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Preventive Services Improvement Initiative

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Title: Preventive Services Improvement Initiative


1
School-Based Health Care (SBHC) 101 Nuts and
Bolts
Laura Brey, MS Tammy Alexander, M.Ed. NASBHC
Training of Trainers April 21-23, 2008
2
Participant Expectations
  • Complete the index card and hand it in.

3
Introductions
  • Presenters
  • Tammy Alexander
  • Laura Brey

4
Getting to Know Participants
  • Type of agency
  • Community setting
  • Role in agency
  • School population, if known

5
Objectives
  • 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

6
Objectives
  • Describe the rationale and components of a case
    statement for a new school-based health center
  • Utilize resource materials related to planning,
    evaluating, financing, and working with the media
  • List seven principles describing how to plan and
    implement a school-based health centers

7
Collaboration and Partnerships
Nut and Bolt 1
8
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

9
Why have a Collaboration?
  • 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

10
Characteristics of Successful Collaboration
  • 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.

11
Typical challenges
  • 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

12
Difficult Issues that Undermine Collaborations
  • Territorial questions
  • Confidentiality
  • Certification/Credentialing
  • Conflicting priorities
  • Political roadblocks
  • Financial resources

13
Strategies to Overcome Resistance in Collaboration
  • 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

14
Establish a Planning Group Composition
Considerations
  • 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
  • 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

15
Role Play - Meeting with Partners / Collaborators
16
Conduct the Needs Assessment
Nut and Bolt 2
17
What is a Community Needs Assessment?
  • An accurate appraisal of the current situation
    (strengths, concerns, and general conditions) of
    a communitys population
  • A collection of secondary and first hand
    information and data from a wide range of
    relevant sources and audiences

18
What is a Community Needs Assessment?
  • 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

19
Why Identify Needs and Resources?
  • 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

20
Why Identify Needs and Resources?
  • 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

21
Planning and Implementing the Assessment
  • Step 1 Involve stakeholders
  • Establish working group to guide the planning and
    implementation of Community Needs Assessments

22
Planning and Implementing the Assessment
  • 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 dont you know about these issues? What
    questions do you need to answer?

23
Planning and Implementing the Assessment
  • 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?

24
Planning and Implementing the Assessment (cont)
  • Step 4 Choose your approach/
  • approaches for gathering new
  • information
  • Most common approaches
  • Key informant interviews
  • Focus groups
  • Public forums
  • Surveys

25
Planning and Implementing the Assessment
  • 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
  • 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)

26
Planning and Implementing the Assessment
  • 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

27
Planning and Implementing the Assessment
  • 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

28
Planning and Implementing the Assessment
  • 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

29
Planning and Implementing the Assessment
  • 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

30
Planning and Implementing the Assessment
  • 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

31
Planning and Implementing the Assessment
  • 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

32
Planning and Implementing the Assessment
  • 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

33
Planning and Implementing the Assessment
  • 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

34
Planning and Implementing the Assessment
  • 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 site www.cdc.gov/nccdphp/path/index.htm

35
Planning and Implementing the Assessment
  • Step 5 Implement Plan
  • Collect secondary data
  • Collect primary data (conduct interviews, focus
    groups, surveys, etc)
  • Analyze secondary and primary data
  • Summarize findings

36
Planning and Implementing the Assessment
  • 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

37
Review Anytowns Needs Assessment Document
38
Project Work Plan and Design Example from
Chicago SBHC
  • Convened a planning committee of key community
    stakeholders who met regularly to oversee and
    guide the process
  • Gathered existing data
  • U. S. Census Bureau (2000)
  • Chicago Health and Health Systems Project (CDPH
    2006)
  • Healthy Albany Park Assessment (2004)
  • Illinois State Report Card (2004 2005)
  • CPS School Profile (2004 2005)

39
Project Work Plan and Design
  • Collected new data
  • Conducted fifteen stakeholder interviews with
    school administrators, school personnel, school
    nurses, and external partners working in schools
  • Conducted a focus group with community providers
  • Analyzed findings
  • Drafted initial recommendations

40
Make Recommendations
  • Based on Needs Assessment Findings

41
Select the School
  • Elementary
  • Middle or Junior High
  • K-8
  • High School
  • Alternative School
  • Pre-school

42
Select the Service Delivery Strategy and Model
  • 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

43
Services to Consider for All Grade Levels
  • 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

44
Services at the MS and HS Levels
  • 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

45
The Role of the School Nurse
  • 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

46
Parental/Family Consent / Family Engagement
  • 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 regarding age of consent
    for various health care services

47
Confidentiality
  • Confidential versus nonconfidential services
  • Access to confidential services
  • Release of information
  • Providing follow-up information to school
    personnel and outside agencies
  • Informing students of confidentiality procedures
    and limits of confidentiality

48
Nut and Bolt 3Funding for SBHCs
49
Maslows Hierarchy of Need
  • Its hard to focus on best practice standards
    when your needs are rooted in basic survival.

50
Multiple Funding Sources/ Models for School-Based
Health Centers
  • Foundations
  • Patient Revenue
  • Mixing several or all funding sources
  • Federal grants
  • State grants
  • Local funding
  • Community partnership contributions

51

Federal entitlement programs administered at the
state level MCHB/Title V CDC HIV/AIDS
Prevention SAMHSA/Title XIX (substance abuse and
mental health screening and early
intervention) Title XX/ Soc Services Block Grant
(TANF, daycare, child neglect and abuse) State
Funding State General Revenue Tobacco
Tax/Settlement Education NCLB /ESEA (Title I
improving academic achievement of the
disadvantaged and Title IV safe and drug free
schools) IDEA (health-related special
education services)
BPHC/FQHC (Section 330 of the Public Health
Service Act) Title X of the Public Health Service
Act Family Planning
Figure 1 School-Based Health Center Funding
Models

Federal Public Grants
State Public Grants

Foundations that commonly supports school-based
health care Robert Wood Johnson Foundation KB
Reynolds Charitable Trust WKKF Kellogg
Foundation Welborn Foundation McKesson
Foundation Duke Endowment Health Foundation of
Greater Cincinnati Visit the Grantsmanship Center
at http//www.tgci.com/ and the Foundation Center
at http//fdncenter.org for other foundation
funding opportunities
Local Funding/ Community Partners
Local Funding Public and private grants (e.g.,
universities, United Way) City/county funds Local
businesses (e.g., banks, insurance companies)
Foundations

Community Partners In-Kind Contributions from
schools, hospitals, health departments, community
health departments, and community agencies (e.g.,
staff, facilities, supplies) Examples of
Partners Parents employers Parents health
insurance agencies Local businesses School
districts Universities
Patient revenue
SCHIP Medicaid Private insurance Patient fees
52
Federal public grants
  • BPHC /FQHC (Section 330 of the Public Health
    Services Act)
  • Title X of the Public Health Services Act Family
    Planning

53
Core Funding ModelsFederal
  • 330 Federally Qualified Health Centers
  • Entirely federally dependent
  • Fairly stable
  • Limited community
  • Limited funds for expansion

54
State public grants
  • Federal entitlement programs administered at
    state level
  • MCHB Title V
  • CDC HIV/ AIDS Prevention
  • SAMHSA/ Title XIX (substance abuse and mental
    health screening and early intervention
  • Title XX/ Social Services Block Grant, Temporary
    Aid to Needy Families Programs (TANF) job
    training, pregnancy prevention, daycare, child
    neglect and abuse

55
State public grants
  • Education
  • NCLB/ESEA (Title I improving academic achievement
    of the disadvantaged and Title IV safe and drug
    free schools)
  • IDEA (health-related special education services)

56
State public grants
  • State Funding
  • State General Revenue
  • Tobacco Tax Settlement
  • Juvenile Justice Funds

57
Core Funding ModelState Grants
  • Louisiana MCHBG Tobacco settlement
  • Connecticut MCHBG, state fund
  • Delaware state fund
  • Fairly stable
  • Limited growth targeted funding
  • Requires legislative/administrative advocacy

58
Local Funding
  • Public and private grants (universities, United
    Way
  • City and county funds
  • Local businesses (banks, insurance companies)

59
Core Funding ModelsLocal Government
  • Portland/Multnomah County (OR)
  • Seattle/King County (WA)
  • Great community buy in
  • Fairly stable income

60
Community partners
  • In-kind contributions (staff, facilities,
    supplies) from
  • Schools,
  • Hospitals,
  • Health departments, and
  • Community agencies

61
Community partners
  • Examples of partners
  • Parents employers
  • Parents health insurance agencies,
  • Local businesses,
  • School districts, and
  • Universities

62
Core Funding ModelsCommunity Partnerships
  • Denver SBHCs
  • Baltimore County Public Schools, MD
  • Healthy Kids, Lexington, KY
  • Indianapolis Collaborative
  • Collaboration has inherent difficulties
  • Built over long-term
  • Requires perseverance, leadership

63
Foundations
  • Robert Wood Johnson
  • WK Kellogg Foundation
  • KB Charitable Trust
  • Health Foundation of Greater Cincinnati
  • McDonald Foundation
  • Welborn Foundation

64
Foundations
  • For other foundation funding opportunities visit
  • The Grantsmanship Center at http//www.tgci.com
  • and
  • The Foundation Center at
  • http//fdncenter.org

65
Core Funding ModelsFoundations
  • Indianapolis SBHCs
  • Cincinnati, Ohio SBHCs
  • North Carolina SBHCs
  • Miami SBHCs

66
Patient Revenue
  • SCHIP
  • Medicaid
  • Private insurance
  • Patient fees

67
Core Funding ModelPatient Revenue
  • West Virginia FQHC rate
  • New York Medicaid institution rate
  • Commitment to specific sponsor type
  • Leadership necessary at Medicaid level

68
Mixed Funding Sources
  • Denver School-Based Health Centers
  • Baltimore County School-Based Health Centers
  • Healthy Kids Centers
  • Indianapolis Collaborative

69
Follow the Income Streams
Mental Hlth/Sub Abuse
Health Care
Public Health
Education
70
Funding Service Components
  • Medical/nursing services
  • Public health/promotion
  • Mental health/behavioral health
  • Case management/social services coordination
  • Education support

71
Nut and Bolt 4 Principles of School-Based
Health Care
  • Seven fundamental principles
  • Goals, structures, processes and outcomes

72
SBHC Fundamental Principles
http//www.nasbhc.org/site/c.jsJPKWPFJrH/b.27434
59/k.9519/NASBHC_Principles_and_Goals_for_SBHCs.ht
m
73
The School-Based Health Center
  1. Supports the school
  2. Focuses on the community
  3. Focuses on the student
  4. Provides comprehensive care
  5. Advances health promotion activities
  6. Implements effective systems
  7. Provides leadership in adolescent and child health

74
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.
75
1. Supports the School 1. Supports the School 1. Supports the School 1. Supports the School
Principles/ Goals Structures Processes Outcomes
Understands and respects accountability within the educational system Works with the school administration to develop and achieve a shared vision Communicates the vision to all school constituencies including teachers, support staff, students and parents Builds collaborative and mutually respectful relationships with school personnel Identifies community resources that provide support to students and promote successful learning Serves as a resource in times of school crises and community disasters Mutually agreed upon vision statement for the SBHC Mutually agreed upon roles and responsibilities of each party Mutually agreed upon policies regarding appointment scheduling during school hours and information sharing Delineated role within the schools crisis intervention plan Communication with School Administration, School Nurse, Guidance Counselor, Social Worker, School Psychologist and Faculty Attendance of SBHC personnel at school staff meetings Presence of SBHC personnel at appropriate school functions Partnership in identifying students with issues influencing educational performance Training of SBHC staff on the schools crisis intervention plan and communitys emergency preparedness plan and the SBHCs expected response Recognition by school personnel of the value the SBHC provides in meeting educational mission High satisfaction of school personnel with SBHC services Increased number of appropriate referrals by school personnel Reduced number of students who leave school during the day due to illness In the event of a school crisis or community disaster, SBHC performs effectively according to plan
76
Responds to the Community
The school-based health center is developed
and operates based on continual assessment of
local assets and needs.
77
2. Responds to the Community 2. Responds to the Community 2. Responds to the Community 2. Responds to the Community
Principles/ Goals Structures Processes Outcomes
Assesses child and adolescent health care needs and available resources in the community through formal evaluation methods Informs the community of student health needs and trends Solicits community input to address unmet health needs and support the operations of the program Definition of geographic service area Identification of population to be served including demographic and socioeconomic characteristics Identification of key health indicators Continuous needs assessment System for gathering data on key indicators Resource manual Advisory Committee with appropriate community representation Communications plan Program development based on periodic review of data Advisory Committee meetings Stakeholder meetings Periodic communication with the general public Improved access to primary care as measured by increased utilization of SBHC services Recognition by community of the value of SBHC services in meeting the needs of students and responding to community values High parent satisfaction Improved utilization of other community resources through referrals and/or inter-program collaboration
78
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.
79
3. Focuses on the Student 3. Focuses on the Student 3. Focuses on the Student 3. Focuses on the Student
Principles/Goals Structures Processes Outcomes  
Encourages the students active, age appropriate participation in decisions regarding health care and prevention activities Involves the parents or other adult caregivers as supportive participants in the students health care whenever appropriate and possible Ensures confidentiality of information whether transmitted through conversation, billing activity, telemedicine, or release of medical records Provides services and materials that are culturally sensitive and respectful of family values and diversity Parental consent and parental notification policies Confidentiality and minor consent policy Emancipated minor policy Child abuse and neglect policy Non-discrimination policy Patient rights and responsibilities Patient education materials in languages other than English, where appropriate Methodology for identifying children with special health care needs Methodology for identifying non-users Provision of services in a manner consistent with established policies Treatment of students with acute illness or injury Counseling of students with behavioral issues Management of students with chronic conditions Provision of culturally sensitive anticipatory guidance and health and safety education Student-centered risk assessment and follow-up Family assessment and follow-up Outreach to non-users Increased enrollment for and utilization of SBHC services High user and parent awareness of SBHC policy regarding access to confidential services Improved user knowledge of how and when to utilize the health care system Students with chronic disease or behavioral issues can demonstrate self-care skills High satisfaction among users.
80
Delivers Comprehensive Care
An interdisciplinary team provides access to high
quality comprehensive physical and mental health
services emphasizing prevention and early
intervention.
81
4. Delivers Comprehensive Care 4. Delivers Comprehensive Care 4. Delivers Comprehensive Care 4. Delivers Comprehensive Care
Principles/Goals Structures Processes Outcomes
Provides a scope of services that is consistent with identified health care needs Promotes availability of on-site services whenever the school is open and facilitates after-hours care 24-hour-a-day, seven-days-a-week Adopts generally accepted guidelines for clinical practice Promotes the interdisciplinary role and functions of the school-based health care team Coordinates and integrates efforts with existing systems to optimize complementary programs, improve continuity of care, reduce fragmentation, prevent duplication, and maintain affordable services Defined scope of services to be provided Multidisciplinary team of caregivers Posted hours of operation Effective 24/7 on-call system Staffing guidelines Clinical protocols or practice guidelines consistent with nationally recognized best practices Referral relationships with other providers in the community (including lab, radiology and pharmacy) Standards for medical record keeping Release of information policy Population-based Screening Early identification and treatment Delivery of care consistent with best practices Patient assessment Patient education Patient treatment Patient referral Management of chronic conditions Anticipatory guidance, health promotion and prevention activities Continuity of care Quality assurance Chart review Patient perception that well-being has improved Increasing number of students receiving comprehensive well exam including risk assessment Increasing compliance rates as measured by follow-up visits completed, prescriptions filled, therapy attended, referrals completed. Reduced number of students with disruptive behavior or discipline problems
82
Advances Health Promotion Activities
The school-based health center takes advantage of
its location to advance effective health
promotion activities to students and community.
83
5. Advances Health Promotion Activities 5. Advances Health Promotion Activities 5. Advances Health Promotion Activities 5. Advances Health Promotion Activities
Principles/Goals Structures Processes Outcomes
Serves as a resource to school administration on the selection, development and delivery of health education curricula Participates in classroom-based and school-wide health promotion activities responsive to the risk factors that are prevalent among students Promotes parent and community involvement in health promotion activities Partnership between the schools health education faculty and SBHC staff Coordinated risk assessment and health promotion plan Age appropriate health education materials Delivery of classroom health education segments Display and distribution of multilingual health education materials in SBHC (pamphlets, posters, models, videos, etc.) School-wide health and safety promotional events Increased student awareness of health threats and risk factors Reduced high risk behaviors among students Increased positive health and safety behaviors among students Increased student understanding of important health and psychosocial issues Increased student ability to access valid health information and health promoting products and services Increased student knowledge of health care rights and responsibilities Increased student ability to communicate about and advocate for improved personal health Increased participation of parents in heath promotion activities
84
Implements Effective Systems
Administrative and clinical systems are designed
to support effective delivery of services
incorporating accountability mechanisms and
performance improvement practices.
85
6. Implements Effective Systems 6. Implements Effective Systems 6. Implements Effective Systems 6. Implements Effective Systems
Principles/Goals Structures Processes Outcomes
Ensures compliance with all relevant laws and regulations Develops and measures annual program goals and objectives Maintains a physical plant which is adequate to deliver high quality services and assure patient comfort and privacy Develops all necessary policies and procedures, training manuals, and memoranda of agreement or understanding Develops a human resources system for hiring, credentialing, training and retaining high quality, competent staff Collects, evaluates and reports health outcomes and utilization data Establishes quality improvement practices including but not limited to assessment of patient and community satisfaction Develops strategies and systems to support long-term financial stability Organizational chart Mission statement Goals and objectives Administrative policy and procedure manual Clinical policy and procedure manual Appointment system and scheduling standards Tracking system for missed appointments, follow-up appointments and lab reports Incident reports Staff credentialing Staff training Personnel evaluation and salary review Facility maintenance Strategic business/ marketing/financial plan Billing and collection system Licensing, Certification and/or Accreditation CLIA compliance Medicaid EPSDT compliance Medical record keeping according to accepted standards and demonstrating collaboration and communication among providers Formal quality assurance monitoring of clinical and administrative functions Financial audits Staff knowledge of current laws and regulations affecting delivery of services Treatment for high volume, high risk problems consistent with current professional knowledge High SBHC provider and staff satisfaction Low SBHC provider and staff turnover Increased provider productivity High patient and parent satisfaction with ease of appointment-making and waiting time Operations within budget Eligibility for reimbursement from public and private third-parties
86
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.
87
7. Provides Leadership in Adolescent and Child Health 7. Provides Leadership in Adolescent and Child Health 7. Provides Leadership in Adolescent and Child Health 7. Provides Leadership in Adolescent and Child Health
Principles/Goals Structures Processes Outcomes
Participates in national and local organizations that focus on adolescent and child health Contributes to the body of knowledge on the health care needs of adolescents and children Promotes the School-Based Health Center as a training site for health care professionals Advocates for the resources necessary to increase access to physical, mental and dental health services for adolescents and children Informs elected officials, policy-makers, health professionals, educators, and the community-at-large regarding the unique value, acceptability, efficiency and convenience of the school-based health center model of health care delivery Forms partnerships to develop stable, sustainable funding mechanisms for expanded services Local Conferences National Conferences Journal Articles Annual Reports\ Videotapes Web sites Vehicles to communicate with state and local health authorities Precepting students in the health professions Research Outcome evaluation Process evaluation Clinical trials Medical professional training Curriculum development Public education and advocacy Use of student volunteers Increased public awareness of the health care needs of children and adolescents Greater number of children and adolescents with a medical home Improved access to primary care Increased exposure of health professionals to the SBHC model Legislation and regulation supportive of the SBHC model Increased investment in SBHCs by federal, state, local and private funding sources Increased participation of SBHCs in Medicaid and Child Health Insurance Plans Appropriate contracts with managed care organizations
88
Nut and Bolt 5Developing a Case Statement for a
School-Based Health Center
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Case Statement Content
  • Purpose
  • What you propose to do / what are you seeking
    funding for
  • Summary of needs assessment findings
  • Partners/collaborators and their contributors

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Case Statement Content
  • Service design
  • Model
  • Services
  • Staffing
  • Hours of operation
  • Parent, student, and school staff involvement
  • Community, collaborator/partner involvement

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Case Statement Content
  • Current project support /infrastructure
  • Sponsoring organizations
  • Health center planning group activities
  • In-kind contributions of partners/collaborators
  • Implementation grant possibilities
  • Proposed budget

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Nut and Bolt 6 Using the Media to Your Advantage
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What is the Media?
  • the various means of mass communication
  • considered as a whole
  • including television, radio, magazines, and
    newspapers, together with the people involved in
    their production

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Types of Media
  • Daily Newspapers
  • Weekly Newspapers
  • Wire Services
  • Internet
  • Magazines
  • Television
  • Radio

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Tips for Dealing with the Media
  • Dont be afraid to approach the media with an
    issue or a story idea.
  • Try to keep relationships with the media friendly
    and honest.
  • Remember, the media are doing their jobtry to
    make it easier for them.
  • Access to the media is access to the public.

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Communicating with the Media
  • Be an information resource for the media.
  • Have resources and information to help reporters
    in covering stories.
  • Be familiar with the types of stories each
    publication or station covers and how they report
    the news.

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Role Play in Pairs
  • Phone Call to the Editorial Editor of a Local
    Newspaper

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Technical Assistance Resources for SBHCs
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National Technical Assistance
  • National Assembly on School-Based Health Care
    (NASBHC)
  • Society for Adolescent Medicine (SAM)
  • National Association of Pediatric Nurse
    Practitioners (NAPNP)
  • National Association of Community Health Centers
    (NACHC)

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National Technical Assistance
  • American School Health Association (ASHA)
  • Center for School Mental Health Analysis and
    Action (CSMHA)
  • Center for Health and Health Care in Schools at
    GWU

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State Technical Assistance
  • State Assemblies, Associations, and Coalitions
    for School-Based Health
  • State Health Departments that administer state
    funding for SBHCs
  • State Primary Care Associations
  • State Offices of Rural Health

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National Tools and Resources for Getting Started
  • NASBHC website www.nasbhc.org
  • Basics,
  • Training and Assistance,
  • Publications, and
  • Members Only Sections
  • National Association of Community Health Centers
    (NACHC) CD-Rom, How to Start a Successful
    School-Based Health Center 25 www.nachc.org

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Questions and Complete Evaluations
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