Nuts and Bolts of Oregon School-Based Health Centers

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Nuts and Bolts ofOregon School-Based Health
Centers

• Janet Matthews, MS, FNP, WHCNP
• School-Based Health Center Program Manager
• Adolescent Health Section
• Office of Family Health
• Oregon State Public Health Division, DHS

Aisha Krebs School-Based Health Center Program
Coordinator Columbia Health District- Public
Health Authority
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SBHCs provide accessible health care to youth

• Health care access for youth
• Supports youth being in class
• Prevention messages delivered

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A School Based Health Center.

• Delivers a core set of primary health care
  services (physical, mental, preventive)
• To children and youth in an identifiable school
  space
• During regular scheduled times
• By qualified health professionals
• In a collaborative relationship with the local
  educational and healthcare community

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SBHC Addresses . . .

• Barriers to access
• Health care provider shortage
• Underserved populations
• High proportions of high risk youth

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School Nurse vs. SBHC

• SCHOOL NURSE
• Employed by School
• Manages student immunizations program
• Coordinates screenings
• Chronic SH case mgmnt
• Manage chronic medication delivery during school
• Oversees SH programs
• FERPA regulated

• SBHC
• Employed by Medical Sponsor
• Administers immunizations
• Conducts screenings, PEs
• Acute care of both acute and chronic needs
• Administer and prescribe medications
• Counseling, prevention and wellness promotion
• HIPPA regulated

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Statewide

• 2007 45 Centers in 19 Counties
• 28 High Schools
• 5 Middle Schools
• 9 Elementary Schools
• 3 Combined Grade Schools
• 2006-2007 Oregon SBHCs served
• 20,831 clients
• 69,034 visits

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Total number of Certified SBHCs 45 Total number
of Planning Phase I Sites 17
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Increased access to health care

• Number of SBHCs has doubled each decade

• Number of clients has increased by almost 500
  since their inception in 1986
• Today, 38,606 students have access to SBHCs at
  their school

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Impact Access to Care
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Impact Fewer Classes Missed
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Value of Care 2006-2007

• The State of Oregon contributed 1,370,000 to
  SBHCs
• This supported the delivery of over 2,614,000 in
  health care services including
• Over 1,142,000 in services to uninsured clients

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Funding of Oregon SBHCs

• Public health infrastructure support from State
  DHS
• Based on a formula per range of total number of
  certified SBHCs in a county

• Additional sources found on local level
• County funds
• School districts
• Hospitals
• Community health providers
• Grants
• Local fundraising

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Political climate

• OR Legislature has supported the of SBHCs
  doubling each decade
• 1985-86 Initial Legislative dollars
• 2004 Expansion dollars for SBHCs into
• 5 new counties
• 2007 Expansion dollars for SBHCs into
• 5 new counties and 7 existing counties

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Student Confidentiality

• School Districts request SBHC parental consent
  along with general registration
• Clarify Oregon minor consent laws
• Reproductive health - no age restriction
• Mental Health - 14 yrs and older
• Physical Health - 15 yrs and older

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Columbia CountyPublic Health Need for SBHC

• A. Demographics- Economic Indicators
• 13 of children live in poverty
• 33 of public school children eligible for free
  and reduced lunch
• B. Health Disparities (2006 Col.Co. Data)
• 15 of children were uninsured
• 21 of children were on Oregon Health Plan

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Columbia CountyPublic Health Need for SBHC

• Sacagawea Health Center Data 2006-07
• 20 of patients were on Oregon Health Plan
• 36 of patients had NO insurance
• Of SHC patients who visited the center 3 or more
  times.
• 47 had NO insurance
• 27 on Oregon Health Plan
• 13 had Kaiser insurance (no providers in
  Columbia Co.)

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Columbia CountyPublic Health Need for SBHC

• Health Risk Indicators - BRFSS Data 2002-05
• The percentages of individuals living with these
  risks are statistically significant when compared
  to the data from the entire State of Oregon.

Survey Topic Oregon Columbia County
who have high blood pressure 24.2 30.9
who are obese (body mass index gt30 kg/m2) 22.1 30.9
of adults who currently smoke cigarettes 20.4 25.9
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Columbia CountyPublic Health Need for SBHC

• Columbia County 8th Grade Healthy Teens Survey

Risk Factor Percentage of C.C. 8th Graders
No medical/physical care in previous year 48.6
Drunk alcohol in last month 34.5
Diagnosed with asthma 21.4
High risk of depression 19.3
Seriously considered suicide 16.4
Smoked cigarettes in last month 10.2
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Columbia CountyPublic Health Need for SBHC

• C. Access to Health Care
• Columbia County is the most medically underserved
  County in Oregon
• - Oregon Area of Unmet
  Healthcare Needs Evaluation
• Columbia County currently has a Health
  Professional Shortage Alert
• -Federal Government
  Designation

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For more information

• Aisha Krebs
• SBHC Program Coordinator
• PH 503.397.4651 x 206
• Fax [phone]
• apoole_at_chdpublichealth.com