1. School-Based Health Centers and Coordinated School Health in West Virginia West Virginia Department of Education Alternative Education Conference June 28 & 29, 2010

2. Introductions Paula Fields, MSN, RN Teri Harlan, BS Linda Anderson, MPH

3. Objectives The participant will be able to: 1.Describe school-based health centers in WV and their role in supporting schools, students and coordinated school health. 2.Identify initiatives, opportunities and policy directions occurring in West Virginia and nationally. 3.Identify resources and opportunities for school personnel to engage their community providers in expanding school-based health services.

4. What is a SBHC? SBHCs are health clinics located in schools that provide preventive and primary care to students Specific services are determined by the community, but always include: health education prevention including immunizations and well child exams treatment of acute illnesses management of chronic illnesses mental health services by referral or on site dental services by referral or on site

5. What is a SBHC?  In WV, SBHCs are sponsored by community health centers (18) and hospitals (1) and receive funding from state, federal, private sources, in- kind donations and patient revenue  Serve all students, regardless of ability to pay  WV SBHCs follow a set of standards for care, including parental consent for enrollment and treatment

6. What is a SBHC?  Most SBHCs consist of a waiting/reception area, lab area, exam room(s) and offices (see recommendations in Policy 6200)  Are typically staffed by a receptionist/data entry clerk, nurse, and a nurse practitioner or physician assistant with supervision/consultation from a physician  Work with, but do not replace, the child’s physician or school nurse  Link to or serve as the child’s medical home if they do not have one

9. Snapshot of SBHCs  Nationally, the first SBHCs were created in the 1970’s…today, we have 1700 SBHCs in 45 states serving students in all grades  In WV, SBHCs were piloted in 14 schools in 1994…in 2009-10 there were 49 SBHCs providing services to 61 schools in 24 counties  Interest and commitment continues to grow in WV and across the states

10. Benefits of SBHCs  Provide quality health care services that help children succeed in school  Provide children with easier access to care  Promote prevention and early intervention  Help children stay healthy  Help school employees stay healthy and on the job

11. Benefits of SBHCs Research and evaluation of SBHCs have demonstrated that SBHCs …  Improve children’s health status  Save money on hospitalizations, ER visits and Medicaid expenditures  Show an increase in the number of students returning to class versus being sent home or to another location  Reduce parental time off from work

12. Benefits of SBHCs Studies by John Hopkins University, Emory University, Health Foundation of Greater Cincinnati, and others show that SBHCs:  Decrease absenteeism & tardiness  Reduce school discipline and behavior problems  Save money by reducing the number of visits to the ER for the wrong reasons

13. SBHC Virtual Tour Riverside SBHC in Kanawha County http://www.rhcwellness.com/

14. Principles of SBHCs  Respond to the community  Support the school  Promote collaborative relationships  Focus on the student  Advance health promotion  Provide leadership for adolescent and child health

15. Coordinated School Health

16. A coordinated school health program (CSHP) model consists of eight interactive components: 1.Health Education 2.Physical Education 3.Health Services 4.Nutritional Services 5.Counseling and Psychological Services 6.Healthy School Environment 7.Health Promotion for Staff 8.Family/Community Involvement

17. Coordinated School Health  Schools by themselves cannot—and should not be expected to—solve the nation’s most serious health and social problems.  Families, health care workers, the media, religious organizations, community organizations that serve youth, and young people themselves also must be systematically involved.  However, schools could provide a critical facility in which many agencies might work together to maintain the well-being of young people.

18. Why SBHCs?  23% of WV public school children require regular and ongoing health care services during the school day  55,000 students have IEPs  WV students have high rates of asthma, diabetes, obesity and social-emotional problems  New focus on school-wellness at the national and state levels

19. Why SBHCs?  Healthy Kids Make Better Students  Better Students Make Healthier Communities

20. School Mental Health in West Virginia

21. A growing body of evidence indicates that school mental health programs improve educational outcomes by decreasing absences, reducing disciplinary problems, and improving test scores. Safe Schools, Healthy Students: http://www.promoteprevent.org/webfm_send/709 http://www.promoteprevent.org/webfm_send/709

22. A. Disparities in healthcare can allow treatable disorders to negatively impact schooling B. Childhood conditions can directly affect learning and behavior C. Poor academic performance can increase adolescent risk behavior Three Pathways from Poor Health to High School Dropout From: Breslau (2010) http://cdrp.ucsb.edu/dropouts/pubs_reports.htmhttp://cdrp.ucsb.edu/dropouts/pubs_reports.htm

23. Health & Mental Health Factors Academic Outcomes Educational Behaviors Physical Health/illness Mental Health Mental Health Problems High-risk Behaviors (e.g. Substance use ) Developmental issues Social Competence/Self- esteem Family Strengths/ Issues Attendance Behavioral Competencies Behavioral Problems Educational Motivation Positive Attitudes Toward Schoolwork School Connectedness Graduation/Drop-out Grades Standardized Test Scores Teacher Retention ADAPTED FROM: Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care. Mental Health and Academic Outcomes SMH

24. Mental Health and School Success  Students with serious emotional disturbance or psychological problems are more likely to:  drop out  be suspended or expelled  not complete HS ( Stoep et al.,2003; Woodruff et al.,1999; and others)  21% of 9-17 year olds have a mental illness  2 out of 3 are not getting the help they need  Mental health is the fastest growing component of SBHCs

26. WV’s Expanded School Mental Health Initiative  Partnership between WVDE and DHHR  Steering team representative of local and state level education, health and social service providers  Statewide network  Pilot state for CDC funded MH Capacity Building project

27. WV’s ESMH Model  Is a framework, not a program  Builds on the core services  Recognizes emotional /academic learning link  Is a shared responsibility  Provides the full continuum of care  Complements, supports and is linked with school counselors, PBS, SOC, SBHCs and SAT

28. A Comprehensive System of Learning Supports School Systems Behavioral Health Systems Universal 80-90% Intensive 1-5% Targeted 5-15%

29. The Conundrum Academic Performance School Mental Health

30. A Shared Agenda We Can Promote Academic Success and Well-Being By:  Creating a Safe, Caring, and Enriching Environment  Encouraging Family Driven Policies and Practices  Ensuring High Quality Academic Instruction  Effectively Serving Culturally Diverse Populations  Fostering Positive and Healthy Youth Development  Teaching Problem-Solving Skills  Coordinating Delivery of Effective Services for Youth  Preparing Students for Lifelong Success

31. Family/Community Involvement Health Education Health Promotion for Staff Healthy School Environment MENTAL HEALTH: Counseling, Psychological & Social Services Nutrition Services Health Services Physical Education Coordinated School Health Program Mental Health Strand

32. Expanded School Mental Health Can Help To:  Identify and support students  Assist in IEP development  Refer and case manage at risk youth  Develop and support programs to address school climate, connectedness, mentoring  Intervene in crises  Train and consult with staff  Facilitate parent involvement

33. Resources/Products Define roles, standards, quality for ESMH in WV Provide tools, resources for LEAs Policy re parent notification/consent Information briefs Trainings

34. ANNOUNCING… A NEW WEBSITE FOR SCHOOL MENTAL HEALTH IN WEST VIRGINIA: www.schoolmentalhealthwv.org Resources for schools, parents, students, communities Tool Kits Announcements

36. Funding A combination of public and private sources:  Local School  County School System  Businesses/Corporations  Local Health Care  Foundations  Federal and State Be Creative !!!

37. Opportunities Federal Health Care Reform: funding for new SBHCs Full Service Schools Grants Safe, Drug Free Schools State Community Health Centers Bureau Behavioral Health Title 1

38. Future Directions Preserve, Strengthen and Expand  Maintain current level of services  Expand into new counties and areas that have little or no services  Expand services in existing centers  Develop new models that serve additional students more efficiently

39. Planning Resources  SBHC Fast Facts  WV SBHCs Map  Starting a SBHC – FAQs  NASN School Nurse / SBHC Partnership  NASBHC – Benefits of SBHCs  Opening a SBHC – A Startup Guide WV http://www.wvsbha.org/muta/ta_evaluation_Toolkit_Admin.php http://www.wvsbha.org/muta/ta_evaluation_Toolkit_Admin.php

40. State Resources  West Virginia School Based Health Assembly http://www.wvsbha.orghttp://www.wvsbha.org  Expanded School Mental Health www.schoolmentalhealthwv.org www.schoolmentalhealthwv.org

41. National Resources  National Assembly on School-Based Health Care: www.nasbhc.orgwww.nasbhc.org  Center for Health and Health Care in Schools: www.healthinschools.orgwww.healthinschools.org  Center for School Mental Health http://csmh.umaryland.edu http://csmh.umaryland.edu

42. Partners  WV Department of Education  WV Department of Health and Human Resources Bureau for Public Health, Division of Primary Care Bureau for Behavioral Health and Health Facilities Bureau for Children and Families  WV Immunization Network  National Assembly on School-Based Health Care

43. WVSBHA Mission Advancing comprehensive health services through responsive policies, practices, and partnerships

44. WV School-Based Health Assembly www.wvsbha.org Statewide membership organization working to advance comprehensive health care in school settings WVSBHA Board of Directors Mary Grandon, ChairEric Ruf, Chair Elect Physician Assistant, Riverside SBHCCEO, Belington Medical Center Teri Harlan, SecretaryMichael Judy, Treasurer School Health Director, CEO, Pendleton Community Care New River Health Association wvsbha@gmail.com

45. Marshall University Marshall University WV School Health Technical Assistance and Evaluation Center Robert C. Byrd Center For Rural Health Resources, assistance and training regarding:  School based health centers, including planning and starting a SBHC  School based mental health services  School based dental health www.wvsbha.org ( click on the MU Technical Assistance tab)

46. WV School Health Technical Assistance and Evaluation Center-Marshall University Linda Anderson, MPH Coordinator 304-523-0043 landerson@marshall.edu Bobbi Jo Muto, RDH, BS Oral Health Coordinator 304-542-9592 bjmuto.steele@marshall.edu Stephanie Montgomery Data and Evaluation 540-776-7953 smontgom@marshall.edu Paula Fields, MSN, RN Clinical Issues 304-846-9739 pfields4@yahoo.com Richard Crespo, PhD Director 304-691-1193 crespo@marshall.edu

47. Questions & Discussion