PRIMARY CARE ACCESS & UTILIZATION

Academic success increases with improved health and emotional wellbeing. Conversely, educational achievement is greatly hindered by health disparities, particularly for urban minority youth. Asthma, diabetes, unhealthy weight, vision problems, teen pregnancy, and problems with inattention and hyperactivity have tremendous effect on students’ ability and motivation to learn. School based health centers mitigate many barriers to academic success in underserved youth populations. Dozens of empirical studies demonstrate the effectiveness of school based health centers in reducing absenteeism, emergency room utilization, hospitalization, and Medicaid costs overall, particularly for children with chronic health conditions like asthma.

A study by Johns Hopkins University found that school based health centers reduced inappropriate emergency room use among regular users of school-based health centers. ,
A study of school-based health center costs by Emory University School of Public Health attributed a reduction in Medicaid expenditures related to inpatient, drug and emergency department use to the use of school-based health centers.
A study of elementary school-based health centers conducted by Montefiore Medical Center found a reduction in hospitalization and an increase in school attendance among inner-city school children for asthma.
Another study on school-based health care’s effects on asthma managementfound decreases in hospitalization rates of 75-85% and improvements in the use peak flow meters and inhalers.

Research demonstrates the impact that school based health centers also have on improving mental health and well-being, decreasing teen pregnancy, and improving health and healthcare utilization overall.

School based health centers provide reproductive health services in high schools, providing abstinence-based health education, testing for pregnancy and sexually transmitted infections as well as treatment, and administration of or referral to partners for contraception. A variety of studies point to reduced fertility rates in schools or areas with school based health centers.

School based health centers deliver both clinical and non-clinical services to improve healthy eating and activity and reduce overweight and obesity. Several studies show that school based health centers users get more physical activity and eat more healthy foods than their counterparts.

In studies of school-based health centers’ service utilization, mental health counseling has been repeatedly identified as the leading reason for visits by students. One study found that “inner-city students were 21 times more likely to make mental-health related visits to school based health centers than to community health centers”, reinforcing the imperative for integrated school based health care.

Clearly, evidence of academic impact motivates schools’ adoption of School based health centers. According to the American Public Health Association (APHA), students who use school based health centers have better grade point

Key JD, Washington EC, Hulsey TC. Reduced Emergency Department Utilization Associated with School-Based Clinic Enrollment. Journal of Adolescent Health. Apr 2002;30(4):273-278.
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Adams EK, Johnson V. An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs? Pediatrics. Apr 2000;105(4 Pt 1):780-788.
Webber MP, Carpiniello KE, Oruwariye T, Lo Y, Burton WB, Appel DK. Burden of Asthma in Inner-City Elementary Schoolchildren: Do School-Based Health Centers Make a Difference? Archives of pediatrics & adolescent medicine. Feb 2003;157(2):125-129.
Lurie N, Bauer EJ, Brady C. Asthma Outcomes at an Inner-City School-Based Health Center. J Sch Health. Jan 2001;71(1):9- 16.
Ricketts SA, Guernsey BP. School-based health centers and the decline in black teen fertility during the 1990s in Denver, Colorado. American Journal of Public Health. Sep 2006;96(9):1588-1592. – See more at: http://www.sbh4all.org/school-health-care/health-and-learning/reproductive-health/#sthash.9U1uwcvC.dpuf
McNall MA, Lichty LF, Mavis B. The impact of school-based health centers on the health outcomes of middle school and high school students. American Journal of Public Health. Sep 2010;100(9):1604-1610. – See more at: http://www.sbh4all.org/school-health-care/health-and-learning/healthy-eating-and-active-living/#sthash.XjDHdnVp.dpuf
Waszak C, Neidell S. SchoolBased and School-Linked Clinics: Update 1991. Washington, DC: Center for Population Options; 1991. – See more at: http://www.sbh4all.org/school-health-care/health-and-learning/mental-health/#one
Juszczak L, Melinkovich P, Kaplan D. Use of Health and Mental Mealth Services by Adolescents Across Multiple Delivery Sites. Journal of Adolescent Health. Jun 2003;32(6 Suppl):108-118.

averages (GPA) and attendance than students who do not use school based health centers. Numerous studies have demonstrated the effectiveness of school based health centers in engaging youth in mental health services, and having an impact on tardiness and absenteeism. Oregon and California have also looked to school based health centers as the best place to expand health services to meet the growing needs of newly insured through the Affordable Care Act .

In May 2015, this CDC Task Force recognized school based health centers as an effective intervention for improving health and education outcomes in low-income communities.According to the American Public Health Association (APHA), overall, students who use school-based health centers have better grade point averages (GPA) and attendance than students who do not use school based health centers.

PUBLIC SUPPORT FOR SUSTAINABILITY

School based health centers need public support to sustain and grow. Many State public health and Medicaid offices across the country actively promote the growth and sustainability of school based health services, helping communities to reap the demonstrated benefits of this model for improved student health. Eighteen (18) states have policies and activities that promote school based health centers. Some, like New York, support a network of over 200 school based health centers through a Medicaid carve-out to bill the State directly. This minimizes the challenges caused by a lengthy provider credentialing process. Most of these states have also dedicated dollars from their General Fund, some from the Title V Maternal and Child Health Block Grant.

Seven (7) state Medicaid agencies define school based health centers as a specific provider type, assigning a unique ID number that allows Medicaid agencies to differentiate services provided by the school based health centers, enabling quality performance and improved health care outcomes to be attributed school based health centers. This designated credentialing by the State also provides States with a level of quality assurance and oversight for school based health centers. These states waive the need for pre-authorization from their students seeking care in the school based health centers. Many states further support the provision of confidential reproductive health services for teens in school based health centers by aligning minor consent laws with Medicaid administrative practices related to billing.
Some communities reap the broader benefits of school based health centers on entire communities. Fifty-three percent (53%) of the 2,400 school based health centers across the country serve family members of students; 46% serve faculty and other school personnel to help decrease absenteeism of school staff.

Many school based health centersacross the country operate year-round to serve the broader community with great need (32%). As Pennsylvania works aggressively to reach and insure 1.4 million new Pennsylvanians through expanded Medicaid and also the Exchange, school based health centers can play a pivotal role for the most vulnerable children in the Commonwealth.

OUR RESPONSE

Education Plus Health school based health centers deliver school nursing and primary care to medically underserved students in Philadelphia through a team of school nurse assistant (LPN) and school nurse practitioners. School nurse assistants provide basic care for injury and illness, administration of student medications, and health screenings and care coordination including mental health, asthma, and sexual health risk in the high schools.

The school nurse practitioners provide primary care across the spectrum of need.

preventive well-child care;
acute care;
reproductive health care to adolescents;
render diagnoses, write prescriptions, develop and implement treatment plans;
provide chronic disease management and care coordination;
screen for and provide linkage to behavioral health services;
provide appropriate referrals and lab services; and
fulfill all of the school health reporting requirements.

Journal of Adolescent Health, 2010.
4. Basch CE. Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap. 2010.
National Academy for State Health Policy. School-Based Health Care for Adults, Too. 2013.
Journal of Adolescent Health, 2010.

Education Plus Health school based health centers support and enable the patient centered medical home through collaboration with primary care providers, using the program’s electronic health record (EHR) to transmit important and timely information about care delivered in the centers. Education Plus Health serves over 7,000 through in Philadelphia.

Education Plus Health school based health centers are among the more 2,400 such centers operating across the country to reduce student absenteeism and improve educational outcomes.

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