School Health Centers Putting Care Where the Kids Are Samantha Blackburn, RN, MSN Technical Assistance Director California School Health Centers Association

183 School Health Centers in CA Alameda = 17 Contra Costa = 8 Del Norte = 1 Fresno = 5 Los Angeles = 61 Marin = 2 Orange = 5 Riverside = 3 Sacramento = 4 San Bernardino = 6 San Diego = 13 San Francisco = 17 San Joaquin = 8 San Mateo = 2 Santa Barbara = 1 Santa Clara = 8 Santa Cruz = 8 Shasta = 1 Solano = 2 Sonoma = 2 Stanislaus = 5 Tulare = 1 Tuolumne = 1 Ventura = 1 183 School Health Centers in CA

School Health Center Models School-based health centers (on school campus) Wellness centers (focus on mental health, health promotion) Mobile vans School-linked health centers Student centers (may include after school, employment, college readiness, etc)

Grade Levels Served 183 SBHCs right now: 82 high schools 25 middle schools 60 elementary schools remainder school-linked, or serving multiple schools

What services are provided? % Centers Medical Services 85% Health Education 61% Mental Health Services 59% Reproductive Health - Screening and Education Reproductive Health - Clinical Care 47% Nutrition and Fitness Programs 36% Dental Services - Prevention 30% Dental Services - Treatment 14% Youth Engagement Programs National Assembly on School-Based Health Care, 2007-2008 Census

Service Design Components Vary by SBHC Location Services Staffing Hours of operation Community, partner engagement Use to wrap-up your section, transition to Robert on district’s perspective

Who runs school health centers? Federally Qualified Health Centers and other community health centers (1/2 ~ 90) School districts (1/3 ~ 60) County health departments (10) Hospitals (8) Mental health providers (7) Community-based organizations (5)

How are school health centers financed? Space and utilities are typically contributed by the school Third-party reimbursement Child Health and Disability Program Family PACT Medi-Cal Healthy Families Public and private grants No financial support from the state

Why is sustainability an issue? School health centers serve all students at a school even if they are: Uninsured Enrolled in a managed care plan that will not reimburse the school health center. Reimbursement rates do not cover actual costs. A significant portion of staff time is spent conducting education, outreach and case management which is not generally reimbursable.

School health centers extend health care beyond the walls of the exam room and provide a level of comprehensive service that pediatricians can rarely provide. Manual Arts High School, Los Angeles, CA

Benefits of School-Based Immunization Delivery Kids are there Best turnout at school registration, family events Follow-up Iz delivery easier for series Schools are motivated: student Iz status tied to school, per-pupil funding (ADA) SBHCs offer excellent facilities, follow-up, and case management School districts know student Iz needs but don’t have time or resources to deliver Iz

School Immunization Recommendations Partner with SBHCs Unless they get vaccine and admin fee for all, SBHCs often deliver Iz to active patients only, so need support for community Iz campaigns When there is no SBHC Few school nurses have time/resources to administer, so allocate funding to staff Iz clinics at schools, or partner with another provider (CHC?) Vaccine storage/handling SBHC will have appropriate storage, regular school WILL NOT, so bring storage if no SBHC (coolers)

Considerations Information/education Immunization history Youth-friendly materials best, multiple languages required, written and verbal (bilingual staff) Immunization history Safest if students/families to bring Iz record, SBHCs will have limited records (only for active patients) Recordkeeping School nurses/designee (e.g., secretary) in charge of school Iz records, reviewed at enrollment Share student Iz record with school, even if Iz delivered by off-site provider Bring additional Iz cards/forms

More Considerations Contraindications Adverse events Don’t assume female students not pregnant, don’t ask in front of parent/guardian Most youth don’t know allergy history Adverse events If no SBHC, provide clear guidance to students & families on who to call/where to go, otherwise school inundated with “advice calls” they can’t handle What’s your experience? Partnerships and strategies that worked?

CSHC Resources Join CSHC for member benefits! Trainings and technical assistance Tools and Resources: HIPAA or FERPA? A Primer on School Health Information Sharing in California Guidelines for California’s School Health Centers Third Party Billing: A Manual for California’s School Health Centers Sam

Thank you! To contact us: Samantha Blackburn Technical Assistance Director California School Health Centers Association 510-268-1038 sblackburn@schoolhealthcenters.org www.schoolhealthcenters.org