Health Care for Special Populations Examining the Role of SBHCs

Welcome and Introduction Childworks, PLLC Brooke Lehmann, MSW, Esq. Brooke Lehmann, MSW, Esq. Jennifer Leonard, MBA, Esq. Jennifer Leonard, MBA, Esq. Purpose of Today’s conference

Objectives of Today’s Discussion 1. Participants will have a better understanding of the strengths and challenges associated with the integration of school-based health centers and school-based programs serving special populations. 2. Participants will be able to utilize information gained through today’s discussion to think through opportunities that might exist within their professional positions for advancing collaborations between these two entities.

AGENDA Present information on the Summit’s purpose and execution. Present information on the Summit’s purpose and execution. Discuss in detail the Summit’s findings and recommendations. Discuss in detail the Summit’s findings and recommendations. Generate a list of new recommendations from conference participants. Generate a list of new recommendations from conference participants. Questions/Answers/Wrap up Questions/Answers/Wrap up

Setting the Stage for Summit Discussion: Common Themes From the Field Role for SBHCs in serving Special Populations Role for SBHCs in serving Special Populations Communication is critical Communication is critical Must have shared resources with clear delineation of roles Must have shared resources with clear delineation of roles Funding mandates can drive collaboration Funding mandates can drive collaboration Clarified critical mechanisms Clarified critical mechanisms

Future Trends Increase in the number of uninsured children and families Increase in the number of uninsured children and families Increase in the rate of referrals to special education Increase in the rate of referrals to special education Increase in the need for school-based mental health services Increase in the need for school-based mental health services Strengthening systems that support SBHCs resulting in sustainability and growth Strengthening systems that support SBHCs resulting in sustainability and growth

Summit Objective #1  Build a Common Understanding: Describe the experience of: (1) School-based health centers (SBHCs) in providing services to children and youth with special health care or education needs (“special populations”); and (2) the school- system in utilizing SBHCs to serve special populations

Summit Objective #2 Identify Opportunities: Identify Opportunities: Identify areas of service delivery with the greatest potential to realize benefits from commonalities or synergy between SBHCs and schools in serving special populations

Summit Objective #3 Explore Impact of Policies & Infrastructure: Explore Impact of Policies & Infrastructure: Explore the key challenges (e.g., education and health care policies, finance mechanisms, and infrastructure) in enabling SBHCs and schools to work together to better support special needs populations

Summit Objective #4 Identify Short-term Priorities: Identify Short-term Priorities: Provide feedback on the top three areas of service delivery with the most potential for benefiting SBHCs and schools in serving special populations

Working Definition: Special Populations Children and Youth with Special Health Care Needs: Children and Youth with Special Health Care Needs: ● Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition ● Who also require health and related services of a type or amount beyond that required by children generally (Maternal and Child Health Bureau)

Definitions Continued Special Education: Special Education: ● Defined within the Individuals with Disabilities Education Act (IDEA) which mandates that all children, regardless of their unique learning needs, will be afforded an opportunity to experience a free and appropriate public education in the least restrictive environment ● Specifically designed instruction, at no cost to parents, to meet the unique needs of a child with a disability

Definitions Continued Special Education: ● A child must have a disability that adversely affects educational performance to be eligible ● Children eligible for special education services under IDEA are also protected under Section 504 (but the converse is not true).

Definitions Continued Section 504: Section 504: ● Civil rights law that protects individuals with disabilities from discrimination ● Ensures that children with disabilities have equal access to an education by requiring that they receive benefits and services comparable to those given their non-disabled peers ● To be eligible, child must have a physical or mental impairment that substantially limits at least one major life activity

Definitions Continued School-Based Health Center: School-Based Health Center: ● A health center that is located in or near a school facility ● Is organized through school, community, and health provider relationships and is administered by a sponsoring facility ● Provides, at a minimum, comprehensive primary health services during school hours to children and adolescents

Summary of Exercises Session A: Identify services with commonalities or potential for synergy between SBHCs and school systems in serving special populations Session A: Identify services with commonalities or potential for synergy between SBHCs and school systems in serving special populations Session B: Identify the areas of service delivery with the greatest potential for synergy between SBHCs and schools Session B: Identify the areas of service delivery with the greatest potential for synergy between SBHCs and schools

Summary of Exercises Continued Session C: Identify the key challenges (e.g., education and health care policy, finance mechanisms, and infrastructure) in enabling SBHCs and schools to work together to better support special needs populations. Session C: Identify the key challenges (e.g., education and health care policy, finance mechanisms, and infrastructure) in enabling SBHCs and schools to work together to better support special needs populations. Session D: As a group, agree on the top three areas of service delivery with the most potential for benefiting SBHCs and schools in serving special populations Session D: As a group, agree on the top three areas of service delivery with the most potential for benefiting SBHCs and schools in serving special populations

Finding #1: Mental Health Services Potential Opportunities : why is this a good idea? Proximity to students Proximity to students Consistent with “top concerns” given recent violent events Consistent with “top concerns” given recent violent events Improved identification Improved identification SBHC staff has sensitivity to needs of students SBHC staff has sensitivity to needs of students Multi-disciplinary environment & enhanced collaboration Multi-disciplinary environment & enhanced collaboration Reduced classroom behavioral disruption; stabilized support for students in classroom Reduced classroom behavioral disruption; stabilized support for students in classroom De-stigmatization of MH services by co- locating instead of providing services remotely De-stigmatization of MH services by co- locating instead of providing services remotely

Finding #1: Mental Health Services Potential Challenges: Why might this be difficult to implement? Lack of qualified workforce Lack of qualified workforce Funding issues - Inability to access funding resources for MH services provided in schools; categorical funding an issue Funding issues - Inability to access funding resources for MH services provided in schools; categorical funding an issue Threat to school social worker / counselor Threat to school social worker / counselor Medical providers may not understand the special ed issues Medical providers may not understand the special ed issues Lack of higher authority providing oversight and coordinating end goals for all Lack of higher authority providing oversight and coordinating end goals for all

Finding #2: Primary Care Health Assessment / Medical Care Potential Opportunities: Augment IEP development Augment IEP development Improved absenteeism and truancy Improved absenteeism and truancy PCP able to coordinate and improve access to specialists PCP able to coordinate and improve access to specialists Improved coordination with the school, parents and other health care providers Improved coordination with the school, parents and other health care providers Better positioned to understand child’s special needs in global environment and help child’s chances of staying in school and achieving acad. success Better positioned to understand child’s special needs in global environment and help child’s chances of staying in school and achieving acad. success Caring adult Caring adult

Finding #2: Primary Care Health Assessment / Medical Care Potential Challenges: Another piece to the pie of places to receive primary health care Another piece to the pie of places to receive primary health care Lack of coordination with other providers Lack of coordination with other providers SBHC services not valued the same as “outside” providers SBHC services not valued the same as “outside” providers Limited training or understanding of IDEA Limited training or understanding of IDEA Potential for lawsuits Potential for lawsuits More paperwork and reporting More paperwork and reporting

Finding #3: Identification Potential Opportunities: Streamlined coordination of students Streamlined coordination of students Greater degree of effectiveness Greater degree of effectiveness Improved financial results Improved financial results Increased chance of student success Increased chance of student success Better position to measure effectiveness of specialized services Better position to measure effectiveness of specialized services

Finding #3: Identification Potential Challenges: Collaboration between the school and the SBHC Collaboration between the school and the SBHC Practitioner lens Practitioner lens

Other Recommendations Build bridges to special ed community and leadership Build bridges to special ed community and leadership Advocate for legislation to require Medicaid to support SBHCs Advocate for legislation to require Medicaid to support SBHCs Consider databases and evaluations Consider databases and evaluations Align SBHC with schools system’s needs Align SBHC with schools system’s needs Develop “Principles” for SBHCs serving needs of special populations Develop “Principles” for SBHCs serving needs of special populations

YOUR RECOMMENDATIONS What other areas would you suggest for collaboration?

Questions

THANK YOU Contact Information: Brooke Lehmann: Brooke Lehmann: , , Jennifer Guste Leonard: Jennifer Guste Leonard: , ,