school-based health center snapshot linda juszczak grantmakers in health december 16, 2008

School-Based Health Center Snapshot

Linda Juszczak

Grantmakers in Health

December 16, 2008

School-Based Health Center (SBHC) National Definition

Partnerships created by schools and community health organizations to provide on-site medical, mental health, and/or oral health services that promote the health and educational success of school-aged children and adolescents

SBHC Principles

• Support the school• Respond to the community• Focus on the student• Deliver comprehensive care• Advance health promotion• Implement effective systems• Provide leadership in adolescent and child

health

Where are SBHCs? (n=1708)

Juszczak, Schlitt, Moore. (2007). National SBHC Census. NASBHC. www.nasbhc.org

SBHCs by Community Characteristic

Rural27%

Suburban14%

Urban59%

Ethnic Profile of SBHC Population

White31%

Black30%

Hispanic33%

Asian 4%

Native American

1%

Other1%

SBHC Staffing Models

Primary Care Only31%

Primary Care-Mental Health

34%

Primary Care Mental Health

Plus31%

Other4%

SBHC Primary Care Services

0 10 20 30 40 50 60 70 80 90 100

Treatment of Acute Illness

Comprehensive Health Assessments

Screenings

Prescriptions for Medicines

Anticipatory Guidance

Asthma Treatment

Sports Physicals

Nutrition Counselling

Medications Administed in the Center

Treatment of Chronic Illness

Immunizations

Lab Tests

Standardized Behavioral Risk Assessment

Assessment of Psycholigical Development

Medications Dispensed to be Taken at Home

Care for Infants of Students

Dental Screenings/Diagnostics

Dental Preventive Care

Dental Comprehensive Care

SBHC Mental Health Services

0 10 20 30 40 50 60 70 80 90 100

*Mental Health Diagnosis

*Grief and Loss Therapy

*Crisis Intervention

*Assessment

*Referrals

*Screening

*Skill-Building

*Conflict Res/Mediation

*Tobacco Use Counseling

*Brief Therapy

*Substance Use Counseling

*Case Management

*Psycho-education

*Long Term Therapy

*Medication Mngt/Admin With MH Staff

Without MH Provider

SBHCs that Bill and Collect

0

10

20

30

40

50

60

70

80

Medicaid SCHIP Private Self Pay

% o

f all

SB

HC

s

Bill Collect

Total State-Directed Funding

Schlitt, Juszczak, Eichner. (2008). Current Status of State Policies that Support SBHCs. Public Health Reports.

Non-Patient Revenue

0

10

20

30

40

50

60

70

80

% o

f al

l S

BH

Cs

State Foundations County/City Corporate Federal

Performance and Outcomes

• Evidence of high-quality care and higher performance than other models for selected measures

• Adolescents more likely to come to an SBHC than other settings for mental health services

• Decreased use of urgent and emergency care• Increase in risk assessments and health care

maintenance • Reduction in Medicaid expenditures and cost of

hospitalizations• Decrease in risk behaviors and increase in health

promoting behaviors

Performance and Outcomes (cont’d)

• Centers reach ethnically diverse populations, adolescent males, the uninsured and those without a regular source of care.

• Evidence of student satisfaction with ability of the centers to meet their needs

• Evidence of strong parental support• Evidence that centers complement and do not duplicate

services being provided elsewhere

Challenges• Limitations related to access:

• 44% of centers are available only to students in the school

• Parental consent often required for any service despite state laws that permit adolescents to give their own informed consent for selected services

• State/community restrictions regarding provision of reproductive health services

• Need for mental health services may exceed capacity

• Transient student populations

Priorities for the Movement

• Reimbursement• Growth• Sustainable funding• Raising the profile• Supporting alternate models• Mental health

NASBHC Policy and Advocacy*

• Reimbursement through Medicaid and SCHIP

• Health care reform• Authorization for a Federal SBHC

program• Support the states

*With support from W.K. Kellogg Foundation and The Atlantic Philanthropies