Assessing Your Readiness to Start a SBHC

1
Assessing Your Readiness to Start a SBHC

• Tracy Macdonald, MPP, MPH
• La Clínica de La Raza, Oakland
• California School Health Centers Assoc.

2
What is a school-based health center (SBHC)?

• Located in school
• Works cooperatively with school
• Provides comprehensive range of services that
  meet physical and behavioral needs of young
  people in community
• Multidisciplinary provider team
• Qualified health provider(s)
• Signed parent consents
• Advisory board planning and oversight
• Source NASBHC, 2004

3
School-LINKED health centers

• Formal referral affiliation with school
• Often higher risk (out-of-school) youth
• Can be broader scope of services
• May serve more than one school
• May have extended hours
• Not subject to school board rules (e.g.,
  contraception)!..

4
Who runs SBHCs?

• Many types of organizations serve as lead
  agencies for SBHCs
• Community health centers
• Hospitals
• City or County public health departments
• Schools and school districts
• Mental health agencies
• Other community-based agencies
• Other (e.g., medical society)

5
What are the essential ingredients?

• Identified need
• (Potential) space
• Funding
• Planning/start-up
• Operations
• Service provider(s)
• Coordination
• Community, family, student and SCHOOL support
• IF YOU HAVE 4 OF 6, YOU CAN PROBABLY MAKE THE
  OTHER 2 HAPPEN!...

6
Which comes first?

• What do you have?!
• Review your assets
• Keep in mind the importance of MOMENTUM
• Gather partners

7
Roles and responsibilities

• Employment (payroll, taxes, benefits)
• Service Provision
• Coordination
• Fiscal
• Fund development
• Grants management
• Audit
• Billing for services provided
• Policies and procedures

8
Roles and responsibilities, cont.

• Facilities
• Equipment maintenance/servicing/calibration
• Custodial
• Fire clearance, etc.
• Licensure and certification
• DHS
• CHDP, Family PACT, etc.
• Insurance
• Quality assurance
• Data collection and evaluation

9
Service Provision

• Medical (incl. lab and pharmacy)
• Mental health, social services
• Health education
• Dental, vision
• Youth development programming
• Health insurance enrollment, support services

10
What does coordination include?!

• Coordinating multiple providers at the site
• Referrals, information sharing
• Ensure integrity of each
• Managing the relationship with the school
• Outreach to students, families, other agencies
• Scheduling rooms, appointments, etc.
• Interdisciplinary staff meetings and others
  e.g., case conference, QA

11
Fund Development

• What are potential revenue sources?
• Who will be responsible for fund raising?!?
• Lead agency
• Shared responsibility with partners
• Collaboratives

12
Revenue Sources

• Grants
• Billing revenue
• In-kind support
• Space
• Personnel
• Equipment
• Supplies
• Donations, events, other fundraising (United Way,
  e-scrip)
• Patient fees (e.g., charging insured students 15
  for sports physicals, TB tests for staff)

13
Public Grants
There is no single grant source for starting or
operating SBHCs.

• FEDERAL GRANTS
• Bureau of Primary Health Care
• SAMHSA
• Office of Minority Health
• Office of Population Affairs
• others
• STATE GRANTS
• OFP teen preg. prev.
• CFHC/Title X
• CDE
• Cal Nutrition Network
• MCH matching funds

• LOCAL GRANTS
• Community development block grants
• OFCY
• County AOD contracts
• Schools and school districts
• City Council members
• Others start talking!

Be creative but not TOO creative!...
14
Private Grants

• COMMUNITY FOUNDATIONS
• FAMILY FOUNDATIONS
• SERVICE LEAGUES
• RESEARCH GRANTS
• RFPs, RFAs, initiatives, unsolicited requests
• Pay attention to past grantees and guidelines!..

• FOUNDATIONS
• The Cal. Endowment
• California Wellness
• hers
• CORPORATIONS
• Mervyns, Target
• Clorox
• McKesson
• Whos in your community?!

15
Billing Revenue

• Family PACT
• CHDP
• Medi-Cal Minor Consent, LEA, Full-scope, ESPDT)
• EAPC
• Healthy Families
• Vaccines for Children
• Managed care contracts
• County indigent care programs
• EXPECT 10-50 OF TOTAL COSTS THROUGH
  REIMBURSEMENT

16
Who does fundraising?

• Important to clarify look at relative merits of
  each
• Lead agency
• Shared responsibility with partners
• Collaboratives
• Try to keep school district engaged..

17
Minimum Space Requirements

• One exam room 8x 10 with sink
• Lab (can be incorporated into other spaces)
• Bathroom
• Reception and waiting area (can be together)
• Medical records (double locked)
• Private space for counseling, health education
• Administrative space, charting room
• Consider ADA requirements
• Often done in a single converted classroom!
• Range from 24 x 32 portable to 3,500 square
  feet!!

18
Community Support

• Needs assessment
• Collect supportive data
• Talk to students, families, PTSA, school
  administration and staff
• Local health providers (competition)
• Student surveys, focus groups
• Consider potential controversy

19
Alternatives to Opening a SBHC

• Clear benefits, but sometimes
• Costs too high
• Too much opposition
• Other barriers
• Bad timing
• Alternatives include
• Improved linkages to existing programs
• Student Assistance Programs
• Coordinated School Health
• We can almost always do better with the resources
  we have!