wa doh state plan for healthy communities recommended changes - powerpoint - 09142015

Washington State Department of Health Healthy Communities

State Plan Analysis

School-Based Health Clinics Practicing

TransformationSupports

Presentation by Jim Harvey 2

Department of Health Healthy Communities State Plan Analysis

All Washingtonians



Difference Between School-Based Health Care Services and

School-based Health Clinics



• Screening, Referral and Follow-upCurrent goal: Promote and provide support to build capacity

and availability of healthcare, education, resources and services.

• Social and Emotional WellnessCurrent goal: Improve the knowledge and ability of healthcare

professionals to deliver comprehensive evidence-based services including integrated mental health and chemical dependency screening and interventions from preconception to end of life.

• Quality Clinical and Preventive Treatment ServicesCurrent goal: Support linkage to clinical community prevention

efforts to mobilize services, resources and self-management program from prevention to intervention.

Goals That Can Be Strengthened

Increasing school-based health screenings has to be more than making referrals and ordering follow-up procedures and other activities.

Why?•Washington State’s school districts are faced with limited resources.

Potential solution could be:•Districts, hospitals and other health agencies could pursue reimbursement through Medicaid Administrative Claiming (MAC) and/or through Medicaid administrative activities.

Reason to Expand the State Plan Around SBHC




Reason to Expand the State Plan Around SBHC

In Washington, there continues to be consistent need for community healthy services and educating families to thrive.

Why?The overarching evidence in the state plan did not reflect:

•Evidence of SBHC potential impact toward improved health status affecting learning outcomes, potential educational successes, and affects of lifelong health outcomes; and

•Evidence of SBHC services supporting prevention of both health and educational disparities that can follow similar patterns.



Reason to Expand the State Plan Around SBHCThe state plan reads:

SBHC current goal focuses on increasing mental health and sexual health services. This area of the plan needs to include more types of healthcare services.

Why?•SBHC services need to be accessible to all students and families who have challenges in:

o Financeso Transportationo Social pressureso Access to healthcare




Essential Elements for Establishing SBHC



Essential Elements for Establishing SBHC

Familiesand Students

The percentage of students demonstrating kindergarten readiness in October 2015 was 39.4%, falling short of the 44.8% target indicating a clear need for improvement.

What does the national data say about SBHC?In 2011, the number of SBHCs across the United States had grown to 1930 locations except in the states of Idaho, Montana and North Dakota.


What Does Washington State Data Results Show?


How can we support our public schools?Early learning and healthcare providers in public schools need access to more meaningful ways to support student success.



What Does Washington State Data Results Show?

In Washington State, the state as a whole is doing better than the national average (17.3%) and continues to make significant strides through Affordable Care Act (ACA)-related activities.

What is the challenge?There remain many improvements to be made before 2020. This is being achieved through:

1. Targeted Medicaid enrollment activities to the most needy citizens and students; and

2. Aligning communications and outreach strategies consistently with the Health Care Authority (HCA) and the Health Benefit Exchange (HBE) to promote coverage across all income spectrums.



What Does Other National Data Results Show?

According to the American Journal of Public Health (2010), SBHCs appear to have a significant ability to:

•Reduce health care access disparities among African American students.

•Reduce health care access disparities among disabled students. •Reduce or eliminate access barriers to care and reduce health care disparities for other vulnerable populations.

•Sustain needed resources for heard to reach healthcare sectors including potential cost-savings for hospitalization.



Vision SBHC 2020SBHC interventions are not just an opportunity to improve the physical wellbeing of students, but an opportunity to increase their ability to learn and succeed.

How can this be achieved?



Suggested Revisions to Support SBHC Expansion



Suggested Revisions to Support SBHC Expansion

Why is this important?

Partnering with other agencies statewide, focusing on ways to access Medicaid funding to improve people's "access" and "coordination" of health information and their capacity to use it effectively, would contribute to improving health care services and empowering underserved communities and public schools in Washington.



Why Are Policy Changes Necessary?

According to the National School-based Health Alliance, the data reflects:

•80.8% of adolescents are willing to provide feedback to healthcare professionals.•54.7% of adolescents participate in organizing center-sponsored health education events.•49.9% of adolescents participate in health center committees.•40.7% of adolescents participate in an advocacy role.•36.4% of adolescents are peer mentoring, counseling or educating other adolescents.•27.0% of adolescents participate in the design and delivery of health services.




As the State of Washington strives to create healthy communities, successful partnerships between healthcare providers and school districts are critical. A key component of collaboration is Washington’s ability to provide healthcare services to all students in a school setting.




• Students who start school confident capable and ready to learn, are more likely to succeed.

• The Legislature's goal is to fund full-day kindergarten for all students by the 2017-18 school years.

• The Washington Kindergarten Inventory of Developing Skills (WaKIDS) looks at the "whole child," giving kindergarten teachers information about the social, emotional, physical, cognitive and linguistic development to meet the individual needs of each student.

http://www.k12.wa.us/wakids/

http://www.k12.wa.us/wakids/




• The process connects families and early learning providers in the transition from early learning settings to the classroom.

• To increase awareness among healthcare professionals in both the community and school settings.

• To establish opportunities for early interventions for healthy behaviors during childhood.

• To increase social and physical involvement in communities, worksites, schools, and early care educational settings to promote and reinforce healthier behaviors.

• To establish community-clinical linkages across SBHC, PCPs, advance clinical practitioners and schools supporting access to quality community programs and resources.



1There has to be a partnership developed and maintained, to support schools in making difficult choices between funding their academic mission and funding school healthcare services despite the evidence that healthcare is fundamental to learning.


Footnote1The second decade of life (10-19 years of age) is a critical period when patterns of health-promoting (for example, adopting physical activity habits or learning ways to cope with stress) or potentially health damaging behaviors (for example, whether or not to try cigarette smoking, or to experiment with illicit drugs) are established, and that these behaviors may have a substantial influence on health status (Summary of The Second Decade Summit, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health, Seattle, 2012).



Financial Viability is Necessary for a Healthier Washington

In order for SBHC and the expansion of an multidisciplinary treatment approach, there must be identified sources of funding.




Funding the expansions of SBHC must come from a variety of sources, examples could be:

•Healthcare providers within the SBHC could bill Medicaid directly and/or the families’ private health insurance. The funds would then be reinvested in service expansion. •Collaborating with HCA to expand Medicaid payment options for services provided. •Increasing Medicaid provider eligibility through easier access to CORE Provider Agreements through HCA would strengthen financial resources. •Sponsoring agencies, hospitals and hosting ESDs providing in-kind services to SBHC.



•ESDs around Washington to sponsor “in-kind support” in the form of a health aides or school aides who already work within the districts.

•Healthy Schools and Healthy Communities grants administered by the Department of Health and Human Services’ (HHS) Bureau of Primary Health Care, which is the largest source of federal funding for SBHC to this date.

•State funding being the last resource to support SBHC, the funding would include: Washington State general funds, possible tobacco tax and tobacco settlement dollars, and funding from the ESDs.



Monitoring the efficiency and effectiveness of policies is an important part of the policy management and planning process. This process would need to involve:

Tracking Strategies and Effectiveness

1. Monitoring on a monthly basis that the objectives identified by the key partners are being met.

2. Building on other agencies' policy and plan monitoring efforts.

3. Sharing ideas and allowing room for state-wide training to occur.

4. Recording the information from monitoring and evaluations.



Monitoring the efficiency and effectiveness of policies is an important part of the policy management and planning process. This process would need to involve:


5. Analysing the monitoring and evaluation results, interpreting what they mean, and summarizing the outcomes.

6. Determining where changes are required to the policies and plans as a result of the monitoring and evaluations.

7. Reporting on the results from monitoring, evaluation and the effectiveness.

8. Ensuring the entire process is well documented.




Post-project implementation reporting would need to capture requirements of all elements to include: 1.A brief description of SBHC statewide and the work accomplished.2.Lessons and barriers learned during the expansion process.3.Recommendations for implementation of future SBHC.4.Quality assurance activities. 5.Monitoring of reimbursed claims.

Note: Monitoring would need to be based on identified strategies. Project leads would need to be responsible for monitoring the assigned strategies, identifying key performance indicators (KPI), milestones to be met, and the key partners (i.e., subject matter experts). Expansion of SBHC would fall short unless community members, stakeholders, and public schools are informed and involved in the planning process.




Determining whether SBHC activities were taking place, supported the state plan, evaluations long-term would must include: 1.Determining what key partners worked collaboratively to address chronic health conditions utilizing the SBHC model;2.Determining what efforts were used to encourage self-management, family planning, behavioral and health outcomes; and3.What lessons were learned regarding the advantages of SBHCs.

Note: Monitoring would need to be based on identified strategies. Project leads would need to be responsible for monitoring the assigned strategies, identifying key performance indicators (KPI), milestones to be met, and the key partners (i.e., subject matter experts). Expansion of SBHC would fall short unless community members, stakeholders, and public schools are informed and involved in the planning process.



SBHC Needs to be Expanded in the PlanIt is not enough to give out information. For SBHC Vision 2020 to be successful local policy makers must solicit information from the public they serve and use that information to improve services.

The endeavors would include:


SBHC Needs to be Expanded in the Plan




Building community partnerships can help SBHC, public schools and communities by:

•Improving academic outcomes, attendance and behavior.

•Reducing exposure to adverse childhood experiences.

•Improving health literacy starting at an early age.

•Reducing chances of negative childhood behaviors between ages 10 and 20 that could impact the course of their lives.

•Improving health outcomes for students including mental and behavioral health.




•Reducing the number of students identified as needing special education services.

•Reducing the number of students expelled or suspended.

•Improved healthcare services and care coordination for all students.

•Increasing and improve outreach services.



•Reducing the utilization of emergent medical services in the community.

•Controlling costs in the larger healthcare system through improved outreach activities, delivery, and care coordination in the districts.

•Streamlining services would prevent the duplication of healthcare services.

•Engaging in other efforts to meet students academic goals.




Healthy Communities Need Healthy Schools A Shared Vision Among Washingtonians

Schools are key members of a healthy community and play a critical role by promoting health and safety thus establishing lifelong healthy behavior patterns.

Providing healthcare services within a school district will increase access to care, improve student healthcare outcomes through care coordination, result in improved academic performance and graduation rates.

All of these elements lead to healthier Washingtonians!

What are policy changes necessary?



Proposal: Vision SBHC 2020

Vision SBHC 2020 would rely on elevating population health improvement activities and direct access to health care services. This can happen starting with:

1.Partnerships developed uniformly, consistently and ongoing statewide; and

2.Collaboration between state agencies focused on improving healthcare, educational outcomes, and consistent efficient activities statewide. (e.g., student committees, advocacy, health education events)



Questions from the Audience.



References Dilley, J. (2009). Research Review: School-based Health Interventions and Academic Achievement. Healthy Students, Successful Students Partnership Committee. Retrieved from http://www.doh.wa.gov. Guo, J. J., Wade, T. J., Pan, W., & Keller, K. N. (2010). School-Based Health Centers: Cost–Benefit Analysis and Impact on Health Care Disparities. American Journal of Public Health, 100(9), 1617–1623. http://doi.org/10.2105/AJPH.2009.185181

Johnson, V. (2006). Hutcherson V. A. Study of the utilization patterns of an elementary school-based health clinic over a 5-year period. Journal of School Health, 2006; 76: 373–378. Result Washington. (2015). Early Learning: Kindergarten Ready. Increase from https://data.results.wa.gov/en/stat/goals/ci2z-79bv/ar4i-hyez/w79d-quiu. School-Based Health Alliance. (2011). School-based Health Alliance. Redefining Health for Kids and Teens. 2010-2011 Census Report of School-Based Health Centers. Retrieved from http://www.sbh4all.org.

http://www.sbh4all.org/

wa doh state plan for healthy communities recommended changes - powerpoint - 09142015

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