Community Schools & School-Based Health Centers: Together the Vehicles for Student Success

1. Community Schools & School-Based Health Centers: Together the Vehicles for Student Success A conversation with: Marty Blank, President ,Institute for Educational Leadership, Director, Coalition for Community Schools Joshua Rovner, Director of Policy and Advocacy, National Assembly on School-Based Health Care Marilyn Crumpton, MD, MPH Director, Growing Well Cincinnati December 16, 2010 www.communityschools.org

2. The Coalition for Community Schools • Vision: The Coalition for Community Schools believes that strong communities require strong schools and strong schools require strong communities.  We envision a future in which schools are centers of thriving communities where everyone belongs, works together, and succeeds. • Mission: The Coalition advances opportunities for the success of children, families and communities by promoting the development of more, and more effective, community schools. www.communityschools.org

3. What is a Community School? • A community school is both a place and a set of partnerships between the school and other community resources. It provides academics, health and social services, youth and community development, and community engagement, and brings together many partners to offer a range of support and opportunities for children, youth, families, and communities. The school is generally open for extended hours for everyone in the community. Community schools may operate in all or a subset of schools in an LEA. (Title I Guidelines, U.S. Department of Education, Sept. 2, 2009)

4. Key Community School Principles • Foster strong partnerships • Share accountability for results • Align school and community assets and expertise • Set high expectations for all • Build on the community's strengths • Embrace diversity www.communityschools.org

5. Health & Education Linkages: What Matters Beyond School? • Low birth-weight and non-genetic prenatal influences on children; • Inadequate medical, dental, and vision care; • Asthma; • Physical activity; • Teen pregnancy; • Aggression and violence Sources: Berliner, David C. (2009). Poverty and Potential: Out-of-School Factors and School Success. Boulder and Tempe: Education and the Public Interest Center & Education Policy Research Unit. Retrieved [date] from http://epicpolicy.org/publication/poverty-and-potential Charles Basch, Healthier Students are Better Learners. AS Research Initiative of the Campaign for Educational Equity. Teachers College, 2009 www.communityschools.org

6. Academic Indicators Related to Health • Early Chronic Absenteeism • Tardiness • Safety • School discipline referrals www.communityschools.org

7. What Happens in a Community School? • Engaging Academic Instruction • Comprehensive services: health, mental health, prevention services and family support • Community-based learning (service, civic, experiential) • Adult education and workforce classes • Community building • Early child development • Increased learning time and enriched learning opportunities • Family and community engagement www.communityschools.org

8. Health Services in Community Schools • Vision care • Mental health counseling (for students and families) • Dental care • Immunizations • Health education & programming (dance classes, health eating, etc.) • Community gardens • Peer health promotion www.communityschools.org

9. Community Schools: Integrating Strategies • Results driven • Joint planning • Coordination among partners www.communityschools.org

10. Community Schools & SBHCs – Creating a Systemic Framework • Tulsa, OK • Evansville, IN • Montgomery County, MD • Cincinnati, OH www.communityschools.org

11. How SBHCs improve student achievement Josh Rovner, Director of Policy and Advocacy, National Assembly on School-Based Health Care

12. Overview of School-Based Health Centers

13. How SBHCs Support Learning • Supports the school • Responds to the community • Focuses on the student • Delivers comprehensive care • Advances health promotion activities • Implements effective systems • Provides leadership in adolescent and child health

14. About SBHCs: What do they do? • Provide a comprehensive range of services • Nearly all are open during school hours • 60% are open after the school day ends • 49% open before the school day begins • 36% are open during summer months • Every SBHC is different • 25% provide primary care only • 75% have mental health counselors • Other providers: health educators (19%), nutritionists (14%), dental (12%)

15. Primary Care Services Provided Onsite at SBHCs

16. Starting an SBHC • Resources • NASBHC’s website: “SBHC Roadmap” • NASBHC’s state affiliates • The basics (1 of 2) • Collaboration and community engagement • Local health department • Community or rural health center • Community and/or teaching hospital(s) • Mental health, substance abuse and social service agencies • Private physicians • University faculty • Elected officials • Business and community leaders • Faith community • School superintendent or school board • School administration and faculty • Students • Parents

17. Starting an SBHC, cont. • The basics (2 of 2) • Needs assessment and evaluation • Identify needs and resources in a community • Determine gaps: What is, and what should be • Establish priorities • Funding and other resources • Federal grants • State grants • Local funding • Community partnership contributions • Foundations • Patient Revenue • Mixing several or all funding sources

18. School-Based Health Center Funding Models 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 Federal Public Grants State Public Grants Foundations that support 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/ Community Partners Local Funding Public and private grants (e.g., universities, United Way) City/county funds Local businesses (e.g., banks, insurance companies) Foundations 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 Patient revenue SCHIP Medicaid Private insurance Patient fees

19. Healthy students make better learners • Poor health has a direct and negative impact on student success • Health and education are inexorably linked • SBHCs decrease school absences • SBHCs keep kids in their seats

20. SBHC success stories • In Massachusetts, SBHC users had a 50% decrease in absenteeism and 25% decrease in tardiness two months after receiving school-based mental health and counseling • In North Carolina, African-American male SBHC users were three times more likely to stay in school than their peers who did not use the clinic. • A Dallas SBHC demonstrated that medical services helped decrease absences by 50% among students who had three or more absences in a six-week period • Students who received mental health services had an 85% decline in school discipline referrals

21. Federal interagency collaborations “We are thrilled that part of the [health reform] legislation calls for an expanded footprint of school-based health clinics … I can’t think of a better way to deliver primary care and preventive care to not only students but their families than through school-based clinics. So the Secretary of Education and I have already talked about how we’re going to leverage that money, how widely we can expand that foot print, and how quickly we can get it done.” --HHS Secretary Kathleen Sebelius, 2010 National Forum on Community Schools, April 7, 2010.

22. Affordable Care Act Overview • Regulates private health insurance • Investments in prevention, wellness, primary care • Expands access to coverage through: • Subsidies • Expansion of public insurance • Creation of health insurance exchanges • Cost containment strategies • Improving quality/cost effectiveness

23. Cincinnati SBHCs: Supporting the Mission of a Community School Marilyn Crumpton, MD, MPH Director, Growing Well Cincinnati

24. SBHCs by Sponsoring Agency Nationally (n=1096) • Cincinnati, OH • Cincinnati Health Dept. • Health Foundation of Greater Cincinnati • Neighborhood Health Care • Winton Hill Health & Medical Center

25. Cincinnati SBHC Funding • Combination model: • Health Foundation Center of Greater Cincinnati • Give start up funding • Federally Qualified Health Center/Community Health Center • Provide sustainability in funding www.communityschools.org

26. Cincinnati’s Funding Reality • Schools receive health support in 2 ways: • SBHCs • Public health nurse from the Department of Health • This year: • 12 schools will lose funding for public health nurse www.communityschools.org

27. SBHCs participation in school-wide teams Nationally (N=1096)

28. Where are the Opportunities to Strengthen the Connection?

29. What are the Challenges in the Relationship?How can they be Addressed?

31. Moving Forward • Community Schools Learning Laboratory, Seattle, WA. March 31-April 2, 2011. Click here for more info. • 2011 National School-Based Health Care Convention. June 26-29, 2011. Click here for more info. • Community School Advocacy Day. May 2011. Stay tuned for more info! • WEBINAR: A Deeper Look into Ohio’s SBHC & Community School System…Winter 2011 www.communityschools.org

32. Contact info: • Martin J. Blank, President, Institute for Educational Leadership, Director, Coalition for Community Schools, blankm@iel.org [www.communityschools.org] • Joshua Rovner, Director of Policy and Advocacy, National Assembly on School-Based Health Care, jrovner@nasbhc.org [www.nasbhc.org] • Marilyn Crumpton, MD, MPH Director, Growing Well Cincinnati, mcrumpton@healthfoundation.org [www.healthfoundation.org] www.communityschools.org