Coming Home

John SchlittNational Assemblyon School-Based Health Care

SBHC Beginnings

• West Dallas Youth Center at Pinkston High School, Dallas, TX

A movement is born

My objectives

• Reflect on where we’ve been

• Where we are today

• NASBHC’s vision for where we’re going.

SBHCs: The Early Years

• First SBHC Census, Center for Population Options, 1987

• 110 SBHCs in 28 states• TEXAS:

– West Dallas Youth Clinic– Urban Affairs Corporation, Houston

• New Mexico (1988)– Albuquerque (8)– Pecos

The Good Ole Days

• Predominantly grant funded

• Predominantly adolescents

• No billing: what was the point?

• Accountability was to ourselves and the youth we served

The Good Ole Days

• HIPAA, ICD codes, practice management, managed care, prior authorization, medically necessary, productivity, quality assurance, Medicaid 1500 forms, explanation of benefits.

Support Center for SBCs

“As the movement approaches its adolescence, we find ourselves in the role of proponent and defender, responding to more and more vociferous critics…

“Will a fear of controversy move us to inaction? At a time when so many teens are in need it would be tragic if a few critics succeeded in stopping this movement that has developed through committed efforts of so many communities.– Sharon R. Lovick (Houston, TX), 1987

SBHCs Today

2004-05 Census

• 2100+ SBHCs opened since West Dallas

• ~1600 in operation today

• 44 states

• Texas SBHC Database– 110 SBHCs in 46 communities – 34 sites closed doors (1 in 3)– 76 open today– ????

State SBHC Investments

0

10

20

30

40

50

60

1992 1994 1996 1998 2000 2002 2004

MCHBG State Gen Rev/Other

Mil

lio

ns

Enormous Challenges in face of Incredible Growth

• Insurance expansion

• Role in Managed Care– Accommodating multiple access points

• Billing/collecting– Juice worth the squeeze?

• Managing Outcome Expectations– Academic achievement– Cost-savings/efficiencies

Closing Doors

• 540 SBHCs closed across US

• 34 in Texas

• What’s behind the closures?– Inadequate funding?– Lack of need/poor utilization?– No public will?

• Who’s next?

What’s the Stateof the Field in Texas?

National Assembly onSchool-Based Health Care

NASBHC Strategic PlanningNASBHC Strategic Planning

Winter 2005 – strategic planning survey of membership and stakeholders conducted

April 2005 – Board meets to review strategic planning data, re-affirm mission and vision, and identify critical issues

June 2005 – Board reviews staff progress, informs development of strategic plan

October 2005 – Board evaluates goals and objectives

November 2005 – Staff completes strategic plan

VISION

WE ENVISION schools and communities working

together to ensure that all children and adolescents

have access to health care.

WE BELIEVE… schools are an excellent and time-proven place to

provide health care.

WE REPRESENT… those who support, receive and provide health care

in schools and school-connected programs.

WE ADVOCATE… for national and state policies, programs and funding that sustain, grow and integrate school-based health

care into our nation’s health care and education systems.

WE PROVIDE… leadership, resources and technical assistance to enable school-based health centers to deliver high

quality services, become financially stable, and play an active role in public policy.

WE SUPPORT… the growth of state and regional school-based health

care organizations and networks.

GOAL ONE

• Build Capacity of National, State and Local SBHC Community to Influence Public Policy

– Capacity Building of State and Local SBHC Organizations to Implement Direct Action Campaigns

– Youth/Parent Engagement In Advocacy– SBHC Finance Policy Knowledge– SBHC Campaign Tactics To Secure Federal

Authorization

GOAL TWO

• Set National Benchmarks for SBHC Assessment

– Measuring Productivity in SBHCs– National Census of SBHCs– Measuring Cost in SBHCs– Measuring Quality Improvement in SBHCs– Evaluating Mental Health Programs in

SBHCs– Telling the Story of School-Based Health

Care through Qualitative Data Collection

GOAL THREE

• Improve/Strengthen SBHC Practice – Improving Practice Management in School-

Based Health Centers– Implementing Evidence-Based Behavioral

Health Interventions in School-Based Health Care

– Strengthening HIV/AIDS Prevention and Testing in School-Based Health Centers

– Resources and training for SBHC Practice

GOAL FOUR

• Develop structure to support NASBHC’s growth, make effective/efficient use of staff & Board, and assure accountability across all levels

– Staff Development, Planning and Management– Finance, Data and Technology Management– Board and Leadership Development– Advisory Panel Support and Development– State and Regional Organization Relations

GOAL FIVE

• Build Political and Public Support for NASBHC and its Mission

– NASBHC Positions and Policies that Affect SBHC Practice

– Advocacy for Federal Policies and Funding that Grow and Sustain SBHCs

– Fund Development Plan to Diversify NASBHC's Revenue

– Marketing Campaign to Raise Visibility of NASBHC Mission/Goals

National Policy Initiative

• WKKF Funded• National, State (9) and Local Partners (~50)

• Establish Champions for SBHCs

• Influence policies/funding to sustain and grow SBHCs across country

• Involve SBHC consumers, families and supporters in advocacy

Accomplishments to Date

• NASBHC public affairs/field development

• 200+ meetings with Members of Congress and SBHC advocates

• Federal appropriations campaign– 65 House sponsors; 24 Senators

• Federal authorization campaign

Congressional Interest by Party Affiliation

Unsupportive 0 (0%) 2 (4%) 2 (1%)

Neutral 6 (6%) 23 (48%) 29 (20%)

Supporter 76 (80%) 23 (48%) 99 (69%)

TOTAL 95 48 144

Level of Interest

Democrat Republican Total

Champion 13 (14%) 0 (0%) 14 (10%)

National Campaign for Federal SBHC Program

Principles for Federal Legislation

• Purpose: fund the development and operation of SBHCs to provide comprehensive primary public health services to underinsured and at-risk children, adolescents and their families

• Priorities: communities that demonstrate highest need among school age population

Principles for Federal Legislation

• Medicaid/SCHIP: recognize & reimburse SBHCs for services to enrollees at 100% cost of providing services.

• Federal grants: used to expand existing school health center networks or establish a new program where none exists.

• Allow scope of service to be determined by community and reflect accepted standards of practice for pediatric care.

Importance of Texas Advocates

• Congressman Joe Barton– Chair, House Energy & Commerce Committee

• Congresswoman Kay Granger– Member, House Appropriations Committee

State/Local Successes• New York – campaigning to increase the state’s

investment to $15M• New Mexico – Governor campaigned to double the

number of SBHCs• California – campaigning to establish first ever

state program• Michigan – doubled SBHCs through Medicaid rule

making• Maine – partnering with state’s commercial insurers• New Orleans – leaders pledging to put SBHC in

every new school they open

Determining our Message

Focus Groups/Polling:

Conservative Voters

ARGUMENTS AGAINST SBHCs

Children should not be getting care or treatment without their parents’ consent and involvement.

3.58

Teenagers should not be getting care or treatment without their parents’ consent, especially family planning services. Schools should not be handing out condoms or the morning after pill, nor should they be educating teens about safe sex. This is a role parents should play.

3.35

SBHCs would take money/attention away from more important education priorities. Schools are already having enough trouble educating our children, let’s not give them even more to do.

3.10

Parents are responsible for their children’s health care and well-being. This is not a role that schools, or the government, should play.

2.63

Many services provided by schools are of poor quality. SBHCs are likely to provide poor quality care too, may end up doing more harm than good.

1.60

* Participants scored argument on a 0 to 4 scale on which 0 meant not at all convincing and 4 meant very convincing.

ARGUMENTS FOR SBHCs (high)

SBHCs provide easy access to health care for millions of children who are uninsured or underinsured. Children should not go without health care just because their parents are not in a position to provide the health care they need.

2.95

SBHC provide on-going care for children with chronic diseases like asthma and diabetes, comprehensive on site care in case of accidents, sudden illnesses, outbreaks of infectious disease or other crises.

2.64

Healthy children learn better. By helping children stay healthy, SBHCs give all kids an equal chance to succeed in school.

2.53

SBHCs can teach children about nutrition and help prevent and treat obesity-related conditions among children such as diabetes and high blood pressure.

2.36

* Participants scored argument on a 0 to 4 scale on which 0 meant not at all convincing and 4 meant very convincing.

ARGUMENTS FOR SBHCs (low)

SBHCs aren’t just for low-income children. All students need medical care from time to time. SBHCs work together with children’s regular doctors to give them the best care in school and outside of school.

1.99

Families today are busier than ever. SBHCs provide a convenient way for children and adolescents to get the comprehensive, high quality health care they need. Parents do not need to miss work and students do not need miss school. SBHCs help families and students stay healthy, without spending hours in the doctor’s waiting room.

1.87

* Participants scored argument on a 0 to 4 scale on which 0 meant not at all convincing and 4 meant very convincing.

Early Findings

• Few really know about SBHCs

• Fewer still know that there are so many in existence

• There are two kinds of parents: responsible and irresponsible

• Children of responsible parents don’t need SBHCs 

Take Home Messages

• Important that policymakers know SBHCs are not an untried concept, but a working, established reality

• Less is more: vagueness about extent of services provided at SBHCs might work to our advantage; seems to be a point beyond which participants decide it is "too much."

• In communicating about SBHCs it is necessary to remind audiences about the extent of uninsurance and its negative economic and human consequences.

• At the very least, most of the conservatives agree that many children are doing without health care and that this is a problem that needs to be rectified.

Looking Ahead

• Strengthening the business aspect of SBHC (practice management)

• Quality, quality quality

• population-based approaches

• technology

• mental health in schools

• Rural access strategies

Invitation to Leadership

• Complete the census• Attend national convention

– Portland, OR: June 16-18, 2006– Submit a presentation abstract for 2007

• Join NASBHC: support the nat’l cause• Join TASBHC/get involved• Make contact with elected officials

– Site visits, post card campaigns, parent letters, candidate forums, etc.

Never believe that a few caring people can't

change the world. For, indeed, that's all who ever

have. - Margaret Mead

American Cultural Anthropologist