School-Based Health Care (SBHC) 101: Nuts and Bolts

1. School-Based Health Care (SBHC) 101: Nuts and Bolts Laura Brey, MS Tammy Alexander, M.Ed. NASBHC Training of Trainers April 21-23, 2008

2. Participant Expectations Complete the index card and hand it in.

3. Introductions Presenters: Tammy Alexander Laura Brey

4. Getting to Know Participants • Type of agency • Community setting • Role in agency • School population, if known

5. Objectives • Identify key collaborators and partners • Name the five key components of needs assessment techniques for planning school-based health services • Identify potential funding sources for school-based health services: including public, private, and collaborative partnerships

6. Objectives • Describe the rationale and components of a case statement for a new school-based health center • Utilize resource materials related to planning, evaluating, financing, and working with the media

7. Nut and Bolt #1 Collaboration and Partnerships

8. Collaborative Partnerships • A mutually beneficial and well-defined relationship among two or more organizations to JOINTLY develop structure and share • Responsibility • Resources • Authority • Accountability • Rewards

9. Why have a Collaboration? • To accomplish a common goal that none of the units alone can attain • To help agencies share information, resources, staff and equipment • To create an awareness of needs, problems, or opportunities

10. Characteristics of Successful Collaboration • Develops clear, concrete, achievable goals. • Operate in a receptive environment that facilitates its work. • Have good leadership. • Understand and respect each member for their different role and responsibility. • Build cooperative teams.

11. Typical challenges • Differences among collaborators must be understood and acknowledged. • Mixed loyalty that some members may have to their organization. • Merging of agencies can cause conflict. * Lack of clarity * Lack of awareness

12. Territorial questions Confidentiality Certification/Credentialing Conflicting priorities Political roadblocks Financial resources Difficult Issues that Undermine Collaborations

13. Strategies to Overcome Resistance in Collaboration • Joining with the host school • Relay the message that you are there to support rather than supplant. • Engage in ongoing negotiations with key players. • Developing common goals and group consensus. • Setting Boundaries.

14. Local health department Community or rural health center Community and/or teaching hospital(s) Mental health, substance abuse, and social service agencies Private physicians University faculty Elected Officials Business and community leaders Faith community School superintendent, board, or designee School administration and Faculty (school nurse, teachers, principals, guidance counselors, physical education, nutrition/food services) Students Parents Establish a Planning Group Composition Considerations

15. Role Play - Meeting with Partners / Collaborators

16. Conduct the Needs Assessment Nut and Bolt #2

17. What is a Community Needs Assessment? • An accurate appraisal of the current situation (strengths, concerns, and general conditions) of a community’s population. • A collection of secondary and first hand information and data from a wide range of relevant sources and audiences.

18. What is a Community Needs Assessment? A process for: • identifying needs and resources in a community • determining gaps between what a situation is and what it should be • establishing priorities • An opportunity to paint a picture of the conditions in a community and sharpen your perceptions of the critical issues children and families face.

19. Why Identify Needs and Resources? • Better understand the community in which you will be working • Become aware of needs and concerns you never knew about • Locate hidden strengths or underutilized resources that could be developed • Document need • Make sure future actions are aligned with expressed community needs

20. Why Identify Needs and Resources? • Garner greater support and involve more people in subsequent action • Give voice to individuals in the community who have not traditionally been solicited for comment • Convince outside funders and supporters • Make decisions based on priorities and documented needs

21. Planning and Implementing the Assessment • Step 1:Involve stakeholders • Establish working group to guide the planning and implementation of Community Needs Assessments

22. Planning and Implementing the Assessment Step 2:Determine the Objectives and Outcomes of the Assessment • What are you really interested in knowing? Your questions will flow from this. • What is your vision? How will you use the information obtained? • Which issues, questions, and behaviors are of particular interest? • What don’t you know about these issues? What questions do you need to answer?

23. Planning and Implementing the Assessment Step 3:Identify secondary data sources • Find out what outside resources can be used • What public reports exist (examples of sources: census data, vital statistics, CPS reports) • Have other studies been done? • Are there experts in the community who can help you?

24. Planning and Implementing the Assessment (cont) Step 4: Choose your approach/ approaches for gathering new information Most common approaches: • Key informant interviews • Focus groups • Public forums • Surveys

25. Planning and Implementing the Assessment • When making your choice of approach, take into account: • Purpose of the study • Amount of time you have and number of people assisting you • Available resources • Size and characteristics of target population • Relationship you have with target population “The quality of information about a community is only as good as the technique or combination of techniques used. A single technique may be too narrow; using too many techniques may be costly in terms of time and dollars. Different techniques are appropriate for different needs. Analyze the situation and then weigh the advantages and disadvantages. Sometimes a combination of techniques will provide a more reasonable picture.” (Butler and Howe, 1980)

26. Planning and Implementing the Assessment Key Informant Interviews • Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community • How to implement = compile a list of participants, create protocol, make appointments (either telephone or in-person), gather data, identify common themes

27. Planning and Implementing the Assessment Key Informant Interviews • Advantages • Easy and not expensive • Can discuss confidential issues more readily • Establishes rapport and trust with community • Permits clarification of issues and ideas • Disadvantages • May be difficult to schedule • May provide a biased perspective • Only represents perceptions – not hard data • Personal relationships may influence outcomes • Should be combined with other methods because may not represent whole community

28. Planning and Implementing the Assessment Focus Groups • Purpose = to collect information from those in the community who are in a prime position to know the needs facing the community • How to implement= compile a list of participants, decide on location, create protocol, invite participants (think about food and baby sitting if necessary), use facilitator and documenter, organize and identify common themes

29. Planning and Implementing the Assessment Focus Groups • Advantages • Easy and not expensive • Establishes rapport and trust with community members • Permits clarification of issues and ideas • Easily combined with other techniques • Disadvantages • May provide biased perspectives • Only represents perceptions – not hard data • Sharing opinions and views in a group setting may be inhibiting • Should be combined with other methods because may not represent whole community

30. Planning and Implementing the Assessment (cont) Public forums • Purpose = elicit information from a wide range of residents in a series of public meetings • How to implement= develop list of invitees, create list of questions, select strategically located venue (use different sites and hold at different times), publicize, use facilitator and documenter, identify common themes

31. Planning and Implementing the Assessment Public forums • Advantages: • Get opinions from a wide range of people • Promotes active involvement, community awareness, and buy-in • Inexpensive, quick picture of community • Disadvantages: • Requires good leadership • Opinions limited to those who attend • Lots of advance planning • May generate more questions than answers • May create unrealistic expectations

32. Planning and Implementing the Assessment Surveys • Purpose =collect information from a wide range of respondents • How to implement=find or create carefully developed instrument and administer through a sampling procedure (may be face to face, personal distribution and collection, self-administered in a group, telephone, mailed), analyze results

33. Planning and Implementing the Assessment Surveys • Advantages • Best approach for eliciting attitudes of broad range of individuals • Data usually valid and reliable • Disadvantages • Costly and requires time and expertise • Needs carefully selected tool and sampling • Subject to misinterpretation • Individuals may hesitate to answer questions

34. Planning and Implementing the Assessment • Planned Approach to Community Action (PATCH) • developed by CDC • effective model for planning, conducting, and evaluating community health promotion and disease prevention programs • Used by diverse communities in US and other nations to address health concerns • PATCH Guide for local coordinator has sample surveys and data collection tools • Web sitewww.cdc.gov/nccdphp/path/index.htm

35. Planning and Implementing the Assessment (cont) Step 5: Implement Plan • Collect secondary data • Collect primary data (conduct interviews, focus groups, surveys, etc) • Analyze secondary and primary data • Summarize findings

36. Planning and Implementing the Assessment (cont) Step 5: Implement Plan • Prepare report • Share with working group, interpret data and develop recommendations together • Present to external stakeholders as needed • Create action plan

37. Review Anytown’s Needs Assessment Document

38. Project Work Plan and Design Example from Chicago SBHC • Convened a planning committee of key community stakeholders who met regularly to oversee and guide the process • Gathered existing data • U. S. Census Bureau (2000) • Chicago Health and Health Systems Project (CDPH 2006) • Healthy Albany Park Assessment (2004) • Illinois State Report Card (2004 – 2005) • CPS School Profile (2004 – 2005)

39. Project Work Plan and Design • Collected new data • Conducted fifteen stakeholder interviews with school administrators, school personnel, school nurses, and external partners working in schools • Conducted a focus group with community providers • Analyzed findings • Drafted initial recommendations

40. Make Recommendations Based on Needs Assessment Findings

41. Select the School • Elementary • Middle or Junior High • K-8 • High School • Alternative School • Pre-school

42. Select the Service Delivery Strategy and Model • Service and Staffing Options • Collaborative Partnerships • The role of the school nurse • Policy and Procedures • Referral Networks • Delivery of Service • Parental Consent/Parental Involvement • Integration of the school-based health center with existing school and community resources • Confidentiality Issues

43. Primary Care including biennial risk assessment Immunizations Health Education Physical Examinations Mental Health Laboratory Services Medications Nutrition Counseling Vision, Hearing, and Dental Screening Social Services Chronic Disease co-management Specialty Care Referrals Services to Consider for All Grade Levels

44. Services at the MS and HS Levels • Pregnancy testing • STD testing and treatment • Reproductive health care • Group counseling to address issues such as sexual abuse, depression • Individual mental health counseling • HIV testing and/or counseling • Referral for family planning

45. The Role of the School Nurse • Maintain school nurse mandated functions (vision and hearing screening, immunizations, special ed, etc.) • Member of school-based health team • Identify students for school-based health center services • Provide follow-up • Reach out to parents • Serve as a liaison between the school-based health center and school staff

46. Parental Consent/ Parental Engagement • The majority of SBHCs have a parental consent policy. • Consent form should include: • Services to be offered • Statement about confidentiality /HIPAA • Billing issues • Statement about the relationship between the sponsoring organization and any collaborators including the school district • Review state statutes regardingage of consent for various health care services

47. Confidentiality • Confidential versus nonconfidential services • Access to confidential services • Release of information • Providing follow-up information to school personnel and outside agencies • Informing students of confidentiality procedures and limits of confidentiality

48. Nut and Bolt #3Funding for SBHCs

49. It’s hard to focus on best practice standards when your needs are rooted in basic survival. School health clinics fight for livesKarina BlandThe Arizona RepublicMarch 12, 2001 Maslow’s Hierarchy of Need

50. Federal grants State grants Local funding Community partnership contributions Foundations Patient Revenue Mixing several or all funding sources Multiple Funding Sources/ Models for School-Based Health Centers