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

1. School-Based Health Care (SBHC) 101: Nuts and Bolts Carrie Baker, CAE Executive Director Ohio School Based Health Care Association www.osbhca.org carrie@bakernonprofits.com

2. Identify key collaborators and partners Name the five key components of needs assessment techniques for planning school-based health services Identify potential funding sources for school-based health services: including public, private, and collaborative partnerships Objectives

3. Describe the rationale and components of a case statement for a new school-based health center Utilize resource materials related to planning, evaluating, financing Listseven principles describing how to plan and implement a school-based health centers Objectives

4. NUT AND BOLT #1 PRINCIPLES OF SCHOOL-BASED HEALTH CARE Seven fundamental principles Goals, structures, processes and outcomes

5. Supports the school Focuses on the community Focuses on the student Provides comprehensive care Advances health promotion activities Implements effective systems Provides leadership in adolescent and child health The School-Based Health Center:

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

7. Responds to the Community The school-based health center is developed and operates based on continual assessment of local assets and needs.

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

9. Delivers Comprehensive Care An interdisciplinary team provides access to high quality comprehensive physical and mental health services emphasizing prevention and early intervention.

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

11. Implements Effective Systems Administrative and clinical systems are designed to support effective delivery of services incorporating accountability mechanisms and performance improvement practices.

12. Provides Leadership in Adolescent and Child Health The school-based health center model provides unique opportunities to increase expertise in adolescent and child health, and to inform and influence policy and practice.

13. The SBHC Roadmap http://ww2.nasbhc.org/Roadmap/index.html NASBHC websitewww.nasbhc.org Basics, Training and Assistance, Publications, and Members Only Sections National Tools and Resources for Getting Started

14. Collaboration and Partnerships Nut and Bolt #2

15. Collaborative Partnerships • A mutually beneficial and well-defined relationship among two or more organizations to JOINTLY develop structure and share • Responsibility • Resources • Authority • Accountability • Rewards

16. To accomplish a common goal that none of the units alone can attain To help agencies share information, resources, staff and equipment To create an awareness of needs, problems, or opportunities Why have a Collaboration?

17. Develops clear, concrete, achievable goals. Operate in a receptive environment that facilitates its work. Have good leadership. Understand and respect each member for their different role and responsibility. Build cooperative teams. Characteristics of Successful Collaboration

18. Differences among collaborators must be understood and acknowledged. Mixed loyalty that some members may have to their organization. Merging of agencies can cause conflict. * Lack of clarity * Lack of awareness Typical challenges

19. Territorial questions Confidentiality Certification/Credentialing Conflicting priorities Political roadblocks Financial resources Difficult Issues that Undermine Collaborations

20. Joining with the host school Relay the message that you are there to support rather than supplant Engage in ongoing negotiations with key players Developing common goals and group consensus Setting Boundaries Strategies to Overcome Resistance in Collaboration

21. Local health department Community or rural health center Community and/or teaching hospital(s) Mental health, substance abuse, and social service agencies Private physicians University faculty Elected Officials Business and community leaders Faith community School superintendent, board, or designee School administration and Faculty (school nurse, teachers, principals, guidance counselors, physical education, nutrition/food services) Students Parents Establish a Planning Group Composition Considerations

22. Conduct the Needs Assessment Nut and Bolt #3

23. An accurate appraisal of the current situation (strengths, concerns, and general conditions) of a community’s population A collection of secondary and first hand information and data from a wide range of relevant sources and audiences What is a Community Needs Assessment?

24. A process for: identifying needs and resources in a community determining gaps between what a situation is and what it should be establishing priorities An opportunity to paint a picture of the conditions in a community and sharpen your perceptions of the critical issues children and families face What is a Community Needs Assessment?

25. Better understand the community in which you will be working Become aware of needs and concerns you never knew about Locate hidden strengths or underutilized resources that could be developed Document need Make sure future actions are aligned with expressed community needs Why Identify Needs and Resources?

26. Garner greater support and involve more people in subsequent action Give voice to individuals in the community who have not traditionally been solicited for comment Convince outside funders and supporters Make decisions based on priorities and documented needs Why Identify Needs and Resources?

27. Step 1:Involve stakeholders Establish working group to guide the planning and implementation of Community Needs Assessments Planning and Implementing the Assessment

28. Step 2:Determine the Objectives and Outcomes of the Assessment What are you really interested in knowing? Your questions will flow from this. What is your vision? How will you use the information obtained? Which issues, questions, and behaviors are of particular interest? What don’t you know about these issues? What questions do you need to answer? Planning and Implementing the Assessment

29. Step 3:Identify secondary data sources Find out what outside resources can be used What public reports exist (examples of sources: census data, vital statistics, CPS reports) Have other studies been done? Are there experts in the community who can help you? Planning and Implementing the Assessment

30. Step 4: Choose your approach/ approaches for gathering new information Most common approaches: Key informant interviews Focus groups Public forums Surveys Planning and Implementing the Assessment (cont)

31. When making your choice of approach, take into account: Purpose of the study Amount of time you have and number of people assisting you Available resources Size and characteristics of target population Relationship you have with target population Planning and Implementing the Assessment “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)

32. Key Informant Interviews Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community How to implement = compile a list of participants, create protocol, make appointments (either telephone or in-person), gather data, identify common themes Planning and Implementing the Assessment

33. Key Informant Interviews Advantages Easy and not expensive Can discuss confidential issues more readily Establishes rapport and trust with community Permits clarification of issues and ideas Disadvantages May be difficult to schedule May provide a biased perspective Only represents perceptions – not hard data Personal relationships may influence outcomes Should be combined with other methods because may not represent whole community Planning and Implementing the Assessment

34. Focus Groups Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community How to implement= compile a list of participants, decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify common themes Planning and Implementing the Assessment

35. Focus Groups Advantages Easy and not expensive Establishes rapport and trust with community members Permits clarification of issues and ideas Easily combined with other techniques Disadvantages May provide biased perspectives Only represents perceptions – not hard data Sharing opinions and views in a group setting may be inhibiting Should be combined with other methods because may not represent whole community Planning and Implementing the Assessment

36. Public forums Purpose = elicit information from a wide range of residents in a series of public meetings How to implement= develop list of invitees, create list of questions, select strategically located venue (use different sites and hold at different times), publicize, use facilitator and documenter, identify common themes Planning and Implementing the Assessment

37. Public forums Advantages: Get opinions from a wide range of people Promotes active involvement, community awareness, and buy-in Inexpensive, quick picture of community Disadvantages: Requires good leadership Opinions limited to those who attend Lots of advance planning May generate more questions than answers May create unrealistic expectations Planning and Implementing the Assessment

38. Surveys Purpose =collect information from a wide range of respondents How to implement=find or create carefully developed instrument and administer through a sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, telephone, mailed), analyze results Planning and Implementing the Assessment

39. Surveys Advantages Best approach for eliciting attitudes of broad range of individuals Data usually valid and reliable Disadvantages Costly and requires time and expertise Needs carefully selected tool and sampling Subject to misinterpretation Individuals may hesitate to answer questions Planning and Implementing the Assessment

40. Planned Approach to Community Action (PATCH) developed by CDC effective model for planning, conducting, and evaluating community health promotion and disease prevention programs Used by diverse communities in US and other nations to address health concerns PATCH Guide for local coordinator has sample surveys and data collection tools Web sitewww.cdc.gov/nccdphp/path/index.htm Planning and Implementing the Assessment

41. Step 5: Implement Plan Collect secondary data Collect primary data (conduct interviews, focus groups, surveys, etc) Analyze secondary and primary data Summarize findings Planning and Implementing the Assessment

42. Step 5: Implement Plan Prepare report Share with working group, interpret data and develop recommendations together Present to external stakeholders as needed Create action plan Planning and Implementing the Assessment

43. Review Needs Assessment Document

44. Make Recommendations Based on Needs Assessment Findings

45. Elementary Middle or Junior High K-8 High School Alternative School Pre-school Select the School

46. Service and Staffing Options Collaborative Partnerships The role of the school nurse Policy and Procedures Referral Networks Delivery of Service Parental Consent/Parental Involvement Integration of the school-based health center with existing school and community resources Confidentiality Issues Select the Service Delivery Strategy and Model

47. Primary Care including biennial risk assessment Immunizations Health Education Physical Examinations Mental Health Laboratory Services Medications Nutrition Counseling Vision, Hearing, and Dental Screening Social Services Chronic Disease co-management Specialty Care Referrals Services to Consider for All Grade Levels

48. Pregnancy testing STD testing and treatment Reproductive health care Group counseling to address issues such as sexual abuse, depression Individual mental health counseling HIV testing and/or counseling Referral for family planning Services at the MS and HS Levels

49. Maintain school nurse mandated functions (vision and hearing screening, immunizations, special ed, etc.) Member of school-based health team Identify students for school-based health center services Provide follow-up Reach out to parents Serve as a liaison between the school-based health center and school staff The Role of the School Nurse

50. The majority of SBHCs have a parental/guardian consent policy. Consent form should include: Services to be offered Statement about confidentiality /HIPAA Billing issues Statement about the relationship between the sponsoring organization and any collaborators including the school district Review state statutes regardingage of consent for various health care services Parental/Family Consent / Family Engagement