Maximizing Opportunities for Access to Quality Care With

Maximizing Opportunities for Access to Quality Care with School-Based Health Centers

WHAT are SBHCs? School based health centers (SBHCs) are primary care centers that blend medical care with behavioral health, psychosocial and prevention services. Community members work in concert to determine the types of services needed and the provider resources available to deliver those services most effectively. Physicians, nurse practitioners, nurses and social workers are examples of the practitioners who work in SBHCs or collaborate with SBHCs to ensure appropriate referrals are provided. Through this collaborative effort, centers significantly increase access to services and improve the overall health of children and adolescents.

More than 5000 students, staff and families currently benefit from services at 9 Georgia SBHCs

WHY do we need SBHCs? Georgia ranks 42nd in the nation on child wellbeing1. That means our children are at increased risk for health and mental health challenges, as well as academic underachievement and school dropout. Plus, nearly 240,000 of them are uninsured and have limited access to health care. Even families with health insurance experience significant challenges accessing quality care due to work schedules, availability of medical personnel, and cost of co-pays and deductibles. Approximately 320,000 children miss more than 10 days of school each year due to illness. SBHC services help keep children in school and out of emergency rooms, plus they can keep parents at work while remaining in close contact as the center removes barriers to services in underserved areas. As a result, healthcare costs for underserved populations have decreased and academic outcomes and school climate have improved.

Do SBHCs WORK? More specifically, SBHC services have been demonstrated to improve health outcomes, academic achievement and cost benefits in Georgia and beyond2,3,4:  Reduced emergency room use and hospitalizations for children with asthma  Reduced cost of pediatric health care for Medicaid and Peachcare, as well as for private insurers. The average cost per child to Medicaid was reduced more than 50% for children with SBHC access at the Whitefoord site.  Improved school attendance (decrease in absenteeism). At the Lake Forest site, 50% of the students referred to the SBHC returned to class – without the SBHC, these students would have been sent home.  Decreased time away from work for parents  Decreased prescription drug use  Increased use of mental health and substance abuse services; decreased school discipline referrals

The National Institutes of Health awarded a grant to Dr. Johnson in July 2014 to further examine the benefits of SBHCs. Funding will support data collection across urban, suburban and rural areas of the state. Specifically, the project will evaluate reduction in obesity and asthma disparities, emergency room and inpatient hospital utilization, as well as costs to the Medicaid program. Additionally, the research will examine the impact SBHCs have on school attendance improvements.

HOW do SBHCs work? Approximately 2000 SBHCs operate throughout 44 states and the District of Columbia. In Georgia, the Urban Health Program (UHP) at Emory University has spear-headed the development and expansion of SBHCs throughout the state with support from grant funding. Schools selected for start-up funds complete a 12-month planning process that fully engages the community. Twenty-nine school-based health center planning grants were awarded between 2010 and 2013, representing 34 counties in Georgia. Nine sites are currently operational, with six being comprehensive centers. All have overwhelming support from their local school boards, school administrators and staff, parents, and broader communities. UHP provides 12-month planning grants to communities for the purpose of establishing SBHCs. Grantees are charged with forming a community-wide advisory council, conducting needs assessments, developing a business plan, galvanizing their community to support the SBHC, identifying targeted schools, and researching and applying for SBHC funding.

Funding Types of SBHCs

Georgia 100% Currently, 100% of Georgia’s SBHCs are supported through private foundation grants and health insurance reimbursement for services.

National Average 76% 37% 50%

State Local Governments Private Foundations Nationally, SBHCs on average are funded by a combination of state and local government and private funding5.

Comprehensive on-site care, telemedicine and mobile services are provided at the SBHCs currently operating in Georgia (listed below). In addition, SBHCs are being considered in five additional counties.

 Whitefoord Community Program (Atlanta – opened 1994 – comprehensive center at 2 sites)  Berrien County Med Clinic (Nashville – opened 2010 – telemedicine services)  Ware County School System (Waycross – opened 2012 – telemedicine services)  Tiger Creek Elementary School (Catoosa County – opened 2013 – comprehensive center)  Turner Elementary School (Albany – opened 2013 – comprehensive center)  Lake Forest Elementary School (Sandy Springs – opened 2013 – comprehensive center)

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 Johnson County Elementary (opened 2014 – comprehensive center)  Clayton County Elementary (opened 2014 – mobile services)

Resources 1. The Annie E. Casey Foundation. (2014). The 2014 KIDS COUNT Data Book. Baltimore, MD: Annie E. Casey Foundation’s KIDS COUNT Project. Retried from www.aecf.org/resources/the-2014-kids-count-data-book. 2. National Assembly on school-based health care. (2011). Benefits of School-Based Health Centers [Fact sheet]. Retrieved from http://ww2.nasbhc.org/RoadMap/PUBLIC/advocacy_factsheetbenefits.pdf. 3. National Assembly on school-based health care. (2011). Cost-Savings of School-Based Health Centers Medicaid Savings and Reduced ER & Hospitalization Utilization [Fact sheet]. Retrieved from http://ww2.nasbhc.org/RoadMap/PUBLIC/advocacy_factsheetcostsavings.pdf. 4. National Assembly on school-based health care. (2011). School-Based Health Centers Improving Health Care Access and Student Success [Fact sheet]. Retrieved from http://ww2.nasbhc.org/RoadMap/PUBLIC/advocacy_factsheetAccess.pdf. 5. National Assembly on School-Based Health Care. (2010). THE FACTS: FUNDING FOR SCHOOL-BASED HEALTH CENTERS UNDER THE AFFORDABLE CARE ACT [Fact Sheet]. Retrieved from http://www.nasbhc.org/atf/cf/%7BB241D183-DA6F-443F-9588-3230D027D8DB %7D/SBHC%20PPACA%20FACT%20SHEET%203.8.11.PDF. 6. Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010).