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HomeMy WebLinkAboutAgenda - 04-30-2007-f/q4Qcj4 r APRIL 2007 Orange County School District School -Based Health Center Initiative Working Together to Improve the Health. & Academic Success of Orange County School District Students . Shirley Carraway, EdD, Superintendent, Orange County School District Rosemary L. Summers, MPH, DrPH, Director, Orange County Health Department Overview: The Orange County School District is exploring the idea of opening a health center in C.W. Stanford Middle School in Hillsborough, NC, as part of its Coordinated School Health Program. This is motivated by an appreciation of the direct link between students' physical health, mental health and academic success. Healthy students have better school attendance, are better learners, and are more academically successful than students who are experiencing physical or psychological health problems. Healthy students have a better chance of graduating from high school and making a smooth transition to a healthy, happy, and productive young adulthood. Potential Benefits to Creating a School -Based Health Center (SBHC). School -Based Health Centers (SBHCs) exist across North Carolina and the nation. These centers are typically created as a coordinated effort to improve students' school attendance, academic achievement, and health -- by providing mental and physical health services and increasing access to health care. Health centers are typically staffed with health professionals that are exquisitely sensitive to the importance of a "holistic" approach to adolescent health. Clinicians have the skills to provide traditional health care, but also routinely screen for a broad range of behaviors and issues that impact adolescent health and well - being. In SBHCs there is a very heavy focus on education and counseling to prevent behaviors that place adolescents at risk of health problems, reducing the risk of health problems among students engaged in problem - behaviors, and recognizing the connection between mental and physical health. Scope of Services: The OCSD does not want to interrupt existing relationships with medical homes. When students already have a ".medical home," SBHCs provide services that are not available in that medical home or when asked. Students who do not have a medical home are encouraged to find one, and some SBHCs develop the capacity to provide medical homes if needed. The OCSD is exploring the idea of developing a SBHC that can provide comprehensive physical and mental health services 'to students with unmet needs, including the capacity to address common mental health and substance use problems, acute illnesses/injuries, sports physicals, and comprehensive developmentally - appropriate preventive health screening and counseling. There may also be a need to assist a student's medical home with chronic disease management (e.g. diabetes, asthma, etc). The district realizes that this may require a phased -in approach. SBHCs will NOT provide condoms, contraception, or drug testing. First Steps? • ASCD Health Schools Community Grant will support us to explore these ideas! • We would like to create a Steering Committee! APRIL 2007 How would a SBHC be different than what is already in the schools? A SBHC would pull all of the people who are already working to improve student health.under "one roof' and would bring in new medical and mental health services. The school nurses already provide medical services. What would be new? The school nurses would still be in the schools, and they would continue to do the job that they are doing. They would have a new home in the SBHC, and be part of a team that could provide more comprehensive medical care. Will parents need to provide permission or consent for their child to visit the SBHC? Yes. Can a SBHC take care of sick and injured students? Yes. Right now students who get sick or injured at school go to see the school nurse, who calls parents if she is concerned that the student needs further evaluation. If there is a SBHC, parents can elect to have their child seen in the SBHC. A nurse practitioner or physician will examine the student, perform medical tests if needed, and prescribe medication and treatment. For example, a student with a fever and sore throat could be evaluated for strep throat. A student with a headache or menstrual cramps could be examined, treated, observed for awhile, and go back to classes when they feel better. A student with a flare in their asthma could be examined and get a "breathing treatment" in the SBHC and go back to classes. If a student is too sick or injured to be taken care of in the SBHC, the staff can stabilize the student and arrange for parents or emergency service to pick up the child. Can a SBHC take care of students who have chronic medical conditions? Yes. There are many students with ongoing medical issues, such as asthma, diabetes, high blood pressure, attention deficit disorder (ADD), depression, and acne. The SBHC can assist the.student's regular doctor or "medical home" monitor and managing these problems. If a student does not have a "medical home," the SBHC can help them find a medical home or become the medical home. Can a SBHC provide regular check -ups or shots? Yes. SBHCs can provide these services to students who do not receive this health care elsewhere. All adolescents should have an annual well -child check or preventive health visit. All adolescents should receive routine immunizations. Can a SBHC provide mental health and substance use services? Yes. There are services and support now available for students with mental health or substance use problems and in a SBHC, a team of health care professionals will work together "under one roof' to address a student's physical, mental health, and substance use needs in a holistic way. What types of services will NOT be provided? The SBHC will not provide condoms. The SBHC will not provide birth control. The SBHC will not provide urine drug testing. Who would provide the new medical services? Nurse practitioners would provide most of the new medical services. A physician will always be available if the nurse practitioner has questions. Complex patients may be seen by a physician. What will be the cost of these new medical services? We will not know for sure until a business plan has been developed. We plan to explore reimbursement from insurance companies or Medicaid when possible. We plan to keep costs for services as low as possible. 0) APRIL 2007 REFERENCES 1. Devlin, L. M. and Asay, M. K. (March/April 2005). "Rising Student Health Needs Require a School Safety Net ". NC Med J. 66 (2), 152 -154. 2. School Health Services and Programs. (2006) Eds. Lear JG, Isaacs SL, & Knickman JR The Robert Wood Johnson Foundation Series on Health Policy. Jossey -Bass, San Francisco CA. 3. Silberman, P., Odom C. H., Smith, S. et. al. (March/April 2005) "The North Carolina Healthcare Safety Net, 2005: Fragments of a Lifeline Serving the Uninsured ". NC Med J. 66 (2), 111 -119. 4. Washington, D. M., Brey, L. C. (2005). "Funding, Technical Assistance, and Other Resources for School -Based Health Centers ". Nursing Clinics of North America. 40, 619 -636. WEBSMS CDC's Division of Adolescent and School Health (DASH) hi tp: / /www cdc gov /HealthyYouth/aboutlindex.htm The Center for Health and Health Care in Schools bgp://www.healthinschools.orgkome-M National Assembly on School -Based Health Care hgp: / /www.nasbhc.org/ North Carolina Healthy Schools http / /www nchealthyschools.or schools.org/dat goal of North Carolina Healthy Schools is to create a working infrastructure between education and health to enable schools and communities to create a Coordinated School Health Program. A model school health program includes all eight components: Comprehensive School Health Education; School Health Services; A Safe Physical Environment; School Counseling, Psychological and Social Services; Physical Education; Nutrition Services; School -Site Health Promotion for Staff; Family and Community Involvement in Schools NC Healthy Schools focuses on improving the health of students and staff by providing coordination and resources in eight component areas of school health. With all of these components in place and working together, students will be healthier in school, in class, and ready to learn. In healthy schools, children are more alert, more focused on learning, and miss less school. They not only learn better, but also learn lifelong healthy behaviors to prevent the leading causes of death in North Carolina: heart disease, stroke, and cancer. Healthier schools lead to healthier students which lead to healthier communities. It just makes sense. Ki AfL�mrn+ F-a Working Together to Improve the Health & Academic Success of Orange County School District Students Shirley Carraway, EdD Superintendent, Orange County School District Rosemary L. Summers, MPH, DrPH Director; Orange County Health Department Mm * There is a direct link between students' — physical health — mental health — academic success * Compared to students experiencing physical or psychological health problems, healthy students — have better school attendance — are better learners — are more academically successful — have a better chance of graduating — have a better chance of making a smooth transition to a healthy, happy, and productive young adulthood 1 M- School Health Council • School Board Representative • School Staff and Administrators • Health Dept. Staff and Administrators • Local Physician • County Agencies • Community Members • Parents 0 ror example, we now have.... N Nurses in every school IN Social Workers) in every school • PE teachers in every school • School Improvement Plans for every school • Healthy Active Children Policy for every School • District school nutritionist • District. safety coordinator. • Health education programs • Staff health promotion • Family-focused after-school programs What do we want to consider next? What about health services? El We know our students have unmet health needs..... From Orange County Schools' 2005 -2006 School Nurses End of Year Report Kindergarten through High School Screenings K. Dental -1826 students screened (Of the 191 students referred for outside care only 36% followed through.) z Hearing — 860 students reached (Of the 24 students referred for follow up care only 386/6 of them completed the referral process.) We know our students have unmet health needs..... The Healthy Carolinians and Advocates for Adolescents Committee Assessment on Mental Health Needs of Adolescents in Orange County, October 2006 ❑ Children and adolescents need more education about mental illness and mental health. ❑ Children and adolescents need more knowledge of when and how to seeds mental health services. 5 We know our students have unmet health needs..... From OCS Spring 2006 Communities That Care Survey * 17.78% of 6'h graders (450 students surveyed), 18.63 % of 8th graders (408 students surveyed), and 19.47% of 10th graders (457 students surveyed) reported having their first beer before the age of 11. 2.44% of 6th graders, 5.39% of 8th graders, and 5.69% of 10th graders always threaten to hurt people. From Spring 2005 Youth Risk Behavior Survey E 27% of OCS 8th graders seriously considered suicide in the previous year. in 35% of OCS 8th graders reported that they had felt so sad or hopeless for 2+ weeks in a row that they stopped doing their usual activities in the last 12 months. School-Based Health (SBHC). C We propose a one -year exploratory process to determine whether it is desirable and feasible to develop a School -Based Health Center (SBHC) at CW Stanford Middle School ... as a first step in a system -wide strategy to address unmet health needs of students in the OCSD. Propose • Commiftee Leader: OCSD Superintendent . Co- Leader: OCSD Health Dept. Director Members: Director, OCSD Student Services Director, OCSD Healthful Living Director, OCSD Adolescents in Need Director, School Exceptional Children Program Leader, OCSD School Health Advisory Council 7 Steering Committee Members (Continued) County Commissioner Chair, or designee Health Dept Board Member OCSD Board Member OSS Board Member Local Physician Director, Piedmont Health Services UNC Adolescent Medicine Physician OCSD Nursing Supervisor 0 PC Mental Health Consultant Juvenile justice representation CW- Stanford Middle School Principal Many Questions for Steering Committee to Address... • Is S13HC desirable? • Is S13HC feasible? • Which students and which services? — Students without medical homes? — Urgent care so kids can stay in school? — Helping medical home serve students with chronic care needs? — Synergist coordinated services around high-need students? — Convenient centralized, coordinated, comprehensive services? — Safety-net services? — Mental health/substance use services? E.*1 How to* Best Use SBHC to Improve Important Outcomes..... • Better school attendance • Better academic achievement • Lower drop out rates • Better access to high* quality health care R Better health We are enthusiastic about moving forward! • ASCD Health Schools Community Grant awarded! • Would like to convene Steering Committee - summer of 20071 E Your thoughts ............. E,