Improving Adolescent Health OutcomesHayley Lofink Love, PhDDirector, Research and EvaluationSchool-Based Health Alliance

1. Adolescent health challenges2. Rethinking healthcare3. School-based health centers as a solution

Agenda

Fragmented careEmergency department use

Incomplete care

current health care system is failing to meet the needs of adolescents

Duplicated care

ConvenientAccessibleCulturally and

developmentally appropriate

adolescent-centered care

CONFIDENTIAL

Long-term threats to health and wellbeing

Teen pregnancySubstance use and addiction

School failure

Violence/trauma

Inter-relatedCostlyPreventable

Adverse childhood experiences

Early pregnancy

risk for obesity, alcoholism, depression

School performance

Level of school engagement

School failure

Death rate

Involvement in criminal justice system Health

outcomes

Lifetime earnings

Product: broaden concept to ameliorate effects of nonclinical determinants(Inadequate food, housing, safety)

Place: beyond medical complex

in neighborhoodsProvider: nontraditional team members (Community outreach workers, heath educators, coaches, resource coordination)

Realigning health with care

Rebecca Onie, Paul Farmer, & Heidi Behforouz. Realigning Health with Care. Stanford Social Innovation Review

1.02.0

3.0

Acute/ infectious disease

Reducing deaths

Chronic diseaseProlonging

disability-free life

Wellness/ prevention

Achieving optimal health for all

The evolving health care system

Halfon, Wise, Forrest. The Changing Nature Of Children's Health Development: New Challenges Require Major Policy Solutions Health Aff December 2014 33:122116-2124

1. Point of entry to primary prevention, risk reduction and care management system

2. Inter-disciplinary team: whole child approach that unifies mind and body

3. Screen/address behavioral health needs often undetected and unmet by mainstream PC system

4. Meets young people where they are (literally) in terms of problems, pain, social and developmental challenges

5. Unprecedented opportunity for population health

Schools in the health neighborhood

1. Provide quality, comprehensive health care services that help students succeed in school and in life.

2. Located in or near a school facility and open during school hours.

3. Organized through school, community, and health provider relationships.

4. Staffed by qualified health care professionals.5. Focused on the prevention, early identification, and

treatment of medical and behavioral concerns that can interfere with a student’s learning.

School-based health center characteristics

SBHCs: The Evidence Base1. Increased use of primary care2. Reduced inappropriate emergency room use

Greater than 50% reduction in asthma-related emergency room visits for students enrolled in NYC SBHCs

3. Fewer hospitalizations$3 million savings in asthma-related hospitalization costs for students enrolled in NYC SBHCs

4. Access to harder-to-reach populations - esp minorities and malesAdolescents were 10-21 times more likely to come to a SBHC for mental health services than a CHC or HMO.

SBHCs: The Evidence Base

49 of 50 states

More than 2000 SBHCs

and in DC

Alaska Marshall Islands HawaiiPuerto Rico & Virgin Islands

Locations of SBHCs Nationwide (n=1930)

Tribal government

Mental health agency

University

Other

Private, non-profit

School system

Local health department

Hospital/medical center

Community health center

0% 5% 10% 15% 20% 25% 30% 35%

0.3%

1.3%

3.6%

4.2%

6.3%

11.3%

13.3%

26.4%

33.4%

SBHC Sponsor Agency (n=1341)

66.6% 73.1% 60.8%

> 31 HOURS/WEEK AFTER SCHOOL BEFORE SCHOOL

(n=1285)(n=1295) (n=1284)

PrimaryCare

Mental

Health

Nursing or Clinical Support

Oral Health

Health Educator

Dietician

85.8%

(n=1185)

15.9%

(n=219)

16.0%

(n=221)

10.7%

(n=148)

100%

(n=1381)

70.8%

(n=978)

ProviderTypes

in SBHCs

37.4%

33.4%

29.2%

Primary Care & Mental Health Plus

Primary Care & Mental Health

Primary Care

SBHC Staffing Profiles (n=1381)

Vision Screening

Mental Health

Oral Health

ReproductiveHealth

Immunizations

Alcohol, Tobacco, and Drug

Use Prevention

Healthy Eating, Active Living, and

Weight Management

Injury and Violence

Prevention

have a pre-arranged source of after-hours care

70.6%

52.7%use electronic health or medical records (EHR/EMR)

Revenue Supporting SBHCs(not including in-kind donations) (n=1286)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1.1%

5.1%

6.6%

18.4%

27.4%

32.3%

32.6%

33.1%

40.4%

53.4%

74.7%

State Government

Federal Government

Private Foundations

School/School District

Hospital

County/City Govt.

MCO/Private Insurer

Corps./Businesses

SBHA

State Network/Assoc.

Tribal Government

report billing at least one insurance program (n=1272)

87.9%

85.9% 64.0%

50.0%

Public Sources (n=1273)

Private Sources (n=1300)

Self-pay (n=1309)

Patient Revenue by Source

81.6%64.0%

63.0%

State Medicaid Agency (n=1309)

Medicaid MCOs (n=1311)

CHIP (n=1307)

71.4%

1987 1988 1993 1997 1999 2002 2005 2009 2011 20140

500

1000

1500

2000

2500

30%Grow the number of SBHCs by 2018

50%SBHCs to document performance standards

Questions?

Contact information:

Hayley Lofink Lovehlofink@sbh4all.org