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School-Based Health Care
(SBHC) 101: Nuts and Bolts
Carrie Baker, CAE
Executive Director
Ohio School Based Health Care
Association
www.osbhca.org
[email protected]
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
2
Objectives



Describe the rationale and components
of a case statement for a new schoolbased health center
Utilize resource materials related to
planning, evaluating, financing
List seven principles describing how to
plan and implement a school-based
health centers
3
NUT AND BOLT #1
PRINCIPLES OF SCHOOLBASED HEALTH CARE
Seven fundamental principles
Goals, structures, processes and
outcomes
The School-Based Health Center:
1.
2.
3.
4.
5.
6.
7.
Supports the school
Focuses on the community
Focuses on the student
Provides comprehensive care
Advances health promotion activities
Implements effective systems
Provides leadership in adolescent and
child health
5
Supports the School
6
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.
Responds to the Community
7
The school-based
health center is
developed and
operates based
on continual
assessment of
local assets and
needs.
Focuses on the Student
8
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.
Delivers Comprehensive Care
9
An interdisciplinary team
provides access to high quality
comprehensive physical and
mental health services
emphasizing prevention and
early intervention.
Advances Health Promotion
Activities
1
0
The school-based health
center takes advantage
of its location to
advance effective
health promotion
activities to students and
community.
Implements Effective Systems
1
1
Administrative and clinical
systems are designed to support
effective delivery of services
incorporating accountability
mechanisms and performance
improvement practices.
Provides Leadership in
Adolescent and Child Health
1
2
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.
National Tools and Resources for
Getting Started


The SBHC Roadmap
http://ww2.nasbhc.org/Roadmap/index.html
NASBHC website www.nasbhc.org
 Basics,
 Training and Assistance,
 Publications, and
 Members Only Sections
13
Nut and Bolt #2
Collaboration and Partnerships
14
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
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
16
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.
17
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
18
* Lack of awareness
1
9
Difficult Issues that Undermine
Collaborations

Territorial questions

Conflicting priorities

Confidentiality

Political roadblocks

Financial resources

Certification/
Credentialing
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
20
Establish a Planning Group
Composition Considerations
2
1
• Local health department • Business and community
leaders
• Community or rural health
• Faith community
center
• School superintendent,
• Community and/or
board, or designee
teaching hospital(s)
• Mental health, substance • School administration and
Faculty (school nurse,
abuse, and social service
teachers, principals,
agencies
guidance counselors,
• Private physicians
physical education,
nutrition/food services)
• University faculty
• Students
• Elected Officials
• Parents
Nut and Bolt #3
2
2
Conduct the Needs Assessment
What is a Community Needs
Assessment?
An accurate appraisal of the current
situation (strengths, concerns, and
general conditions) of a community’s
population
A collection of secondary and first hand
information and data from a wide range
of relevant sources and audiences
23
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
24
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
25
expressed community needs
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
26
Planning and Implementing the
Assessment

Step 1: Involve
stakeholders

Establish working group
to guide the planning
and implementation of
Community Needs
Assessments
27
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 don’t you know about these issues? What
questions do you need to answer?
28
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?
29
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
30
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
31 the
advantages and disadvantages. Sometimes a combination of techniques will provide a more reasonable
picture.” (Butler and Howe, 1980)
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 inperson), gather data, identify common
themes
32
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
33
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
34
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
35
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
36
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
37
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
38
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
39
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

40
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
41
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
42
43
REVIEW NEEDS ASSESSMENT
DOCUMENT
44
MAKE RECOMMENDATIONS
Based on Needs Assessment Findings
Select the School






Elementary
Middle or Junior High
K-8
High School
Alternative School
Pre-school
45
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
46
Services to Consider for
All Grade Levels
4
7







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 comanagement
Specialty Care
Referrals
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
48
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
49
health center and school staff
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
50
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
51
52
NUT AND BOLT #4
FUNDING FOR SBHCS
Maslow’s Hierarchy of Need
5
3
It’s hard to focus on
best practice
standards when your
needs are rooted in
basic survival.
School health clinics
fight for lives
Karina Bland
The Arizona Republic
March 12, 2001
Multiple Funding Sources/ Models
for School-Based Health Centers
5
4




Federal grants
State grants
Local funding
Community
partnership
contributions



Foundations
Patient
Revenue
Mixing several
or all funding
sources
BPHC/FQHC (Section 330 of
the Public Health Service
Act)
Title X of the Public Health
Service Act: Family
Planning
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
5
5
Figure 1 School-Based Health Center Funding Models
Federal Public
Grants
State Public
Grants
Foundations
Local
Funding/
Community
Partners
Patient revenue
SCHIP
Medicaid
Private insurance
Patient fees
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)
Local Funding
Public and private grants (e.g.,
universities, United Way)
City/county funds
Local businesses (e.g., banks,
insurance companies)
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
Community partners

In-kind contributions (staff, facilities,
supplies) from
 Schools,
 Hospitals,
 Health
departments, and
 Community
agencies
56
Community partners

Examples of partners
 Parents’
employers
 Parents’
health insurance agencies,
 Local
businesses,
 School
districts, and
 Universities
57
Patient Revenue

SCHIP

Medicaid

Private insurance

Patient fees
58
Follow the Income Streams
Mental
Hlth/Sub
Abuse
Health
Care
Education
Public
Health
59
Funding Service Components

Medical/nursing services

Public health/promotion

Mental health/behavioral health


Case management/social services
coordination
Education support
60
Questions
61
Contact:
Carrie Baker , Executive Director
and/or
Heidi Welch, State Advocacy Director
Ohio School Based Health Care
Association
50 West Broad Street
Suite 1801
Columbus, Ohio 43215
614.222.8502-office
614.441.2323-cell
614.222.8503-fax
www.osbhca.org