SBHC Best Practices – Telling our story with data WV Back to School Workshop Paula Fields, MSN, BSN, RN Senior Program Manager School-Based Health Alliance pfields@sbh4all.org www.sbh4all.org Good morning! and thanks for joining this session. Today we are going to discuss how we can make the most compelling case for school-based health care, and how you can be a part of it.

Objectives The participant will have an increased understanding of the importance of the National SBHC Census and Quality Counts The participant will be able to describe the five National SBHC Performance Measures The participant will be able to give four examples of successful implementations of SBHC best practices related to performance measures

Brief Overview – School-Based Health Alliance The Alliance has been around for over 20 years and works to improve health status of children by advancing and advocating for School-Based Health Care. We work to improve the health status of children through our goals which are to increase the number of SBHC programs across the country and assure they deliver the highest quality of care. John Schlitt, President http://www.sbh4all.org

State Affiliates – Fun Fact Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Illinois Louisiana Maine Maine Maryland Michigan New Mexico New York North Carolina Ohio Oregon Washington West Virginia The School-Based Health Alliance is privileged to work with a group of state organizations that share our vision. While our focus is on the national level, these affiliate organizations represent the school-based health care movement at the state and local levels. Do you know that WV was a founding member of the SBHA (formerly called NASBHC)? I’m guessing there are a few founders in the room? In WV, John Kennedy is the SBH Coordinator with the WVPCA and is the state affiliate contact.

Growth of SBHCs, 1987-2016 So let’s start with some good news (it feels fairly rare these days). The number of SBHCs is growing. We’re reaching toward 3,000+ SBHCs nationally and more children and adolescents are accessing primary care and behavioral health care (among other services) at school.

Could someone help me with these? I’m late for math class. But young people across the US face numerous challenges. In your health centers, you witness children and adolescents who are exposed to stressors that lead to disparities in health and education outcomes. These are the kids you see every day. They arrive to school carrying burdens such as hunger, food insecurity, chronic stress, and homelessness. These health disparities related to inadequate food access, low physical activity, and teen pregnancy ALL impact student achievement. They lead to poor attendance and drop out AND depression, substance use, and obesity. Schools and health care systems are being asked take on this complexity and to do a better job. And increasingly finding that when schools and healthcare systems work collaboratively they can lift children's health and education outcomes at the same time.

Tell a compelling story with data And while we have exciting successes and have been recognized for this hard work, the challenges for SBHCs are real. If we want to continue to sustain and grow the school-based health care model, especially in this new environment, we are going to need really strong data to show the impact we are having on children’s lives. Today I am going talk about the Alliance’s current efforts that will help us tell that compelling story of SBHCs with data. Data that conveys the hard work you do everyday; the comprehensive care that you provide that helps children lead better lives.

National Quality Initiative – Quality Counts! School-Based Health Care Census National Quality Initiative – Quality Counts! These two opportunities are the National School-Based Health Care Census and the National Quality Initiative. The first may be more familiar to school-based health veterans in the room, but the second is likely newer to many of you.

WHAT IS THE CENSUS OF SBHCs WHAT IS THE CENSUS OF SBHCs ? The National School-Based Health Care Census is a survey conducted by the School-Based Health Alliance to collect valuable information on the school-based health care field. The first census was completed in 1985, so we build on a really rich 30-year history of data collection in our field. The Census collects data on SBHC locations, staffing models, services provided, populations served, and funding sources. These data are vital to demonstrating the breadth and impact of SBHCs nationwide. They are used to advocate for SBHCs and help describe the hard work SBHCs do everyday.

How is data used? Research Advocacy Technical assistance How will the data be used? The School-Based Health Alliance and those it serves use the data constantly to advocate for local, state, and national policy initiatives, as well as to provide targeted technical assistance to the field. When we are asked where are SBHCs, how many have a mental health provider, who is paying for them, and how long have they been around…we know the answers because of the census. We also use the Census data for research to better understand trends in SBHCs over time. And we use it to add update information to the Children’s Health and Education Mapping Tool. Children’s Health and Education Mapping Tool

In June, we launched the 2016-17 Census of SBHCs. WHAT’S NEW THIS YEAR In June, we launched the 2016-17 Census of SBHCs. WHAT’S NEW THIS YEAR ? First, its shorter! Dramatically shorter. It includes 22 questions and should take an SBHC no longer than 15 minutes to complete. Second, we’ve made it easier to complete the survey for multiple SBHCs. Sponsoring organizations with multiple SBHCs are now able to enter data for all sites at one time. We are partnering with National Research, LLC (NR), an experienced survey research firm based in Washington, DC. NR will be available to administer the Census survey by phone. You may receive an email or call from them!

100% School-based School-linked Mobile Telemedicine Who is participating in the Census ? We are asking every school-based or school-linked health center, mobile health, and telemedicine program in the nation to participate in the 2016-17 Census. What information is the 2016-17 Census collecting? The 2016-17 Census of SBHCs requests that you share the following information: SBHC’s sponsoring/administrative organization(s); Hours of operation; Populations eligible to use the SBHC; Schools served by the SBHC; SBHC staffing, services, policies, and electronic health record (EHR) use; Funding sources; and Client and visit data. Telemedicine

QUESTIONS Does anyone have any questions?

Challenging the SBHC field to adopt the first ever set of standardized performance measures Now I want to discuss the School Health Services National Quality Initiative, an initiative we call the NQI. It is funded by the Maternal and Child Health Bureau and is a partnership with the Center for School Mental Health. The initiative is challenging the school-based health care field to voluntarily adopt and report the first ever set of standardized performance measures.

What does this make possible for us? So what does this initiative make possible for us?

Improve quality align COMPARE We believe that: If school-based health centers (SBHCs) can align priorities and voluntarily collect data in a standardized way, we will be able to describe the quality of care being delivered in SBHCs at the national level, which is paramount to the sustainability of the model. As the healthcare landscape becomes increasingly competitive and based on value rather than volume, we need to be able to demonstrate the care being delivered. By reporting standardized data to the Alliance, SBHCs will be able to compare themselves at local, state, and national levels and assess their strengths and areas for improvement. AND by investing time in assessing our data and identifying ways to improve practices, the quality of care that children receive will improve.

As the saying goes, “What gets measured, gets done” As the saying goes, “What gets measured, gets done”. Together with this initiative we can improve care for children and adolescents.

How can we work together to achieve this goal? So, how can we work together to achieve this goal?   We’ve already started! We have been working together with members of the field since day one of this initiative knowing that its success hinges on working together at every step.

Important Sensitive Feasible Usable We needed YOU, members of the field, to tell us what we should be measuring, the measures that convey our value-add to the healthcare system. So we invited people representing diverse stakeholder groups to help us. Ultimately, 90 individuals representing the field participated in the process, which took six months to complete. Alliance members, board members, and staff; SBHC providers and administrators; representatives from state affiliate organizations and government offices that fund SBHCs; and educators and payers were part of the process   You told us what measures you think are the most important, sensitive, feasible to collect, and usable for quality improvement and advocacy. And we listened.

FIVE Standardized performance measures for SBHCs Core Measures Annual well child visit Annual risk assessment BMI screening and nutrition/physical activity counseling Depression screening Chlamydia screening Stretch Measures Student disposition log (seat time saved) SBHC student user survey Annual well child visit Annual risk assessment BMI screening and nutrition/physical activity counseling Depression screening Chlamydia screening You decided that the best way to demonstrate the value add of SBHCs to the healthcare system is to work to ensure that children and adolescents have an annual (1) well-child visit, (2) risk assessment, and (3) BMI screening. You also decided that adolescents should be screened for (4) depression and (5) chlamydia We are thrilled with the measures you selected: They align with existing national child quality measurement frameworks (HEDIS, CHIPRA, Meaningful Use) – allowing SBHCs to compare themselves with one another and with other healthcare settings.

Right now, the way SBHCs report data looks a bit like this (apples) Right now, the way SBHCs report data looks a bit like this (apples). There is commonality but with measurement the devil is in the detail and there is considerable variability in the definitions of the measures.

This initiative allows us to be able to compare apples to apples, and be aligned not only with one another but also with national child measurement priorities.

We see these five measures as our starting point and we anticipate that the measures may expand in the future as we grow in our understanding of the interaction between health and education. These five are meant to be a manageable starting point and allows us to start aligning our priorities. For example, very soon, our goal is to introduce a measure that allows you to document the amount seat time saved when children can access care in an SBHC – ultimately helping reduce absenteeism and improve student achievement.

Since November 2015, a number of very brave school-based health center programs in eight states joined a community of peers as innovators and early adopters of the five standardized performance measures. SBHC programs in Colorado, Connecticut, North Carolina, and Seattle-King County have been working together as a part of a learning collaborative focused on how to adopt and report the performance measures. Teams of SBHCs in New York, Ohio, California, and Minnesota have also been reporting the measures. We have learned a tremendous amount from the experiences of these pioneers and we are translating the lessons learned into resources that can be utilized by the field.

It’s challenging IT’S WORTH IT If our participants in the learning collaborative were up here on stage right now, they would tell you that it has been challenging but its worth it. Teams of SBHC administrators/providers/IT support/and coordinators are getting together, examining the measures, and setting bold goals for improvement.

They started looking at their data each month and many of them initially said “wait a second here, there is something going on here – this data doesn’t reflect what I am doing in my health center” When you look at data, amazing thing can start to happen. When people start to see data, they start to ask questions, they become aware of areas for improvement, and behavior starts to change.

Teams are overcoming challenges that they felt were insurmountable just a few months ago. They’re adapting their electronic health records and figuring out how to get data in and out. This has taken time for sites – many started saying that they were unable to report the data we were requesting – they said thing like “we don’t document this”, “we all do it a bit differently” – “we’ve never done this before” and now they can. The motivation to improve is awesome to observe: To improve well-child visits, teams are pulling data from health information exchanges and building relationships with providers in the community (some of them using a box of doughnuts to open the conversation) To improve practices around depression screening, they are standardizing the practices so that all providers are measuring the same way. Providers are also thinking creatively about how to identify sexually active students – simply figuring out how to ask the right question - in order to provide appropriate preventive services

They are delivering better care. Put simply, they are delivering better care because of this initiative.

Join us! Today we invite you to join us in this movement. Quality Counts and this is your opportunity to adopt the performance measures.

sponsoring agency approval SBHC Providers, Support Staff, Directors, and Administrators SBHC Sponsor Organization Representative IT/EHR Support SBHC Coordinators and Support Staff Step #1 sponsoring agency approval We challenge you: First and foremost you must have sponsoring agency approval and buy in to participate. In WV the PCA is working with most SBHC sponsors to get the census and quality work on the CEO/sponsoring agency's radar and to get buy in and approval. You will likely see more info on this in the near future. Next: We encourage you to form a team – get all hands on deck. Engage your sponsor organization and get SBHC staff (providers, coordinators, and support staff) to buy-in If you have access to IT or EHR vendor support, get them on board as early as possible and ask them to set up your Electronic Health Record (EHR) (87% of SBHCs reported that they are using an electronic health record)

definitions and resources Review the measure definitions and resources Step #2 We also encourage you to carefully review the measure definitions. It may be that you are already required to report similar data; however, your definitions may vary slightly and you will need to set up your system to collect the correct data

www.sbh4all.org We have created a website where you will find multiple supports to help you get started. Go to the resources tab and click on Quality Counts

You’ll be taken to this page where you can review definitions of the five performance measures Learn about promising strategies to improve the care being delivered View tips on how to set up your EHR to collect data and how to report data to the Alliance Understand what data is being collected and when as well as how data will be used and how privacy will be protected Join an online community of peers adopting the performance measures, register for webinars, and request support from the Alliance

Measures which are included at the end of the census . . . Report the five performance Measures which are included at the end of the census . . . Step #3

By October 31, 2017 Don’t worry if you’ve already completed the census, you can log back in and enter the quality measures

Download a report to view your data and compare it to others Step #4 After you enter your data you can download a report to view your data. Let me show you what the reports look like.

No protected health information Aggregate, de-identified health center client data Some of you may be asking – are they requesting personal or protected health information? The answer is No. Participants will only be asked to report aggregate, de-identified health center client data. You will NOT provide ANY "protected health information (PHI)” about health center clients, such as an individual’s past, present or future physical or mental health or condition.

~300 We have verbal commitments (ADD ANIMATION) from more than 300 SBHCs that they are going to document and report the five performance measure for the 2016-17 school year. We want you to add to this number. Although I am a bit partial to WV, we have always been a leader, and I have no doubt we will continue to lead in SBHC.

Unprecedented opportunity This initiative will challenge the field to align its priorities, but the potential gains are enormous. It is an unprecedented opportunity to be able to tell our story in a more uniform way. This will allow us to tell a much stronger story – it will allow us to learn from SBHCs that are doing particularly well – it will help us find ways we can improve. We’ll be able to show everybody that SBHCs are vital to a Culture of Health. These data will be allow us to show what we are already know. We will be able to prove to others that care is top notch. These data will resonate with our national partners and you’ll be recognized for all the hard work you are doing because a positive light will be shined on SBHCs.

IT’S WORTH IT Let’s do this together. Let’s continue to build a Culture of Health for children and adolescents and show the value of the SBHC model.

Next Steps - Standardized performance measures for SBHCs Core Measures Annual well child visit Annual risk assessment BMI screening and nutrition/physical activity counseling Depression screening Chlamydia screening Stretch Measures Student disposition log (seat time saved) SBHC student user survey Annual well child visit Annual risk assessment BMI screening and nutrition/physical activity counseling Depression screening Chlamydia screening We would like to take the rest of the time to talk with you about the standardized performance measures including barriers and successes. Lori is going to capture your responses as we work together over the next bit of time.

Tracking system? Successes? Barriers?

Tracking system? Successes? Barriers?

Tracking system? Successes? Barriers?

Tracking system? Successes? Barriers?

Tracking system? Successes? Barriers?

Assignment Identify at least 1 indicator that you/your SBHC wants to work on Write your name on that poster as you go to break Next Steps Ask Lori to facilitate this slide

Does anyone have any questions? Or do any of the participants in the CoIIN want to share any reflections with the audience about their experiences so far? PLUG WORKSHOP: If this presentation has whet your appetite, we have a session after lunch where you can learn more from participants in our CoIIN about how they have adopted the measures.