School-Based Health Centers (SBHCs) 101: Service Delivery Models Service Delivery Models.
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Transcript of School-Based Health Centers (SBHCs) 101: Service Delivery Models Service Delivery Models.
School-Based Health CentersSchool-Based Health Centers(SBHCs) 101:(SBHCs) 101:
Service Delivery ModelsService Delivery Models
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SBHC Service SBHC Service Delivery Models Delivery Models
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Primary Care Only ModelPrimary Care Only Model
NP/PA/MD 1-5 days/weekNP/PA/MD 1-5 days/weekFull or part-time (FT/PT) coverageFull or part-time (FT/PT) coverageNo Mental Health/Substance Abuse No Mental Health/Substance Abuse
ServicesServices
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Primary Care-Mental Health ModelPrimary Care-Mental Health Model PT or FT coveragePT or FT coverage Full Range of Prevention/Early Full Range of Prevention/Early
Intervention Physical and Behavioral Intervention Physical and Behavioral Health Services (age and Health Services (age and developmentally appropriate, e.g. developmentally appropriate, e.g. reproductive health)reproductive health)
Diagnosis, Treatment and Management Diagnosis, Treatment and Management of Minor Acute/Chronic Illnesses of Minor Acute/Chronic Illnesses
Provision for after-hours careProvision for after-hours care
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Staffing for Primary Care-Mental Staffing for Primary Care-Mental Health ModelHealth Model
Medical provider (NP/PA/MD)Medical provider (NP/PA/MD)School nurse (if present)School nurse (if present)Mental Health provider (e.g.)Mental Health provider (e.g.)
– Clinical Social Worker,Clinical Social Worker,– Psychologist/Psychiatrist,Psychologist/Psychiatrist,
May include Substance Abuse May include Substance Abuse Counselor if appropriateCounselor if appropriate
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Primary Care-Mental Health PLUS Primary Care-Mental Health PLUS ModelModel
FT coverage if possible FT coverage if possible Primary care and mental health plusPrimary care and mental health plus:: (one or more of the following)(one or more of the following)
– Dental ServicesDental Services– Reproductive Health Services that include Reproductive Health Services that include
contraception dispensing/prescribingcontraception dispensing/prescribing– Nutrition CounselingNutrition Counseling– On-site Substance Abuse TreatmentOn-site Substance Abuse Treatment
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Staffing for Primary Care-Mental Staffing for Primary Care-Mental Health PLUS ModelHealth PLUS Model
School NurseSchool Nurse Medical provider (NP/PA/MD)Medical provider (NP/PA/MD) Mental Health providerMental Health provider Dentist/Dental HygienistDentist/Dental Hygienist Addictions CounselorAddictions Counselor NutritionistNutritionist Health EducatorHealth Educator Social WorkerSocial Worker
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SBHC Staffing ModelsSBHC Staffing Models(N=1235)(N=1235)
Unknown4%
Primary Care-Mental Health
34%
Primary Care Only31%
Primary Care Mental Health
Plus31%
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Alternative ModelsAlternative ModelsServices and StaffingServices and Staffing
School-Linked Health CentersSchool-Linked Health Centers• Can mirror the service and staffing Can mirror the service and staffing
patterns of primary care only, patterns of primary care only, primary care-mental health, and primary primary care-mental health, and primary
care-mental health PLUS modelscare-mental health PLUS modelsMobile Health CentersMobile Health Centers
• Can mirror the service and staffing Can mirror the service and staffing patterns of primary care only, primary patterns of primary care only, primary care-mental health, and primary care-care-mental health, and primary care-mental health PLUS modelsmental health PLUS models
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What Services Do SBHCs What Services Do SBHCs Offer?Offer?
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Primary Care Services Provided by SBHCsPrimary Care Services Provided by SBHCs(N= 1176-1259)(N= 1176-1259)
0 10 20 30 40 50 60 70 80 90 100
Treatment of Acute Illness
Comprehensive Health Assessments
Screenings
Prescriptions for Medicines
Anticipatory Guidance
Asthma Treatment
Sports Physicals
Nutrition Counselling
Medications Administed in the Center
Treatment of Chronic Illness
Immunizations
Lab Tests
Standardized Behavioral Risk Assessment
Assessment of Psycholigical Development
Medications Dispensed to be Taken at Home
Care for Infants of Students
Dental Screenings/Diagnostics
Dental Preventive Care
Dental Comprehensive Care
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Reproductive Health Services Offered Reproductive Health Services Offered to Adolescents on Siteto Adolescents on Site (n= 897-931 )(n= 897-931 )
community typecommunity type0 10 20 30 40 50 60 70 80 90
Pregnancy testing
Abstinence Counseling
HIV AIDS Counseling
Counseling for Birth Control
STD Diagnosis and Treatment
Chlamydia Screening
Gyn Exams
Sexual Orientation Counseling
Urine Based Chlamydia Screening
Follow- up of Contraceptive Users
HIV testing
Pap Smears
Prenatal Care
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Contraception ProhibitionContraception Prohibition(N=853)(N=853)
0 10 20 30 40 50 60 70
YES70%
NO30%
Who Prohibits Dispensing Who Prohibits Dispensing Contraceptives in SBHCsContraceptives in SBHCs
OtherOther
Don’t knowDon’t know
State PolicyState Policy
School PolicySchool Policy
State LawState Law
Health CenterHealth Center
School DistrictSchool District
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Mental Health Services in SBHCs With (n=805) and Mental Health Services in SBHCs With (n=805) and Without (n=388) Mental Health Providers Without (n=388) Mental Health Providers
0 10 20 30 40 50 60 70 80 90 100
*Mental Health Diagnosis
*Grief and Loss Therapy
*Crisis Intervention
*Assessment
*Referrals
*Screening
*Skill-Building
*Conflict Res/Mediation
*Tobacco Use Counseling
*Brief Therapy
*Substance Use Counseling
*Case Management
*Psycho-education
*Long Term Therapy
*Medication Mngt/Admin With MH StaffWithout MH Provider
* P<.01* P<.01
Examples of Commonly Raised Examples of Commonly Raised Concerns and IssuesConcerns and Issues
The following are issues that typically arise when discussing SBHCs and being prepared to answer adequately is the best strategy.– Reproductive Health– Parental Consent– Cost– Why in a school setting – resources
concern
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National Tools and Resources for National Tools and Resources for Getting StartedGetting Started
NASBHC websiteNASBHC website www.nasbhc.org – Basics, Basics, – Training and Assistance, Training and Assistance, – Publications, and Publications, and – Members Only Sections Members Only Sections
National Association of Community National Association of Community Health Centers’ (NACHC) CD-Rom, Health Centers’ (NACHC) CD-Rom, How How to Start a Successful School-Based to Start a Successful School-Based Health CenterHealth Center $25 $25 www.nachc.org
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Questions and AnswersQuestions and Answers