D R . N A T H A N S U T E R , D D S O R A L H E A L T H D I R E C T O R & D E N T I S T

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COMTREA’s School Based Health Centers

Common characteristics of SBHCs

Located in schools or on school grounds. Work cooperatively within the school to become an integral part of

the school. Provide a comprehensive range of services that meet the specific

physical, dental, and behavioral health needs of the young people in the community.

Employ a multidisciplinary team of providers to care for the students: nurse practitioners, registered nurses, physician assistants, social workers, physicians, alcohol and drug counselors, dentists, dental hygienists, and other health professionals.

Provide clinical services through a qualified health provider such as a hospital, health department, federally qualified health center, or medical practice.

Require parents to sign written consents for their children to receive the full scope of services provided at the SBHC.

Types of SBHCs

Service Delivery Types Portable

Mobile

Fixed

Telehealth

Hybrid

Provider Groups Private for profit

FQHC

Local Health Dept.

Hospital

University Partnership

Primary Care Chronic Conditions

OBGYN

Pediatrics

Dental Care Preventive

Full Service

Behavioral Health Counseling

Psychiatry

Substance Abuse CSTAR

COMTREA Comprehensive Health Center

Community Mental Health Center since 1974

Federally Qualified Health Center (FQHC) since 2012

First School Based Health Center opened in 2013

School Based Oral Health Screenings Mobile / Portable Prevention Follow up Comprehensive care

Tooth Fairy PSP in all schools

Valley Clinic Fixed Clinic – 3 chairs Comprehensive Care Adults and Children

Fox Clinic Fixed Clinic – 5 chairs Comprehensive Care Adults and Children

Tooth Titan Mobile/ Portable Hybrid Prevention and Exams Limited Restorative Children Only

Valley SBHC Clinical Services

Providers and Staff 2 Dentists 1 Child Psychiatrist 1 APN Child Psych 3 Counselors 1 Case manager 2 Hygienists 3 Dental Assistants 3 Secretaries

Dental Services Monday-Friday

8:00-6:00 Primary Care

Coming fall 2016

Counseling Services

Monday and Tuesday 7:30 -3:00

Wednesday 7:30-6:00

Thursday 7:30-5:00

Fridays 7:30-3:00

Psychiatric Services

Wednesdays 7:30-3:00

CSTAR Substance Abuse Services

Monday-Friday 9:00-5:30

Supporting NWR1 Graduates: COMTREA’s Team Members

Lauren Willis

Dental Assistant

Class of 2013

Nicole Bollinger

Dental Operations Manager

Class of 2004

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Northwest R-1 District 2014-2015 PSP Data

Percent Untreated Decay Percent with No Sealant

Northwest R-1 District Statistics

6,700 Students Population

2,597 Students F&R Lunch

38.76% Free and Reduced

914 students screened

35% had untreated tooth decay

State average 24%

82% have no dental sealant

State Untreated Decay Average 24%

Fox Service Center / Early Childhood Center

Providers and Staff 2 Dentists 2 Hygienists 3 Dental Assistants 2 Secretaries

Dental Services Monday-Friday

8:00-6:00 Behavioral Health

Coming soon…

Nathan Suter, DDS

Ashley Wegener, RDH

Renee Blanken, RDH

Toni Rushing, DA

Supporting Fox Graduates: COMTREA’s Team Members

Missouri Foundation for Health COHI Project

New School Based Health Center

Largest School District in Jefferson County

Covers 1/3 of the Jefferson County

Highest Number of Free and Reduced Lunch Participants

$300,000 MFH Grant for Equipment

$400,000 COMTREA Match for Construction

Estimated 2,000 patient visits a year projected

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Fox C-6 District 2014-2015 PSP Data

Percentage Untreated Decay Percentage with No Sealants

Fox C-6 District Statistics

11,679 Students Population

3657 Students F&R Lunch

31.31% Free and Reduced

1363 students screened

31% had untreated tooth decay

State average 24%

82% have no dental sealant

State Untreated Decay Average 24%

Valley Clinic

Cedar Springs

Murphy

Maple Grove

Early Child

NW High

Woodridge

Brennan Woods

High Ridge

School Based Health Center: Hub & Spoke Model

• On-Site Diagnosis & Prevention

• Tooth Titans

• By Dentist & Hygienist

• Those with needs get identified.

• Those with only cleanings and checkups stay at school.

• Needed Resource for the Community

• Innovative Model: 1st like it in Missouri

• Students restorative needs are referred to the SBHC Clinics

• Students with complicated needs are referred to a Main Clinic.

Dental Outreach and Care Coordination Workflow

PSP Screenings

Urgent Needs

Early Needs

Low Needs

Recalls Refer out

Private Office

Free Dental Screenings performed at all but 3 Jefferson County school districts

Fixed Clinic Valley, Fox, or

Hillsboro

Tooth Titan Mobile Van

Single Operatory Mobile /Portable Clinic:

Prevention, Diagnostics, and limited treatment.

Tooth Titans Mobile Dental Van

Able to transport portable equipment to set up inside of a school.

Also able to treat inside the vehicle.

Care Coordination

School Dental Health Coordinator Part Time School District

Employee Nurses Room Aid COMTREA provides a

vehicle Desk inside COMTREA office Coordinates appointments Finalizes paperwork and

consent forms with parent Communicates with school

district staff Transports students from

surrounding school buildings

Moving away from appointment based scheduling

Coordinating different systems of care Mobile Telehealth Portable Fixed Clinic Hospital

Managing a population’s care and not waiting for the patient to show up.

Funding Sources

Grants

Missouri Foundation for Health

HRSA – Primary Care Expansion

Fee-for-service

Sliding fee

Medicaid

FQHC enhanced reimbursement.

Provides sustainability

85%

11% 4%

Valley SBHC Dental Payor Mix

Medicaid % Uninsured % Comm Insurance %

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Nov 2015 Dec 2015 Jan 2016 Feb 2016

COMTREA SBHCs‘ Dental Visits by Clinic

Valley Fox

Challenges and Lessons Learned

Nurses are the Gatekeeper!!

Creative ways to get enrollment in SBHC Program.

Factor in Snow Days

Simplify Paperwork

School District Buy-In Make or Break

Increase Access when school is out.

Kids like to knock their teeth out. CE for tooth trauma

Build on each year Integrate into the community as a

resource.

Hub & Spoke Model Outreach Education Mobile Fixed Clinic Care Coordination

Keys to Replication

Needs assessment of schools MO DHSS PSP Program

Grant writing to invest in initial capital for startup. Community Stakeholder buy-in.

School Board and Superintendent are KEY!!! Happy Nurses make for a good SBHC.

A robust effort to enroll students in the SBHC Screenings, educational events, open houses, sporting events,

kindergarten registration, school enrollment packets.

Flexible Staff and Providers that want to work in a unique setting.

School nurses are looking for dental solutions for the students. They will pick a program like this over the corporate “prophy mills” the majority of the time.