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Improving Adolescent Health OutcomesHayley Lofink Love, PhDDirector, Research and EvaluationSchool-Based Health Alliance
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1. Adolescent health challenges2. Rethinking healthcare3. School-based health centers as a solution
Agenda
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Fragmented careEmergency department use
Incomplete care
current health care system is failing to meet the needs of adolescents
Duplicated care
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ConvenientAccessibleCulturally and
developmentally appropriate
adolescent-centered care
CONFIDENTIAL
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Long-term threats to health and wellbeing
Teen pregnancySubstance use and addiction
School failure
Violence/trauma
Inter-relatedCostlyPreventable
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Adverse childhood experiences
Early pregnancy
risk for obesity, alcoholism, depression
School performance
Level of school engagement
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School failure
Death rate
Involvement in criminal justice system Health
outcomes
Lifetime earnings
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Product: broaden concept to ameliorate effects of nonclinical determinants(Inadequate food, housing, safety)
Place: beyond medical complex
in neighborhoodsProvider: nontraditional team members (Community outreach workers, heath educators, coaches, resource coordination)
Realigning health with care
Rebecca Onie, Paul Farmer, & Heidi Behforouz. Realigning Health with Care. Stanford Social Innovation Review
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1.02.0
3.0
Acute/ infectious disease
Reducing deaths
Chronic diseaseProlonging
disability-free life
Wellness/ prevention
Achieving optimal health for all
The evolving health care system
Halfon, Wise, Forrest. The Changing Nature Of Children's Health Development: New Challenges Require Major Policy Solutions Health Aff December 2014 33:122116-2124
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1. Point of entry to primary prevention, risk reduction and care management system
2. Inter-disciplinary team: whole child approach that unifies mind and body
3. Screen/address behavioral health needs often undetected and unmet by mainstream PC system
4. Meets young people where they are (literally) in terms of problems, pain, social and developmental challenges
5. Unprecedented opportunity for population health
Schools in the health neighborhood
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1. Provide quality, comprehensive health care services that help students succeed in school and in life.
2. Located in or near a school facility and open during school hours.
3. Organized through school, community, and health provider relationships.
4. Staffed by qualified health care professionals.5. Focused on the prevention, early identification, and
treatment of medical and behavioral concerns that can interfere with a student’s learning.
School-based health center characteristics
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SBHCs: The Evidence Base1. Increased use of primary care2. Reduced inappropriate emergency room use
Greater than 50% reduction in asthma-related emergency room visits for students enrolled in NYC SBHCs
3. Fewer hospitalizations$3 million savings in asthma-related hospitalization costs for students enrolled in NYC SBHCs
4. Access to harder-to-reach populations - esp minorities and malesAdolescents were 10-21 times more likely to come to a SBHC for mental health services than a CHC or HMO.
SBHCs: The Evidence Base
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49 of 50 states
More than 2000 SBHCs
and in DC
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Alaska Marshall Islands HawaiiPuerto Rico & Virgin Islands
Locations of SBHCs Nationwide (n=1930)
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Tribal government
Mental health agency
University
Other
Private, non-profit
School system
Local health department
Hospital/medical center
Community health center
0% 5% 10% 15% 20% 25% 30% 35%
0.3%
1.3%
3.6%
4.2%
6.3%
11.3%
13.3%
26.4%
33.4%
SBHC Sponsor Agency (n=1341)
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66.6% 73.1% 60.8%
> 31 HOURS/WEEK AFTER SCHOOL BEFORE SCHOOL
(n=1285)(n=1295) (n=1284)
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PrimaryCare
Mental
Health
Nursing or Clinical Support
Oral Health
Health Educator
Dietician
85.8%
(n=1185)
15.9%
(n=219)
16.0%
(n=221)
10.7%
(n=148)
100%
(n=1381)
70.8%
(n=978)
ProviderTypes
in SBHCs
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37.4%
33.4%
29.2%
Primary Care & Mental Health Plus
Primary Care & Mental Health
Primary Care
SBHC Staffing Profiles (n=1381)
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Vision Screening
Mental Health
Oral Health
ReproductiveHealth
Immunizations
Alcohol, Tobacco, and Drug
Use Prevention
Healthy Eating, Active Living, and
Weight Management
Injury and Violence
Prevention
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have a pre-arranged source of after-hours care
70.6%
52.7%use electronic health or medical records (EHR/EMR)
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Revenue Supporting SBHCs(not including in-kind donations) (n=1286)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1.1%
5.1%
6.6%
18.4%
27.4%
32.3%
32.6%
33.1%
40.4%
53.4%
74.7%
State Government
Federal Government
Private Foundations
School/School District
Hospital
County/City Govt.
MCO/Private Insurer
Corps./Businesses
SBHA
State Network/Assoc.
Tribal Government
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report billing at least one insurance program (n=1272)
87.9%
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85.9% 64.0%
50.0%
Public Sources (n=1273)
Private Sources (n=1300)
Self-pay (n=1309)
Patient Revenue by Source
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81.6%64.0%
63.0%
State Medicaid Agency (n=1309)
Medicaid MCOs (n=1311)
CHIP (n=1307)
71.4%
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1987 1988 1993 1997 1999 2002 2005 2009 2011 20140
500
1000
1500
2000
2500
30%Grow the number of SBHCs by 2018
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50%SBHCs to document performance standards
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Questions?