INTEGRATED CARE FOR YOUTH: SCHOOL BASED HEALTH CENTERS and COMMUNITY MENTAL HEALTH COLLABORATION

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INTEGRATED CARE FOR YOUTH SCHOOL BASED HEALTH
CENTERS and COMMUNITY MENTAL HEALTH COLLABORATION

• BANGOR HEALTH CENTER
• VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
• PRESENTED BY
• ANGELA BONO REED,
  PEDIATRIC NURSE PRACTITIONER
• REBEKAH FATZINGER,
  HEALTH CENTER COORDINATOR
• DEBRA HESS, CEO

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WHAT DO ALL THESE YOUTH HAVE IN COMMON?

• Chronic asthmatic
• Pregnant 10th grader
• 11th grade drug user
• Middle school student in foster care
• Depressed adolescent with suicidal thoughts
• Anxious bully victim
• Homeless ninth grader
• Teen experiencing chronic headaches
• Sixth grader with painful dental abscess
• Overweight eighth grader who is borderline
  diabetic
• 12th grader living with violence in the home
• They all have health and social problems that
  compromise their academic
• potential, resulting in missed classes, poor
  academic performance
• and even school failure and/or drop out.
• They all have help through their school based
  health center.

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WHY SCHOOL BASED HEALTH CENTERS?

• Academic success is strongly linked with health.
• Disparities in health and in educational
  achievement are closely linked.
• Poor health has a direct and negative impact on
  school success.
• Students who dont graduate face lifelong health
  risks and high medical costs, and are more likely
  to engage in risky health behaviors.

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WHY SCHOOL BASED HEALTH CENTERS?

• School based health center staff are in the best
  position to see the social factors and stressors
  that affect students, and to work with the school
  and community to remove those barriers so
  students can learn and graduate.

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Goals

• Reduce barriers to learning and help students
  succeed in school.
• Promote health and educational success
• Identify and address risk factors/behaviors of
  adolescents through education, treatment and
  referrals.
• Early intervention for medical and behavioral
  problems.
• Best possible physical, intellectual, and
  emotional status of adolescents by providing
  services that are high quality, accessible and
  acceptable to youth.

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Outcomes

• School wide impact
• Less emotional discomfort
• Less physical discomfort
• Higher self-esteem
• Engaging in fewer individual risks
• Fewer threats to achievement
• Fewer negative
• Peer influences
• Michigan Evaluation of School-based Health,
• Michigan State University, 2010

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Outcomes

• For users of services, additional benefits
• Greater satisfaction with health
• Greater self-esteem
• Less physical discomfort
• Michigan Evaluation of School-based Health,
• Michigan State University, 2010

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More outcomes

• Decrease in absenteeism and tardiness
• More likely to stay in school
• Decreased substance use
• Reduction in school discipline referrals
• Reduced hospitalization and increased school
  attendance
• Specific citations found on www.nasbhc.com

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Values

• High quality
• Improved Access
• Acceptable to youth

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School Based Health Centers

• Over 85 centers in Michigan more than 1900
  across the country
• Variety of fiduciary types
• In Michigan, mental health is consistently one of
  biggest unmet needs depression, anxiety, anger,
  trauma, bullying, family issues

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School Based Health Centers

• Nationally recognized as one of best ways to
  provide effective, efficient, and appropriate
  health care services to adolescents
• Proven to overcome barriers to care for
  underserved youth, and reduce costs such as
  hospitalizations, ER visits, and reduce parental
  work leave time
• Strengthens classroom performance by keeping kids
  in school and in class
• Healthy Kids Make Better Learners
• Academic success is an excellent indicator of
  overall well-being of youth and a primary
  predictor and determinant of adult health
  outcomes.

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Bangor Health Center

• Staffing
• Pediatric Nurse Practitioner
• Health Center Coordinator
• Licensed Master Social Worker
• Certified Medical Assistant
• Biller/clerical support
• Oversight by physician
• (In-Kind) Mental health screener (TeenScreen)

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Bangor Health Center

• Approximately 500 unduplicated patients per year
• Past five years
• Over 10,000 medical services
• 800 mental health services
• 1,330 well child exams
• Over 700 referrals
• More than 100 completed TeenScreens
• Classroom health education presentations to over
  250 students

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Bangor Health Center

• Core set of quality services primary health
  care, behavioral health care, health promotion
  and health education
• Adolescents ages 10-21
• Acute illnesses, minor injuries
• Co-management of chronic diseases
• Immunizations
• Reproductive health (no birth control)
• STD diagnosis treatment
• Medicaid outreach and enrollment
• Mental health counseling individual group
• Referrals for specialty care
• Services require parent/guardian consent (except
  for confidential services legally not requiring
  consent)

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Bangor Health Center

• Integrated approach primary care and behavioral
  health
• Supervising physician pediatrician/psychiatrist
• Increased early identification of problems
  through screening and assessment RAAPS (Rapid
  Adolescent Assessment for Preventive Services),
  Bright Futures, TeenScreen
• Focus on whole child not just presenting problem

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Behavioral Health Integration

• Type 4 Close collaboration in partly integrated
  system share same systems committed team
  approach frequent face-to-face communication
  between providers shared work space
• Type 5 Close collaboration approaching a fully
  integrated system integrated/single treatment
  plan unified behavioral and physical health
  services
• Type 6 Care provided through team based
  approach involving joint assessment and treatment
  plans, with shared responsibilities for outcomes
  patients view system as cohesive and holistic

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Funding

• Medicaid carve out for CAHCs
• Partnership (LOA) with school
• State funding
• Other grant funding
• Reimbursement from insurance
• Local match

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Additional information

• Child and Adolescent Health Centers, MDCH,
  www.michigan.gov/cahc
• National Assembly on School Based Health Care
  (NASBHC), www.nasbhc.org
• Michigan Evaluation of School-based Health,
  Michigan State University, www.outreach.msu.edu/ce
  ru/
• Behavioral Health Integration, Michigan Primary
  Care Association, www.mpca.net
• Health and Academics, Centers for Disease Control
  and Prevention, www.cdc.gov/healthyyouth/health_an
  d_academics
• Health, Well-Being and Educational Success of
  School-Age Youth and School Based Health Care,
  Center for School, Health and Education, American
  Public Health Association, www.schoolbasedhealthca
  re.org

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Bangor Health Center

• Contact information
• Angela Bono Reed, PNP
• areed_at_vbcmh.com
• 269-427-6810
• Rebekah Fatzinger, LMSW
• bfatzinger_at_vbcmh.com
• 269-427-6810
• Debra Hess, CEO
• dhess_at_vbcmh.com
• 269-657-5574