You want a school based health center, now what?

1. You want a school based health center, now what? Marshall Logo

2. Why have a School-Based Health Center? • Many children do not receive adequate health care- often due to lack of access or financial means; • 23% of WV public school children require regular and ongoing healthcare services during the school day; • 55,000 students have Individualized Education Programs (IEPs); • WV students have high rates of asthma, diabetes, and obesity; • SBHCs can provide a safety net to reach the kids falling through the cracks.

3. Why have a School-Based Health Center? • Many children do not receive adequate health care- often due to lack of access or financial means; • 23% of WV public school children require regular and ongoing healthcare services during the school day; • 55,000 students have Individualized Education Programs (IEPs); • WV students have high rates of asthma, diabetes, and obesity; • SBHCs can provide a safety net to reach the kids falling through the cracks.

4. What is a School-Based Health Center? • SBHCs are health clinics located in schools or on school grounds that provide preventive and primary care to students. • They provide a comprehensive range of services that meet the health needs of the young people and staff who attend the school. • SBHCs have an advisory board consisting of community representatives, parents, youth, and family organization to provide planning and oversight.

5. What is a School-Based Health Center? • They employ a multidisciplinary team of providers to care for students: physician assistants/ nurse practitioners, registered nurses, counselors, social workers, psychologists and other health professionals. • They can work with, but aren’t meant to replace, the child’s physician/medical home or school nurse. • They can serve as a child’s primary care provider if he/she doesn’t have one, ensuring that all students receive health care, regardless of their families’ ability to pay.

6. What is a School-Based Health Center? • Most SBHCS consist of a waiting/reception area, lab area, exam room(s) and offices. • Are typically staffed by a receptionist/data entry clerk, nurse, and a nurse practitioner or physician assistant with supervision/consultation from a physician

7. Pictures Simple exam room at Eastern Greenbrier Middle School SBHC

8. Pictures Exam Room at Lincoln County High School

9. Pictures Wayne County High School SBHC

10. Pictures Clerical area- ACT’s SBHC in Raleigh County

11. Pictures Jefferson Elementary Wellness Center in Parkersburg

12. Pictures SBHC built into the school- River View SBHC in McDowell County

13. What is a School-Based Health Center? • Respond to the community • Support the school • Promote collaborative relationships • Focus on the student • Advance health promotion • Provide leadership for adolescent and children’s health

14. What is a School-Based Health Center? • Some SBHCs offer Behavioral Health Services– Currently, 30 out of 88 SBHCs report either staffing or contracting for mental health services. • Some SBHCs offer Oral Health Services- Of the 88 SBHCs, 22 report providing dental services.

15. Benefits- for students • Provides all children with easier access to comprehensive health care; • Promotes prevention and early intervention; • Decreases absenteeism and tardiness; • Helps keep all student healthy, and healthy children make better learners.

16. Benefits-for families • Since parents or caregivers do not have to take time off to take their children to see their provider, it reduces parental time off from work. • Ensures that all children receive medical attention, regardless of the family’s ability to pay; • Assists families in participating in beneficial social programs, as needed.

17. Benefits- for schools • Research shows an increase in the number of students returning to class versus being sent home. • Reduces school discipline and behavior problems; • Can keep staff healthy and foster an environment that promotes “wellness;” • They give all children an equal chance to succeed in school!

18. Benefits- for communities • Reduces unnecessary emergency room visits and hospitalizations- Research shows that schools with a SBHC have a significant decrease in absenteeism as well as fewer hospitalizations and trips to the emergency room. - Journal of Adolescent Health, 2010; • Teaches students and families to be better health care consumers; • Strengthens the connection between the community and the school.

19. National Overview of SBHCs

20. National Overview of SBHCs

21. National Overview of SBHCs

22. State Overview of SBHCs Today, there are 88 SBHCs serving 107 schools in 32 counties. More are anticipated to open by the end of 2013.

23. There are 21 sponsoring agencies of SBHCs in our state and comprise the majority of our leadership. Twenty community health centers: Access Health/Community Health Systems Belington Medical Center Community Care of West Virginia, Inc. Cabin Creek Health System Camden-on-Gauley Medical Center, Inc. E.A. Hawse Health Center FamilyCare HealthCenter Hygeia Facilities Foundation Lincoln Primary Care Center Minnie Hamilton Health System Monongahela Valley Association of Health Centers, Inc. Monroe County Health Center New River Health Association, Inc. Pendleton Community Care Rainelle Medical Center, Inc. Ritchie Regional Health Care Tri-County Health Clinic, Inc. Tug River Health Association, Inc. Valley Health Systems, Inc. Wirt County Health Services Association One hospital- Roane General Hospital

24. School-Based Health Centers are at the Intersection of Health and Education. Specifically in our state, between The Bureau for Public Health and the West Virginia Department of Education.

25. First Steps • Engage school administrators • Ensure that the county board of education is informed and approve • Engage school nurses • Identify “champions” • Check basic logistics • Is there room? • Access to a restroom? • Access to water? • Etc.

26. First Steps • Identify potential medical sponsors • Ensure to be transparent in your communication to all potential sponsors • Remember that the SBHC sponsor needs to ensure that the center is financially sustainable, so be prepared to negotiate what services will be provided, and when. • Contact us.

27. What is a FQHC? • Federally Qualified Health Centers are community-based organizations that provide comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages. • FQHCs operate under a consumer Board of Directors governance structure and function under the supervision of the Health Resources and Services Administration, which is part of the United States Department of Health and Human Services. • FQHCs provide their services to all persons regardless of ability to pay, and charge for services on a community board approved sliding-fee scale that is based on patients' family income and size. • In return for serving all patients regardless of ability to pay, FQHCs receive consideration from the Federal government in the form of a cash grant, cost-based reimbursement for their Medicaid patients, and free malpractice coverage under the Federal Tort Claims Act (FTCA). • FQHCs are also called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics.

28. Why are FQHCs a good fit for SBHCs? Similar in mission and goals Serve all people regardless of the ability to pay Sustainability: • Cost-based reimbursement • FTCA malpractice coverage • Patient base can be followed when school is not in session • Administrative structure that can easily add SBHCs • Skilled in billing, sliding scale fee, grant writing and other resources • Access to funds through HRSA and state uncompensated care funding Payer Sources for all WV FQHCs from the WVPCA

29. Strategically located: 26 FQHCs, 2 FQHC look a likes and over 160 total sites, including SBHCs

30. Other Potential Sponsors • Hospitals • Private practice providers • Health departments • Urgent care facilities • County School Systems Sponsors will be expected to staff the center, provide the equipment, and provide liability insurance.

31. The Basics of Growing SBHCs and Services The Ground • Remember that where a SBHC “should” be isn’t always where the ground is most fertile for growth; • Talk to WVSBHA and school administrators and potential medical sponsors before bringing other community members to the table; • Get to know your Regional School Wellness Specialists. Public health and education contacts will have data on each county and school. Know “the lay of the land.”

32. The Basics of Growing SBHCs and Services The Need • Specific needs that a SBHC can address is important information to bring to the table. Examples: vaccination requirements for 7th and 12th graders, sports physicals, and teen pregnancy, risk assessment screening; • Fostering collaboration between public health and education at the community level is an important way to ensure that the health and social needs of the child are met, and SBHCs are providing the necessary services; • Coordination at the state level is an important way to ensure that barriers to providing these services are alleviated.

33. The Basics of Growing SBHCs and Services The Light • Communication is key; • Be prepared to join health coalitions, networks, etc. Some regional staff are very receptive to collaboration. Some are not; • In West Virginia, every county is different. Every sponsoring agency is different, and every board of education is different. Documentation is key; • Make communicating with your organization as easy as possible for public employees.

34. Coordinated School-Public Health Structure

35. Coordinated School-Public Health Partnership Public Policy State Agencies Support Community Regional Team District Team School Team Student

36. Coordinated School-Public Health Partnership • Adolescent Health Initiative • Adolescent Pregnancy Prevention • Regional Tobacco Coalition Coordinators

37. Coordinated School-Public Health Partnership • West Virginia Asthma Coalition • West Virginia Teen Pregnancy Task Force • West Virginia Immunization Network • West Virginia Youth Tobacco Prevention Program

38. Partnerships • SBHCs in WV are funded and supported by a number of partners—many of whom sit on the WVSBHA Board of Directors. • WVDHHR- Office of Community Health Systems • WVDE- Office of Healthy Schools • Marshall University School Health Tech Assistance Center • WV Primary Care Association

39. WVDHHR- Division Primary Care Office of Community Health Systems Nell Phillips, RN, MSM/HCA - nell.h.phillips@wv.gov Joan Skaggs, RN, MSN - joan.d.skaggs@wv.gov Phone: 304-558-4007 The Division of Primary Care within the Office of Community Health Systems allocates funding to community-based comprehensive Primary Care Health Centers and Free Clinics (Health Rights) to improve the health status among medically underserved (uninsured) populations.

40. WVDE-Office of Healthy Schools Paula Fields WVDE- Coordinator prfields@access.k12.wv.us 304-558-8630 Rebecca King WVDE-Coordinator rjking@access.k12.wv.us 304.558.8830 Our mission is to provide leadership, training and support for schools and their communities designed to improve collaboration and ensure the health and educational achievement of children in a safe, nurturing and disciplined environment.

41. West Virginia Primary Care Association Louise Reese- Executive Director Louise.reese@wvpca.org 304-346-0032 Mission Statement To assure accessible, high quality, and cost effective health services for all West Virginians, regardless of economic or social status, through the cultivation of financial, political, and philanthropic relationships.

42. School Health Technical Assistance Center • The place to go for resources, assistance, and training related to SBHCs, school-based behavioral and oral health programs. Visitwww.wvshtac.orgfor more info Linda Anderson, MPH Mental Health 304-544-3917 landerson@marshall.edu Stephanie Montgomery Data Management 304-634-1008 smontgom@marshall.edu Mary Grandon, PA-C Clinical Services 304-206-7362 grandon@marshall.edu Bobbi Jo Muto, RDH, BS Oral Health Coordinator 304-542-9592 bjmuto.steele@marshall.edu Richard Crespo, PhD Director 304-691-1193 crespo@marshall.edu

43. West Virginia School-Based Health Assembly Kelli Caseman, Executive Director Kelli@wvsbha.org 304.444.5917 The mission of the West Virginia School-Based Health Assembly (WVSBHA) is to advance comprehensive health care in school settings. Formed in 1995, WVSBHA serves as the lead membership organization and unified voice in the state for the advancement of school-based health care.

44. Together we serve the WHOLE CHILD

45. Marshal Logo Mary’s contact Info Kelli Caseman, MA PO Box 11436 Charleston, WV 25339 304.444.5917 kelli@wvsbha.org www.wvsbha.org • Mary Grandon, PA-C • SBHC Clinical Services • 304-206-7362 • grandon@marshall.edu • www.wvshtac.org