1. School-Based Health Centers
Improving Access and Strengthening Quality of Care for Adolescents
American Public Human Services Association, November 19, 2001
Julia Graham Lear, Director, Center for Health and Health Care in Schools, School of Public Health & Health Services, The George Washington University

2. Survey of State SBHC Initiatives
School Year

3. Top Ten States with School-Based
Health Centers
Survey of State SBHC Initiatives. The survey was conducted by the Making the Grade National Program Office in the summer of In February 2001, Making the Grade became The Center for Health and Health Care in Schools. The Center remains at The George Washington University and is co-sponsored by the School of Public Health and Health Services and the Graduate School of Education and Human Development.

4. Location of School-Based Health Centers
Survey of State SBHC Initiatives. Center for Health & Health Care in Schools.

5. Types of Schools Housing SBHCs
Survey of State SBHC Initiatives. Center for Health & Health Care in Schools.

6. State Policies to Support SBHCs

7. State Financial Policies to Support SBHCs

8. SBHCs and Managed Care

9. State Dollars Supporting SBHCs
*Other includes: Juvenile Justice funds, STD training dollars, Special Education funds, EPSTD, and The Robert Wood Johnson Foundation dollars

10. Data from the Census of the National Assembly on School-Based Health Care, NASBHC, Washington, DC 2000
Data collected in 1999

11. How Old Are SBHCs? 41% were established five or more years ago.
59% of SBHCs were established in the last four years.

12. SBHC Staff
Clinical Support
Mental Health
Primary Care

13. Physical Health Professionals Onsite
% Hrs/wk
Physician
Physician Assistant
Nurse Practitioner
Physical Health All

14. Mental Health Professionals Onsite
% Hrs/wk
Clinical social worker
Mental health (other)
Psychologist
Substance abuse
Psychiatrist
Mental Health All

15. SBHC Staff, Other % Hrs/wk Director 24 22 Health Educ 19 22
Social Srvs
Nutritionist
Dentist
Dental Hyg
Other

16. SBHC Health Services Comp. health assessment 95%
Anticipatory guidance 95%
Screenings (vision, hearing) 94%
Treatment of acute illness 94%
Nutrition counseling 91%
Asthma treatment 91%
Prescriptions for medication 90%
Sports physicals 90%
Lab tests 89%
Meds administered in SBHC 86%
Treatment of chronic illness 84%
Psychosocial assessment 73%
Medications dispensed 62%
Dental screenings 52%

17. SBHC Characteristics 69% operate more than 30 hrs/week
48% operate summer hours
75% bill Medicaid/third-party
88% use computerized encounter system
31% accredited by JCAHO/other
34% certified by state
96% train health professionals on site

18. Recent Developments in School-Based Health Centers
Focus on quality standards and quality improvement
Broadening political base for SBHCs
Increased interest in school-based initiatives to provide mental health and dental health services

19. Quality Standards and Quality Improvement for SBHCs
Direction over time
Informal to more formal
Local to state to national
1980s- no uniform standards, what was done determined by funding and reporting requirements of funding bodies
Late 1980s and 1990s - state standards began to be developed
development of outcomes-focused CQI tool.

20. SBHC CQI Tool
home.asp
The tool
Data collection forms
Instructions
Resources/glossary/directory
FAQ’s

21. Broadened Political Support But Fiscal Uncertainty Looms
SBHCs and distributional politics
Bipartisan support: CT, DE, LA, NY, RI
Fiscal uncertainty: the downside of a state or local funding base

22. Increasing Mental Health and Dental Health Services in School through SBHCs
Surgeon General reports on mental health and oral health
Disparities data especially striking in these two areas
Increased recognition by public and professionals that more children’s mental health services are essential
RWJF grant initiative -- Caring for Kids: Expanding Mental Health and Dental Health Services through SBHCs

23. Opportunities for Medicaid Partnerships with SBHCs
Benefits: Increased access for Medicaid & SCHIP beneficiaries
Accountability -- SBHCs receptive to use of CQI measures
Cost-effective use of personnel
Making the partnership work
Collaboration with Family Health or MCH
Offices in DOH, other relevant state agencies
Commitment of time for mutual education &
negotiation