Service, Operating, and Targeting Guidelines New York

Definitions “School Based Health Centers (SBHCs) provide age-appropriate primary health, mental health, social and health education services. These services must comply with New York State Child/Teen Health Plan C/THP requirements*. In Comprehensive SBHCs, primary health and mental health care services are performed on-site. Some services, based on local need and expertise, may be made available by referral and appropriate follow-up. In Intermediate SBHCs, primary health care services are provided on site but mental health services are assured through referral and appropriate follow-up.” (Guidelines for School Based Health Centers in New York)

Service Guidelines

Services Comprehensive SBHCs Intermediate SBHCs
Medical Care
  • Comprehensive health assessments: medical, psychosocial, and immunization history; examination; scoliosis screening; height and weight charts; vision and hearing screening; hematocrit/ hemoglobin; urinalysis; and care plan; referrals and follow-up.As necessary: tuberculin test; sickle-cell screening; lead testing; and immunizations.
  • Diagnosis, treatment, triage and referrals for minor and acute problems;
  • Routine management for chronic conditions (asthma, diabetes, etc.);
  • Prescriptions for minor and acute problems, and chronic conditions.
  • Same as Comprehensive
Mental HealthOn-site or by referral: individual, group, and family counseling; and psychiatric evaluation or treatment.
  • Assessment, treatment, referral, and crisis intervention for issues including: physical/ sexual abuse, alcohol/substance abuse, social isolation, depression, and suicide.
  • Mental health services are not required. Limited mental health services may be provided on site or through a referral.
Laboratory Testing
    Tests performed on-site include (but are not limited to): hematocrits/hemoglobins; urinalysis-dipstix; wet-prep.
  • Same as Comprehensive
Reproductive Health Care
  • Age-Appropriate reproductive health care is to be considered an essential component of comprehensive primary care.
  • Same as Comprehensive
Health Education: individual; group; family; and support for classroom education.
  • Areas can include: substance prevention and cessation; intentional and unintentional injury prevention; nutrition; social skills development; death and dying issues; physical and emotional development; conflict resolution; child abuse prevention; violence prevention; STD/HIV/AIDS prevention; pregnancy prevention; chronic conditions (i.e. asthma); general parenting skills; chronic disease prevention (smoking cessation/prevention, heart disease, osteoporosis); and dental health.
  • Same as Comprehensive
Social Services Social service assessment, referral, and follow-up for needs such as:

  • Basic needs (food, shelter, clothing);
  • Legal services;
  • Public Assistance;
  • Assistance with Medicaid and other health insurance enrollment;
  • Employment services; and
  • Day-care services.
  • Same as Comprehensive
Other Services: Provided on-site or by referral:

  • Dental care;
  • Nutrition services;
  • Specialty care; and
  • Well-child care of students’ children.
  • Same as Comprehensive

*The C/THP is New York State’s EPSDT program. It is a federally mandated initiative to provide comprehensive preventive health care and diagnostic treatment and follow-up to children who are eligible for Medicaid, up to the age of 21. It is designed to meet the Federal and State requirements for the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program which was created by the Title XIX of the Social Security Act.

Operating Guidelines

Operating Guidelines Comprehensive SBHCs Intermediate SBHCs
Facility Requirements
  • 1500 to 2000 square feet is recommended per 700 students;
  • At least 1 exam room w/ a sink (1 room per full-time provider);
  • 1 of each for the following: counseling room/private area; laboratory area; patient bathroom; waiting room; clerical area; infirmary area; and designated clean and soiled space for clinic functions;
  • Private telephone line for confidentiality and access to community and back-up health providers.
  • Same as Comprehensive
Staffing Requirements
  • A multi-disciplinary team must include: nurse practitioner/physician assistant (1 FTE/700-1500 students enrolled in center); physician (on site at least one 3-hr. session/week per NP or PA); mental health counselor (1FTE/700-1500 enrolled students); mental health supervisor (.1-.5 FTE per 700-1500 enrolled students); and Health Assistant (full time – all school hours).
  • Staff provided according to need: program manager; health educator; community outreach worker; school nurse (RN); nutritionist; dentist; dental hygienist.
  • Same as Comprehensive SBHC with the exception of mental health staff. Staffing hours and student/staff ratios are equivalent to the Comprehensive SBHC requirements.
Health Care Access
  • SBHCs must be open and staffed during all normal school hours;
  • Sponsoring institution ensures 24-hour access to services for enrolled students during non-school hours and vacation;
  • Parental consent is required unless individual is at least 18 years in age or qualifies to give consent under Section 2504 of the NY State Public Health Law.
  • Same as Comprehensive
Managed Care
  • Agreements must be negotiated between the sponsoring institution and managed care plans whose Medicaid and Child Health Plus enrollees are served by the SBHC.
  • Same as Comprehensive
Sponsoring Institutions
  • “…Article 28 and Article 44 facilities and other health care providers experienced in delivering ambulatory care services to school age children.”*
  • Same as Comprehensive
Quality Management and Improvement
  • QM and QI activities should address: management of clinical conditions, documentation of care, use of services, staff qualifications, system organization, patient satisfaction, patient knowledge and changes in patient behaviors.
  • Designate a quality management and improvement coordinator.
  • Clearly define goals, objectives and standards of care that identify what program wants to accomplish.
  • Measure the achievement of desired performance and take actions to address problems identified.
  • Written policy and procedures on the following: provider credentials and maintenance; professional continuing education; pre-employment procedures; staff and program evaluation; measures of patient satisfaction; medical record review; complaint and incident review; and corrective actions and time frame.
  • Same as Comprehensive

*Public Health Laws – Article 28 licenses diagnostic and treatment centers (hospitals and free standing community health centers); and Article 44 licenses health maintenance organizations.

Targeting Guidelines

General Purpose: “School-based health centers (SBHCS) can improve access to primary care for underserved children and youth. SBHCs bring comprehensive primary care services to the place where children and youth are during the day and address critical health problems that make it difficult for students to learn.”

Targeting Criteria Comprehensive SBHCs Intermediate SBHCs
SBHC Location
  • Facility must serve a high health need area as designated by Ambulatory Care Sensitive Condition (ACSC) indicators or other indicators such as: vital statistics, Statewide Planning and Research Cooperative System (SPARCS), Health Manpower Shortage Area (HMSA), or Health Professional Shortage Area (HPSA) designations.ACSCs are diagnoses with the greatest potential for primary care intervention and are defined using ICD-9-CM diagnostic codes.
  • Same as Comprehensive
Student Need
  • Number of children in underserved communities;
  • Demographics: socio-economic status (students eligible for free or reduced lunch program and Medicaid); ethnic/racial breakdown;
  • Health status indicators (i.e. infant mortality rates, adolescent pregnancy rates, and immunization levels);
  • Size of total school population.
  • Same as Comprehensive
Sustainable Programs
  • SBHC must be able to demonstrate financial viability.
  • Same as Comprehensive

Sources

New York State Department of Health. Principles and Guidelines for School-Based Health Centers in New York. New York: New York State Department of Health, Revised May, 1996.

New York State Department of Health. Request For Application For School Based Health Centers. New York: New York State Department of Health, 1995.

New York State Department of Health. School-Based Health Centers in New York: One Page Summary, No date.