Transcript Nuts and Bolts presentation

School-Based Health Care
(SBHC) 101: Nuts and Bolts
Laura Brey, MS
Tammy Alexander, M.Ed.
NASBHC Training of Trainers
April 21-23, 2008
Participant Expectations
Complete the index card and
hand it in.
2
Introductions
Presenters:
Tammy Alexander
Laura Brey
3
Getting to Know Participants




Type of agency
Community setting
Role in agency
School population, if
known
4
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

5
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

6
Nut and Bolt #1
Collaboration and Partnerships
7
Collaborative Partnerships

A mutually
beneficial and welldefined 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

9
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.

10
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

11
Difficult Issues that
Undermine Collaborations

Territorial
questions

Conflicting
priorities

Confidentiality

Political roadblocks

Certification/Crede
ntialing

Financial resources
12
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.

13
Establish a Planning Group
Composition Considerations
• Local health department
• Community or rural health
center
• Business and community
leaders
• Faith community
• Community and/or
teaching hospital(s)
• School superintendent,
board, or designee
• Mental health, substance
abuse, and social service
agencies
• School administration and
Faculty (school nurse,
teachers, principals,
guidance counselors,
physical education,
nutrition/food services)
• Private physicians
• University faculty
• Elected Officials
• Students
• Parents
14
Role Play - Meeting with
Partners / Collaborators
15
Nut and Bolt #2
Conduct the Needs Assessment
16
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.
17
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.
18
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
19
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
20
Planning and Implementing the
Assessment

Step 1: Involve stakeholders

Establish working group to guide the
planning and implementation of
Community Needs Assessments
21
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?
22
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?
23
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
24
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)
25
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
26
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
27
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
28
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
29
Planning and Implementing the
Assessment (cont)
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
30
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
31
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
32
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


33
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
34
Planning and Implementing the
Assessment (cont)
Step 5: Implement Plan

Collect secondary data

Collect primary data (conduct interviews, focus
groups, surveys, etc)

Analyze secondary and primary data

Summarize findings
35
Planning and Implementing the
Assessment (cont)
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
36
Review Anytown’s Needs
Assessment Document
37
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)
38
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
39
Make Recommendations
Based on Needs Assessment
Findings
40
Select the School
Elementary
 Middle or Junior High
 K-8
 High School
 Alternative School
 Pre-school

41
Select the Service Delivery Strategy
and Model

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






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
42
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 comanagement
Specialty Care
Referrals
43
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
44
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
45
Parental Consent/ Parental
Engagement

The majority of SBHCs have a parental 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
46
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
47
Nut and Bolt #3
Funding for SBHCs
48
Maslow’s Hierarchy of Need
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
49
Multiple Funding Sources/
Models for School-Based Health
Centers




Federal grants
State grants
Local funding
Community
partnership
contributions



Foundations
Patient
Revenue
Mixing several
or all funding
sources
50
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
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
51
Federal public grants

BPHC /FQHC (Section 330 of the Public
Health Services Act)

Title X of the Public Health Services Act:
Family Planning
52
Core Funding Models
Federal

330 Federally Qualified Health Centers
Entirely federally dependent
Fairly stable
Limited community
Limited funds for expansion
53
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
54
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)
55
State public grants

State Funding
– State General Revenue
– Tobacco Tax Settlement
– Juvenile Justice Funds
56
Core Funding Model
State Grants

Louisiana – MCHBG; Tobacco
settlement

Connecticut – MCHBG, state fund

Delaware – state fund
 Fairly stable
 Limited growth; targeted funding
 Requires legislative/administrative advocacy
57
Local Funding

Public and private grants
(universities, United Way

City and county funds

Local businesses (banks, insurance
companies)
58
Core Funding Models
Local Government

Portland/Multnomah County (OR)

Seattle/King County (WA)
Great community buy in
Fairly stable income
59
Community partners

In-kind contributions (staff, facilities,
supplies) from
– Schools,
– Hospitals,
– Health departments, and
– Community agencies
60
Community partners

Examples of partners
– Parents’ employers
– Parents’ health insurance agencies,
– Local businesses,
– School districts, and
– Universities
61
Core Funding Models
Community 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
62
Foundations

Robert Wood Johnson

WK Kellogg Foundation

KB Charitable Trust

Health Foundation of Greater
Cincinnati

McDonald Foundation

Welborn Foundation
63
Foundations

For other foundation funding
opportunities visit
– The Grantsmanship Center at
http://www.tgci.com
and
– The Foundation Center at
http://fdncenter.org
64
Core Funding Models
Foundations

Indianapolis SBHCs

Cincinnati, Ohio SBHCs

North Carolina SBHCs

Miami SBHCs
65
Patient Revenue

SCHIP

Medicaid

Private insurance

Patient fees
66
Core Funding Model
Patient Revenue

West Virginia – FQHC rate

New York – Medicaid institution rate
Commitment to specific sponsor type
Leadership necessary at Medicaid level
67
Mixed Funding Sources

Denver School-Based Health Centers

Baltimore County School-Based Health
Centers

Healthy Kids Centers

Indianapolis Collaborative
68
Follow the Income Streams
Mental
Hlth/Sub
Abuse
Health
Care
Education
Public
Health
69
Funding Service
Components

Medical/nursing services

Public health/promotion

Mental health/behavioral health

Case management/social services
coordination

Education support
70
Technical Assistance
Resources for SBHCs
71
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)
72
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
73
•Figure 2 National Assembly’s Trainings, Tools, and Resources for SBHCS
•STDs/HIV Prevention
•CQI tool sentinel condition
•Quality improvement collaborative
•Conference call presentations
•Obesity/Cardio Health
•Conference call presentation
•Continuing Education
•Panel work group
•Health Education
•Web-based tools and information
•Parent Engagement
•Web-based tools and information
•Practice Management Improvement
•Web-based tools and information
•Continuing education
•Evaluation Measures
•Academic Outcomes
•Productivity
•SBHC Census
•Mental Health Evaluation Template
•Asthma
•Green Zone web-based tool kit
•CQI tool sentinel condition
•Center work group
•
•
•
•
Web-based resources
Conference call presentations
Continuing education programs
Quality improvement collaboratives
•New SBHCs/Expansion
•Peer-to-peer exchange
•Conference call presentations
•Web-based tools and information
•New SBHC Expansion
•Peer to peer exchange
•Conference call presentations
•Web-based tools and information
•Mental Health Intervention
•CQI tool sentinel conditions
•Continuing education
•Quality improvement collaborative
•Center work groups
•Conference call presentations
74
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
75
Nut and Bolt #4
Developing a Case Statement for
a School-Based Health Center
76
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
77
Case Statement Content

Service design
– Model
– Services
– Staffing
– Hours of operation
– Parent, student, and school staff
involvement
– Community, collaborator/partner
involvement
78
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
79
Nut and Bolt #5
Using the Media to Your Advantage
80
What is the “Media”?
 “Media” encompass both print and
broadcast news organizations.

Print media includes daily and weekly
newspapers, news wires, and magazines.

Broadcast media includes television and
radio.
81
Types of Media

Daily Newspapers

Magazines

Weekly
Newspapers

Television

Radio

Wire Services

Internet
82
Tips for Dealing with the
Media

Don’t 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 job—
try to make it easier for them.

Access to the media is access to the public.
83
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.
84
Role Play in Pairs
Phone Call to the Editorial
Editor of a Local Newspaper
85
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 SchoolBased Health Center $25
www.nachc.org
86
Questions and Complete
Evaluations
87