School-Based Health Center Snapshot Linda Juszczak Grantmakers in Health December 16, 2008

School-Based Health Center (SBHC) National Definition Partnerships created by schools and community health organizations to provide on-site medical, mental health, and/or oral health services that promote the health and educational success of school-aged children and adolescents

SBHC Principles Support the school Respond to the community Focus on the student Deliver comprehensive care Advance health promotion Implement effective systems Provide leadership in adolescent and child health

Where are SBHCs? (n=1708) Juszczak, Schlitt, Moore. (2007). National SBHC Census. NASBHC.

SBHCs by Community Characteristic

Ethnic Profile of SBHC Population

SBHC Staffing Models

SBHC Primary Care Services

SBHC Mental Health Services

SBHCs that Bill and Collect

Total State-Directed Funding Schlitt, Juszczak, Eichner. (2008). Current Status of State Policies that Support SBHCs. Public Health Reports.

Non-Patient Revenue

Performance and Outcomes Evidence of high-quality care and higher performance than other models for selected measures Adolescents more likely to come to an SBHC than other settings for mental health services Decreased use of urgent and emergency care Increase in risk assessments and health care maintenance Reduction in Medicaid expenditures and cost of hospitalizations Decrease in risk behaviors and increase in health promoting behaviors

Performance and Outcomes (cont’d) Centers reach ethnically diverse populations, adolescent males, the uninsured and those without a regular source of care. Evidence of student satisfaction with ability of the centers to meet their needs Evidence of strong parental support Evidence that centers complement and do not duplicate services being provided elsewhere

Challenges Limitations related to access: 44% of centers are available only to students in the school Parental consent often required for any service despite state laws that permit adolescents to give their own informed consent for selected services State/community restrictions regarding provision of reproductive health services Need for mental health services may exceed capacity Transient student populations

Priorities for the Movement Reimbursement Growth Sustainable funding Raising the profile Supporting alternate models Mental health

NASBHC Policy and Advocacy* Reimbursement through Medicaid and SCHIP Health care reform Authorization for a Federal SBHC program Support the states *With support from W.K. Kellogg Foundation and The Atlantic Philanthropies