Transcript School-Based Health Centers

School-Based Health
Centers
Improving Access and
Strengthening Quality of Care
for Adolescents
American Public Human Services Association, November 19, 2001
Julia Graham Lear, Director, Center for Health and Health Care in
Schools, School of Public Health & Health Services, The George
Washington University
Survey of State SBHC Initiatives
School Year 1999-2000
1380
1200
10
1100
1
1000
44
0
900
17
0
20
0
3 3
38
159
0
800
42
0
700
1
2
102
43
33
116
500
7
70
300
1
200
59
2
26
32
40
7
56
27
41
12
6
400
15
6
6
30
17
20
32
34
1
600
31
26
44
3
7
1
80
100
0
83
90
92
94
96
Map reports number of centers by state for school year 1999-2000.
Graph indicates number of centers reported in previous years.
98
00
Top Ten States with School-Based
Health Centers
43
Illinois
Oregon
44
44
Massachusetts
56
Connecticut
Maryland
59
Texas
70
80
Florida
102
Calif ornia
116
Arizona
159
New Y ork
0
20
40
60
80
10 0
12 0
14 0
16 0
Survey of State SBHC Initiatives. The survey was conducted by the Making the Grade National Program Office in the
summer of 2000. In February 2001, Making the Grade became The Center for Health and Health Care in Schools. The
Center remains at The George Washington University and is co-sponsored by the School of Public Health and Health
Services and the Graduate School of Education and Human Development.
Location of School-Based Health Centers
Rural
24%
Urban
58%
Suburban
18%
Survey of State SBHC Initiatives. Center for Health & Health Care in Schools.
Types of Schools Housing SBHCs
K-12
5%
Alternative Other
5%
1%
High School
34%
Elementary
38%
Middle
17%
Survey of State SBHC Initiatives. Center for Health & Health Care in Schools.
State Policies to Support SBHCs
Yes
No
State office charged with providing
technical assistance to communities
interested in SBHCs
29
16
States with grant programs to support
school-based health centers
24
21
States have targeting guidelines for
state-fund ed SBHCs
15
30
States have operating standards
for SBHCs
21
23
States license SBHCs
10
34
Survey of St ate SBHC Init iat ives. Center for Health & Health
Care in Schools.
State Financial Policies to Support SBHCs
Yes
No
SBHCs are eligible for reimbursement under FFS Medicaid
36
4
SBHCs are eligible for reimbursement under FFS SCHIP
30
8
States require that Medicaid managed
care provider networks include
SBHCs
6
30
States encourage that Medicaid MC
provider networks include SBHCs
8
23
States require SCHIP MC provider
networks to include SBHCs
7
27
States encourage SCHIP MC provider
networks to include SBHCs
8
21
Survey of State SBHC Init iat ives. Center for Health & Health
Care in Schools.
SBHCs and Managed Care
Yes
No
Do any SBHCs in your state have
contracts with Medicaid MC?
17
25
Do any SBHCs in your state
contract with commercial plans?
11
18
Does state law permit NPs to
participate in managed care
networks as primary care providers
35
6
Survey of State SBHC Initiatives. Center for
Health & Health Ca re in Schools.
State Dollars Supporting SBHCs
Source of stat e dollars
T itle V M CH Block Grant (st ate-direct ed dollars)
(N=15)
T it le V MCH Block Grant (local-direct ed dollars)
(N=4)
T it le XX Social Service Block Grant (N =1)
State General Funds (N=18)
P reventive Health and Health Services
Block Grant (N= 2)
T obacco T ax Dollars (N=2)
T obacco Set tlem ent Dollars (N=3)
Ot her* (N=12)
T otal
Amount
$
8,156,165
$
$
$
1,970,161
788,300
31,978,697
$
$
$
$
$
250,500
7,950,000
5,583,457
5,269,154
61,946,434
*Other includes: Juvenile Justice funds, STD training dollars, Special Education funds,
EPSTD, and The Robert Wood Johnson Foundation dollars
Data from the Census of the National
Assembly on School-Based Health Care,
NASBHC, Washington, DC 2000
Data collected in 1999
How Old Are SBHCs?
41% were established five or more years ago.
59% of SBHCs were established in the last four
years.
10 yrs+
20%
5-9 yrs
21%
<2 yrs
17%
2-4 yrs
42%
SBHC Staff
Clinical Support
Hours
Per Week
Mental Health
On Site
Primary Care
0
20
40
60
Physical Health Professionals Onsite
Physician
Physician Assistant
Nurse Practitioner
Physical Health All
%
50
12
76
92
Hrs/wk
6
20
25
27
Mental Health Professionals Onsite
Clinical social worker
Mental health (other)
Psychologist
Substance abuse
Psychiatrist
Mental Health All
%
36
18
12
8
4
57
Hrs/wk
30
23
15
15
6
33
SBHC Staff, Other
Director
Health Educ
Social Srvs
Nutritionist
Dentist
Dental Hyg.
Other
%
24
19
19
14
6
5
18
Hrs/wk
22
22
32
6
8
10
22
SBHC Health Services














Comp. health assessment
Anticipatory guidance
Screenings (vision, hearing)
Treatment of acute illness
Nutrition counseling
Asthma treatment
Prescriptions for medication
Sports physicals
Lab tests
Meds administered in SBHC
Treatment of chronic illness
Psychosocial assessment
Medications dispensed
Dental screenings
95%
95%
94%
94%
91%
91%
90%
90%
89%
86%
84%
73%
62%
52%
SBHC Characteristics







69% operate more than 30 hrs/week
48% operate summer hours
75% bill Medicaid/third-party
88% use computerized encounter system
31% accredited by JCAHO/other
34% certified by state
96% train health professionals on site
Recent Developments in School-Based
Health Centers
Focus on quality standards and quality
improvement
Broadening political base for SBHCs
Increased interest in school-based
initiatives to provide mental health and
dental health services
Quality Standards and Quality
Improvement for SBHCs
Direction over time
 Informal to more formal
 Local to state to national
1980s- no uniform standards, what was
done determined by funding and reporting
requirements of funding bodies
Late 1980s and 1990s - state standards
began to be developed
2000 - development of outcomes-focused
CQI tool.
SBHC CQI Tool
http://www.healthinschools.org/
home.asp
The tool
Data collection forms
Instructions
Resources/glossary/directory
FAQ’s
Broadened Political Support But Fiscal
Uncertainty Looms
SBHCs and distributional politics
Bipartisan support: CT, DE, LA, NY, RI
Fiscal uncertainty: the downside of a
state or local funding base
Increasing Mental Health and Dental Health
Services in School through SBHCs
 Surgeon General reports on mental health and oral
health
 Disparities data especially striking in these two areas
 Increased recognition by public and professionals that
more children’s mental health services are essential
 RWJF grant initiative -- Caring for Kids: Expanding
Mental Health and Dental Health Services through
SBHCs
Opportunities for Medicaid Partnerships
with SBHCs
 Benefits: Increased access for Medicaid & SCHIP
beneficiaries
Accountability -- SBHCs receptive to use of
CQI measures
Cost-effective use of personnel
 Making the partnership work
Collaboration with Family Health or MCH
Offices in DOH, other relevant state agencies
Commitment of time for mutual education &
negotiation