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