Transcript School-Based and School-Linked Health Centers

School Resource Officers and the
School-Based Health Center
STEPHANIE S. DANIEL, PH.D.
PROFESSOR, DEPT. OF FAMILY AND
COMMUNITY MEDICINE, WAKE FOREST
SCHOOL OF MEDICINE
PRESIDENT, BOARD OF DIRECTORS
NORTH CAROLINA SCHOOL-BASED HEALTH
ALLIANCE
EXECUTIVE DIRECTOR
SCHOOL HEALTH ALLIANCE FOR FORSYTH
COUNTY
OCTOBER 14, 2015
Objectives
2
 Briefly define school-based health centers and
summarize school-based health center
outcomes and benefits
 Provide an overview of The School Health
Alliance for Forsyth County (SHA)
 Describe current programs and services of the
School Health Alliance (SHA) for Forsyth
County
Definition of School-Based Health Centers
3
 SBHCs are partnerships created by schools and
community health organizations to provide on-site
medical and mental health services that promote the
health and educational success of school-aged
children and adolescents
 SBHC providers work collaboratively with other
service providers in the school and community
 SBHC are typically staffed by an interdiscplinary
team of medical and mental health professionals that
provide medical, nutrition, mental health, and health
education services
Definition of School-Based Health Center
4
 A health center located on a school campus (school-based) or
affiliated with schools in the community (school-linked)
 Require parents to sign written consents for their children to
receive the services offered by the health center
 Monitored by an Advisory Committee to ensure compliance
with standards, evaluate services offered, and make policy
recommendations
 SBHCs are supported by local, state, and federal public
health and primary care grants, community foundations,
students and families, and reimbursement from public and
private health insurance
Definition of School-Based Health Center
5
 SBHC services can include:
1.
Well-child visits or care including immunizations
2.
Primary care for acute and chronic health conditions
3.
Mental health services
4.
Substance abuse services
5.
Case management
6.
Dental health services
7.
Nutrition education
8.
Health education and health promotion
Rationale for School-Based Health Center
Services as “Best Practice”
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 SBHCs increase children and adolescent’s access to health
and mental health services and overcome many of the
barriers (e.g., financial/economic, transportation, cultural,
geographic, and other family circumstances) associated
with getting health/mental health services
 School-based health centers provide services to students,
regardless of their ability to pay
 Decreased stigma associated with receiving services in
SBHCs relative to community health centers/providers
(students are 10-21 times more likely to come to a SBHC for
mental health services than a community health center or
other community provider)
Rationale for School-Based Health Center
Services as “Best Practice”
7
 Unmet mental health needs and physical health problems are
substantial barriers to school learning and academic success for
children and adolescents (Brown and Bolen, 2008).
 SBHCs are widely recognized as a critical resource for evaluation
and treatment of mental (and physical) health needs among
school children and adolescents (Taras and H.L., 2004; Kopec,
Randel et. al., 2010; Pediatrics 2012)
 SBHCs offer quality health and mental health services and are
recognized for using an integrated strategy for addressing health
and mental health issues
 SBHC services provide an opportunity for early identification
and treatment of health and mental health problems and
concerns
State and National Associations for SBHC
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 State-North Carolina School-Based Health Alliance
(NCSBHA)
 National-National School-Based Health Alliance:
http://www.sbha4all.org
 Both organizations advocate for policies, programs,
and funding to expand and strengthen SBHCs, while
also supporting the SBHC movement with training
and technical assistance
9
North Carolina is currently home to over 90 school
health center sites serving 25 of NC’s counties.
SBHC Outcomes and Benefits
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 Improved academic functioning and success
1.
2.
3.
4.
5.
Decrease in absenteeism/Increase in attendance
Decrease in tardiness
More likely to stay in school/graduate
Higher ratings of academic expectations, school
engagement, and safety and respect relative to
schools without a SBHC
Declines in discipline referrals (85% decline in
Dallas for students who received mental health
services in a SBHC)
SBHC Outcomes and Benefits
13
 Cost-Savings
1.
2.
3.
4.
5.
Reduced inappropriate emergency room use
Reduction in hospitalizations
Reduction of after-hours care/visits
Reduction in Medicaid expenditures
Significant increase in health care access by
students who used SBHC (71%) compared to
students without access to a SBHC (59%)
Overview of the SHA
14
 The School Health Alliance for Forsyth County is a
partner and supporting organization to the WinstonSalem/Forsyth County Schools (WS/FCS).
 We work in collaboration with local health and human
service agencies, parents, and educators to serve our
WS/FCS students.
 As a non-profit, tax exempt organization, we are
committed to improving child and adolescent physical
and mental health in Forsyth County through health
system changes and the development of new health
services with the end goal of achieving both positive
health and educational outcomes for our WS/FCS
students.
Forsyth County’s SBHC History
15
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Spring 1997- Forsyth County School Health Initiative received RWJF grant
March 1998- Independence High School SBHC opened (Total Care Center)
April 1999- Mineral Springs Elem. & Middle School SBHCs opened (Bulldog)
Dec. 1999-School Health Alliance for Forsyth County nonprofit formed
August 2001- Ashley Elem. & Atkins Middle School Wellness Centers opened
June 2003- Independence High School and SBHC closed
August 2003- Enhanced mental health model opened at North Forsyth High School
April 2005- Meadowlark Elem. & Middle School Wellness Centers opened
June 2009- Meadowlark Elem. & Middle school Wellness centers closed
Dec. 2009- Mental Health Consultation Clinic at WSPA opened, serving students > 10
June 2010- North Forsyth High School enhanced MH model closed
August 2011- Mental health Consultation Clinic at WSPA expanded to serve students ages 5
to 9
August 2011-School-Based Social Work Program started to provide mental health
screenings at all WS/FCS and mental health treatment at 19 new schools in Forsyth County
September 2013-Mobile Medical Unit
Overview of the SHA
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 Our mission is to improve the ability of students to
learn by improving the health and safety of Forsyth
County’s school-age children and adolescents
through the provision of direct services and by
coordinating and targeting the efforts and resources
of all types of community health care providers.
Overview of the SHA
17
 As of January, 2004, the SHA also serves as the
School Health Advisory Council (SHAC) for
WS/FCS, providing guidance on policy issues that
affect students’ health, in accordance with North
Carolina statutes.
 Since assuming the role of SHAC, the SHA has also
become a forum for addressing community health
issues relevant to school-aged children and
adolescents and developing health policy
recommendations for WS/FCS.
Current SHA Programs
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 The SHA currently operates and evaluates health centers
representing 5 models of school-based health care:
1) A comprehensive health center serving Mineral Springs
Elementary School and Mineral Springs Middle School,
providing medical and nursing care, mental health care,
and nutrition services to enrolled students;
2) Wellness centers serving Ashley Elementary and
Winston-Salem Preparatory Academy at Atkins,
consisting of a registered nurse and a licensed clinical
social worker, working together;
Current SHA Programs
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3)
4)
5)
A mental health consultation clinic (MHCC), providing psychiatric
consultation, care planning, and therapy services for children
referred by school personnel, juvenile justice, or primary care
providers;
School social workers providing mental health assessment and
treatment services on site at designated schools (SHA School-Based
Social Work Program).
A mobile medical unit (MMU) at Carver High School, North Hills
Elementary, Main Street Academy, and Parkland High School
providing medical care and mental health screening for enrolled
students with the goal of connecting/reconnecting students to their
primary medical and/or mental health home. MMU is operated in
partnership with WSSU, Northwest Community Care Network
(NCCN), and Downtown Health Plaza (DHP)
Current SHA Programs
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6) Cross County Collaborative (use of Adolescent
Questionnaire/Rapid Assessment for Adolescent
Preventive Services-RAAPS)
Number of Schools in the WS/FCS District
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As of February 25, 2015
 Elementary – 43
 Middle – 14
 High – 15
 Non-Traditional/ “Special Schools” – 9
 Total of 81 schools, serving 54,000 students
SHA Evaluation and Research
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 In order to measure whether the SHA has
accomplished its mission and to inform quality
improvement efforts, the SHA has an evaluation and
research plan, approved each year by the SHA Board
of Directors. This plan is developed and carried out
by the SHA evaluation team.
EVALUATION DATA FOR SHA PROGRAMS
We review and summarize the following data:
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8.
9.
Referral sources
Demographics and psychiatric diagnoses
Service utilization
Vanderbilt Assessment Scale (Teacher Reports)
Strengths and Difficulties Questionnaire (SDQ) Parent and Youth
report
School grades, attendance and discipline data
Program Satisfaction Data (Parent, Youth, Teacher and Provider
Reports)
Risk Assessment Data (Adolescent Questionnaire/RAAPS/PHQ-9A)
Program Specific Outcomes
Other Evaluation Efforts for the SHA
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 Examples of other data collection tools and efforts
used by the SHA (past and current):
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Pediatric Symptom Checklist
CRAFFT
CAFAS (Child and Adolescent Functional Assessment Scale)
Child Behavior Checklist
Medicaid Claims data (e.g., Emergency room visits,
hospitalizations, connecting/reconnecting with a medical
home)
Productivity by Site/Program Over Time All Sites
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SY
2006/2007
SY
2007/2008
SY
2008/2009
SY
2009/2010
SY
2010/2011
SY
2011/2012
SY
2012/2013
# Users
2,024
1,882
1,904
1,538
1,393
1,541
1,536
# Visits
7,903
7,978
7,214
7,939
7,214
7,592
7,236
# Immunizations
468
905
1,280
1,632
1,153
1,345
1,192
# Risk Screenings
729
788
761
14,955
1,148
1,152
1,053
2,162
2,149
2,020
3,016
2,350
2,473
2,026
All Sites Combined Totals
# Mental Health Visits
Unique Visits by Site by Visit Type
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Unique
Visits
by Site
Mineral
Springs
Student Health
Center
WinstonSalem
Preparatory
Academy
Wellness
Center
Ashley
Wellness
Center
Mental Health
Consultation
Clinic Ages
5-9
Mental Health
Consultation
Clinic Ages
10-19
School-Based
Social Work
Program
Visit Type
FY12
FY13
FY12
FY13
FY12
FY13
FY12
FY13
FY12
FY13
FY12
FY13
Medical
2,788
2,631
545
744
1,004
1,066
24
0
136
90
0
0
Mental
Health
1,055
926
380
343
465
351
112
155
355
318
728
612
Total
Count
3,843
3,557
925
1,087
1,469
1,417
136
155
491
408
728
612
All Sites Combined Visits by Type
Visit Type
FY12
FY13
Medical Visits
4,497
4,531
Mental Health Visits
3,095
2,705
Total Count
7,592
7,236
Mineral Springs Student Health Center
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Winston-Salem Preparatory Academy
Wellness Center
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Ashley Elementary Wellness Center
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School Health Alliance for Forsyth County Staff
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Stephanie Daniel, Ph.D., Executive Director
Leigh Howell, M.D., Medical Director
Sheila Whisenant, MHCC Coordinator and Mobile Medical Unit Coordinator
Palmer Edwards, M.D., MHCC Psychiatrist
Matthew Hough, D.O., MHCC Psychiatrist
Karen Virga, R.N., Clinic Nurse
Maureen Haynes, R.N., Clinic Nurse
Michelle Butler, NP, Mobile Unit Nurse Practitioner
Michael Pesce, LCSW, WS/FCS Director of Social Work Department, and SHA
School-Based Social Work Program
15 LCSWs (SBSWP)
Ron Lean, Ph.D., LCSW, Mental Health Provider
Karen Pearson, LCSW, Mental Health Provider
Tracy Bradshaw, Practice Manager
Pamela Benton, Medical Office Assistant
Lisa Rankin, Medical Office Assistant
Becky Butcher, Medical Office Assistant
Katie Catton, M.A., ADHD Project Assistant
Andrew Mayfield, MMFT, Evaluator
Lyn Treadway, M.A., Evaluator
Current Partner Organizations/Agencies
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 Winston-Salem/Forsyth County Schools
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Administration – Faculty – PTA Council – Food Services
Wake Forest School of Medicine
 Dept. of Pediatrics
 Dept. of Family and Community Medicine
 Dept. of Psychiatry
Northwest Community Care Network
CenterPoint Human Services
Forsyth County Department of Public Health
Forsyth-Stokes-Davie County Medical Society
Wake Forest Baptist Medical Center (Downtown Health Plaza)
UNCG, Dept. of Nursing and Dept. of Social Work
UNCG, Dept. of Social Work
WFU, Counseling Department
Winston-Salem State University
The Need for Services: Child and Adolescent
Mental Health Problems and Concerns
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 21% of children and adolescents in the U.S. meet
diagnostic criteria for MH disorder with impaired
functioning
 16% of children and adolescents in the U.S. have
impaired MH functioning and do not meet criteria
for a MH disorder
 13% of school-aged, and 10% of preschool children
with typical functioning have parents with
“concerns”
 50% of adults in the U.S. diagnosed with MH
disorders had symptoms by the age of 14 years
The Need for Services: Child and Adolescent
Mental Health Problems and Concerns
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60%
50%
40%
30%
20%
10%
0%
Meet
Have Impaired School Aged
Preschool
Adults in US
diagnostic
MH
children
children
had symptoms
criteria for
functioning parents have parents have by age 14 years
MH disorder
concerns
concerns
Symptom Onset and Treatment Seeking
34
 Researchers supported by the National Institute of Mental
Health (NIMH) have found that:
 Half of all lifetime cases of mental illness begin by age 14;
 Despite effective treatments, there are long delays —
sometimes decades — between first onset of symptoms and
when people seek and receive treatment; and
 An untreated mental disorder can lead to a more severe, more
difficult to treat illness, and to the development of cooccurring mental illnesses.
See Ronald Kessler, Ph.D., et.al., (2005). Archives of General
Psychiatry, June 6th Issue.
North Carolina Demographics
35
 1.5 million public school student in North Carolina
(includes Charter School students)

One of the largest school systems in the country
 180 thousand school personnel
 115 school systems
Students with Mental Health Issues
The chart below shows the number of students with a
known diagnosis as reported by school nurses from
the N.C. Annual Report of School Health Services.
Elementary
Middle
High
Total
2011-2012
Mental Health Issues
5,111
3,530
4,038
12,679
2012-2013
Mental Health Issues
6,582
5,988
8,259
20,829
NC Students with Known Suicide Attempts and
Deaths 2011-2013
Suicide
attempts by
grade level
Deaths from
suicide
Deaths from
homicide
High 11-12
264
15
8
High 12-13
318
32
5
Middle 11-12
99
3
3
Middle 12-13
127
4
2
Elem 11-12
29
1
1
Elem 12-13
37
1
4
Questions and Contact
Information
38
SCHOOL HEALTH ALLIANCE FOR FORSYTH
COUNTY
OFFICE PHONE: 336-713-7188
(TRACY BRADSHAW, PRACTICE MANAGER)
EMAIL: [email protected]
STEPHANIE DANIEL, PH.D.
EXECUTIVE DIRECTOR
OFFICE PHONE: 336-716-1839
[email protected]