atlantic conference 2013_sbhc presentation
TRANSCRIPT
Making Sustainability Real: Measuring Indicators and Implementing Inventions towards Sustainability
2013 Elev8 Fall Learning InstituteModerator: Kimi Sakashita, MPH, Associate Director
Alameda County Center for Healthy Schools & Communities
Presenters: Sara Geierstanger, MPH, Senior Evaluator
Philip R. Lee Institute for Health Policy StudiesUniversity of California, San Francisco
Erica Snow, MS, MPA, Senior Program OfficerThe Colorado Health Foundation
Naomi Shapiro, RN, PhD, CPNP, Clinical ProfessorSchool of Nursing
University of California, San Francisco
Presentation OverviewDevelopment and use of an SBHC sustainability indicators
measurement tool, as well as results from administration in Colorado (Sara)
Motivation for a major foundation to focus on SBHC sustainability, the tools they developed, and how sustainability assessment results are guiding interaction with and funding of grantees (Erica)
Mutual benefits of university-school health collaboration and its contribution to school health center sustainability (Naomi)
Questions and Discussion
The Colorado Health Foundation’s School Based Health Care Initiative
4-year investment in school-based health careSupport the planning and implementation of at least 20 new or
expanded school-based health care programs (SBHC) Improve the effectiveness of SBHCs at reaching underserved
populations Identify and address policy barriers Ensure the financial sustainability of SBHCs
School-Based Health Centers
Series10
10
20
30
40
50
Goal Achieved
---------------------------------------------------
8
36
20
October 15th • 2 implementation
proposals• 2 planning proposals
Expanded
New
SBHC Implementation Grantees
Rocky Mountain Aurora School Youth Services/Roaring District/RMYC Fork School District
Grand River Community Health Hospital District Services, Inc.
Eagle County Denver Health School District
Montrose County Summit Community School District Care Clinic
Sheridan Health Services
Metro Community Provider Network
Durango 9-R School District Cripple Creek
School District
Southwest Open School Pueblo CommunityHealth Centers
Policy Wins Two provisions in the Patient Protection and Affordable Care
Act Authorization of a federal SBHC grant program Creation of an emergency appropriation that has provided
Colorado SBHCs $2.9 million in capital funding
Passage of HB11-1019, which exempts SBHCs from deductible and co-payment requirement from privately insured patients
Increase in state general line-item for the SBHC grant program by approximately $4.3 million
SBHC Application Process Step 1: Complete Readiness AssessmentStep 2: Develop Business PlanStep 3: Implementation
Initiative Process
Develop Readiness Assessment
Develop Business Plan
Financial Template1
2
3
4
5
3.84.0
4.2
3.2
3.84.2
HelpfulnessDifficulty
Mos
t Hel
pful
/Cha
lleng
ing
Evaluation Selected Philip R. Lee Institute for Health Policy Studies at
the University of California, San Francisco to conduct evaluation
Timeline: January 2010 – January 2014
Purpose: Determine if TCHF’s Initiative process was effective in driving Colorado SBHCs toward increased self-sustainability
Evaluation Methods2011 2012 2013
Planning Grantee Interviews 8 5
Sustainability Self-Assessment Tool 16 40
Implementation Grantee Interviews 8 9 13
Key Stakeholder Interviews 11 9
Case Study Interviews 15
Development of the Sustainability Self-Assessment Tool
Facility
Staffing
Services
Community Partnerships
Funding Strategies
Management
School Integration
Marketing & Outreach
Tool developed by our UCSF/PRA evaluation team in 2010.
Use of the Sustainability Self-Assessment Tool
First administered to 16 Alameda County School Health Centers by UCSF for 2010-11.
Revised and administered to Colorado SBHCs 16 Group 1 grantees for 2010-1116 Group 1 grantees for 2011-1224 Group 2 grantees for 2011-12
Administered to XX Elev8 SBHCs for 2011-12 by the School Based Health Alliance.
Tool is now available on the School Based Health Alliance web-site and being used by other researchers.
Sustainability Scores Summary
Facility Indicators
Staffing
Provision of Services
Funding Strategies
Management
Community Partnerships
School Integration
Marketing and Outreach
4.0
3.9
3.9
3.8
3.7
3.4
3.4
2.9
1=Not in Place 4=Full Implementation
2=In Planning 3=Partial Implementation
<2.99 Not in place/planning
3-3.49 Partial implementation
≥3.5 Near/at Full implementation
Facility Indicators
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
SBHC includes at least the following functional elements:Computers/telecommunications 4.00 0 4.00One exam room. 4.00 0 4.00Waiting/reception area. 3.81 .13 4.00Counseling room/private area. 3.88 0 4.00
Privacy, confidentiality, safety 3.75 .06 4.00Dedicated space only for SBHC 4.00 -.13 4.00Average Score 3.92 0.01 4.00
Staffing Indicators
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Staff training 3.50 .38 3.96Organizational chart 3.50 .38 3.92Culturally appropriate hiring 3.69 .19 3.96Written job descriptions 3.75 .06 3.92Average Score 3.61 0.25 3.94
Provision of Services
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Needs assessments 3.38 .44 3.29Address barriers to (safety, transportation, hours) 3.69 .31 3.9624-hour, 7 days per week coverage 3.06 .25 3.88Follows clinical practice guidelines 3.56 .13 4.00Conducts student outreach 3.94 .06 4.00Has an administrator for overall program management 3.94 .06 4.00Extends eligibility to all students 4.00 0 4.00Services are welcoming and respectful of student diversity 4.00 0 4.00
Complies with federal and state regulations 3.94 0 4.00Collects student and parent feedback 3.69 0 3.75Coordination of care among SBHC staff 3.63 -.19 4.00Average Score 3.71 0.10 3.90
Funding Strategies
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Has a sliding fee scale 3.31 .50 3.96Conducts Medicaid outreach and application assistance 3.81 .19 4.00Medicaid and third party revenue returned to SBHC 3.44 .13 4.00Effective and efficient billing system 3.25 .06 3.83Written billing policies for SBHCs 3.38 -.07 3.96Average Score 3.44 0.16 3.95
Management
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Tracks student health and academic outcomes 2.69 .63 3.96Evaluates practice management measures 3.31 .31 3.96Plans for continuous quality improvement 3.50 .25 3.96Involvement of provider in clinical policies and procedures 3.56 .20 4.00Written policy on exchange of information with school staff 3.19 .19 4.00Written record of progress toward selected measures. 3.19 .13 3.96Annual budget describes funding, including in-kind 3.88 .06 3.96E.H.R. facilitates the provision of care 3.13 .06 3.96Obtains consent for sharing SBHC records 4.00 0 4.00Develops and updates business/strategic plan 3.75 -.06 3.96Reports revenues and expenses 3.75 -.13 3.96Works with community advisory council 3.94 -.50 3.88Solicits youth involvement 2.94 -.56 3.00Average Score 3.45 0.04 3.89
School Integration
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Partners in school-wide programs 2.50 .69 3.21Advocates for school health programs and policies 1.88 .69 4.00Joint funding opportunities with the SBHC 3.00 .63 3.00Active in school-wide committees 3.44 .40 3.50Policy about roles of SBHC and the school nurse 3.25 .38 3.54Involved in school health program decision-making 1.94 .20 3.61Co-locates with the school health staff 2.88 .19 3.63Provides in-services to school staff/consults teachers 3.69 .13 3.33Advocates for district health programs and policies 2.44 .13 3.79Communication and coordination with school health staff 3.75 -.13 4.00Average school stakeholder support 3.94 -0.11 3.55Average school stakeholder engagement 2.66 0.02 2.79Average school health provider collaboration 3.12 0.17 3.52Average Score 2.96 0.26 3.50
Community Partnerships
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Solicits participation from other key community stakeholders. 4.00 0 4.00Communicates and coordinates with primary care provide 3.75 -.06 3.71Parent and local community support 3.86 -0.15 3.37Parent and local community engagement 2.18 0.08 2.22Lead medical agency/community partner collaboration 3.22 -0.12 3.78Average Score 3.40 -0.05 3.42
Marketing & Outreach
Group 1Baseline (N=16)
Group 1 Change (N=16)
Group 2 Baseline (N=24)
Strategy for addressing opposition 2.93 .47 2.04Uses data to promote school health services 3.25 .44 3.26Uses a variety of marketing and outreach strategies 3.94 -.06 3.00Crafted messages for different audiences 3.87 -.33 3.04Has a written marketing plan 2.81 -.69 2.21Average Score 3.36 -0.15 2.71
RecommendationsContinue to support SBHC facility expansion
Continue to focus on funding and management
Encourage SBHC partnerships with school-wide programs
Continue to focus on SBHC marketing strategies
Advocate for government policy/funding for SBHCs
Continue to assess, monitor and improve sustainability factors!
Results into Action Funding
Support State SBHC association and partner with Colorado Dept. Public Health and Environment in SBHC learning forums
Continue advocacy support for SBHCs
Case study highlighting “Best Practices to Improve Billing”
Case study “Providing services to Uninsured Clients”
Position SBHCs as part of community health networks
Continue to support integration of mental and oral health
Results into Action Marketing and Outreach
Technical assistance to SBHCs via private marketing firm Kaleidoscope video- Foundation’s storytelling campaign
Community Partnerships Youth group development at Foundation Reexamine how to better engage families and students, e.g. focus
groups
School Integration Healthy Schools Collective Impact project with Community Wealth
Partners
Questions and Discussion
Contact InformationSara Geierstanger: [email protected] Snow: [email protected] Shapiro: [email protected]