1. School-Based Health Care (SBHC) 101: Nuts and Bolts Laura Brey, MS Tammy Alexander, M.Ed. NASBHC Training of Trainers April 21-23, 2008

2. 2 Participant Expectations Complete the index card and hand it in.

3. 3 Introductions Presenters: Tammy Alexander Laura Brey

4. 4 Getting to Know Participants Type of agency Type of agency Community setting Community setting Role in agency Role in agency School population, if known School population, if known

5. 5 Objectives Identify key collaborators and partners Identify key collaborators and partners Name the five key components of needs assessment techniques for planning school-based health services Name the five key components of needs assessment techniques for planning school-based health services Identify potential funding sources for school-based health services: including public, private, and collaborative partnerships Identify potential funding sources for school-based health services: including public, private, and collaborative partnerships

6. 6 Objectives Describe the rationale and components of a case statement for a new school-based health center Describe the rationale and components of a case statement for a new school-based health center Utilize resource materials related to planning, evaluating, financing, and working with the media Utilize resource materials related to planning, evaluating, financing, and working with the media List seven principles describing how to plan and implement a school-based health centers List seven principles describing how to plan and implement a school-based health centers

7. 7 Collaboration and Partnerships Nut and Bolt #1

8. Collaborative Partnerships A mutually beneficial and well- defined relationship among two or more organizations to JOINTLY develop structure and share A mutually beneficial and well- defined relationship among two or more organizations to JOINTLY develop structure and share ResponsibilityResponsibility Resources Resources Authority Authority Accountability Accountability Rewards Rewards

9. 9 Why have a Collaboration? To accomplish a common goal that none of the units alone can attain To accomplish a common goal that none of the units alone can attain To help agencies share information, resources, staff and equipment To help agencies share information, resources, staff and equipment To create an awareness of needs, problems, or opportunities To create an awareness of needs, problems, or opportunities

10. 10 Characteristics of Successful Collaboration Develops clear, concrete, achievable goals. Develops clear, concrete, achievable goals. Operate in a receptive environment that facilitates its work. Operate in a receptive environment that facilitates its work. Have good leadership. Have good leadership. Understand and respect each member for their different role and responsibility. Understand and respect each member for their different role and responsibility. Build cooperative teams. Build cooperative teams.

11. 11 Typical challenges Differences among collaborators must be understood and acknowledged. Differences among collaborators must be understood and acknowledged. Mixed loyalty that some members may have to their organization. Mixed loyalty that some members may have to their organization. Merging of agencies can cause conflict. Merging of agencies can cause conflict. * Lack of clarity * Lack of awareness

12. 12 Difficult Issues that Undermine Collaborations Territorial questions Territorial questions Confidentiality Confidentiality Certification/Crede ntialing Certification/Crede ntialing Conflicting priorities Conflicting priorities Political roadblocks Political roadblocks Financial resources Financial resources

13. 13 Strategies to Overcome Resistance in Collaboration Joining with the host school Joining with the host school Relay the message that you are there to support rather than supplant Relay the message that you are there to support rather than supplant Engage in ongoing negotiations with key players Engage in ongoing negotiations with key players Developing common goals and group consensus Developing common goals and group consensus Setting Boundaries Setting Boundaries

14. 14 Establish a Planning Group Composition Considerations Local health departmentLocal health department Community or rural health centerCommunity or rural health center Community and/or teaching hospital(s)Community and/or teaching hospital(s) Mental health, substance abuse, and social service agenciesMental health, substance abuse, and social service agencies Private physiciansPrivate physicians University facultyUniversity faculty Elected OfficialsElected Officials Business and community leadersBusiness and community leaders Faith communityFaith community School superintendent, board, or designeeSchool superintendent, board, or designee School administration and Faculty (school nurse, teachers, principals, guidance counselors, physical education, nutrition/food services)School administration and Faculty (school nurse, teachers, principals, guidance counselors, physical education, nutrition/food services) StudentsStudents ParentsParents

15. 15 Role Play - Meeting with Partners / Collaborators

16. 16 Conduct the Needs Assessment Nut and Bolt #2

17. 17 What is a Community Needs Assessment? An accurate appraisal of the current situation (strengths, concerns, and general conditions) of a community’s population A collection of secondary and first hand information and data from a wide range of relevant sources and audiences

18. 18 What is a Community Needs Assessment? A process for: identifying needs and resources in a community determining gaps between what a situation is and what it should be establishing priorities An opportunity to paint a picture of the conditions in a community and sharpen your perceptions of the critical issues children and families face

19. 19 Why Identify Needs and Resources? Better understand the community in which you will be working Better understand the community in which you will be working Become aware of needs and concerns you never knew about Become aware of needs and concerns you never knew about Locate hidden strengths or underutilized resources that could be developed Locate hidden strengths or underutilized resources that could be developed Document need Document need Make sure future actions are aligned with expressed community needs Make sure future actions are aligned with expressed community needs

20. 20 Why Identify Needs and Resources? Garner greater support and involve more people in subsequent action Garner greater support and involve more people in subsequent action Give voice to individuals in the community who have not traditionally been solicited for comment Give voice to individuals in the community who have not traditionally been solicited for comment Convince outside funders and supporters Convince outside funders and supporters Make decisions based on priorities and documented needs Make decisions based on priorities and documented needs

21. 21 Planning and Implementing the Assessment Step 1: Involve stakeholders Step 1: Involve stakeholders Establish working group to guide the planning and implementation of Community Needs Assessments Establish working group to guide the planning and implementation of Community Needs Assessments

22. 22 Planning and Implementing the Assessment Step 2: Determine the Objectives and Outcomes of the Assessment What are you really interested in knowing? Your questions will flow from this. What are you really interested in knowing? Your questions will flow from this. What is your vision? How will you use the information obtained? What is your vision? How will you use the information obtained? Which issues, questions, and behaviors are of particular interest? Which issues, questions, and behaviors are of particular interest? What don’t you know about these issues? What questions do you need to answer? What don’t you know about these issues? What questions do you need to answer?

23. 23 Planning and Implementing the Assessment Step 3: Identify secondary data sources Find out what outside resources can be used Find out what outside resources can be used What public reports exist (examples of sources: census data, vital statistics, CPS reports) What public reports exist (examples of sources: census data, vital statistics, CPS reports) – Have other studies been done? Are there experts in the community who can help you? Are there experts in the community who can help you?

24. 24 Planning and Implementing the Assessment (cont) Step 4: Choose your approach/ approaches for gathering new information Most common approaches: Key informant interviews Key informant interviews Focus groups Focus groups Public forums Public forums Surveys Surveys

25. 25 Planning and Implementing the Assessment When making your choice of approach, take into account: When making your choice of approach, take into account: Purpose of the study Purpose of the study Amount of time you have and number of people assisting you Amount of time you have and number of people assisting you Available resources Available resources Size and characteristics of target population Size and characteristics of target population Relationship you have with target population Relationship you have with target population “ The quality of information about a community is only as good as the technique or combination of techniques used. A single technique may be too narrow; using too many techniques may be costly in terms of time and dollars. Different techniques are appropriate for different needs. Analyze the situation and then weigh the advantages and disadvantages. Sometimes a combination of techniques will provide a more reasonable picture.” (Butler and Howe, 1980)

26. 26 Planning and Implementing the Assessment Key Informant Interviews Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community How to implement = compile a list of participants, create protocol, make appointments (either telephone or in- person), gather data, identify common themes How to implement = compile a list of participants, create protocol, make appointments (either telephone or in- person), gather data, identify common themes

27. 27 Planning and Implementing the Assessment Key Informant Interviews Advantages Advantages Easy and not expensive Easy and not expensive Can discuss confidential issues more readily Can discuss confidential issues more readily Establishes rapport and trust with community Establishes rapport and trust with community Permits clarification of issues and ideas Permits clarification of issues and ideas Disadvantages Disadvantages May be difficult to schedule May be difficult to schedule May provide a biased perspective May provide a biased perspective Only represents perceptions – not hard data Only represents perceptions – not hard data Personal relationships may influence outcomes Personal relationships may influence outcomes Should be combined with other methods because may not represent whole community Should be combined with other methods because may not represent whole community

28. 28 Planning and Implementing the Assessment Focus Groups Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community How to implement = compile a list of participants, decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify common themes How to implement = compile a list of participants, decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify common themes

29. 29 Planning and Implementing the Assessment Focus Groups Advantages Advantages Easy and not expensive Easy and not expensive Establishes rapport and trust with community members Establishes rapport and trust with community members Permits clarification of issues and ideas Permits clarification of issues and ideas Easily combined with other techniques Easily combined with other techniques Disadvantages Disadvantages May provide biased perspectives May provide biased perspectives Only represents perceptions – not hard data Only represents perceptions – not hard data Sharing opinions and views in a group setting may be inhibiting Sharing opinions and views in a group setting may be inhibiting Should be combined with other methods because may not represent whole community Should be combined with other methods because may not represent whole community

30. 30 Planning and Implementing the Assessment Public forums Purpose = elicit information from a wide range of residents in a series of public meetings Purpose = elicit information from a wide range of residents in a series of public meetings How to implement = develop list of invitees, create list of questions, select strategically located venue (use different sites and hold at different times), publicize, use facilitator and documenter, identify common themes How to implement = develop list of invitees, create list of questions, select strategically located venue (use different sites and hold at different times), publicize, use facilitator and documenter, identify common themes

31. 31 Planning and Implementing the Assessment Public forums Advantages: Advantages: Get opinions from a wide range of people Get opinions from a wide range of people Promotes active involvement, community awareness, and buy-in Promotes active involvement, community awareness, and buy-in Inexpensive, quick picture of community Inexpensive, quick picture of community Disadvantages: Disadvantages: Requires good leadership Requires good leadership Opinions limited to those who attend Opinions limited to those who attend Lots of advance planning Lots of advance planning May generate more questions than answers May generate more questions than answers May create unrealistic expectations May create unrealistic expectations

32. 32 Planning and Implementing the Assessment Surveys Purpose = collect information from a wide range of respondents Purpose = collect information from a wide range of respondents How to implement = find or create carefully developed instrument and administer through a sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, telephone, mailed), analyze results How to implement = find or create carefully developed instrument and administer through a sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, telephone, mailed), analyze results

33. 33 Planning and Implementing the Assessment Surveys Advantages Advantages Best approach for eliciting attitudes of broad range of individuals Best approach for eliciting attitudes of broad range of individuals Data usually valid and reliable Data usually valid and reliable Disadvantages Disadvantages Costly and requires time and expertise Costly and requires time and expertise Needs carefully selected tool and sampling Needs carefully selected tool and sampling Subject to misinterpretation Subject to misinterpretation Individuals may hesitate to answer questions Individuals may hesitate to answer questions

34. 34 Planning and Implementing the Assessment Planned Approach to Community Action (PATCH) Planned Approach to Community Action (PATCH) –developed by CDC –effective model for planning, conducting, and evaluating community health promotion and disease prevention programs –Used by diverse communities in US and other nations to address health concerns –PATCH Guide for local coordinator has sample surveys and data collection tools –Web site www.cdc.gov/nccdphp/path/index.htm www.cdc.gov/nccdphp/path/index.htm

35. 35 Planning and Implementing the Assessment Step 5: Implement Plan Collect secondary data Collect secondary data Collect primary data (conduct interviews, focus groups, surveys, etc) Collect primary data (conduct interviews, focus groups, surveys, etc) Analyze secondary and primary data Analyze secondary and primary data Summarize findings Summarize findings

36. 36 Planning and Implementing the Assessment Step 5: Implement Plan Prepare report Prepare report Share with working group, interpret data and develop recommendations together Share with working group, interpret data and develop recommendations together Present to external stakeholders as needed Present to external stakeholders as needed Create action plan Create action plan

37. 37 Review Anytown’s Needs Assessment Document

38. 38 Project Work Plan and Design Example from Chicago SBHC Convened a planning committee of key community stakeholders who met regularly to oversee and guide the process Convened a planning committee of key community stakeholders who met regularly to oversee and guide the process Gathered existing data Gathered existing data U. S. Census Bureau (2000) U. S. Census Bureau (2000) Chicago Health and Health Systems Project (CDPH 2006) Chicago Health and Health Systems Project (CDPH 2006) Healthy Albany Park Assessment (2004) Healthy Albany Park Assessment (2004) Illinois State Report Card (2004 – 2005) Illinois State Report Card (2004 – 2005) CPS School Profile (2004 – 2005) CPS School Profile (2004 – 2005)

39. 39 Project Work Plan and Design Collected new data Collected new data Conducted fifteen stakeholder interviews with school administrators, school personnel, school nurses, and external partners working in schools Conducted fifteen stakeholder interviews with school administrators, school personnel, school nurses, and external partners working in schools Conducted a focus group with community providers Conducted a focus group with community providers Analyzed findings Analyzed findings Drafted initial recommendations Drafted initial recommendations

40. 40 Make Recommendations Based on Needs Assessment Findings

41. 41 Select the School Elementary Elementary Middle or Junior High Middle or Junior High K-8 K-8 High School High School Alternative School Alternative School Pre-school Pre-school

42. 42 Select the Service Delivery Strategy and Model Service and Staffing Options Service and Staffing Options Collaborative Partnerships Collaborative Partnerships The role of the school nurse The role of the school nurse Policy and Procedures Policy and Procedures Referral Networks Referral Networks Delivery of Service Delivery of Service Parental Consent/Parental Involvement Parental Consent/Parental Involvement Integration of the school-based health center with existing school and community resources Integration of the school-based health center with existing school and community resources Confidentiality Issues Confidentiality Issues

43. 43 Services to Consider for All Grade Levels Primary Care including biennial risk assessment Primary Care including biennial risk assessment Immunizations Immunizations Health Education Health Education Physical Examinations Physical Examinations Mental Health Mental Health Laboratory Services Laboratory Services Medications Medications Nutrition Counseling Nutrition Counseling Vision, Hearing, and Dental Screening Vision, Hearing, and Dental Screening Social Services Social Services Chronic Disease co- management Chronic Disease co- management Specialty Care Referrals Specialty Care Referrals

44. 44 Services at the MS and HS Levels Pregnancy testing Pregnancy testing STD testing and treatment STD testing and treatment Reproductive health care Reproductive health care Group counseling to address issues such as sexual abuse, depression Group counseling to address issues such as sexual abuse, depression Individual mental health counseling Individual mental health counseling HIV testing and/or counseling HIV testing and/or counseling Referral for family planning Referral for family planning

45. 45 The Role of the School Nurse Maintain school nurse mandated functions (vision and hearing screening, immunizations, special ed, etc.) Maintain school nurse mandated functions (vision and hearing screening, immunizations, special ed, etc.) Member of school-based health team Member of school-based health team –Identify students for school-based health center services –Provide follow-up –Reach out to parents –Serve as a liaison between the school-based health center and school staff

46. 46 Parental/Family Consent / Family Engagement The majority of SBHCs have a parental/guardian consent policy. The majority of SBHCs have a parental/guardian consent policy. Consent form should include: Consent form should include: –Services to be offered –Statement about confidentiality /HIPAA –Billing issues –Statement about the relationship between the sponsoring organization and any collaborators including the school district Review state statutes regarding age of consent for various health care services Review state statutes regarding age of consent for various health care services

47. 47 Confidentiality Confidential versus nonconfidential services Confidential versus nonconfidential services Access to confidential services Access to confidential services Release of information Release of information Providing follow-up information to school personnel and outside agencies Providing follow-up information to school personnel and outside agencies Informing students of confidentiality procedures and limits of confidentiality Informing students of confidentiality procedures and limits of confidentiality

48. 48 Nut and Bolt #3 Funding for SBHCs

49. 49 Maslow’s Hierarchy of Need It’s hard to focus on best practice standards when your needs are rooted in basic survival. School health clinics fight for lives Karina Bland The Arizona Republic March 12, 2001

50. 50 Multiple Funding Sources/ Models for School-Based Health Centers Federal grants Federal grants State grants State grants Local funding Local funding Community partnership contributions Community partnership contributions Foundations Foundations Patient Revenue Patient Revenue Mixing several or all funding sources Mixing several or all funding sources

51. 51 Foundations Federal Public Grants Local Funding/ Community Partners State Public Grants SCHIP Medicaid Private insurance Patient fees Federal entitlement programs administered at the state level MCHB/Title V CDC HIV/AIDS Prevention SAMHSA/Title XIX (substance abuse and mental health screening and early intervention) Title XX/ Soc Services Block Grant (TANF, daycare, child neglect and abuse) State Funding State General Revenue Tobacco Tax/Settlement Education NCLB /ESEA (Title I improving academic achievement of the disadvantaged and Title IV safe and drug free schools) IDEA (health-related special education services) BPHC/FQHC (Section 330 of the Public Health Service Act) Title X of the Public Health Service Act: Family Planning Figure 1 School-Based Health Center Funding Models Patient revenue Foundations that commonly supports school-based health care Robert Wood Johnson Foundation KB Reynolds Charitable Trust WKKF Kellogg Foundation Welborn Foundation McKesson Foundation Duke Endowment Health Foundation of Greater Cincinnati Visit the Grantsmanship Center at http://www.tgci.com/ and the Foundation Center at http://fdncenter.org for other foundation funding opportunities Local Funding Public and private grants (e.g., universities, United Way) City/county funds Local businesses (e.g., banks, insurance companies) Community Partners In-Kind Contributions from schools, hospitals, health departments, community health departments, and community agencies (e.g., staff, facilities, supplies) Examples of Partners Parents’ employers Parents’ health insurance agencies Local businesses School districts Universities

52. 52 Federal public grants BPHC /FQHC (Section 330 of the Public Health Services Act) BPHC /FQHC (Section 330 of the Public Health Services Act) Title X of the Public Health Services Act: Family Planning Title X of the Public Health Services Act: Family Planning

53. 53 Core Funding Models Federal 330 Federally Qualified Health Centers 330 Federally Qualified Health Centers Entirely federally dependent Entirely federally dependent Fairly stable Fairly stable Limited community Limited community Limited funds for expansion Limited funds for expansion

54. 54 State public grants Federal entitlement programs administered at state level Federal entitlement programs administered at state level –MCHB Title V –CDC HIV/ AIDS Prevention –SAMHSA/ Title XIX (substance abuse and mental health screening and early intervention –Title XX/ Social Services Block Grant, Temporary Aid to Needy Families Programs (TANF) job training, pregnancy prevention, daycare, child neglect and abuse

55. 55 State public grants Education Education –NCLB/ESEA (Title I improving academic achievement of the disadvantaged and Title IV safe and drug free schools) –IDEA (health-related special education services)

56. 56 State public grants State Funding State Funding –State General Revenue –Tobacco Tax Settlement –Juvenile Justice Funds

57. 57 Core Funding Model State Grants Louisiana – MCHBG; Tobacco settlement Louisiana – MCHBG; Tobacco settlement Connecticut – MCHBG, state fund Connecticut – MCHBG, state fund Delaware – state fund Delaware – state fund Fairly stable Fairly stable Limited growth; targeted funding Limited growth; targeted funding Requires legislative/administrative advocacy Requires legislative/administrative advocacy

58. 58 Local Funding Public and private grants (universities, United Way Public and private grants (universities, United Way City and county funds City and county funds Local businesses (banks, insurance companies) Local businesses (banks, insurance companies)

59. 59 Core Funding Models Local Government Portland/Multnomah County (OR) Portland/Multnomah County (OR) Seattle/King County (WA) Seattle/King County (WA) Great community buy in Great community buy in Fairly stable income Fairly stable income

60. 60 Community partners In-kind contributions (staff, facilities, supplies) from In-kind contributions (staff, facilities, supplies) from –Schools, –Hospitals, –Health departments, and –Community agencies

61. 61 Community partners Examples of partners Examples of partners –Parents’ employers –Parents’ health insurance agencies, –Local businesses, –School districts, and –Universities

62. 62 Core Funding Models Community Partnerships Denver SBHCs Denver SBHCs Baltimore County Public Schools, MD Baltimore County Public Schools, MD Healthy Kids, Lexington, KY Healthy Kids, Lexington, KY Indianapolis Collaborative Indianapolis Collaborative Collaboration has inherent difficulties Collaboration has inherent difficulties Built over long-term Built over long-term Requires perseverance, leadership Requires perseverance, leadership

63. 63 Foundations Robert Wood Johnson Robert Wood Johnson WK Kellogg Foundation WK Kellogg Foundation KB Charitable Trust KB Charitable Trust Health Foundation of Greater Cincinnati Health Foundation of Greater Cincinnati McDonald Foundation McDonald Foundation Welborn Foundation Welborn Foundation

64. 64 Foundations For other foundation funding opportunities visit For other foundation funding opportunities visit –The Grantsmanship Center at http://www.tgci.com http://www.tgci.com and –The Foundation Center at http://fdncenter.org

65. 65 Core Funding Models Foundations Indianapolis SBHCs Indianapolis SBHCs Cincinnati, Ohio SBHCs Cincinnati, Ohio SBHCs North Carolina SBHCs North Carolina SBHCs Miami SBHCs Miami SBHCs

66. 66 Patient Revenue SCHIP SCHIP Medicaid Medicaid Private insurance Private insurance Patient fees Patient fees

67. 67 Core Funding Model Patient Revenue West Virginia – FQHC rate West Virginia – FQHC rate New York – Medicaid institution rate New York – Medicaid institution rate Commitment to specific sponsor type Commitment to specific sponsor type Leadership necessary at Medicaid level Leadership necessary at Medicaid level

68. 68 Mixed Funding Sources Denver School-Based Health Centers Denver School-Based Health Centers Baltimore County School-Based Health Centers Baltimore County School-Based Health Centers Healthy Kids Centers Healthy Kids Centers Indianapolis Collaborative Indianapolis Collaborative

69. 69 Follow the Income Streams Education Mental Hlth/Sub Abuse Public Health Care

70. 70 Funding Service Components Medical/nursing services Medical/nursing services Public health/promotion Public health/promotion Mental health/behavioral health Mental health/behavioral health Case management/social services coordination Case management/social services coordination Education support Education support

71. Nut and Bolt #4 Principles of School-Based Health Care Seven fundamental principles Seven fundamental principles Goals, structures, processes and outcomes Goals, structures, processes and outcomes

72. 72 SBHC Fundamental Principles http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.274345 9/k.9519/NASBHC_Principles_and_Goals_for_SBHC s.htm http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.274345 9/k.9519/NASBHC_Principles_and_Goals_for_SBHC s.htm

73. 73 The School-Based Health Center: 1. Supports the school 2. Focuses on the community 3. Focuses on the student 4. Provides comprehensive care 5. Advances health promotion activities 6. Implements effective systems 7. Provides leadership in adolescent and child health

74. 74 Supports the School The school-based health center is built upon mutual respect and collaboration between the school and the health provider to promote the health and educational success of school-aged children.

75. 75 1. Supports the School Principles/ Goals StructuresProcessesOutcomes  Understands and respects accountability within the accountability within the educational system educational system  Works with the school administration to develop and achieve a shared vision  Communicates the vision to all school constituencies including teachers, support staff, students and parents  Builds collaborative and mutually respectful relationships with school personnel  Identifies community resources that provide support to students and promote successful learning  Serves as a resource in times of school crises and community disasters  Mutually agreed upon vision statement for the SBHC  Mutually agreed upon roles and responsibilities of each party  Mutually agreed upon policies regarding appointment scheduling during school hours and information sharing  Delineated role within the school’s crisis intervention plan  Communication with School Administration, School Nurse, Guidance Counselor, Social Worker, School Psychologist and Faculty  Attendance of SBHC personnel at school staff meetings  Presence of SBHC personnel at appropriate school functions  Partnership in identifying students with issues influencing educational performance  Training of SBHC staff on the school’s crisis intervention plan and community’s emergency preparedness plan and the SBHCs expected response  Recognition by school personnel of the value the SBHC provides in meeting educational mission  High satisfaction of school personnel with SBHC services  Increased number of appropriate referrals by school personnel  Reduced number of students who leave school during the day due to illness  In the event of a school crisis or community disaster, SBHC performs effectively according to plan

76. 76 Responds to the Community The school-based health center is developed and operates based on continual assessment of local assets and needs.

77. 77 2. Responds to the Community Principles/ Goals StructuresProcessesOutcomes  Assesses child and adolescent health care needs and available resources in the community through formal evaluation methods  Informs the community of student health needs and trends  Solicits community input to address unmet health needs and support the operations of the program  Definition of geographic service area  Identification of population to be served including demographic and socioeconomic characteristics  Identification of key health indicators  Continuous needs assessment  System for gathering data on key indicators  Resource manual  Advisory Committee with appropriate community representation  Communications plan  Program development based on periodic review of data  Advisory Committee meetings  Stakeholder meetings  Periodic communication with the general public  Improved access to primary care as measured by increased utilization of SBHC services  Recognition by community of the value of SBHC services in meeting the needs of students and responding to community values  High parent satisfaction  Improved utilization of other community resources through referrals and/or inter- program collaboration

78. 78 Focuses on the Student Services involve students as responsible participants in their health care, encourage the role of parents and other family members, and are accessible, confidential, culturally sensitive, and developmentally appropriate.

79. 79 3. Focuses on the Student Principles/GoalsStructuresProcessesOutcomes  Encourages the student’s active, age appropriate participation in decisions regarding health care and prevention activities  Involves the parents or other adult caregivers as supportive participants in the student’s health care whenever appropriate and possible  Ensures confidentiality of information whether transmitted through conversation, billing activity, telemedicine, or release of medical records  Provides services and materials that are culturally sensitive and respectful of family values and diversity  Parental consent and parental notification policies  Confidentiality and minor consent policy  Emancipated minor policy  Child abuse and neglect policy  Non-discrimination policy  Patient rights and responsibilities  Patient education materials in languages other than English, where appropriate  Methodology for identifying children with special health care needs  Methodology for identifying non-users  Provision of services in a manner consistent with established policies  Treatment of students with acute illness or injury  Counseling of students with behavioral issues  Management of students with chronic conditions  Provision of culturally sensitive anticipatory guidance and health and safety education  Student-centered risk assessment and follow-up  Family assessment and follow-up  Outreach to non-users  Increased enrollment for and utilization of SBHC services  High user and parent awareness of SBHC policy regarding access to confidential services  Improved user knowledge of how and when to utilize the health care system  Students with chronic disease or behavioral issues can demonstrate self-care skills  High satisfaction among users.

80. 80 Delivers Comprehensive Care An interdisciplinary team provides access to high quality comprehensive physical and mental health services emphasizing prevention and early intervention.

81. 81 4. Delivers Comprehensive Care Principles/GoalsStructuresProcessesOutcomes  Provides a scope of services that is consistent with identified health care needs  Promotes availability of on- site services whenever the school is open and facilitates after-hours care 24-hour-a- day, seven-days-a-week  Adopts generally accepted guidelines for clinical practice  Promotes the interdisciplinary role and functions of the school-based health care team  Coordinates and integrates efforts with existing systems to optimize complementary programs, improve continuity of care, reduce fragmentation, prevent duplication, and maintain affordable services  Defined scope of services to be provided  Multidisciplinary team of caregivers  Posted hours of operation  Effective 24/7 on-call system  Staffing guidelines  Clinical protocols or practice guidelines consistent with nationally recognized best practices  Referral relationships with other providers in the community (including lab, radiology and pharmacy)  Standards for medical record keeping  Release of information policy  Population-based Screening  Early identification and treatment  Delivery of care consistent with best practices  Patient assessment  Patient education  Patient treatment  Patient referral  Management of chronic conditions  Anticipatory guidance, health promotion and prevention activities  Continuity of care  Quality assurance  Chart review  Patient perception that well-being has improved  Increasing number of students receiving comprehensive well exam including risk assessment  Increasing compliance rates as measured by follow-up visits completed, prescriptions filled, therapy attended, referrals completed.  Reduced number of students with disruptive behavior or discipline problems

82. 82 Advances Health Promotion Activities The school-based health center takes advantage of its location to advance effective health promotion activities to students and community.

83. 83 5. Advances Health Promotion Activities Principles/GoalsStructuresProcessesOutcomes  Serves as a resource to school administration on the selection, development and delivery of health education curricula  Participates in classroom-based and school-wide health promotion activities responsive to the risk factors that are prevalent among students  Promotes parent and community involvement in health promotion activities  Partnership between the school’s health education faculty and SBHC staff  Coordinated risk assessment and health promotion plan  Age appropriate health education materials  Delivery of classroom health education segments  Display and distribution of multilingual health education materials in SBHC (pamphlets, posters, models, videos, etc.)  School-wide health and safety promotional events  Increased student awareness of health threats and risk factors  Reduced high risk behaviors among students  Increased positive health and safety behaviors among students  Increased student understanding of important health and psychosocial issues  Increased student ability to access valid health information and health promoting products and services  Increased student knowledge of health care rights and responsibilities  Increased student ability to communicate about and advocate for improved personal health  Increased participation of parents in heath promotion activities

84. 84 Implements Effective Systems Administrative and clinical systems are designed to support effective delivery of services incorporating accountability mechanisms and performance improvement practices.

85. 85 6. Implements Effective Systems Principles/GoalsStructuresProcessesOutcomes  Ensures compliance with all relevant laws and regulations  Develops and measures annual program goals and objectives  Maintains a physical plant which is adequate to deliver high quality services and assure patient comfort and privacy  Develops all necessary policies and procedures, training manuals, and memoranda of agreement or understanding  Develops a human resources system for hiring, credentialing, training and retaining high quality, competent staff  Collects, evaluates and reports health outcomes and utilization data  Establishes quality improvement practices including but not limited to assessment of patient and community satisfaction  Develops strategies and systems to support long-term financial stability  Organizational chart  Mission statement  Goals and objectives  Administrative policy and procedure manual  Clinical policy and procedure manual  Appointment system and scheduling standards  Tracking system for missed appointments, follow-up appointments and lab reports  Incident reports  Staff credentialing  Staff training  Personnel evaluation and salary review  Facility maintenance  Strategic business/ marketing/financial plan  Billing and collection system  Licensing, Certification and/or Accreditation  CLIA compliance  Medicaid EPSDT compliance  Medical record keeping according to accepted standards and demonstrating collaboration and communication among providers  Formal quality assurance monitoring of clinical and administrative functions  Financial audits  Staff knowledge of current laws and regulations affecting delivery of services  Treatment for high volume, high risk problems consistent with current professional knowledge  High SBHC provider and staff satisfaction  Low SBHC provider and staff turnover  Increased provider productivity  High patient and parent satisfaction with ease of appointment-making and waiting time  Operations within budget  Eligibility for reimbursement from public and private third-parties

86. 86 Provides Leadership in Adolescent and Child Health The school-based health center model provides unique opportunities to increase expertise in adolescent and child health, and to inform and influence policy and practice.

87. 87 7. Provides Leadership in Adolescent and Child Health Principles/GoalsStructuresProcessesOutcomes  Participates in national and local organizations that focus on adolescent and child health  Contributes to the body of knowledge on the health care needs of adolescents and children  Promotes the School-Based Health Center as a training site for health care professionals  Advocates for the resources necessary to increase access to physical, mental and dental health services for adolescents and children  Informs elected officials, policy- makers, health professionals, educators, and the community-at-large regarding the unique value, acceptability, efficiency and convenience of the school-based health center model of health care delivery  Forms partnerships to develop stable, sustainable funding mechanisms for expanded services  Local Conferences  National Conferences  Journal Articles  Annual Reports\  Videotapes  Web sites  Vehicles to communicate with state and local health authorities  Precepting students in the health professions  Research  Outcome evaluation  Process evaluation  Clinical trials  Medical professional training  Curriculum development  Public education and advocacy  Use of student volunteers  Increased public awareness of the health care needs of children and adolescents  Greater number of children and adolescents with a medical home  Improved access to primary care  Increased exposure of health professionals to the SBHC model  Legislation and regulation supportive of the SBHC model  Increased investment in SBHCs by federal, state, local and private funding sources  Increased participation of SBHCs in Medicaid and Child Health Insurance Plans  Appropriate contracts with managed care organizations

88. 88 Nut and Bolt #5 Developing a Case Statement for a School-Based Health Center

89. 89 Case Statement Content Purpose Purpose –What you propose to do / what are you seeking funding for –Summary of needs assessment findings –Partners/collaborators and their contributors

90. 90 Case Statement Content Service design Service design –Model –Services –Staffing –Hours of operation –Parent, student, and school staff involvement –Community, collaborator/partner involvement

91. 91 Case Statement Content Current project support /infrastructure Current project support /infrastructure –Sponsoring organizations –Health center planning group activities –In-kind contributions of partners/collaborators –Implementation grant possibilities Proposed budget Proposed budget

92. 92 Nut and Bolt #6 Using the Media to Your Advantage

93. 93 What is the “Media”? the various means of mass communication the various means of mass communication considered as a whole considered as a whole including television, radio, magazines, and newspapers, together with the people involved in their production including television, radio, magazines, and newspapers, together with the people involved in their production

94. 94 Types of Media Daily Newspapers Daily Newspapers Weekly Newspapers Weekly Newspapers Wire Services Wire Services Internet Internet Magazines Magazines Television Television Radio Radio

95. 95 Tips for Dealing with the Media Don’t be afraid to approach the media with an issue or a story idea. Don’t be afraid to approach the media with an issue or a story idea. Try to keep relationships with the media friendly and honest. Try to keep relationships with the media friendly and honest. Remember, the media are doing their job— try to make it easier for them. Remember, the media are doing their job— try to make it easier for them. Access to the media is access to the public. Access to the media is access to the public.

96. 96 Communicating with the Media Be an information resource for the media. Be an information resource for the media. Have resources and information to help reporters in covering stories. Have resources and information to help reporters in covering stories. Be familiar with the types of stories each publication or station covers and how they report the news. Be familiar with the types of stories each publication or station covers and how they report the news.

97. 97 Role Play in Pairs Phone Call to the Editorial Editor of a Local Newspaper

98. 98 Technical Assistance Resources for SBHCs

99. 99 National Technical Assistance National Assembly on School-Based Health Care (NASBHC) National Assembly on School-Based Health Care (NASBHC) Society for Adolescent Medicine (SAM) Society for Adolescent Medicine (SAM) National Association of Pediatric Nurse Practitioners (NAPNP) National Association of Pediatric Nurse Practitioners (NAPNP) National Association of Community Health Centers (NACHC) National Association of Community Health Centers (NACHC)

100. 100 National Technical Assistance American School Health Association (ASHA) American School Health Association (ASHA) Center for School Mental Health Analysis and Action (CSMHA) Center for School Mental Health Analysis and Action (CSMHA) Center for Health and Health Care in Schools at GWU Center for Health and Health Care in Schools at GWU

101. 101 Figure 2 National Assembly’s Trainings, Tools, and Resources for SBHCS Mental Health Intervention CQI tool sentinel conditions Continuing education Quality improvement collaborative Center work groups Conference call presentations Asthma Green Zone web-based tool kit CQI tool sentinel condition Center work group New SBHC Expansion Peer to peer exchange Conference call presentations Web-based tools and information Practice Management Improvement Web-based tools and information Continuing education Family Engagement Web-based tools and information Health Education Web-based tools and information Obesity/Cardio Health Conference call presentation Continuing Education Panel work group STDs/HIV Prevention CQI tool sentinel condition Quality improvement collaborative Conference call presentations Web-based resources Conference call presentations Continuing education programs Quality improvement collaboratives New SBHCs/Expansion Peer-to-peer exchange Conference call presentations Web-based tools and information Evaluation Measures Academic Outcomes Productivity SBHC Census Mental Health Evaluation Template

102. 102 State Technical Assistance State Assemblies, Associations, and Coalitions for School-Based Health State Assemblies, Associations, and Coalitions for School-Based Health State Health Departments that administer state funding for SBHCs State Health Departments that administer state funding for SBHCs State Primary Care Associations State Primary Care Associations State Offices of Rural Health State Offices of Rural Health

103. 103 National Tools and Resources for Getting Started NASBHC website www.nasbhc.org NASBHC website www.nasbhc.orgwww.nasbhc.org – –Basics, – –Training and Assistance, – –Publications, and – –Members Only Sections Community Health Centers’ (NACHC) CD-Rom, www.nachc.org National Association of Community Health Centers’ (NACHC) CD-Rom, How to Start a Successful School- Based Health Center $25 www.nachc.org www.nachc.org

104. 104 Questions and Complete Evaluations