problem that needs to be rectified.
Looking Ahead
• Strengthening the business aspect of
SBHC (practice management)
• Quality, quality quality
• population-based approaches
• technology
• mental health in schools
• Rural access strategies
Invitation to Leadership
• Complete the census
• Attend national convention
– Portland, OR: June 16-18, 2006
– Submit a presentation abstract for 2007
• Join NASBHC: support the nat’l cause
• Join TASBHC/get involved
• Make contact with elected officials
– Site visits, post card campaigns, parent
letters, candidate forums, etc.
Never believe that a few
caring people can't change
the world. For, indeed,
that's all who ever have.
- Margaret Mead
American Cultural Anthropologist