School-Based Health Care (SBHC) 101: Nuts and Bolts Laura Brey, MS Tammy Alexander, M.Ed. NASBHC...

School-Based Health Care School-Based Health Care (SBHC) 101: Nuts and Bolts(SBHC) 101: Nuts and Bolts

Laura Brey, MSLaura Brey, MSTammy Alexander, M.Ed. Tammy Alexander, M.Ed.

NASBHC Training of TrainersNASBHC Training of TrainersApril 21-23, 2008April 21-23, 2008

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Participant ExpectationsParticipant Expectations

Complete the index card and Complete the index card and hand it in.hand it in.

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IntroductionsIntroductions

Presenters: Presenters:

Tammy AlexanderTammy Alexander

Laura BreyLaura Brey

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Getting to Know ParticipantsGetting to Know Participants

Type of agencyType of agency

Community settingCommunity setting

Role in agencyRole in agency

School population, if School population, if knownknown

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ObjectivesObjectives

IdentifyIdentify key collaborators and partners key collaborators and partnersNameName the five key components of the five key components of

needs assessment techniques for needs assessment techniques for planning school-based health servicesplanning school-based health services

Identify Identify potential funding sources for potential funding sources for school-based health services: school-based health services: including public, private, and including public, private, and collaborative partnershipscollaborative partnerships

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ObjectivesObjectives

DescribeDescribe the rationale and the rationale and components of a case statement for a components of a case statement for a new school-based health center new school-based health center

UtilizeUtilize resource materials related to resource materials related to planning, evaluating, financing, and planning, evaluating, financing, and working with the media working with the media

ListList seven principles describing how to seven principles describing how to plan and implement a school-based plan and implement a school-based health centershealth centers

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Collaboration and PartnershipsCollaboration and Partnerships

Nut and Bolt #1Nut and Bolt #1

Collaborative PartnershipsCollaborative Partnerships

A mutually A mutually beneficial and well-beneficial and well-defined relationship defined relationship among two or more among two or more organizations to organizations to JOINTLY develop JOINTLY develop structure and sharestructure and share

• ResponsibilityResponsibility• ResourcesResources

• AuthorityAuthority• AccountabilityAccountability• RewardsRewards

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Why have a Collaboration?Why have a Collaboration?

To accomplish a To accomplish a common goal common goal that that none of the units alone can attainnone of the units alone can attain

To help agencies To help agencies shareshare information, information, resources, staff and equipmentresources, staff and equipment

To To createcreate an awareness of needs, an awareness of needs, problems, or opportunitiesproblems, or opportunities

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Characteristics of Successful Characteristics of Successful CollaborationCollaboration

Develops clear, concrete, achievable Develops clear, concrete, achievable goals.goals.

Operate in a receptive environment Operate in a receptive environment that facilitates its work.that facilitates its work.

Have good leadership.Have good leadership.Understand and respect each Understand and respect each

member for their different role and member for their different role and responsibility.responsibility.

Build cooperative teams.Build cooperative teams.

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Typical challengesTypical challenges

Differences among collaborators must Differences among collaborators must be understood and acknowledged.be understood and acknowledged.

Mixed loyalty that some members may Mixed loyalty that some members may have to their organization.have to their organization.

Merging of agencies can cause Merging of agencies can cause conflict.conflict.

* Lack of clarity* Lack of clarity* Lack of awareness* Lack of awareness

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Difficult Issues that Difficult Issues that Undermine CollaborationsUndermine Collaborations

Territorial questionsTerritorial questions

ConfidentialityConfidentiality

Certification/Certification/CredentialingCredentialing

Conflicting Conflicting prioritiespriorities

Political roadblocksPolitical roadblocks

Financial resourcesFinancial resources

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Strategies to Overcome Strategies to Overcome Resistance in CollaborationResistance in Collaboration

Joining with the host schoolJoining with the host schoolRelay the message that you are there Relay the message that you are there

to support rather than supplantto support rather than supplantEngage in ongoing negotiations with Engage in ongoing negotiations with

key playerskey playersDeveloping common goals and group Developing common goals and group

consensusconsensusSetting BoundariesSetting Boundaries

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Establish a Planning Group Establish a Planning Group Composition ConsiderationsComposition Considerations

• Local health department Local health department

• Community or rural health Community or rural health centercenter

• Community and/or Community and/or teaching hospital(s) teaching hospital(s)

• Mental health, substance Mental health, substance abuse, and social service abuse, and social service agenciesagencies

• Private physiciansPrivate physicians

• University faculty University faculty

• Elected OfficialsElected Officials

• Business and community Business and community leadersleaders

• Faith community Faith community

• School superintendent, School superintendent, board, or designeeboard, or designee

• School administration and School administration and Faculty (school nurse, Faculty (school nurse, teachers, principals, teachers, principals, guidance counselors, guidance counselors, physical education, physical education, nutrition/food services)nutrition/food services)

• StudentsStudents

• ParentsParents

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Role Play - Meeting with Role Play - Meeting with Partners / CollaboratorsPartners / Collaborators

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Conduct the Needs AssessmentConduct the Needs Assessment

Nut and Bolt #2Nut and Bolt #2

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What is a Community Needs What is a Community Needs Assessment?Assessment?

An accurate appraisal of the current An accurate appraisal of the current situation (strengths, concerns, and general situation (strengths, concerns, and general conditions) of a community’s populationconditions) of a community’s population

A collection of secondary and first hand A collection of secondary and first hand information and data from a wide range of information and data from a wide range of relevant sources and audiencesrelevant sources and audiences

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What is a Community Needs What is a Community Needs Assessment?Assessment?

A process for:A process for:identifying needs and resources in a identifying needs and resources in a community community determining gaps between what a determining gaps between what a situation is and what it should besituation is and what it should beestablishing prioritiesestablishing priorities

An opportunity to paint a picture of the An opportunity to paint a picture of the conditions in a community and sharpen your conditions in a community and sharpen your perceptions of the critical issues children perceptions of the critical issues children and families faceand families face

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Why Identify Needs and Why Identify Needs and Resources?Resources?

Better understand the community in which Better understand the community in which you will be workingyou will be working

Become aware of needs and concerns you Become aware of needs and concerns you never knew aboutnever knew about

Locate hidden strengths or underutilized Locate hidden strengths or underutilized resources that could be developedresources that could be developed

Document needDocument need

Make sure future actions are aligned with Make sure future actions are aligned with expressed community needsexpressed community needs

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Why Identify Needs and Why Identify Needs and Resources?Resources?

Garner greater support and involve more Garner greater support and involve more people in subsequent actionpeople in subsequent action

Give voice to individuals in the community Give voice to individuals in the community who have not traditionally been solicited for who have not traditionally been solicited for commentcomment

Convince outside funders and supportersConvince outside funders and supporters

Make decisions based on priorities and Make decisions based on priorities and documented needsdocumented needs

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Planning and Implementing the Planning and Implementing the AssessmentAssessment

Step 1:Step 1: Involve stakeholdersInvolve stakeholders

Establish working group to guide the Establish working group to guide the planning and implementation of planning and implementation of Community Needs Assessments Community Needs Assessments

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Step 2:Step 2: Determine the Objectives and Determine the Objectives and Outcomes of the AssessmentOutcomes of the Assessment

What are you really interested in knowing? Your What are you really interested in knowing? Your questions will flow from this.questions will flow from this.

What is your vision? How will you use the What is your vision? How will you use the information obtained?information obtained?

Which issues, questions, and behaviors are of Which issues, questions, and behaviors are of particular interest?particular interest?

What don’t you know about these issues? What What don’t you know about these issues? What questions do you need to answer?questions do you need to answer?

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Step 3:Step 3: Identify secondary data sourcesIdentify secondary data sources

Find out what outside resources can be used Find out what outside resources can be used

What public reports exist (examples of What public reports exist (examples of sources: census data, vital statistics, CPS sources: census data, vital statistics, CPS reports)reports)

– Have other studies been done?Have other studies been done?

Are there experts in the community who can Are there experts in the community who can help you?help you?

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Planning and Implementing the Planning and Implementing the Assessment Assessment (cont)(cont)

Step 4: Choose your approach/ Step 4: Choose your approach/ approaches for gathering newapproaches for gathering newinformationinformation

Most common approaches:Most common approaches: Key informant interviewsKey informant interviews

Focus groups Focus groups

Public forumsPublic forums

SurveysSurveys

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Planning and Implementing the Planning and Implementing the Assessment Assessment

When making your choice of approach, When making your choice of approach, take into account:take into account:

Purpose of the studyPurpose of the study

Amount of time you have and number of people Amount of time you have and number of people assisting youassisting you

Available resourcesAvailable resourcesSize and characteristics of target populationSize and characteristics of target populationRelationship you have with target populationRelationship you have with target population

“The quality of information about a community is only as good as the technique or combination of techniques used. A single technique may be too narrow; using too many techniques may be costly in terms of time and dollars. Different techniques are appropriate for different needs. Analyze the situation and then weigh the advantages and disadvantages. Sometimes a combination of techniques will provide a more reasonable picture.” (Butler and Howe, 1980)

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Key Informant InterviewsKey Informant Interviews

PurposePurpose = to collect information from those in = to collect information from those in the community who are in a prime position to the community who are in a prime position to know the needs facing the community know the needs facing the community

How to implementHow to implement = compile a list of = compile a list of participants, create protocol, make participants, create protocol, make appointments (either telephone or in-person), appointments (either telephone or in-person), gather data, identify common themesgather data, identify common themes

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Key Informant InterviewsKey Informant Interviews

AdvantagesAdvantages Easy and not expensiveEasy and not expensive Can discuss confidential issues more readilyCan discuss confidential issues more readily Establishes rapport and trust with communityEstablishes rapport and trust with community Permits clarification of issues and ideasPermits clarification of issues and ideas

DisadvantagesDisadvantages May be difficult to schedule May be difficult to schedule May provide a biased perspectiveMay provide a biased perspective Only represents perceptions – not hard dataOnly represents perceptions – not hard data Personal relationships may influence outcomesPersonal relationships may influence outcomes Should be combined with other methods because may not Should be combined with other methods because may not

represent whole communityrepresent whole community

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Focus GroupsFocus Groups

PurposePurpose = = to collect information from those in the to collect information from those in the community who are in a prime position to know the community who are in a prime position to know the needs facing the community needs facing the community

How to implementHow to implement = = compile a list of participants, compile a list of participants, decide on location, create protocol, invite participants decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify facilitator and documenter, organize and identify common themescommon themes

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Focus GrouFocus GroupspsAdvantagesAdvantages

Easy and not expensiveEasy and not expensive Establishes rapport and trust with community Establishes rapport and trust with community

membersmembers Permits clarification of issues and ideasPermits clarification of issues and ideas Easily combined with other techniques Easily combined with other techniques

DisadvantagesDisadvantages May provide biased perspectivesMay provide biased perspectives Only represents perceptions – not hard dataOnly represents perceptions – not hard data Sharing opinions and views in a group setting may Sharing opinions and views in a group setting may

be inhibitingbe inhibiting Should be combined with other methods because Should be combined with other methods because

may not represent whole communitymay not represent whole community

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Purpose Purpose = elicit information from a wide range = elicit information from a wide range of residents in a series of public meetingsof residents in a series of public meetings

How to implementHow to implement = develop list of invitees, = develop list of invitees, create list of questions, select strategically create list of questions, select strategically located venue (use different sites and hold at located venue (use different sites and hold at different times), publicize, use facilitator and different times), publicize, use facilitator and documenter, identify common themesdocumenter, identify common themes

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Advantages:Advantages: Get opinions from a wide range of peopleGet opinions from a wide range of people Promotes active involvement, community awareness, Promotes active involvement, community awareness,

and buy-inand buy-in Inexpensive, quick picture of communityInexpensive, quick picture of community

Disadvantages:Disadvantages: Requires good leadershipRequires good leadership Opinions limited to those who attendOpinions limited to those who attend Lots of advance planningLots of advance planning May generate more questions than answersMay generate more questions than answers May create unrealistic expectationsMay create unrealistic expectations

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SurveysSurveys

PurposePurpose = = collect information from a wide range of collect information from a wide range of respondentsrespondents

How to implementHow to implement == find or create carefully find or create carefully developed instrument and administer through a developed instrument and administer through a sampling procedure (may be face to face, personal sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, distribution and collection, self-administered in a group, telephone, mailed), analyze resultstelephone, mailed), analyze results

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SurveysSurveys

AdvantagesAdvantages Best approach for eliciting attitudes of broad range Best approach for eliciting attitudes of broad range

of individuals of individuals Data usually valid and reliable Data usually valid and reliable

DisadvantagesDisadvantages Costly and requires time and expertiseCostly and requires time and expertise Needs carefully selected tool and sampling Needs carefully selected tool and sampling Subject to misinterpretationSubject to misinterpretation Individuals may hesitate to answer questionsIndividuals may hesitate to answer questions

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Planned Approach to Community Action (PATCH)Planned Approach to Community Action (PATCH)– developed by CDCdeveloped by CDC– effective model for planning, conducting, and evaluating effective model for planning, conducting, and evaluating

community health promotion and disease prevention programscommunity health promotion and disease prevention programs– Used by diverse communities in US and other nations to address Used by diverse communities in US and other nations to address

health concerns health concerns – PATCH Guide for local coordinator has sample surveys and data PATCH Guide for local coordinator has sample surveys and data

collection toolscollection tools– Web siteWeb site www.cdc.gov/nccdphp/path/index.htm

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Step 5: Implement PlanStep 5: Implement Plan

Collect secondary dataCollect secondary data

Collect primary data (conduct interviews, focus Collect primary data (conduct interviews, focus groups, surveys, etc)groups, surveys, etc)

Analyze secondary and primary dataAnalyze secondary and primary data

Summarize findingsSummarize findings

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Step 5: Implement PlanStep 5: Implement Plan

Prepare report Prepare report

Share with working group, interpret data and Share with working group, interpret data and develop recommendations together develop recommendations together

Present to external stakeholders as neededPresent to external stakeholders as needed

Create action planCreate action plan

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Review Anytown’s Needs Review Anytown’s Needs Assessment DocumentAssessment Document

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Project Work Plan and Design Project Work Plan and Design Example from Chicago SBHCExample from Chicago SBHC

Convened a planning committee of key community Convened a planning committee of key community stakeholders who met regularly to oversee and stakeholders who met regularly to oversee and guide the process guide the process

Gathered existing dataGathered existing dataU. S. Census Bureau (2000)U. S. Census Bureau (2000)Chicago Health and Health Systems Project Chicago Health and Health Systems Project

(CDPH 2006)(CDPH 2006)Healthy Albany Park Assessment (2004)Healthy Albany Park Assessment (2004)Illinois State Report Card (2004 – 2005)Illinois State Report Card (2004 – 2005)CPS School Profile (2004 – 2005CPS School Profile (2004 – 2005))

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Project Work Plan and DesignProject Work Plan and Design

Collected new dataCollected new data Conducted fifteen stakeholder interviews with Conducted fifteen stakeholder interviews with

school administrators, school personnel, school administrators, school personnel, school nurses, and external partners working school nurses, and external partners working in schoolsin schools

Conducted a focus group with community Conducted a focus group with community providers providers

Analyzed findingsAnalyzed findings

Drafted initial recommendationsDrafted initial recommendations

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Make RecommendationsMake Recommendations

Based on Needs Assessment Based on Needs Assessment FindingsFindings

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Select the SchoolSelect the School

ElementaryElementaryMiddle or Junior High Middle or Junior High K-8K-8High SchoolHigh SchoolAlternative School Alternative School Pre-school Pre-school

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Select the Service Delivery Strategy Select the Service Delivery Strategy and Modeland Model

Service and Staffing OptionsService and Staffing Options Collaborative PartnershipsCollaborative Partnerships The role of the school nurseThe role of the school nurse Policy and ProceduresPolicy and Procedures Referral NetworksReferral Networks Delivery of ServiceDelivery of Service Parental Consent/Parental InvolvementParental Consent/Parental Involvement Integration of the school-based health center with Integration of the school-based health center with

existing school and community resourcesexisting school and community resources Confidentiality IssuesConfidentiality Issues

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Services to Consider for Services to Consider for All Grade LevelsAll Grade Levels

Primary Care including Primary Care including biennial risk biennial risk assessmentassessment

ImmunizationsImmunizations Health EducationHealth Education Physical ExaminationsPhysical Examinations Mental HealthMental Health Laboratory ServicesLaboratory Services MedicationsMedications

Nutrition CounselingNutrition Counseling Vision, Hearing, and Vision, Hearing, and

Dental ScreeningDental Screening Social Services Social Services Chronic Disease co-Chronic Disease co-

management management Specialty Care Specialty Care

ReferralsReferrals

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Services at the MS and HS LevelsServices at the MS and HS Levels

Pregnancy testingPregnancy testing

STD testing and treatmentSTD testing and treatment

Reproductive health careReproductive health care

Group counseling to address issues such as Group counseling to address issues such as sexual abuse, depressionsexual abuse, depression

Individual mental health counseling Individual mental health counseling

HIV testing and/or counselingHIV testing and/or counseling

Referral for family planning Referral for family planning

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The Role of the School NurseThe Role of the School Nurse

Maintain school nurse mandated functions Maintain school nurse mandated functions (vision and hearing screening, (vision and hearing screening, immunizations, special ed, etc.)immunizations, special ed, etc.)

Member of school-based health team Member of school-based health team

– Identify students for school-based health center Identify students for school-based health center servicesservices

– Provide follow-upProvide follow-up

– Reach out to parentsReach out to parents

– Serve as a liaison between the school-based Serve as a liaison between the school-based health center and school staff health center and school staff

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Parental/Family Consent / Family Parental/Family Consent / Family EngagementEngagement

The majority of SBHCs have a parental/guardian The majority of SBHCs have a parental/guardian consent policy. consent policy.

Consent form should include:Consent form should include:

– Services to be offeredServices to be offered

– Statement about confidentiality /HIPAAStatement about confidentiality /HIPAA

– Billing issuesBilling issues

– Statement about the relationship between the Statement about the relationship between the sponsoring organization and any collaborators sponsoring organization and any collaborators including the school district including the school district

Review state statutes regardingReview state statutes regarding age of consent for age of consent for various health care servicesvarious health care services

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ConfidentialityConfidentiality

Confidential versus nonconfidential Confidential versus nonconfidential services services

Access to confidential servicesAccess to confidential services

Release of informationRelease of information

Providing follow-up information to school Providing follow-up information to school personnel and outside agenciespersonnel and outside agencies

Informing students of confidentiality Informing students of confidentiality procedures and limits of confidentiality procedures and limits of confidentiality

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Nut and Bolt #3Nut and Bolt #3Funding for SBHCs Funding for SBHCs

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Maslow’s Hierarchy of NeedMaslow’s Hierarchy of Need

It’s hard to focus on best practice standards when your needs are rooted in basic survival.

School health clinics fight for lives

Karina BlandThe Arizona RepublicMarch 12, 2001

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Multiple Funding Sources/ Multiple Funding Sources/ Models for School-Based Health Models for School-Based Health CentersCenters

Federal grantsFederal grants State grantsState grants Local fundingLocal funding Community Community

partnership partnership contributionscontributions

FoundationsFoundations Patient Patient

RevenueRevenue Mixing several Mixing several

or all funding or all funding sourcessources

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Foundations

Federal Public Grants

Local Funding/Community Partners

State Public Grants

SCHIPMedicaidPrivate insurancePatient fees

Federal entitlement programs administered at the state level MCHB/Title VCDC HIV/AIDS PreventionSAMHSA/Title XIX (substance abuse and mental health screening and early intervention)Title XX/ Soc Services Block Grant (TANF, daycare, child neglect and

abuse) State FundingState General RevenueTobacco Tax/SettlementEducationNCLB /ESEA (Title I improving academic achievement of the disadvantaged and Title IV safe and drug free schools) IDEA (health-related special education services)

BPHC/FQHC (Section 330 of the Public Health Service Act)Title X of the Public Health Service Act: Family Planning

Figure 1 School-Based Health Center Funding Models

Patient revenue

Foundations that commonly supports school-based health careRobert Wood Johnson FoundationKB Reynolds Charitable TrustWKKF Kellogg FoundationWelborn FoundationMcKesson FoundationDuke EndowmentHealth Foundation of Greater CincinnatiVisit the Grantsmanship Center at http://www.tgci.com/ and the Foundation Center at http://fdncenter.org for other foundation funding opportunities

Local FundingPublic and private grants (e.g., universities, United Way)City/county fundsLocal businesses (e.g., banks, insurance companies)

Community PartnersIn-Kind Contributions from schools, hospitals, health departments, community health departments, and community agencies (e.g., staff, facilities, supplies)Examples of PartnersParents’ employersParents’ health insurance agenciesLocal businessesSchool districtsUniversities

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Federal public grantsFederal public grants

BPHC /FQHC (Section 330 of the Public BPHC /FQHC (Section 330 of the Public Health Services Act)Health Services Act)

Title X of the Public Health Services Act: Title X of the Public Health Services Act: Family PlanningFamily Planning

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Core Funding ModelsCore Funding ModelsFederalFederal

330 Federally Qualified Health Centers330 Federally Qualified Health Centers

Entirely federally dependentEntirely federally dependentFairly stableFairly stableLimited community Limited community Limited funds for expansionLimited funds for expansion

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State public grantsState public grants

Federal entitlement programs administered at Federal entitlement programs administered at state levelstate level

– MCHB Title VMCHB Title V

– CDC HIV/ AIDS PreventionCDC HIV/ AIDS Prevention

– SAMHSA/ Title XIX (substance abuse and mental SAMHSA/ Title XIX (substance abuse and mental health screening and early interventionhealth screening and early intervention

– Title XX/ Social Services Block Grant, Temporary Title XX/ Social Services Block Grant, Temporary Aid to Needy Families Programs (TANF) job Aid to Needy Families Programs (TANF) job training, pregnancy prevention, daycare, child training, pregnancy prevention, daycare, child neglect and abuseneglect and abuse

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EducationEducation

– NCLB/ESEA (Title I improving NCLB/ESEA (Title I improving academic achievement of the academic achievement of the disadvantaged and Title IV safe disadvantaged and Title IV safe and drug free schools)and drug free schools)

– IDEA (health-related special IDEA (health-related special education services)education services)

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State FundingState Funding

– State General RevenueState General Revenue

– Tobacco Tax SettlementTobacco Tax Settlement

– Juvenile Justice FundsJuvenile Justice Funds

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Core Funding ModelCore Funding ModelState GrantsState Grants

Louisiana – MCHBG; Tobacco Louisiana – MCHBG; Tobacco settlementsettlement

Connecticut – MCHBG, state fundConnecticut – MCHBG, state fund

Delaware – state fundDelaware – state fund

Fairly stableFairly stableLimited growth; targeted fundingLimited growth; targeted fundingRequires legislative/administrative advocacyRequires legislative/administrative advocacy

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Local FundingLocal Funding

Public and private grantsPublic and private grants (universities, United Way(universities, United Way

City and county fundsCity and county funds

Local businesses Local businesses (banks, insurance (banks, insurance companies)companies)

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Core Funding ModelsCore Funding ModelsLocal GovernmentLocal Government

Portland/Multnomah County (OR)Portland/Multnomah County (OR)

Seattle/King County (WA)Seattle/King County (WA)

Great community buy inGreat community buy in

Fairly stable incomeFairly stable income

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Community partnersCommunity partners

In-kind contributionsIn-kind contributions (staff, facilities, (staff, facilities, supplies) from supplies) from

– Schools,Schools,

– Hospitals,Hospitals,

– Health departments, andHealth departments, and

– Community agenciesCommunity agencies

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Community partnersCommunity partners

Examples of partnersExamples of partners

– Parents’ employersParents’ employers

– Parents’ health insurance agencies,Parents’ health insurance agencies,

– Local businesses,Local businesses,

– School districts, andSchool districts, and

– Universities Universities

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Core Funding ModelsCore Funding ModelsCommunity PartnershipsCommunity Partnerships

Denver SBHCsDenver SBHCs

Baltimore County Public Schools, MDBaltimore County Public Schools, MD

Healthy Kids, Lexington, KYHealthy Kids, Lexington, KY

Indianapolis CollaborativeIndianapolis Collaborative

Collaboration has inherent difficultiesCollaboration has inherent difficulties

Built over long-termBuilt over long-term

Requires perseverance, leadershipRequires perseverance, leadership

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FoundationsFoundations

Robert Wood JohnsonRobert Wood Johnson

WK Kellogg FoundationWK Kellogg Foundation

KB Charitable TrustKB Charitable Trust

Health Foundation of Greater Health Foundation of Greater CincinnatiCincinnati

McDonald FoundationMcDonald Foundation

Welborn FoundationWelborn Foundation

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FoundationsFoundations

For other foundation funding For other foundation funding opportunities visitopportunities visit– The Grantsmanship Center at The Grantsmanship Center at

http://www.tgci.com

andand

– The Foundation Center atThe Foundation Center at

http://fdncenter.org

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Core Funding ModelsCore Funding ModelsFoundationsFoundations

Indianapolis SBHCsIndianapolis SBHCs

Cincinnati, Ohio SBHCsCincinnati, Ohio SBHCs

North Carolina SBHCsNorth Carolina SBHCs

Miami SBHCsMiami SBHCs

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Patient RevenuePatient Revenue

SCHIPSCHIPMedicaidMedicaidPrivate insurancePrivate insurancePatient feesPatient fees

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Core Funding ModelCore Funding ModelPatient RevenuePatient Revenue

West Virginia – FQHC rateWest Virginia – FQHC rate

New York – Medicaid institution rateNew York – Medicaid institution rate

Commitment to specific sponsor typeCommitment to specific sponsor type

Leadership necessary at Medicaid levelLeadership necessary at Medicaid level

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Mixed Funding SourcesMixed Funding Sources

Denver School-Based Health Centers Denver School-Based Health Centers

Baltimore County School-Based Health Baltimore County School-Based Health CentersCenters

Healthy Kids CentersHealthy Kids Centers

Indianapolis CollaborativeIndianapolis Collaborative

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Follow the Income StreamsFollow the Income Streams

Education

Mental Hlth/Sub

Abuse

PublicHealth

HealthCare

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Funding Service Funding Service ComponentsComponents

Medical/nursing servicesMedical/nursing services

Public health/promotionPublic health/promotion

Mental health/behavioral healthMental health/behavioral health

Case management/social services Case management/social services coordinationcoordination

Education supportEducation support

Nut and Bolt #4 Nut and Bolt #4 Principles of School-Based Principles of School-Based

Health Care Health Care

Seven fundamental principlesSeven fundamental principles

Goals, structures, processes and Goals, structures, processes and outcomes outcomes

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SBHC Fundamental SBHC Fundamental PrinciplesPrinciples

http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2743459/k.9519/NASBHC_Principles_and_Goals_for_SBHCs.htm

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The School-Based Health The School-Based Health Center:Center:

1.1. Supports the schoolSupports the school2.2. Focuses on the communityFocuses on the community3.3. Focuses on the studentFocuses on the student4.4. Provides comprehensive careProvides comprehensive care5.5. Advances health promotion activitiesAdvances health promotion activities6.6. Implements effective systemsImplements effective systems7.7. Provides leadership in adolescent and Provides leadership in adolescent and

child healthchild health

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Supports the SchoolSupports the School

The school-based health center is The school-based health center is built upon mutual respect and built upon mutual respect and collaboration between the school collaboration between the school and the health provider to promote and the health provider to promote the health and educational success the health and educational success of school-aged children.of school-aged children.

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1. 1. Supports the SchoolSupports the School

Principles/ GoalsPrinciples/ Goals StructuresStructures ProcessesProcesses OutcomesOutcomes Understands and respects Understands and respects accountability within the accountability within the educational systemeducational system

Works with the school Works with the school administration to develop and administration to develop and achieve a shared visionachieve a shared vision

Communicates the vision to Communicates the vision to all school constituencies all school constituencies including teachers, support including teachers, support staff, students and parentsstaff, students and parents

Builds collaborative and Builds collaborative and mutually respectful mutually respectful relationships with school relationships with school personnelpersonnel

Identifies community Identifies community resources that provide resources that provide support to students and support to students and promote successful learningpromote successful learning

Serves as a resource in Serves as a resource in times of school crises and times of school crises and community disasterscommunity disasters

Mutually agreed upon Mutually agreed upon vision statement for vision statement for the SBHCthe SBHC

Mutually agreed upon Mutually agreed upon roles and roles and responsibilities of responsibilities of each partyeach party

Mutually agreed upon Mutually agreed upon policies regarding policies regarding appointment appointment scheduling during scheduling during school hours and school hours and information sharing information sharing

Delineated role within Delineated role within the school’s crisis the school’s crisis intervention planintervention plan

Communication with Communication with School Administration, School Administration, School Nurse, Guidance School Nurse, Guidance Counselor, Social Worker, Counselor, Social Worker, School Psychologist and School Psychologist and FacultyFaculty

Attendance of SBHC Attendance of SBHC personnel at school staff personnel at school staff meetingsmeetings

Presence of SBHC Presence of SBHC personnel at appropriate personnel at appropriate school functionsschool functions

Partnership in identifying Partnership in identifying students with issues students with issues influencing educational influencing educational performanceperformance

Training of SBHC staff on Training of SBHC staff on the school’s crisis the school’s crisis intervention plan and intervention plan and community’s emergency community’s emergency preparedness plan and the preparedness plan and the SBHCs expected responseSBHCs expected response

Recognition by school Recognition by school personnel of the value the personnel of the value the SBHC provides in meeting SBHC provides in meeting educational missioneducational mission

High satisfaction of High satisfaction of school personnel with school personnel with SBHC servicesSBHC services

Increased number of Increased number of appropriate referrals by appropriate referrals by school personnel school personnel

Reduced number of Reduced number of students who leave school students who leave school during the day due to during the day due to illnessillness

In the event of a school In the event of a school crisis or community crisis or community disaster, SBHC performs disaster, SBHC performs effectively according to effectively according to planplan

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Responds to the Responds to the CommunityCommunity

The school-based health center is The school-based health center is developed and operates based on developed and operates based on continual assessment of local continual assessment of local assets and needsassets and needs..

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2. Responds to the Community2. Responds to the Community Principles/ GoalsPrinciples/ Goals StructuresStructures ProcessesProcesses OutcomesOutcomesAssesses child and Assesses child and adolescent health care adolescent health care needs and available needs and available resources in the resources in the community through formal community through formal evaluation methodsevaluation methods

Informs the community of Informs the community of student health needs and student health needs and trendstrends

Solicits community input Solicits community input to address unmet health to address unmet health needs and support the needs and support the operations of the programoperations of the program

Definition of geographic Definition of geographic service areaservice area

Identification of population to Identification of population to be served including be served including demographic and demographic and socioeconomic characteristicssocioeconomic characteristics

Identification of key health Identification of key health indicatorsindicators

Continuous needs Continuous needs assessmentassessment

System for gathering data on System for gathering data on key indicatorskey indicators

Resource manualResource manual

Advisory Committee with Advisory Committee with appropriate community appropriate community representationrepresentation

Communications planCommunications plan

Program Program development based development based on periodic review of on periodic review of datadata

Advisory Committee Advisory Committee meetingsmeetings

Stakeholder Stakeholder meetingsmeetings

Periodic Periodic communication with communication with the general publicthe general public

Improved access to Improved access to primary care as primary care as measured by increased measured by increased utilization of SBHC utilization of SBHC services services

Recognition by Recognition by community of the value community of the value of SBHC services in of SBHC services in meeting the needs of meeting the needs of students and responding students and responding to community valuesto community values

High parent satisfactionHigh parent satisfaction

Improved utilization of Improved utilization of other community other community resources through resources through referrals and/or inter-referrals and/or inter-program collaborationprogram collaboration

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Focuses on the StudentFocuses on the Student

Services involve students as Services involve students as responsible participants in their responsible participants in their health care, encourage the role health care, encourage the role of parents and other family of parents and other family members, and are accessible, members, and are accessible, confidential, culturally sensitive, confidential, culturally sensitive, and developmentally appropriate.and developmentally appropriate.

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3. Focuses on the Student

Principles/Goals Structures Processes Outcomes

Encourages the student’s active, age appropriate participation in decisions regarding health care and prevention activities

Involves the parents or other adult caregivers as supportive participants in the student’s health care whenever appropriate and possible

Ensures confidentiality of information whether transmitted through conversation, billing activity, telemedicine, or release of medical records

Provides services and materials that are culturally sensitive and respectful of family values and diversity

Parental consent and parental notification policies

Confidentiality and minor consent policy

Emancipated minor policy

Child abuse and neglect policy

Non-discrimination policy

Patient rights and responsibilities

Patient education materials in languages other than English, where appropriate

Methodology for identifying children with special health care needs

Methodology for identifying non-users

Provision of services in a manner consistent with established policies

Treatment of students with acute illness or injury

Counseling of students with behavioral issues

Management of students with chronic conditions

Provision of culturally sensitive anticipatory guidance and health and safety education

Student-centered risk assessment and follow-up

Family assessment and follow-up

Outreach to non-users

Increased enrollment for and utilization of SBHC services

High user and parent awareness of SBHC policy regarding access to confidential services

Improved user knowledge of how and when to utilize the health care system

Students with chronic disease or behavioral issues can demonstrate self-care skills

High satisfaction among users.

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Delivers Comprehensive Delivers Comprehensive CareCare

An interdisciplinary team provides An interdisciplinary team provides access to high quality access to high quality comprehensive physical and comprehensive physical and mental health services mental health services emphasizing prevention and early emphasizing prevention and early interventionintervention..

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4. Delivers Comprehensive Care

Principles/Goals Structures Processes OutcomesProvides a scope of services that is consistent with identified health care needs

Promotes availability of on-site services whenever the school is open and facilitates after-hours care 24-hour-a-day, seven-days-a-week

Adopts generally accepted guidelines for clinical practice

Promotes the interdisciplinary role and functions of the school-based health care team

Coordinates and integrates efforts with existing systems to optimize complementary programs, improve continuity of care, reduce fragmentation, prevent duplication, and maintain affordable services

Defined scope of services to be provided

Multidisciplinary team of caregivers

Posted hours of operation

Effective 24/7 on-call system

Staffing guidelines

Clinical protocols or practice guidelines consistent with nationally recognized best practices

Referral relationships with other providers in the community (including lab, radiology and pharmacy)

Standards for medical record keeping

Release of information policy

Population-based Screening

Early identification and treatment

Delivery of care consistent with best practices

Patient assessment

Patient education

Patient treatment

Patient referral

Management of chronic conditions

Anticipatory guidance, health promotion and prevention activities

Continuity of care

Quality assurance

Chart review

Patient perception that well-being has improved

Increasing number of students receiving comprehensive well exam including risk assessment

Increasing compliance rates as measured by follow-up visits completed, prescriptions filled, therapy attended, referrals completed.

Reduced number of students with disruptive behavior or discipline problems

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Advances Health Advances Health Promotion ActivitiesPromotion Activities

The school-based health center The school-based health center takes advantage of its location to takes advantage of its location to advance effective health advance effective health promotion activities to students promotion activities to students and community.and community.

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5. Advances Health Promotion Activities

Principles/Goals Structures Processes OutcomesServes as a resource to school administration on the selection, development and delivery of health education curricula

Participates in classroom-based and school-wide health promotion activities responsive to the risk factors that are prevalent among students

Promotes parent and community involvement in health promotion activities

Partnership between the school’s health education faculty and SBHC staff

Coordinated risk assessment and health promotion plan

Age appropriate health education materials

Delivery of classroom health education segments

Display and distribution of multilingual health education materials in SBHC (pamphlets, posters, models, videos, etc.)

School-wide health and safety promotional events

Increased student awareness of health threats and risk factors

Reduced high risk behaviors among students

Increased positive health and safety behaviors among students

Increased student understanding of important health and psychosocial issues

Increased student ability to access valid health information and health promoting products and services

Increased student knowledge of health care rights and responsibilities

Increased student ability to communicate about and advocate for improved personal health

Increased participation of parents in heath promotion activities

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Implements Effective Implements Effective SystemsSystems

Administrative and clinical systems Administrative and clinical systems are designed to support effective are designed to support effective delivery of services incorporating delivery of services incorporating accountability mechanisms and accountability mechanisms and performance improvement performance improvement practicespractices..

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6. Implements Effective SystemsPrinciples/Goals Structures Processes OutcomesEnsures compliance with all relevant laws and regulations

Develops and measures annual program goals and objectives

Maintains a physical plant which is adequate to deliver high quality services and assure patient comfort and privacy

Develops all necessary policies and procedures, training manuals, and memoranda of agreement or understanding

Develops a human resources system for hiring, credentialing, training and retaining high quality, competent staff

Collects, evaluates and reports health outcomes and utilization data

Establishes quality improvement practices including but not limited to assessment of patient and community satisfaction

Develops strategies and systems to support long-term financial stability

Organizational chart

Mission statement

Goals and objectives

Administrative policy and procedure manual

Clinical policy and procedure manual

Appointment system and scheduling standards

Tracking system for missed appointments, follow-up appointments and lab reports

Incident reports

Staff credentialing

Staff training

Personnel evaluation and salary review

Facility maintenance

Strategic business/ marketing/financial plan

Billing and collection system

Licensing, Certification and/or Accreditation

CLIA compliance

Medicaid EPSDT compliance

Medical record keeping according to accepted standards and demonstrating collaboration and communication among providers

Formal quality assurance monitoring of clinical and administrative functions

Financial audits

Staff knowledge of current laws and regulations affecting delivery of services

Treatment for high volume, high risk problems consistent with current professional knowledge

High SBHC provider and staff satisfaction

Low SBHC provider and staff turnover

Increased provider productivity

High patient and parent satisfaction with ease of appointment-making and waiting time

Operations within budget

Eligibility for reimbursement from public and private third-parties

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Provides Leadership in Provides Leadership in Adolescent and Child Adolescent and Child HealthHealth

The school-based health center The school-based health center model provides unique opportunities model provides unique opportunities to increase expertise in adolescent to increase expertise in adolescent and child health, and to inform and and child health, and to inform and influence policy and practice.influence policy and practice.

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7. Provides Leadership in Adolescent and Child HealthPrinciples/Goals Structures Processes Outcomes

Participates in national and local organizations that focus on adolescent and child health

Contributes to the body of knowledge on the health care needs of adolescents and children

Promotes the School-Based Health Center as a training site for health care professionals

Advocates for the resources necessary to increase access to physical, mental and dental health services for adolescents and children

Informs elected officials, policy-makers, health professionals, educators, and the community-at-large regarding the unique value, acceptability, efficiency and convenience of the school-based health center model of health care delivery

Forms partnerships to develop stable, sustainable funding mechanisms for expanded services

Local Conferences

National Conferences

Journal Articles

Annual Reports\

Videotapes

Web sites

Vehicles to communicate with state and local health authorities

Precepting students in the health professions

Research

Outcome evaluation

Process evaluation

Clinical trials

Medical professional training

Curriculum development

Public education and advocacy

Use of student volunteers

Increased public awareness of the health care needs of children and adolescents

Greater number of children and adolescents with a medical home

Improved access to primary care

Increased exposure of health professionals to the SBHC model

Legislation and regulation supportive of the SBHC model

Increased investment in SBHCs by federal, state, local and private funding sources

Increased participation of SBHCs in Medicaid and Child Health Insurance Plans

Appropriate contracts with managed care organizations

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Nut and Bolt #5Nut and Bolt #5Developing a Case Statement for Developing a Case Statement for

a School-Based Health Centera School-Based Health Center

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Case Statement ContentCase Statement Content

PurposePurpose

– What you propose to do / what are you What you propose to do / what are you seeking funding forseeking funding for

– Summary of needs assessment findingsSummary of needs assessment findings

– Partners/collaborators and their Partners/collaborators and their contributorscontributors

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Case Statement Content Case Statement Content Service designService design

– ModelModel

– ServicesServices

– StaffingStaffing

– Hours of operationHours of operation

– Parent, student, and school staff Parent, student, and school staff involvementinvolvement

– Community, collaborator/partner Community, collaborator/partner involvementinvolvement

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Case Statement ContentCase Statement Content

Current project support /infrastructureCurrent project support /infrastructure

– Sponsoring organizationsSponsoring organizations

– Health center planning group activitiesHealth center planning group activities

– In-kind contributions of In-kind contributions of partners/collaboratorspartners/collaborators

– Implementation grant possibilitiesImplementation grant possibilitiesProposed budgetProposed budget

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Nut and Bolt #6Nut and Bolt #6 Using the Media to Your AdvantageUsing the Media to Your Advantage

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What is the “Media”?What is the “Media”?

the various means of mass communicationthe various means of mass communication

considered as a wholeconsidered as a whole

including television, radio, magazines, and including television, radio, magazines, and newspapers, together with the people newspapers, together with the people involved in their productioninvolved in their production

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Types of MediaTypes of Media

Daily NewspapersDaily Newspapers

Weekly Weekly NewspapersNewspapers

Wire ServicesWire Services

InternetInternet

MagazinesMagazines

TelevisionTelevision

RadioRadio

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Tips for Dealing with the Tips for Dealing with the MediaMedia

Don’t be afraid to approach the media with Don’t be afraid to approach the media with an issue or a story idea.an issue or a story idea.

Try to keep relationships with the media Try to keep relationships with the media friendly and honest.friendly and honest.

Remember, the media are doing their job—Remember, the media are doing their job—try to make it easier for them.try to make it easier for them.

Access to the media is access to the publicAccess to the media is access to the public..

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CommunicatingCommunicating with the with the MediaMedia

Be an information resource for the media.Be an information resource for the media.

Have resources and information to help Have resources and information to help reporters in covering stories.reporters in covering stories.

Be familiar with the types of stories each Be familiar with the types of stories each publication or station covers and how they publication or station covers and how they report the news.report the news.

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Role Play in PairsRole Play in Pairs

Phone Call to the Editorial Phone Call to the Editorial Editor of a Local NewspapeEditor of a Local Newspaperr

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Technical Assistance Technical Assistance Resources for SBHCsResources for SBHCs

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National Technical National Technical AssistanceAssistance

National Assembly on School-Based Health National Assembly on School-Based Health Care (NASBHC)Care (NASBHC)

Society for Adolescent Medicine (SAM)Society for Adolescent Medicine (SAM)

National Association of Pediatric Nurse National Association of Pediatric Nurse Practitioners (NAPNP)Practitioners (NAPNP)

National Association of Community Health National Association of Community Health Centers (NACHC)Centers (NACHC)

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National Technical National Technical AssistanceAssistance

American School Health Association American School Health Association (ASHA)(ASHA)

Center for School Mental Health Center for School Mental Health Analysis and Action (CSMHA)Analysis and Action (CSMHA)

Center for Health and Health Care in Center for Health and Health Care in Schools at GWUSchools at GWU

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•Figure 2 National Assembly’s Trainings, Tools, and Resources for SBHCS

•Mental Health Intervention

•CQI tool sentinel conditions

•Continuing education

•Quality improvement collaborative

•Center work groups

•Conference call presentations

•Asthma

•Green Zone web-based tool kit

•CQI tool sentinel condition

•Center work group

•New SBHC Expansion

•Peer to peer exchange


•Web-based tools and information

•Practice Management Improvement


•Continuing education

•Family Engagement


•Health Education


•Obesity/Cardio Health

•Conference call presentation

•Continuing Education

•Panel work group

•STDs/HIV Prevention

•CQI tool sentinel condition

•Quality improvement collaborative


• Web-based resources

• Conference call presentations

• Continuing education programs

• Quality improvement collaboratives

•New SBHCs/Expansion

•Peer-to-peer exchange



•Evaluation Measures

•Academic Outcomes

•Productivity

•SBHC Census

•Mental Health Evaluation Template

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State Technical AssistanceState Technical Assistance

State Assemblies, Associations, and State Assemblies, Associations, and Coalitions for School-Based Health Coalitions for School-Based Health

State Health Departments that State Health Departments that administer state funding for SBHCsadminister state funding for SBHCs

State Primary Care AssociationsState Primary Care Associations

State Offices of Rural HealthState Offices of Rural Health

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National Tools and Resources for National Tools and Resources for Getting StartedGetting Started

NASBHC websiteNASBHC website www.nasbhc.org – Basics, – Training and Assistance, – Publications, and – Members Only Sections

National Association of Community Community Health Centers’ (NACHC) CD-Rom, Health Centers’ (NACHC) CD-Rom, How to Start a Successful School-Based Health Center $25 www.nachc.org

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