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State Funding of School-Based Health Centers: the Oregon Story & National Landscape

State Funding of School-Based Health Centers: the Oregon Story & National Landscape. Washington School-Based Health Alliance Student Health Summit May 3, 2019. Presenters:. William Thomas: retired SBHC Champion, OSBHA past president and current board member, tireless children's’ advocate

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State Funding of School-Based Health Centers: the Oregon Story & National Landscape

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  1. State Funding of School-Based Health Centers: the Oregon Story & National Landscape Washington School-Based Health Alliance Student Health Summit May 3, 2019

  2. Presenters: • William Thomas: • retired SBHC Champion, OSBHA past president and current board member, tireless children's’ advocate • Tammy Alexander: • Director, Programs at the National School-Based Health Alliance

  3. Objectives • Gain a national perspective on which other states provide state funding for SBHCs and how the models differ • Be able to describe the role of state funding in supporting development of sustainable school-based health and mental health services. • Understand Oregon’s pathway to state-level recognition, standards, and funding of SBHCs • Be able to describe key lessons learned in Oregon and other states’ pathways toward state funding.

  4. We are The national SBHC advocacy, technical assistance and training organization based in Washington DC, founded in 1995 Our Mission • To improve the health status of children and youth by advancing and advocating for school-based health care Our Goals Support strong school-based health care practices Be the national voice Expand and strengthen the SBHC movement Advance policies that sustain SBHC

  5. Working at the intersection of health and education–Addressing unmet needs that interfere with learningand lead to addiction and other social issues–Supporting prevention anddevelopmentally appropriate treatment within the safe and confidential setting ofSCHOOL-BASED HEALTH CENTERS

  6. 2016-17 National School-Based Health Care Census The Census identified 2,584 School-Based Health Centers in 48 of 50 states and in the District of Columbia and Puerto Rico.

  7. 2016-17 National School-Based Health Care Census Number of School-Based Health Centers, 1998-2017 • Note: From 1998-99 through 2013-14, behavioral health and oral health only programs were included in the overall count of SBHCs. For the 2016-17 Census, we elected to only include SBHCs with primary care and SBHCs that we confirmed are open.

  8. 2016-17 National School-Based Health Care Census Location of SBHCs

  9. 2016-17 National School-Based Health Care Census 6.3 million*students in 10,629 public schools have access to an SBHC *Exact number is 6,344,907 schools

  10. 2016-2017 National School-Based Health Care Census SBHC Delivery Models

  11. State Dedicated Funds for SBHCs, FY17 ME $.70 (in millions) WI VT NH AK WA ID MT ND MN IL $4.3 MI $20 NY $17 RI MA $2.9 OR $7.4 NV WY SD IA IN OH PA NJ CT $10 CA* UT NE CO $4.4 MO KY WV $.80 VA MD $2.6 DE $3.9 HI AZ NM $3.1 KS AR $2.0 TN NC $1.4 SC DC $2.6 OK LA $7.4 MS AL GA TX $.50 FL *State program office exists, but at time of survey, did not provide funding to SBHCs

  12. Survey Highlights Summary, 1996-2017 *Data from School-Based Health Care National Census, School-Based Health Alliance

  13. Characteristics of SBHC Funding Allotment Strategy

  14. SBHC Models Eligible for State Directed Funding

  15. Medicaid Policies and SBHCs, by State

  16. 2016-17 National School-Based Health Care Census (n=2,301)

  17. 2016-17 National School-Based Health Care Census (n=1,877)

  18. 2016-17 National School-Based Health Care Census (n=87)

  19. 2016-17 National School-Based Health Care Census (n=69)

  20. 2016-17 National School-Based Health Care Census (n=266)

  21. 2013-14 Census of School-Based Health Centers Percentage of SBHCs thatBill Entities for Reimbursement

  22. 2016-2017 National School-Based Health Care Census

  23. 2016-17 National School-Based Health Care Census Geographic Location of Communities Served by SBHCs Suburban Urban Rural (n=2,310)

  24. 2016-17 National School-Based Health Care Census Grade Levels of Schools Where SBHCs are Located (n=2,080) Note: This includes traditional and 100% telehealth SBHCs. School-linked and mobile SBHCs are excluded because they are not located at one school.

  25. 2016-17 National School-Based Health Care Census Populations Eligible to Receive Care at SBHCs 62% of SBHCs provide care to populations other than students enrolled in their schools (n=2,313) Non-student populations served by SBHCs include:

  26. 2013-14 Census of School-Based Health Centers (n=1,624)

  27. 2016-17 National School-Based Health Care Census SBHC Provider Teams 41% Primary care + behavioral health + expanded care team HOURS: 75% 31 or more hours per week 24% Primary care + behavioral health 35% Primary care only • Note: Expanded care team is defined as at least one of the following providers: Dentist, Dental assistant, Dental hygienist, Care coordinator, Health Educator, Nutritionist, Ophthalmic Technician, Optometrist or Ophthalmologist, Outreach coordinator, or Registered dietician. (n=2,317)

  28. 2013-14 Census of School-Based Health Centers

  29. 2016-17 National School-Based Health Care Census Types of Organizations SBHCs Collaborate with to Address the Social Determinants of Health Organization Focus/Type (n=2,109)

  30. 2013-14 Census of School-Based Health Centers (n=1,624)

  31. Oregon Story

  32. 1985: First 5 SBHCs in Oregon-$212,000 initial $ • 1994: RWJF Grant • 2000: First Standards for Certification • 2003: Major budget cuts • 2004: “Funding formula” developed • 2004: Planning Grants • 2000s: Continued growth • 2012: HRSA grants • 2013: HB 2445 and Mental Health Expansion • 2017: Revised Standards for Certification • 2017-2018 SBHC Mental Health Capacity Grants • 2019: 18.5 million 77 certified SBHCs and team at OHA

  33. Key Points along the Trajectory • 1993: OHD designates staff • 1993: Advocacy Day and Restoration of funding cuts • 1994: RWF Grant, more staff • Safety Net Designation • Youth Focus • Oregon School-Based Health Care Network and NASBHC • 2000: Funding Cuts, Rabid Volunteers, Bridge Funding and Restoration • 2006: Kellogg Funding of Network and Policy Change • 2010: SPO and Oregon Alliance National Recognition

  34. National School-Based Health Alliance News

  35. Our Consulting Team • Over 200 years of combined experience in design, operation, and evaluation of SBHCs • Our team is committed to working towards four goals: • Increased revenue • New school services • Stronger partnerships • Expanded services

  36. Examples of SBHC Consulting Services –

  37. Annual risk assessment BMI screening and nutrition/physical activity counseling Annual well child visit SBHC student user survey Student disposition log (seat time saved) Standardized national performance measures for SBHCs https://www.sbh4all.org/current_initiatives/nqi/ Core Chlamydia screening Depression screening • Core Measures • Annual well child visit • Annual risk assessment • BMI screening and nutrition/physical activity counseling • Depression screening • Chlamydia screening • Stretch Measures • Student disposition log (seat time saved) • SBHC student user survey Stretch

  38. SBHC Reauthorization ActH.R.2075/S.1013 • Urge members of your Congressional delegation to co-sponsor the School-Based Health Center Reauthorization Act : calls, letters, stories from students and school partners • The bill extends the federal School-Based Health Centers program authorization through 2024. • House sponsors include Reps. John Sarbanes (D-MD), Paul Tonko (D-NY), Elise Stefanik (R-NY), and Fred Upton (R-MI). • Senate sponsors are Senators Debbie Stabenow (D-MI) and Shelley Moore Capito (R-WV) • Visit Alliance online advocacy center: https://www.sbh4all.org/advocacy/advocacy-center/

  39. STATE AFFILIATES 21 and growing • Nevada School-Based Health Alliance • New Mexico Alliance for School-Based Health Care • New York School-Based Health Alliance • North Carolina School-Based Health Alliance • Ohio School-Based Health Alliance • Oregon School-Based Health Alliance • Washington School-Based Health Alliance • West Virginia School-Based Health Assembly • Emerging Affiliates • Alabama, Mississippi, Missouri, Montana, Pennsylvania, and South Carolina • Arizona School-Based Health Alliance • School-Based Health Alliance of Arkansas • California School-Based Health Alliance • Colorado Association for School-Based Health Care • Connecticut Association of School-Based Health Care • Delaware School Based Health Alliance • Georgia School-Based Health Alliance • Illinois School-Based Health Alliance • Louisiana School-Based Health Alliance • Maryland Assembly on School-Based Health Care • Massachusetts School-Based Health Alliance • School-Community Health Alliance of Michigan • Minnesota School-Based Health Center Alliance

  40. Planningfor a Sustainable SBHC

  41. Six Proven Service Development Strategies For Funding & Sustainability The success of the SBHC Initiative is based on: • Collaboration Across Systems • Common Vision and Collaborative Goals • Community Mobilization • Comprehensive and Integrated Clinical Model • Structures for Accountability • Sustainable Business Plan

  42. Results - The Good News! Since 2007: • secured over $6,000,000 in private and public grants • to develop and operate five new high school SBHCs serving seven school districts with 85,000 + students • Tigard in April 2008 • Forest Grove/Gaston/Banks in April 2009 • Century (Hillsboro) in March 2013 • Beaverton in December 2014 • Tualatin/Sherwood in April 2015

  43. 1. Collaboration Across Systems More than 25 funders and organizations committed to a common vision, mission & goals • Two Community Health/Mental Health Providers • Two Universities - OHSU and Pacific University • Three County Agencies – Children & Families, Mental Health and Public Health • Four Hospital Systems – Kaiser Permanente, Legacy, Providence and Tuality Healthcare • Seven School Districts and the Regional ESD

  44. 2. Commitment To A Common Vision • Increaseaccess to healthcareprevention, primary care, dentalcare, behavioral health, mentalhealth & substance abuse services • Reduce barriers to learning and other risk factors for children and youth • Promote wellness, educational success and other protective factors for children, youth and their families, and thereby move upstream to address the social determinants of health

  45. 3. Effective community mobilization • Community readiness and involvement – Engage faith, civic, school and other community leaders, as well as parents and students, in SBHC development, advocacy and oversight • Marketing, outreach and enrollment -On-going marketing and outreach campaigns are essential for maximizing SBHC utilization, as well as for maximizing Medicaid/SCHIP enrollment • Youth engagement and empowerment – Youth Advisory Councils support youth-led advocacy, marketing and health promotion

  46. 4. Comprehensive, integrated clinical model • Federally Qualified Health Center (FQHC) as SBHC medical sponsor: FQHC has robust referral systems, is state certified for provision of mental health services and can be certified as Tier III Patient-Centered Primary Care Home (PCPCH) • Comprehensiveservices: includes prevention, primary care, dental care, behavioral health, mental health and substance abuse services • Integrated electronic health records: billing, practice management and service integration

  47. 5. Structures For Accountability • Contract -among County, medical sponsor and school districts, which specifies expectations for certification, collaboration, funding and services • Memorandum of Understanding – between school district and medical sponsor, specifying roles and responsibilities for the SBHC facility • Operations Teams – for on-going problem solving among partners in each SHBC– over time the SBHC Operations Teams have been combined with local • SBHC Advisory Boards

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