Transcript Preventive Services Improvement Initiative

School-Based Health Center
Snapshot
Linda Juszczak
Grantmakers in Health
December 16, 2008
School-Based Health Center
(SBHC) National Definition
Partnerships created by schools and
community health organizations to
provide on-site medical, mental health,
and/or oral health services that promote
the health and educational success of
school-aged children and adolescents
SBHC Principles
•
•
•
•
•
•
•
Support the school
Respond to the community
Focus on the student
Deliver comprehensive care
Advance health promotion
Implement effective systems
Provide leadership in adolescent and child
health
Where are SBHCs? (n=1708)
Juszczak, Schlitt, Moore. (2007). National SBHC Census. NASBHC. www.nasbhc.org
SBHCs by Community Characteristic
Suburban
14%
Rural
27%
Urban
59%
Ethnic Profile of SBHC Population
Asian 4%
Native
American
1%
Hispanic
33%
Other
1%
White
31%
Black
30%
SBHC Staffing Models
Primary Care
Mental Health
Plus
31%
Other
4%
Primary CareMental Health
34%
Primary Care
Only
31%
SBHC Primary Care Services
Dental Comprehensive Care
Dental Preventive Care
Dental Screenings/Diagnostics
Care for Infants of Students
Medications Dispensed to be Taken at Home
Assessment of Psycholigical Development
Standardized Behavioral Risk Assessment
Lab Tests
Immunizations
Treatment of Chronic Illness
Medications Administed in the Center
Nutrition Counselling
Sports Physicals
Asthma Treatment
Anticipatory Guidance
Prescriptions for Medicines
Screenings
Comprehensive Health Assessments
Treatment of Acute Illness
0
10
20
30
40
50
60
70
80
90
100
SBHC Mental Health Services
*Medication Mngt/Admin
With MH Staff
*Long Term Therapy
Without MH Provider
*Psycho-education
*Case Management
*Substance Use Counseling
*Brief Therapy
*Tobacco Use Counseling
*Conflict Res/Mediation
*Skill-Building
*Screening
*Referrals
*Assessment
*Crisis Intervention
*Grief and Loss Therapy
*Mental Health Diagnosis
0
10
20
30
40
50
60
70
80
90
100
% of all SBHCs
SBHCs that Bill and Collect
80
70
60
50
40
30
20
10
0
Medicaid
SCHIP
Bill
Private
Collect
Self Pay
Total State-Directed Funding
Schlitt, Juszczak, Eichner. (2008). Current Status of State Policies that Support SBHCs. Public Health Reports.
Non-Patient Revenue
80
% of all SBHCs
70
60
50
40
30
20
10
0
State
Foundations
County/City
Corporate
Federal
Performance and Outcomes
•
•
•
•
•
•
Evidence of high-quality care and higher performance
than other models for selected measures
Adolescents more likely to come to an SBHC than
other settings for mental health services
Decreased use of urgent and emergency care
Increase in risk assessments and health care
maintenance
Reduction in Medicaid expenditures and cost of
hospitalizations
Decrease in risk behaviors and increase in health
promoting behaviors
Performance and Outcomes (cont’d)
•
•
•
•
Centers reach ethnically diverse populations, adolescent
males, the uninsured and those without a regular source
of care.
Evidence of student satisfaction with ability of the
centers to meet their needs
Evidence of strong parental support
Evidence that centers complement and do not duplicate
services being provided elsewhere
Challenges
•
Limitations related to access:
• 44% of centers are available only to students in
the school
• Parental consent often required for any service
despite state laws that permit adolescents to give
their own informed consent for selected services
• State/community restrictions regarding provision
of reproductive health services
•
•
Need for mental health services may exceed
capacity
Transient student populations
Priorities for the Movement
•
•
•
•
•
•
Reimbursement
Growth
Sustainable funding
Raising the profile
Supporting alternate models
Mental health
NASBHC Policy and Advocacy*
•
•
•
•
Reimbursement through Medicaid and
SCHIP
Health care reform
Authorization for a Federal SBHC
program
Support the states
*With support from W.K. Kellogg Foundation and The Atlantic Philanthropies