Early Prenatal Care by Maternal Race United States, 1984 - 1995

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• WELCOME !

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Healthy Students Developing A School-Based
Health Center
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By the end of our time together today you should
be able to

• Identify the steps involved with opening a
  school-based health center
• Understand the intersection of health and
  education
• Differentiate roles of school nurses and school
  based health center personnel

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Can someone help me with these, Im late for
math class?
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How education improves health

• More education contributes to
• Higher incomes (and the purchase of better food
  and housing, more health care, etc.)
• More skills, knowledge and resources to protect
  health
• More social support and stronger social networks
• Lower rates of unhealthy behavior

J.W. Richardson, PhD
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How better health contributes to school
achievement

• Healthy children and young people
• Attend school more
• Pay attention to what goes on in classroom
• See, hear and understand the teacher
• Focus more on education as a goal

J.W. Richardson, PhD
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• You cannot educate a child who is not healthy
  and you cannot keep a child healthy who is not
  educated.
• Jocelyn Elders
• Former Surgeon General

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The virtuous circle of education and health

• Freudenberg

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The Health-Academic Outcomes Connection

• Graduation
• GPA
• Standardized test scores

Health Risk Behaviors
Educational Outcomes

• Substance use
• Mental health
• Poor diet
• Intentional injuries
• Physical illness
• Self-esteem
• Sexual behaviors

SBHCs

• Attendance
• Dropout Rates
• Behavioral Problems

Educational Behaviors
Source Geierstanger, S. P., Amaral, G. (2004).
School-Based Health Centers and Academic
Performance What is the Intersection? April 2004
Meeting Proceedings. White Paper. Washington,
D.C. National Assembly on School-Based Health
Care.
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Freudenbergs Seminal Article
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School failure is a public health concern

Source Freudenberg N, Ruglis J. Reframing school
dropout as a public health issue. Prev Chronic
Des 20074(4). http//www.cdc.gov/ped/2007/oct/07
_0063.htm
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Education Elixir

Source Freudenberg N, Ruglis J. Reframing school
dropout as a public health issue. Prev Chronic
Des 20074(4). http//www.cdc.gov/ped/2007/oct/07
_0063.htm
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• Health Care in Schools

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Continuum of Health Care Services in Schools
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SBHC Partnerships School Nurses

• Source NASBHC Census 2004-2005

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School Nursing Health Services

• HEALTH CARE
• Promote high quality school health services to
  all children within the community
• HEALTH EDUCATION
• Support the educational process
• COLLABORATION OF PUBLIC HEALTH CARE
• Link the school health service program to all
  aspects of the health care delivery system that
  serves children and their families.

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School Nurses

• On average
• 98 of the student body are seen annually, and
  80 are seen 4 or more times.
• 93 of students return to class following a
  school nurse visit.
• 50 - 100 students per day seen for acute and
  chronic health care needs.
• 15 30 school staff per day seen for acute and
  chronic health care needs.
• 80 of the student body access school nurses
  office for
• mandated state screenings.
• 50 student access school nurses office for
  medication
• administration.

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School Nurses

• Assess for new onset illnesses and for chronic
  diseases such as asthma and diabetes
• Refer to the students primary care provider or
  to the school-based health center for
  immunization follow up, diagnosis and treatment
  plan
• Provide health education and support for
  preventative and confidential health care
  concerns

• Assess
• Refer
• Provide health education and support

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School Nursing Services

• Assessments and treatment of students, staff and
  even visitors as needed
• Physical/Psychological/Behavioral health
  conditions with referrals to primary care
  providers, E.R. services, and/or counseling
  services
• Reassurance/Supportive care
• the school nurse offices are safe places for
  students
• Education
• Providing nursing coverage in each building
  allows students to attend school regardless of
  health conditions. Enabling ALL Fitchburg
  students to be prepared and ready to learn.
• Resources for health education and/or health
  careers
• Connections and coordination to primary care
  practices and health insurance
• Modeling of positive health practices
• Hand washing, nutrition, physical activity, and
  continued learning.

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School Nursing Mandated Screenings

• Vision
• 4,677 students screened
• 979 referred
• Hearing
• 4596 students screened
• 247 referred
• Postural Screening
• 1,789 students screened
• 52 referred

• Heights and Weights
• 3,274 students screened
• BMIs for grades 1,4,7, 10
• 1417 students screened
• 51 students within normal BMI range
• 49 outside of normal BMI range

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Health Conditions

• 37 of our students have Special Health Care
  Needs requiring nursing intervention (compared to
  2007-2008 ESHS schools 24)
• Special Health Care needs are defined as those
  that require health and related services of a
  type or amount beyond those required by children
  generally
• Life threatening allergies
• Arthritis
• Asthma
• Blood dyscrasias
• Cancer
• Cardiac conditions
• Diabetes
• ADHD
• Depression
• Migraine headaches
• Neurological conditions
• Eating disorders
• Mental Health/Emotional issues

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Health Procedures

• Health / Nursing Procedures include
• Blood Glucose Testing
• Blood Pressure monitoring
• Catheterizations
• Tube Feedings
• Nebulizer treatments
• Wound Dressing changes
• Otoscopic Exam
• Many Others

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Communications

• Parent/Guardian communications about individual
  health issues 8,650 865 per month
• (typical ESHS districts reporting 550.8
  communications per month)
• Staff communication regarding student health
  issues 2,637 263.7 per month
• (typical ESHS districts reporting 297 meetings
  per month)
• Communication with Health Care Providers and/or
  agencies 601 60.1 per month
• (typical ESHS districts reporting 25.8
  communications per month )
• Phone calls regarding IEPs and 504 Plans
  86 8.6 per month
• (typical ESHS districts reporting 15.1 meetings
  per month)

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Health Care Today is influenced by

• Family structure changes
• Family employment status
• Diverse cultural and linguistic ethnicities
  within our community
• Increase in complex health conditions
• Severity of illness and special health care
  needs
• Insurance coverage

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Differentiated/Coordinated Health Services
School Nurses and School-Based Health Centers
(SBHC)
SBHC Comprehensive Risk Resiliency
Assessment Conduct laboratory tests (i.e.
strep, ear infection) Diagnose, establish
treatment plan if necessary medication
prescription as needed
School Nurse Relationship Building/
Initial Assessment Refer to SBHC/Primary Care
Provider Carry out treatment plan Continued
follow up/Reassessment
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• What is a School-Based Health Center?

Accessible, Convenient, Consistent Confidential
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School-Based Health Centers

• School and community health partnerships
• On-site primary and mental health services
• Accessible comprehensive health care to
  underserved populations

Outcome Decreased time out of school
increased time on learning
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School-Based Health Centers

• With permission from parent, provide quality
  comprehensive health care services
• Collaborates with the school administration and
  school nurse to maximize utilization of health
  care services available. Including scheduling
  appointments to maximize students time in the
  classroom.
• On site enrollment into eligible health care
  programs
• Cost effective delivery site

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Elm Park Community School - Worcester
Rogers Middle School Lowell
Taunton High School
Lowell High
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• Steps to Opening a School-Based Health Center

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• 1
• Create A
• Pre-Planning Team

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Planning Committee

• Fitchburg Public School Superintendent
• Lead School Nurse
• State Legislator
• Community Health Connections, Inc Staff
• Massachusetts Coalition of School-Based Health
  Centers

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• 2
• Create A
• Planning Team

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Planning Committee

• Fitchburg Public Schools
• HealthAlliance Hospital
• State Legislators
• Massachusetts Coalition of School-Based Health
  Centers
• CAVU Foundation
• Community Health Connections, Inc

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Role of the Planning Committee

• Create strategic development and implementation
  plan
• Monitor the process
• Engage Key Stakeholders
• Establish An Advisory Committee

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Role of the Planning Committee

• Conduct Surveys
• Identify the Financial Feasibility
• Assist with School Board Approval
• Support the Physical Infrastructure Licensure
  Processes
• Share information and make recommendations to the
  Advisory Committee

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• 3
• Create A
• Timeline

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Create A Timeline
Date Activity Person(s) Responsible Status
May 1,2008 Hire Project Coordinator SBHC Planning Committee Complete
June July 2008 Develop Advisory Committee SBHC Planning Committee / Project Coordinator Complete
August 2008 Develop message to key stakeholders recruitment of Advisory Board Project Coordinator/ SBHC Planning Committee/ Advisory Committee Complete
August - September 2008 Develop Data Collection Tools Project Coordinator/ SBHC Planning Committee Complete
September 2008 Advisory Board meetings begin Project Coordinator/ SBHC Planning Committee Date set 9/18/08
September - December 2008 Administer Surveys Project Coordinator Date set 9/25/08
January 2009 Analyze Share Survey Responses Project Coordinator TBD
January February 2009 Determine sustainability by examining funding sources and projected revenues and expenses Project Coordinator/ Project Manager /CFO of CHC, Inc. TBD
February April 2009 Develop and implement communication plan to key stakeholders Project Coordinator/ Advisory Committee TBD
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• 4
• Create An
• Advisory

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Advisory Committee Members

• Advisory Committees are essential in guiding the
  development of School-Based Health Center
  services including a school and community
  perspective.
• The Advisory Committee should have a diverse
  representation of the community including
• sponsoring health agency, participating school,
  clergy, community based agency representatives,
  municipality staff, parents/PTO members and
  students.

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What is the Role of the Advisory Committee

• To provide guidance around the development and
  operation of the School-Based Health Center
• Identify services offered both on and off-site
• Provide feedback make recommendations
• Establish the Mission Vision of the
  School-Based Health Center
• Serve as Ambassadors of the School-Based Health
  Center at school and community meetings

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Advisory Committee Meetings

• Initially meet monthly to proactively address its
  responsibilities
• Mission Vision statements, progress review
  feedback discussion with Planning Committee,
  engaging support with School Committee, etc.
• Advisory Committee will help determine the
  meeting schedule that best suits their calendars.
• Planning Committee representatives will
  coordinate meetings, take notes, and provide
  minutes.

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• 5
• Conduct Needs Assessments Surveys

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Resource Mapping
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• 6
• Establish Vision Mission

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Fitchburg High Schools School-Based Health
Center Vision Statement

• Our Vision is that all Fitchburg High School
  students will have health care.

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Fitchburg High Schools School-Based Health
Center Mission Statement

• Our Mission is to provide access to complete,
  consistent and comprehensive health care to all
  Fitchburg High School students, responsive to a
  culturally and linguistically diverse population,
  partnering with students to make healthy
  decisions, provided in a safe and caring
  environment, to improve student engagement in
  their learning.

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• 7
• Identification of Suitable Space and Location
  Options

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Fitchburg High School SBHC LOCATION

• FHS SBHC expansion within the Nursing Station
• The strongest School-Based Health Center is
  usually co-located within the Nursing Office.
• At Fitchburg High Schools Nursing Office the
  basic floor-plan would remain in-tact utilizing
  an unused exam room with minor renovations to
  include dirty utility, NP office staff space.
• The caveat with this lay-out is the need of a DPH
  waiver to accept Behavioral Health Counseling
  space down the hall in the Guidance Dept. meeting
  space.

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Fitchburg High School SBHC LOCATION

• The benefits of partnering the 2 units (nursing
  dept. the SBHC) in the space together
• Staff connectivity/awareness
• Stronger student support services
• Stronger student accessibility to the SBHC.
• SBHC Sustainability

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• 8
• Work with Community Physicians

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• 9
• Work with School Committee

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• 10
• Renovation Planning

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Fitchburg School-Based Health CenterSketch
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• 11
• Maintain Communication

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Take Home Message

• As an school committee member or school
  superintendent YOU can contribute towards meeting
  the health and educational needs of adolescents

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School-Based Health Center Resources

• MA Coalition of School-Based Health Centers
  www.mcsbhc.org
• National Assembly on School-Based Health Care
  www.nasbhc.org
• Center for Health and Health Care in Schools
  www.healthinschools.org
• Center for School Based Health, Bureau for
  Primary Health Care, HRSA www.bphc.hrsa.gov

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Questions?
Selena K. Johnson Director of School Community
Initiatives Community Health Connections Family
Health Centers Fitchburg Gardner Leominster
ACTION 275 Nichols Road, Fitchburg, MA
01420 Office 978-878-8308 E-mail
selenajohnson_at_chcfhc.org
Pamela Rivers RN, MPH, NCSN Nurse Leader
Fitchburg School District 140 Arnhow Farm Road
Fitchburg, MA 01420 Phone [phone] Email
riversp_at_fitchburg.k12.ma.us 

• Antonia M. Blinn, Program Director
• MA Coalition of School-Based Health Centers
• Office 617-988-2243
• ablinn_at_mcsbhc.org

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Thank You