Beyond Mom and Pop: A New Vision for School-Based Health Centers The National Assembly on School-Based Health Care June 26, 2003 Julia Graham Lear, PhD, Director, Center for Health and Health Care in Schools, School of Public Health and Health Services, The George Washington University The Center for Health and Health Care in Schools

Beyond Mom and Pop: An Overview The Take-Home Message A New Vision for SBHCs Opportunities and Threats Don’t Look Back: The Future is Gaining on Us

Tale of Two Cities The Bronx and Montefiore Medical Center Denver and Denver Health

The Take-Home Message A new vision: A shift from ‘small is beautiful’ to ‘big is better’ Program stability may be easier to achieve through bigger budgets and larger programs Pursuit of larger SBHC programs will require new ways of doing business

A New Vision for SBHCs: Program Purpose & Characteristics Purpose: a safety net for the community’s children Multi-site, serving significant numbers of high-need children Primary care and mental health services that meet standards of care for safety and quality Integrated into mainstream payment and service delivery systems Eg: Portland,OR, NYC-Columbia SPH, Denver

Arguments in Favor of a New Vision for SBHCs  Moral obligation: The right thing to do, eg. public consensus that access to primary care for underserved populations is important Persistent unmet need in many communities Self-interest: Will benefit SBHCs in long run

Arguments Opposed to This New Vision Departure from SBHC history -- emphasis on “getting the model right” -- community/grassroots tradition, desire to be separate from mainstream healthcare; resulting disconnect with sponsor agency and mainstream healthcare providers Emphasizes health service delivery over public health/preventive care priorities Inconsistent with personal visions and skill sets of SBHC staff & leadership

The Future is Upon Us Budgetary realities; federal & state funding cuts affecting SBHC sponsors; reduction in state grants for SBHCs, some SBHCs closing Continued opposition to federal support in U.S. House of Representatives A response is required

The Future is Upon Us, #2 For established programs -- a time to choose. What is your purpose? Can you demonstrate effectiveness in meeting that purpose? Is that purpose congruent with public goals? Rural programs may require different strategies, eg. A network of SBHC that function both as a local entity and a state-wide network.

What we have before us are some breathtaking opportunities disguised as insoluble problems. John W. Gardner, 1965

Contact Information The Center for Health and Health Care in Schools 1350 Connecticut Avenue, NW Suite 505 Washington, DC 20036 202-466-3396 202-466-3467 fax www.healthinschools.org The Center for Health and Health Care in Schools