Health Care for Special Populations Examining the Role of SBHCs

1. Health Care for Special Populations Examining the Role of SBHCs

2. Welcome and Introduction Childworks, PLLC • Brooke Lehmann, MSW, Esq. • Jennifer Leonard, MBA, Esq. Purpose of Today’s conference

3. Objectives of Today’s Discussion • Participants will have a better understanding of the strengths and challenges associated with the integration of school-based health centers and school-based programs serving special populations. • Participants will be able to utilize information gained through today’s discussion to think through opportunities that might exist within their professional positions for advancing collaborations between these two entities.

4. AGENDA • Present information on the Summit’s purpose and execution. • Discuss in detail the Summit’s findings and recommendations. • Generate a list of new recommendations from conference participants. • Questions/Answers/Wrap up

5. Setting the Stage for Summit Discussion: Common Themes From the Field • Role for SBHCs in serving Special Populations • Communication is critical • Must have shared resources with clear delineation of roles • Funding mandates can drive collaboration • Clarified critical mechanisms

6. Future Trends • Increase in the number of uninsured children and families • Increase in the rate of referrals to special education • Increase in the need for school-based mental health services • Strengthening systems that support SBHCs resulting in sustainability and growth

7. Summit Objective #1 • Build a Common Understanding: Describe the experience of: (1) School-based health centers (SBHCs) in providing services to children and youth with special health care or education needs (“special populations”); and (2) the school-system in utilizing SBHCs to serve special populations

8. Summit Objective #2 • Identify Opportunities: Identify areas of service delivery with the greatest potential to realize benefits from commonalities or synergy between SBHCs and schools in serving special populations

9. Summit Objective #3 • Explore Impact of Policies & Infrastructure: Explore the key challenges (e.g., education and health care policies, finance mechanisms, and infrastructure) in enabling SBHCs and schools to work together to better support special needs populations

10. Summit Objective #4 • Identify Short-term Priorities: Provide feedback on the top three areas of service delivery with the most potential for benefiting SBHCs and schools in serving special populations

11. Working Definition: Special Populations • Children and Youth with Special Health Care Needs: • Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition • Who also require health and related services of a type or amount beyond that required by children generally (Maternal and Child Health Bureau)

12. Definitions Continued • Special Education: • Defined within the Individuals with Disabilities Education Act (IDEA) which mandates that all children, regardless of their unique learning needs, will be afforded an opportunity to experience a free and appropriate public education in the least restrictive environment • Specifically designed instruction, at no cost to parents, to meet the unique needs of a child with a disability

13. Definitions Continued Special Education: • A child must have a disability that adversely affects educational performanceto be eligible • Children eligible for special education services under IDEA are also protected under Section 504 (but the converse is not true).

14. Definitions Continued • Section 504: • Civil rights law that protects individuals with disabilities from discrimination • Ensures that children with disabilities have equal access to an education by requiring that they receive benefits and services comparable to those given their non-disabled peers • To be eligible, child must have a physical or mental impairment that substantially limits at least one major life activity

15. Definitions Continued • School-Based Health Center: • A health center that is located in or near a school facility • Is organized through school, community, and health provider relationships and is administered by a sponsoring facility • Provides, at a minimum, comprehensive primary health services during school hours to children and adolescents

16. Summary of Exercises • Session A: Identify services with commonalities or potential for synergy between SBHCs and school systems in serving special populations • Session B: Identify the areas of service delivery with the greatest potential for synergy between SBHCs and schools

17. Summary of Exercises Continued • Session C: Identify the key challenges (e.g., education and health care policy, finance mechanisms, and infrastructure) in enabling SBHCs and schools to work together to better support special needs populations. • Session D: As a group, agree on the top three areas of service delivery with the most potential for benefiting SBHCs and schools in serving special populations

18. Finding #1: Mental Health Services Potential Opportunities: why is this a good idea? • Proximity to students • Consistent with “top concerns” given recent violent events • Improved identification • SBHC staff has sensitivity to needs of students • Multi-disciplinary environment & enhanced collaboration • Reduced classroom behavioral disruption; stabilized support for students in classroom • De-stigmatization of MH services by co-locating instead of providing services remotely

19. Finding #1: Mental Health Services Potential Challenges: Why might this be difficult to implement? • Lack of qualified workforce • Funding issues - Inability to access funding resources for MH services provided in schools; categorical funding an issue • Threat to school social worker / counselor • Medical providers may not understand the special ed issues • Lack of higher authority providing oversight and coordinating end goals for all

20. Finding #2: Primary Care Health Assessment / Medical Care Potential Opportunities: • Augment IEP development • Improved absenteeism and truancy • PCP able to coordinate and improve access to specialists • Improved coordination with the school, parents and other health care providers • Better positioned to understand child’s special needs in global environment and help child’s chances of staying in school and achieving acad. success • Caring adult

21. Finding #2: Primary Care Health Assessment / Medical Care Potential Challenges: • Another piece to the pie of places to receive primary health care • Lack of coordination with other providers • SBHC services not valued the same as “outside” providers • Limited training or understanding of IDEA • Potential for lawsuits • More paperwork and reporting

22. Finding #3: Identification Potential Opportunities: • Streamlined coordination of students • Greater degree of effectiveness • Improved financial results • Increased chance of student success • Better position to measure effectiveness of specialized services

23. Finding #3: Identification Potential Challenges: • Collaboration between the school and the SBHC • Practitioner lens

24. Other Recommendations • Build bridges to special ed community and leadership • Advocate for legislation to require Medicaid to support SBHCs • Consider databases and evaluations • Align SBHC with schools system’s needs • Develop “Principles” for SBHCs serving needs of special populations

25. YOUR RECOMMENDATIONS What other areas would you suggest for collaboration?

26. Questions

27. THANK YOU Contact Information: • Brooke Lehmann: 202-333-2770, BLehmann@Childworkspllc.com • Jennifer Guste Leonard: 202-237-6855, JLeonard@Childworkspllc.com