Jump to content

School-based health centers: Difference between revisions

Add links
From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
FieldsTom (talk | contribs)
463 edits
FieldsTom (talk | contribs)
463 edits
Line 33: Line 33:
Researchers have examined the impact of SBHCs across a number of health and education domains.
Researchers have examined the impact of SBHCs across a number of health and education domains.
'''Access to care:''' Children with the greatest unmet need, including uninsured students, benefit most from SBHC services<ref>Wade, T. J., Mansour, M. E., Guo, J. J., Huentelman, T., Line, K. & Keller, K. N. (2008). Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools. ''Public Health Reports, 123'', 739-750 Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/19711655</ref><ref>Foy, J. E. & Hahn, K. (2009). School-based health centers: A four year experience, with a focus on reducing student exclusion rates. Osteopathic Medicine and Primary Care, 3, 1-4. Retrieved February 22, 2012, from http://www.om-pc.com/content/3/1/3</ref> SBHCs appear to have a significant ability to reduce health care access disparities among African Americans and disabled students<ref>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 Hgealth, 100'', 1617-1623. Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20634450</ref> The Bienestar Health Program has strong evidence that supports its ability to increase positive health behaviors and reduce risk factors for type 2 diabetes among Mexican-American and other at-risk youth.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=http://www.innovations.ahrq.gov/content.aspx?id=2085 |title=Comprehensive School-Based Program Increases Positive Health Behaviors and Reduces Risk Factors for Type 2 Diabetes Among Mexican-American and Other At-Risk Youth |date=2013-10-19 |accessdate=2013-05-10}}</ref> In Chicago, the Rush University College of Nursing operates health centers inside three public schools, providing convenient, comprehensive reproductive and sexual health services to students who are primarily African-American.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=http://www.innovations.ahrq.gov/content.aspx?id=2085 |title=Inner-City School Health Center's Comprehensive Reproductive Health Services: Enhancing Access to Screening for Sexually Transmitted Diseases, Prenatal Care, and Contraception |date=2013-03-27 |accessdate=2013-05-10}}</ref>
'''Access to care:''' Children with the greatest unmet need, including uninsured students, benefit most from SBHC services<ref>Wade, T. J., Mansour, M. E., Guo, J. J., Huentelman, T., Line, K. & Keller, K. N. (2008). Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools. ''Public Health Reports, 123'', 739-750 Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/19711655</ref><ref>Foy, J. E. & Hahn, K. (2009). School-based health centers: A four year experience, with a focus on reducing student exclusion rates. Osteopathic Medicine and Primary Care, 3, 1-4. Retrieved February 22, 2012, from http://www.om-pc.com/content/3/1/3</ref> SBHCs appear to have a significant ability to reduce health care access disparities among African Americans and disabled students<ref>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 Hgealth, 100'', 1617-1623. Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20634450</ref> The Bienestar Health Program has strong evidence that supports its ability to increase positive health behaviors and reduce risk factors for type 2 diabetes among Mexican-American and other at-risk youth.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=http://www.innovations.ahrq.gov/content.aspx?id=2085 |title=Comprehensive School-Based Program Increases Positive Health Behaviors and Reduces Risk Factors for Type 2 Diabetes Among Mexican-American and Other At-Risk Youth |date=2013-10-19 |accessdate=2013-05-10}}</ref> In Chicago, the Rush University College of Nursing operates health centers inside three public schools, providing convenient, comprehensive reproductive and sexual health services to students who are primarily African-American.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=http://www.innovations.ahrq.gov/content.aspx?id=3779 |title=Inner-City School Health Center's Comprehensive Reproductive Health Services: Enhancing Access to Screening for Sexually Transmitted Diseases, Prenatal Care, and Contraception |date=2013-03-27 |accessdate=2013-05-10}}</ref>


'''Clinical services:''' School-based health centers facilitate immunization services for adolescents with greater efficiency than community health centers.<ref>Federico, S. G. et. al., (2010). Addressing adolescent immunization disparities: A retrospective analysis of school-based health center immunization delivery. American Journal of Public Health, 100, 1630-1634. Retrieved February 22, 2012, from ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2009.176628</ref> Children living with asthma benefit greatly from school-based health center services, as evidenced by fewer emergency room visits and reduced activity restriction.<ref>Mansour, M. E., Rose, B., Toole, K., Luzader, C. P., & Atherton, H. D. (2008). Pursuing perfection: An asthma quality improvement initiative in school-based health centers with community partners. Public Health Reports, 123, 717-730. Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/19711653</ref> Children with asthma served also have improved attendance in school.<ref>Webber, M. P., Carpiniello, K. E., Oruwariye, T., Lo, Y., Burton, W. B. & Appel, D. K. (2003). Burden of asthma in innter-city elementary schoolchildren. Archives of Pediatrics & Adolescent Medicine, 157, 125-129. Retrieved February 22, 2012, from http://archpedi.ama-assn.org/cgi/content/abstract/157/2/125</ref>
'''Clinical services:''' School-based health centers facilitate immunization services for adolescents with greater efficiency than community health centers.<ref>Federico, S. G. et. al., (2010). Addressing adolescent immunization disparities: A retrospective analysis of school-based health center immunization delivery. American Journal of Public Health, 100, 1630-1634. Retrieved February 22, 2012, from ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2009.176628</ref> Children living with asthma benefit greatly from school-based health center services, as evidenced by fewer emergency room visits and reduced activity restriction.<ref>Mansour, M. E., Rose, B., Toole, K., Luzader, C. P., & Atherton, H. D. (2008). Pursuing perfection: An asthma quality improvement initiative in school-based health centers with community partners. Public Health Reports, 123, 717-730. Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/19711653</ref> Children with asthma served also have improved attendance in school.<ref>Webber, M. P., Carpiniello, K. E., Oruwariye, T., Lo, Y., Burton, W. B. & Appel, D. K. (2003). Burden of asthma in innter-city elementary schoolchildren. Archives of Pediatrics & Adolescent Medicine, 157, 125-129. Retrieved February 22, 2012, from http://archpedi.ama-assn.org/cgi/content/abstract/157/2/125</ref>


'''Educational Impact:''' SBHCs aid in reducing school absences and promoting healthy behaviors.<ref>{{cite web|url=http://articles.latimes.com/2011/nov/28/local/la-me-school-health-20111128 |title=Taking healthcare to students - Los Angeles Times |publisher=Articles.latimes.com |date=2011-11-28 |accessdate=2012-02-03}}</ref>
'''Educational Impact:''' SBHCs aid in reducing school absences and promoting healthy behaviors.<ref>{{cite web|url=http://articles.latimes.com/2011/nov/28/local/la-me-school-health-20111128 |title=Taking healthcare to students - Los Angeles Times |publisher=Articles.latimes.com |date=2011-11-28 |accessdate=2012-02-03}}</ref> In Connecticut, 96.7 percent of students using school-based centers return to class the same day.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=http://www.innovations.ahrq.gov/content.aspx?id=3843 |title=School-Based Health Centers Enhance Access to Mental Health Services for Adolescents, Particularly African-American and Hispanic Males |date=2013-03-27 |accessdate=2013-05-10}}</ref>


'''Cost-savings:''' SBHCs result in cost-savings for Medicaid due to reduced emergency room use and hospitalizations.<ref>Adams, E. K. & Johnson, V. (2000). An elementary school-based health clinic: Can it reduce Medicaid costs? Pediatrics, 105, 780-788. Retrieved February 22, 2012, from http://pediatrics.aappublications.org/content/105/4/780</ref>
'''Cost-savings:''' SBHCs result in cost-savings for Medicaid due to reduced emergency room use and hospitalizations.<ref>Adams, E. K. & Johnson, V. (2000). An elementary school-based health clinic: Can it reduce Medicaid costs? Pediatrics, 105, 780-788. Retrieved February 22, 2012, from http://pediatrics.aappublications.org/content/105/4/780</ref>

Revision as of 19:15, 10 May 2013

School-based health centers (SBHCs) are primary care clinics based on primary and secondary school campuses in the United States.  Most SBHCs provide a combination of primary care, mental health care, substance abuse counseling, case management, dental health, nutrition education, health education and health promotion. An emphasis is placed on prevention and early intervention.[1] School-based health centers generally operate as a partnership between the school district and a community health organization, such as a community health center, hospital, or the local health department.[2] Most SBHCs report that the majority of their student population is eligible for the National School Lunch program, a common indicator of low socioeconomic status.[3]

History

Providing medical services in schools to achieve both public health and child health objectives has a deep history in the United States. In 1894, New York City officials initiated the first school health program in the U.S.[4] Its purpose was to assess and, if needed, exclude children with contagious diseases from the classroom. In 1902, the program expanded and employed the nation’s first school nurse. As school health programs spread across the country, health screening and communicable disease control were their principal focus.

President Lyndon Johnson’s War on Poverty in the mid-1960s is credited with bringing into focus the significance of health issues among impoverished school-age children.[5]  The enactment of Medicaid in 1965 was indicative of a perception in the public policy community that there was a need to develop programs in service of better health care for low-income individuals, including children.

In 1967, Philip J. Porter, head of pediatrics at Cambridge City Hospital in Massachusetts and director of Maternal and Child Health for the city's health department, began to address this issue.[6] He assigned a nurse practitioner to work on site in an elementary school to deliver primary medical care to enrollees. Four additional health clinics were opened in Cambridge schools in the years that followed.[5]

The first school-based health centers opened in Cambridge, Massachusetts (1967), Dallas, Texas (1970), and St. Paul, Minnesota (1973).[7] The first two were launched because their founders believed that school-based health care could provide accessible, affordable health care to poor children. In 1970, the West Dallas Youth Center at Pinkston High School was opened as an outreach center for a federally funded Children and Youth Program based in the University of Texas Health Sciences Center Pediatrics Department. Pinkston High School was the nation’s first high school to offer comprehensive care provided by nurse practitioners, physicians, social workers, nutritionists, and health educators.[8] These early centers demonstrated that they were effective in increasing young people’s access to care.

School-Based Health Center Growth in the U.S. from 1984 to 2008

Current Status

In the past 40 years, school-based health centers have grown from a handful to 1,909 in 45 states.[9][10] The initial survey in 1985, conducted by the Center for Population Options (now known as Advocates for Youth), reported 35 centers nationwide.[11] Follow-up surveys by The Center for Health and Health Care in Schools (previously known as the Making the Grade National Program Office ) continued to document SBHC growth through the 1990s and early 2000s.[12][13] Since the late 1990s, the National Assembly on School-Based Health Care (NASBHC) has conducted a nationwide census of individual centers tri-annually, every 3 years.

Demographics and Characteristics

SBHCs serve all school-levels: in elementary schools (20%), middle/junior high schools (15%), high schools (30%) and a mix of elementary, middle, and high schools (21%). They are located in urban (59%), rural (27%), and suburban (14%) communities in all regions of the country.[14] The centers often tailor their services and outreach specifically to the school's student population. Seventy percent of the student body in schools with SBHCs are minorities. They include Hispanic/Latino (36.8%), Black (non-Hispanic/Latino) (26.2%), Asian/Pacific Islander (4.4%), Native American/Alaskan Native (1.7%) and “other” (1.4%) youth.[15] Facilities are staffed by one or more different types of health care providers, including nurse practitioners, physician assistants, social workers, substance abuse counselors, and mental health professionals.[16]

Controversy

Despite the growing number of school-based health care during the past three decades, the issue of providing reproductive health care at school-based health centers continues to spark controversy. Data has demonstrated how these controversies about reproductive health may frame more general concerns about school-based care.[17]  In response to these issues, in recent years SBHCs have begun requiring parents to sign written consents for their children to receive the full array of services the centers provide. Most facilities have an advisory board consisting of community representatives, parents, youth, and family organizations to provide planning and oversight.[18]

Funding

Historically, federal funding for school-based health centers came primarily from the maternal and child health block grant and the Healthy Schools/Healthy Communities program. However, as SBHCs have begun to focus on third-party reimbursement, Medicaid has also become an important source of support.[19] The Center for Health and Health Care in Schools, a grant program of the Robert Wood Johnson Foundation, assisted states over the past two decades in developing the long-term financing policies required to sustain school-based health centers.[20]

About 20 percent of SBHCs receive funding through the Health Resources and Services Administration (HRSA) Health Center Program, a division of the United States Department of Health and Human Services.[21]  Other funding is derived from various sources such as community-based health centers, healthcare systems, foundation grants, and state and local funds.[22]

In July of 2011, $95 million was awarded to 278 school-based health center programs nationwide, as part of the Patient Protection and Affordable Care Act(PPACA). This was the first award in a series of allocations to the School-Based Health Center Capital Program. PPACA's allocations for this program will ultimately total $200 million in funding for SBHCs over four years. The awards will enable recipients to expand their offerings and to increase their collective capacity by over 50 percent.[23]

Outcomes

Researchers have examined the impact of SBHCs across a number of health and education domains.

Access to care: Children with the greatest unmet need, including uninsured students, benefit most from SBHC services[24][25] SBHCs appear to have a significant ability to reduce health care access disparities among African Americans and disabled students[26] The Bienestar Health Program has strong evidence that supports its ability to increase positive health behaviors and reduce risk factors for type 2 diabetes among Mexican-American and other at-risk youth.[27] In Chicago, the Rush University College of Nursing operates health centers inside three public schools, providing convenient, comprehensive reproductive and sexual health services to students who are primarily African-American.[28]

Clinical services: School-based health centers facilitate immunization services for adolescents with greater efficiency than community health centers.[29] Children living with asthma benefit greatly from school-based health center services, as evidenced by fewer emergency room visits and reduced activity restriction.[30] Children with asthma served also have improved attendance in school.[31]

Educational Impact: SBHCs aid in reducing school absences and promoting healthy behaviors.[32] In Connecticut, 96.7 percent of students using school-based centers return to class the same day.[33]

Cost-savings: SBHCs result in cost-savings for Medicaid due to reduced emergency room use and hospitalizations.[34]

References

  1. ^ "The Affordable Care Act and the School-Based Health Center Capital Program". HealthCare.gov. 2011-12-08. Retrieved 2012-02-04.
  2. ^ "School-Based Health Centers". Hrsa.gov. 2011-07-14. Retrieved 2012-02-04.
  3. ^ "The School-Based Health Care Policy Program: Capstone Evaluation" (PDF). American Public Health Association. 2011-12-08. Retrieved 2012-02-15.
  4. ^ Stern, A. M., Reilly, M. B., Cetron, M. S., & Markel, H. (2010). "Better off in school": School medical inspection as a public health strategy during the 1918-119 influenza pandemic in the United States. Public Health Reports, 125 (S3), 63-79.
  5. ^ a b Paul Brodeurk (1986-11-07). "School-Based Health Clinics". Rwjf.org. Retrieved 2012-02-04.
  6. ^ Porter, P. J., Avery, E. H. & Fellows, J. A. (1974). Model for the reorganization of child health services within an urban community. American Journal of Public Health, 64, 618-619.
  7. ^ Lear, J. G., Gleicher, H. B., St. Germaine, A., & Porter, P. J. (1991). Reorganizing health care for adolescents: The experience of the school-based adolescent health care program. Journal of Adolescent Health, 12, 450-458.
  8. ^ Lear, J. G. (1996). School-based services and adolescent health: Past, present and future. Adolescent Medicine, 7, 163-180.
  9. ^ "School-based health centers: National census school year 2007-2008" (PDF). National Assembly on School-Based Health Care. Retrieved 2012-02-15.
  10. ^ U. S. Government Accountability Office. (2010). School-based health centers: Available information on federal funding. (Publication No. GAO-11-18R).
  11. ^ "School Based Health Centers". Advocates for Youth. Retrieved 2012-02-15.
  12. ^ Schlitt, J.J., Juszczak, L. J, & Eichner, N. H. (2008). Current status of state policies that support school-based health centers. Public Health Reports, 123, 731-738.
  13. ^ "1999-2000 Survey of School-Based Health Center Initiatives: Number of Centers and State Financing". The Center for Health and Health Care in Schools. Retrieved 2012-02-15.
  14. ^ "School-based health centers: National census school year 2007-2008" (PDF). National Assembly on School-Based Health Care. Retrieved 2012-02-15.
  15. ^ "School-based health centers: National census school year 2007-2008" (PDF). National Assembly on School-Based Health Care. Retrieved 2012-02-15.
  16. ^ "School-Based Health Centers Bibliography (Updated January 2012)". The Center for Health and Health Care in Schools. Retrieved 2012-02-03.
  17. ^ USA (2011-10-03). "Community reactions to reproductive health care... [J Sch Health. 1996] - PubMed - NCBI". Ncbi.nlm.nih.gov. Retrieved 2012-02-04.
  18. ^ "Role and Benefits of SBHCs". LPHI. Retrieved 2012-02-04.
  19. ^ "School-Based Health Centers and the Birth Control Debate". Guttmacher.org. 2000-10-01. Retrieved 2012-02-03.
  20. ^ http://www.rwjf.org/reports/grr/031658.htm
  21. ^ "School-Based Health Centers". Hrsa.gov. 2011-07-14. Retrieved 2012-02-03.
  22. ^ "School-based health clinics play vital role in childrens' lives - Los Angeles Times". Articles.latimes.com. 2011-09-12. Retrieved 2012-02-03.
  23. ^ "School-Based Health Center Capital Program: July 2011 Grantees". Hhs.gov. 2011-07-13. Retrieved 2012-02-03.
  24. ^ Wade, T. J., Mansour, M. E., Guo, J. J., Huentelman, T., Line, K. & Keller, K. N. (2008). Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools. Public Health Reports, 123, 739-750 Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/19711655
  25. ^ Foy, J. E. & Hahn, K. (2009). School-based health centers: A four year experience, with a focus on reducing student exclusion rates. Osteopathic Medicine and Primary Care, 3, 1-4. Retrieved February 22, 2012, from http://www.om-pc.com/content/3/1/3
  26. ^ 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 Hgealth, 100, 1617-1623. Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20634450
  27. ^ "Comprehensive School-Based Program Increases Positive Health Behaviors and Reduces Risk Factors for Type 2 Diabetes Among Mexican-American and Other At-Risk Youth". Agency for Healthcare Research and Quality. 2013-10-19. Retrieved 2013-05-10.
  28. ^ "Inner-City School Health Center's Comprehensive Reproductive Health Services: Enhancing Access to Screening for Sexually Transmitted Diseases, Prenatal Care, and Contraception". Agency for Healthcare Research and Quality. 2013-03-27. Retrieved 2013-05-10.
  29. ^ Federico, S. G. et. al., (2010). Addressing adolescent immunization disparities: A retrospective analysis of school-based health center immunization delivery. American Journal of Public Health, 100, 1630-1634. Retrieved February 22, 2012, from ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2009.176628
  30. ^ Mansour, M. E., Rose, B., Toole, K., Luzader, C. P., & Atherton, H. D. (2008). Pursuing perfection: An asthma quality improvement initiative in school-based health centers with community partners. Public Health Reports, 123, 717-730. Retrieved February 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/19711653
  31. ^ Webber, M. P., Carpiniello, K. E., Oruwariye, T., Lo, Y., Burton, W. B. & Appel, D. K. (2003). Burden of asthma in innter-city elementary schoolchildren. Archives of Pediatrics & Adolescent Medicine, 157, 125-129. Retrieved February 22, 2012, from http://archpedi.ama-assn.org/cgi/content/abstract/157/2/125
  32. ^ "Taking healthcare to students - Los Angeles Times". Articles.latimes.com. 2011-11-28. Retrieved 2012-02-03.
  33. ^ "School-Based Health Centers Enhance Access to Mental Health Services for Adolescents, Particularly African-American and Hispanic Males". Agency for Healthcare Research and Quality. 2013-03-27. Retrieved 2013-05-10.
  34. ^ Adams, E. K. & Johnson, V. (2000). An elementary school-based health clinic: Can it reduce Medicaid costs? Pediatrics, 105, 780-788. Retrieved February 22, 2012, from http://pediatrics.aappublications.org/content/105/4/780
Retrieved from "https://en.wikipedia.org/w/index.php?title=School-based_health_centers&oldid=554488649"