About the Alliance’s Past Initiatives
The following federal- and private-funded initiatives are complete. A brief description about each is provided below.
HIV/STD Prevention Among Adolescents
In September 2016, the School-Based Health Alliance was awarded a two-year cooperative agreement from the Centers for Disease Control and Prevention (CDC) to increase education of key stakeholders on CDC-developed school-based approaches for creating healthier adolescents (10-19 years old) by reducing HIV and sexually transmitted disease (STD) infection.
New Directions for School-Based Health
The New Directions for School-Based Health Grant — funded by CVS Health and administered by the School-Based Health Alliance — built the capacity of the school-based health care (SBHC) field to become integrated and active participants in the larger health care ecosystem through policy and practice solutions.
Grantees improved access to health services for children and created system level changes that elevated the role of SBHC in achieving population-level outcomes. The transformational framework for the New Directions project included:
- Adopting a patient-centered medical home (PCMH) practice,
- Building a financially sustainable business model,
- Implementing public health strategies to achieve population-level change, and
- Engaging parent and youth consumers to improve health literacy and self-management.
Read more about New Directions on our blog. Click the arrow below to read more about each New Direction grant.
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Dr. John T. Macdonald Foundation School Health Initiative of the University of Miami
Because children spend a substantial amount of their time in the school, setting linkages between health care and education can have constructive value. Families often access other community agencies for additional medical, social, or community resources. This multi-point method of access often goes unnoticed by providers and paves the way for a lack of coordination of care.
Additionally, by determining the monetary value of school health services including those rendered through coordinated care, more sustainable models of school health become possible.
The School Health Initiative utilizes a multidisciplinary team approach consisting of physicians, nurses, social workers, dentists, psychiatrists, and community health workers to meet the health care needs of children and adolescents within the school setting making it a viable single point of entry to access services for healthcare, education, public health services, and home services for better coordination of care.
Through improved communication methods between clinical staff, a local emergency room, and parents, care coordination will be enhanced during the course of the first project through multiple electronic data systems that allow for sharing of information. The School Health Initiative plans to utilize an ER notification system, a text messaging system, brochures, website information, and the CHEER data system to enhance care coordination and ultimately achieve PCMH designation.
The Initiative will also implement a second project to demonstrate a health model deemed successful through effective cost savings data and insurance policy development. The School Health Initiative aims to demonstrate cost savings that may be used for advocacy and insurance policy development during the course of the second project.
Erie Family Health Center
As a school-based patient ages, they face new concerns that they must be educated about. As they move into adulthood, students must be empowered to proactively manage their own health and transition into a traditional primary care setting. By seeking out innovative ways to mold patient-centered care to meet the specific needs of adolescents, school-based health patient engagement can increase and ultimately empower youth to become informed health care consumers into adulthood.
PCMH Project Project #1
The first project focuses on improving efficiencies and expanding capacity within the electronic health record system to capture health outcomes specific to adolescents and filter them into a health outcome dashboard that will allow the clinical care team to view progress on health outcomes regularly. This tracking will enable Erie to target individuals who have fallen out of compliance on a particular health concern and, on a broader level, will allow Erie to build interventions specific to each condition so performance can be improved.
PCMH Project Project #2
The second project focuses on deepening involvement with patients as they age and go through key developmental milestones that may affect their health or access to primary care. Erie will develop electronic and paper care transition education materials that will be made available to patients both inside and outside the patient visit; build a care transitions checklist within Erie’s EHRS that will prompt school-based clinical care team on new screenings; and provide individualized assistance and coaching to patients as they manage care transitions.
Family Health Centers of San Diego
San Diego, California
Children and families in low income areas are more susceptible to higher rates of chronic conditions such as asthma, diabetes, and obesity. Additionally, families in these areas can also experience a lack of access to: affordable primary healthcare, fresh fruits and vegetables, safe outdoor spaces for physical recreations, and a lack of resources on information to: establish a PCMH, enroll in health coverage, stay healthy, prevent disease, and address behavioral health issues. By engaging students in their own physical and emotional health at a young age, and engaging parents around the role of a PCMH and the importance of health for overall well being and academic success, the capacity to become advocates for their own healthcare and the ability to navigate local health and community resources will increase.
Parent and Youth Engagement Project
STEP for Health will offer student empowerment groups and parent classes, where students and parents will learn about a range of topics including healthy habits, nutrition, and how to access local health and social service resources. Guest speakers from FHCSD and community groups will present on topics such as health coverage options and parent involvement opportunities through the Parent Teacher Association. In addition, STEP for Health will lead family recreational events, to help reduce isolation and build social ties among students and their families. Throughout the program, students and parents will be connected to a PCMH at the on-site SBHC. Family Health Centers of San Diego anticipates that at least half of all participating students and parents will access primary care services at the on-campus SBHC as a result of the program.
Health Choice Network of Florida, Inc.
The psychosocial needs of school children often can exceed the capacity of schools. Children and their families need to be identified expeditiously for appropriate intervention. Systematic identification, referral, and tracking of the highest-risk students can increase access to quality services and demonstrate the value of an integrated medical-educational approach in facilitating early detection and intervention towards improving children’s health and education outcomes.
Public Health Project #1
Health Choice Network of Florida, Inc. (HCNFL) will develop an algorithm for behavioral distress using the scalable CHEER (Children Health Education and Economic Recourse) system, an innovative school and community health approach of shared medical, educational, and economic data.
Public Health Project #2
Trained personnel will identify mental and behavioral health risks using the information in the CHEER system to identify students in need of early intervention. HCNFL will work with the Miami Children’s Initiative to develop a coordinated network of community-based organizations for services to children with characteristics for behavioral distress and their families. The model will decrease physical and mental health disparities by targeting underserved and minority populations, creating a healthier environment for future generations.
Loyola University Chicago Marcella Niehoff School of Nursing, in Partnership with Loyola University Health System (LUHS)-Trinity CHE
Adolescent mental health problems often manifest themselves through high-risk behaviors which lead to a need for disciplinary action. Some of the highest risk students do not seek mental health services at the SBHC and instead end up in the disciplinary system where they may receive suspension or expulsion without a mental health assessment. Early identification of disciplinary problems is a practical way to conduct surveillance and reach out to high-risk students for assessment and intervention.
In addition, continual operation of school-based health care, given the changes to the health care system, will not be achieved unless a financial planning strategy is adopted to maximize patient revenue and streamline operations.
Public Health Project
The first project aims to counteract the negative social determinants of health in the community by increasing the population level impact of the SBHC. This will be accomplished through early identification of mental health and behavioral problems among students by collecting school disciplinary data. Classroom-based interventions and curricula will be developed and delivered by an LCSW within the school’s in-school suspension room to increase resilience and decrease behavioral problems leading to disciplinary actions and/or school suspension. Loyola plans to evaluate the impacts and share resources that can be replicated by Mental Health staff at other SBHCs.
In an effort to impact overall school environment, the SBHC will educate the school’s teachers on mental health issues, warning signs of suicide, and de-escalation techniques in the classroom through “Lunch and Learn” educational seminars. These seminars will also be delivered to teachers within District 89’s feeder schools as an outreach effort.
With their second project, Loyola aims to achieve long-term financial stability by clearly identifying assets, expenses, and potential new partners in order to develop a business plan for the SBHC. The project includes the creation of a billing infrastructure to begin capturing reimbursement for selected services and providing a new revenue stream for the SBHC. Loyola will calculate a three-year projection of the SBHC’s revenue and expenses as well as conduct an environmental scan of current and potential partnerships.
New York-Presbyterian Hospital, Center for Community Health and Education
New York, New York
New York State Level 3 PCMH status requires an EMR and achieving at least baseline scores in ten areas of patient care: patient access and communication, patient tracking and registry, care management, patient self-management support, electronic prescriptions, test tracking, referral tracking, clinical performance measurement, adoption of evidence-based guidelines for three chronic diseases, and analysis of data to organize clinical information and identify important diagnosis and conditions. PCMH certification enables NYS SBHCs to receive a higher reimbursement base rate for each patient visit, ultimately increasing revenue derived from PCMH certification and improved data entry monitoring.
There will be two integrated project activities: 1) adapt and install the RDE eCOMPAS data extraction, aggregation, and analysis program to support the SBHC’s existing Eclipsys EMR; and 2) submit an application to NYS DOH that is approved for the SBHC to be a Level 3 PCMH clinic. NYS Level 3 PCMH status requires an EMR and achieving at least baseline scores in each of ten areas of patient care: patient access and communication, patient tracking and registry, care management, patient self-management support, electronic prescriptions, test tracking, referral tracking, clinical performance measurement, adoption of evidence-based guidelines for three chronic diseases, and analysis of data to organize clinical information and identify important diagnoses and conditions. The JFK SBHC substantially meets all Level 3 requirements except for the capacity to extract, aggregate, and analyze individual record EMR data for reporting, Quality Control and Quality Improvement, and care coordination. The eCOMPAS system will help to meet PCMH data management and analysis requirements.
Project Vida Health Center
El Paso, Texas
According to the Texas School Survey of Substance Use 2012, the likelihood a teen will smoke tobacco steadily increases each year from 7th grade through 12th grade. The 2012 Texas Leadership Academy for Wellness and Smoking Cessation Summit established a goal to reduce the teen smoking rate in the state of Texas from 11% to 5% by 2017. Further efforts surrounding tobacco cessation and smoking prevention programs are needed to meet this goal.
Parent and Youth Engagement Project
Project Vida Health Center will implement a project focused on decreasing smoking and increasing smoking cessation among teenagers and their parents through comprehensive, evidence-based cessation programs for middle and high school teenagers as well as their parents. The proposed project will encompass: 1. Medical Referral system, 2. School referral system, 3.Education classes for teens using Not-On-Tobacco (NOT) evidence base curriculum, 4. Education classes for parents using Freedom Smoking evidence base curriculum and, 5. Evaluation. The smoking cessation programs will be held in an after school setting for teenagers and in a clinical setting for the parents. Both programs are focusing on behavioral change through groups of five to ten participants per session in a weekly basis for a period of 8-10 weeks. This will be made possible through partnerships with Middle school and High school counselors and teachers, PVHC medical providers, and Diabetes Self-Management Education Program. The PVHC team will develop a series of three NOT programs and a series of two Freedom from Smoking programs reaching a total of 36 participants during the project year. The educational sessions will be bilingual and evaluated using tools to follow participant progress on a weekly basis.
Sisters of Charity Hospital
Buffalo, New York
The immediate need for sustainability involves policy changes underway at the New York state level. The majority of children served by Sisters of Charity SBHCs are enrolled in mandatory Medicaid Managed Care plans. Under the current Medicaid system, SBHCs are “carved out” of Managed Care and are able to bill the state Medicaid agency directly for services provided to Medicaid enrollees, irrespective of the child’s assigned managed care plan. This protects the SBHCs from the cost of uncompensated visits by Medicaid enrollees in health plans that refuse to pay for out-of-plan visits. Under New York’s “Medicaid Redesign” Initiative, the carve-out will be eliminated. SBHCs will then receive decreased reimbursement for services or potentially no reimbursement at all.
A priority of this project will be to negotiate fair and equitable contracts with the Buffalo area’s four Medicaid Managed Care Organizations. Sister of Charity’s additional strategies for making the SBHCs more sustainable include developing partnerships with community stakeholders, financial analysis to highlight the value of their work to internal and external audiences, self-advocacy within the insurance policy environment, assertive contracting with HMOs and MCOs, and raising productivity where ever possible. The SBHCs Manager will work closely with a consultant, defining the issues to be covered and problems to be resolved including fiscal analysis, negotiations, improving the visibility of SBHCs, maximizing SBHCs productivity, and assessing the ways in which the SBHC model fits into standard HMO/MCO contracts.
Thundermist Health Center
Woonsocket, Rhode Island
Ensuring that students are academically successful helps break the cycles of violence, poverty, and teen parenthood and ultimately improves the lives of generations to come. By developing and implementing a system to collaboratively address the health and educational outcomes of high-risk students, students receive both the care and the skills they need to be successful.
Public Health Project
Thundermist Health Center will work with the Woonsocket Education Department and the West Warwick Public Schools to design and implement a Surveillance/“Hot Spotters” project. The intervention will target 80 of the schools’ highest risk students, including high absenteeism, chronically truant, chronically tardy, using substances, or at high-risk for pregnancy. The intervention will increase the coordination of care between the school and the school based health center nurse practitioner and behavioral health clinician. Thundermist will also pilot the use of a Patient Navigator, who will work with students to increase their decision making skills and help families identify and breakdown barriers to care. Additionally, Thundermist will provide Botivin LifeSkills Training curriculum to student groups after school, focusing on personal self-management skills, healthy decision making, reducing stress, managing anger, general social skills, strengthening communication skills, and understanding the consequences of substance abuse and risk-taking.
States Seek Policies to Assure Place for School-Based Health Centers in Redesigned Health Systems
With the goal of positioning school-based health centers (SBHCs) more prominently within state health care finance and delivery reforms, the School-Based Health Alliance is spearheading a multistate, 18-month policy learning collaborative. With funding from Atlantic Philanthropies, the Alliance has recruited teams comprised of our state affiliates, representatives from public sector funders (state SBHC program office and Medicaid) and philanthropy, and school-based health care advocates.
The purpose of the collaborative is to ensure the preventive health needs of school-aged youth—and the essential community health models like SBHCs that meet those needs—are a pillar for health care transformation. The teams are tasked with developing a policy framework that secures both a role and reimbursement for SBHCs in their respective state’s delivery and payment reform strategies.
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Lessons learned during the collaborative are being used to support and advance state and national advocacy efforts. The following state affiliate organizations participated in the policy collaborative:
- California School-Based Health Alliance
- Connecticut Association of School-Based Health Centers
- Everthrive Illinois
- Georgia School-Based Health Alliance
- Oregon School-Based Health Alliance
- School-Based Health Alliance of Arkansas